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Derm 1 Flashcards

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1
Q

What is the pH of normal skin?

A

5.5

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2
Q

What are the layers of the skin? Superficial to deep

A

Epidermis > Dermis > Subcutaneous Fat

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3
Q

What layer of the skin are Corneo-desmosomes and desmosomes found? What diseases affect them?

A

Epidermis

Increased number = psoriasis

Decreased number = atopic eczema

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4
Q

What are found in the Dermis?

A

Meissner’s corpuscle - light touch

Pacinian corpuscle - coarse touch/vibration

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5
Q

What cells are found in the epidermis?

A

Keratinocytes - produce keratin

Langerhans cells - present antigens and activate T cells

Melanocytes - produce melanin, which protects from UV radiation

Merkel cells - specialised nerve endings for sensation

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6
Q

What are some differentials for itch WITH rash?

A

Urticaria (hives, weals, welts)
Atopic eczema
Psoriasis
Scabies

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7
Q

What are some differentials for itch with NO rash?

A 
Renal failure
Jaundice
Iron Deficiency
Lymphoma - hodgkins
Polycythamia - bath itch
Pregnancy
Drugs
Diabetes
Cholestasis
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8
Q

What is the pathophysiology of Acne?

A
  1. Narrowing of hair follicle due to hypercornification
  2. Results in increased sebum production
  3. Sebum stagnates at pit of the follicle where there is NO oxygen
  4. These anaerobic conditions allow Propionibacterium acnes to multiply
  5. P.acne break down triglycerides in sebum into FFA = irritation, inflammation and the attraction of neutrophils
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9
Q

How would Acne present? How would you diagnose?

A

Whiteheads
Blackheads
Papules
Pustules

Usually clinical diagnosis
Skin swabs for MC&S

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10
Q

How would you manage Acne?

A

Topical retinoid/salicylic acid - tretinoin topical, salicylic acid

Topical benzoyl peroxide

Topical azelaic acid

Oral retinoid - isotretinoin

Oral corticosteroid - prednisolone

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11
Q

What are the two types of Eczema/Dermatitis?

A

Endogenous (atopic) - usually due to hypersensitivity

Exogenous - contact dermatitis usually precipitated by chemicals, sweat and abrasives

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12
Q

What are some risk factors for Eczema/Dermatitis?

A

Faulty gene that codes for Filaggrin

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13
Q

How does Eczema/Dermatitis present?

A

Commonly on the face and flexure surfaces of the limbs

Itchy, erythematous and scaly patches esp in the flexure of elbwos, knee, ankles, wrists and around the neck

Increased dryness of skin

Recurrent Staph. Aureus infections may be common

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14
Q

How would you diagnose eczema/dermatitis?

A

For eczema it would be clinical diagnoses

Contact dermatitis - patch testing, repeated open application test

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15
Q

How would you manage eczema/dermatitis?

A

moisturisers, topical hydrocortisone

tacrolimus

oral corticosteroids

*eczema could try antihistamine (chlorphenamine)

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16
Q

What is psoriasis? What are the different forms?

A

hyper-proliferation of skin leading to thickened plaques

  1. Chronic plaque psoriasis
  2. Flexural psoriasis
  3. Guttate (rain-drop) psoriasis
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17
Q

What are some risk factors for psoriasis?

A

polygenic

infection with group A strep

lithium

UV light

High alcohol use

Stress

Fam Hx

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18
Q

How does Chronic plaque psoriasis present?

A

Most common

Well demarcated disc-shaped, Salmon-pink silvery plaques occur on the exterior surface of the limbs, particularly the elbows and knees

Scalp involvement is common and is most seen at the hair margin

New plaques occur at sites of skin trauma

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19
Q

How would you treat chronic plaque psoriasis ?

A

emollients

topical corticosteroid - hydrocortisone

topical vitamin D analogue - calcipotriol

PUVA (risk of neoplastic skin lesions)

mtx

apremilast

ciclosporin

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20
Q

How does flexural psoriasis present?

A

later in life

well demarcated, red, glazed, non-scaly plaques

scaling is absent

confined to - groin, natal cleft and sub-mammary areas

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21
Q

How does guttate psoriasis present?

A

commonly in chilfren and young adults

generalised, concentrating on the trunk, upper arms and legs

explosive eruption of very small circular or oval plaques appears over the trunk about 2 weeks after a streptococcal sore throat

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22
Q

How do you treat guttate psoriasis?

A

phototherapy + psoralen (photosensitising agent)

MTX

Oral retinoid - acitretin

Ciclosporin

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23
Q

What are venous ulcers? How do they occur?

A

Loss of skin below the knee on the leg or foot that takes more than 2 weeks to heal

Result of sustained venous hypertension in the superficial veins

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24
Q

How do venous ulcers present?

A

sloping and gradual edges

ulcers are large, shallow, irregular and exudative

usually minimal pain

oedema of the lower leg

venous eczema

brown pigmentation from haemosiderin

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25
How would you treat a venous ulcer?
high compression 4 layered bandage leg elevation to reduce venous hypertension antibiotics for infection analgesia support stockings for life
26
How do arterial ulcers present?
Punch-out ulcers higher up the leg or on the feet Intense pain that is worse when elevated leg is cold and pale ulcer is small, sharply defined and has anecrotic base absent peripheral pulses NO OEDEMA
27
How would you investigate an arterial ulcer? How would you manage it?
Doppler USS - confirm arterial disease ABPI will suggest arterial insufficiency Keep ulcer clean and covered Analgesia NEVER USE COMPRESSION BANDAGING
28
What are neuropathic ulcers?
often painless seen over pressure areas of feet such as the metatarsal heads or heels commonly assoc with diabetes and neurological disease = peripheral neuropathy
29
What are some characteristics of Squamous Cell Carcinoma?
presents in later-life malignant tumour of the squamal keratinocytes more aggressive than BCC and has a higher metatastic potential
30
What is Bowen's disease?
in situ SCC that is confined to the epidermis
31
What are risk factors for squamous cell carcinoma?
UV exposure Chronic inflammation
32
How does squamous cell carcinoma present?
most common on sun-exposed sites in later life can grow very rapidly ulcerates lesions on the lower lip or ear are often more aggressive
33
How would you treat squamous cell carcinoma?
destructive therapies - cryotherapy topical therapy - fluorouracil surgical excision/Mohs surgery (micrographic surgery) radiotherapy
34
What are some characteristics of a basal cell carcinoma?
majority non-pigmented majority in elderly on the head and neck may ulcerate - called a rodent ulcer rarely metastasises but is locally destructive
35
What cells are a basal cell carcinoma?
tumour of basal keratinocytes
36
What are some risk factors for basal cell carcinoma?
UV exposure Skin type 1 - that burns and doesn't tan Ageing
37
How does a basal cell carcinoma present?
border of ulcerated lesions are raised with a pearly appearance can be nodular (most common), superficial (plaque-like), cystic, morphoiec, keratotic and pigmented
38
How would you treat basal cell carcinoma?
Vismodegib Curretage +/- cautery and biopsy Radiotherapy Mohs surgery
39
What is a malignant melanoma?
Malignant tumour of the melanocytes most malignant for of skin cancer commonly affects younger patients
40
What are risk factors for malignant melanoma?
UV exposure Red hair High density freckles Skin type 1 Atypical moles Sun sensitivity Immunosuppresion Fam Hx
41
How does a malignant melanoma present?
commonest site in men - back/chest commonest site in women is on lower legs 95% melanomas show very dark colour, black or almost black
42
How would you investigate a malignant melanoma?
ABCDE Asymmetrical shape Border irregularity Colour irregularity Diameter >6mm Elevation/Evolution Major signs - change in size, shape or colour Minor signs - inflammation, crustin or bleeding, sensory change, itching
43
What are the types of melanoma?
Superficial spreading (SSMM) Nodular - most aggressive Lentigo maligna - usually on the face Acral - restricted to palms/soles
44
What are some differentials of malignant melanoma?
Benign pigmented naevus Seborrhoiec wart pyogenic granuloma
45
How would you treat malignant melanoma?
surgical excision ipilimumab high-dose interferon alfa-2b or peginteferon alfa-2b
46
What are some ways of staging malignant melanoma?
Breslow depth Clark's staging
47
What makes for a poor prognosis of malignant melanoma?
thicker lesions over 60 male ulceration trunk
48
What is cellulitis?
bacterial infection of the deep sub-cutaneous tissues
49
What are the causes/risk factors for cellulitis?
group A beta-haemolytic strep (strep pyogenes most common) Staph Aureus MRSA Lymphoedema Leg Ulcer Immunosuppresion Traumatic wounds Athletes foot Leg oedema Obesity
50
How does cellulitis present?
Local inflammation- proximally spreading Hot erythema Poorly demarcated margins, swelling, warmth and tenderness Blisters if oedema is prominent Systemically unwell with pyrexia
51
How would you diagnose/investigate cellulitis?
FBC count - raised WCC Purulent focus culture - growth of typical pathogen
52
How would you treat cellulitis?
Vancomycin/Daptomycin/Linezolid Bite-related - amoxicillin + metronidazole + tetanus immunisation
53
What is necrotising fasciitis?
Deep seated infection of the subcut tissue that results in a fulminant and spreading destruction of fascia and fat that initially spares the skin
54
What are the types of necrotising fasciitis?
Type 1 : caused by mixture of aerobic and anerobic bacteria following abdo surgery or in diabetes Type 2 : caused by group A beta-haemolytic streptocci (strep pyogenes most common
55
How does necrotising fasciitis present?
Severe pain that is out of proportion to skin findings at the initial site of infection rapidly followed by tissue necrosis spreading erythema, pain and sometime crepitus fever, toxicity and pain multi-organ failure is common
56
How would you investigate necrotising fasciitis?
Abnormally high or low WBC Serum urea and creatinine - may be seen in any systemic infection or circulatory collapse CRP - elevated CK - elevated Lactate - elevated Blood and tissue cultures - positive
57
How would you treat necrotising fasciitis?
surgical debridement and haemodynamic support vancomycin
58
What is a comedone?
plug in sebaceous follicle containing altered sebum, bacteria and cellular debris ``` open = blackhead closed = whitehead ```
59
What is the Koebner phenomenon?
A linear eruption arising at site of trauma e.g. in psoriasis
60
What are the following? ``` Macule Papule Nodule Vesicle Bulla ```
Macule - flat area with altered colour Papule - solid raised lesion <0.5cm Nodule - solid raised lesion >0.5cm Vesicle - raised,clear fluid-filled lesion <0.5cm Bulla - raised, clear fluid-filled lesion >0.5cm
61
What are the 4 stages of wound healing?
Haemostasis Inflammation Proliferation Remodelling
62
What happens during the haemostasis and inflammation in the wound healing process?
Haemostasis - vasoconstriction and platelet aggregation, clot formation Inflammation - vasodilation, migration of neutrophils and macrophages, phagocytosis of cellular debris and invading bacteria
63
What happens during proliferation and remodelling in the wound healing process?
Proliferation - granulation tissue formation and angiogenesis, re-epithelisation Remodelling - collagen fibre re-organisation, scar maturation

Dermatology (2 decks)

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