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OTHERS Flashcards

1
Q

What causes scabies?

A

The mite sarcoptes scabiei and its spread by prolonged skin contact

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2
Q

What age does scabies typically affect?

A

Children and young adults

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3
Q

Pathophysiology of scabies?

A

The scabies mite burrows into the skin, laying its eggs in the stratum corneum
The intense pruritus associated with scabies is due to a delayed type 4 hypersensitivity reaction to mites/eggs which occurs about 30 days after the initial infection

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4
Q

Clinical features of scabies?

A

Widespread pruritus
Linear burrows on the sides of fingers, interdigital webs and flexor aspects of the wrist
Secondary features due to scratching - excoriations and infection

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5
Q

Management of scabies?

A

Permethrin 5% is first line - apply to all areas paying close attention to between fingers/toes, under nails, armpit area, creases of skin. Allow to dry and leave on skin for 8-12 hours before washing off. Reapply if washed off during treatment period.
Repeat treatment 7 days later

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6
Q

How long does pruritus last in scabies?

A

Usually 4-6 weeks post eradication

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7
Q

Advice for household members when scabies is diagnosed?

A

avoid close physical contact with others until treatment is complete
all household and close physical contacts should be treated at the same time, even if asymptomatic
launder, iron or tumble dry clothing, bedding, towels, etc., on the first day of treatment to kill off mites.

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8
Q

What us crusted scabies?

A

Aka Norwegian scabies
This is seen in patients with suppressed immunity, especially HIV
The crusted skin will be teeming with hundreds and thousands of organisms

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9
Q

Management of crusted scabies?

A

Ivermectin
Isolation is essential

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10
Q

Clinical features of lichen planus?

A

An itchy, papular rash most common on the palms, soles, genitalia and flexor surfaces of arms
Rash is polygonal in shape with white-lines pattern on the surface
Koebner phenomenon may be seen
Oral involvement in 50% of cases - white-lace pattern
Nail changes - thinning of nail plate and longitudinal ridging

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11
Q

What causes lichen planus?

A

Unknown aetiology, most probably immune-mediated

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12
Q

Drug causes of lichen planus?

A

Gold
Quinine
Thiazides

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13
Q

Management of lichen planus?

A

Potent topical steroids
Benzydamine mouthwash or spray for oral lichen planus

If extensive it may require oral steroids or immunosuppression

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14
Q

What is Henoch-schonlein purpura?

A

An IgA mediated small vessel vasculitis
Usually seen in children following an infection

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15
Q

Clinical features of HSP?

A

Palpable purpuric rash with localise oedema - over buttocks and extensor surfaces of arms and legs
Abdominal pain
Polyarthritis
Features of IgA nephropathy may occur e.g. haematuria

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16
Q

Management of HSP?

A

Analgesia if arthalgia
Supportive

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17
Q

Prognosis of HSP?

A

Excellent - usually a self-limiting condition especially in children without renal disease
Bp and urinalysis should be monitored to detect progressive renal involvement
1/3rd of patients have a relapse

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18
Q

What can cause purpura in children?

A

Meningococcal septicaemia
ALL
Congenital bleeding disorders
ITP
HSP
Non-accidental injury

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19
Q

Causes of purpura in adults?

A

ITP
Bone marrow failure e.g. leukaemia or myelodysplasia
Senile purpura
Drugs e.g. anti thrombotic
Nutritional deficiencies e.g. vit B12 or C or folate

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20
Q

What is senile purpura?

A

Aka actinic purpura
A common benign condition characterised by recurrent purple ecchymoses on extensor surfaces of foreharms following minor trauma

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21
Q

What are keloid scars?

A

Tumour-like lesions that arise from the connective tissue of a scar and extend beyond the dimensions of the original wound

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22
Q

Predisposing factors for keloid scars?

A

Ethnicity: dark skin
Young adults

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23
Q

Common sites for keloid scars?

A

In order of decreasing frequency:
Sternum
Shoulder
Neck
Face
Extensor surface of limbs
Trunk

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24
Q

Treatment of keloid scars?

A

If early it may be treated with intra-lesional steroids e.g. triamcinolone
Excision is sometimes required but careful consideration is needed for the potential to create further keloid scarring

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25
What is a a thesis nigricans?
Symmetrical brown velvety plaques found often on the neck, axilla and groin
26
Causes of acanthosis nigricans?
T2DM GI cancer Obesity PCOS Acromegaly Cushing disease Hypothyroidism Familial Prader-Willi syndrome Drugs - COCP and nicotinic acid
27
Pathophysiology of acanthosis nigricans?
insulin resistance → hyperinsulinemia → stimulation of keratinocytes and dermal fibroblast proliferation via interaction with insulin-like growth factor receptor-1 (IGFR1)
28
What are headline?
Pediculus humanus capitis parasite
29
Management of head lice?
Dimeticone 4% lotion - apply to hair leave for 8 hours then wash off. Repeat 7 days later Special fine combs NICE recommend the Bug Buster Kit
30
What is erythema about igne?
A. Skin disorder caused by over-exposure to infrared radiation Typically an elderly woman who always sits next to an open fire
31
Presentation of erythema ab igne?
Reticulated, erythematous patches with hyperpigmentation and telangiectasia
32
Tx of erythema ab igne?
Stop exposure To the heat source
33
Why is erythema ab igne important to treat?
If the cause is not treated then patients may go on to develop squamous cell skin cancer.
34
What is hirsutism?
Androgen-dependant hair growth in women
35
What is hypertrichosis?
Androgen-independant hair growth
36
Causes of hirsutism?
PCOS - most common Cushing Congenital adrenal hyperplasia Androgen therapy Obesity Adrenal tumour Androgen secreting ovarian tumour Drugs: phenytoin or corticosteroids
37
Scoring system for assessing hirsutism?
Ferriman-Gallwey scoring system
38
Management of hirsutism?
Advise weight loss if overweight Waxing/bleaching COCP such as co-cyprindiol (dianette) or yasmin Topical eflornithine can be used for facial hirsutism
39
Causes of hypertrichosis?
Drugs: minoxidil, Ciclosporin, diazoxide Congenital hypertrichosis lanuginosa Congenital hypertrichosis terminal is Porphyria cutanea tarda Anorexia nervosa
40
What is hyperhidrosis?
Excessive sweat production
41
Management options for hyperhidrosis?
topical aluminium chloride - first line preparations are first-line iontophoresis - weak electric current passes through water to temporarily stop sweat glands botulinum toxin surgery e.g. Endoscopic transthoracic sympathectomy
42
What are milia and who are they most common in?
Small, benign, keratin-filled cysts that typically appear around the face Most common in newborns
43
What is pellagra?
A niacin deficiency that causes the 3 Ds: dermatitis, diarrhoea and dementia
44
What can cause pellagra?
Isoniazid therapy (as isoniazid’s inhibits the conversion of tryptophan to niacin) Alcoholics
45
What is pyoderma gangrenosum?
A rare, non-infectious, inflammatory disorder that causes a very painful skin ulceration
46
Where is pyoderma gangrenosum most commonly found?
The lower legs
47
Causes of pyoderma gangrenosum?
Idiopathic IBD Rheumatological - arthritis, SLE Haematological - lymphoma, myeloproliferative disorders, myeloid leukaemias, monoclonal gammopathy Granulpmatosis with polyangiitis PBC
48
Features of pyoderma gangrenosum?
Sudden small pustule, red bump or blood blister Late the skin breaks down resulting in a p flu ulcer. The edge of the ulcer is often purple and the ulcer itself may be deep and necrotic May be accompanied by fever and myalgia
49
Diagnosis of pyoderma gangrenosum?
Histology can be done but is not specific Would show dense infiltration of neutrophils as its a neutrophilic dermatosis
50
Management of pyoderma gangrenosum?
Oral steroids As potential for rapid progression is high!
51
Why should surgery be postponed until all pyoderma gangrenosum is completely controlled on immunosuppression?
To prevent worsening the disease Pathergy - this is when trauma of the skin leads to ulcers/inkjury that may be resistant to healing
52
What is a salmon patch? Who are they common in? How do they present?
A vascular birthmark see in 50% of newborn babies Pink and blotchy Fade over a few months Commonly on forehead, eyelids and nape of neck
53
What are port wine stains How do they present? Treatment?
Vascular birthmarks Unilateral, deep red or purple mark that darkens and raises over time Cosmetic camouflage or laser therapy can treat it
54
DDx of shin lesions?
Erythema nodosum Pyoderma gangrenosum Pretibilial myxoedema Necrobiosis lipoidica diabeticorum
55
How does pretibial myxoedema present?
Symmetrical, erythematous lesions Shiny, orange peel skin
56
What is necrobiosis lipoidica diabeticorum?
A skin rash often on the shins Rare Presents with shiny, painless areas of yellow/red skin Associated with telangiectasia
57
Skin manifestations of SLE?
photosensitive 'butterfly' rash - nasolabial sparing discoid lupus alopecia livedo reticularis: net-like rash
58
Features of atopic eruption of pregnancy?
is the commonest skin disorder found in pregnancy it typically presents as an eczematous, itchy red rash. no specific treatment is needed
59
Features of polymorphic eruption of pregnancy?
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
60
Features of 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
61
Causes of spider naevi?
Liver disease Pregnancy COCP
62
What are spider naevi?
Central red papules with surrounding capillaries that blanch on pressure Almost always found on upper part of body
63
How can spider naevi be differentiated from telangiectasia?
Spider naevi can be differentiated from telangiectasia by pressing on them and watching them fill. Spider naevi fill from the centre, telangiectasia from the edge .
64
What is thr most common malignancy associated with acanthosis nigricans?
Adenocarcinoma

DERMATOLOGY (14 decks)

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