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ICA > Dermatology > Flashcards

Dermatology Flashcards

1
Q

How should we describe a skin lesion systematically?

A
  • Site and distribution
  • Configuration
  • Colour
  • Morphology/primary lesions
  • Surface features/secondary lesions (evolved from primary lesions)
  • Hair and nail findings
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2
Q

What are some common skin conditions?

A
  • Atopic eczema
  • Acne vulgaris
  • Psoriasis
  • Urticaria
  • Molluscum contagiosum
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3
Q

Outline atopic eczema

A
  • Characterised by pruritis and inflammation
  • Epidermal changes e.g. papules, vesicles
  • Can occur anywhere but often flexural
  • Exogenous vs endogenous causes
  • Acute vs chronic
  • Clinical diagnosis including: personal or family history of atopy e.g. hay fever, asthma
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4
Q

How is eczema treated?

A
  • Treatment
  • Education and support
  • Avoidance of exacerbating factors
  • Topical therapies e.g. emollients, use of soap substitute, steroids/calcineurin inhibitors
  • Phototherapy
  • Systemic therapies
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5
Q

How might eczema present?

A
  • Generalised
  • Hyperpigmented
  • Patches
  • Scaly
  • Lichenification
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6
Q

How might acne present?

A
  • Localised
  • Well defined
  • Discrete
  • Erythema
  • Papules
  • Vesicles
  • Pustules
  • Crusts
  • Comedones
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7
Q

Outline acne vulgaris

A
  • Found mostly in skin of face, neck and upper body (back or chest)
  • Chronic skin disease due to blockage of hair follicles in skin
  • Clinical diagnosis
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8
Q

What are the causes of acne vulgaris?

A
  • Increased sebum production (androgen influence)
  • Excessive deposition of keratin in pores
  • Overgrowth of Cutibacterium acnes (skin commensal)
  • Pro-inflammatory chemicals released into skin
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9
Q

How is acne vulgaris treated?

A
  • Topical
  • Non-antibiotic treatments e.g. benzoyl peroxide, retinoids etc
  • Antibiotic treatments e.g. erythromycin, tetracycline, clindamycin
  • Systemic treatments such as antibiotics, oral contraceptive pill, isotretinoin
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10
Q

How might psoriasis present?

A
  • Extensor
  • Well-defined
  • Hyperpigmented
  • Plaque
  • Scaly
  • Can be symmetrical
  • Can be erythematous
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11
Q

Outline psoriasis

A
  • Chronic skin condition
  • Occurs equally in men and women
  • Often occurs between 20-30 years old and 50-60 years old
  • Strong genetic predisposition
  • Has a relapsing and remitting course
  • Most common type is plaque psoriasis
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12
Q

What can cause psoriasis?

A
  • Immune mediated inflammatory disease
  • T cells cytokine production is stimulated
  • Causes keratinocyte proliferation
  • Identify any triggers or iatrogenic causes (including medications such as ACEi, B blockers, NSAIDs, Lithium, anti-malaria)
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13
Q

How is psoriasis treated?

A
  • Topical e.g. emollients, corticosteroids, vit D analogues, calcineurin inhibitors, salicylic acid, vit A, tar preparations
  • Phototherapy broad-band or narrow-band UV B light
  • Oral systemic medication e.g. acitretin, ciclosporin, methotrexate
  • Injectable systemic medication e.g. TNF antagonists, monoclonal antibodies
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14
Q

Outline urticaria

A
  • Transient (<24 hours) +/- angioedema
  • Acute vs. chronic (persists for over 6 weeks)
  • Mast cell degranulation and histamine release
  • Leads to increased capillary permeability and leakage of fluid into surrounding tissue
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15
Q

How is urticaria treated?

A
  • Suppress symptoms
  • H1 anti-histamines (fexofenadine, cetirizine, loratadine)
  • H2 anti-histamines (cimetidine, ranitidine)
  • Steroids, ciclosporin, montelukast
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16
Q

Outline molluscum contagiosum

A
  • Pox virus infection
  • 2-6 week incubation period
  • More common in atopic and immunocompromised patients
  • Most self-resolve within 6-9 months
  • No treatment required
17
Q

How do we take a dermatological history?

A
  • Presenting complaint
  • History of presenting complaint
  • Past medical history
  • Family history
  • Social history
  • Drug history and allergies
  • Impact on quality of life/ICE
18
Q

What information do we need to ascertain when a patient presents with a skin problem?

A
  • Nature e.g. rash vs lesion
  • Site
  • Duration - how long has it been there? how rapidly did it appear?
19
Q

How do we find out the history of presenting complaint of a skin problem?

A
  • Initial appearance and evolution
  • Symptoms (particularly itch and pain)
  • Aggravating and relieving factors (triggers)
  • Previous and current treatments - effective or not
  • Which treatments have worked before? Which treatments have not? Why did they stop taking treatment?
20
Q

What past medical history should we obtain from a patient with a skin problem?

A
  • Systemic diseases
  • History of atopy (asthma, hay fever, eczema)
  • History of skin cancer or pre-cancer
  • History of sunburn/sunbathing/sun-bed use
  • Skin type
21
Q

What family history should we obtain from a patient with a skin problem?

A
  • Family history of skin disease
  • Family history of atopy
  • Family history of autoimmune disease
22
Q

What social history should we obtain from a patient with a skin problem?

A
  • Occupation
  • Sun exposure
  • Contactants
  • Improvement in skin condition when away from work
23
Q

What drug history should we obtain from a patient with a skin problem?

A
  • Regular and recent
  • Systemic and topical
  • Get specific with topical treatments (find out what treatment is, find out what strength it is)
  • Where?
  • How much?
  • How long for?
24
Q

How do we examine the skin?

A
  • Inspect
  • Palpate
  • Describe
  • Systemic check (whole skin, hair, nails, mucous membranes)
25
Q

How do we describe skin problems?

A
  • S - site, distribution (rash) or size and shape (lesion)
  • C - colour and configuration
  • A - associated changes e.g. surface features
  • M - morphology
26
Q

How do we describe pigmented lesions?

A
  • Asymmetry
  • Border (irregular or blurred)
  • Colour
  • Diameter
27
Q

How can we describe the site and distribution of a skin rash/lesion?

A
  • Generalised
  • Flexural
  • Extensor
  • Photosensitive
28
Q

How can we describe the configuration of a skin rash/lesion?

A
  • Discrete (separate little lesions)
  • Confluent (spots merge into each other)
  • Linear
  • Target (darker centre with a lighter border)
29
Q

How can we describe the colour of a skin rash/lesion?

A
  • Erythematous (red and blanching)
  • Purpuric (red or purple and non-blanching)
  • Brown or black (pigmented or hyperpigmented)
  • Hypo pigmented (depigmented if total loss of colour)
30
Q

How can we describe the surface features of a skin rash/lesion?

A
  • Scale (built-up keratin)
  • Crust (dried exudate)
  • Excoriation (erosion from scratching)
  • Erosion/ulceration (partial or full thickness loss)
31
Q

How can we describe the morphology of a skin rash/lesion?

A
  • Macule (flat and small)
  • Patch (flat and bigger)
  • Papule (raised and little)
  • Plaque (raised and extensive)
  • Nodule (large solid lump)
  • Vesicle (small fluid-filled blister e.g. chickenpox)
  • Pustule (skin blister filled with pus)
  • Bulla (large fluid-filled blister)
  • Annular (ring-shaped e.g. fungal skin presentation)
  • Wheal (lesions become raised due to oedema in dermis of skin)
  • Discoid/nummular
  • Comedones
32
Q

How can we describe hair findings?

A
  • Alopecia (patchy or diffuse)
  • Hypertrichosis
  • Hirsutism
33
Q

How can we describe nail findings?

A
  • Koilonychia (spoon shaped nails)
  • Pitting
  • Onycholysis
  • Clubbing

ICA (5 decks)

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