Week 10 - Dermatology Flashcards
What are some pre-malignant variants of Squamous cell carcinoma?
Bowen’s disease
Actinic keratosis
Topical Imiquimod / 5- Fluorouracil
Cryotherapy, photodynamic therapy, Sun protection
Describe characteristics of BCC
Face
sun damaged/ UV exposed skin
shiny ‘pearly’, telangiectasia
Mutation to basal cell DNA
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
Describe characteristics of SCC
Crusty
ears, lips, burns
pre-malignant variants
keratinocytes
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)
What is cellulitis?
A skin and soft tissue bacterial infection. Caused by Streptococcus Pyogens or staphylococcus aureus.
What are some symptoms of cellulitis?
Peau d' organe (dimpling) Warmth Blistering Erosion and ulceration Abscess formation Purpura
What antibiotic would you give for cellulitis from S.pyogens?
Ampicillin orFlucloxacillin
and give analgesia and fluids
What antibiotic would you give for cellulitis caused by s.aureus or MRSA?
Flucloxacillin or vancomycin
and give analgesia and fluids
What is necrotising fasciitis?
Rapidly spreading infection of the subcutaneous fascia
How would you differentiate necrotising fasciitis from cellulitis?
Pain becoming painless Rapid progression systemically unwell dusky skin and necrosis may have skin crepitus
What are the 5 antibiotics used in necrotising fasciitis?
Penicillin, flucloxacillin, clindamycin, gentamicin, metronidazole
What is Erysipelas?
Superficial form of cellulitis
upper dermis and superficial lymphatics
How could you tell cellulitis from erysipelas (Group A strep)?
Erysipelas involves the ears
What does Impetigo look like?
Honey coloured crust
Staphylococcal infection of the epidermis
often peri-oral
What is PVL producing S.aureus?
PVL is a toxin that destroys WBC
What can the Human Parvovirus B19 cause (via resp droplets)?
Erythema infectiosum (slapped cheeks) - self limiting 7-10d Fever, headache, runny nose, pruitic rash
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
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
What virus may be latent in sensory nerve ganglia?
Herpes Simplex virus
What virus remind dormant in dorsal root ganglia?
Varicella zoster virus
What viral conditions presents with a dermatomal rash?
Shingles
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
What is the first line of treatment in bites?
Agressive debridement and abscess drainage
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?
- Topical - Salicylic acid, Vit D, emollients, steroids
- UV phototherapy - reduce T cell proliferation and skin turnover, encourages Vit D
- 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
