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W19 70 skin diseases Flashcards

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1
Q

What are the different types of flat lesions?

A

Macula - flat circumscribed area of skin <0.5cm
Patch - flag circumscribed area of skin >0.5cm

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2
Q

What are the different kinds of lumpy lesions?

A

Papule - raised lesion <0.5cm
Nodule - raised lesion >0.5cm
Plaque - large flat topped areas

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3
Q

What is a vesicle and a bulla?

A

Vesicle = fluid filled lesion <0.5cm
Bulla = fluid filled lesion >0.5cm

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4
Q

What is a pustule?

A

Pus filled lesion

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5
Q

What is a weal?

A

Raised erythmatous lesion with surrounding flare/oedema (associated usually with hives)

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6
Q

What is lichenidication?

A

A flat topped thickening of the skin (epidermis) secondary to scratching

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7
Q

What is a scale?

A

Visible and palpable flakes due to aggregation/abnormal shedding of epidermal cells

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8
Q

What is an ulcer?

A

A loss of epidermis (often with loss of underlying dermis and subcutis)

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9
Q

What different inflammatory dermatoses are there?

A

Eczema - atopic, contact dermatitis
Urticaria and angioedema
Psoriasis
Lichen planus

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10
Q

What is eczema?

A

Dermatitis

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11
Q

What are the different types of eczema?

A

Endogenous - atopic (eg people more predisposed to hay fever, asthma etc) or seborrhoeic (more associated where there are lots of oral producing glands)
Exogenous - irritant contact dermatitis, allergic contact dermatitis

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12
Q

Describe atopic eczema

A

Usually occurs in childhood only
Mainly affects head and neck
Affects the flexures (creases and folds of body)
Causes erythema, scaling, lichenification, pruritus, secondary infection (staph aureus)

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13
Q

What is the treatment for atopic eczema?

A

Emollients (moisturises)
Topical corticosteroids
Antibiotics (anti-staph aureus)
Phototherapy
Immunosuppressant - ciclosporin, methotrexate, azathioprine

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14
Q

How does seborrheoic eczema present?

A

Facial rash, erythema, scaling, ‘cradle cap’ (in children)
Pityriasis Capitis (bad dandruff)

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15
Q

How do you manage seborrhoeic eczema?

A

Olive oil on the scalp - in children
In adults it is more chronic and recurrent affecting the face

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16
Q

What type of reaction is allergic contact dermatitis?

A

Type IV hypersensitivity (cell mediated response, CD4 and T helper cells recognise foreign antigens and present them to cause the response).
Caused by allergies

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17
Q

What things can cause irritant contact dermatitis?

A

Physical/chemical change/damage
H2O
Detergent
Acids/alkalis

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18
Q

How do you test for allergic contact dermatitis?

A

Patch testing - place lots of chemicals on back for a week and take off to see what was responded to

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19
Q

How do you test for type I hypersensitivity reactions eg house dust mites, grass, pollens etc?

A

Put allergens on skin, then prick it with skin prick. Don’t break the skin/make bleed. Histamine will be positive if allergic, control will be negative and compare the response.

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20
Q

What is the different between urticaria and angioedema?

A

Urticaria is more superficial
Angioedema is deeper

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21
Q

What type of reactions are urticaria and angioedema?

A

Type I (type II?) hypersensitivity reactions
Mast cell mediated

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22
Q

What can you get with urticaria and angioedema?

A

Erythema
Oedema
Pruritus (itchy skin)

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23
Q

What can urticaria and angioedema be associated with?

A

Drugs - aspirin/NSAIDs, opiates
Latex

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24
Q

What is psoriasis?

A

Inflammatory condition causing erythema and silver scale
Commonly affects more of the extensors
Classically affects the scalp
Usually strong family history related

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25
What can lichen planus present as on the skin?
Itchy, usually wrists, symmetrical, purple/violaceous, shiny, polygonal and flat topped, wickham striae, cause unknown Self-limiting
26
What is treatment for lichen planus?
Topical steroids
27
What is oral lichen planus?
White, scaly patches Can be scratched off the mucosa like oral candidiasis
28
What is the treatment for oral lichen planus?
Soluble prednisolone Meticulous oral hygiene Toothpaste without SLS Stop smoking Topical steroids Steroid injections Mouth rinse containing the calcineurin inhibitors: ciclosporin or tacrolimus
29
What is impetigo?
Usually staphylococcal Initially blisters, often pus, gold coloured crust Very contagious
30
What is folliculitis?
Hair follicles becoming inflamed Staphylococcal Outer part of the foillucle Painful pustules Hair in centre
31
What is furunculosis?
Deeper infection of the hair follicle Can lead to abscess formation where the hair follicle is, which has inflammation with accumulation of pus and necrotic tissue inside these Staphylococcal
32
What is erysipelas/cellulitis?
Streptococcal. In erysipelas only the dermis is involved but in cellulitis it goes deeper. Dermal infection Systemic upset Well-demarcated Tender Unilateral Urgent treatment with antibiotics
33
What is herpes simplex virus associated with?
HSV1 and 2 HSV1 usually skin infections, HSV2 usually genitals Grouped vesicles Painful Prodrome
34
Describe herpes zoster virus?
Pain, dermatomal, prodrome Tend to treat if it affects the eye or if patients are immunocompromised
35
What is a prodrome?
The early symptoms and signs of illness preceding the characteristic manifestations
36
Give examples of blistering diseases?
Erythema multiforme (SJS-TEN) Pemphigus Bulbous pemphigoid
37
How does erythema multiforme present?
Asymptomatic rash, acral distribution, symmetrical, target lesions Symmetrical well defined round erythematous maculae’s on the knees, palms, feet etc evolving into papules and target lesions, blistering over the couple of days.
38
Erythema multiforme is self-limiting, but what is it triggered by?
HSV, drugs, idiopathic Usually resolves itself within about 4 weeks
39
How can erythema multiforme affect the oral cavity and how do you manage this?
May have ulcers on mucosal surfaces (also involving genitals but usually oral) Moutwash for pain relief, good spot to take a viral swab from to confirm whether HSV related.
40
Describe SJS - onset, presentation etc
Most likely a drug reaction Clsssic reaction around the lips with bleeding
41
What is the Nekolski sign?
Firm bit of pressure to the skin will separate it from the epidermis, classical of TEN - toxic epidermal necrolysis. If more than 30% is involved, it is TEN - a dermatological emergency.
42
What is Pemphigus?
Rare autoimmune intraepithelial blistering disease, caused by circulating autoantibodies that disrupt the desmosomal attachments of the skin to keratinocytes
43
How does Pemphigus present?
Widespread FLACCID superficial blisters and painful erosions Commonly can see slow healing irregular shaped erosions in the oral mucosal membranes, sometimes can be first sign before developing skin lesions Usually trunk, extensive denudation, no scarring
44
What is treatment for Pemphigus and what can this cause?
Treatment is immunosuporession. Long term steroids will cause osteonecrosis of the lower jaw.
45
What is pemphigoid, how does it present?
TENSE deep blisters Very itchy, initially thighs Clear but turn haemorrhagic Crusting, not scarring Autoimmune
46
What is treatment for pemphigoid?
Immunosuppression
47
How to remember pemphigus and pemphigoid?
Pemphigus - s for superficial. It is intra-epidermal. Pemphigoid - d for deep. It is sub-epidermal.
48
What is mucosal involvement in pemphigoid a sign of?
Mucosal involvement is a sign that this is bad and progressive (oral blistering might occur in cicatrical pemphigoid - rare)
49
What are some types of cutaneous malignancy?
Basal cell carcinoma Squamous cell carcinoma Malignant melanoma
50
Describe the features of basal cell carcinoma - PG668 IMAGE
Usually in sun exposed skin Slow growth Unlikely to metastasise Raised edge, superficial pearl edge Surface telangiectasia - lots of blood vessels superficially Depressed centre
51
How do you treat a basal cell carcinoma?
Non-urgent referral - want to get rid of since it will infiltrate organs eventually Usually just excision, or less invasive treatment before it grows
52
Describe the features of a squamous cell carcinoma
Sore/ulcer fails to heal, potentially continues to bleed Rapid expansion Indicated plaque/nodule Keratotic Purulent base
53
Where are squamous cell carcinomas commonly found/high risk areas?
Common in head and neck - high risk area Can be found in floor of mouth/base of tongue
54
What is treatment for squamous cell carcinoma?
URGENT referral Needs removal before it spreads - can treat with radiotherapy Checks for the next 2-3 years, check lymph nodes since there is a slightly higher risk of metastasising with these
55
What are malignant melanomas?
Melanoma skin cancers - the worrying ones that can metastasis and are aggressive, need dealing with ASAP
56
PG669 IMAGE. What are the differences between normal skin moles and melanomas?
Normal: symmetrical, borders are even, one colour, diameter smaller than a quarter inch, not evolving Melanoma: asymmetrical, borders are uneven, multiple colours, larger than a quarter inch in diameter, changing in size shape and colour (ABCDEs - asymmetry, border, colour, diameter, evolving)
57
What is lentigo maligna?
In-situ melanoma Sun-exposed skin Flat pigmented lesion Irregular colour Irregular border URGENT referral
58
What benign pigmented lesions are there?
Labial melanotic macules Provoked by sun exposure Harmless
59
What widespread conditions might multiple benign pigmented lesions be a sign of?
Addison disease Peutz-legers syndrome Laugier-Hunziker syndrome
60
How do mucocoeles of the lip form?
Forms when mucous or saliva escapes into surrounding tissues and a lining of the granulation or connective tissue is formed to create a smooth, soft round fluid-filled lump.
61
Where do mucoceoles usually form?
On the inner surface of the lower lip Called ramulae on the floor of the mouth Gingiva, buccal mucosa and tongue
62
How do mucoceoles form and how do you treat them?
Usually result of trauma in the mouth, which injures the tiny salivary ducts inside of the lip Superficial mucoceoles usually resolve sponteously and require no specific treatment
63
What does botulinum toxin do?
Causes chemo denervated of muscles by blocking acetylcholine release, stopping skin from moving
64
What are the clinical uses of botulinum toxin?
Intramuscular infections for disorders of muscular hyperactivity, eg strabismus, hemifacial spasm, muscle contractions and limb spasticity, bladder spasms, neck and back pain Chronic migraines Post herpetic neuralgia Hyperhidrosis Correction of facial asymmetry Cosmetic use for forehead lines
65
Contraindications for botulinum toxin
Pregnancy/breastfeeding Neurological disorders eg MG, motor neurone disease Caution with the following meds: - aminoglycoside antibodies (may increase effect of BT) - chloroquine and hydroxychloroquine (may reduce effect) - blood thinning agents eg warfarin or aspirin (may result in bruising)
66
What are the complications of botulinum toxin?
BoTN-A can affect non-targeted muscles or glandular tissue in areas surrounding injection cause: eyelid ptosis, lower eyelid laxity, excessive tearing (epiphora), mouth incompetence, difficulties in speech Formation of neutralising antibodies leading to non-response of subsequent injections - injecting lowest effective dose with longest feasible internals minimised risk Allergic reaction/anaphylaxis
67
What are dermal fillers?
Used for reconstructive and cosmetic procedures Injected just below skin surface
68
What are the complications of dermal fillers?
Tenderness, bleeding and bruising Lumps, nodules, overcorrection, blue appearance from too superficial injection Allergic reactions Non-allergic inflammatory reactions Numbness due to nerve palsy Vascular injury Permanant blindness if too close to optic nerve Infections eg reactivation of herpes viruses, staphylococcal infection, infectious granulomas and biofilms: painful fluctuating lump Movement of extrusion of implant

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