Skin Flashcards
Atopic Eczema
Chronic itchy inflammatory skin condition associated with asthma and hay fever.
C: Examples of triggers include soap and detergent, animal dander, house dust mites, extreme temperatures, rough clothing, pollen, certain foods and stress.
S: Erythematous papulovesicular rash usually involving skin creases (armpit, bends of elbows, behind the knees), itching, dry skin.
D: Assess severity, look for bleeding, oozing, cracking, skin thickening, weeping, crusted.
T: Advice - wear loose cotton clothing, avoiding wool, avoiding excessive heat, keeping nails short and wearing gloves in bed. Emollients, topical steroids, if infected Topical antibiotics (flucloxacillin or erythromycin), rescue therapy - oral prednisolone, antihistamines, wet wrapping if exudative.
Contact dermatitis
A type of eczema that is precipitated by an exogenous agent which is irritant due to direct toxic effects.
C: Water, abrasives, chemicals, detergents or allergens (such as nickel and chrome).
S: Itchy erythema and skin oedema with papules, vesicles or blisters. Usually on the hands. If chronic, lichenification (skin condition caused by excessive itching) , scaling and fissuring.
D: Identify cause. Biopsy will show epidermal spongiosis.
T: Avoid trigger, hand care, emoillents, topical steroids, treat possible infection.
Psoriasis
Red, flaky, crusty patches of skin covered with silvery scales.
C: Genetic causes. Runs in families. Associated with IBS.
S: Red patches of skin covered with thick, silvery scales. Itching and burning. Dry, cracked skin that may bleed. Usually occurs on extensor surfaces (elbows and knees), trunk, flexures, sacral and natal cleft, scalp and behind the ears, and umbilicus.
D: Identify distribution, size and shape of the lesions, severity, surface features, colour and involvement of other areas.
T: Emollients, Salicylic acid, coal tar, Vitamin D analogue, Dithranol, Topical retinoids, Phototherapy and other immunosuppressant medication can be used.
Chicken Pox
A highly contagious infection that causes an itchy, spotty rash.
C: Varicella Zoster virus. Spread by being in the same room as someone with it. It’s also spread by touching clothes or bedding that has fluid from the blisters on them.
S: Develop spots on face and chest which then turn to blisters/vesicles which scab and crust. They are infectious as long as they are weeping.
May also get fever, aches and pains, feeling generally unwell, loss of appetite.
T: Reassurance and treat symptomatically with emollients, antihistamines and analgesia. Should clear up in 1-2 weeks.
Shingles
A viral infection that causes a painful rash.
C: Varicella Zoster virus lies dormant in the dorsal root ganglion. Reactivated by ageing (most patients are over 50 years old), immunosuppressive illness, or psychological or physical trauma.
S: Burning, itching or paraesthesia in one dermatome. Patch of erythematous, swollen plaques with clusters of small vesicles appears, usually with acute neuritic pain. They then crust and fall off within 3 weeks. Pain lasting longer than 30 days is Postherpetic neuralgia.
D: Clinical diagnosis - rash follows a dermatome and doesn’t cross the midline.
T: If presenting within 72 hours, Acyclovir 800mg 5xdaily for 7 days to reduce the risk of PHN. Amitriptyline can help with the pain and additional simple analgesia.
Molluscum Contagiosum
Common and harmless viral infection.
C: Caused by a pox virus called molluscum contagiosum virus. Transmission is usually by direct skin contact and has occurred in contact sports and by sharing baths, towels and gymnasium equipment.
S: Raised ‘pearly’ lesions, can be itchy. They may be single or more typically in clusters of up to 30 lesions. More extensive in immunocompromised patients. Quickly spread through families. Can last 18 months.
D: Clinical diagnosis.
T: Avoid treating unless very unsightly or immunocompromised. Can use cryotherapy but will disappear on their own. If there is evidence of secondary bacterial infection, a topical antibiotic cream may be required. An emollient or mild steroid cream (such as hydrocortisone 1%) may be helpful if there is surrounding eczema or inflammation.
Cellulitis
Cellulitis is a acute, painful and potentially serious infection of the skin.
C: The most common causative organisms are Streptococcus or Staphylococcus spp. but they can be caused by a wide range of both aerobic and anaerobic bacteria.
S: Usually unilateral, usually an obvious precipitating skin lesion, such as a traumatic wound or ulcer, erythema, pain, swelling and warmth of affected skin. Blisters and bullae may form. Patient may have fever or malaise.
D: Clinical diagnosis. Blood culture and swabs and culture of any blister fluid. CRP.
T: Rest, elevation, analgesia. First-line Flucloxacillin 500 mg four times daily. Erythromycin, clarithromycin, doxycycline can be used if allergic. Co-amoxiclav if near the eyes or nose.
Cold sores
Contagious painful lumps or blisters.
C: Herpes simplex virus (HSV), usually type 1 strain (HSV-1). The virus infects through the moist inner skin that lines the mouth. Passed on through kissing.
Illness, menstruation, stress or sunshine may trigger the reactivation of the virus.
S: Tingle or an itch before the blisters appear. The blisters contain fluid that is teeming with the herpes virus. The blisters may weep and take several days to form scabs. Cold sores can be very tender and painful.
D: Taking a sample of the blister fluid. Blood tests.
T: Choline salicylate gel or Lidocaine for painkilling gel. Aciclovir can prevent it from getting worse. Can be used as a cream or oral tablet. Photodynamic therapy.
Impetigo
Common contagious infection of the skin. Usually occurs in young children.
C: Caused by Staphylococcus aureus, Streptococcus pyogenes or MRSA. May occur alongside eczema or psoriasis.
S: Impetigo causes red sores or blisters that burst and leave crusty, golden-brown patches. They can look a bit like cornflakes stuck to your skin. Sores (non-bullous impetigo) or blisters (bullous impetigo) can start anywhere – but usually on exposed areas like your face and hands.
D: Clinical diagnosis.
T: Can clear without treatment in 2-3 weeks. Hydrogen peroxide 1% cream can be used for localised non-bullous impetigo. The crusts should be washed off with warm soapy water and then Fusidic acid cream applied for 5 days. If severe, oral flucloxacillin for seven days. Avoid passing it on to others - good hygiene, no sharing.
Urticaria
An itchy red blotchy rash resulting from swelling of the superficial part of the skin. It can be localised or more widespread.
C: Activation of mast cells in the skin, resulting in the release of histamine and other mediators. May be a trigger such as allergies, viral infections, skin contact with chemicals, nettles, latex, pressure, cold, heat.
S: Central itchy white papule or plaque due to swelling of the surface of the skin (weal or wheal). This is surrounded by an erythematous flare. May be associated with swelling of the soft tissues of the eyelids, lips and tongue.
D: Clinical diagnosis. If recurrent, FBC, CRP, allergy challenge, patch testing/prick testing, IgE tests for specific allergens.
T: Avoid overheating, stress, alcohol, caffeine and NSAIDs, ACEi. Topical anti-pruritic agents such as calamine lotion or topical menthol 1% in aqueous cream. Non-sedating H1 antihistamines such as cetirizine, ioratadine and fexofenadine. If severe, oral prednisolone 40 mg daily for seven days. Antileukotrienes (eg, montelukast) may be considered.
Pityriasis rosea
Self-limiting red ovally rash.
C: Not associated with any bacteria, virus or fungus. Certain types of human herpes viruses may be a part of the cause. It is not associated with food, medicines or stress.
S: It begins with a single red and slightly scaly area known as a “herald patch”. This is then followed, days to weeks later, by a rash of many similar but smaller round or oval lesions, mainly on the trunk and upper limbs. May also have a headache, fever, nausea, fatigue. May or may not be itchy.
D: Clinical diagnosis.
T: No treatment needed. May last 2-12 weeks. If itchy, emollients, menthol cream, antihistamines, steroid cream if severe.
Fungal nail infection
Different fungal organisms may infect the nails, with different patterns of presentation, affecting any part of the nail from the nail bed to the nail matrix and plate. Cause poor cosmetic appearance.
C: Trichophyton rubrum or Trichophyton mentagrophytes are common causative organisms. Candida albicans can cause it.
S: Nail may look thickened and discoloured (often a greeny-yellow colour). Usually painless. White or yellow patches may appear where the nail has come away from the skin under the nail. Whole nail may come away. Walking may become uncomfortable.
D: Clinical diagnosis. Nail clipping and scraping.
T: If mild and unbothersome, no treatment. If troublesome, Terbinafine tablets for 6 weeks - 6 months. Or Itraconazole tablets in a pulsed course 21 days apart. Poor success rate. Amorolfine nail lacquer is an alternative. Nail removal.
Seborrhoeic keratosis
Seborrhoeic warts (also known as seborrhoeic keratoses) are common benign, hyperkeratotic skin lesions associated with ageing.
C: Associated with age and sun exposure.
S: Flat-topped or warty-looking lesions that appear to be ‘stuck on’ to the skin. Usually pigmented. Well-circumscribed border.
D: Clinical diagnosis.
T: Reassurance. Remove where there is cosmetic dislike, repeated irritation or chafing from clothes, or diagnostic uncertainty. Remove by cryotherapy, curettage and cautery or shave excision.
Basal cell carcinoma
Most common form of skin cancer. It tends to be locally invasive but rarely metastasizes.
C: Risk factors - UV light, previous non melanoma skin cancer, family history, pale skin, large number of moles and suppressed immune system.
S: Usually occurs on the face. Usually a small pearly nodule and can necrose centrally causing a small crusted ulcer with pearly, rolled edge. May also present as red scaley plaques with pearly edges.
D: Clinical diagnosis. Biopsy.
T: Excision with primary closure, flaps and grafts: an excision margin of 4 mm around the tumour is recommended where possible. May also be treated with cryotherapy, curettage, cautery/electrodesiccation, photodynamic therapy, radiotherapy.
Squamous cell carcinoma
A non melanoma type of cancer. Occurs in areas of skin exposed areas and can metastasises.
C: Gene mutations. Risk factors - other skin cancers, actinic keratoses, outdoor occupation, fair skin and hair, smoking, ionising radiation, immunosupression.
S: Usually presents as scaly or crusty raised areas of skin with a red or inflamed base. It often ulcerates keratinised (crumbly white/yellow crusts).
Grow over weeks/months. Often painful. Usually face, lips, ears, hands, forearms and lower legs.
D: Clinical diagnosis. Biopsy.
T: Surgicial removal with 3–10 mm margin. Flap or skin graft may be needed to repair the area. Agressive cryotherapy, curettage and electrocautery may be used for small low-risk tumours.
