Skin Discolouration

Question 1

What is vitiligo?

Answer 1

• Loss of pigmentation

- Localised

Question 2

Describe vitiligo (4)

Answer 2

• Pale patches that progressively turning white
• Smooth/irregular edges
• Itchy
• White permanently

Question 3

What are the edges of a vitiligo patch like?

Answer 3

Smooth/irregular

Question 4

What does vitiligo do to the scalp?

Answer 4

Lack of melanin turns affected area = white/grey

Question 5

Describe the distribution of vitiligo

Answer 5

Segmental/non segmental distribution

Question 6

How do you know that vitiligo is autoimmuune in origin?

Answer 6

Non segmental distribution

Question 7

What is blushing? (3)

Answer 7

• Sympathetic nervous system causes blood vessels to dilate
• Increases blood flow to face
• Produces redness

Question 8

What are the normal causes of blushing? (6)

Answer 8

• Emotional trigger
• Alcohol
• Hot/spicy foods
• Fever
• Strenuous exercise
• Sudden hot/cold temperature

Question 9

What are the medical conditions that cause blushing? (5)

Answer 9

• Rosacea
• Menopause
• Mastocytosis
• Carcinoid syndrome
• Medications

Question 10

What is a phobia of blushing known as?

Answer 10

Erythrophobia

Question 11

What is erythrophobia associated with?

Answer 11

Other phobias/mood disorders e.g social phobia and general anxiety disorder (GAD)

Question 12

What is mastocytosis?

Answer 12

Excessive amounts of histamine and other chemicals released into the blood

Question 13

What is carcinoid syndrome?

Answer 13

Hormones realised by neuroendocrine tumours

Question 14

What is rosacea?

Answer 14

Chronic inflammatory facial dermatosis

Question 15

What is rosacea characterised by on examination? (5)

Answer 15

• Erythema
• Pustules/papules
• Telangiectasia
• Cheeks/forehead/chin
• Dome-shaped

Question 16

Difference between acne and rosacea?

Answer 16

No nodules/blackheads

Question 17

Milaria rubia presentation (5)

Answer 17

• Red
• 2–4 mm
• Non-follicular papules
• Erythema background
• Upper trunk, scalp, neck, flexures

Question 18

What causes milaria rubia?

Answer 18

Sweat glands blocked giving itchy red rash in heat

Question 19

What is polymorphic light eruption?

Answer 19

• Delayed primary photo(hyper)sensitivity

- UV alters skin compound = immune response

Question 20

Describe a polymorphic light eruption

Answer 20

Sun exposure
Crops of 2–5 mm pink or red papules
(more mild blended together tiny spots extensive)

Question 21

Describe a polymorphic light eruption

Answer 21

Sun exposure
Crops of 2–5 mm pink or red papules
(more mild blended together tiny spots extensive, not as red as milaria rubra)

Question 22

What are the most important factors to note for with distribution of rashes?

Answer 22

• Flexor vs extensor
• Age changes
• Thickening/darkening of skin

Question 23

What surfaces does eczema cover?

Answer 23

Flexor

Question 24

What surfaces does psoriasis cover?

Answer 24

Extensor

Question 25

Where is eczema found in infants in comparison to children and adults?

Answer 25

Extensor in infants Flexor in children Adults = regress completely

Question 26

Describe Acanthosis nigricans (4)

Answer 26

- Darkening (hyperpigmentation) - Thickening (hyperkeratosis) - Distribution: folds of skin eg axilla/groin/back of neck - +/- prititus

Question 27

What common condition is acanthosis nigricans found in?

Answer 27

Diabetes

Question 28

What is spotting acanthosis nigricans in diabetes useful?

Answer 28

Person otherwise feels well, (asymptomatic) so speeds up diagnosis

Question 29

What causes a blue skin colour change? (2)

Answer 29

- Cold | - Cyanosis (low oxygen to tissues)

Question 30

What causes a yellow skin colour change and why?

Answer 30

Jaundice - bilirubin breakdown

Question 31

What causes a red skin colour change? (4)

Answer 31

- Blushing (emotional change) - Heat distribution - Insect bite - Infection

Question 32

Describe cellulitus (9)

Answer 32

- Well defined localised area - Spreading erythema - Swelling - Blistering - Most often: lower limbs e.g effecting 1 leg/ - Unilateral: bilateral=other cause - Tracking: along blood vessels from site of skin damage - Pain - Warmth - First signs= systemically unwell = flu like symptoms, fever etc

Question 33

What 2 types of pathogen causes cellulitus? GIve examples (4)

Answer 33

Streptococci e.g Streptococcus pyogenes Gram positive staphloccoci - Staph aureus MSSA - Staph aureus MRSA (resistant)

Question 34

Describe the distribution of cellulitus (3)

Answer 34

- Localised - Well defined - Normally: unlateral lower limb

Question 35

What causes chickenpox?

Answer 35

Primary infection varicella zoster virus

Question 36

Describe chickenpox (3)

Answer 36

- Itchy red papules progressing to vesicles - Widespread vascular rash - Systemic: high fever, headache, v&D

Question 37

Difference between chickenpox in children and adults

Answer 37

Adults: more severe predormal symptoms for 48 hrs (fever/malaise/abdo pain/abdo pain) before rash

Question 38

Describe shingles (herpes zoster)

Answer 38

- Single dermatome distribution - Not crossing midline: cut off at anterior/posterior midline = unlateral - Painful - Localised blistering rash - Painful - +/- lympathic patches

Question 39

What causes shingles?

Answer 39

Varicella zoster virus reactivation persisting in dorsal root ganglia after primary infection = herpes zoster

Question 40

Shingles risk factors (3)

Answer 40

- Immunosurpressed - Drugs - Stress

Question 41

Conditions associated with atopic eczema (5)

Answer 41

Atopic conditions - Food allergy - Rhinitus - Food allergy/ - Hay fever - Asthma