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Derm I Flashcards

(109 cards)

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1
Q

Define atopic eczema

A

A chronic, relapsing inflammatory skin condition

Characterised with itchy, erythematous scaly patches

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2
Q

Pathophysiology of atopic eczema

A 
Defect in the skin barrier 
Immune function disorder
- Th2 mediated immune response 
Exacerbating factors 
- infection, soaps
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3
Q

Presentation of atopic eczema

A 
RF
- hx of atopy 
- family hx 
Pruritus 
Xerosis ( dry skin) 
Erythematous scaly patches @ FLEXOR surfaces 
Acute lesions: vesicles and weeping 
Lichenification and excoriation 
Hypopigmentation
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4
Q

Diagnostic criteria of eczema

A

Itchy skin + 3 of

  • Flexural invovlement
  • Visible dermatitis
  • Person history of atopy
  • General dry skin for the last year
  • Onset <2
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5
Q

Management of atopic eczema

A
  1. Skin hydrate, emollients, avoid irritants, identify and address the triggers
  2. Low/ Mid potency TCS/ TCI (tacrolimus)
  3. Mid/ High potency TCS and/ or TCI
  4. Systemic therapy or UV therapy
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6
Q

List the types of contact dermatitis

A

Irritant
- direct toxicity without prior sensitisation
Allergic
- delayed hypersensitivity

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7
Q

Management of contact dermatitis

A

Irritant

  • Emollients
  • Topical corticosteriods
  • Irritant avoidance

Allergic

  • Topical corticosteroids
  • Allergen avoidance
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8
Q

Presentation of seborrhoeic dermatitis

A

Pruritic erythematous scaly patched
Scalp, nasolabial fold
Anterior chest

Infants: cradle cap
Adults: flares with stress

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9
Q

Treatment of seborrhoeic dermatitis

A

Infants

  • emollients
  • topical corticosteriods

Adults

  • topical shampoo
  • topical corticosteriods

if non scalp: topical anti fungal (Ketaconazole)
if > 3months: oral anti fungal

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10
Q

Define psoriasis

A

Inflammatory disease due to hyper proliferation of keratinocytes and inflammatory cell infiltrate

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11
Q

Presentation of psoriasis

A

Extensive erythematous, well circumscribed scaly plaques
Silver surfaces
Extensor surfaces

Nail changes

  • Pitting
  • Beau’s lines
  • Onychlysis

Psoriatic arthritis

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12
Q

List the types of psoriasis

A
  1. Plaque
    - well-circumsided, erythematous, scaly plaques with silver scales
    - Auspitz sign: blled on scale removal
  2. Guttate
    - raindrop on trunk, arms and legs post strep tonsillitis
    - young
  3. Seborrhoeic
    - nasolabial
  4. Flexural
    - body folds
    - seen in women
  5. Palmar-plantar pustular
    - yellow brown pustules
  6. Eryhrodermic
    - total body redness
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13
Q

Outline the treatment options for psoriasis

A

General

  • Educate
  • Avoid precipitants
  • Emollients

Topical

  • Vit D analogues (calcipotriol)
  • Topical corticosteriods
  • Coal tar prep
  • Dithranol (for 20 minutes and then wash off)

Phototherapy

  • Extenspive disease
  • UVB + PUVA

Oral therapies

  • Methotrexate
  • Acitretin (retinoid)
  • Ciclosporin

Biological

  • Adalimumab
  • Etanercept
  • Infliximab
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14
Q

List the first line treatment for the following types of psoriasis

  • Plaque
  • Erythrodermic
  • Guttate
  • Pustular
A

Plaque

  • Topical corticosteriod
  • Vit D analogue

Eryhtrodermic
- Ciclosporin

Guttate
- Phototherapy

Pustular
- Oral retinoid

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15
Q

Outline the pathology of acne vulgaris

A

Inflammatory disease of pilosebaceous follicles
Hormonal
- excess androgens
- increase sebum production
- comedone formation by hypercornification of abnormal follicles
- colonised with propionibacterium acnes
- inflammatory reaction

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16
Q

List the conditions associated with acne

A

PCOS
Cushings
Steroid use
Puberty

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17
Q

Presentation of acne vulgarise

A 
Open comedones (blackhead)
Closed comedones (whiteheads)
Papules 
Nodules 
Cysts

Post inflammatory hyperpigmentation
Scarring
Deformity

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18
Q

Management of acne vulgarise

A

Mild

  • Topical keratolytic (benzoyl peroxide or salicyclic acid
  • Topical retinoids (synthetic Vit A - isotretinoin)
  • Topical Abx (clindamycin/erythromycin)

Moderate/Severe

  • Topical retinoid + oral abx (tetracyclin, doxycycline)
  • Anti-androgens (COCP)
  • Oral retinoids, isotretinoin, beware of suicidal thoughts side effects
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19
Q

List the pre-malignant and malignant conditions

A 
Actinic keratosis
Bowen's disease 
Squamous cell carcinoma 
Basal cell carcinoma 
Malignant melanoma
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20
Q

Presentation of squamous cell carcinoma

A 
Keratotic
Ill defined nodule 
Ulceration 
Bleeding 
Lymphadenopathy
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21
Q

Management of squamous cell carcinoma

A 
In-situ: cryotherapy (destructive) 
topical chemotherapy (fluoracil)
Invasive: wide surgical excision 
<2cm: MOH's micrographic surgery 
Metastic: excision + radiotherapy 
3-6 months f/up
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22
Q

Presentation of basal cell carcinoma

A

Rodent ulcer
Slow growing, locally invasive, malignant tumour or epidermal keratinocytes
From hair follicle

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23
Q

Types of basal cell carcinoma

A

Nodular: head/neck, papule nodule, rolled edge
Superficial: central clearing, threadlike border, truck and shoulders
Sclerosing: blue, brown grey melanoma

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24
Q

Management of a basal cell carcinoma

A
  1. Surgical excision
  2. Moh’s micrographic surgery
  3. Radiotherapy
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25
Presentation of malignant melanoma
Irregular Ulcerates Bleeds
26
List the investigations for malignant melanoma
1. Dermatoscopy 2. Skin biopsy - if confined to the epidermis (melanoma in situ) - if spread to the dermis (invasive melanoma) 3. Assess metastasis (liver most common site)
27
Staging of a malignant melanoma
Breslow's thickness - depth of invasion, measured on histology Clark's levels - less accurate
28
Management of melanoma
IN SITU - wide local excision Melanoma - wide local excision - sentinel lymph node biopsy Metastatic disease - lymphadenectomy
29
List the types of blistering disorders
Immunobullous disease - bullous perphigoid Blistering skin infection - herpes simplex - impetigo
30
Pathology of bulls pemphigoidd
A chronic blistering skin disorder affecting the elderly | autoantibodies vs hemidesmosal antigens in epidermis and dermis
31
Presentation of bullous pemphigoid
``` Tense fluid filled blisters on erythematous base Itchy Trunk and limbs Symmetrical Favour flexures Non specific itchy rash ```
32
Management of bulls pemphiigoid
General measure - Wound dressing - Monitor for signs of infection Topical therapies (for localised) - Corticosteriods - Tacrolimus Oral therapies (widespread lesions) - Steriods (prednisolone, - Sedating antihistamines (hydroxyzine) - Nicotinamide + oral tertracycline - Immunosupressives (azathioprine, methotrexate, ciclosporin)
33
Pathology of pemphigus vulgaris
Autoimmune blistering skin disorder Middle aged Autoantibodies vs antigens in the epidermis Intra-epidermal spilt
34
Presentation of pemphigus vulgaris
Flaccid easily rupture blisters forming erosions and crusts | Mucosal areaS
35
Management of pemphigus vulgaris
General - wound dressing - prevent infection Oral therapies - High dose oral steriods - Immunosupressants (methotrexate, azathioprine, cyclophosphamide)
36
List the pathogens responsible for impetigo
Staph aureus
37
Presentation of impetigo
Children Golden crust or vesicles/bullae in bullous impetigo Highly contagious
38
Management of impetigo
Good hygiene to avoid spread Topical fusidic acid Intranasal mupirocin Oral flucloxacillin
39
Types of herpes simplex
Type I: oral herpes (oral ulcer with vermillion border or vesicles Type II: Gential herpes
40
Treatment with herpes simplex
Aciclovir | Oral or topical
41
List the common causing organism involved in cellulitis
S.aureus Strep pyogenes Spreading bacterial infection of the deep subcutaneous tissue
42
Presentation of cellulitis
Local signs of inflammation Systemically unwell Well defined raised red border @ eyes - periorbital cellulitis - orbital cellulitis - beaware as it can track back and cause near infection
43
Management of cellulitus
General - flucloxacillin 250mg/ 6hourly Orbital - ceftriaxone (IV) + vancomycin (IV) - orbital decompression Severely ill - parenteral abx - MRSA cover (vac/taz)
44
Pathology of scalded skin syndrome
In children | Production of epidermolytic toxin from benzylpenicillin-resistant coagulase negative staph
45
Presentation of scalded skin syndrome
Painful intraepidermal blistering Flaccid bullae Perioral crusting Fever
46
Treatment of scalded skin syndrome
Analgesia Antibiotics: flucloxacillin, start IV then oral Fluids
47
List the three main groups of fungal infections
Dermatophytes - tinea - ringworm Yeast - candidiasis Moulds - aspergillus
48
Types of tinea
Tinea corporis - titchy annular lesions with clear defined raised scaly edge Tinea pedis - scaling and fissuring (toewebs) Tinea capitis - scaly ringworm - patches of broken hair - scaling and inflammtion
49
Presentation of candidiasis
White plaques on mucosal read | Erythema with satellite lesions in flexures
50
Management of fungal infections
Establish dx - skin scrapings - swabs Rx precipitating factors - immunosupressives Topical antifungal - ketocanazole - selenium sulphate shampoo Oral antifungal - fluconazole Avoid topical steroids - tinea incognito
51
Treatment of warts
Cryotherapy Silver nitrate Debridement Salicylic acid common in the immunocompromised
52
Presentation of molluscum contagious
Acquired through skin to skin contact Pearly sooth papule with a central umbilication @ face and groin
53
Treatment of molluscum contagiosum
Curettage | Cryotherapy
54
Treatment of scabies
Topical permetin (apply from the neck down, wash after 8 hours) Antihistamines Wash clothes at >60 degrees
55
Pathology of venous ulcers
Chronic venous insufficiency Other signs - Ankle swelling - Hyperpigementation - Lipodermatosclerosis - Telangiectasias - Varicose veins
56
Presentation of venous ulcers
``` Medial/ lateral malleolus Knee and ankle Large Shallow/sloping edge Painless/mild pain Irregular border Most granulating base ```
57
Management of venous ulcers
Graduated compression + leg elevation Debridement and cleaning Dressing
58
Pathology of arterial ulcers
Atherosclerosis and tissue hypoxia | Think of arterial disease risk
59
Presentation of an arterial ulcer
``` Dorsum of the foot and toes Painful Irregular edge Grey granulating base Punched out appearance ```
60
Management of arterial ulcers
ABPI <0.9 peripheral arterial disease Do NOT use compression Refer to vascular surgeon
61
Presentation of a neuropathic ulcer
``` Over pressure points Punched out Deep sinus Surrounded by chronic inflammatory tissue Brisk bleeding if probed Painless Necrotic base ```
62
Treatment of neuropathic ulcers
Diabetic foot management
63
Presentation of rosacea
Flushing dilated telangiectasia, facial erythema, inflammatory papules Prominent sebaceous glands Blepharitis
64
Rosacea triggers
Climate (sunshine) Chemical/ingested agents Stress Hot baths/ drinks
65
Management of rosacea
Topical antibiotic Anti-inflammatory + oral antibiotic - Metronidazole - Doxycycline/ tetracycline
66
Presentation of sborrhoeic keratosis
Stuck on lesions Well circumscribed plaques on papules Painless Warty like lesions
67
Treatment of seborrhoea keratosis
Itchy: topical steriods Flat: cryotherapy Raised" curettage or cautery
68
Define lichen planus
self-limiting inflammatory disease affects the skin (+genitals), nails, hair and mucous membrane Intense pruritus Scarring alopecia
69
Presentation of lichen planus
Itchy shiny flat topped violacceous papillose and plaques On extremitis Wickham's striae Oral erosions
70
Management of lichen planus
Cutaneous - topical corticosteriods (clobetasol) - antihistamine (chlorphenamine) Oral - topical corticosteriods - oral corticosteriods Genital - topical corticosteriods - calcineurin inhibitor
71
Presentation of urticaria
Itchy wheels Central swelling with peripheral eythema Swelling of the superficial dermis Due to the local increase in permeability of capillaries and venules Driven by histamine From skin mast cells Can often present with angiooedema + anaphylaxis
72
Treatment for urticaria
Antihistamines
73
Possible causes of urticaria
Immune (IgE) - Penicillins - Cephalosporins Non-Immune (direct mast cell degranulation) - Morphine - Codeine - NSAIDs - Contrast
74
Management of the following scenarios - Actue urticaria + angiooedema + airway involvement - Acute urticaria + angiooedema + no airway involvement - Chronic urticaria
1. IM adrenaline + airway protection + IV antihistamines (chlorphenamine/depenhydramine) 2. 2nd generation antihistamine H1 receptor antagomist (loratadine) + systemic corticosteriod 3. Loratadine
75
Pathology of erythema nodosum
Erythematous lumps form on the shins due to the inflammation of subcutaneous fat
76
List the possible causes of erythema nodosum
Inflammatory bowel disease TB Throat infection Sarcoidosis If severe give steroids (pred)
77
Pathology of erythema multiform
Hypersensitivity reaction triggered by infection Acute self limiting inflammatory condition HSV main precipitant (+SLE)
78
Presentation of erythema multiforme
Hundreds of lesions spreading from hands/back of feet Iris/target lesions: sharp margin, regular round shape, 3 concentric colour ones 1. Outer: bright red 2. Middle: pale pink, oedematous and raised 3. Inner: dusky/dark red with blister centre and crust
79
Features of Stevens-Johnson syndrome
Mucocutaneous necrosis with at least 2 mucosal sites involved <10% of total body surface area Preceding hx of medication use or infection (anticonvulsants, Abx, NSAIDs) Detachment of epidermis from dermis Maculopapular rash and bullae (keratinocyte apoptosis ) Nikolsky sign (sloughing at press)
80
Features of Toxic Epidermal Necrolysis
Mucocuntaneous necrosis 2 mucosal site involved with systemic toxicity >30% total body areas Detachment of epidermis from dermis Maculopapular rash and bullae (keratinocyte apoptosis ) Nikolsky sign (sloughing at press)
81
Management of SJS and TEN
1. Escalate 2. Withdrawal of causative agent 3. Dressing and topical antibacterial and emollients 4. IV Fluids 5. Analgesia
82
Complications of SJS and TEN
Dehydration Infection (sepsis) Electrolyte imbalance Multi organ failure
83
Pathology of erythroderma
Exfoliative dermatitis | Involves 90% of the skin surface
84
Presentation of erythroderma
Inflammed Oedematous scaly skin Systemically unwell Lymphadenopathy
85
Cause of erythroderma
Previous skin disease (eczema, psoriasis) Lyphoma Drugs (sulphonamides, gold, penicillin)
86
Management of erythroderma
``` Rx cause s Emollients Wet wraps Topical steriods Beware of secondary infection, fluid loss, electrolyte imbalance, hypothermia, high output cardiac failure. ```
87
Pathology of necrotising fascitis
Rapidly spreading infection of deep fascia with secondary tissue necrosis Grp A haemolytic strep pyogenes
88
Presentation of necrotising fascitis
Severe pain Erythematous blistering, necrotic skin Systemically unwell Crepitus
89
Management of necrotising fasciitis
Surgical debridement and haemodynamic support | Empirical broad spectrum Abx ( van and tax)
90
Cause of eczema herpeticum
Herpes simplex virus
91
Presentation of eczema herpeticum
Extensive crusted papules, blister and erosisns | Systemically unwell with fever and malaise
92
Management of eczema herpeticum
Antivirals | Antibiotics
93
Outline the skin manifestation of RA
Erythema marginatum
94
Outline the skin manifestation of Lyme's disease
Erythema migrans
95
Outline the skin manifestation of Crohn's
Erythema nodosum | Pyoderma gangrenosum
96
Outline the skin manifestation of dermatomyositis
Heliotrope rash on eyelids Shawl sign Gottrons papules Mechanic;s hands
97
Outline the skin manifestation of sarcoidosis
Erythema nodosum Erythema multiforme Lupus pernio Hypopigemented areas
98
Outline the skin manifestation of coeliac
Dermatitis herpetiformis
99
Outline the skin manifestation of Grave's
Pre-tibial myxoedema
100
Outline the skin manifestation of SLE
Malar rash | Discoid rash
101
Outline the skin manifestation of systemic sclerosis
``` Calcinosis Raynaud's Sclerodactyly Telangiectasia Generalised skin thickening ```
102
Outline the skin manifestation of Liver disease
``` Palmar erythema Spider naevi Brusing Jaundice Excoritations ```
103
Outline the skin manifestation of ESRD
Pruritus Xerosis Pigment change Bullous disease
104
List the pathology of alopecia aerate
Autoimmune disease Inflammatory cells ( T-cell) target the hair follicle Prevents growth
105
List the types of alopecia
Patchy alopecia areta Alopecia totalis Alopecia universalis
106
Treatment for alopecia
Limited: - topical corticosteroid - cosmetic camouflage - intralesional corticosteriod Extensive - topical immunotherapy - cometic camouflage
107
Pathology of androgenic alopecia (male-pattern baldness)
Genetically determined patterned progressive hair loss from the scalp Dominantly inherited with variable penetrance Family hx is relevant
108
Presentation of androgenic alopecia
Onset 20-25 years Receding frontal hairline Thining in temporal areas progressing to crown
109
Treatment for male pattern baldness
Topical minoxidil Oral finasteride (not for women) Cosmetic aids

Dermatology (3 decks)

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