Common Skin Conditions Flashcards
(91 cards)
1
Q
Clinical features of atopic eczema/dermatitis
A
- Pruritus
- flexural
- can occur in response to triggers
2
Q
What is atopic eczema/dermatitis?
A
Dry itchy inflammed skin
Erythema
Flaking
3
Q
Common history of atopic eczema/dermaitis
A
- often begins in childhood
- atopy
- family history
- recent change in soaps, fabric softeners etc.
4
Q
Presentation of eczema
A
- dry, red, itchy patches of skin
- often in flexor surfaces, face + neck
5
Q
What could be a trigger for atopic eczema/dermatitis?
A
Smoke
Soap
Perfume
Excessively dry skin
6
Q
Diagnosis of atopic eczema/dermatitis
A
Clinical diagnosis
7
Q
Treatment of atopic eczema/dermatitis
A
- education + support
- avoidance of triggers
- systemic therapy
- topical: emollients, soap substitutes, steroids, phototherapy
8
Q
Treatment of eczema flares
A
- thicker emollients
- topical steroids 1 finger tip uint for twice area of flat adult hand
- wet wraps
9
Q
two types of emollients + examples
A
_Thin creams_
- E45
- cetraban cream
- aveeno cream
- eparderm cream
.
_Thick, greasy emollients_
- 50:50 ointment
- cetraban ointment
- epaderm ointment
- hydromol ointment
10
Q
What advice should be given to a patient for emollient use?
A
- least to most effective: lotions > creams > ointments
- wash and dry hands thoroughly
- apply in the direction of hair growth
- if in a pot, do not use your fingers to remove - instead use a clean spoon or stick
- 250g a week
- use emollient first, wait 30 mins then apply steroid
11
Q
Stepwise steroid ladder from weakest to most potent
A
- hydrocortisone 0.5%, 1%, 2.5%
- eumovate
- betnovate
- dermovate
12
Q
What advice should be given to patients for topical steroid use?
A
- wash and dry hands thoroughly
- apply finger tip amount for area represented by both palms
- avoid using with emollients as it will dilute the steroid + reduce the effectiveness
- week on, week off schedule
13
Q
What is eczema herpeticum?
A
viral skin infection in patients with eczema caused by herpes simplex virus 1/2 or varicella zoster virus
14
Q
Presentation of eczema herpeticum
A
- rapidly progressive
- widespread, painful, vescicular rash - punched out erosions
- lethargy
- fever
- reduced oral intake
- lymphoadenopathy
15
Q
Management of eczema herpeticum
A
viral swabs of vesicles
admit + IV aciclovir
16
Q
Describe acne vulgaris
A
Formation of comedones, papules, pustules, nodules + cysts due to inflammation of pilosebaceous units
17
Q
pathophysiology of acne vulgaris
A
- increased sebum production
- excessive deposition of keratin in pores/pilosebaceous unit
- overgrowth of cutibacterium acnes
- pro-inflammatory chemicals released in skin
18
Q
Types of comodones + cause
A
- closed comedones - whitehead
- open comedones - blackhead
- due to dilated sebaceous follicle
19
Q
Severity of acne vulgaris
A
- mild: open + closed comedones +/- sparse inflammatory lesions
- moderate: widespread non inflammatory lesions + numerous papules + pustules
- severe: extensive inflammatory lesions, which may include nodules, pitting + scarring*
20
Q
Management of mild to moderate acne
A
topical benzoyl peroxide + clindamycin/adapalene or topical clindamycin + tretinoin for 12 weeks
21
Q
Management of moderate to severe acne
A
12 week course of:
- topical benzoyl peroxide + adapalene +/- oral lymecylcine/doxycylcine
- topical tretinoin + clindamycin
- topical azeliac acid + oral lymecylcine/doxycyline
.
- COCP in women
- last line: oral retinoids e..g isotretinoin/roaccutate + contraception
22
Q
general management of acne vulagris
A
- topical benzoyl peroxide
- topical retinoids
- topical antibiotics e.g. clindamycin
- oral antibioitcs e.g. lymecycline
- COCP
- oral retinoids as last line option e.g. isotretinoin/roaccunate - contraception needed in females
- consider psychological impact
23
Q
When should dermatology referral be considered in acne vulgaris?
A
- mild-moderate not responded to 2 complete 12 week course treatment
- moderate-severe not responded to previous treatment incl oral abx
- acne with scarring
- acne with peristing pigmentary changes
- acne causing perisitent psychological distress
24
Q
What contraceptive is needed in retinoid use?
A
two forms
e.g. condoms + COCP
25
Why is contraception needed if a woman is on isotretinoin?
it is highly teratogenic
26
Mechanism of action of isotretinoin/roaccutane
it is a retinoid
reduces sebum production
reduces inflammation
reduces bacterial growth
27
Side effects of isotretinoin/roaccutane
- teratogenic
- dry skin + lips + mouth
- increased sensitivity to UV
- depression, anxiety, aggression
- suicidal ideation
- headache
- ED
- rashes/mild itching
- hair thinning
28
What is the most effective combined contraceptive pill for acne + why?
Why is it not prescribed long term?
**Co-cyprindiol** (dianette)
due to its anti-androgen effects
Risk of thromboembolism
29
Common history of psoriasis
- chronic skin condition
- equally in men + women
- often between 20-30s + 50-60s
- genetic predisposition
- relapsing + remitting
- identify triggers or iatrogenic cause
30
Describe psoriasis
- White flaky scales
- raised rough plaques
- often over extensor surfaces + scalp
31
Name and describe 3 specific signs suggestive of psoriasis
- **auspitz sign**: small points of bleeding when plaques are scraped off
- **koebner phenomenon**: development of psoriatic lesions to areas of skin affected by trauma
- **residual pigmentation** of the skin after the lesions resolve
32
Associated changes/conditions of psorasis
- psoriatic arthrisits
- nail psoriasis > pitting, oncholysis, thickening, ridging
- psychological implications *e.g. depression, anxiety*
- increased risk of melanoma (SPF use)
33
Exacerbating factors of psoriasis
- trauma
- alcohol
- drugs *e.g. B blockers, lithium, NSAIDs, ACEi*
- withdrawal of systemic steroids
- strep infection can trigger guttate psorasis
34
Types of psoriasis
- **plaque psoriasis** (most common)
- **guttate psoriasis**: transient psoriatic rash, multiple red lesions
- **pustular psoriasis**: on palms + soles
- **erythrodermic psoriasis**
35
Cause of psoriasis
- chronic autoimmune condition
- T cell cytokine production is stimulated > keratinocytes proliferation
- rapid generation of new skin cells > abnormal build up + thickening of skin in those areas
36
Management of psoriasis
- first line: **dovobet + enstilar**: potent steroid + vitamin D analogues once daily each applied separately
- second line: **topical calcipotriol** (vitamin D analogues) twice a day
- third line: **topical steroids or coal tar preparation** twice daily
- **phototherapy** with narrow band UVB light
- **methotrexate, cyclosporine or retinoids** if severe
37
how long should the break be between courses of topical steroids in psoriasis?
4 weeks
38
Management of guttate psoriasis
most resolve within 2-3 months
if not, topical steroids + vitamin D analogues
UVB phototherapy
39
What is erythema nodosum?
inflammation of SC fat
40
Presentation of erythema nodosum
- red, raised, inflamed, subcutaneous nodules across both shins
- nodules can be painful + tender
41
Causes of erythema nodosum
**NODOSUM**
- **NO** cause
- **D**rugs *e.g. COCP, penicillins*
- **O**ver counter prescriptions
- **S**arcoidosis/TB + **S**treptococcus
- **U**lcerative colitis + Crohn’s disease
- **M**aterinity Mycobacterium - pregnancy
42
Investigations if a person has erythema nodosum + why
- **inflammatory markers**
- **throat swab** - for strep infection
- **chest X ray** - for sarcoidosis or TB
- **stool microscopy + culture**- for salmonella or campylobacter
- **faecal calprotectin** - for IBD
43
Management of erythema nodosum
- investigations to find underlying conditions/cause
- rest + analgesia
44
Describe urticaria (hives)
- Central swelling of variable size (red or white) with area of erythema
- Itchy/pururitic
- Wheels
- Wide distribution (often)
- Fleeting nature, with skin returning to normal within 1-24 hours
- Associated with angio odema + flushing
45
Pathophysiology of urticaria
**Mast cell degranulation + histamine release** > increased capillary permeability + leakage of fluid into surrounding tissue
46
Types of urticaria
acute urticaria (often allergies) - most common
chronic urticaria (autoimmune)
47
Treatment of urticaria
- identify + avoid trigger
- general education
- first line: **non sedating antihistamines** e.g. *fexofenadine*
- sedating antihistamine considered for night time use *e.g. chlorphenamine*
- oral steroids for severe flares
48
Types of viral skin infections
Shingles
Molluscum contagiosum
hand food + mouth
erythema infectiosum/fifth disease/slapped cheek syndrome
49
What is molluscum contagiosum?
- Viral skin infection
- Small firm spots that have a dimple in the middle
- Often in children
- Due to pox virus
- self limiting
50
Treatment of molluscum contagiosum
Self limiting
51
What is shingles?
- Viral skin incfection
- Due to varicella zoster virus
- Painful rash
- Tingling sensation prior to rash
- Vesicles in dermatomal pattern - most commonly T1-L2
52
Treatment of shingles
- first line: **analgesia** - paracetamol + NSAIDs
- second line: **oral corticosteroid**
- antivirals *aciclovir*
- Avoiding particular patient groups *e.g. immunosuppressed, pregnant, not had chickenpox*
- infectious until ALL stops have crusted over
53
What is hand, food and mouth disease?
presenation
- self limiting condition in children
- caused by coxsackie A virus
- starts with typical URTI symptoms
- 1-2 days later mouth ulcers appear
- then red blistering spots across the body
54
Management of hand, foot + mouth disease
- Supportive management with adequate fluid intake, simple analgesia
- if well, do not keep of school??
- highly contagious education for avoiding transmission
55
What causes fifth disease?
parovirus 19
56
Presentation of fifth disease
diffuse bright red rash on both cheels 'slapped cheeks'
57
Management of fifth disease
supportive - fluids, analgesia
58
Types of bacteria skin infections
Impetigo
59
What is impetigo
- Bacterial skin infection
- highly contagious
- due to staph aureus or strep pyogenes
- in areas of broken skin
60
What is impetigo caused by?
what is the tranmission?
- Staph aureus (golden crust formation)
- Strep pyogenes
- direct contact with discharges from scabs into minor abrasions on skin
- indirect spread via toys, clothing etc.
61
management of impetigo
- topical mupirocin
- **oral flucloxacillin** if severe or widespread
- **hydrogen peroxide cream** if in one area (not commonly used)
- education on hand hygiene, avoid sharing towels + cutlery
- off school until lesions have healed or 48 hours after commencing abx treatment
CHECK!!
62
What is dermatophytosis infection?
- superficial fungal infection
- spread by direct contact
63
Treatment of dermatophytosis infection
- topical antifungals
- advice: wash towels often, keep skin dry
64
Types of skin cancer
Malignant melanoma
Squamous cell carcinoma
Basal cell carcinoma
65
Main cause of malignant melanoma
UV light exposure
66
Risk factors of malignant melanoma
Pale skin
Red/blonde hair
Lots of freckles
Family history
Sun exposure
67
Treatment of malignant melanoma
Surgery
Radiotherapy if spread
Avoid prolonged sun exposure + use sun protection
68
What is malignant melanoma?
Cancer from melanocytes
69
What is squamous cell carcinoma characterised by?
- abnormal + accelerated growth of squamous cells
- in areas exposed to sun
- non healing ulcer
70
risk factors of squamous cell carinoma
- escessive UV exposure
- bowen's disease
- immunosuppresion *e..g after renal transplant, HIV*
- smoking
- Marjolin's ulcers
- xeroderma pigmentosum
71
Treatment of squamous cell carcinoma
- 2WW referral to specialist for skin biopsy to confirm
- avoid prolonged sun exposure + use sun protection
- surgery to remove lesion
- teach patient how to check their skin for new/changing lesions + taking photos of them with tape measure if found
72
What is Bowen's disease?
precanerous dermatosis that is a precursor to squamous cell carcinoma
73
features of bowen's disease
red,scaly patches
slow growing
osften 10-15mm
in sun exposed areas
74
management of bowen's disease
topicl 5-fluorouracil
75
Most common type of skin cancer
Basal cell carcinoma
76
What does basal cell carcinoma look like?
- shiny skin coloured bump
- is translucent
- glossy looking/pearly
- possible central 'crater'
77
Compare the age demographic effected between squamous and basal cell carcinoma
**Squamous**: middle age or older
**Basal**: older adults
78
Cause of basal cell carcinoma
When one of the skin’s basal cells develops a mutation in its DNA
Often due to UV radiation
79
Management of basal cell carcinoma
- routine referral to specialist for skin biopsy to confirm
- avoid prolonged sun exposure + use sun protection
- surgery to remove lesion
- cryotherapy
- radiotherapy
- teach patient how to check their skin for new/changing lesions + taking photos of them with tape measure if found
80
Outline referral of skin cancers to
2WW in squamous cell carcinoma + melanoma
Routine referral in basal cell carcinoma
81
features of scabies
- widespread pruritis
- liear burrows on fingers, interdigital webs, flexor aspect of wrist
- excoriations
82
Treatment of scabies
- First line: **Topical permethrin 0.5% applied for 12 hours**
- second line: **Topical malathion 0.5% applied for 24 hours**
- Treatment also to all household + close physical contacts
- Hot wash bedsheets
- avoid close physical contact with other until treatment complete
83
What are seborrhoeic keratoses?
Benign epidermal skin lesions seen in older people
84
Features of seborrhoeic keratoses
- Large variation in colour - from flesh, to light brown to black
- ‘stuck on’ appearance
- keratosis plugs may be seen on surface
85
Management of seborrhoeic keratoses
Reassurance
Leave it alone
Removal - cryosurgery, shave biopsy
86
what is hidradenitis suppurativa?
chronic painful inflammatory skin disorder causing recurrent, painful inflamed nodules which can rupture with purulent discharge
most commonly on axilla
87
management of hidradenitis suppurativa
- encourage good hygiene
- loose fitting clothes
- smoking cessation
- weight loss
- steroids for acute flares
- topica or oral clindamycin for long term
88
What is seborrhoeic deramtitis>?
chronic dermatitis due to inflammator reaction related to a normal skin fungus
89
presentation of seborrhoeic dermatitis
- eczzematous lesions on sebum rich areas *e.g. sclap, periorbital, auricular, nasolabial folds
- on sclap can cause dandruff
- otitis externa
- blepharitis
90
management of seborrhoeic dermatitis on the scalp
- first line: **ketoconaozle 2% shampoo**
- Head and shoulder's or TGel over the counter
- topical corticosteroids
91
management of seborrhoeic dermatitis on face and body
- topical antifungals *e.g. ketoconazole*
- topical steroids short term
