Posters 2- week 2 derm Flashcards
(176 cards)
1
Q
What is a cream
A
Semi-solid emulsion of water and oil.
Contain an emulsifier and a preservative
2
Q
What are creams good for?
A
Higher water content so good for dry skin
3
Q
What is the risk of creams?
A
Patients can be allergic to the preservative.
4
Q
What are lotions
A
Liquid formulation
Suspension or solution of medication in water, alcohol or other liquids
5
Q
What are lotions good for?
A
Scalp and hair bearing areas
6
Q
What are pastes?
A
Semisolids
Contain finely powdered material
Stiff, greasy and difficult to apply
7
Q
What are pastes used for?
A
Often used in cooling, drying, soothing bandages.
8
Q
What are ointments?
A
Semisolids grease/oils with no preservative
Occlusive (meaning not well absorbed)
9
Q
What are ointments good for?
A
Very good moisturisers
10
Q
What are gels
A
Thickened aqueous solutions
Semi-solids which contain high molecular weight polymers
11
Q
Where would gels be used?
A
Scalp, hair bearing areas and face.
12
Q
What is wet wrap therapy used for? Drawbacks
A
Very dry xerotic skin
However difficult and time consuming to apply
13
Q
What are emollients used for?
A
Enhance rehydrating of the epidermis- used for all dry/scaly skin conditions such as eczema.
14
Q
Three ways topical corticosteroids work
A
Vasoconstrictive
Anti-inflammatory
Anti-proliferative
15
Q
Side effects of topical corticosteroids
A
Thinning of the skin
Purpura
Stretch marks
Steroid rosacea
Perioral dermatitis (raised bumps around the mouth)
Fixed telangiectasia (lots of blood vessels)
16
Q
Antiseptics
A
Have bacteriostatic or bacteriocidal effects
True to use over antibiotics due to resistance
17
Q
When are antiseptics clinically used
A
Recurrent infections
Antibiotic resistance
Wound irrigation
18
Q
Treatment for thrush
A
Nystatin
Clotrimazole
19
Q
treatment for ringworm
A
Clotrimazole
Terbinafine cream
20
Q
Antipriuritics
A
Menthol
Capsaicin- depletes substance P at nerve endings
Camphor/phenol
21
Q
Topical antibiotics used for acne
A
Clindamycin
Erythromycin
Tetracycline
22
Q
Topical antibiotics used for rosacea
A
Metronidazole
23
Q
Topical antibiotics used for impetigo
A
Mupirocin
Fusidic acid
24
Q
What are keritolytics used for?
A
Used to soften keratin in viral warts, hyperkeratotic eczema, corns and calluses, remove keratin plaques.
25
What virus causes shingles and chicken pox
Varicella zoster virus
26
Symptoms of chickenpox
Generalised rash and fever
| Macules, to papules to vesicles to recovery to scabs.
27
Symptoms of shingles
Reactivation of latent virus
Occurs in a dermatomal distribution
Tingling pain to erythema to vesicles to crusts
28
Complications of chicken pox
Secondary bacterial infection
Pneumonitis
Scarring
Encaphilitis
29
When is chickenpox severe
Extremes of age
| Depressed cell mediated immunity
30
How is neonatal varicella zoster caused
Secondary to chicken pox in the mother in the late stages of pregnancy.
31
How to prevent neonatal varicella zoster
Give Varicella Zoster Immunoglobulin in susceptible women
32
What is ophthalmic zoster and where does it effect? Management
Ophthalmic zoster effects the ophthalmic division of the face (around the eye and on the forehead)
urgent referral
33
What is maxillary zoster and where does it effect?
Maxillary division of the trigeminal nerve affected (around nose and mouth),
34
What is mandibular zoster and where does it effect?
Effects the mandibular division of the trigeminal nerve.
35
How does herpes simplex virus present?
Primary gingivostomatitis- (inflammation of the gingiva and oral mucosa)
Extensive ulceration around the mouth
36
Who does herpes simplex virus normally affect?
Generally preschool children.
37
What does reoccurring herpes simplex virus present as?
Blistering rash at vermillion border.
| Can spread.
38
Herpes simplex virus can be categorised into?
Type 1 and type 2
39
Effects of type 1 herpes simplex
Main cause of oral lesions
Accounts for half of genital lesions
Can cause encephalitis (inflammation of the brain)
40
Effects of type 2 herpes simplex virus
Rare cause of oral lesions
Accounts for half of genital lesions.
Also can cause encephalitis.
41
How would you confirm it was herpes simplex virus?
Lab confirmation with viral transport medium.
| Antibody tests.
42
Therapy for herpes simplex virus and varicella zoster virus?
Aciclovir (analogue of guanosine)- selectively incorporated into viral DNA to inhibit replication.
43
What is erythema multiforme?
Well defined 'target' lesions with erythema.
44
What can trigger erythema multiforme?
Drug reactions and injections.
45
What is molluscum contagiosum?
Fleshy, firm depressed nodules.
46
Treatment for molluscum contagiosum?
Self limiting however can take months to clear.
| Could use liquid nitrogen
47
How is molluscum contagiosum acquired and who does it infect?
Common in children.
| Can be transmitted sexually.
48
What virus causes warts?
Human papilloma virus
49
When is a wart called a verruca?
If it is on the feet.
50
Treatment of warts?
```
Self-limiting.
Could use keratinolytics (to thin the keratin layer)
Formaldehyde
Glutaraldehyde
Cryotherapy (usually liquid nitrogen)
```
51
Who gets warts?
Most commonly children.
52
Other diseases caused by human papilloma virus
```
Genital warts (types 6 and 11)
Cervical cancer (types 16 and 18)
Warts (types 1-4)
```
53
What vaccines are available for HPV
Gardasil- protects against types 6,11, 16 and 18.
| Cervarix- protects against types 16 and 18
54
What treatment can you use for genital warts?
Imiquimod- has antiviral and anti tumour effect.
55
Treatment of psoriasis
```
Emollients AND
coal tar (however messy and smelly)
Vitamin D analogue
Keratolytic
Topical steroids
Dithranol
```
56
How would treatment of psoriasis differ if it was axillary psoriasis?
Steroids need to be more dilute because the skin is more prone to thinning.
57
How would treatment of psoriasis differ if it was scalp psoriasis
Greasy ointments to soften scalp.
Tar shampoo
Steroids in the shampoo
Vitamin D analogues (calcipotriol- Daivonex trade name)
58
What does hyperkeratosis mean?
Increased thickness of the keratin layer
59
What does parakeratosis mean?
Persistence of nuclei in the keratin layer.
60
What is aconthosis?
Increased thickness of the epithelium.
61
What is papillomatosis?
Irregular epithelial thickening
62
What is spongiosis?
Oedema fluid increasing in prominence of intercellular prickles.
63
Name the 4 main classifications of pathological skin disease?
Psorisiform
Spongiotic intraepidermal oedema
Vesiculobullous
Lichenoid-
64
What does lichenoid mean?
Basal layer damage. Most common condition is lichen planus
65
An example of spongiotic intraepidermal oedema?
Eczema.
66
Pathology of psoriasis
Remains relatively unknown- could be due to
Epidermal hyperplasia
Hereditary factors
Sites of trauma
Complement mediated attack on keratin layer (due to neutrophils gathering in surface layer of the epidermis)
67
Signs and symptoms of psoriasis
Blood vessels come very close to the surface- Ausfitz sign (when you pick the scab it bleeds a lot)
Dystrophic nails
Nuclei persist in the keratin layer.
68
What is lichen planus?
Itchy, flat topped, violet coloured papules.
69
Histological appearance of lichen planus
Irregular, saw tooth, aconthosis.
Hypergranulosis (increased thickness of granular layer)
Band like upper dermal infiltrate of lymphocytes.
Basal damage with formation of cymoid bodies.
70
What resembles lichen planus?
Discoid lupus
| Drug reactions
71
Vacuolar interface change
Change at the DEJ.
72
What are immunobullous disorders?
Blisters are the primary feature (in lots of other conditions they are secondary)
73
What is pemphigus?
Rare autoimmune condition where you get loss of epidermal cell adhesion.
74
Immunological explanation of pemphigus
Autoantibodies made against desmoglien 3 (the bit that holds the epidermal cells together). Therefore causes immune complexes to form on the cell surface activating complement and protease release.
75
Treatment of pemphigus
Responds to steroids.
76
Pemphigus can be divided into
4 distinct subtypes. Most common (80%) pemphigus vulgaris.
77
Symptoms of pemphigus vulgaris
Fluid filled blisters that rupture to form shallow erosions.
May affect the mucosa
Involves skin especially on the scalp, face, axillae and groin.
78
What is bullous pemphigoid?
Circulating IgG antibodies react with hemidesmosomes which anchor the basal cells to the basement membrane.
79
Symptoms of bullous pemphigoid?
Fluid filled blisters- that don't easily rupture when touched.
Itchy and red skin
80
Investigations into bullous pemphigoid and what they will show
Immunoflourescence- will show linear IgG and complement deposited around the basement membrane.
81
What is dermatitis herpetiformis?
Relatively rare condition where IgA antibodies target gliadin in gluten but cross react with connective tissue matrix proteins.
82
What is dermatitis herpetiformis associated with?
HLA DQ2
| Gluten sensitive enteropathy (coeliac disease)
83
Symptoms of dermatitis herpetiformis
```
Extreme itch (priuritis)
Eruption classically seen on the buttocks and extensor surfaces of the arms and legs.
Papillary dermal micro-abscesses.
```
84
Pathogenesis of acne
In puberty- increased androgens are produced
Androgen sensitivity in sebaceous glands also increases meaning they make more keratin
The keratin and sebum plug the pilosebaceous unit
The build up can be infected with bacteria.
85
Presentation of rosacea
Rhinophyma
Red flushed cheeks
Visible blood vessels
Pustules.
86
What triggers rosacea
Sunlight
Alcohol
Stress
Spicy food
87
Pathology of rosacea
```
Vascular ectasia (blockage). Patchy inflammation therefore occurs with plasma cells. Pustules form. Perifollicular granulomas.
Follicular dermodex mites often noted.
```
88
The two phases of eczema
Acute and chronic
89
Acute phase of eczema
Papillovesicular
Red erythematous lesions
Oedema (spongiosis)
Ooze or scaling and crusting
90
Chronic phase of eczema
Thickening (lichenification)
Elevated plaques
Increased scaling.
91
Name all 7 types of dermatitis
```
Contact allergic dermatitis
Contact irritant dermatitis
Atopic
Drug induced
Photosensitive or photoinduced
Lichen simplex
Stasis dermatitis
```
92
What is contact allergic dermatitis?
Delayed type 4 hypersensitivity reaction- in response to chemicals, topical therapies etc.
93
Immunopathology of contact allergic dermatitis
Langerhan cells in the epidermis process the antigen
This is then presented to naive T cells
Sensitised T cells then migrate to lymph nodes and the presentation becomes amplified
On the next appearance of the antigen- sensitised T cells proliferate and migrate to the skin
94
How would you identify the substance triggering the contact allergic dermatitis
Patch testing.
95
What is irritate contact dermatitis
Non-immunological process where damage is caused directly to the skin through trauma/abrasion.
96
What thing is key in the history to find out whether it is irritant contact dermatitis?
Occupation
97
What is atopic eczema?
Genetic and environment factors resulting in inflammation.
98
Which age group are likely to be effected by atopic eczema?
School aged children.
99
Why does itch have an effect on neurological development?
Priuritis leads to sleep disturbance which causes neurocognitive impairment.
100
Symptoms of atopic eczema?
Itch
Ill defined erythema and scaling
Generalised dry skin
Flexural distribution (involving skin folds)
Associated with other atopic diseases (asthma)
101
Complications of atopic eczema?
Staph aureus is a common secondary infection.
| Eczema herpeticum- eczema infected with herpes
102
Presentation of eczema herpeticum
Monomorphic punched out lesions
103
Sign of staph aureus infected eczema
Crusting.
104
Diagnostic criteria for atopic eczema
Itching plus 3 or more of:
- flexural rash
- previous flexural rash
- History of atopy
- Generally dry skin
- Onset before 2.
105
Treatment of atopic eczema
```
Plenty of emollients
Avoidance of irritants
Topical steroids
Treat any infections
Phototherapy- mainly UVB
Systemic immunosuppressants
```
106
Discoid eczema
Well defined erythema and scale
| Patients often atopic too
107
Photosensitive eczema
Contact eczema to airborne allergens and UV light.
108
Stasis eczema
Skin under pressure secondary to hydrostatic pressure. Oedema and red cell extravasation.
109
Seborrhoeic dermatitis
Combination of atopic eczema and pittosporum on skin
110
Pompholyx eczema
Spongiotic vesicles characteristically down lateral aspects of digits.
111
What virus causes herpangina?
Enterovirus e.g. cocksackie virus or echo virus.
112
What is herpangina?
Blistering rash at the back of the mouth.
113
Treatment of herpangina
self limiting.
114
Investigations into herpangina?
Swab lesion
| Stool sample for enterovirus PCR.
115
What is hand foot and mouth disease
Wart like blisters on the back of the mouth, typically occurring in children and has some family outbreaks.
116
What is erythema infectiosum?
Slapped cheek disease- caused by parovirus B19. As the rash on the face fades- a lacy macular rash on the body appears.
117
Erythema infectiosum presentation in adults
In adults the rash may be absent and acute poly arthritis of the small joints may be more prominent.
118
Lab confirmation of erythema infectiosum
Antibody testing
| Parovirus B19 IgM
119
Complications of erythema infectiosum
Spontaneous abortion
Aplastic crises (sudden drop in Hb seen in patients with short RBC life span)
Chronic anaemia.
120
What is Orf?
Virus of sheep "scabby mouth"
121
Presentation of Orf?
Firm, fleshy nodule on farmers hand.
122
Treatment and diagnosis of orf
Self limiting and diagnosed clinically.
123
How does syphilis progress?
Through three phases, primary, secondary and tertiary.
124
Primary phase of syphilis
Chancre- painless ulcer on the genitals
125
Secondary phase of syphilis
Red rash over the body. Particularly prominent on the soles of the feet and palms of the hands.
Mucous membranes have small track ulcers.
126
Tertiary phase of syphilis
CNS, cardiovascular, gummatous.
127
What causes syphilis?
STD with bacterium treponema pallidum
128
Lab confirmation of syphilis
Blood test
| Swab of chancre for PCR
129
Treatment of syphilis
Penicillin injections
130
What causes Lyme disease?
Caused by ticks
| Borrelia burgdorferi
131
Presentation of Lyme disease?
Early- erythema migrans
| Late- heart block, nerve palsies, arthritis.
132
Lab confirmation of Lyme disease
Blood test for antibodies for the organism.
133
Treatment of Lyme disease
Docycline or amoxicillin
134
How is Zika virus spread?
Mosquitos
| Can be transmitted sexually.
135
Symptoms of zika virus
```
Mild fever
Rash
Headaches
Arthralgia
Myalgia
Non-purulent conjunctivitis
```
136
Complications of Zika virus
Guillian Barre Syndrome
| Microcephaly
137
Name for ringworm
Tinea
138
Ringworm on the scalp
Tinea capititis
139
Ringworm on the beard
Tinea barbae
140
Ringworm on the body
Tinea corporis
141
Ringworm on the hand
Tinea manuum
142
Ringworm on the nails
Tinea unguium
143
Ringworm in the groin
Tinea cruris
144
Ringworm on the foot
Tinea pedis
145
What is the source of a ringworm infection?
Other infected people
Animals
Soil
146
Pathogenesis of ringworm
Fungus enters abraded or soggy skin.
Hyphae spread in stratum corneum.
Infects keratinised tissues only.
Increased epidermal turnover causes scaling. Inflammatory response provoked.
Hair follicles and shafts invaded.
Lesions grows outwards and heals in the centre.
147
Organisms that can cause ringworm
Trichophytom rubrum- 70% from human to human
Trichophytom mentagraphytes- 20% human to human
Microsporium canis- from cats and dogs to humans
148
How is the diagnosis of ringworm made?
Clinical appearance
Wood lamps
Skin scrapings/nail clippings
149
Treatment of ringworm
Small areas of infected skin/nails- clotrimazole
| Extensive infections, nail infections or scalp infections- terbinafine orally
150
Candida infection
Causes thrush
| Infection within the skin folds (e.g. under breasts)
151
How to diagnose candida infection
Swab for culture.
152
Treatment of candida infection
Clotrimazole cream.
153
2 types of staphylococcus
Staph aureus
| Coagulase negative staph
154
What colour does staph aureus show on coagulase?
Golden yellow
155
What colour does coagulase negative staph show on coagulase?
White
156
What does staph aureus cause?
Wound, skin and joint infections
157
What antibiotic can be used against staph aureus
Flucloxicillin
158
Which strains of staph aureus produce toxins?
Enterotoxin- food poisoning
SSSST- staph scalded skin syndrome toxin
PVL- panton valentine leukocidin.
159
Where are coagulase negative staph usually found?
It is a skin commensal
160
When would coagulase negative staph cause infection?
On artificial implanted material e.g. heart valves.
161
Which coagulase negative staph causes UTI's in women of child bearing age
Staph saprophylicus
162
Describe staphylococcal bacteria
Gram positive circular aerobic bacteria arranged in clumps
163
Describe streptococcus bacteria
Gram positive circular aerobic bacteria arranged in chains.
164
How can streptococcal species be classified?
Haemolysis- either alpha haemolysis- partial
Beta haemolysis- complete
or gamma haemolytic which is none.
165
Describe beta haemolytic strep
Pathogenic organisms
Produce haemolysin as a toxin (among others)
Further classified by antigenic structure into group A and group B
166
What does group A beta haemolytic strep commonly cause?
Throat and severe skin infections
167
What does group B haemolytic strep commonly cause?
Meningitis in neonates.
168
What are the two important categories in alpha haemolytic strep
Strep pneumoniae
| Strep viridian's- commensals of throat, vagina (rarely cause infection)
169
Where would you find/ what are non-haemolytic strep
Enterococcus species
Commensals of the bowel
Common cause of UTI's
170
When does staph aureus cause skin infection?
```
In boils and carbuncles
Cellulitis
Infected eczema
Impetigo
Wound infection
SSSST
```
171
When does strep pyogenes (group A strep) cause skin infection?
Infected eczema
Impetigo
Cellulitis
Necrotising fasciitis
172
How to diagnose strep pyogenes
Swab of lesion if surface has broken
Pus or tissue if deeper lesion
+/- blood cultures
173
Treatment of strep pyogenes
Penicillin or flucloxicillin
174
What is necrotising fasciitis?
Bacterial infection spreading along fascial planes below the skin surface causing rapid tissue destruction. Causes severe pain
175
Causative organism for necrotising fasciitis
Either group A streptococcal (type 2) or mixed anaerobes and coliforms (type 1)
176
Treatment of necrotising fasciitis
Life threatening- EMERGENCY SURGICAL DEBRIDEMENT.
