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dermatology > Common Rashes > Flashcards

Common Rashes Flashcards

1
Q

Clinical features of acute eczema

A

Papulovesicular erythematous lesions
Itch
Ill defined
Oedema
Ooze or scaling and crusting

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2
Q

Histology of acute eczema

A

Inflammatory infiltrate in the upper dermis
Fluid collections

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3
Q

Clinical presentation of chronic eczema

A

Lichenification
Elevated plaques
Increased scaling
Excoriation
Secondary infection

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4
Q

Clinical feature of adult eczema

A

Generalised dryness and itching, hand eczema may be the primary manifestation of

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5
Q

Clinical feature of childhood eczema

A

Predominantly flexural

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6
Q

Clinical features of infantile eczema

A

Primarily involves face, scalp, and extensor surfaces of the limbs
Nappy area usually spared

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7
Q

What kind of reaction is contact allergy dermatitis

A

Type 4 hypersensitivity reaction to an external antigen

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8
Q

Sensitisation stage of contact allergic dermatitis

A

Generation of memory T cells following exposure to antigen via langerhans cells in the epidermis and MHC-II

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9
Q

Allergic stage of contact allergic dermatitis

A

Activation of sensitised Th cells in response to antigen causing the release of inflammatory cytokines and cell mediated cytotoxicity

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10
Q

Investigations for contact allergy dermatitis

A

Patch testing

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11
Q

What happens in patch testing

A

Allergens prepared into Finn chambers which are applied on the back and removed at 48 hours

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12
Q

What is contact irritant dermatitis

A

Non-specific physical irritation

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13
Q

What can cause contact irritant dermatitis

A

Soap
Water
Cleaning products
Nappy rash

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14
Q

Where does contact irritant dermatitis usually present

A

On the hands

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15
Q

Genetic association with atopic eczema

A

Mutations in fillagrin gene

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16
Q

Clinical features of atopic eczema

A

Ill defined erythema and scaling
Itch-scratch cycle
Generalised dry skin

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17
Q

What distribution is seen in atopic eczema

A

Flexural

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18
Q

Complication of atopic eczema

A

nodular prurigo

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19
Q

What is nodular prurigo

A

Itchy nodules or papules on the skin

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20
Q

What is atopic eczema usually associated with

A

Asthma, allergic rhinitis, food allergy

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21
Q

Diagnostic criteria for atopic eczema

A

Itching + 3 or more of the following:
Visible flexural rash or history
History of atopy
Generally dry skin
Onset before age of 2

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22
Q

Management of atopic eczema

A

Targeted blocking of IL4 and IL14

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23
Q

Drug related eczema

A

Type 1 or 4 hypersensitivity, eosinophils will be present

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24
Q

Photo-induced or photosensitive eczema

A

Well defined
Patients are often atopic
Reaction to UV light OR secondary to photosensitising drugs

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25
Q

What causes lichen simplex

A

Physical trauma to skin

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26
Q

What causes stasis dermatitis

A

Physical trauma to skin caused by increased hydrostatic pressure of the blood (venous insufficiency)

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27
Q

Where is stasis dermatitis seen

A

Lower legs

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28
Q

What is discoid eczema

A

Eczema which occurs in well defined circular or oval patches

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29
Q

What is another name for seborrhoeic eczema

A

Cradle cap

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30
Q

Where does seborrhoeic eczema tend to affect

A

Nose, eyebrows, ears and scalp

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31
Q

When does dyshidrotic eczema occur

A

When there is a very sudden acute flare up of eczema and the spongiotic vesicles join together

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32
Q

Clinical presentation of dyshidrotic eczema

A

Tiny blisters develop in hands and feet
Classically on the sides of fingers

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33
Q

What is another name for dyshidrotic eczema

A

Pompholyx eczema

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34
Q

General measures for managing eczema

A

Avoid irritants
Loose cotton clothing
Emollients

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35
Q

Management of mild eczema

A

Topical steroid

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36
Q

Management of moderate eczema

A

Moderate topical steroid

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37
Q

Give an example of a moderate topical steroid

A

Betamethasone valerate 0.025%

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38
Q

Management of severe eczema

A

Potent topical steroid
Consider occlusive dressings
Treat infection if that’s a factor

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39
Q

Secondary care options for the management of eczema

A

Phototherapy
Immunosuppression
Biological agents

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40
Q

What is psoriasis

A

A common chronic inflammatory dermatosis

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41
Q

Genetic links in psoriasis

A

Associated with HLA genes and PSORS1 locus

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42
Q

When does psoriasis usually present

A

2 peaks in incidence
20s and 50s

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43
Q

Precipitating factors for psoriasis

A

Stress
Trauma
Alcohol and smoking
Infection
HIV/AIDS
Drugs

44
Q

Name some drugs associated with psoriasis

A

B blockers
Lithium
Anti malarial drugs

45
Q

What causes rebound psoriasis

A

Swift withdrawal of topical or systemic steroids

46
Q

What is the Koebner phenomenon

A

The development of new skin lesions on previously unaffected skin following trauma, injury or irritation

47
Q

Give an example of an infection which can precipitate psoriasis

A

Strep throat

48
Q

Pathophysiology of psoriasis

A

Hyperproliferation of epidermal cells

49
Q

Clinical presentation of psoriasis

A

Symmetrically distributed, red scaly plaques with well defined edges
Scale is silvery white
Itchy

50
Q

Common sites for psoriasis

A

Scalp, elbows and knees

51
Q

What is auspitz sign

A

When psioritic plaques are scraped or removed, pinpoint bleeding points are observed on the skin surface

52
Q

Name 3 nail changes that can be seen in patients with psoriasis

A

Nail bed pitting
Onycholysis
Subungual hyperkeratosis

53
Q

What is nail bed pitting

A

Superficial depressions in the nail bed

54
Q

What is onycholysis

A

Separation of the nail plate from the nail bed

55
Q

What is subungual hyperkeratosis

A

Thickening of the nail bed

56
Q

What is the commonest type of psoriasis

A

Chronic plaque psoriasis

57
Q

Presentation of chronic plaque psoriasis

A

Symmetrical plaques on the extensor surface of the limbs, scalp and lower back
Plaques are raised with silvery scale

58
Q

How does flexural psoriasis present

A

Smooth, erythematous plaques without scale in flexures and skin folds colonised by candida yeasts

59
Q

Where does flexural psoriasis present

A

Groin, axilla, inframammary areas

60
Q

Management of flexural psoriasis

A

Mild topical steroid + antifungal preparations

61
Q

When does guttate psoriasis occur

A

After a strep infection in young adults

62
Q

What does guttate psoriasis present like

A

Multiple small, tear drop shaped erythematous plaques

63
Q

Where does guttate psoriasis present

A

On the trunk

64
Q

How does pustular psoriasis present

A

Multiple petechiae and pustules on the palms and soles

65
Q

Causes of pustular psoriasis

A

Withdrawal of steroids, infection, pregnancy, hypocalcaemia

66
Q

Causes of erythrodermic psoriasis

A

Withdrawal of potential topical or systemic steroids
Drug reactions
UV burns

67
Q

Management of erythrodermic psoriasis

A

Fluid balance, bed rest, emollients, systemic immunosuppression

68
Q

Unstable plaque psoriasis

A

The rapid extension of existing or new plaques

69
Q

Histological features of psoriasis

A

Rete pegs
Munro micro-abscesses in stratum corneum
Expanded prickle cell layer

70
Q

Management pathway for psoriasis

A
  1. Topical
  2. Phototherapy
  3. Oral treatments
  4. Biologic therapy
71
Q

Topical treatments for psoriasis

A

Topical corticosteroids
Emollients
Tar preparations
Vitamin D analogues
Salicylic acid

72
Q

What is acne

A

Inflammatory condition of the pilosebaceous unit

73
Q

When does acne present

A

12-24

74
Q

Diet associated with acne

A

High glycemic index and excess dairy consumption

75
Q

Pathophysiology of acne

A

Increased androgens at puberty
Hypercornification causes keratin plugging of pilosebaceous unit
Infection with corynebacterium acnes within sebum in the hair follicles
Production of comedones due to the build up of keratin and sebum
Rupture causes acute inflammation

76
Q

Closed comedones

A

whiteheads

77
Q

Open comedones

A

Blackheads

78
Q

Acne conglobata

A

Severe form of nodulocystic acne

79
Q

Acne fulminans

A

Acute, painful, ulcerating and haemorrhagic clinical form of acne

80
Q

Where does acne present

A

Reflects sebaceous gland sites
Face, upper back, anterior chest

81
Q

Complications of chronic acne

A

Atrophic scars and hyperpigmentation

82
Q

Mild acne

A

Comedones, papules and pustules

83
Q

Moderate acne

A

Numerous papules, pustules and mild atrophic scarring

84
Q

Severe acne

A

Numerous papules, pustules, severe atrophic scarring and cysts and nodules

85
Q

Histology of acne vulgaris (3)

A

Dilated follicular opening with cellular debris and bacteria
Leukocytes and fragmented hair shaft
Marked perifollicular inflammation

86
Q

Management of mild acne

A

Topical treatment

87
Q

Management of moderate acne

A

Topical treatment and oral antibiotics

88
Q

Management of severe acne

A

Isotretinoin

89
Q

Topical treatments for acne

A

Benzoyl peroxide
Retinoids
Topical antibiotics

90
Q

Caution of benzoyl peroxide

A

Bleaches clothes etc.

91
Q

Systemic treatments of acne

A

Oral antibiotics
Contraceptives

92
Q

Give some examples of oral antibiotics used in acne

A

Erythromycin, doxycycline, lymecycline

93
Q

Who usually presents with rosacea

A

Women in 30-40s

94
Q

Pathophysiology of rosacea

A

Involves chronic inflammation of the skin and is especially associated with triggers that increase body temp

95
Q

Clinical presentation of rosacea

A

Recurrent facial blushing
Erythema with papules and pustules on the nose, chin cheeks and forehead - sparing of naso-labial folds
Thickening of the skin

96
Q

Management pathway for rosacea

A
  1. Topical metronidazole
  2. Topical therapies + doxycycline
  3. Isotretinoin
97
Q

Complications of rosacea

A

Rhinophyma
Telangiectasia
Ocular inflammation

98
Q

What is rhinophyma

A

Thickening of skin on the nose resulting in a bulbous and enlarged appearance

99
Q

What is the most common lichenoid disorder

A

Lichen planus

100
Q

What characterises lichenoid disorders

A

Damage to the basal epidermis

101
Q

What condition is associated with lichen planus

A

Hepatitis C

102
Q

Clinical presentation of lichen planus

A

Itchy flat-topped violaceous papules
Oral lesions - lacy white on the inside of the cheek

103
Q

Distribution seen in lichen planus

A

Flexor surfaces if the wrist/forearm, ankles and legs

104
Q

Histology of lichen planus

A

Irregular sawtooth acanthosis
Hypergranulosis and orthohyperkeratosis
Upper-dermal infiltrate of lymphocytes
Basal damage with formation of cytoid bodies

105
Q

Management of lichen planus

A

Topical steroid + antihistamine

dermatology (13 decks)

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