Derm Flashcards
(129 cards)
1
Q
Functions of the skin
A
Protect against environment Temp regulation Vit D synthesis Immunosureveillance Stop fluid loss
2
Q
Which skin cells present antigens and activate t-lymphocytes?
A
Langerhans
3
Q
Merkel cells?
A
Nerve endings for sensation
4
Q
Melanocytes?
A
Produce melanin - pigment and protects nuclei from UV radiation induced DNA damage
5
Q
Epidermis is made from?
A
Keratinocytes
6
Q
Types of sweat gland and function?
A
Eccrine (skin)
Apocrine (axilla, anus. genitalia –> from puberty, body odour)
7
Q
Stages of wound healing
A
Haemostasis
Inflam
Proliferation
Remodeling
8
Q
What happens in haemostasis and inflammation?
A
Vasoconstriction and pt aggregation (clot formation)
Vasodilation, migration NP and MP –> phagocytosis of debris
9
Q
What happens in proliferation and remodelling?
A
Granulation tissue formation and angiogenesis
Collagen fibre reorganisation, scar maturation
10
Q
Why use emollients?
A
Rehydrate skin, re-establish surface lipid layer.
Use at dry, scaling conditions as soap substitute
11
Q
SE of emollients?
A
Irritant - rash
12
Q
Indications for topical corticosteroids?
A
Anti-inflammatory, anti-proliferative
Allergic/immune conditions, blistering, inflam skin, connective tissue disease, vasculitis
13
Q
4 strengths of topical corticosteroid cream (weakest to strongest)
A
Hydrocortisone
Clobetasone butyrate (eumovate)
Betamethasone valerate (betnovate)
Clobetasol propionate (dermovate)
14
Q
SEs of topical corticosteroids?
A
Skin atrophy, telangiectasia, striae, exacerbation skin conditions, acne
15
Q
SEs of oral corticosteroids
A
Syndrome (Cushings) HTN Immunosuppression Psychosis Diabetes Osteoporosis Cataracts
16
Q
Egs of topical abx
A
Fusidic acid
Mupirocin
Neomycin
17
Q
SEs of abx
A
Local (irritation, allergy)
Systemic: GI upset, rash, anaphylaxis, candidiasis, abx assos infections
18
Q
Eg of an oral retinoid
A
Isotretinoin, acitretin
19
Q
Indications for oral retinoids?
A
Acne
Psoriasis
Disorders of keratinisation
20
Q
SEs of oral retinoids?
A
Mucocutaneous reaction [dry skin, lips, eyes]
Disordered LFTs
Hypercholesterolaemia
Myalgia, arthralgia, depression
Teratogenicity
21
Q
SE of ciclosporin?
A
HTN and renal dysfunction
MUST monitor BP, U+Es
22
Q
SEs of azathioprine?
A
Hepatotoxicity
Myelotoxicity
23
Q
Atopic eczema?
A
Chronic, relapsing inflammatory skin condition characterised by itchy, erytheatous scaly pathces
24
Q
Where is eczema in infants?
In adults?
A
Infants = face + extensor
Adults = flexor surfaces
25
Dx of eczema?
Itchy skin + 3 of:
* history of flexural involvement
* visible flexural dermatitis
* personal hx of asthma, hayfever (or FH if <4y)
* Dry skin
* onset < 2
26
Ix in atopic eczema
Serum IgE
Allergy testing
27
Complications of eczema
Psychological stress
Bacterial superinfection
Eczema herpeticum - EMERGENCY
28
Mx of occupational dermatitis?
Avoid irritant (eg gloves)
Topical corticosteroids
29
Seborrhoeic dermatitis found where?
Scalp
Nasolabial fold
Anterior chest
30
What is seborrhoeic dermatitis called in babies?
Cradle cap (usually resolves by 12m)
31
Mx of seborrhoeic dermatitis?
Scalp?
Non-scalp?
Scalp [topical shampoo: salicylic acid, coal tar, ketoconazole. Topical corticosteroids]
Non-scalp [topical corticosteroids +/- topical ketoconazole]
If >3months --> oral ketoconazole
32
Psoriasis?
Inflammatory disease due to hyperproliferation of keratinocytes and inflammatory cell infiltrate
33
Biopsy of psoriasis?
Focal parakeratosis
| Epidermal acanthosis
34
Associations with psoriasis?
50% - nail changes [pitting, onycholysis]
| 10% psoriatic arthiris
35
Most common form of psoriasis?
Plaque - well circumscribed, erythematous scaly plaques
| Bleed on picking (Auspitz's sign)
36
Guttate psoriasis appearance?
| Who seen in?
Raindrop like on trunk, arms and legs
Post strep tonsillitis in the young
37
Mx of psoriasis?
Education, avoid triggers
Emollients
Topical corticosteroids
Vit D analogues
Phototherapy
If severe [MTX, ciclosporin, acitretin,]
Biologics [etanercept, infliximab]
38
Mx of guttate?
Phototherapy
39
Mx of pustular psoriasis?
Oral retinoid (acitretin)
40
Comps of acne?
Depression
Scarring
Deformity
Hyperpigmentation
41
Mx of mild acne?
Topical keratolytic
or topical retioid
or topical abx
42
Mx of mod acne?
Topical retinoid
| + oral abx (doxycycline)
43
Mx of severe acne?
Oral retinoid --> isotretinoin
44
Which cells are BCC from?
Hair follicle
45
RFs for SCC?
```
UV exposure
Pre-malignant [actinic keratoses, Bowen's]
Chronic inflam
Immunosuppression
White
```
46
Pres of SCC?
Keratotic, ill defined nodule +/- ulceration +/- bleeding
47
What is Bowens?
Superficial red, scaley patch on skin - easy to treat
| AKA "SCC in situ"
48
Ix for SCC?
Biopsy
| CT/MRI
49
Types of SCC?
Actinic keratosis
Bowen's
Invasive - penetrates basal memb to dermis
50
Mets for SCC
LNs, lung, liver, brain, bone
51
Mx of Bowen's disease?
```
Cryotherapy
Topical chemo (fluoracil)
```
52
Mx of invasive SCC?
If mets?
Wide surgical excision
+ radiotherapy
53
BCC RFs
```
UV exposure
Sunburn
Skin type I
Age
Male
Immunosuppresion
```
54
Pres of BCC?
Rodent ulcer
55
Histopathology of BCC?
Small, dark staining basal cells, invading dermis
56
Mx of BCC?
Surgical
57
How to describe a lesion?
```
Asymmetry
Border
Colour
Diameter
Evolution
```
58
Problem with melanoma?
Mets early
59
RFs melanoma?
UV exposure
Skin type I
FHx
Immunosuppressed
60
Where do you get melanoma?
| Who?
Common on lower limbs
| Young / middle aged
61
Appearance of melanoma?
Large + flat + irreg pigment
62
Growth of melanoma?
Laterally then invades deep
63
Ix for melanoma?
Deramatoscope
Biopsy
Assess for mets [sentinel LN biopsy, liver USS, CXR, CT chest/abdo/pelvis]
64
Mets from melanoma to where?
Liver
65
Mx melanoma in situ?
Wide local excision / Mohs
66
What is bullous pemphigoid?
Chronic blistering disorder usually affecting elderly
67
Cause of bullous pemphigoid?
Autoantibodies against hemidesmosal antigens in epidermis and dermis
68
Ix for bullous pemphigoid
biopsy - histopathology
69
Mx of bullous pemphigoid
Wound dressing, monitor for infections
Topical corticosteroids
If widespread --> Prednisolone PO + antihistamine
Immunosuppresants
70
What is pemphigus vulgaris?
Autoimmune blistering skin disorder affecting the middle aged
71
Cause of pemphigus vulgaris?
Autoantibodies against antigens in epidermis
| shallower than bullous
72
Mx pemphigus vulgaris?
Wound dressing, monitor for infection
High dose oral steroids, immunosuppressants
73
Impetigo pres?
| Cause?
Golden crust / vesicles
S. aureus
seen in kids
74
What makes susceptible to impetigo?
Trauma
| Skin breaks - eg eczema
75
Mx impetigo
Topical fusidic acid
Intranasal mupirocin
Oral flucloxacillin
76
Mx of orbal cellulitis
Ceftriaxone (IV) + Vancomycin (IV) +/- orbital decompression
Risk of blindness / abscess
77
Causer of scalded skin syndrome?
Production of a circulating epidermolytic toxin from benzypenicillin-resistant Staph.
78
Mx of scalded skin
analgesia, abx (flucloxacillin), fluids
79
Ix of fungal infections
skin scrapings / swabs / nail clippings
80
Mx of fungal infections
Treat precipitating factors
Topical antifungal [ketoconazole]
Oral antifungal [itraconazole, fluconazole]
81
Cause of warts
HPV (6-11)
82
Mx of warts
Cryotherapy
Silver nitrate
Debridement
Salicylic acid
83
Molluscum contagiosum appearance?
Distribution?
Pearly, smooth papule with a central umbilication
Face and groin
84
Mx of molluscum contagiosum?
Curettage
| Cryotherapy
85
Scabies cause?>
infection with mites
86
Mx of scabies?
Treat all contacts + wash clothes
Topical permethrin + antihistamine
87
Things to check in ulcers?
Site
Edge
Base
88
Cause of venous ulcers?
Chronic venous insufficicency
89
Signs of chronic venous insufficiency?
Ulcers
Ankle swelling, hyperpigmentation, lipodermatosclerosis, heavy legs, dry/scaly skin, telangiectasia, varicose veins, itch
90
Where are venous ulcers usually?
Medial/lateral malleolus
| Between knee + ankle
91
Appearance of venous ulcers>
```
Large
Shallow/sloping edge
painless
Irreg border
Moist granulating base
```
92
Ix for venous ulcers?
ABPI
| Swabs for microbiology
93
When to biopsy venous ulcers?
If atypical
| or fail to heal in 12 weeks
94
Mx of venous ulcers?
Graduated compression + elevation
Debridement + cleaning
Dressing
Abx if cellulitis
95
Cause of arterial ulcers?
atherosclerosis and tissue hypoxia
96
When would you suspect arterial ulcer?
CV RFs, absent pulses, ischaemic features
More distal
Painful
Grey granulating base
97
Features of ischaemia?
Pale, pulseless, perishingly cold, parasthesia, paralysis
98
Dx of peripheral arterial disease?
ABPI
Systolic at ankle / systolic at arm
--> <0.9 implies disease
99
Mx of arterial?
DO NOT COMPRESS
100
Location of neuropathic ulcers?
Bottom of foot - pressure points
101
Mx of neuropathic ulcer?
Find cause
Diabetic foot managment (shoes, cleaning etc)
102
Pres of urticaria?
Itchy wheals - central swelling with peripheral erythema
103
Cause of urticaria?
Skin mast cells --> histamine --> permeable capillaries and venules
104
Mx of urticaria?
Antihistamines
105
What is angioedema?
Swelling of tongue,, eyelids and lips
106
Comps of angioedema?
Asphyxia, cardiac arrest, death
107
Anaphylaxis hallmarks?
Bronchospasm
Facial/laryngeal oedema
Hypotension
108
Mx of acute urticaria +/- angioedema with airway involved?
IM adrenaline (1/1000)
+ airway protection
+ IV chlorphenamine
+ IV hydrocortisone
109
Mx of chronic urticaria?
loratadine
110
Erythema nodosum?
Erythematous lumps on shins due to inflam of SC fat
111
Causes of erythema nodosum?
IBD
TB
Strep throat
Sarcoidosis
112
Erythema multiforme?
Hypersensitivity reaction triggered by infection --> target lesions
113
Cause of erythema multiforme?
| mx?
Usually HSV
| acute + self limiting
114
Cause of Stevens-Johnsons syndrome?
Medication / infection
115
TEN vs SJS?
Extent of skin coverage..
TEN > 30%
SJS < 10%
116
What characterises TEN + SJS?
Detachment of epidermis from dermis
Maculopapular rash + bullae
Keratinocye apoptosis
Sloughs at pressure
117
Dx of SJS / TEN?
Skin biopsy + histopathology
118
Mx of SJS / TEN
```
Help!
Withdraw causative agent
Dressing + topical abx / emollients
IV fluids
Analgesia
```
119
Necrotising fasciitis?
Cause?
Rapidly spreading infection of deep fascia with 2dary tissue necrosis
Group A haemolytic strep (pyogenes) / S aureus / Pseudomonas aeruginosa
120
RFs for nec fasc
abdo surg, DM, malignancy
121
Pres of nec fasc
SEVERE PAIN
Erythematous, blistering, necrotic skin
Systemically unwell
CREPITUS subcutaneously
122
Mx of nec fasc
Surgical debridement
ABCDE
Empirical broad spec --> Vanc + Taz
123
Rosacea pres
Flushing, dilated telangiectasia, erythema
124
Mx of rosacea
Topical abx/anti-inflam
+/- oral abx
Metronidazole otpical
Doxycycline PO
125
Seborrhoeic keratosis pres?
Multiple lesions 'Stuck-on', well dermacated grey-brown-black plaques on torso/head
In over 50yos
126
Mx of seborrhoeic keratosis
Itch --> topical steroids
Flat --> cryotherapy
Raised --> curettage/cautery
127
Alopecia?
AI affecting hair follicles
128
Mx of alopecia?
Corticteroids
+/- immunotherapy
129
Pemphigus vs pemphigoid?
Pemphigus goes busy --> blisters pop early
Pemphigoid is deeper so blisters more prononounced
