Skin Flashcards
What is Dermatology
Specialty of medicine that deal with the skin and skin diseases
What is a dermatologist
Dermatologists – medical doctors who have specialised in diagnosis and management skin disease
Describe the current issue with dermatologists in the UK
Proportionate to the population, the UK has a small number of dermatologists- thus many skin diseases are treated by GPs or pharmacists.
What is the rule for skin cancers
Must be seen by a dermatologist within 2 weeks
What is a dermatoscope
Torch with magnifying glass- can look into lesion
Describe the characteristics of a typical lesion of malignant melanoma
Asymmetric
Streaks
Grey spots
Atypical melanocytes in an abnormal architecture
How are lesions moved
Depending on depth- wide excision (1-2cm deep) in fat layer will remove the lesion. Need to also assess its spread and treat accordingly.
Describe Toxic Epidermonecrolysis
Reaction to drug in an immune-modulated way- keratinocytes in the epidermis apoptose- it dies and sloughs off- often all over the body- mucous surface in eye and genital area also effected.
Describe the treatment for Toxic Epidermonecrolysis
Intensive care unit- supportive care- treated as burns patient- stop taking the drug.
Describe Psoriasis
Inflammatory dermatosis- not an infection- over proliferation of keratinocytes - inflamed plaques formed- salmon pink colour- elbows- knees and scalp affected- but can be anywhere- sore or itchy- disfiguring for patients
What are the implications of Psoriasis for patients
Has a low quality of life equivalent to T2DM, predisposition to T2DM, CVD and psoriatic arthritis.
Describe the treatment for psoriasis
Topical steroids, methotextrate- biological agents
What is meant by a topical steroid
Odourless, tasteless, colourless- excellent for psoriasis and eczema
Describe Herpes Zoster
Reactivation of chicken pox- due to stress and low immunity- chicken pox appear along a nerve dermatome- area initially has a stinging sensation before the onset of a rash- 2-3 weeks to heal.
Which area does Herpes Zoster usually affect
Ophthalmic division of the trigemminal nerve- supplies the eyes and eyelid.
How can we treat Herpes Zoster
Acyclovir- some have chronic pain and eyelid problems.
Vaccine also available (not routine)- to stop chicken pox. Also a vaccine for those older than 70- but not widely encouraged.
Describe the history of dermatology
1572 – first printed book on dermatology
Pre 18th Century
Skin disease treated by physicians and surgeons
18th – 19th Century
Specialty emerges
Classification and naming of diseases
Eg mycosis fungoides
19th Century –
Many diseases named after German and French Dermatologists
Many skin hospitals eg St. Johns Hospital for diseases of the skin, Lisle Street
1878 – Sir Erasmus Wilson bring Cleopatra’s Needle to London
Describe the key developments in the 20th century
1903 – Nobel prize for treatment of Lupus Vulgaris with UVB
1920 – X-rays used to treat skin fungal infections and cancer
1928 – Penicillin discovered by Sir Alexander Fleming
1930s – Sulphonamide antibiotics for cellulitis and bacterial skin infections
1940s – UVB + tar treatments for psoriasis
1940s - Venereology and Dermatology become separate specialties in UK
1940s – Penicillin introduced into clinical practice widely
1950s- Topical steroids
1960 - Griseofulvin for fungal infections
1970s – PUVA for psoriasis
1980s – Isotretinoin for acne
2000s- Biologics for psoriasis
Why should we learn about the skin
20% consultations in GP
Under represented in curriculum
Overlaps with many specialties
Largest organ (16% body mass, 1.8m2 surface area)
Clinical skills paramount in diagnosis
Over 2000 diseases affect the skin
Describe some common skin conditions
Common skin diseases include skin cancers, inflammatory conditions such as acne, eczema and psoriasis and many systemic diseases will have a skin manifestation. Infections of the skin or that involve the skin are common and create a burden especially in resource poor communities
How are many skin diseases recognised
Many skin diseases are able to be diagnosed without specialised investigations, but rather depend on the clinical skills of the doctor in recognising the condition by the clinical features manifested in the patient.
What is the issue with some of the classifications of skin diseases
Don’t match what they are
e.g mycosis fungoides- are a lymphoma
What is Lupus Vulgans
TB infecting the skin
What is PUVA
Psorylin UVA Tablet photosensitises the skin Phototoxic rays reaction between keratinocytes and light immunosuppresses the inflamed skin