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Dermatology Flashcards

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1
Q

What are the functions of the skin?

A 
protect against environmental antigens
temperature regulation
sense
vitamin D synthesis
prevent fluid loss
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2
Q

What are the 3 layers of the skin?

A

Epidermis, dermis, SC tissue

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3
Q

What are emollients used for? give 2 examples

A

to rehydrate the skin and re-establish lipid layer.

Double base and Diprobase

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4
Q

Name the topical corticosteroid ladder?

A

Hydrocortisone –> eumovate –> Betnovate –> dermovate

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5
Q

3 examples where a topical corticosteroid might be used?

A

anti-inflammatory, anti-proliferative, autoimmune conditions, allergic conditions

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6
Q

When might oral retanoids be used?

A

acne, psoriasis

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7
Q

Side effects of oral retanoids?

A

dry skin/lips, disordered LFTs, increased cholsterol, myalgia, tetarogenic

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8
Q

How does tacrolimus act?

A

immunosuppressant. Calcineurin inhibitor.

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9
Q

What conditions is atopic eczema associated with?

A

atopic dermatitis, rhinitis, allergic asthma

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10
Q

What is atopic eczema? What is the distribution?

A

chronic relapsing inflammatory condition characterized by itchy erythematous scaly patches.
Adults - flexor surface
Infants - face and extensors

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11
Q

What is the pathophys of eczema?

A
  1. defective skin barrier function - increases exposure and sensitisation to antigens.
  2. Immune dysfunction - increased Th2 mediated response which increases IgE response
  3. Exacerbating factors - infection/soap/dust mites
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12
Q

What is the diagnostic criteria for eczema?

A

UK working party diagnostic criteria

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13
Q

What are some signs of eczema?

A

location of the lesions, pruritis, dry skin, erythematous patches, vesicles, weeping

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14
Q

signs of chronic eczema?

A

lichenification, hypopigmentation

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15
Q

Ix for eczema?

A

clinical history, serum IgE, allergy testing

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16
Q

Mx pathway for eczema?

A
  1. BASIC - hydrate skin, emollients, avoid triggers, antihistamines
  2. topical steroids
  3. increasing doses of topical steroids
  4. systemic therapy (ciclosporin)/UV therapy
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17
Q

What is psoriasis?

A

inflammatory and hyperproliferative disorder of the keratinocytes and inflammatory cell infiltrate

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18
Q

Signs of psoriasis?

A

erythematous well circumscribed scaly plaques at extensor surfaces and scalp and belly button
nail pitting, beau lines, oncholysis, arthritis

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19
Q

Management pathway for psoriasis?

A
  1. GENERAL - educate, avoid drugs/alcohol/stress which precipitate
  2. MILD - topical corticosteroids + vitamin D analogue (calcipitriol)
  3. phototherapy, methotrexate, retinoid
  4. Ciclosporin
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20
Q

What causes acne?

A

inflammation of the pilosebaceous follicles

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21
Q

How do hormones contribute to acne?

A

increased androgens increase the sebum produced. This leads to formation of comedomes and an inflammatory reaction.

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22
Q

Conditions associated with acne?

A

PCOS, cushing, puberty

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23
Q

Complications of unresolved acne?

A

hyperpigmentation, scarring, deformity, psychological and confidence issues

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24
Q

management pathway of acne?

A
  1. topical benzyl peroxide/retinoid
  2. topical antibiotic added
  3. Systemic tetracycline
  4. Oral isoretinoin

Oral contaceptive might be used in girls

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25
Which cells are affected in SCC?
cancer of the keratinocytes
26
RF for all skin cancer?
sun exposure, chronic inflammation, immunosuppressed, previous cancer
27
What does SCC look like?
crusty and scaly lesion, ill-defined nodule which can ulcerate and bleed.
28
What is BCC?
slow growing tumour of the epidermal keratiocytes arising from hair follicle.
29
How do you go about describing a skin lesion?
``` A - asymmetry B - border C - colour D - diameter E - evolution ```
30
What is malignant melenoma?
invasive malignant tumour of the epidermal melanocytes, with high potential to metastasize
31
What is the score used to quantify the depth of invasion on histology for skin cancer?
Breslow thickness score.
32
What does impetigo look like? What causes it?
good crusting and weeping, caused by S.Aureus
33
Mx of impetigo?
topical fusidic acid, oral fluclox
34
What is cellulitis? Causes?
spreading bacterial infection of the deep SC tissue causing overlying skin inflammation. Erythematous, oedema, warm and tender. CAUSE: S.Aureus
35
DD for cellulitis?
bakers cyst, abscess, DVT, gout, necrotizing fasciitis
36
Mx for cellulitis?
flucloxacillin
37
What is scalded skin syndrome caused by?
toxin realised by coag +ve staph, causes blistering and fever
38
Mx of scalded skin syndrome?
analgesia, fluclox, fluids (VERY PRONE TO DEHYDRATE)
39
what is scabies?
infection with mites (transmitted skin to skin)
40
Features of scabies?
pruritis, erythematous papules, linear burrows in interdigital spaces
41
Ix for scabies?
skin scrapings - can visualised the mites and eggs with a microscope
42
Mx for scabies
Topical Permethrin + antihistamine (treat whole family)
43
Causes of a venous ulcer?
chronic venous insufficiency, incompetent valves, varicus veins, oedema
44
Signs of venous insufficiency
ankle swelling, increased pigment, heavy legs, itching, varicose veins, lipodermatosclerosis
45
what do venous ulcers look like?
large and shallow with sloping edges. They are not painful and have an irregular border.
46
Ix of any leg ulcer?
ABPI, pulses, measure the area, swab for microbiology and biopsy
47
Mx of a venous ulcer?
gradual compression and leg elevation, keep clean.
48
Causes of an arterial ulcer?
atherosclerosis, tissue hypoxia
49
Signs of arterial insufficiency?
absent pulses, pale, peripherally cold, parathesia, paralysis
50
Symptoms of a arterial ulcer?
painful, irregular edge, grey base, no bleeding on debridement, punched out
51
What must you not do to a arterial ulcer?
COMPRESS
52
Appearance of a neuropathic ulcer?
punched out, surrounded by inflammation, bleeding with debridement painless, sloughy and necrotic base
53
How does urticaria present? why?
itchy wheals - increased permeability of capillaries due to histamine released by skin mast cels.
54
Mx or urticaria?
antihistamines
55
What is angio-oedema?
swelling of tongue/eyelids/lips - can cause asphyxia, cardiac arrest and death.
56
What is anaphylaxis?
life threatening bronchospasm, facial and laryngeal oedema and hypotension
57
Mx of anaphylaxis?
IM adrenaline, airway protection, IV chlorphenamine, IV corticosteroids
58
What drugs causes SJS?
anticonvulsants, Abx, NSAIDS
59
What does SJS look like? What sign is positive?
detatchment of epidermis from dermis, mucotaneous necrosis and systemic toxicity. Nivolsky sign positive.
60
What bacteria causes nectrotizing fasciitis?
group A haemolytic strep
61
Presentation of NF?
severe pain, erythematous blistering and nectrotic pain, systemically unwell.
62
Mx of NF?
fluids, Tazocin, surgical debridement

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