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Human Diseases Yr4 > Skin > Flashcards

Skin Flashcards

(73 cards)

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1
Q

What should be asked in a basic rash history?

A 
Where did the rash begin
How has it evolved 
Previous skin diagnosis 
Does sun exposure worsen (lupus) or improve rash (eczema/psoriasis) 
Symptoms - itch, pain weeping 
Occupation/hobbies - contact dermatitis 
Drugs 
Family history
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2
Q

What are the clinical features of an epidermis skin pathology?

A

Often fractures, fluid can seep out of cracks, oozing or dryness (scales)

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3
Q

What are the clinical features of a dermis skin pathology?

A

Skin stays smooth, raised surface e.g. uticaria (nettle rash)

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4
Q

When describing a surface, what is

a) Macule
b) Papule
c) Patch
d) Nodule
e) Vesicle
f) Bulla

A

a) Little <0.5cm and flat
b) Little and raised
c) Big >0.5cm and flat
d) Big and raised
e) Small and fluid filled
f) Large and fluid filled

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5
Q

What other physical signs should be used when describing a lesion?

A

Colour:
Redness - increased blood flow, Pigmentation - haemosiderin yellow/brown from blood, femelanin (ginger), u-melanin (brown)

Surface changes:
Crust and scale

Thickness of skin

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6
Q

What is crust? What can it be confused with?

A

Dried serum - orange/yellow colour

May be confused with keratin (white/yellow) - always remove crust to reveal underlying pathology

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7
Q

What is scale?

A

Abnormal stratum corneum
Accumulation of keratin
‘Hyperkeratotic’

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8
Q

Why can skin become thickened at the epidermal layer and the dermal layer?

A 
Epidermal = lichenification and warty processes 
Dermal = scarring/infiltrative processes
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9
Q

What is an erosion?

A

Partial loss of epidermins
Heals without scarring
Usually secondary i.e. weepy eczema, burst intra-epidermal blister

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10
Q

What is an ulcer?

A

Full thickness loss of epidermis and some dermis
Heals with scarring
Surface: orange/yellow = exudate/crust, yellow = pus, necrotic tissue/slough = grey/green

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11
Q

What is excoriation?

A

Localised damage due to scratching

Linear crusts or erosions

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12
Q

If the pattern of a rash is unilateral or bilateral, what does this suggest?

A 
Unilateral = external cause e.g. athletes foot 
Bilateral = internal cause e.g. eczema
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13
Q

What are the most abundant cells in the epithelial layer?

A

Keratinocytes and then melanocytes

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14
Q

What is the dermis made up of?

A

Collagen, elastic fibres, hair follicules, seberaceous glands, sweat glands, vascular supply

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15
Q

What is in the subcutaneous layer?

A

Adipocytes

Neurovascular bundles

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16
Q

What are the risk factors for basal cell carcinoma?

A 
UV exposure
Fair skin 
Genetics 
Immunosuppression 
Radiotherapy
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17
Q

What are the clinical features of basal cell carcinoma?

A 
Pearly 
Telangiectasia
Ulcerated (rolled edge) 
Pigmentation 
Common on head and neck
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18
Q

What are the clinical variants of BCCs?

A

Superficial BCC - less than 0.3mm into dermis
Pigmented BCC
Morphoeic BCC - high risk looks like a scar
Nodulocystic BCC

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19
Q

What are the histological features of a basal cell carcinoma?

A

Deep purply basal squamous cells against basement membrane expected but should not be in dermis - nests of BCs
Cleft between abnormal cells and stroma of dermis

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20
Q

What are the clinical features of SCC?

A 
Typically hyperkeratotic (scaly) 
Sometimes ulcerated 
Not typically pearly or telangiectatic 
Sometimes painful 
Grow rapidly 
Common on scalp, pinna dorsal hand
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21
Q

What are the risk factors for SCC?

A 
UV exposure
Skin type fair 
Genetics 
Immunosuppression
Radiation 
Chronic inflammation 
Scar tissue 
Arsenic
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22
Q

What are the histological features of squamous cell carcinoma?

A

Epidermis thickened with dysplastic squamous cells
Dermis has nests of squamous cells producing pearls of keratin
Inflammatory infiltrate

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23
Q

What are the clinical variants of a malignant melanoma?

A
  • Superficial spreading melanoma
  • Nodular melanoma
  • Acral lentiginous melanoma
  • Lentigo maligna (melanoma)
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24
Q

What is Hutchinson’s sign in acral lentiginous melanoma?

A

Pigmentation on proximal nail fold. Splitting of nail plate

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25
What are the histological features of malignant melanomas?
Nests of malignant melanocytes just above basement membrane and invading into dermis Dense inflammatory cell infiltrate
26
What is the ABCDE for melanomas?
``` Asymmetry - colour and shape Border irregularity Colour variation (often 3+ colours Diameter (usually >6mm) Evolving - change in size colour shape over months/years Ugly duckling ```
27
What is the treatment for BCCs?
Excision Mohs micrographic surgery Curettage and cautery (small nodular/superficial and low risk BCC) Cryotherapy (superficial BCC) Topical therapy - aldara cream Photodynamic therapy - photosensitive drug applied to lesion to destroy cells Radiotherapy - if BCC large and difficult to excise Vismodegib (oral drug designed to inhibit signalling and hedgehog pathway - if not a candidate for surgery
28
What is Mohs micrographic surgery (used in the treatment of BCCs)?
2mm clinical margin around BCC excised and specimin prepared in frozen sections for histology. Identify positive margins for further resection for clearance. Keep analysing until margin negative.
29
What is the treatment for SCCs?
``` Surgery Curettage and cautery Cryotherapy Lymph node dissection Adjuvant radiotherapy Chemotherapy Immunotherapy ```
30
What is the treatment for melanomas Stage 1 or 2?
Surgery and monitor for 5 years. If stage 1c-2b biopsy
31
What is the treatment for melanomas Stage 3?
Lymph node dissection and biopsy
32
What is the treatment for melanomas Stage 4?
Immunotherapy - Nivolumab, pembrolizumab, ipilimubab Targeted treatments - Vemurafenib, Dabrafenib - not a cure but reduces symptoms and extends life expectancy Radiotherapy and chemotherapy seldom used
33
What is the treatment for lentigo maligna?
Surgery preffered option - excision, mohs micrographic surgery excision Imiquimod topically Radiotherapy Cryotherapy
34
What is merkel cell carcinoma?
Rare skin cancer is usually older and sun damaged pts. Rapidly enlarging pink nodule with high metastatic potential - poor prognosis
35
What is atypical fibroxanthoma?
Rare skin cancer often in head and neck, sun damaged and elderly
36
What is extramemory Pagets disease?
An uncommon adenocarcinoma of the anogenital region
37
Name 3 sarcomas that are rare skin cancers
- Dermatofibrosarcoma protuberans = in dermis, high risk of recurrence, presents early life and rarely metastasises - Angiosarcoma - Leiomyosarcoma
38
What is scabies?
Scabies mites burrow into skin (0.3mm) forming small tunnel, sometimes with a blister. Mainly on hands, genitalia, flexural area. Allergy to mite and secretions causes generalised erythematous rash
39
What is eczema?
Dermatitis - inflammatory condition of the skin - a reaction pattern not a disease
40
What clinical signs indicate whether eczema is acute or chronic?
Acute - severe and weeping | chronic - scaly
41
What is irritant contact eczema?
From substances that have a direct noxious effect on skin barrier function, may be due to repetitive and cumulative exposure e.g. detergents, gloves, nappy rash from ammonia in breakdown of urea
42
What is Type 1 hypersensitivity / allergic contact uticaria?
Not really eczema - caused by mast cell histamine release triggered by IgE. Immediate e,g, contact urticaria, anaphylaxis etc for latex gloves
43
What is Type IV hypersensitivity / allergic contact eczema
By T cells proliferating - delayed type as takes days. Must patch test
44
What are the common causes of allergic contact eczema?
Nickel e.g. earrings Elastoplast Suncream Dental acrylates in dentures and denture composites
45
What is lichen simplex?
Eczema due to scratching
46
What is endogenous eczema?
Genetic component often childhood into adult - lichenification, thickened skin and accentuated skin markings. Phototherapy or immunosuppressants e.g. methotrexate if severe and persistent
47
How can you prevent hand eczema?
Avoid irritants - 3-6 months to heal as lipid accumulation slow Less allergenic gloves Minimise skin contacts with acrylates Treat with topical steroids
48
What is seborrheic eczema?
Dandruff
49
What is eczema herpeticum?
Herpes simplex virus, coldsores in eczema with discrete erosions. Treated with aciclovir
50
What is the histological features of lichenoid inflammation?
Keratinocyte death especially at basal layer Civatte/colloid bodies (dead cells) Inflammatory cell infiltrate beneath epithelium
51
What are the clinical features of lichen planus?
Purplish rash - flat topped shiny papules Usually in flexural areas In mucosa - whitish, reticulate, wicken striae
52
Although there is no satisfactory treatment for oral lichen planus, what is sometimes used?
- Topical/systemic immunosuppression e.g. prednisalone or cyclosporin - Topical sterouds e.g. clobetazol/dermavate
53
What 3 conditions are due to lichenoid inflammation (autoimmune destruction of the epithelium)?
Lichen planus Lupus Erythema multiforme
54
What are the clinical features of systemic lupus erythematous?
Butterfly rash | Widespread oral ulcerations
55
What are the clinical features of discoid lupus?
Disc shaped plaques | Causes scarring and permanent pigmentary change
56
What is erythema multiforme?
Spectrum of different diseases with the same pathology: death of dermal cells Target lesion characteristic
57
What is the most severe form of erythema multiforme?
Toxic epidermal necrolysis (TEN) - life threatening mortality 20-50%. Once the surface area is over 10-30% the mortality increases as water and protein leak
58
What is the Steven Johnsons Syndrome varient of erythema multiforme (often affecting oral mucosa) often triggered by?
Atypical pneumonia
59
What drugs can trigger erythema multiforme?
- Sulphonamindes e.g. Septrin and trimethoprim - Allopurinol (for gout) - Anticonvulsants (lamotrigine, phenytoin, carbamazepine)
60
What can the target lesions in erythema multiforme be triggered by?
Herpes simplex
61
Where in the mouth does orofacial granulomatosis occur?
Facial swelling particularly in lips In dermis of submucosal layer May be variant of Crohns - cobblestoning
62
What is an inherited mechanobullous (mechanical trauma) disorder that causes deep blistering affecting the dermal layers following trauma and digits can fuse together?
Epidermolysis bullosa
63
Of the autoimmune bullous disorders, which is the worst?
Pemphigus
64
What are the intraepidermal blisters that are seen in pemphigus called?
Acantholysis
65
In pempigus what happens on a cellular level?
Anti-desmosome antibodies - desmosome that holds dermal and mucosa cells together detaches and crumbles
66
What is the age group pemphigus often presents in?
50-70 years
67
How is pemphigus treated
Immunosupression:100mg prednisolone | Rituximab - CD20 on B cells
68
What is bullous pemphigoid?
Autoimmune subepidermal bullous disease
69
What are the characteristics of a bullous pemphigoid blister?
``` Intact epidermal layer Firm and don't break easily when touched Can get widespread itchy rash first Haemorrhagic blisters Occasionally presents in mouth ```
70
What does the immunofluorescence look like in bullous pemphigoid?
No immunofluoresence at the top (epidermis) but green line separating dermis from epidermis Basement membrane splits and epidermis detaches
71
What is characteristic of mucous membrane pemphigoid?
Subepidermal blisters that lead to scarring affecting the mucous membranes - oral, occular, skin, genital, nasopharynx, oesophageal, laryngeal
72
What is slightly different between mucous membrane pemphigoid and bullous pemphigoid?
MMP - deeper antigens closer to dermis
73
What is an early sign of mucous membrane pemphigoid?
Desquamative gingivitis

Human Diseases Yr4 (10 decks)

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