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Dermatology Flashcards

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1
Q

Ulcer

Causes

A

Vascular (chronic venous insufficiency, arterial, mixed, vasculitis)

Mechanical (pressure, friction, shear, trauma)

Neuropathic Surgical, malignancy, infection

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2
Q

Chronic Venous Incompetence

Signs

A

Oedema Staining

Lipodermatosclerosis

Lower 1/3 of the leg

Painless

Irregular shape

Exudate

Inverted champagne bottle legs

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3
Q

Arterial ulcers

Clinical Presentation

A

Claudication, rest pain

Lower ABI

Weak/absent pulses

Sluggish capillary refill

Regular, punched out appearance

Below ankles to toes

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4
Q

Chronic Venous Incompetence

Treatment

A

Graduated compression bandages

Address factors that delay wound healing - nutrition, smoking, exercise, prolonged standing

Surgery

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5
Q

Arterial ulcers

Management

A

Improve blood flow through angioplasty, stenting, by-pass grafting

Often requires amputation

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6
Q

Neuropathic ulcers

A

Painless

Bony prominence or area of pressure

Good blood supply for healing

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7
Q

Ischaemic ulcers

A

Painful

Not essentially on pressure areas

Poor blood supply will negatively affect healing

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8
Q

Burns dressings

A

Hydrogels

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9
Q

Hydrocolloid dressings

A

Contraindicated on foot ulcers in patients with diabetes or PAD

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10
Q

Red scaly rashes DDx

A

FLAWED PINS

Fungal

LP

Acne

Warts

Eczema

Drug reactions

Psoriasis, P. Rosea

Infections

Neoplasia

Seborrhoea keratoses, solar keratoses, seborrhoeic dermatitis

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11
Q

Non-itchy rash DDx

A

Neoplasia

Erythema Multiforme (target lesions - drug reaction)

Pityriasis lichenoides chronica (hypersensitivity reaction to EBV or parvovirus)

Sarcoid

Acne

Impetigo (school sores - Staph/Strep)

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12
Q

Itchy rash (5/10) DDx

A

Acute - P. Rosea, Lupus

Chronic fluctuating - psoriasis, tinea, subaceous dermatitis

Chronic persistent - mycosis fungoides

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13
Q

Itchy rash (10/10) DDx

A

Eczema

Dermatitis Herpetiformis

Lichen Planus (autoimmune)

Scabies

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14
Q

Eczema

A

Vague border

Erythematous base

Puffy surface, scale, wet crusts, erosions, exudative lesions

Vesicles, papules

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15
Q

Contact dermatitis

A

Eczema

Irritant contact dermatitis

Allergic contact dermatitis

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16
Q

Scabies

A

Burrows - grey, C/S shaped, black dot at one end

Papules - scattered, red, small, monomorphous

Vesicles - infants, palmar, plantar, occular

Nodules - penile, buttocks, scrotum, axillae

Poor symmetry

Site - below chin line in adults, penis, nipple

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17
Q

Actinic keratoses

A

Hyperkeratotic adherent scale

Skin coloured, erythematous, brown

Rough

Distributed around maximally sun exposed sites

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18
Q

Bowen’s disease

A

Skin cancer

Evenly coloured, well demarcated, adherent scale

Distributed around sun exposed sites

Asymettrical

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19
Q

BCC

A

Skin cancer

Risk factors - fair skin, sunlight exposure, age >40, previous BCC

Common sites - head and neck, trunk, limbs

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20
Q
A

Scabies

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21
Q

Keratoacanthoma

A

Risk factors - male, >50yo, sun exposure, fair skin

Signs - rapid evolution nodule, central keratotic plug, firm fleshy, skin coloured or red, may resolve spontaenously

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22
Q

SCC Signs

A

Crusty, scaling, tender nodule

Inflamed, may bleed

Grows over weeks to months

Poorly defined

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23
Q

SCC Sites

A

Head and neck

Limbs

Trunk

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24
Q

Ephelides

A

Freckles

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25
Solar lentigines
Hypermelanosis (incraesed melanocytes) Fair skin, \>60yo Induced by UVR, phototherapy Surface scaling usually absent. Usually multiple. Reticulated pigment under dermatoscope
26
Seborrhoeic keratoses
Stuck on appearance Lusterless
27
Dermatofibroma
Common benign fibrous skin lesion May arise at site of minor trauma such as insect bite Often on arms and legs. Firm, asymptomatic and persistent May be pink, yellow-brown or dark. "Button hole" sign if it is squeezed forming a dimple
28
Melanoma Risk factors
UVL Skin phenotype Family history History of non-melanoma skin cancer Melanocytic naevi (1/3 associated) Previous melanoma
29
Melanoma Subtypes
Superficial spreading (70%) Nodular (15%) Acral lentiginous (10%) Lentigo MM (5%) Desmoplastic
30
Melanoma Clinical features
ABCDE Asymmetry Border irregularity Colour variegation Diameter \>6mm Enlargement over months
31
Atopic eczema
Mutations of the filaggrin gene. Leads to dry skin caused by a decrease of fatty acids in the epidermis Associated with asthma and hayfever, more common in Melbourne and winter (with heaters) Family history of atopic eczema Allergens only responsible in 10% - food in infants, house dust mite/pet fur in children/adults. Most childhood cases improve with age but will always have "sensitive skin". Advise against nursing, hair-dressing, mechanic
32
Eczema Appearance
Red, dry, scaly, itchy "Water colours" Can blister, be lichenified, weep or be infected/crusted
33
Atopic Eczema Clinical Features
Infant - face Childhood/adulthood - flexural (cubital/popliteal fossa), neck, wrists, ankles, eyelids, nipples, hands
34
Infected Eczema Organisms
Staphylococcus aureus (most common) Herpes simplex virus
35
Seborrhoeic Dermatitis
Type of eczema "Butterfly rash" - scalp, top of eyebrows, top of nose and chest Malassezia species involved
36
Pompholyx Eczema
Vesicles affecting the hands and feet
37
Discoid Eczema
Circular Children or adults Unknown cause
38
Varicose Eczema
Chronic venous insufficiency Lipodermatosclerosis (tethered and hardened skin)
39
Asteototic Eczema
Elderly Lower legs "Crazy paving" appearance
40
Lichen Simplex
Eczema due to simply scratching Often occurs at the side of the neck or side of the knees
41
Irritant contact dermatitis Common causes
Water Detergents and soap Solvents and abrasives Oils Acids and alkalis
42
Allergic Contact Dermatitis
Type IV immunological response Due to allergen contacting the skin
43
Eczema General Treatment
Avoid dryness - no long hot showers, no soap (use moisturisers/bath oil) Avoid overheating - clothing, bedding Avoid irritation - clothing (remove labels, avoid wool) Moisturisers +++ Topical steroids (ointments are preferred) Treat infection (soak off crusts, oral antibiotics, steroid cream) Wet dressings (applied over steroid ointment, removed when dry)
44
Psoriasis
Chronic inflammatory disease - 2-3x increased risk of CVD 10% psoriatic arthritis Family history Peak incidence in early adulthood Occurs due to a rapid turnover in keratinocytes, resulting in a thick scale
45
Psoriasis Clinical Presentation
Usually not itchy Improves with sunlight "Oil colours" Silvery scale on salmon pink plaques Extensor surfaces - elbows, knees Lower back/buttocks Scalp Affects nails Tends to spare face Koebner phenomenon - if you scratch normal skill, psoriasis develops in that area
46
Flexural psoriasis
Psoriasis in the flexor regions No scaliness Still has a deep "oil colour" colour
47
Nail psoriasis
Thickening of the nail Onycholysis (lifting up of the distal end of the nail bed) Pitting
48
Pustular psoriasis
Pustules and brown macules Usually on the hands/feet Often without plaques May be painful or burning
49
Guttate psoriasis
"Rain drops" with uniform scaling Acute onset Triggered by Strep. throat infection Younger patients
50
Psoriasis Treatment
Moisturisers +++ Potent topical steroids (short term, intermittent use to avoid rebound psoriasis aka tachyphylaxis) Topical calcipotriol (vit D) long-term Topical tar/dithranol/salicyclic acid Phototherapy (artificial UVB light or natural sunlight) Oral methotrexate Oral acitretin (vit A derivative) Oral cyclosporin Biological (TNF-alpha blockers)
51
Acne Causative factors
Androgen mediated increase in sebum Hyperproliferation of keratinocytes in the intrafollicular duct leading to comedones Overgrowth of Priopionibacterium acnes Inflammation
52
Acne Treatment - Simple Measures
Wash face 1-2 times day Don't squeeze spots Avoid excess makeup, removing before bed Wash hair regularly
53
Mild comedonal acne Treatment
Topical retinoid
54
Mild papulo-pustular acne Treatment
Topical retinoid with benzoyl peroxide OR Topical antibiotic with benzyol peroxide
55
Severe nodulo-cystic acne
Oral isotretinoin (dermatologist only) for 6-8 months
56
Rosacea Exacerbating factors
Heat Sunlight Alcohol Spicy foods
57
Rosacea Clinical Presentation
Ace of clubs sign Erythema Flushing Telangectasiae Papules and pustules (no comedones) Rhinophima (swelling on the tip of the nose)
58
Rosacea Treatment
Avoid exacerbating factors Sun protection Metronidazole gel - papules Antibiotics (as per acne) - papules and erythema, preventing rhinophima Laser
59
POD (Perioral/periorofacial dermatitis)
Variant of rosacea - erythema and papules Occurs around the mouth, base of the nose and eyelids
60
POD Treatment
Stop topical steroids (will get an initial flare due to steroid withdrawal) Antibiotics (as per acne)
61
Cradle cap
Seborrheaic dermatitis Soften scales with olive oil WIll drop off
62
Vitiligo
Sharply demarkated loss of pigment Autoimmune B12 deficiency, thyroid dysfunction, diabetes UVB can be used but not very effective
63
Melazma
Hyperpigmentation of the face Due to pregnancy or OCP
64
Lichenplanus
Cobble stoned yet smooth appearance of plaques, slightly elevated red skin Idiopathic inflammatory 70% resolve spontaneously over 12 months
65
Erythema nodosum
Think of underlying sarcoid, strep, drugs, malignancy, pregnancy, others Often idiopathic
66
School sores
Impetigo Caused by staph/strep infection Occur on the side of mouth or upper thighs Tx - fluclox
67
Pityriasis Rosacea
X-mas tree pattern, begins with a herald patch Salmon pink Presents similarly to syphilis
68
Erythema multiformi
Target lesions Causes - drugs, herpes, myocplasma Systemic features might indicate Steven-Johnson's syndrome
69
Eczema
70
Atopic eczema with lichenification
71
Infected eczema
72
Eczema herpeticum
73
Seborrhoeic dermatitis
74
Discoid eczema
75
Psoriasis
76
Guttate psoriasis
77
Papular and pustular acne
78
Nodular/cystic acne
79
Rosacea
80
Mumps Clinical Presentation
Painful swelling of parotid gland Can also cause testicular swelling Maculopapular rash extending from the face to the extremities
81
Bowen's disease
Early form of SCC Usually affects the lower leg Slow growing, rarely irritating
82
Molluscum Contagiosum
Central clearing, not painful, slightly itchy, common in immunocompromised
83
Rash after Ivy
Contact allergic dermatitis
84
Herald patch
Pityriasis rosacea
85
Brushfield's spots
Down syndrome
86
Koplic spots
Measles
87
Rash with peri-orbital sparing
Scarlet fever
88
Rash in webbed spaces of fingers
Scabies

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