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Flashcards in Dermatology Deck (61):
1

Common benign markers of photodamage to skin?

Wrinkles
Telangiectasias
Lentigines
Mottled pigmentation

2

3 pre-malignant UV induced skin lesions?

Cutaneous horns
Solar/actinic keratosis (firm rough scaly papules)
Bowens disease (red scaly plaque on female leg)

3

Which skin types are at increased risk of skin cancer?

I and II - increased likelihood of burning

4

What is a macule?

Flat discoloured lesion less than half a cm

5

What is a patch?

A flat lesion >5mm e.g. Neurofibromatosis, morphoea

6

What is a papule?

Raised lesion less than half a cm

7

Example of a condition where papules, vesicles, pustules and nodules are all seen alongside each other (along with commedones)?

Acne

8

What is a plaque?

Raised but flattened lesion >5mm e.g. Psoriasis

9

What are nodules?

Raised lesions >5mm inclu most skin cancers

10

What is a vesicle?

Fluid filled papule e.g. Chickenpox, herpes

11

What is a pustule?

An infected vesicle e.g. Acne, chicken pox

12

What is a bulla/blister?

Raised, fluid filled lesion >5mm
Only bullous infection is bullous impetigo

13

What is a wheal?

Classical of urticaria, hives - transient, itchy lesions that look circular

14

Example of condition that can give you sterile pustules and nail changes?

Palmar plantar (pustular) psoriasis

15

3 nail changes associated with psoriasis?

Onykolysis
Subungual hyperkeratosis
Pitting

16

What is crusting?

Dried exudate e.g. From pustules, vesicles, bullae

17

What is scaling?

Keratinisation, typical of psoriasis

18

What is maceration?

Typical of e.g. Athletes foot, fungal infections - fluid destroying surrounding skin

19

2 things that target lesion is typical of?

Single lesion = Lyme disease
Multiple = erythema multiforme (drug reaction)

20

What is the difference in appearance between 'classic' acne and steroid induced acne?

Steroid induced acne does not feature commedones, just papules vesicles pustules and nodules

21

What is erythroderma? 2 common causes?

Red, shedding skin typically all over body
Either drug reaction or lymphoma

22

What is eczema herpeticum?

Herpes infection in pre-existing eczema potentially causing sepsis, eye damage

23

ABCDE of describing malignant melanoma?

Asymmetry
Border (irregular)
Colour (change or multiple different colours)
Diameter (>6-7mm)
Elevation, extra Sx and extra lesions

24

RFs for BCC?

Acute sunburn as child
Skin types I and II
Sunbed use
Immunosuppression
Old age

25

Describe a BCC?

Pearly papule with raised, rolled edges and importantly telangiectasias typically on the face
Eroded centre, can become rodent ulcer
Slow growing, months-years

26

Management of BCC?

Typically Mohs micrography excision
Can use cryotherapy, cautery etc.

27

RFs for SCC?

Chronic, accumulative UV exposure/sunburn incl pUVA Rx for psoriasis
Skin types I, II
Immunosuppression
Old age
Chronic skin damage, ulceration
NER defect (xeroderma pigmentosa)

28

Describe an SCC?

Keratinising nodule - rapidly growing, scaly, red mess often painful and firm
Rapidly growing

29

Management of SCCs?

Surgical excision with fairly wide margins

30

RFs for malignant melanoma?

Prev malignant melanoma
Moley person
Acute sunburn
FH

31

Risk associated with malignant melanoma - how is this quantified histologically? Management?

Higher risk of metastasis based on Breslow thickness
Surgical removal, wide margin excision

32

Ddx for malignant melanoma which doesn't change or evolve rapidly, is less pigmented?

Seborrhoeic wart

33

How can skin mets of malignant melanoma present?

Bluey-purple lesions ddx angioma

34

What is lentigo maligna?

Precancerous, irregular macule on face of elderly person

35

Methods of minimising UV exposure?

Avoidance of sun especially between 11-3pm
Avoid sun beds
Clothing - good covering, good type of fabric
Suncreams, high uv factor, good thickness every 2 hours

36

What is eczema?

Chronic inflammatory disorder affecting epidermis and dermis, usually with background of atopy

37

Typical progression of eczema through life?

Really common in kids esp under 1, starts on face and often gets flexures by 18m
Often completely regresses during teenage years; rare to have new onset in adulthood

38

4 types of triggers for eczema?

Irritant e.g. Chemicals, perfumed soaps
Allergic e.g. Pet hairs, dust mites, pollen
Infectious
Environmental incl temp, stress, sweat

39

What is discoid eczema? In whom does it most commonly present?

Men aged 60-70, smaller peak in young women
Annular lesions on extensor surfaces (legs, trunk, hands) - not face/scalp
Ddx for psoriasis and taenia

40

What is the difference between allergic contact dermatitis and irritant contact dermatitis?

Allergic is hypersensitivity (type 4) background - needs initial sensitisation, subsequent exposure can trigger major reactions
Irritant can happen on first exposure, due to repeated disruption of normal skin barriers

41

Typical presentations of allergic contact dermatitis?

Specific locations - e.g. Nickel earrings, watches, tattoos, hair dye, detergents...

42

Typical presentations of irritant contact dermatitis?

Chronic wet-dry cycling e.g. People who wash hands a lot
Air conditioning, detergents etc.

43

1st line management of eczema? 3 types of these?

Emollients - lotions, creams, and ointments (from watery->thick)

44

Why are emollients and topical steroids best used together for eczema?

Emollients improve skin barrier function and this increase effectiveness of steroids

45

Mild topical steroid?

Hydrocortisone (Dermol)

46

Moderate strength topical steroid?

Eumovate

47

Potent topical steroid?

Betnovate

48

Very potent topical steroid?

Dermovate

49

Alternative therapies after steroids for use in eczema?

Calcineurin inhibitors e.g. Tacrolimus
Occlusive wraps and dressings
Phototherapy
Systemic immunomodulation - methotrexate

50

What is psoriasis?

Chronic, typically relapsing remitting autoimmune disorder causing rapid skin turnover and hyperkeratosis-> scaling

51

Most common type of psoriasis?

Chronic stable psoriasis - erythematous papular lesions confluencing into plaques with scaling, typically on extensors incl sacrum and scalp

52

What is guttate psoriasis?

Loads of small papules, triggered by viral illness often pharyngitis

53

What is palmar plantar psoriasis? 1 differential for it?

Pustular psoriasis - sterile pustules affecting hands and feet
Ddx is pompholyx eczema

54

1st line management of psoriasis?

Emollients and steroids

55

After emollients and steroids, what 3 things are next line for outpatient psoriasis management?

Vit D analogues e.g. Calcitriol
Calcineurin inhibitors e.g. Tacrolimus
Coal tar

56

Inpatient management of psoriasis?

Dithranol

57

What is used after topical therapy for psoriasis?

pUVA, UVB
Oral immunomodulation e.g. Methotrexate

58

What is a Marjolins ulcer?

Skin ulcer with skin cancer (BCC) inside it

59

What is lipodermatosclerosis?

Ddx for cellulitis causing inverse champagne bottle legs

60

What is asteatotic eczema?

Dry, cracked skin - crazy paving
More typical of elderly/alcoholics

61

What is acrodermatitis enteropathica?

Zinc deficiency (autosomal dominant) causing acro and periorifice eczema-like rash, alopecia and diarrhoea