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Flashcards in dermatology (in depth) Deck (38):
1

dermatitis
- main three types? (+ causes)
- presentation?
- treatment?

- atopic dermatitis (eczema)
- allergic contact dermatitis
(both autoimmune)

- irritant contact dermatitis
(caused by over exposure to water, cold, certain chemicals)

red, itchy, scaly patches (norm on inside of joints) with accompanying scarring

- topical steroids if autoimmune
- remove irritants/moisturise

nb autoimmune often occurs in 'flare ups'

2

psoriasis
- what is it?
- presentation?
- treatment?

autoimmune condition which results in over production of skin cells
-> scaly patches on extensor surfaces

- normally small patches but can be larger and can also effect joints (psoriatic arthritis)

topical steroids and vit D treatment
- if bad, us UV treatment

nb sun is good as damages skin cells!

nb affects around 2% of people, men = women

3

acne vulgaris
- what is it?
- presentation?
- treatment?

inflammatory disease of hair follicle
- androgen makes worse

varying lesions on face, chest + top of back

mild:
- open + closed comedones (black + white heads)

moderate:
- above PLUS inflammatory lesions (papules, pustules, nodules + cysts)

severe:
- above but worse/more lesions

treatment depends on severity:
- topical therapies (benzoyl peroxide, Abx, retinoids)
- oral therapies (anti-androgens, Abx, retinoids)

nb vulgaris means common

4

Rosacea:
- what is it?
- presentation?
- treatment?

poorly understood condition

- flushing
- persistent facial redness
- visible blood vessels
- papules + pustules
- thickened skin

often worse on nose, cheeks, forehead + chin

nb sunlight makes it worse

- topical metronidazole
- topical azelaic acid

5

urticaria:
- pathogenesis?
- causes? 4
- treatments? 2

a trigger causes high levels of histamine to be released in the skin -> leakage from blood vessels -> red, swollen pathes which are itchy

nb looks like a severe nettle rash

- allergic reaction (eg to food or insect bite/sting)
- cold or heat exposure
- infection (eg common cold)
- some drugs (eg NSAIDs, Abx)

nb complication of severe urticaria is angioedema +/or anaphylaxis

6

lichen planus:
- what is it?
- what does it look like?
- treatment? 2
- prognosis?

a chronic inflammatory skin condition affecting skin +/or mucosal surfaces
- several different types

- cutaneous lesions look a bit like psoriasis but less white scale and are often itchy
- mucosal lesions (most often in mouth) often begin as painless white streaks but can become painful and more ulcer-like
- lesions on nails cause thinning and ridging of nails + nails may stop growing

nb are other variants but 3 above are most common

- topical (or oral) steroids
- if severe, can use drugs such as methotrexate

nb treatment is not needed for mild cases which are often self-limiting

nb can lead to cancer dt chronic inflammation

- tends to clear within a couple of years in most people but mucosal lichen planus persists longer (eg around a decade)
- spontaneous recovery is unpredictable + may suffer recurrence

7

impetigo:
- appearance?
- causative organisms? 2
- how enter skin?
- other risk factors? 2

itchy red sores that eventually crust over before healing with a red patch
- often itchy

- staph aureus
- strep pyogenes

through:
- cut
- insect bite
- eczema

- diabetes
- immunocompromised (HIV, on chemo)

nb very contagious

nb normally found around nose + mouth but can affect other sites too

8

impetigo:
- non-pharm management? 2
- pharm management? 1

- don't itch/scratch
- avoid close ocntact w others (esp kids)

- topical Abx (oral if v bad, fever etc)

9

cellulitis and erysipelas:
- what's the difference?
- norm causative organisms? 2
- who's at risk? 11

erypsiela = infection of upper dermis + sub cut lymphatics

cellulitis = infection of lower dermis + subcut tissue

nb often occur together

- strep pyogenes (group A strep) - 2/3rds
- staph aureus - 1/3rd

nb strep pyogenes causes almost all erysipelas

- previous episode of erysipelas/cellulitis
- underlying skin condition (athletes foot, tinea pedis, cracked heels)
- venous disease +/or lymphoedema
- injury/trauma (incl radiation)
- immunodeficiency
- immunosuppressive meds
- diabetes
- CKD
- chronic liver disease/alcoholism
- obesity
- pregnancy

nb young and elderly most at risk pops

10

cellulitis + erysipelas:
- clinical presentation?
- where on body norm affected?
- treatment?

very sharp raised border (in erysipelas)

bright red, firm and swollen

(dimpled skin - peus d'orange)

painful and warm

can be blistering and necrotic

can have fever

norm on legs but can be anywhere


- wound care/dressings
- elevation of leg

Abx - norm penicillin based

11

cellulitis:
- differential diagnoses? 10

- eczema/dermatitis
- psoriasis

- thrombophlebitis
- fungal infection (eg tinea corporis)

- drug reaction
- insect bites/stings

- radiation damage (eg radiotherapy)
- inflammatory breast cancer

- lipodermatosclerosis

- DVT

12

folliculitis:
- cause?
- 2 commonest causative organisms?
- where found on body?

inflammation of hair follicles

can be due to infection, occlusion + various skin diseases

norm staph aureus in bacterial folliculitis

(nb pseudomonas aeruginosa infects people in hot tubs if inadequately chlorinated)

norm:
- chest, back, buttocks, arms, legs or face
- ie anywhere there's hair

tender red spots, often with a surface pustule

nb acne is also a form of folliculitis

trestment depends on cause

13

intertrigo:
- what is it?
- where does it affect?
- risk factors? 3

an inflammatory rash in the flexures or body folds

nb can get superficial infection on top of

- overweight
- genetic tendency to skin disease
- hyperhydrosis (incl dt hot/humid climate)

14

difference between chicken pox and shingles:
- transmission
- signs/symptoms
- distribution of rash
- character of rash

chicken pox:
- respiratory secretions + vesicular fluid
--- malaise, fever, rash
- truck initially, progressing to face + extremities
- non-grouped, itchy vesicles

shingles:
- reactivation of VZV in nerve root
--- dermatological rash, neuralgia, weakness of affected nerve, malaise, fever
- a nerve root distribution, often on trunk or branch of trigeminal
- grouped, markedly erythematous, painful vesicles

15

Herpes simplex:
- two types? where do they infect?
- mechanism of reactivation?
- common triggers? 4
- treatment?

Herpes simplex type 1 - mouth

Herpes simplex type 2 - genitals

- virus stays active in nerve root and is then reactivated to form a blistering spot, often in the same place

- other infections (e.g. cold or flu)
- sunlight on the area
- generally getting run down
- a skin injury at the sight of recurrence

- antiviral tablets (take as soon as notice it's coming +/- antiviral cream

16

HIV
- pathogenesis?
- high risk groups? 4
- initial symptoms?

Virus binds to CD4 receptors on helper T cells and then replicate inside the cell before bursting out to bind to other helper T cells

- sex workers
- MSM
- black African heterosexuals
- IVDU

1-2 week flu-like illness
- fever
- sore throat
- body rash
- fatigue
- joint pain

nb then can be a latent period varying from a month to over 10 years with no symptoms

17

HIV:
- definition of AIDS?
- list some of the conditions?

1) infected with HIV virus
AND
2a) a CD4+ T-cell count below 200 cells/uL
OR
2b) has one of the aids-defining conditions

- candidiasis of oesophagus/trachea/lungs (nb not mouth)
- cervical cancer (invasive)
- cytomegalovirus
- encephalopathy (HIV-related)
- chronic herpes simplex (ulcer for >month)
- Kaposi's sarcoma
- certain types of lymphoma
- TB (any)
- toxoplasmosis of brain
- wasting syndrome (due to TB)

nb there are about 30 conditions in all!

18

HIV
- two types of prophylaxis?
- two monitoring blood tests?
- treatment

- PEP (post-exposure prophylaxis)
- PrEP (pre-exposure prophylaxis)

- HIV viral load (conc of virus in blood)
- CD4 count (affect of virus on immune system

HAART

19

viral warts:
- virus cause?
- what are they?
- group most commonly affected?
- possible complication?
- treatments?

human papilloma virus (HPV)

hyperkeratotic papules

children

HPV 16 + 18 infection around genitals can lead to cervical or penile carcinoma

- paints/gels of salicylic acid
- occlusion with duct tape
- cryotherapy
- regular paring with a scalpel

20

molluscum contageosum:
- what is it?
- who gets it?
- what it looks like?
- management?

Viral infection that affects skin

- mainly children
- immunosuppressed (HIV, chemo)

The spots are usually firm and dome-shaped, with a small dimple in the middle. They're usually less than 5mm (0.5cm) across, but can sometimes be bigger.

They're typically pink or red, although they may have a tiny white or yellow head in the centre. If this head ruptures (splits), a thick yellowy-white substance will be released, which is highly infectious.

Normally self limiting

Treat if immunosuppresed or particularly unsightly in adults

21

Tinea:
- causative organism?
Name if infects:
- beard
- head
- body
- groin
- foot
- nail

Treatment?

- dermatophyte fungus

- beard - tinea barbae
- head - tinea capitis
- body - tinea corporis (ringworm)
- groin - tinea cruris (jock itch)
- foot - tinea pedis (athletes foot)
- nail - tinea unguium

Topical antifungals (systemic for barbae, capitis + unguium as doesn’t penetrate hair or nails)

Keep area dry!!

22

genital candida:
- who's at risk? 3
- symptoms in women?
- symptoms in men?
- treatment? 3

- pregnant + breastfeeding women
- diabetes
- poor immune system

- white discharge (like cottage cheese, nb not usually smelly)
- vaginal itching/irritation
- soreness & stinging during sex or when peeing

- irritation, burning + redness around head of penis
- white discharge (like cottage cheese)
- unpleasant smell
- difficulty pulling back foreskin

- oral antifungals
- antifungal creams
- pessary (pills in vag)

23

oral candida:
- risk factors? 5
- symptoms/signs? 4
- treatment? 2
- prevention? 1

- chemo/radiotherapy
- on corticosteroids (incl inhalers) or wide-spec Abx
- wear dentures
- have diabetes
- have HIV (can spread to oesophagus)

- white/yellow patches on tongue, lips, gums, roof of mouth + inner cheeks
- redness + soreness in mouth + throat
- cracking at corners of mouth
- pain when swallowing

- antifungal gels
- oral antifungals

- chlohexadine mouthwash if at risk/poor immune system

24

Pityriasis versicolor:
- what is it?
- what does it look/feel like?
- risk factors? 2
- treatment?

yeast infection of the skin

- scaly patches of hypo or hyper pigmented skin on trunk, neck +/or arms

can be itchy or not

- young adults
- hot, humid climates (summer, sweating)

- topical antifungals

25

scabies:
- what is it?
- who most at risk?
- how does it present? 3
- pharm management? 1
- non-pharm management? 2

parasite burrowing under the skin + laying eggs

- people who live in close proximity to others (uni halls, care homes etc)

- intense itching (esp at night)
- bumpy lines under skin -> red dots, norm starts on the hand + works way up
- rash spreads over whole body (norm bar head/neck)

it is VERY contagious so likely to have spread to others in household etc

- topical cream (Permethrin 5% cream)

- everyone in house needs to be treated
- wash all bedding + clothing at hight temps

26

insect bite reactions:
- three types of reaction?
- how to treat?
- when to get help?

- normal reaction
- local allergic reaction
- anaphylactic reaction

- avoid scratching
- cold compress
- anti-histamines (cream +/or oral)

- if get anaphylaxis
- if symptoms are getting worse or don't improve after a few days
- if large area (>10cm) around bite becomes red +swollen
- flu-like symptoms

27

head lice
- what are nits?
- symptoms?
- treatment?

- head lice eggs

- itching
(sometimes feeling like there's something moving in your hair)

- OTC head lice shampoos
- comb through with a special comb

28

what are melanocytic naevi?

pigmented moles

have potential to develop in to melanoma but vast majority don't

29

malignant melanoma:
- risk factors? 6
- commonest type?
- acronym for working out if a mole is likely to be malignant? 5
- treatment?
- staging system?

- increasing age
- many melanocytic naevi (moles)
- white skin (that burns easily)
- PMH of any type of skin cancer
- FH of melanoma
- excessive sun exposure

- superficial spreading melanoma (70%)

nb can get nodular or ones around nails or melanotic too

ABCDE

A - Asymmetry
B - Border irregularity/blurred
C - Colour if not uniform
D - Diameter >6mm
E - Evolving size, shape or colour (or elevation)

also
- itchy
- bleeding or becoming crusty

normally on back in.men + legs in women

- surgical removal

- breslow thickness

30

basal cell carcinoma
- risk factors? 6
- colloquially called?
- look + other symptoms?
- treatment? 4

- age
- male
- PMH of any type of skin cancer
- sun damage, esp repeated sunburn
- fair skin
- immunosuppression

- rodent ulcer

- small, shiny pink or pearly white lump, sometimes variation in pigment
- rolled edge
- lump slowly grows + may become crusty, bleed
- non-healing

nb normally found on sun-exposed skin

- surgery
- cryotherapy
- anti-cancer creams

31

squamous cell carcinoma
- risk factors? 7
- look and other symptoms?

- age
- male
- PMH of any type of skin cancer
- sun damage, esp repeated sunburn
- fair skin
- immunosuppression
- actinic keratosis

- enlarging scaly or crusted lumps
- usually arise within pre-existing actinic keratosis
- may ulcerate
- often painful or tender
- appear on sun-exposed sites

32

squamous cell carcinoma
- factors which indicate a poorer prognosis? 3
- primary site of metastasis?
- treatment?

- diameter > 2cm
- location on ear, lip, central face, hands, feet, genitalia (near orifices)
- immunocompromised or elderly patients

- regional lymph nodes (80%)

- surgery/excision is mainstay

- can do intensive cryotherapy if very small
- can do adjuvant radiotherapy if spread or large

33

seborrhoeic keratosis:
- colloquial name?
- what is it?
- who gets it?
- prognosis?
- management?

seborrhoeic warts

harmless warty spot that appears during adult life as a common sign of skin aging (some people have hundreds)
- stuck on warty plaque

all people of all races as they get older, start to develop in 30s, rare under age of 20 (90% of over 60s have some)
- some genetic component
- not related to sun exposure

- no malignant potential (but may be mistaken for malignancy)

- if itchy, catches on clothing or unsightly can be removed by shave excision and other methods
- if worried, take picture and monitor over time

nb often grow during pregnancy due to increase in hormones

don't confuse with ACTINIC keratosis which is premalignant!!! - totally different but similar name!

34

lipoma:
- what are the features of it?
- risk factors? 3
- diagnosis?
- treatment?

- grows under skin in subcutaneous tissue
- dome or egg-shaped lump 2-10cm in diameter
- feels soft + smooth + is easily moved under the skin with the fingers
- some have rubbery or doughy consistency
- grow slowly over many years
- most common on shoulders, trunk, neck + arms

- if painful may be a liposarcoma but, more commonly just have more blood vessels (angiolipoma)

- FH
- can occur following trauma to area
- tend to develop during middle age

- clinical diagnosis, if any doubt, can do biopsy

often need no treatment, most stop growing
- if interfere with movement can remove surgically or by liposuction

35

epidermoid cyst:
- previously known as?
- what are they?
- common sites?
- complications? 2
- management?

- sebaceous cysts

slow-growing overgrowth of epidermoid cells with dense fluid inside
- no malignant potential

anywhere where there is little hair:
- face
- neck
- trunk

most arise in adult life

- infection
- rupture (irritates surrounding skin)

leave alone
- can excise but often recur
- drain and treat w Abx if infected

36

dermatofibromas:
- what are they?
- what do they look like?
- where normally found?
- gender more commonly affected?
- most common complication?
- treatment? (incl when given)

common benign fibrous nodule

small (0.5-1.5cm diameter), firm nodules, tethered to the skin+ mobile over sub cut tissue
- skin dimples on pinching the lesion
- may appear paler in the centre

normally found on lower legs (sometimes arms)

- women

- often traumatised by things like shaving, may be itchy or painful

nb if immunosuppressed, lots can emerge in short space of time - nb no malignant potential

can be removed surgically if bothering
- can be biopsied if irregular or other signs suspicious of dermatofibrosarcoma

37

campbell de morgan spots
- aka?
- what are they?
- what do they look like?
- where on body normally found?
- what increases risk?
- treatment?

cherry angioma (aka senile angioma)
- benign overgrowth of endothelial/blood vessel cells

firm red, purple or blue papule (when thrombosed, can appear black)

- trunk + head

- increase in number after age 40

none, unless remove for cosmetic reasons
- if large may remove to exclude nodular melanoma

38

fibroepithelial polyps:
- colloquially known as?
- what can they be mistaken for? 2
- commonest areas found on body?
- risk factors? 3
- treatment?

skin tags

often mistaken for:
- seborrhaeic keratosis
- molluscum contagiosum

- skin folds (neck, armpit, groin)

- obesity
- diabetes mellitus
- increased age

harmless
- can be removed for cosmetic reasons using crytherapy, surgery or by ligation (tieing a suture around base)