Module 5

Question 1

Describe the importance of the epidermis, dermis and hypodermis

Answer 1

epidermis- thickest layer of skin, protective barrier, Langerhan cells (immunity and allergic reaction), melanocytes (protects against UV)
dermis- macrophages, mast cells, hitocytes and fibroblasts; contacts sweat glands, assists in wound healing, generates connective tissue
hypodermis- subq layer of skin, connects dermis to muscle, contains additional macrophages, fibroblasts, blood cells etc

Question 2

Describe Langerhan cells and their responsibility in immunity

Answer 2

Lanngherans form into dendritic cells -important for adaptive immunity,
dendritic cells initiate the immune response by presenting antigens to T cells and creation of IgM and immune cells

Question 3

Characteristics of pityriasis rosacea and tx

Answer 3

“herald patch” (red, scaly, rash)
preceeds eruption of rash in tree like formation
fawn coloured, oval shaped maculopapular rash
occ. pruritis
rash and ovals have crinkled borders
lines up with body creases

tx: usually none
antihistamines or oral corticosteroid for severe cases

Question 4

Characteristics of perioral dermatitis

Answer 4

scaly erythematous acneiform papules and pustules in perioral, perinasal skin folds

Question 5

Characteristics of ezcema

Answer 5

appears to be general dry skin with itching
red scaly patches on creases of the body
excoriations and lichenification
dry, fish like scaling

Question 6

Characteristics of psoriasis

Answer 6

silvery scales on scalp, elbow, knees, gluteal cleft
chronic inflammatory condition
can have silver nail beds and pitting nails

Question 7

what is guttate psoriasis?

Answer 7

psoriasis that occurs after strep throat infection

Question 8

Characteristics of actinic keratosis

Answer 8

sun induced precancerous lesions, macules or paputes
usually flesh coloured, pink or hyperpigmented
usually premalignant-can become SCC
consider for biopsy

Question 9

Characteristics of seborrheic keratosis

Answer 9

waxy stuck on appearance
usually in sun exposed areas
range in size
cryotherapy treatment

Question 10

HSV - clinical presentation, etiology, complications, management and patient education

Answer 10

etiology:
HSV 1 or 2- orofacial or genital sites, common in 85% of the populations

burning, stinging, pruritic vesicles that group together, neuralgia often occurs before eruption

management: earlier tx is better in management, acyclovir or valtrex 7-10 days
topical therapy has little effectiveness

no negative sequalae
could have hsv related meningitis, uveitis, neonatal HSV

Question 11

VZV- clinical presentation, etiology, complications, mangement and patient education

Answer 11

etiology:
immunocompromised, > 55
if younger should consider testing

manifestation: neurological pain along dermatome
eruptions of grouped vesicble after 48 hours

management:
antivirals within 72 hours show best effect
valtrex or acycolvir

complications
post herpetic neuralgia, sacral zosster
Guillan barrer, encephalitis

Question 12

What are the clinical derm manifestations of peripheral artery disease (PAD)

Answer 12

asymptomatic, cramping pain, weak femoral pulses
poor perfusion causes atrophic changes in the skin; hair loss, thinning of skin
ulceration, gangrene, redness, burning if severe

Question 13

What are the derm manifestaions of venous diseases

Answer 13

varicose veins
dilated torturous venins of thigh and calf may be palpable
hyperpigmentation, brownish, induratio or fibrosis in chronic venous insufficiency

Question 14

Benign vs malignant skin tumours characteristics

Answer 14

benign: small, macule, papule, well defined bornder no changes, no itching or bleeding (ABCDE)

malignant: irregular bordedr, varying colours, black brown, red, blue
flat or raised
referral if high risk (prev. cancers or malignant changes

Question 15

Shave biopsy- what is it and when is it used

Answer 15

used in protruding portion of skin lesion

do not perform if melanoma is suspceted

Question 16

punch biopsy-what is it and when to use

Answer 16

full thickness, cylindrical specifcem
good for small lesions with there is suspicion of lesion
used when melanoma is suspceted

Question 17

excisional biopsy what is it and when to use

Answer 17

entire lesion needs to be removed including full thickness of skin needed
usually requires sharp incision and sututing
can be used to remove malignant lesions where margins are confirmed and assessed

Question 18

what are contraindications to skin biopsies?

Answer 18

severe coagulopathy
allergic to materials
don’t do partial thickness, may not yield complete results

Question 19

clinical manifestations of lupus erythemaous

Answer 19

papules, plaques, atrophy and sacrring ususing to sun exposed areas (scalpe, face, ears)
sub acute has not scarring and not atrophic
butterfly rash in acute lupus erythematous

Question 20

clinical manifestations of dermatmyositis

Answer 20

connective tissue disoder
rash to eyelids, scalp, muscle and bony weakness
“shawl sign” rash drapes across back, neck and sholulders
hair loss, erythema, scaling

Question 21

clinical manifestaionts of scleroderma

Answer 21

connective tissue disorders
multisystems
fibrosing condition to hands leg and face, erythematous swollen skin
raynaud’s often the first sign
intense pruritis, tight smooth yellow skin, calcification hair loss