Dermatology Flashcards

(120 cards)

1
Q

What is acanthosis nigricans?

Causes of acanthosis nigricans

A

Symmetrical, brown, velvety plaques on the neck, axilla and groin

Seen in: GI cancer, DM, obesity, PCOS, Cushings disease, acromegaly, hypothyroidism, familial, prader willi
Drugs: OCP, nicotinic acid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Features of acne rosacea

A
nose, cheeks and forehead
Flushing
Telangiectasia
Later develops into persistent erythema with papules and pustules
Rhinophyma
Blepharitis
Sunlight may exacerbate symptoms
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Management of acne rosacea

A

Topical metronidazole for mild symptoms
Abx (oxytetracycline) for more severe disease
Laser therapy for telangiectasia

High factor sunscreen
Concealer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Pathophysiology of acne vulgaris

A

Follicular epidermal hyperproliferation -> keratin plug formation -> obstruction of pilosebaceous follicles -> colonisation by anaerobic bacteria (Proprionibacterium acnes) -> inflammation

Activity of sebaceous glands are controlled by androgen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Features of acne vulgaris

A

Comedones due to dilated sebaceous follicle (closed = whitehead, open = blackhead)

Papules and pustules (follicle bursts -> releases irritants -> inflammation)

Excessive inflammation -> nodules and cysts

Eventually leads to scarring -> ice-pick scars and hypertrophic scars

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Classification of acne vulgaris

A

Mild - open and closed comedones +/- sparse inflammatory lesions

Moderate - widespread non-inflammatory lesions and numerous papules and pustules

Severe - extensive inflammatory lesions, nodules, pitting, scarring

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Management of acne vulgaris

A
  1. Single topical therapy (topical retinoids, benzoyl peroxide)
  2. Topical combination therapy (topical abx, benzoyl peroxide, topical retinoid)
  3. Oral abx: tetracyclines (limecycline, doxycycline, oxytetracycline), erythromycin
    Oral abx should be coprescribed with a topical retinoid or benzoyl peroxide.
    COCP is an alternative in women
  4. Oral isotretinoin under specialist supervision (C/I in pregnancy)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Features of actinic keratosis

A

Premalignant skin lesion as a result of chronic skin exposure

Small, crusty, scaly lesions
Pink/red/brown or same colour as skin
Typically on sun-exposed areas
Multiple lesions may be present

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Management of actinic keratosis

A

Prevention of further risk: sun avoidance, sun cream

Fluorouracil cream
Topical diclofenac
Topical imiquimod
Cryotherapy
Curettage and cautery
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Features and treatment of alopecia areata

A

Features - autoimmune condition, localised well de-marcated patches of hair loss with small broken exclamation mark hairs at the edge of the hair loss

Management - explanation is often sufficient as majority will regrow, other treatment includes topical/intralesional corticosteroids, topical minoxidil, phototherapy, dithranol, contact immunotherapy, wigs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Basal cell carcinoma features

A

Sun-exposed sites
Pearly, flesh-coloured papule with telangiectasia
May later ulcerate leaving a central crater
Slow growing and local invasion
Metastasis is rare

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Management for basal cell carcinoma

A
Surgical removal
Curettage
Cryotherapy
Topical cream: imiquimod, fluorouracil
Radiotherapy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Bowen’s disease features and management

A

Squamous cell carcinoma in situ

More common in elderly females
Red, scaly patches
Often occurs on sun-exposed areas (eg. lower limb)

Management - topical 5-fluorouracil or imiquimod, cryotherapy, excision

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Features of bullous pemphigoid

A

Autoimmune condition causing sub-epidermal blistering of the skin, secondary to antibodies against hemidesmosomal proteins

More common in elderly patients
Itchy, tense blisters typically around flexures
Blisters usually heal without scarring
Mouth is usually spared

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Management of bullous pemphigoid

A

Referral to dermatologist for biopsy and confirmation of diagnosis
Oral corticosteroids are mainstay of treatment
Topical corticosteroids, immunosuppressants and abx are also used

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Investigations for bullous pemphigoid

A

Skin biopsy -> immunofluorescence shows IgG and C3 at the dermoepidermal junction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Immediate management of burns (inc. heat burns, electrical burns and chemical burns)

A

A-E, analgesia

Heat burns: remove person from source, irrigate the burn with cool water for 10-30min, cover burn with clingfilm

Electrical burns: switch off power supply, remove person from source

Chemical burns: brush any powder off then irrigate with water

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Assessing the extent of burns

A

Wallace’s rule of nines: Head+neck 9%, each arm 9%, each anterior leg 9%, each posterior leg 9%, anterior chest 9%, posterior chest 9%, anterior abdomen 9%, posterior abdomen 9%

The palmar surface is roughly equivalent to 1% of total body surface area

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Different depths of burns and their features

A

Superficial epidermal = red and painful

Partial thickness (superficial dermal) = pale pink, painful, blistered

Partial thickness (deep dermal) = typically white, may have patches of non-blanching erythema, reduced sensation

Full thickness = white/brown/black in colour, no blisters, no pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Burns referral to secondary care

A
  • Deep dermal and full thickness burns
  • Superficial dermal burns of more than 3% total body surface area (adults) or 2% (children)
  • Superficial dermal burns involving face, hands, feet, perineum, genitalia, or any flexure, circumferential burns of the limbs, torso or neck
  • Any inhalation injury
  • Any electrical or chemical burn injury
  • Suspicion of NAI
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Calculating amount of fluids required following burns

A

Parkland formula:
Vol of fluid = total body surface area of the burn (%) x weight (kg) x 4

Half of the fluid should be administered in the first 8 hours

Urinary catheter inserted

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is an escharotomy and what are the indications

A

careful division of the encasing band of burn tissue to potentially improve ventilation, or relieve compartment syndrome and oedema

Indications: circumferential full thickness burns to the torso or limbs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Contact dermatitis two different types

A

Irritant contact dermatitis: common, non-allergic due to weak acids/alkalis, often on hands. Erythema is typical, crusting and vesicles are rare

Allergic contact dermatitis: type IV hypersensitivity. Uncommon, seen on the head following hair dye. Topical treatment with potent steroid is indicated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Features of dermatitis herpetiformis

A

Autoimmune blistering skin disorder, associated with coeliac disease
Caused by deposition of IgA in the dermis

Itchy, vesicular skin lesions of the extensor surfaces

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Diagnosis and management of dermatitis herpetiformis
Diagnosis: skin biopsy -> direct immunofluorescence shows deposition of IgA in a granular pattern in the upper dermis Management: gluten-free diet, dapsone
26
Eczema herpeticum - Cause - Risk factor - Presentation - Examination finding - Management
Severe primary infection of the skin caused by herpes simplex virus 1 or 2 Commonly seen in children with atopic eczema Often presents as a rapidly progressing painful rash O/E: monomorphic punched out erosions (circular, depressed, ulcerated lesions), usually 1-3mm in diameter Potentially life-threatening, so children should be admitted for IV aciclovir
27
Management of eczema
Emollients and soap substitutes Topical steroids UV radiation Immunosuppressants (ciclosporin, antihistamines, azathioprines)
28
Topical steroids ranked by potency
Mild: hydrocortisone Moderate: betnovate RD, eumovate Potent: betnovate, cutivate Very potent: dermovate 1 finger tip (0.5g) should treat a skin area about twice that of the flat of an adult hand
29
Features of erythema multiforme
Hypersensitivity reaction commonly triggered by infections Divided into minor and major forms Target lesions Initially seen on the back of hands/feet before spreading to torso Upper limbs more commonly affected than lower limbs Pruritus occasionally seen and usually mild
30
Causes of erythema multiforme
``` Viruses (herpes simplex virus) Idiopathic Bacteria (mycoplasma, streptococcus) Drugs (penicillin, sulphonamides, carbamazepine, allopurinol, NSAIDs, OCP) Connective tissue disease (SLE) Sarcoidosis Malignancy ```
31
Causes of erythema nodosum
Infection (streptococci, TB), systemic disease (sarcoidosis, IBD, Behcets), malignancy/lymphoma, drugs (penicillins, sulphonamides, COCP), pregnancy
32
Erythema nodosum features
``` inflammation of subcut fat Typically causes tender, erythematous, nodular lesions Usually occurs over shins Usually resolves within 6 weeks Lesions heal without scarring ```
33
What is erythroderma? | Causes of erythroderma
A term used when more than 95% of the skin is involved in a rash of any kind Eczema, psoriasis, drugs (gold), lymphomas, leukaemias, idiopathic
34
Causes and risk factors of fungal nail (onychomycosis)
Causes: dermatophytes (Trichophyton), yeasts (candida), non-dermatophyte moulds Risk factors: DM, increasing age
35
Features of onychomycosis (fungal nail)
Unsightly nails | Thickened, rough, opaque nails
36
Investigations of fungal nail (onychomycosis)
Nail clippings | Scrapings of the affected nail
37
Management of fungal nail (onychomycosis)
No treatment required if asymptomatic Dermatophyte infection: oral terbinafine first line, oral itraconazole second line. 6wks-3m for fingernails, 3-6m for toenails Candida infection: topical antifungal (amorolfine) for mild disease, oral itraconazole for 12 weeks for more severe infection
38
Guttate psoriasis features
2-4 weeks after streptococal infection | Tear drop papules on trink and limbs
39
Management of guttate psoriasis
``` Most cases resolve spontaneously in 2-3 months Regular emollients Potent topical corticosteroid Topical vitamin D analogue UVB phototherapy ```
40
Hereditary haemorrhagic telangiectasia - inheritance pattern - diagnostic criteria
Autosomal dominant If the patient has 2 then they are said to have a possible diagnosis of HHT, if they have 3+ then they are said to have definite diagnosis of HHT 1. Spontaneous recurrent epistaxis 2. Telangiectases at the lips/oral cavity/fingers/nose 3. Visceral lesions (eg. GI telangiectasia, pulmonary arteriovenous malformations, hepatic AVM, cerebral AVM, spinal AVM) 4. Family history (first degree relative with HHT)
41
What is herpes zoster? Features and cause Management of herpes zoster
Shingles. Acute, unilateral, painful blistering rash caused by reactivation of varicella zoster virus Management: oral aciclovir
42
Shingles vaccine - who is it offered to? - what type of vaccine is it? - vaccine contraindication
Offered to all patients aged 70-79 yrs Live-attenuated and given subcutaneously C/I in immunosuppression as it is live-attenuated
43
Causes of hirsutism
Cushing's syndrome, congenital adrenal hyperplasia, androgen therapy, obesity (insulin resistance), adrenal tumour, androgen secreting ovarian tumour, drugs (phenytoin, corticosteroids)
44
Management of hirsutism
Weight loss if overweight Waxing/bleaching COCP
45
Management of hyperhidrosis
Topical aluminium chloride is first line (S/E = skin irritation) Iontophoresis Botulinum toxin (for axillary symptoms) Surgery
46
Causes and spread of impetigo
Superficial bacterial skin infection - Staphylococcus aureus or Streptococcus pyogenes It can be a primary infection or a complication of an existing skin condition (eg. eczema, scabies, insect bite) Common in children, particularly during warm weather Spread by direct contact with discharges from the scabs
47
Features of impetigo
Golden crusted skin lesions typically found around the mouth Very contagious
48
Management of impetigo
Limited, localised disease: - Topical fusidic acid is first line - Topical mupirocin if MRSA Extensive disease: -Oral flucloxacillin first line Oral erythromycin is pen-allergic Children should be excluded from school until the lesions are crusted and healed, or 48hrs after starting abx
49
Adverse effects of isotretinoin
Teratogenicity (use two forms of contraception) Dry skin, eyes, lips/mouth (most common side effect) Low mood Raised triglycerides Hair thinning Nose bleeds Photosensitivity Intracranial hypertension (avoid prescribing with tetracyclines)
50
Features and management of a keratocanthoma
Looks like a volcano/crate Initially a smooth dome-shaped papule Rapidly grows to become a crater centrally-filled with keratin Spontaneous regression within 3 months usually, however should be excised urgently as it is clinically difficult to exclude form a SCC
51
What is the Koebner phenomenon? What conditions is it seen in?
Skin lesions which appear at the site of injury Seen in: psoriasis, vitiligo, warts, lichen planus, lichen sclerosus, molluscum contagiosum
52
Leukoplakia - features - diagnosis - management
Premalignant condition, presents as white, hard spots on mucous membranes in the mouth Common in smokers Diagnosis of exclusion, rule out candidiasis and lichen planus Biopsies often performed to exclude SCC Regular follow up to exclude malignant transformation into SCC
53
Lichen planus features
Itchy, papular rash most common on palms, soles, genitalia and flexor surfaces of arms Rash is polygonal in shape, with a 'white-lines' pattern on the surface (Wickham's striae) Koebner phenomenon (new lesions at the site of trauma) Oral involvement (white lace pattern on buccal mucosa) Thinning of nail plate, longitiduinal ridging
54
Management of lichen planus
Topical steroids Benzydamine mouthwash/spray for oral lichen planus Oral steroids/ immunosuppression for extensive lichen planus
55
Lichen sclerosus features
Inflammatory condition usually affecting the vagina More common in elderly females Leads to atrophy of the epidermis with white plaques forming Very itchy
56
Lichen sclerosus diagnosis and management
Diagnosis is usually clinical, but biopsy may be done it atypical features are present Management - topical steroids and emollients Follow up due to increased risk of vulval cancer
57
Features, diagnosis and management of lipoma
Smooth, mobile, painless lump Generally found in the subcutaneous tissues Clinical diagnosis Mx: observation. Remove if diagnosis uncertain or if compressing surrounding structures
58
4 main types of malignant melanoma (frequency, typically affected body part, appearance)
Superficial spreading: Commonest. Affects arms, legs, back and chest in young people. Growing moles with change in size/ shape/ colour/ discharge Nodular: second commonest. Sun-exposed skin in middle-aged people. Red or black lump which bleeds/ oozes Lentigo maligna: less common. Chronically sun-exposed skin in older people. Growing mole with change in size/shape/ colour/ discharge Acral lentiginous: rare. Nails, palms, or soles in african-americans or asians. Subungal pigmentation (Hutchinsons sign) or on palms/ feet
59
Margins of excision
``` Breslow thickness 0-1mm thick = 1cm margin 1-2mm thick = 1-2 cm 2-4mm thick = 2-3 cm >4 = 3 cm ```
60
Management of malignant melanoma
Suspicious lesion -> excision biopsy (remove lesion completely with a 2mm margin) Once diagnosis is confirmed, Breslow thickness should be assessed to determine whether further re-excision of margins is required
61
Malignant melanoma risk factors
Increased UV exposure, sunburn, fair complexion, lots of moles, positive family history, previous melanoma, elderly
62
Signs of malignant melanoma
``` ABCDEF Asymmetry Border irregularity or blurring Colour variation Diameter >6mm Evolution of mole Funny looking mole ```
63
Prognosis of malignant melanoma
``` Depends on Breslow thickness <1mm = 95-100% 5-yr survival 1-2mm = 80-96% 2.1-4mm = 60-75% >4 mm = 50% ```
64
Cause of molluscum contagiosum
Skin infection caused by molluscum contagiosum virus Transmission occurs directly by close personal contact, or indirectly via contaminated surfaces Majority of cases occur in children (esp children with atopic eczema), often 1-4 yrs May occur around the genitals in adults as a result of sexual contact
65
Features of molluscum contagiosum
Characteristic pink/pearly white papules with a central umbilication which are up to 5mm in diameter Lesions appear in clusters anywhere on the body, with sparing of the palm and sole
66
Management of molluscum contagiosum
No treatment usually, as it is self limiting Spontaneous resolution within 18 months Contagious so avoid sharing towels/clothing/baths Encourage not to scratch lesion If lesions are troublesome then use cryotherapy or squeeze the lesion following a bath No need to exclude form school/swimming Prescribe an emollient and a mild topical corticosteroid if itchy Prescribe a topical abx (fusidic acid) if skin looks infected
67
Causes of nail pitting
Psoriasis | Alopecia areata
68
Causes of leuconychia
Hypoalbuminaemia Fungal disease Lymphoma
69
Features of pellagra | Causes of pellagra
Dermatitis, diarrhoea, dementia (3 Ds) Also depression, and death if not treated Caused by nicotinic acid deficiency, may occur as a consequence of isoniazid therapy. More common in alcoholics
70
Cause of pemphigus vulgaris
Autoimmune disease caused by antibodies ageinst desmoglein 3 | More common in Ashkenazi jewish population
71
Features of pemphigus vulgaris
Mucosal ulceration, oral involvement Skin blistering - flaccid, easily ruptured vesicles and bullae Lesions are painful but not itchy
72
Diagnosis and management of pemphigus vulgaris
Acantholysis on biopsy Management - steroids first line, immunosuppressants
73
What is pityriasis rosea? Who does it tend to affect? What causes it?
Acute, self-limiting rash Tends to affect young adults Thought to be due to Herpes hominis virus 7 (HHV 7)
74
Features of pityriasis rosea
Majority of patients have no prodrome, but some patients give a history of a recent viral infection Pruritus Herald patch usually on trunk Herald patch is followed by erythematous, oval, scaly patches Oval patches follow a characteristic distribution with the longitudinal diameters of the oval patches running parallel to the line of Langer (fir-tree appearance)
75
Management of pityriasis rosea
Self-limiting, usually disappears after 6-12 weeks so no treatment needed
76
Pityriasis versicolor - what is it - cause - predisposing factors
Superficial cutaneous fungal infection caused by Malassezia furfur Predisposing factors: occurs in healthy individuals, immunosuppression, malnutrition, Cushing's
77
Pityriasis versicolor features
``` Most commonly on the trunk Hypopigmented, pink or brown patches May be more noticeable following a suntan Scale is common Mild pruritus ```
78
Management of pityriasis versicolor
Topical antifungal (ketoconazole shampoo) If failure to respond, consider alternative diagnoses (send scrapings) + oral itraconazole
79
Causes of pruritus
``` Liver disease Iron deficiency anaemia Polycythaemia Chronic kidney disease Lymphoma ``` ``` Other causes: Hyper/hypothyroidism DM Pregnancy Urticaria Skin disorders: eczema, scabies, psoriasis, pityriasis rosea ```
80
Subtypes of psoriasis
Plaque psoriasis: most common. typical well demarcated red scaly patches on the extensor surfaces Flexural psoriasis: smooth skin Guttate psoriasis: transient psoriatic rash triggered by Strep infection. Red teardrop lesions Pustular psoriasis: usually on palms and soles
81
Features and complications of psoriasis
Raised red plaques with silver scaling, typically on extensor surfaces Nail signs: pitting, onycholysis Arthritis ``` Complications: Psoriatic arthropathy Metabolic syndrome Cardiovascular disease VTE Psychological distress ```
82
Exacerbating factors of psoriasis
Trauma Alcohol Drugs (beta blockers, lithium, antimalarials, NSAIDs, ACEI, infliximab) Withdrawal of systemic steroids Streptococcal infection may trigger guttate psoriasis
83
Management of psoriasis
Regular emollients to reduce scale loss and pruritus First line: potent topical corticosteroid and topical vit D analogue OD for up to 4 weeks as initial treatment Second line: if no improvement after 8 weeks then offer vit D analogue BD Third line: if no improvement after 8 weeks then offer either: potent topical corticosteroid BD for up to 4 weeks, or a coal tar preparation OD/BD Short acting dithranol may be used Secondary care: - Phototherapy - Systemic therapy (oral methotrexate first line)
84
Advice for using topical corticosteroids in psoriasis
Aim for a 4 week break between courses of topical corticosteroids Use potent topical corticosteroids for no longer than 8wks at a time
85
Vitamin D analogues - examples - MoA - Side effects
Examples: calcipotriol, calcitriol, etc MoA: reduce cell division and differentiation. they tend to reduce the scales and plaque thickness but not the erythema SE: uncommon. Avoid in pregnancy Unlike corticosteorids they may be used long term Unlike coal tar prep and dithranol they do not smell or stain
86
Systemic therapy used in secondary care for the management of psoriasis
Methotrexate - first line Ciclosporin Systemic retinoids Biological agents: infliximab, etanercept
87
Phototherapy for psoriasis - type of phototherapy - how often - side effects
Narrow band UV B light is now the treatment of choice Can be given 3 times a week Adverse effects include skin ageing and squamous cell carcinoma
88
Childhood causes of purpura
``` Meningococcal septicaemia Acute lymphoblastic leukaemia Congenital bleeding disorders Immune thrombocytopenic purpura Henoch-Schönlein purpura NAI ```
89
Adulthood causes of purpura
Immune thrombocytopenic purpura Bone marrow failure Senile purpura Drugs (quinine, antiepileptics, antithrombotics) Nutritional deficiency (vit B12, C, folate)
90
Pyoderma gangrenosum features
Typically on lower limbs Initially small red papules Later deep, red, necrotic ulcers with a violaceous border May be accompanied with systemic symptoms (fever, myalgia)
91
Causes of pyoderma gangrenosum
``` Idiopathic (50%) IBC RA, SLE Myeloproliferative disorders Lymphoma, myeloid leukaemias Monoclonal gammopathy Primary biliary cirrhosis ```
92
Management of pyoderma gangrenosum
Oral steroids are first line | Ciclosporin and infliximab have a role in difficult cases
93
Features of pyogenic granuloma
Most common sites: head/neck, upper trunk and hands (oral mucosa is common in pregnancy) Initially small red/brown spot Rapidly progresses within days/weeks forming raised red/brown lesions which are often spherical in shape Lesions may bleed profusely and ulcerate
94
Management of pyogenic granuloma
If pregnancy-related they often resolve spontaneously post-partum Other lesions usually persist Removal methods: curettage and cautery, cryotherapy, excision
95
Scabies pathophysiology
Caused by the Sarcoptes scabiei mite and is spread by prolonged skin contact Scabies mite burrows into the skin, laying its eggs in the stratum corneum Intense pruritus due to a delayed type 4 hypersensitivity reaction to the mites/eggs about 30 days after initial infection
96
Features of scabies
widespread pruritus Linear burrows on the side of fingers, interdigital webs and flexor aspects of the wrist Secondary features due to itching: excoriation, infection
97
Management of scabies
Permethrin 5% is first line Malathion 0.5% second line Pruritus persists for up to 4-6 weeks post eradication Avoid close contact with others All household and close contacts should be treated Launder, iron and tumble dry clothing, bedding and towels on the first day of treatment
98
Seborrhoeic dermatitis in adults - cause - features - associated conditions
- cause: chronic dermatitis thought to be caused by an inflammatory reaction related to proliferation of a normal skin inhabitant, Malassezia furfur - features: eczematous lesions on sebum-rich areas (scalp-> dandruff, periorbital, auricular, nasolabial folds), otitis externa, blepharitis 0Associated with HIV and parkinsons disease
99
Management of adult seborrheic dermatitis
Scalp disease: First line: OTC preparations containing zinc pyrithione (head and shoulders) and tar (neutrogena T gel) Second line: ketoconazole shampoo Selenium sulphide and topical corticosteroid may be useful Face and body management: Topical antifungals (ketoconazole) Topical steroids Difficult to treat, recurrence is common
100
Seborrhoeic keratoses - what is it - features - management
benign epidermal skin lesions seen in older people Features: stuck-on appearance, large variation in colour from flesh colour to light brown or black, keratotic plugs on the surface Management: reassurance (benign), may remove (curettage, cryotherapy, shave biopsy)
101
Polymorphic eruption of pregnancy - what is it - features - management
Pruritic condition associated with last trimester lesions often first appear in abdominal striae Management: emollients, mild potency topical steroids, and oral steroids depending on severity
102
Pemphigoid gestationis - features - when does it develop - management
Pruritic blistering lesions, often develop in peri-umbilical region, later spreading to the trunk, back, buttocks and arms Usually presents in 2nd or 3rd trimester and rarely seen in first pregnancy Management: oral corticosteroids
103
5 types of basal cell carcinoma
Nodular BCC - commonest. Raised translucent papule, usually on face Superficial BCC - superficial erythematous macule on the trunk, may show spontaneous regression Morpheaform BCC - flat, slightly atrophic lesion or plaque without well-defined borders, high recurrence rate Cystic BCC - clear or blue-grey appearance, may resemble nodular BCC Basosquamous carcinoma - atypical, features resemble BCC and SCC, biologically more aggressive and more destructive, metastatic disease may occur
104
Skin types
Fitzpatrick classification 1 - never tans, always burns (red hair, freckles, blue eyes) 2 - burns easily, tans poorly 3 - may burn, tans poorly 4 - burns minimally, tans easily (olive) 5 - rarely burns, always tans (asian) 6 - never burns, tans darkly (black african)
105
Spider naevi - what are they - where are they found - vs. telangiectasia - associated conditions
Central red papule with surrounding capillaries which blanch upon pressure Almost always found on upper part of body Can be differentiated from telangiectasia by pressing on them and watching them fill - spider naevi fill from the centre, telangiectasia fill from the edge Associations - liver disease, pregnancy, COCP
106
Squamous cell carcinoma risk factors
``` Excessive exposure to sunlight Actinic keratosis/ bowens disease Immunosuppression Smoking Long standing leg ulcers Genetic conditions ```
107
treatment of squamous cell carcinomas
Wide local excision for diagnostic biopsy, then repeat surgery to gain adequate margins Surgical excision with 4mm margin if lesion <20mm in diameter, and 6mm margin if lesion >20mm diameter Moh's micrographic surgery used in high-risk patients and in cosmetically important sites
108
Poor prognostic factors of squamous cell carcinoma
Poorly differentiated >20mm in diameter >4mm deep Immunosuppression
109
Invasive SCC features
Erythematous keratotic papule or nodule on a background of sun exposure Ulceration may occur Regional lymphadenopathy may be present May metastasise
110
Tinea capitis - features - cause - diagnosis - management
``` Scalp ringworm (dermatophyte fungal infection) Scarring alopecia, mainly seen in children If untreated, a raised, pustular, spongy/boggy mass (kerion) may form ``` Most common cause: Trichophyton tonsurans) Diagnosis: scalp scrapings Management: oral antifungal (terbinafine), topical ketoconazole shampoo for the first two weeks to reduce transmission
111
Tinea corporis - causes - features - management
Ringworm (dermatophyte fungal infection) Causes: Trichophyton rubrum and Trichophyton verrucosum (contact with cattle) Well-defined annular, erythematous lesions with pustules and papules Management: oral fluconazole
112
Tinea pedis features
``` Athletes foot (dermatophyte fungal infection) Itchy, peeling skin between toes Common in adolescence ```
113
Toxic epidermal necrolysis (TEN) - causes - features
Potentially life-threatening skin disorder, commonly seen secondary to a drug reaction Examples: phenytoin, sulphonamides, allopurinol, penicillins, carbamazepine, NSAIDs Scalded appearance over an extensive area Systemically unwell (pyrexia, tachycardia) Positive Nikolsky sign (epidermis separates with mild lateral pressure)
114
Toxic epidermal necrolysis management
Stop precipitating factor ITU supportive care IV Ig first line Other options: ciclosporin, cyclophosphamide, plasmapharesis
115
Venous ulceration - features - risk factors - investigations - management
features: medial malleolus, shallow ulcer with granulated base risk factors: varicose veins, DVT, venous insufficiency, poor calf muscle function, AV fistulae, obesity, leg fracture, trauma over medial malleolus Ix: Duplex USS, ABPI normal (0.9-1.2) Mx: compression bandaging (four layers) Oral pentoxifylline (peripheral vasodilator)
116
Features of vitiligo and associated conditions
Autoimmune Well-demarcated patches of depigmented skin Peripheries tend to be most affected Trauma may precipitate new lesion (koebner phenomenon) T1DM, Addisons, autoimmune thyroid disease, pernicious anaemia, alopecia areata
117
Management of vitiligo
Sunblock Camouflage makeup Topical corticosteroids may reverse changes if applied early Topical tacrolimus and phototherapy may be helpful
118
Arterial ulceration - features - ix - mx
Features: small deep lesions, well-defined borders, evidence of arterial insufficiency, found at distal sites Ix: ABPI either reduced (<0.9) or raised (due to calcification, >1.2), duplex USS, CT angiography Mx: lifestyle advise, statin, aspirin, optimise BP and DM, angioplasty or bypass grafting, amputation
119
Neuropathic ulceration - features - ix - mx
Features: painless, over areas of abnormal pressure, often secondary to joint deformity in DM Ix: blood glucose levels, ABPI normal, duplex USS, swab if ?Infection, X-ray if ?osteomyelitis, neuro foot exam Mx: optimise DM control, improve diet, increase evercise, regular chiropody, abx for any infection, surgical debridement, amputation
120
What is Charcot's foot?
Neuroarthropathy whereby a loss of joint sensation results in continual unnoticed trauma and deformity Neuropathic ulcers can be seen alongside Charcot's foot Patients present with swelling, distortion, pain, and loss of function