Skin Flashcards
Psoriasis Triggers
Infection
Emotional Stress
Trauma
Sun Exposure
Puberty and Menopause
Drugs (B blocker, NSAIDS,OCP)
Obesity
Alcohol
Smoking
Pink or Brown, Nodular,
Feels like a split pea when rolling between fingers
Dermatofibroma
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.
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)
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)
Involving skinfolds esp Breast, buttock, axilla
Inflammed
Well demarcated
No scaling,
Typically shiny and smooth
Inverse Psoriasis
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)
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)
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.
Nodular, occurring on the nose and chin.
Firm on palpation.
Never bled.
No telangiectasia.
Benign fibrous papules
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)
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.
Widespread oedema
Followed by desquamation
Whole of body may be involved
Erythrodermic Psoriasis
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
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
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
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
- Manage leg oedema - avoid prolonged standing, keep legs elevated, compression stockings, regular walks, etc. medication review (ca ch blocker)
- Topical steroids, heavy moisturiser, Abs if infection, condys crystals or vinegar wraps. Protect lower limbs from injury.
