Dermatology Flashcards
(147 cards)
1
Q
how does female pattern hair loss present?
A
diffuse reduction in the density of the hair over the crown and frontal scalp, and widening pf the central parting, with retention of the frontal hair line
2
Q
how common is female pattern hair loss?
A
over 10% of premenopausal women have some evidence of hair loss, and it affects up to 56% of woman up to the age of 70 years old
3
Q
what are the four phases of the hair growth cycle?
A
Anogen
Catagen
Telogen
Anogen restart/ exogen phase
4
Q
What happens in the anagen hair growth phase?
A
most active phase of the cycle, hair grows around 1-2cm per year
hair follicles are actively producing new hair cells - called keratinocytes
lasts 3-6 years
5
Q
what happens in the catagen hair growth phase?
A
transitional phase - hair growth slows and reduces by around 50%, and may even stop, lasting 2-4 weeks
6
Q
what happens in the telogen hair growth phase?
A
hair growth stops completely but the hair remains in situ, this lasts 3-6 months. At the end of this phase, the hair falls out, and new hair replaces it.
7
Q
what happens during the exogen phase of the hair cycle?
A
hair strands are released from their hair follicles - known as shedding
this can last 2-5 months
around 50 - 100 hairs fall out during this time - this is normal
8
Q
how can the differentials for hair loss in women be characterised?
A
non-scarring alopecia
scarring alopecia
other causes
9
Q
what are some non-scarring alopecia differentials for hair loss in women?
A
alopecia areata
telogen effluvium
traction alopecia
trichotilomania
syphillis
10
Q
what are some scarring alopecia differentials for hair loss in women?
A
frontal firbosing alopecia
tinea capitis
discoid lupus erythematous
lichen planopilaris
dermatomyositis
11
Q
what are some other causes of hair loss in women?
A
endocrine - hypothyroidism, PCOS, hyperprolactinaemia
iron deficiency anaemia
vit D deficiency
poor nutritional status
medications
12
Q
what is alopecia areata?
A
Alopecia areata is a presumed chronic, autoimmune condition causing localised, well demarcated patches of hair loss. At the edge of the hair loss, there may be small, broken ‘exclamation mark’ hairs.
This is where there is hair loss, but the follicles of the hair themselves are usually preserved.
13
Q
which areas are most commonly affected in alopecia areata?
A
any hair-bearing skin - most commonly the scalp, beard, and less frequently the eyebrows and eyelashes
14
Q
what is the pathophysiology of alopecia areata?
A
the hair follows are prematurely converted from the anagen (active growth phase) to the telogen phase (hair loss phase). The exact cause for this is unknown, however is thought to be autoimmune.
15
Q
what is the prognosis of alopecia areata?
A
spontaneous remission within 1 year is seen in up to half of affected people
but most people do experience repeated episodes after remission
16
Q
management options for alopecia areata in GP?
A
if there is evidence of hair re-growth then no treatment is needed
if no hair regrowth, then consider trial of topical corticosteroid such as betamethasone validate 0.1%, or a vert potent corticosteroid such as clobetasol propionate 0.05% - for 3 months total.
offer referral to dermatology - if diagnosis is uncertain, if child, pregnant or breastfeeding, if hair loss not responding to treatment, if corticosteroids contraindicated or pt declines but still wishes for medical management
17
Q
what are the management options for alopecia areata in dermatology?
A
intralesional corticosteroids
oral corticosteroids
topical immunotherapy
topical minoxidil
biological agents/immunosurpressive drugs
18
Q
what is telogen effluvium?
A
common condition characterised by excessive shedding of telogen hair - usually occurs around 3 months after a triggering event and is self-limiting lasting around 6 months
19
Q
what are some triggers for telogen effluvium?
A
childbirth
severe infection
excessive diets
major surgery
drug treatment i.e. chemotherapy, antidepressants, anticoagulants
20
Q
what is traction alopecia?
A
type of hair loss caused by constant pulling of hair in high tension hairstyles
21
Q
what is trichotilomania?
A
a psychiatric condition in which people pull their hair out. It may be associated with obsessive-compulsive disorder and is more common in women than in men.
22
Q
what is frontal fibrosing alopecia?
A
hair loss specifically around the frontal region of the scalp, caused by inflammation which destroys the hair follicle replacing it with permanent scarring.
23
Q
who is usually affected by frontal fibrosing alopecia?
A
post-menopausal women
24
Q
what condition if frontal fibrosing alopecia associated with?
A
lichen planopilaris
25
what is the management of frontal fibrosing alopecia?
there is not cure however topical treatments such as oral steroids, intralesional steroidsd injections and anti-inflammatory antibiotics such as tetracyclines can be trialled.
26
what is tinea capitis?
fungal infection of the scalp - ringworm of the scalp
27
what causes tinea capitis?
tinea capitis is caused by dermatophytic fungi capable of invading keratinised tissue, such as the hair and nails. While over 40 different species of dermatophytes are known to exist, only a small number are associated with tinea capitis
28
is tinea capitis contagious?
yes - advised to inform the school, and other family members to also present for examination / consideration of treatment if needed.
Children should be allowed to attend school or nursery once treatment with an oral antifungal medication and a medicated shampoo has been started
29
management of tinea capitis?
4 month course of oral anti fungal agents such as terbinafine, irtaconazole and fluconazole - in adults
Griseofulvin - in paediatrics
30
how does tinea capitis present?
areas of scaling, grey patches with hair loss in the scalp
31
what is discoid lupus erythematous?
chronic condition characterised by persistent scaly plaques on the scalp, face, and ears which subsequently can progress to scarring, atrophy, dyspigmentation, and permanent hair loss in affected hair-bearing areas.
32
what is lichen planopilaris?
disease associated with lichen plants, which affects the hair follicles. It results in patchy, progressive permanent hair loss mainly on the scalp.
33
what does lichen planopilaris look like?
smooth white patches of scalp loss. No hair follicles can be seen in this area, and scaling can surround each hair follicle at the edges of these patches.
34
what is the management of lichen planopilaris?
corticosteroids - oral, topical, intralesional
topical tacrolimus
topical monoxidil
tetracylcine i.e doxycycline
35
what investigations should be carried out for female pattern hair loss?
thyroid function test
FBC
vitamin D
ferritin
If there are any features of androgen excess - (i.e. excessive facial hair or body hair, severe acne) -> can order free androgen index ( on day 2-5 of cycle, 2 months off of COCP), and prolactin level
36
Management of female pattern hair loss?
Consider minoxidil 2% topical solution - OTC - explain that the onset and degree of hair loss in unpredictable
Trial of this for 6 months, if no response then consider referring to dermatologist
37
what is the male pattern hair loss (or androgenetic alopecia)?
genetically determined, patterned, progressive hair loss from the scalp - usually involving the front and sides of the scalp initially, then progresses towards the back of the head
38
what is the cause of male pattern hair loss?
dihydrotestosterone (a testosterone metabolite) - binds to the andorgen receptor and activates genes responsible for the shortening of the anagen (hair growth) phase. This gradually transforms the hair from large terminal hair follicles to miniaturised follicles.
39
differentials for male pattern hair loss?
telogen effluvium
alopecia areata
syphillis
traction alopecia
trichotillomania
tinea wapitis
discoid lupus erythematous
dermatomyositis
endocrine - hypothyroidism
iron deficiency anaemia
vit D deficiency
medications
40
Investigations for male pattern hair loss?
usually no bloods needed however if suspected deficiency can order -
FBC, TFT, ferritin and vit D
41
Management of male pattern hair loss?
if the man prefers drug treatment -
- minoxidil 5% solution or foam
- finasteride 1mg tablets
these are not available on the NHS, but can be accessed through private prescriptions
42
how does finasteride work for hair loss?
inhibits the expression of the enzyme 5-alpha reductase which regulates the production of dihydrotestosterone. This lowers the levels of DHT, which reduces its harmful effect on hair follicles.
43
how does minoxidil work for hair loss?
Minoxidil solution dilates small blood vessels.
When applied to the affected areas of the scalp twice daily it has been shown to stimulate hair regrowth probably by enhancing cell proliferation.
44
how can acne be characterized?
mild acne - predominantly non-inflamed lesions (open and closed comedomes) with few inflammatory lesions
moderate - more widespread with an increased number of inflammatory papules and pustules
severe acne - widespread inflammatory papules, pustules and nodules or cysts. Scarring can be present.
45
what are some generic/lifestyle advice to be given to patients presenting with acne?
avoid over washing - acne is not caused by poor hygiene
use skin pH neutral cleanser twice daily
avoid oil based comedogenic skin care products, make up, sunscreens
avoid picking/squeezing spots for risk of scarring
46
management of people with mild-moderate acne?
12 week course of one of the following:
A fixed combination of topical adapalene with topical benzoyl peroxide (0.1% or 0.3% adapalene with 2.5% benzoyl peroxide).
A fixed combination of topical tretinoin with topical clindamycin (0.025% tretinoin with 1% clindamycin).
A fixed combination of topical benzoyl peroxide with topical clindamycin (3% or 5% benzoyl peroxide with 1% clindamycin).
47
management of people with moderate-severe acne?
12 week course of either:
A fixed combination of topical adapalene with topical benzoyl peroxide to be applied once daily in the evening.
A fixed combination of topical tretinoin with topical clindamycin to be applied once daily in the evening.
A fixed combination of topical adapalene with topical benzoyl peroxide to be applied once daily in the evening, together with either oral lymecycline 408 mg or oral doxycycline 100 mg once daily.
Topical azelaic acid (15% or 20%) applied twice daily, with either oral lymecycline 408 mg or oral doxycycline 100 mg once daily.
48
criteria for referring to dermatologist for acne?
urgent refer same day if acne fulminans
if there is diagnostic uncertainty
if nodulo-cystic acne
if mild to moderate acne completed 2 course of treatment with no response
if moderate to severe has not responded to previous treatment including antibiotic.
acne with scarring.
acne with persistent pigmentary changes.
49
how should patients with acne be followed up?
review in 12 weeks to assess whether improved with treatment
if completely cleared - can stop oral abx, and consider continuing topical tx
if partially cleared - can consider continuing the abx and topical tx for further 12 weeks.
50
how should patients with relapse in acne be managed?
if acne responded well to first line tx - can consider another 12 week course of same treatment, or alternative 12 week regimen.
51
if a patient has been treated with oral isotretinoin previously, and now has a recurrence of their acne which is mild-moderate, what should be done?
consider appropriate treatment option - i.e. topical and oral abx combination.
52
if the patient has been treated with oral isotretinoin previously and now has a recurrence of their acne which is moderate-severe, what should be done?
consider referring back to dermatology or appropriate treatment option i.e. topical and oral abx.
53
which oral contraceptives have been suggested as possibly improving acne?
Yasmin
Lucette
54
what is rosacea?
chronic, inflammatory skin condition which usually affects the face. The exact cause is unknown, although it is believed to be due to chronic vasodilation.
55
what are some aggrevating factors for rosacea?
anything that predisposes to flushing e.g. sunlight, caffeine, alcohol, spicy food
medications that can cause rosacea
topical steroids
56
what does rosacea present as?
erythema - initially intermittent, but can become more permanent
Telangiectasia
pustules and papules
absence of open comedomes (blackheads) - how you can differentiate from acne
thickening of the skin as it becomes more chronic
57
how can rosacea affect the eyes?
can cause gritty eyes, conjunctivitis, blepharitis, episcleritis, and chalazion
58
what is the normal pattern of rosacea if left without treatment?
the condition usually persists for 2-3 years, then regresses with scarring
59
what are some general measures for managing rosacea?
minimise aggrevating factors - reduce tea and coffee, alcohol, spicy foods, excessive heat, direct sunshine, topical steroids
Emollients are generally helpful and soothing
60
what are the first line treatments for rosacea?
topical treatment - Soolantra (ivermectin 10mg/g) cream OD for three months
second line: Finacea (azealic acid 15%) BD
Rosex (metronidazole 0.75% gel BD)
Brimonidine gel - for patients with predominant flushing but limited telangiectasia
61
what are the second line treatments for rosacea?
Systemic treatments
Use if topical agents fail or if presenting symptoms more severe
First-line: the tetracycline's (contraindicated in pregnancy). Consider doxycycline 40mg OD as the smaller dose reduces the risk of antibiotic resistance. Other options include lymecycline 408 mg OD and doxycycline 100 mg OD. Unlike oxytetracycline, these drugs can be taken with (or without) food
Second-line: clarithromycin or erythromycin 250-500 mg BD
A standard course is three months, although sometimes a shorter course will suffice
62
what causes recurrent itchy, chronic, recurrent, often symmetric eruption on the palms of hands, fingers, and soles of the feet?
pompholyx dermatitis
63
what could be the cause of bloody/recurrent diarrhoea and eczema skin changes in a new born?
could be CMPA
consider alternative formula/referral to dermatology
64
how can you manage severe itching in eczema?
consider trial of oral non-sedating antihistamine
65
examples of moderate potnecy steroids?
betamethasone valerate 0.025%
clobetasone butyrate 0.05%
66
examples of potent cotent steroids?
betamethasone valerate 0.1%
mometasone furoate 0.1%
betamethasone dipropionate 0.05%
hydrocortisone butyrate 0.1%
67
what are some examples of very potent steroids?
clobetasol proprionate 0.05%
diflucortolone vlaerate 0.3%
68
hat are the different types of psoriasis?
guttate
chronic plaque
flexure psoriasis
scalp
nail - pitting , onycholysis - associated with inflammatory arthritis
erythrodermic psoriasis
69
management of guttate psoriasis?
usually self-limiting after a few months
use of regular emollients
usually does not need referral unless severe
70
what is erythrodermic psoriasis?
rare
can result in systemic illness
may or may not preceed another form of psoriasis
results in generalised scaly skin across the body
71
how do you manage psoriasis generally?
regular emollient use
corticosteroids - potent or very potent
vitamin D analogue - calcipotriol (usually prescribe calcipitriol + corticosteroid combined treatment for 4-8 weeks, followed by singular calcipitriol use)
coal tar shampoo
salicylic acid
72
criteria for referral to dermatology for psoriasis?
moderate - severe psoriasis resistant to topical tx
nail disease is severe
having functional or cosmetic impact
significnat impact on psychological or social wellbeing
73
what treatments are offered for psoriasis in secondary care?
topical clacineurin
systemic or biologic therapy
light therapy
74
features of viral rash in paediatrics?
erythematous rash associated with systemic symptoms, fever, malaise, headache
non -specific exanthem
75
when is chicken pox contagious for?
contagious from day 1-2 until all blisters have scabbed over
76
symptoms of measles?
fever, malaise, anorexia, conjunctivitis of the eyes, cough, coryza and koplik spots in mouth
rash that starts on the cheeks and spreads to trunk and limbs
77
how long is measles contagious for?
2 days before and 5 days after onset of the rash
78
what cuases slapped cheek disease
parvovirus b19
79
symptoms of slapped cheek?
red cheeks bilaterally
viral symptomsa
80
what is the main risk of slapped cheek?
high risk for congenital infection in the first or second trimester which can result in foetal hydrops, anaemia and intrauterin death
encourage patients to notify school in order to protect pregnant ladies!!
81
symptoms of hand/foot/mouth disease?
typical small flat blisters hands, feet, around mouth
occasionally on buttocks
can be painful mouth ulcers
spares the torso
82
management of hand foot and mouth disease?
supportive
83
which rash starts with a herald atch 1-2 weeks prior to the generalised rash mainly on trunk?
pityriasis rosea
84
what causes pityriasis rosea?
herpes virus 6 and 7
85
management of pitryiasis rosea?
takes several weeks to settle
non-contagious
reassurance
86
gianotti costi syndrome?
papular rash in 6 months to 12 years
causes by viruses
usually just needs reassurance, occasionally emollients
87
what is molluscum contagiosum?
multiple soft umbilicated papules
can last up to 18 months
childhood viral rash
88
how to manage molloscum?
usually no treatment needed - self-limiting
evidence is that treatment can actually increase risk of scarring
can treat lesions if they become infected with antibiotics
89
symptoms of scarlet fever?
sandpaper rash - comes after 12-48 hours
strawberry tongue
high fever, malaise, sore throat, vomiting, headache
90
treatment of scarlet fever?
pen V
avoid school for 48 hours after starting antibiotics
91
what causes pustules and honey coloured crusted erosions around the mouth?
impetigo
92
how to treat impetigo?
oral flucloxacillin course
93
advice regarding school for impetigo?
avoid school for 48 hours after starting abx
94
how to treat nappy rash?
topical clotrimazole
95
what fungal infection causes pityriasis versicolor?
malassezia fungus
96
management of pityriasis versicolor?
hypopigmented skin - usually treated with antifungal shampoo (ketoconazole)
97
Examples of dermatophyte fungal infections?
tinea pedis
tinea barbae
tinea capitis
fungal nail infection
98
management of fungal nail?
amorolofine nail laquer - need to apply 2-3 times per week for 6 month course
if that fails - confirm nail mycology by sending nail clippings
start oral antifungal - LFT's to be done prior and after 6 weeks of taking medications
Terbanafine 250mg OD for 6-8 months
99
what is a pyogenic granuloma?
acquired proliferation of capillary blood vessels - rapid growth in 1- 2 weeks
100
management of pyogenic granuloma?
imiquimod cream trial
cryoptherapy
surgical excision
if any uncertainty around the diagnosis - 2ww ref
101
what are the three types of skin Ca?
BCC
SCC
melanoma
102
types of BCC?
nodular - non-healing, rolled edges, gradually increasing in size
superficial - growing, not healing
morphoeic
103
risk factors for SCC?
age
actinic keratosis
outdoor occupation
smoking
organ transplant recipients
104
SCC features?
growing in size
non-healing
keratinized, hard
non-healing ulcers
105
risk factors for melanoma?
age
px hx of melanoma
other types of skin Ca
many melanocytic naevi
strong FHx
white fair skin
parkinsons
UV exposure
hx of sunburn
weakened immune sx
cancer-prone syndromes
106
types of melanoma?
superficial spreading
nodular
melanoma of nail unit
amelanocytic
107
how do you treat actinic keratoses in a small area?
5-fluorouracil (Efudix) cream
Imiquod (aldara cream)
108
how do you treat actinic keratosis in a large area?
3% diclofenac gel (solaraze)
Use twice a day for 8-12 weeks. Review patient four weeks after treatment has finished to assess response
Zyclara ® cream (3.75% imiquimod cream)
Apply once daily for two weeks, followed by a two week treatment-free period, and then a further once daily application for two weeks (ie six weeks in total, but only four weeks of treatment)
109
what is epysipelas?
a rapidly spreading, usually Streptococcal, infection of the skin and subcutaneous tissue of the face characterised by cellulitis and lymphangitis. Patients are often unwell at the time with fever.
110
how do you treat eysipelas?
treat with co-amoxiclav first line (clari with metronidazole is a second line option) - if deteriorating despite abx in 2-3, then consider admission
111
what is tinea cruris?
fungal infection of the skin commonly affecting men and in the groin
presents with large erythematous lesions with a fine scale and annular border. The erythema and scale tends to be most pronounced at the leading edge of the rash.
112
how do you treat tinea cruris?
topicla fungal cream such as clotrimazole or miconazole for 1-2 weeks until completely disappeared
oral terbinafine - if resistant
113
what is eczema herpeticum?
serious complication of eczema - disseminated viral infection with the herpes virus leading to widespread blisters and punched out erosions
114
what are the signs of eczema herpeticum?
Areas of rapidly worsening painful eczema
Clustered blisters
Punched out erosions
Fever, lethargy or distress
115
management of eczema herpeticum?
hospital admission - dermatological emergency , needs antiviral and antibiotic cover
116
what are dermatofibromas?
common, benign skin neoplasms composed of collagen, macrophages, capillaries and fibroblasts. they are firm bumps that feel like small rubbery buttons lying just beneath the surface of the skin.
117
what is the pinch test for dermatofibroma?
pinch the lesion - if dimpling occurs over the skin indicates likely a dermatofibroma
118
what is the management of a dermatofibroma?
reassurance
if surgically excised, often times a scar can form that resembles the original lesion
119
what are the clinical signs and symptoms of HSP?
Rash (all) – symmetrical red patches within which areas of haemorrhage and palpable purpura particularly affecting extensor surfaces (knees, elbows and buttocks); the rash typically lasts 2–3 months before subsiding
Joint involvement (75%) – arthritis/arthralgia
Gastrointestinal (GI) symptoms (65%) – diffuse abdominal pain and/or GI bleeding
Kidney disease (50%) – haematuria, proteinuria and/or impaired renal function
120
what is HSP?
small vessel vasculitis - cause unknown , but up to a third have had preceeding group A strep infection
121
name the steroid creams from least potent to most potent?
Hydrocortisone 0.1–2.5% is mildly potent
Clobetasone butyrate (Eumovate®) is moderately potent
Betamethasone valerate 0.1% (Betnovate®) is potent
Clobetasolproprionate 0.05% (Dermovate®) is very potent
122
what is the lesion - initially started as flat red papule, then grew rapidly over the space of 2 weeks to become a crater centrally filled with keratin or volcano?
keratoacanthoma
123
what is a keratoacanthoma?
benign epithelial tumour - more common with advancing age and rare in young people
124
what is often the underlying cause if patients have tried athletes food treatments recurrently with no improvement in symptoms?
pitted keratolysis - bacterial skin infection associated with hyperhidrosis and malodour
treated with fusidic acid
125
what can often trigger guttate psoriasis?
strep sore throat
smoking
beta blockers
126
what are the four stages of a pressure ulcer?
The stages of pressure ulcers are:
Stage 1: Non-blanchable redness of intact skin
Stage 2: Partial thickness skin loss or blister
Stage 3: Full thickness skin loss (fat visible)
Stage 4: Full thickness tissue loss (muscle or bone visible)
127
what is asteatotic eczema?
pruritis of the elderly - very dry skin in the elderly due to loss of the free fatty acis in the stratum corneum
128
what is second line treatment of chronic urticaria
consider LRTA antagonist + antihistamine
129
what is eczema craquele?
type of dermatitis that forms due to extremely dry skin that has cracked appearance
130
what are 4 systemic causes of eczema craquele?
Underactive thyroid
Malnutrition
Severe weight loss
Lymphoma
131
what commonly causes rash underneath the breasts?
intertrigo - fungal infection also due to friction
132
how is intertrigo treated?
anti-fungal with hydrocortisone cream
if treatment fails - take skin swab to guide further treatment
133
what skin condition is associated with coeliac?
dermatits herpetifromis
134
what 2 skin conditions are associated with coeliac and crohns disease?
erythema nodosum
pyoderma gangrenosum
135
what skin condition is associated with pancreatic cancer?
thrombophlebitis migrans
136
what is the management of flexural psoriasis?
mild or moderate potency corticosteroid once or twice daily for 2 weeks
137
what condition causes the presence of intensely puritic urticarial plaques that progress to form tense vesicles in third trimester of pregnancy?
pemphigoid gestationis
138
what condition causes urticarial papules and plaques that spare the preiumbilical region in pregnancy?
polymorphic eruption of pregnancy
139
what are three associations of spider naevi?
liver disease
COCP
pregnancy
140
which burns must be referred into secondary care?
all deep dermal and full-thickness burns
superficial dermal burns of more than 3% TBSA in adults, or more than 2% TBSA in children
superficial dermal burns involving the face, hands, feet, perineum, genitalia, or any flexure, or circumferential burns of the limbs, torso, or neck
any inhalation injury
any electrical or chemical burn injury
suspicion of non-accidental injury
141
what causes seborrhoeic dermatitis?
overgrowth of malassezia furfur which is naturally found within the scalp
142
where is venous ulceration typically seen ?
above the medial malleolus
143
what is the first line investigation for a non healing venous ulcer?
ABPI - need to assess for poor artieral flow which could impair healing
144
what is a normal ABPI?
0.9-1.2
145
what is the management of venous ulceration?
compression bandaging
146
what organism causes tinea capitis?
trichphyton tonsurans
147
