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Flashcards in dermatology (brief) Deck (21):
1

what is erythroderma?

intense and usually widespread reddening of the skin due to inflammatory skin disease

- often precedes or is associated with exfoliation (skin peeling off in scales or layers), when it may also be known as exfoliative dermatitis (ED)

- most patients have underlying systemic +/or skin condition (eg eczema or psoriasis)

- Idiopathic erythroderma is sometimes called the ‘red man syndrome’

nb can also be side effect of drugs

2

what is toxic epidermal necrolysis?

on a spectrum with stevens-johnsons syndrome (TEN is more severe that SJS)

almost always as a allergic response to a drug
- more common in people with HIV

- flu-like prodrome
- red, necrosisng skin with detachment of epidermal layer
- also affects mucosal membranes

nb 20-30% mortality - most patients die of sepsis from secondary infection due to breaks in skin

stop offending treatment and supportive treatment

3

generalised pustular psoriasis:
- old name?
- possible triggers? 4
- presentation?
- treatment?

impetigo herpetiformis (nb no longer favoured as nothing to do with either HSV or impetigo)

- genetic defect
- sudden withdrawal of oral/IM steroids
- some drugs
- infection

- initially dry, red, tender skin
-> small pustules appear
-> pustules coalexce to form 'lakes of pus'
-> these dry out to form smooth surface on which more pustules may then form

- get systemic symptoms indicative of inflammation

nb distinct/slightly different mechanism to psoriasis however 10% of people who get it also have psoriasis

- admission to hospital to stabilise fluid loss etc
- topical + oral steroids
- other drugs such as methotrexate
- Abx for superimposed infection

4

acanthosis nigricans:
- presentation?
- causes? 5
- treatment?

brown/black, poorly defined, velvety hyperpigmentation + thickening
- norm found in body folds, esp armpit + neck

- obesity
- over-production of hormones (eg cushings or hyperinsulinaemia)
- idiopathic
- hereditary
- underlying malignancy (most commonly a GI tumour)

nb underlying malignancy is rare, norm due to benign cause

- treat underlying cause

5

nicrobiosis lipoidica
- what is it/appearance?
- who's most likely to get it?
- treatment?

a rare granulomatous skin condition that presents as red/brown patches on the front of shins

nb often painless but at risk of secondary infection

diabetics (though can occur in non-diabetics)

topical steroid cream is first line
(other treatments after that)

nb pathophysiology is not wel understood

6

Granuloma annulare
- looks like?
- caused by?
- mainly affects?
- prognosis?

a rash that often looks like a ring of small pink, purple or skin-coloured bumps

Lots of different types/appearances

A delayed hypersensitivity reaction

Children/young adults

Often goes away after a few weeks by itself, steroid cream may help

Nb can sometimes be associated w DM

7

Erythema nodosum
- what is it?
- how does it present?
- cause?
- treatment?

A type of inflammatory condition of subcutaneous fat

Red lumps appear on body (mainly on SHINS/legs)

Probably a hypersensitivity reaction (either to drugs or infections or other autoimmune conditions)

Treat underlying cause and wear tight bandages/compression stockings

8

SLE:
- what is it?
- type of antibodies present?
- 3 most common symptoms?
- 3 other common symptoms?
- organs commonly affected? 3
- non-pharm management? 2

Autoimmune condition affecting many parts of the body

Anti-nuclear antibodies

- joint pain
- skin rashes (esp butterfly rash)
- fatigue

Nb rashes on sunlight sensitive areas

- fever
- weight loss
- lymphadenopathy

- kidneys (inflammation -> CKD)
- brain (migraines, depression, anxiety)
- heart (pericarditis)
- lungs (pleuritis)

- stop smoking
- stay out of sun

9

Discoid lupus
- features?
- what percentage develop SLE?

- rash and thickening of skin on sun exposed skin (often butterfly rash)
- patches of baldness

- 5% will develop SLE

10

morphoea:
- what is it?
- AKA?
- cause?
- morphology?
- symptoms?
- treatment?

- patches of inflammation + fibrosis of the skin due to increased collagen deposition

- aka local scleroderma

- autoimmune (certain HLA types)
- often triggered by something external (insect bites, repeated friction, extreme exercise)

nb lots of subtypes

- inflam phase (pink/purple/bruise-like areas)
- sclerosis (skin is hard/thick/pale)
- dyspigmentation + atrophy (often hyper pigmentation, atrophy to deeper tissues can occur)

- itch +/or pain
- hair loss (if on scalp etc)
- pain/tingling + mild weakness

nb can get symptoms from deeper skin involvement too

autoimmune
- steroid creams
- phototherapy
- systemic drugs like methotrexate, steroids etc

11

lichen sclerosis:
- what is it?
- areas of body affected?
- who's most at risk?
- morphology?
- symptoms?
- complications?
- treatment?

chronic (autoimmune) skin condition
- genital areas
- perianal areas

nb can rarely affect other areas too

- women
- over 50 (often post-menopausal)
- PMH or FH of autoimmune

in women: affects labia minor +/- majora
in men: often affects glans of penis

- bruises, blood blister + ulcers appear from scratching/minimal friction
- urine can sting + irritate
- painful sex
- discomfort or bleeding on bowel movement

increased risk of vulval, penile or anal cancer

- emollients
- avoid friction to area
- topical steroids

can use systemic if not responding

surgery if cancerous

12

Systemic scleroderma
- what is it?
- who most at risk?
- signs and symptoms?
- types of treatment?

Autoimmune condition attacking connective tissue

Women 30-50

- raynauds phenomenon
- thick skin over hands, feet + face
- heartburn
- problems swallowing (dysphagia)

- weight loss
- fatigue
- joint pain/stiffness

Problems conceiving/repeated miscarriages

- medication to improve circulation
- medicines that reduce the activity of the immune system and slow the progression of the condition
- steroid medication to relieve joint and muscle problems
- moisturising affected areas of skin to help keep it supple and relieve itchiness
- various medicines to control other symptoms (such as pain, heartburn and high blood pressure)


13

dermatomyositis:
- what is it?
- who does it affect?
- symptoms?
- tests?
- treatment?

inflammation of voluntary muscles in association with a rash
- rare acquired inflammatory muscle disease

- women (2:1)
- most common 50-70 ages

- symptomless, itchy or burning rash
- affects sun-exposed areas
- rash almost always occurs before onset of muscle weakness
- get proximal muscle weakness and other variations of rash

- ANA and histology of rash (looks similar to SLE)
- testing for cancers

25% of people have an underlying malignancy (norm ovarian, breast or lung)

- immune suppressants (steroids, cytotoxic, biologics)
- treat cancer (if relevant)

14

vitiligo:
- what is it?
- risk factors? 5
- signs/symptoms?
- tests?
- treatment?

acquired depigmenting of skin, autoimmune reaction to melanocytes
- can be particularly cosmetically disabling, esp in people with dark skin

- South Indian ethnicities
- average onset 15-30 years
- FH of vitiligo
- PMH or FH of autoimmune conditions
- PMH of haematological conditions/cancers

nb male + female affected equally

hypo pigmentation well defined areas:
- sun-exposed areas
- body folds
- sites of injury
- genitalia + nipples

nb can mimic hypopigmented malignant melanoma...

extension of vitiligo over a few months then skin regiments then may relapse

- clinical diagnosis (see better under UV light)
- screen for other autoimmune conditions

- avoid sunlight (use high SPF suncream)
- use camouflage makeup
- use topical steroids
- maybe some new biologics??

15

cutaneous vasculitis:
- what is it?
- what can it be a sign of?
- what does it look like?
- treatment?

large group of disorders which involve inflamed blood vessels in the skin (varying sizes eg capiliritis, medium vessel vasculitis etc)
- in a minority of cases can be a sign of underlying systemic vasculitis

most are idiopathic and self-limiting

depends of size of vessel involved but:
- purpura
- petechiae
- etc

steroids and DMARDS (depending on severity)

16

presentation + underlying cause of:
- bullous pemphigoid
- pemphigus
- dermatitis herpetiformis

nb all of these are know as immunobullous diseases

bullous pemphigoid:
- blister is tense (sub-epidermal bullae)
- older patients


pemphigus
- "S for Superficial - often already 'popped'" (intraepidermal bullae)
- older patients
- often a reaction to drugs or underlying cancer


dermatitis herpetiformis
- 85% have coeliac disease
- extensor surfaces
- very itchy
- symmetrical distribution
- small blister (looks like a herpes rash)

17

photodermatoses:
- what are they?
- examples that we should know? 4

skin disorders that are precipitated by exposure to sunlight

polymorphic light eruption

porphyrias

chronic actinic dermatits

cutaneous LE
- (nb discoid lupus is a subtype)

18

polymorphic light eruption
- who affected?
- what is it?
- what it looks like?
- management?

- generally affects women aged 20-40 with pale skin

- is a delayed hypersensitivity reaction

- can manifest as lots of different sorts of rashes but basically a rash that comes on with exposure to sunlight/UV then completely heals (without scarring) after time out of sun

- reduce time in sun
- can have steroids for short period if v bad

- nb can be first presentation of discoid lupus

19

porphyrias
- what are they?
- two main groups?
- features of each group?

(almost always) inherited
- due to gene deficits, production of haem (for Hb) is slowed down, causing a build up of porphyrins

depending on where in the production of haem the gene is faulty depends on the type of porphyria suffered (about a dozen different types)

acute porphyrias
- get acute attacks which then resolve (may only get one or two in life, nb attacks are rare before puberty)
- severe abdo/back pain
- nausea/vomiting/constipation
- red or brown urine
- low blood sodium
- rapid pulse + high BP

skin (cutaneous) porphyrias
- build up of light-sensitive porphyrins in skin which, on exposure to UV, cause damage to skin
- basically get very red and blistering skin on exposure to sunlight
- ie really bad sunburn

20

chronic actinic dermatitis
- what is it?
- age and gender most at risk?
- appearance of skin?
- treatment?

photosensitive rash, maybe immune-modulated

- middle aged and elderly men

- severely itchy, red, inflamed, THICKENED skin on sun-exposed areas

- avoid sun
- emollients
- topical steroids

21

cutaneous LE (nb discoid lupus is a subtype)
- what is it?
- gender more commonly affected?
- presentation + appearance?
- aggravating factors? 5
- how diagnosed?
- treatment?

autoimmune connective tissue disorder
- any type of lupus almost always affects skin to some degree

- female (often middle-aged)

hugely variable dependent on subtype
- can be continuous or relapsing/remitting
- can be localised or generalised

- butterfly rash
- erythematous popular rash on arms, sometimes in plaques
- rash on sun-exposed areas
- chelitis + mouth ulcers
- often non-itchy (can scar, depending on type)

- sun exposure
- cigarette smoking
- hormones
- viral infection
- certain drugs

- presence of anti-nuclear antibodies (ANA) and/or extractable nuclear antigens (ENA)

- potent topical steroids
- systemic steroids and DMARDs