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Year 3: GP > Skin Conditions > Flashcards

Skin Conditions Flashcards

1
Q

How do skin infections present?

A
  • Painful red lump or bump
  • Hot, red and swollen skin
  • Sores, crusts or blister
  • Sore, red eyelids or eyes
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2
Q

How are Skin Infections managed?

A
  • Prescribe oral antibiotics for cellulitis and admit to hospital
  • Advise on preventative measure to reduce risk of recurrence
  • Identify and manage any underlying risk factors such as skin infections and leg ulcer
  • Identify and manage co-morbidities
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3
Q

How does Eczema present?

A
  • Skin becomes itchy, dry cracked, sore and red
  • Scratching can disrupt your sleep, make your skin bleed and cause secondary infections. Can lead to sleepless nights and difficulty concentrating t school or work
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4
Q

How do infections affect Eczema?

A

Infections:

  • Eczema getting a lot worse,
  • Fluid oozing from the skin, Yellow crust on the skin surface or small yellowish-white spots
  • Skin becoming swollen and sore
  • High temperature and generally feeling unwell.
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5
Q

What causes Eczema?

A
  • Irritants
  • Environmental factors or allergens
  • Food allergies
  • Certain material worn net to the skin
  • Hormonal changes
  • Skin infections
  • Hormonal changes
  • Skin Infections
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6
Q

How is Eczema managed?

A

Medications

  • Emollients
  • Mild Topical Corticosteroids
  • Topical Pimecrolimus or tacrolimus
  • Bandages or Special body suits to allow the body to heal underneath

Consider referring to hospital if the patient has serious moderate to severe eczema. Refer to immunology, dermatology or pediatrics if food allergy suspected.

Consider trigger factors or infection. Avoid the triggers such as certain fabrics, heat, soaps and detergents

Consider prescribing a one-month trial of non-sedating antihistamine if severe

Reduce damage from scratching

Dietary changes can trigger eczema symptoms.

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7
Q

How does Acne Vulgaris form?

A
  • Tiny holes in the skin known as hair follicles become blocked.
  • Sebaceous glands are tiny glands found near the surface of your skin.
  • The glands are attached to hair follicles, which are small holes in your skin that an individual hair grows out of.
  • If plugged follicle is close to the surface of the skin, it bulges outwards creating a whitehead.
  • Plugged follicle can be open to the skin, creating a blackhead
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8
Q

What are associated factor s to acne vulgaris?

A
  • Testosterone (triggered in puberty)
  • Family history
  • Periods
  • Pregnancy
  • Polycystic ovary syndrome
  • Cosmetic products
  • Certain medications
  • Wearing items that place pressure on affected area of skin
  • Smoking
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9
Q

What is the presentation of Acne Vulgaris?

A

Mild – mostly whiteheads and blackheads, with a few papules and pustules

Moderate – more widespread whiteheads and blackheads, with many papules and pustules

Severe – lots of large, painful papules, pustules, nodules or cysts; you might also have some scarring

Acne in women accompanied by Excessive body hair and Irregular or Light Periods

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10
Q

What are medication used for Acne Vulgaris?

A

Mild to Moderate acne

  • Topical retinoid,
  • Topical antibiotic
  • Azelaic Acid
  • Benzoyl Peroxide (antiseptic)

Moderate Acne not responding to topical treatment

  • Topical retinoid or benzoyl peroxide
  • Combined oral contraceptives
  • Antibiotic tablets
  • Co-cyprindiol

Refer to dermatology if they have severe variant acne, have acne with visible scarring, multiple treatments in primary care have failed

Arrange follow to review each treatment step at 8-12 weeks

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11
Q

What are some lifestyle changes advised in Acne Vulgaris?

A
  • To avoid over cleaning the skin
  • Avoid picking and squeezing spots which may increase
  • The risk of scarring
  • Treatments are effective but take time to work
  • Maintain a healthy diet
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12
Q

What can cause Psoriasis?

A

Problems with the immune system – T cells attacking the healthy skin cells by mistake

Genetics

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13
Q

What triggers Psoriasis?

A

?-Injury to your skin

  • Drinking excessive amounts of alcohol, Smoking
  • Stress
  • Hormonal changes
  • Certain medicine
  • Throat infections-
  • Immune disorders such as HIV
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14
Q

What are the presentations of Psoriasis?

A
  • Plaque Psoriasis
  • Scalp Psoriasis
  • Nail Psoriasis
  • Guttate Psoriasis
  • Inverse Psoriasis (flexural)
  • Pustular Psoriasis
  • Generalised Pustular Psoriasis
  • Palmoplantar Pustulosis
  • Acropustulosis
  • Erythrodermic Psoriasis
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15
Q

What is plaque psoriasis?

A

Dry red skin lesions covered in silver scales. Normally appear on your elbows, knees, scalp and lower back. Can be itchy, sore or both. In severe cases skin around joints may crack and bleed.

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16
Q

What is Scalp Psoriasis?

A

Red patches of skin in thick, silvery scales. Extremely itchy while other no discomfort. Can cause hair loss

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17
Q

What is Nail Psoriasis?

A

Cause nails to develop tiny pits, become discolored or grow abnormally. Can often become loose and separate from nail bed and may crumble in severe cases

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18
Q

What is Guttate Psoraisis?

A

Small drop-shaped sores on your chest, arms, legs and scalp. Lasts few weeks

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19
Q

What is Inverse Psoriasis?

A

Affects folds in your skin such as armpits, groin, between the buttocks and under the breast. Can cause large, smooth red patches

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20
Q

What is Genralised Pustular Psoriasis and Pustular Psoriasis?

A

Rarer type of psoriasis that causes pus-filled blisters to appear on your skin

Pustules develop very quickly on a wide area of skin. Pus consists of white blood cells and not a sign of infection. Reappear every few days or weeks in cycles. Can cause fever, chills, weight loss and fatigue.

21
Q

What is Palmoplantar Pustulosis?

A

Pustules appear on the palms of your hand and soles of your feet. Pustules gradually develop into circular, brown, scaly spots then peel off. May reappear few days or weeks

22
Q

What is Acropustulosis?

A

Pustules appear on your fingers and toes. Pustules burst, leaving bright red areas that may ooze or become scaly. May lead to painful nail deformities

23
Q

What is Erythrodermic Psoriasis?

A
  • Rare form of psoriasis that affects nearly all skin on the body.
  • Can cause intense itching or burning.
  • Can cause body to lose proteins and fluid leading to further problems such as infection, dehydration, heart failure, hypothermia and malnutrition.
24
Q

What are lifestyle factors to manage in Psoriasis?

A
  • Smoking cessation
  • Stopping Alcohol Consumption
  • Weight Loss
  • Assess for associated stress, distress, anxiety, and/or depression and manage appropriately
25
Q

What is the medication used to manage Psoriasis?

A
  • Topical corticosteroids for localized areas of psoriasis
  • Creams, lotions or gels are suitable for widespread psoriasis
  • Ointments are suitable for area of skin with thick scale
  • Lotions, solutions or gels are suitable for hair-bearing areas
  • Vitamin Analogues alongside steroid creams
  • Phototherapy

-Others: Coal tar, Dithranol, Calcineurin inhibitors

26
Q

What are factors to assess in the management of Psoriasis?

A

Follow-Ups: Assess for joints, Assess for Cardiovascular Disease, Review four weeks after treatment.

Asses for anxiety, depression or any associated stress

Nail Psoriasis: keep nails short, avoid manicure of the cuticle.

27
Q

What can cause Allergic rashes and urticaria?

A
  • Food
  • Pollen and Plants
  • Insect Bites and Stings
  • Chemicals
  • Latex
  • Dust Mites
  • Heat
  • Sunlight
  • Exercise
  • Water,
  • Medicines
  • Infections
  • Emotional Stress
28
Q

What is the presentation of Allergic rashes and urticaria?

A
  • Itchy
  • Stinging or Burning
  • Red Spots or patches
29
Q

How do you manage allergic rashes and urticaria?

A
  • Avoid Triggers
  • Offer non-sedating antihistamine for up to 6 weeks. If it carried on precribe antihistamine daily
  • Severe symptoms are severe so give a short course of oral corticosteroids in addition to the non-sedating oral antihistamine
  • Arrange referral to the dermatologist or immunologist for people that have painful an persistent urticaria, people who can’t be controlled, urticaria due to food or latex allergy
30
Q

How is Chronic Urticaria classified?

A

-For chronic urticaria use validated too Chronic Urticaria Quality of Life Questionnare (CU-Q2oL)

31
Q

How often does each type of skin cancer present?

A

BCC - 75%

SCC - 20%

32
Q

How does BCC present?

A
  • Usually appears as a small, shiny pink or pearly -white lump with a translucent or waxy appearance. Can also look like a red, scaly patch. Sometimes brown or blac pigment within the patch
  • Can develop to painless ulcer. Slowly gets bigger and may become crusty, bleed.
  • Does not require urgent referral and see specialist within 18 weeks
33
Q

How does SCC present?

A
  • Appears as a firm pink lump with a rough or crusted surface
  • Lot of surface scale and sometimes even spiky horn spiking up from the surface
  • Lump is often tender to touch, bleeds easily and may develop into an ulcer
  • Requires an urgent referral
34
Q

What are causes of Skin cancer?

A
  • Sunlight: Ultraviolet A, Ultraviolet B, Ultraviolet C

- Sunlamps and tanning beds

35
Q

What are risk factors for skin cancers?

A
  • Having pale skin that doesn’t tan easily
  • Have blonde or red hair
  • Having blue eyes, older age
  • Having large number of moles
  • Having a large number of freckles
  • Having an area of skin previously damage by burning or radiotherapy treatment,
  • Suppression of immune system
  • Exposure to certain chemicals such as arsenic
  • Having been previously diagnosed with skin cancer
36
Q

What do cancerous lumps tend to present as?

A

-Most cases, the cancerous lumps are red and firm and sometimes turn into ulcers

37
Q

What is referral for skin cancer based on?

A
  • Change in size
  • Irregular shape
  • Irregular colour
  • Largest diameter 7 mm or more
  • Inflammation
  • Oozing
  • Change in sensation
38
Q

What are investigations for Skin Cancer?

A
  • Biopsy

- Fine needles aspiration in some cases

39
Q

What are preventative steps for skin cancers?

A
  • Reduce chances of developing it by avoiding overexposure to UV light
  • Protect yourself from sunburn by using high factor sunscreen, dressing sensibly in the sun and limiting the amount of time you spend in the sun on the hottest part of the day
40
Q

What is Bowen’s disease?

A
  • Is a precancerous form of SCC referred to as squamous cell carcinoma in situ.
  • It develops slowly and is easily treated.
  • Although not classed as non-melanoma skin cancer, Bowen’s disease can sometimes develop into squamous cell carcinoma if left untreated.
41
Q

How does Bowen’s disease present?

A
  • Red or pink
  • Scaly or crusty
  • Flat or raised
  • Up to a few centimetres across
  • Itchy but isn’t always
  • Can appear on any area of skin.
  • Most commonly affects elderly women and often found on lower leg
42
Q

What are causes of Bower’s disease?

A
  • Long term exposure to the sun or use of sunbeds especially in people with fair skin
  • Having a weak immune system
  • Previously having radiotherapy treatment
  • HPV which often affects the genital area and can cause genital warts
43
Q

How is Bowen’s disease managed?

A
  • Cryotherapy
  • Chemotherapy cream
  • Curettage and cautery
  • Photodynamic therapy
  • Surgery
44
Q

What is Actinic Keratinosis?

A

•Commonly get on face, forearms, hands, scalp, ears and lower legs

Patches can be:

  • Red, pink, brown or skin coloured
  • Rough or scaly
  • Flat or stick out from the skin
  • Few millimeters to a few centimeters across
  • Sore or itchy
45
Q

What are signs that Actinic Keratosis developed into cancer?

A
  • Growing quickly
  • Hurting
  • Bleeding
46
Q

What causes Actinic Keratosis

A
  • Rough patches of skin caused by damage from years of sun exposure.
  • Aren’t usually serious problems and go away on their own. Chance of turning into skin cancer however
47
Q

How can Actinic Keratosis be treated?

A

Check the patches regularly and come back if they start to grow quickly, hurt or bleed. If it is serious then:

Prescription creams and gels – including 5-fluorouracil cream, imiquimod cream, diclofenac gel (this isn’t the same as the painkilling gel you can buy) and ingenol mebutate gel

Freezing the patches (cryotherapy) – this makes the patches turn into blisters and fall off after a few weeks

Scraping away the patches (curettage) with a sharp spoon-like instrument called a curette while your skin is numbed with local anaesthetic

Photodynamic therapy (PDT) – where special cream is applied to the patches and a light is shone onto them to kill the unusual cells; this usually involves using a lamp, but sometimes natural sunlight is used instead

Cutting out the patches with a scalpel while your skin is numbed with local anaesthetic

48
Q

How can Actinic Keratosis be prevented?

A
  • Protect yourself from the sun by covering your skin with clothes and a hat during the summer months
  • Apply sunscreen with a sun protection factor of at least 15 before going out in the sun
  • Try and stay inside or in the shade when the sun is at it strongest

Year 3: GP (5 decks)

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