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MD2 FT > W8L6: Introduction to Dermatology and Skin Infections > Flashcards

W8L6: Introduction to Dermatology and Skin Infections Flashcards

1
Q

What are the key questions on history for someone with a rash (besides usual SQSTCARA)?

A

When/ in what context did it begin?

Where did it begin?
How has it evolved?-> Where did it start, where has it gone and how else has it changed?

Ass F: Pain (red flag), itch, bleeding

Ever happened before?

Have you come into contact with any new substances?

Have you commenced any new medications including OTC, herbs, immunisations.

Has anyone else around you had a similar rash?

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2
Q

What are the key other symptoms that may acompany a rash that you need to ask about?

A 
– Shortnessof breath
– Tongueswelling
– Joint pain
– Fever, sweats
– New lumps or bumps
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3
Q

What are you worried about with presentation of a PAINFUL skin lesion?

A

SSC

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4
Q

What is erythema due to?

A

Vasodilation

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5
Q

What is the significance of non-blanching erythema?

A

RBs have extravasated into the skin (pushing onto skin should constrict the vessels and blanch the area)

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6
Q

What are the things you are worried about if erythema cover more than 90% of the body?

A

Shock, heat loss, protein and water loss (similar to a burn)

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7
Q

What is scale due to?

A

Abnormal accumulation of keratin in the epidermis.

Can be due to overproduction or not shedding enough.

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8
Q

What causes psoriasis?

A

Overproduction of keratin

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9
Q

What is the presentation of asteatotic eczema and what is this due to?

A

Scaly skin–> retain top layers of epidermis inappropriately, and they don’t stick together properly.

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10
Q

What is a macule? + 2egs

A

flat lesion of skin that has hyper or hypo-pigmentation. Impalpable.

eg: freckles, vitiligo

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11
Q

What is a papule?+2 egs

A

Elevated (palpable
lesion), <5mm

eg: keratosis pilaris, pimple without a heard (ie prior to filling with neutrophils)

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12
Q

What is a nodule?

A

Elevated (palpable

lesion),>5mm“Lump”

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13
Q

What is the presentation of a basal cell carcinoma?

A

“pearly” coloured, vascular, ulcerated

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14
Q

Which skin cancers can become hyperkeratotic?

A

SCC

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15
Q

What is a cyst?

A

Cystisnodulethathas fluid within - fluctuant

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16
Q

What height of a raised nodule indicate?

A

More height= invaded lower down into dermis

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17
Q

What is a plaque? +1eg

A 
Plaque
– Circumscribed, elevated
area of skin
– Broadness is greater than thickness
eg: Psoriasis
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18
Q

What is a wheal? What does it indicate?

A

– Area of localised oedema and erythema of skin. Indicates dermal change (rather than epidermal)

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19
Q

What is a vesicle?

+2egs

A

Fluid-filled blister of the epidermis

eg: Herpes zoster (shingles), herpes simplex (cold sore)

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20
Q

What is a bullae

A

Blister >5cm that extends deeper than the epidermis

eg: bullous pemphigoid, an autoimmune condition that causes separation of the dermis and epidermis.

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21
Q

What is a pustule?

A

– A vesicle or bulla
containing pus
– Pus may be sterile

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22
Q

What is an example of infective pustules and an example of sterile pustules?

A

Infective folliculitis (Staph. Aureus)

Pustular psoriasis (Sterile pustules)

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23
Q

What is an erosion? 1eg

A

– A superficial loss of
epidermis
– Does not scar

eg: impetigo (S. aureus)

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24
Q

What is an ulcer? 2egs

A

– An area of tissue loss
through dermis
– Forms scars

eg: from pyoderma gangrenosum, or caused by advanced breast cancer

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25
What is a crust? +2egs
– Scab=dried exudate from an erosion or ulcer eg: in the context ofecsema and impetigo
26
What is Telangiectasia? +1eg
– Dilated blood vessels – Often the result of rosacea and sun-damage eg: due to rosacea
27
What are petechiae?
– Pinpoint bleeding into dermis or mucosae – Does not blanch -indicated damaged capillaries
28
What can cause petechiae is the face/ eyelids
Too much coughing
29
What is a purpura? +1eg
– Discolouration of skin or mucous membranes due to bleeding from small vessels, non-blanching - eg a venule with immune complexes which causes blood leeching into the skin--> meningococcaemia
30
What is alopecia? +3egs
- focal hair loss * Alopecia areata is commonest cause of hair loss – autoimmune in nature (1% of population) * Tinea capitis (fungal infection that damages the hair follicle) * Discoid lupus causes cutaneous scarring
31
What is sclerosis?
– Hardening of the subcutaneous tissue, dermis
32
What is lipodermatosclerosis? Which populations develop this?
Lipodermatosclerosis refers to a skin change of the lower legs that often occurs in patients who have venous insufficiency. It is a type of panniculitis (inflammation of subcutaneous fat). Two-thirds of affected patients are obese. Affected legs typically have the following characteristics: ``` Skin induration (hardening) Increased pigmentation Swelling Redness “Inverted champagne bottle” or “bowling pin” appearance ```
33
What is skin atrophy? What is a common cause?
Thinning of the epidermis. A common cause is topical steroid use.
34
Which is more common on flexor surfaces- psoriasis or eczema?
Eczema
35
Which is more common on extensor surfaces: Psoriasis or eczema?
Psoriasis
36
What are the 10 dermatological red flags?
• Skin pain • Blisters or pustules– esp if widespread * “Punched out” lesions * Mucosal involvement * Rapid change in any presentation * Purpura (mening, DIC, vasculitis) * Confluent erythema - signs of anaphylaxis - urticaria - change - any systemic symptoms
37
What is toxic epidermal necrolysis? What is it caused by?
Severe drug reaction – mucosal, skin and systemic involvement Caused by anti-epileptic drugs, sulphur antibiotics eg bactrim, cabomezipines, penicillin. More common in pts with lupus, pts with HIV, some skin colours.
38
Presentation: a number of itchy areas on body, spreading. Annular, scaly rash that has an active edge with a central clearing. Non-responsive to topical steroids. Diagnosis?
Dermatophyte infection of the skin: most likely Ringworm--> tinea corporis
39
What is the presentation of tinea pedis?
Scaly rash on the feet, either on the sides or between the toes.
40
If a pt has tinea pedis, where else must you look for tinea?
Nails (often a reservoir for tinea pedis)--> Tinea unguium (onychomycosis)
41
How do you need to treat tinea unguium?
Systemic treatment is needed if nails are involved
42
Rash with an active edge and proximal clearing, spreading outwards from the groin/ pelvic creases. Diagnosis?
Tinea cruris (jock itch)
43
Which type of tinea causes hair loss? Common in which population?
Tinea capitis, most common in children.
44
How do you confirm the diagnosis of a fungal infection?
Superficial scrape of skin for fungal microscopy or culture.
45
How is tinea managed?
Topically: imidazole or terbinafine Oral: terbinafine, itraconazole or fluconazole
46
What is an important thing to look for in a patient with tinea for permanent eradication?
In all cases–look for the reservoir–most often on feet and nails, sometimes in animals.
47
What are the features of varicella zoster --> chickenpox?
* Often in childhood * Prodrome of approx 2 weeks * Fevers * Crops of papules, vesicles, pustules, then crusts * Can be mucosal * Trunk,head>limbs
48
What are the features, diagnosis, treatment and complications of herpes zoster--> shingles
``` • Varicella in dorsal ganglion react ivat ion • Classically dermatomal (unilateral) • Prodrome of pain, tingling • Eruption of papules, vesicles, crusts • Diagnosis: Zoster PCR • Treatment: Systemic antiviral treatment • Complication: Post-herpetic neuralgia, ophthalmic involvement ```
49
Which HSV is oral and which is genital (mostly)? How is each treated?
HSV 1 – cold sores •Crops of vesicles on lips commonly •Treatment: Topical or systemic acyclovir or other antiviral treatment ``` HSV 2 – Genital herpes •Crops of vesicles on genital areas •Sexually transmitted disease •Diagnosis: HSV PCR •Treatment: Systemic antiviral treatment, may need prophylactic antiviral treatment ```
50
What is the presentation of skin infection by molluscum contagiosum virus (MCV) (poxviridae family) Which populations is it common in? How does it spread?
Presentation: Molluscum contagiosum presents as clusters of small round bumps (papules) especially in the warm moist places such as the armpit, groin or behind the knees. They range in size from 1 to 6 mm and may be white, pink or brown. They often have a waxy, pinkish look with a small central pit (umbilicated). As they resolve, they may become inflamed, crusted or scabby. There may be few or hundreds of spots on one individual. --> may cause scarring * Common disease of childhood and can be a sign of HIV (immunosuppression) * Outbreaks in family common • Spread of infection particularly due to pools– “itch of the baths”due to fomites
51
How is molluscum contagiosum treated (3)?
(besides showers rather than baths, not sharing towels etc) Topical irritants–eg salicylic acid wart paint Topical immunostimulants– dilute imiquimod cream Destructive methods– tape stripping, topical cantharidine treatment, curettage
52
What are viral warts caused by?
different types of HPV
53
What is the most common cause of viral warts?
Verruca vulgaris – commonest
54
Which kinds of warts can lead to cancer?
Anogenital (particularly in women)
55
What is the treatment of a small number of warts in an immunocompetent pt?
Nothing: spontaneous remission
56
What are the 2 bacteria that cause the majority of cutaneous infection?
S. aureus | S. pyogenes (Group A strep)
57
Which bacteria causes most folliculitis (infection of the hair follicle)? What is a risk factor for bacterial folliculitis?
S. aureus Eczema is a risk factor
58
How do you treat folliculitis?
Systemic abx (flucloxacillin, cephalexin)
59
Which bacteria usually causes impetigo?
S. aureus
60
Which bacteria usually causes cellulitis
S. pyogenes
61
Describe the mechanisma nd presentation of cellulitis
Group A Strep. – hyaluronidase cleaves connective tissue hence spread Patient often febrile, systemically unwell and has erythematous, shiny area of skin.
62
What does eczema=
Dermatitis

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