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Year 3 GP > Dermatology > Flashcards

Dermatology Flashcards

(66 cards)

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1
Q

How to describe skin lesion

A

Site
Colour
Associated changes
Morphology

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2
Q

How to describe a pigmented skin lesion

A 
Asymmetry
Border 
Colour
Diameter 
Evolution `
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3
Q

Psychosocial effects of eczema and acne

A 
Self-conscious 
Social isolation 
Embarrassed 
Cover up 
Anxiety
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4
Q

Structure of skin

A

Epidermis
Dermis
Subcutaneous tissue

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5
Q

Epidermis

A

Physical barrier
Stratum corneum is keratanised and constantly replaced
Thicker stratum corneum on hands and feet
Contains Langerhans cells - defence against pathogens

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6
Q

Dermis

A

Thick layer made of collagen, elastin and fibrillin
Gives flexibility and strength
Contains nerve endings, glands, hair follicles and blood vessels

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7
Q

Malignant Melanoma

A 
Asymmetrical
Border: irregular
Colour: non-uniform
Diameter > 6mm
Evolving / Elevation
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8
Q

Risk factors for malignant melanoma

A 
Sunlight: esp. intense exposure in early years
Fair-skinned (Low Fitzpatrick Skin Type)
↑ no. of common moles
\+ve FH
↑ age
Immunosuppression
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9
Q

Classification of malignant melanomas

A 
Superficial spreading - 80% 
Lentigo Maligna 
Acral Lentiginous 
Nodular 
Amelanotic - atypical appearance with delayed dx
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10
Q

Lentigo Maligna

A

Elderly pts

Face or scalp

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11
Q

Acral Lentiginous

A

Asians/blacks

Palms, soles

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12
Q

Nodular Melanoma

A

All sites:
Younger age, new lesion
Invade deeply and metastasis early = poor prog

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13
Q

Common metastases of malignant melanoma

A

Liver

Eye

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14
Q

Mx of malignant melanoma

A

Excision + secondary margin excision depending on depth
± lymphadenectomy
± adjuvant chemo

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15
Q

Poor prognostic indicators of malignant melanoma

A

Male sex (more tumours on trunk cf females)
↑ mitoses
Satellite lesions (lymphatic spread)
Ulceration

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16
Q

Squamous Cell Carcinoma

A

Ulcerated lesion with hard, raised everted edges
Sun exposed areas
May arise in chronic ulcers: Marjolin’s Ulcer

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17
Q

Basal cell carcinoma

A

Commonest skin cancer

  • Rodent ulcers
  • Pearly nodule with rolled telangiectactic edge
  • May ulcerate
  • Typically on face in sun-exposed area

Behaviour:
Very rarely metastasise
Locally invasive

Mx: if closed to eye
Excision
Cryo/radio may be used.

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18
Q

Evolution and Mx of SCC

A

Solar/actinic keratosis → Bowen’s → SCC
Lymph node spread is rare

Rx:
Excision + radiotherapy to affected nodes

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19
Q

Actinic Keratoses

A

Irregular, crusty warty lesions.
Pre-malignant

Mx: for cosmetic effect
Cautery
- Cryotherapy 
- 5- flourouracil 
- Photodynamic phototherapy
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20
Q

Bowen’s Disease

A

Red/brown scaly plaques

SCC in situ

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21
Q

Psoriasis risk factors and pathology

A

Age: peaks in 20s and 50s
FHx

Type IV hypersensitivity reaction

  • Epidermal proliferation
  • T-cell driven inflammatory infiltration
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22
Q

Psoriatic histology

A

Acanthosis: thickening of the epidermis

Parakeratosis: nuclei in stratum corneum

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23
Q

Psoriatic triggers

A 
Stress
Infections: esp. streps
Skin trauma
Drugs: β-B, Li, anti-malarials, EtOH
Smoking
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24
Q

Signs of psoriasis

A

Symmetrical well-defined red plaques with silvery scale

Distribution:
Extensors: elbows, knees
Flexures - in children(
Scalp, behind ears, navel, sacrum

Psoriatic arthritis:
Mono-/oligo-arthritis: DIPs commonly involved
Asymmetrical
Psoriatic spondylitis

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25
Psoriatic nail changes
Pitting Onycholysis Subungual hyperkeratosis - excessive skin cells that accumulate between the nail and the nail bed
26
Mx of psoriasis
``` Education: Avoid triggers Soap Substitute Emollients Topical Therapy: Vit D3 analogue: Steroids: e.g. betamethasone ``` Tar: mainly reserved for in-patient use UV Phototherapy Non-Biologicals - Methotrexate - Ciclosporin
27
Atopic dermatitis presentation
Extremely itchy Poorly demarcated rash Acute: oozing papules and vesicles - Subacute: red and scaly - Chronic eczema → lichenification - Skin thickening with exaggeration of skin markings Commonly on flexors, cheeks and around eyes PMHx- atopy FHx
28
Pathophysiology of atopic dermatitis
TH2 driven inflammation with ↑IgE production
29
Adult Seborrhoeic Dermatitis
Red, scaly, rash Cause: overgrowth of skin yeasts Location: scalp (dandruff), eyebrows, cheeks, nasolabial folds Rx: mild topical steroids / antifungal e.g. Daktacort: miconazole + hydrocortisone
30
Mx of atopic dermatitis
Education: Avoid triggers Emollients Topical Steroids 2nd line Therapies: - Topical tacrolimus - Phototherapy - Ciclosporin or azathioprine
31
Topical Steroids
1% Hydrocortisone: face, groins Betnovate Dermovate: very strong, brief use on thick skin - Palms, soles
32
Surface features
Scale - build up of keratin Crust - dried exudate Excoriation - linear erosions from scratching Erosions/ulceration
33
Papule
Small lump < 5mm
34
Nodule
Larger lump - 5 - 10mm
35
Vesicle
Small water blister
36
Bulla
Large water blister
37
Pustule
Pus filled vesicle
38
Telangiectasia
Thead veins
39
Alopecia
Hair loss or thinning
40
Macule
Non palpable area of discolouration < 10mm
41
Patch
Non palpable area of discolouration > 10mm
42
Plaque
Elevated area > 2cm
43
Erosion
Palpable, flat-topped area- 1cm
44
Ulcer
Palpable, flat topped area- 2cm
45
Lichenification
Loss of epidermis - superficial Loss of epidermis and dermis - deep Thickening
46
Comedone
Black head - open or closed
47
Erythema multiform
Target appearance | Multiple coalescing erythematous patches
48
Tinea
Superficial mycosis caused by dermatophytes - fungi
49
Presentation of tinea
Round scaly lesion Itchy Central clearing with raised annular ring Scalp, body, foot, groin, nails
50
Ix and Mx for Tinea corporis
Ix: Skin sample and fungal microscopy Mx: Topical antifungals: - Terbinafine - Imidazole - OTC Inflammation: Topical corticosteroid - hydrocortisone 1% - should not be used alone Severe: Oral antifungal if there is: +ve fungal microscopy or culture Strong clinical suspicion Arrange repeat skin sampling
51
Conservative mx of tinea corporis
Loose fitting clothes made of cotton Good hygiene - wash affected area daily and dry thoroughly Do not share towels Wash clothes and bed linen to remove fungal spores
52
Onychomycosis
Starts at edges of nails Nail discolours and lifts off White/yellow opaque streak on one side of nail Mx: Antifungal nail cream - Apply for 12 months but doesn’t always work Nail softening cream - 2 weeks to soften nail so infection can be scraped off the nail If severe - oral antifungals for 6 months or remove
53
Tinea versicolor
- Fungus interferes with the normal pigmentation of the skin - small, discoloured patches. - May be lighter or darker in colour - Commonly affect the trunk and shoulders
54
Impetigo
Contagious superficial skin rash caused by S. aureus Presentation: Age: peak @ 2-5yrs Honey-coloured crusts on erythematous base Common on face Mx Mild: topical Abx - fusidic acid More severe: flucloxacillin PO
55
Pityriasis Rosea
Presents with inflamed skin patch first. Followed by further skin eruptions Associated with a sore throat and a cold before sin changes occur Herald patch precedes rash, mainly on the trunk
56
Acne Vulgaris Mx
Pt. education - wash face and moisturise twice a day Mild: topical therapy - Benzoyl peroxide Moderate - Topical benzoyl peroxide + oral Abx (doxy or erythro) Severe: - Isotretinoin (vitamin A analogue) - Retinol
57
Side effects of retinol
Teratogenic, hepatitis, ↑lipids, depression, dry skin, myalgia Suicidal thoughts Monitor: LFTs, lipids, FBC May try Dianette (COCP) in women - only give if scarring and needs dermatologist review
58
Urticaria
Wheals ± angioedema and anaphylaxis Rapid onset after taking drug - treat anaphylaxis and remove trigger - non sedating anti-histamine - cetirizine - sedative antihistamine - chlorphenamine
59
Parvovirus
Slapped cheek
60
Erysipelas
Sharply defined superficial infection by S. pyogenes - Often affects the face - High fever + ↑ WCC Mx - Benpen IV - Pen V and fluclox PO
61
Lichen Planus
Flexors: wrists, forearms, ankles, legs Purple and Pruritic papules on palms, soles and flexors Lacy white marks Mx: topical steroids - clobetasonr butyrate
62
Scabies
Highly contagious: spread by direct contact - Female mite digs burrows and lays eggs Presentation: Burrows: short, red line, block dot Hypersensitivity rash: eczematous, vesicles Extremely itchy → escoriation Particularly affects the finger web spaces (esp. 1st) Also: axillae, groin, umbilicus ``` Mx Permethrin cream: applied from neck down for 24hrs, 2 doses 2 weeks apart to all close contacts as well 2nd line: Malathion 3rd line: oral ivermectin Treat all members of the household ``` Wash bed sheets and curtains
63
Treatment of impetigo
Hydrogen peroxide 1% cream Topical antibiotics - fusidic acid If extensive - flucloxacillin or erythromycin if allergic Children should not go to school until 48 hours after start of abx
64
Types of acne
Comedonal - open or closed Inflammatory - papules and pustules Nodulocystic - nodules, cysts and scars often neck and trunk Acne fulminans - severe acne associated with fever, myalgia and arthralgia
65
Ice pick scarring
Irregular deep pitted lesions due to acne | Not due to picking or scratching
66
Acanthosis nigricans causes
``` T2DM GI cancer Obesity PCOS Acromegaly Cushing's disease Hypothyroidisim COCP ```

Year 3 GP (20 decks)

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