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Dermatology > Lower leg issues > Flashcards

Lower leg issues Flashcards

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Dermatology Board Prep flashcards
1
Q

Lower leg issues:

Most common?

A

Dermatitis

  • atopic eczema
  • discoid eczema
  • stasis dermatitis (varicose dermatitis, gravitational dermatitis)
  • lichen simplex
  • prurigo nodularis
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2
Q

Lower leg issues:

Scaly rashes?

A
  • Psoriasis
  • Lichen planus (T cell mediated- includes guttate psoriasis)
  • BCCs
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3
Q

Lower leg issues:

Infections?

A
  • Cellulitis (more adults than children, warm, spreading, well defined)
  • Folliculitis
  • Tinea corpis
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4
Q

Lower leg issues:

Red/purple rashes?

A
  • Panniculitis (painful, poorly demarcated,subcutaneous nodules - most common form is Erythema nodosum)
  • Myxoedema
  • Vasculitis
  • Necrobiosis lipoidica (granulomatous condition normally in diabetes)
  • Capillaritis (well people, post exercise, leaking capillaries with haemosiderin deposits)
  • bruising
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5
Q

Lower leg issues:

stasis eczema mechanism?

A

Immune reaction to fluid collecting in tissues

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6
Q

Lower leg issues:

stasis eczema management?

A
  • avoid prolonged standing
  • elevate feet where possible
  • compression/banding
  • topical (1 -2%) or oral horse chestnut extract (antiplatelet, venous vasoconstriction, anti inflammatory)
  • emollients
  • topical steroid
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7
Q

Lower leg issues:

What is lichen simplex?

A

Chronic lichenified skin secondary to persistent localised pruritus (variable underlying cause - infection, neuropathy, inflammatory)

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8
Q

Lower leg issues:

Lichen simplex management?

A
  • treat primary cause
  • potent topical steroids with occlusion until resolved
  • reduce potency once resolved
  • emollients
  • menthol creams (cooling)
  • antihistamine/TCA (itch and sleep assistance)
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9
Q

Lower leg issues:

What is prurigo nodularis?

A
  • Firm itchy lumps usually grouped associated with systemic disease (eg iron deficiency, HIV renal failure etc)
  • unknown mechanism
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10
Q

Lower leg issues:

Prurigo nodularis management and prognosis?

A
  • emollients
  • menthol creams
  • antihistamine
  • potent steroid
  • steroid injections in thicker nodules
  • coal tar
  • calcipotriol
  • capsaicin cream
  • cryotherapy

Treatment resistant

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11
Q

Lower leg issues:

insect bite features?

A
  • exposed areas
  • grouped
  • urticarial
  • *pruritic**
  • exaggerated reactions can be bullous (can indicated underlying viral infection or haematological malignancy)
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12
Q

Lower leg issues:

Panniculitis causes?

A
  • its rare*
  • infection
  • trauma
  • cold exposure
  • alpha 1 antitrypsin deficiency
  • connective tissue disorder
  • malignant infiltration
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13
Q

Lower leg issues:

Bruising considerations?

A
  • should be on extensor surfaces
  • recurrent bruising to minimal trauma should trigger investigation for thrombocytopaenia, haemophilias, von willebrands, vitamin C deficiency, Ehlers danlos syndrome, henoch-schonlein purpura)
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14
Q

Lower leg issues:

Erythema nodosum disease pattern?

A
  • occur at any age

- prodromal URTI, fever, malaise or arthralgia 1-3 weeks prior to rash

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15
Q

Lower leg issues:

Erythema nodosum clinical features?

A
  • symmetrical
  • commonly pretibial
  • nodules do NOT ulcerate
  • last up to 6 - 12 weeks then resolve
  • chronic forms can last months to years
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16
Q

Lower leg issues:

Erythema nodosum causes?

A
  • URTI
  • other causes include drugs (COCP), IBD, sarcoidosis
  • 50% idiopathic
17
Q

Lower leg issues:

Erythema nodosum management?

A

1) identify underlying cause (Antistreptolysin O titre = ASOT, ACE levels = sarcoidosis, colonoscopy = IBD)
2) Symptom management (NSAIDs, oral prednisolone until resolution)

18
Q

Lower leg issues:

What is myxoedema?

A

Accumulation of mucopolysaccharides (water holding complex carbohydrates used for lubrication and hydration of tissues)

19
Q

Lower leg issues:

What is it associated with most commonly?

A

Graves disease
Females in 40 - 60yo age group
Females 3.5 : 1 Males

20
Q

Lower leg issues:

Cardinal triad of Graves?

A

1) Pretibial Myxoedema
2) opthalmopathy (myxoedema pushing eyes outward)
3) Acropachy (swelling and overgrown nail plates - similar appearance to clubbing)

21
Q

Lower leg issues:

Clinical appearance of myxoedema?

A 
occurs in areas of prior trauma
bilateral
firm
pruritic
non pitting
asymmetric
plaques/nodules
prominent hair follicles/increased hair growth in region
22
Q

Lower leg issues:

Management of myxoedema?

A

1) Thyroid control
2) smoking cessation and normal range of body weight
3) Compression stockings
4) Potent topical steroids

Dermatology (12 decks)

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