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Mnemonics Flashcards

1
Q

Acquired diffuse PPK

A

EF PLC SPRAINED
Eczema
Fungal infections
Psoriasis
Lichen planus
Climactericum keratoderma

SLE, DME
PRP
Reiter’s
Acanthosis nigricans
Infection (syphilis, scabies)
Neoplasms (MF, Sezary, Bazex)
Endocrine (hypothyroid)
Drugs (nibs)

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2
Q

Acquired focal or punctate PPK (including drugs list)

A

CLAW DRIP
Callosities
LP/LE
Arsenic
Warts
Drug*
Reiters
Infection
Porokeratosis/psoriasis

Drug - FLIC BT
Flu vax
Lithium
Iodine
Calcium channel blockers
BRAF inhibitors
TNF inhibitors

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3
Q

Behcet’s systemic manifestations

A

Eye CARVNG
Eye: ocular in 90% pts. M>F. Painful, may lead to blindness. Retinal vasculitis, posterior uveitis (most characteristic eye finding), anterior uveitis, secondary glaucoma, cataracts, conjunctivitis, keratitis, scleritis, vitreous haemorrhage, optic neuritis
Cardiopulmonary: coronary arteritis, valvular disease, myocarditis, recurrent ventricular arrhythmias, pulmonary artery aneurysms
Arthritis: ~50% pts. In ~80% pts the duration is <2/12. Mono or polyarthritic and nonerosive. Knees, wrists, ankles
Renal: GN
Vascular: aneurysmal or occlusive arterial disease, s/f or DVT
Neurologic: usually later in disease. A/W poor prognosis. Acute meningo-encephalitis, CN palsies, brainstem lesions which can induce swallowing difficulties, laughter and crying; pyramidal or extrapyramidal signs
GI: abdo pain, haemorrhage, ulcerations

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4
Q

Behcet’s diagnostic criteria

A

O PEGS
MAJOR: Aphthous idiopathic oral ulceration recurring at least 3 times in 12/12
and 2 of minor
MINOR:
- Pathergy test interpreted at 24 - 48hrs
- Eye lesions: anterior or posterior uveitis, cells in vitreous by slit lamp examination or retinal vasculitis
- Recurrent genital ulceration
- Skin lesions: EN like lesions, papulopustular lesions or pseudofolliculitis, or characteristic acneiform nodules

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5
Q

Drug causes DRESS

A

Drug causes - DRESS
Dapsone (and other sulphas), minocycline, bactrim (and other sulphonamides), vanc, amoxicillin, piptaz
Retrovirals - abacavir, nevirapine
Epileptics - lamotrigine, aromatic anticonvulsants (phenobarbital, phenytoin, carbamazepine)
So Sore - allopurinol, NSAIDs
Frusemide, Omeprazole

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6
Q

SJS/TEN drug causes

A

ASS CLAAPPPN T
Allopurinol
Sulfa ABx (sulfamethoxazole, sulfadiazine)
Sulfasalazine
Carbamazepine
Lamotrigine
Antibiotics (other: aminopenicillins, quinolones, cephalosporins, tetracyclines)
Antiretrovirals (nevirapine)
Phenytoin
Phenobarbital
Paracetamol
NSAIDs
Terbinafine

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7
Q

Complications of SCARs, erythroderma

A

THEINET - complications of SCARS in general
Thermoregulatory
Haemodynamic
Electrolytes
Infection
Nutrition
Ectropion
Thromboembolism

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8
Q

SCORTEN - prognostic indicator in SJS TEN

A

TAMEBUG:1 point each
Tachycardia >120bpm
Age >40
Malignancy
Epidermal detachment - BSA day 1 >10%
Bicarb <20mmol/L
Urea >10mmol/L
Glucose >14mmol/L

0-1: 3.2% mortality
2: 12.1% mortality
3: 35.8% mortality
4: 58.3% mortality
>5: 90% mortality

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9
Q

Acquired ichthyosis

A

> Drugs: retinoids, allopurinol, statins, cholestyramine, clofazamine, lithium
Renal disease and liver disease, Refsum disease (genoderm, weakness or numbness in hands and feet, lack enzyme for fitanic acid)
Infections (HIV, leprosy, LGV – chlamydia, syphilis, HTLV1)
Neoplasm (lymphomas - Hodgkins, NHL, MF, KS, breast, lung, GVHD, gastric adeno), >Nutrition (essential fatty acid deficiency, vitamin A deficiency, haemochromatosis, marasmus and wasting diseases)
Endocrine (hypothyroid, hypoparathyroid, hypopituitarism), Eczema
Sarcoid
Solar damage
SLE, Sjogren’s

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10
Q

Drug causes acquired ichthyosis

A

CRACKL
Clofazamine, cholestyramine, cimetidine
Retinoids
Allopurinol, antipsychotics
Chol lowering agents - statins, nicotinic acid
Kava, tyrosine Kinase inhibs
Lithium, lasix and other diuretics

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11
Q

Ichthyoses - autosomal dominant inheritance

A

ADVERBS
Autosomal
Dominant
Vulgaris (IV)
Erythrokeratoderma variabilis
Reticular ichthyosiform erythroderma (confetti)
BIE
Siemens, IH

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12
Q

Ichthyoses - autosomal recessive inheritance

A

ARLICH
Autosomal
Recessive
Lamellar
Ichthyosis
CIE
Harlequin ichthyosis
Rare: bathing suit ichthyosis, self-healing collodion, ichthyosis prematurity syndrome

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13
Q

Ichthyoses - syndromic

A

N SIReNS
Netherton’s
Sjogren Larsson
IBIDS
Refsum
Neutral lipid storage disease
Sulfatase deficiency

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14
Q

Erythema nodosum - associations

A

BEDREST:
Behcet,
Estrogens,
Drugs (OCP, sulphonamides, penicillin, bromides, TNFi, BRAFi),
Recent infection (strep, yersinia),
Enteropathy (Crohn’s, UC),
Sarcoid (eg Lofgren),
Tuberculosis
And haem malignancy

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15
Q

Drug causes / triggers psoriasis

A

BLASTIN
Beta blockers
Lithium
Antimalarials, acei
Steroid withdrawal
Terbinafine, TNFi
Interferon, Infliximab
NSAIDs

Also: PD1, dupilumab

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16
Q

Erythroderma drugs of concern

A

BERNS A
Biotics
Epileptics
Retrovirals
NSAIDs
Sulphurs
Allopurinol

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17
Q

Erythroderma -
Common causes
Less common causes

A

PEDLI
GOLF PINS

Psoriasis
Eczema: atopic, allergic contact, id reaction, stasis, CAD, seborrhoeic
Drug: exanthematous, DRESS, SJS/TEN
Lymphoma
Idiopathic

Gvhd
Ofuji - papuloerythroderma of
Lupus, LP
Fungus - dermatophyte
PRP, paraneoplastic, pemphigus, pemphigoid
Infection/infestation, ichthyoses
Netherton’s, neoplastic (mastocytosis, LCH)
Sarcoidosis

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18
Q

LP variants

A

I HAVE A LEAN FLAG

Inverse
Hypertrophic
Actinic
Vesiculobullous
Erosive
Linear
Exanthematous
Annular
Palms/soles
Follicular
LPP
Atrophic
Guttate

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19
Q

Drug causes lichen planus / lichenoid drug eruption

A

ABCD LGPTQ TT

ACEi
Beta blockers
Calcium channel blockers
Diuretics - frusemide, spiro, thiazides
Lithium
Gold
PD1i, Penicillamine
Tetracyclines, TNF
Quinidine, quinine

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20
Q

Hanifin and Rajka diagnostic criteria AD

A

CHIP BAKES DRIP
Chronicity
Hx of atopy, personal or Fhx
Involvement face and flexures
Pruritus

Blanching - delayed, due to cholinergics
Anterior subcapsular cataract
Keratoconus
E - IgE raised
Skin test - immediate type 1
Dennie Morgan lines
Recurrent skin infections
Ichthyosis vulgaris over palmar crease
Pallor on face

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21
Q

DDx intertriginous dermatoses

A

BIGGLE SPINNED

Babboon - SDRIFE
Infection - candidiasis, tinea, erythrasma
Granular parakeratosis
Genetic - HHD, Darier
LCH
EMPD

Seb derm
Psoriasis, inverse
Intertrigo
Nutritional - Zn deficiency
Necrolytic migratory erythema
Extra - cutaneous Crohn’s
Dermatitis, allergic contact

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22
Q

Types of Malassezia

A

F GROS

Furfur
Globosa
Restricta
Obtusa
Sloofiae

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23
Q

Acute rheumatic fever - JONES criteria

A

Jones criteria: (major) 2 major OR 1 major and 2 minor PLUS evidence GAS infection (culture, rising ASOT or anti-Dnase B)
J - joints. Migratory polyarthritis. Commonly ankles, knees, elbows, wrists
O - heart. Carditis
N - nodules. Subcutaneous nodules. <2% pts. Over joints (elbows, knees, ankles, knuckles). Firm, round, mobile . 0.5-2cm in size. Nodules only present when severe carditis is present
E - erythema marginatum
S - Sydenham chorea. Jerky, uncoordinated movements esp affecting hands, feet, tongue, face. ‘Milkmaid’s grip’
(Minor)
Fever, arthralgias, abnormal lab findings (elevated ESR, CRP, prolonged PR on ECG)

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24
Q

Borrelia features

A

SHANE
Skin - ECM, ACA, sclerodermoid plaques
Heart - AV block, myocarditis, pericarditis
Arthritis, arthralgias
Neuro - meningitis, peripheral neuropathies, Bell’s palsy, headaches
Eyes - conjunctivitis, keratitis, episcleritis, iritis

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25
Q

Prognostic scoring / mortality estimator for TEN

A

SCORTEN - TAMEBUG
TAMEBUG:1 point each
Tachycardia >120bpm
Age >40
Malignancy
Epidermal detachment - BSA day 1 >10%
Bicarb <20mmol/L
Urea >10mmol/L
Glucose >14mmol/L

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26
Q

Causes AGEP

A

BADFACE
Bactrim
Abx
Diltiazem
Frusemide
Allopurinol
Antimalarials
Cimetidine
Epileptics

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27
Q

Acneiform drug eruption

A

PIMPLE J CATS
○ Prednisolone
○ Isoniazid/Iodides
○ MEKi (trametinib)
○ Progestins
○ Lithium
○ EGFR inhibs (cetuximab / antiepileptics
○ JAKs
○ CsA
○ AZA
Testosterone, tacro, sirolimus

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28
Q

Triggers for CSVV
Drug triggers

A

Triggers for CSVV: MANIC: medication, autoimmune, NSAID, infection, cancer
Medication triggers for CSVV 10-15% cases: PAIN MEH OR MEAN HIP
Beta lactams, GCSF
Penicillin, penicillamine, propylthiouracil, PPI (omeprazole)
Allopurinol, Abx (quinolones, sulfonamides, cefalosporin)
Interferon, infliximab
NSAIDs
MTx, minocycline, macrolides
Epileptics (gabapentin, lamotrigine)
Hypertensives (thiazide, hydralazine)

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29
Q

Sweets associations (including drugs)

A

MINT DROPS
Malignancy - haematological (10-20%) - AML, myelodysplasia; solid organ
Infection - viral URTI, CMV, HBV, HCV, HIV; bacteria (Yersinia, Strep), Mycobacteria (M TB, M leprae), fungi (sporotrichosis, coccidiomycosis)
Neutrophilic - other (Behcet’s PG)
Thyroid disease , Autoimmune (SLE, RA, DM, relapsing polychondritis, Sjogren)

Drugs - Abx (mino, bactrim), antihypertensive, antineoplastics, G-CSF, contraceptives, immsupp (AZA), NSAIDs, retinoids
**Drug causes of Sweets - think Allens lollies
All-lans (antis) ATRA, Abx (bactrim, mino, quinolones), some are fruit flavoured (frusemide), some are gummy lollies (G-CSF), then you get tooth ache (need NSAID) and need to check (checkpoint inhibitors) for cavities (abacavir), sugar high makes you mad (imatinib) as (AZA) a hatter (hydralazine) interferes with your day/function (IFNa), need to take NSAIDs for your toothache
Sweet AF GANCHINIs
ATRA
Frusemide
G-CSF
Abx (mino, bactrim), abacavir
NSAIDs
Checkpoint inhibitors, contraceptives
Hydralazine
Imatinib
Neoplastics (ipilimumab, pembrolizumab, vemurafenib)
Immunosuppressants (AZA)
RA
Organ / bOwel - IBD (UC, Crohn’s)
Pregnancy
SLE, sarcoid

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30
Q

Subtypes/variants of PG

A

PPE- Pyodermatitis pyostomatitis (w IBD), Peristomal, Extracutaneous to the PUBS - Pustular, Ulcerative, Bullous, Superficial

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31
Q

Behcet’s Diagnostic Criteria

O PEGS

A

Diagnostic criteria - 1990 international study group - O PEGS
MAJOR: Aphthous idiopathic oral ulceration recurring at least 3 times in 12/12
and 2 of minor
MINOR:
- Pathergy test interpreted at 24 - 48hrs
- Eye lesions: anterior or posterior uveitis, cells in vitreous by slit lamp examination or retinal vasculitis
- Recurrent genital ulceration
- Skin lesions: EN like lesions, papulopustular lesions or pseudofolliculitis, or characteristic acneiform nodules

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32
Q

Bullous pemphigoid - drug causes

A

Drug induced:
SPACED PING:
Sulfas, Spironolactone
Penicillin, penicillamine, potassium iodide
ACE-I,
Diuretics - frusemide, spiro

Psoralens, PD1i, PPI (Laura in clinic 27/7)
Inhibitors - TNFi, checkpoint inhibitors (PD1i (nivolumab, pembrolizumab, cemiplimab), CTLA-4i (ipilimumab)
NSAIDs - ibuprofen, top diclofenac
Gliptins (dipeptidyl peptidase 4 inhibitor)
?Gold

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33
Q

Bullous pemphigoid - clinical variants

A

Clinical variants of BP - GLUED VANT:
Generalised, gestational
Lichen planus pemphigoides, localised (Brunsting Perry –> also variant of MMP not BP, stump, umbilical, peristomal, pretibial)
Urticarial
Erythrodermic, eczematous
Dyshidrosiform
Vesicular, vegetative, localised vulval
Acral (childhood)
Pemphigoid nodularis (Johannes long case, think about in prurigo nodularis, do Bx with DIF as part of workup)
TEN like

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34
Q

EBA - associations

A

Associations of EBA: CHADS
EBA about you. Think about finance CHADS
Crohn’s (> UC)
Haem malignancy
Arthritis / RA, AICTD
Drugs, diabetes
SLE

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35
Q

LABD - drug causes

A

VP CANS: Vancomycin
P: penicillins, phenytoin
C: cephalosporins, captopril
A: ACEi, ARB, amiodarone
N: NSAIDs (diclofenac, naproxen, oxaprozin, piroxicam)
S: sulphonamides
Less common - phenytoin, sulphonamides
Lithium, phenytoin, frusemide, atorvastatin
Drug induced LABD usually remits within 2-6/52 of cessation, but some cases have persisted for months

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36
Q

DDx acneiform eruption

A

DDx for acneiform eruption: ACNE PHAD
Acne agminata; acneiform follicular mucinosis
Chloracne; cosmetics
Naevus comedonicus
Elastosis, favre racouchot (rac coo show)
Perioral dermatitis; folliculotropic MF
Halogenoderma
Apert syndrome
Drugs

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37
Q

DDx facial plaques

A

GIRLS FAT
GF and GA
Infection - TB, leprosy, tinea
Rosacea
Lymphocytoma cutis, CTCL/CBCL, Jessner’s, LE tumid / discoid
Sweets, Sarcoid
Follicular mucinosis
Amyloid
tumours - BCC, Bowens

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38
Q

HS associations

A

ADIOS PAPI
Arthritis, up to 50% pts
Diabetes, up to 30% pts. 3x increased risk
IBD. 2x increased risk Crohn’s, 1.5x increased risk UC
Obesity, ~75% pts
Smoking, Scc (more common in men. Anal/gluteal area)
PCOS, ~10% pts, 3x increased risk
Anxiety or depression (JAAD Jan 2022. Higher depression in paeds and adults), Acne tetrad
Pyoderma gangrenosum
Insulin resistance or metabolic syndrome

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39
Q

Hyperhidrosis - causes of secondary hyperhidrosis
Then drug causes secondary hyperhidrosis

A

Causes secondary hyperhidrosis: DENIM
Drugs: SWEAT
Endocrine: hyperthyroidism, diabetes, menopause, phaeochromocytoma, carcinoid syndrome. POEMS
Neurological: Parkinson’s, stroke, spinal surgery, psychiatric disorders. Frey syndrome
Infection: HIV, malaria, TB
Malignancies: leukaemia, lymphoma, Menopause

Drug causes secondary hyperhidrosis: SWEAT
SSRI and other antidepressants, Stimulants (amphetamines, caffeine)
Wee wee - sildenafil
Endocrine drugs - sulphonylureas, insulin
Anti-Parkinson’s, antipsychotic, antidepressant, ACEi, antiemetics
Tramadol, opioids

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40
Q

Criteria for primary hyperhidrosis

A

Sweaty Sam Smith WAS FAB
Sweat = exces sweating
Six monthsn
Secondary causes - none
Was fab
- Weekly episodes at least
- ADLs impaired
- Sleeping - stops during sleep
- FHx
- Age onset <25
Bilat and symmetric

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41
Q

Nonspecific cutaneous findings of SLE

(SPAM N RAV)

A

Nonspecific cutaneous findings of SLE - SPAM N RAV
S: Sweets like neutrophilic dermatosis
P: palmar erythema
A: alopecia, diffuse non-scarring
M: mucinosis, papular and nodular; papulonodular mucinosis of Gold
N: nailfold telangiectasias and erythema
R: Raynauds
A: Antiphospholipid syndrome signs
V: vasculitis

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42
Q

Causes / precipitating factors for lupus

(MUSIC)

A

Causes/precipitating factors for lupus: MUSIC
Medications
UVR
Stress, silica, solvents
Infections (EBV)
Cigarettes

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43
Q

Drug causes ACLE

(PIMP BEATS HO)

A

Drug induced
a/w anti-histone Ab (up to 95% cases), anti-dsDNA usually neg
Usually ANA +ve
Key features: MSK (arthritis, arthralgia, myalgia), serositis (pleuritis, pericarditis). Cutaneous involvement less common
PIMP BEATS HO
P: PPI, psychotics
I: isoniazid
M: methyldopa, minocycline
P: procainamide, penicillamine
B: beta blockers
E: epileptics - valproate, phenytoin
A: allopurinol
T: TNF
S: sulphonamides
H: hydralazine
O: OCP

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44
Q

Cutaneous signs antiphospholipid antibody syndrome

A

Cutaneous signs in APLA syndrome - LA DULA
L: livedo reticularis
A: acrocyanosis
D: Degos like lesions
U: ulcerations
L: livedoid vasculopathy
A: atrophie blanche like lesions

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45
Q

SLE EULAR / ACR 2019 Diagnostic criteria

A

SLE EULAR/ACR 2019 Diagnostic criteria - Clinical - MONARCHS - like butterfly
MSK - joint involvement
Oral/cutaneous - nonscarring alopecia, oral ulcers, SCLE/DLE/ACLE.
Neuropsychiatric - delirium, psychosis, seizure
ANA positive
Renal - proteinuria, renal Bx showing lupus nephritis
Constitutional - fever
Haematologic - leukopaenia, thrombocytopaenia, AI haemolysis
Serosal - pleural or pericardial effusion, acute pericarditis

Immunology -
Antiphospholipid antibodies, complement (low C3 and/or C4) or SLE specific Ab (anti-sm, anti-dsDNA)

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46
Q

Drug causes SCLE

(SPACE TTTT) PATCH

A

SPACE TTTT
S: statins
P: PPI
A: ACEi
C: calcium channel blockers
E: epileptics
T: terbinafine
T: TNFa
T: thiazides
T: taxanes

Patch - Tom’s one
PPI
ACEi, antiepileptics
Twrbinafine, TNF, griseo
Calcium channel
Hctz

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47
Q

Drug induced Dermatomyositis

(DERMATO M)

A
  • Drug induced DM: DERMATO-M
    ○ DM - stat: statins
    ○ Epileptics - phenytoin
    ○ Reflux - PPI
    ○ MSAIDs - NSAIDs
    ○ Anti-TNF
    ○ Terbinafine
    ○ O - hydrOxyurea
    Mine - penicillamine
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48
Q

Cutaneous features of SSc

A

SSc: TURNIP: Telangiectasias, Ulcers, Raynaud’s, Nailfold capillaries, I - calcinosis, Pruritus, Pigmentary changes

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49
Q

DDx sclerodermoid skin changes

A

Sclerodermoid skin changes: SCLEROGAMES
Scleroderma, scleredema, scleromyxoedema
Carcinoid, CTD mixed
Lichen sclerosus, morphoea, lipodermatosclerosis, lupus profundus & other panniculitides
Eosinophilic fasciitis
Radiotherapy, nephrogenic systemic fibrosis
Occupational: PVC, silicone, solvents (trichlorethylene in dry cleaning), epoxy resins, pesticides, bleomycin
GVHD
Amyloid, acrodermatitis chronica atrophicans (Lyme disease),
Ageing syndromes (progeria, acrogeria)
Metabolic (PCT, nephrogenic systemic fibrosis), Morphoea, Medications (bleomycin, docetaxel, vit K)
Endocrine: myxoedema, POEMs, diabetic cheiroarthropathy
Stiff skin syndrome

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50
Q

Treatments for calcinosis

A

IWARP - ivig, warfarin, abatacept, ritux, probenecid

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51
Q

ACR/EULAR Dx criteria for SSc

A

ACR/EULAR Dx criteria for SSc - Fingers CAPUT
Fingers 3 -
– thickening prox to MCP
– puffy / sclerodactyly
– raynauds
Capillaries
Antibodies
Pulmonary disease - PAH, ILD
Ulcers, digital OR pitted scars
Telangiectasias

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52
Q

Scleromyxoedema - variants

A

Variants: DANC
-Discrete papular lichen myxoedematosus (clin: not hands, can be anywhere else. Limbs and trunk, symmetrical)
-Acral persistent papular mucinosis (clin: dorsal hands. F>M. Ivory to skin coloured papules)
-Nodular lichen myxoedematosus (clin: deep nodules, mm to cm. indurated)
-Cutaneous (papular) mucinosis of infancy (clin: classic upper arms, torso, head and neck)

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53
Q

Drug triggers for PCT

A

BEGS for Alcoholic Drinks
Barbiturates
Estrogen; Ergot
Griseofulvin
Sulfonamides
Alcohol/Anticonvulsants
Dapsone

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54
Q

PCT cutaneous features

A

PCT cutaneous features: SHAVEMO
Sclerodermoid changes
Hyperpigmentation, Hypertrichosis
Alopecia
Vesicles and bullae
Erosions
Milia
Onycholysis

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55
Q

Acute porphyrias - triggers for acute attacks

A

SHOE BAGS
Sulphur drugs
Hormones: late luteal cycle, pregnancy, IVF, HRT
OCP
Epileptics - carbamazepine, valproate and EtOH
Barbiturates
Antimalarials, amphetamines
Griseofulvin
Sedatives

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56
Q

Acanthosis nigricans - associations

A

FOAMED DS
Familial - hereditary benign AN. Progresses until puberty then stabilises or regresses
Obesity
AI - lupus, Sjogren, SSc, hashimoto thyroiditis
Malignancy
Endocrine - hypothyroid, cushing’s , addison’s, hyperandrogenism, acromegaly
Diabetes
Drugs
Syndromes - HAIR AN (hyperandrogenism, insulin resistance, acanthosis nigricans), leprechaunism, Crouzon

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57
Q

Acanthosis nigricans - drug causes

A

Drugs - COPING
Corticosteroids
OCP
Protease inhibitors
Insulin
Nicotinic acid lotion
GH

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58
Q

Acquired ichthyosis - causes inc drugs

A

Acquired ichthyoses - DRINNESSS:
Drugs: retinoids, allopurinol, statins, cholestyramine, clofazamine, lithium
CRACKLSS
Cholestyramine; Retinoids; Allopurinol; Clofazamine; Kava; Lithium; Statins; Spiro (diuretics)
Wake up in the morning. Wash off retinoid. Put on clofes clofazamine. Go downstairs and say allo (purinol),. Etc]
Big smile on your face - lithium
Have cholestserol lowering with breakfast -
Renal disease, Refsum disease (genoderm, weakness or numbness in hands and feet, lack enzyme for fitanic acid)
Infections (HIV, leprosy, LGV – chlamydia)
Neoplasm (lymphomas, MF, KS),
Nutrition (essential fatty acid deficiency, vitamin A deficiency, haemochromatosis, marasmus and wasting diseases)
Endocrine (hypothyroid, hypoparathyroid, hypopituitarism), Eczema
Sarcoid
Solar damage
SLE, Sjogren’s

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59
Q

Inherited ichthyoses, AD

A

Ichthyoses Inheritance - autosomal dominant: ADVERBS
ADVERBS:
Autosomal
Dominant
Vulgaris (IV)
Erythrokeratoderma variabilis
Reticular ichthyosiform erythroderma (confetti)
BIE
Siemens, IH

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60
Q

Inherited ichthyoses, AR

A

Ichthyoses Inheritance - autosomal recessive: ARLICH
ARLICH:
Autosomal
Recessive
Lamellar
Ichthyosis
CIE
Harlequin ichthyosis

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61
Q

Netherton - features

A

BARE ASS Spank
Bamboo hair
Atopic derm
REcessive
igE
Anaphylactic food allergy
Seb derm
Serine protease
SPINK 5

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62
Q

Conradi Hunerman Happle
CHH EBP
SAD FACE X

A

Conradi Hunerman Happle - features - CHH EBP
Transient blaschkoid ichthyosiform erythroderma at birth, resolves by 1yo with linear and follicular atrophoderma
Cataracts, CNS malformations, congenital cardiac defects, congenital renal
Hyper and hypopigmentation
Hyperkeratosis at birth, replaced by follicular atrophoderma, dilated follicular openings, ice pick like scars. Most pronounced forearms, dorsal hands
– Conrad the honey man, ice pick scars and atrophoderma like honeycomb
E - EBP gene
Bones/skeletal - limb shortening, stippled epiphyses (chondrodysplasia punctata on XR)
Patchy alopecia, nail dystrophy

SAD FACE X
Short stature
Asymmetrical limbs or cataracts
Dysmorphic facies - frontal bossing, macrocephaly
Follicular atrophoderma replacing blaschkoid hyperkeratosis
Alopecia
Chondrodysplasia punctata
Erythroderma at birth
XLD, EBP gene

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63
Q

Collodion baby causes

A

Clint Eastwood - CLNT SHNS
CIE
LI
Netherton’s
Trithothiodystrophy

Sjogren Larsson
Harlequin ichthyosis
Neutral lipid storage
Self healing

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64
Q

PPK - diffuse acquired

A
  • FEPLC (common) - EFPLC ( ef PLC – presbytarian ladies college ) SPRAINED (uncommon)
    ○ Fungal - tinea
    § Beware unilateral hand rash
    ○ Eczema
    § Hyperkeratotic hand eczema
    § Irritant > allergic
    ○ Psoriasis
    § Examine other sites
    ○ Lichen planus
    § Examine other sites
    ○ Climactericum (keratoderma climactericum) - Haxthausen disease
    § Epi: women >45yrs. Obese perimenopausal women
    § Assoc: obesity, cold dry climates, backless shoes (sandals)
    § Clinical: hyperkeratosis begins over pressure points on heels. Formation of fissures makes walking painful. Feet esp pressure areas. Worse in winter
    • SPRAINED
      ○ SLE/DM
      ○ PRP
      § Yellow sandal. Perifollicular papules. Orange-red colour. Splinter haemorrhages
      ○ Reiter’s
      § Keratoderma blenorrhagicum
      § Circinate balanitis/vulvitis. Psoriasiform rash. Arthritis, urethritis, conjunctivitis
      ○ Acanthosis nigricans
      § Pachydermatoglyphy (yellow rugose appearance - tripe palms). Acanthosis palmaris
      § Associations: adenocarcinomas, lymphoma, leukaemia
      ○ Infection (scabies, syphilis)
      ○ Neoplasia (MF/Sezary, Bazex)
      § Bazex - acrokeratosis paraneoplastica. SCC upper aerodigestive tract. Scale fingertips, nailfolds, nose, ears. SCC upper resp tract or GI tract (oral cavity, pharynx, larynx, oesophagus), SCC thymus, vulva, adenocarcinoma of uterus
      ○ Endocrine
      § Hypothyroidism. Improves or resolves with thyroid replacement therapy
      Drugs (vemurafenib, trametinib, imatinib)
65
Q

DDx palmar / plantar pits

A

DDx for palmar pits / plantar pits: CD GAP PPD
Cowden’s
Darier’s
Gorlin’s
Acropigmentation of Kitamura, reticulate / Acrokeratosis verruciformis of Hopf
Punctate PPKs - BAFS (Buschke Fischer Brauer, Acrokeratoelastoidosis, Focal acral hyperkeratosis, Spiny keratoderma)

Pitted keratolysis
Punctate porokeratosis
Dupuytren’s contracture

66
Q

DDx acral keratoses

A

Acral keratoses DDx:
Arsenic
Acrokeratosis verruciformis of Hopf
Cowden/PTEN
Darier
Rothmund Thomson syndrome

67
Q

Acquired focal / punctate PPK

A

Causes acquired focal/punctate PPK: CLAW DRIPS
Callosities
LP/LE
Arsenic
Warts

Drug - FLIC BT
Reiters
Infection
Porokeratosis, Psoriasis

Drug causes acquired focal/punctate PPK - FLIC B T
* Lizzo with her fresh claws feeling suspiciously good as hell with all of her drugs
* Flu vax – pro flu vax
* Lithium – pro mental health
* Iodine – colour of her dress
* Calcium channel blockers – she’s on all the radio channels
* BRAF inhibitors
TNF inhibitors

68
Q

Multiple CALM

A

Multiple Café au Lait macules - TNF BLAME
Tuberous sclerosis
Neurofibromatosis, Noonans
Fanconi anaemia, Familial
Blooms
LEOPARD (Noonan with multiple lentigines), Legius
Ataxia telangiectasia
McCune Albright, Maffucci syndrome
Endocrine neoplasia, multiple - MEN 1, MEN 2B

Noonan: CALM, pigmented naevi. Lymphoedema. Coarse woolly hair. Craniofacial changes. Webbed neck. Cryptorchidism
Fanconi: CALM,diffuse hypomelanosis of scalp hair, vitiligo, strabismus, bone marrow failure, short stature

69
Q

Blooms

A

Blooms: photosensitivity. CALM
PC BLOOMS
Photosensitivity, poikiloderma
Café au lait macule
Butterfly erythema
Low fertility
Opportunistic infection / immunodeficiency
Oshkenazi Jews (but perhaps not per bolognia)
Malignancy - lymphoma, leukaemia - lymphoproliferative and GI
Short stature, syndactyly

70
Q

LEOPARD syndrome

A

LEOPARD: (Noonan syndrome with multiple lentigines),
Lentigines,
Electrocardiographic conduction defects,
Ocular hypertelorism,
Pulmonary stenosis,
Abnormalities of the genitalia,
Retardation of growth,
Deafness

71
Q

NF diagnostic criteria

A

NF Diagnostic criteria: NF SCORE
2 or more:
Criteria met by 97% by 8yo, 100% by 20yo
Neurofibromas: 2 or more, or one plexiform NF
Freckling in axillary or inguinal, Crowe’s sign (I’m like a bird)
Skeletal: osseous lesion such as sphenoid wing dysplasia (I’m like a bird) or thinning of long bone cortex (she’s really skinny) +/- pseudarthrosis (abnormal bowing, can progress to segment of bone loss, simulating appearance of a joint. Usually apparent shortly after birth, rarely diagnosed after age 2)
Café au lait macules: 6 or more >5mm in prepubertal, >15mm post pubertal (she’s super calm on stage)
Optic glioma (has glee in her eyes)
Relative: first degree with NF1 by these criteria (dedicating the show to her audience)
Eye: 2 or more Lisch nodules (iris hamartomas) (her friend Leisha Keys is there woo-ing her on)

72
Q

NF malignancies

A

NF - malignancies. BORE3D JOGN
Breast
Optic glioma
Rhabdomyosarcoma
Endo x3:
-Phaeochromocytoma
-Somatostatinoma
-Parathyroid adenoma
Duodenal carcinoid

JMML
Other CNS - astrocytoma, brainstem glioma
GIST, glomus
NST - MPNST

73
Q

TS diagnostic criteria - major and minor

A

PASH: major features
Periungual/subungual fibromas; at least 2 (Koenen tumours)
Angiofibromas; at least 3 OR fibrous cephalic plaque
Shagreen patch
Hypopigmented macules; at least 3

CORNER: major extracutaneous features
Cardiac rhabdomyomas
Ocular retinal hamartomas
Renal bilat angiomyolipomas
Neuro: subependymal nodules, SEGA (subependymal giant cell astrocytoma)
Extra brain stuff: cortical dysplasias – cortical tubers, cerebral white matter radial migration lines
Respiratory: pulmonary LALM
________________________________________

Minor: CHAFER OR CAFÉ HR
Confetti like skin lesions
Hamartomas, non renal
Achromic retinal patch
Fibromas, intraoral >2
Dental Enamel pits >3
Renal cysts, multiple

74
Q

TS organ involvement

A

Organ involvement: TS COMPLEX
Teeth
Skin

Cardiovascular
Ocular
Mental (neurological)
Pulmonary
Le kidneys
Endocrine
Xray (skeletal)

75
Q

Goltz syndrome / focal dermal hypoplasia

A

GOLTZ
Golden blobs of fat - from dermal atrophy with fat herniation
Osteopathia striata
Linear hyper and hypopigmentation
Teeth/hair/nails
Z - limbZ (syndactyly, ectrodactyly) and eyeZ (colobomas, microphthalmia, anophthalmia)

76
Q

Epidermal naevi - types

A

Types of epidermal naevi: VBCASE
Verrucous, Becker, Comedonal, Apocrine 9rare), Sebaceous, Eccrine (rare)f

77
Q

Epidermal naevi syndromes - types

A

Types of epidermal naevi syndrome: VB CASE
Verrucous: CHILD, type 2 segmental Cowden, FGFR3 ENS
Becker naevus syndrome
Comedo naevus syndrome
Angora hair naevus syndrome
Sebaceous:
Extra: Proteus, CLOVE

Associations of ENS: skeletal, optic, neurological

78
Q

Proteus syndrome

A

PROTEUS syndrome. AKT1
Progressive overgrowth, Palmoplantar connective tissue naevi
R - shape of the back, hunched over. Disproportionate overgrowth and focal atrophy of upper arm muscles and neck, leading to hunched over look. Respiratory - lung cysts
Orthopaedic and soft tissue overgrowth. Disproportionate, asymmetric
Thromboembolism
Epidermal naevi, Lipomas
U - Vascular and lymphatic malformations
Spleen, thymus overgrowth

79
Q

SOLAMEN syndrome

A

Segmental Overgrowth, Lipomatosis, Arteriovenous Malformation, Epidermal Naevus

80
Q

Autosomal dominant mosaicism disorders

A

DN PHaB LAB: Do Not enter the PHaB LAB
Darier’s
NF
Porokeratosis
Hailey Hailey
Benign lesions
Legius
Angiofibromas
BCC

81
Q

Linear inflammatory disorders

A

Linear inflammatory disorders: VBPLS
Vitiligo
Blaschkitis
Psoriasis
Lichen planus
Striatus, lichen

82
Q

Cowdens - major and minor criteria

A

Cowdens/PHTS Major Criteria: TO PLANT MacBETH

Oral papillomas / cobblestoning

Penile freckling
Lhermitte duclos - dysplastic cerebellar gnagliocytoma
Acral keratoses on dorsal hands, punctate keratoses of palms
Neuromas mucocutaneous
Tricholemmomas

Macrocephaly
Breast Ca
Endometrial Ca
Thyroid cancer - follicular. It would be a folly to miss it
Hamartomas of GI

Cowden’s Minor Criteria: GRAVL
GI malignancy - CRC
Rcc
ASD
Vascular anomalies
Lipomas, testicular lipoma

83
Q

Cowden’s malignancies

A

Cowden’s Malignancies - BLT REG - get a BLT on the regular
Breast
Lhermitte Duclos
Thyroid, follicular
Renal cell carcinoma
Endometrial
GI hamartomas/polyposis

84
Q

Cowdens features

A

MILK FLOAT
Mucocutaneous neuromas
Invasife. Melanomas
Lipomas
K - cognition, cancer, cerebellar disease
Fibromas
Lentigines of glans penis
Oral papillomas
Acral keratoses
Tricholemmomas

PLANT MOM
Penile freckling
Lipomas
Acral keratoses
Neuromas, mucosal
Tricholemmomas
Macrocephaly
Oral papillomas
Melanomas

85
Q

GI polyps and skin signs (no mnemonic)

A

GI polyps and skin signs:
Gardner
Peutz Jegher
Muir Torre
PTEN hamartoma tumour syndrome - Cowden
Juvenile polyposis syndromes can be a/w HHT

86
Q

Vitiligo associations

A

Vitiligo associations: TADA CARL!
Thyroid disease
Anaemia, pernicious
Diabetes
Addison disease
Coeliac disease
Atopic dermatitis
Rheumatoid arthritis
Lupus erythematosus

87
Q

DDx hypopigmentation

A

DDx for hypopigmentation: VIC GETS NIP
V: vitiligo
I: infection – leprosy, onchocerciasis, syphilis, pit versi, leishmaniasis
C: chemical leukoderma – drugs (imatinib)
G: genetic eg piebaldism, TS, pigmentary dilution list CAPN M GOH
E: eating – nutrition: Kwashiorkor, copper, selenium
T: tinea versicolour
S: syphilis, scleroderma
N: naevus depigmentosus
I: idiopathic guttate hypomelanosis
P: post inflammatory, MF

88
Q

DDx pigmentary dilution

A

Pigmentary dilution: CAPN M GOH (Captain Michelle Goh)
Chediak Higashi
Apert syndrome
Phenylketonuria
Nutritional - copper, selenium deficiency
Menke’s
Griscelli
Oculocutaneous albinism
Hermansky Pudlak

89
Q

DDx diffuse hyperpigmentation

A

NED PLANKS
Neoplasms - melanoma, ACTH producing
Endocrine - Addison’s, cushing’s phaeochromocytoma, carcinoid, hyperthyroidism, pregnancy
Drugs
PIH, PCT
Liver disease - haemochromatosis, Wilson’s
Anaemias - Fanconi, haemolytic, IDA
Nutritional deficiencies - pellagra, vit b12, kwashiorkor
Kidney failure
SSc, other CTD

90
Q

DDx linear hyperpigmentation

A

Causes of linear hyperpigmentation - FFILL X COMB
Flagellate
Focal dermal hypoplasia (Goltz)
Incontinentia pigmenti
Linear lichen planus
Linear naevoid hypermelanosis
X linked reticulate
Conradi hunerman happle
Morphoea - linear atrophoderma of Moulin
Blaschkitis

91
Q

DDx blaschkoid linear hyperpigmentation

A

Blaschkiod linear hyperpigmentation - Conrad FLEXI at Moulin Rouge
Conradi Hunerman Happle
Focal dermal dysplasia AKA Goltz syndrome
Linear and whorled naevoid hypermelanosis
Epidermal naevus
X linked reticulate pigmentary disorder
Incontinentia pigmenti
Moulin - linear atrophoderma of Moulin

92
Q

DDx reticulated hyperpigmentation

A

Reticulate hyperpigmentation: DEEP DANC DIP X. Reticulate, fishing net, in the ocean. Deep danc dark dip, x marks the spot
Dyskeratosis congenita
Erythema ab igne
EBS with mottled pigmentation
Prurigo pigmentosa
Dowling Degos disease
Amyloid, macular
Naegeli Franceschetti Jadassohn syndrome
CARP
Drugs: diltiazem, 5FU, bleo
Incontinentia pigmenti
PIH
X linked reticulate pigmentary disorder

93
Q

Dowling Degos disease

A

Dowling Degos Disease: DDD
Dirty pits - acquired reticulated hyperpigmentation flexural sites
Dents in the face - pitted facial scars. Comedones, HS like features
Don’t care - no other associations. Develops over time - acquired.

94
Q

Drug causes - telogen effluvium

A

ABCD ROME
ACEi, AntiTNF (JAAD R/V 06/23)
Beta blockers
Anti Coagulants - enoxaparin, Chemotherapy/Targeted therapy (anagen effluvium. Scalp cooling)
Anti Depressants
Retinoids
OCP/hormones
Minoxidil (telogen release)
Anti Epileptics - lamotrigine
Tacrolimus
Vaccines - zoster
Most don’t have evidence to suggest cause and effect. All kinds of alopecia

95
Q

DDx causes onycholysis

A

Causes of onycholysis: IPEELD
Infection: Candida, dermatophytes, HPV
Psoriasis
Environmental: irritants, water, trauma, UV photoonycholysis
Endocrine: hyperthyroidism
Lesions: SCC, subungual exostosis
Drugs: tetracyclines, taxanes, psoralens, PDT

96
Q

Causes gingival hyperplasia

A

Causes of gingival hyperplasia - GINGIVA
Geno - Cowden
Infiltrate - leukaemia cutis
Nutritional - vit D def, vit C def
Geno - TS
Iatrogenic - drugs.
Vasculitis - GPA
Acromegaly
Drugs - CsA, phenytoin, nifedipine/calcium channel blockers
+ pregnancy

Drugs causing gingival hyperplasia:
Calcium channel blockers
CsA
Dilantin (phenytoin)

97
Q

Clinical features of LEPROMATOUS leprosy

A

SMILE with your EYES and jazz hands SMILES G CORP(glove and stocking). V shaped smile – Virchow cells on path
Saddle nose
Madarosis
Ichthyosis
Leonine facies
Earlobe infiltration
Scrotum - testicular atrophy, orchitis, infertility
Glove and stocking anaesthesia
Claw hand - median nerve and ulnar nerve
Ocular – lagopthalmos, corneal and conjunctival anaesthesia
Radial nerve - wrist drop
Pope hand - ulnar nerve

98
Q

Clinical features TUBERCULOID leprosy

A

SHAG:
Scaly plaques;
Hypopigmented;
Anaesthesia and Alopecia;
Granulomas but no organisms
If you had to shag someone with leprosy, you would want tuberculoid
Anaesthetic patches. Few well hypopigmented patches and plaques
Thickening of nerves
Alopecia in patches
Path – granulomatous. No organisms

99
Q

Treatment of rickettsial infections

A

If suspect –> begin empiric Rx
1: doxycycline 100mg PO/IV BD. Until >3 days after defervescence, min course 5-7 days
OR chloramphenicol 500mg IV QID if pregnant and non-life threatening
OR rifampin 300mg PO BD for non-life threatening ehrlichiosis or granulocytic anaplasmosis
OR azithromycin 500mg PO OD for scrub typhus in pregnant women #1

DARC- get bitten by ticks in the dark

100
Q

Tinea capitis - endothrix organisms

A

Endothrix: non-fluorescent arthroconidia within the hair shaft. Presentation variable - from ‘black dots’ and patchy alopecia, to kerion
T tonsurans - ‘black dot’ tinea capitis, due to hair breakage near scalp - having a night in because you have a sore throat/consils
T violaceum - violent sudanese film
T soudanense - watching international Sudanese film
T gourvilli - having gourmet food
T yaoundei – sitting at in yao undei’s
T rubrum – red wine
Schoenlenii
Watch TV inside (endothrix) with the lights off (don’t fluoresce), so get your red (wine)

101
Q

Tinea capitis - ectothrix - organisms

A

Ectothrix: arthroconidia are formed from fragmented hyphae outside the hairshaft. Leads to cuticle destruction. May or may not be fluorescent via Wood’s lamp.
M canis*
M audouinii* - dry, scaly patches ‘grey patch’ tinea capitis – like houdini makes the hair disappear
M distortum* - distorts the hair
M ferrugineum* - furry animals
M gypseum - gypsy with clumped hair, gypsum rock grey
T rubrum (rarely)
Verrucosum, Mentagrophytes
Micro Cats and dogs fight and growl
Yellow-green fluorescence in FACD

102
Q

EBV associated conditions

A

EBV associated conditions: SLEIGH CLM
Severe mosquito bite allergy
Lipschutz ulcer
Extranodal NK/T cell lymphoma
Infectious mononucleosis
Gianotti Crosti
HV LPD
Chronic active EBV infection
Lymphomatoid granulosis
Mucocutaneous ulceration

103
Q

Conditions caused by / associated with HTLV1

A

Conditions caused by HTLV1 - SPASTIC
Seb derm
Paraperesis - myelopathy / tropical spastic paraparesis
Adult T cell leukaemia/lymphoma
Strongyloides, scabies
Tinea
Infective dermatitis; ichthyosis
Corneal opacities, HTLV1 associated uveitis

104
Q

Leishmaniasis - old and new world infections. Which cause visceral, cutaneous, diffuse, mucocutaneous

A

Old world: DAMIT - at war again Midle East Afrida India
Donovani –> visceral
Aethiopica
Major*
Infantum –> visceral
Tropica*

New world: B MAC - big mac, central america/texas
Braziliensis –> mucocutaneous
Mexicana –> cutaneous
Amazonesis
Infantum Chagasi –> visceral

Visceral - DIC. donovani, infantum, chagasi Visceral involvement, have DIC they are so unwell
Cutaneous - TMM. Tropica, Major, Mexicana Too much mouth
Diffuse - AA. Amazon and Aethiopica. Big diffuse countries
Mucocutaneous - BP. Braziliensis, Peruviana Think BP , can affect mucous membranes

105
Q

Xeroderma pigmentosum - features

A

LIMP ON
Lentigines - by age 2
Internal malignancy - brain, lung, oral cavity, GIT, kidney, haem
Gynae tumours - per a 2023 Nature article
Leukaemia, CNS, thyroid, gynae
Malignancy - skin cancers
Photosensitivity (290-340), poikiloderma

Ocular issues - photophobia, keratitis, corneal opacities
Neurological issues (except XP variant) - mental retardation, hyporeflexia, deafness, seizures
Neuro abnormalities more common in groups A and D
In ~20-30% pts

106
Q

Rothnmund Thomson features

A

SCORPAD
Short stature, SCC acral
Cataracts
Osteosarcoma of long bone
Radial ray defects
Poikiloderma, Photosensitivity
Acral keratoses, Alopecia
Dental issues

107
Q

Drugs causing photosensitivity

A

Drugs causing photosensitivity: TAN GARP SPF
Thiazides, Tetracyclines
Antimalarials
NSAIDS
Griseofulvin
Amiodarone
Retinoids
Psoralens
Sulfonamides, sulphonylureas
Phenothiazines
Fluoroquinolones

Voriconazole - and increased risk SCC
Vemurafenib
PPIs

VV TAN GARP SPF

108
Q

Bruising in kids - when is bruising concerning for abuse. Screening tool

A

TEN-4-FACES-P: mnemonic for suspicious bruising in children <4yo
TEN4: in child <4yo, and any region for infant <4 months
Torso
Ear
Neck

FACES-P:
Frenulum
Auricular area, angle of jaw
Cheek
Eyelid
Sclera
Patterned bruising

109
Q

Lofgren and Heerfordt syndromes

A

○ Lofgren: LEAF: lymphadenopathy (hilar), EN, arthritis, fever
○ Heerfordt: PUFF: parotid gland enlargement, uveitis, fever, facial/cranial nerve palsy
AKA uveoparotid fever

110
Q

Sarcoid variants

A

Variants: HUMANS PELVIS
Hypopigmented, Ulcerative, Maculopapular/mucosal, Angiolupoid/annular/atrophic/alopecia, Nodular/nail, Subcutaneous
Papular/plaque/psoriasiform/palmoplantar, EN/erythrodermic, Lupus pernio/lichenoid, Verrucous, Ichthyotic, Scar, tattoo

111
Q

Drug causes sarcoid

A

BRIT is so sarcastic
BRAF and checkpoint
Retrovirals
IFN, IL-1, implants
TNFi

112
Q

Drug causes granulomatous dermatitis

A

Granulomatous drug causes: SATAN
Statins
Antihypertensive - amlodipine, ACEI
TNFs
Allopurinol
NSAIDs

113
Q

Causes of secondary anetoderma

A

ANITA
AI: DLE SLE, APLS, Graves
Nfection: VZV, HIV, folliculitis, leprosy TB, syphilis, molluscum
Inflammation: JXG, LP, acne, mastocytosis
Tumours: JXG, involuted IH, pilomatricoma, DF, DFSP, MF
A - penicillAmine

114
Q

Ulcerating panniculitis

A

NICE PLANT
Neutrophilic - a/w RA, subcutaneous sweets
Infective - EI
Calciphylaxis, Cytophagic histiocytic panniculitis
Enzymatic - pancreatic, alpha 1 antitrypsin

Pan
Lymphoma
Alpha 1 antitrypsin
NLD
Trauma, factitial

115
Q

Panniculitis - septal, NO vasculitis

A

GRENS
Granuloma annulare, deep
Rheumatoid nodules
Erythema nodosum
NLD
Scleroderma, morphoea

116
Q

Panniculitis - septal, WITH vasculitis

A

PLS
PAN
LCV
Superficial thrombophlebitis

117
Q

Panniculitis - lobular, WITH vasculitis

A

EE
Erythema induratum of Bazin, Whitfield
Erythema nodosum leprosum

118
Q

Panniculitis - lobular, NO vasculitis

A

PANNICULITIS
Pancreatic
Alpha 1 antitrypsin
Newborn - subcutaneous fat necrosis
Neonatal sclerema
Infiltrates - lymphoma, infectious, gout, factitious
CTD - lupus, DM, eosinophilic fasciitis, cold, crystals - gout, cholesterol, calcium
Unknown - Weber Christian
LDS, lipoatrophy, lipodystrophy
Insect bite reaction and other eosinophilic - Well’s, parasite, hypereosinophilic
Trauma
Injected or induced - factitial
Sweets, post steroid, sarcoid

119
Q

Erythema nodosum - associations

A

BEDREST:
Behcet,
Estrogens, pregnancy
Drugs (OCP, sulphonamides, penicillin, bromides, TNFi, BRAFi),
Recent infection (strep, yersinia),
Enteropathy (Crohn’s > UC),
Sarcoid (eg Lofgren) 10-20% cases in some series,
Tuberculosis
And haem malignancy

120
Q

Erythema nodosum - drug causes

A

Drug causes of EN - P BITES
Penicillin
Bromides, BRAF
Iodides
TNFs
Estrogen
Sulphonamides/sulpha

121
Q

IH - PHACES

A

PHACES - large facial haemangioma with extracutaneous manifestations
Posterior fossa malformation
Haemangioma - large head and neck
Arterial anomalies
Cardiac anomalies
Eye and endocrine anomalies
Sternal defects, supraumbilical raphe (longitudinal ridge, seam)
PHACES = acronym for major criteria

122
Q

IH - LUMBAR

A

LUMBAR
Lower body haemangioma and Lipomas or other skin anomalies (eg skin tags)
Urogenital anomalies and Ulceration of the haemangioma
Myelopathy (spinal dysraphism)
Bony deformities
Anorectal malformations and Arterial anomalies
Renal anomalies

123
Q

Causes lymphoedema

A

Secondary/acquired: –> MT VISOR - THIN VISOR

Trauma, Thrombosis
HS / Heart failure
IBD (Crohn’s)
Malignancy/Neoplasia, Nephrotic syndrome, liver impairment (resulting in hypoalbuminaemia)
Venous insufficiency (chronic)
Infection - recurrent cellulitis, filariasis (Wuchereria bancrofti), podoconiosis (exposure to volcanic soils, eastern Africa Gordon - from absorption of silica within volcanic soils. Google - noninfectious, from barefoot exposure to irritant red clay volcanic soil. Endemic nonfilarial elephantiasis)
Surgical LN dissection
Obesity, morbid
Radiation

124
Q

Causes of livedo

A

Causes of livedo: LIVEDO
Lopathy / vasculopathy: Sneddon syndrome, livedoid vasculopathy, LTA
Infection: meningococcal, hep C (cryos), SBE, syphilis, Mycoplasma (cold agglutinins)
Vasculitis: PAN, cryoglobulinaemic. AICTD associated vasculitis - rheumatoid, SLE
Embolic: cholesterol, thrombotic, septic
Disorders of connective tissue: lupus, DM, scleroderma, Sjogren’s. Due to vasospasm a/w AICTD
O: blood. Increased blood components (Polycythaemia, thrombocythaemia), abnormal proteins (paraprotein, cryoglobulins, cryofibrinogen), hypercoagulability (APLS, protein C and S deficiencies, antithrombin III, factor V leiden, homocysteinuria)

125
Q

Causes of flushing

A

Causes of flushing: TRAMPED
Thyrotoxicosis
Rosacea
Alcohol
Menopause, mastocytosis, malignancy (pancreatic, renal)
Physiological
Endocrine tumours - phaeochromocytoma, medullary thyroid cancer, carcinoid
Drugs

126
Q

Drug causes flushing

A

Drug causes of flushing: NACHOES- GP
* Nitrates (glyceryl trinitrate), Nicotinic acid
* ACE inhibitors, Antidepressants
* Calcium channel blockers (diltiazem), Cyclosporin, Cancer drugs (tamoxifen)
* Hydralazine
* Opiates
* Ethanol, fumaric acid Esters
* Sildenafil
* Gold
Prostaglandins

Red man syndrome list:
- Vancomycin
Rifampicin

127
Q

Facial papules

A

BASKET CASE
Syndromic:
BCC - Gorlin’s
Angiofibromas - TS
Sebaceous neoplasms - Muir Torre
KAs - Ferguson Smith, Gryzbowski
Epidermoid cysts - Gardner, Gorlin
Trichoepitheliomas - Brooke Spiegler
Trichilemmomas - Cowden’s
Trichodiscomas/fibrofolliculomas - Birt Hogg Dube

Non syndromic:
Cysts
Acne, acne agminata, rosacea, POD, demodex folliculitis
Sarcoid, syringomas
Eruptive milia

128
Q

Syringomas - associations

A

Associations of syringomas: DAMPED HAIR
Downs
Asians
Marfans
Pregnancy
Ehlers Danlos
Diabetes
Hair - scarring alopecia (?)

Think of that pt of Claire’s who had down syndrome

129
Q

Mastocytosis - triggers

A

DR MASTO +/- CHEF
D: dextromethorphan (cough suppressant - Robitussin), dextran (in some IV solutions)
R: radiocontrast (iodine based)
M: NSAIDs, aspirin
A: anticholinergics (scopolamine), +/- aspirin, alcohol. ACD handout - antibiotics (vanc, polymyxin B, amphotericin)
S: suxamethonium, other systemic anaesthetics (lidocaine [but local injections are safe], thiopental, succinylcholine, isoflurane, enflurane, metocurine). ACD handout - local anaesthetics like procaine
T: tasty things - spicy foods, alcohol, hot beverages
O: opioids
+/- CHEF (cold, heat, exercise, friction)
Bee and wasp stings

130
Q

Mastocytosis - WHO criteria for Dx systemic masto

A

MAST C: WHO criteria for diagnosis of systemic mastocytosis
Mast cells - multifocal infiltrates. >/=15
Activating cKIT variant
Spindled or atypical mast cells >25% in bone marrow or extracutaneous tissues
Tryptase >20
CD2/25 expressed in extracutaneous mast cells

131
Q

DDx blueberry muffin baby

A

Blueberry muffin DDx - Ha Ha Ha, Look The Little NICU Child Rash
Haematopoiesis, extramedullary
Haemangiomas
Haemolytic anaemias - congenital spherocytosis, Rhesus disease
LCH
Twin twin transfusion syndrome
Neuroblastoma
CMV
Rubella

132
Q

CsA interactions - drugs which inhibit CYP450 (thereby increasing level of CsA)

A

GECKO - inhibit CYPP450. Thereby increasing level of CsA
Drugs which inhibit CYP450 –
JAKi
Grapefruit juice
Erythromycin - macrolides
Calcium channel blockers - verapamil, diltiazem. Ciprofloxacin - fluoroquinolones
Ketoconazole - triazoles
OCP (Mims)
Protease inhibitors
Antidepressants SSRI
Updated 16.3.24 bsaed on MIMs/Wolverton

133
Q

CsA interactions - drugs which induce CYP450 (thereby decreasing level of CsA)

A

Ridges - reduced serum level of CsA
Drugs which induce CYP450 - RIDGES
St John (St John’s wort) standing on top of a ridge, has TB and isn’t well (rifampicin, isoniazid), brought up his deck chair (dexamethasone) which attracted lightning he got zapped and hat a fit (epileptics – carbamazepine, phenytoin), and a grizzly bear (griseofulvin) came out and ate him up

134
Q

CsA side effects

A

SE of CsA: SIR HASN’T GB
SCCs
Infection
Renal, hypertension

Hypertrichosis, hyperlipidaemia, hyperuricaemia, hyperkalaemia, hyPOmagnesaemia
Acne
Sebaceous hyperplasia
Neuro - paraesthesias, headaches
Tremors
Gum hyperplasia, GI (nausea, diarrhoea)
Breast lumps, benign adenomas

135
Q

MTx drug interactions

A

SLANT
Sulpha drugs eg TMP, sulphamethox, dapsone - folate antagonists. Increase myelosuppression
Loop diuretics - inc MTx levels
Acitretin, alcohol - nc risk liver impairment - (Wolverton thinks laspirin lower risk)
NSAIDs - probenecid. Increase level
Tetracyclines - Wolverton thinks low risk inc level

136
Q

HCQ - contraindications then AEs

A

Justin Bieber - PRG HLM
Pregnancy, Psoriasis
Retinopathy / maculopathy
G6PD
Haem - severe blood dyscrasia
Liver - severe hepatic disease
Myasthenia gravis, severe neurological disease

OH classy girl now
OHCNG
Ocular -
- Reversible: blurred vision, halos, photophobia, retinal pigment
- Irreversible: bulls eye maculopathy
- MO:
○ Reversible: DIPLO, not as famous. Diplopia, Halo (blonde hair), Photophobia and blurred vision (desn’t wear galsses)
○ Irreversible: Pit Bull. Bulls eye maculopathy Mr worldwide -central scotoma. Always wearing glasses - bad night vision
Haem - agranulocytosis, pancytopaenia
Neuro - rare irritability, headache, vertigo, tinnitus, psychosis
GI: N/V/D
Cutaneous - psoriasis, drug rash, pigmentation, achromotrichia

137
Q

Sirolimus - AEs

A

AH BLOW UP
A: acne
H: hypertension, hyperlipidaemia
B: bone marrow suppression
L: lung consolidation
O: peripheral oedema
W: wound healing issues
U: ulcers
P: proteinuria

138
Q

DDx painful skin nodules

A

BLEND AN EGG
Blue rubber bleb
Leiomyoma
Eccrine spiradenoma
Neuroma
Dermatofibroma
Angiolipoma
Neurilemmoma
Endometriosis
Granular cell tumours
Glomus tumour

139
Q

Intracellular organisms

A

Intracellular organisms: HIS GIRL PENELOPE
- Histoplasmosis
- Granuloma inguinale (aka donovanosis) - klebsiella granulomatosis, Donovan bodies (BT: said to look like safety pins)
- Ehrlichioses
- Rhinoscleroma - klebsiella rhinoscleromatosis, Russel bodies, mikulicz cell, Rickettsial (Rickettsiae, Ehrlichiosis, Coxiella burnetti)
- Leishmaniasis
- Penicillium marneffei
Rickettisiae, Ehrlichioses
Q fever (Coxiella burnetti)
Cryptococcosis

140
Q

Koebnerising conditions

A

PELVIS
Psoriasis, perforating dermatoses
EM
LP, LS, lichen nitidus
Vitiligo
Infections - warts
Sweet’s

141
Q

DDx leonine facies

A

CLAMPS x2-3
- Carcinoid, CAD, cutis verticis gyrata
○ Cowdens
- Leishmaniasis, lepromatous leprosy, lipoid proteinosis, leukaemia cutis
- Acromegaly, amyloidosis, alopecia mucinosis, atopic derm (airborne)
- Multi centric reticulohistiocytosis, MF, mastocytosis
- Pachydermoperiostosis, progressive nodular histiocytosis, phymatous rosacea
Sarcoid, scleromyxoedema, syphilis

142
Q

DDx follicular papules

A

K FLIPS
- Keratosis pilaris
- Follicular mucinosis, follicular MF
- Lichen spinulosus, lichen scrofuloderma, lichen nitidus, lichen planopilaris
- Inflammatory - eczema, psoriasis, ichthyosis
- PRP, phrynoderma
- Sarcoid, syphilis
BRAF inhibitors - can cause keratotic if you don’t use MEKi you get the cutaneous effects a lot more - inc scc

143
Q

DDx dermal

A

GIVEN + LP
Granulomatous
Infiltrates
Vascular
Erythemas
Neoplastic
Lichen planus

144
Q

Skin associations Down syndrome

A

Skin associations Down syndrome – FAT FACES PALMS
Folliculitis
Alopecia areata
Tinea

Fissured tongue
Anetoderma
Cutis laxa; milia like calcinosis
Elastosis perforans serpiginosa; eczema
Syringomas; seb derm

Psoriasis/PRP; palmar crease
Ageing; acrocyanosis
Lichen nitidus; livedoid plaques
Melanoma
Suppurativa, hidradenitis

145
Q

Medication causes of pemphigus

A

Medication causes pemphigus: CRAPT
Captopril and ACEi, Cephalosporins
Rifampicin, XRT
Amoxil, Alliums, INFa
Penicillamine, Psoralens, Propranolol, Piroxicam
Thiols

146
Q

DDx itchy papules

A

SIGNALLED
Scabies
Infiltrates; Insect bite reaction
Grovers
Neurodermatoses, Nodular prurigo
Another - urticaria
Lichen planus; Lichenoid drug
Lichenoides chronica, pityriasis
Eczema, papular
DH; Darier’s; Drug

147
Q

IgG4 related disease - associated skin disorders

A

FKAR, this is such a fucker
Faciale, granuloma
Kimura disease
Angiolymphoid hyperplasia with eosinophilia
Rosai Dorfman disease

148
Q

DDx for retiform purpura

A

PC ADVICE
Platelet related: HIT, PNH, TTP
Coagulopathy: livedoid vasculopathy, malignant atrophic papulosis/Degos, Sneddon syndrome, DADA2
Antiphospholipid Ab syndrome. Protein C, S deficiency
Drug: warfarin, levamisole cocaine, hydroxyurea, heparin
Vasculitis: ANCA, PAN, AICTD associated
Infection: fungal (Mucor, Aspergillus) ecthyma gangrenosum (Pseudomonas), lucio phenom, rickettsial, disseminated strongyloidiasis
Calciphylaxis
Cold precipitable: cryoglob, cryofibrin, cold agglut
Embolic: cholesterol, oxalate crystal, septic, atrial myxoma

149
Q

Keratoacanthoma types
Solitary - CMGS
Multiple - CMGF

A

Solitary - CMGS
Classic - SCC variant
Mucosal
Giant
Subungual (erodes bone and does not resolve compared w other types

Multiple - CMGF
Centrifugum marginatum
Muir Torre associated
Gryzbowski - ectropion, PN like, pruritic
Ferguson Smith - childhood onset

150
Q

Features of Chediak Higashi

A

Features of Chediak Higashi - HIGASH
HLH
Immunodeficiencies
Giant melanosomes on biopsy
Anormal neutrophils
Silver hair
Hypopigmentation

151
Q

DDx telangiectasias

A

SUGAR PATCH V
Spider naevi
Unilateral naevoid telangiectasia
Generalised essential telangiectasia, Benign essential telangiectasia; GVHD
Ataxia telangiectasia; Angioma serpiginosum
Radiotherapy; Rosacea
Poikiloderma ddx - XP, RTS, DKC, GVHD, MF, Bloom
Atrophy from steroids
TMEP
CREST; CTDs (DM, DLE, CREST, angiolupoid sarcoid); Carcinoid
HHT, CM AVM2
Varicose veins; Vascular malformations (CMTC, IH-MAG)

152
Q

DDx bad eczema baby
Reasons why bad eczema baby not improving?

A

DDx - bad eczema baby
Wiskott Aldrich
IPEX
Netherton
Omenn syndrome
SCID

Reason for bad eczema baby not responding
- Food allergy
- Ichthyosis
- Immunodeficiency
Non compliance

153
Q

Drug causes hypertrichosis

A

Drug causes hypertrichosis: M SPACE
Minoxidil, Mmf
Steroids, Streptomycin
Phenytoin, Psoralens
Acetazolamide
CsA
EGFR inhibitors

154
Q

Cutaneous features of Birt Hogg Dube

A

Hog at the disco gets turned into a FAT MAC - Cutaneous features of BHD
Fibrofolliculoma
Angiofibroma
Trichodiscoma
Melanoma
Acrochordon
Connective tissue naevi

155
Q

Path DDx - small blue cell tumours

A

LEMONS
Lymphoma
Ewing sarcoma
Merkel cell carcinoma / melanoma
Oat cell carcinoma of lung
Neuroblastoma
Small cell endocrine carcinoma

156
Q

Gorlin’s diagnostic criteria

A

Diagnostic criteria Gorlin’s. 1 major + genetics OR 2 major OR 1 major + 2 minor
Major: BC PROM
BCCs <20yo or multiple
Calcification of falx cerebri
Palmar or plantar pitting
Relative, first degree
OKCs <20yo
Medulloblastoma
Minor: MC FLOOR
Macrocephaly
Cleft lip/palate
Fibroma, ovarian or cardiac
Lymphomesenteric cysts
Ocular: strabismus, hypertelorism, congenital cataracts, glaucoma, coloboma
Other skeletal: vertebral anomalies, kyphoscoliosis etc
Rib abnormalities

157
Q

Cockayne - my new one

A

Cockayne = COCAINE
Cachectic, dwarf appearance
Ocular - salt and pepper retina, optic atrophy
Cataracts
Aged appearance, Mickey Mouse like
Irrationally large hands and feet, long limbs
Neuro - SNHL, demyelination of CNS and PNS, progressive
Erythema without pigment change

158
Q
A

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