Dermatology Flashcards
(67 cards)
1
Q
Actinic keratoses features
A
- Premalignant lesions in sun exposed areas
- Crusty, scaly lesions
2
Q
Actinic keratosis mx
A
- Topical 5-fu
- Topical imiquimod
- Cryotherapy
- Curettage / cautery
3
Q
Skin disorders in pregnancy and basic features
A
Polymorphic eruption of pregnancy
- pruritic erythematous eruption
- last trimester
Pemphigoid gestationis
- pruritic blistering lesions
- peri-umbilical before spreading
- 2nd or 3rd trimester, rarely seen in 1st pregnancy
Melasma
- large flat hyperpigmented macules
- cheeks, forehead, nose, upper lip
- resolves after delivery
- also HRT / COCP use
4
Q
Polymorphic eruption of pregnancy mx
A
- emollients
- mild topical steroids
- oral steroid
5
Q
Pemphigoid gestationis
A
PO steroids
6
Q
Dermatitis herpetiformis features
A
- inflammatory skin condition assoc w/ coeliac
- pruritic, vesicular, blistering lesions on EXTENSORS
7
Q
Dermatitis herpetiformis ix
A
Skin biopsy: IgA deposition granular pattern (upper dermis)
8
Q
Dermatitis herpetiformis mx
A
Dapsone
- monitor fbc (risk haemolytic anaemia, agranulocytosis)
- be aware peripheral neuropathy
Gluten free diet (ix coeliac)
9
Q
Acne rosacea mx
A
All: suncream, camouflage creams
1) topical metro
- topical brimonidine for predominant flushing
- Laser therapy: for predominant telangiectasia
2) systemic abx e.g. oxytetracycline
10
Q
Shingles mx
A
1) PO aciclovir
2) Simple analgesia
3) Neuropathic drugs e.g. pregabalin
4) Corticosteroids PO (acute only)
11
Q
Shingles vaccine
A
Live attenuated VZV
All patients 70-79
Contraindicated: immunosuppression
12
Q
Pityriasis rosea features
A
- can be preceded by prodromal illness
- Hypopigmented herald patch trunk
- then erythematous, oval, scaly patches ‘fir tree’ distribution
13
Q
Pityriasis rosea mx
A
None
Self limiting 6-12 weeks
14
Q
Erythema multiforme causes
A
- viruses: HSV
- bacteria: Mycoplasma, Streptococcus
- drugs: penicillin, sulphonamides, carbamazepine, allopurinol, NSAIDs, oral contraceptive pill, nevirapine
- CTD: SLE, sarcoid
- malignancy
- idiopathic
15
Q
Erythema nodosum causes
A
- Infection: streptococci, TB, brucellosis
- systemic disease: sarcoidosis, IBD, Behcet’s
- malignancy / lymphoma
- drugs: penicilin, sulphonamides, COCP
- pregnancy
16
Q
Pyogenic granuloma features
A
- benign lesions
- small brown spot -> raised -> spherical
- may catch and bleed
- trauma, pregnancy, young women
Mx: cryo, cautery, excision
17
Q
Pyoderma gangrenosum features
A
- usually lower limbs
- small red papule -> deep, red, necrotic ulcers
- violaceous border
- +/- fever, myalgia
18
Q
Causes pyoderma gangrenosum
A
- idiopathic 50%
- IBD, PBC
- RA / SLE
- haem: lymphoma, leukaemia, MGUS, myeloproliferative disorders
19
Q
Mx pyoderma gangrenosum
A
1) PO steroids
2) Consider immunosuppresion: ciclosporin / infliximab
20
Q
Complication of psoriasis
A
- 10% psoriatic arthropathy
- metabolic syndrome
- CV disease
- VTE
- psychological distress
21
Q
Pemphigus vulgaris features
A
- autoimmune disease vs desmoglein 3 (cadherin)
- ashkenazi jewish
- can be associated with coeliac
- flaccid skin blistering
- Nikolsky’s sign
- mucosal involvement
IX: direct immunofluorescence, acatholysis (biopsy)
22
Q
Pemphigus vulgaris mx
A
1) PO steroids
2) immunosuppression
23
Q
Factors that exacerbate psoriasis
A
- trauma
- alcohol
- beta blockers
- ACEi
- NSAIDs
- lithium
- antimalarials (chloroquine and hydroxychloroquine)
- infliximab
- withdrawal of systemic steroids
24
Q
Squamous cell carcinoma features
A
- scaly, crusted lesion
- painful
- may bleed / ulcerate
- might be within actinic keratosis
25
RFs for squamous cell carcinoma
- elderly males
- sun exposure
- actinic keratosis
- smoking
- immunosuppressing disease e.g. CLL, HIV, organ transplant
- immunosuppresant drugs e.g. azathioprine, infliximab
26
Mx squamous cell carcinoma
1) excision
+ adjuncts for locally advanced / metastatic disease
- radiotherapy
- cemiplimab (PD-1 and PD-2 inhibitor)
27
Thromboangiitis obliterans / Buerger's disease
- inflammatory nonatherosclerotic peripheral vascular disease & limb ischaemia
- young male smokers
- angio: patchy occlusion distally, corkscrew collaterals
- mx: stop smoking
28
Necrobiosis lipoidica
- usually on both shins and are rarely found in other sites
- oval, round or irregular plaques
- yellow / red and shiny
- centre starts to become pale with telangiectasia
- asymptomatic or painless
- may ulcerate after injury
- seen in insulin-dependent diabetes
- mx: systemic steroids, immunosuppression
29
Seborrhoeic keratosis
- benign ageing spot
- stuck on, brown, waxy appearance
- Leser-Trélat sign: sudden appearance of several lesions suggests underlying cancer, usually GI
30
Seborrhoeic dermatitis
```
- malassezia furfur
greasy, scaly, oily patches / plaques
- affects face, nasolabial folds, scalp
- gets better with sun
- RFs: HIV, Parkinson's
- complications: blepharitis, otitis externa
```
Mx: topical ketoconazole +/- steroids
31
Guttate psoriasis presentation
- 1st presentation of psoriasis
- OR flare of known psoriasis
- classically few weeks post strep throat
- tear trop scaly papules over trunk and limbs
- rarely affects hands / feet
32
Guttate psoriasis mx
- usually self resolve in 2-3 months
- topical agents as for psoriasis: emollients, topical steroid / vit D analogue, coal tar preparation
- UVB phototherapy
- tonsillectomy if recurrent
33
Vitiligo mx
- sun block
- camouflage make-up
- topical corticosteroids may reverse the changes if applied early
- topical tacrolimus
- phototherapy
34
Basal cell carcinoma mx
- surgical removal
- curettage
- cryotherapy
- topical cream: imiquimod, fluorouracil
- radiotherapy
35
Scabies
1) 5% permethrin - apply to whole body, leave for 6 hours, repeat in 1 week. All household contacts to do the same
2) 0.5% malathion
Immunosuppressed with crusted scabies: isolate and ivermectin
36
Bullous pemphigoid features
- Itchy, tense blisters
- usually spares mucosa
- usually heals without scarring
37
Bullous pemphigoid RFs
- elderly
- PD1 inhibitors e.g. pembrolizumab
- furosemide
- captopril
- penicillin & other abx
- sulfasalazine
38
Bullos pemphigoid IX and MX
IX: skin biopsy - immunofluorescence shows IgG and C3 at the dermoepidermal junction
Mx:
- emollients
- topical steroids (if <10%)
- systemic steroids
- abx e.g. doxycycline
- immunosuppression
39
Erythroderma
- any rash involving >95% skin
Typical causes
- eczema
- psoriasis
- drugs e.g. gold
- lymphomas, leukaemias
- idiopathic
40
Bowen's disease
Intra-epithelial SCC - 3% risk of becoming invasive cancer
41
Bowen's disease mx
- topical 5-fluorouracil or imiquimod
- cryotherapy
- excision
42
Scalp psoriasis mx
1) 4 weeks topical steroid
| 2) Different formulation e.g. shampoo +/- agent to remove scale e.g. emollient, agent with salicylic acid
43
Flexural / genitial psoriasis
1) 2 weeks max mild-mod potency topical steroid
44
Pityriasis versicolor features
- malassezia furfur
- scaly hypopigmented patches, itchy
- usually on trunk
- RFs: immunosuppression, malnutrition, Cushing's
45
Pityriasis versicolor ix & mx
- Ix:
- skin scrapings
- yellow/green under Wood's lamp
- Mx: ketoconazole topical -> oral itraconazole
46
Stevens-Johnson Syndrome features
- 1-4 weeks post drug exposure
- maculopapular lesions, target lesions
- my develop vesicles / bullae
- Nikolsy sign
- mucosal involvement
- fever, arthralgia
47
Stevens-Johnson Syndrome causes
- penicillin
- sulphonamides e.g. sulfamethoxazole in co-trimox
- lamotrigine, carbamazepine, phenytoin
- allopurinol
- NSAIDs
- combined oral contraceptive pill
48
SJS / TEN overlap
- <10% is SJS
- 10-30% SJS/TEN overlap
- >30% is TEN
49
Keratoacanthoma
- benign epithelial tumour
- fast growing
- initially fleshy -> keratinised centre
- following minor skin trauma OR areas of sun damaged skin
- Mx: excise to exclude SCC
50
Solar lentigo vs lentigo maligna
- Lentigo maligna is more irregular
| - can progress to lentigo maligna melanoma
51
Lichen planus
- purple, polygonal, pruritic, papules / plaques
- oral lesions can occur
- white line pattern over the surface 'wickham's striae'
- koebner phenomenon
- betablockers, thiazide diuretics, anti-malarials can precipitate
mx: topical steroids
52
Causes of acanthosis nigricans
- gastrointestinal cancer
- diabetes, PCOS, obesity, Cushing's disease
- acromegaly, hypothyroidism
- familial
- Prader-Willi syndrome
- drugs: oral contraceptive pill, nicotinic acid
53
Chondrodermatitis nodularis helicis
Painful nodule on the ear
54
Psoriasis management
ALL regular emollients
1) 4 weeks potent topical corticosteroid OD + OD vit D analogue
2) BD vit D analogue
3) BD potent corticosteroid OR coal-tar preparation
Phototherapy
1) narrow band UVB
2) Psoralen + UVA
Systemic therapy - failed above / can't tolerate phototherapy / >10% body / severe uncontrolled sx with poor QoL
1) methotrexate
2) ciclosporin if intolerant / doesn't work / want to conceive
Biologics
infliximab, etanercept and adalimumab
ustekinumab
55
Palmar-plantar erythrodysesthesia
- days to months into chemo treatment
- tingling or numbness first in the fingers and palms and then toes and soles of the feet
- followed by an erythematous rash which can desquamate, blister and ulcerate
- mx: supportive or delay chemo
56
Leukoplakia
- white oral mucosal lesions similar to candida
- can't be rubbed off
- hard
- assoc HIV
Mx: ART if HIV
57
Drugs causing photosensitive skin rashes
- abx: tetracyclines, fluroquinolones, sulphonamides
- NSAIDs
- furosemide, bumetanide
- sulphonylureas
- neuroleptics e.g. chlorpromazine
- antifungals e.g. terbinafine, itraconazole
- amiodarone, diltiazem
58
Mx photosensitive drug rash
- discontinue
- topical steroid
- systemic steroid if severe
59
Tinea features and management
- annular lesion
- alopecia if on scalp
- ix: wood's lamp fluorescence
- mx
1) ketoconazole cream
2) oral itraconazole
3) terbinafine PO
60
Lichen planus mx
1) topical steroid
2) oral pred
Usually resolves in 6-18 months
61
Erythema nodosum HLA linkage
B27
62
Mx erythema nodosum
1) NSAIDs
2) topical K iodide
3) PO pred
63
Treatment of male pattern hairloss in women
1) topical minoxidil
| 2) PO finasteride (antiandrogen)
64
Acitretin and pregnancy
Avoid 4 weeks before starting
| Avoid 3 years after completing
65
Pyoderma gangrenosum mx
1) topical steroids
2) PO steroids
3) Immunosuppressants: ciclosporin, MMF, anti-TNF
66
Discoid lupus
- photosensitive dermatosis
- 28% develop full SLE
Mx
1) sun block
2) topical stroids
3) hydroxychloroquine
4) immunosuppressants
67
Granuloma annulare
Circular lesion
Otherwise asymptomatic
Mx: months to self-resolve, otherwise topical steroids
