Skin Flashcards
Acne vulgaris - Pathophysiology
Inflammatory disease of pilosebaceous follicles
Hormonal - increased androgen sensitivity
Acne vulgaris - Complications
Scars
Psychological/social
Erythematous/pigmented macules
Acne vulgaris - Treatment
Avoid over washing Don't pick Diet Topical retinoid and benzoyl peroxide Topical antibiotics (clindamycin) Oral antibiotics (doxycycline) Oral retinoid
General eczema - Pathophysioogy
Chronic, relapsing and remitting, inflammatory condition
Vesicles and bullae cause red scaly patches
General eczema - 2 Types
Endogenous - Atopic eczema (early childhood)
Exogenous - Contact dermatitis
Atopic eczema - Cause
Family history of atopy
Atopic eczema - Exacerbating factors
Infection
Strong detergents
Cats/dogs
Stress
Atopic eczema - Investigation
Serum IgE
Skin-prick test
RAST (Specific IgE)
Atopic eczema - Treatment
Avoid exacerbating factors
Frequent emmolients
Bath soap substitutes
Topical corticosteroids (mild, moderate, potent
Adjuvant therapy - Oral antibiotoics, oral antihistmaines, bandages
Phototherapy (severe)
Atopic eczema - Complications
Secondary bacterial/viral infection
Psoriasis - Pathophysiology
Chronic, inflammatory skin condition occurring due to hyperproliferation of keratinocytes
Chronic plaque
Psoriasis - Causes
Genetic
Environmental
Psoriasis - Exacerbating factors
Trauma Infection Drugs Stress Alcohol
Psoriasis - Symptoms
Red, scaly plaques Itchy Painful Nail changes Lower back, scalp, elbows, knees (extensor areas)
Psoriasis - Treatment
Avoid irritants
Use emmolients
1st line - Topical therapy (corticosteroids)
2nd line - Phototherapy, methotrexate
3rd line - Biological agents - TNF - alpha inhibitors
Venous ulcer - Pathophysiology
Venous disease involving varicose veins, DVT
Venous ulcer - Symptoms
Large, shallow, irregular Exudative and granulating Medial malleolus to knee Painful, worse standing Normal pulses
Venous ulcer - Treatment
Compression bandaging
What does ABPI stand for?
Ankle brachial pressure index
Arterial insufficiency = <0.8
Arterial ulcer - Pathophysiology
Atherosclerosis
Arterial ulcer - Symptoms
Small, defined, deep Necrotic base Very painful at night Pressure sites Absent peripheral pulses
Arterial ulcer - Investigations
ABPI (<0.8 = arterial insufficiency)
Doppler
Angiography
Arterial ulcer - Treatment
Vascular reconstruction
Neuropathic ulcer - Pathophysiology
Diabetes
Neurological disease
Neuropathic ulcer - Symptoms
Variable size and depth Painless Pressure sites (soles, heels, toes) Granulating base Peripheral neuropathy
Neuropathic ulcer - Investigations
ABPI (<0.8)
XR
Neuropathic ulcer - Treatment
Wound debridement (Removal of dead tissue)
Appropriate footwear
Diet
Basal cell carcinoma - Pathophysiology
Slow growing, locally invasive malignant tumour of the epidermal keratinocytes
Rarely metastatic!
Basal cell carcinoma - Risk factors
Sun damage
Age
Basal cell carcinoma - Treatment
Surgical excision
Radio
Squamous cell carcinoma - Pathophysiology
Locally invasive malignant tumour of epidermal keratinocytes
Grows quicker than basal cell carcinoma
Potential to metastasise via lymph
Squamous cell carcinoma - Risk factors
UV
Skin conditions
Chronic inflammation
Squamous cell carcinoma - Treatment
Surgical excision
Radio
Skin cancer - Types
Non-melanoma - BCC and SCC
Melanoma - Malignant melanoma
What is the single most preventative risk factor for skin cancer?
Sun exposure
Malignant melanoma - Pathophysiology
Invasive, malignant tumour of epidermal melanocytes
Potential to metastasise from epidermis to dermis (invasive melanoma)
Malignant melanoma - Risk factors
UV radiation
Type 1 skin (fair skin)
Multiple/atypical moles
Malignant melanoma - Symptoms (ABCDE)
Pigmented skin lesion Asymmetry Border irregularity Colour irregularity Diameter >6mm Evolution of lesion (change in size/shape)
Malignant melanoma - Treatment
Surgical excision
Radio
Chemo (managing mets)
Malignant melanoma - Prognosis
Recurrence based on thickness of tumour
Gangrene - Pathophysiology
Death of tissue from poor vascular supply
Gangrene - 2 Types
Dry gangrene - Necrosis without infection
Wet gangrene - Necrosis with infection
Gangrene - Treatment
Dry gangrene - Amputation
Wet gangrene - Analgesia, IV antibodies, surgical debridement, amputation (last resort)
Cellulitis - Pathophysiology
Acute bacterial infection of the dermis and subcutaneous tissue
Cellulitis - Causes
Strep pyogenes
Staph aureus
Cellulitis - Risk factors
Immunosuppression Break in skin Ulcers Fungal infection between toes Skin disorder (eczema)
Cellulitis - Symptoms
Acute hot, red, swollen and tender skin Fever Nausea Lower limb Unilateral
Cellulitis - Differential diagnoses
DVT
Septic arthritis
Gout
Cellulitis - Investigations
Exam
Bloods - Raised WCC, ESR/CRP, cultures
Cellulitis - Treatment
Antibiotics - Fluclooxacillin
Leg rest, elevation
Analgesia
If allergic to flucloxacillin what is alternative antibiotics?
Clarithromycin
Cellulitis - Complications
Necrotising fasciitis
Necrotising fasciitis - Pathophysiology
Life-threatening infection of deep fascia causing necrosis of subcutaneous tissue
Rapidly progressive
Necrotising fasciitis - Risk factors
Abdo surgery
Necrotising fasciitis - Cause
Group A haemolytic streptococcus
Polymicrobial
Necrotising fasciitis - Symptoms
Intense pain over affected area
Erythematous, necrotic and blistering skin
Fever
Tachycardia
Necrotising fasciitis - Treatment
Radical debridement
Amputation
IV antibiotics - Clarithromycin, benzylpenicillin
