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MY REVISION - ALL TO DO > TO DO DERMATOLOGY > Flashcards

TO DO DERMATOLOGY Flashcards

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1
Q

ACNE VULGARIS
Briefly describe the pathophysiology of acne

A

comedones are non-inflammatory lesions and can be open (blackheads) or closed (whiteheads). When the follicle bursts, inflammatory lesions such as papules and pustules may form. Excessive inflammation results in nodules, and cysts

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2
Q

ACNE VULGARIS
Describe the signs of acne

A

MILD
- non-inflamed lesions (open + closed comedones) with few inflammatory lesions

MODERATE
- more widespread
- increased inflammatory papules + pustules

SEVERE
- widespread inflammatory papules pustules, nodules or cysts
- scarring

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3
Q

ACNE VULGARIS
Describe the treatment for acne

A

1st line
- topical retinoid +/- benzoyl peroxide,
- topical antibiotic (clindamycin)
- topical azelaic acid 20%

2nd line
- oral tetracycline (doxycycline, lymecycline) with topical benzoyl peroxide +/- topical retinoid
- COCP (co-cyprindiol)

3rd line
- isotretinoin (accutane)

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4
Q

ECZEMA
what is the management?

A

MILD
- emollients
- mild corticosteroids (hydrocortisone 1%)

MODERATE
- emollients
- moderate corticosteroids (betamethasone 0.025% or clobetasone 0.05%)
- antihistamines

SEVERE
- emollients
- potent corticosteroid (betamethasone 0.1%)
- oral corticosteroid
- antihistamine

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5
Q

BCC
what are the risk factors for BCC?

A
  • male
  • UV exposure
  • fair skin
  • xeroderma pigmentosa
  • immunosuppression
  • arsenic exposure
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6
Q

BCC
what is the clinical presentation?

A
  • pearly indurated flesh-coloured papule with rolled border
  • covered in telangiectasia
  • may ulcerate + create central crater
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7
Q

CELLULITIS
what are the most common causes?

A
  • s.aureus
  • s.pyogenes
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8
Q

CELLULITIS
what are the risk factors?

A
  • break in cutaneous barrier
  • immunocompromise
  • other skin conditions (eczema, shingles)
  • history of cellulitis
  • obesity
  • venous insufficiency
  • lymphoedema
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9
Q

CELLULITIS
how is it classified?

A

Erons classification

CLASS 1 - no systemic signs (outpatient/oral abx)

CLASS 2 - systemically unwell or systemically well but have comorbidity (possible admission)

CLASS 3 - significant systemic upset (admission required)

CLASS 4 - sepsis

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10
Q

CELLULITIS
what is the management?

A

antibiotics
- 1st line = flucloxacillin
- if penicillin allergic = clarthromycin/erythromycin/doxycycline
- 1st line if near eyes/nose = co-amoxiclav
- severe infection = co-amoxiclav/cefuroxime/clindamycin
- MRSA = add vancomycin

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11
Q

CONTACT DERMATITIS
give some examples of common allergens that cause contact dermatitis

A

nickel sulfate
neomycin
formaldehyde
sodium gold thiosulfate

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12
Q

CONTACT DERMATITIS
what are the risk factors?

A
  • occupation with frequent exposure to water and caustic materials e.g. labourers, chefs, farmers
  • history of atopic eczema
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13
Q

CONTACT DERMATITIS
how long do symptoms last for?

A
  • ICD takes 3-6 weeks to resolve
  • ACD typically resolves within a few days
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14
Q

CONTACT DERMATITIS
what is the management for irritant contact dermatitis (ICD)?

A

1st line
- avoidance of irritant
- skin emollients

2nd line
- topical corticosteroids (hydrocortisone, betamethasone)

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15
Q

CONTACT DERMATITIS
what is the management of allergic contact dermatitis (ACD)?

A

1st line
- avoidance of allergen
- topical corticosteroids (hydrocortisone, betamethasone)

2nd line
- topical calcineurin inhibitors (tacrolimus, pimecrolimus)

3rd line
- oral corticosteroids (prednisolone, dexamethasone)
- phototherapy (BUVB, PUVA)
- immunosuppressants (azathioprine, ciclosporin)

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16
Q

CUTANEOUS WARTS
what is the pathophysiology?

A

they are caused by human papillomavirus (HPV) types 2 and 4

The virus invades the skin through small cuts or abrasions and causes rapid growth of cells on the outer layer of the skin, leading to the formation of a wart

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17
Q

CUTANEOUS WARTS
what are the risk factors?

A
  • use of public showers
  • close contact with a person with warts
  • skin trauma
  • immunosuppression
  • meat handlers
  • Caucasian ethnicity
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18
Q

CUTANEOUS WARTS
what are the clinical features?

A

often asymptomatic
- firm rough papules or nodules
- interrupted skin lines over warts
- black dots within wart (thrombosed capillaries)

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19
Q

CUTANEOUS WARTS
what is the management?

A

1st line
- watchful waiting
- topical salicylic acid

2nd line
- cryotherapy (freezing with liquid nitrogen)
- immunotherapy

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20
Q

FOLLICULITIS
what are the risk factors?

A
  • trauma (shaving, hair extraction)
  • topical corticosteroid use
  • diabetes mellitus
  • immunosuppression
  • drug-induced (corticosteroids, androgenic hormones, isoniazid, lithium)
  • hot tub use
    chronic inflammatory skin disease
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21
Q

FOLLICULITIS
what is hot tub folliculitis caused by?

A

pseudomonas aeruginosa

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22
Q

FOLLICULITIS
what are the clinical features?

A

SYMPTOMS
- erythema
- papules (small, clusters)
- pustules (small, whiteheads)
- pruritis (localised)

SIGNS
- localised to shaving area
- blistering if severe
- subdermal mass (abscess if severe)
- raised eosinophils

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23
Q

FOLLICULITIS
what is the management?

A

CONSERVATIVE
- use clean sterile razors for shaving
- wear loose clothing
- antibacterial soap
- avoid hot tubs

MEDICAL
- mild = no treatment or topical antibiotics
- moderate bacterial = oral flucloxacillin (s.aureus) or oral ciprofloxacin (pseudomonas)
- moderate viral = oral aciclovir
- moderate fungal = ketoconazole, fluconazole, itraconazole

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24
Q

CUTANEOUS FUNGAL INFECTION (RINGWORM)
what are the risk factors?

A
  • close contact with infected individuals or animals
  • damp, warm environments
  • participation in contact sports
  • shared facilities
  • immunocompromised states
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25
CUTANEOUS FUNGAL INFECTION (RINGWORM) what are the clinical features?
SYMPTOMS - itching - discomfort - hair loss SIGNS - annular (ring shaped lesions) - central clearing of the rash - scaling of the skin - erythema - nail thickening and crumbling
26
CUTANEOUS FUNGAL INFECTION (RINGWORM) what is the management?
1st line - topical antifungals (clomitrazole, terbinafine) - skin care (avoid sharing towels, keep area clean and dry) 2nd line - oral antifungals (terbinafine, itraconazole, fluconazole)
27
HEAD LICE what causes head lice?
parasites (Pediculus humanus capitis) cause an infestation called pediculosis capitis
28
HEAD LICE what is the management?
1st line - medicated lotions/sprays (dimeticone, isopropyl myrisate, cyclomethicone) - wet combing (over 2 week period, days 1, 5, 9 and 13) - insecticide (malathion)
29
IMPETIGO what are the most common causative organisms?
s.aureus = most common s.pyogenes
30
IMPETIGO what is the management?
non-bullous - localised = hydrogen peroxide 1% cream or topical antibiotic (fusidic acid, mupirocin) - widespread = topical (fusidic acid or mupirocin) or oral antibiotics (flucloxacillin, clarithromycin or erythromycin) bullous - oral antibiotics (flucloxacillin, clarithromycin or erythromycin)
31
IMPETIGO what is the general advice for school/work?
- avoid sharing towels - stay away until lesions have healed, dry and crusted over or 48 hours after initiation of antibiotics
32
LICHEN PLANUS what is the pathophysiology?
immune response leading to T-cell mediated inflammation and keratinocyte apoptosis
33
LICHEN PLANUS what are the risk factors?
- ages 40-60 - hep C - drugs (thiazide diuretics, beta-blockers, NSAIDS and antimalarials) - vaccinations - stress - family history
34
LICHEN PLANUS what are the clinical features?
SYMPTOMS - itching - oral discomfort - hair loss SIGNS - purple, polygonal, flat-topped papules on wrists, ankles and lower back - wickhams striae (white streaks overlying rash) - rough thinning nails with grooves - sore, red patches on vulva - ring-shaped (annular) purple/white patches on penis
35
LICHEN PLANUS what is the management?
1st line - topical corticosteroids - conservative (wash with warm water, emollients, avoid tight clothing) 2nd line - oral corticosteroids - topical calcineurin inhibitors (tacrolimus) - phototherapy
36
MALIGNANT MELANOMA why can it affect GI tract and brain?
melanocytes are derived from neural crests melanoma can occur anywhere neural cells migrate such as GI tract and brain
37
MALIGNANT MELANOMA what is the most common gene mutation associated with melanomas?
BRAF gene mutation - found in 50% of cases
38
MALIGNANT MELANOMA what are the risk factors?
- increasing age - family history - pale skin (fitzpatrick type I and II) - red/blonde/light coloured hair - UV exposure - precursor lesions (dysplastic naevi) - previous skin cancer - immunosuppression - xeroderma pigementosum
39
MALIGNANT MELANOMA how do you assess a nevus?
ABCDE A - asymmetry of lesion B - border irregular C - colour non-uniform D - diameter >6 mm E - evolution: changing shape, size or colour
40
MALIGNANT MELANOMA what are the different types?
- superficial spreading (most common, horizontal growth) - nodular (may ulcerate + bleed, vertical growth) - lentigo maligna (seen in elderly, on face) - acral lentiginous (palms, soles and nailbed, more common in darker skin) - amelanotic (pink, lack pigment)
41
MALIGNANT MELANOMA what is the diagnostic criteria?
MAJOR (2 points each) - change in size - irregular shape/border - irregular colour MINOR (1 point each) - largest diameter >7mm - inflammation - oozing or crusting - change in sensation (including itch) >3 points = strong concerns about cancer
42
MALIGNANT MELANOMA what are the investigations?
- dermoscopy (ABCDE) - excision biopsy to consider - sentinel node biopsy - CT chest, abdomen and pelvis - genetic studies
43
MALIGNANT MELANOMA how is it staged?
AJCC staging system 0 = confined to epidermis, melanoma in situ 1 = breslow thickness <2mm, no nodal involvement/mets 2 = breslow thickness 1-2mm with ulceration, or >2mm with/without ulceration, no nodal involvement/mets 3 = any thickness, involvement of local skin/LN 4 = any thickness, distant mets/LN
44
MALIGNANT MELANOMA what is the management?
EARLY STAGE (0-2) - excision with adequate margin - topical imiquimod STAGE 3 - LN dissection - radiotherapy - resection of mets STAGE 4 - systemic treatments (chemo/immunotherapy) - radiotherapy - resection of mets
45
MALIGNANT MELANOMA where does it tend to spread to?
lymph nodes brain bones liver lung GI tract
46
PITYRIASIS ROSEA what is it?
inflammatory skin condition of uncertain aetiology, though an association with human herpesviruses 6 and 7
47
PITYRIASIS ROSEA what is the characteristic feature?
herald patch - single, oval scaly patch up to 10cm diameter and appears 2 weeks before rest of rash
48
PITYRIASIS ROSEA what are the clinical features?
- herald patch - itchy rash (erythematous, oval, papular scaly patches on trunk + extremities) - fir tree appearance
49
PITYRIASIS ROSEA what is the management?
- emollients - topical steroid = mild (hydrocortisone 1%) or moderate (betamethasone valerate 0.025%) - antihistamine (chlorphenamine) if itching affects sleep
50
PITYRIASIS VERSICOLOR what is it?
common superficial fungal infection caused by the Malassezia species, a yeast that is part of the normal skin flora
51
PITYRIASIS VERSICOLOR what are the risk factors?
- hot and humid climates - excessive sweating - oily skin - immunocompromised - age (teenagers + young adults)
52
PITYRIASIS VERSICOLOR what are the clinical features?
- itching (may also be asymptomatic) - rash on back, chest and upper arms - well-demarcated round/oval scaly patches - rash worsens with sun exposure - colour variation
53
PITYRIASIS VERSICOLOR what is the management?
1st line - topical antifungals (ketonazole, selenium sulphide shampoo) - sun protection 2nd line - oral antifungals (fluconazole)
54
PSORIASIS what is the pathophysiology?
- immune-mediated - abnormal T-cell activity that stimulates proliferation of keratinocytes
55
PSORIASIS what are the genetic factors that are strongly associated with psoriasis?
HLA-B13 HLA-B17
56
PSORIASIS what are the risk factors?
- family history - obesity - smoking and alcohol consumption - medications (ACEi, BB, NSAIDs, lithium, hydroxychloroquine, steroid withdrawal, abx)
57
PSORIASIS what are the nail changes?
- pitting - onycholysis - subungual hyperkeratosis - nail loss
58
PSORIASIS what is the management?
1st line - patient education - regular emollients - topical corticosteroids + vit D for 4 weeks - if poor response, continue for 4 more weeks - if poor response after 8 weeks, stop corticosteroid + take vit D BD - if poor response after 12 weeks, potent topical steroid BD for 4 weeks 2nd line - short-acting dithranol - phototherapy 3rd line - DMARDS (methotrexate, apremilast, ciclosporin) - biologics (adalimumab, infliximab)
59
SCABIES what is the pathophysiology?
- infestation with Sarcoptes scabiei - type IV hypersensitivity reaction
60
SCABIES how long does it take for symptoms to develop?
- 1st time exposure = 3-6 weeks - it is contagious before the rash develops - in cases of re-infestation = 1-3 days
61
SCABIES what is the management?
1st line - permethrin 5% cream - topical crotamiton cream (symptomatic relief) 2nd line - malathion aqueous 0.5%
62
SCC what is the pre-cancerous form of SCC?
actinic keratosis
63
SCC what are the invasive forms of SCC?
- cutaneous horn - marjolin ulcer - keratoacanthoma
64
SCC what are the risk factors?
- sun exposure and history of sunburns - use of tanning beds - chronic skin inflammation or injury - HPV infection - immunosuppression
65
SCC what are the clinical features?
SYMPTOMS - itchy, tender or painful lesions - ulcerating lesions - lesions on sun-exposed areas SIGNS - scaly or erythematous lesions - crusted or indurated lesions - bleeding lesions - irregular borders
66
SCC what is the management?
- surgical excision (wide local or Mohs) - agressive cryotherapy - topical 5-fluorouracil - imiquimod - radiotherapy
67
NECROTISING FASCIITIS what are the different types?
it is classified according to causative organism type 1 = polymicrobial (most common) type 2 = group A haemolytic strep (s.pyogenes) type 3 = gas gangrene type 4 = fungal
68
NECROTISING FASCIITIS what are the risk factors?
- recent trauma, burns or skin infection - increasing age - immunosuppressed - DM - SGLT-2 inhibitors - marine exposure - close contact with someone with necrotising fasciitis
69
NECROTISING FASCIITIS what are the clinical features?
EARLY - intense pain - skin puncture or injury - flu-like symptoms - erythema, warmness, swelling, tenderness - hypersensitive site - fever LATE - gas or crepitus - skin necrosis - fever - purple/blue skin discolouration - reduced sensation - hypotension + tachycardia
70
NECROTISING FASCIITIS what is the management?
- immediate surgical debridement - IV antibiotics (broad-spectrum) - supportive care - amputation
71
URTICARIA AND ANGIOEDEMA what are the causes?
- viral infection - idiopathic - cold - heat - exercise - stress - medications - NSAIDS, antihypertensives - thyroid function
72
URTICARIA AND ANGIOEDEMA what is the management?
- 1st line = non-sedating antihistamines (cetirizine, loratadine and fexofenadine) - 2nd line = leukotriene receptor antagonists - montelukast, or omalizumab if symptoms persist a short course of oral corticosteroid can be used in addition to above SYMPTOMATIC RELIEF - calamine lotion - topical menthol 1% aqueous cream - sedating antihistamines (chlorphenamine) if disturbing sleep
73
GANGRENE what are the different types?
wet gangrene = infectious gangrene (necrotising fasciitis, gas gangrene) dry gangrene = ischaemic gangrene secondary to reduced blood flow
74
GANGRENE what are the causes of dry gangrene?
atherosclerosis peripheral artery disease thrombosis vasculitis vasospasm
75
GANGRENE what are the clinical features of dry gangrene?
well-demarcated necrotic area without signs of infection
76
GANGRENE what are the clinical features of wet gangrene?
necrotic area is poorly demarcated from surrounding tissue patients present with fever + sepsis
77
GANGRENE what are the investigations for wet gangrene?
BLOODS - FBC - blood cultures - inflammatory markers (CRP + ESR) IMAGING - X-ray, USS or CT scan (to assess extent of disease) TISSUE BIOPSY - to identify causative organism
78
GANGRENE what are the investigations for dry gangrene?
BLOODS - FBC - inflammatory markers (CRP + ESR) - glucose level - coagulation profile IMAGING - doppler USS or angiography TISSUE BIOPSY - not typically needed
79
GANGRENE what is the management of wet gangrene?
- surgical debridement - amputation - broad-spectrum antibiotics
80
GANGRENE what is the management of dry gangrene?
- surgical debridement - amputation
81
GANGRENE what is the cause of gas gangrene?
clostridium perfringens
82
GANGRENE what are the clinical features of gas gangrene?
- acute onset severe localised pain - minimal local inflammation - skin darkening + spreading erythema - fever (hot to touch) - gas production in affected area - distinctive potent smell from infected area
83
URTICARIA AND ANGIOEDEMA what are the risk factors?
- allergens (food, medications, insect stings) - physical stimuli (pressure, cold, heat) - infections (viral, bacterial) - autoimmune processes - stress + emotional factors
84
ONYCHOMYCOSIS what are the causative organisms?
- dermatophytes (trichophyton rubrum) = most common - yeasts (candida) - non-dermatophyte moulds
85
ONYCHOMYCOSIS what are the risk factors?
- increasing age - diabetes mellitus - psoriasis - repeated nail trauma
86
ONYCHOMYCOSIS what is the management?
- asymptomatic = not treatment limited involvement (<50% nail affected, <2 nails affected, superficial) - 1st line = topical amorolfine 5% nail lacquer, 6m for hands + 9-12m for feet extensive dermatophyte infection - 1st line = oral terbinafine, 6w-3m for hands + 3-6m for feet extensive candida infection - 1st line = oral itraconazole, 'pulsed' weekly therapy
87
ROSACEA what are the clinical features?
- typically affects nose, cheeks + forehead - flushing is often 1st symptom - telangiectasia - later develops into persistent erythema with papules + pustules - rhinophyma - ocular involvement (blepharitis) - sunlight may exacerbate symptoms
88
ROSACEA what is the management?
CONSERVATIVE - high factor sun cream - camouflage cream to conceal redness SYMPTOM CONTROL - flushing = topical brimonidine gel or oral propranolol - telangiectasia = laser therapy - papules/pustules - mild-moderate = 1st line - ivermectin (other options = topical metronidazole, topical azelaic acid) - mod-severe = topical ivermectin + oral doxycycline

MY REVISION - ALL TO DO (21 decks)

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