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Year 4 > Dermatology > Flashcards

Dermatology Flashcards

(71 cards)

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1
Q

What is a macule?

A

An area different in colour or consistency with no elevation

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2
Q

What is a papule?

A

Raised lesion <1cm diameter

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3
Q

What is a nodule?

A

Raised lesion >1cm

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4
Q

What is a plaque

A

Circumscribed, superficial, elevated plateau area

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5
Q

What is a vesicle?

A

Raised lesion containing fluid

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6
Q

What is a bulla

A

Large lesion containing fluid >0.5cm

Looks like a blister

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7
Q

What is a pustule?

A

Circumscribed lesion containing pus

May be white or yellow

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8
Q

What is an erosion?

A

Loss of epidermis that generally heels without scaring

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9
Q

What is an ulcer?

A

Deeper loss of epidermis/dermis

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10
Q

What is a patch?

A

Large area of colour change

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11
Q

What is the pathophysiology of eczema?

A

Immune response occurs due to exposure to irritants and allergens
This immune response leads to breaks the layers of the skin
Water leaks out and skin becomes dry and itchy

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12
Q

What factors can exacerbate eczema?

A 
Stress
Sweat
Climate 
Foods
House dust mite
Infection
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13
Q

If atopic eczema is present in a child, will it progress to adulthood?

A

10-20% of children have it
Only 1-2% adults have it
As some children grow older, their skin disease may improve or disappear altogether, although their skin often remains dry and easily irritated

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14
Q

Which protein is mutated in 50% of cases of severe eczema?

A

Filggrin (FLG)

This is a protein in the epidermis which helps the layers to stick - loss of protein leads to break in the epidermal layer making it easier for irritants and allergens to enter the skin with resultant inflammation

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15
Q

In which area of the body is eczema more common?

A

Flexor surfaces

Note in infancy the cheeks is the most common place

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16
Q

What is eczema Herpeticum?

A

Herpes simplex virus infection of eczema areas of skin

Severe complication of eczema and may be life threatening

May be caused by being in contact with someone who has a cold sore

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17
Q

How do you spot the signs of eczema Herpeticum?

A

Areas of rapidly worsening painful eczema
Clustered blisters - that look like early stage cold sores
Skin erosions (Any skin that has broken away)
Possible fever

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18
Q

What are the life threatening complications of eczema Herpeticum?

A

Hepatitis
Encephalitis
Pneumonia

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19
Q

What is contact dermatitis?

A

A type of eczema
Due to a type IV hypersensitivity immune reaction
Either to an allergen e.g, latex, perfumes
Or to an irritant e/g, bleach, acid, pepper spray

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20
Q

What is linchenified skin?

A

Thickened skin which can be seen in areas of chronic eczema

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21
Q

What is the clinical picture of eczema?

A 
Flexural surfaces 
Dry and cracked skin 
Red itchy scaly patches 
Can be weepy or blistered 
Skin can be linchenified (thickened) in chronic eczema
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22
Q

What is the management of eczema?

A

Conservative: Avoid triggers
Emollients: e.g, diprobase, epidermis
Steroid cream: mild hydrocortisone, moderate eumovate

For more severe eczema may consider phototherapy and systemic medication

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23
Q

What kind of emollients are available and where are they best used?

A

Creams - good for daytime use as they aren’t very greasy and absorbed quickly
Lotions - good for hairy or damaged areas of skin (weeping eczema) they are thin and spread easily
Sprays - for hard to reach areas
Ointments - these are more greasy, but good for very dry skin so good for night time use. Not to be used on weeping eczema
Soap substitutes - don’t foam like normal soap (remember to pat dry)

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24
Q

How often should emollients be applied in eczema?

A

As much as you like to keep skin moisturised

Ideally 3-4 times a day

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25
How would you counsel someone on how to apply an emollient?
Apply generously Use a clean spoon or spatula to remove from a pot or tub - this reduces risk of infections from contaminated pots Be careful not to slip when using emollients in bath/shower or tiled floor - protect floor with a towel Apply in a downwards motion Apply after showering Apply before steroids
26
What are calcineurin inhibitors? Give some examples?
Immunemodulators used as an alternative to steroid therapy for eczema They suppress the T lymphocyte response Used as 2nd line treatments when you want to avoid the side effects of prolonged steroid use Examples: tacrolmius, pimecrolimus
27
What is Dupilimab?
Immuneregulator Antibody which inhibits the Th2 immune response Approved for moderate to severe eczema
28
What is the pathophysiology of psoriasis?
Autoimmune skin condition Where there is rapid turnover of skin cells (keratinocytes) Cells only take 3-5 days to migrate to surface (normal cells take 23) This causes hyperkeratosis - thickened skin and scaling Leads to immature skin cells at the surface
29
What is the auspitz sign?
When the skin of psoriasis is scraped off it reveals dilating blood vessels underneath This accounts for much of the erythema in psoriatic plaques
30
What is the clinical presentation of psoriasis?
Silver plaques - usually found on extensor surfaces Scaling Waxy appearance Erythema
31
What are the psoriatic nail changes?
Nail pitting - small depressions in the nail Subungal hyperkeratosis- chalky looking material under nail Onycholysis - lifting of nail bed Splinter haemorrhages - due to leaking of blood from capillaries
32
What are the different types of psoriasis?
Chronic plaques psoriasis (most common) - extensor surfaces Flexural Psoriasis - seen in axilla, groin, and other skin folds Pallmar plantar - lesions on palms and soles Gluttate Psoriasis - plaques on trunk and limbs Erythrodermic psoriasis - serious condition with confluence eczema effecting 90% of skin
33
What is the most common type of psoriasis?
Chronic plaque psoriasis
34
What infection usually precedes gluttate Psoriasis?
Sore throat - with associated group B strep
35
What age group does gluttate Psoriasis usually effect?
Adolescents
36
What are the triggers for Psoriasis?
``` Illness Stress Alcohol Smoking Infection - e.g, group B strep Certain drugs - lithium, beta blockers, antimalarials ```
37
What is the major risk factor for palmar planter psoriasis?
Smoking
38
What is the genetic basis for Psoriasis?
Inherited Th1 cell mediated disease
39
What is psoriatic arthopathy?
When patients with psoriasis also have arthritis in their joints due to the immune response
40
How is mild/moderate psoriasis managed?
Emollients Coal tar (only to be used on stable Psoriasis) - can normalise keratinocyte growth patterns) Calcipotrol - vit D analogues Corticosteroids - to reduce inflammation
41
How is severe psoriasis managed?
Phototherapy - 2-3 times a week for 10 weeks (UV rays slow growth of keritonocytes) Systemic treatment - methotrexate (immune modulator) Give folic acid along side it Biological agents - e.g, infliximab
42
What is the presentation of acne?
Papules Pustules Whiteheads (close comedomes) Blackheads (open comodomes)
43
What is the pathophysiology of acne?
Inside hair follicles there is sebaceous glands (oil producing) In acne an abnormal amount of oil is produced which can block the hair follicle Blocked hair follicle becomes inflamed Any harmless germs that live on skin surface can get trapped and exacerbate the situation
44
How can hormones effect acne?
Androgens can increase the size of sebaceous glands which increases the amount of oil produced
45
What are the different types of acne?
Acne vulgaris (most common) Acne excoriee - where patient picks at skin and produces erosions Infantile acne - seen in first few months of life Acne fulminans - severe form seen in tropical climates
46
How is acne graded?
Mild - no scaring, a few small comedones Moderate - no scaring, large close comedones Moderately severe - some scaring, papular and pustular acne Severe acne - severe scaring, nodules and cyst
47
What is the conservative lifestyle management for acne?
Avoid humid conditions Diet - low sugar, low protein, low dairy. Lots of fruit and veg Stop smoking - as nicotine increases sebum retention Minimise face products - as oils and cosmetics can alter skin Don't scratch or pick lesions Exposure to sunlight helps
48
How is mild acne managed?
Benzoyl peroxide face wash Topical antibitoics - e.g, erythromycin solution or gel Topical retinoids - eg, isotretinoin
49
How is moderate acne managed?
``` Benzylperoxide face wash Topical retinoids Antibiotics - e.g, tetracycline or doxyclicine 6-8 week course Oral contraception - can help with girls NSAIDs - short term use my help ```
50
What is the management for severe acne?
Oral isotretanoin
51
What must you counsel a girl on before starting oral isotretanoin
Works in 90% of cases - see improvement with 4-6 months It is teratogenic So make sure she is not pregnant and is using contraception Must wait 3 months after finishing course to get pregnant
52
What is acne rosacea?
Characterised by facial flushing, persistent erythema, talangiestasia, inflammatory pustules and oedema
53
How is acne rosacea managed?
Avoid triggers - heat, hot food/drink, spicy food, alcohol, sunlight Topical metronidazole Oral antibiotics
54
What is actinic keratoses?
Rough scaly keratotic lesions on areas of exposed skin Usually occur in patients who have worked outdoors They are a precursor for skin cancer
55
How are actinic keratoses managed?
Liquid nitrogen - for individual lesions | 5-FU cream - useful for large or multiple AKs, applied OD for 4-6 weeks
56
What is bowens disease?
Type of squamous cell carcinoma in situ Only in epidermis with no dermis invasion Seen on trunks or limbs Well defined erythematous macule with slight crusting Lesions enlarge slowly Risk of developing SCC is 3-5%
57
How is bowens disease managed?
Excision, curettage and cautery | Cryotherapy
58
What is the appearance of a basal cell carcinoma?
Small papules that slowly grow Lesions have pearly, shiny, translucent quality Characteristic rolled edge Have telangiectasia - dilated blood vessels near the surface of skin
59
What is the most common type of skin cancer?
Basal cell carcinoma
60
Where are the majority of squamous cell carcinomas found?
Head and neck
61
How can you tell the difference between a BCC and a SCC?
BCC - slow growing | SCC - rapidly growing, painful, markedly hyperkaratoic
62
What is the appearance of SCC?
Usually nodular with surface changes - crusting, ulceration, formation of cutaneous horn Hyperkeratosis surfaces
63
What risk factors are specific for SCC?
Smoking Chronic ulcers Xederma pigemntosum - autosomal recessive condition that causes extreme sun sensitivity
64
Which types of SCC have poor prognosis?
>2cm in size Lesions on lip or ear Invasion >4mm deep Poorly differentiated cells
65
What is the medical name for a mole?
Melanocytic naevus
66
What is the ABCDEF for lesions?
A - asymmetrical B - borders (regular or irregular) C - colour (any variation, is it hyperpigmented) D - diameter (>6mm (pencil rubber) is atypical) E - evolution - has it changed, over what time period F - family and friends (do others look similar)
67
What is a melanoma?
An invasive malignant tumour or melanocytes in the skin
68
What is breslow thickness?
Measures the distance in mm from the epidermis to the deepest layer of invasion in the dermis
69
How is eczema Herpeticum managed?
Admit to hospital | IV aciclovir
70
Which drugs can exacerbate psoriasis?
``` Lithium Beta blockers NSAIDs ACEi Anti-materials ```
71
What is the difference between a petechiae and a purpuric rash?
Petechiae - blanching macular <3mm | Purpura - raised blanching 3-10mm

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