Skin Flashcards by Justin Oughton

Psoriasis Triggers

Infection

Emotional Stress

Trauma

Sun Exposure

Puberty and Menopause

Drugs (B blocker, NSAIDS,OCP)

Obesity

Alcohol

Smoking

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Pink or Brown, Nodular,

Feels like a split pea when rolling between fingers

Dermatofibroma

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Deep blue, macular lesion,

Perfectly round

No pigment network is seen with dermatoscopy.

Blue Naeuvus

New, large or rapidly enlarging lesions may require a biopsy to exclude nodular melanoma.

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Older patient

Recurrent Itchy lesion on lower limbs

Oval/round shape

Diagnosis?

Precipitants?

Treagtment?

Discoid Eczema/Nummular Dermatitis

Precipitants: trauma, infection (esp S. aureus), dry skin, contact irritant, varicose veins

Treatment: Heavy emolient moisturisers, Topical corticosteroids, Antibiotics, sedating antihistamine, Photoherapy, Oral Steroids, Methotrexate/cyclosporine etc.

Ddx Tinea corporis (ring worm)

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Melanoma Warning Signs

Patient Concern

Lesion Changing

Lesion stands out from others

Rapid Growing nodule regardless of colour

Dermatoscopy charachteristics

Change on subsequent dermatoscopy

(eTG)

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Involving skinfolds esp Breast, buttock, axilla

Inflammed

Well demarcated

No scaling,

Typically shiny and smooth

Inverse Psoriasis

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Thick scaley patches

Chronically itchy

Persistant patches

Remaining skin healthy

Neurodermatitis (Lichen simplex chronicus)

Habitual component.

Tx:

Protect area from scratching

Emolient moisturiser

High potency intermittent topical steroids (up to 2 weeks)

Topical calcineurin inhibitors (eg tacrolimus)

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Multiple

Discrete

Small Red papules

Esp Trunk and Limbs

Guttate Psoriasis

Management:

treat with Abs if underlying strep infection.

Emolient Moisturisers

Tar based preparations

Topical Corticosteroids (mild face, potent body)

Calcipotriol

Phototherapy

Picrolimus (NCGP)

Methotrexate (eTG)

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Commenced with single lesion initially treated with anti fungals.

2 weeks later, multiple scaly oval salmon-coloured macules appeared, 1 to 2 cm in diameter.

Confined to the trunk and proximal limbs

Arranged along the skin creases,

Pityriasis Rosea

Self resolving

Lasts up to 12 weeks

Usually follows an URTI

Can treat with Topical Steroids if itchy.

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Nodular, occurring on the nose and chin.

Firm on palpation.

Never bled.

No telangiectasia.

Benign fibrous papules

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Small vesicles to papulo-vesicular rash

Itchy

Elbows and knees and in the lumbosacral region

Appearing in 20s

Chronic

Associated abdominal pain, bloating, loose stool.

Dx, assosciation and treatment?

Dermatitis Herpetiformis

Associated with coeliac disease

Tx:

1st line: Avoidance of gluten

2nd line: Referral to dermatologist for Dapsone 50 mg orally, once daily (can slowly inc to 200mg)

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Dermo-hypodermic rounded nodules

May be bright red or purplish,

Bilaterally symmetrical,

Located on the extensor surface of the legs, esp shins

May be tender and warm.

Erythema Nodosum

Inflammation of the subcutaneous fat:

Associations:

Inflamatory: Sarcoidosis, Inflammatory Bowel Disease, Behcet’s Disease

Infections: Streptococcal, Mycoplasma pneumoniae, Cat Scratch, Yersinia, Tuberculosis

Medications: OCP, NSAIDs, Sulfonamides

Pregnancy

Tx: Bed rest, compression bandaging, anti-inflammatories, doxycycline.

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Widespread oedema

Followed by desquamation

Whole of body may be involved

Erythrodermic Psoriasis

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Rapid growth (weeks to months).

Dome Shaped appearance.

May be pigmented.

Uniform rounded structures on dermoscopy.

Spitz nevus

Tx:

In children: monitor. If becoming atypical will require excision biopsy.

In adults: Excision biopsy due to difficulty predicting outcome

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Types of Dermatitis

Acute reactions tend to be labeled Dermatitis

Chronic reactions tend to be labled Eczema

Endogenous: atopic, seborrhoeic, discoid, asteatotic, venous, hand and/or foot, lichen simplex

Exogenous: irritant, allergic, photoallergic, photoxic, photophytodermatitis

Atopic Dermatis: most common

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Diabetes

Velvety hyperpigmentation

Skin folds

Diagnosis, Causes and Management?

Acantholysis nigricans

Causes: insulin resistance, Medication, Malignancy, Obesity

Management:

Control hyperinsulinemia (diet and medication)

Weight loss

Identify and remove tumour

Cease medication

Cosmetic treatment with topical retinoids, dermabrasion or laser

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Appear at or shortly after birth.

Single or multi-pigmented.

Round or oval shaped patches.

May have increased hair growth (hyertrichosis).

Surface may be slightly rough or bumpy.

Growth at same rate as child

Congenital Melanocytic Naevi

Risk of melanoma related to size:

Small and medium: Risk < 1%.

Giant: 5-10% (esp across the spine or multiple satellite lesions).

The risk of melanoma is greater in early childhood; 70% of melanomas associated with giant congenital melanocytic naevi are diagnosed by the age of ten years

Well Defined

Raised Red Plaques

Topped with Silvery scales

esp. Limbs and trunk

Plaque Psoriasis

or Chronic Plaque Psoriasis

Ddx:

Drug Reaction, Discoid Eczema, Candidiasis, Tinea Corporis, Dermatitis, Heat Rash, Urticaria, Guttate Psoriasis.

Provoking Agents: Stress, Trauma, Infection, Medication, UV exposure,

Melanoma Features on Dermatoscopy

asymmetric pigmentation

blue-white veil

multiple brown dots

pseudopods

radial streaming

Treatment of Psoriasis

Emolient Moisturisers

Topical Tar Preparations

Topical Corticosteroids

Calcipotriol Ointment

Phototherapy

Pimecrolimus (NCGPT)

Oral Corticosteroids (NCGPT)

Methotrexate (eTG)

Melanoma Types

Melanoma in situ

Superficial spreading melanoma

Acral lentiginous melanoma

Mucosal melanoma

Nodular melanoma

Polypoid melanoma

Desmoplastic melanoma

Amelanotic melanoma

Soft-tissue melanoma

Affects the skin of children, teenagers or young adults

One or more skin coloured bumps occur in rings in the skin over joints, particularly the knuckles. The centre of each ring is often a little depressed.

Granuloma annulare

Granuloma annulare is a delayed hypersensitivity reaction.

Localised granuloma annulare usually affects the fingers or the backs of both hands, but is also common on top of the foot or ankle, and over one or both elbows.

A painful nodule on the ear helix.

There is a central crust.

Chondrodermatitis nodularis helices chronicus

Ddx: BCC - needs biopsy to exclude

Sudden Onset esp. Winter

Male >50

Central chest and Mid back

small discreet, red papules

Usually Itchy

Associated with sweating

Transient Acantholytic Dermatosis

(Grover’s Disease)

Tx:

Keep area cool

Diphemanil Methylsulphate Powder

Mild topical steroid lotion (Hydrocortisone 1%)

Calcipotriol Cream

Oral Doxycycline or Itraconazole

Lesion on forearms and shins, Pigmented, Thread like circumferential elevated border

Diffuse superficial actinic porokeratosis

What is it What is it associated with

Oral Hairy Leukoplakia Associated with: Ebstein Barr Virus HIV and other immunosuppressed patients.

ABCDE of Melanoma

Asymmetry Irregular Border Multi colours Diameter \> 6mm Elevation or Evolving

\> 30 YO Usually \> 60 YO Women \> Men Sun exposed skin Well-demarcated, Irregular border Slowly expanding Erythematous and scaling plaque

Bowen's disease (squamous cell carcinoma in-situ) (May be mistaken for psoriasis or dermatitis) Tx: Fluorouracil 5% cream topically, once daily for 3 to 4 weeks, or Imiquimod 5% cream topically, at night 5 times weekly for up to 6 weeks. Phototherapy Cryotherapy Keratolytics (eg Salycilic Acid)

Female Dyspareunia vaginal itch Discharge

Lichen Planus Wickham's striae - charachteristic lacey pattern Management: Biopsy Topical high potency steroids Specialist referral

Child Rapidly enlarging Pigmented lesion

Spitz Naevus Harmless May rapidly enlarge for a period of time then become static Can regress Do not require surgery if classical. Can be removed for cosmetic reasons.

Pigmented lesion, First appearring as a child, Increasing in number, Lesions may become elevated. Regular colour and border

Benign Melanocytic Naevus Types: Junctional Naevi: macular, melanocytes are confined to the junction between the dermis and epidermis. 5- 10 years of age Compound Naevi: papular, melanocytes are found in the junction and the deeper dermis. 10 - 20 years of age Intradermal Naevi: melanocytes at the junction disappear leaving only melanocytes in the deeper dermis. These intradermal naevi then persist 10–20 years before eventually disappearing altogether. 20 - 40 years of age.

Flat, red and scaly Back of hand or forearm Non tender to palpation

Solar Keratosis Note: SCC are often tender to lateral pressure Ddx: SCC, Melanoma insitu

Multiple large brown waxy lesions, well demarcated, Appearing stuck onto the skin.

Seborrhoeic keratosis If pink and inflamed termed benign lichenoid keratosis Ddx: in situ melanoma BCC

Yellow deposit Medial limbus oft. \> 40 YO

Pinguecula If inflammed termed pingeulitis Can manage inflammation with anti inflammatories.

Occurring on the forehead, nose or upper cheeks. Yellow or faintly orange. Multiple, Raised, not growing over time. No telangiectasia in their border Central punctum.

Sebaceous Hyperplasia

Pink to Red Macule Can turn black overnight Distinctive blood filled lobules on dermatoscopy

Capillary Haemangioma

begins as an inflammatory papule or pustule Then breaks down to form an enlarging ulcer. The ulcer has characteristic raised purplish undermined edges and can stabilise or expand in size (slowly or rapidly). Ulcers may be single or multiple, and are often at sites where venous or arterial ulcers are unusual.

Pyoderma gangrenosum Investigate for underlying auto-immune disorder. (50%) eg. RA, IBD, myeloproliferative and lymphoproliferative disorders.

Intensly Itchy Vesicles on hand

Pompholyx (dyshidrotic eczema) Management: Protective Gloves Heavy emmolients High potency steroids Occlusive or wet dressings Short Course oral steroids

White plaque on tongue margin 50yo Exsmoker 10/day for 25 years 3std drinks/day otherwise well diagnosis? causes? Management

Oral Leukoplakia Causes inc: Carcinoma insitu, Nicotine stomatitis, Trauma (biting, friction), Candida, Oral lichen planus, Lupus erythramatosus Management: Reduce irritants inc. smoking and etoh cessation, change toothpaste, etc. swab for tinea biopsy for carcinoma and lichen planus. Candida tends to be toungue surface and the angles of the mouth.

85 yo itchy scaley rash with erythema, skin discoloratiion varicose veins and intermittent ankle swelling diagnosis and management

Venous Eczema m 1. Manage leg oedema - avoid prolonged standing, keep legs elevated, compression stockings, regular walks, etc. medication review (ca ch blocker) 2. Topical steroids, heavy moisturiser, Abs if infection, condys crystals or vinegar wraps. Protect lower limbs from injury.