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General Flashcards

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Dermatology Board Prep flashcards
1
Q

What are the causes of acnathosis nagricans?

A

type 2 diabetes mellitus
gastrointestinal cancer
obesity
polycystic ovarian syndrome
acromegaly
Cushing’s disease
hypothyroidism
familial
Prader-Willi syndrome

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2
Q

What drugs cause acanthuses nagricans?

A

OCP
Nictonic

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3
Q

Mechanism of acanthuses nagricans?

A

insulin resistance → hyperinsulinemia → stimulation of keratinocytes and dermal fibroblast proliferation via interaction with insulin-like growth factor receptor-1 (IGFR1)

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4
Q

What is the pathophysiology of acne vulgaris?

A
  • Follicular epidermal hyperproliferation resulting in the formation of a keratin plug.
  • Obstruction of the pilosebaceous follicle.
  • Activity of sebaceous glands may be controlled by androgen, although levels are often normal in patients with acne
  • colonisation by the anaerobic bacterium
  • Propionibacterium acnes
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5
Q

Features of mild acne?

A

mild: open and closed comedones with or without sparse inflammatory lesions

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6
Q

Features of moderate acne?

A

widespread non-inflammatory lesions and numerous papules and pustules

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7
Q

Features of severe acne?

A

extensive inflammatory lesions, which may include nodules, pitting, and scarring

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8
Q

Management of acne vulgaris?

A
  1. single topical therapy (topical retinoids, benzoyl peroxide)
  2. Topical combination therapy (topical retinoids + benzoyl peroxide)
  3. Oral therapy:
    - Tetracyclines
    - If pregnant –> erythromycin
  4. If women: Oral contraceptive pill
  5. Oral isotretinoin
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9
Q

If a gram negative folliculitis is found from acne treatment, how is this managed?

A

This is a complication of long term antibiotics
High dose trimethoprim

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10
Q

Features of actinic keratosis?

A

small, crusty or scaly, lesions
may be pink, red, brown or the same colour as the skin
typically on sun-exposed areas e.g. temples of head
multiple lesions may be present

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11
Q

Management of actinic keratosis?

A
  1. Sun avoidance
  2. fluorouracil cream: typically a 2 to 3 week course.
    - topical chemotherapy, inflames skin
  3. Topical diclofenac
  4. Topical imiquidmod
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12
Q

Causes of scarring alopecia?

A

trauma, burns
radiotherapy
lichen planus
discoid lupus
tinea capitis*

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13
Q

Causes of non-scarring alopecia?

A

male-pattern baldness
drugs: cytotoxic drugs, carbimazole, heparin, oral contraceptive pill, colchicine
nutritional: iron and zinc deficiency
autoimmune: alopecia areata
telogen effluvium
- hair loss following stressful period e.g. surgery
trichotillomania

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14
Q

What is alopecia areata?

A

autoimmune condition causing localised, well demarcated patches of hair loss. At the edge of the hair loss, there may be small, broken ‘exclamation mark’ hairs

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15
Q

Management of alopecia areata?

A

topical or intralesional corticosteroids
topical minoxidil
phototherapy
dithranol
contact immunotherapy
wigs

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16
Q

What can be seen in alopecia areata?

A

edge of the hair loss, there may be small, broken ‘exclamation mark’ hairs

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17
Q

In alopecia areata how often does hair regrow?

A

In 50% of cases in 1 year, 80-90% in one year

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18
Q

Sedating anti-histamine?

A

Chlorpheniramine

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19
Q

Non-sedating anti-histamine?

A

Loratidine
Cetirizine

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20
Q

Features of BCC?

A

rodent ulcers and are characterised by slow-growth and local invasion. Metastases are extremely rare. BCC is the most common type of cancer in the Western world.

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21
Q

What is the most common type of cancer in the western world?

A

BCC

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22
Q

Morphology of BCC?

A

Sun exposed site

initially a pearly, flesh-coloured papule with telangiectasia
may later ulcerate leaving a central ‘crater’

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23
Q

In bulls pemphigoid, what do the antibodies target?

A

Hemidesmosomes BP180
BP230

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24
Q

Features of bullous pemphigoid?

A

itchy, tense blisters typically around flexures
the blisters usually heal without scarring
there is usually no mucosal involvement (i.e. the mouth is spared)*

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25
Q

Features of skin biopsy in bullous pemphigoid?

A

immunofluorescence shows IgG and C3 at the dermoepidermal junction

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26
Q

what type of hypersensitivity type of pemphigoid?

A

Type 2

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27
Q

What type of hypersensitivity is contact dermatitis?

A

Type 4

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28
Q

What are the two types of dermatitis?

A

Irritant contact dermatitis
Allergic contact dermatitis

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29
Q

What is dermatitis artefacta?

A

self-inflicted skin lesions
Patients often deny they are self inflicted
linear/geometric lesions that are well-demarcated from normal skin.
- depends on mechanism of injury
Skin lesions “suddenly appear overnight”
Patient may be not phased - “ la belle difference”

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30
Q

Diagnostic approach to dermatitis artefacta?

A

exclusion of other dermatological conditions
Biopsy
Psychiatry assessment

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31
Q

Mechanism behind dermatitis herpetiformis?

A

deposition of IgA in the dermis.

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32
Q

Common areas affected by dermatitis herpetiformis?

A

Knee
Elbows
Buttock

Papules and vesicles

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33
Q

Diagnosis of dermatitis herpetiformis?

A

Skin biopsy

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34
Q

Management of dermatitis herpetiformis?

A

Gluten free diet
Dapsone

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35
Q

Causes of eczema herpeticum?

A

Herpes simplex 1
Herpes simplex 2

CMV!!! - uncommon

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36
Q

Features of eczema herpeticum?

A

monomorphic punched-out erosions (circular, depressed, ulcerated lesions) usually 1–3 mm in diameter are typically seen.

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37
Q

Management of eczema herpeticum?

A

admitted for IV aciclovir.

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38
Q

Mild topical steroid?

A

Hydrocortisone 0.5-2.5%

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39
Q

Moderate topical steroid?

A

Betamethasone valerate 0.025% (Betnovate RD)

Clobetasone butyrate 0.05% (Eumovate)

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40
Q

Potent topical steroid?

A

Fluticasone propionate 0.05% (Cutivate)

Betamethasone valerate 0.1% (Betnovate)

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41
Q

Very potent topical steroid?

A

Clobetasol propionate 0.05% (Dermovate)

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42
Q

Mechanism of erythema ab igne?

A

caused by over exposure to infrared radiation. Characteristic features include reticulated, erythematous patches with hyperpigmentation and telangiectasia

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43
Q

What can erythema ab igne turn into ?

A

SCC

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44
Q

Features of erythema multiform?

A

target lesions
initially seen on the back of the hands / feet before spreading to the torso
upper limbs are more commonly affected than the lower limbs
pruritus is occasionally seen and is usually mild

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45
Q

Causes of erythema multiform?

A

viruses: herpes simplex virus (the most common cause), Orf*
idiopathic
bacteria: Mycoplasma, Streptococcus
drugs: penicillin, sulphonamides, carbamazepine, allopurinol, NSAIDs, oral contraceptive pill, nevirapine
connective tissue disease e.g. Systemic lupus erythematosus
sarcoidosis
malignancy

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46
Q

What is erythema multiform major?

A

Erythema multiform, with mucosal involvement

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47
Q

What is the pathophysiology behind erythema nodosum?

A

Inflammation of subcutaneous fat
Nodular lesions

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48
Q

Causes of erythema nodosum?

A

infection
- streptococci
- tuberculosis
- brucellosis
systemic disease

sarcoidosis

inflammatory bowel disease
Behcet’s
malignancy/lymphoma

drugs
- penicillins
- sulphonamides
- combined oral contraceptive pill

Pregnancy

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49
Q

What is erythrasma and what is its cause?

A

flat, slightly scaly, pink or brown rash usually found in the groin or axillae
overgrowth of the diphtheroid Corynebacterium minutissimum

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50
Q

How should erythrasma be investigated?

A

Examination with Wood’s light reveals a coral-red fluorescence.

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51
Q

Management of erythrasma?

A

Topical miconazole or antibacterial are usually effective. Oral erythromycin may be used for more extensive infection

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52
Q

What is the definition of erythroderma?

A

95% body coverage rash

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53
Q

Causes of erythroderma?

A

eczema
psoriasis
drugs e.g. gold
lymphomas, leukaemias
idiopathic

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54
Q

Most common causes of fungal nail?

A

dermatophytes - mainly Trichophyton rubrum, accounts for 90% of cases
yeasts - such as Candida
non-dermatophyte moulds

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55
Q

Other causes of unsightly nails?

A

Differential diagnosis
psoriasis
repeated trauma
lichen planus
yellow nail syndrome

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56
Q

How to investigate nail fungus?

A

nail clippings
- high false negative rate

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57
Q

If nail fungal dermatophyte, management?

A

dermatophyte infection:
oral terbinafine is currently recommended first-line with oral itraconazole as an alternative
6 weeks - 3 months therapy is needed for fingernail infections whilst toenails should be treated for 3 - 6 months
treatment is successful in around 50-80% of people

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58
Q

If nail fungus is candida, management?

A

mild disease should be treated with topical antifungals (e.g. Amorolfine) whilst more severe infections should be treated with oral itraconazole for a period of 12 weeks

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59
Q

How long should topical agents for nail fungus be used for toes?

A

9-12 months

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60
Q

How long should topical agents for nail fungus be used for fingers?

A

6 months

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61
Q

Features of granuloma annulare?

A

papular lesions
slightly hyperpigmented and depressed centrally
dorsal surfaces of the hands and feet, and on the extensor aspects of the arms and legs

Associated with T2DM

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62
Q

When do you get guttate psoriasis?

A

Precipitated by a streptococcal infection 2-4 weeks prior to the lesions appearing.

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63
Q

Features of guttate psoriasis?

A

Tear drop papules on the trunk and limbs
- gutta is Latin for drop
- pink, scaly patches or plques of psoriasis
tends to be acute onset over days

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64
Q

How does the rash of guttate psoriasis differ from pityriasis rosea?

A

Guttate psoriasis: Sclary tear drop
raised oval lesions with a fine scale confined to the outer aspects of the lesions.

PR: Herald patch, followed by rest of rash 1-2 weeks
distribution with the longitudinal diameters of the oval lesions running parallel to the line of Langer.
Fir tree appearance

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65
Q

Management of guttate psoriasis?

A

most cases resolve spontaneously within 2-3 months
there is no firm evidence to support the use of antibiotics to eradicate streptococcal infection
topical agents as per psoriasis
UVB phototherapy

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66
Q

Features of hereditary haemorrhage telengectasia?

A

Autosomal dominant
epistaxis : spontaneous, recurrent nosebleeds
telangiectases: multiple at characteristic sites (lips, oral cavity, fingers, nose)
visceral lesions: for example gastrointestinal telangiectasia (with or without bleeding), pulmonary arteriovenous malformations (AVM), hepatic AVM, cerebral AVM, spinal AVM
family history: a first-degree relative with HHT

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67
Q

Most common cause of hirsutism?

A

PCOS

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68
Q

Causes of hirsutism?

A

PCOS
Cushing’s syndrome
congenital adrenal hyperplasia
androgen therapy
obesity: thought to be due to insulin resistance
adrenal tumour
androgen secreting ovarian tumour
drugs: phenytoin, corticosteroids

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69
Q

Difference between hirsutism and hypertrichosis?

A

androgen-dependent hair growth in women,

hypertrichosis being used for androgen-independent hair growth

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70
Q

Causes of hypertrichosis ?

A

drugs: minoxidil, ciclosporin, diazoxide
congenital hypertrichosis lanuginosa, congenital hypertrichosis terminalis
porphyria cutanea tarda
anorexia nervosa

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71
Q

Best OCP for hirsutism?

A

co-cyprindiol (Dianette)
ethinylestradiol and drospirenone (Yasmin)

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72
Q

Management of facial hirsutism?

A

Topical eflornithine
CANNOT BREAST FEED / BE PREGNANT*

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73
Q

Management of hyperhidrosis?

A
  1. Topical aluminium chloride
  2. iontophoresis: particularly useful for patients with palmar, plantar and axillary hyperhidrosis
  3. botulinum toxin: currently licensed for axillary symptoms
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74
Q

Causes of impetigo?

A

Staph aureus
Strep pyogenes

Features:
‘golden’, crusted skin lesions typically found around the mouth
very contagious

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75
Q

Management of impetigo?

A
  1. hydrogen peroxide 1% cream for ‘people who are not systemically unwell or at a high risk of complications’

Other:
topical antibiotic creams:
topical fusidic acid
topical mupirocin should be used if fusidic acid resistance is suspected
MRSA is not susceptible to either fusidic acid or retapamulin. Topical mupirocin should, therefore, be used in this situation

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76
Q

Risk factors for keloid scars?

A

ethnicity: more common in people with dark skin
common sites (in order of decreasing frequency): sternum, shoulder, neck, face, extensor surface of limbs, trunk

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77
Q

What is a keratocanthoma?

A

benign epithelial tumour

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78
Q

What are the features of a keratocanthoma?

A

Features - said to look like a volcano or crater
initially a smooth dome-shaped papule
rapidly grows to become a crater centrally-filled with keratin

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79
Q

Management of keratocantoma?

A

Urgent excision for ? SCC

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80
Q

What is the koebner phenomena?

A

skin lesions that appear at the site of injury

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81
Q

What diseases exhibit koebner phenomena.?

A

psoriasis
vitiligo
warts
lichen planus
lichen sclerosus
molluscum contagiosum

82
Q

What is lentigo maligna?

A

melanoma in-situ
Progresses slowly
May eventually become invasive –> lentigo maligna melanoma.

83
Q

Features of lichen planus?

A

Itchy, papular rash most common on the palms, soles, genitalia and flexor surfaces of arms
Rash often polygonal in shape, with a ‘white-lines’ pattern on the surface (Wickham’s striae)
Koebner phenomenon
50% of patients white-lace pattern on the buccal mucosa
nails: thinning of nail plate, longitudinal ridging

planus: purple, pruritic, papular, polygonal rash on flexor surfaces. Wickham’s striae over surface. Oral involvement common
sclerosus: itchy white spots typically seen on the vulva of elderly women

84
Q

Lichenoid drug eruption causes?

A

gold
quinine
thiazides

85
Q

Management of lichen planus?

A

potent topical steroids are the mainstay of treatment
benzydamine mouthwash or spray is recommended for oral lichen planus
extensive lichen planus may require oral steroids or immunosuppression

86
Q

What is lichen sclerosis?

A

inflammatory condition that usually affects the genitalia and is more common in elderly females

87
Q

Features of lichen sclerosis ?

A

white patches that may scar
itch is prominent
may result in pain during intercourse or urination

88
Q

Causes of livido reticularis?

A

idiopathic (most common)
polyarteritis nodosa
systemic lupus erythematosus
cryoglobulinaemia
antiphospholipid syndrome
Ehlers-Danlos Syndrome
homocystinuria

89
Q

What causes livido reticularis?

A

purplish, non-blanching, reticulated rash caused by obstruction of the capillaries resulting in swollen venules.

90
Q

Most common type of malignant melanoma?

A
  1. superficial spreading
  2. nodular
  3. lentigo maligna
  4. aural lentiginous
91
Q

Diagnostic criteria for malignant melanoma biopsy?

A

Major:
Change in size
Change in shape
Change in colour

Minor
Diameter >= 7mm
Inflammation
Oozing or bleeding
Altered sensation

92
Q

What is mycosis fungoides?

A

Mycosis fungoides is a rare form of T-cell lymphoma that affects the skin.

93
Q

How does mycosis fungoides appear different to other skin conditions?

A

itchy, red patches
lesions tend to be of different colours in contrast to eczema/psoriasis where there is greater homogenicity

94
Q

Malignant melanoma prognosis?

A

Breslow Thickness Approximate 5 year survival
< 0.75 mm 95-100%
0.76 - 1.50 mm 80-96%
1.51 - 4 mm 60-75%
> 4 mm 50%

95
Q

What causes molloscum contagiosum?

A

Molloscum contagiosum virus

96
Q

Features of molloscum contagiosum?

A

molluscum contagiosum presents with characteristic pinkish or pearly white papules with a central umbilication, which are up to 5 mm in diameter.

97
Q

Management of molloscum?

A

Squeezing (with fingernails) or piercing (orange stick) lesions may be tried, following a bath. Treatment should be limited to a few lesions at one time

Cryotherapy may be used in older children or adults, if the healthcare professional is experienced in the procedure

Eczema or inflammation can develop around lesions prior to resolution. Treatment may be required if:

98
Q

When should referral be sent for molloscum?

A
  1. HIV-positive with extensive lesions urgent referral to a HIV specialist
  2. Eyelid marginal lesions
  3. anogenital lesions should be referred to genito-urinary medicine, for screening for other sexually transmitted infections
99
Q

What type of hypersensitivity is nickel allergy?

A

Type IV hypersensitivity

100
Q

What is oncholysis ?

A

idiopathic
trauma e.g. Excessive manicuring
infection: especially fungal
skin disease: psoriasis, dermatitis
impaired peripheral circulation e.g. Raynaud’s
systemic disease: hyper- and hypothyroidism

101
Q

Causes of oncholysis?

A

idiopathic
trauma e.g. Excessive manicuring
infection: especially fungal
skin disease: psoriasis, dermatitis
impaired peripheral circulation e.g. Raynaud’s
systemic disease: hyper- and hypothyroidism

102
Q

What causes pellagra?

A

Pellagra is a caused by nicotinic acid (niacin) deficiency.

103
Q

Features of pellagra?

A

dermatitis (brown scaly rash on sun-exposed sites - termed Casal’s necklace if around neck)
diarrhoea
dementia, depression
death if not treated

104
Q

What is the cause of pemphigus?

A

antibodies directed against desmoglein 3, a cadherin-type epithelial cell adhesion molecule.

105
Q

Features of pemphigus?

A

mucosal ulceration 50-60%
flaccid, easily ruptured vesicles and bullae
Nikolsky’s positive: Nikolsky’s describes the spread of bullae following application of horizontal, tangential pressure to the skin

acantholysis on biopsy - separation of layers

106
Q

Management of pemphigus?

A

Steroids
Immunosuppression

107
Q

What is the viral cause of pityriasis rosea?

A

herpes hominis virus 7 (HHV-7)

108
Q

Features of pityriasis rosea?

A

no prodrome, but a minority may give a history of a recent viral infection
Herald patch ( on trunk)
followed by erythematous, oval, scaly patches which follow a characteristic distribution with the longitudinal diameters of the oval lesions running parallel to the line of Langer

109
Q

Cause of pityriasis versicolor?

A

Malassezia furfur (formerly termed Pityrosporum ovale)

110
Q

Features of pityriasis versicolor?

A

most commonly affects trunk
patches may be hypopigmented, pink or brown (hence versicolor). May be more noticeable following a suntan
scale is common
mild pruritus

111
Q

Risk factors pf pityrasis versicolor?

A

occurs in healthy individuals
immunosuppression
malnutrition
Cushing’s

112
Q

Management of pityriasis versicolor?

A
  1. Ketoconazole shampoo
  2. Failure to improve: scrapings + itronconazole
113
Q

Features of pomphlyx eczema?

A

small blisters on the palms and soles
pruritic
- often intensely itchy
- sometimes burning sensation
once blisters burst skin may become dry and crack

114
Q

Factors that precipitate pomphlyx eczema?

A

humidity (e.g. sweating) and high temperatures.

115
Q

Genetics behind porphyria cutanea tarde?

A

nherited defect in uroporphyrinogen decarboxylase
Can be acquired from damage to hepatocyte:
- Alcohol
- Hepatitis C
- Oestrogen

116
Q

Features of porphyria cutanea tarde?

A

classically presents with photosensitive rash with blistering and skin fragility on the face and dorsal aspect of hands (most common feature)
hypertrichosis
hyperpigmentation

117
Q

Investigation findings for porphyria cutanea tarda?

A

urine: elevated uroporphyrinogen and pink fluorescence of urine under Wood’s lamp
serum iron ferritin level is used to guide therapy

118
Q

Management of porphyria cutanea trada?

A

chloroquine

venesection
- preferred if iron ferritin is above 600 ng/ml

119
Q

HLA associations in psoriasis?

A

HLA-B13, -B17, and -Cw6.

120
Q

Types of psoriasis?

A

Plaque psoriasis: raise clay plaques
Flexural psoriasis: skin is smooth
Guttate psoriasis: transient psoriasis
Pustular psoriasis: commonly soles and palms

121
Q

Complications of psoriasis ?

A

psoriatic arthropathy (around 10%)
increased incidence of metabolic syndrome
increased incidence of cardiovascular disease
increased incidence of venous thromboembolism
psychological distress

122
Q

Exacerbating factors of psoriasis?

A

trauma
alcohol
drugs: beta blockers, lithium, antimalarials (chloroquine and hydroxychloroquine), NSAIDs and ACE inhibitors, infliximab
withdrawal of systemic steroids

Streptococcal infection -> guttate psoriasis

123
Q

Management of chronic plaque psoriasis?

A
  1. Steroid + vitamin D analogue

If no improvement in 8 weeks:
2. Vitamin D analogue twice daily

If no improvement 8-12 weeks:
3. a potent corticosteroid applied twice daily for up to 4 weeks, or
a coal tar preparation applied once or twice daily

124
Q

Types of light therapy offered is chronic plaque psoriasis?

A

Ultraviolet light B
or
Psoralen treatment + ultraviolet light A

125
Q

adverse effects of light therapy for psoriasis?

A

Skin ageing
Squamous cell cancer (not melanoma)

126
Q

Systemic therapy for chronic plaque psoriasis?

A

oral methotrexate is used first-line. It is particularly useful if there is associated joint disease
ciclosporin
systemic retinoids
biological agents: infliximab, etanercept and adalimumab
ustekinumab (IL-12 and IL-23 blocker) is showing promise in early trials

127
Q

Management of scale psoriasis?

A

potent topical corticosteroids used once daily for 4 weeks

128
Q

Management of flexural psoriasis?

A

mild or moderate potency corticosteroid applied once or twice daily for a maximum of 2 weeks

129
Q

Mechanism of vitamin D analogues?

A

they work by ↓ cell division and differentiation → ↓ epidermal proliferation
DOES NOT REDUCE INFLAMMATION

130
Q

Can vitamin D analogues be used in pregnancy?

A

No

131
Q

Pathphysiology of pyoderma gangreonsum?

A

non-infectious, inflammatory disorder.
Neutrophilliic dermatosis - deep infiltration of neutrophils

132
Q

Causes of pyoderma gangreonsum?

A

Inflammatory bowel disease in 10-15%
- ulcerative colitis
- Crohn’s

rheumatological
- rheumatoid arthritis
- SLE

haematological
- myeloproliferative disorders
- lymphoma
- myeloid leukaemias
- monoclonal gammopathy (IgA)

granulomatosis with polyangiitis
primary biliary cirrhosis

133
Q

Features of pyoderma gangreonsum?

A

Typically lower limb
usually starts quite suddenly –>small pustule, red bump or blood-blister
Skin break down –> ulcer
Ulcer: purple, violaceous and undermined.

134
Q

Management of pyoderma gangreonsum?

A
  1. Oral steroids
  2. Immunosuppression: ciclospoorin, inflixamab
135
Q

Causes of pyogenic granuloma?

A

trauma
pregnancy
more common in women and young adults

136
Q

What oral retinoid is used in acne?

A

Isotretinoin is an oral retinoid used in the treatment of severe acne.

137
Q

Adverse effects of retinoids?

A

Teratogenic: put on pill
Dry skin - dry mouth - most common side effect
Low mood
raised triglycerides
hair thinning
nose bleeds (caused by dryness of the nasal mucosa)
intracranial hypertension: isotretinoin treatment should not be combined with tetracyclines for this reason
photosensitivity

138
Q

Features of rosacea?

A

typically affects nose, cheeks and forehead
flushing is often first symptom
telangiectasia are common
later develops into persistent erythema with papules and pustules
rhinophyma
ocular involvement: blepharitis
sunlight may exacerbate symptoms/

Rosacea features:
nose, cheeks and forehead
flushing, erythema, telangiectasia → papules and pustules

139
Q

Management of rosacea?

A

topical metronidazole may be used for mild symptoms (i.e. Limited number of papules and pustules, no plaques)

topical brimonidine gel may be considered for patients with predominant flushing but limited telangiectasia

more severe disease is treated with systemic antibiotics e.g. Oxytetracycline

140
Q

What is the mite that causes scabies?

A

Sarcoptes scabiei

141
Q

What type of hypersensitivity reaction is scabies?

A

Type IV

scabies mite burrows into the skin, laying its eggs in the stratum corneum.

142
Q

Feature of scabies?

A

widespread pruritus
linear burrows on the side of fingers, interdigital webs and flexor aspects of the wrist
in infants, the face and scalp may also be affected
secondary features are seen due to scratching: excoriation, infection

143
Q

Causative organism of seborrheic dermatitis?

A

Malassezia furfur

144
Q

Features of seborrheic dermatitis ?

A

eczematous lesions on the sebum-rich areas: scalp (may cause dandruff), periorbital, auricular and nasolabial folds
otitis externa and blepharitis may develop

145
Q

Associated conditions with seborrheic dermatitis?

A

HIV
Parkinsons

146
Q

Management of seborrheic dermatitis?

A
  1. T Gel
  2. Ketocondazole shampooo

Face and body management
topical antifungals: e.g. ketoconazole
topical steroids: best used for short periods
difficult to treat - recurrences are common

147
Q

What is sezary syndrome?

A

T-cell cutaenous lymphoma.

pruritus
erythroderma typically affecting the palms, soles and face
atypical T cells
lymphadenopathy
hepatosplenomegaly

148
Q

Descriptions of erythema nodosum?

A

symmetrical, erythematous, tender, nodules which heal without scarring

multiple, discrete, raised erythematous lesions on the arms and legs ranging from 8cm in diameter to 12cm in diameter. There is pain on active and passive joint movement.

most common causes are streptococcal infections, sarcoidosis, inflammatory bowel disease and drugs (penicillins, sulphonamides, oral contraceptive pill)

149
Q

Descriptions of pretibial myoedema?

A

symmetrical, erythematous lesions seen in Graves’ disease
shiny, orange peel skin

150
Q

Description of pyoderma gangerosum?

A

initially small red papule
later deep, red, necrotic ulcers with a violaceous border
idiopathic in 50%, may also be seen in inflammatory bowel disease, connective tissue disorders and myeloproliferative disorders

151
Q

Description of necrobiosis lipodica?

A

shiny, painless areas of yellow/red skin typically on the shin of diabetics
often associated with telangiectasia

152
Q

Skin conditions associated with diabetes?

A

Necrobiosis lipodcia
Candida
Neuropathic ulcers
Vitiligo
Granuloma annular

153
Q

Skin condition associated with gastric cancer?

A

Acanthosis nagaricans

154
Q

Skin condition associated with lymphoma?

A

Acquired ichthyosis
(dry scaly skin)

Erythroderma

155
Q

Most common skin eruption in pregnancy?

A

Atopic eruptions

156
Q

What skin disorder is associated with last trimester pregnancy/

A

Polymorphic eruption

pruritic condition associated with last trimester
lesions often first appear in abdominal striae
management depends on severity: emollients, mild potency topical steroids and oral steroids may be used

157
Q

Skin conditions that is blistering in pregnancy ?

A

Pemphigoid gestationis
pruritic blistering lesions
often develop in peri-umbilical region, later spreading to the trunk, back, buttocks and arms
usually presents 2nd or 3rd trimester and is rarely seen in the first pregnancy
oral corticosteroids are usually required

158
Q

Skin conditions associated with tuberculosis?

A

lupus vulgaris (accounts for 50% of cases)
erythema nodosum
scarring alopecia
scrofuloderma: breakdown of skin overlying a tuberculous focus
verrucosa cutis
gumma

159
Q

What is lupus vulgaris?

A

cutaneous TB seen in the Indian subcontinent. It generally occurs on the face and is common around the nose and mouth. The initial lesion is an erythematous flat plaque which gradually becomes elevated and may ulcerate later

160
Q

Risk factors for SCC?

A

excessive exposure to sunlight / psoralen UVA therapy
actinic keratoses and Bowen’s disease
immunosuppression e.g. following renal transplant, HIV
smoking
long-standing leg ulcers (Marjolin’s ulcer)
genetic conditions e.g. xeroderma pigmentosum, oculocutaneous albinism

161
Q

Excision parameters for SCC?

A
  1. 4mm margins if lesion <20mm in diameter.
  2. If tumour >20mm then margins should be 6mm. 3.Mohs micrographic surgery may be used in high-risk patients
162
Q

Causes of Steven Johnson syndrome?

A

penicillin
sulphonamides
lamotrigine, carbamazepine, phenytoin
allopurinol
NSAIDs
oral contraceptive pill

163
Q

Features of Steven Johnson syndrome?

A

Rash is typically maculopapular with target lesions being characteristic
may develop into vesicles or bullae
Nikolsky sign is positive in erythematous areas - blisters and erosions appear when the skin is rubbed gently
mucosal involvement
systemic symptoms: fever, arthralgia

164
Q

Features of systemic mastocytosis?

A

urticaria pigmentosa - produces a wheal on rubbing (Darier’s sign)
flushing
abdominal pain
monocytosis on the blood film

165
Q

Investigation findings in systemic mastocytosis?

A

raised serum tryptase levels
urinary histamine

166
Q

Drug causes of toxic epidermal necrolysis?

A

phenytoin
sulphonamides
allopurinol
penicillins
carbamazepine
NSAIDs

167
Q

Features of toxic epidermal necrolysis ?

A

systemically unwell e.g. pyrexia, tachycardic
positive Nikolsky’s sign: the epidermis separates with mild lateral pressure

168
Q

Large vessle vasculitis?

A

temporal arteritis
Takayasu’s arteritis

169
Q

Medium vessel vasculitis?

A

polyarteritis nodosa
Kawasaki disease

170
Q

Small vessel vasculitis?

A

ANCA-associated vasculitides:
granulomatosis with polyangiitis (Wegener’s granulomatosis)
eosinophilic granulomatosis with polyangiitis (Churg-Strauss syndrome)
microscopic polyangiitis

immune complex small-vessel vasculitis:
Henoch-Schonlein purpura
Goodpasture’s syndrome (anti-glomerular basement membrane disease)
cryoglobulinaemic vasculitis
hypocomplementemic urticarial vasculitis (anti-C1q vasculitis)

171
Q

What is a normal ankle brachial pulse index?

A

0.9 - 1.2.

Values below 0.9 indicate arterial disease, or above 1.3 .

172
Q

Association of yellow nail syndrome?

A

congenital lymphoedema
pleural effusions
bronchiectasis
chronic sinus infections

173
Q

Features of zinc deficiency?

A

acrodermatitis: red, crusted lesions
- acral distribution
- peri-orificial
- perianal

alopecia
short stature
hypogonadism
hepatosplenomegaly
geophagia (ingesting clay/soil)
cognitive impairment

174
Q

What is the most common ulcer on the lower lip?

A

SCC

175
Q

How does irritant dermatitis present vs allergic dermatitis?

A

Allergic: Acute weeping eczema which predominately affects the margins of the hairline rather than the hairy scalp itself
Irritant: Often seen on the hands. Erythema is typical, crusting and vesicles are rare

176
Q

Name of rash with STI’s and presentation?

A

Keratoderma blennorrhagica may be precipitated by chlamydia in the context of reactive arthritis. This rash is found on the soles of the feet but can also affect the palms. It can be vesico-pustular but tends to have a waxy brown appearance rather than being erythematous and itchy.

177
Q

Causes of eczema herpeticum?

A

simplex 1
Herpes simplex 2

178
Q

What type of monoclonals are good in psoriasis / psoriatic arthritis? - Example ?

A

Anti- TNF
Enteracept

179
Q

What type of rash do you get in eczema herpeticum?

A

Monomorphic punched out

180
Q

What is melanoma, how does it present?

A

“A 33-year-old lady presents complaining of facial discolouration. She is 26 weeks pregnant. So far it has been an uncomplicated pregnancy. She has a background of rheumatoid arthritis but has been off treatment for 2 years.
“
Melasma is a benign but relatively common skin condition which can appear in pregnancy. In this situation it may resolve a few months after delivery.

181
Q

Difference between pemphigus and pemphigoid?

A

no mucosal involvement: bullous pemphigoid
mucosal involvement: pemphigus vulgaris

182
Q

Why skin cancers do renal patients typically get?

A

SCC

183
Q

?Treatment of eczema herpeticum

A

As it is potentially life-threatening children should be admitted for IV aciclovir.

184
Q

Rash associated with gastric cancer?

A

Acanthosis nagricans

185
Q

Rash associated with lymphoma?

A

Acquired ichthyosis

186
Q

Rash associated with GI and lung cancer?

A

Acquired hypertrichosis lanuginosa

187
Q

Rash associated with Ovarian and lung cancer

A

Dermatomyositis

188
Q

Rash associated with lung cancer?

A

Erythema gyratum repens

189
Q

Rash associated with lymphoma?

A

erythroderma

190
Q

Rash associated with pancreatic cancer?

A

Migratory thrombophlebitis

191
Q

Rash associated with glucagonoma?

A

Necrolytic migratory erythema

192
Q

Rash associated with myeloproliferative disorders?

A

Pyoderma gangrenosum (bullous and non-bullous forms)

193
Q

Rash associated with myeldysplastic syndrome (purple plaques)?

A

Sweet’s syndrome

194
Q

Rash associated with myeldysplastic syndrome (purple plaques)?

A

Sweet’s syndrome

195
Q

Appearance of lentigo maligna?

A

Lentigo maligna is a type of melanoma in-situ. It typically progresses slowly but may at some stage become invasive causing lentigo maligna melanoma.

196
Q

What is auspitz sign?

A

Pin point bleeding after scratching

197
Q

If a ? keratokanthoma, how should this be referred?

A

Urgent referral to dermatology

198
Q

How to apply insecticide in scabies?

A

allow to dry and leave on the skin for 8-12 hours for permethrin, or for 24 hours for malathion, before washing off
repeat treatment 7 days later

199
Q

You can get scabies on the penis

A

Euuw

200
Q

Where do you typically get lentigo maligna melanoma?

A

Suspicious freckle on face or scalp of chronically sun-exposed patients

201
Q

Which malignant melanoma has the worst prognosis ?

A

Nodular

202
Q

Management of keloid scar?

A

early keloids may be treated with intra-lesional steroids e.g. triamcinolone
excision is sometimes required but careful consideration needs to given to the potential to create further keloid scarring

MRCP Dermatology (2 decks)

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