Skin Flashcards by Faheem Saeed

Acne vulgaris - Pathophysiology

Inflammatory disease of pilosebaceous follicles

Hormonal - increased androgen sensitivity

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Acne vulgaris - Complications

Scars
Psychological/social
Erythematous/pigmented macules

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Acne vulgaris - Treatment

Avoid over washing
Don't pick
Diet
Topical retinoid and benzoyl peroxide
Topical antibiotics (clindamycin)
Oral antibiotics (doxycycline)
Oral retinoid

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General eczema - Pathophysioogy

Chronic, relapsing and remitting, inflammatory condition

Vesicles and bullae cause red scaly patches

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General eczema - 2 Types

Endogenous - Atopic eczema (early childhood)

Exogenous - Contact dermatitis

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Atopic eczema - Cause

Family history of atopy

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Atopic eczema - Exacerbating factors

Infection
Strong detergents
Cats/dogs
Stress

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Atopic eczema - Investigation

Serum IgE
Skin-prick test
RAST (Specific IgE)

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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)

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Atopic eczema - Complications

Secondary bacterial/viral infection

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Psoriasis - Pathophysiology

Chronic, inflammatory skin condition occurring due to hyperproliferation of keratinocytes
Chronic plaque

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Psoriasis - Causes

Genetic

Environmental

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Psoriasis - Exacerbating factors

Trauma
Infection 
Drugs
Stress
Alcohol

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Psoriasis - Symptoms

Red, scaly plaques
Itchy
Painful 
Nail changes
Lower back, scalp, elbows, knees (extensor areas)

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Psoriasis - Treatment

Avoid irritants
Use emmolients
1st line - Topical therapy (corticosteroids)
2nd line - Phototherapy, methotrexate
3rd line - Biological agents - TNF - alpha inhibitors

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Venous ulcer - Pathophysiology

Venous disease involving varicose veins, DVT

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Venous ulcer - Symptoms

Large, shallow, irregular
Exudative and granulating
Medial malleolus to knee
Painful, worse standing 
Normal pulses

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Venous ulcer - Treatment

Compression bandaging

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What does ABPI stand for?

Ankle brachial pressure index

Arterial insufficiency = <0.8

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Arterial ulcer - Pathophysiology

Atherosclerosis

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Arterial ulcer - Symptoms

Small, defined, deep
Necrotic base
Very painful at night
Pressure sites
Absent peripheral pulses

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Arterial ulcer - Investigations

ABPI (<0.8 = arterial insufficiency)
Doppler
Angiography

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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