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Year 3 GP > Dermatology > Flashcards

Dermatology Flashcards

1
Q

How to describe skin lesion

A

Site
Colour
Associated changes
Morphology

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2
Q

How to describe a pigmented skin lesion

A 
Asymmetry
Border 
Colour
Diameter 
Evolution `
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3
Q

Psychosocial effects of eczema and acne

A 
Self-conscious 
Social isolation 
Embarrassed 
Cover up 
Anxiety
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4
Q

Structure of skin

A

Epidermis
Dermis
Subcutaneous tissue

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5
Q

Epidermis

A

Physical barrier
Stratum corneum is keratanised and constantly replaced
Thicker stratum corneum on hands and feet
Contains Langerhans cells - defence against pathogens

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6
Q

Dermis

A

Thick layer made of collagen, elastin and fibrillin
Gives flexibility and strength
Contains nerve endings, glands, hair follicles and blood vessels

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7
Q

Malignant Melanoma

A 
Asymmetrical
Border: irregular
Colour: non-uniform
Diameter > 6mm
Evolving / Elevation
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8
Q

Risk factors for malignant melanoma

A 
Sunlight: esp. intense exposure in early years
Fair-skinned (Low Fitzpatrick Skin Type)
↑ no. of common moles
\+ve FH
↑ age
Immunosuppression
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9
Q

Classification of malignant melanomas

A 
Superficial spreading - 80% 
Lentigo Maligna 
Acral Lentiginous 
Nodular 
Amelanotic - atypical appearance with delayed dx
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10
Q

Lentigo Maligna

A

Elderly pts

Face or scalp

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11
Q

Acral Lentiginous

A

Asians/blacks

Palms, soles

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12
Q

Nodular Melanoma

A

All sites:
Younger age, new lesion
Invade deeply and metastasis early = poor prog

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13
Q

Common metastases of malignant melanoma

A

Liver

Eye

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14
Q

Mx of malignant melanoma

A

Excision + secondary margin excision depending on depth
± lymphadenectomy
± adjuvant chemo

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15
Q

Poor prognostic indicators of malignant melanoma

A

Male sex (more tumours on trunk cf females)
↑ mitoses
Satellite lesions (lymphatic spread)
Ulceration

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16
Q

Squamous Cell Carcinoma

A

Ulcerated lesion with hard, raised everted edges
Sun exposed areas
May arise in chronic ulcers: Marjolin’s Ulcer

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17
Q

Basal cell carcinoma

A

Commonest skin cancer

  • Rodent ulcers
  • Pearly nodule with rolled telangiectactic edge
  • May ulcerate
  • Typically on face in sun-exposed area

Behaviour:
Very rarely metastasise
Locally invasive

Mx: if closed to eye
Excision
Cryo/radio may be used.

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18
Q

Evolution and Mx of SCC

A

Solar/actinic keratosis → Bowen’s → SCC
Lymph node spread is rare

Rx:
Excision + radiotherapy to affected nodes

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19
Q

Actinic Keratoses

A

Irregular, crusty warty lesions.
Pre-malignant

Mx: for cosmetic effect
Cautery
- Cryotherapy 
- 5- flourouracil 
- Photodynamic phototherapy
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20
Q

Bowen’s Disease

A

Red/brown scaly plaques

SCC in situ

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21
Q

Psoriasis risk factors and pathology

A

Age: peaks in 20s and 50s
FHx

Type IV hypersensitivity reaction

  • Epidermal proliferation
  • T-cell driven inflammatory infiltration
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22
Q

Psoriatic histology

A

Acanthosis: thickening of the epidermis

Parakeratosis: nuclei in stratum corneum

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23
Q

Psoriatic triggers

A 
Stress
Infections: esp. streps
Skin trauma
Drugs: β-B, Li, anti-malarials, EtOH
Smoking
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24
Q

Signs of psoriasis

A

Symmetrical well-defined red plaques with silvery scale

Distribution:
Extensors: elbows, knees
Flexures - in children(
Scalp, behind ears, navel, sacrum

Psoriatic arthritis:
Mono-/oligo-arthritis: DIPs commonly involved
Asymmetrical
Psoriatic spondylitis

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25
Q

Psoriatic nail changes

A

Pitting
Onycholysis
Subungual hyperkeratosis - excessive skin cells that accumulate between the nail and the nail bed

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26
Q

Mx of psoriasis

A 
Education:  Avoid triggers
Soap Substitute
Emollients
Topical Therapy: Vit D3 analogue: 
Steroids: e.g. betamethasone

Tar: mainly reserved for in-patient use

UV Phototherapy

Non-Biologicals

  • Methotrexate
  • Ciclosporin
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27
Q

Atopic dermatitis presentation

A

Extremely itchy
Poorly demarcated rash

Acute: oozing papules and vesicles

  • Subacute: red and scaly
  • Chronic eczema → lichenification
  • Skin thickening with exaggeration of skin markings

Commonly on flexors, cheeks and around eyes

PMHx- atopy
FHx

28
Q

Pathophysiology of atopic dermatitis

A

TH2 driven inflammation with ↑IgE production

29
Q

Adult Seborrhoeic Dermatitis

A

Red, scaly, rash
Cause: overgrowth of skin yeasts
Location: scalp (dandruff), eyebrows, cheeks, nasolabial folds

Rx: mild topical steroids / antifungal e.g. Daktacort: miconazole + hydrocortisone

30
Q

Mx of atopic dermatitis

A

Education: Avoid triggers

Emollients
Topical Steroids

2nd line Therapies:

  • Topical tacrolimus
  • Phototherapy
  • Ciclosporin or azathioprine
31
Q

Topical Steroids

A

1% Hydrocortisone: face, groins

Betnovate
Dermovate: very strong, brief use on thick skin - Palms, soles

32
Q

Surface features

A

Scale - build up of keratin
Crust - dried exudate
Excoriation - linear erosions from scratching
Erosions/ulceration

33
Q

Papule

A

Small lump < 5mm

34
Q

Nodule

A

Larger lump - 5 - 10mm

35
Q

Vesicle

A

Small water blister

36
Q

Bulla

A

Large water blister

37
Q

Pustule

A

Pus filled vesicle

38
Q

Telangiectasia

A

Thead veins

39
Q

Alopecia

A

Hair loss or thinning

40
Q

Macule

A

Non palpable area of discolouration < 10mm

41
Q

Patch

A

Non palpable area of discolouration > 10mm

42
Q

Plaque

A

Elevated area > 2cm

43
Q

Erosion

A

Palpable, flat-topped area- 1cm

44
Q

Ulcer

A

Palpable, flat topped area- 2cm

45
Q

Lichenification

A

Loss of epidermis - superficial
Loss of epidermis and dermis - deep
Thickening

46
Q

Comedone

A

Black head - open or closed

47
Q

Erythema multiform

A

Target appearance

Multiple coalescing erythematous patches

48
Q

Tinea

A

Superficial mycosis caused by dermatophytes - fungi

49
Q

Presentation of tinea

A

Round scaly lesion
Itchy
Central clearing with raised annular ring
Scalp, body, foot, groin, nails

50
Q

Ix and Mx for Tinea corporis

A

Ix: Skin sample and fungal microscopy

Mx:
Topical antifungals:
- Terbinafine
- Imidazole - OTC

Inflammation:
Topical corticosteroid - hydrocortisone 1% - should not be used alone

Severe: Oral antifungal if there is:
+ve fungal microscopy or culture
Strong clinical suspicion
Arrange repeat skin sampling

51
Q

Conservative mx of tinea corporis

A

Loose fitting clothes made of cotton
Good hygiene - wash affected area daily and dry thoroughly
Do not share towels
Wash clothes and bed linen to remove fungal spores

52
Q

Onychomycosis

A

Starts at edges of nails
Nail discolours and lifts off
White/yellow opaque streak on one side of nail

Mx:
Antifungal nail cream -
Apply for 12 months but doesn’t always work
Nail softening cream -
2 weeks to soften nail so infection can be scraped off the nail
If severe - oral antifungals for 6 months or remove

53
Q

Tinea versicolor

A
  • Fungus interferes with the normal pigmentation of the skin - small, discoloured patches.
  • May be lighter or darker in colour
  • Commonly affect the trunk and shoulders
54
Q

Impetigo

A

Contagious superficial skin rash caused by S. aureus

Presentation:
Age: peak @ 2-5yrs
Honey-coloured crusts on erythematous base
Common on face

Mx
Mild: topical Abx - fusidic acid
More severe: flucloxacillin PO

55
Q

Pityriasis Rosea

A

Presents with inflamed skin patch first.
Followed by further skin eruptions
Associated with a sore throat and a cold before sin changes occur

Herald patch precedes rash, mainly on the trunk

56
Q

Acne Vulgaris Mx

A

Pt. education - wash face and moisturise twice a day

Mild: topical therapy
- Benzoyl peroxide

Moderate
- Topical benzoyl peroxide + oral Abx (doxy or erythro)

Severe:
- Isotretinoin (vitamin A analogue) - Retinol

57
Q

Side effects of retinol

A

Teratogenic, hepatitis, ↑lipids, depression, dry
skin, myalgia
Suicidal thoughts

Monitor: LFTs, lipids, FBC
May try Dianette (COCP) in women

  • only give if scarring and needs dermatologist review
58
Q

Urticaria

A

Wheals ± angioedema and anaphylaxis
Rapid onset after taking drug

  • treat anaphylaxis and remove trigger
  • non sedating anti-histamine - cetirizine
  • sedative antihistamine - chlorphenamine
59
Q

Parvovirus

A

Slapped cheek

60
Q

Erysipelas

A

Sharply defined superficial infection by S. pyogenes

  • Often affects the face
  • High fever + ↑ WCC

Mx

  • Benpen IV
  • Pen V and fluclox PO
61
Q

Lichen Planus

A

Flexors: wrists, forearms, ankles, legs
Purple and Pruritic papules on palms, soles and flexors
Lacy white marks

Mx: topical steroids - clobetasonr butyrate

62
Q

Scabies

A

Highly contagious: spread by direct contact
- Female mite digs burrows and lays eggs

Presentation:
Burrows: short, red line, block dot

Hypersensitivity rash: eczematous, vesicles
Extremely itchy → escoriation
Particularly affects the finger web spaces (esp. 1st)
Also: axillae, groin, umbilicus

Mx
Permethrin cream: applied from neck down for 24hrs, 2 doses 2 weeks apart to all close contacts as well 
2nd line: Malathion
3rd line: oral ivermectin
Treat all members of the household

Wash bed sheets and curtains

63
Q

Treatment of impetigo

A

Hydrogen peroxide 1% cream
Topical antibiotics - fusidic acid
If extensive - flucloxacillin or erythromycin if allergic

Children should not go to school until 48 hours after start of abx

64
Q

Types of acne

A

Comedonal - open or closed
Inflammatory - papules and pustules
Nodulocystic - nodules, cysts and scars often neck and trunk
Acne fulminans - severe acne associated with fever, myalgia and arthralgia

65
Q

Ice pick scarring

A

Irregular deep pitted lesions due to acne

Not due to picking or scratching

66
Q

Acanthosis nigricans causes

A 
T2DM
GI cancer 
Obesity 
PCOS
Acromegaly 
Cushing's disease 
Hypothyroidisim 
COCP

Year 3 GP (20 decks)

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