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4th yr- CMS- Medicine > Skin disease > Flashcards

Skin disease Flashcards

1
Q

What system is the skin a part of

A

Th integumentary system

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2
Q

Name the largest organ in the body

A

skin

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3
Q

What are appendages

A

Hair and nails

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4
Q

What are the functions of normal skin

A
  1. Flexible mechanical barrier
  2. Temperature control
  3. Immune functions
  4. Protection versus UV light
  5. Vitamin D metabolism
  6. Nerve endings
  7. Aesthetics
  8. Absorption
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5
Q

What do we mean by the skin acting as a barrier

A
  1. It prevents entry of infectious agents
  2. Controls loss of fluid from the body
  3. Waterproofing
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6
Q

How do the skin control temperature

A
  1. Blood vessels
  2. Sweet glands
  3. Hairs
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7
Q

How do blood vessels help control temperature

A

Vasodilation and vasoconstriction changes temperature

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8
Q

How does har on the skin help control temperature

A

pilirection holds a layer of air next to the skin raising the body temp

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9
Q

Name the cell that helps protect us from UV

A

Melanocytes

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10
Q

What do melanocytes do

A

They secrete melanin which protects us from UV damage

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11
Q

What do nerve endings in the skin detect

A
  1. Heat
  2. Cold
  3. Vibration
  4. Denture touch
  5. Deep pressure
  6. Pain
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12
Q

Name the different layers of the skin

A
  1. Epidermis

2. Dermis

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13
Q

What is the epidermis

A

A waterproofing and barrier to infection

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14
Q

How many layers make up the epidermis

A

5 Layers

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15
Q

What is the dermis

A

It is where the appendages to the skin are found

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16
Q

Name the 5 laters of the epidermis starting with the outermost layer

A
  1. Stratum corneum
  2. Stratum lucidum
  3. Stratum granulosum
  4. Stratum Spinosum
  5. Stratum basale
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17
Q

What is found under the dermis?

A

Hypodermis

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18
Q

what is the hypodermis

A

A subcutaneous adipose tissue that acts as an attachment to underlying structures

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19
Q

Name the cells found in the skin

A
  1. Basal Keratinocytes

2. Melanocytes

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20
Q

Where are Basal Keratinocytes found

A

In the stratum basale layer

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21
Q

What happens in the stratum basale layer

A

It is the main site for the generation of new keratinocytes

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22
Q

What are keratinocytes

A

Stem cells

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23
Q

What is the function of keratinocytes

A

Keratinocytes needed to replace those lost from the skin surface and for wound healing

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24
Q

What are melanocytes derived from

A

Neural crest

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25
Q

What does melanin determine

A

Skin colour

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26
Q

What is melanin synthesis promoted by

A

Oestrogen, pituitary hormones

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27
Q

What is found in the Stratum Spinosum layer

A

Maturing keratinocytes and langerhans cells

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28
Q

What is found in the Stratum Granulosum later

A

Keratinocytes that become increasingly fun of keratins and other proteins as they undergo programmed cell death

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29
Q

Describe the Stratum Lucidum later

A

It is a thin layer of dead skin cells

Composed of 3-5 layers of dead flattened keratinocytes

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30
Q

What is found in the Stratum Corneum later

A

Dead cells, keratin and waterproofing substances

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31
Q

Describe the dermis layer

A

It is less cellular than the epidermis

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32
Q

What does the dermis play an important role in

A

Important in

  1. Support
  2. Strength
  3. Elasticity
  4. Vascular supply
  5. Nerves
  6. Sweat glands
  7. Sebaceous glands
  8. Hair
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33
Q

Name some normal skin lesions

A
  1. Freckles

2. Moles

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34
Q

What is another term for freckles

A

Ephelis

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35
Q

Describe freckles

A

Small flat brown marks arising on the face and other sun exposed sites

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36
Q

What is another term for moles

A

Melanotic macule or menaocytic naevus

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37
Q

What are moles

A

They are benign proliferating melanocytes

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38
Q

Describe how a mole may look

A

Can vary in tone from pink to black

The number of moles is determined by genetics and degree of sun exposure

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39
Q

Name some different types of naevi

A
  1. Junctional Naevi
  2. Compound naevus
  3. Intradermal naevus
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40
Q

Describe where junctional naevi

A

Early naevus cells form nests on the junction between the epidermis and the dermis

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41
Q

How do junctional naevi look

A

These moles are flat and colourful

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42
Q

Describe where compound naevi

A

Nest of naevus cells formed in the dermis

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43
Q

Describe where intradermal naevi

A

These are contained within the dermis only

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44
Q

How do intradermal naevi look

A

They are thickens and protrude from the skin surface

They may not be pigmented

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45
Q

How do we classify skin types

A

The Fitzpatrick scale

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46
Q

How do we use the Fitzpatrick scale to classify skin types

A

I- VI

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47
Q

Describe skin type I

A

Always burns
Never tans
Light, pale white

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48
Q

Describe skin type II

A

Usually burns
Sometimes tans
White, fair appearance

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49
Q

Describe skin type III

A

Sometimes mildly burns
Usually tans
Medium, white to love appearance

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50
Q

Describe skin type IV

A

Rarely burns
Always tans
Olive, moderate brown appearance

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51
Q

Describe skin type V

A

Very rarely burns
Tans with ease
Moderate constitutional pigmentation
Brown, dark brown appearance

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52
Q

Describe skin type VI

A

Never burns
Tans very easily
Marked constitutional pigmentation
Very dark brown, black in appearance

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53
Q

Give some signs of sun damage

A

Sun burn

Tan

54
Q

What is photoaging

A

UVA radiation damage due to excessive sun exposure

55
Q

Give some sighs of photoaging

A
  1. Winkles
  2. Dry rough leathery skin
  3. Freckles
  4. Discolouration
56
Q

What is solar lentigo

A

Large flat brown spots on the face and hand arising in middle age as a result of sun damage

57
Q

What Is solar lentigo also known as

A

Age spots or liver spots

58
Q

What can increase skin caner risk

A

UVA and UVB radiation from the sun

59
Q

How can UVA and UVB increase risk of skin cancer

A

UV induces DNA damage

60
Q

List some sun protective practices

A
  1. Avoid sun in tree hottest times of the day
  2. Cover up with suitable clothing
  3. Consider wearing sun protective clothing
  4. Use SPF
  5. Avoid tanning beds and lamps
61
Q

What is actinic chelitis

A

Is a lesion on the external parts of the lip skin

62
Q

In whom is actinic/ solar keratosis common in

A

Fair skinned older individuals

63
Q

Where is actinic/ solar keratosis seen

A

Face, scalp if bald and arms or hands

64
Q

What are some symptoms of actinic/ solar keratosis

A

Asymptomatic
Mild irritation
Awareness of changes to skin appearance and texture

65
Q

What are the signs of actinic/ solar keratosis

A

Single or raised maculae or papules which vary in colour form pink to yellow-black with rough scaly surface
Around 1-3mm in diameter and up to 4cm wide

66
Q

What medicaments can be used to help manage actinic/ solar keratosis

A
  1. 5 FU (Fluorouracil) cream fro 2-4 weeks
  2. 10% trichloroacetic acid for widespread lesions
  3. Systemic acitretin or isotretinoin to reduce number of lesion
  4. Diclofenac cream
67
Q

Name the different types of skin cancer

A
  1. Primary malignancies

2. Secondary malignancies

68
Q

Give examples of primary malignancies

A
  1. Malignant melanoma

2. Non melanoma skin cancers

69
Q

What do non melanoma skin cancers include

A
  1. Basal cell carcinomas
  2. Squamous cell carcinomas
  3. Appendage and epidermal tumours
  4. Dermal and subcutaneous tumours
70
Q

What are malignant melanomas

A

Cancers of the cutaneous melanocytes

71
Q

What is the lifetime risk of a man getting malignant melanoma

72
Q

What is the lifetime risk of a woman getting malignant melanoma

73
Q

What are the risk factors for melanoma

A
  1. UV light exposure
  2. Skin types which do not tan but burn easily (scale I-III)
  3. Red or blond hair
  4. Pale eye colour
74
Q

Name the 5 main types of malignant melanomas

A
  1. Superficial spreading
  2. Nodular
  3. Lentigo maligna
  4. Acral lentigines
  5. Amelanotic melanoma
75
Q

Name some high risk patients for malignant melanomas

A
  1. Those with more than 100 normal naevi
  2. More than 5 atypical naevi
  3. Patients with changing moles
  4. Patients with 2 or more cases of melanoma in first degree relative
  5. Age over 65
76
Q

Describe superficial spreading malignant melanoma

A
  1. Most common in middle aged patients
  2. Mostly >7mm at diameter
  3. Slow growth initially - Grow horizontally before invade deep tissues
77
Q

Describe nodular malignant melanomas

A
  1. More rapidly growing and tend to invade from start
  2. Sun exposed areas affected eg back and chest
  3. Very dark brown or black in colour
  4. Common in middle aged patients
78
Q

Descrive lentigo maligna

A
  1. Most common in aged over 60s
  2. Most common on the face
  3. Develop in a pre-existing pigmented macule
  4. Growth is slow and metastasis only after many years
  5. Is an aggressive cancer
79
Q

Describe Acral lentigines

A
  1. Rarest type
  2. more common in feet than hands
  3. Occur in al skin types and ethnicities
  4. Most common melanoma in dark skinned peoples
  5. Thought to be unrelated to sun exposure
80
Q

What secondary prevention should we implement for high risk melanoma patients

A

High risk patients should be referred to a dermatologist for surveillance of moles and self examination o help pick up changes in skin early

81
Q

List some concerning factors we should monitor on skin lesions

A

lesion is:

  1. Getting bigger
  2. Changing shape
  3. Edges becoming irregular
  4. Changing colour
  5. Itching or in pain
  6. Bleeding or crusting
  7. Inflammation locally
  8. Nail lesions
82
Q

What mnemonic do we use to assess pigmentation of a skin lesion

83
Q

What is the ABCDE of pigmentation assessment

A 
Asymmetry 
Border
Colour variation 
Diameter 
Evolutionary change
84
Q

What needs an URGANT referral

A
  1. New moles which are growing quickly if patient is over the age of puberty
  2. Any mole which has 3+ colours and lost its symmetry
  3. Any new moles which is growing and is pigmented or vascular in appearance
  4. New pigmentation line under nail
  5. Something growing under a nail
85
Q

Describe a lesion that has a favourable prognosis

A
  1. Shallow lesions have a more favourable prognosis

2. Superficial lesions with lymph node involvement

86
Q

How do we manage melanomas

A
  1. Excisional biopsy

2. Adjunctive therapies eg chemotherapym immunotherapy, radiotherapy

87
Q

What is the survival rate of melanomas

88
Q

What is seborrhoeic keratosis

A

A very common condition characterised by brown senile warts

Not related sun exposure

89
Q

What is seborrhoeic keratosis also called

A

Basal cell papillomas

90
Q

Describe the skin lesions found in seborrhoeic keratosis

A

Greasy brown stuck on appearance

They tend to get more wrinkled with time and become darker with age

91
Q

What are basal cell carcinomas

A

Rodent ulcers neloebed to arise from undifferentiated basal keratinocytes

92
Q

Who is most at risk of basal cell carcinomas

A

Fair skinned people

Older people

93
Q

What are the risk factors of basal cell carcinomas

A
  1. UV sun exposure
  2. Ionising radiation
  3. Arsenic ingestion
  4. Hereditary genetic predisposition
94
Q

Where are basal cell carcinoma lesions found

A

Primarily found on sun exposed body parts

95
Q

What are the different classifications of basal cell carcinoma lesions

A
  1. Nodular
  2. Superficial
  3. Morpheaform
96
Q

Name the most normal category of basal cell carcinomas

97
Q

Describe nodular basal cell carcinomas

A
  1. Head and neck affected
  2. Small translucent pearly white lesion
  3. Telangiectasia superficially
  4. Enlarging causses central ulcerations with rolled border and a crusted top
98
Q

Describe superficial basal cell carcinomas

A
  1. Pink scalp plaque
  2. Difficult to discern from other diagnosis
  3. Responsive to topical chemotherapy
99
Q

What is Morpheaform basal cell carcinoma also called

A

sclerosing or infiltrative basal cell carcinoma

100
Q

Describe Morpheaform basal cell carcinoma

A
  1. Slowly expanding, white, scar like plaque with poorly defined edges
  2. similar appearance to scleroderma
  3. may be more extensive than it initially appears
  4. tend to be aggressive with peripheral spread
101
Q

How do we manage basal cell carcinoma

A
  1. Sun protection
  2. Local tumour destruction or removal
  3. Local ones are easier to treat
102
Q

What is squamous cell carcinomas

A

It is an uncommon cancer of keratinocytes

103
Q

Describe the growth of squamous cell carcinomas

A

Locally destructive and can grow rapidly and will metastasise if ignored

104
Q

What are the risk factors of squamous cell carcinomas

A
  1. UV Light
  2. Chronic ulcerations and scarring
  3. Ionising radiation
  4. Arsenic ingestion
  5. industrial chemicals
  6. Immunosuppression
  7. HPV infections
105
Q

What are the clinical features of squamous cell carcinomas

A
  1. Evolving behaviour starting as a small crusted nodule or plaque
  2. Becomes more nodular and indurated.
  3. Ultimately ulcerated
  4. Affects sun exposed skin
106
Q

How do we manage squamous cell carcinomas

A
  1. Sun protection
  2. Surgical excision
  3. Radiotherapy
  4. Topical chemotherapy or immunotherapy
  5. Very early lesions can be treated with local destructive methods
107
Q

Name a skin diseases other than cancer

A

Dermatitis

108
Q

What is another term for dermatitis

109
Q

How common is dermatitis

A

Very common: up to 20% of children affected and 10% adults

110
Q

What are the clinical features of dermatitis

A
  1. Itchy
  2. Hot red skin
  3. Oedema in acute condition
  4. Oozing and weeping of tissue fluid
  5. Crusting in the acute phase
  6. Fissuring and scaling in the chronic phase
  7. Excoriation due to itching
  8. Secondary infection
  9. Impairment of thermoregulation
111
Q

Name the types of dermatitis

A
  1. Endogenous dermatiti s

2. Exogenous dermatitis

112
Q

What is endogenous dermatitis

A

Dermatitis caused from within mainly manifests in childhood

113
Q

Give examples of endogenous dermatitis

A
  1. Atopic dermatitis

2. Seborrhoeic dermatitis

114
Q

What are the features of atopic dermatitis

A
  1. Asthma
  2. Allergic conjunctivitis
  3. Rhinitis
  4. Urticaria
115
Q

What is the pathogenesis of atopic dermatitis

A

Multifactorial:

  1. Genetic predisposition
  2. Abnormality of lipid glue in the building blocks of the skin
  3. Abnormal response to allergen with chronically high IgE levels
116
Q

What is the prevalence of atopic dermatitis

A

10-20% in children

1=3% in adults

117
Q

What is Seborrhoeic dermatitis also known as

A

Cradle cap

118
Q

How common Is Seborrhoeic dermatitis

A

affects 3-5% of the population

119
Q

Which area in the body is affected by Seborrhoeic dermatitis

A

Areas rich in sebum eg face, scalp and anterior chest

120
Q

What is Seborrhoeic dermatitis caused by

A

It is usually an inappropriate immune response to skin commensalism

121
Q

What are the clinical features of Seborrhoeic dermatitis

A

Red scale patches with flaking

122
Q

Give examples of exogenous dermatitis

A
  1. Primary irritant

2. Allergic contact

123
Q

What is primary irritant dermatitis

A

An acute or chronic exposure to an irritant source eg soap detergent, solvents

124
Q

What is allergic contact dermatitis

A

A type IV hypersensitive reaction to nickel, colophony, many perfumes

125
Q

How can we diagnose type IV hypersensitivity allergic contact dermatitis

A

Skin patch testing

126
Q

How do we diagnose dermatitis

A
  1. History
  2. Examination
  3. Skin patch testing
127
Q

What can happen to a person with dermatitis

A

That area can get infected

128
Q

What can dermatitis areas be infected by

A
  1. S aureus

2. HSV1 or 2

129
Q

How do we manage dermatitis

A
  1. Patient education to avoid problematic habits
  2. Emollients are key eg lotions, creams, ointments
  3. Corticosteroids to reduce inflammation
  4. Wet wraps
  5. Occlusion therapy
  6. Antimicrobials
  7. PUVA phototherapy
  8. immunomodulatory drugs
130
Q

List some problematic habits bit dermatitis patents

A
  1. Compulsive Handwashing

2. Use of irritants

4th yr- CMS- Medicine (14 decks)

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