DERMATOLOGY Flashcards
(131 cards)
1
Q
Vitiligo
A
Autoimmune which results in loss of melanocytes and depigmentation of skin. Affects 1% typically first presents 20-30 years old.
Peripheries more affected
Trauma may precipitate new lesions- koebners phenomenon.
Associated with type 1 DM, Addison’s disease, thyroid disorders.
2
Q
Lichen planus
A
Thought to be immune mediated. Itchy papular rash most common on palms soles genitalia and flexor surfaces of arms. Also in mouth Koebnar phenomenon Oral involvement in 50% Thinning of nail plate Tx is topical steroids
3
Q
Acne Rosacea
A
Typically affects nose cheeks and forehead
Flushing is often first symptom
Telangiectasia are common
Later develops into persistent erythema with papules and pustules
Rhiophyma
Blepharitis
Tx topical methronidazole, soolantra-ivermectin
4
Q
Alopecia areata
A
Autoimmune
5
Q
Pityriasis Versicolour
A
Superficial cutaneous skin infection caused by malassezia fur furfur.
Most commonly effects trunk
Patches may be hypopigmented, pink or brown
May be more noticeable after suntan
Mild pruritus
Topical antifungal/ ketoconazole shampoo for large areas.
6
Q
Bullous Pemphigoid
A
Autoimmune- ab develop against hemidesmosomal proteins
More common in elderly Itchy tense blisters around flexures Blisters usually heal without scarring Mouth is often spared Referral to deem for biopsy- igG adnC3 Oral corticosteroids
7
Q
Pyoderma gangrenosum
A
Typically on lower limbs Initally small red papule Later deep red necrotic ulcer with a violaceous border May be accompanied by fever, myalgia 50% idiopathic IBD RA SLE Primary binary cirrhosis Oral steroids to tx
8
Q
Erythema ab igne
A
Caused by over exposure to IR.
CHARACTERISTICS; reticulate erythematous patches with hyperpig and telangiectasia.
Can develop into squamous skin
Hot water bottles and fires
9
Q
Polymoprhic eruption in pregnancy
A
Pruitt can condition associated with last trimester
Lesion often first appear in abdo striae
Mgmt depend on severity; emollients mild potency steroids
10
Q
Pemphigoid Gestationis
A
Pruritic blistering lesion
Often develop in peri umbilical region later spreading to the trunk back buttocks and arms
Usually presents in 2nd 3 rd trimester and is rarely seen in the first preg
Oral corticosteroids are usually required
11
Q
Scabies
A
Spread by prolonged skin contact
Scariest mite lay eggs in stratum cornermen
Intense pruritus is associated with the delayed type Iv hypersensititvy to mites/eggs- occurs 30days after initial infection
Fts
Widespread pruritus
Linear burrows on the side of fingers, interdigital webs and flexor aspects of the wrist
In infants- face and scalp
Permethrin 5% first line
Pruritus persists up to 4-6 weeks post eradication
12
Q
Psoriasis
A
2% prevalence
Red scaly patches on skin
Increased risk of arthritis and cardiovascular disease, metabolic syndrome venous thromboembolism
Subtypes- plaque- most common - extensor surfaces
Flexures- skin smooth
Guttate- triggered by strep infection, multiple red teardrop lesions appear on the body
Pustular - palms and soles
Other fts;
Nail pitting and onycholysis
Arthritis
13
Q
Seborrhoeic dermatitis
A
Thought to be caused by proliferation of malassezia furfur. 2% of pop
Fts; eczematous lesions on the sebum rish areas- scalp periorbital auricular and nasolabial folds
Associated with HIV and Parkinson’s
Mgmt; zinc pyrithione , antifungal, topical steroids, difficult to tx.
14
Q
Leukoplakia
A
Premalignant condition
Presents as hard white spots on mucous membrane of mouth
More common in smokers
Diagnosis of exclusion- candidiasis and lichen planus should be considered- especially if lesions rub off
15
Q
Squamous carcinoma of skin
A
COMMON
Mets are rare
From; excessive exposure to sunlight
Actinic keratosis and bowens disease
Immunosuppressive
Long standing leg ulcers- Marjolins ulcer
16
Q
Seborrhoeic keratosis
A
BENGIN EPIDERMAL SKIN LESIONS seen in older Doppler
Large variation of colour from flesh to light brown to black
Have stuck on appearance
Keratotomy plugs may be seen on the surface
17
Q
Cherry haemangioma
A
Cherry haemangioma Campbell de Morgan spots- benign skin lesions which contain an abnormal proliferation of capillaries More common with increasing age. Erythematous papular lesions Typically 1-3 mm in size Non blanching Not found on mucous membrane
18
Q
Spider naevi
A
Central red papule with surrounding capillaries
Lesion blanch upon pressure
Almost always found on the upper part of the body
10-15% of people will have one or more
Associated with liver disease
Preg
Cocp
19
Q
Actinic keratoses
A
Actinic keratoses
Common premalignant skin lesion- due to chronic sun exposure
Small crusty, scaly lesions
May be pink red brown or same colour as skin
Typically on sun exposed areas multiple lesions may be present
Mgmt; prevention of further risk
FU cream 2-3 week course
Topical hydro after to settle inflammation
Topical imiquimod
20
Q
Basal cell carcinoma
A
Most common skin cancer
Lesions known as rodent ulcers- slow growth and local invasion
Mets are rare
Sun exposed sites
Initally pearly flesh coloured appearance, rolled up edges, telangiectasia
May ulcerate
21
Q
Fungal nail infection
A
Onychomycosis is a fungal infection of the nails.
May be causes by dematophytes- T. Rubrum accounts for 90%
Yeasts- candida
Non derma mounds
Up slightly nails are a common reason for presentation
Thickened rough opaque nails
Nail clippings
Scrapings of the affected nail
Tx is successful in 50-80% of people Diagnosis should be confirmed by micro before tx Oral terbinafine 6 weeks to 3 months for fingernail 3-6 months toenails
22
Q
Dermatitis heretiforms
A
Autoimmune blistering of skin associated with coeliac disease
Caused by deposition of IgA in dermis
Itchy vesicular skin lesions of extensor surfaces
Tx by gluten free diet
Dapsone
23
Q
Guttate psoriasis
A
More common in children and adolescents
May be prescipitated by a strep infection 2-4 weeks prior
Tear drop papules on the trunk and limbs
Most cases resolve spontaneously within 2-3 months
Ubv phototherapy
Rarely seen on soles
24
Q
Differential diagnosis for shin lesions
A
Erythema nodosum
Pretibial myxoedema
PYODERMA GANGRENOSUM
Necrobiosis lipoidica
25
Erythema nodosum
Symmetrical erythematous tender nodules which heal w/o scarring
Most common causes are strep infections, sarcoidosis, IBD and drugs- penicillin, sulphonamides and oral pill
26
Pretibial myxoedema
Symmetrical erythematous lesions seen in Graves' disease
| Shiny orange peel skin
27
Pyoderma gangrenosum
Initially small red papule
Later deep red necrotic ulcers with a violaceous border
Idiopathic in 50% may also be seen in IBD, connective tissue disorders nad myeloprolif disorders
28
Necrobiosis lipoidica
Shiny painless areas of yellow/ red skin typically on the shin of diabetics
Often associated with telangiectasia
29
Erythema nodosum
Infammation of sub q fat
Typically causes tender erythematous nodular lesions
Usually occurs over shins- ,at be else here
Usually resolves In6 weeks
Heals without scarring
```
Causes;
Infection- strep, to, brucellosis
Systemic- sarcoidosis, IBD, behcets
Malignancy
Drugs- penicillin sulphonamides and cocp
Pregnancy
```
30
LICHEN SCLEROSUS
Inflammatory condition which usually affects the genitialia and is more common in elderly females
Itch is prominent
Topical steroids and emollients to tx
Increased risk of vulval cancer
31
Alopecia areata
Autoimmune causing localised demarcated patches of hair loss. Edge of hair loss exclamation hairs
Hair will regrow in 50% in 1 year. 80-90% eventually.
32
Impetigo
Superficial bacterial infection caused by strep pyogens or staph aureus.
Features; golden crusted skin lesions typically found around the mouth. Very contagious
Mgmt; limited localised disease
Topical fusiliers acid is first line
Extensive disease oral flucloxacillin
33
Skin manifestations of SLE
Discoid lupus
Photosensitive butterfly rash
Alopecia
Livedo reticularis
34
HSV
Two strains 1 and 2.
Primary infection may present with severe gingivostomatitis, cold sores, painful genital ulceration.
Oral acid lover, chlorhexidine mouthwash
C section recommended if you get an attack of herpes after 28 weeks
35
Eczema in children
15-20% if kids
Typically presents before 6 months but clears in 50% by 5 years, 75% by 10.
In infants face and trunk often effected,
Younger children's extensor surfaces
Older flexor surfaces
36
Acanthosis nigricans
| I
Occurs mainly in axillary, groin and back of neck and appears as a thickened brown velvety patches of skin.
Skin tags often found in area.
Obesity associated an is the most common type and is often linked to insulin resistance.
Also associated with Cushing syndrome, pcos and drugs like nicotinic acid and systemic corticosteroids, pill.
Rare cases can be a sign of malignancy- stomach cancer.
37
Keloid scarsmpet
Tumour like lesions that arise from the connectivee tissue of a scar and extend beyond the dimensions of the original wound.
More common in those with dark skin.
Young adults
Sternum most common, shoulder, neck face
Less likely if incisionsa re made along relaxed skin tension lines.
Early tx intra lesion also steroids
Excision is sometimes required.
38
Keratoacanthoma
Benign epithelial tumour.
More frequent in middle age and no not become more common in increasing age
Looks like a volcano or crater
Initally smooth dome shaped papule
Rapidly grows to become a crater filled with keratin
Spontaneous sregression within 3 months is common, often results in scar. Removed often because difficult clinal you to exclude squamous cell. Removal may prevent scarring.
39
Acne vulgaris mgmt
Usually in adolescence
Face neck upper trunk
Comedones inflammation and pustules
Mild- open and closed condones with or without inflamm lesions
Mod- wind spread non inflamm- papules and pustules
Severe- extensive inflamm lesions
No role in diet modifications
40
Fungal nail infections
Onychomycosis- fungal infection
May be caused by dermatophytes- trichophyton rubrum 90%
Yeasts Candida
Non dermatophye mounds
Oral terbinafine
41
Lichen planus
Skin disorder immune mediated
Itchy , papular rash most common on palms soles genitilia and flexor surfaces of arms
Rash often polygonal in shape white lace pattern on the surface.
Koebner phenomenon
Oral involvement in 50%
Nails; thinning of the plate and lontiduinal ridging
Causes gold, quinine thiazides
Tx topical steroids
6 p's planus; pruritic, purple papular and polygonal - flexor
42
Vasulitides
Large vessel
Temporal arteritis
Takaysau ateritis
Medical vessel
Polyarthritis nodosa
Kawasaki disease
Small vessel
ANCA
Henoch schonlein
43
Venous ulceration
Seen above medial malleolus
ABPI- Normal 0.9-1.2
Below 0.9 arterial disease
Above 1.3 arterial disease
Mgmt
Compression bandage
Oral pentoiftyline- vasodilator
44
Dermatomyositis
```
Inflamm disorder causing symmetrical proximal muscle weakness and characteristic skin lesions
May be idiopathic or associated with connective tissue disorders or underlying malignany- gastric and ovarian tumors
ANA
Skin fts
Photosensitive
Macular rash over back and shoulder
Heliotrope rash in periorbital region
Gottrons papules- extensor of fingers
Nail fold capillary dilatation
```
```
Other fts
Proximal muscle weakness +- tenderness
Raynauds
Respiratory muscle weakness
Interstitial lung disease
Dyspagia
Dysphona
```
45
Actinic keratoses
```
Common premalignat skin lesion- consequence of sun exposure
Fts; small, crusty, scaly lesions
May be skin brown or same colour as skin
Typically on sun exposed areas
Multiple lesions may be present
```
Mgmt
5fu
Avoid sun
46
Lentigo maligna
Type of melanoma in situ.
Typically progresses slowly
Asymmetrical as opposed to symmetrical seen in solar lentigo.
47
Drug induced lupus
Usually resolves after stopping drug
Fts arthralgia, myalgia, malar rash, pleurisy
Ana positive in 100% dsDNA neg
Most common causes;
Procainamide- anti arrhythmic
Hydralazine- smooth muscle relaxant- HTN tx.
Less common
Isoniazid
Minocyclin
Phenytoin
48
Eczema herpeticum
Primary infection of the skin by herpes simplex 1 or 2. More commonly seen in children with atopic eczema.
Admission for IV aciclovir.
49
Rheumatic fever
```
Develops 2-6 weeks after strep pyogenes infection
Fts
Erythema marginatum
Chorea
Polysrthritis
Carditis
Subcut nodules
```
Minor
Raised crp esr
Pyrexia
Prolonged PR
50
Liver disease fts
History of alcohol excess
Stigamata - spider naevi, bruising, palmar erythema, gynecomastia
Evidence of decompensation; as cites, jaundice, encephalopathy
51
Iron def anaemia
```
Pallor
Koilonychia
Strophic glossitis
Post cricoid webs
Angular stomatitis
```
52
Polycythemia
Pruritus after warm bath
Ruddy complexion
Gout
PUD
53
CKD
Lethargy and pallor
Oedema and weight gain
Hypertension
54
Lymphoma
```
Night sweats
LN
Splenomegaly
Hepatomegaly
Fatigue
```
55
Stephen Johnson syndrome
Severe form of erythema multoforme- mucosal involment and systemic symptoms
Fts;
Rash has target lesions - may develop into vesicles or bulla
Mucosal involement
Systemic symptoms- fever arthralgia
```
Causes;
Idiopathic
Bacteria- mycoplasma, strep
Virus- herpes simplex
Drugs- penicillin, sulphonamides, lamotrigine, carbamexepine allopurinol NSAIDS, pill
Sarcoidosis
Malignancy
```
56
Breslin thickness
Single most important factor in determining prognosis of patients with malignant melanoma
<1mm 5 year survival 95-100
>4 50%
57
Bowens disease
Untraepidermal squamous cell carcinoma
More common in elderly females
3% chance of developing into invasive skin cancer
Red scaly patches
Often occur in lower limbs
58
Isotretinoin side effects
```
Teratogenic
Dry skin eyes lips
Low mood
Elevated TAG
Hair thinning
Nose bleeds
Benign intracranial hypertension - no tetracyclines too
Photosensitivity
```
59
Chrondrodermatitis nodularis helicis
Benign condition
Development of painful nodule on ear
Persistent pressure on ear
More common in men
Mgmt
Ear protectors for sleeping
Steroid/ collagen injections
60
Pityriasis rosea
Acute self limiting rash
Affects young adults
Viral mediated
Herald patch on trunk
Erythematous oval scaly patches which follow a characteristic distribution / fir tree
Self limiting usually disappears after 4-12weeks
61
Hereditary haemorrhagic telangiectasia
Olser Weber- Rendu syndrome
Autosomal dominant condition
Multiple telangiectasia over the skin and mucus membranes
20% of cases occur spontaneously without prior family history,
Epitaphs
Tell Angie tases
Family hx
62
Psoriasis- exacerbating factors
Trauma
Alcohol
Drugs- beta blockers, lithium, antimalarials, NSAID ace
Withdrawal of systemic steroids
63
After burns- children
Stress ulcers- duodenum
64
Rhabdomyolysis
Electrical high voltage burns .
ATN may occur
Aggressive iV fluids
65
Circumfrenential burns
Constrict the limb and cause compartment syndrome- eshcarotomy and decompression
66
Burns
Immediate first aid- ABC
Remove person from source
Irrigate within 20mins with cool water
Cover with cling film- layer don’t wrap
Lung and browder- most accurate method
67
Types of burns
Superficial epidermal- red and painful
Superficial partial thickness- pale pink , blistered
Deep partial thickness- white but may be patches of non- blanching erythema, reduced sensation
Full thickness- white, black, no blisters, no pain
68
Referral to secondary care
All deep dermal and full thickness burns
Superficial dermal burns more than 3% tbsa adult or 2% children
Superficial dermal burns involving face, hands, feet, genitalia and flexors or circumferential burns of limbs torso
Electrical or chemical
Suspicion of non accidental injury
69
Pathophysiology of severe burns
After burn- local response with progressive tissue loss and release of inflammatory cytokines
Systemically there are cvs effects from fluid loss and sequestration of fluid into the third space
Catabolic response
Immunosupression
Sepsis
70
Mgmt of severe burns
IV fluids for children >10% Tisa, adults 15%.
Parkland formula- volume of fluid= tbsa of burn x weight x 4. Half fluid in first 8hrs since burn.
Catheter insertion
Analgesia
Referral for complex burns, hand, face, perineum large Tisa
71
Hyperhidrosis
Excessive production of sweat
```
Mgmt;
Topical aluminum chloride- s/e skin irritation
Iontophoreiss- palmar and axillary
Botox- axillary
Endoscopic transthoaracic sympathectomy
```
72
Lipomata
```
Benign tumor of adipocytes
Occur in Middle aged adults
Smooth, mobile, painless
Subtypes; angiolipoma, angiolipoleiomyoma
Malignant transformation is rare
```
```
Worried if
>5cm
Increasing size
Pain
Deep anatomical location
```
73
Seborrhoeic dermatitis
First line tx is ketoconazole
74
Erythema multiforme
Hypersensitivity reaction most commonly triggers by infections
Minor and major forms
SJS is not a severe form- now a separate condition
```
Fts
Target lesions
Initially seen on back of hands/ feet before spreading to torso
Upper limbs most commonly affected
Pruriris mild and less common
```
75
Causes Erythmea multi force
```
Viruses; hsv- most common
Idiopathic
Bacteria- strep, mycoplasma
Penicillin, sulphonamides, carbamazepine, allopurinol, cocp, NSAID
CTD
Sarcoidosis
Malignancy
```
76
Athletes foot
Tinea pedis
Scaling flaking and itching between toes
Topical imidazole, or terbinafine
77
Pyoderma Gangrenosum features
Seen usually on lower limbs
Initially small red papule
Later deep red nectrotic ulcer with violaceous border
May be accompanied by systemic symptoms
78
Causes of pyoderma gangrenosum
```
Idiopathic
IBD
RA
SLE
Myeloproliferative disorders
Lymphoma
Myeloid leukemia
IgA
PBC
```
79
Tx for pyoderma gangrenosum
Oral steroids
80
Erythema nodosum
```
Inflammation over subq fat
Tender erythematous nodular lesions
Usually over shins- may be elsewhere
Usually resolves in 6 weeks
Heal without scarring
```
81
Causes of erythema nodosum
```
Infection- tb, step, brucellosis
Systemic disease- sarcoidosis, IBD, bechets
Malignancy
Penicillin sulphonamids, cocp
Pregnancy
```
82
Vitiligo
Autoimmine- loss of melanocytes and depigmentation of the skin
20-30. 1% of population
Fts- well demarcated patches of depigmented skin
Peripheries most affected
Koebner phenomenon
83
Conditions associated with vitiligo
```
Type 1DM
Addison’s
Autoimmune thyroid
Pernicious anemia
Alopecia areata
```
84
Mgmt vitiligo
Sun block
Make up
Early- topical corticosteroids
85
Strawberry nevi
Type of congenital haemangionma occuring in 1/20
Grow rapidly until 6-9 months then regress over a period of years
Usually don’t require treatment
Usually face scalp and back
86
Skin prick test
Drops of diluted antigen are placed on skin, skin pricked with needle.
Large number of allergens can be tested in one session.
A wheal develops if someone has an allergy.
Can be interpreted after 15mins.
Useful for food allergens and pollen
87
RAST test
Determines amount of IgE that reacts specifically with suspected or known allergens.
Results given 0-no allergy to 6- strongly positive
Useful for food allergens, inhaled allergens/ wasps bee venom
88
Skin patch testing
Useful for contact dermatitis
30-4- allergens placed on back.
Patches removed after 48hrs and interpreted
89
Contact dermatitis
Irritant contact dermatitis- non allergic rxn due to weak acids or alkalis. Often seen in hands. Erythema is typical, crusting vesicles are rare.
Allergic contact dermatitis
Type IV hypersensitivy rxn
Uncommon
Presents as acute weeping eczema which predominantly affects the margins of the hairline rather than hairy scalp itself. Topical to with a potent steroid.
90
Skin disorders associated with SLE
Photosensitive butterfly rash
Discoid lupus
Slope is
Livedo reticularis - net like rash
91
Impetigo px
Mild- topical fusidic acid
| Severe- oral flucloxacillin
92
Pressure ulcers risk factors
Malnourishment
Incontinence
Lack of mobility
Pain
93
Px of pressure ulcers
Waterlow score used to screen patients at risk of pressure ulcer
```
Mgmt;
Hydrocolloid dressing hydrogels
Referral to tissue viability nurse
Surgical debridement may be necassary
No routine to swab as it will be colonized with bacteria anyway
```
94
Hirsutism causes
```
PCOS
Congenital adrenal hyperplasia
Androgen therapy
Obesity - oestrogen converted to androgens
Adrenal tumor
Drugs- phenyton
Androgen secreting ovarian tumor
```
95
Assessment of hirsutism
Ferriman gallway scoring system >15- mod/ severe hirsutisum
96
Mgmt of hirsutism
Advise weight loss
Cosmetic techniques
COCP- co-pyprinidol(dianette) yasmin
97
PYROGENIC GRANULOMA
Often appear at sites of trauma
Overgrowth of blood vessels
Red nodules
May mimic amelanotic melanoma
98
Erythema no do sum
```
Symmetrical erythematoius tender nodules which heal without scarring
Most common causes are strep infections
Sarcoidosis
IBD
Drugs- pill penicillin and sulphonamides
```
99
Pyoderma gangrenosum
```
Initially small red papule
Later deep red necrotic ulcer with a viola exodus border
Idiopathic in 50%
IBD
Ctd
```
100
Pretibial myxoedema
Symmetrical erythematious lesions in Graves’ disease
| Shiny orange peel skin
101
Dermoid cysts
Embryological remnants and may be lined by hair and squamous epithelium
Often located in the midline
Complete excision required
102
Desmoid tumors
Commonly develop in ligaments and tendons
| Mgmt similar to soft tissue sarcomas
103
Kapsoi Sarcoma
Tumour of vascular and lymphatic endothelium
Purple cutaneous nodules
Associated with immune suppression
Classical form affect elderly males and is slow for growing
More aggressive if immunosupressed
104
Dermatitis herpetiformis
Chronic itchy clusters of blisters
| Linked to underlying gluten enteropathy
105
Dermatofibroma
Benign lesion
Firm elevated nodules
Usually hx of trauma
Lesion consists of histiocytes blood vessels and fibrotic changes
106
Pyogenic granuloma
Overgrowth of blood vessels
Red nodules
Usually follow trauma
May mimic amelanotic melanoma
107
Polymorphic eruption of pregnancy
Pruritic condition associated with last trimester
Lesions often first appear in abdominal striae
Mgmt depends on severity emollients, mild potency topical steroids and oral steroids
Not associated with blistering
108
Pemphigoid gestation is
Pruritic blistering lesions
Oftendevelop in peri umbilical region later spreading to the trunk back buttocks and arms
Usually presents 2nd and 3rd trimester and is rarely seen in first pregnancy
Oral steroids are usually required
109
Milia
Small benign keratin filled cysts that typically appear around the face,
Many appear at any age but are more common in newborns
Resolve spontaneously
110
Liver disease
Hx of alcohol excess
Stigmata of lchronic liver disease; spider naevi, bruising, palmar erythema, gynaecomastia
Evidence of decompensation; ascites, jaundice, encephalopathy, iron def anaemia
Other signs
Koilonychia, strophic glossitits, post cricoid webs.
111
Polycythaemia
Pruritus after warm bath
Ruddy complexion
Gout
Peptic ulcer disease
112
Chronic kidney disease
Lethargy
Pallor
Oedema and weight gain
Hypertension
113
Lymphoma
```
Night sweats
Lymphadenopathy
Splenomegaly
Hepatomegaly
Fatigue
```
114
Impetigo
Superficial bacterial skin infection usually caused by staph aureus or strep pyogenes.
Ft’s golden crusted skin lesions usually found around the mouth
Very contagious
115
Mgmt impetigo
Limited localised disease- topical fusidic acid is first line
Extensive disease- oral flucloxacillin
Erythromycin if allergic
116
Molluscum contagiosum
Common skin infection caused by MCV.
Transmission occurs directly by close personal contact or indirectly via contaminated surfaces.
Usually seen 1-4 years
117
Molluscum contagiosum fts,
Pinkish or perky white papules with a central umbilication which are up to 5mm in diameter.
Lesions appear in clusters, in kids usually seen on trunk
Soles palms are spared.
118
Self care advice molluscum contagiosum
Self limiting
Spontaneous resolution occurs in 18months
Lesions are contagious but exclusion from school not needed
Cryotherapy
119
Keratoacanthoma
Benign epithelial tumour.
More frequent in middle age and do not become more common in old age.
Said to look like a volcano or crater- initally a smooth dome shaped papule.
Rapidly grows to become a crater centrally filled with keratin
Spontaneous regression within 3 months is common- may have scar.
Should be excised because need to rule out SCC. Removal may prevent scarring.
120
Sarcoidosis
Multisystem disorder of unknown aetiology characterised by non caseating granulomas.
More common in young adults and Africans
121
Features of sarcoidosis
Acute; erythema nodosum, bilateral hilar lymphadenopathy, swinging fever, polyarthralgia.
Insidious; dyspnoea, non productive cough, malaise, weight loss
Skin; lupus pernicious
Hyerpcal- macrophages inside the granulomas cause an increase in conversion of vit D to active form.
122
Lofgren’s syndrome
Acute form of sarcoidosis characterised by bilateral hilar lymphadenopathy, erythema nodosum, fever and polyarthralgia. Excellent prognosis
123
Heefordt’s syndrome
There is parotid enlargement, fever and uveitis secondary to sarcoidosis
124
Syndromes associated with sarcoidosis
Lofgren’s syndrome
| Heerfordt’s syndrome
125
Sarcoidosis presentation and treatment
Often asymptomatic but can present acutely with arthritis- often sudden onset
Ace levels are normally high.
Treatment involves steroids and surveillance of hilar LN using CXR.
126
Toxic epidermal necrolysis
Potentially life threatening skin disorder - most commonly seen secondary to drug reaction.
Skin develops a scalded appearance over an extensive area.
127
Features of TEN
Systemically unwell
| Positive Nikolsky’s sign; the epidermis separates with mild lateral pressure
128
Drugs known to induce TEN
```
Phenytoin
Sulphonamides
Allopurinol
Penicillin
Carbamazepine
NSAIDs
```
129
Mgmt of TENS
IV immunoglobulin
Immunosuppressive
Plasmapheresis
130
Acne Vulgaris
Common skin disorder usually appears in adolescents
Effects the face neck and upper trunk
Due to obstruction of pilosevaceous follicle with keratin plugs which results in comedomes, inflammation and pustules
Effects 80-90% of teenagers
10-15 % F over 25
5% males
131
Granuloma annulare
Papular lesions that are often slightly hyperpigmented and depressed centrally
Occur on the dorsal surfaces of hands and feet and extensor of arms and legs
