Dermatology Flashcards
(88 cards)
1
Q
List signs and symptoms of basal cell carcinoma
A
- Ulcer with raised rolled edge
- Telangiectasia (blood vessels)
- Nodule on the skin (pearly or waxy)
2
Q
Describe diagnosis of basal cell carcinoma
A
- Visually
- Confirmation with excision biopsy
3
Q
Define basal cell carcinoma
A
- A malignant neoplasm and the most common type of skin cancer.
- Rarely metastasises
4
Q
Describe epidemiology of basal cell carcinoma
A
- 75000 diagnosed a year UK
- Full time GP diagnoses one person per year
5
Q
List risks for basal cell carcinoma
A
- Exposure to UV
- Older age
- Male
- Radiation exposure
- Over 50
- History of skin cancer
- Fair skin
- Chronic infections and skin inflammation
- Immunosuppression
6
Q
List risk factors for squamous cell carcinoma
A
- Over exposure to sunlight
- Outdoor occupation
- Fair skin
- Immunosuppression
- Smoking
- Age
- Skin trauma (chronic inflammation eg. ulcers)
- Asbestos, arsenic
- More common in men
7
Q
Describe epidemiology of squamous cell carcinoma
A
- 25000 diagnosed each year
- Full time GP diagnoses someone every 1-2 years
- 2nd most common skin cancer
8
Q
Describe signs and symptoms of squamous cell carcinoma
A
- Raised lesion of the skin
- Flat reddish or brownish patches in the skin, often with a rough, scaly, or crusted surface
- Hyper keratotic, ulcerated, rolled edges, non-healing
- Presence of pearls = good prognosis as it indicated the tumour is well differentiated
9
Q
Describe diagnosis of squamous cell carcinoma
A
- Can be diagnosed visually
- Confirm with excision biopsy
10
Q
Define squamous cell carcinoma
A
- A skin cancer in the squamous cells of the middle and outer layers of the skin, affecting keratinocytes
- Usually not life threatening though can be aggressive
11
Q
Define melanoma
A
Tumour of melanocytes. Malignant skin cancer, rapidly metastasises
12
Q
Describe epidemiology of melanoma
A
- 13000 each year in UK
- Full time GP diagnoses one every 3-5 years
13
Q
List risk factors for melanoma
A
- UVB and artificial light
- Repeated sunburn
- Moles
- Genetic (cdk inhibitor 2a tumour supressor gene mutation)
- Pale skin
- Radiotherapy
- Immunosuppression
- Increased age
- Previous diagnosis of skin cancer
14
Q
List signs and symptoms of melanoma
A
ABCDE (asymmetry, border, colour, diameter over 6mm, evolving)
- Asymmetrical
- Blurred, irregular border with jagged edges
- Multiple shades (eg. brown and black)
- More than 6mm wide
- Evolving
- In women, commonly in lower legs. In men, commonly on head, neck, chest and back.
- More worrying if thick and over 6mm
15
Q
Describe investigations of melanoma
A
- Dermoscopy - looking for irregularity in colour, borders, blue-white veil, broad network, irregular vascularity
- Biopsy to identify thickness (melanoma invasion)
16
Q
Define psoriasis
A
- A condition where there is inflammation of the skin, and signs of psoriasis are red spots or patches which characteristically become scaly - autoimmune
- It tends to come and go throughout the patients’ lifespan, and the severity of the condition can vary from patient to patient.
17
Q
Describe aetiology of psoriasis
A
- Patients make skin cells more quickly than normal leading to inflammation (epidermal cells of the malphigan layer of the skin)
- Thought the be autoimmune, genetic and environmental.
- Palmoplantar is associated with smoking
18
Q
List types of psoriasis
A
- Plaque most common (75-90%)
- Pustular
- Guttate
- Flexural
- Erythodermic
19
Q
List signs and symptoms of plaque psoriasis
A
- Patches of various sizes of red skin with white scales
- Bleed when scales are removed (auspitz sign)
- Can be very thick, particularly in scalp
20
Q
List signs and symptoms of pustular psoriasis
A
- Small fluid filled pustules, can be localised or generalised
- Generalised is a medical emergency as it can be fatal. Here, you have widespread erythema and non-follicular pustules which can coalesce.
- The patient often has fever, malaise, a raised heart rate and is systemically unwell.
21
Q
List signs and symptoms of guttate psoriasis
A
- Body covered with multiple teardrop-like psoriatic patches
- Follows bacterial throat infection
22
Q
List signs and symptoms of flexural psoriasis
A
- Red and shiny
- Affects groin, axillae, inframammary folds
23
Q
List signs and symptoms of erythodermic psoriasis
A
- Presents with widespread painful red skin – severe psoriasis with more than 90% of the body affected.
- It is a serious condition and is potentially life threatening
24
Q
List factors that exacerbate psoriasis
A
- Bacterial (streptococcal) and fungal infection may precipitate psoriasis.
- Lithium, beta-blockers, anti-malarials, ACE inhibitors and withdrawal of steroids may also cause a flare-up.
- Psoriasis may appear in the site of a recent skin injury.
- Ultraviolet light is usually beneficial except in cases of photosensitive psoriasis.
- Additionally, hormonal changes can affect psoriasis as well – female patients may find it is worse during puberty and menopause, and improves during pregnancy.
- Stress, smoking alcohol
25
Describe epidemiology of psoriasis
- Around 1–3% of the world's population has psoriasis
- About 1.3–2.2% of the UK population is estimated to have psoriasis
- A UK retrospective cohort study found the incidence rate of adult psoriasis to be 28 per 10,000 person-years
= Onset may occur at any age, but there are two peaks in incidence — between 20–30 years of age and 50–60 years of age
- Guttate psoriasis is more common in people under 30 years of age
- Men and women are typically equally affected however localized pustular psoriasis is more common in women
- Most common in white people
26
Describe investigations of psoriasis
- Clinical diagnosis
- Ask about symptoms
- Associated conditions
- Perception of severity
- Stress, anxiety, depression
- Family history
- Examine for systemic illness, and classify type by distribution, number of lesions, size and shape of lesions, colour, surface features, involvement of other arms
- Document total body percentage
- Skin patch testing, IgE, skin biopsy
27
List the general symptoms of psoriasis
- Itch, irritation, burining, pain, bleeding and scaling
- Systenic illness - fever, malaise, weight loss
- Onycholysis, pitting, sublingual hyperkeratosis
- Psoriatic arthritis causes symmetrical polyarthritis
28
Define eczema including subtypes
- Atopic eczema is a chronic, itchy, inflammatory skin condition that affects people of all ages, although it presents most frequently in childhood. Type 1/4 hypersensitivity
- Contact caused by contact with a particular substance, type 4
- Discoid skin is itchy, swollen and cracked in circular or oval patches, more common in elderly
- Dyshidrotic is where tiny blisters develop on the fingers, palms of hands and soles of feet
- Herpeticum is a viral infection in people with eczema affecting large areas of skin, caused by HSV1
- Seborrheic eczema is a common skin condition causing redness, scaly patches and dandruff most commonly affecting the scalp
29
Define actinic keratoses
- Discrete, dry, rough, adherent scaly lesions that can be single or multiple and occur in sun exposed areas.
- Increases risk of squamous cell carcinoma
30
List types of melanoma
- Solar lentigo (brown fixed patches on sun exposed areas) can form lentigo maligna (often on face or back)
- Nodular melanoma (tend to be more invasive, domed shape with rapid growth)
- Superficial spreading (most common)
- Amelanotic
- Acral (affecting the nail)
31
Describe bowens disease
- Scaly keratosis, benign and eventually develops into SCC.
| - Red scaly patch on skin
32
List signs and symptoms of eczema
- Bilateral
- Erythematous
- Red
- Face, scalp and flexures often effected in children, and creases, chest and neck in adults
- If chronic, lichenification
- Pruritis
- In eczema herpiceticum large patches of eczema with heretic type blisters, painful with fevers and lethargy
33
Describe epidemiology of eczema
- Affects approximately 20-30% of children in developed countries. Incidence is highest in developed countries in urbanised areas
- Prevalence is increasing
- Most cases present before the age of 5
34
Describe aetiology of eczema
- History of atopy (70% of cases)
- Asthma
- Hay fever
- Allergic rhinitis
- Family history – genetic component (filaggrin gene mutation)
- Breast feeding – breast feeding a child as the sole nutrition in the first 3 months of life decreases risk in those with a family history of atopy
35
List common triggers for eczema
- Soaps, detergents, shower gels, bubble baths, washing-up liquids
- Skin infections – particularly staphylococcus aureus
- Extremes of temperature
- Abrasive or synthetic fabrics (e.g. wool, nylon)
- Dietary factors (more common in children)
- Inhaled allergens
- House dust mites
- Pollen
- Pet dander
- Mould
- Stress
- Hormonal changes in women (pregnancy, with menstrual cycle)
36
Describe diagnosis of eczema
Itchy skin, PLUS three of:
- Itchiness in the skin folds in front of elbows and back of knees
- History of asthma or hay fever (one point only even if both are present)
- Generally dry skin
- Visible patches of eczema in the skin folds
- Onset in the first 2 years of life
- Patch testing
37
Define lipoma
Slow-growing, benign, mesenchymal tumours that form well-circumscribed, lobulated lesions composed of adipocytes.
38
Describe epidemiology of lipoma
- Approximately 1% of the general population has a lipoma.
- Although they can occur at any age, they are most common between 40 and 60 years of age.
- Congenital lipomas have been reported in children.
39
List risk factors for lipoma
- Heavy drinking (madelungs disease)
- Genetic predisposition (gardners)
- Trauma
40
List signs and symptoms of lipoma
- Soft, mobile, superficial cutaneous mass
- Size under 5mm
- Painless cutaneous mass
RARE
- Gastrointestinal obstruction
- Gastrointestinal bleeding
- Abdominal mass
- Muscle weakness
- Paraesthesia
41
List investigations for lipoma
- MRI
- CT scan (typically discrete, encapsulated, homogeneous mass, with few or no thin, discrete septa; density similar to normal fat)
- Ultrasound
- Core needle biopsy
- Incisional biopsy
- Excisional biopsy
- Upper gastrointestinal contrast study
42
Define epidermal and pilar cysts
- Epidermal cysts (also known as epithelial or infundibular cysts) are intradermal or subcutaneous tumours.
- Epidermoid cysts may occur anywhere on the body but occur most often on the face, scalp, neck, back and scrotum.
- Pilar cysts (also called trichilemmal cysts) are clinically indistinguishable from epidermal cysts. They form around hair follicles
- They contain keratinous material, are usually multiple and there is often an autosomal dominant inheritance.
43
Describe epidemiology of epidermal and pilar cysts
- They are both extremely common and probably most people will have at least one over the course of a lifetime.
- They can often resolve spontaneously.
- They are around twice as common in men as in women and most frequent in those aged in their 20s and 30s.
- Simple epidermoid cysts can run in families.
- Pilar cysts occur in 5-10% of the population.
- Over 90% occur on the scalp, where pilar cysts are the most common cutaneous cyst
44
List risk factors for epidermal and pilar cysts
- Acne
| - Pilar more common in women, run strongly in families (autosomal dominant)
45
List signs and symptoms of epidermal and pilar cysts
- Painless skin lump.
- Discharge of a foul cheese-like material.
- If they become infected, they are red, inflamed and painful.
- Lesions of the genitals can be painful during intercourse and cause problems with walking or wearing underwear. They can also interfere with micturition.
- Epidermoid and pilar cysts appear as firm, round, mobile, flesh-coloured to yellow or white subcutaneous nodules of variable size.
- A central pore or punctum may tether the cyst to the overlying epidermis and a thick cheesy material can sometimes be expressed.
- In people with dark skin, the cysts may also be pigmented.
- Most commonly affect the face, neck, trunk, and genitals (epidermoid) and scalp (pilar)
46
Describe investigations for epidermal and pilar cysts
- Examination and history
| - If unsure, excisional biopsy and histology
47
Describe Campbell di Morgan spots
Cherry angiomas - no known pathology, affect lots of people over 40
48
Which skin condition is chrons linked to?
Erythema nodosum
49
Which type of reaction is contact dermatitis?
Type 4
50
Define necrotising fasciitis
A life-threatening subcutaneous soft-tissue infection that may extend to the deep fascia, but not into the underlying muscle.
51
Describe aetiology of necrotising fasciitis
- The causal organisms may be aerobic, anaerobic, or mixed flora.
- Type I necrotising fasciitis is a polymicrobial infection with an anaerobe such as Bacteroides or Peptostreptococcus and a facultative anaerobe such as certain Enterobacterales or non-group A streptococcus.
- Type II necrotising fasciitis is most commonly a monomicrobial infection with Streptococcus pyogenes (group A streptococci).
- Other infectious aetiologies may rarely cause a monomicrobial necrotising infection that may be associated with specific exposures or risk factors (e.g., freshwater exposure associated with Aeromonas hydrophila, saltwater exposure or consumption of raw oysters associated with Vibrio vulnificus).
52
List risk factors for necrotising fasciitis
- Diabetes mellitus
- Peripheral vascular disease
- Immunocompromising conditions
- Chronic renal or hepatic insufficiency
- Chickenpox or herpes zoster
- Intravenous drug use
- Certain medications (e.g., corticosteroids, NSAIDs)
- Cutaneous surgery, injury or trauma
- Skin lesions
53
Describe epidemiology of necrotising fasciitis
- Type I (polymicrobial) more common than type II (MRSA group A strep)
- In US 2017 study complicated 5% of invasive group A streptococcal infections in 3.5 million cases per population per year
54
List symptoms of necrotising fasciitis
- Anaesthesia or severe pain over site of cellulitis
- Palpitations
- Light headed-ness
- Nausea and vomiting
- Delerium (systemic infection)
- Grey discolouration of the skin
55
List signs of necrotising fasciitis
- Oedema or induration
- Lower extremities most common
- Vesicles or bullae
- Crepitus
- Fever
- Tachycardia, tachypnoea, hypotension
56
List investigations for necrotising fasciitis
- Full blood count (high WBC, low in severe sepsis)
- Serum electrolytes (low sodium), urea and creatinine (high creatinine), CRP (raised), creatine kinase (raised), and lactate (raised)
- Blood and tissue cultures
- Gram stain
- Arterial blood gas (hypoxaemia, acidosis)
- Radiography, CT/MRI, ultrasound (oedema extending along fascial plane and soft tissue gas)
- Surgical exploration (necrotising soft tissue infection - gold standard)
57
Define burns
Very common injuries, predominantly to the skin and superficial tissues, caused by heat from hot liquids, flame, or contact with heated objects, electrical current, or chemicals.
58
Describe epidemiology of burns
- 11 mill needed medical attention worldwide 2004
- 180000 people die evry year after burns injuries, mainly in developing countries
- Rate of child deaths higher in developing countries
- Children surviving burns at risk of other physical and emotional issues
- UK 250000 people annually injured, 175000 of these attend A&E and 13000 are admitted to hospital
59
Describe aetiology of burns
Thermal burns:
- Caused by heat, from hot liquids, flame, or contact with heated objects
- In young children, about 70% of burns caused by scalding from hot liquids
- In older children and young working adults, flame injuries are more likely
- In older adults, scalds and cooking accidents are most common.
Electrical burns:
- Caused by low-, intermediate-, and high-voltage exposures, producing a variety of local and systemic injuries.
Chemical burns:
- Caused by exposure to industrial or household chemical products.
Non-accidental burns:
- Approximately 20% of burns in younger children involve abuse or neglect.
60
List risk factors for burns
- Young children
- Age over 60
- Male sex
61
List signs and symptoms of burns
- Erythema
- Dry and painful (first degree, only involve the epidermis)
- Wet and painful (second degree, epidermis and upper dermis)
- May be dry and insensate (3rd degree, epidermis, dermis, damage to appendiges)
- Affecting subcutaneous tissue, tendon or bone (fourth degree)
- Cellulitis
- Clouded cornea - serious burn
62
List investigations for burns
- Full blood count (neutropenia and thrombocytopenia indicate sepsis)
- Metabolic panel (urea, creatinine, glucose, hyponatraemia, hypokalaemia)
- Carboxyhaemoglobin (high levels in inhalation injury)
- Arterial blood gas (metabolic acidosis in inhalation injury)
- Fluorescein staining (damaged corneal epithelial cells in corneal burns)
- Computed tomography scan of head and spine (trauma)
- Wound biopsy culture (if sepsis suspected)
- Wound histology (if sepsis suspected)
63
Define erythema multiforme
An acute, self-limiting but often relapsing, mucocutaneous inflammatory condition. (type 4) It is a hypersensitivity reaction associated with certain infections, vaccinations, and, less commonly, medications
64
Describe epidemiology of erythema multiforme
- Peak incidence in 2nd and 3rd decade, rarely occurs under 3 or over 50
- 20% of cases occur in children
- Young children experience more severe disease
- 3:2 male to female ratio, recurrent in 30% of patients
65
Describe aetiology of erythema multiforme
- Hypersensitivity response pattern
- HSV and mycoplasma most common associated infections
- Hep B, EBV, cytomegalovirus, histoplasmosis, kawasaki and herpes zoster can also cause it
- Associated drugs include penecillins, contraceptives, anticonvulsants and lidocaine
- Vaccines such as Hep B, smallpox, varicella, HPV
- Allergens and tattoos
- Statins
66
List risks for erythema multiforme
- Prior occurrence
- Herpes simplex virus (HSV) infection
- Mycoplasma pneumonia
- Cytomegalovirus (CMV) infection
- Epstein-Barr virus (EBV) infection
- Hepatitis B virus infection
- Histoplasmosis
- HIV infection
- Lymphoma
- Orf virus infection
- Medications
- Tattoos
- Hepatitis B vaccine
- Syphillis
67
List signs and symptoms of erythema multiforme
- Target lesions (central vesicle/crust with ring of pallor and erythema) on the extremities
- Recurrent
- Mucosal erosions
- Targetoid lesions
- Rapid onset + self limiting
- Clustered vesicles on an erythematous base
- Rhonchi, rales and/or wheeze/ prodrome
- Rarely red tympanic membranes and hepatomegaly
68
List investigations for erythema multiforme
- FBC (High WCC)
- Serum electrolytes
- Herpes simplex virus (HSV) serology
- Rapid PCR
- Cold-haemagglutination serology
- M pneumoniae titres
- CXR
- Haematoxylin and eosin biopsy (satellite cell necrosis, vacuolar degeneration of the basement membrane, severe papillary oedema; lymphocytic infiltration and non-specific immune deposits)
- Immunofluorescence biopsy
- Hepatitis B virus (HBV) serology
- LFTs
69
Define erythema nodosum
A common cutaneous hypersensitivity reaction consisting of erythematous, tender nodules most commonly located over the shins, but also reported over the thighs, upper extremities, calves, buttocks, and face.
70
Describe the epidemiology of erythema nodosum
- More frequent in Europe than in North America
- Peaks between age 20-30
- Women affected 3-6 times more than men
- Common in women of childbearing years, associated with pregnancy and lactation
71
Describe aetiology of erythema nodosum
- Infections (streptococcal = commonest infectious cause); TB; Mycoplasma pneumonia; psittacosis; Yersinia, Salmonella and Campylobacter gastroenteritis
- Systemic fungal infections including histoplasmosis, blastomycosis, coccidioidomycosis);
- Sarcoidosis
- Inflammatory bowel disease (Crohn’s disease and Ulcerative colitis)
- Neoplasia (leukaemia, Hodgkin’s disease)
- Drugs especially sulfonamides and oral contraceptives
- Pregnancy.
72
List risk factors for erythema nodosum
- Streptococcal infection
- Sarcoidosis
- Tuberculosis
- Coccidioidomycosis
- Histoplasmosis
- Blastomycosis
- Behcet's disease
- Oral contraceptives
- Leprosy
- Brucellosis
- Sulfonamides
- Iodides and anti-epileptic drugs
- Psittacosis
- Inflammatory bowel disease
73
List symptoms and signs of erythema nodosum
- Nodules on shins, does not ulcerate or scar
- Uveitis red eyes, retinal nodules, candle wax drippings (sarcoidosis)
- Nodules on other skin areas
- Anaesthetic patches
- Joint pain
- Fever
- GI symptoms (underying IBD/ behcets)
- Enlarged spleen
- Miliary nodules on the retina
74
List investigations of erythema nodosum
- FBC (leukocytosis)
- Anti-stroptolysin-O titre
- CXR
- Purified protein derivative skin testing (TB)
- Serum ACE level
- Granuloma lesion biopsy
- Investigations for underlying cause (colonoscopy, serology, x ray, rheumatoud factor, incisional biopsies)
75
Define urticaria
- Erythematous, blanching, oedematous, non-painful, pruritic lesions that develop rapidly, usually over minutes.
- Urticaria typically lasts less than 24 hours and leaves no residual skin markings upon resolution.
76
Describe epidemiology of urticaria
- 20% lifetime prevalence
- 30% of people experience prolongued symptoms
- Acute is more common in children and adolescents, while chronic more typically affects adults
- Women affected by chronic more than men
77
Describe aetiology of urticatia
Acute
- Allergic, caused by IgR mediated reaction
- Commonly caused by drugs, foods, insect bites or allergens
Chronic
- Poorly understood. Less than 10% of patients have a trigger
- Food and dugs are rarely a cause
- Causes include heat, cold, pressure, sunlight, vibration, acetylcholine release and water
- Thought to be autoimmune/antibody associated due to IgG antibodies to IgE receptor or IgE
78
List signs and symptoms of urticaria
- Erythematous oedematous lesions
- Pruritis
- Angiooedema + stridor may be associated
- Blanching lesions
79
List risks for urticaria
- Positive family history
- Exposure to drug trigger
- Exposure to food trigger
- Recent viral infection
- Recent insect bite or sting
- Female sex
80
List investigations for urticaria
- FBC with differential (normal/eosinophil or neutrophil raised)
- ESR, CRP (may be normal or elevated)
- Thyroid-stimulating hormone (TSH - chronic urticaria with thyroid signs)
- Antinuclear antibodies (ANA- chronic urticaria and rheumatological signs)
- Skin prick testing
- Allergen avoidance diet
- Serum tryptase (if anaphylaxis suspected)
- Skin biopsy (may show vasculitis)
- Specific IgE to suspected allergen
81
List subtypes of basal cell carcinoma
- Nodular (most common)
- Morpheic (yellow waxy plaque, scar-like)
- Superficial (flat shape)
- Pigmented (dense colour, speks of colour)
82
Define molluscum contangiosum
Skin infection due to pox virus (molluscum contangiosum virus)
83
Describe epidemiology of molluscum contrangiosum
- Common
| - Often affects children, 5-12% prevalence
84
List risk factors/aetiology for molluscum contangiosum
- Immunocompromised (eg. HIV), close contact, swimming
- Transmitted by close contact (MCV1 and 1v in children, MCV2 sexually transmitted or whole body immunocompromised, MCV3 rare)
85
Describe signs and symptoms of molluscum contangiosum
- Smooth papule
- Umbilicated (central dell)
- Usually painless, but often itchy
86
List investigations for molluscum contangiosum
- Physical examination
- Basic obs
- Usually a clinical diagnosis
- Consider HIV/underlying cause
87
Describe necrobiosis lipodipica
- A complication of diabetes
- Granulomatous
- A dark patch of skin on the shins, shiny with telangiectasia
88
Describe granuloma annulare
- Complication of diabetes
- Typified clinically by annular, smooth, discoloured papules and plaques, and necrobiotic granulomas on histology.
- Red bumps form a ring, on the hands or feet
