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Stage 3 - Case 4 (Endocrine) > Lecture 1,2 & 3: Skin Infections & Pathophysiology Of Skin Disorders > Flashcards

Lecture 1,2 & 3: Skin Infections & Pathophysiology Of Skin Disorders Flashcards

1
Q

Name some bacterial skin infections.

A
  • Impetigo
  • Cellulitis
  • Folliculitis
  • Furuncles & Carbuncles
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2
Q

What are the symptoms of Impetigo and where does it occur?

A
  • Rash
  • Sore blisters
  • When burst = gold crust
  • Face/hands
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3
Q

What is the treatment for Impetigo?

A
  • Topical Mupirocin or Fusidic acid for 5 days TDS
  • Antibiotics Fluxocallin or Clarithromycin 250mg BD
  • It is self limiting (heals in 2/3 weeks)
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4
Q

What are the symptoms of Cellulitis and where does it happen?

A
  • Red, hot, painful rash
  • Lower leg, face, arms
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5
Q

What is the treatment of Cellulitis?

A
  • Oral/ IV antibiotics
  • Fluxocallin oral 7 days 500mg QDS
  • Clarithromycin BD if penicillin allergy
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6
Q

What are the symptoms of Folliculitis and where does it happens?

A
  • Red bumps, pus filled
  • Hair follicles
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7
Q

What is the treatment for Folliculitis?

A
  • Topical antiseptics and drainage if necessary
  • Severe cases: antibiotics
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8
Q

What are the symptoms of Furuncles and Carbuncles and where do they occur?

A
  • Boil, pus filled lump on skin, Carbuncles are collections of boils
  • Painful, descends into deep tissue and affects blood flow
  • Face, neck, armpits, thighs, waist, groin
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9
Q

What are the treatments for Furuncles and Carbuncles?

A
  • Self limiting, drainage if necessary
  • If severe: antibiotics
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10
Q

What are the different viral infections?

A
  • Herpes Simplex Virus
  • Varicella-Boster Virus
  • Molluscum Contagiosum
  • Warts (HPV)
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11
Q

What are the symptoms of Herpes Simplex Virus and where does it occur?

A
  • Blisters, sores, body aches, swollen
  • Mouth, genitals, eyes
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12
Q

What is the treatment for Herpes Simplex Virus?

A
  • If severe: antivirals
  • Aciclovir: 7 days. Antihistamine for itching
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13
Q

What are the symptoms of Varicella Boster Virus and where does it occur?

A
  • Chicken Pox: spots, itchy, red, painful rash. Shingles: reactivation of the dormant virus
  • Anywhere on body. Chest, tummy, face
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14
Q

What is the treatment of Varicella Boster Virus?

A
  • If severe: antivirals: aciclovir for 7 days.
  • Antihistamine for itching
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15
Q

What are the symptoms for Molluscum Contagiosum and where does it occur?

A
  • Small, firm, painless, bumps, flesh coloured clusters
  • Face, arms, legs, abdomen
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16
Q

What is the treatment for Molluscum Contagiosum?

A
  • Self limiting
  • Cryotherapy but not routinely offered
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17
Q

What are warts and where do they occur?

A
  • Firm and rough spots
  • Palms, knuckles, knees, fingers, genitals (direct contact through weakened surfaces)
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18
Q

What is the treatment for warts?

A
  • Cryotherapy
  • Salicylic acid but damages healthy skin
  • Laser Therapy
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19
Q

What are some fungal infections?

A
  • Dermaphytosis (tinea infection/ ring worm)
  • Candidiasis
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20
Q

What are the symptoms of ring worm and where does it occur?

A
  • Red, scaly, rash, ring shaped, contagious
  • Damp conditions, arms, legs, feet, groin, scalp, nails
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21
Q

What is the treatment for Ring worm?

A
  • Topical anti fungal e.g clotrimazole
  • If severe oral antifungal e.g terbinafine, itraconazole
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22
Q

What are the symptoms of candidiasis and where does it occur?

A
  • White rash, itchy
  • Throat and vagina
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23
Q

What is the treatment of Candidiasis?

A
  • Topical nystatin (solution for mouth) or clotrimazole. If severe: oral fluconazole
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24
Q

What are some common parasitic infections?

A
  • Scabies
  • Cutaneous larva migrans
  • Lice
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25
What are the symptoms of scabies and where do they occur?
- Microscopic mites burrowing into skin and causes symptom from exudate - Red, itchy spots - Anywhere on skin except head and neck (particularly in skin folds)
26
What is the treatment for scabies?
- Topical permethrin 5% to entire body especially in wet creases - Oral ivermectin if severe
27
What are the symptoms of cutaneous larva migrans and where do they occur?
- Red, itchy, like winding tracks - Feet, lower legs and buttocks
28
What is the treatment of cutaneous larva migrans?
- Albendazole, Ivermectin
29
What are the symptoms of lice and where does they occur?
- Itching, worse at night, tickling, sores, rash - Scalp
30
What is the treatment for lice?
- Fatty acid insecticides, dimeticone - Requires repeated applications to catch hatched eggs
31
What are the different questions to ask on a history taking for a skin infection?
- Onset: viral: quick, bacterial and fungal = longer, parasitic = depends on allergy to exudate - Duration: Viral= few days to weeks (self limiting), bacterial and fungal = 2/3 weeks, parasitic = years if untreated - Associated symptoms: fever, spots, infection, pink/brown wee - Exposures: direct skin contact
32
What are the different things to look out for on a physical examination of a skin infection?
- Location, distribution, size, shape, presence of systemic symptoms - Not routine,y done: swab cultures: gram staining, PCR
33
What are the things to rule out when taking a history of a skin infection?
- Accident, bruise, trauma, insect bites, recent travel (DVT)
34
What are some non-pharmaceutical advice for skin infection? And name some for cellulitis
- Proper hygiene and wound care - Dry and avoid damp clothes - For transmission: hand washing for 2 mins, don’t share towel - Cellulitis: leg elevation, reduce swelling, adequate hydration.
35
What are some referral symptoms for skin infections?
- Abscess formation: fluid filled sac - Necrotising fasciitis: skin = very dark, purple, immediate isolation - Post streptococcal glomerulonephritis: infection to kidney (pink, brown wee) - Systemic symptoms: raised temp,
36
What are some common side effects of penicillins?
- Diarrhoea - Vomiting - Skin reactions
37
What are some risk factors for Impetigo?
- Skin traumas - Poor hygiene - Hot and humid weather
38
What are some adverse effects of Aciclovir?
- Skin reactions - Headaches - Drowsiness - Nausea
39
What are the different questions you ask on a clinical assessment with skin?
- Distribution: elbows, knees, trunk, scalp - Characteristics: size, colour, shape, contours, pattern - Secondary sites: hair, nails, joints
40
What are the skin check up questions for moles for detecting melanoma?
- Asymmetry: The 2 halves may differ in shape - Border: Edges irregular or blurred - Colour: Uneven. - Diameter: Any change in size/ shape - Evolving: Change = refer to consultant
41
What is a lesion, macule and papule?
- Lesion: Area of altered skin - Macule: Flat area of altered colour - Papule: solid, raised spot
42
What is a Pustule, nodule, plaque and vesicle?
- Pustule: Raised lesion but pus filled - Nodule: Solid raised spot but bigger in diameter - Plaque: Palpable raised lesions - Vesicle: small blister, fluid filled
43
What is a Bulla, Naevus and Comedone?
- Bulla: large blister, clear fluid filled - Naevus: Localised malformation of tissue (mole) - Comedone: a plug in sebaceous follicle. Blackhead = open, whitehead = closed
44
What does Excoriation, Lichenification and Dermatone mean?
- Excoriation: scratches - Lichenification: Thickening of the skin - Dermatome: An area of skin supplied by single spinal nerve
45
What does Erythema and Purpura mean?
- Erythema: redness - Purpura: Red/purple
46
What are 4 dermatological issues related to diabetes?
- Acanthosis Nigricans - Acrochordons - Dermopathy - Eruptive Xanthoma
47
What is Acanthosis Nigricans?
- characerised by dark, thickened patches - Associated with insulin resistance where insulin levels stimulate skin growth - Obesity leads to insulin resistance - Common on neck, groin, under breast, armpits
48
What are Acrochordons?
- Skin tags - Flesh coloured growths attached by a tiny stalk - Neck, armpits, groin, under breasts - High insulin levels activate insulin like growth factor 1 which stimulates keratinocytes and fibroblasts (excessive growth)
49
What is Dermopathy?
- Shin spots - Complication with long standing or poorly controlled diabetes. Damage to small blood vessels due to chronic hyperglycaemia - Leads to poor circulation, skin thinning and hyperpigmentation - Oval/round red brown patches w/ no itch - On shins
50
What is Eruptive Xanthoma?
- Sudden outbreaks of yellowish red papules. Firm, mild itching - By hypertriglyceridema. Lipid deposits and macrophage accumulation forming foam cells - On buttocks, arms, legs, elbows, back
51
What is epidermal necrolysis?
- Steven Johnson Syndrome - Life threatening severe drug reaction (sitagliptin) that causes massive skin and mucosal detachment due to immune mediated destruction of keratinocytes
52
What is skin atrophy and what can it be caused by?
- Loss of latency (thinning) to skin caused by repeated insulin injection/ topical steroid use for over 4 weeks or sustained pressure (sore)
53
What is Xerosis and what is it caused by?
- Dry skin caused by aging, cold weather, harsh soaps
54
What is eczema and dermatitis?
- Eczema: is an umbrella term that refers to a group of inflammatory skin conditions characterised by itching, erythema and scale - Dermatitis: Chronic relapsing inflammation of skin. Red, dry, cracked
55
What areas are mostly affected in infants, children and adults?
- Infants: Face, scalp, arms, legs - Children: Neck, flexual parts of arms and knees - Adults: Flexures arms and knees, hands eyelids
56
What is the pathogenesis (how disease started) of atopic dermatitis?
- Multi factorial (not completely understood) - Genetics: Mutation w/ fillagrin gene. Filagrin protein binds keratinocytes and holds integration of epithelial cells otherwise impaired skin barrier. Also impairs natural moisturising factors - Environmental: Lower exposure to pathogens. skin ph, climate and smoking affect this
57
What are the 2 hypothesis of the pathophysiology of atopic dermatitis?
- Immunological hypothesis: AD results from imbalance of T cells (T helper cells 1,2, 17, 22 and regulatory T cells). TH2 dominant in acute and production of interleukin 4,5,13,31 which causes symptoms. iGE and TH1 differentiation are inhibited - Skin barrier hypothesis: comes from defective barrier
58
What are the aims of treatment of atopic dermatitis?
- To treat itching pin and discomfort - Recuce inflammation - Replace moisture -Improve QOL
59
What are the treatment types for atopic dermatitis?
- Reduced intact w/ irritant avoid overheating, direct contact with rough fibres - 1st line emollients: hydrate and soften skin - 2nd line corticosteroids - Antihistamines h1 receptor antagonist - Antibiotics if skin broken - steroids - other herbals, soaps
60
What is the mechanism of action of Glucocorticoids?
- Glucocorticoids diffuse through cell membrane and bind to cytoplasmic Glucocorticoid receptors - The glucocorticoid-GR complex translocates to nucleus - The complex binds to glucocorticoid response elements on DNA and upregulates anti-inflammatory IL-10 - Inhibits pro-inflammatory transcription factors NFkb and AP1 reducing TNFa and 1,6 - Suppresses prostaglandin and leukotriene synthesis
61
What are the different types of emollients that can be used?
- Ointments: For very dry, oil based and occlusive - Pastes: Ointment suspension, application of noxious chemicals for localised delivery - Creams: More water content, quicker absorption - Lotions: For less dry skin, cooling effect - Gels: High water content, dont act as long
62
What are some topical preparations that can be used?
- Emollients - Corticosteroid ointment: Low potency for shortest time - Calcinuerin Inhibitors: Tacrolimus used on sensitive areas - Tar bandages: not often used - Phototherapy: Narrow band UVB in clinic when severe
63
What are some counselling points for emollients?
- Apply to skin to reduce water loss - Can be used instead of soap - In direction of hair growth - At least BD - Dont put fingers in pot
64
What are some counselling points for topical corticosteroids?
- OD/ BD for 1/2 weeks only to affected areas in direction to hair growth - If using emollients: use steroid first then wait 30 mins then CCS - Use fingertip unit (squeeze line from tip of finger to first crease) 1 hands, elbows, knees, 2.5 for face and neck
65
What are some examples of topical corticosteroids?
- Very mild: hydrocortisone - Moderate: Clobetasone butyrate - Strong: mometasone, dermovate
66
What are some side effects of topical corticosteroids?
- Burning/stinging usually improves with use - Less common: inflamed hair follicles, thinning of skin, acne worsening, excessive hair growth - Elderly and very young most vulnerable
67
What are some non-pharmacological advice for atopic dermatitis?
- Avoid irritants - Gloves - Identifying allergens - Avoid abrasive fabrics - Re apply emollient after wetting skin
68
What type of hypersensitivity reaction is allergic contact dermatitis?
- Type 4 - Caused by irritants or allergens when in contact with skin
69
What is the Type 4 hypersensitivity reaction leading to allergic dermatitis?
- Antigen processed by APC. First time CD4+ T cells differentiate into Th1/17 (memory T cells) - TH1 cells primed by first exposure migrate to site of infection and become activated - Release cytokines which activate local endothelial cells which recruit inflammatory cells - Fluid, more leukocytes accumulate over 24-72hrs, red,itchy
70
What are some treatment strategies allergic contact dermatitis?
- Use barriers to irritants - Dilute topical CCS - Liberal application of emollients
71
What are the functions of the skin?
- Regulate body temp - Stores blood - Protects body from external environment - Detects cutaneous sensations - Excretes and absorbs substances - Synthesises Vit D
72
What are the layers of the skin?
- Epidermis (first line defence) 5 layers. corneum, lucidum, granulosum are dead, basale and spinosum are alive keratinocytes - Dermis: made of collagen, blood vessels and sweat glands - Hypodermic: protective layer between skin and organs
73
What is Seborrheic dermatitis and what is the treatment?
- Area rich of sebaceous glands (exocrine glands open into hair follicle to release oil) - Become inflamed and red - Ketoconazole shampoo or cream or anti-dandruff shampoo - Hydrocortisone for flare ups
74
What is the pathophysiology of Psoriasis?
- Chronic autoimmune disease - T cells (Th1 and 17) attack healthy cells leading to vascular and inflammatory changes - Release of pro-inflammatory cytokines (tnf a, il-17, il-23), leads to excess proliferation - Skin renewal shortens from 28 to 3-7 days - Has strong genetic component
75
What are the common places for psoriasis and what are some aggravating factors?
- Head, elbow, knees - Alcohol, smoking
76
What are some medicines that make psoriasis worse?
- Lithium - Beta blockers - ACE inhibitors - Chloroquine - NSAIDS
77
What is the treatment for psoriasis?
- Topical corticosteroids - Calcineurin inhibitors - Phototherapy if severe
78
What are some other forms of psoriasis?
- Guttate - triggered by streptococcal infection (red, scaly lesions on arms and legs) - Nail psoriasis - Psoriatic arthritis: characterised by pain and swelling in fingers, joints and tendons
79
What are some skin features that need referring?
- Anything in face/sensitive area - Anything infected - Anything covering more than 9% of body (1 full leg) - Burns that are painless (nerve destruction)

Stage 3 - Case 4 (Endocrine) (12 decks)

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