Flashcards in Dermatology Deck (61):
Common benign markers of photodamage to skin?
3 pre-malignant UV induced skin lesions?
Solar/actinic keratosis (firm rough scaly papules)
Bowens disease (red scaly plaque on female leg)
Which skin types are at increased risk of skin cancer?
I and II - increased likelihood of burning
What is a macule?
Flat discoloured lesion less than half a cm
What is a patch?
A flat lesion >5mm e.g. Neurofibromatosis, morphoea
What is a papule?
Raised lesion less than half a cm
Example of a condition where papules, vesicles, pustules and nodules are all seen alongside each other (along with commedones)?
What is a plaque?
Raised but flattened lesion >5mm e.g. Psoriasis
What are nodules?
Raised lesions >5mm inclu most skin cancers
What is a vesicle?
Fluid filled papule e.g. Chickenpox, herpes
What is a pustule?
An infected vesicle e.g. Acne, chicken pox
What is a bulla/blister?
Raised, fluid filled lesion >5mm
Only bullous infection is bullous impetigo
What is a wheal?
Classical of urticaria, hives - transient, itchy lesions that look circular
Example of condition that can give you sterile pustules and nail changes?
Palmar plantar (pustular) psoriasis
3 nail changes associated with psoriasis?
What is crusting?
Dried exudate e.g. From pustules, vesicles, bullae
What is scaling?
Keratinisation, typical of psoriasis
What is maceration?
Typical of e.g. Athletes foot, fungal infections - fluid destroying surrounding skin
2 things that target lesion is typical of?
Single lesion = Lyme disease
Multiple = erythema multiforme (drug reaction)
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
What is erythroderma? 2 common causes?
Red, shedding skin typically all over body
Either drug reaction or lymphoma
What is eczema herpeticum?
Herpes infection in pre-existing eczema potentially causing sepsis, eye damage
ABCDE of describing malignant melanoma?
Colour (change or multiple different colours)
Elevation, extra Sx and extra lesions
RFs for BCC?
Acute sunburn as child
Skin types I and II
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
Management of BCC?
Typically Mohs micrography excision
Can use cryotherapy, cautery etc.
RFs for SCC?
Chronic, accumulative UV exposure/sunburn incl pUVA Rx for psoriasis
Skin types I, II
Chronic skin damage, ulceration
NER defect (xeroderma pigmentosa)
Describe an SCC?
Keratinising nodule - rapidly growing, scaly, red mess often painful and firm
Management of SCCs?
Surgical excision with fairly wide margins
RFs for malignant melanoma?
Prev malignant melanoma
Risk associated with malignant melanoma - how is this quantified histologically? Management?
Higher risk of metastasis based on Breslow thickness
Surgical removal, wide margin excision
Ddx for malignant melanoma which doesn't change or evolve rapidly, is less pigmented?
How can skin mets of malignant melanoma present?
Bluey-purple lesions ddx angioma
What is lentigo maligna?
Precancerous, irregular macule on face of elderly person
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
What is eczema?
Chronic inflammatory disorder affecting epidermis and dermis, usually with background of atopy
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
4 types of triggers for eczema?
Irritant e.g. Chemicals, perfumed soaps
Allergic e.g. Pet hairs, dust mites, pollen
Environmental incl temp, stress, sweat
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
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
Typical presentations of allergic contact dermatitis?
Specific locations - e.g. Nickel earrings, watches, tattoos, hair dye, detergents...
Typical presentations of irritant contact dermatitis?
Chronic wet-dry cycling e.g. People who wash hands a lot
Air conditioning, detergents etc.
1st line management of eczema? 3 types of these?
Emollients - lotions, creams, and ointments (from watery->thick)
Why are emollients and topical steroids best used together for eczema?
Emollients improve skin barrier function and this increase effectiveness of steroids
Mild topical steroid?
Moderate strength topical steroid?
Potent topical steroid?
Very potent topical steroid?
Alternative therapies after steroids for use in eczema?
Calcineurin inhibitors e.g. Tacrolimus
Occlusive wraps and dressings
Systemic immunomodulation - methotrexate
What is psoriasis?
Chronic, typically relapsing remitting autoimmune disorder causing rapid skin turnover and hyperkeratosis-> scaling
Most common type of psoriasis?
Chronic stable psoriasis - erythematous papular lesions confluencing into plaques with scaling, typically on extensors incl sacrum and scalp
What is guttate psoriasis?
Loads of small papules, triggered by viral illness often pharyngitis
What is palmar plantar psoriasis? 1 differential for it?
Pustular psoriasis - sterile pustules affecting hands and feet
Ddx is pompholyx eczema
1st line management of psoriasis?
Emollients and steroids
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
Inpatient management of psoriasis?
What is used after topical therapy for psoriasis?
Oral immunomodulation e.g. Methotrexate
What is a Marjolins ulcer?
Skin ulcer with skin cancer (BCC) inside it
What is lipodermatosclerosis?
Ddx for cellulitis causing inverse champagne bottle legs
What is asteatotic eczema?
Dry, cracked skin - crazy paving
More typical of elderly/alcoholics