Spot diagnosis Flashcards
Punched out ulcer - due to PVD - Check ABPI & treat underlying cause
Arterial leg ulcer
Wet ulcer with sloping edges over the medial malleolus - due to venous insufficiency –> compress
Venous leg ulcer
Red weals due to mast cell degranulation –> chronic/acute, spontaneous or induced –> may lead to anaphylaxis
Urticaria
Autosomal dominant mutation of the TSc-1/TSc2 gene - variable penetrance
- Mental retardation, ash leaf spots & growths - treat growths
Tuberous sclerosis
TSST-1 superantigen - s.pyogenes & s.aureus - activates 1:5 T-cells - treat for sepsis
Toxic shock syndrome
Drug reaction causing skin blistering - Can lead to skin failure - supportive treatment
Toxic Epidermal necrolysis/sjs
Fungal infection - seen under woods lamp - ketrazole
Tinea (Ringworm)
Skin cancer - red patch that grows superficially - remove
Squamous Cell Carcinoma
Pedunculated skin growth - remove or leave
Skin tag
Cradle cap - eczema in sebaceous areas - keratolytics
Seborrhoeic dermatitis
Insect infestation - itchy and easily spread permethrin cream
Scabies
Erythematous rash with pustules & rhinopyema –> skin protection & hydroquine
Rosacea
HLA-B27 - descrete red patch with silver scales
Emolients, steroids, coaltar, uvb, keratolytics
Psoriasis
Hypotension, fever, fatigue, rash
Presentations of systemic bacterial infection
Fungal infection - looks like vitiligo -
Pityriasis vesicolor
Fitzpatrick scale - UVA & B most damaging
Photosensitivity
Bullous blistering condition - seen on skin and mucous membranes - anti-desmoglinin 1 & 3 - steroids
pemphigus vulgaris
Deeper AI disease of the elderly - anti-desmoglinin 3 - steroids
Pemphigoid
Lots of little warts due to poxvirus - will clear up alone
Molluscum contagiosum, Orf and Milker’s nodule
dark lesion –> cancer –> ABCDE
Melanoma
Benign collection of melanocytes in the skin
Melanocytic naevi (moles)
Borrelia burgdorferi - targer shaped lesion
Lyme disease
Red rash with lacy top - corticosteroids
Lichen Planus and other lichenoid eruptions
Lots of brown spots - seen in paul-jheutz
Lentigines
Dermatitis in places of use - consider occupation - emollients & steroids
Irritant dermatitis
Golden crusty rash around childrens mouths - s.aureus - fusic acid
Impetigo
AI disease of hypopigmentation –> kobner effect seen
Vitilligo
Cold sore - topical aciclovir
Can infect eczema and cause an emergency
Herpes simplex virus
Eczema infected with HSV - emergency - treat with aciclovir
Eczema herpeticum
Fungal infection
Dermatophyte infection
Erythmatous, itchy rash over childs body - seen in cluster outbreaks - paracetamol & calmine lotion
Chicken pox
Reactivation of VZV - dermatomal pattern - burning rash –> blisters
Shingles
Pre-ssc lesion usually seen on the leg - cryotherapy or topical FU-5
Bowens disease
Blue birthmark seen on far eastern children - resolves age 5
Blue naevi
Most common form of skin cancer - rodent cell ulcer - pearly nodule with central ulceration & rolled edges - constant sun exposure
Basal Cell Carcinoma
Eczema linked with hayfever & asthma
Atopic Dermatitis
Pre-ssc seen on head - cryotherapy of topical 5-fu
Actinic keratosis
Pustules & comodones - p.acnes causes inflammation of sebaceous glands - treat with topical retinoids, BPO, oral contraceptives & isotretanoin
Acne
Asymmetry Boarders Colour Diameter Evolution
Evaluation of malignant melanoma
the most common sub-type resulting in the typical well-demarcated red, scaly patches affecting the extensor surfaces, sacrum and scalp
Plaque psoriasis
transient psoriatic rash frequently triggered by a streptococcal infection. Multiple red, teardrop lesions appear on the body
Guttate psoriasis
Prognostic consideration - from prickle layer –> deepest layer
Breslows thickness
Actinic keratoses are discrete, dry, rough, adherent scaly lesions that can be single or multiple and occur in sun exposed areas.
Actinic keratosis
Treatment options fo actinic keratosis
Observation, cryotherapy, Topical 5-FU, Currettage & cautery, Imiquimod, Diclofenac gel, Photodynamic therapy
Scattered discrete patches of eczema - any age or gender - topical steroids
Discoid eczema
Treatment for discoid eczema
Emollients, antibiotics, oral antihistamines, phototherapy, systemic steroids
Dermatophyte infection - flat red patch on skin - skin scrapings & anti-fungal needed
Tinea corporis
AR - nucleotide excision repair - Children must avoid the sun
Xeroderma pigmentosa
Full thickness ulcer - inflammatory (steroid treatment) - associations - IDB, Arthritis, some haemological disorders
Pyoderma gangrenosum
Mutation in porphobiligen deaminase - acute abdo pain, port wine coloured urine, Psych issues & polyneuropathy
Acute intermittent porphoria - build up of porphobilinogen and aminolevulinic acid
Alcohol, CYP450 inducing drugs, starvation
Acute intermittent porphoria triggers
Give hemin
Acute intermittent porphoria treatment
Chocolate button wart with stuck on appearance - no treatment needed - seen in older people
Basal Cell Papilloma (Seborrhoeic Wart)
S.aureus & s.pyogenes infection of deep dermis & hypodermis - diffuse erythmatous area - seen in diabetics
Cellulitis
Superficial skin infection - S.pyogenes - well demarcated erythmatous lesion
Eryspielas
Lesions on lower limbs - red brown nodules
Dermatofibroma
6+ cafe au late spots
Leich spots
Neurofibromas
Scoliosis
Neurofibromatosis type 1
acoustic neuromas (usually bilateral) in 90%
meningiomas
gliomas (including optic nerve glioma)
cutaneous neurofibromas (30%).
Neurofibromatosis type 2
Stuck on apperance
Basal cell papilloma
Pearly border, rodent ulcer
BCC - Most common
IgA rash seen on the flexure surfaces in coeliac disease
Dermatitis herpetiformis
Causes of erythema nodosum
Sarcoidosis, IBD, TB, OCP
Silver scales on extensor surfaces - Auspitz sign positive
Common plaque psoriasis - hyperkeratosis
Cauliflower apperance
Plantar warts caused by HPV - self clearing
Intense erythema on cheeks
Slapped cheek syndrome - parovirus b19
Small, umbilicated, translucent papules that look fluid-filled but are solid
Poxvirus - no treatment needed
Flaccid blisters than can be burst easily to form erythematous erosions
Pemphigus Vulgaris - anti-desmoglen 1&3 - oral involvement
Large tense bullae that are itchy and cannot be burst
Bullous Pemphigoid
Heliotrope rash and scaly knuckles (Gottorn’s papule)
Dermatomyositis - inflammation of the outer cover of muscle - perimysial layer
Fish scale skin
Ichythyosis
Velvety thickened lesions in axillae
acanthosis nigricans, Insulin resistance