S4: dermatology Flashcards
Describe acne vulgaris
Increased production of sebum leads to a blockage of the pilosebaceous follicles
Multi-factorial cause, but likely to have a hormonal element -> overgrowth of Propionibacterium acnes
Leads to inflammatory changes in the skin as well as the formation of comedomes
Describe the treatment for acne vulgaris
Based on a ladder of:
1) Topical and non-antibiotic treatments
2) Topical antibiotic treatments
3) Oral antibiotics
4) Oral isotretinoin
Describe roscea
Relapsing and remitting condition seen later in life
Facial redness often a common symptom
Treatment: recognition and mitigation of any triggers, in some cases preventative topical or oral, antibiotics (tetracyclines) are often used
Describe eczema (atopic dermatitis)
Inflammation, relapsing & remitting course
Typical pattern in skin creases & can also be seen in response to a specific trigger
Usually begins in childhood, multifactorial with trigger factors
Clinical diagnosis – pattern, presence of itch, dry skin & strong associated with asthma and allergies
Describe the management of eczema
Patient/carer education
Mainstay use of emollients
Periodic use of topical anti-inflammatories for flare ups
Escalation of treatment where needed
Describe molluscum contagiosum
Virus often passed from close contact
Commonly seen in children, each skin change is a small-wart like lump
Typically lasts 12-18 months and resolves
Doesn’t spread all that easily
Describe shingles
Reactivation of dormant virus in dorsal root ganglia typically after childhood infection
Characteristic dermatomal rash appears
Advice and explanation are important as shingles is infectious
Early use of anti-viral medication (acyclovir) is important in preventing longer term post-herpetic neuralgia
Describe staphylococcal infection in skin
Superficial bacterial skin infections are common – impetigo
Seen in areas of broken skin
Often seen in children
Consider and look for cellulitis
Advice and explanation are important as impetigo can spread
Topical antibiotics are often used
Describe dermatophytosis
Can grow in dead keratin and often in a ring-like pattern
Often classified by the area impacted eg. scalp – tinea capitis, body – tinea corporis
Itch and hair loss are common features
Responds well to treatment
Describe psoriasis
Inflammatory, has a relapsing and remitting course
T cells cytokine production is stimulated, this is turn causes keratinocyte proliferation
Mostly begins in early life
Important to identify any triggers or iatrogenic causes: medication, arthritis
Describe examination of plaque psoriasis
Clear
Itchy, well demarcated circular or oval pink plaques with a symmetrical distribution
Often an overlying white or silvery scale
Describe the management of psoriasis
Patient/carer education
First-line therapy – traditional topical therapies eg. corticosteroids or vitamin D analogues
Second-line therapy – phototherapy, broad-band or narrow-band ultraviolet B light
Third-line therapy – systemic biological therapies eg. TNF antagonists and monoclonal antibodies
Describe seborrhoeic keratosis
Hyper-keratotic skin change mostly seen with ageing
Very common
Benign
Mostly conservative management
Describe malignant melanoma
Melanocytes are found in the basal layer of the epidermis
If melanoma cells reach the dermis of the skin they can spread to other tissues via the lymphatic system or more widely via the bloodstream
UV exposure is the main risk factor, alongside skin type & genetic factors
Describe the ABCDE approach to malignant melanoma
Asymmetry Border irregular Colour irregular Diameter greater than 7mm Evolving
