Skin Flashcards
State four facts about skin?
1) skin is the largest organ in the body
2) skin is the major barrier between the inside and outside of your body
3) the thickness of skin varies from 0.5mm thick on the eyelids to 4.0mm thick on the heels of your feet
4) it has an area of 2 square meters (22square feet) in adults, and weighs about 5 kilograms.
What are the four functions of skin?
1) protection: it protects against UV light, mechanical, thermal and chemical stresses, dehydration and invasion by micro-organisms
2) sensation: skin has receptors that sense touch, pressure, pain and temperature.
3) thermoregulation: various features of the skin are involved in regulating temperature of the body. For example, sweat glands, hair, and adipose tissue.
4) metabolic function: subcutaneous adipose tissue is involved in production of vitamin D, and triglycerides.
Name a few viral infections
Measles
Rubella
Chicken pox
Herpes
Shingles
Warts
What are the symptoms of measles?
Dry cough and runny rose
Body pains and headache
Sore throat
Watering and swelling in eyes
Loss of appetite
Diarrhoea
Discomfort and fatigue
Light sensitivity
Inflammation in lymph nodes
Koplik’s spots (blue and red spots in the mouth)
Is measles a respiratory infection?
Yes.
Are measles and Rubella preventable diseases?
Yes
What is the number of days between which measles and rubella resolve?
7-10 days
What will a small number of people develop if they have measles?
Meningitis
Pneumonia
What are the symptoms of Rubella?
Similar to measles
Mild respiratory illness
Rash
Malaise/arthralgia
What are the complications of measles or rubella?
High risk to pregnancy
<20 weeks, foetal abnormalities, deafness
90% chance of transmission from mother to baby
What are the characteristics of chickenpox?
Common childhood infection
Mild illness
Itch as skin lesions reviver
What are the two types of Herpes Simplex Virus?
HSV-1: Oral to oral contact
HSV-2: genital contact, STD
HSV-1:
Subclinical in many patients
Latent virus jn trigeminal ganglion
Reactivation - recurrent herpes labialis
What is the treatment for Herpes Simplex Virus?
Aciclovir
Inhibits viral DNA replication
Prevents viral replication
This is the treatment for shingles and chickenpox too
This treatment shortens the length of illness, but does not mean recent recurrence.
What is ocular herpes?
Painful, red, swollen
Contact with active herpes lesions
May lead to loss of vision
What is herpetic whitlow?
Painful, red, swollen finger or nail
Blisters or sores on your finger
Active Herpes Simplex Virus (HSV) lesion
Can spread to other areas
What are warts?
Small lumps that develop on the skin
Caused by Human Papillomavirus (HPV)
They are normally self limiting, can be treated with cryotherapy and salicylic acid cream.
Are warts and cervical cancer from the same virus?
No. They are from the same family as HPV but not the same virus.
What are a few examples of bacterial infections?
Folliculitis
Boils
Carbuncles
Furuncles
What type of infection is Erysipelas? What is it?
Bacterial infection, streptococcal infection
Oedema/cellulitis of dermis
May be systemically unwell
Is impetigo a bacterial infection?
Yes - step+ staphylococcus
Is impetigo contagious?
Yes
Name examples of immunologically mediated skin diseases
Eczema
Contact dermatitis
Psoriasis
SLE/DLE
Scleroderma
Lichen planus
Pemphigoid
Pemphigus
What is Eczema?
Common childhood condition
Related to Type 1 hypersensitivity
IgE-mediated inflammation
Caused by unknown allergen
Affects flexor surfaces
How does broken skin cause eczema?
Broken skin
Increased permeability
Antigen entry
Inflammation
How is eczema managed?
Break the cycle
Moisturiser
Avoid using string soap
Usage of topical antihistamines
Usage of topical steroids
What are the characteristics of contact dermatitis?
Similar to eczema but only in relation to specific contacts
Managed the same way as eczema
What are the characteristics of psoriasis?
Inflammatory condition
Unknown cause
HLA association
Increased rate of cell production
Increased thickness of skin
White, scaly patches
May be associated with arthritis - psoriatic arthritis
What is the treatment of psoriasis?
Vitamin D which slows keratinocyte proliferation
Phototherapy
Systemic steroids
What is systemic lupus erythematosis (SLE)?
Systemic disease
Affects skin, joints, kidney, liver, GIT, vascular system, blood
Variable severity
Causes butterfly rash on back and shoulders
What is Discoid Lulus Erythematosis (DLE)?
Similar to SLE
Affects 20% of patients with SLE
Many DLE patients will not develop SLE
How is DLE managed?
Depends on severity and systems involved
Steroids, methotrexate, biological response modifiers
What are the characteristics of Scleroderma?
Causes thickening and hardening of the skin
May also affect the GI tract and other organs
Causes obstruction and restriction - Raynaud’s phenomenon
Causes white extremities due to poor perfusion
What is lichen planus?
Clusters of red/white patches on the skin
Whickham’s Striae
You can also develop oral lichen planus
This may be associated with skin/genital lesions
May be oral only
Typically bilateral
How is lichen planus (including oral lichen planus) managed?
Steroids
Management of oral lichen planus:
Confirm diagnosis
Manage symptoms
Benzydamine hydrochloride mouthwash
Try SLS free toothpaste
Topical steroids
Systemic steroids
What is pemphigus and pemphigoid?
Auto-immune diseases
Causes by antibodies against molecules connecting layers of epidermis together
Produce vesicles or bullae (vesiculobullous disease)
If vesicles/bullae rupture this will leave blistering and ulceration
What are the characteristics of pemphigus vulgaris?
Antibodies against desmosomes
Intra-epithelial lesions
Delicate bullae
Break easily
Severe disease
Rare
40-50 years peak
What are the characteristics of pemphigoid?
Mucous membrane pemphigoid
Antibodies against hemidesmosomes
Sub-epithelial lesions
Less severe
Affects elderly, more common than pemphigus
What are other examples of a vesiculobullous disease apart from pemphigus and pemphigoid?
1) Dermatitis herpetiformis
Related to coeliac disease
2) linear IgA disease
Similar presentation to others, commonly a drug reaction and may affect younger patients
How would you describe skin lesions?
Where is it?
How big is it?
What shape is it?
Does it move?
Consistency, what does it feel like?
Is it overlying skin/mucosa?
What other significant findings may you find associated with a skin lesion?
Sinus
Facial nerve weakness
Numbness
Other lymphadenopathy
Other skin or neck lumps
What are skin cysts usually caused by?
Usually caused by blocked sebaceous glands
Do skin cysts require treatment?
Most of the time they don’t require treatment however, they can occasionally flare up and become infected.
Why should you be careful about diagnosing a skin cyst?
Always look in the pts mouth. Is they have what looks to be a skin cyst on their cheek, it may not necessarily be a skin cyst. There may be something else going on for example, a chronic dental sinus.
You can stick a GP point in an open sinus and take a radiograph - this will show you which tooth is causing the problem.
What are vascular lesions caused by?
Vascular tumours or vascular malformation
What is the most common type of vascular lesion?
Telangiectasia
What is spider naevus and what is it characterised by?
It’s a type of vascular lesion.
Characterised by little dilated blood vessels
What two factors does the colour of vascular lesions depend on?
Colour depends on:
1) Depth of the lesion
2) blood flow - oxygenated blood is brighter red then venous blood (blue/purple)
What is Sturge-Weber syndrome?
Type of vacular lesion.
Associated with facial vascular malformation aka ‘port wine stain’.
Due to distribution of the trigeminal nerve.
When examining vascular lesions, what three questions do you need to enquire about?
Does it empty?
Does it refill?
How quickly?
How are vascular lesions managed?
- May not need treatment if no functional problems
- Medical treatment - propranolol
- Sclerotherapy
- Embolisation
- Surgical resection
- Laser treatment for superficial lesions
What is a melanoma?
It’s a type of skin cancer - invasive pigmented lesion
Is oral cancer more common than melanoma?
A melanoma is more common than oral cancer however, survival rates are better than oral cancer.
What are the five main ways to protect yourself from skin cancer?
SLIP - slip on a top
SLOP - slop on some Sun cream
SLAP - slap on a high hat
SEEK - seek shade
SLIDE - slide on sunglasses
Avoid excessive exposure to UV radiation.
What is the 7-point checklist for examining a melanoma?
Change in size
Irregular pigmentation
Irregular border
Itch or altered sensation
Larger than other lesions
Inflammation
Oozing/crusting
What are the characteristics of non-melanoma skin cancer-basal cell carcinoma?
Slow growing
Pearly raised edge
May be flat
Bleeding/oozing late feature
Face and neck 80%
Metastasis is rare
Locally aggressive
Also associated with UV radiation similar to melanoma.
Mainly affects older patients
What is the difference between basal cell carcinoma and squamous cell carcinoma?
BCC is less aggressive than SCC
They may appear similar
SCC is more likely to metastasise.
How is skin cancer treated?
First stage is to arrange a biopsy and diagnose the patient
Staging - depends on depth and size of lesion, TNM systems for staging (Tumour Nodes Metastases)
If tumour then - wide local excision at primary site which depends on the aggressiveness of the lesion.
If abnormal lymph node, pt would be treated with neck dissection which would involve removing lymph nodes from the affected side of neck or both sides.
If skin cancer has metastasised, patient would undergo chemotherapy and immunotherapy.
