Skin examination Flashcards
Will erythema blanch or not?
- it will blanch
Will purpura blanch?
- no
Define confluent
- no normal background skin
What are the causes of psoriasis?
- genetic
- environmental (stress, drugs, infection)
What is the presentation of psoriasis?
- symmetrical
- well demeractated
- scaly
- erythema plaques
- extensor surfaces
What nail changes would you see in a patient with psoriasis?
- pitting
- oncholysis
- dystrophy
- subungal hyperkeratosis
What is koebner phenomenon?
- seen in psoriasis
- plaques form at sites of skin trauma
What is auspitz sign?
- removal of a plaque leaves visible tiny bleeding points
What are the co-morbidites of psoriasis?
- psoriatic arthritis
- crohn’s
- cancer
- depression
What drug treatments could be given in psoriasis?
- emolients
- steroid ointments (hydrocortisone)
- vitamin D
- Coal tar
What is acne vulgaris?
- chronic inflammatory disease of the pilosebacous unit
What is the presentation of acne vulgaris
- pilosebecaous units
- comedone
- pustules and papules
Treatment for acne
- topical benzoylperoxide
- retinoid topical
- systemic antibiotics (tetracycline)
- systemic oral retinoids (isotretinoin)
Where does rosacea affect?
- nose
- chin
- forehead
- cheeks
What is a visible difference between acne and rosacea?
- rosacea has no comedones
What is the presentation of rosacea?
- recurrent facial flushing
- rhinophyma (large nose)
Management of rosacea
- limit trigger
- tetracycline
- isotretinoin (severe)
What is the presentation of lichen planus?
- shiny
- pink, flat, plaques
Wickhams striae is associated with what?
- lichen planus
Nickolskys sign positive?
- pempigus
- superficial
Nickolskys sign negative
- pemphioid
- deeper
What investigations are done into bullous disorders?
- Skin biopsy
- direct immunofluroensnce
Difference between pemphiogoid and pemphigus
- pemphigus = superfical
- pemphigoid = deeper
Pemphigus if untreated has a high rate of mortality.
TRUE OR FALSE
- TRUE
Primary care first line treatment for acne vulgaris?
- Topical retinoid (adapalene)
- Topical antibiotic (clindamcin 1%)
- Azeaic acid 20%
Primary care 2nd line treatment for acne vulgaris?
- Oral antibiotic +/- topical retinoid
- COCP
Primary care 3rd line treatment for acne vulgaris?
- Refer to dermatology (isotretinoin - oral retinoid)
What is seen in the acute phase of eczema?
- papulovescular
- erythematous lesions
- oedema
- ooze
What is seen in the chronic phase of eczema?
- thickening of skin
- elevated plaques
- increased scalling
How can you diagnose a contact dermatitis?
- batteries of allergies patch test
Eczema hepeticum appears as what?
- monomorphic punched out lesions
Treatment of eczema?
- emollients
- avoid irritants
- topical steriods
- treat infection
What is the gene often involved in ezcema?
- flaggrin gene
What is the diagnostic criteria for eczema?
- itch
- flexure rash
- history of atopy
- dry skin
- onset before age of 2
Eczema appears like?
- illdefined erythema and scaling
- flexure distribution
What is a common side effect of eczema?
- infection
Define itch?
- poorly localised, non-adapting sensation that provokes the desire to scratch
What fibres are involved in itching?
- Unmyelinated C fibres
Where is an ‘itch’ processed?
- forebrain and hypothalamus
Define pruritis?
- itch
What are some mediators of itch
- histamine
- PGE2
- ACh
- 5HT3
- Unmyelinated C fibres
- opiates
When a mast cell degranulates what are the preformed chemicals that are released?
- proteases
- heparin
- histamine
When a mast cell degranulates what are the newly-formed chemicals that are released?
- Prostaglandin D2
- Leukotrines
What is a pruritoceptive itch
- Itch sensation due to something in the skin
What is a neuropathic itch?
- Itch sensation due to damage to CNS or PNS
What is a neurogenic itch?
- Itch sensation due to opiates released from CNS, but with no evidence of damage
What is a psychogenic itch?
- psychological causes
What are the management strategies of itch?
- Determine cause if appropriate
- treat the cause
- sedative anti-histamines
- mehtol emollients
- antidepressants
Urticaria drug reaction is what type of hypersensitivity?
- Type I
Pemphigoid and pemphigus drug reaction is what type of hypersensitivity?
- Type II
Purpura drug reaction is what type of hypersensitivity?
- Type III
Erythema drug reaction is what type of hypersensitivity?
- Type IV
What is the general presentation of a drug eruption?
- exanhematous
- urticaria
- papulosquamous
- itch
- photosensitivity
Exanthematous drug eruption appears like?
- widespread, symmetrical rash
Urticarial drug eruptions may be associated with what?
- angioedema
- anaphylaxis
Fixed drug eruptions are associated with what drugs?
- Tetracycline
- Paracetamol
- NSAIDS
What drugs may cause a phototoxic cutaneous drug reaction?
- doxyxlicline
- thiazide
- NSAIDs
What treatment can be given for actintic keratosis?
- imiquimod
Basal cell papilloma is another term for what condition?
- seborrheic keratosis
What treatment can be offered for seborrheic keratosis?
- benign so no treatment needed
- cryotherapy if troublesome
Describe the appearance of a blue naevus?
- dense
- even pigmenation
- blue black colour
- benign
A raised brown symmetrical lesion on the skin, present for several years and unchanging?
- Compound naveus
What colour is a intradermal naevus?
- Raised
- Skin colour
What is the appearance of a junctional naevi?
- flat
What type of melanoma can metastasise?
- vertical melanoma
Explain the appearance of a dermatofibroma?
- raised
- firm lesion
- fibroblast proliferation
- scar like white centre on dermoscopy
Actinic keratosis is _______ thickness dysplasia?
- partial thickness
Bowens disease is _______ thickness dysplasia?
- Full thickness
What would a haemanginoma appear like down the dermoscopy?
- deep red/purple lacunae
- blood as a global feature
Describe a macule
- change in skin colour
- flat
- less than 1cm
Describe a patch
- a macule >1cm
Describe a papule
- solid
- raised
- less than 1cm
Describe a plaque
- solid
- raised
- flat topped lesion
- greater than 1 cm
Describe a nodule
- solid
- raised
- not flat topped
- greater than 1 cm
