Dermatology Flashcards
(42 cards)
What is actinic keratosis?
Actinic, or solar, keratoses (AK) is a common premalignant skin lesion that develops as a consequence of chronic sun exposure
Features of actinic keratosis?
small, crusty or scaly, lesions
may be pink, red, brown or the same colour as the skin
typically on sun-exposed areas e.g. temples of head
multiple lesions may be present
Mx of actinic keratosis
prevention of further risk: e.g. sun avoidance, sun cream
fluorouracil cream: typically a 2 to 3 week course. The skin will become red and inflamed - sometimes topical hydrocortisone is given following fluorouracil to help settle the inflammation
topical diclofenac: may be used for mild AKs. Moderate efficacy but much fewer side-effects
topical imiquimod: trials have shown good efficacy
cryotherapy
curettage and cautery
Features of Acne Rosacea
Features typically affects nose, cheeks and forehead flushing is often first symptom telangiectasia are common later develops into persistent erythema with papules and pustules rhinophyma ocular involvement: blepharitis sunlight may exacerbate symptoms/
Mx of Acne Rosacea
Management
Mild - topical metronidazole
Flushing without telangiectasia - topical brimonidine gel
severe - systemic antibiotics e.g. Oxytetracycline
Also:
-daily high-factor sunscreen
- camouflage creams
- laser therapy for prominent telangiectasia
- rhinophyma should be referred to dermatology
Mx of hyperhidrosis
topical aluminium chloride first-line. Main side effect is skin irritation
iontophoresis: particularly useful for patients with palmar, plantar and axillary hyperhidrosis
botulinum toxin: currently licensed for axillary symptoms
surgery: e.g. Endoscopic transthoracic sympathectomy. Patients should be made aware of the risk of compensatory sweating
What are Cherry Hemangiomas?
Features x4
Cherry haemangiomas (Campbell de Morgan spots) are benign skin lesions which contain an abnormal proliferation of capillaries. They are more common with advancing age and affect men and women equally. erythematous, papular lesions typically 1-3 mm in size non-blanching not found on the mucous membranes
What is piteous rosacea?
a self-limiting condition flowing viral infection in teenagers and young people.
Features include:
initial herald patch followed by more patches on the trunk
erythematous plaques with scaley edges
no treatment unless itchy, then consider antihistamines or topical steroids.
What is alopecia areata?
Outcomes
Mx options
presumed autoimmune condition causing localised, well-demarcated patches of hair loss. At the edge of the hair loss, there may be small, broken ‘exclamation mark’ hairs
Hair will regrow in 50% of patients by 1 year, and in 80-90% eventually. Careful explanation is therefore sufficient in many patients. Other treatment options include: topical or intralesional corticosteroids topical minoxidil phototherapy dithranol contact immunotherapy wigs
what are Curlings ulcers?
Stress ulcers in burns patients are referred to as Curlings ulcers and may cause haematemesis.
What is Erythema Nodosum?
inflammation of subcutaneous fat
typically causes tender, erythematous, nodular lesions
usually occurs over shins, may also occur elsewhere (e.g. forearms, thighs)
usually resolves within 6 weeks
lesions heal without scarring
What causes erythema nodosum?
infection: streptococci, tuberculosis, brucellosis
systemic disease: sarcoidosis, inflammatory bowel disease, Behcet’s
malignancy/lymphoma
drugs: penicillins, sulphonamides, combined oral contraceptive pill
pregnancy
What is guttate psoriasis?
Guttate psoriasis is more common in children and adolescents. It may be precipitated by a streptococcal infection 2-4 weeks prior to the lesions appearing.
Features
tear drop papules on the trunk and limbs
Mx of guttate psoriasis
most cases resolve spontaneously within 2-3 months
there is no firm evidence to support the use of antibiotics to eradicate streptococcal infection
topical agents as per psoriasis
UVB phototherapy
tonsillectomy may be necessary with recurrent episodes
What is Hereditary haemorrhagic telangiectasia?
Dx criteria.
autosomal dominant condition characterised by (as the name suggests) multiple telangiectasia over the skin and mucous membranes. Twenty percent of cases occur spontaneously without prior family history.
Definite diagnosis if 3 of:
epistaxis : spontaneous, recurrent nosebleeds
telangiectases: multiple at characteristic sites (lips, oral cavity, fingers, nose)
visceral lesions: for example gastrointestinal telangiectasia (with or without bleeding), pulmonary arteriovenous malformations (AVM), hepatic AVM, cerebral AVM, spinal AVM
family history: a first-degree relative with HHT
What is Kaposi’s Sarcoma
Tumour of vascular and lymphatic endothelium.
Purple cutaneous nodules.
Associated with immuno supression.
Classical form affects elderly males and is slow growing.
Immunosupression form is much more aggressive and tends to affect those with HIV related disease.
What is dermatitis herpitiformis
Chronic itchy clusters of blisters.
Linked to underlying gluten enteropathy (coeliac disease).
What is a dermatofibroma
Benign lesion.
Firm elevated nodules.
Usually history of trauma.
Lesion consists of histiocytes, blood vessels and fibrotic changes.
What is a pyogenic granuloma
Overgrowth of blood vessels.
Red nodules.
Usually follow trauma.
May mimic amelanotic melanoma.
What is acanthosis nigrans?
Brown to black, poorly defined, velvety hyperpigmentation of the skin.
Usually found in body folds
The most common cause is insulin resistance, which leads to increased circulating insulin levels. Insulin spillover into the skin results in its abnormal increase in growth (hyperplasia of the skin).
In the context of a malignant disease, acanthosis nigricans is a paraneoplastic syndrome and is then commonly referred to as acanthosis nigricans maligna. Involvement of mucous membranes is rare and suggests a coexisting malignant condition.
What is Lichen Sclerosis key features diagnosis management risks
Lichen sclerosus is an inflammatory condition which usually affects the genitalia and is more common in elderly females. Lichen sclerosus leads to atrophy of the epidermis with white plaques forming
itch is prominent
The diagnosis is usually made on clinical grounds but a biopsy may be performed if atypical features are present*
topical steroids and emollients
increased risk of vulval cancer
Features of impetigo
Features
‘golden’, crusted skin lesions typically found around the mouth
very contagious
Mx of impetigo
Limited, localised disease
topical fusidic acid
topical retapamulin is used second-line if fusidic acid has been ineffective or is not tolerated
Extensive disease
oral flucloxacillin or erythromycin if penicillin-allergic
children should be excluded from school until the lesions are crusted and healed or 48 hours after commencing antibiotic treatment
Subtypes of malignant melanoma
Superficial spreading - most common, limbs and torso of young people, a growing mole
Nodular - 2nd most common, sun-exposed skin in middle-aged people, red or black lump which may bleed or oozes
Lentigo maligna - uncommon, older people, a growing mole in a sun-exposed area
Acral lentiginous - rare, nails palms or soles. more common in African Americans or asians, subungual pigmentation.
