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Dermatology Flashcards

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1
Q

What is ecthyma?

A

Secondary infection of eczema with staphylococcus aureus

Causes deeper ulcers with thick yellow/grey scabs

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2
Q

What causes bullous pemphigoid?

A

auto-antibodies against antigens between the dermis and epidermis

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3
Q

What conditions are pyoderma gangrenosum associated with?

A

Rheumatological conditions e.g. RA, Ulcerative colitis

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4
Q

How does pyoderma gangrenosum present?

A

Painful rash on lower leg
Purplish, indurated edges

Often start as erythema nodosum or a small pustule which rapidly deepens and widens

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5
Q

Which type of skin cancer causes only local invasion rather than distant metastasis?

A

Basal cell carcinoma

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6
Q

What is erythroderma?

A

DERM EMERGENCY

Redness >90% of the whole body
Caused by:
Drugs (NSAIDs, antibiotics, anticonvulsants, antimalarials)
Eczema
Psoriasis
Pityriasis rubra pilaris
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7
Q

What are the main concerns in erythroderma?

A

Dehydration and hypotension- loss of fluid autoregulation
Infection- loss of protective barrier
Hypothermia- loss of thermoregulation

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8
Q

What are the management options for vitiligo?

A

Steroids

Phototherapy

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9
Q

What is eczema herpeticum?

A

Herpes simplex complication of eczema
Causes extensive crusted papules, punched-out blisters and erosions
Rash is painful and associated with fever and malaise
Derm emergency, especially if over eyelid- risk of blindness

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10
Q

How is eczema herpeticum managed?

A

Oral aciclovir 400–800 mg 5 times daily, or, if available, valaciclovir 1 g twice daily, for 10–14 days or until lesions heal. - same day dermatological review

Intravenous aciclovir is prescribed if the patient is too sick to take tablets, or if the infection is deteriorating despite treatment. If eye involvement, go straight to IV treatment.

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11
Q

What nail changes are associated with psoriasis?

A 
Nail pitting
Leukonychia
Onycholysis
Subungal hyperkeratosis 
Subungal haemorrhage

= collectively known as psoriatic onychodystrophy

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12
Q

Where does scabies commonly affect?

A

Between the fingers
Genitalia

Permethrin treatment

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13
Q

What conditions are erythema nodosum associated with?

A 
IBD
TB
Strep throat infections
Sarcoid
Drugs
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14
Q

What bacterial superinfection causes a green hue to lesions?

A

Pseudomonas

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15
Q

Where are the most common sites to suffer eczema?

A

In children: face and extensor surfaces

In adults: flexor surfaces

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16
Q

What are potential complications of eczema?

A

Bacterial superinfection e.g. staph aureus and impetiginastion
Viral superinfection e.g. eczema herpeticum
Other atopic conditions
Interruption to quality of life

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17
Q

Which drugs commonly cause photosensitivity?

A 
Tetracyclines: doxycycline, limecycline
Ciprofloxacin 
Amiodarone
Hydroxychloroquine
Isotretinoin
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18
Q

How is eczema classically managed?

A
  1. Emollient treatment, non-bio washing detergens, avoiding perfumes and allergens
  2. Topical steroids
  3. Immunomodulators: topical tacrolimus
    Addition of bandage occlusion and wraps
  4. Phototherapy: 2-3x weekly sessions 6-8w
  5. Systemic immunosuppression
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19
Q

What counselling points are there for emollient use?

A
  1. Apply as regularly as possible
  2. Apply 30mins BEFORE steroids
  3. Apply in direction of hair growth
  4. Stay away from flames + be aware of clothing being flammable
  5. Be aware of slipping in the bath
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20
Q

What counselling points are there for steroid use?

A
  1. Only use as often as prescribed
  2. Only apply to affected areas and very thin layer
  3. Apply 30 mins after emollients
  4. 1 finger tip unit = Two palm sized areas
  5. Don’t use on areas of infection
  6. Wash hands after use
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21
Q

What is the steroid ladder?

A
  1. Hydrocortisone 0.1-2.5% (1% usually good place to start)
  2. Eumovate
  3. Betnovate
  4. Dermovate
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22
Q

How is bacterial superinfection of eczema usually treated?

A

Topical antimicrobials: fusidic acid, neomycin

Systemic antibiotics: flucloxacillin first line (or erythromycin if allergic)

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23
Q

What are potential complications of eczema herpeticum?

A 
Blindness
Herpes hepatitis
Encephalitis
Pneumonitis
DIC
death
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24
Q

What is the classic presentation of psoriasis?

A

Itchy, scaly, erythematous plaques on the extensor surfaces
Nail changes
Plaques may develop on scars/areas of minor trauma
May have family history

Improvement in sunlight
May have associated arthropathy

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25
What is guttate psoriasis?
Small, red, teardrop-shaped lesions on the trunk and limbs Common occurs following strep throat infection Self-limiting and disappear within 3 months- no treatment required
26
What is general pustular psoriasis?
Uncommon condition, result of severe and unstable psoriasis Acute, erythematous tender skin with sheets of monomorphic small vesicles Pustules initially occur at the margins of plaques EMERGENCY and often need ITU management
27
How is psoriasis managed?
1. Topical emollients (less effective than in eczema) and soap substitutes e.g. coal tar shampoo 2. Topical steroids: usually potent, 4-8w courses (ideally 4 week breaks between courses) 3. Vitamin D analogues: calcipotriol 4. Sulphur-based preparations If treatment-resistant: 5. Phototherapy <10 weeks 6. Ciclosporin (max 1-2 years) 7. Methotrexate 8. Acitretin (works best in combo with PUVA) 9. TNF inhibitors= infliximab 10. Other biologics
28
What is the best prognostic indicator in melanoma?
Breslow Score | -> distance in mm from granular layer in the epidermis to the deepest level of invasion into the dermis
29
What is the treatment indicated in melanoma?
Urgent excision with 2mm margins Biopsy of any palpable lymph nodes If positive margins after excision, imiquimod treatment Follow-up at 3m and 12m, regular skin checks and sun protection
30
What is the most common type of skin cancer?
Basal cell carcinoma
31
What are the risk factors for squamous cell carcinoma?
``` Sun exposure / UV from sunbeds Fair skin (low Fitzpatrick number) Smoking Immunosuppressants Chronic ulcers Xeroderma pigmentosum (genetic cause of extreme sun sensitivity) ```
32
How do SCCs usually present?
Indurated nodular lesions Rolled edge and surface telangiectasia Often have crusted/hyperkeratotic surfaces May be painful and grow rapidly Common sites include: face, scalp, backs of hands Most common in >60s
33
How is SCC treated?
Surgical excision with margins: 6mm in high risk and 4mm in low risk Moh's micrographic surgery Adjuvant radiotherapy In low-risk lesions: Curretage and cautery Topical efudix - especially in actinic keratoses
34
What are treatment options for actinic keratoses?
Cryotherapy 5-FU cream / efudix / immiquimod topical treatments If no response, biopsy to rule out invasive malignancy
35
What is Bowen's disease?
SCC in situ, no dermal invasion Well-defined erythematous patches with slight crusting Pre-malignant lesions Can be removed or treated the same as actinic keratoses
36
Which type of skin cancer is not associated with smoking?
Basal cell carcinoma
37
What are risk factors of BCC?
UV light exposure Fitzpatrick skin types 1 and 2 Gorlin's syndrome Immunocompromise
38
How does BCC normally present?
Small nodule with a rolled edge, often have a central depression which can become ulcerated May also have pearly-nodular appearance
39
How is BCC managed?
Surgical excision with margins Moh's micrographic surgery - best cosmetic outcomes Radiotherapy Cryotherapy and imiquimod also options
40
What must be present for a diagnosis of acne to be made?
Open and closed comedones
41
What are the features of acne?
``` Open (blackheads) or closed (whiteheads) comedones Inflammatory papules or pustules Nodules or cysts Scarring Changes in pigmentation Seborrhoea (oily skin) ```
42
What is the management algorithm for acne?
1. Topical benzoyl peroxide Topical adapalene Topical antibiotics: clindamycin/erythromycin Trial the above + combinations for at least 3 months Change contraceptive/start contraceptive in girls with acne in combo with topical treatment 2. Oral antibiotics: oxytetracycline / tetracycline / limecycline 3 month course 3. Isotretinoin: Roaccutane, oral retinoid which reduces sebum secretion Women need contraception due to teratogenicity SE: severe dryness of the skin + mucous membranes, nose bleeds, joint plain, mood prob
43
What are the features of rosacea?
Facial flushing, persistent erythema, telangiectasia, inflammatory papules, oedema Over time, skin can become rough/course Worsened by alcohol and sunlight + heat/exercise/hot food and drink/spicy food/emotion
44
How is rosacea managed?
Conservative: Sun protection, reduce alcohol consumption, avoid triggers Medical: Topical brimonidine for erythema- can reduce redness in 30 mins Topical ivermectin Topical metronidazole Oral antibiotics: tetracycline, doxycycline, erythromycin (often in combination with topical ivermectin) Surgical: Laser ablation of telangiectasia Intense pulsed light therapy
45
What is the difference between SJS and TEN?
SJS: skin detachment of <10% of the body surface area TEN: detachment of >10% of the body surface area, large epidermal sheets TEN with spots: detachment >30% of the BSA, widespread purpuric macules SJS/TEN overlap = 10-30% detachment with purpuric macules
46
What are the causes of SJS/TEN?
Most commonly drugs - Antibiotics (40%) - Anti-epileptics: lamotrigine, carbamazepine, phenytoin, phenobarbital - Allopurinol - Anti-retroviral therapy - NSAIDs Can also be infective: mycoplasma, herpes, hepatitis, mumps Immunisations ^ risk in immunodeficiency e.g. HIV
47
What are the symptoms of SJS/TEN?
Sudden spreading rash, often after initiation of new medication Mucosal ulceration/erosion Nikolsky's sign: peeling of skin (indicates progression to TEN) Painful skin, may have purpuric macules Fever >39, fatigue Sore throat Myalgia
48
How is SJS/TEN diagnosed?
Generally a clinical diagnosis Should take skin swabs + biopsy, blood cultures and other baseline bloods
49
What are the differentials for SJS/TEN?
``` Staphylococcal scalded skin Burn Erythema multiform Toxic shock syndrome Septic shock ```
50
How should SJS/TEN be managed?
Dermatological emergency - A-E assessment - Fluid and temperature support - Stop causative agent - VTE prophylaxis, nutrition (may need enteral feeding due to mucosal involvement) - Non-adhesive dressings, topical antibacterials, emollients - May need immunosuppression: ciclosporin, immunoglobulin
51
What are complications of SJS/TEN?
``` Dehydration Malnutrition Skin infection Loss of temperature regulation ARDS VTE and DIC Organ failure, GI ulceration and perforation Compartment syndrome Mucous membrane stricture ```
52
What are the causes of erythema multiforme?
Most commonly infections: HSV = most common cause, usually HSV1 Mycoplasma = second-most common Can also be caused by medication, but this is more likely to be an alternative diagnosis e.g. SJS
53
What are the clinical features of erythema multiforme?
No prodrome Several to hundreds of skin lesions develop within 24 hours First seen on the backs of hands and/or tops of feet and then spread down the limbs towards the trunk. The upper limbs are more commonly affected than the lower. Palms and soles may be involved. The face, neck and trunk are common sites. There may be an associated mild itch or burning sensation. The typical target lesion has a sharp margin, regular round shape and three concentric colour zones: - The centre is dusky or dark red with a blister or crust - Next ring is a paler pink and is raised due to oedema (fluid swelling) - The outermost ring is bright red. Mucosal lesions may develop a few days later
54
How is erythema multiforme managed?
Treatment of underlying infection Topical steroids Eye and mouth care Nutritional and fluid support
55
Which conditions are most strongly associated with pyoderma gangrenosum?
IBD (UC more commonly than Crohn's) Rheumatoid arthritis Blood cancers GPA
56
How does pyoderma gangrenosum present?
At the site of a minor injury/small wound Skin breakdown and rapid ulceration Blue/purple margins Extremely painful rash
57
How is pyoderma gangrenosum managed?
Removal of any necrotic tissue Topical steroid/tacrolimus/steroid injection into edge Special dressings and compression bandages Oral doxycycline Systemic immunomodulation for more extensive disease
58
What is a pyogenic granuloma?
Reactive proliferation of capillaries- completely benign Looks like a raspberry/mincemeat lesion stuck onto the skin Most common on the hands and can bleed a lot More common in pregnancy Usually go away on their own but can be removed for cosmetic purposes
59
What are risk factors for alopecia areata?
Thyroid disease, vitiligo, atopic eczema Chromosome disorders e.g. Down's Family history Biologic medications
60
What are the features of alopecia areata
Patches of non-scarring alopecia- exclamation mark hairs or complete baldness Cycling stages of hair loss, bald patch enlargement and regrowth May also have nail disease
61
How is alopecia areata managed?
``` Potent topical steroids Steroid injections into bald patches Systemic corticosteroids Wigs/hair pieces/false lashes and brows Counselling ```
62
Which conditions are most associated with erythema nodosum?
``` Streptococcal throat infections Sarcoid TB IBD Pregnancy Behçet;s ```
63
What are the clinical features of lichen planus?
Oral lesions: white lace-like lesions on the sides of cheeks and tongue Skin lesions: Shiny, flat-topped plaques with fine white lines over them Vaginal: Painless white streaks in a lacy or fern-like pattern Painful and persistent erosions and ulcers (erosive lichen planus ) Scarring, resulting in adhesions, resorption of labia minora and introital stenosis
64
What are the clinical features of lichen sclerosus?
Lichen sclerosus presents as white crinkled or thickened patches of skin that tend to scar. Affects the non-hair bearing areas of the vagina, penis and anus Extremely itchy and sore lesions Very painful sex Complications: infection, squamous cell carcinoma Steroid management

Finals Revision (23 decks)

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