Random Flashcards
Naevus sebaceous growth risks
Trichoblastoma
BCC
Syringocystadenoma papilliferum
Multiple facial tumours
ANTTSS on the face Adenoma sebaceum Neurofibromas Trichilemmoma Trichoepithelioma Syringoma Sebaceous hyperplasia
CALM associations
BATANS Blooms Albrights TS Ataxia telangiectasia Neurofibromatosis Silver-Russell syndrome
Acute attack porphyrias
VAH
Variegate porphyria
Acute intermittent
Hereditary coproporphyria
Porphyria acute attack triggers
FIGBEANS Fever Infection Griseofulvin Barbituates Oestrogen Alcohol Nutrition Sulfonamides
Subepidermal blister with neutrophils
Herpetic LIPS Dermatitis herpetiformis Lupus (bullous) Linear IgA Pemphigoid Sweets
Subepidermal blister, cell poor
Blistering APE BP and ischaemic blister Amyloidosis PCT EB
Septal panniculitis differentials
Always Make Septal Panniculitis Easy Nowadays Alpha 1 antitrypsin deficiency Scleroderma/morphoea PAN EN NLD Migratory thrombophlebitis
Associations with EN
NoDOSUM No cause Drugs - iodide, sulfonamide OCP Sarcoid, Lofgrens Ulcer - Behcets, UC, Crohns M - microbiology
Papillomatosis differential
CAVES CARP Acanthosis nigricans, acrochordon, acrokeratosis verruciformis Verruca vulgaris Epidermal naevus Seb k, syringocystadenoma
Colloidon baby
Lamellar ichthyosis Congenital ichthyosiform erythroderma Sjogren Larson Conradi Hunermann Trichothiodystrophjy Ectodermal dysplasia Infantile Gaucher disease Hay-Wells Neutral lipid storage disease
Grenze zone ddx
LG
Leukaemia/lymphoma
Granuloma faciale, EED
Hairy tongue causes
- Drugs - Poor oral hygiene - Smoking or chewing tobacco - Drinking alcohol - Cocaine - Chlorhexidine or peroxidase-containing mouthwash - Coloured beverages, including coffee - Dehydration - Hyposalivation (dry mouth) - Radiation therapy
Elastosis perforans serpinginosa associations
MADPORES Marfans Acrogeria Down's syndrom Pseudoxanthoma Elasticum Osteogenesis Imperfecta Rothmund Thompson Ehlers Danlos Scleroderma
Differential for facial papules
Hair and cysts: angiofibromas, trichoepithelioma, tricholemmoma, fibrofolliculoma, trichodiscoma, syringoma, hidrocystoma
acne, rosacea, acne agminata, perioroficial dermatitis, demodecosis
Lymphocytoma cutis, Jessners, lymphoma Sarcoidosis TB, lichen scrofulosorum Sweets Granuloma faciale LCH/nLCH Amyloidosis, scleromyxoedema, lichen myxoedematosus
Erythromelanosis follicularis faciei
Brooke Spiegler three skin things they get
Cylindroma
Trichoepithelioma
Spiradenoma
Can you get hair loss in lichen striatus
Yes it can be peri follicular.
Complications of nethertons baby
Hypernatraemic dehydration
Sporotrichoid spread ddx
SLAMN
Sporotrichosis, sweets, sarcoidosis, staph, strep, sporothrix schenkii
Leishmaniasis, lymphoma
Actinomycosis, anthrax
M Marinum, mycobacteria TB etc, metastases
Nocardia
+ tuleraemia
Birt Hogg Dube mnemonic
FAT TRAP Fibrofolliculomas, FLCN gene Acrochorcons Trichodiscomas Thyroid goiter, carcinoma Renal cancer AD, angiolipomas Pulmonary cysts, pneumothorax
BRAF inhibitor adverse effects mnemonic
Rash - acneiform, maculopapular
Alopecia
Palmoplantar dysaesthesia, Photosensitivity
Itchiness
Dry skin
SCC, AK, KA, Seb-derm like eruption, also eruptive melanocytic naevi
KP-like eruption
Also: arthralgia, fatigue, nausea, headache, altered taste, hepatotoxicity
DDx for CALMS mnemonic
TS Neurofibromatosis 1 & 2 and Noonans Fanconi anaemia, Familial Bloom's LEOPARD, Legius Ataxia telangiectasia McCune Albright, Maffucci’s syndrome Endocrine neoplasia, multiple - MEN 2B
eGFR Reactions mnemonic
HANDI
Hair: curly, brittle hair, alopecia, hypertrichosis
Acneiform eruption
Nail changes: paronychia, pyogenic granuloma, onycholysis
Dryness
Itchiness
Eosinophilic fasciitis aetiologic factors mnemonic
THIRDS Thyroiditis Haem malignancies / dyscrasias Infection (Borrelia) Radiation Drugs (L-tryptophan, atorvastatin) Strenuous exercise
Facial papules ddx
BASKET IN CASE Syndromic BCC – Gorlin’s Angiofibromas - TS Sebaceous neoplasms – Muir Torre KAs – Ferguson-Smith, Gryzbowski Epidemoid cysts – Gardner’s, Gorlin’s Trichoepitheliomas - BSS Tricholemmomas – Cowden’s Trichodiscomas - BHD Non-syndromic Cysts, Colloid milium Acne, acne agminata, rosacea, POD, demodex folliculitis Sarcoid, syringomas Eruptive milia Other: lipoid proteinosis (along eyelid margin) Infections (warts) Neurofibromas
Flushing causes ddx mnemonic
TRAMPED Thyrotoxicosis Rosacea Alcohol Menopause, masocytosis, Malignancy (pancreatic, renal) Physiological Endocrine tumours eg phaeochromocytoma, medullary thyroid cancer, carcinoid syndrome Drugs
Leonine facies ddx mnemonic
Carcinoid, CAD, Cutis verticis gyrata
Leishmaniasis, leprosy
Acromegaly, Amyloidosis, Alopecia mucinosis, Atopic dermatitis (Airborne)
MF, Multicentric Reticulohistiocytosis
Phymatous rosacea, Pachydermoperiostosis (genetic condition)
Sarcoidosis, Scleromyxoedema, Syphilis
Mastocytosis drugs to avoid ddx mnemonic
ROMAN V Radiocontrast Opioids Muscle relaxants, depolarising (suxamethonium) Alcohol NSAIDs inc aspirin Vancomycin, venom
What to do with biológics psoriasis patient who wants to fall pregnant
And then if they are pregnant
Cimzia - Pegylated TNF alpha - unsure if available
General advise to cease pre conception - conservative advice is 6 month wash out
Biológic data so far reassuring particularly for TNF alphas- baby can’t have live vaccines until 6 months old
Is phototherapy fine in pregnancy?
UVB fine but ensure folic acid supplementation
PuVa not ok
Types of sarcoidosis - classic
Angiolupoid Annular Papular Plaque Scar Subcutaneous- Darrier Roussy EN LUPUS PERNIO Maculopapular Modular
Types of atypical sarcoidosis
Verrucous A Lp or LE like Ulcerated Erythroderma Atrophic
Hypo or hyperpigmentation PPK Psoriatic Ichthyotic Mucosal Alopecia Nail
Where is angiolupoid sarcoid
Particularly face: marked telangiectatic component
Classic location is near the medial canthus
Most common cutaneous manifestation of sarcoid
Papular
Arises in crops
Face and extensor limbs
Favourable prognosis
Which cutaneous sarcoid represents systemic sarcoid changes
Scar sarcoid
So if worsening be concerned of systemic worseninf
Not itchy
Distribution of subcutaneous sarcoid (Darier Roussy)
Extremities: upper over lower
Systemic involvement usually present
Tender OR painless nodules
Associations of lupus pernio
Respiratory tract sarcoidosis Bone cysts Lacrimal gland involvement Renal sarcoidosis Hyperglobulinaemka Hypercalcaemia
Which sarcoid are chronic - ie worse
Plaque
Lupus pernio
EN is acute
Heerfordts syndrome
Sarcoidosis: Parotid gland enlargement Uveitis Fever Facial nerve palsy
Specific findings for histo for sarcoid
Schaumann body (basophils)
Crystalline inclusion: colour less oval inclusions ? Precursor of Schaumann bodies
Asteroid bodies: eosinophilix
And then obviously non case aging sarcoidal granuloma
Utility of doing ACE level in sarcoidosis
Elevated in about 75% of untreated sarcoid
Poor sensitivity and specificity
Lots of other conditions cause elevation of
In terms of monitoring - unclear
UVB spectrum
290-320
NBUVB spectrum
311-313
Excimer laser nm
308 nm
UVA1 spectrum
340-400
UVA spectrum
320-400
UVC spectrum
2000-290
Lamellar ichthyosis mutation
TGM1
Harlequin ichthyosis mutation
ABCA12
Fabry disease associations
f - febrile episodes
A - angiokeratomas and alpha galactose
b - burning pain - peripheral neuropathy in hands and feet
R - renal failure and retinal abnormalities
Y - young death
C - cardiovascular and cerebrovascular disease
C - ceramide trihexoside
REGISCAR Diagnostic criteria for DRESS
>5 is definite, 4-5 is probably 6 clinical: 1. Fever 2. Cutaneous >50% 3. Cutaneous eruption that looks like DRESS 4. Lymphadenopathy 5. Resolution >15 days 6. Internal organ involvement 4 investigations: 1. Biopsy consistent with 2. Atypical lymphocytes 3. Eos >1.5 4. Negative for ANA, mycoplasma, chlamydia, hepatitis and blood cultures
J-SCAR Diagnostic criteria for dress
4 clinical, 3 investigations
Clinical
1. Fever
2. Maculopapular rash >3 weeks after starting select medication
3. Lymphadenopathy
4. Long time to resolve once removal of medication
Investigations
1. HHV-6 reactivation
2. LFT derangement ALT >1000
3. Leukocyte abnormality: lymphocytosis, lymphocyte abnormalities, eosinophilia
Drugs that cause acanthosis nigricans
OCP, growth hormone, niacin, steroids, protease inhibitors
What is the glucagonoma syndrome
Consists of necrolytic migratory erythema, adult onset diabetes, weight loss and glossitis
Can also have anaemia and personality changes
Medications that cause Telogen effluvium
OCP cessation
Retinoids
Anticoagulants- particularly heparin
Anti thyroid: propylthiouraxil, methimazole
Anti convulsants- valproate, carba, phenytoin
Heavy metals
Beta blockers
What is diagnostic for Telogen effluvium
20% telogen count
HLA for allopurinol
B*5801 for Han Chinese and Taiwanese
HLa for carbamazepine
Han chinese 1502 SJS
Lamotrigone hla
1502 for SJS - Taiwanese
Most common cause of serum sickness like drug eruption
Cefaclor 1/2000 kids
ANCA positive vasculitis drug causes
Propylthiouracil
Hydralazine
Levamisole
Minocycline
AGEP medications
CHANT: Calcium channel blockers, carbamazepine, cetirizine Herbal medicines Abx, acetaminophen, anti malarials NSAIDs Terbinafine
Medications that cause SWEETS
Change Checkpoint inhibitor, contraceptives Hydralazine Azathioptine and abx (Mino, TMP-SMX, quinolone) GCSF Efflux of fluid - frusemide
Timeline for immunologically mediated drug reaction
8-21 days
Exanthematous eruption time interval
4-14 days
FDE time interval
1-2 week at first, re exposure <48 hours
AGEP time
<4 days
DRESS time
15-40 days
Drugs that cause ANCA positive vasculitides
PTU
Hydralazine
Levamisole
Minocycline
Drugs that cause sweets
CHANGE Checkpoint inhibitors, imatinib, contraceptives Hydralazine Abx TMP SMX minocycline quinolones GCSF Efflux of fluid: frusemide
Meds that cause FDE
Abx sulfonamides tetracyclines over beta lactam NSAIDS Paracetamol Azole anti fungals PPI Dapsone Barbituates
Drugs that cause linear IgA bullous dermatosis
CAPPINPISS Vancomycin Captopril, cephalosporin, cyclosporine Amiodarone, allopurinol Phenytoin Interferon alpha NSAIDS Penicillins Sulfonamides Somatostatin
Frusemide
Lithium
Drugs that cause BP
Gliptins TNF alphas Abx - amoxicillin Anti PD1s NSAIDS Diuretics
Drugs that induce pemphigus
Those with a thiol group - bind to desmosomal antigen complex
Penicillamines
Captopril and other ACEI
Gold
Non thiols
Beta lactams
Nifedipine
Propranolol
Common phototoxic agents
STAND UP C**T
Sulfonamides Tetracyclines Triazole antifungals: voriconazole Anti arrhythmics: amiodarone NSAIDS Diuretics PDT and psoralens Calcium channel blockers - diltiazem Tars
Drugs that cause pseudoporphyria
FIND Frusemide Isotretinoin NSAIDs Dapsone and doxy
Drugs that cause photoallergy
Sulfur moieties: thiazide diuretics, sulfonamide abx, sulfonylureas
Others: quinine, quinidine, TCA, griseo, NSAIDs
Hydroxyurea cutaneous effects
Painful ulcerations of maleolar region of legs
Drugs that cause alopecia
Telogen: Anticoagulants: heparin > warfarin Beta blockers Interferons Lithium Retinoids
Anagen: Anti neoplastics Arsenic Gold Etc
Drugs that cause SCLE
TTTCHANGE
Terbinafine, thiazides, TNF alpha Calcium channel blocker, carbamazepine HMG coa reductase ACEI NSAIDs Griseo Esomeprazols Beta blockeds
Meds that cause psoriasis
Beta blockers Lithium NSAIDs TNF alphas Interferons
Genes associated with HS
NCSTN PSEN1 and PSENEN
Treatment for Erythema migrans
Can I actually diagnose
Cefuroxime 500 mg BD
Amoxicillin 500 mg TDS
Doxycycline 100 mg BD
Medications that cause flushing
STOP CHIN MAD FAG
Sildenafil Tamoxifen Opiates Prostaglandins Calcium channel blockers, calcitonin, chlorpropamide, cyclosporine Hydralazine Nicotinic, nitrates Monosodium glutamate, sodium nitrate Alcohol Disulfiram Foods – fish ACE inhibitor Gold
Antibodies for systemic sclerosis
Anti-topoisomerase I (anti-Scl70), anti-RNA polymerase III and anti-centromere
Type 6 PRP
HIV associated follicular syndrome
HIV, PRP, nodulocystic acne, follicular spines including lichen spinulosis
Ddx for follicular papules with keratotic picture
Phrynoderma Keratosis circunscripta Follicular ichthyosis juvenile PRP Trichodysplasia Follicular mucinosis Demodex
Antibodies for systemic sclerosis
Anti-topoisomerase I (anti-Scl70), anti-RNA polymerase III and anti-centromere
Variants of vitiligo
Vitiligo ponctue (confetti) Trichome vitiligo Blue vitiligo Inflammatory vitiligo Hypochromic vitiligo (seborrhoeic distribution) Isomorphic Koebner phenomenon Childhood vitiligo
Subtypes of vitiligo
Generalized:
Vulgaris
Acrofacial
Universalis
Localized:
Focal
Segmental
Mixed
What is Vogt Kayanagi Harada classified by
- Uveitis
- Aseptic meningitis
- Otic involvement - dysacusia (difficulty hearing because can’t process input)
- Vitiligo - particularly of face or sacral region, and associated poliosis
Allezandrini syndrome - what is it classified by
- Rare disorder, believed to be closely related to Vogt-Koyanagi-Harada syndrome
- Characterized by unilateral whitening of scalp hair, eyebrows, eyelashes
- Ipsilateral depigmentation of facial skin and visual changes
- Affected eye: decreased visual acuity and an atrophic iris
Gene associated with DH
HLA DQ2 or HLA DQ8
Pathogenesis of hydroa vacciniforme
Trigger: sun
EBV implicated- When severe EBV –> evidence of NK cell lymphocytosis, exaggerated response to mosquito bites and haemophagocytic syndrome
- Subset of children and adults with EBV driven lymphorpoliferative disorder so screen for that: LN, hepatosplenomegaly, fever
Hydro vacciniforme main clinicals
M>F
Within hours tender bullae, blisters, vesicles, plaques, papules. Heals with telangiectasias and varioliform scars
Can get fever, headache, malaise
Can’t play outdoors
- Basically this will get worse with sun exposure, and result in facial swelling, ulcerated nodules, mosquito bite reactions ++. fevers, hepatosplenomegaly, pancytopaenias, deranged LFTs, increased NK lymphocytes, high EBV DNA load
- Rarely, ocular findings may be present: such as photophobia, lacrimation, conjunctivitis, corneal infiltration with vascularization, keratitis, or uveitis [37-39]. Referral to an ophthalmologist is recommended if eye symptoms are presen
Treatment for hydroa vacciniforme
- ecalcitrant
- Photoprotection: tinted windows, barriers
- Anecdotal: phototherapy, PUVA, beta-carotene, antimalarials, azathioprine, thalidomide, cyclosporine, dietary fish oil
CAD resolution
10% over 5 years, 50% of 15 years
Rothmund Thompson gene and clinical features
RECQL4
- Teeth abnormalities
- Hypogonadism
- Ocular: bilateral cataracts
- Microcephaly
- Poikiloderma and photosensitivity
- Short stature, skin cancers
- Osteosarcoma 10-30% + other cancers: gastric, Hodgkin lymphoma, malignant eccrine poroma
- No hair, Sparse hair, hypoplastic nails, acral keratoses
Systemic photoallergic agents
- Antiarrhythmics: quinidine
- Antimalarials: quinine
- Antifungals: griseofulvin
- Antimicrobials: sulfonamides
- NSAIDs: piroxicam
- Photoallergic reactions include: those with sulfur moiety
- Thiazide diuretics
- Sulfonamide abs
- Sulfonylureas
- Phenothiazines
- Others: quinine, quinidine, TCA, griseo, NSAIDs
Which ingredient in sunscreen is most common cause of photoallergy
Oxybenzone
Associations with EPS
POO DAMPER: Penicillamine, Osteogenesis imperfecta, Downs, Acrogeria, Marfan, PXE, Ehlers Danlos, Rothmund Thomson
HS genes
PSEN1, PSENEN, NCSTN
Causes of interstitial granulomatous drug reactions
Calcium channel blockers
Statins
TNF alpha inhibitors
Drugs that cause acne
MISPLACE MEK inhibitors (trametinib) Iodides, isoniazid Steroids Phenytoin, progestins Lithium Anabolic steroids - danazol, testosterone Corticotropin, cyclosporin EGFR inhibitors