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Y6 > Dermatology > Flashcards

Dermatology Flashcards

1
Q

What are seborrhoeic keratoses?

A

Benign epidermal skin lesions seen in older people

Features:
* large variation in colour from flesh to light-brown to black
* have a ‘stuck-on’ appearance
* keratotic plugs may be seen on the surface

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2
Q

What is the management for seborrhoeic keratoses?

A

Reassurance about the benign nature of the lesion is an option

Options for removal include curettage, cryosurgery and shave biopsy

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3
Q

What is used first-line in hyperhidrosis?

A

Topical aluminium chloride

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4
Q

What are features of squamous cell carcinoma?

A
  • typically on sun-exposed sites such as the head and neck or dorsum of the hands and arms
  • rapidly expanding painless, ulcerate nodules
  • may have a cauliflower-like appearance
  • there may be areas of bleeding
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5
Q

What are risk factors for squamous cell carcinoma?

A
  • excessive exposure to sunlight / psoralen UVA therapy
  • actinic keratoses and Bowen’s disease
  • immunosuppression e.g. following renal transplant, HIV
  • smoking
  • long-standing leg ulcers (Marjolin’s ulcer)
  • genetic conditions e.g. xeroderma pigmentosum, oculocutaneous albinism
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6
Q

What conditions are associated with seborrhoeic dermatitis?

A

Otitis externa
Blepharitis

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7
Q

What is the management of seborrhoeic dermatitis?

A

Scalp disease: ketoconazole 2% shampoo

Face and body management:
* Topical antifungals: e.g. ketoconazole
* topical steroids: best used for short periods

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8
Q

What is seborrhoeic dermatitis?

A

Chronic dermatitis thought to be caused by an inflammatory reaction related to a proliferation of a normal skin inhabitant, a fungus called Malassezia furfur (formerly known as Pityrosporum ovale)

Presentation: eczematous lesions on the sebum-rich areas: scalp (may cause dandruff), periorbital, auricular and nasolabial folds

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9
Q

What analgesia can be given in shingles?

A
  • Paracetamol and NSAIDs are first-line
  • If not responding then use of neuropathic agents (e.g. amitriptyline)
  • Oral corticosteroids may be considered in the first 2 weeks in immunocompetent adults with localized shingles if the pain is severe and not responding to the above treatments
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10
Q

What is hidradenitis suppurativa?

A

A chronic, painful, inflammatory skin disorder. It is characterized by the development of inflammatory nodules, pustules, sinus tracts, and scars in intertriginous areas.

It should be suspected in pubertal or post-pubertal patients who have a diagnosis of recurrent furuncles or boils, especially in intertriginous areas.

The axilla is the most common site.

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11
Q

What is the management of erythema nodosum?

A

No active management - arrange follow-up

Usually resolves within 6 weeks
Lesions heal without scarring

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12
Q

What early intervention should be done in patients with severe burns?

A

Early intubation should be considered in patients with severe burns, particularly if there is deep burns to the face or neck, blisters or oedema of the oropharynx, stridor etc

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13
Q

What is pyoderma gangrenosum?

A

Non-infectious, inflammatory disorder. It is an uncommon cause of very painful skin ulceration. It may affect any part of the skin, but the lower legs are the most common site.

Also known as neutrophilic dermatosis: dense infiltration of neutrophils in the affected tissue and this is often seen on biopsy

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14
Q

What are the causes of pyoderma gangrenosum?

A
  • Idiopathic in 50%
  • Inflammatory bowel disease in 10-15%
  • Rheumatological: rheumatoid arthritis, SLE
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15
Q

What are the 4 components of acne?

A
  1. Follicular epidermal hyperproliferation with subsequent plugging of the follicle
  2. Excess sebum production
  3. Presence and activity of the commensal bacteria Cutibacterium acnes
  4. Inflammation
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16
Q

What antibiotics is preferred in human and animal bites?

A

Co-amoxiclav

If penicillin-allergic then doxycycline + metronidazole

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17
Q

What is the treatment of mild/moderate cellulitis?

A

Oral flucloxacillin

oral clarithromycin, erythromycin (in pregnancy) or doxycycline if penicillin-allergic

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18
Q

What is the treatment of severe cellulitis?

A

oral/IV co-amoxiclav, oral/IV clindamycin, IV cefuroxime or IV ceftriaxone

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19
Q

What is the difference between a skin prick and a skin patch test?

A

Skin prick - type 1 hypersensitivity reactions such as food allergies and urticaria

Skin patch - type 4 hypersensitivity reactions like contact dermatitis

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20
Q

What is a radioallergosorbent test (RAST)?

A

Determines the amount of IgE that reacts specifically with suspected or known allergens, for example IgE to egg protein. Results are given in grades from 0 (negative) to 6 (strongly positive)

Blood tests may be used when skin prick tests are not suitable, for example if there is extensive eczema or if the patient is taking antihistamines

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21
Q

What are different subtypes of psoriasis and their associated features?

A

Plaque psoriasis: the most common sub-type resulting in the typical well-demarcated red, scaly patches affecting the extensor surfaces, sacrum and scalp

Flexural psoriasis: in contrast to plaque psoriasis the skin is smooth

Guttate psoriasis: transient psoriatic rash frequently triggered by a streptococcal infection. Multiple red, teardrop lesions appear on the body

Pustular psoriasis: commonly occurs on the palms and soles

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22
Q

What conditions are associated with Koebners phenomenon?

A

Psoriasis
Vitiligo
Lichen planus
Molluscum contagiosum

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23
Q

What is the treatment of lichen planus?

A

Potent topical steroids
Benzydamine mouthwash or spray for oral lesions
Extensive disease may require oral corticosteroids or immunosuppression

24
Q

What are the characteristics of lichen planus?

A

5Ps:
Pruritic, Purple, Polygonal, Planar, Papules

+ Wickham’s striae

25
Q

Name causes of erythema nodosum

A

NO- Idiopathic
D- Drugs (Penicillins and sulphonamides)
O-Oral Contreceptives/ Pregnancy
S-Sarcoidosis/ TB
U-UC, Crohns, Behcets
M-Microbiology (Strep, Myco, EBV etc.)

26
Q

What antibiotics can be used in acne if a patient is pregnant?

A

Erythromycin

27
Q

What is the treatment for impetigo?

A

1st line: Hydrogen peroxide 1% cream

Abx: topical fusidic acid

28
Q

What are features of acne rosacea?

A
  • typically affects nose, cheeks and forehead
  • flushing is often first symptom
  • telangiectasia are common
  • later develops into persistent erythema with papules and pustules
  • rhinophyma
  • ocular involvement: blepharitis
  • sunlight may exacerbate symptoms
29
Q

What management is given in acne rosacea?

A

Predominant erythema/flushing: topical brimonidine

Mild-to-moderate papules and/or pustules: topical ivermectin or topical metronidazole or topical azelaic acid

Moderate-to-severe papules and/or pustules: combination of topical ivermectin + oral doxycycline

30
Q

What is erysipelas?

A

Erysipelas is localised skin infection caused by Streptococcus pyogenes. In simple terms, it is a more superficial, limited version of cellulitis.

The treatment of choice is flucloxacillin.

31
Q

What organisms cause fungal nail infections?

A
  • Dermatophytes (90% of cases) - Trichophyton rubrum
  • Yeasts (5-10% of cases) - Candida
  • Non-dermatophyte moulds
32
Q

What is the managment of fungal nail infections?

A

If dermatophyte or Candida infection and limited involvement ((≤50% nail affected, ≤ 2 nails affected, more superficial white onychomycosis): topical treatment with amorolfine 5% nail lacquer)

If extensive dermatophyte: oral terbinafine

If extensive candida: oral itraconazole

33
Q

What are features of scabies?

A

This is a delayed type IV hypersensitivity reaction:
* widespread pruritus
* linear burrows on the side of fingers, interdigital webs and flexor aspects of the wrist
* in infants, the face and scalp may also be affected
* secondary features are seen due to scratching: excoriation, infection

34
Q

What is the 1st-line treatment of scabies?

A

Permethrin 5%

  • avoid close physical contact with others until treatment is complete
  • all household and close physical contacts should be treated at the same time, even if asymptomatic
  • launder, iron or tumble dry clothing, bedding, towels, etc., on the first day of treatment to kill off mites.
35
Q

What is the treatment of pityriasis versicolor?

A

Ketoconazole shampoo as this is more cost effective for large areas

If failure to respond to topical treatment then consider alternative diagnoses (e.g. send scrapings to confirm the diagnosis) + oral itraconazole

36
Q

How can you differentiate erysipelas from cellulitis?

A

Erysipelas is raised with sharp and well defined borders.

In cellulitis the borders are classically poorly defined- in practice people mark the borders with a marker to note any improvement, because it is generally hard to see where the cellulitis obviously ends

37
Q

What is the recommended break period between steroid courses in psoriasis?

A

4 weeks

38
Q

What are the most common sites for keloid scars?

A

In order of decreasing frequency:
Sternum
Shoulder
Neck
Face
Extensor surface of limbs
Trunk

39
Q

How is dermatitis herpetiformis diagnosed?

A

Skin biopsy which shows granular pattern of IgA deposition

40
Q

What drugs worsen psoriasis?

A

BLANQ:
Beta blockers
Lithium
ACEi
NSAIDs
Quinines

41
Q

What is erythroderma?

A

Term used when more than 95% of the skin is involved in a rash of any kind

Causes:
* eczema
* psoriasis
* drugs e.g. gold
* lymphomas, leukaemias
* idiopathic

42
Q

What must patients with erythroderma be monitored for?

A

Dehydration
Infection
High-output heart failure

43
Q

What is the most common form of melanoma

A

From most common to least:
* Superficial spreading (70%)
* Nodular
* Lentigo maligna
* Acral lentiginous

44
Q

What are the features of the different types of melanomas?

A

Superficial spreading:
* Typical ABCDE melanoma signs
* Affects arms, legs, back and chest
* Common in young people

Nodular:
* Red or black lump or lump which bleeds or oozes
* Sun-exposed skin
* Middle-aged people

Lentigo maligna:
* Typical ABCDE melanoma signs
* Chronically sun-exposed skin
* Older people

Acral lentiginous:
* Subungual pigmentation (Hutchinson’s sign) or on palms, feet or nails
* Affects people with darker skin pigmentation

45
Q

What are the typical ABCDE melanoma signs?

A

Asymmetry
(Irregular) Borders
(Multiple) Colours
>5mm diameter
Evolving

46
Q

What are keratoacanthomas?

A

Benign epithelial tumours that look like a volcano/crater
* Initially a smooth dome-shaped papule
* Rapidly grows to become a crater centrally-filled with keratin

They spontaneously regress within 3 months and this results in a scar - however they are commonly excised as it can be difficult to exclude a SCC

47
Q

What is a pyogenic granuloma?

A
  • Overgrowth of blood vessels.
  • Red nodules.
  • Usually follow trauma.
  • May mimic amelanotic melanoma.
48
Q

What should you do when a child presents with a new purpuric rash?

A

Refer to secondary care immediately to rule out meningococcal septicaemia or ALL

49
Q

What is an easy way to distinguish between bullous pemphigoid and pemphigus vulgaris?

A

Bullous pemphigoid: no mucosal involvement (in exams at least). They also rupture less easily

Pemphigus vulgaris: mucosal involvement

50
Q

What should you do someone has a systemic reaction to an insect bite?

A

Refer to allergy specialist - for consideration of adrenaline and medical alert bracelet/device

51
Q

How long does pityriasis rosea usually last?

A

6-12 weeks as it is self-limiting

52
Q

What procedure can you do in burns where there is impeding respiration?

A

Escharotomy:
* Indicated in circumferential full thickness burns to the torso or limbs.
* Careful division of the encasing band of burn tissue will potentially improve ventilation (if the burn involves the torso), or relieve compartment syndrome and oedema (where a limb is involved)

53
Q

What is periorificial dermatitis?

A

Typically seen in women aged 20-45 years old where topical corticosteroids, and to a lesser extent, inhaled corticosteroids are often implicated in the development of the condition.

Features:
* Clustered erythematous papules, papulovesicles and papulopustules
* Most commonly in the perioral region but also the perinasal and periocular region
* Skin immediately adjacent to the vermilion border of the lip is typically spared

Management:
* Steroids may worsen symptoms
* Should be treated with topical or oral antibiotics

54
Q

What are the different stages of wound healing?

A
  1. Haemostasis
  2. Inflammation
  3. Regeneration
  4. Remodelling
55
Q

Hypertrophic vs keloid scars

A

Both are a result of excess collagen within a scar

Hypertrophic:
* Confined to extent of wound itself
* Typically develop within weeks of injury
* They may regress over time

Keloid:
* Pass beyond the boundaries of the original injury
* Typically develops within months of injury
* Do not regress over time and may recur following removal

56
Q

What are the different types of contact dermatitis?

A

Irritant:
* Non-allergic reaction due to weak acids or alkalis (e.g. detergents)
* Often seen on the hands
* Erythema is typical, crusting and vesicles are rare

Allergic:
* Type IV hypersensitivity reaction
* Uncommon - often seen on the head following hair dyes
* Presents as an acute weeping eczema which predominately affects the margins of the hairline rather than the hairy scalp itself
* Treatment: potent topical steroid

57
Q

What is the most common causative organism of osteomyelitis?

A

Staph. aureus is the most common

Except in patients with sickle-cell anaemia where Salmonella species predominate

Y6 (24 decks)

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