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Year 3 core conditions > dermatology > Flashcards

dermatology Flashcards

1
Q

eczema

A

inflammatory skin condition which can either be endogenous or exogenous

aka dermatitis

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2
Q

types of endogenous eczema

A 
atopic
discoid
pompholyx
gravitational 
seborrhoeic
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3
Q

types of exogenous ezcema

A

irritant
allergic
photodermatitis

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4
Q

atopic eczema

A

presents in infancy
chronically relapsing
association with atopic triad (+asthma+hayfever)

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5
Q

discoid eczema

A

scattered, well-defined, coin shaped and coin size plaques of eczema

also called nummular dermatitis

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6
Q

pompholyx eczema

A

tiny blisters on palms and soles

often adults <40

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7
Q

gravitational eczema

A

common form of eczema occuring on lower extremitites in patients with chronic venous insufficiency

precursor to more problematic conditions such as venous leg ulceration and lipodermatosclerosis

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8
Q

seborrheic dermatitis

A

common skin condition affecting only the scalp

causes scaly patches, red skin and stubborn dandruff

also affects oilet areas of the body such as face, nose, eyebrows, ears, eyelids and chest

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9
Q

irritant dermatitis

A

irritant contact dermatitis is most common type

non allergic skin reaction that occurs when a substance damages your skins outer protective layer

some people react to strong irritants after 1 exposure, others develop signs and symptoms after repeated exposures to even mild irritants

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10
Q

allergic dermatitis

A

contact dermatitis is red, itchy rash caused by direct contact with substance and allergic reaction to it

non contagious or life threatenng but can be v uncomfortable

soaps, cosmetics, fragrances, jewlery, plants

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11
Q

photodermatitis

A

drug induced photosensitivity - thiazides, tetracyclines, NSAIDs

phototoxic chemicals - photocontact dermatitis - plants, veg, fruit, fragrances

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12
Q

aggravating factors of atopic dermatitis

A

dryness
stress
infection
allergy

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13
Q

presentation of atopic dermatitis

infants, childhood and adults

A

infants - starts on face, nappy area spared, once crawling affects knees, secondary to infection common

childhood - found on flexures, neck involved, infraorbital/demimorgan folds,

adults - increased lichenification, flexures and hands, pitting and ridging of nails

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14
Q

diagnostic criteria of atopic eczema

A 
itchy skin condition
onset <2 yrs
skin crease involvement
dry skin
relative with atopy
visible flexural dermatitis
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15
Q

management of eczema

A

look for and reduce aggravating factors

emollients

topical steroids - using steroid ladder

topical immunomodulators

if doesnt work - abx for secondary infection, oral steroids, phototherapy, immunosuppressants

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16
Q

what is psoriasis

A

condition that causes red and crusty patches of skin covered with silvery scales.

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17
Q

types of psoriasis

A 
chronic plaque
guttate
flexural
erythrodermic
pustular - localised or generalised
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18
Q

risk factors for psoriasis

A 
trauma - koebner phenomenon
infection
metabolic factors
drugs
psychogenic factors
alcohol
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19
Q

presentation of psoriasis

A

acute intermittent or chronic disease of:

  • red scaly plaque
  • disease on scalp, elbows and knees
  • potential involvement of the whole skin
  • nail disease
  • joint disease in 5-10%
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20
Q

conditions associated with psoriasis

A

psoriatic arthritis and spondyloarthropathies
IBD, uveitis, coeliac disease
obesity, hypertension, cvd, t2dm

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21
Q

PASI scoring

A

psoriasis area and severity index

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22
Q

DLQI

A

dermatology life quality index

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23
Q

treatment of psoriasis

A

non specific - emollients, keratolytics, topical steroids, tar preparations, occlusion

specific - vit D and A analogues, dithranol

topical therapy

phototherapy

disease modifying therapy

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24
Q

what is acne?

A

issues with sebaceous glands

  • androgens stimulate sebaceous glands and cause more sebum to nbe secreted = comedone plug in hair follicle, this traps p.acnes and causes spot to form (abscess like)
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25
Q

late onset acne location

A

chin/jaw

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26
Q

presentation of acne

A

seborrhoea (greasy)
comedomes (bumpy)
papules, pustules, nodules (keratin and pus) and cysts (enclosed sac of fluids and cell products)

mild, mod or severe

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27
Q

grading acne

A

lees acne grading system

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28
Q

acne management

A

OTC
topical - benzoyl peroxide, retinoids, antibiotics

systemic - antiandrogens,(ocp) , abx, retinoids

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29
Q

what is rosacea

A

common skin condition causing blushing or flushing and visible blood vessels in your facw

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30
Q

causes of rosacea

A

sum damage

inflammatory

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31
Q

presentation of rosacea

A

middle aged
sun exposed sites - face and chest

erythema - papules, pustules, telangiectasia, flushing

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32
Q

rhinophyma

A

progressive skin condition affecting the nose in rosacea - big bumpy red nose

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33
Q

blepharitis

A

inflammation on the edges of the eyelids as they become irritated and itchy and appear greasy and crusted with scales clinging to lashes

  • happens in rosacea
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34
Q

signs of rosacea

A

rhinophyma
blepharitis
lymphoedema

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35
Q

treatment of rosacea

A

lifestyle - avoid triggers and irritants

topical - azelaic acid, metronidazole gel

systemic - lymecycline, doxycycline, low dose isotretinoin

laser treatment

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36
Q

herpes simplex skin infection

A

common infection
causes of cold sores and herpetic whitlow
affects most people during their lives

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37
Q

herpes simplex type 1

A

oral and facial infections

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38
Q

herpes simplex type 2

A

genital and rectal infections, often sexually transmitted

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39
Q

how is herpes simplex spread?

A

direct or indirect contact

remains dormant in dorsal root nerves where it can be reactivated
virus can be transferred to new skin sites by the patient during an attack

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40
Q

risk factors for herpes simplex

A

infants and young children

less developed countries, nearly all under 5yo have it

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41
Q

which type of herpes simplex is more symptomatic?

A

type 2

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42
Q

presentation of herpes simplex 1

A

gingivostomatitis in children 1-5

fever, dribbling and bad breath, gums red and swollen, white vesicles, yellow uclers on tongue, throat, palate and inside cheeks, lymphadenopathy

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43
Q

presentation of type 2 herpes simplex

A

genital herpes after onset of sexual activity
painful vesicles, ulcers, redness, swelling for 2-3 weeks

in males - glans, foreskin and shaft, anal herpes with MSM

females - vulva and vagina , painful to urinate, cervical infection may lead to severe ulcers

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44
Q

complications of herpes simplex

A 
eye infection
throat infection
eczema herpeticum
erythema multiforme
disseminated/widespread infection
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45
Q

treatment of herpes simplex

A

uncomplicated eruptions are self-limiting

antiviral drugs used for severe infection or
immunocompromised patient

if recurrent prophylactic antivirals

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46
Q

forms of Varicella Zoster virus

A

chicken pox

shingles

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47
Q

chicken pox vs shingles

A

chicken pox = highly contagious and occurs mostly in children <10. once had it, unlikely to get again

shingles = reactivation of VZV - localised painful rash

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48
Q

contagion of VZV

A

airborne or contact with fluid from open sores

  • if not had chicken pox before can contract chicken pox from those with chicken pox or shingles
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49
Q

who gets chicken pox?

A

children <10

immunocompromised

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50
Q

who gets shingles

A

elderly
poor immunity
triggers - nerve pressure, radiotherapy at level of nerve root, spinal surgery, infectin

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51
Q

presentation of chicken pox

+adult presentation

A

itchy red papules&raquo_space;vesicles
stomach, back , face and can spread to other body parts

blisters can also be in mouth

systemic feagtures - fever, headache, D+V

adults:

  • prodromal symptoms 48hrs before rash (fever, malaise, headahce, loss of appetite, abdo pain)
  • more severe, can be life threatening
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52
Q

complications of chicken pox in children

A

Secondary bacterial infection caused by scratching

Dehydration from D&V

Viral pneumonia

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53
Q

complications of chicken pox in immunocompromised and adult patient

A

Disseminated varicella infection (high morbidity)

CNS complications (Reye’s, Guillain-Barre, encephalitis)

Thrombocytopenia & purpura

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54
Q

complciations of chicken pox in pregnancy

A

viral pneumonia, premature labour

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55
Q

presentation of shingles

A
  1. severe pain in one sensory nerve distribution
  2. fever, headache, lymphadenopathy in affected area
  3. after 1-3 days, blistering rash appears in same area of skin - red papules»blistering or pustules that crust over. most commonly chest, neck, forehead and lymbar/sacrak regions
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56
Q

complications of shingles

A

muscle weakness - facial nerve palsy

infection of organs

pregnancy - can harm foetus

post-herpetic neuralgia

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57
Q

management of chicken pox

A

clea rup naturally in 1-3 wks, may leave scars. supportive treatment: trim fingernails, warm bath and moisturiser, paracet for fever, oral antihistamines to help itch

immunocompromised = IV aciclovir

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58
Q

shingles management

A

uncomplicated cases - recovery 2-3 weeks, 3-4 in older

antiviral treatment to reduce pain and symptom duration -aciclovir

management of acute - rest and pain relief, protect rash (vaseline), oral abx for secodnary infection

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59
Q

what are viral warts?

A

very common

non cancerous growths

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60
Q

causes of viral warts

A

HPV

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61
Q

contagion of viral warts

A

skin to skin contact or auto inoculation (if scratched, virus can spread to another area)

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62
Q

incubation period of viral warts

A

up to 12 months

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63
Q

risk factors of viral warts

A

school aged
eczema - defective skin barrier
immunosuppressed individuals

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64
Q

presentation of viral warts

A

hard surface with black dot in middle of each scale

common - plantar, plane, filiform, mucosal

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65
Q

treatment of viral warts

A

topical treatment - salicyclic acid - removes dead surface cells, works in 12 weeks

cryotherapy - freezing, sucess after 3-4 months

electrosurgery - curettage and cautery for large/persistent warts

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66
Q

what is molluscum contagiosum

A

common childhood skin infection

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67
Q

cause of molluscum contagiosum

A

poxvirus

spread by skin to skin contact, indirect, auto inoculation and sexual transmission

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68
Q

risk factors of molluscum contagiosum

A 
children < 10
warmer climates
wet conditions
overcrowded environments
atopic eczema (deficient skin barrier)
immunocompromised
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69
Q

presentation of molluscum contagiosum

A

clusters of small round papules
white brown or pink
often shiny with umbilicated pit

contain white, cheesy material
arise in warm/moist places - flexures

frequently induce dermatitis

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70
Q

complications of molluscum contagiosum

A

secondayr bacterial infection = impetigo
secondary eczema
conjuntivitis if eyelid becomes infected
large and numerous mollusca in immuno compromised individuals

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71
Q

treatment of molluscum contagiosum

A

reduce spread - wash hands, avoid scratching etc

physical treatment - picking out white core, cryotherapy, laser ablation,

medical treatment- antiseptic (hydrogen peroxide), wart paint (salicylic acid)

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72
Q

what is impetigo

A

highly contagious skin infection mainly affecting infants and young children

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73
Q

what causes impetigo

A

bacteria - staphylococci organism

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74
Q

risk factors of impetigo

A 
2-5 yo
close contact
warm, humid weather
broken skin
other health conditions - eczema, diabetes, immunocompromised
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75
Q

Presentation of impetigo

A

reddish sores on face, espcially around nose and mouth and on hands and feet

after a week the sores burst and develop honey coloured crusts

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76
Q

complications of impetigo

A

cellulitis, kidney problems, scarring

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77
Q

prevention of impetigo

A

gently wash affected area with mild soap and running water

wash infected persons clothes, sheets etc

gloves to apply antibiotic ointment

cut nails

regular handwashing and good hygiene

keep child at home until uncontagious

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78
Q

treatment of impetigo

A

mupirocin antibiotic ointment or cream applied directly to sores 2-3 times a day, 5-10 days

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79
Q

what is erysepilas

A

superficial form of cellulitis

potentially serious bacterial infection affecting the skin

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80
Q

who gets erysepilas

A

infants and older people

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81
Q

cause of erysepilas

A

group A beta-haemolytic streptococci

staph A, MRSA, strep pnuemoniae, klebsiella pnuemoniae, yersinina enterolitica, haemophilus influenzae

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82
Q

risk factors of erysepilas

A

Prev episodes

Breaks in skin barrier – insect bites, ulcers, chronic skin conditions – psoriasis, athletes foot and eczema

Current or piror injury (trauma, surgical wounds, radiotherapy)

Umbilical cord and vaccination site injury in newborns

Nasopharyngeal infection

Venous disease and lymphodema

Immune deficiency or compromise

Nephrotic syndrome

pregnancy

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83
Q

pesentation of erysepilas

A

abrupt onset and accompanied by fever, chills and shivering

skin of lower limbs

butterfly distribution of face

sharped raised border, bright red firm, swollen, finely dimpled, blistered, necrotic, purpura

umbilicus or diaper region in infants

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84
Q

complications of erysepilas

A

Abscess

Gangrene

Thrombophlebitis

Chronic leg swelling

Infections distant to site of erysupelas – infective endocaridtis, septic arthritis, bursitits, tendonitiis

Post streptococca; glomerulonephritis

Cavernous sinus thrombosis

Streptococcal TSS

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85
Q

investigations for erysepilas

A

FBC - raised WCC, c reactive protein, positive blood culture indentifying organism

MRI and CT in deep infection

skin biopsy

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86
Q

treatment of erysepilas

A

general - cold packs, analgesics, elevation of limb, compression stockings, saline dressings

antibiotics - oral or IV penicillin

long term preventative penicillin for recurrent attacks

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87
Q

what are dermatophytes

A

cause fungal infection affecting the skin, hair and nails

aka dermatophytosis or tinea

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88
Q

________ are most common cause of superficial fungal infections

A

tinea infections

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89
Q

tinea corpis

A

ringworm - arms, trunk and legs

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90
Q

tinea capitis

A

scalp ringworm - scalp and hair shafts

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91
Q

tinea facei

A

facial skin

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92
Q

tinea cruris

A

jock itch - groin and inner thighs

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93
Q

tinea pedis

A

athletes foot

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94
Q

tinea manuum

A

feet and hands

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95
Q

tinea barbae

A

facial hair follicles

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96
Q

tinea unguium

A

nail infections

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97
Q

cause of tinea infections

A

dermatophytes - filamentous fungi requiring keratin for frowth

98
Q

risk factors of tinea infections`

A

Decreased immune repsonse

Older individuals

Children

Diabetes

Poor circulation

Topical corticosteroid use

99
Q

presentation of tinea infections

A

round red itchy rash with inflamed scaly border

can be either inflammatory (pus filled lumps + permanent hair loss) or non inflammatory

100
Q

investigations of tinea infections

A

microscopy, fungal cultures, woods light examination (UV light to detect fluorescence caused by certain dermatophytes)

101
Q

treatment of tinea infections

A

antifungals - clotrimazole
oral antifungals in scalp as topical cannot penetrate

nail infection treated with chemical or surgical removal of affected nail

102
Q

what is candida

A

yeast infection

103
Q

causes of candida

A

c. albicans = most common

c. parapsilosis, c. tropicalis

104
Q

risk factors for candida

A

weakened or less competition in immune system

candida overgrowth

diabetes, HIV, steroids, radiotherapy, chemotherapy

105
Q

presentation of candida

A

pseudomembranous = weakened immune system

erythematous

106
Q

thrush

A

candida of mouth and oesophagus

107
Q

vulvovaginitis

A

caused by yeast infection - vaginal itching, discharge and dysuria

108
Q

treatment of oral thrush

A

oral nystatin suspension

109
Q

treatment of vulvovaginitis

A

topical antifungals

if resistant, azole antifungals

110
Q

treatment of severe thrush infections

A

remove device, amphotericin, azole antifungals echinocandins

111
Q

what is pityriasis versicolour

A

common fungal infection of skin localised to outermost layer of epidermis

112
Q

cause of pitryriasis versicolour

A

mycelial growth of funghi of the genus malassezia

113
Q

risk factors for pitryriasis versicolour

A

hot and humid climate
summer
teenagers and young adults - sebaceous glands more active
genetics

114
Q

presentation of pitryriasis versicolour

A

affects the trunk, neck and/or arms

patches of coppery brown, paler than surrounding skin or pink

pale patches more common on darker skin (pituyriasis veriscolour alba)

patches can start scaly and brown then reoslve through a non scaly an white stage

115
Q

investigations for pityriasis versicolour

A

wood lamp (black light) examination = yellow/green fkiyresence observed inaffected areas

microscopy of skin scraping - spaghetti and meatballs

fungal culture

skin biopsy

116
Q

treatment of pityriasis versicolour

A

topical antifungal angents

oral antifungals if severe or topical agents failed

reapplication of topical treatment once rash has cleared to prevent recurrence

117
Q

scabies what is it

A

parasitic mite causing itchy skin condition = contagious

118
Q

cause of scabies

A

parasitic mite

contagious - spread through close physical contact, sharing clothes, bedding etc

119
Q

presentation of scabies

A

itchy, often severe and usually worse at night

thin irregular burrow tracts made of tiny blisers or bumps on skin - appear in skin folds

infants and young = scalp, palms, soles

120
Q

complications of scabies

A

secondary bacterial infection - impetigo

crusted scabies in high risk groups - chronically immunosuppressed, ill and old peep

121
Q

investigations for scabies

A

microscopy to determine presence of mites or their eggs

122
Q

treatment of scabies

A

prevention - clean all clothes and linin, starve mites by leaving materials in sealed plastic bag for couples weeks

permethrin cream - kill mites
ivermectin - oral med for altered immune system
crotamiton cream
lotion to sooth
antihistamines
123
Q

what are cutaneous drug erruptions

A

acute or subacute adverse cutaneous reactions to a drug or medication

124
Q

SCAR

A

severe cutaneous adverse reaction

125
Q

most common cutaneous dry erruptions

A

morbilliform or exanthematous drug erruption

urticaria and/or angioedema

126
Q

risk factors of cutaneous drug erruptions

A

genetics
female
underlying viral infections
prev allergic reaction to another drugs

127
Q

cause of cutaneous drug erruptions

A

true allergy - immediate (IgE), delayed (IgG)

predictable reactions explicable by pharmacology

drug intolerances

psuedoallergy - urticarial reaction

128
Q

presentation of cutaneous drug erruptions

A

fever
malaise
other organ involvement

129
Q

complications of cutaneous drug erruptions

A

deprivation of sueful meds
death in SCAR
permanent scarring lafing to blindness and deformity in scar

130
Q

investigations for cutaneous drug erruptions

A

determine prev exposure to meds

meds stopped then reintroduced to see if symptoms recur

blood tests - FBC, LFTs, U+Es

skin intradermal/prick tests

patch tests

131
Q

treatment of cutaneous drug erruptions

A

topical corticosteroids

emmolients

drug induced urticaria reposnds to antihistaminea

132
Q

what is erythroderma?

A

inflammatory ski disease affecting the entire surface of the skin

acute or chronic

often precedes or is associated with exfoliation = exfoliative dermatitis

133
Q

causes of erythroderma

A 
adverse drug erruption
dermatitis
psoriasis 
pityriasis rubra pilaris (PRP)
immunobullous disease
cutaneous t cell lymphama 
underlying systemic malignancy
graft vs host disease
HIV infection
134
Q

presentation of erythroderma

A 
generalised erythema 
oedema
serous exudate (ecezema)
scaling (eczema, psoriasis)
itchy (eczema, bullous disease)

hair loss, keratoderma of palms and soles, ectropion, hyper or hypopigmentation, localised or generalised lymphadenopathy

135
Q

complications of erythroderma

A 
secondary infection
loss of temp control
high output heart failure
fluid and electrolyte imbalance
hypoalbuminaemia
136
Q

investigations of erythroderma

A

skin swabs for bacterial culture
haematology and biochemistry
skin bipsy

137
Q

treatment of erythroderma

A

determine underlying cause
discontinue all unecessary meds
apply amolients and mild topical steroids

wet dressings, fluids and body temo, oral and IV abx, sedcative antihistamines

138
Q

what is SJS?

A

steven johnson syndrome

rare and serious disorder of skin and mucous membranes

reaction to meds starting with flu like symptoms followed by painful rash that spreads like blisters

139
Q

cause of SJS

A

normally triggered by medication, infection or both

140
Q

drugs that can cause SJS

A

anti-gout meds - allopurinol

anticonvulsants and antipsychotics

antibacterial sulfonamides

nevirapine

pain releivers - acetaminophen, ibuprogen, naproxen sodium

141
Q

risk factors of SJS

A

HIV, immunos uppressed

cancer
history of SJS + family history

genetic factors

142
Q

presentation of SJS

A

fever sore mouth and thorat, fatigue, burning eyes

unexplained widespread skin pain, red or purplish rash that spreads

blister on skin and mucous membranes of the nose, eyes and genitals

shedding of skin within days after blisters form

143
Q

complications of SJS

A 
dehydration
sepsis
eye problems
lung involvement - acute resp failure
permanent skin damage
144
Q

investigations of SJS

A

review of medical history and physical exam

skin biopsy

culture

imaging - CXR for pneumonia

blood tests

145
Q

treatment of SJS

A

hospitalisation

supportive care - fluids, nutrition, wound care, eye care

medications - pain meds, anti inflammatory, antibiotics, topical or oral/IV if severe
IV immunoglobulin

146
Q

what is toxic epidermal necrolysis (ten)

A

rare life threatening skin reaction caused by medication usually

severe form of SJS - when >30% skin and moist linings of body have extensive damage

147
Q

cause of TENS

A

skin reaction to medication

symptoms 1-4 weeks after starting new drug

148
Q

risk factors of TENS

A 
HIV infection
weakened immune system
cancer
history of SJS/TEN
family history of SJS/TEN
genetic factors
149
Q

presentation of TENS

A

widespread skin pain
spreading rash covering >30% of the body
blisters and large areas of peeling skin
sores, swelling and crusting on mucous membranes, inc mouth eyes and vagina

150
Q

complications of TENS

A 
sepsis
lung involvement - acute resp fialure
visual impairment 
permanent skin damage
vaginal sores
emotional distress
151
Q

treatment of TENS

A

supportive care - fluid replacement and nutrition, wound care, breathing help, pain control, eye care

medications - cyclosporine, etanercept, IVIG

152
Q

what is melanom

A

most serious type of skin cancer

occurs in melanocytes (produce skin colour)

153
Q

causes of melanoma

A

UV exposure increase risk

environment genetic factora

154
Q

presentation of melanoma

A

change in existing mole

development of new pigmented or unusual looking growth on skin

155
Q

unusual mole signs

A

A-E

asymmetrical
irregular borders
changes in colou
diameter >6mm
evolving - itchness/blededing etc
156
Q

hidden melanoma

A

under nail acral-lentiginous melanoma

melanoma in mouth, GI tract, urinary tract or vagina

melanoma in the eye

157
Q

investigations of melanoma

A

physical exam

biopsy

158
Q

management of melanoma

A

small = surgery

surgery to remove lymph nodes

immunotherapy

targeted therapy

radiation therapy

chemotherapy

159
Q

basal cell carcinoma what is it

A

skin basal cell develops mutation in DNA

skin cell that produces new skin cells

160
Q

risk factors for basal cell carcinoma

A 
UV exposure
radiation therapy
fair skin 
increasing age
family history of skin cancer
immune suppressing drugs 
exposue to aresnic 
inherited syndromes that cause skin cancer
161
Q

presentation of basal cell carcinoma

A

change in skin - growth or sore that won’t heal

  • shiny skin colour bump,
  • brown, black or blue lesion
  • flat, scaly ptach with a raised edge
  • white, waxy, scar like lesion
162
Q

complications of basal cell carcinoma

A

risk of recurrance
increased risk of other types of skin cancer
cancer spreads beyond the skin

163
Q

management of basal cell carcinoma

A

surgery - surgical excision or mohs surgery

curettage and electordessciation

radiation therapy

frezzing

topical treatments

photodynamic therapy

164
Q

mohs surgery

A

removes cancer layer by layer

reccommended if high risk of recurrence or if larger or extends deeper in the skin or if located on the face

165
Q

squamous cell carcinoma

A

cancer f sqaumous cells

not usually life threatening but it can be aggressive and if untreated can metastasise causing serious complications

166
Q

squamous cell carcinoma causes

A

prolonged UV exopsre

history of skin cancer

weakened immune system

rare genetic disorder

167
Q

presentation of squamous cell caricnomas

A

firm red nodule

flat sore with a scaly crust

new sore or raised area on an old scar or ulcer

rough sclay patchy on lip that may evolve to open sore

red sore or rough patch inside mouth

red raised patchy or wartlike sore on o in anus or genitals

168
Q

complications of squamous cell carcinoma

A

spread to lymph nodes or other organs

risk of agressive SCC increased when particularly deep involves mucous membranes such as lips, weakened immune system

169
Q

management of SCC

A 
minor surgery
cutteage  and electrodessciecation
laser therapy
freezing 
photodynamic therapy
170
Q

management of SCC metastasis

A

chemotherapy
targeted drug therapy
immunotherapy

171
Q 
seborrheic keratoses
lipoma
epidermoids cysts
dermatofibromas
cambell de morgan spots
fibroepithelial polyps
A

benign skin tumours

172
Q

seborrheic keratoses

A

aka senile warts
middle aged and elderly
aetiology unknown

173
Q

presentation of seborrhoeic keratoses

A

often multiple
asymptomatic
sign of skin aging
warty, greasy papules or nodules with well defined borders , colour varies, stuck on appearance

174
Q

management of seborrheic keratoses

A

no treatment

may be removed if catch on clothing or for cosmetic reasons

175
Q

sudden erruption of multiple seborrheic keratoses

A

sign of underlying malignancy

176
Q

lipoma

A

very common
middle aged ppl
aetiology not understood
adipose tissue proliferation

177
Q

presentation of lipoma

A

slitary more in women
multiple more in men

asymptomatic

slow growing, soft, smooth, mobile, subcutaneous nodules, 2-10cm

178
Q

management of lipomas

A

usually no treatment required

may be surgically removed if impacting nearby muscles

179
Q

complication of lipomas? rare

A

liposarcoma

180
Q

what are epidermoid cysts

A

follicular infundibular cysts/epidermal cysts/keratin cysts

caused by epidermal cell proliferation

181
Q

presentation of epidermoid cysts

A

solitary or multiple

more in men

commonly on face, neck and trunk

asymptomatic

coloured/yellow, firm round nodules with central punctum

offensive smelling keratinous contenta

182
Q

management of epidermoid cysts

A

usually no treatment required, antibiotics if infection occurs

183
Q

dermatofibroids

A

aka histiocytomas

caused by fibroblast proliferation

184
Q

presentation of dermatofibroids

A

common on lower legs, often after insect bite, eruptions of dermatofibroma may occur in immuno suppressed people

F>M

asymptomatic but often itchy and painful

firm fibrous dermal nodules or papules, skin dimples upon compression

185
Q

management of dermatofibromas

A

usually no treatment required

186
Q

campbell de morgan spots

A

aka cherry angiomas

aetiology unknown

endothelial cell proliferation and subsequent blood vessel overgrowth

187
Q

presentation of campbell de morgan spots

A

number of spots increases with age

common on midtrunk

red/purple/balck papules or macules

188
Q

fibroepithelial polyps

A

skin tags

common

develop with age

aetiology not fully understood

189
Q

management of campbell de morgan spots

A

usually no treatment required - but may be removed for cosmetic reasons

190
Q

presentation of fibroepithelial polyps

A

commonly found in skin folds e.g. armpits

usually skin coloured, vary in size

191
Q

management of fibroepithelial polyps

A

may be removed for cosmetic reasons

192
Q

acanthosis nigracans - what is it

A

hyperpigmentation and hyperkeratosis of the skin folds and mucosa

193
Q

who gets acanthosis nigracans

A

obesity

endocrine conditons

drug induced

underlying GI malignancy

194
Q

necrobiosis lipoidica - what is it?

A

rare granulomatous skin disorder

1+ tender yellow/brown patches on the lower legs

centre of patch skiny, atrophic and telangiectasia

can ulcerate

195
Q

who gets necrobiosis lipoidica

A

diabetes

196
Q

treatment of necrobiosis lipodica

A

no always needed

topical steorids
PUVA
immuno suppressants

197
Q

what is granuloma annulare

A

common

delayed hypersensitivity reaction to dermis with unknown cause

smooth, discoloured, thickened, nummular/annular plaque lesions

can occur anywhere on the body or be widespread

198
Q

who gets granuloma annulare

A

if extensive -
autoimmune thyroiditis
DM
hyperlipidaemia

lymphoma or HIV

199
Q

management of granuloma annulare

A

most often no treatment and resolve spontaneously in 18 months

steroids, calcineurin inhibitors, immunosuppressants, phototherapy if widespread

200
Q

what is erythema nodosum

A

hypersensitivity resonse often to recent infection

lesions are tender nodules for 1-2 weeks which appear like bruises then resolve. do not ulcerate or scar

commonly on shins, size of cherry to grapefruit

201
Q

causes of erythema nodosum

A 
group A strep
primary TB
pregnancy
malignancy
inflammatory bowel disease
chlamydia
leprosy
OCP
sarcoidosis
202
Q

treatment of erythema nodosum

A

treat underlying infection

bed rest, supportive bandages + antinflammatory medicine

203
Q

pyoderma gangrenosum - what is it?

A

rare painful ulcerating condition following minor trauma

most common on legs

uclers have violaceous undermined border

autoinflammatory disease

204
Q

who gets pyoderma gangrenosum

A

IBD
RA
myeloid blood disorders (leukaemia)

205
Q

treatment of pyoderma gangrenosum

A

avoid surgical debridement when ulcers active as may increase its size

abx not useful unless secondary infection

steroids, ciclosporin, biologics

metronidazole, useful if pts complain of odour

206
Q

what does vasculitis show?

A

skin changes give clue to size of vessels affected and therefore diagnosis

207
Q

skins of rheumatic disease

A 
Cutaneous atrophy.
Palmar erythema.
Onycholysis.
Periungual erythema.
Yellow nail syndrome.
splinter haemorrhage.
Hyperpigmentation.
Erythromelalgia.
208
Q

what is vitiligo

A

condition which causes loss of skin colour in patches

209
Q

cause of vitligo

A

cells that produce melanin die or stop functioning

autoimmune conditon, family hsitory and often trigger events (stress, severe sunburn, skin trauma etc)

210
Q

vitiligo many parts of body affected

A

generalised vitiligo

211
Q

segmental vitligo

A

only one side of body

212
Q

focalised vitiligo

A

one or only a few areas of body affected

213
Q

acrofacial vitiligo

A

face and hands affected

214
Q

presentation of vitiligo

A

patchy loss of ski n colour appearing on hands, face and areas around body openings and genitals

premature whitening or greying of hair on scalp, eyelashes, eyebrows or beard

loss of colour in mucous membranes

215
Q

complications of vitiligo

A

increased risk of social or psychological disease, sunburn, eye problems, hearing loss

216
Q

investigations for vitiligo

A

medical history and examine skin

may need biopsy and blood tests (FBC, ANA)

217
Q

management of vitiligo

A

depends on extent of disease and age

medications - antiinflammatory drugs (steroid cream), immunosuppresants (calcineurin inhibitors)

therapies - UV light therapy, psoralen and lgith therapy, depigmentation

surgery - skin grafting, blister grafting, cellular suspension transplant

218
Q

alopecia areata - what is it?

A

patchy hair loss

219
Q

who gets alopecia areata?

A

those with family history or other autoimmune disorders such as diabetes, lupus or thyroid disease

220
Q

cause of alopecia areata

A

autoimmune disease (attacks their own hair follicles)

genetics + wirus/substance which may trigger

221
Q

presentation of alopecia areata

A

hair falls out, often in clumps the size and shape of a coin

extent of hairloss varies

unpredictabel disease - can grow back

222
Q

investigations for alopecia areata

A

blood tests
pull test - determine stage of shedding process
scalp biopsy
light microscopy

223
Q

management of alopecia areata

A

corticosteoirds - injection into scalp, topically or oral

orgaine - topical drug for pattern baldness

224
Q

what is lupus?

A

autoimmune disease

develops when those with an inherited predisposition come into contact with something in the environment that causes it

225
Q

who gets lupus

A

women more
15-45 yo
african americans, hispanics, asian americans

226
Q

presentation of lupus

A

fatigue, fever,
joint pain, stiffness and swelling
butterfly rash on face, skin lesions appear or worsen with sun exp`osure
fingers and toes that turn white or blue when exposed to cold or stress

sob, chest pain

dry eyes,

headache, confusion, memory loss

227
Q

investigations of lupus

A

bloods - FBC, ESR, U+Es, LFTs and ANA

Urinalysis

CXR, ECHO

biopsy kindyes

228
Q

management of lupus

A

NSAIDS for pain, swelling and fever associated

antimalarial drugs - decrease risk of flare ups

corticosteorids - reduce inflamm

immunosuppressants

biologics - reduce lupus symptoms

229
Q

dermatomyositis

A

uncommon inflammatory disease marked by muscle weakness and distinctive skin rash

230
Q

who gets dermatomyositis

A

adults and children

5-15 yo, 40-60 yo

F>M

231
Q

cause of dermatomyositis

A

unknown

more common w certain conditions - raynauds, connective tissue disorders, cardiovaSCULAR DISEASE, lung disease, lung disease, cancer

232
Q

presentation of dermatomyositis

A

skin changes - violet or dusky red rash, face and eyelids and knuckles, elbows, knees, chest and back. can be itchy and painful

muscle weakness - progressive on muscles closest to trunk - hips, shoulders, upper arms and neck, bilateral

complications - difficulty swallowing (wt loss, malnutrition), aspiration pneumonai, breathing probs, calcium deposits in muscles, skin and connective tissue

233
Q

investigations for dermatomyositis

A

bloods: troponins and ANA

CXR - lung dmaage

electromyography

MRI - inflammation in muscle

skin or muscle biopsy

234
Q

management of dermatomyositis

A

improve skin and muscle strength and function:

  • corticosteroids - control symptoms
  • corticosteroid sparing agents
  • rituximab - treat RA
  • antimalarial meds for rash
  • sunscreens to manage rash

therapy - phsycial therapy, speech therpay, dietetic assessment (teach how to prep easy to eat foods)

surgery - remove caclium depostis and prevent recurrent skin infections

235
Q

what is vasculitis

A

inflammation of blood vessels

thicken and reduces width of passage

blood flow restricted

organ and tissue damage

236
Q

cause of vasculitis

A

possible triggers of immune reaction = infection (hep B and C), blood cancers, autoimmune disease, reactions to certain drugs

237
Q

presentation of vasculitis

A

fever, headache, fatigue, weight loss, general aches and pains

Digestive system – pain after eating and blood in stool if perorations or ulcers

Ears – dizziness, ringing in ears and abrupt hearing loss

Eyes – red and itchy, giant cell arteritis (double vision and temporary or permanent blindness)

Hands or feet – numbness or weakness in hand or foot. Palms of hands and soles of feet might swell or harden

Lungs – SOB or haemoptysis if lungs affected

Skin – red spots from bleeding under skin, lumps or open sores on skin

238
Q

complications of vasculitis

A

organ damage
blood clots and aneurysms
vision loss or blindness -GCA
infections

239
Q

investigations of vasculitis

A

CRP, FBC, ANCA

imaging, angiography

biopsy

240
Q

management of vasculitis

A

corticosteroids and surgery

Year 3 core conditions (15 decks)

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