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Flashcards in Dermatology Deck (105):
1

Describe the different types of skin carcinoma

-basal cell carcinoma: usually presents as raised, smooth, pearly bump on the sun-exposed skin of head neck or shoulders, ulceration and telangiectasia may also feature

-squamous cell carcinoma: common presents as a red scaling thickened patch over sun-exposed skin. More malignant than BCC but less common, also associated with immunosuppression and HPV.

-malignant melanoma: the least common but most malignant usually presents as an asymmetrical area with irregular border and colour variation from shades of brown to black. Though some more aggressive melanomas called amelanotic appear pink, red of fleshy. Tend to be larger than 6mm and evolve over time. ABCDE Criteria, Asymmetry , Border irregular, Colour variation, Diameter greater than 0.5cm, Evolving over time. Subungual melanoma presents I totally with pigment band of nail that becomes wider, can cause lifting of the nail (onycholysis), Hutchinsons sign is an important clue characterised by extension of brown or black pigment from the nail bed to the cuticle and nail folds.

2

What is a macule?

Flat non-palpable lesion less than 0.5cm in size

3

What is a patch?

Flat non-palpable lesion greater than 0.5cm, I.e. A large macule

4

What is a nodule?

A large raised lesion greater than 0.5cm in diameter I.e a solid lump

5

What is a papule?

A small well defined raised lesion less than 0.5cm in diameter

6

What is a plaque?

A raised flat-topped lesion usually over 2cm in diameter.

7

What is a vesicle?

Small fluid-filled blisters less than 0.5cm in size

8

What is a bulla?

A large fluid-filled blister greater than 0.5cm in diameter I.e. A large vesicle

9

What is a pustule?

A pus-filled blister. Usually the size of vesicles

10

What is scale?

Fragment of dry skin, flakes of keratin

11

What is crust?

Dry brownish exudate

12

What is ulceration?

Loss of the epidermis

13

What is an erosion?

Superficial break in epidermal surface, heals without scarring

14

What is excoriation?

A scratch hitch has broken the surface of the skin. It is a superficial erosion secondary to scratching.

15

What is lichenification?

Skin thickening with hyper pigmentation, giving a shiny appearance, it is a result of repeated trauma

16

What is koebnerisation?

Skin lesions which develop at the site of injury e.g. A scar. Seen in psoriasis, lichen planus, plane warts, and vitiligo

17

What are the main types of eczema (dermatitis)?

-atopic eczema
-allergic contact dermatitis
-irritant dermatitis
-adult seborrhoeic dermatitis
-discoid eczema

18

Describe atopic eczema, it's presentation, and management

Acute eczema causes a rash with less scale and less demarcated than psoriasis.

Presentation: Typically in children presents as itchy red skin. Family history of atopy is common. May suffer from asthma or hay fever. Itching may lead to staph infection.

Management:
-rule out other types of dermatitis
-control not cure
-use emollients twice a day, greasy better in severe eczema e.g. 50/50 emulsifying ointment and liquid paraffin.
-daily steroid ointment for active sites, strengths vary on severity, site and age. For face, flexures and groin 1% hydrocortisone for other areas quick control can be achieved with betamethasone 0.1% ointment for less than 7days.
-if no response consider systemic treatment with ciclosporin.
-beware eczema herpitcum concurrent infection with herpes simplex.

19

Describe Irritant dermatitis, it's presentation, and management

Presentation: think of new soaps, new gloves etc.

Presentation: typically dry erythematous skin on hands. Common irritants that may come up in history include, soap, oils, solvents, alkalis, too much water. Occupation is important.

Management:
-avoid irritants
-hand care I.e. Regular emollients, careful drying of hands
-topical steroids for acute flare-ups

20

Describe allergic contact dermatitis, it's presentation, common causes, and management

It is a type IV hypersensitivity reaction.

Presentation: the pattern of contact gives a clue at a cause tends to be well demarcated and of a certain shape e.g. Ring, or around neck line of shirt

Common allergens: nickel (jewelry, watches, coins, keys), chromates (cements, leather), plants, topical neomycin, framycetin, antihistamines.

Management:
-consider patch testing to list allergens to avoid
-topical steroid depending on severity

21

Describe adult seborrhoeic dermatitis, it's features, associated conditions, and management.

Seborrhoeic dermatitis in adults is a chronic dermatitis thought to be caused by an inflammatory reaction related to proliferation of a normal skin inhabitant a fungus called Malassezia Furfur.

Features: Common, red scaly rash affecting scalp (dandruff), eyebrows, nasal labial folds, cheeks and flexure, otitis externally and blepharitis may also develop.

Associated Condition:
-HIV
-Parkinson's disease

Management:
-Scalp management: over the counter preparations containing Zinc pyrithione (Head and Shoulders), and tar are first line. Ketoconazole is second line. Selenium sulphide and topical corticosteroids may also be useful.
-Face and body management: Topical antifungals e.g. ketoconazole. Topical steroids. Difficult to treat and recurrences are common.

22

What is a halo nevus?

Benign mole occurs most often on the back of young adults. Appears as a fading mole with a surrounding white hypopigmented area. The white halo results from loss of melanocytes by lymphocyte action. May repigment

23

Describe Toxic epidermal necrosis, it's signs, causes and management.

The bad end of the erythema multiforme/ Stevens-Johnson syndrome spectrum. Mortality approx 30%

Signs: Widespread erythema, then necrosis of large sheets of epidermis. Mucosae severely affected. Risk of TEN in HIV patients in 1000-fold higher.

Causes: Sulfonamides, Anticonvulsants, penicillins, allopurinol, NSAIDs.

Management:
-Stop likely drug offenders
-specialist managemeant in a dermatology or burns unit
-short-term dexamethasone pulse therapy IV Ig may be needed

24

What are the different classifications for skin types?

Type I - Pale white, blond or red hair, blue eyes, freckles, always burns, never tans

Type II - White, fair, blond or red hair, blue green or hazel eyes, usually burns, tans minimally

Type III - Cream white, fair with any hair or eye colour, quite common, sometimes mild burn, tans uniformly

Type IV - moderate brown, typical Mediterranean skin tone, burns, always tans well.

Type V - Dark brown, middle eastern skin types, very rarely burns, tans very easily

Type V - deeply pigmented dark brown, never burns, never tans.

25

What is a capillary haemangioma (strawberry naevi)?

Occurs in neonates as a rapidly engaging red spot. Most go by the age of 5-7 years. No treatment is required unless a vital function is imparied e.g. Obscuring ears or eyes. If treatment is required Propanalol is the drug of choice

26

Describe Acanthosis Nigricans and its causes.

Pigmented, rough velvety thickening of axillary, neck or groin skin with warty lesions often associated with Diabetes Mellitus.

Causes:
-Gastrointestinal cancer
-Endometrial Cancer
-Diabetes Mellitus
-Obesity
-PCOS
-Acromegaly
-Cushing's Disease
-Hypothyroidism
-Familial
-Prader-Willi Syndrome
-Drugs: OCP, Nicotinic acid

27

Describe Alopecia, it's types and causes.

Hair loss may be scarring or non-scarring. Non-scarring causes may be reversible but scarring alopecia implies irreversible loss. Scalp disorders may be signs of skin elsewhere e.g. Lichen planus or SLE.

Scarring Causes:
-Nutritional (Fe or Zn deficiency),
-Androgenetic
-autoimmune (alopecia areata, smooth round patches of hair loss on scalp, hairs like exclamation marks are a typical feature, often spontaneously regrows)
-Telogen effluvium (shedding of Telogen phase hairs after period of stress eg. Childbirth, surgery, severe illness.

Scaring Causes:
-Lichen planus
-discoid lupus Erythematosus
-trauma

28

Describe Alopecia Areata, its symptoms and management.

An autoimmune cause of non-scarring hair loss.

Symptoms: Smooth round, well demarcated patches of hair loss on scalp with exclamation like hairs are a typical feature.

Management:
-Often spontaneously regrows by 1 year in 50% and in 80-90% eventually.
-May require topical steroids, phototherapy, contact immunotherapy.

29

What is a kerion?

A raised spongy honeycomb lesion on the scalp or beard which occurs as the result of a hosts response to a fungal ringworm infection of the hair follicles accompanied by secondary bacterial infection. It is a severely painful inflammatory response.

30

Describe Pruritis, it's causes and investigations.

Can be very distressing, skin will usually be scraped or rubbed and number so secondary skin signs are seen such as excoriation a, lichenification, papules or nodules.

Causes: primary or systemic?
-Primary include Scabies (burrows in finger-webs, wrists, groin buttock), urticaria, atopic eczema (flexural eruption, lichenification), dermatitis herpetiformis (very itchy blisters on elbows and shoulders), lichen planus (flat violet wrist papules)
-Systemic such as IDA (koilonychia, pale), lymphoma (nodes, hepatosplenomegaly), hypo/hyperthyroidism, liver disease (jaundice, spider naevi), chronic renal failure (dry sallow skin), malignancy (clubbing, masses), drugs.

Investigations: FBC (anaemia, lymphoma), ESR (vasculitis), Ferritin (IDA), LFT, U+E, Glucose, TSH, CXR.

31

Describe Discoid Eczema, it's presentation, and management.

Presentation: Coin-shaped lesions may begin as vesicles. Typical patient is a male 50-70yrs or female 20-30rs, with somewhat symmetrical round very itchy vesicles or popular plaques of on legs +/- trunk and arm, but not face. They may crust and get infected by staphs before flattening into hyperpigmented macules.

Management:
-Sunlight may help.
-lukewarm baths, moisturisers, steroid ointment, oral antihistamine.

32

Describe Psoriasis, the types, it's presentation, and management.

Psoriasis is a chronic inflammatory skin condition, peaking in 20s and 50s. It is due to epidermal proliferation and T-cell driven inflammatory infiltration of the dermis and epidermis.

Types + Presentation:
-Plaque psoriasis, Symmetrical well-defined red plaques with silvery scale on extensor aspects of the elbows, knees, scalp, and sacrum.
-Guttate psoriasis, Small plaques (Guttate) are see in the young (especially if associated with concurrent streptococcal infection).
-Pustular psoriasis (palmoplantar)
-Flexural psoriasis, Flexures (axillae, groins, submammary areas, and umbilicus) also frequently affected but lesions are non-scaly
-Nail changes in 50% such as pitting, onchylosis (separation from nail bed), thickening and subungual hyper keratosis).
-Erythrodermic psoriasis is a variant which affects more than 80% of the body area, it may cause severe systemic upset, fever, raised WBC, dehydration. Also triggered by rapid withdrawal of steroids.
-Psoriatic arthritis, some develop a sero-negative arthropathy.

Management:
-education is vital, control not cure. Encourage support group. Remove triggers e.g. B-blockers antimalarials, lithium, NSAIDs, alcohol, obesity, smoking.
-If mild creams are mostly used e.g. Vitamin D analogues calcipotriol and betamethasone (dovobet)
-if arthropathy consider, methotrexate, infliximab, etanercept
-moderate severe disease may benefit from UV phototherapy + etanercept or adalimumab

33

What is exanthem?

Widespread rash that accompanies system illness typically viral infection may occur in a laterothoracic variant affecting one side of the body typically in younger children.

34

What is a Mongolian blue spot?

Benign blue grey patch/naevi that dissapers on its own.

35

What is the fingertip rule?

One pea sized portion of steroid cream can cover the area of 2 adult hands.

36

What are the different strengths of steroid cream from least potent to most?

-Hydrocortisone = mild
-Clobetatsone = moderate
-betamethasone = potent
-Clobetatsol = super potent

37

Describe Erythema Multiforme, it's causes, and management

Minor form: target lesions, usually on extensor surface especially of peripheries, palms and soles.
Major form: Steven-Johnson syndrome/toxic epidermal necrolysis. Associated with systemic upset, fever, severe mucosal involvement, including conjuctivae.

Causes: herpes simplex (70%), mycoplasma, viruses (minor form), drugs especially Sulfonamides, penicillins (major form).

Management:
-treat/stop cause. Supportive care. Dermatological input.

38

Describe scabies, it's signs, and management.

A highly contagious, common disorder particularly affecting children and young adults. Spread is direct person to person. The female mite digs a burrow (pathognomonic sign, a short wavy grey or red line on the skin surface) and lays eggs which hatch as larvae. The itch and subsequent rash is probably due to allergic sensitivity to the mite and its products.

Signs: It presents as very itchy papules, vesicles, pustules, nodules affecting finger-webs, wrist Flexures, axillae, abdomen (especially around umbilicus and waistband area), buttocks and groin.

Management:
-Permethrin 5% dermal cream applied o all areas of the skin from neck down for 24h. All members of household should be treated at the same time even if asymptomatic.
-Crotamiton cream is an anti-pruritic medication which may help.

39

Describe Acne Vulgaris and its management

Basal keratinocytes proliferation in pilosebasceous follicles (androgen and CRH driven), increased sebum production, propionibacterium acnes colonisation, inflammation and comedones (white and black head) blocking secretions hence papules, nodules, cysts and scars.

Management:
-mild acne, mainly facial comedones, topical benzoyl peroxide as twice weekly wash, roll on antibiotics (clindamycin as Dalacin T)
-moderate acne, inflammatory lesions face and torso, doxycycline for 4-6months with topical benzoyl peroxide twice weekly. Then topical retinoids e.g. Adapalene or isotretinioin used in combination with above.
-severe acne, nodules, cysts, scars, isotretinioin is first choice, it is teratogenic so good contraception must be used during and for 1 month after treatment. Monitor triglycerides (can cause hyperlipidaemia), AST, ALT (can cause hepatitis) cholesterol and FBC

40

Describe Acne Rosacea, its features and management.

It is a chronic relapsing/remitting disorder of blood vessels and pilosebasceous units in convex central facial areas typically in fair skinned people. Irritated by alcohol and spices.

Features: red rash typically affecting nose, cheeks and forehead, flushing is often first symptom, telangiectasia are common, later develops into persistent erythema with papules and pustules. Rhinophyma and ocular involvement blephatits

Management:
-avoid irritants and sun overexposure.
-CBT may help with avoiding blushing
-topical azelaic acid + metronidazole, for mild to moderate disease.
-Oral tetracyclines may be used
-rarely isotretinioin and lasers are needed for resistant cases.

41

Describe Plantar Warts (Verrucas) and its management

Cause by human papilloma virus in keratinocytes. Large con fluent lesions often resist treatment (can last 2 years). They are infectious.

Management: Try topical salicyclic acid or combination therapy such as CPS (Cantharidin, podophyllotoin, Salicyclic acid)

42

Describe Lichen Planus and its management

Lesions, typically on the flexor aspects of wrists, forearms, ankles and legs, appear purple, pruritic, poly-angular, planar (flat-topped), papules. Occur at any age, and may be outlined by white lacy markings known as Wickham's striae. Can also cause scarring alopecia.

Management:
-usually persists for 6-18months.
-topical steroids +/- antifungals are first line.

43

Describe Bullous Pemphigoid, its features and management.

The chief autoimmune blistering disorder in the elderly, due to IgG antibodies against hemidesmosomal proteins BP180 and BP230

Features:
-tense blisters on an urticated base. typically around flexures. mouth is usually spared.
-skin biopsy shows IgG and C3 on immunofluorescence at the dermoepidermal junction

Management:
-referral to dermatologist
-Clobetatsol cream up to 40g/d is better than oral steroids.

44

Describe Pemphigus Vulgaris, its symptoms, and management.

Affects you get people that's Pemphigoid and is due to IgG antibodies against desmosomal components. This leads to acantholysis (separation of keratinocytes). May be caused by drugs e.g. ACEi, NSAID, Phenobarbital, L-dopa.

Symptoms: Flaccid blisters which rupture easily to leave widespread erosions. The oral mucosa is often affected early.

Management:
-skin biopsy +ve immunoflourescence intracellular IgG giving a crazy-paving effect.
-Oral Prednisolone 60-80mg/d
-IVIs of rituximab and immunoglobulin may have a dramatic effect.

45

What is Solar lentigo?

A precursor to seborrhoeic keratosis (benign brown warts common in elderly). Found on chronically sun exposed skin. Appears as yellow, light or dark brown regular or irregular macule of thin plaque.

46

What is Seborrhoeic Keratosis?

Benign epidermal skin lesions commonly seen in elderly people.

Large variation in colour from flesh to light-brown to black, they look stuck on and keratosis plugs may be seen on surface.

47

What is Erysipelas and its management?

Sharply defined superficial skin infection caused by Strep Pyogenes. Often affects the face (unliateral) with fever and raised WCC.

Management:
-systemic penicillin 500mg/6h PO. Erythromycin if pen-allergic.

48

Describe urticaria, it's causes, symptoms and management

AKA Hives, may be acute where symptoms develop quickly but often resolve within 48 hours, and chronic where the rash persists for more than 6 weeks. Partly mediated from release of histamine in skin.

Causes: Idiopathic, autoimmune, allergic (type 1 hypersensitivity mediated) e.g. Food allergies, medications, bee stings etc, drug causes e.g. Aspirin, NSAIDS, ACE-inhibitors.

Symptoms: As a whole it appears as an itchy red blotchy rash. Angio-oedema occurs when deeper tissues are involved. A typical lesion is a central itchy White papule due to swelling of the surface of the skin (wheal), surrounded by an erythematous flair.

Management:
-anti-histamine
-menthol aqueous cream to sooth itching.



49

Describe Pyoderma gangenosum, it's features, causes, and management.

Features: initially a small red papule or pustule typically on lower limbs, that develops later into a deep red necrotic ulcer with a violaceous ( Purplish) border. May be accompanied by systems symptoms such as fever, myalgia.

Causes: idiopathic in 50%, IBD, RA, SLE, myeloproliferative disorders, lymphoma, myeloid leukaemias, PBC.

Management:
-Topical Calcineurin inhibitors such as Tacrolimus can result in resolution of limited PG in up to 50% of cases.
-Oral high dose steroids for more extensive disease.
-consider additional immunosuppressive therapy for example ciclosporin or infliximab in difficult cases.

50

Describe Erythema Toxicum

It is a common self-limiting rash of neonate, that although appears quite alarming causes no harm to the baby. It last only a few days an usually requires no treatment. It is charaterised by small pustule lesions each on a separate reddened base.

51

Describe Bowen's disease

Squamous cell carcinoma in situ of the skin. Slow growing red-scaly plaque e.g. On shin. Most commonly found on limbs in sun exposed areas. Treated with cryo or topical flourouracil

52

Describe Actinic Keratosis and its management.

Pre-malignant crumbly yellow-White scarily crust occur on sun-exposed skin from dysplastic intra-epidermal proliferation of atypical keratinocytes.

Management:
-Topical 5-FU cream used BD for 6 weeks, tends to get worse before gets better.

53

Describe Keratoacanthoma, it's presentation, and management.

A benign rapid growing squamo-proliferative lesion that looks like SCC pathologically. They are characterised by rapid growth over a few weeks to months, followed by spontaneous resolution over 4-6months in most cases.

Presentation: Rapid growth over a few weeks, occur on sun-exposed areas. Usually solitary and begin as firm round skin colour papules that progress to dome-shaped nodules with a smooth shiny surface and a central crater of ulceration am develop, or a keratin plug that may project like a horn.

Management:
-referred under 2 week wait as difficult to distinguish between SCCs, however reassure that they will not cause harm
-complete excision treatment of choice.

54

Describe Staphylococcal Scalded Skin Syndrome, its symptoms, and management.

The syndrome is induced by epidermolytic exotoxins A and B which are real eased by S aureus and cause detachment within the epidermal layer by breaking down the desmosomes. Most common in children under 6 years but can be seen in immunosuppressed or renal failure patients.

Symptoms: The disease presents with widespread formation of fluid-filled blisters that are thin walled and easily ruptured and the patient can be positive for nikolsky's signs. Ritters disease of the Newborn is the most severe form of SSSS with similar signs and symptoms. SSSS often includes a widespread painful erythroderma. Unlike toxic epidermal necrolysis mucous membranes are spared.

Management:
-Mostly supportive, with eradication of primary infection.
-these include, rehydration, antipyretic S, management of thermal burns and stabilisation.
-Prognosis is goo with complete resolution within 10days but important to differentiate from TEN which carries a poor prognosis.

55

Describe Pityriasis Rosea, its symptoms, and management.

Common rash usually last 6-8wks. Possibly due to viral infection.

Symptoms: Mild headache/ URTI symptoms before rash. Itchy Scaly pink patch (herald patch) which spreads a few days or weeks later to become a widespread scaly, patchy rash, often in Christmas tree distribution.

Management:
-self-limiting, emollients may help itching.
-oral antihistamine for itching

56

Describe Pityriasis Versicolor, it's symptoms, and management.

Common rash due to overgrowth of yeasts called malassezia. Most common in early 20s.

Symptoms: Itchy rash usually on the trunk, flat slightly scaly areas of altered colour.

Management:
-Topical ketoconazole or selinium sulphide shampoo
-if severe or widespread oral fluconazole/itraconazole

57

Describe Chloasma (Melasma) and its treatment.

Brown patches especially on the face, related to pregnancy, COCP, HRT.

Treatment:
-may respond to topical azelaic acid

58

Describe Pyogenic Granuloma, it's presentation and management.

A harmless lesion thought to arise as a result of minor trauma, typically occurring on fingers. It is not infections or granulomatous.

Presentation: Moist red lesion which grows rapidly and bleed easily, not painful

Management:
-some shrink with time
-curette

59

What are Campbell De Morgan spots?

Cherry angiomas, a cluster of capillaries at the surface of the skin forming a small red papule. Usually 1-2mm in size but can grow to 1cm. Do not require treatment but if subject to frequent bleeding an be cauterised.

60

Describe Chondrodermatitis nodularis helicis, its features and management.

A common and benign condition though to be caused by factors such as persistent pressure on the ear, trauma or cold. More common in men and with increasing age.

Features: painful nodule on ear, may occasionally bleed

Management:
-reduce pressure on ear, ear protectors may be used during sleep
-cryotherapy, steroid injection, collagen injection
-surgical treatment may be used but there is high recurrence rate.

61

Describe Toxic Shock Syndrome and its features

A severe systemic reaction to staphylococcal exotoxins.

Features: Fever over 39, hypotension, diffuse erythematous rash with desquamation especially over the palms and soles. Involvement of 3 or more organ systems e.g. D+V GI, mucous emmebrane eyrthema, renal failure, hepatitis, thrombocytopenia, CNS involvement.

62

What is a Marjolin's ulcer?

Squamous cell carcinoma occurring at sites of chronic inflammation e.g. Burns, osteomyelitis, mainly occur on lower limb

63

Describe Dermatitis Herpetiformis, its features and management.

An autoimmune blistering skin disorder associated with coeliacs disease, it is caused by deposition of IgA in the dermis.

Features: Itchy, vesicular skin lesions on the extensor surfaces (e.g. Elbows, knees, buttocks) diagnosed with skin biopsy and direct immunofluorescence shows IgA deposition in a granular pattern in the upper dermis.

Management:
-gluten free diet
-Dapsone

64

Describe Genital Crohn’s disease

Skin condition that arises when granulomas affect the genitals and adjacent skin. The skin disease can join up with the bowel disease or be completely separate (in this case it is called metastatic crohn’s disease). It is more common in females (2:1 ratio). Treated with Oral metronidazole, Steroids sparing agents or topical corticosteroids/ calcineurin inhibitors.

65

Which malignancies are associated with Acanthosis Nigricans?

Gastric cancer

66

Which malignancies are associated with Acquired ichthyosis?

Lymphoma

67

Which malignancies are associated with Acquired Hypertrichosis Lanuginosa?

Gastrointestinal and Lung cancer.

68

Which malignancies are associated with Dermatomyositis?

Ovarian and lung cancer

69

Which malignancies are associated with Erythema Gryatum repens?

Lung cancer

70

Which malignancies are associated with Erythroderma?

Lymphoma

71

Which malignancies are associate with migratory thrombophlebitis?

Pancreatic Cancer

72

Which malignancies are associated with necrolytic migratory erythema?

Glucagonoma

73

Which malignancies are associated with pyoderma gangrenosum?

Myeloproliferative disorders

74

Which malignancies are associated with Sweet’s syndrome?

Haematological Malignancy e.g. myelodysplasia tender purple plaques

75

Which malignancies are associated with tylosis?

Oesophageal cancer

76

Describe pompholyx, its features, and management.

Pompholyx is a type of eczema which affects both the hands and the feet. It is also known as dyshidrotic eczema.

Features: Small blisters on the palms and soles, prurtic, sometimes burning sensation, one blisters burst skin may become dry and crack.

Managment:
-cool compresses
-Emollients
-Topical steroids

77

What are the layers of the epidermis?

The epidermis is the outermost layer of the skin and is composed of stratified squamous epithelium with an underlying basal lamina it may be divided into five layers:
-Stratum Corneum - Flat, dead, scale-like cells filled with keratin, continually shed
-Stratum lucidum - clear layer, present in thick skin only
-Stratum Granulosum - cells form links with neighbours
-Stratum spinosum - squamous ells begin keratin synthesis, thickest layer of epidermis
-Stratum germinativum - the basement membrane, single layer of columnar epithelial cells, gives rise to keratinocytes and contains melanocytes.

78

Describe Eosinophilic fasciitis, its features, and management

Aka Shulman's syndrome, a form of fasciitis an inflammatory disease that affects the fascia. It is usually limited to arms and legs and may be associated with aplastic anaemia. Typical age of onset is 40-50yrs.

Features:
-Severe pain and swelling in muscles
-May have orange peel appearance
-occasionally joint pain and carpal tunnel syndrome
-eosinophilia
-Groove sign (depressions in skin parallel to course of superficial veins more obvious with raising the arm)

Management:
-Most cases resolve themselves
-Corticosteroids

79

Describe Erythrasma, its features, and management

Generally asymptomatic, flat slightly scaly pink or brown rash usually found in the groin or axillae. It is caused by an overgrowth of the diphtheroid corynebacterium minutissimum.

Examination with Wood's light reveal a coral-red fluorescence.

Topical mixonazole or antibacterial are usually effective. Oral erythromycin may be used for more extensive infection

80

Describe Darier's disease and its features

An autosomal dominant condition with cutaneous features typically becomes apparent in early adulthood.

Features: Wart papules and plaques in seborrhoea areas (e.g. central chest, back, scalp and flexures), palmar puts and nail dystrophy.

Management:
-Retinoid acitretin can be used to treat symptoms cases.

81

Describe Granuloma Annulare, its features, and management.

A common skin condition aka Necrobiotic papulosis. Typically affects younger adults and children. Caused by a delayed hypersensitivity reaction to some component of the dermis. Mediated by Tumour Necrosis Factor Alpha (TNF-a). Associated with autoimmune thyroiditis.

Features: Smooth discoloured plaques, usually thickened and ring-shaped.

Management:
-Nil usually resolve in a few months.
-Topical corticosteroids

82

Describe Pityriasis Lichenoides Et Varioliformis Acuta (PLEVA), its features and management

A rare skin condition lies at one end of a spectrum with pityriasis lichenoides chronic at the other. More common in males.

Features: Mild systemic symptoms, itchy/burning scattered papules + nodules with fine peripheral scale and some pronounced haemorrhage crust.

Management:
-Topical corticosteroids
-Anti-inflammatory antibiotics
-phototherapy
-systemic immunosuppressants.

83

Describe Pityriasis Licehnoides Chronica, its features and management

A rare skin condition lies at one end of a spectrum with pityriasis lichenoides chronic at the other. More common in males. Has a more low-grade clinical course than PLEVA.

Features: Small pink papule that turns a reddish-brown colour. Usually a fine mica-like adherent scale attached to the central spot. Over several weeks the spot flattens out and leaves a brown mark which fades over several months. Generally asymptomatic.

Management:
-Topical corticosteroids
-Anti-inflammatory antibiotics
-phototherapy
-systemic immunosuppressants.

84

Describe Necrobiosis lipoidica, its features, and management

An unusual complication of diabetes mellitus, but can also occur in non-diabetics. It is thought to be due to small-vessel damage leading to partial necrosis of dermal collagen, and connective tissue, and a histiocytic cellular response.

Features: The skin over the shins is commonly affected and the disease presents as erythematous plaque that gradually develop yellowish-brown waxy discolouration with marked atrophy and prominent telangiectasia.

Management: Usually poor response to treatment. Topical steroids/tacrolimus may may be tried and even oral steroids/immunosupressents.

85

What are some causes of onchylolysis?

Skin Disease: Psoriasis, Dermatitis, PCT, Pemphigus Vulgaris

Infection: Dermatophyte fungus, Yeast, Bacteria e.g. pseudomonas, Viral e.g. Herpes simplex

Internal Disease: Amyloid, Multiple myeloma,IDA, Diabetes mellitus, thyroid disease, pellagra, sarcoidosis, scleroderma, yellow nail syndrome

Drugs: Tetracyclines, Psoralens, Fluoroquinolone antibiotics, chlorpromazine, OCP

86

Describe Xeroderma Pigmentosum and its features.

A rare autosomal recessive skin disorder where a person is highly sensitive to sunlight, has premature skin ageing and is prone to developing skin cancers. It is caused by a cellular hypersensitivity to UV radiation. Also be called DeSanctis-Cacchione syndrome.

Features:
-Stage 1 occurring around 6 months of age, areas exposed to sun show reddening scaling and irregular dark spots.
-Stage 2 continued sun exposure leads to poikiloderma, skin atrophy, telangiectasia, mottled hyperpigmenation and hypopigmentation.
-Stage 3 is the development of actinic keratoses and skin cancers.

87

Decribe Discoid Lupus erythematous, its features, and management.

Discoid Lupus is the most common chronic form of cutaneous lupus. It may be localised (above neck in 80%) or generalised (above and below neck in 20%)

Features: Persistent scaly, disc-like plaques on scalp, face and ears, that may cause pigmentary changes (hyperpigmentation on edge of older lesions), scarring (results in hypopigmentation and hair loss)
Follicular keratosis (i.e. plugs of keratin within hair follicles)

Management:
-Diagnosis confirmed by skin biopsy (Interface and periadnexal dermatitis, follicular plugging, atrophy and scarring) Direct Immunoflourescene is often positive in lesions skin in DLE (Positive lupus band test)
-CLASI scoring index.
-Sun protection + Vitamin D
-Topic cortical steroids + Topical Calcineurin inhibitors.
-Systemic treatment e.g. Hydroxycholorquine or Methotrexate may be needed in resistant cases.

88

What are Gottron's Papules?

Discrete red areas overlying the knocks in person with dermatomyositis

89

What are some prognostic factors of melanoma?

Presence of ulceration (Poorer prognosis)
Thickness
Lymph node involvement
Metastasis

90

What is tines incognito?

The name given to a final infection whose appearance as been altered by inappropriate usually a topical steroid which use causes the rash to slowly extend and grow larger however may appear less Erythematous

91

Describe Erythema gyratum repens

A clinically distinctive annular Erythema that is usually associated with underling malignancy. The eruptions is rapidly migration and composed of concentric rings forming a word grain pattern.

92

Describe Lichen Simplex Chronicus and its management

A skin disorder characterised by chronic itching and scratching causing thick leathery darkened skin.

Managed with moisturising creams and antihistamines

93

What is a hermetic whitlow?

A Lesion on a finger to thumb caused by HSV.

94

Describe cowden syndrome and its features

An Autosomal dominant multisystemic disorder characterised by benign overgrowth called hamartomas, as well as an increased lifetime risk of breast, thyroid, uterine and other cancers.

Feature:
-Trichilemmomas
-oral pappilomas
-Palmar keratoses, cafe-au-lait spots, lipomas.
-thyroid e.g. Follicular adenomas or multinodular goitre
-Macrocephaly

95

Describe Hidradenitis Suppurativa and its features

A chronic debilitating inflammatory disorder. Thought to be due to follicular occlusion wit plugging and dilatation and future of the follicle wit secondary inflammation of the aprocine glands. It is associated with insulin resistance, PCOS, and obesity.

Features: Recurrent boils in flexible surfaces, skin signs include comedones, subcutaneous nodules, abscess, scars, sinus tracts.

96

What is Auspitz’s sign?

Punctuate bleeding spots are seen when scales are removed from the surface of a plaque it is typical of psoriasis.

97

What is Hutchinson’s sign?

Hyperpigmentation of the nail bed and matrix is important in diagnosing subungual melanoma

98

What is Nickolsky’s sign?

Slight rubbing of the skin can result in exfoliation of the epidermis causing a blister sign of TEN

99

Describe Urticaria Pigmentosa and its features

Aka cutaneous mastocytosis, a disease in which mast cells proliferate and accumulate in the skin and other organs.

UP is a localised form of mastocytosis confided to the skin. It manifests in brown, freckle like macules that urticate if rubbed.

100

Describe Erythema nodosum and its management

An inflammatory skin condition characterised by inflammation of the fat cells under the skin resulting in tender red nodules or lumps usually seen on both shins.

Cause: SORE SHINS
Streptococci
OCP
Rickettsia,
Eponymous (Behcets)
Sulfonamides
Hanson’s disease (Leprosy)
IBD, Idiopathic
NHL
Sarcoidosis

Management:
Usually self limiting. Colcincine is occasionally used where it is particularly painful of disfiguring.

101

Describe Morphea, its features and management.

A form of localised scleroderma that may be circumscribed or generalised. In circumscribed there may be just one or two lesions with no generalised spread. The condition usually resolves within 3-5 years although sometimes a patch may persist up to over 25 years.

Features: The changes often begin with small, violaceous or erythematous skin lesions which enlarge and progress to a firm hidebound skin with a variable degree of hypo/hyperpigmentation. These lesions eventually settle into a waxy white appearance with subsequent atrophy. Lesions vary in diameter between 1-10cm.

Management:
-no therapy is usually need for a single lesion, but emollients, low concentration topical corticosteroids or calcipotriene may help relieve some dryness and itching.

102

Describe Retention Keratosis and its management.

A benign but malodorous condition caused by the build up of keratin, common in people with poorly managed oedematous legs / Varicose veins whom infrequent changing of dressings leads to interference with normal desquamation.

Management:
-Gentle debridement after soaking in arachis oils.
-recurrence prevented by skin care with emollients.

103

What is Capillaritis?

Aka Progressive pigmented purpura or Schamberg’s disease. Can arise due to exercises, for no known cause, and due to venous insufficiency. It is asymptomatic and has no systemic associations. In the case of trauma will resolve over a few days.

104

Describe acrokeratosis neoplastica and its features.

A rare skin condition with features similar to psoriasis, it is more often that not asssoicated with squamous cell carcinoma of the upper respiratory or gastrointestinal tract. It is far more common in males.

Features:
-Scaling dermatosis of the fingers and toes which spreads to the nails.
-Scaly eruptions on the external ears that progress to involve the cheeks and nose.
-Diffuse scaling and thickening of the palms and soles keratoderma with peculiar honeycomb appearance
-may be itchy.
-also malignant features e.g. weight loss, Malaise.

105

Describe exofoliative dermatitis and its features

A spread erythema and scaling of the skin. Erythematous skin begins to desquamation around days 2-6 and this is followed by pigmentation similar to tanning after sunburn. The pigmentary change may be permanent or resolve rafter a few months and can be hypo or hyperpigmentation,