Dermatology Flashcards
(165 cards)
1
Q
What is a macule?
A
Flat, non-palpable change in skin colour, <0.5cm diameter
2
Q
What is a patch?
A
Flat, non-palpable change in skin colour, >0.5cm diameter
3
Q
What is a vesicle?
A
Fluid within upper layers of skin, <0.5cm diameter
4
Q
What is a blister?
A
Fluid within upper layers of skin, >0.5cm diameter
5
Q
What is a bulla?
A
Large fluid-filled lesion below epidermis, >10cm diameter
6
Q
What is a pustule?
A
Visible collection of pus in subcutis
7
Q
What is a nodule?
A
Mass or lump >0.5cm diameter
8
Q
What is a callus?
A
Hyperplastic epidermis, often found on the soles,
palms + other areas of excessive use
9
Q
What is a plaque?
A
Raised area >2cm diameter
10
Q
What is a wheal?
A
Dermal oedema
11
Q
What is a fissure?
A
Linear crack
12
Q
What is an ulcer?
A
Full thickness skin loss
13
Q
What is an excoriation?
A
Scratch mark
14
Q
What is lichenification?
A
Thickening of epidermis with exaggerated skin marking usually due to repeated scratching
15
Q
What are telangiectasia?
A
Easily visible superficial blood vessels
16
Q
What is purpura?
A
Rash caused by blood in skin
17
Q
What is petechia?
A
Micro-haemorrhage, 1-2mm diameter
18
Q
What are some examples of hypopigmented or depigmented lesions?
A
Vitiligo
Pityriasis versicolor
Pityriasis alba
19
Q
What are some examples of hyperpigmented lesions?
A
Lentigos Café-au-lait spots Melasma (chloasma) Melanocytic naevi Seborrhoeic keratoses Systemic diseases: Addison’s, haemochromatosis
20
Q
What are some examples of ring shaped lesions?
A
BCC
Tinea (ringworm)
Granuloma annulare
Erythema multiforme
21
Q
What are some examples of round/discoid lesions?
A
Bowen’s disease Discoid eczema Psoriasis Pityriasis rosea Erythema migrans Impetigo
22
Q
What are some examples of linear lesions?
A
Kobner phenomenon: lesions related to skin injury
Dermatitis artefacta: lesions induced by pt
Herpes zoster
Scabies burrows
23
Q
What dermatological conditions cause itchy lesions?
A
Scabies, urticaria, atopic eczema, dermatitis herpetiformis, lichen planus
24
Q
What systemic diseases are associated with itchy lesions?
A
Iron def., lymphoma, hypo/hyperthyroidism, liver disease, CKD, polycythaemia, drugs (statins, ACEi, opiates)
25
How should vitiligo be managed?
Sun protection, cosmetic camo, topical steroids may induce repigmentation, phototherapy
26
What is pityriasis versicolor?
Superficial slightly scaly yeast infection
| Appears hypopigmented on darker skin
27
What is pityriasis alba?
Post-eczema hypopigmentation, often on child’s face
28
What are lentigos?
Brown macules/patches that persist in winter, unlike freckles
29
Describe the appearance of seborrhoeic keratoses:
Benign greasy-brown warty lesions usually on back,
chest and face
Stuck on appearance
30
What are actinic (solar) keratoses?
Pre-malignant crumbly yellow-white scaly crusts on sun-exposed skin
31
What are some management options for actinic keratoses?
Observation
Topical 5-FU, imiquimod or diclofenac
Cryotherapy, photodynamic therapy
Surgical excision and curettage
32
What is Bowen's disease?
Well-defined slowly enlarging red scaly plaque with flat edge
3-5% progress to SCC
33
What are some management options for Bowen's disease?
Cryo, topical 5-FU or imiquimod,
| photodynamic, curettage, excision
34
What is keratoacanthoma?
Smooth dome-shaped papule, rapidly grows to become a crater centrally
35
What is the management for keratoacanthoma?
Urgent excision
36
Describe the appearance of squamous cell carcinoma:
Persistently ulcerated or crusted firm irregular lesion often on sun-exposed sites
37
What factors increase the risk of metastasis in squamous cell carcinoma?
If on lip, ear or non-sun exposed site
>2cm
Poor differentiation
Immunosuppression
38
What is the management for squamous cell carcinoma?
Local complete excision with 4-6mm margin
39
Describe the appearance of nodular basal cell carcinoma:
Pearly nodule with rolled telangiectatic edge on face or sun-exposed site
40
Describe the appearance of superficial basal cell carcinoma:
Red, scaly plaques with raised smooth edge, often on trunk or shoulders
41
How should basal cell carcinoma be managed?
Excision
| Can use cryo, curettage, RT, photodynamic, topical if superficial at low risk site
42
What cancers may metastasise to the skin?
Breast, stomach + colon, lung, genitourinary
43
What is leukoplakia? Who is it more common in?
Premalignant condition, white hard spots on mucous membrane of mouth
More common in smokers
44
What is mycosis fungoides?
Cutaneous T-cell lymphoma
| Well-defined itchy red scaly plaques progressing to red-brown infiltrated plaques and ulcerating tumours
45
What is Fitzpatrick skin type I?
Pale white skin, blonde/red hair
| Always burns, does not tan
46
What is Fitzpatrick skin type II?
Fair skin, blue eyes
| Burns easily, tans poorly
47
What is Fitzpatrick skin type III?
Darker white skin
| Tans after initial burn
48
What is Fitzpatrick skin type IV?
Light brown skin
| Burns minimally, tans easily
49
What is Fitzpatrick skin type V?
Brown skin
| Rarely burns, tans darkly easily
50
What is Fitzpatrick skin type VI?
Dark brown or black skin
| Never burns, always tans darkly
51
What are some risk factors for malignant melanoma?
UV exposure, sunburn, fair complexion, >50 melanocytic or dysplastic naevi, FH, previous melanoma, age
52
What are some signs of malignant melanoma (ABCDEF)?
```
Asymmetry in outline of lesion
Border irregularity
Colour variation
Diameter >6mm
Evolution (size, elevation, colour)
Funny looking mole, different from others/mole signature
```
53
What are the types of malignant melanoma?
Superficial spreading (70%)
Nodular (15%)
Acral lentiginous (10%)
Lentigo maligna melanoma (5%)
54
How should malignant melanoma be managed?
Excision biopsy with 2mm margin allowing for histological diagnosis and Breslow thickness
If MM confirmed, wider excision (up to 3cm) to
ensure complete removal and may do SNLB
55
How should metastatic melanoma be managed?
Palliation: chemo, biological, novel targeting therapy and ipilimumab
56
What is psoriasis?
Chronic inflammatory skin condition characterised by scaly erythematous plaques, typically relapsing remitting course
57
What are some triggers for psoriasis?
Stress, infections, skin trauma (Kobner), drugs (lithium, NSAIDs, beta blockers), withdrawal of systemic steroids
58
What are the types of psoriasis?
```
Chronic plaque
Flexural
Guttate
Pustular
Generalised
```
59
Describe chronic plaque psoriasis:
Symmetrical well-defined red plaques with silvery scale on extensor aspects, scalp and sacrum
60
Describe guttate psoriasis:
Large numbers of small plaques <1cm (teardrop) over trunk and limbs, seen in young (esp. after acute strep infection), lasting 3-4m
61
What nail changes are associated with psoriaisis?
Pitting, onycholysis (separation from nail bed),
| thickening, subungal hyperkeratosis
62
How should psoriatic arthropathy treated?
NSAIDs, DMARDs, anti-TNF
63
What are the management options for psoriasis?
Emollients
Topical corticosteroid and topical vit D
Phototherapy or systemic therapy if not controlled or if >10% body area affected
64
What are the side effects of phototherapy?
Increased risk of SCC, sunburn, dry skin, folliculitis, cold sores, polymorphic light eruption
65
What non-biologic oral drugs may be used in the management of psoriasis?
Methotrexate
Ciclosporin
Acitretin
Dimethyl fumarate and apremilast
66
What biologics may be used in the management of psoriasis and what is the MoA?
Inhibit T cell activation and function or neutralise cytokines
Infliximab, adalimumab, etanercept (anti-TNF), ustekinumab (interleukin inhibitor)
67
What are the diagnostic criteria for atopic eczema?
Child must have itchy skin with 3+ of:
1. Onset before 2y
2. Past flexural involvement
3. History of generally dry skin
4. Personal history of other atopy
5. Visible flexural dermatitis or on cheeks/forehead if <4y
68
What are the management options for atopic eczema?
Emollients: use liberally (3-4x/day)
Topical steroids for exacerbations
Treat secondary bacterial infection with oral Abx
Topical tacrolimus if not controlled
Azathioprine, ciclosporin or methotrexate if uncontrolled severe disease
69
Describe adult seborrheic dermatitis:
Overgrowth of skin yeasts causes red, scaly rash affecting scalp (dandruff), eyebrows, nasolabial folds, cheeks and flexures
70
How should adult seborrheic dermatitis be managed?
Scalp: OTC preps containing zinc pyrithione (Head + Shoulders)
Body: mild topical steroid/antifungal prep e.g. Daktacort or ketoconazole
71
What can cause irritant dermatitis?
Detergents, soaps, oils, solvents, alkalis
72
How should irritant dermatitis be managed?
Avoiding irritants, hand care with soap substitutes, emollients, careful drying and gloves
73
What can cause allergic contact dermatitis?
Nickel (jewellery, watches), chromates (leather), lanolin, rubber, plants
74
How can allergic contact dermatitis be managed?
Patch testing and avoidance of allergen, use topical
| steroid based on severity
75
What is an example of a mild topical steroid?
Hydrocortisone
76
What is an example of a moderate topical steroid?
Eumovate (Clobetasone)
77
What is an example of a potent steroid?
Betnovate (Betamethasone)
78
What is an example of a very potent steroid?
Dermovate (Clobetasol)
79
What are some side effects of topical steroids?
Skin thinning, irreversible striae, telangiectasia, worsening of untreated infection, contact dermatitis
80
Approximately what area is covered by one fingertip unit of topical steroid?
Palmar surface of 2 adult hands
81
What is the pathophysiology of acne vulgaris?
Basal keratinocyte proliferation in pilosebaceous follicles, ↑sebum production, Propionibacterium acnes colonisation, inflammation, comedones blocking secretions hence papules, nodules, cysts and scars
82
Describe mild acne:
Mainly facial comedones
83
What is the management for mild acne?
Topical BPO, topical retinoid e.g. isotretinoin or topical Abx alone
84
Describe moderate acne:
Inflammatory lesions (papules and pustules)
85
What is the management for moderate acne?
Topical BPO combined with Abx or topical retinoid (Epiduo)
| Then lymecycline or erythromycin (pregnant or <12y), use for 3m with topical BPO
86
Describe severe acne:
Nodules, cysts, scars and inflammatory papules or pustules
87
What is the management for severe acne?
Oral isotretinoin
88
What is rosacea?
Chronic relapsing/remitting disorder of BVs and
| pilosebaceous units in central facial areas
89
What can trigger rosacea?
Stress/blushing, alcohol and spices
90
What are some signs of rosacea?
Central facial rash with erythema, telangiectasia,
| papules, pustules, inflammatory nodules
91
How should rosacea be managed (include mild + severe)?
Soap substitutes, avoid sun over-exposure, use sun-block
Mild: topical metronidazole or topical 15% azelaic acid gel
Moderate or severe: oral tetracycline for 4m
92
Describe morbilliform drug eruption:
Generalised erythematous macules + papules often on trunk within 1-3w of drug exposure
93
Describe urticaria drug reaction:
Itchy erythematous wheals appear rapidly after drug exposure ± angioedema/anaphylaxis
94
Describe erythroderma (exfoliative dermatitis):
Widespread erythema and dermatitis affecting >90% body surface
95
Describe Stevens-Johnson syndrome:
Painful erythematous macules evolving to form target lesions, severe mucosal ulceration of 2+ surfaces e.g.
conjunctiva, oral cavity, labia, urethra
96
Describe toxic epidermal necrolysis:
Widespread painful dusky erythema then necrosis of
| epidermis with mucosa severely affected
97
What are some examples of drugs that can cause drug eruptions?
Sulphonamides, anti-epileptics, penicillins, NSAIDs, cephalosporins, allopurinol
98
What skin signs can diabetes cause?
Flexural candidiasis, acanthosis nigricans, granuloma annulare, folliculitis
99
What skin signs can lupus cause?
Facial butterfly rash, photosensitivity, diffuse alopecia, discoid lupus, livedo reticularis
100
What skin signs can IBD cause?
Erythema nodosum, pyoderma gangrenosum
101
How does erythema multiforme present?
Well defined target lesions on extensor surfaces of
| peripheries
102
What can cause erythema multiforme?
Herpes simplex (70%), mycoplasma, CMV, drugs.
103
Describe erythema migrans:
Papule becomes spreading red ring lasting weeks to months (pathognomonic of Lyme disease)
104
Describe livedo reticularis:
Non-blanching vague pink-blue mottling caused by capillary dilatation and stasis in skin venules, most often in legs
105
Describe ringworm infection:
Round, scaly, itchy lesion with inflammed edge compared to centre
106
How should ringworm infection be investigated?
Sending skin scrapings from active edge, scalp brushings or nail clippings for microscopy and culture
107
How should ringworm infection be managed (include management for nail infection)?
Topical antifungal creams (terbinafine or imidazole) for 2w
| If nail: oral terbinafine
108
What is the management for candida?
Imidazole creams
109
What is the management for pityriaisis versicolor?
Imidazole creams, ketoconazole shampoo
110
What is onychomycosis?
Thickened, rough, opaque nails
| Mainly due to Trichophyton rubrum
111
When and how should onychomycosis be treated?
Only treat if symptomatic and use oral terbinafine for months
112
What is impetigo?
Contagious superficial infection caused by S. aureus Lesions usually start around nose and face with honey coloured crusts on erythematous base
113
How should impetigo be treated?
Hydrogen peroxide, topical fusidic acid or flucloxacillin if severe
114
What is erysipelas?
Sharply defined superficial infection caused by S. pyogenes
115
What are some signs of cellulitis?
Pain, swelling, erythema, systemic upset, lymphadenopathy
116
How should cellulitis be managed?
Benpen IV + fluclox PO
117
What is the cause of warts?
HPV in keratinocytes
118
How should common warts be managed?
If painful or persisting can use topical salicylic acid, cryotherapy, duct tape occlusion
119
How should genital warts be managed?
Observe, podophyllin/imiquimod cream, cryotherapy
120
Describe the appearance of molluscum contagiosum:
Pink papules with umbilicated central punctum
121
What is the cause of molluscum contagiosum?
Pox virus
122
Describe herpes simplex infection:
Grouped painful vesicles on erythematous base
123
When should shingles be treated with oral acyclovir?
If >50y, ophthalmic, severe, immunosuppressed
124
What are some complications of herpes zoster infection?
Post-herpetic neuralgia, meningitis, encephalitis
125
Describe the appearance of lichen planus:
Lesions are purple, pruritic, poly-angular, planar, papules
| Can have white lines on surface (Wickham’s striae). Often on flexor aspects of wrists, forearms, ankle and legs
126
How should lichen planus be managed?
Topical steroids
127
Describe the appearance of pyogenic granuloma:
Fleshy moist red lesion which grows rapidly and bleeds easily
128
How should pyogenic granuloma be managed?
Curettage
129
Describe the appearance of pityriasis rosea:
Self-limiting rash preceded by herald patch (oval red scaly patch)
130
Describe alopecia areata:
Smooth well-defined round patches of hair loss on
| scalp, exclamation mark hairs
131
What can cause scarring alopecia?
Lichen planus, discoid lupus, trauma, BCC, SCC
132
What is the cause of bullous pemphigoid and how does it present?
IgG autoantibodies to BM
| Tense blisters on inflammed or normal skin
133
How should bullous pemphigoid be managed?
Very potent steroids (clobetasol), oral pred
134
What is the cause of pemphigus vulgaris and how does it present?
IgG autoantibodies against desmosomal components which leads to acantholysis (keratinocytes separate from each other)
Mucosal ulceration, skin blistering
135
How should pemphigus vulgaris be managed?
Treat with pred
| Rituximab + IV Ig (if resistant)
136
What is eczema herpeticum?
Severe primary infection often by HSV1/2
| More common in children with atopic eczema
137
How does eczema herpeticum present?
Rapidly progressing painful rash, monomorphic punched out erosions
138
How should eczema herpeticum be managed?
Admit for IV acyclovir
139
What can cause chondrodermatitis nodularis helicis?
Persistent pressure (sleep), trauma or cold
140
How should chondrodermatitis nodularis helicis be managed?
Use ear protectors during sleep, cryo, steroid infection, collagen injection
141
What is dermatitis herpetiformis?
Autoimmune blistering skin disorder associated with
| coealic, deposition of IgA in dermis
142
How does dermatitis herpetiformis present?
Itchy, vesicular skin lesions on extensor surfaces and buttocks
143
How should dermatitis herpetiformis be managed?
Gluten free diet and dapsone
144
What is erythema ab igne?
Reticulated, erythematous patches with hyperpigmentation and telangiectasia due to exposure to infrared radiation
145
What is erythema nodosum?
Inflamm of subcut fat causes tender, erythematous, nodular lesions
Usually occurs over shins
146
What are some causes of erythema nodosum?
Infection (strep, TB), sarcoid, IBD, malignancy, pregnancy
147
Describe the appearance of pyoderma gangrenosum:
Small red papule -> deep, red, necrotic ulcer with violaceous border
148
What are some causes of pyoderma gangrenosum?
Idiopathic (50%), IBD, RA, SLE, malignancy
149
What is the cause of staphylococcal scalded skin syndrome?
Release of exotoxins by S. aureus
150
How should staphylococcal scalded skin syndrome be managed?
IV Abx
151
What are some common causes of skin ulcers?
Neuropathy
Vascular – venous (75%), arterial (10%), mixed (15%)
Trauma
152
What are some risk factors for venous ulcers?
Varicose veins, DVT, venous insufficiency, poor calf muscle function, AV fistula, obesity, leg fracture
153
How should venous ulcers be treated and what investigations must be performed before treatment?
Compression bandaging and occlusive dressings
| Dopplers and ABPI to exclude arterial disease
154
What are some risk factors for pressure ulcers?
Extremes of age, reduced mobility and sensation, vascular disease, chronic/terminal illness
155
What are the 4 stages of pressure ulcers?
Stage I: non-blanching erythema over intact skin
Stage II: partial thickness skin loss
Stage III: full thickness skin loss, extending into fat
Stage IV: destruction of muscle, bone or tendon
156
How should pressure ulcers be managed?
Pressure-relieving mattress and cushions, freq repositioning, modern dressing, debride dead tissue, negative pressure treatment
157
How can pressure ulcers be prevented?
Initial and ongoing assessment, regular inspection of skin, minimise excess moisture, regular turning
158
What is the cause of Kaposi's sarcoma?
HHV-8
159
How does Kaposi's sarcoma present?
Purple patches or plaques on skin and mucosa of any organ
160
What is the treatment for Kaposi's sarcoma?
HAART, systemic interferon alfa or chemo, excision
161
What are some signs of scabies infestation?
Very itchy papules, vesicles, pustules and nodules affecting finger webs, wrist flexures, axilla, abdo, buttocks and groins
162
How should scabies be managed?
Treat all members of household and close contacts with permethrin 5% cream
163
How should headlice be managed?
Malathion, dimeticone
| Fine-toothed comb to remove lice and nits
164
What is a papule?
Raised area <0.5cm diameter
165
What are some side effects of oral isotretinoin?
Teratogen, skin and mucosal dryness, depression
