Body Parts Connected to the Skin

Question 1

How many telangiectasia on the body are considered to be pathological?

Answer 1

More than 5

Question 2

If you see multiple Telangiectasia around the mouth, what condition should you consider?

Answer 2

Osler Weber Rendu

Question 3

In what conditions do multiple telangiectasia appear?

Answer 3

• Liver disease
• Rheuamtoid Arthritis
• Pregnancy
• Various Drugs (COCP)
• Post Radiation
• Connective Tissue Disease (Systemic Sclerosis)

Question 4

What are some viral causes of oral lesions?

Answer 4

• Herpes Simplex 1 & 2 - grouped vesicles.
  
  • Gingivostomatitis
• Chicken pox
• Measles - Koplik spots
• Coxsackie Viruses - mouth ulcers - herpangina
• Hand Foot and Mouth - greyish mouth ulcers.
  
  • • fever, lymphadenopathy and malise

Question 5

This child had a sore mouth, bad breath, pain on swallowing and swollen gums.

What is this?

Answer 5

Gingivostomatitis due to HSV

Question 6

What is this?

Answer 6

Herpangina

Usually due to coxackie virus.

Question 7

What are these?

Answer 7

Koplik Spots

Question 8

What is this and what are some causes of it?

Answer 8

Cheilitis

• Atopic eczema
• Irritant dermatitis (usually from saliva)
• Contact dermatitis
• Nutritional deficiencies (especially Vit C and Zinc deficiency)
• Drug-induced cheilitis
• Angular cheilitis
• Actinic cheilitis
• Granulomatous cheilitis
• Trauma

Question 9

In younger patients, what is the main cause of angular cheilitis?

Answer 9

Irritant contac with saliva or licking of lips

Question 10

In older patients, what is the main cause of angular cheilitis?

Answer 10

Poorly fitting dentures.

Question 11

If a patient has angular cheilitis, what should also be considered?

Answer 11

Secondary infection with Staph or candida.

Question 12

What nutritional deficiencies can cause angular cheilitis?

Answer 12

Vitamin C and Zinc

(Most commonly caused by alcoholism and eating disorders)

Question 13

What is the treatment for angular cheilitis?

Answer 13

1. Mild to moderate topical steroid +/- antibiotic/ antifungal.
2. Once resolved, give soft white paraffin to maintain control.

Question 14

What are the 2 main causes of contact dermatitis on the lips?

Answer 14

1. Agents put directly on the lips (lipstick, mouthwashes)
2. Agents transferred to the lips fom the hands (e.g nail varnish)

Question 15

What is this and what is the management for this?

Answer 15

Acitinic Cheilitis

• Ablative therapy -e.g. cryotherapy; curettage and cautery; shave cautery
• Topical agents -e.g. 5-fluorouracil (Efudix) or Imiquimod cream (Aldara)
• Daily use of a high factor sunscreen for the lips

Question 16

What is this and what is the treatment?

Answer 16

SCC of the lip

Excision.

Question 17

This patient has Granulomatous Cheilitis.

What diseases is it associated with?

What investigations should be done?

Answer 17

• Crohn’s disease
• Sarcoidosis
• Chronic Contact Dermatitis due to dental materials such as cinnamates.

Investigations

• Biopsy
• Chest X-Ray
• Bowel investigations for crohns
• Patch Testing.

Question 18

What syndrome can granulomatous cheilitis be associated with?

Answer 18

Melkerson-Rosenthal Syndrome

• Tongue swelling (Scrotal tongue)
• Recurrent facial palsy

Usually idiopathic or associated with the aforementioned conditions on the other card.

Question 19

What is the treatment for Granulomatous Cheilitis?

Answer 19

• Topical steroids (usually moderately potent is enough)
• Intralesional steroids (be careful of skin atrophy)
• Oral immunomodulatory drugs (rarely needed)

Question 20

What is the treatment for an apthous ulcer?

Answer 20

• Hydrocortisone buccal tablets.
• Chlorhexidine mouthwash.

Question 21

What rare conditions can cause oral ulcers to form?

Answer 21

• Behçet’s disease
• Drugs
• Irradiation
• Blistering disorders
• Systemic diseases (Crohn’s disease)
• Metabolic deficiency diseases (vitamin C deficiency i.e. scurvy, zinc deficiency)
• connective tissue disorders (e.g. SLE)
• HIV
• Other viral illnesses.

Question 22

What is the treatment approach to apthous ulcers?

Answer 22

• Exclude systemic disease - 10% of Crohn’s patients have recurrent apthous ulcers.
• Exclude infection - herpes etc.
• Advice good oral hygeine
• Symptomatic treatment - hydrocortisone buccal tablets and chlorhexidine mouthwash.

Question 23

What are the features of Behcet’s Syndrome?

Answer 23

Triad of:

1. Recurrent oral ulcers
2. Genital ulcers
3. Uveitis

• Other features include: arthropathy, meningo-encephalitis, colitis, neuropathies, vasculitis.

Question 24

What test is indicative of Behcet’s disease?

Answer 24

Pathergy test - pustules at the site of venepuncture.

Question 25

What are the causes of Behcet's Disease?

Answer 25

* It is **generally not known**. * **Genetic** link to **HLA B51** * **Correlated** with **Streptococcal infection** * Considered an **auto-inflammatory disorder.**

Question 26

What ethnic group is Behcet's disease more common in?

Answer 26

Eastern Mediterranean and Middle Eastern.

Question 27

What is the management of Behcet's Disease?

Answer 27

* **Apthous Ulcers** - treat. * **Resistant disease** - consider Prednisolone, Colchicine, Dapsone, Sulfasalazine.

Question 28

**Which of the two will affect the oral mucosa?** Bullous Pemphigoid or Pemphigus Vulgaris?

Answer 28

Pemphigus Vulgaris

Question 29

What is this? What malignancy is it associated with?

Answer 29

* **Paraneoplastic pemphigus** - severe and painful oral ulcerations of the lips and lateral borders of the tongue. * Associated with **B Cell Lymphoproliferative** disorders.

Question 30

What condition is this?

Answer 30

Oral Lichen Planus

Question 31

What % of patients with generalised LP have intraoral LP?

Answer 31

1-2%

Question 32

Oral Lichen Planus is usually a clinical diagnosis. But what can be done if you are unsure?

Answer 32

A biopsy

Question 33

What is the treatment for oral lichen planus?

Answer 33

Same as aphthous ulcers.

Question 34

What is a potential problem for people with oral lichen planus?

Answer 34

1-5% will develop oral LP (It is more common with the erosive form)

Question 35

What are some causes of gingival hyperplasia?

Answer 35

* Crohn’s disease * Pregnancy * Scurvy * Drugs * Phenytoin * Cyclosporin * Nifedipine * Myeloma.

Question 36

What is perifolicular hyperplasia associated with?

Answer 36

Scurvy

Question 37

How is atopic or contact exczema of the eyelids treated?

Answer 37

* Mild topical steroids. * Pimecrolimus or Tacrolimus can also be used.

Question 38

What conditions cause thinnning of the eybrows?

Answer 38

* Hypothyroidism * Foolicular mucinosis * Secondary Syphilis * Leprosy

Question 39

What conditions can cause loss of the eyebrows?

Answer 39

* Seborrhoeic dermatitis * Discoid lupus erythematosus

Question 40

What can cause periorbital swelling?

Answer 40

* **Local** * Eyelid infections * Contact dermatitis * Orbital tumours * Chalazion (granulomatous reaction in a Meibomian gland). * **Systemic** * Angio-oedema * Dermatomyositis * Renal disease * Cardiac failure * Thyroid disease * Superior vena caval syndrome * Bacterial, viral or parasitic/protozoal infections.

Question 41

What is this?

Answer 41

Syringiomas | (A Form of benign lesion)

Question 42

What are these?

Answer 42

Milia

Question 43

What is the most common form of cancer around the eye?

Answer 43

BCC (70% of malignant eyelid tumours are BCCs)

Question 44

What are some postoperative problems of BCC eyelid surgery?

Answer 44

* Tear flow problems * Recurrent infections * Local Reocurrence of the tumour is common.

Question 45

What is this?

Answer 45

Sebaceous carcinoma of the lower eyelid. it can mimic a chalazion.

Question 46

What is this?

Answer 46

BCC of the lower eyelid

Question 47

Bleparitis is associated with what condition?

Answer 47

Seborrheic dermatitis

Question 48

90% of oral cancers are what type of cancer?

Answer 48

Squamous Cell Carcinomas

Question 49

What oral areas are most commonly affected?

Answer 49

The Lips (30%) The Tongue (25%)

Question 50

How do intra-oral neoplasia usually present?

Answer 50

* Persistent **erythroplasia** * Persistent **ulceration** especially with fissuring or raised margins * **Persistent lump** * Fixed **induration** * **Leukoplakia** * Unexplained **local lymphadenopathy**.

Question 51

What are the causes of intra-oral neoplasia?

Answer 51

* **Smoking** * **Chewing tobacco** * **Alcohol** * Poor **oral hygeine**. * **Chronic inflammation** from **Lichen planus** * **Rare: Plummer-Vinson Syndrome**

Question 52

What is this and what should you do?

Answer 52

This is leukoplakia. It needs to be biopsied.

Question 53

What is this?

Answer 53

**Oral hairy leukoplakia** * Caused by the **Epstein**-**Barr virus** * Common in **HIV patients** if poorly controlled.

Question 54

What is this?

Answer 54

Chondrodermatitis nodularis Helicis

Question 55

Who is CNH (Condrodermatitis nodularis helicis) more common in?

Answer 55

Middle-aged or elderly patients

Question 56

What causes CNH/

Answer 56

It is a form of pressure sore It is commonly misdiagnosed as a BCC, SCC or SK.

Question 57

What are the treatment options for CNH?

Answer 57

* Topical steroids * Cryotherapy * Excision of the nodule and a portion of the inflammed cartilage.

Question 58

What can commonly cause contact dermatitis in the ear?

Answer 58

* Hair products * Plastic or rubber ear appliances * Objects used to blean the ear (hairpins, matches) * Topical medication * Neomycin * Propylene glycol.