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Medicine Phase 2a Dermatology > Peer Teaching > Flashcards

Flashcards in Peer Teaching Deck (73):
1

3 layers of skin

Epidermis
Dermis
Subcutaneous tissue (fat)

2

Layers of epidermis

Stratum corneum (layer of keratin)
Stratum granulosum
Stratum spinosum
Stratum basale (dividing cells)

3

Corpuscles found in dermis and what they detect

Meissner's corpuscle (light touch)
Pacinian corpuscle (coarse touch/vibration)

4

Cells types in the epidermis

Keratinocytes
Langerhans cells
Melanocytes
Merkel cells

5

Function of keratinocytes

Produce keratin as a protective barrier

6

Function of langerhans cells

Present antigens and activate T cells

7

Function of melanoytes

Produce melanin which protects from UV radiation

8

Function of Merkel cells

Contain specialised nerve endings or sensation

9

Functions of skin

Sensation
Temperature regulation
Vitamin D synthesis
Immunosurveillence
Protective barrier
Fluid/electrolyte balance (sweating)
Structural (body shape)
Waterproofing
UV barrier

10

Inflammatory skin conditions

Eczema
Acne
Psoriasis

11

Cancers of skin

Squamous cell carcinoma
Basal cell carcinoma
Malignant melanoma

12

Infections of the skin

Cellulitis/necrotising fasciitis

13

Other skin conditions (not inflammatory, cancerous or infectious)

Ulcers - venous/arterial/neuropathic

14

Describe eczema

Papules and vesicles on an erythematous base

15

Clinical presentation of eczema

Papules and vesicles on an erythematous base; Itchy; Reaction pattern to stimuli
Commonly found on the face and flexure surfaces of the limbs

16

Types of eczema

Endogenous (atopic)
Exogenous (contact dermatitis)

17

Cause of exogenous eczema

Exogenous agent
e.g. Chemicals, Sweat, Abrasives

18

Describe history suggestive of eczema

Skin crease involvement
History of asthma or hay fever
Dry skin
Onset in childhood
Family history of atopy

19

Pathophysiology of exogenous eczema

Impaired skin barrier
-> Exogenous allergen penetration
-> Inflammation

20

What is filaggrin

A skin barrier protein which, if damaged increases the risk of eczema
Genetic predisposition if faulty gene

21

Management of eczema

Avoid triggers
Keep nails short in children
Topical therapies (emollients, steroids for flare ups)
Oral therapies (anti-histamines, antibiotics like flucloxacillin, oral steroids if severe, phototherapy, immunosuppressants like ciclosporin)

22

Medical treatment of eczema

Topical therapies: emollients, steroids for flare ups
Oral therapies:
anti-histamines,
antibiotics like flucloxacillin,
oral steroids if severe,
phototherapy,
immunosuppressants like ciclosporin

23

What is acne vulgaris

Inflammatory disease of the pilosebaceous follicles

24

Pathophysiology of acne vulgaris

Increased sebum production (hormonal in adolescents)
Abnormal follicular keratinization
Pilosebaceous duct obstruction
Bacterial colonisation with Propionibacterium acne
Inflammation

25

Clinical presentation of acne vulgaris

Blackheads and whiteheads (open and closed comedomes), inflammatory lesions, papules, nodules, cysts.
Commonly found on face, chest and upper back.

26

Epidemiology of acne vulgaris

Puberty
Polycystic Ovary Syndrome (in adult women in which acne suddenly arises)

27

Management for acne:
Mild
Moderate
Severe

Mild – topical therapies e.g. benzylperoxide and topical antibiotics and topical retinoids
Moderate – oral therapies e.g. oral antibiotics and anti-androgens in females (COCP or cyproterone acetate)
Severe – oral retinoids

28

What is psoriasis

Chronic, inflammatory skin disease due to hyper-proliferation of Keratinocytes + inflammatory cell infiltration

29

Clinical presentation of psoriasis

Well demarcated erythematous plaques topped with silvery scales on extensor surfaces
Associated nail changes - pitting, onycholysis
Unusual in children
NOT itchy
Genetic predisposition

30

Precipitating factors of psoriasis

trauma, drugs (lithium, beta blockers), stress, smoking and alcohol

31

Management of psoriasis:
Mild Moderate Severe

Mild – topical vit D analogues e.g. calcipotriol, topical corticosteroids, coal tar preparations, topical retinoids
Moderate – phototherapy
Severe – oral methotrexate, retinoids, ciclosporin, infliximab

32

Describe basal cell carcinoma

Slow growing
Locally invasive
Tumour of the epidermal keratinocytes
Rarely metastasises but locally destructive
Common on head and neck, Pearly appearance

33

Risk factors of basal cell carcinoma

UV exposure
Skin type 1 (burns rather than tans)
Aging

34

Treatment of basal cell carcinoma and complications

Surgically excise
Radiotherapy if surgery is not appropriate
Complications – local tissue destruction

35

Describe squamous cell carcinoma

Locally invasive malignant tumour of keratinocytes

36

Risk factors of squamous cell carcinoma

UV exposure
Chronic inflammation e.g. wound scars, immunosuppression

37

Presentation of squamous cell carcinoma

Scaly and crusty
Ill-defined edges
May ulcerate

38

Management of squamous cell carcinoma

Surgical excision/radiotherapy if non-resectable

39

What is malignant melanoma

Invasive tumour of melanocytes

40

Risk factors of malignant melanoma

UV exposure, skin type 1, atypical moles, multiple moles, family history

41

*Symptoms and Presentation of malignant melanoma

ABCDE symptoms
A – asymmetrical shape
B – boarder irregularity
C – colour irregularity
D- diameter >5cm
E – evolution/change of lesion
SYMPTOMS e.g. bleeding, itching

42

Treatment of malignant melanoma

Surgical, radiotherapy
Chemo is metastatic

43

Site of arterial skin ulcers

Toes, foot and ankle

44

Site of venous skin ulcers

Medial gaiter region

45

Edges of arterial vs venous skin ulcers

Arterial - Punched out and Well defined
Venous - Sloping and gradual

46

Wound bed appearance of arterial vs venous skin ulcers

Arterial - Covered with slough and necrotic tissue
Venous - covered with slough

47

Size of arterial vs venous skin ulcers

Arterial - Small
Venous - Large

48

Exudate level of arterial vs venous skin ulcers

Arterial - low
Venous - high

49

Pain level of arterial vs venous skin ulcers

Arterial - has pain
Venous - minimal pain

50

Pulses of arterial vs venous skin ulcers

Arterial - decreased
Venous - is present

51

Capillary refill of arterial vs venous skin ulcers

Arterial - > 3seconds
Venous - <3seconds

52

Oedema in arterial vs venous skin ulcers

Arterial - none
Venous - present

53

Hair in arterial vs venous skin ulcers

Arterial - none
Venous - none or may be some

54

Skin colour of arterial vs venous skin ulcers

Arterial - rubor, elevation pallor
Venous - brown varicose veins

55

Ulcer of arterial vs venous skin ulcers

Arterial - Tip toes, heel, lat ankle
Venous - Medial ankle

56

Risk factors of arterial skin ulcer

Arterial disease (atherosclerosis)
Smoking
Cholestrol
Diabetes Mellitus

57

Describe each of these for arterial skin ulcer:
Clinical presentation and symptoms
Ulcer appearance
ABPI

Pain, worse when legs elevated
Ulcer: small, sharply defined, necrotic base
Cold skin, absent peripheral pulses, shiny pale skin, loss of hair
ABPI < 0.8 suggests arterial insufficiency

58

Investigations and management of arterial skin ulcer

Ix - Doppler studies
Mx - Vascular reconstruction (no compression bandaging)

59

Risk factors for venous skin ulcer

Varicose veins
DVT

60

Describe each of these for venous skin ulcer:
Clinical presentation and symptoms
Ulcer appearance
ABPI

Pain (minimal)
Large, shallow, irregular, exudative
Warm skin
Normal peripheral pulses, leg oedema, haemosiderin, lipodermatoosclerosis
ABPI normal (>0.8 – 1)

61

Management of venous skin ulcer

Compression bandaging

62

Describe neuropathic skin ulcer

Often painless
Found at pressure sites (e.g. heel or toes)
Variable size, maybe surrounded by callus
Warm skin and normal peripheral pulses
Associated peripheral neuropathy

63

Management of neuropathic skin ulcer

Appropriate foot wear
Control DM
Podiatary

64

What is cellulitis

Bacterial infection of the deep subcutaneous tissue

65

Causes of cellulitis

S. pyogenes
S. aureus

66

Risk factors of cellulitis

immunosuppression, wounds, leg ulcers, trauma, athletes foot

67

Presentation of cellulitis

Local inflammation
Systemically unwell

68

Management of cellulitis

Antibiotics (flucloxacilin or benpen)

69

what is necrotising fasciitis

Bacterial infection of deep fascia and tissue necrosis

70

Causes of necrotising fasciitis

Group A haemolytic streptococcus

71

Risk factors of necrotising fasciitis

Abdominal surgery
Immunosuppression

72

Presentation of necrotising fasciitis

severe pain out of proportion, necrotic skin, systemically unwell, soft tissue gas seen on Xray

73

Management of necrotising fasciitis

surgical debridement, IV antibiotics