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PHASE 2A > Dermatology > Flashcards

Dermatology Flashcards

(109 cards)

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1
Q

Name 5 functions of the skin

A
  1. Barrier to infection
  2. Thermoregulation
  3. Protection against trauma
  4. Protection against UV
  5. Vitamin D synthesis
  6. Regulate H2O loss
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2
Q

What is the pH of normal skin?

A

5.5 = allows protease to remain on the skin

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3
Q

Describe skin pathophysiology

A

New cells in basal layer of epidermis vs mature corneocytes shed from surface of stratum corneum (desquamation)

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4
Q

How does desquamation work?

A

Involves degradation of extracellular corneodesmosomes under the action of protease enzymes

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5
Q

Name the 3 layers of skin

A
  1. Epidermis
  2. Dermis
  3. Subcutaneous tissue
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6
Q

What are the layers of the epidermis?

A
  1. Stratum corneum (outmost - layer of keratin)
  2. Stratum lucid
  3. Stratum granulosum
  4. Stratum spinous
  5. Stratum basale (dividing cells)
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7
Q

What is the stratum corneum made up of?

A

Corneodesmosomes = adhesion molecules keeping corneocytes together
Desmosomes

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8
Q

What does the dermis layer of skin contain?

A

Meissner’s corpuscle - light touch

Pacinian corpuscle = coarse touch and vibration

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9
Q

Name 4 cell types of the epidermis

A
  1. Keratinocytes = produce keratin as protective barrier
  2. Langerhans cells = present antigens and activate T cells
  3. Melanocytes = produce melanin (protect from UV)
  4. Merkel cells = contain specialised cells for sensation
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10
Q

Name 3 common causes of an itch WITH rash

A
  1. Urticaria
  2. Atopic eczema
  3. Psoriasis
  4. Scabies
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11
Q

Name 3 common causes of an itch WITHOUT a rash

A
  1. Renal failure
  2. Jaundice
  3. Iron deficiency
  4. Lymphoma
  5. Polycythaemia
  6. Pregnancy
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12
Q

What does an increase in corneodesmosomes lead to?

A

Thickening of skin = psoriasis

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13
Q

What does a decrease in corneodesmosomes lead to?

A

Thinning of skin = eczema

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14
Q

What is main cause of all skin cancer?

A

Sun exposure - UV light

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15
Q

Name 3 types of skin cancer

A
  1. Basal Cell Carcinoma (75%) = benign, grows slowly
  2. Squamous Cell Carcinoma (20%) = can metastasise, grows rapidly
  3. Melanoma (5%) = most malignant form of skin cancer
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16
Q

Give 4 risk factors for melanoma

A
  1. Sunlight exposure
  2. Red hair
  3. High density freckles
  4. Skin type 1
  5. Atypical moles
  6. Family history
  7. Immunosuppression
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17
Q

What is the presentation/ABCDE features of melanoma?

A 
Asymmetry of mole 
Border irregularity
Colour variation 
Diameter >6mm
Elevation/evolution
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18
Q

Name 4 type of melanoma

A
  1. Lentigo malignant melanoma
  2. Superficial Spreading malignant melanoma
  3. Nodule malignant melanoma
  4. Acral lentiginous malignant melanoma
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19
Q

Describe the progression from melanocytic nave (mole) to nodular melanoma

A

Melanocytic nave –> dysplastic melanocytic nave –> in situ melanoma –> superficial spreading melanoma –> nodular melanoma

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20
Q

What is a lentigo malignant melanoma?

A

A patch of lentigo maligna - a slow growing macular area of pigmentation often on face in elderly
Develops a nodule signalling invasive malignancy

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21
Q

What is a Superficial Spreading malignant melanoma?

A

Large, flat, irregularly pigmented lesion

Grows laterally before vertical invasion

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22
Q

What is a Nodule malignant melanoma?

A

Rapidly growing pigmented nodule which bleeds or ulcerates (most aggressive)

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23
Q

What is a Acral lentiginous malignant melanoma?

A

Pigmented lesions on the palm, sole or under the nail

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24
Q

What is Hutchinson’s sign?

A

Pigmentation of nail and proximal nail fold

Important sign of subungual melanoma

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25
Give 3 factors that can be used to determine the prognosis of melanoma
1. Breslow's thickness - the thinner (<1mm) the better 2. Younger = better prognosis 3. Female = better prognosis
26
What is the treatment for melanoma?
Wide surgical excision
27
What is Glasgow's 7 point checklist?
``` Criteria for melanomas Major criteria 1. Change in size 2. Change in shape 3. Change in colour Minor criteria 4. Diameter >6mm 5. Inflammation 6. Oozing/bleeding 7. Mild itch/altered sensation ```
28
Define squamous cell carcinoma (SCC)
Locally invasive malignant tumour of the squamal keratinocytes
29
How do SCC present?
Keratotic, ill-defined nodules that ulcerate and grow rapidly
30
What is Bowen's disease?
SCC in situ | Isolated scaly red plaques resembling psoriasis
31
What is keratoacanthoma?
Benign variant of SCC | Fasting growing and dome shaped
32
What are solar keratinises?
Erythematous silver-scaly papules with red base
33
What is the treatment for a SCC?
Surgical excision with a minimal margin of 5mm | Radiotherapy to affected nodes
34
Define Basal cell carcinoma (BCC)
Tumour of basal keratinocytes
35
How does a BCC present?
95% = non-pigmented Shiny pearly nodules which may ulcerate Bleeds following minor trauma and doesn't heal
36
What is the treatment for a BCC?
Surgical excision | Alternative = radiotherapy, photodynamic therapy, cryotherapy
37
Define psoriasis
Chronic, inflammatory skin disease due to hyperproliferation of keratinocytes and inflammatory cell infiltration
38
When does psoriasis usually present?
2 peaks = 20s and 50s
39
What environmental factors can cause psoriasis in a genetically susceptible individual?
1. Group A Streptococcal infection 2. Lithium 3. UV light 4. Alcohol 5. Stress
40
Describe the pathophysiology of psoriasis
T cell activation --> up-regulation of Th1 types of T cell cytokines --> increase uncontrolled hyper proliferation of keratinocytes in epidermis + increase in epidermal cell turnover rate
41
Name the different types of psoriasis
1. Chronic plaque psoriasis 2. Flexural psoriasis 3. Guttate psoriasis 4. Erythrodermic and pustular psoriasis
42
How does chronic plaque psoriasis present?
Salmon-pink silvery scaly lesions on extensor surfaces of limbs (knees, elbows) with scalp involvement
43
How does flexural psoriasis present?
Red glazed, non-scaly plaques in flexures (groin, axillae, submammary)
44
How does Guttate psoriasis present?
Raindrop psoriasis - explosive eruption of small plaques appear on trunk after strep infection Mainly children and young adults affected
45
How does erythrodermic and pustular psoriasis present?
Widespread intense inflammation of skin, with malaise, pyrexia and circulatory problems
46
Name 4 associated symptoms of psoriasis
1. Pitting of nail plate 2. Onycholysis (separation of fingernail from nail bed) 3. Discolouration of nails 4. Subungual hyperkeratosis 5. Psoriatic arthritis
47
Describe the treatment of psoriasis
1. Emollients and reassurance 2. Vitamin D and A analogues (retinoids) - calcipotriol and tazarotene 3. Topical corticosteroids - hydrocortisone, betamethasone 4. Phototherapy 5. Immunosuppression or biological agents - methotrexate, infliximab
48
What are emollients used for?
Hydrate the skin and reduce itching
49
How does hydrocortisone work?
Targets cytoplasmic receptors | Leads to reduction in pro-inflammatory cytokines and an increase in anti-inflammatories
50
Give 3 potential side effects of corticosteroids
1. Skin thinning 2. Oral candidaisis 3. Acne 4. Striae 5. Bruising
51
How does calcipotriol work in the treatment of psoriasis?
Vitamin D analogue | Anti-proliferative and anti-inflammatory effects
52
How does tazarotene work?
Vitamin A analogue | Modifies gene expression and inhibits cell proliferation
53
Would you prescribe tazarotene to a pregnant lady?
No = highly teratogenic
54
Why do transdermal drugs need to lipophilic?
In order to get through the lipid rich stratum corneum
55
Give 2 essential properties of transdermal drugs
1. Lipophilic | 2. High affinity for their targets
56
Give 2 advantages of transdermal drug delivery
1. Avoids first pass effect, hardly metabolised 2. No pain 3. Controlled dosing
57
Describe the pathophysiology of atopic eczema
Abnormal epithelial barrier function - allows antigenic and irritant agents to penetrate and reach immune cells Initial activation of Th2 type CD4 cells drive inflammatory process (increase in IgE production)
58
Name 3 exacerbating factors of atopic eczema
1. Strong detergents and chemicals 2. House dust mites 3. Animal fur 4. Diet
59
How does eczema present?
Itchy, erythematous scaly patches in flexures (elbows, ankles, knees) Increased dryness of skin Hypo or hyper pigmentation Risk of secondary infection due to broken skin
60
What are 2 signs of chronic eczema?
1. Excoriations (stretch marks) | 2. Skin thickening (lichenification)
61
What happens to the serum IgE in eczema?
In 80% = raised
62
How do you diagnose eczema?
Must have itchy skin condition in past 6 months + 3 or more of 1. History of involvement of skin creases 2. Personal history of asthma or hay fever 3. History of generally dry skin 4. Childhood onset
63
Describe the aetiology of eczema
1. Genetic predisposition - loss of function mutation in filaggrin 2. Environmental triggers and irritants
64
Describe the treatment for eczema
1. Avoid irritants and allergens 2. Use emollients 3. Hydrocortisone (1st line) or stronger steroids 4. Tacrolimus (2nd line) - topical immunomodulators 5. Antibiotics for secondary infections
65
Briefly describe the natural history of eczema
Sub-clinical skin barrier defect --> sub-clnicial inflammation --> AD phase 1 (non-atopic) --> AD phase 2 (true atopic, extrinsic), high IgE
66
Define allergic dermatitis
Sensitisation of T lymphocytes over a period of time - itching and dermatitis results upon re-exposure to the antigen
67
Give 3 causes of contact dermatitis
1. Detergents 2. Soaps 3. Oils 4. Solvents 5. Type 4 hypersensitivity reaction
68
How does contact dermatitis present?
Rash with Clear demarcation/odd-shaped area
69
How can you diagnose contact/allergic dermatitis?
Patch testing = identify the allergen
70
How can you treat contact dermatitis?
Remove cause Steroids Anti-pruritic agents
71
Where does seborrhoeic dermatitis usually effect?
Scalp and face - thickened, scaly skin
72
What can trigger seborrhoeic dermatitis?
Yeast infection
73
What is the treatment for seborrhoeic dermatitis?
1. Antifungal treatment | 2. Keratolytic agents to reduce thickening
74
What is cellulitis?
Bacterial infection of the deep subcutaneous tissue of the skin
75
Give 4 risk factors for cellulitis
1. Lymphoedema 2. Site of entry - leg ulcer, trauma, tinea pedis 3. Venous insufficiency 4. Leg oedema 5. Obesity
76
Name 3 causes of cellulitis
1. Strep pyogenes (most common) 2. Staph aureus 3. Community acquired MRSA
77
Give 4 signs of cellulitis
1. Erythema, with poorly marked margins 2. Inflammation 3. Swelling 4. Warmth 5. Tenderness 6. Low grade fever
78
What is the differential diagnosis in someone it the signs and symptoms of cellulitis?
DVT
79
What is the treatment for cellulitis?
Phenoxymethylpenicillin and flucloxacillin (erythromycin if allergic to penicillin)
80
What is necrotising fasciitis?
Rapidly progressive infection of deep fascia resulting in necrosis of subcutaneous tissue
81
Give 3 risk factors for necrotising fasciitis
1. IVDU 2. DM 3. Homeless 4. Recent surgery
82
What bacteria can cause necrotising fasciitis?
Type 1 = aerobic and anaerobic bacteria | Type 2 = Group A beta-haemolytic strep (strep pyogenes)
83
Give 4 signs of necrotising fasciitis
1. Intense pain that is out of proportion to the skin findings of initial site of infection 2. Spreading erythema and pain 3. Crepitus 4. Fever 5. Multi-organ failure --> death
84
What is the treatment for necrotising fasciitis?
Surgical debridement +/- amputation Type 1 = broad spec Abx with inclusion of metronidazole Type 2 = benzylpenicillin and clindamycin
85
Briefly describe the pathophysiology of acne
Seborrhea (increased sebum production) --> narrowed follicle (due to hypercornification) blocks sebum --> sebum stagnates and p. acne colonises --> irritation, inflammation and attraction of neutrophils
86
Describe the signs of acne
1. Open comedones (blackheads) 2. Closed comedones (whiteheads) 3. Papules and pustules 4. Hyperpigmentation 5. Scarring
87
Describe the treatment for acne
Regular washing with acne soap to remove grease Benzoyl peroxide (keratolytic) and clindamycin Topical retinoids - tazarotene Low dose Abx - doxycycline or minocycline Hormonal treatment - co-cyprindiol
88
Give 3 signs of rosacea
1. Flushing 2. Erythema 3. Papules and pustules
89
How does Rosacea differ for acne?
Rosacea = no comedones and tends to affect older people
90
Define ulcer
Abnormal breaks in an epithelial surface
91
Define venous ulceration
Loss of skin below the knee on the leg or foot that takes more than 2 weeks to heal
92
Give 3 causes of venous ulceration
Sustained venous Hypertension in superficial veins due to: - Incompetent valves - Previous DVT - Atherosclerosis - Vasculitis - SLE, RA
93
Describe the pathophysiology of a venous ulcer
Increased pressure --> extravasation of fibrinogen through capillary wall --> perivascular fibrin deposition --> poor oxygenation of surrounding skin
94
How does a venous ulcer present?
``` Sloping, gradual edges Large, shallow, irregular and exudative ulcer Oedema of lower leg Venous eczema Varicose veins Lipodermaosclerosis ```
95
What investigations would you do on a patient you suspect to have a venous ulcer?
Doppler US - to exclude artery disease
96
What is the treatment for venous ulceration?
High compression bandaging and leg elevation
97
What is an arterial ulcer?
Punched out, painful ulcer higher up on the leg or on the feet
98
What are 3 risk factors for an arterial ulcer?
1. Claudication 2. Hypertension 3. Angina 4. Smoking
99
What are the signs of an arterial ulcer?
1. Cold and pale leg 2. Loss of leg hair 3 Absent peripheral pulses
100
How would you confirm an arterial ulcer?
Doppler US
101
What is the treatment for an arterial ulcer?
Clean and cover Analgesia Vascular reconstruction if needed NO compression bandaging
102
How do neuropathic ulcers usually present?
Painless | Seen over pressure areas of feet or heel due to repeated trauma
103
What diseases are associate with neuropathic ulcers?
1. DM | 2. Neurological disease
104
How do you treat neuropathic ulcers?
Keep clean and remove pressure/trauma | Correctly fitting shoes
105
What is the most common cutaneous vasculitis?
Leucocytoclastic vasculitis/angitis | = symmetrical palpable purpura
106
Give 3 causes of Leucocytoclastic vasculitis
1. Idiopathic 2. Drugs 3. Infection 4. Inflammatory disease 5. Malignant disease
107
How do you confirm cutaneous vasculitis?
Skin biopsy
108
What is the treatment for cutaneous vasculitis?
Analgesia Support stockings Dapsone (Abx) or prednisone
109
Name 3 other types of ulcer
1. Infective - TB, syphilis 2. Traumatic 3. Malignant 4. Lymphoedema 5. Pyoderma gangranosum 6. Drug induced

PHASE 2A (16 decks)

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