PASSMED Flashcards
what is erythema multiforme
hypersensitivity reaction which is most commonly triggered by infections. It may be divided into minor and major forms.
features of erythema multiforme
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
causes of erythema multiforme
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
what is alopeica areata
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
management of alopecia areata
Hair will regrow in 50% of patients by 1 year, and in 80-90% eventually. Careful explanation is therefore sufficient in many patients. Other treatment options include: topical or intralesional corticosteroids topical minoxidil phototherapy dithranol contact immunotherapy wigs
small rubbery mass
lipoma
what is a lipoma
benign tumour of adipocytes
pathophysiology of lipomas
- they are generally found in subcutaneous tissues
- rarely, they may also occur in deeper adipose tissues
- malignant transformation to liposarcoma is very rare
features of lipoma
lump characteristics:
smooth
mobile
painless
if lipoma more than 5cm what do u do
US to rule out liposarcoma
management of lipoma
- may be observed
- if diagnosis uncertain, or compressing on surrounding structures then may be removed
features of liposarcoma
Size >5cm
Increasing size
Pain
Deep anatomical location
derm drug that causes gynaecomastia
ketoconazole
how to differentiate between spider naevi and telangectasia
press on lesion
fill from the centre - spider naevi
fill from the edge - telangiectasia
what is spider naevi
describe a central red papule with surrounding capillaries. The lesions blanch upon pressure. Spider naevi are almost always found on the upper part of the body.
associations of spider naevi
liver disease
pregnancy
combined oral contraceptive pill
1 day following skin grafts he becomes tachycardic and hypotensive. He vomits twice and this shows evidence of haematemesis
Curlings Ulcer
urine analysis he has + blood. His U+E’s show mild hyperkalaemia and a CK of 3000
rhabdomyolysis
aggressive IV fluids
increasing pain in lower leg and on examination there is parasthesia and severe pain in the lower leg. Foot pulses are normal
compartment syndrome
Eshcarotomy is required, and compartmental decompression
features of lichen planus
- 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 may be seen (new skin lesions appearing at the site of trauma)
- oral involvement in around 50% of patients: typically a white-lace pattern on the buccal mucosa
- nails: thinning of nail plate, longitudinal ridging
causes of lichenoid drug eruptions
gold
quinine
thiazides
management for lichen planus
- 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
venous ulceration commonly seen
above the medial malleolus
Ix for venous ulceration
ankle-brachial pressure index (ABPI) is important in non-healing ulcers to assess for poor arterial flow which could impair healing
a ‘normal’ ABPI may be regarded as between 0.9 - 1.2. Values below 0.9 indicate arterial disease. Interestingly, values above 1.3 may also indicate arterial disease, in the form of false-negative results secondary to arterial calcification (e.g. In diabetics)
management for venous ulceration
compression bandaging, usually four layer (only treatment shown to be of real benefit)
oral pentoxifylline, a peripheral vasodilator, improves healing rate
small evidence base supporting use of flavinoids
little evidence to suggest benefit from hydrocolloid dressings, topical growth factors, ultrasound therapy and intermittent pneumatic compression
melasma ass with
sun exposure
NSAIDs
oral contraceptives
DD for shin lesions
- erythema nodosum
- pretibial myxoedema
- pyoderma gangrenosum
- necrobiosis lipoidica diabeticorum
features of pretibial myxoedema
symmetrical, erythematous lesions seen in Graves’ disease
shiny, orange peel skin
features of Necrobiosis lipoidica diabeticorum
shiny, painless areas of yellow/red skin typically on the shin of diabetics
often associated with telangiectasia
what is Necrobiosis lipoidica diabeticorum
rare granulomatous skin disorder which can affect the shin of insulin-dependent diabetics, although it may occur in non-diabetic subjects as well.
features of HHT
- 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
features of Von Hippel Lindau disease
faulty tumour suppressor gene resulting in the development of multiple unusual tumours
1) haemangioblastoma, 2)phaeochromocytoma
3) renal cell carcinoma.
peutz jegher syndrome
large numbers of polyps in the intestine which become cancerous in a majority of patients.
features of Granulomatosis with polyangiitis
Sinus dysfunction is the most common initial symptom causing nasal congestion or epistaxis. If a rash is present, it is usually made up of palpable purpura from small vessel inflammation.
what is HHT
autosomal dominant condition
features of strawberry naeuvs
erythematous, raised and multilobed tumours.
duration of strawberry naevus
until around 6-9 months before regressing over the next few years
common sites of strawberry naevus
face, scalp and back
potential complications of strawberry naevus
- mechanical e.g. Obstructing visual fields or airway
- bleeding
- ulceration
- thrombocytopaenia
treatment of strawberry naevus if required
propranolol is increasingly replacing systemic steroids
features of iron deficiency anaemia
Pallor
Other signs: koilonychia, atrophic glossitis, post-cricoid webs, angular stomatitis
features of polycythaemia
Pruritus particularly after warm bath
‘Ruddy complexion’
Gout
Peptic ulcer disease
features of CKD
Lethargy & pallor
Oedema & weight gain
Hypertension
features of lymphoma
Night sweats
Lymphadenopathy
Splenomegaly, hepatomegaly
§
what are salmon patches
pink and blotchy, and commonly found on the forehead, eyelids and nape of the neck.
birthmark
A 35-year-old woman presents with a 6 week history of a worsening facial rash. She says she has a history of ‘intermittent eczema’‛ on the face for which she self medicates with a topical agent.
perioral dermatitis
management for perioral dermatits
oral ABx like acne
stop steroids
what is eryhtema ab igne
skin reaction caused by chronic exposure to infrared radiation in the form of heat
what is erythema gyratum repens
rare paraneoplastic type of annular erythema w a distinctive figurative ‘wood grain’ appearance
strong ass w malignancy
predisposing factors of keloid scars
ethnicity: more common in pp with dark skin
- more common in young adults
- common site -> sternum, shoulder, neck. face, extensor surface of limbs, trunk
Mx of keloid scars
early ones may be treated with intra-lesional steroids ie. triamcinolone
causes of itch eruption (pruritus)
eczema scabies urticaria lichen planus iron deficiency anaemia parasitic infestation
Mx of pruritus
keep the pt cool keep skin well oiled with emoillients avoid excessive bathing - drying antihistamines sedatives low dose amitryptilline short nails
CKD features
Lethargy & pallor
Oedema & weight gain
Hypertension
pruritus
advise about emollients
Initially applying emollients 2-3 times per day (including immediately after washing)
When skin worsens emollients can be applied hourly
Wash hands before applying emollient to prevent infection of damaged skin
Either dispense emollient using a pump or spoon from a tub to avoid contamination of the tub.
Apply emollient generously to all areas of the body onto the skin in a downward motion in direction of hair
Do not rub in emollients, but rather leave them to soak in.
