Week 10 - Dermatology Flashcards by niamh cummings

What are some pre-malignant variants of Squamous cell carcinoma?

Bowen’s disease
Actinic keratosis

Topical Imiquimod / 5- Fluorouracil
Cryotherapy, photodynamic therapy, Sun protection

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Describe characteristics of BCC

Face
sun damaged/ UV exposed skin
shiny ‘pearly’, telangiectasia
Mutation to basal cell DNA

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List the types of BCC

Nodular; >0.5 cm raised lesion, shiny, central ulceration, telangiectasia
Superficial; flatter, broken lightening bolt vessels
Pigmented; shiny, pigmented
morphoeic/ sclerotic; less obvious

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Describe characteristics of SCC

Crusty
ears, lips, burns
pre-malignant variants
keratinocytes

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Name some cutaneous tumour syndromes

Gorlins syndrome (multiple BCC, jaw cysts, risk of breast cancer)
Gardeners syndrome (soft tissue tumours, polyps, bowel cancer)
Cowdens syndrome (multiple hamartomas, thyroid/breast cancer)
Brook spieler syndrome (multiple BCC)

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What is cellulitis?

A skin and soft tissue bacterial infection. Caused by Streptococcus Pyogens or staphylococcus aureus.

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What are some symptoms of cellulitis?

Peau d' organe (dimpling)
Warmth
Blistering
Erosion and ulceration
Abscess formation
Purpura

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What antibiotic would you give for cellulitis from S.pyogens?

Ampicillin orFlucloxacillin

and give analgesia and fluids

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What antibiotic would you give for cellulitis caused by s.aureus or MRSA?

Flucloxacillin or vancomycin

and give analgesia and fluids

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What is necrotising fasciitis?

Rapidly spreading infection of the subcutaneous fascia

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How would you differentiate necrotising fasciitis from cellulitis?

Pain becoming painless
Rapid progression
systemically unwell
dusky skin and necrosis
may have skin crepitus

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What are the 5 antibiotics used in necrotising fasciitis?

Penicillin, flucloxacillin, clindamycin, gentamicin, metronidazole

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What is Erysipelas?

Superficial form of cellulitis

upper dermis and superficial lymphatics

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How could you tell cellulitis from erysipelas (Group A strep)?

Erysipelas involves the ears

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What does Impetigo look like?

Honey coloured crust
Staphylococcal infection of the epidermis
often peri-oral

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What is PVL producing S.aureus?

PVL is a toxin that destroys WBC

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What can the Human Parvovirus B19 cause (via resp droplets)?

Erythema infectiosum (slapped cheeks) - self limiting 7-10d
Fever, headache, runny nose, pruitic rash

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What can the Coxsakie virus A16 cause?

Hand, foot and mouth disease
Highly contagious in the first few weeks
Fever, rash, sore throat, headache, oropharyngeal ulcers

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What viral illness causes Koplik (bright red with white centres on buccal mucosa) spots 3 days after Sx and then presents with a maculopapular red rash 3-5 days after?

Measles
starts on the face and hairline as flat spots
Fever, cough, coryzal, conjunctivitis

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What virus may be latent in sensory nerve ganglia?

Herpes Simplex virus

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What virus remind dormant in dorsal root ganglia?

Varicella zoster virus

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What viral conditions presents with a dermatomal rash?

Shingles

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What are the classification of burns?

Superficial (1st)- Epidermis only (red/dry, painful, blanches with pressure, lasts 7 days)
Partial thickness (2nd)- Epidermis and dermis (blisters, pain>painless, <21 days) - Abx/surgery/grafting
Full thickness (3rd) Subcutaneous tissue (painless, non-blanching)
4th degree - Bone, muscles, fascia

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What is the first line of treatment in bites?

Agressive debridement and abscess drainage

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What is the commonest pathogen isolated from bites?

Pasteurella

What type of rash may lithium or beta blockers induce?

Drug induced psoriasiform rash

What type of rash might a slow growing tumour of the alpha pancreatic cells produce?

Necrolytic migratory erythema

What skin change is described as, | 'reddened concentric bands whorled woodgrain pattern?'

Erythema gyratum repens | strong association with Lung cancer

What cutaneous feature is B12 deficiency associated with?

Angular cheilitis - red, swollen patches at corners of the mouth

What cutaneous feature is zinc deficiency associated with?

Acrodermatitis Enteropathica (pustules, bullae, scaling) Intestinal zinc transporter mutation - inherited Alcoholic, malabsorption, IBD, bowel surgery - acquired

Why might breast milk contain low levels of zinc leading to Acrodermatitis Enteropathica?

Alcoholism Malabsorption states Inflammatory bowel disease Bowel surgery

What are some cutaneous features of scurvy - Vit C def?

Dry skin, Dry hair, corkscrew curly hairs | palpable Purpura, brusing, hyperpigmentation SHINS

What overgrowth causes Seborrhoeic dermatitis?

Pityrosporum ovale yeast

What is necrobiosis lipodicia?

In diabetes, Waxy, shiny, yellow discolouration. Occasionally ulcerates and scars

What 2 pathways interact to cause skin cancer?

Direct action of UV on keratinocytes for neoplastic transformation via DNA damage Effect of UV on hosts immune system

How would you treat cutaneous anthrax? (black eschar, erythema, lymphadenopathy, serous fluid discharge)

5 antibiotics: Ciprofloxacin, clindamycin, flucloxacillin, penicillin, metronidazole

What are some complications of infant atopic eczema? Symmetrical, vesicular Inflammation of the epidermis

``` Bacterial infections (s.aureus) Viral infections (Viral warts, molluscum, eczema herpeticum) Tiredness, growth reduction, psychological impact ```

What is acne fulminans?

Very severe, sudden onset. Can have fever and joint paint.

What is necrolytic migratory erythema?

Glucagonoma syndrome Erythematous, scaly plaques on aural, intertriginous and periorificial areas. Tumour of the islet alpha cells of the pancreas HYPERGLYCAEMIA, diarrhoea, weight loss, glossitis

What is Erythema gyratum repens?

Reddened concentric bands whorled woodgrain pattern. Severe pruitis and peripheral eosinophilia. strong association with LUNG CANCER

What is acanthosis nigricans?

Smooth, velvet like hyperkeratonic plaque Type 1 associated with malignancy - GI adenocarcinomas (stomach cancer) Type 2 familial AD Type 3 obesity and insulin resistance

What is pellagra and what causes it?

``` Characterised by Dermatitis, diarrhoea and dementia B3 def (Niacin) and death ```

What is caused by B6 (pyridoxine) def?

Dermatitis

What is Erythema Nodosum? | Associated diseases - IBD, sarcoidosis, pregnancy, OCP, NSAIDs, TB, strep infections, lymphoma

Inflammatory disorder affecting the subcutaneous fat. tender bilateral red nodules on the anterior shin. fever and joint pain, NO ulceration.

What does pyoderma gangrenous look like?

Rapidly enlarging painful blister with PURPLE edge Shiny, ulcerated plaque Debride. skin graft, flucloxacillin

Tx options in acne?

Topical Retinoid, topical (or oral) Benzoyl peroxide (1st line) Oral Isotretinoin

Tx options for psoriasis?

1. Topical - Salicylic acid, Vit D, emollients, steroids 2. UV phototherapy - reduce T cell proliferation and skin turnover, encourages Vit D 3. Systemic therapy - Immunosuppressants (methotrexate, cyclosporins), acitretin, dimethyl fumarate, apremilast, 4. Biologics (Adalimumab, Usketinumab - IL12/23)

What drugs might cause maculopapular rashes?

Antibiotics

What drugs might cause photosensitive rashes?

Diuretics, antibiotics

What drugs might cause Severe idiosyncratic reaction- TEN?

Anti-epileptics, antibiotics

What drugs might cause urticarial reaction?

Opiates, antibiotics, NSAIDs, ACEi

Topical imiquimod and 5-fluorouracil cream can be used in BCC and SCC, what do they do?

Stimulate the body immune system to target the tumour cells

What skin condition may have a BRAF or NRAS mutation?

Melanoma

Apart from excision what therapies can you use on a melanoma?

Immunotherapy - Ipilimumab or Nivolumab MEK inhibitors/ Check point inhibitors - Trametinib Biologic antibodies e.g. BRAF genetic defects - Debrafanib Systemic drug in metastatic - Pembrolizumab

What may be described as a chocolate cookie appearance?

Seborrhoeic wart

What might a beta lactam cause?

Acute generalised exanthematous pustulosis

Define psoriasis. 20% develop arthritis PASI, DQLI, SCORAD - severity scores- can use for acne too

Chronic relapsing and remitting scaly skin disease. T cell AI mediated. Overproduction of keratinocytes Red scaly patches - Plaque or guttate

What is the Koebner phenomenon?

Psorasis at the site of trauma/ scars

What biologic is available for eczema?

Dupilumab - IL4/13

What are the features of Cutaneous anthrax? Bacillus anthracis Hands, forearms, face, neck MP CCF - Methotrexate, penicillin, clindamycin, ciprofloxacin, flucloxacillin

local black skin pustules / black eschar Progresses over 2-6 days - papule, vesicles, ulcer, black eschar Discharges serous fluid Local erythema, lymphadenopathy Systemic malaise, headache, chills, sore throat