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ABPI Unit 7 Dermatology > Dermatology > Flashcards

Dermatology Flashcards

(98 cards)

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1
Q

What is the average area of the skin?

A

2 square metres

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2
Q

How much does the skin weigh?

A

4-5kg

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3
Q

What is the average thickness of skin

A

1-2mm

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4
Q

What are the three layers of the skin?

A
  1. Epidermis
  2. Dermis
  3. Subcutaneous layer
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5
Q

Skin structure

A
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6
Q

Epidermis structure

A
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7
Q

What is acne?

A

Characterised by formation of comedones (black and whiteheads) and spots known as papules and pustules

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8
Q

What causes acne?

A

Inflammation of the pilosebaceous units of skin

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9
Q

What factors can combine to form acne?

A
  1. Rise in sebum secretion in response to sex hormones in adolescence
  2. Overgrowth of bacterium in follicular duct
  3. Formation of bacterial plug blocking follicle
  4. Inflammation caused by body’s immune response
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10
Q

What are the four main skin changes in acne?

A
  1. Open comedomes - blackheads
  2. Closed comedomes - whiteheads, completely blocked follicle
  3. Papules - red or flesh-coloured bumps on surface of skin
  4. Pustules - white or yellow pus-filled pimples
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11
Q

How is acne classified by severity?

A

Mild - comedomes, papules/pustules
Moderate - papules, pustules, nodules
Severe - scarring, nodulocystic acne

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12
Q

What are the aims of acne treatment?

A
  1. Reduce sebum secretion
  2. Prevent blockage of the pilosebaceous duct
  3. Reduce or eliminate colonisation by P. acnes
  4. Reduce inflammation
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13
Q

How were the recommendations for the treatment of acne produced by the Guidance Alliance to Improve Outcomes in Acne in 2003 updated in 2009?

A

Reduced reliance on antibiotics and increased focus on acne as a chronic

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14
Q

What topical therapies can be used for acne?

A

Benzyl peroxide
Retinoids - reduce sebum production and inflammation
Comedolytics and keratolytics - soften hard keratin and slowing shedding of skin cells
Topical antibiotics - erythromycin and clindamycin

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15
Q

What are the effects of topical medicines used to treat acne?

A
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16
Q

What oral therapies can be used to treat acne?

A

Oral ABX - tetra, oxytetra, doxy or lymecycline
Hormonal - COC, co-cyprindiol
Retinoids isotretinoin

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17
Q

What is rosacea?

A

Chronic skin condition that affects the face. Begins with episodes of facial flushing, may progress to acne-like symptoms as well as thickened, bumpy skin and eye problems

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18
Q

How is rosacea classified?

A

Type 1-4

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19
Q

How is type 1 rosacea classified?

A

Erythematolangiectatic - flushing and redness around centre of face. May also see swelling and red blood vessels, rough patches of skin, burning and stinging sensations

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20
Q

How is type 2 rosacea classified?

A

Papulopustular - persistent redness around centre of face, with bumps and pimples resembling acne. Burning and stinging may also occur. Often seen after or in combo with type 1

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21
Q

How is type 3 rosacea classified?

A

Phymatous - thickened skin with bumpy surface. Most often affects nose (rhinophyma)

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22
Q

How is type 4 rosacea classified?

A

Red, irritated eyes. Feeling like there is something in eye, burning, dryness, light sensitivity, blurred vision. May occur with or without rosacea

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23
Q

What are the triggers of rosacea?

A 
Exposure to sunlight
Stress
Exercise 
Cold weather (wind)
Heat 
Menopause 
Vasodilator drugs
Hot drinks
Alcohol and caffeine 
Spicy foods
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24
Q

What are the topical treatments for mild rosacea?

A

Topical ABX - metronidazole, sodium sulfacetamide to treat pustules
Topical comedolytic agents - azelaic acid to unblock pores and reduce inflammation

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25
What oral treatments can be used to treat moderate-to-severe rosacea?
ABX - tetracyclines or erythromycin | Retinoids - isotretinoin
26
What is dermatitis?
Immunological, inflammatory reaction in skin. Many different forms, including eczema. Can be acute or chronic
27
What are exogenous factors?
Those outside the body that cause disease e.g. chemical in soap, sunlight
28
What are endogenous factors?
Those within the body that cause disease
29
What are some types of dermatitis and what ages to they affect?
30
What is irritant contact dermatitis?
Skin reaction where causative agent is external. Immediate or cumulative reaction, irritation occurs once chemicals are able to penetrate the keratinous part of skin and trigger inflammatory immune response within dermis cells
31
What are characteristics of irritant contact dermatitis?
Rash - localised to area of exposure, may be erythematous (reddened), inflamed, itchy, swollen. Small vesicles may be present. Prolonged exposure gives cracked, scaly skin
32
What is allergic contact dermatitis?
Hypersensitivity reactions which has potential to appear on other parts of body as well as area directly exposed to allergen
33
What are the stages of development of allergic dermatitis?
1. An allergen enters skin and encounters Langerhans cells, found scattered in epidermis 2. These take up the allergen which pass on the identification to T-cells 3. T-cells multiply, circulate round body and begin to accumulate at site of reaction 4. If allergen still detected, T-cell activated and respond by releasing variety of inflammatory molecules , causing redness, swelling, inflammation
34
What is atopic eczema?
Most common form of eczema. Chronic. Inflammation and disruption of various layers throughout skin Skin initially itchy, flaky, erythematous and dry in acute phase Thickened, cracked and crusted as condition progresses
35
What gene is atopic eczema associated with?
Filaggrin gene
36
What is seborrhoeic dermatitis in infants?
Caused by overactive sebaceous glands and results in oily skin. Common in nappy area or head Not itchy or sore however secondary infection may occur
37
What is seborrhoeic dermatitis in adults?
Affects areas where there are most sebaceous glands (face, scalp, chest), but sebum secretion appears normal
38
What factors cause adult seborrhoeic eczema?
Genetic and endogenous factors which permit excessive growth of a yeast Malassezia furfur
39
What is an un-inflamed form of seborrhoeic dermatitis?
Dandruff
40
What is gravitational eczema?
Arises in lower legs, affects mainly middle-aged and elderly people Due to underlying disease of deep vein valves, causes increased pressure, leakage of fluid into skin, reddish-brown pigmentation, itching, blistering
41
What is discoid eczema?
Circular, coin-sized rings of itchy red lesions on limbs or small pustules on hands. Lesions weep, become crusted and infected. Cause unknown
42
What is pompholyx eczema>
Restricted to hands and feet, characterised by blistering
43
What is asteatotic eczema?
Affects elderly, mostly on lower legs, occasionally on upper arms, thighs and lower back. Cause unknown Distinctive banded pattern with cracking
44
What are treatment options for dermatitis?
Emollients Topical corticosteroids - reduce inflammation, potency depends of severity of inflammation and location Antibiotics or antimicrobials Antipruritics - reduce itching and break itch-scratch cycle Immunosuppressants
45
What is psoriasis?
Chronic, autoimmune inflammatory condition characterised by inflamed, thickened areas of skin, often topped by silvery scales
46
What triggers psoriasis?
Thought to be genetically determined but triggered by environmental factors such as stress
47
What is a secondary condition to psoriasis?
5-10% patients suffer from psoriatic arthritis
48
What is the most obvious symptom of psoriasis?
Flaky lesions on skin or in hair. Sometimes when scratched off, small blood droplets appear (Auspitz's sign)
49
Why do skin lesions of psoriasis occur?
There are increased numbers of cells in the basal later that divide up to 20x faster than normal skin. This causes new skin cells to rise to the surface of epidermis much more quickly than normal skin cell division
50
In which two periods of life is psoriasis most likely to develop?
Teenage years into twenties, and in sixties
51
What is the most common form of psoriasis?
Plaque psoriasis - usually occurs on knees, elbows, lower back, scalp Lesions appear as circular red patches with a well-defined edge and silvery scaly surface. Symmetrical lesions
52
What are the characteristics of guttate psoriasis?
Rash-like lesions on truck/limbs
53
What are the characteristics of guttate psoriasis?
Rash-like lesions on truck/limbs
54
What are the characteristics of flexural psoriasis?
Lesions smooth and glazed appearance. Under arms, groin, folds under breasts and cleft of buttocks
55
What are the characteristics of palmoplantar psoriasis?
Sterile pustules on palms of hands or soles of feet
56
What are the characteristics or erythrodermic psoriasis?
Serious condition in which entire skin inflamed
57
Apart from skin, psoriasis can also affect what?
Nails of up to 50% people with condition, causing nails to become pitted and ridged
58
Is there a cure for psoriasis?
No, however, medicine can control the lesions and improve quality of life
59
How can psoriasis be treated with emollients?
Help soften and moisturised skin to reduce cracking, inflammation and pain
60
How can psoriasis be treated with tar preparations?
Impregnated bandages and dressings. Coal tar is thought to inhibit DNA synthesis to reduce rate of cell division
61
How can psoriasis be treated with corticosteroids?
Treat inflamed, stubborn plaques on body
62
How can psoriasis be treated with vitamin D analogues?
Topical preparations closely related to vitamin D. Control rate of cell multiplication and formation of excess keratinocytes
63
How can psoriasis be treated with phototherapy?
Narrow band UVB and/or UVA can be used to slow the growth of affected skin cells
64
How can psoriasis be treated with retinoids?
Reduce inflammatory changes in skin and change rate of turnover of keratinocytes
65
How can psoriasis be treated with dithranol?
Chemical derivative of natural product that can be applied to lesions as a paste, blocks cell division
66
How can psoriasis be treated with immunosuppressants?
Methotrexate can slow cell division and is valuable in severe psoriasis
67
How can psoriasis be treated with biologic agents?
Reduce inflammation by targeting specific overactive cells or chemicals in immune system Common targets - Tumour necrosis factor alpha (TNFa), IL-12 and IL-13
68
What are actinic keratoses?
Areas of sun-damaged skin which develop on areas of body frequently exposed to sunlight. Can be skin coloured, pink, red or brown, feels rough and dry
69
What percentage of actinic keratoses transform into squamous cell carcinoma?
20%
70
What are the two classifications of skin cancer?
Melanoma and non-melanoma
71
What is the main cause of all skin cancers?
Excessive UV exposure
72
What is superficial spreading melanoma?
Most common type of skin melanoma Most common on chest and back in men and legs in women Melanoma cells spread out across surface of skin
73
What is a nodular melanoma?
Cells grow more quickly than other melanomas and is usually found on chest, back, head or neck
74
What is lentigo maligna melanoma?
Found on areas of skin with lots of sunlight exposure | Develops from slow-growing precancerous lentigo maligna which looks like a stain on the skin
75
What is acral melanoma?
Rarest type, found on palms of hands, soles of feet, under nails
76
How is early melanoma treated?
Local surgery
77
How is melanoma treated if it returns?
Further surgery with chemo and/or radiotherapy. Further mABs may be used to stop spread
78
What is basal cell carcinoma?
Most common non-melanoma skin cancer Originates from cells lining bottom of epidermis (basal cells) Appears red or pink lump, or flat, flesh-coloured or brown patches of skin. Pearly rolled edges
79
What is an alternative BCC treatment to surgery?
``` Photodynamic therapy (PDT) Administer cream containing 5-aminolaevulinic acid (ALA) which is absorbed into cells Skin exposed to light and cells containing ALA destroyed ```
80
What is squamous cell carcinoma?
Originates from cells lining top of epidermis (squamous cells) Firm red lump or flat, scaly, crusty scab-like lesion that doesn't heal Don't spread easily
81
What is cutaneous T cell lymphoma?
Non-melanoma skin cancer Caused by T cells in skin growing in uncontrolled manner Symptoms can look like eczema, may be one or more tumours on skin Topical chemo, UVA, radiotherapy
82
What is Kaposi's sarcoma?
Rare type of cancer commonly affecting HIV patients Main cause is HHV8 virus Not a true cancer - rather reactive hyperplasia Antiviral treatments in HIV pts, switching immunosuppressants Radiotherapy to shrink lesions and chemo for internal tumours
83
What is angiosarcoma?
``` Rare cancer of inner lining of blood vessels Usually found on scalp and face Usually fast, aggressive tumours Surgery with chemo/radiation Poor prognosis ```
84
What is Merkel cell carcinoma?
Rare, forms when Merkel cells (found in epidermis) grow out of control Single lump that is fast-growing, painless, firm, dome-shaped or raised, red or violet in colour Spreads to lymph nodes Surgery with chemo/radiotherapy
85
When do boils occur?
Hair follicle becomes infected, producing pus-filled lump on skin Drained, ABX (fluclox, clarithromycin) S. aureus
86
What are carbuncles?
Multiple boils occurring when hair follicles next to each other become infected Drain, ABX
87
What is chronic furunculosis?
Groups of boils occur over a period of time, episodically or continuously ABX or surgery
88
What is folliculitis?
Inflammation of hair follicles in skin. Very small pustules develop at base of hair Can resolve itself or need ABX S. aureus
89
What are three types of folliculitis?
1. Hot-tub - avoid by keeping hot tubs clean and showering after use 2. Sycosis barbae - associated with bearded area of man's face 3. Gram-negative - associated with long term ABX treatment for acne
90
What is herpes simplex virus?
Lies dormant in nerve root, virus reactivated when individual unwell or stressed causing sore blisters
91
Which HSVs cause oral vs genital herpes?
Oral - HSV1 | Genital - HSV2
92
How is HSV treated?
Antiviral medication - aciclovir
93
What is Varicella zoster?
Causes chickenpox in childhood | May lie dormant in a sensory nerve root and recur as shingles later in life
94
What causes warts and verrucae?
HPV
95
What is Orf?
Caused by parapox virus from lambs and goats Small firm red or reddish-blue lesions develop, and will form blister tinged with blood No treatment, regresses within 3-6 weeks
96
What is athlete's foot?
Fungal infection of foot that causes peeling, itching, redness, and sometimes blisters and sores Caused by trichphyton rubrum
97
What is ringworm?
Fungal infection, circular red flat sore, scaly skin
98
What is thrush?
C. albicans is a common fungus often present in mouth, stomach, skin and vagina Usually causes no problems, but if person is unwell, pregnant, has diabetes or is taking ABX, fungi can multiply causing thrush symptoms Small white patches which leave red mark when rubbed off

ABPI Unit 7 Dermatology (1 decks)

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