Pigmented lesions Flashcards
What are seborrhoeic warts/ seborrhoeic keratosis?
Harmless warty spot that appears during adult life as a common sign of skin ageing.
Presentation of seborrhoeic warts/ seborrhoeic keratosis?
Middle aged - elderly
Multiple and asymptomatic
- Flat or raised papule or plaque
- 1 mm to several cm in diameter
- Varied colours: Skin coloured, yellow, grey, light brown, dark brown, black or mixed colours
- Smooth, waxy or warty surface
- Solitary or grouped in certain areas, such as within the scalp, under the breasts, over the spine or in the groin
Common sites for seborrhoeic warts/ seborrhoeic keratosis?
Face
Trunk
Never really on palms or soles
How are seborrhoeic warts/ seborrhoeic keratosis diagnosed?
Many of them seen
Have a ‘stuck on’ appearance, with well defined edges
Management of seborrhoeic warts/ seborrhoeic keratosis?
Only If symptomatic
Curette and cautery
Cryotherapy
What is a melanocytic naevi?
A melanocytic naevus (American spelling ‘nevus’), or mole, is a common benign skin lesion due to a local proliferation of pigment cells (melanocytes).
Common features in presentation of melanocytic naevus?
Not present at birth
Developed during infancy, childhood or adolescence
Asymptomatic
Types of melanocytic naevi?
Congenital naevi
Junctional naevi
Intradermal naevi
Compound naevi
Management of melanocytic naevi?
Only manage if symptomatic
Shave or complete excision
What is melasma?
Aquired chronic skin disorder, where there is increased pigmentation in the skin
Cause of melasma?
Genetic predisposition
Triggered by factors - sun exposure, hormonal changes e.g. pregame’s, COCP
Pigmentation is caused by overproduction of melanin by melanocytes
Presentation of melasma?
Brown macules (freckle-like spots)
Can have larger patches
Irregular border
Symmetrical distribution
Common sites for melasma to present?
Forehead
Cutaneous upper lips or cheeks
Rare = neck, shoulder, upper arms
Management of melasma?
Lifelong sun protection
Discontinue COCP/POP
Cosmetic camouflage
Topical treatment to inhibit formation of new melanin = hydroquinone, azelaic acid, kojic acid, vitamin C
Laser treatment (use w/ caution as can cause hyperpigmentation)
What is this?
Seborrhoic keratosis
What is this?
Vitiligo
What is this?
Melanocytic naevus
What is this?
Melasma
What is vitiligo?
Acquired depigmenting disorder - where you lose melanocytes
Cause of vitiligo?
AI disorder - innate immune system destroys melanocytes, so lose pigment formation in skin
Presentation of vitiligo?
Any age
Single patch or multiple patches of depigmentation
Sites of previous injury are favoured
Affects face, hands, feet, body folds, genitalia
Management of vitiligo?
Minimise skin injury - can trigger new patch!
Topical treatments - topical steroids, calcineurin inhibitors
Phototherapy - UVB therapy
Oral immunosuppression - methotrexate, ciclosporin, mycophenolate mofetil
What is this?
Senile purpura
Presentation of senile purpura?
Elderly population with sun-damaged skin
Present on extensor surfaces of hands and forearms
Non-palpable purpura
Surrounding skin is atrophic and thin
Pt is systemically wel
Investigations for senile purpura?
Bloods
Urine analysis
Skin biopsy
What is present in Hx of pt with vasculitis?
(clue: to do with the lesions they have)
Painful lesions which are palpable !
Common sites for vasculitis?
Legs, buttocks, flanks (dependent areas i.e. influenced by gravity)
What is this?
Vasculitis
Investigations for vasculitis?
Skin biopsy
Bloods
Urinalysis
Management of vasculitis?
Treat underlying cause
Steroids and immunosuppressants needed if systemic involvement
What is this?
Kaposi’s sarcoma
How does Kaposi’s sarcoma present?
Purple papules or plaques on skin or mucosa
Lesions can ulcerate
Respiratory system involvement = haemoptysis, pleural effusion
Who may Kaposi’s sarcoma develop in?
- Descents from Mediterranean and Middle European backgrounds and in men in Sub-Saharan Africa.
- Pts with HIV associated KS
- Pt from certain parts of Africa, where it is common in children/ young adults
- Pts on drug treatment causing immune suppression.
Causes of Kaposi’s sarcoma?
Human Herpes Virus 8
Low CD4 count - in AIDS
Management of Kaposi’s sarcoma?
If HIV related = HAART anti-retrovirals
If localised lesion = Radiotherapy + resection
