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Dermatology Diploma > Skin Problems in Pigmented Skin > Flashcards

Skin Problems in Pigmented Skin Flashcards

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1
Q

What is the cause of PIH?

A

Increase melanin in the dermis and epidermis.

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2
Q

What sort of dermatoses are particularly susceptible to PIH?

A

Dermatoses with both dermal and epidermal changes.

  • Lichen planus
  • Lupus erythematosus
  • Fixed drug eruption
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3
Q

If the pigmentation is mainly epidermal, how long can it take to resolve?

A

6 months

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4
Q

What can help PIH resolve quicker?

A

Bleaching agents like Hydroquinone

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5
Q

What is essential in PIH?

A

To use daily sunscreen

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6
Q

Dermal PIH is resistant and can last for long periods of time. What can help it?

A

Laser therpay

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7
Q

What types of scars are more prominent in coloured skin types?

A

Keloid scarring

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8
Q

If you do decide to excise a keloid scar, what can you do?

A

Inject it with triamcinolone

  • This can help to reduce the chance of recurrence - though the chance is still high.
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9
Q

What is a more favourable approach to keloid scars than excision?

A
  • Triamcinolone and cryotherapy
  • Shave excision and hyfrecation.
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10
Q

What is this?

A

Acne keloidis nuchae

  • Keloidal bands with scarring alopecia.
  • If chronic, pustules and subcutaneous abscesses with sinuses can form.
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11
Q

What is this?

A

Pseudofolliculitis barbae

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12
Q

What is the treatment for pseudofoliculitis barbae?

A
  • 6 months of anti-inflammatory antibiotic (e.g. minocycline) for 6 months.
  • Stop shaving for 3 to 6 months.
    • Keep the hair 5mm long with clippers.
    • Look for ingrown hairs daily and remove with sterile needles.
    • Warm compress and mild steroids are useful.
  • Shaving
    • Do not pull the skin
    • Do not shave against the direction of growth.
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13
Q

Does Acne keloidis nuchae cause scarring or non-scarring alopecia?

A

Scarring

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14
Q

Where is the most common place for vitiligo to appear?

A
  • Perioral region
  • Dorsa of the hands
  • Feet
  • Elbows
  • Ankles.
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15
Q

What is the pathophysiology of vitiligo?

A

The exact pathogenesis is uncertain.

  • Can be familial.
  • Positive association with HLA type DR4
  • Negative association with HLA type DR3.
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16
Q

What is vitiligo associated with?

A

Vitiligo is associated with autoimmune endocrinopathies:

  • Thyroid disease
  • Pernicious anaemia
  • Addison’s disease.
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17
Q

What is the treatment for vitiligo?

A
  • Localized:
    • Potent topical steroids (e.g betamethasone) for local areas.
    • If no improvement after 2 months then discontinued.
  • Generalized
    • Narrow band UVB - use for 1 year.
    • Pigmentation may recur when discontinued.
    • If considering, specialist review is essential.
    • Hydroquinone (monobenzyl ether of hydroquinone).
      • Induces irreversible bleaching of the normal skin.
  • The depigmented skin of vitiligo is susceptible to sunburn and a sunscreen should be used.
18
Q

What is this?

A

Melasma

19
Q

What gender is melasma more common in?

A

Women

20
Q

What ethnicity is Melasma more common in?

A

Hispanic and Asian

21
Q

What factors can contribute to melasma formation?

A
  • Genetic Predisposition
  • UV light
  • COCP use
  • Pregnancy
22
Q

What other pigmentation conditions can be mistook for melasma?

A
  • Drug-Induced pigmentation
  • PIH
  • Acitinic lichen planus
  • External ochronosis
23
Q

What is the treatment for melasma?

A
  • Sun protection
  • Stop hormonal therapies - COCP and HRT.
  • Hydroquinone
  • Tretinoin - takes 6 months.
  • Azelaic acid
  • Kligman’s solution
  • Chemical peels - glycolic acid.
24
Q

What is Kligmann’s Solution made of?

How do you advise someone to take it?

A
  • (Hydroquinone, topical tretinoin and 1% hydrocortisone)
  • Apply to small areas for 20 minutes at a time intially.
  • Then build up to keep on overnight and wash off in the AM.
  • it can burn the skin so warn patients.
25
Q

What is this?

A

Dermatosis Papulosa Nigra

26
Q

When do they first appear?

A

In Puberty (increase in number over time)

27
Q

What is the treatment?

A

Consider Snip Excision or hyfrectation

Be mindful of cosmetic outcomes - they can be worse than the lesions themselves.

28
Q

What are the 3 major types of primary cutaneous amyloidosis?

A
  • Macular
  • Lichen
  • Nodular.

(Note: Macular & Lichen are more common in skin types 3 and 4)

29
Q

Amyloidosis - is the abnormal extracelluarl deposition of amyloid.

How do you divide it?

A
  • Systemic
  • Localised (Primary Cutaneous forms)
30
Q

What is this?

Where does it most commonly occur?

What symptoms come with it?

A

Macular amyloidosis

Upper back.

Pruritus

31
Q

What is this?

How does it usually present?

A

Lichen Amyloidosis

Persistent pruritic plaques

32
Q

What is this?

How does it usually appear?

A

Nodular amyloidosis

A waxy infiltration that usually appears on the trunk.

33
Q

What are the two types of lichen planus that are more relavant to the physician treating pigmented skin?

A
  • Hypertrophic lichen planus
  • Acitinic Lichen planus
34
Q

What is this?

How does it appear different in patients of colour?

A

Hypertrophic Lichen Planus

Black flat-topped papules

35
Q

What countries more commonly get hypertrophic lichen planus?

A

Southern india and Sri Lanka

36
Q

What is this?

What causes it?

Who gets it?

What are the 3 clinical presentations?

A

Acitinic Lichen Planus (This is the Annular type)

Sun Exposure

Children and young adults - more common in middle eastern

  1. Annular
  2. Dyschromic
  3. Pigmented
37
Q

What is the most common form of lichen planus?

A
  • Annular type
  • Brownish plaques with an annular configuration most commonly affecting the lateral aspects of the forehead, dorsum of the hands, forearms, lower lip, cheeks, and the V shaped area of the neck.
  • Annular lesion develops hypopigmentation centrally and some subtle atrophy.
  • Dark skinned individuals.
  • Women are affected more than men
  • Younger age of onset than classic lichen planus.
38
Q

What skin serology is annular lichen planus associated with?

A

None

39
Q

What is the treatment for lichen planus?

A
  • Avoidance of precipitant factors -scratching or UV.
  • Sunscreen.
  • Topical steroids +/- occlusion or intralesional steroids.
  • Systemic steroids if severe or rapid progression.
  • Systemic retinoids have been used successfully in widespread lichen planus as well as cyclosporin, dapsone, and antimalarials.
  • Actinic lichen respond to systemic anti malarials.
  • Hypertrophic lichen planus = intralesional steroids and topical steroids under occlusion.
    • We find that a potent steroid combined with 5 or 10% Salicylic acid is particularly effective put on twice a day for a period of at least 3 to 6 weeks.
  • Phototherapy can be used to treat most cutaneous forms of lichen planus apart from actinic lichen planus.
40
Q

What is this?

A

Eczema

It patients of colour it usually presents with a follicular pattern

41
Q

What is this?

A

Pityriasis alba – hypopigmented patches on the face.

Occurs in white patients but less obvious.

More common in children

Associated with atopic dermatitis.

42
Q
A

Dermatology Diploma (39 decks)

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