Dermatology Flashcards
(439 cards)
1
Q
When performing an examination of the skin what are the four steps?
A
inspect describe palpate systemic check
2
Q
what acronyms are used in the describe step of investigating a lesion
A
SSCAMM: size shape colour associated secondary changes morphology and margin plus if the lesion is pigmented ABCD asymmetry irregular border two or more colours within the lesion diameter >6mm
3
Q
the presence of which features of a lesion would indicate melanoma
A
asymmetry irregular border two or more colours within the lesion and a diameter greater than 6 cm
4
Q
what are the layers of the epidermis
A
stratum corneum stratum lucidum stratum granulosum strarym spinosum stratum basale
5
Q
what is the composition of the stratum basale
A
actively dividing cells
6
Q
what is the composition of the stratum spinosum
A
differentiating cells
7
Q
What is the composition of the stratum granulosum
A
differentiated cells begin to use the nucleus and contain granules of keratohyaline which secrete lipids into the intracellular spaces
8
Q
what is the composition of the stratum lucidum?
A
this is found only in areas of thick skin such as the soles of feet and consists of paler compacted keratin
9
Q
what is the composition of the stratum corneum
A
layers of keratin it is the most superficial layer
10
Q
what with three ways in which pathology can occur in the epidermis
A
changes in theepidermal turnover time (e.g. psoriasis has decreased turnover time)/changes in skin surface or epidermal loss (e.g. crusting exudates ulcers)/changes in skin pigmentation
11
Q
what substances are found in the dermis of the skin ? And what is their function?
A
collagen and elastin glycolosaminoglycans - allow for elasticity and strength / immune cells nerves skin appendages such as her and lymphatic tissue and blood vessels
12
Q
what synthesises glycolosaminoglycans in the skin?
A
fibroblasts
13
Q
what are the ways in which pathology can occur in the dermis?
A
changes in skin control or loss of dermis (e.g. papules nodules skin atrophy and ulcers) disorders of skin appendages (hair and sebaceous glands) changes related to lymphatic and blood vessels (erythema urticaria and purpura)
14
Q
how would you describe this image below?
A
a wheal - a transient raised lesion due to dermal oedema
15
Q
how would you describe the image below?
A
a discrete lesion – individual lesions separate from each other
16
Q
how would you describe the image below
A
confluent – lesions are merging together also known as maculopapular
17
Q
how would you describe the image below?
A
Linear common scabies or scratch
18
Q
how would you describe the image below?
A
target – like a bull’s-eye or dartboard
19
Q
how would you describe the image below?
A
annular – a ring/hollow cycle
20
Q
how would you describe the image below?
A
discoid/nummular - around lesion
21
Q
what does the term naevus mean?
A
localised malformations of tissue structures for example moral
22
Q
what does the term commedone mean
A
a plug-in the sebaceous follicle causing altered Seaburn, bacteria and cellular debris deposit which can be open (blackhead) or closed (Whitehead)
23
Q
what is meant by flexor distribution
A
usually found in the body folds
24
Q
what is meant by an extensive distribution
A
usually found on the knees and elbows shins
25
what is the definition of a dermatome
and area of skin supplied by single nerve (spinal)
26
what is meant by term Köeber Phenomenon?
linear eruption arising from the site of trauma mainly found in psoriasis
27
what is the function of the skin
a protective barrier against environmental insults cosmetic appearance immuno survey temperature regulation vitamin D synthesis and sensation
28
what are the four stages of wound healing
haemostasis inflammation proliferation remodelling
29
what occurs in the haemostasis stage of wound healing
vasoconstriction and platelet aggregation clot formation
30
what occurs in the inflammatory stage of wound healing
vasodilation migration of neutrophils and macrophages phagocytosis of cellular debris and invading bacteria
31
what is the mechanism of the proliferative stage of wound healing
fibroblasts are proliferating and causing granulation tissue to form (synthesised by fibroblasts) and angiogenesis occurs / epidermal cell proliferation and migration then allows for re-epithelisation
32
what occurs in the remodelling stage of wound healing
there is collagen fibre reorganisation and scar maturation the freshly healed epidermis will be slightly red
33
what are the two types of urticaria
immunological or non-immunological which means there is no IgE involvement
34
what is the pathophysiology of urticaria
inflammation occurs in response to a trigger increasing permeability of the small manuals inflammatory mediators especially histamine released from mast cells and other driving force in the inflammatory reaction resulting in the swelling of the dermis and raising the epidermis
35
which layer of skin is urticaria occur in
in the dermis however the swelling of the dermis has knock-on effect causing swelling of the epidermis
36
what are the common triggers of urticaria?
food drugs insect bites contact with chemicals or latex viral or parasitic infections autoimmune hereditary
37
what drugs commonly cause urticaria
penicillin contrast media and ACE inhibitors
38
what can be a severe consequence of urticaria
angioedema which is a red flag for anaphylaxis
39
what is angioedema
a swelling of the dermis and deeper tissues which occurs in the face and lips
40
what is the management for urticaria
antihistamines and if there is severe reactions give corticosteroids (usually of angioedema is present)
41
what is the criteria for acute urticaria?
less than six weeks and linked to allergen or viral infections
42
what is the criteria for chronic urticaria
over six weeks without any links to allergens/viruses
43
what are usually the triggers for chronic urticaria
cold or heat sun aquagenic cholinergic
44
what is erythema nodosum?
hypersensitivity response to various stimuli
45
what is the image below show
urticaria
46
what is image below show
erythema nodosum
47
what is the presentation of erythema nodosum
discrete tender nodules which appear for one – two weeks and then leave a bruise -like discolouration because they resolve most commonly occurring at the shins
48
what are some causes of erythema nodosum?
primary TB pregnancy malignancy IBD group a beta haemolytic strep chlamydia leprosy sarcoidosis
49
what does the image below show
erythema multiforme
50
what is erythema multiforme?
atypically acute self-limiting but often relapsing inflammatory condition
51
what are the two most common causes of erythema multiforme
drug reactions or post infectious (herpes simplex and Mycoplasma pneumoniae)
52
what is the characteristic presentation of erythema multiforme
target lesions that resemble a bull's-eye erupting over 24 – 48 hours lasting for 1 – 2 weeks
53
what is the image below show
SJS
54
what is Stevens Johnson syndrome
characterised by mucocutaneous necrosis with more than two sites involved where there is skin detachment and mucocutaneous involvement
55
why the presentation of SJS
severe erythema mucocutaneous necrosis and detachment of skin
56
what sign is usually present in SJS
Nikolskys signs
57
what is nikoskys sign
epidermal layer easily slows off when pressure is applied to the blister or erythema to this area
58
what is the difference between SJS and TENS
SGS there is less than 10% skin involvement whereas TENS there is a larger proportion of skin involved and thus has a higher mortality rate
59
what usually triggers SJS
infections or drug reactions
60
do drug reactions usually cause SJS or TENS
TENS
61
why is the mortality rates are high in TENS
often due to: sepsis easily occurs electrolyte imbalances and multisystem organ failure and shock
62
what is the management of both TENS and SJS
stop any reactive agents / IV fluid nutritional support/ IVIg/ /analgesia/PPI (stress-related gastritis)/ dressings topical antibiotics and the millions/ U+E close monitoring and eeplacing deficiencies/ urgent ophthalmological evaluation
63
what investigations are required in SJS/TENS
Cultures for ? Causative agent / U+E for derrangement and monitoring organ function / ECG for electrolyte abnormalities affecting heart / SKIN BIOPSY - diagnostic
64
what is the image below show
classic rash associated with meningococcacemia
65
what pathogen usually causes meningitice septicaemia
nesseria meningitidis
66
what is the description of the rush associated with meningitis septicaemia
non-blanching maculopapular purpuric rash - although at the start of the disease it may be blanching / usually found on trunk and extremities and can rapidly progress
67
what is the presentation of meningitic septicaemia?
will undertake symptoms (headaches fever next) hypotension fever myalgia tachycardia and other symptoms of septicaemia plus the rash
68
what does the rash rapidly progress to in meningitic septicaemia?
echymoses aka brusing, haemorrhagic bullae and tissue necrosis
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who is most likely to get meningitic septicaemia
those under five teenagers aged 11 to 22 years over 65s
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what investigation team into performing in ?meningitis
blood cultures/ urine cutures / FBC / U+E / LFT and coag panel / VBG/ actate - FULL SEPTIC SCREEN
71
what is the management of meningitic septicaemia?
cephalosporin (ceftriaxone) ampicillin and vancomycin adj. corticosteroids IV dexamethosone
72
what does the image below show
erythroderma
73
what is erythroderma
an exfoliative dermatitis involving 90% of the skins surface
74
what is the presentation of erythroderma
inflamed oedematous scaly peeling skin with systemic features of lymphadenopathy and malaise
75
what are common causes of erythroderma?
most commonly drug reactions but also: eczema and psoriasis lymphoma or idiopathic
76
which drugs commonly cause erythroderma
sulphanamides / gold/ penicillin / allopurinol / captopril
77
what is the management of erythroderma
stop causative agent / underlying cause / only ends and wet wraps/IV fluids and any nutritional support/ topical steroids/systemic steroids if appropriate/watch out for any secondary infections give topical antibiotics if necessary and moving up to Ivy
78
what are consequences of erythroderma
secondary infections fluid loss electrolyte imbalance hypothermia high cardiac output heart failure and capillary leakage syndrome
79
how do you monitor the complications associated with erythroderma
fluid balance / U+E / FBC / skin biopsy + serum albumin
80
how does psoriasis or eczema cause erythroderma?
usually from steroid withdrawal or triggered by use of beta-blockers, lithmus and antimalarials
81
what is eczema herpeticum?
a widespread eruption caused by HSV when there is a concordant skin disease/underlying pathology usually axeman
82
eczema herpeticum is usually a manifestation of a _______ HSV infection
1ry
83
what does the image below show
eczema herpeticum
84
what is the presentation of eczema herpeticum
extensive crusted papules blisters and erosions as well as systemic features of malaise and fever
85
what is a diagnostic test for eczema herpeticum
swab and culture with PCR
86
What is the management of eczema herpeticum
acyclovir and cover for any secondary infections if they can occur with antibiotics
87
what are complications which can arise because of eczema herpeticum
herpes hepatitis herpes encephalitis secondary infections DIC
88
what are the two types of HSV
type I causing and skin lesions Type II causing genital lesions
89
what is the presentation of a primary infection of HSV
is usually asymptomatic but may present with high fever sore throats myalgia cervical lymphadenopathy also said appear a few days later on the Fangio and mouth mucosa
90
what is a typical presentation of HSV eruption
has prodromal tingling and burning and then a vesicular lesion which can turn ulcerative
91
what is a serious complication of a primary infection of HSV
HSV aseptic meningitis
92
what investigations should be performed in HSV meningitis
anyone suspected of having central nervous system HSP should have CSF HSP PCR as well as viral cultures in any active lesions
93
what can trigger an eruption of HSV vesicle?
UV lights or trauma
94
what other symptoms of genital HSV
dysuria tingling and burning can be with or without recurrent genital ulceration and ulcers can range from asymptomatic to painful there can be discharged and proctitis in males
95
how does the presentation of genital HSV differ in male and female
females tend to have stronger symptomatic response on primary infection and so will have more systemic symptoms such as fever constipation neuralgia and lower back pain or pain down the back of the legs
96
what investigations are diagnostic for genital herpes?
active lesions should be swamped for HSV and then PCR
97
what investigations are needed for oral herpes?
Nan into their clinical diagnosis however H is the culture/swab and PCR should be performed if there is any doubt
98
what is the management of a primary genital HSV infection
oral acyclovir or valacyclovir
99
how does the management differ in HSV for immunocompetent and immunocompromised patients
if immunocompromised give foscernet
100
what is the management of oral HSV?
oral acyclovir or valacyclovir topical antivirals may be used and can be bought over-the-counter however this is not typically recommended
101
what is the management of HSV in a woman who is 36 weeks gestation
prophylactic acyclovir
102
what are the indications for IV acyclovir in HSV infection
visceral involvement: pneumonitis hepatitis CNS (meningitis) eczema herpeticum corneal scarring from eye involvement
103
what is necrotising fasciitis?
rapidly spreading infection of the deep facia with secondary tissue necrosis
104
what pathogens usually cause necrotising fasciitis
group A haemolytic strep or mic of aerobic and anaerobic
105
what is the most common precipitating factors of necrotising fascitis?
recent abdominal surgery or with many medical comorbidities such as diabetes and pregnancy immunosuppressed
106
what is the presentation of necrotising fasciitis?
severe pain erythematous blistering necrotic skin and cellulitis systemic features of sepsis presence of crepitus
107
what would crepitus indicate in necrotising fasciitis
subcut emphysema
108
what investigations are necessary in necrotising fasciitis
CT/MRI blood and tissue cultures and septic screen especially checking U+E and Lactate
109
what would you see on CT/MRI in necrotising fasciitis?
oedema along fascial plane and soft tissue gas
110
what features would indicate circulatory collapse in necrotising fasciitis?
hyponatraemia lactate and creatine kinase ++
111
what is the management of necrotising fasciitis?
surgical debridement and IV antibiotics
112
what are the most common pathogens which cuase bacterial skin infectons?
streptococcal staphylococcal
113
what are the most common pathogens which cause viral skin infections?
HPV HSV
114
was the most common pathogens which cause fungal skin infections?
Candida Tinea
115
what are the most common types of infestations of skin ?
lice scabies cutaneous leishamaniasis
116
what is cellulitis
infection of the deep subcutaneous tissue
117
what is erysipelas?
acute superficial form of cellulitis involving only the dermis and the upper subcutaneous tissue
118
what pathogens are usually caused cellulitis
strep pyogenes and Staphylococcus aureus
119
what risk factors are associated with cellulitis
prior episode of cellulitis lymphadenoma ulcer/wound up Tinea pedis venous insufficiency
120
what is the image below show
cellulitis
121
what is the presentation cellulitis
swelling warmth erythema pain systemic symptoms of malaise and rigors
122
how does a presentation between cellulitis and erysipela differ?
cellulitis has a less well-defined red border
123
what are complication associated with cellulitis
local necrosis abscesses and septicaemia
124
what is management of cellulitis
flucloxacillin +/- vancomycin for MRSA cover + supportive care including rest like elevation sterile dressings and analgesia
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what is staphylococcal scalded skin syndrome
skin infection which produces an acute scolded the skin -like appearance
126
what is the pathophysiology behind staphylococcus scalded skin syndrome
staphylococcus produces an epidermolytic toxin
127
what is the picture below show
staphylococcal scalded skin syndrome
128
what is the presentation of staphylococcus called skin syndrome
onset of hours – days tends to be worse on face neck axilla and groin skin has a scolded appearance with redness, large flaccid bulla painful lesions intra epidermal blistering and perioral crusting
129
what is the management of staphylococcal scalded skin syndrome
Iv flucloxacillin or erythromycin + vancomycin if ?MRSA / analgesia / top emmolients and Abx + skin hydiene
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what is impetigo
a highly common and contagious bacterial infection caused by either strep or staph
131
what is image below show
impetigo
132
what is the presentation of impetigo
vesicles/bullae with golden crusting and associated erythema
133
what is the management of impetigo
usually resolves spontaneously but topical abx given or topical antiseptics --> PO abx
134
what three types of fungal infections which can happen on skin most commonly?
dermatophytes (tinea/ringworm) yeasts (candidiasis malassezia) moulds (aspergillus)
135
where does tinea corporis affect?
trunk and limbs
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where does tinea cruris affect?
groin and natal cleft
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where does tinea pedis affect?
athletes foot
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where does tinea manum affect
hand
139
where does tinea capitis affect
head
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where does tinea ungium affet
nails
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where does tinea incogneto affect
wherever there has been inappropriate treatment of a tinea infection with topical or systemic steroids it is ill-defined and less scaly
142
what is the presentation of tinea corpsris
itchy circular or annular lesions with a clearly defined raised scaly edge
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what is a presentation of tinea cruris
itchy circular or annular lesions with a clearly defined raised scaly edge
144
what is the presentation of tinea pedis
moisture scaling and for sharing in web spaces spreading to the sole and dorsal aspect with itching
145
what is the presentation of tinea manum
scaling and dryness of palmar creases and itching
146
what is a presentation of tinea captis
patches of broken hair scaling and inflammation
147
what is the presentation of tinea ungium
yellow discolouration and thickened crumbling nail
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what is the image below show
tinea captis
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what is image below show
tinea gruris
150
what is the image below show
althletes foot/tinea pedis
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what does the image below show
tinea manum
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what does the image below show
tinea captis
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what does the image below show
tinea ungium
154
how word candidiasis at present as a skin infection
white plaques on mucosal areas erythema and satellite leasions in flexures
155
what is the presentation of pitryasis
scaly brown patches on the upper trunk that failed to turn on sun exposure they are usually asymptomatic
156
how would you diagnose a fungal skin infection
skin scraping her toenail clippings or skin swabs as appropriate
157
what is the management of fungal skin infections
topical antifungal is terbinofine cream / oral antifungal if a severe widespread infections
158
what is the management of a tinea captis
oral and topical antifungal
159
what is scabies
and intensely itchy skin infestation caused by the human parasite sarcoptes scabiei
160
what causes the symptoms of scabies
immune response to the mites and their saliva eggs or faeces
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what is the image below show
scabies
162
what is a presentation of scabies
pruritus particularly at night linear boroughs with wavy threadlike whitish lines connecting them symmetrical erythematous papules which are often excoriated common in the inter-digital web spaces or extensors
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how would the presentation of scabies differ if it is present on the scrotum penis buttocks or groin or axilla
there may be nodules which are violet in colour and intensely itchy
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where is scabies most common on the body
into digital web spaces expenses folds of skin but can be anywhere especially in elderly and young children
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what is crusted scabies
are hyper infestation with thousands or millions of mites which are present in exfoliating scales of skin caused by immunodeficiency
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what is the image below show
crusted scabies
167
what risk factors are associated with scabies
family or close contacts also having scabies overcrowded living conditions children and elderly
168
what test is diagnostic for scabies
Inc Barrow test plus microscopy of skin scrapings
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what is the management of scabies
if under two months of age: paediatric dermatologist referral non-crusted scabies: topical insecticide - permethrin cream 5%
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What are the two types of skin cancer
melanoma and non-melanoma
171
what subtypes are there of non-melanoma skin cancer
Basal cell carcinoma's claim as cell carcinoma
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which have skin cancer usually has the highest mortality
melanoma
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what does the image below show
nodular basal cell carcinoma
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what does the image below show
superficial basal cell carcinoma
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what does the image below show
pigmented basal cell carcinoma
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what does the image below show
morphoeic basal call carcinoma
177
what does the image below show
basosquamous basal cell carcinoma
178
which is the most common type of basal cell carcinoma
nodular
179
what is the description of a nodular basal cell carcinoma
small and skin coloured papule or nodule with superficial telangactasia (mai=king appearance slightly red) and pearly rolled edges can have a necrotic or ulcerated core
180
what are risk factors associated with basal cell carcinoma
UV exposure increased age male immunosuppression history of skin cancer genetic predisposition frequent or severe sunburn in childhood skin type I
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person describes the skin is very pale which always burns never tans what type of skin type is this
skin type I
182
what complications usually arise because basal cell carcinoma
local tissue invasion and destruction
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what is the treatment of most types of basal cell carcinoma
excision and radiotherapy
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does the image below show
squamous cell carcinoma
185
what cells do squamous cell carcinomas affect
epidermal keratinocytes + appendages
186
describe the appearance of a squamous cell carcinoma
keratoic appearance (scaly +custy) and ill-defined nodule which may ulcerate
187
what is the treatment of squamous cell carcinoma
surgical excision with 5 mm margins and radiotherapy for large non-respectable tumours
188
what are the risk factors associated with squamous cell carcinoma
UV exposure pre-malignant skin conditions (aka actinic keratoses) chronic inflammation ( leg ulcers, wound scars) immunosuppression genetic predisposition
189
what is actinic keratosis
a premalignant skin condition which is strongly associated with sun exposure
190
what is the image below show
actinic keratosis
191
what risk factors are associated with actinic keratosis
chronic sun exposure skin type I older age immunosuppression
192
describe the appearance of actinic keratosis
typically ill-defined irregularly shaped small scaly macules/papules however can also be skin coloured or pigmented i.e. yellow
193
how would you diagnose actinic keratosis
usually a clinical diagnosis however demonstrably or skin biopsy can be used if unsure/ in atypical cases
194
what is the management of actinic keratosis
topical therapies (flurocil) unless there are many thick lesions in which case a cryo surgery in widespread lesions which attain chemical peels and topical diclofenac
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what is malignant melanoma
and invasive malignant tumour of epidermal melanocytes which has strong potential to metastasise
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what are the risk factors associated with malignant melanoma
UV exposure skin type I history of multiple moles atypical moles family history or previous melanoma
197
what our early warning signs of cancer
asymmetrical mole moles of the blurry or jagged border moulds with multiple colours models with a diameter larger than a pencil eraser (6 mm) a mole that has gone through a sudden change size shape or colour
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what are the types of malignant melanoma
superficial spreading nodular melanoma lentigo melanoma acral lentigious melanoma
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where is superficial spreading melanoma most common and in which age group
in the lower limbs and in the younger patient
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where is nodular melanoma most common and in which age group
common in the trunk and younger patients
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where is Lentigo melanoma most common and in which age group
common in the face and in elderly patients
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where is acral lentigios melanoma most common and in which age group
, in the palms and soles of feet as well as nail beds
203
what is different about the risk factors associated with acral lengigious melanoma compared to other types of melanoma
no clear relation to UV exposure is the most common melanoma in darker skin types
204
how do you diagnose melanoma
with biopsy
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how would you describe the staging of melanoma (TNM)
T1 just in the upper epidermis T2 reaching the stratum basale of the epidermis T3 reaching through the dermis T4 reaching the fat under the dermis
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what advice can you give to prevent melanoma from occurring
always use SPF 30 with UVB protection and high style UVA protection have protective clothing and sunglasses the initiate from 11 AM to 3 PM keep children out of direct sunlight and avoid all tanning
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what are differentials of acral lentigious melanoma
black nails/ trauma and haemorrhage or fungal infection
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what is the management on Acral lentigious melanoma
amputation and the extent of which is decided through biopsy and margins
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what are the names of inflammatory skin conditions
eczema acne psoriasis
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describe how the itch scratch cycle worsens inflammatory skin conditions
there is a compromised skin barrier irritants and allergens and the skin barrier causing inflammation which causes further itching which causes further scratching which further compromises the skin barrier
211
describe the physiology of the skin barrier
in the epidermis the outermost layer is made out of corneocytes and lipids which accumulate in a brick -like structure the skin lipids consist of caramide, cholesterol and fatty acids and has a lamellar structure in which several layers are stacked on top of one another
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what is image below show
eczema
213
described the presentation of eczema
itchy Erica Matthaus dry scaly patches which can be excoriated and weepy
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how does the distribution of eczema differ in adults to children
in infants tend to be on extensor surfaces on anyone older than infant tends to be on instances can be on the face in both age groups
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describe the presentation of acute lesions of eczema
the lesions are erythematous vesicular and exudative
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describe the appearance of chronic lesions in eczema
excoriation and lichenification
217
what other features (apart from skin manifestations) can there be in ecxema?
nail piercing and ridging
218
what risk factors are associated with eczema
past medical history of ATP family history of ATP primary genetic skin defect in the skin barrier or function exposure to exacerbating factors such as chemicals found in sweat heat or stress
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works general advice can you give to someone suffering from eczema
avoid itching avoid known exacerbate his use of frequent invariants
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describe the stepwise management of eczema
basic advice --> low potency/mild potency topical corticosteroids +/ or topical calcineurin inhibitors --> may destroy high potency corticosteroid +/- top CI --> systemic therapy or UV therapy
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give examples of calcineurin inhibitors
tacrolimus
222
what is an example of a mild corticosteroid
hydrocortisone
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what is an example of a moderate corticosteroid
clobetasome (Euvmovate)
224
what is an example of a potent corticosteroid
betamethosone (betnovate)
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give an example of a very potent topical corticosteroid used in dermatology?
clobetasol (dermovate)
226
what are signs that there is a secondary bacterial infection affecting eczema
there is a crusted weepy lesion
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what are secondary viral infections which can affect eczema
molluscum contagiosum viral warts eczema herpeticum
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what does the image below show
molluscum contagiosum viral warts eczema herpeticum
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what is contact dermatitis
an inflammatory skin condition which occurs as a result of exposure to an external irritant or allergen
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what type of hypersensitivity reaction is contact dermatitis
T4
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describe the meaning of type 4 hypersensitivity reaction
there is sensitisation and subsequent exposure to specific allergen which causes an immune response
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what is the difference between irritant contact dermatitis and contact dermatitis
irritant contact dermatitis is non-immunological it does not require prior sensitisation and it is caused directly by the physical and toxic effects of irritant substance
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what substances can cause irritant contact dermatitis
repeated prolonged exposure to water detergents and cleaning agents with acids and alkalis and certain plants
234
what are common triggers for contact dermatitis
cosmetics skincare nail varnishes fragrances and heard I metals commonly nickel topical medications such as antibiotics or corticosteroids plants such as sunflower
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what is the difference in presentation between acute dermatitis and chronic dermatitis
acute dermatitis: erythema and visiculations + dryness scaling and bullae chronic: dryness lichenification and fissuring - but presentation is usually mixed
236
how do you diagnose contact dermatitis
identifies the cause of the contact dermatitis (thorough history) definitive diagnosis is through patch testing however it not always needed if irritant is clear
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what is the management contact dermatitis
avoiding contact with the stimulus liberal application of ammonia consider prescribing topical corticosteroids if severe treating any secondary skin infections
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when would a referral to a dermatologist be necessary for contact dermatitis
is associated with occupation severe or chronic dermatitis especially if on the hands or face newly unstable dermatitis atypical or unresponsive dermatitis
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what must an employee do if their employee develops contact dermatitis because of their workplace
it is an employer's legal duty to report a case of occupational skin disease to the health and safety executive
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acne vulgaris is inflammation of the XXXXXXX
pilosebacious follicle
241
describe the pathophysiology of acne vulgaris
mainly caused by androgen hormones which increase sebum production because of abnormal follicular keratinisation and with us because bacterial colonisation and inflammation
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what are the two types of acne vulgaris
noninflammatory and inflammatory
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what are examples of noninflammatory acne vulgaris
open or closed comedones
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what are examples of inflammatory acne vulgaris
papules pustules and nodules or cysts considered moderate/severe acne
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what is the stepwise management of acne vulgaris
Top benzyl peroxie --> Top retinoids ----> Top Abx (usually for those who don’t want oral therpay) ---> oral therapy Abx ----> oral retinoids
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what antibiotics are used in treatment of acne vulgaris
doxycycline/ tetracycline or doxycycline/ Lymecyclin (if pregnant Erythromycin) ----> trimethoprim but must be initiated by specialists
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what is the name of the oral retinoid used in very severe acne
isoretinoin aka acutane
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what endocrine abnormalities can induce acne
PCOS cushings congenital adrenal hyperplasia
249
what medication can induce acne
systemic and topical steroids progesterone only contraception anabolic steroids lithium phenytoin isoniazid
250
what are the side effects and risks associated with isotretninoin
dry skin light sensitivity muscle/joint aches mild increase in blood fats/liver inflammation (ideally avoid alcohol) rarely can cause: mood disturbances depression suicidal ideation hepatitis or pancreatitis intracranial hypertension
251
how do you avoid intracranial hypertension in a patient prescribed isotretinoin
avoid concomitant use with tetracycline
252
what is rosacea
chronic rash involving the centre of the face characterised by papules pustules and telangiectasia
253
what does the image below show
rosacea
254
what are the types of rosacea
erythematotelangiectatic Papulopustular phymatous occular
255
what is the image below show
phymatous changes
256
describe the presentation of rosacea
flushed skin which can be dry and flaky skin is very sensitive and easily blushes that each subtype will have a predominant feature of erythema telangiectasia papules pustules phymatous and occular involvement
257
what complications can occur due to rosacea
ocular rosacea rhinophyma mobian disease
258
what is ocular rosacea
read gritty eyelids and sties due to posterior blepharitis with an increased chance of conjunctivitis keratosis or a episcleritis
259
what is rhinophyma
an enlarged unshaped knows due to sebaceous hyperplasia and vigourous thickening
260
how do you diagnose rosacea
usually clinical diagnosis but occasionally biopsies required
261
what would biopsy show in rosacea
chronic inflammation and vascular changes
262
what is the non pharmacological management of rosacea
avoid facial flushing and triggers + use SPS use water-based make-up only and avoid all use of oil based products
263
what is the pharmacological management of rosacea
clonidine alpha-2 reductase inhibitor
264
what is contraindicated in the management of rosacea
lavatory with steroids
265
how can you manage pastulopapular changes in rosecia
metronidazole gel azaelic acid ivermectin ---> tetracycline or metranidazole PO --> iroretinoin
266
how you manage eryhtematoustelengactasia manifesttations of roseacia
metronidazole gel azaelic acid --> lazer
267
how to manage rhynophyoma?
isotretinoin --> surgery
268
What is the pathophysiology of psoriasis?
a chronic inflammatory skin disease due to hyperproliferation of keratinocytes and inflammatory cell infiltration
269
what are the types of psoriasis
chronic plaque Guttate Sebhorric Flexural Pustular Erythrodermic
270
what does the image below show
psoriasis
271
what can precipitate an attack of psoriasis
trauma infections drugs alcohol and stress
272
where are psoriatic lesions usually found
on extensor surfaces and on the scalp
273
what is the presentation of psoriasis
well demarcated erythematous skinny black lesions which can be itchy burn or be painful
274
what signs and symptoms may be present apart from skin manifestations
50% have associated nail changes – pitting or Oncholysis , psoriatic arthropathy
275
what is the presentation of psoriatic arthropathy
an asymmetrical polyarteritis with asymmetrical oligomonoarthritis - can be lone distel interpharyngeal disease
276
what does the picture below show
arthritis mutilans
277
what is the management of mild psoriasis
topical therapy: vitamin D analogues , corticosteroids, retinoids, keratolytics (then things like dithranol or coal tar preparations)
278
how do vitamin D analogues help psoriasis
regulate the immune system and slow skin growth
279
how do corticosteroids help psoriasis
decrease inflammation and itching and slow down skin growth
280
what would you use as management for extensive disease that is not yet classed as severe
phototherapy
281
what is the management of extensive and severe psoriasis
methotrexate PO: retinoids cyclosporin is biological agents fumaric acid acretin
282
describe the psoriasis severity scoring
insert picture page 35
283
what conditions does psoriasis also increase the risk of
cardiovascular disease/metabolic syndrome and ETS
284
how would METS present
abdominal obesity hypertension type II diabetes mellitus non-alcoholic fatty liver disease
285
describe the stepwise treatment of psoriasis
general measures and Moulin topical treatments phototherapy traditional systemic therapy biologics
286
what are the main risks and side effects of methotrexate
risk of overdose side effects include GI discomfort tiredness mouth ulcers liver and lung fibrosis alcohol and is contraindicated in pregnancy
287
What are the side effects associated with acitretin
dry skin hair thinning tiredness myalgia deranged liver function lipids iCI in pregnancy
288
what are the main side-effects associated cyclosporins
hypertension and kidney function failure
289
what is image below show
flexural psoriasis
290
what does the image below show
Guttate psoriasis
291
what is a presentation of Guttate psoriasis
tear drop shape
292
where is sebhorric dermatitis most common
naso labial + retro aurticular
293
Where does pustual psorias most commonly occur
palmar plantar
294
where does erythrodermic psoriasis usually occur
everywhere !! A medical emergancy
295
the image below show
particular psoriasis
296
what is the picture below show
seborrhoeic psoriasis
297
how does the management of flexura; psoriasis differ from other types of psoriasis
only use steroids +/- adj antifunal and ABx
298
what is lichen planus
an autoimmune chronic inflammatory skin condition affecting skin and mucosal surfaces
299
whilst are the risk factors associated with lichen planus
genetics physical and emotional stress injury to skin localised skin disease systemic viral infection drugs
300
what drugs can predispose to lichen planus
gold quuinine captopril
301
what infections can predispose to lichen planus
hepatitis C but many more
302
what is the presentation of cutaneous lichen planus
papules and polygonal plaques crossed with fine white lines
303
what is the presentation of oral lichen planus
painless white streaks with accompanying painful and persistent erosions/ulcers and can have disquamative gingivitis
304
XXXXX is the more common type of lichen planus
Mucosal
305
what is the image below show
cutaneus lichen planus
306
what does the image below show
oral lichen planus
307
where are the areas which mucosal lichen planus can occur
mouth Volvo penis or any other mucosal site
308
what are the types of lichen planus
cutaneous mucosal/oral nail pigmentosis
309
what is the presentation of nail lichen planus
ridging of the nail oncholysis or scarring of the cuticle
310
what is the presentation of pigmentosis lichen planus
ill-defined oval greyish brown marks which can occur anywhere on the body without prior inflammatory phase
311
what is the management of lichen planus
topical steroid / Tacrolimus ointment / Topical Retinoids --> PO sterois ---> methotrexate (Adj. Phototherapy at any stage)
312
what is prickly heat
heat rash or miliaria rubra caused by excess sweating
313
where does prickly heat usually occur
shoulders chest or folds of the skin
314
what does the image below show
prickly heat
315
describes a rash that occurs in prickly heat
discrete papules that may blister
316
what is the management of prickly heat
Calamine lotion --> top. Steroids + loose fitting clothing + avoiding skin products with petrolium + mineral oil
317
What are common blistering disorder?
immunobullous diseases (bullous penphoid or pemphgus vulgaris) blistering skin infections (HSV HZV) impetigo insect bites vesicular eczema and burns
318
what is vesicular exczema?
Dyohydrotic eczema cantact with irritant causes vesicular eruptions
319
where does vesicular exczema usually occur?
hands or feet - usually around the edges
320
What are the usual triggers for vesicular exczema
vesicular eruptions itching and burning once blister peels thhere are red painful fissues
321
what other manifestations are there (apart from skin) in vesicular exczema?
dystrophy and paronychia
322
how do you diagnose vesicular eczema
clinical unless looks uncertain then do skin scrape/ patch testing (is chronic then biopsy)
323
what is a common DD for vesicular eczema?
tinea pedia
324
how do you manage vesicular eczema?
cold packs / emmolients / proper fitting footwear with x2 soxks and bandages to reduce moisture ---> top CS and anticholinergic if caused by hyperhydrosis ---> systemic CS then for severe disease
325
what does the image below show?
bullous pemphigoid
326
What is bullous pemphigoid?
a blistering skin disorder usually affecting the elderly
327
what is the pathophysiology of bullous pemphigoid?
autoantiodies against antigens found between the epidermis and dermis causing a sub epidermal split in the skin
328
Describe the presentation of bullous pemphigoid?
fluid-filled blisters on an erythematous base lesions are often itchy and proceeded by non-specific skin rash usually found on the trunks and limbs
329
what is the management of bullous pemphigoid?
topical steroids --> oral therapy: steroid tetracycline and niacinamide immunosuppression
330
what is pemphigoid vulgaris?
a bullous pemphigoid found in those who are middle-aged with a slightly different presentation to normal bullus pemphigoid
331
what is the image below show
pemphigoid vulgaris
332
what is the presentation of pemphigoid vulgaris?
flaccid easily personal blisters once they burst because erosions and crusts painful lesions usually are mucosal areas but then spread to normal skin
333
what is the management of pemphigoid vulgaris?
monitoring and wound care good oral hygiene high-dose oral corticosteroids and immunosuppressants
334
what are the three types of leg ulcer
venous arterial neuropathic
335
history of: ulcer that is painfulmore painful on standing and the history of varicose veins and DVT suggest which type of ulcer
Venous
336
A history of and also which is painful especially at night and pain gets worse when legs elevated and has a history of arteriosclerosis suggests which type of ulcer
arterial
337
a history of and also which is often painless and there is little sensation to the foot and patient has a history of diabetes/neurological disease suggest which type ulcer
neuropathic
338
which type of ulcer is most common on the malleolar area (eps medial)
Venus
339
which type of ulcer is most common on pressure and trauma sites such as pre-tibial supramalleolar (especially lateral) and at close
arterial
340
which type of ulcer is most common on the soles of feet heal toes and metatarsal heads
neuropathic ulcer
341
which type of ulcer is shown below
Venus
342
which type of ulcer is shown below
arterial
343
which type of ulcer is shown below
neuropathic
344
and also which is large shallow and irregular with and exudative and granulating base describes which type of ulcer?
Venous
345
and also which is small sharply defined and deep with a necrotic base defines which type of ulcer
arterial
346
an ulcer which can be either large or small and can be superficial or deep but has a granulating base and is surrounded by or is underneath a hyperkeratotic lesion eg callus describes which type of ulcer
neuropathic
347
patient with an ulcer has once again normal peripheral pulses signs of leg oedema and areas of brown pigmentation as well as areas of white scarring with dilated capillaries (atrophie blanche) this patient is most likely to have which type of ulcer
Venus
348
what is the ABPI of a patient with a venous ulcer
normal
349
what is the management of a venous ulcer
compression bandages
350
what must you exclude before applying compression bandages to a venous ulcer
arterial insufficiency
351
a patient with an ulcer has called skin weak or absent peripheral pulses shiny pale skin and loss of hair on the shins type of ulcer are they most likely to have
arterial
352
what is the ABPI a patient with an arterial ulcer
low: <0.8 - arterial insufficiency
353
what further investigations might you want to perform in a patient with arterial ulcer
Doppler studies and angiography
354
what is the management of an arterial ulcer
vascular reconstruction
355
what is contraindicated in the management of arterial ulcers
compression bandages
356
a patient with an ulcer present and they have warm skin normal peripheral pulses but on examination you note there is peripheral neuropathy what is the most likely type of ulcer?
neuropathic
357
what is the ABPI like in a neuropathic ulcer
normal usually
358
a patient with a history of diabetes presenting with an ulcer who has diminished peripheral pulses and a low ABPI - was the most likely type of ulcer
neuro ischaemic
359
what further investigations would you want to in a patient who has a neuropathic ulcer
x-ray to exclude osteomyelitis especially in deep ulcers
360
what is a management of a neuropathic ulcer
wound to bride meant regular repositioning appropriate footwear and good nutrition
361
what is a sebhorreic wart?
are benign condition which is common in middle-aged/elderly where there are multiple asymptomatic warty greasy papules on the skin which appear stuck on with well defined edges management is rarely needed
362
What's acid substances typically cause chemical burns
sulphuric acid nitric acid hydrochloric acid
363
what alkali substances usually cause chemical
sodium hydroxide ammonia phosphate sodium and calcium hypo chloride
364
why are gaseous chemicals more dangerous if ingested than liquid
take longer to digestive and liquids causing more severe burns
365
what is the presentation of a chemical burn
redness irritation burning pain or numbness vision changes can have low blood pressure muscle twitching/seizures cardiac arrest/arrhythmias feeling weak dizzy or having a headache or cough/shortness of breath
366
what feature of a chemical burn presentation would suggest an alkali burn
deep tissue injury due to liquefaction necrosis
367
what feature of a chemical burn presentation would suggest an acid burn
formation of black dead skin eschar
368
how would you manage a chemical burn
remove contaminated clothing irrigates for 20 minutes once reached the hospital treat as a thermal burn
369
when weight irrigation be contraindicated in the management of a chemical burn
if the burn involves elemental metals such as sodium magnesium lithium or potassium
370
management of a band which involves elemental metals is…?
soaking with mineral oil instead of irrigation
371
describes the thickness of a first-degree burn
it is superficial only reaching the epidermis
372
what are the characteristic features of a thermal 1st° burn
pain redness mild swelling
373
What other characteristic features of a thermal second-degree burn
pain blisters splotchy skin and severe swelling
374
describe the thickness of a second-degree burn
reaches the dermis specifically the papillary region
375
describe the thickness of a third-degree burn
is deep reaching the dermis reticular region
376
what is the presentation of a third-degree burn
white leathery relatively painless
377
described the thickness of a 4° burn
full thickness reaching the hypo dermis a.k.a. subcutaneous tissue
378
what is the presentation of a fall/4th° burn
child insensate tissue with formation of black dead skin – eschar
379
what is the management of a thermal burn
evaluate the airway taking care to secure and maintain circulatory support once the patient is stable (ABC DEF approach specifically looking at the airway loss of fluids/electrolytes and thermal regulation)
380
how would you evaluate severity of burns
look at the depth of the ban and evaluate the extent of the ban using the ruke of 9s
381
if a patient requires in patient management after thermal burn what would be the management
wound the bride meant and facilitating the closure of wound unless there is a full thickness burn which must be removed fully. Closure is used with autografts. Gave antibiotics wound cleansing etc
382
describe how male pattern baldness occurs
it is to do with androgenic alopecia with an ineffective androgenic pathway due to issues with five alpha reductase
383
how does male pattern baldness differ from female pattern baldness in its pathophysiology
although females also develop it doesn't share an androgenic pathway
384
describe the pattern of male pattern baldness
thinning of the temporal areas advancing to the Crown
385
describe the pattern of female pattern baldness
diffuse thinning
386
how do you manage male pattern baldness
topical minoxidil +/- PO finesteride
387
how do you manage female pattern baldness
topical minoxidil and for women with hyper androginism use androgen suppressants such as spinoro lactone
388
what is image below show
alopecia
389
what the pathophysiology of alopecia
and autoimmune condition are targets hair follicles
390
describe the presentation of alopecia
round patchy onset of sudden hair loss with a distinct border
391
how do you diagnose alopecia
a positive pull test and presence of exclamation marks (these are short broken hairs) you might want to perform the scalp biopsy which will show peri follicular inflammation
392
what is the management of alopecia
topical or intra-lesional corticosteroids
393
what is tricholomania
manifestation of OCD resulting in the pulling out of hairs
394
what does the image below show
chickenpox
395
XXXXXX is the virus which causes chickenpox
varicella zoster virus
396
in which people would chickenpox be dangerous
all the children/adults pregnant women immunosuppression neonates
397
what is the presentation of chickenpox
a vesicular rash initially appearing centrally before spreading to the extremities lesions filled with clear fluid and surrounded by erythema and appearing in crops so different groups of lesions will be at different stages by day seven – 10 lesions are completely crusted over has prodromal symptoms of fever fatigue headache and sore throat
398
what are the complications which can occur due to VZV infection
pneumonia hepatitis secondary bacterial infection that encephalitis cerebro-meningitis intercranial vasculitis hepatitis Reyes syndrome
399
how would you diagnose chickenpox
usually clinical findings are sufficient to make a diagnosis
400
in which individuals would you want to do further investigations for chickenpox
atypical presentations or high risk individuals
401
what investigations would you want to perform in certain individuals with chickenpox
skin swab and PCR all lumbar puncture and CSS PCR. You can perform a culture but you have to wait 21 days for diagnosis
402
what is the management of chickenpox in an uncomplicated patient
a self-limiting disease treated symptomatically: paracetamol alien antihistamines and calamine lotion
403
what is management of chickenpox in a complicated patient
antiviral therapy acyclovir (PO- moderate IV - severe/complications)
404
what does the image below show
warts
405
what is image below show
Cherry angiomaa
406
what does the image below show
pyogenic granuloma
407
how do you treat the pyogenic granuloma
usually resolve on their own can be removed with a curette and then cauterise
408
what is a pyogenic granuloma
reactive proliferation of capillary blood vessels
409
who is most at risk of getting a pyogenic granuloma
children or pregnant women
410
describe the pathophysiology of venous leg ulcers
begins with venous pathology i.e. reflux or varicose cveins. This causes a backflow of blood causing venous hypertension/pooling of blood and entrapment of leucocytes causes chronic inflammation as they become activated and pro-inflammatory this breaks down the skin and the capillaries causing an ulcer
411
why is the diagnosis of eczema in infants younger than two months and likely
because it is usually seborrhoeic dermatitis
412
What type of brthmark is a salmon patch?
vascular
413
what is the management of asalmon patch
nothing - they usually dissapear within months unless they are on the face and neck (then upto4y)
414
what does the image below show?
salmon patch / stork mark
415
What is the image below show
a strawberry mark/infantile haemangioma
416
what type of birthmark is a infantile haemangioma
vascular birthmark
417
described how an infantile haemangioma will change over time
will rapidly increase in size around six months but then disappear around seven years
418
What is the management of an infantile haemangioma
nothing wait for it to disappear over few years surgery is only required if affecting vision or feeding
419
what does the image below show
a port wine stain
420
give a description of port wine stain
flat red or purple mark which can be small to very large and is usually unilateral
421
what causes a port wine stain
capillary malformations making its avascular birthmark
422
how does a port wine stain change over time
they deepen in colour with age and hormonal changes they do not usually disappear
423
what is the management of a port wine stain
laser therapies can be used to help reduce the appearance of port wine stain
424
what does the image below show
Mongolian spot
425
where do Mongolian spots usually occur
lower back or buttocks
426
how does a Mongolian spot change over time
usually disappear around for years of age and are harmless however look like bruises which can cause ?child abuse
427
what does the image below show
a congenital Melanocytic nevus
428
describe the appearance of a congenital militaristic nevus
a relatively larger black or brown mould presenting at birth which can be very extensive
429
what causes congenital anaesthetic naevus
overgrowth of melanocytes
430
how word a can gentleman anaesthetic nevus change over time
tends to get smaller with age
431
what is the management of a congenital melanocytic naevus
surgery or laser is used depending on where it is found
432
what are the risks associated with a congenital melanocytic naevus
increased risk of skin cancer
433
What does the image below show?
nappy rash
434
what causes nappy rash
by babys skin being in contact with urine or faeces for a long time + nppy is rubbing against the babys skin or using aggressive soaps, wipes or detergents (esp. alcohol based stuff) or not cleaning the nappy area enough
435
is nappy rash painful
usually not unless it is severe
436
how can you avoid nappy nash
changing asap after urination or defication and changing them regularly. Wiping front to back and drying baby gently after washing do ot use soaps or ralcum powder but you can use rash creams
437
what does the image below show?
millia aka milk spots
438
where are millia found
nose and eyes most (+ face in general) commonly
439
what is the management of millia
nothing heal spontanously after a few weeks of birth
