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Dermatology Flashcards

1
Q

What is eczema

A

Common, chronic atopic, inflammatory skin condition caused by defects in normal continuity of skin barrier leading to inflammation of skin

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2
Q

Associations of eczema

A
  • Asthma, hayfever, allergic rhinitis
  • Family history
  • Breast feeding decreases risk
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3
Q

Triggers of eczema flares

A
  • Soaps, detergents, shower gels, bubble baths, washing-up liquids
  • Skin infections (staph aureus)
  • Extremes of temperature
  • Abrasive or synthetic fabrics
  • Dietary factors
  • Inhaled allergens = house, dust mites, pollen, pet dander, mould
  • Stress/ emotional events
  • Hormonal changes in women = pregnancy, menstrual cycle
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4
Q

Presentation of eczema

A
  • Typically affects flexor surfaces, skin folds, elbows and behind knees
  • Pruritus
  • Onset within first 3m of life but can occur later
  • Dry red skin skin
  • Presents in flares
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5
Q

Diagnosis criteria for eczema

A
  • Itchy skin + 3 of:
    o Itchiness in skin folds in front of elbows and back of knees
    o History of asthma or hay fever
    o Generally dry skin
    o Visible patches of eczema in skin folds
    o Onset in first 2 years of life
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6
Q

General advice for eczema

A

Avoid woollen clothes, extremes of temp, hot baths, scratching

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7
Q

Management of eczema

A
  • Emollients
    o Creams < lotions < ointments
    o Apply every 4 hours or at least 3-4x per day
    o Use >500ml/week
    o Bath/shower emollients available
  • Steroids
    o Bring exacerbation under control
    o Use steroids at first sign of flare-up
    o Apply before emollients 1-2x per day
    o Mild = 1% hydrocortisone
    o Moderate = Eumovate
    o Potent = Betnovate
    o Very potent = dermovate
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8
Q

Management of severe or complicated eczema

A
  • Antibiotics (Tx of staph infection)
    o Flucloxacillin for 1-2 wks
  • Immune modulating agents
    o Pimecrolimus and tacrolimus
  • Wet wraps
  • Severe eczema
    o Zinc impregnated bandages
    o Topical tacrolimus
    o Phototherapy
    o Systemic immunosuppressants
    o Oral ciclosporin
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9
Q

Complications of eczema

A
  • Lichenification = Skin becomes thickened and leathery
  • Bacterial infection (staph aureus) = Crusting and weeping of lesions with surrounding erythema
  • Eczema herpeticum = Eczema with co-exisiting herpes simplex infection
  • Cataracts
  • Erythemic eczema
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10
Q

Side effects of topical steroids

A

thinning of skins, bruising, tearing, stretch marks, enlarged blood vessels, systemic absorption

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11
Q

Features of acne rosacea

A
  • Typically red rash affects nose, cheeks and forehead often with inflammatory papules
  • Facial Flushing
  • Increased skin sensitivity and stinging sensations
  • Later develops into persistent erythema with papules and pustules and nodes without comedones
  • Telangiectasia
  • Rhinophyma
  • Facial oedema
  • Seborrheic dermatitis
  • Sunlight may exacerbate symptoms
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12
Q

Management of acne rosacea

A
  • Predominant erythema/flushing
    o Topical brimonidine gel PRN
  • Mild-mod papules +/- pustules
    o Topical ivermectin
    o Alternatives: topical metronidazole or topical azelaic acid
  • Mod-severe papules +/- pustules
    o Topical ivermectin + oral doxycycline
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13
Q

General advice for acne rosacea

A
  • Daily suncream
  • Camouflage creams to conceal redness
  • Gentle soap-free cleanser
  • Avoid oil based creams and topical steroids
  • Avoid factors that cause facial flushing  heat, wind, sudden changes in temp, alcohol, excessive exercise, hot baths, spicy foods, hot drinks
  • Cool packs
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14
Q

Management of extreme acne rosacea

A
  • Laser treatment for telangectasia
  • Surgical correction of rhinophyma
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15
Q

Referral criteria for acne rosacea

A
  • Symptoms not improved with optimal management in primary care
  • Patients with rhinophyma
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16
Q

Complications of acne rosacea

A
  • Blepharitis
  • Conjunctivitis
  • Rhinophyma = large bulbous nose
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17
Q

Associations for acne vulgaris

A
  • PCOS
  • Steroid use
  • Certain skincare products (heavy makeup)
  • Colonisation by Propionibacterium acnes
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18
Q

Features of acne vulgaris

A
  • Typically affects face, neck and upper trunk
  • Greasy skin
  • Comedones
    o Open comedomes  blackheads
    o Closed comedomes  whiteheads
  • Inflammation
  • Papules  Small, inflammatory usually raised red lesions
  • Pustules (more superficial)
  • Nodules = bigger papules
  • Cysts  Develop when further infection and inflammation due to P.acnes
  • Atrophic scars
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19
Q

Classification of acne vulgaris

A
  • Mild: open and closed comedones +/- sparse inflammatory lesions
  • Moderate: widespread non-inflammatory lesions and numerous papules and pustules
  • Severe: extensive inflammatory lesions, nodules, pitting and scarring
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20
Q

General advice for acne vulgaris

A

o Washing twice daily with soap and water
o Avoid use of oily products

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21
Q

Pharmacological management of acne vulgaris

A
  1. topical retinoids (adapeline), benzoyl peroxide
  2. combination therapy (topical Abx, retinoid, benzoyl peroxide)
  3. Oral Abx
    o Tetracyclines (lymecycline, doxycycline)
     Avoid in pregnancy or breastfeeding and children <12
    o Erythromycin or clindamycin  Used in pregnancy
    o Single Abx used for max 3m
    o Topical retinoid or benzyl peroxide always co-prescribed
  4. COCP alternative to oral Abx in women
  5. Oral isotretinoin under specialist supervision
    o Do not use in pregnancy
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22
Q

Referral criteria for acne vulgaris

A
  • Patients with acne congolbat
  • Patients with nodulo-cystic acne
  • Considered with
    o Mild to moderate acne that has not responded to two completed courses of treatment
    o Moderate to severe acne that has not responded to previous treatment that includes an oral antibiotic
    o Acne with scarring
    o Acne with persistent pigmentary changes
    o Acne is causing or contributing to persistent psychological distress or mental health
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23
Q

Complications of acne vulgaris

A
  • Depression, anxiety, social phobia
  • Scarring
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24
Q

Epidemiology of psoriasis

A
  • Peaks of incidence at 15-25 and 50-60
  • Caucasian
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25
Q

Precipitating factors for psoriasis

A
  • Trauma
  • Infection
  • Drugs  BB, lithium, anti-malarials, NSAIDs, ACEi, infliximab, withdrawal of systemic steroids
  • Emotional stress
  • Sunlight
  • Puberty
  • Menopause
  • Alcohol
  • Obesity
  • Smoking
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26
Q

Associated disorders for psoriasis

A
  • Psoriatic arthritis
  • IBD
  • Uveitis
  • Coeliac disease
  • Metabolic syndrome = T2DM, hypertension, hyperlipidaemia, gout, cardiovascular disease
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27
Q

Presentation of psoriasis

A
  • Symmetrical red scaly plaques (white/silvery coloured)
  • Extensor surfaces  front of knees, back of elbows
  • Itchy ± excoriation/lichenificiation
  • Pitting nails, onycholysis, subungual hyperkeratosis, BEAUs lines, loss of nail
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28
Q

Lifestyle management of psoriasis

A

smoking cessation
reduce alcohol
weight loss
avoid sun exposure
manage stress

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29
Q

Management of psoriasis

A
  • Regular emollients help reduce scale loss and reduce pruritus
    1. Potent corticosteroid + vitamin D analogue (calcipotriol)
    a. Applied separately, one in morning and one in evening
    b. Up to 4 wks as initial treatment
    2. if no improvement after 8 wks vitamin D analogue twice daily
    3. if no improvement after 8-12 wks
    o Potent corticosteroid applied twice daily for up to 4 wks
    o Or coal tar preparation applied once or twice daily
  • Short-acting dithranol
  • Scalp psoriasis
    o Potent topical corticosteroids used once daily for 4 weeks
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30
Q

Indications for referral to secondary care for psoriasis

A
  • > 10% of body surface area affects
  • Psoriasis not responding to topical treatment
  • Psoriasis in children
  • Psoriasis having major impact on psychological health
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31
Q

Secondary care management options for psoriasis

A

o Phototherapy
o Oral methotrexate
o Ciclosporin
o Systemic retinoids
o Biological agents

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32
Q

Complications of psoriasis

A
  • Depression, anxiety
  • Reduced rates of employment
  • Koebner phenomenon = skin lesions appear at site of injury
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33
Q

What is cellulitis

A

Bacterial infection that affects the dermis and deeper subcutaneous tissues

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34
Q

Causes of cellulitis

A
  • Streptococcus pyogenes
  • Staph. Aureus
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35
Q

Presentation of cellulitis

A
  • Unilateral erythematous rash and swelling
  • Usually on shins
  • Blisters and bullae with more severe disease
  • Fever
  • Malaise
  • Nausea
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36
Q

Classification of cellulitis

A

Eron
- I - No signs of systemic toxicity and no uncontrolled co-morbidities
- II – either systemically unwell or systemically well but with co-morbidity which may complicate or delay resolution of infection
- III - significant systemic upset (acute confusion, tachycardia, tachypnoea, hypotension) or unstable co-morbidities that may interfere with response to treatment, or a limb-threatening infection due to vascular compromise
- IV – sepsis syndrome or a severe life-threatening infection such as necrotising fasciitis

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37
Q

Admission criteria for cellulitis

A
  • Eron class III-IV
  • Severe or rapidly deterioriating cellulitis
  • Aged <1 year or frail
  • Immunocompromised
  • Significant lymphoedema
  • Facial cellulitis or periorbital cellulitis
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38
Q

Management of cellulitis

A
  • Eron class I – oral flucloxacillin (1st line)
  • Eron class II – IV/oral Abx
  • Eron class III-IV - admit and oral/IV co-amoxiclav or clindamycin or cefuroxime or ceftriaxone
  • Penicillin allergic = oral clarithromycin, erythromycin (pregnancy) or doxycycline
39
Q

Risk factors for skin cancer

A
  • Age
  • Sun bed use
  • Fair skin
  • Hx of sunburn
  • Hx of living overseas/places with lot of sun exposure
  • FHX
  • Outdoor occupations
  • Phototherapy
40
Q

Assessing a skin lesion

A
  • A = asymmetry
  • B = border irregularity
  • C = colour (multiple)
  • D = diameter >7mm
  • E = evolution/enlargement
41
Q

What is actinic keratoses

A

Common premalignant skin lesion that develops due to chronic sun exposure

42
Q

Presentation of actinic keratoses

A
  • Small, crusty or scaly lesions
  • Pink, red, brown or same colour as skin
43
Q

Management of actinic keratoses

A
  • Prevention  sun avoidance, sun cream
  • Fluorouracil cream 2-3 wks
  • Topical diclofenac
  • Topical imiquimod
  • Cryotherapy
  • Curettage and cautery
44
Q

Risk factors for squamous cell carcinoma

A
  • Smoking
  • Sun exposure
  • Actinic keratosis/solar keratoses
  • Age
  • Skin trauma
  • Exposure to carbon containing compounds
  • Asbestos
  • Arsenic
  • Ionising radiation
  • Metals
45
Q

Presentation of SCC

A
  • Solitary papule/nodule often eroded at centre or crusty, purulent or bleeding
  • Fleshy lesion
  • May resemble giant warts ± pain
  • Sun-exposed area
  • Hard, scaly, dome-like scturctures
  • Can bleed or itch
  • Lower lip if related to smoking
  • Bowen’s disease = SCC in situ
46
Q

Treatment of SCC

A
  • Definitive = surgical excision with minimum 2mm margin
  • Topical cream
    o 5-fluorouracil applied 1-2x daily for 4 weeks
  • Cryotherapy
  • Solar keratoses = topical agents or cryotherapy
47
Q

What is melanoma

A

Proliferation of atypical melanocytes with potential for dermal invasion and widespread metastases

48
Q

Epidemiology of melanoma

A
  • Women  common on lower legs
  • Men  common on back
  • Australia has highest incidence
49
Q

Risk factors for melanoma

A
  • Sun exposure (sunburn before age of 10)
  • Male gender
  • > 50 moles (benign naevi)
  • FHx or PMH of melanoma or other skin cancers
  • Fair complexion
  • Smoking
  • Age
  • Previous sunburn
50
Q

Types of melanoma

A
  • Lentigo maligna melanoma
    o Large, flat, dark lesion
    o Usually on face or other sunexposed areas in elderly patients
  • Superficial spreading melanoma
    o Most common on legs of women and torso/.back of men
    o Slightly raised plaque
  • Nodular melanoma
    o Often dark coloured but can be pearly or lack pigment
    o Grow rapidly but rarely metastasise
  • Acral and subungal melanoma
    o Most common in Black Africans
    o Palms or soles or subungal skin
51
Q

Metastatic spread of melanoma

A
  • Local lymph nodes
  • Satellite lesions
  • Skin
52
Q

Management of melanoma

A

Excision

53
Q

Follow up of melanoma

A

o <1mm thickness  6 monthly for 2 years
o 1-2mm thickness  4 monthly for 2 years, 6 monthly for 2 years, yearly for 10 years
o >2mm thickness  annual CXR and regular GP and specialist FU

54
Q

Presentation of Basal cell carcinoma

A
  • Pearly nodule with raised red edge
  • Maybe scaly
  • May be ulcerated
55
Q

Management of BCC

A
  • Surgical excision with 3mm margin
  • Imiquimod applied once daily, 5 days a week for up to 6 weeks
  • Cryotherapyd
56
Q

Risk factor for shingles

A
  • Immunocompromised
  • HIV, Hodgkin’s lymphoma and bone marrow transplants
57
Q

Cause of shingles

A

Reactivation of varicella zoster virus (chickenpox) usually within dorsal root ganglia

58
Q

Presentation of shingles

A
  • Pain and paraesthesia in dermatomal distribution priced rash for days
  • Malaise, myalgia, headache and fever
  • Rash = consists of papules and vesicles restricted to same dermatome
    o Crust formation and drying occurs over next week with resolution in 2-3 weeks
59
Q

Management of shingles

A
  • Oral antiviral therapy begun within 72 hrs of rash onset
    o Oral acyclovir x5 daily
    o Or oral valiciclovir/famciclovir x2 daily
  • Topical antibiotic treatment for secondary bacterial infection
  • Analgesia = ibuprofen
60
Q

Complications of shingles

A
  • Ophthalmic branch of trigeminal nerve damage
  • Post herpetic neuralgia = Pain lasting more than 4 months after developing shingles
61
Q

Causes of acanthosis nigricans

A
  • T2DM
  • Gastrointestinal cancer
  • Obesity
  • PCOS
  • Acromegaly
  • Cushing’s disease
  • Hypothyroidism
  • Familial
  • Prader-Willi syndrome
  • Drugs = COCP, nicotinic acid
62
Q

Presentation of scabies

A
  • Widespread pruritus
  • Linear burrows on side of fingers, interdigital webs and flexor aspects of wrists
  • Infants = face, scalp
  • Scratching  excoriation, infection
63
Q

Management of scabies

A
  1. permethrin 5%
  2. malathion 0.5%
64
Q

General advice for scabies

A
  • Pruritus persists 4-6 wks post eradication
  • Avoid close physical contact with others until treatment complete
  • All household and close physical contacts treated at same time even if asymptomatic
  • Launder, iron or tumble dry clothing, bedding, towels on first day of treatment
65
Q

Complications of scabies

A
  • Crusted scabies (suppressed immunity)
    o Tx = Ivermectin
    o Isolation
66
Q

Presentation of seborrheoic keratoses

A
  • Large variation in colour from flesh to light-brown to black
  • ‘Stuck on’ appearance
  • Keratotic plugs
67
Q

Management of seborrhoeic keratoses

A
  • Reassurance about benign nature of lesion is option
  • Removal  curettage, cryosurgery, shave biopsy
68
Q

What is seborrhoeic dermatitis

A

Chronic dermatitis thought to be caused by inflammatory reaction related to proliferation of normal skin inhabitant

69
Q

Cause of seborrhoeic dermatitis

A

Malassezia furfur (pityrosporum ovale)

70
Q

Associations of seborrhoeic dermatitis

A
  • HIV
  • Parkinson’s disease
71
Q

Presentation of seborrheoic dermatitis

A

Eczematous lesions on sebum-rich areas: scalp, periorbital, auricular, nasolabial folds

72
Q

Management of seborrhoeic dermatitis

A
  • Scalp
    o Ketoconazole 2% shampoo
    o OTC preparations containing zinc pyrithione and tar
    o Selenium sulphide and topical corticosteroid
  • Face and body
    o Topical antifungals  ketoconazole
    o Short course Topical steroids
73
Q

Complications of seborrhoeic dermatitis

A

Otitis externa
Blepharitis

74
Q

Causes of lichen planus

A
  • Drugs = gold, quinine, thiazides
75
Q

Presentation of lichen planus

A
  • Itchy, popular rash most common on palms, soles, genitalia and flexor surfaces of arms
  • Rash often polygonal in shape with white lines pattern on surface  Wickham’s striae
  • Koebner phenomenon
  • Oral involvement  white-lace pattern on buccal muosa
  • Nails  thinning of nail plate, longitudinal ridging
76
Q

Management of lichen planus

A
  • Potent topical steroids
  • Benzydamine mouthwash or spray
  • Oral steroids or immunosuppression
77
Q

What is erythema nodosum

A

Inflammation of subcutaneous fat

78
Q

Causes of erythema nodosum

A

pregnancy, strep infections, sarcoidosis, TB, IBD, drugs (penicillins, sulphonamides, oral contraceptive pill)

79
Q

Presentation of erythema nodosum

A

Symmetrical, erythematous, tender, nodules which heal without scarring

80
Q

Management of erythema nodosum

A

treat underlying cause, provide Sx relief with analgesia and rest

81
Q

Presentation of pretibial myxoedema

A

o Symmetrical, erythematous lesions seen in Graves
o Shiny, orange peel skin

82
Q

Presentation of pyoderma gangrenosum

A

o Initially Small red papule
o Later deep, red, necrotic ulcers with violaceous border

83
Q

Presentation of necrobiosis lipoidica diabeticorum

A

o Shiny, painless areas of yellow/red skin typically on shin of diabetics
o Telangiectasia

84
Q

What is erythema multiforme

A

Hypersensitivity reaction most commonly triggered by infections

85
Q

Causes of erythema multiforme

A
  • Viruses  HSV
  • Idiopathic
  • Bacteria  mycoplasmia, strep
  • Drugs  penicillin, sulphonamides, carbamazepine, allopurinol, NSAIDs, Oral contraceptive pill, nevirapine
  • Connective tissue disease (SLE)
  • Sarcoidosis
  • Malignancy
86
Q

Presentation of erythema multiforme

A
  • Target lesions
  • Initially seen on back of hands/feet before spreading to torso
  • Upper limbs > lower limbs
  • Pruritus
  • Sore throat followed by fever, myalgia and lethargy
  • Erythema multiforme major  mucosal involvement
87
Q

Causes of urticaria

A
  • Acute
    o Allergies to food, medications, animals
    o Contact with chemicals, latex or stinging nettles
    o Medications
    o Viral infections
    o Insect bites
    o Dermatographism (rubbing of skin)
  • Chronic
    o Chronic idiopathic urticaria  no clear underlying cause or trigger
    o Chronic inducible urticaria
     Sunlight
     Temperature
     Exercise
     Strong emotions
     Hot/cold weather
     Pressure
    o Autoimmune urticaria  Systemic lupus erythematosus
88
Q

Management of urticaria

A
  • Antihistamines (fexofenadine)
  • Short course oral steroids for severe flares
  • Specialist treatment
    o Anti-leukotrienes (montelukast)
    o Omalizumab
    o Cyclosporin
89
Q

Causes of nectrotising fasciitis

A
  • Type 1 = mixed anaerobes and aerobes
  • Type 2 = streptococcus pyogenes
90
Q

Risk factors for necrotising fasciitis

A
  • Recent trauma, burns or soft tissue infections
  • Diabetes mellitus
    o Esp if taking SGLT-2 inhibitors
  • IVDU
  • Immunosuppression
91
Q

Most common site of nectrotising fasciitis

A

perineum (Fournier’s gangrene)

92
Q

Presentation of nectrotising fasciitis

A
  • Acute onset
  • Pain, swelling, erythema at affected site
    o Rapidly worsening cellulitis with pain out of keeping with physical features
    o Extremely tender over infect tissue with hypoaethesia to light touch
  • Late signs
    o Skin necrosis
    o Crepitus/gas gangrene
    o Fever
    o Tachycardia
93
Q

Management of necrotising fasciitis

A
  • Urgent surgical referral for debridement
  • IV Abx

Finals (23 decks)

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