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Dermatology Diploma > Skin Problems in Pigmented Skin > Flashcards

Flashcards in Skin Problems in Pigmented Skin Deck (42)
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1

What is the cause of PIH?

Increase melanin in the dermis and epidermis.

2

What sort of dermatoses are particularly susceptible to PIH?

Dermatoses with both dermal and epidermal changes.

  • Lichen planus
  • Lupus erythematosus
  • Fixed drug eruption

3

If the pigmentation is mainly epidermal, how long can it take to resolve?

6 months

4

What can help PIH resolve quicker?

Bleaching agents like Hydroquinone

5

What is essential in PIH?

To use daily sunscreen

6

Dermal PIH is resistant and can last for long periods of time. What can help it?

Laser therpay

7

What types of scars are more prominent in coloured skin types?

Keloid scarring

8

If you do decide to excise a keloid scar, what can you do?

Inject it with triamcinolone

  • This can help to reduce the chance of recurrence - though the chance is still high.

9

What is a more favourable approach to keloid scars than excision?

  • Triamcinolone and cryotherapy
  • Shave excision and hyfrecation.

 

10

What is this?

Acne keloidis nuchae

  • Keloidal bands with scarring alopecia.
  • If chronic, pustules and subcutaneous abscesses with sinuses can form.

11

What is this?

Pseudofolliculitis barbae 

12

What is the treatment for pseudofoliculitis barbae?

  • 6 months of anti-inflammatory antibiotic (e.g. minocycline) for 6 months.
  • Stop shaving for 3 to 6 months.
    • Keep the hair 5mm long with clippers.
    • Look for ingrown hairs daily and remove with sterile needles.
    • Warm compress and mild steroids are useful.
  • Shaving
    • Do not pull the skin
    • Do not shave against the direction of growth.

13

Does Acne keloidis nuchae cause scarring or non-scarring alopecia?

Scarring

14

Where is the most common place for vitiligo to appear?

  • Perioral region
  • Dorsa of the hands
  • Feet
  • Elbows
  • Ankles.

15

What is the pathophysiology of vitiligo?

The exact pathogenesis is uncertain.

  • Can be familial.
  • Positive association with HLA type DR4
  • Negative association with HLA type DR3.

16

What is vitiligo associated with?

Vitiligo is associated with autoimmune endocrinopathies:

  • Thyroid disease
  • Pernicious anaemia
  • Addison’s disease.

17

What is the treatment for vitiligo?

  • Localized:
    • Potent topical steroids (e.g betamethasone) for local areas.
    • If no improvement after 2 months then discontinued.
  • Generalized
    • Narrow band UVB - use for 1 year.
    • Pigmentation may recur when discontinued.
    • If considering, specialist review is essential.
    • Hydroquinone (monobenzyl ether of hydroquinone).
      • Induces irreversible bleaching of the normal skin.
  • The depigmented skin of vitiligo is susceptible to sunburn and a sunscreen should be used.

18

What is this?

Melasma

19

What gender is melasma more common in?

Women

20

What ethnicity is Melasma more common in?

Hispanic and Asian

 

21

What factors can contribute to melasma formation?

  • Genetic Predisposition
  • UV light
  • COCP use
  • Pregnancy

 

22

What other pigmentation conditions can be mistook for melasma?

  • Drug-Induced pigmentation
  • PIH
  • Acitinic lichen planus
  • External ochronosis

23

What is the treatment for melasma?

  • Sun protection
  • Stop hormonal therapies - COCP and HRT.
  • Hydroquinone
  • Tretinoin - takes 6 months.
  • Azelaic acid
  • Kligman's solution
  • Chemical peels - glycolic acid.

24

What is Kligmann's Solution made of?

How do you advise someone to take it?

  • (Hydroquinone, topical tretinoin and 1% hydrocortisone)

 

  • Apply to small areas for 20 minutes at a time intially.
  • Then build up to keep on overnight and wash off in the AM.
  • it can burn the skin so warn patients.

25

What is this?

Dermatosis Papulosa Nigra

26

When do they first appear?

In Puberty (increase in number over time)

27

What is the treatment?

Consider Snip Excision or hyfrectation

Be mindful of cosmetic outcomes - they can be worse than the lesions themselves.

28

What are the 3 major types of primary cutaneous amyloidosis?

  • Macular
  • Lichen
  • Nodular.

(Note: Macular & Lichen are more common in skin types 3 and 4)

29

Amyloidosis - is the abnormal extracelluarl deposition of amyloid.

How do you divide it?

  • Systemic
  • Localised (Primary Cutaneous forms)

30

What is this?

Where does it most commonly occur?

What symptoms come with it?

Macular amyloidosis

Upper back.

Pruritus