Passmedicine – Dermatology – Flashcards
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What is Vitiligo?
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Autoimmune condition resulting in the loss of melanocytes and consequent depigmentation of the skin. 1% of the population
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What are the features of vitiligo?
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well demarcated patches of depigmented skin The peripheries tend to be most affected Trauma may precipitate new lesions (Koebner phenomenon)
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What conditions are associated with vitiligo?
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Type 1 diabetes addison's disease autoimmune thyroid disorders pernicious anaemia alopecia areata
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How is vitiligo managed?
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Sun block camoflage make-up topical corticosteroids if used early phototherapy and topical tacrolimus
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What is lichen planus?
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skin disorder of unknown aetiology, most probably being immune mediated
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What are the features of lichen planus?
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itchy, papular rash on palms, soles, genitalia and flexor surfaces of arms. Rash often polygonal in shape, 'white-lace' pattern on the surface (Wickham's striae) Oral involvement in around 50% of patients
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Causes of lichenoid drug eruptions?
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gold quinine thiazides
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How are lichen planus eruptions managed?
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topical steroids oral steroids or immunosuppression in severe cases
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What is acne rosacea?
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chronic skin disease of unknown aetiology
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What are the features of acne rosacea?
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typically affects nose, cheeks and forehead flushing is often first symptom telangiectasia are common later develops into persistent erythema with papules and pustules rhinophyma ocular involvement: blepharitis
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How is acne rosacea managed?
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topical metronidazole for mild symptoms. Camoflage creams Sunscreen systemic antibiotics in severe cases
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What is alopecia areata?
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Presumed autoimmune condition causing localised, well demarcated patches of hair loss. At the edge of the hair loss there may be small broken 'exclamation mark' hairs
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How is alopecia areata managed?
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Hair normally regrows. Drugs include topical corticosteroids topical minoxidil phototherapy dithranol contact immunotherapy wigs
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What is the immediate first aid for burns?
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ABC remove source of burns irrigate with cold water for 10-30 mins Dress with layers of cling film. check circulation beyond the area of the burn Electrical - switch off power supply and remove person from source Chemical: brush off powder then irrigate. DO NOT NEUTRALISE THE CHEMICAL
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How do superficial epidermal burns appear?
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red and painful
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How do partial thickness (superficial dermal) burns appear?
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pale pink, painful, blistered
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How do partial thickness (deep dermal) burns appear?
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Typically whie bu may have patches of non-blanching erythema. Reduced sensation
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How do full thickness burns appear?
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White/brown/black in colour, no blisters, no pain
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When to refer burns to secondary care?
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all deep dermal and full-thickness burns. >10% of surface area or 5% in paeds Any inhalation injury Any chemical injury Sensitive area Suspicion of non-accidental injury
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How should superficial epidermal burns be managed?
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sumptomatic relief - analgesia, emollients etc
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How should superficial dermal burns be managed?
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cleanse wound, leave blister intact, non-adherent dressing, avoid topical creams, review in 24 hrs
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What is Erythema ab igne?
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a skin disorder caused by over exposure to infrared ratioation. Pts may develop squamous cell skin cancer
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What are the features of erythema ab igne?
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reticulated, erythematous patches with hyperpigmentation and telangiectasia.
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What is polymorphic eruption of pregnancy>
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pruritic condition associated with last trimester Lesions often first appear in abdominal striae
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How are polymorphic eruptions managed?
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Depends on severity. Emollients, mild potency topical steroids and oral steroids may be used
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What is Pemphigoid gestationis?
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pruritic blistering in peri-umbilical region. Usually 2nd or 3rd trimester. Corticosteroids for management
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What are Scabies?
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caused by the mite sarcoptes scabiei and is spread by prolonged skin contact. It typically affects young children and adults.
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What are the features of scabies?
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widespread pruritus Linear burrows on the side of fingers, interdigital webs and flexor aspect of the wrist Secondary features are seen due to scratching:excoriation, infection
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How is Scabies managed?
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permethrin 5% pruritius persists for up to 4-6 weeks post eradication
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What is psoriasis?
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A common and chronic skin disorder. Multifactorial in origin
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What is plaque psoriasis?
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Most recognised sub-type resulting in the typical well demarcated red, scaly patches affecting the extensor surfaces, sacrum and scalp
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What is flexural psoriasis?
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In contrast to plaque psoriasis the skin is smooth
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What complications are seen in psoriasis?
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psoriatic arthropathy increased incidence of metabolic syndrome, cardiovascular disease, venous thromboembolism, psychological distress.
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What are the features of pyoderma gangrenosum?
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typically on the lower limbs initially small red papule later deep, red, necrotic ulcers with a violaceous border may be accompanies by systemic symptoms
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What are the causes of pyoderma gangrenosum?
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idiopathic IBF: crohn's, UC Rheumatoid arthritis, SLE myeloproliferative disorders Lymphoma, Myeloid leukaemias monoclonal gammopathy (IgQA) Primary biliary cirrhosis
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How is pyoderma gangrenosum managed?
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Oral steroids and other immunosuppressive therapies may have a role.
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What is bullous pemphigoid?
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Autoimmune condition causing sub-epidermal blistering of the skin. Secondary to the development of antibodies against hemidesmosomal proteins BP180 and BP230
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What are the features of bullous pemphigoid?
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itchy, tense blisters typically around flexures The blisters usually heal without scarring Mouth is spared
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How is bullous pemphigoid managed?
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Refer to dermatologist Oral corticosteroids Immunosuppressants and antibiotics
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What is Pityriasis versicolor?
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called tinea versicolor, is a superficial cutaneous fungal infection caused by Malassezia furfur
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What are the features of pityriasis versicolor?
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most commonly affects trunk Patches may be hypopigmented, pink or brown Scale is common Mild pruritus
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What are the predisposing factors for pityriasis versicolor?
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occurs in healthy individuals Immunosuppression malnutrition Cushing's
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What is the management of pityriasis versicolor?
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topical antifungal
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What is seborrhoeic dermatitis?
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Inflammatory reaction related to a proliferation of a normal skin inhabitant, a fungus called Malassezia furfur.
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What are the features of seborrhoeic dermatitis in adults?
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eczematous lesions on the sebum-rich areas Otitis externa and blepharitis may develop
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What is seborrhoeic dermatitis associated with?
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HIV Parkinson's disease
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What is the management of Seborrhoeic dermatitis?
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zinc pyrithione and tar for the scalp topical antifungals and steroids for the face
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What is leukoplakia?
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Premalignant condition presenting as white, hard spots on the mucous membrnes of the mouth. It is more common in smokers.
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What is squamous cell carcinoma?
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Commonest variant of skin cancer. Mets are rare but may occur
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What is the commonest variant of skin cancer?
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squamous cell carcinoma
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WHat are the risk factors for squamous cell carcinoma?
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excessive exposure to sunlight actinic keratoses and Bowen's disease Immunosuppression e.g. following renal transplant Smoking Long-standing leg ulcers (Marjolin's ulcer)
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What are suborrhoeic keratoeses?
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benign epidermal skin lesions seen in older people
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WHat are the features of suborrhoeic keratoeses?
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large variation in colour from fresh to light-brown to black have a 'stuck-on' appearance keratotic plaugs may be seen on the surface
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How are suborrhoeic keratoeses managed?
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reassurance about the benign nature of the lesion Options for removal include cryosurgery, curettage and shave biopsy
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What are cherry haemangiomas?
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Benign skin lesions which contain an abnormal proliferation of capillaries. More common with advancing age and affect men and women equally
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What are the features of cherry haemangiomas?
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erythematous papular lesions typically 1-3 mm in size non-blanching not found on the mucous membranes
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What are spider naevi?
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describe a central papule with surrounding capillaries. The lesions blanch upon pressure. Spider naevi are almost always found on the upper part of the body.
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What conditions are associated with spider naevi?
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liver disease preganncy combined oral contraceptive pill 10-15% of healthy people have them
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What are actinic keratoeses?
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A common premalignant skin lesion that develops as a consequence of chronic sun exposure
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What are the features of actinic keratoses?
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small, crusty or scaly, lesions may be pink, red, brown or the same colour as the skin typically on sun-exposed areas e.g. temples of head multiple lesions may be present
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How is actinic keratoses managed?
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prevention of further risk fluorouracil cream topical diclofenac topical imiquimod cryotherapy curettage and cautery
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What are Basal cell carcinomas?
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One of the 3 main types of skin cancer. Characterised by slow-growth and local invasion. Mets are rare
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WHat are the features of basal cell carcinomas?
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nodular is most common sun-exposed sites initially a pearly, flesh-coloured papule with telangiectasia May later ulcerate leaving a central 'crater'
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How are basal cell carcinomas managed?
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surgical removal, curettage, cryotherapy, topical cream: imiquimod, fluorouracil, radiotherapy
