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Dermatology Flashcards

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1
Q

What are the 3 features you talk about when describing a rash

A

Distribution (where on the body)
Configuration (discoid, linear)
Morphology (pustule, plaque etc)

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2
Q

What is the function of the skin

A

1) Physical barrier
2) Temperature control
3) Prevent fluid loss
4) Immunosurveillance
5) Vitamin D synthesis
6) Sensation

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3
Q

What are the layers of the skin (basic)

A

Epidermis
Dermis
Subcutaneous tissue

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4
Q

What cells can be found in the epidermis (and their function)

A

Melanocytes - UV protection
Langerhans’ cells - produce T lymphocytes and antigens
Merkel cells - sensation
Keratinocytes - physical barrier

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5
Q

What are the layers of the epidermis

A 
Each layer represents a different layer of differentiation of keratinocytes 
Stratum basale 
Stratum spinosum 
Stratum granulosum 
(+ stratum lucidum in soles etc)
Stratum cornea
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6
Q

What cells can be found in the dermis and what is the dermis made of

A

The dermis contains
Collagen
Elastin
GAG (glycosaminoglycans)

In the dermis there are

  • T and B cells
  • Nerve endings
  • Blood vessels
  • Appendages (hair and glands etc)
  • Lymphatics
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7
Q

What are skin appendages

A 
Hair 
- Laguno 
- Vellus (body) 
- Terminal (eyelashes, scalp)
Nails 
Sebaceous glands 
Sweat glands - (apocrine and eccrine)
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8
Q

What are the phases of wound healing

A

1) Haemostasis - vasoconstriction and platelet aggregation
2) Inflammation- vasodilation and NP and MP migration - phagocytosis of debris
3) Proliferation - angiogenesis, granulation tissue formation(by fibroblasts)
4) Remodelling - scar tissue formation

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9
Q

Side effects of topical steroids

A

Striae
Skin atrophy
Acne
Telangiectasia

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10
Q

Side effects of systemic steroids

A 
Cushings 
HTN 
Immunosuppression 
Diabetes 
Osteoporosis 
Cataracts
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11
Q

Side effects of retinoids

A 
Depression 
Teratogenic 
Dry skin, eyes, lips 
Liver disorders 
Myalgia 
Arthralgia 
Hypercholesterolaemia
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12
Q

Side effects of ciclosporin

A

HTN
Renal dysfunction

Check BP and U+E when giving!!

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13
Q

Definition of eczema

A

Chronic, relapsing and remitting disorder characterised by:
itchy
erythematous
scaly patches

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14
Q

What is the distribution of eczema

A

Flexor surfaces for adults and children

Infants: extensor and face

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15
Q

Aetiology of eczema

A

Fam Hx

Hygiene hypothesis

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16
Q

Pathophysiology of eczema

A 
Defect in the barrier 
- increased pH --> increased protease 
- Increased fillagrin 
Defect in immune system 
- Lots of IL 4,5,13
- Th2 mediated response

IgE and eosinophilia!

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17
Q

Eczema triggers

A 
Heat 
Sweat 
Stress 
House dust mites 
Soaps 
Infection
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18
Q

Presentation of eczema

A

Remember distribution of:
Face and trunk - infants
Flexor surfaces - child + adult

Itchy 
DRY skin
Erythematous scaly patches
Hypopigmentation 
Vesicles + weeping if acute 
Chronic scratching - lichenification
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19
Q

Criteria for eczema (atopic)

A

ITCHY + 3 of the following

1) Hx of atopy
2) Dry skin in past year
3) Active flexor involvement
4) Flexor involvement in past year
5) Onset <2

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20
Q

Management of eczema

A

1) Emollients and avoid triggers
2) TCS or TCI
3) TCS or TCI high dose
4) Systemic therapy or UV therapy

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21
Q

Complication of eczema

A

1) Bacterial superinfection - Staph A (rx fluclox)
2) Eczema herpticum (emergency) - HSV
3) Psychological disturbance

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22
Q

Definition of psoriasis

A

Inflammatory condition in which there is hyperproliferation of keratinocytes + parakeratosis

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23
Q

Presentation of psoriasis (types)

A

ITCHY erythematous scales in extensor surfaces:

1) Plaques - most common - scaly plaque - plaque falls off –> Auspitz’s sign
2) Guttate - raindrop - trunk + limbs (post strep)
3) Flexor - women + elderly
4) Seborrhic (associated with parkinsons) - nasolabial folds, retro-auricular
5) Palmer/ plantar - yellow/brown pustules
6) Erythrodermic - redness all over

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24
Q

Extra-dermal features of psoriasis

A 
Psoriatic arthritis 
Nail changes 
- Pitting 
- Onychomycosis 
- Beau's lines
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25
Aetiology of psoriasis
``` Post strep (guttate) Trauma (koebner's phenomoenon) Genetics Environment Drugs - BB - Lithium - Antimalarials - NSAIDS - ACE i ```
26
Drugs which worsen psoriasis
``` BB Lithium Antimalarials NSAIDS ACE i ```
27
Management for psoriasis (plaque)
Potent TCS OD + vit D analogue OD After 8w: ^ vit D to bd then potent TCS BD orrr coal tar preparation Other: Phototherapy (UV-B) Photochemotherapy SE: SCC, skin ageing Systemic: - Oral methotrexate (good if articular features too) - Infliximab - Ciclosporin (SE: HTN, renal dysfunction)
28
Contact dermatitis Types Investigation Management
Irritant - local Allergic - systemic - type IV hypersensitivity Investigations - patch testing Management - Irritant - emollient/ TCS Allergic - TCS
29
Seborrhoeic dermatitis | Pathophysiology
Inflammatory disorder due to overgrowth/proliferation of malassezia furfur (fungus) //inflammatory response to a normal skin inhabitant malassezia furfur
30
Seborrhoeic dermatitis presentation
Red itchy greasy skin in the distribution of: Adults - Nasolabial folds - Periauricular - Periorbital - Scalp - Anterior chest Children - Cradle cap - Nappy area - Flexors (limbs) - Face
31
Conditions associated with seborrheoic dermatitis
HIV | Parkinson's
32
Management of seborrhoeic dermatitis
Adults scalp - coal tar shampoo/ head and shoulders - or Tketoconazole/ TCS Adult other TCS/ketoconazole - if >3m can have oral ketoconazole Child - usually spontaneously resolves within 12m - can give emollients / TCS
33
Acne vulgaris definition
inflammatory skin condition of pilosebaceous follicles
34
Aetiopathophysiology of acne vulgaris
Excess androgens - Puberty - PCOS - Cushings - steroid use Excess androgens --> --> increase in sebum production --> comedone --> infection of comedone by propionibacterium acnes --> inflammation of the infection
35
Types of acne vulgaris + presentation
Non-inflammatory Open comedone - blackhead Closed comedone - whitehead Inflammatory - Papules/ pustules - Nodules - Cysts
36
Management of acne
Step wise Single - - keratinolytic - salicylic acid/benzol peroxide/ topical retinoid 2nd combined topical Oral abx and topical retinoid - Oral retinoid - Anti-androgens - COCP
37
Complications of acne vulgaris
- Psychological - Hyperpigmentation (post-inflammatory) - Scarring
38
SCC of the skin | Definition and RFs
Definition: malignant disease of the keratinocytes and their skin appendages (its fast growing, high recurrence rate, low met rate) RFs - UV - Previous SCC (big RF) - Immunosuppression - Chronic inflammation - Smoking - Actinic keratosis (pre-malig)
39
Presentation of SCC of the skin
Keratotic (scaly, crusty) Ill defined nodule Ulceration and bleeding Other - lymphadenopathy - hepatomegaly
40
Spread of SCC of the skin
RNL, Lung, liver, brain, bone
41
Pre-malignant conditions of SCC
Pre-malignant - actinic keratosis | In situ - bowen's (has not invaded the basement membrane)
42
Management of SCC
In situ (Bowen's) - cryotherapy/ topical chemotherapy (fluoracil) <2cm - wide surgical excision >2cm/cosmesis - mohs micrographic surgery Mets - + radio
43
BCC Definition RFs
Definition: locally invasive malignancy of epidermal keratinocytes airsing from hair appendages RF - Age - Male - Immunosupp - UV - Previous
44
Morphological types of BCC
Pearly flesh coloured lesion May have telangiectasia May have ulcerated --> central crater ``` Nodules - most common, necrotic centre Superficial - thread border, erythmatous Cystic - yellow Morphoeic - blue/grey/brown Pigmented ```
45
Investigations for BCC
Biopsy | CT
46
Management of BCC
``` Surgical excision Curettage Cryotherapy Imiquimod Mohs Radio ```
47
Malignant melanoma Definition RFs Distribution
``` malignancy of melanocytes RF - UV - Fam Hx - Immunosupp - Previous ``` Distribution: Women - legs Men - trunk
48
How to describe a pigmented lesion
``` ABCDE Asymmetry Border Colour Diameter Evolution ```
49
Types of malignant melanoma
Superficial (most common) - legs Nodule - trunk - most aggressive - rapidly enlarging lump Lentigo melanoma - face Acral lentiginous - palms, soles, not related to UV, can get subungal pigmentation - hutchinson sign - black nail stripe
50
Where does melanoma met to
LIVER | BONE
51
Classification of malignant melanoma in biopsy
Breslow's thickness and Clark's level
52
Management of melanoma
In situ - wide local excision Melanoma - surgical excision + Sentinal node biopsy Mets - + radio/chemp
53
Complications of melanoma
- Surgery to skin – infection, bleeding etc - Lymph surgery – lymphoedema - Recurrence – recurrence rate based on Breslow thickness
54
``` Cellulitis Causative organisms RFs Presentation Investigations Criteria Management ```
Staph A Strep pyogenes RFs - Immunocomp - Ulcers - Poor healing - eg poor nutrition, poor vasculature from DM etc - Erythematous, pain Rule out DVT Nec Fasc Investigations - Blood cultures, skin swab yada yada Eron classification - urgently admit to hospital someone with III or IV, OR - v young, v old - immunocomp - Significant lymphoedema - facial - rapidly deteriorating Criteria - who to give IV abx to? - class III and IV (II = a grey area and depends on local guidelines I - no systemic upset/ co-morbs II - systemic upset/ no S upset and co-morbs III - systemic upset + co morbs IV - sepsis
55
Eron classification for cellulitis
Admit urgently to hospital for abx IF: - III or IV - Immunocompromised - Y young (<1 or v old - Facial cellulitis - Significant lymphoedema - Rapidly deteriorating
56
Management of cellulitis
Oral Fluclox (clindamycin if allergic) Severe - IVBenzyl and fluclox (unsure check this) Orbital - co-amox
57
Scalded skin syndrome Organism Presentation Management
Staph - coag +ve - epidermolytic toxin eryethema - desquamates on pressing it (Nickolsky's sign) --> flaccid bullae (fluid filled blisters) PAINFUL cracked around the mouth Where? Face + neck Axilla Groin Management - FLUIDS FLUIDS FLUIDS - these poor kiddos can get so DEHYDRATED - Fluclox
58
Cause and management of warts
HPV - 6-11 Management - Cryotherapy - Silver nitrate - Salicylic acid
59
``` Molluscum contagiosum Cause Spread Presentation Management ```
Cause - Molluscum contagiosum virus (MCV) Spread - skin skin contact/ sexually in adults Presentation - FACE AND GROIN - pearly white smooth papule Management - self limi
60
``` Scabies Cause Spread Presentation Investigations Management ```
Mites Skin skin/ overcrowded conditions Presentation: - Erythematous papules - Linear burrows - ITCHY AF - In between fingers! Investigations Clinical diagnosis but can confirm by skin scrapings Management - Permethrin - to ALL household contacts + wash clothes and bedding at 60 degrees
61
``` Bullous pemphigoid What is it Presentation Investigations Management ```
Autoimmune disease in which the body creates antibodies against hemidesmosal (in dermis and epidermis) ``` Presentation ITCHY erythematous tense blisters - Trunk - Limb flexures (mouth usually spared) Preceded by a rash ``` Investigations Immunofluoresc Skin biopsy (refer to derm) Management - Oral Steroids - Immunosupressants - Abx
62
Pemphigoid vulgaris What is it Presentation Management
Autoimmune conditions in which there are antibodies against desmoglein 3 Presentation Mouth ulcers - then months later can get --> Flaccid blisters that are easily broken PAINFUL not itchy Management Steroids Immunosup
63
``` Impetigo Cause Presentation Investigations Management ```
``` Cause staph A (can be strep pyogenes) ``` Presentation Golden crusted lesions around the mouth - common in kiddos RF - Post-trauma - Eczema ``` Management Limited disease - Topical fusicid acid - Topical retampulin - Topical murpirocin - if MRSA ``` Extensive disease - Oral fluclox
64
School exclusion in impetigo
when lesions have crusted or 48hrs after abx commenced
65
Pathophysiology of venous ulcers
incompetent valves + chronic venous insufficiency --> stasis of blood flow/ blood flows into the superficial veins rather than to the heart --> oedema, venous eczema, varicose veins
66
Signs and symptoms of venous ulcer + RFs
Site - medial and lateral malleolus, (+ between the knee and ankle) Edge -shallow, irregular border, sloping edges Base - moist, granulomatous base PAINLESS (or pain relieved by elevation) RFs - Age - Smoking - Fam Hx - Orthostatic occupation
67
Signs and symptoms of venous insufficiency
Ankle oedema Heavy legs ``` Dry scaly skin Itching Ulcers/ varicose veins Lipodermatosclerosis Hyperpigmentation ```
68
Venous ulcer investigation
Measure SA ABPI swab + culture Doppler studies
69
Management of venous ulcer
debridement +/- abx if infection compression (if ABPI >0.9) Occlusive hydrocolloidal dressing
70
Appearance of arterial ulcers
Site - dorsal foot, toe, heel Edge - punched out - cold shiny surrounding skin Base - grey granulomatous PAINFUL Does not bleed on probing
71
Investigations for arterial ulcers
ABPI <0.9 DO NOT FUCKING USE COMPRESSION Doppler studies Angio +/- stent
72
Appearance Management of neuropathic ulcers
Site - plantar surface of metatarsal and hallux Edge - punched out - surrounded by chronic inflammatory tissue Base - sloughy/ necrotic Management - diabetic foot care eg footwear
73
Complications of psoriasis
``` Psychological Psoriatic arthritis Increased risk of: VTE CVA Metabolic syndrome ```
74
Complications cellulitis
Sepsis Gangrene Osteomyelitis
75
Necrotising fasciitis Cause RF Pres Rx
``` Cause Strep progenies (group A strep) ``` RF - Diabetes - Abdominal surgery Pres - SEVERE PAIN - Especially out of proportion to the physical signs (v key info) - Systemic upset - Erythematous, necrotic skin - Haemorrhagic bullae - Subcutaneous emphysema Rx - URGENT Surgical debridement - Broad spec abx VANC + TAZ
76
Pres Nec fasciitis
- SEVERE PAIN - Especially out of proportion to the physical signs (v key info) - Systemic upset - Erythematous, necrotic skin - Haemorrhagic bullae - Subcutaneous emphysema
77
Symptom to distinguish from arterial v venous ulcers
Arterial are PAINFUL
78
Acne rosacea Presentation
``` Flushing – first symptom Dilated telangiectasia Later --> Inflammatory papules + pustules Rhinophyma Occular – blephartiris SYMMETRY ```
79
Good way to differentiate acne v from R
Obvs flushing etc in acne R but also is SYMMETRICAL
80
Triggers of acne rosacea
Sunshine Alcohol Stress Hot bath/drinks
81
Acne rosacea Rx
Topic abx - metronidazole Oral abx - tetracycline Telangiectasia - laser therapy Other - Wear sunscreen - Anti-inflammatory like azelaic acid
82
Seborrhoeic keratosis Definition Presentation Association Rx
Definition Common multiple benign skin lesions ``` Presentation Face and trunk STUCK ON lesions May be warty Grey/brown/black PAINLESS ``` Association UV sun damage Rx TCS if itchy Flat – Cyrotherapy Raised – curettage
83
Lichen planus Definition Presentation Rx
Definition Inflammatory skin condition Presentation The Ps Pruritis, Purple, Papule, polygonal rash ``` INTENSE ITCHING Flat shiny white papules Wickham striae - white lacy network MUCOSAL INVOLVEMENT nail thinning ``` ``` Rx Cutaneous - TCS + antihistamine Oral - TCS/ oral steroid Genital - TCS/ TCI/ ?imiquimod ``` Triggers - Gold - Thiazides - Quinine
84
SCC that has not invaded the basement membrane is called a what
BOWEN'S | Carcinoma in situ
85
68 y/o male has been told by his GP he has a pre-malignant condition due to chronic UV exposure What does the GP mean by this
Actinic keratosis (pre-malignant to SCC)
86
Most important prognostic factor in malignant melanoma
depth (breslow's thickness)
87
Mets of malignant melanoma
LIVER | BONE
88
Erythema nodosum | definition
inflammation of the subcutaneous fat
89
Erythema nodosum | Presentation
Tender Erythematous nodules Typically on shins
90
Erythema nodosum | Causes
``` NODOSUM NO - idiopathic Drugs - penicillin, sulphasalazine OCP/ pregnancy Sarcoidosis/ TB UC/crohn's Micro - strep ```
91
Erythema nodosum | Rx
Rx cause | Resolves in 6w
92
What investigation could you do in someone with erythema nodosum
CXR - rule out TB and sarcoidosis
93
Erythroderma Definition Aetiology Rx Complications
Definition When >95% body is a rash Aetiology - Eczema - Psoriasis Rx - Replace fluids - Emollients - Wet wraps ``` Complications DEHYDRATION High output cardiac failure (SOB!) Electrolyte ∆ Hypothermia ```
94
Erythroderma complications
DEHYDRATION High output cardiac failure (SOB!) Electrolyte ∆ Hypothermia
95
Erythema multiforme
Hypersensitivity reaction Usually HSV TARGET LESION - back of hands + feet and then --> body Rx Rx cause
96
TARGET LESION - multiple on back of hards
Erythema multiforme
97
Pyoderma gangrenousum Aetiology Presentation Rx
Aetiology IBD RA/ SLE Presentation Small red papule --> later --> deep red necrotic ulcer Rx Oral steroids Immunosuppression
98
Skin lesions in IBD
Pyoderma gangrenosum

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