General Flashcards
(202 cards)
1
Q
What are the causes of acnathosis nagricans?
A
type 2 diabetes mellitus
gastrointestinal cancer
obesity
polycystic ovarian syndrome
acromegaly
Cushing’s disease
hypothyroidism
familial
Prader-Willi syndrome
2
Q
What drugs cause acanthuses nagricans?
A
OCP
Nictonic
3
Q
Mechanism of acanthuses nagricans?
A
insulin resistance → hyperinsulinemia → stimulation of keratinocytes and dermal fibroblast proliferation via interaction with insulin-like growth factor receptor-1 (IGFR1)
4
Q
What is the pathophysiology of acne vulgaris?
A
- Follicular epidermal hyperproliferation resulting in the formation of a keratin plug.
- Obstruction of the pilosebaceous follicle.
- Activity of sebaceous glands may be controlled by androgen, although levels are often normal in patients with acne
- colonisation by the anaerobic bacterium
- Propionibacterium acnes
5
Q
Features of mild acne?
A
mild: open and closed comedones with or without sparse inflammatory lesions
6
Q
Features of moderate acne?
A
widespread non-inflammatory lesions and numerous papules and pustules
7
Q
Features of severe acne?
A
extensive inflammatory lesions, which may include nodules, pitting, and scarring
8
Q
Management of acne vulgaris?
A
- single topical therapy (topical retinoids, benzoyl peroxide)
- Topical combination therapy (topical retinoids + benzoyl peroxide)
- Oral therapy:
- Tetracyclines
- If pregnant –> erythromycin - If women: Oral contraceptive pill
- Oral isotretinoin
9
Q
If a gram negative folliculitis is found from acne treatment, how is this managed?
A
This is a complication of long term antibiotics
High dose trimethoprim
10
Q
Features of actinic keratosis?
A
small, crusty or scaly, lesions
may be pink, red, brown or the same colour as the skin
typically on sun-exposed areas e.g. temples of head
multiple lesions may be present
11
Q
Management of actinic keratosis?
A
- Sun avoidance
- fluorouracil cream: typically a 2 to 3 week course.
- topical chemotherapy, inflames skin - Topical diclofenac
- Topical imiquidmod
12
Q
Causes of scarring alopecia?
A
trauma, burns
radiotherapy
lichen planus
discoid lupus
tinea capitis*
13
Q
Causes of non-scarring alopecia?
A
male-pattern baldness
drugs: cytotoxic drugs, carbimazole, heparin, oral contraceptive pill, colchicine
nutritional: iron and zinc deficiency
autoimmune: alopecia areata
telogen effluvium
- hair loss following stressful period e.g. surgery
trichotillomania
14
Q
What is alopecia areata?
A
autoimmune condition causing localised, well demarcated patches of hair loss. At the edge of the hair loss, there may be small, broken ‘exclamation mark’ hairs
15
Q
Management of alopecia areata?
A
topical or intralesional corticosteroids
topical minoxidil
phototherapy
dithranol
contact immunotherapy
wigs
16
Q
What can be seen in alopecia areata?
A
edge of the hair loss, there may be small, broken ‘exclamation mark’ hairs
17
Q
In alopecia areata how often does hair regrow?
A
In 50% of cases in 1 year, 80-90% in one year
18
Q
Sedating anti-histamine?
A
Chlorpheniramine
19
Q
Non-sedating anti-histamine?
A
Loratidine
Cetirizine
20
Q
Features of BCC?
A
rodent ulcers and are characterised by slow-growth and local invasion. Metastases are extremely rare. BCC is the most common type of cancer in the Western world.
21
Q
What is the most common type of cancer in the western world?
A
BCC
22
Q
Morphology of BCC?
A
Sun exposed site
initially a pearly, flesh-coloured papule with telangiectasia
may later ulcerate leaving a central ‘crater’
23
Q
In bulls pemphigoid, what do the antibodies target?
A
Hemidesmosomes BP180
BP230
24
Q
Features of bullous pemphigoid?
A
itchy, tense blisters typically around flexures
the blisters usually heal without scarring
there is usually no mucosal involvement (i.e. the mouth is spared)*
25
Features of skin biopsy in bullous pemphigoid?
immunofluorescence shows IgG and C3 at the dermoepidermal junction
26
what type of hypersensitivity type of pemphigoid?
Type 2
27
What type of hypersensitivity is contact dermatitis?
Type 4
28
What are the two types of dermatitis?
Irritant contact dermatitis
Allergic contact dermatitis
29
What is dermatitis artefacta?
self-inflicted skin lesions
Patients often deny they are self inflicted
linear/geometric lesions that are well-demarcated from normal skin.
- depends on mechanism of injury
Skin lesions "suddenly appear overnight"
Patient may be not phased - " la belle difference"
30
Diagnostic approach to dermatitis artefacta?
exclusion of other dermatological conditions
Biopsy
Psychiatry assessment
31
Mechanism behind dermatitis herpetiformis?
deposition of IgA in the dermis.
32
Common areas affected by dermatitis herpetiformis?
Knee
Elbows
Buttock
Papules and vesicles
33
Diagnosis of dermatitis herpetiformis?
Skin biopsy
34
Management of dermatitis herpetiformis?
Gluten free diet
Dapsone
35
Causes of eczema herpeticum?
Herpes simplex 1
Herpes simplex 2
CMV!!! - uncommon
36
Features of eczema herpeticum?
monomorphic punched-out erosions (circular, depressed, ulcerated lesions) usually 1–3 mm in diameter are typically seen.
37
Management of eczema herpeticum?
admitted for IV aciclovir.
38
Mild topical steroid?
Hydrocortisone 0.5-2.5%
39
Moderate topical steroid?
Betamethasone valerate 0.025% (Betnovate RD)
Clobetasone butyrate 0.05% (Eumovate)
40
Potent topical steroid?
Fluticasone propionate 0.05% (Cutivate)
Betamethasone valerate 0.1% (Betnovate)
41
Very potent topical steroid?
Clobetasol propionate 0.05% (Dermovate)
42
Mechanism of erythema ab igne?
caused by over exposure to infrared radiation. Characteristic features include reticulated, erythematous patches with hyperpigmentation and telangiectasia
43
What can erythema ab igne turn into ?
SCC
44
Features of erythema multiform?
target lesions
initially seen on the back of the hands / feet before spreading to the torso
upper limbs are more commonly affected than the lower limbs
pruritus is occasionally seen and is usually mild
45
Causes of erythema multiform?
viruses: herpes simplex virus (the most common cause), Orf*
idiopathic
bacteria: Mycoplasma, Streptococcus
drugs: penicillin, sulphonamides, carbamazepine, allopurinol, NSAIDs, oral contraceptive pill, nevirapine
connective tissue disease e.g. Systemic lupus erythematosus
sarcoidosis
malignancy
46
What is erythema multiform major?
Erythema multiform, with mucosal involvement
47
What is the pathophysiology behind erythema nodosum?
Inflammation of subcutaneous fat
Nodular lesions
48
Causes of erythema nodosum?
infection
- streptococci
- tuberculosis
- brucellosis
systemic disease
sarcoidosis
inflammatory bowel disease
Behcet's
malignancy/lymphoma
drugs
- penicillins
- sulphonamides
- combined oral contraceptive pill
Pregnancy
49
What is erythrasma and what is its cause?
flat, slightly scaly, pink or brown rash usually found in the groin or axillae
overgrowth of the diphtheroid Corynebacterium minutissimum
50
How should erythrasma be investigated?
Examination with Wood's light reveals a coral-red fluorescence.
51
Management of erythrasma?
Topical miconazole or antibacterial are usually effective. Oral erythromycin may be used for more extensive infection
52
What is the definition of erythroderma?
95% body coverage rash
53
Causes of erythroderma?
eczema
psoriasis
drugs e.g. gold
lymphomas, leukaemias
idiopathic
54
Most common causes of fungal nail?
dermatophytes - mainly Trichophyton rubrum, accounts for 90% of cases
yeasts - such as Candida
non-dermatophyte moulds
55
Other causes of unsightly nails?
Differential diagnosis
psoriasis
repeated trauma
lichen planus
yellow nail syndrome
56
How to investigate nail fungus?
nail clippings
- high false negative rate
57
If nail fungal dermatophyte, management?
dermatophyte infection:
oral terbinafine is currently recommended first-line with oral itraconazole as an alternative
6 weeks - 3 months therapy is needed for fingernail infections whilst toenails should be treated for 3 - 6 months
treatment is successful in around 50-80% of people
58
If nail fungus is candida, management?
mild disease should be treated with topical antifungals (e.g. Amorolfine) whilst more severe infections should be treated with oral itraconazole for a period of 12 weeks
59
How long should topical agents for nail fungus be used for toes?
9-12 months
60
How long should topical agents for nail fungus be used for fingers?
6 months
61
Features of granuloma annulare?
papular lesions
slightly hyperpigmented and depressed centrally
dorsal surfaces of the hands and feet, and on the extensor aspects of the arms and legs
Associated with T2DM
62
When do you get guttate psoriasis?
Precipitated by a streptococcal infection 2-4 weeks prior to the lesions appearing.
63
Features of guttate psoriasis?
Tear drop papules on the trunk and limbs
- gutta is Latin for drop
- pink, scaly patches or plques of psoriasis
tends to be acute onset over days
64
How does the rash of guttate psoriasis differ from pityriasis rosea?
Guttate psoriasis: Sclary tear drop
raised oval lesions with a fine scale confined to the outer aspects of the lesions.
PR: Herald patch, followed by rest of rash 1-2 weeks
distribution with the longitudinal diameters of the oval lesions running parallel to the line of Langer.
Fir tree appearance
65
Management of guttate psoriasis?
most cases resolve spontaneously within 2-3 months
there is no firm evidence to support the use of antibiotics to eradicate streptococcal infection
topical agents as per psoriasis
UVB phototherapy
66
Features of hereditary haemorrhage telengectasia?
Autosomal dominant
epistaxis : spontaneous, recurrent nosebleeds
telangiectases: multiple at characteristic sites (lips, oral cavity, fingers, nose)
visceral lesions: for example gastrointestinal telangiectasia (with or without bleeding), pulmonary arteriovenous malformations (AVM), hepatic AVM, cerebral AVM, spinal AVM
family history: a first-degree relative with HHT
67
Most common cause of hirsutism?
PCOS
68
Causes of hirsutism?
PCOS
Cushing's syndrome
congenital adrenal hyperplasia
androgen therapy
obesity: thought to be due to insulin resistance
adrenal tumour
androgen secreting ovarian tumour
drugs: phenytoin, corticosteroids
69
Difference between hirsutism and hypertrichosis?
androgen-dependent hair growth in women,
hypertrichosis being used for androgen-independent hair growth
70
Causes of hypertrichosis ?
drugs: minoxidil, ciclosporin, diazoxide
congenital hypertrichosis lanuginosa, congenital hypertrichosis terminalis
porphyria cutanea tarda
anorexia nervosa
71
Best OCP for hirsutism?
co-cyprindiol (Dianette)
ethinylestradiol and drospirenone (Yasmin)
72
Management of facial hirsutism?
Topical eflornithine
**CANNOT BREAST FEED / BE PREGNANT***
73
Management of hyperhidrosis?
1. Topical aluminium chloride
2. iontophoresis: particularly useful for patients with palmar, plantar and axillary hyperhidrosis
3. botulinum toxin: currently licensed for axillary symptoms
74
Causes of impetigo?
Staph aureus
Strep pyogenes
Features:
'golden', crusted skin lesions typically found around the mouth
very contagious
75
Management of impetigo?
1. hydrogen peroxide 1% cream for 'people who are not systemically unwell or at a high risk of complications'
Other:
topical antibiotic creams:
topical fusidic acid
topical mupirocin should be used if fusidic acid resistance is suspected
MRSA is not susceptible to either fusidic acid or retapamulin. Topical mupirocin should, therefore, be used in this situation
76
Risk factors for keloid scars?
ethnicity: more common in people with dark skin
common sites (in order of decreasing frequency): sternum, shoulder, neck, face, extensor surface of limbs, trunk
77
What is a keratocanthoma?
benign epithelial tumour
78
What are the features of a keratocanthoma?
Features - said to look like a volcano or crater
initially a smooth dome-shaped papule
rapidly grows to become a crater centrally-filled with keratin
79
Management of keratocantoma?
Urgent excision for ? SCC
80
What is the koebner phenomena?
skin lesions that appear at the site of injury
81
What diseases exhibit koebner phenomena.?
psoriasis
vitiligo
warts
lichen planus
lichen sclerosus
molluscum contagiosum
82
What is lentigo maligna?
melanoma in-situ
Progresses slowly
May eventually become invasive --> lentigo maligna melanoma.
83
Features of lichen planus?
Itchy, papular rash most common on the palms, soles, genitalia and flexor surfaces of arms
Rash often polygonal in shape, with a 'white-lines' pattern on the surface (Wickham's striae)
Koebner phenomenon
50% of patients white-lace pattern on the buccal mucosa
nails: thinning of nail plate, longitudinal ridging
planus: purple, pruritic, papular, polygonal rash on flexor surfaces. Wickham's striae over surface. Oral involvement common
sclerosus: itchy white spots typically seen on the vulva of elderly women
84
Lichenoid drug eruption causes?
gold
quinine
thiazides
85
Management of lichen planus?
potent topical steroids are the mainstay of treatment
benzydamine mouthwash or spray is recommended for oral lichen planus
extensive lichen planus may require oral steroids or immunosuppression
86
What is lichen sclerosis?
inflammatory condition that usually affects the genitalia and is more common in elderly females
87
Features of lichen sclerosis ?
white patches that may scar
itch is prominent
may result in pain during intercourse or urination
88
Causes of livido reticularis?
idiopathic (most common)
polyarteritis nodosa
systemic lupus erythematosus
cryoglobulinaemia
antiphospholipid syndrome
Ehlers-Danlos Syndrome
homocystinuria
89
What causes livido reticularis?
purplish, non-blanching, reticulated rash caused by obstruction of the capillaries resulting in swollen venules.
90
Most common type of malignant melanoma?
1. superficial spreading
2. nodular
3. lentigo maligna
4. aural lentiginous
91
Diagnostic criteria for malignant melanoma biopsy?
Major:
Change in size
Change in shape
Change in colour
Minor
Diameter >= 7mm
Inflammation
Oozing or bleeding
Altered sensation
92
What is mycosis fungoides?
Mycosis fungoides is a rare form of T-cell lymphoma that affects the skin.
93
How does mycosis fungoides appear different to other skin conditions?
itchy, red patches
lesions tend to be of different colours in contrast to eczema/psoriasis where there is greater homogenicity
94
Malignant melanoma prognosis?
Breslow Thickness Approximate 5 year survival
< 0.75 mm 95-100%
0.76 - 1.50 mm 80-96%
1.51 - 4 mm 60-75%
> 4 mm 50%
95
What causes molloscum contagiosum?
Molloscum contagiosum virus
96
Features of molloscum contagiosum?
molluscum contagiosum presents with characteristic pinkish or pearly white papules with a central umbilication, which are up to 5 mm in diameter.
97
Management of molloscum?
Squeezing (with fingernails) or piercing (orange stick) lesions may be tried, following a bath. Treatment should be limited to a few lesions at one time
Cryotherapy may be used in older children or adults, if the healthcare professional is experienced in the procedure
Eczema or inflammation can develop around lesions prior to resolution. Treatment may be required if:
98
When should referral be sent for molloscum?
1. HIV-positive with extensive lesions urgent referral to a HIV specialist
2. Eyelid marginal lesions
3. anogenital lesions should be referred to genito-urinary medicine, for screening for other sexually transmitted infections
99
What type of hypersensitivity is nickel allergy?
Type IV hypersensitivity
100
What is oncholysis ?
idiopathic
trauma e.g. Excessive manicuring
infection: especially fungal
skin disease: psoriasis, dermatitis
impaired peripheral circulation e.g. Raynaud's
systemic disease: hyper- and hypothyroidism
101
Causes of oncholysis?
idiopathic
trauma e.g. Excessive manicuring
infection: especially fungal
skin disease: psoriasis, dermatitis
impaired peripheral circulation e.g. Raynaud's
systemic disease: hyper- and hypothyroidism
102
What causes pellagra?
Pellagra is a caused by nicotinic acid (niacin) deficiency.
103
Features of pellagra?
dermatitis (brown scaly rash on sun-exposed sites - termed Casal's necklace if around neck)
diarrhoea
dementia, depression
death if not treated
104
What is the cause of pemphigus?
antibodies directed against desmoglein 3, a cadherin-type epithelial cell adhesion molecule.
105
Features of pemphigus?
mucosal ulceration 50-60%
flaccid, easily ruptured vesicles and bullae
Nikolsky's positive: Nikolsky's describes the spread of bullae following application of horizontal, tangential pressure to the skin
acantholysis on biopsy - separation of layers
106
Management of pemphigus?
Steroids
Immunosuppression
107
What is the viral cause of pityriasis rosea?
herpes hominis virus 7 (HHV-7)
108
Features of pityriasis rosea?
no prodrome, but a minority may give a history of a recent viral infection
Herald patch ( on trunk)
followed by erythematous, oval, scaly patches which follow a characteristic distribution with the longitudinal diameters of the oval lesions running parallel to the line of Langer
109
Cause of pityriasis versicolor?
Malassezia furfur (formerly termed Pityrosporum ovale)
110
Features of pityriasis versicolor?
most commonly affects trunk
patches may be hypopigmented, pink or brown (hence versicolor). May be more noticeable following a suntan
scale is common
mild pruritus
111
Risk factors pf pityrasis versicolor?
occurs in healthy individuals
immunosuppression
malnutrition
Cushing's
112
Management of pityriasis versicolor?
1. Ketoconazole shampoo
2. Failure to improve: scrapings + itronconazole
113
Features of pomphlyx eczema?
small blisters on the palms and soles
pruritic
- often intensely itchy
- sometimes burning sensation
once blisters burst skin may become dry and crack
114
Factors that precipitate pomphlyx eczema?
humidity (e.g. sweating) and high temperatures.
115
Genetics behind porphyria cutanea tarde?
nherited defect in uroporphyrinogen decarboxylase
Can be acquired from damage to hepatocyte:
- Alcohol
- Hepatitis C
- Oestrogen
116
Features of porphyria cutanea tarde?
classically presents with photosensitive rash with blistering and skin fragility on the face and dorsal aspect of hands (most common feature)
hypertrichosis
hyperpigmentation
117
Investigation findings for porphyria cutanea tarda?
urine: elevated uroporphyrinogen and pink fluorescence of urine under Wood's lamp
serum iron ferritin level is used to guide therapy
118
Management of porphyria cutanea trada?
chloroquine
venesection
- preferred if iron ferritin is above 600 ng/ml
119
HLA associations in psoriasis?
HLA-B13, -B17, and -Cw6.
120
Types of psoriasis?
Plaque psoriasis: raise clay plaques
Flexural psoriasis: skin is smooth
Guttate psoriasis: transient psoriasis
Pustular psoriasis: commonly soles and palms
121
Complications of psoriasis ?
psoriatic arthropathy (around 10%)
increased incidence of metabolic syndrome
increased incidence of cardiovascular disease
increased incidence of venous thromboembolism
psychological distress
122
Exacerbating factors of psoriasis?
trauma
alcohol
drugs: beta blockers, lithium, antimalarials (chloroquine and hydroxychloroquine), NSAIDs and ACE inhibitors, infliximab
withdrawal of systemic steroids
Streptococcal infection -> guttate psoriasis
123
Management of chronic plaque psoriasis?
1. Steroid + vitamin D analogue
If no improvement in 8 weeks:
2. Vitamin D analogue twice daily
If no improvement 8-12 weeks:
3. a potent corticosteroid applied twice daily for up to 4 weeks, or
a coal tar preparation applied once or twice daily
124
Types of light therapy offered is chronic plaque psoriasis?
Ultraviolet light B
or
Psoralen treatment + ultraviolet light A
125
adverse effects of light therapy for psoriasis?
Skin ageing
Squamous cell cancer (not melanoma)
126
Systemic therapy for chronic plaque psoriasis?
oral methotrexate is used first-line. It is particularly useful if there is associated joint disease
ciclosporin
systemic retinoids
biological agents: infliximab, etanercept and adalimumab
ustekinumab (IL-12 and IL-23 blocker) is showing promise in early trials
127
Management of scale psoriasis?
potent topical corticosteroids used once daily for 4 weeks
128
Management of flexural psoriasis?
mild or moderate potency corticosteroid applied once or twice daily for a maximum of 2 weeks
129
Mechanism of vitamin D analogues?
they work by ↓ cell division and differentiation → ↓ epidermal proliferation
DOES NOT REDUCE INFLAMMATION
130
Can vitamin D analogues be used in pregnancy?
No
131
Pathphysiology of pyoderma gangreonsum?
non-infectious, inflammatory disorder.
Neutrophilliic dermatosis - deep infiltration of neutrophils
132
Causes of pyoderma gangreonsum?
Inflammatory bowel disease in 10-15%
- ulcerative colitis
- Crohn's
rheumatological
- rheumatoid arthritis
- SLE
haematological
- myeloproliferative disorders
- lymphoma
- myeloid leukaemias
- monoclonal gammopathy (IgA)
granulomatosis with polyangiitis
primary biliary cirrhosis
133
Features of pyoderma gangreonsum?
Typically lower limb
usually starts quite suddenly -->small pustule, red bump or blood-blister
Skin break down --> ulcer
Ulcer: purple, violaceous and undermined.
134
Management of pyoderma gangreonsum?
1. Oral steroids
2. Immunosuppression: ciclospoorin, inflixamab
135
Causes of pyogenic granuloma?
trauma
pregnancy
more common in women and young adults
136
What oral retinoid is used in acne?
Isotretinoin is an oral retinoid used in the treatment of severe acne.
137
Adverse effects of retinoids?
Teratogenic: put on pill
Dry skin - dry mouth - most common side effect
Low mood
raised triglycerides
hair thinning
nose bleeds (caused by dryness of the nasal mucosa)
intracranial hypertension: isotretinoin treatment should not be combined with tetracyclines for this reason
photosensitivity
138
Features of rosacea?
typically affects nose, cheeks and forehead
flushing is often first symptom
telangiectasia are common
later develops into persistent erythema with papules and pustules
rhinophyma
ocular involvement: blepharitis
sunlight may exacerbate symptoms/
Rosacea features:
nose, cheeks and forehead
flushing, erythema, telangiectasia → papules and pustules
139
Management of rosacea?
topical metronidazole may be used for mild symptoms (i.e. Limited number of papules and pustules, no plaques)
topical brimonidine gel may be considered for patients with predominant flushing but limited telangiectasia
more severe disease is treated with systemic antibiotics e.g. Oxytetracycline
140
What is the mite that causes scabies?
Sarcoptes scabiei
141
What type of hypersensitivity reaction is scabies?
Type IV
scabies mite burrows into the skin, laying its eggs in the stratum corneum.
142
Feature of scabies?
widespread pruritus
linear burrows on the side of fingers, interdigital webs and flexor aspects of the wrist
in infants, the face and scalp may also be affected
secondary features are seen due to scratching: excoriation, infection
143
Causative organism of seborrheic dermatitis?
Malassezia furfur
144
Features of seborrheic dermatitis ?
eczematous lesions on the sebum-rich areas: scalp (may cause dandruff), periorbital, auricular and nasolabial folds
otitis externa and blepharitis may develop
145
Associated conditions with seborrheic dermatitis?
HIV
Parkinsons
146
Management of seborrheic dermatitis?
1. T Gel
2. Ketocondazole shampooo
Face and body management
topical antifungals: e.g. ketoconazole
topical steroids: best used for short periods
difficult to treat - recurrences are common
147
What is sezary syndrome?
T-cell cutaenous lymphoma.
pruritus
erythroderma typically affecting the palms, soles and face
atypical T cells
lymphadenopathy
hepatosplenomegaly
148
Descriptions of erythema nodosum?
symmetrical, erythematous, tender, nodules which heal without scarring
multiple, discrete, raised erythematous lesions on the arms and legs ranging from 8cm in diameter to 12cm in diameter. There is pain on active and passive joint movement.
most common causes are streptococcal infections, sarcoidosis, inflammatory bowel disease and drugs (penicillins, sulphonamides, oral contraceptive pill)
149
Descriptions of pretibial myoedema?
symmetrical, erythematous lesions seen in Graves' disease
shiny, orange peel skin
150
Description of pyoderma gangerosum?
initially small red papule
later deep, red, necrotic ulcers with a violaceous border
idiopathic in 50%, may also be seen in inflammatory bowel disease, connective tissue disorders and myeloproliferative disorders
151
Description of necrobiosis lipodica?
shiny, painless areas of yellow/red skin typically on the shin of diabetics
often associated with telangiectasia
152
Skin conditions associated with diabetes?
Necrobiosis lipodcia
Candida
Neuropathic ulcers
Vitiligo
Granuloma annular
153
Skin condition associated with gastric cancer?
Acanthosis nagaricans
154
Skin condition associated with lymphoma?
Acquired ichthyosis
(dry scaly skin)
Erythroderma
155
Most common skin eruption in pregnancy?
Atopic eruptions
156
What skin disorder is associated with last trimester pregnancy/
Polymorphic eruption
pruritic condition associated with last trimester
lesions often first appear in abdominal striae
management depends on severity: emollients, mild potency topical steroids and oral steroids may be used
157
Skin conditions that is blistering in pregnancy ?
Pemphigoid gestationis
pruritic blistering lesions
often develop in peri-umbilical region, later spreading to the trunk, back, buttocks and arms
usually presents 2nd or 3rd trimester and is rarely seen in the first pregnancy
oral corticosteroids are usually required
158
Skin conditions associated with tuberculosis?
lupus vulgaris (accounts for 50% of cases)
erythema nodosum
scarring alopecia
scrofuloderma: breakdown of skin overlying a tuberculous focus
verrucosa cutis
gumma
159
What is lupus vulgaris?
cutaneous TB seen in the Indian subcontinent. It generally occurs on the face and is common around the nose and mouth. The initial lesion is an erythematous flat plaque which gradually becomes elevated and may ulcerate later
160
Risk factors for SCC?
excessive exposure to sunlight / psoralen UVA therapy
actinic keratoses and Bowen's disease
immunosuppression e.g. following renal transplant, HIV
smoking
long-standing leg ulcers (Marjolin's ulcer)
genetic conditions e.g. xeroderma pigmentosum, oculocutaneous albinism
161
Excision parameters for SCC?
1. 4mm margins if lesion <20mm in diameter.
2. If tumour >20mm then margins should be 6mm. 3.Mohs micrographic surgery may be used in high-risk patients
162
Causes of Steven Johnson syndrome?
penicillin
sulphonamides
lamotrigine, carbamazepine, phenytoin
allopurinol
NSAIDs
oral contraceptive pill
163
Features of Steven Johnson syndrome?
Rash is typically maculopapular with target lesions being characteristic
may develop into vesicles or bullae
Nikolsky sign is positive in erythematous areas - blisters and erosions appear when the skin is rubbed gently
mucosal involvement
systemic symptoms: fever, arthralgia
164
Features of systemic mastocytosis?
urticaria pigmentosa - produces a wheal on rubbing (Darier's sign)
flushing
abdominal pain
monocytosis on the blood film
165
Investigation findings in systemic mastocytosis?
raised serum tryptase levels
urinary histamine
166
Drug causes of toxic epidermal necrolysis?
phenytoin
sulphonamides
allopurinol
penicillins
carbamazepine
NSAIDs
167
Features of toxic epidermal necrolysis ?
systemically unwell e.g. pyrexia, tachycardic
positive Nikolsky's sign: the epidermis separates with mild lateral pressure
168
Large vessle vasculitis?
temporal arteritis
Takayasu's arteritis
169
Medium vessel vasculitis?
polyarteritis nodosa
Kawasaki disease
170
Small vessel vasculitis?
ANCA-associated vasculitides:
granulomatosis with polyangiitis (Wegener's granulomatosis)
eosinophilic granulomatosis with polyangiitis (Churg-Strauss syndrome)
microscopic polyangiitis
immune complex small-vessel vasculitis:
Henoch-Schonlein purpura
Goodpasture's syndrome (anti-glomerular basement membrane disease)
cryoglobulinaemic vasculitis
hypocomplementemic urticarial vasculitis (anti-C1q vasculitis)
171
What is a normal ankle brachial pulse index?
0.9 - 1.2.
Values below 0.9 indicate arterial disease, or above 1.3 .
172
Association of yellow nail syndrome?
congenital lymphoedema
pleural effusions
bronchiectasis
chronic sinus infections
173
Features of zinc deficiency?
acrodermatitis: red, crusted lesions
- acral distribution
- peri-orificial
- perianal
alopecia
short stature
hypogonadism
hepatosplenomegaly
geophagia (ingesting clay/soil)
cognitive impairment
174
What is the most common ulcer on the lower lip?
SCC
175
How does irritant dermatitis present vs allergic dermatitis?
Allergic: Acute weeping eczema which predominately affects the margins of the hairline rather than the hairy scalp itself
Irritant: Often seen on the hands. Erythema is typical, crusting and vesicles are rare
176
Name of rash with STI's and presentation?
Keratoderma blennorrhagica may be precipitated by chlamydia in the context of reactive arthritis. This rash is found on the soles of the feet but can also affect the palms. It can be vesico-pustular but tends to have a waxy brown appearance rather than being erythematous and itchy.
177
Causes of eczema herpeticum?
simplex 1
Herpes simplex 2
178
What type of monoclonals are good in psoriasis / psoriatic arthritis? - Example ?
Anti- TNF
Enteracept
179
What type of rash do you get in eczema herpeticum?
Monomorphic punched out
180
What is melanoma, how does it present?
"A 33-year-old lady presents complaining of facial discolouration. She is 26 weeks pregnant. So far it has been an uncomplicated pregnancy. She has a background of rheumatoid arthritis but has been off treatment for 2 years.
"
Melasma is a benign but relatively common skin condition which can appear in pregnancy. In this situation it may resolve a few months after delivery.
181
Difference between pemphigus and pemphigoid?
no mucosal involvement: bullous pemphigoid
mucosal involvement: pemphigus vulgaris
182
Why skin cancers do renal patients typically get?
SCC
183
?Treatment of eczema herpeticum
As it is potentially life-threatening children should be admitted for IV aciclovir.
184
Rash associated with gastric cancer?
Acanthosis nagricans
185
Rash associated with lymphoma?
Acquired ichthyosis
186
Rash associated with GI and lung cancer?
Acquired hypertrichosis lanuginosa
187
Rash associated with Ovarian and lung cancer
Dermatomyositis
188
Rash associated with lung cancer?
Erythema gyratum repens
189
Rash associated with lymphoma?
erythroderma
190
Rash associated with pancreatic cancer?
Migratory thrombophlebitis
191
Rash associated with glucagonoma?
Necrolytic migratory erythema
192
Rash associated with myeloproliferative disorders?
Pyoderma gangrenosum (bullous and non-bullous forms)
193
Rash associated with myeldysplastic syndrome (purple plaques)?
Sweet's syndrome
194
Rash associated with myeldysplastic syndrome (purple plaques)?
Sweet's syndrome
195
Appearance of lentigo maligna?
Lentigo maligna is a type of melanoma in-situ. It typically progresses slowly but may at some stage become invasive causing lentigo maligna melanoma.
196
What is auspitz sign?
Pin point bleeding after scratching
197
If a ? keratokanthoma, how should this be referred?
Urgent referral to dermatology
198
How to apply insecticide in scabies?
allow to dry and leave on the skin for 8-12 hours for permethrin, or for 24 hours for malathion, before washing off
repeat treatment 7 days later
199
You can get scabies on the penis
Euuw
200
Where do you typically get lentigo maligna melanoma?
Suspicious freckle on face or scalp of chronically sun-exposed patients
201
Which malignant melanoma has the worst prognosis ?
Nodular
202
Management of keloid scar?
early keloids may be treated with intra-lesional steroids e.g. triamcinolone
excision is sometimes required but careful consideration needs to given to the potential to create further keloid scarring
