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Pharm301 Topics > Topic 0: Dermatology > Flashcards

Topic 0: Dermatology Flashcards

1
Q

What are the functions of the skin?

A
  • protecting underlying tissues from external injury and overexposure to UV light
  • barring entry to microbes and harmful chemicals
  • acting as sensory organ for pressure, touch, temperature, pain and vibration
  • maintaining the homeostatic body temperature
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2
Q

What are the two main parts of the skin?

A

epidermis (outer but thinner layer)

dermis (inner, but thicker layer)

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3
Q

What is the hypodermis?

A

a subcutaneous layer beneath the dermis

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4
Q

What is the epidermis?

A
  • major protective layer
  • divided into 4 distinct layers
  • basal layer = active cell division.
  • new cells move up through epidermis to form outer keratinised layer
  • cell turnover is continual, lasting 35 days
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5
Q

What is the result of pathological changes in the epidermis?

A

may produce rash or lesion which abnormal scale, loss of surface integrity or changes to pigmentation

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6
Q

What is the dermis?

A
  • layer below epidermis
  • majority comprises of connective tissue, collagen for strength and elastic fibres for stretching
  • provides support, blood and nerve supply to epidermis
  • hair follicles,, sebaceous glands, sweat glands and arrector pili muscle also located here.
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7
Q

What do conditions of the skin result in?

A

elevation of the skin such as papules and nodules

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8
Q

What is the function of hair?

A

protection

  • each hair consists of a shaft, and a root.
  • the hair follicle surrounds the root
  • the base of the hair follicle is enlarged into a bulb structure
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9
Q

What is the purpose of a sebaceous gland?

A

secretes sebum into each hair follicle which lubricates it and protects it from damage

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10
Q

Where are sebaceous glands abundant?

A

they are found in large numbers on the face, chest and upper back.

These glands become large and active due to hormonal changes in puberty

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11
Q

How are sweat glands classified?

A
  • eccrine

- apocrine

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12
Q

Where are eccrine sweat glands found?

A

all over the body

-these play a role in the elimination of waste products and the maintenance of a constant core temperature.

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13
Q

Where are apocrine sweat glands found?

A

-mainly located in the axilla

these begin to function at puberty.

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14
Q

What are the sort of questions to consider when taking a dermatological history ?

A
  • WHERE did the problem FIRST appear
  • are there any OTHER symptoms?
  • What is the OCCUPATIONAL history?
  • What is the GENERAL MEDICAL history?
  • Have they been travelling?
  • Is there any family and household contact history?
  • What does the patient think might have caused the problem
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15
Q

Why is knowing where the condition first appeared important?

A
  • certain skin condtitions start in one particular location before spreading to other parts of the body e.g. impetigo usually starts on face before spreading to limbs
  • patients may want to treat the largest affected area first rather than tell you where the problem first appeared
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16
Q

What is the importance of knowing if there are any other symptoms?

A
  • generally these are itch or pain.
  • mild itch is assoc. with many skin conditions (psoriasis and medicine eruptions)
  • sever itch is associated with scabies, atopic and contact dermatitis
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17
Q

Why is occupational history relevant?

A

-for contact dermatitis, it can help to find what caused it. e.g. do symptoms improve when they are away from work?

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18
Q

What is the relevance of taking a medical history?

A

-Skin signs often the first marker of internal disease (diabetes can manifest with pruritus, fungal or bacterial infection and thyroid disease can present with hair loss and pruritus.)

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19
Q

Why is travelling relevant to skin conditions?

A

-more people are taking longer holidays and exposing themselves to tropical diseases which often manifest as skin lesions.

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20
Q

What is the relevance of family and household contact history?

A

infections like scabies can infect relatives and others whom the patient is in close contact with.

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21
Q

What is the relevance of the patient’s thoughts on the cause of the problem?

A

Can help with diagnosis or shed light on the anxieties and theories

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22
Q

what are hyperproliferative skin disorders characterised by?

A

a combination of

  • increased cell turnover rate
  • shortening of time it takes for cells to migrate from basal to outer horny layer.

typically in hyperproliferative disorders the cell turnover rate is 10x faster than normal and cell migration takes 3-4 days instead of 35

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23
Q

What is psoriasis?

A

chronic relapsing inflammatory disorder.

-characterised by a variety of morphological lesions presenting in a number of forms.

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24
Q

What is the most common form of psoriasis?

A

plaque psoriasis

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25
Q

when does psoriasis usually present?

A
  • can present any time in life
  • more prevalent in the 2nd and 6th decades
  • rare in infants, uncommon in children
  • males more likely to be affected than females
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26
Q

What is the aetiology of psoriasis?

A

exact cause remains unclear

  • inherited factors important.
  • environmental factors also needed
27
Q

where do psoriasis lesions often develop?

A

at sites of skin trauma e.g. sunburn, cuts, following streptococcal throat infection
during periods of stress

28
Q

What is the difference between a macule and a patch?

A

macule = flat lesion 1cm in diameter

29
Q

what is the difference between a papule and a nodule?

A 
papule = raised solid lesion < 1cm in diameter
nodule = raised solid lesion >1cm in diameter
30
Q

What is the difference between a vesicle and a bulla?

A

vesicle = clear fluid-filled lesion lasting a few days which is 1cm in diameter

31
Q

What is a pustule?

A

pus filled lesion lasting a few days that is <1cm in diameter

32
Q

What is a comedone?

A

A papule which is plugged with keratin and sebum

33
Q

What is a erythema?

A

redness due to dilated blood vessels that blanche when pressed.

34
Q

What is excoriation?

A

localised damage to the skin due to scratching

35
Q

What is lichenification?

A

thickening of epidermis with increased skin markings due to scratching.

36
Q

What are the two forms of psoriasis that can be managed by the community pharmacy?

A

plaque psoriasis, scap psoriasis

37
Q

What factors should be considered when performing a dermatological examination?

A

temperature
lesions
recent trauma

38
Q

Why is temperature relevant to a dermatological examination?

A
  • assessed by using the back of your fingers
  • enables you to identify generalised warmth/coolness and note temperature of any red areas
  • generalised warmth may indicate fever while local warmth might indicate inflammation/cellulitis
39
Q

Why are the distribution and feel of lesions relevant to a dermatological examination?

A

distribution: many skin diseases have a typical distribution

feel of lesions:
very few skin conditions are infectious.
If smooth: urticaria
rough: solar keratosis

40
Q

What is the relevance of recent trauma to a dermatological examination?

A

-signs that individual lesions developed on site of trauma or injury like a scratch is often seen in psoriasis and viral warts.

41
Q

What does a symmetrical lesion distribution indicate?

A

acne and psoriasis

42
Q

What does asymmetrical lesion distribution indicate?

A

contact dermatitis

43
Q

What does unilateral lesion distribution indicate?

A

shingles

44
Q

what does localised lesion distribution indicate?

A

nappy rash

45
Q

What does discrete lesion arrangement indicate?

A

this means with healthy skin in between.

indicates psoriasis

46
Q

What does coalescing (merging together) arrangement of lesions indicate?

A

eczema

47
Q

What does a group arrangement of lesions indicate?

A

insect bites

48
Q

what are the clinical features of plaque psoriasis?

A
  • salmon-pink lesions with silvery-white scales with well defined boundaries
  • lesions cn vary in size from pinpoint to extensive covering
  • if the scales on the surface of the plaque are gentlyremoved and the lesion is rubbed, pinpoint bleeding occurs from superficial dilated capillaries
49
Q

What are the clinical features of scalp psoriasis?

A
  • can be mild exhibiting slight redness of scalp
  • can also be severe with marked inflammation and thick scaling.
  • redness often extends beyonD hair margin
  • commonly seen behind the ears.
50
Q

What are the conditions to eliminate for psoriasis?

A 
pustular psoriasis
seborrhoeic psoriasis (flexural psoriasis)
guttate psoriasis
erythrodermic psoriasis
tinea corporis
lichen planus
pityriasis rosacea
51
Q

How is pustular psoriasis identified?

A
  • pustules
  • these tend to be located on the advancing edge of lesions
  • these typically occur on palms and soles
52
Q

How is seborrhoeic psoriasis identified?

A
  • classic lesions that commonly affect the scalp (which may be the only sign in mild cases)
  • less typical lesions can be found in the body folds (groins and axillae)
  • prominent itching
53
Q

How is guttate psoriasis identified?

A
  • crops of scattered small lesions <1cm covered with light flaky scales
  • affect trunk and proximal part of limbs
  • usually occurs in adolescents following a strep infection in patients genetically predisposed
  • usually self limiting.
54
Q

How is erythrodermic psoriasis identified?

A
  • extensive erythema showing very few classic lesions
  • serious condition which can be life threatening
  • systemic symptoms (severe) include fever, joint pain, diarrhoea.
55
Q

How is tinea corporis identified?

A
  • superficially looks like plaque psoriasis
  • does not involve face, hands, feet, groin or scalp.
  • itchy pink or red scaly patches with well defined inflammed border
  • lesions can appear polycyclic
  • big red circular lesions
56
Q

How is Lichen planus identified?

A
  • very uncommon condition
  • lesions similar to plaque psoriasis but are usually itchy and located on inner surfaces of wrists, shins (atypical for psoriasis)
  • oral mucous membranes normally affected with white, slightly raised lesions like a spider’s web
  • patient will not have a family history of psoriasis
57
Q

How is pityriasis rosacea identified?

A

red scaling mainly on trunk,

  • can also occur on thighs and upper arms
  • herald disc lesion, single scaly lesion is apparent
  • commonly misdiagnosed as ringworm
  • followed by extensive rash one week later.
  • commonly affects young adults
  • acute onset and patient can usually identify the initial herald lesion
58
Q

what medicines trigger or aggravate psoriasis?

A 
lithium
beta blockers
hydroxychlroquine
terbinafine
withdrawal from steroids
59
Q

What conditions are there to eliminate for sclap psoriasis?

A 
seborrhoeic dermatitis
tinea capitis (fungal infection of the sclap)
60
Q

How is seborrhoeic dermatitis indentified?

A

mild scalp psoriasis is very hard to differentiate from seborrhoeic dermatitis
but treatment is both non prescription shampoos can be used in mild-mod cases,
with scalp involvement, zinc pyrithione or ciclopriox olamine can be tried
selenium and ketoconazole for resistant/moderate disease.
antifungals and corticosteroids for face and torso involvement. to be referred

61
Q

How is tinea capitis identified?

A

uncommon infection

-patient may have scaling skin, broken hairs and patch of alopecia

62
Q

What are the trigger points for referring psoriasis?

A
  • extensive lesions, lesions which follow recent infection or cause mod-severe itching
  • patients with psoriatic-type lesions with no family history or past personal history of psoriasis
  • pustular psoriatic lesions
63
Q

Who should non prescription remedies for psoriasis be limited to?

A

patients with mild-moderate plaque psoriasis and scalp psoriasis

Pharm301 Topics (8 decks)

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