Dermatology - intro/pharmcology

Question 1

What is found in the subcutaneous layer of skin (hypodermis)?

Answer 1

Fat energy store, insulation

Fibrous bands anchor skin to fascia

Question 2

What is found in the dermis layer of skin?

Answer 2

Collagen and elastin matrix with mucopolysaccharide gel, fibroblasts, dermal dendritis cells, macrophages

Question 3

What are the three cell types found in the epidermis?

Answer 3

Keratinocytes
Melanocytes
Langerhans cells

Question 4

What do Langerhans cells do in the skin?

Answer 4

Process antigens and migrate to lymph nodes to induce an immune response

Question 5

What are the five layers of the epidermis (superficial -> deep)?

Answer 5

Stratum corneum
Stratum lucidum
Stratum granulosum
Stratum spinosum
Stratum basale

Question 6

What are the three phases of the hair cycle?

Answer 6

Anagen
Catagen
Telogen

Question 7

What is the active growing phase of the hair cycle?

Answer 7

Anagen

Question 8

What is the resting phase of the hair cycle?

Answer 8

Telogen

Question 9

What are the main functions of the skin?

Answer 9

Thermoregulation
Skin immune system
Barrier e.g. mechanical, chemical, UV light, keeping water in
Sensation
Vitamin D synthesis
Interpersonal communication

Question 10

What are examples of external reasons for skin disease?

Answer 10

Temperature: cold injury, cold urticaria
Photosensitivity: medications, sensitive to UVA/UVB/visible light
Trauma
Chemical
Infection

Question 11

What are examples of internal reasons for skin disease?

Answer 11

Genetic
Drug reaction
Autoimmune

Question 12

How would you describe a small skin lesion?

Answer 12

Macule

Question 13

How would you describe a large skin lesion?

Answer 13

Patch

Question 14

How would you describe a small raised area of skin?

Answer 14

Papule

Question 15

How would you describe a large raised area of skin?

Answer 15

Plaque

Question 16

How would you describe a small fluid filled skin lesion?

Answer 16

Vesicle

Question 17

How would you describe a large fluid filled skin lesion?

Answer 17

Bulla

Question 18

How would you describe a small pus filled skin lesion?

Answer 18

Pustule

Question 19

How would you describe a large pus filled skin lesion?

Answer 19

Abscess

Question 20

How would you describe the loss of epidermis?

Answer 20

Erosion

Question 21

How would you describe the loss of epidermis and dermis?

Answer 21

Ulcer

Question 22

Which layers of skin have been lost if there is an ulcer?

Answer 22

Epidermis and dermis

Question 23

What is eruptive xanthoma associated with?

Answer 23

Hyperlipidaemia

Question 24

What diseases/conditions is acanthuses nigricans associated with?

Answer 24

Diabetes, obesity, insulin resistance

Question 25

Which disease is pretibial myxoedema associated with?

Answer 25

Grave's disease

Question 26

What investigation would you do if a bacterial infection was suspected?

Answer 26

Charcoal swab | MC&S

Question 27

What does MC&S stand for?

Answer 27

Microscopy, culture and sensitives

Question 28

What investigation would you do if a viral infection was suspected?

Answer 28

Viral swab for PCR

Question 29

What investigation would you do if a fungal infection was suspected?

Answer 29

Skin scraping/nail clipping/hair sample | Fungal cultures

Question 30

What is the method called to take a skin biopsy?

Answer 30

Punch biopsy

Question 31

What do unlicensed medicines mean?

Answer 31

Not approved for use in UK

Question 32

What do 'off label' medications mean?

Answer 32

A licensed medication that is being used for an unlicensed indication

Question 33

What does 'specials' medication mean?

Answer 33

Unlicensed dermatological preparations | Long history of use, no strong evidence base but clinically effective e.g. coal tar

Question 34

What does pharmokinetics mean?

Answer 34

Effect of the body on the drug

Question 35

What does pharmodynamics mean?

Answer 35

Effect of the drug on the body

Question 36

What is a medication vehicle and give some examples?

Answer 36

Pharmacologically inert, physically and chemically stable substance that carries the active drug E.g. solution, cream, lotion, gel, ointment, paint, shampoo

Question 37

What factors affect drug absorption?

Answer 37

``` Concentration Base/vehicle Chemical properties of the drug Thickness and hydration of stratum corneum Temperature Skin site Occlusion ```

Question 38

What do topical steroids do?

Answer 38

Anti-inflammatory and immunosuppressive properties Regulate pro-inflammatory cytokines Suppress fibroblast, endothelial and leukocyte function Vasoconstriction Inhibit vascular permeability

Question 39

How much is a finger tip unit approximately?

Answer 39

0.5g

Question 40

What are some side effects of topical steroids?

Answer 40

Thinning/atrophy, striae, bruising, hirsutism, telangiectasia, acne/rosacea/perioral dermatitis, glaucoma, systemic absorption, cataracts

Question 41

What is telangiectasia?

Answer 41

Widened venules cause threadlike red lines or patterns on the skin

Question 42

What are some examples of systemic treatments in dermatology?

Answer 42

Retinoids Traditional immunosuppressants Biologics

Question 43

What are retinoids and how do they work?

Answer 43

Vitamin A analogues: Normalise keratinocyte function Anti inflammatory and anti cancer effects

Question 44

What is a retinoid used in acne?

Answer 44

Isotretinoin

Question 45

What is a retinoid used in psoriasis?

Answer 45

Acitretin

Question 46

What are the side effects of retinoids?

Answer 46

Teratogenic Cheilitis (dry lips), xerosis (dry skin) Increase in transaminases and triglycerides Rarely psychiatric, eye, bone SE

Question 47

What are immunosuppressants used for in dermatology?

Answer 47

Treatment of inflammatory skin disorders

Question 48

What are examples of immunosuppressants?

Answer 48

``` Oral steroids Azathioprine Ciclosporin Methotrexate Mycophenolate mofetil ```

Question 49

What are the risks with immunosuppresants?

Answer 49

Risk of malignancy and serious infection | Need regularly blood monitoring: FBC, renal and liver function

Question 50

What are biologics?

Answer 50

Genetically engineered proteins derived from human genes designed to inhibit specific components of the immune system

Question 51

How do biologics ususally end?

Answer 51

- cept | - mab

Question 52

What are the risks with biologics?

Answer 52

Risk of infection Risk of malignancy Risk of demyelination - TNF inhibitors