Term
|
Definition
use Wallace's rules of nines
head and neck 9%
anterior leg 9% posterior leg 9%
anterior chest 9% posterior chest 9%
anterior and posterior abdomen 9% each
each arm 9% |
|
|
Term
|
Definition
face and trunk in infants
flexors in young children
extensors in older children |
|
|
Term
|
Definition
emollients to steroid 10:1. if giving steroid then apply cream first, wait 30 mins and then then apply steroid
creams soak in faster than ointments |
|
|
Term
| clobetasone butyrate is AKA? |
|
Definition
|
|
Term
| betametasone valerate AKA |
|
Definition
|
|
Term
| Clobetasol propionate AKA |
|
Definition
|
|
Term
| how to remember potencies of steroids? |
|
Definition
Help
Every
Budding
Dermotologist |
|
|
Term
| what is the finger tip rule? |
|
Definition
1 FTU is 0.5g of steroid
this is enough to rx a skin area about twice that of a flat adult palm. |
|
|
Term
what causes eczema herpeticum?
rx> |
|
Definition
more common in atopic eczema
causes by HSV type 1 or 2
rx: IV aciclovir |
|
|
Term
what do you call eczema that affects both the hand and feet?
this is also known as dishydrotic eczema. |
|
Definition
Pompholyx
hands: cheiropompholyx
feet: pedopompholyx |
|
|
Term
|
Definition
small blisters on palms and soles
pruritic sometimes burning sensation. once they burst, blisters may become dry and crack
mx: cool compress, emollients, steroids |
|
|
Term
| as a result of increased venous pressure what type of eczema might you get? |
|
Definition
varicose eczema.
haemosiderin
lipodermatosclerosis
atrophy blanche
ulceration of skin |
|
|
Term
| genetic associations (HLA) of psoriasis? |
|
Definition
|
|
Term
| most common subtype of psoriasis? |
|
Definition
plaque psoriasis
red scaly plaques on extensor surface, sacrum and scalp |
|
|
Term
| characetrististics of flexural psoriasis |
|
Definition
| it is smooth rather than a plaque |
|
|
Term
| post strep what type of psoriasis would we expect? |
|
Definition
guttae psoriasis
teardrop shaped appear on body |
|
|
Term
| what type of psoriasis do we expect to appear on palms and soles? |
|
Definition
|
|
Term
|
Definition
nails changes are associated with arthropathy
pitting
onycholysis
subungal hyperkeratosis
loss of nail |
|
|
Term
| complications of psoriasis |
|
Definition
CVS disease, HTN
arthritis
psychological distress, depression
increased risk for metabolic syndrome
increased risk for VTE
UC and Chronhs
non melanoma skin cancer
other cancer of GI |
|
|
Term
| things that can exacerbate psoriasis |
|
Definition
trauma
alcohol
withdrawal of steroids
drugs:-
beta blockers
NSAIDS
anti malarials
ACE-i
lithium
infliximab |
|
|
Term
| features of guttae psoriasis |
|
Definition
more common in children and adolescents
preceded by strep infection 2-4 weeks before lesions appear
affect trunk and limbs
resolves in 2-3 months
mx: topical agents normally used in psoriasis and UVB
if recurrent strep infections then tonsillectomy |
|
|
Term
|
Definition
1st line: potent corticosteroid plus vit D analogue applied opposite times of day. duration: 4 weeks
2nd line: if no improvement after 8w offer vit D analogue BD
3rd line: potent corticosteroid BD for 4 weeks or coal tar OD/BD. short acting dithranol can also be used. |
|
|
Term
| potent corticosteroids should be used for no longer than how many weeks? |
|
Definition
|
|
Term
| very potent corticosteroids should be used for no longer than how many weeks? |
|
Definition
|
|
Term
| NICE recommend we take a break of how long before starting another course of steroids in psoriasis? |
|
Definition
| 4 weeks. e.g. 1st line is steroid and vitamin D analogue for 4 weeks. if this is unsuccessful we wait for another 4 weeks before starting steroids again. |
|
|
Term
| give examples of Vitamin D analogues |
|
Definition
Dovonex (calcipotriol)
Calcitriol
Tacalcitol |
|
|
Term
| what do vitamin D analogues do? |
|
Definition
reduce cell division and differentiation
they can be used long term and do not smell or stain
tend to reduce scale and thickness of plaques but not erythema
avoid in pregnancy
max weekly amount in adults in 100g |
|
|
Term
secondary care in psoriasis phototherapy features
and adverse effects |
|
Definition
UVB rx of choice given 3 x week
photchemotherapy: psoralen and UVA = PUVA
adverse effects: skin ageing and squamous cell cancer (not melanoma) |
|
|
Term
| systemic therapy used in psoriasis |
|
Definition
MTX if there is associated joint disease
ciclosporin
systemic retinoids
biologics
USTEKINUMAB IL23 and IL12 blocker |
|
|
Term
|
Definition
|
|
Term
| mechanism of vitamin D analogue calcipotrol |
|
Definition
| reduces epidermal proliferation and restores a normal horny cell layer. |
|
|
Term
MOA of dithranol?
can you leave it on?
what are side effects of this medication? |
|
Definition
inhibits DNA synthesis
you need to wash of after 30 mins
SE: burning, staining |
|
|
Term
herpes zoster features
aka shingles |
|
Definition
due to reactivation of varicella zoster virus
unilateral painful blistering rash following dermatomal fashion
management aciclovir |
|
|
Term
shingles vaccine
what sort of vaccine is it?
who is it offered to? |
|
Definition
live attenuated vaccine
given S/C
offered to 70-79 years old
not available to those over 80 as it seems to be ineffective in this age group |
|
|
Term
what name is given to reactivation of VZV in the opthalmic division of the trigeminal nerve?
what does the hutchinson sign indicate? |
|
Definition
herpes zoster opthalmicus
hutchikinson: rash on tip or side of nose indicates nasociliary involvement and is a strong risk factor for ocular involvement.
mx: PO antiviral 7-10 days started within 72hours
ocular involvement requires urgent opthalmic review |
|
|
Term
| true or false topical anti viral is not given in herpes zoster opthalmicus? |
|
Definition
this is true
it is PO therapy for 7-10 days started within 72 hours
also corticosteroids may be given, they reduce pain but not incidence of post herpetic neuralgia |
|
|
Term
| complications of herpes zoster opthalmicus |
|
Definition
occular: conjunctivitis, keratitis, anterior uveitis, episcleritis
ptosis
post herpetic neuralgia |
|
|
Term
| what causes scabies (the name of the organism?) |
|
Definition
sarcoptes scabiei
spread by prolong skin contact and affects children and young adults |
|
|
Term
| in which layer of the skin does scabies mice lay her eggs? |
|
Definition
|
|
Term
| explain pathophysiology of the itching associated with scabies |
|
Definition
due to a delayed type IV hypersensitivity reaction to the mite eggs.
this occurs ~30 days after the initial infection. |
|
|
Term
|
Definition
linear burrows on sides of fingers, inter digital webs and wrist flexor aspects
face and scalp may be affected in infants
secondary signs due to scratching. |
|
|
Term
|
Definition
1st line: 5% permethrin
2nd: 0.5% malathion |
|
|
Term
| what is the % of permethrin and malathion? which one is 1st line and which one is 2nd? |
|
Definition
Permethrin is 5% and 1st line
malathion is 0.5% and 2nd line |
|
|
Term
| what advice would you give about the itching post scabies treatment? |
|
Definition
| it persists 4-6 weeks after treatment is complete. |
|
|
Term
| how to apply the treatment and what other precautions should you take in scabies |
|
Definition
permethrin: apply and keep on for 8-12 hours then wash off. repeat after 7 days.
Malathion: apply and keep for 24 hours then wash off, repeat after 7 days
wash all clothes and towels on 1st day to kill off mites
all household contacts should be treated even if they are asymptomatic |
|
|
Term
| what is crusted norweigen scabies and what is the rx of choice? |
|
Definition
it is scabies seen in immunosuppressed people especially those with HIV
the rx of choice is Ivermectin |
|
|
Term
| acne vulgaris is characterised by? |
|
Definition
blockage of the pilosebaceous follicle with keratin plugs.
This results in comedones, inflammation and pustules. |
|
|
Term
| pathophysiology in acne vulgaris |
|
Definition
follicular epidermal hyperproliferation forming keratin plug
this obstruct pilosebaceous follicle
androgen levels may affect activity of sebaceous glands but levels are normal in most
there is colonisation by anaerobic bacterium Propionibcterium acnes
this causes inflammation |
|
|
Term
| name the anaerobic bacteria that colonises pilosebacous glands in acne vulgaris? |
|
Definition
|
|
Term
| in acne vulgatis comedones can be white of black. how is this differentiated? |
|
Definition
in whiteheads the top is closed
in blackheads the top is open |
|
|
Term
|
Definition
severe acne associated with systemic upset (fever)
hospital admission often required
condition responds to PO steroids |
|
|
Term
| name 2 different types of scars that may result from having acne vulgaris? |
|
Definition
ice pick scars
hypertrophic scars |
|
|
Term
| what drug can cause drug induced acne? |
|
Definition
|
|
Term
| acne can be classified as mild moderate or severe.. explain these |
|
Definition
mild: open/ closed comedones +/- inflammatory lesions
moderate: widespread lesion, numbers papules and pustules
severe: extensive inflammatory lesions, nodules, pitting and scarring |
|
|
Term
|
Definition
1st: topical retinoids: benzoyl peroxide
next: combo therapy topical ABx and topical retinoid
PO Abx: Oxytetracycline or doxycycline
PO isotretoin |
|
|
Term
in terms of Abx therapy in acne which tetracycline is now not used and why?
how long will it take to see an effect with PO Abx
what is a consequence of long term PO Abx ? if this happens what can you use? |
|
Definition
Minocycline is less considered because it may cause irreversible pigmentation
it takes 3-4 months to see an effect of PO Abx
gram neg folliculitis may occur as a consequence of LT Abx PO. if this happens you can take PO high dose trimethoprim |
|
|
Term
which acne am i?
i affect nose, cheeks and forehead
I cause flushing and telangiectasia and people might think you're an alcoholic lol |
|
Definition
|
|
Term
|
Definition
affects nose cheeks forehead
flushing is 1st symptom and common to have telangiectasia
later: papules and pustules and erythema is persistent. there is rhinophyma
occular involvement: blepharitis |
|
|
Term
|
Definition
| bullous nose that occurs in rosaea |
|
|
Term
| management of acne rosacea |
|
Definition
topical metronidazole for mild symptoms
systemic Abx for more severe disease e.g oxytetracycline
apply high factor sun cream
camaflouge creams may help conceal telangiectasia
laser therapy appropriate for those with bare telangiectasia |
|
|
Term
| what is the name given to a dermatophyte fungal infection? |
|
Definition
tinea
there are 3 types
tinea capitis - scalp
corporis - trunk
pedis - foot |
|
|
Term
what might form if tinea capitis is left untreated?
which organism commonly causes tine capitis? |
|
Definition
a kerion.
Trichophyton tonsurans |
|
|
Term
if tinea capitis is caught from cats and dogs which is the most likely causative organism?
which lamp can you use to diagnose this? |
|
Definition
Microsporum canis from cats and dogs
these show as green fluorescence under Wood's lamp but the most useful ix is scalp scrapings |
|
|
Term
| mx for tinea due to Trichophyton tonsurans infection |
|
Definition
Terbinafine
topical ketoconazole shampoo given foo 1st two weeks to reduce transmission |
|
|
Term
| mx for tinea from microsporium infections? |
|
Definition
|
|
Term
tinea corporis main causative organisms
where do they come from
what is the lesion like?
what can be used to rx this? |
|
Definition
trichophyton rubrum and verucosum from cattle
well defined red lesions with pustules and papules
rx: PO fluconazole |
|
|
Term
| tinea can be due to trichophyton and microsporium species. which lesions do not typical flu ores under Woods light? |
|
Definition
| Trichophyton lesions do not really show up under the light |
|
|
Term
| malasezzia furfur causes what? |
|
Definition
pityriasis versicolor
superficial cutaneous fungal infection |
|
|
Term
| features of pityriasis versicolour |
|
Definition
hypo pigmented patches that mare seem more obvious following sun exposure
mild itching
scale is common
predisposing factors: you can be health, malnutrition, immunosuppressed or have Cushings
mx: mild disease topical anti fungal
more severe: PO itraconazzole |
|
|
Term
| posh name for fungal nail infection? |
|
Definition
onychomycosis
causes: trichophytan rubrum 90%
yeasts such as candia
non dermatophyte moulds can also cause it |
|
|
Term
| mx for dermatophyte nail infection? |
|
Definition
PO terbinafine
alternative: PO itraconazole
6weeks -3 months for fingernails
3months -6 months for toe nails |
|
|
Term
| mx for candida nail infection? |
|
Definition
topical antifungal is ok e.g. Amorolfine
severe infections should be treated with PO itraconzaole for 12 weeks |
|
|
Term
| sebhorrheic keratoses features |
|
Definition
benign epidermal skin lesions seen in older people
stuck on appearance
keratotic plugs may be seen on the surface
mx:
reassurance about benign nature
options for removal include curettage, cryotherapy and shave biopsy |
|
|
Term
| features and risk factors for SCC |
|
Definition
mets are rare but do occur
risk factors:
xs sunlight/PUVA therapy for psoriasis
actinic keratoses and bowers
Marjolins ulcer
smoking
immunosuppresion e.g post transplant or HIV
genetics: occulocutaneous albinism and xeroderma pigmentosum |
|
|
Term
|
Definition
if lesion <20mm then excision with 4mm margin
if lesion >20mm then margin should be 6mm |
|
|
Term
| good prognostic factors in SCC |
|
Definition
well differentiated
<20mm wide
<2mm deep
no associated diseases |
|
|
Term
| poor prognostic factors for SCC |
|
Definition
poorly differentiated
>20mm wide
>4mm deep
immunosupression for whatever reason |
|
|
Term
| bowen's is red scaly patches often found in women. the are a form of intreepidermal SCC. where are they often found in the body? |
|
Definition
|
|
Term
if you had chronic long term sun exposure which skin cancer would you get?
if you had sporadic exposure to sun but burnt when you did sunbathe which cancer might you get in the future?
out of SCC and BCC which is more common? |
|
Definition
chronic long term sun exposure: increased risk to SCC
sporadic sun exposure with burning: BCC likelihood increased
BBC is more common than SCC. 80% BCC and 20% SCC |
|
|
Term
organ transplant recipients have an increased risk to which cancer?
which virus is found in majority of transplant recipient cancer? |
|
Definition
SCC
HPV found in majority of transplant recipient SCC |
|
|
Term
why are actinic keratosis viewed as premalignant?
if someone has 7 or more of these what are their chances of SCC? |
|
Definition
premalignant because there are ATYPICAL KERATINOCYTES in the epidermis
7 lesions = 10% chance of SCC at 10 years
lesions is rough with white to yellow scale
lesions typically clustered at sites of chronic sun exposure |
|
|
Term
| list the 5 subtypes of BCC |
|
Definition
nodular: most common
superficial: horizontal growth pattern predominates
cystic: often clear or grey/blue appearance.
morphaeform: flat lesions without well defined borders. reoccurs due to sub clinical lateral spread
basosquamous : atypical BCC. more aggressive and more destructive |
|
|
Term
| which cancer is AKA rodent ulcer? |
|
Definition
|
|
Term
BCC growth pattern
mets ability |
|
Definition
slow growth
mets extremely rare
most common type of cancer in western world |
|
|
Term
where do majority of BCC occur?
features? |
|
Definition
sun exposed sites especially head and neck
pearly flesh coloured papule with telangiectasia. it can later ulcerate leaving a central crater |
|
|
Term
|
Definition
surgical removal
curretage
cryotherapy
topical cream: imiquimod, fluorouracil
radiotherapy |
|
|
Term
| list 3 major criteria for malignant melanoma (MM) |
|
Definition
change is shape
size
colour |
|
|
Term
| secondary, minor features for MM? |
|
Definition
diameter >6mm
inflammation
oozing
altered sensation |
|
|
Term
| what is the single most important factor in determining the prognosis for MM? |
|
Definition
The invasion depth of a tumour AKA Breslow's depth
<1mm = 95-100% 5 year survival
>4mm = 50% 5 year survival |
|
|
Term
| breslow thickness prognostic factors |
|
Definition
<1 mm =95-100% 5yr survival
1-2mm = 80=96%
2.1-4mm =60-75%
>4mm = 50% survival at 5 years |
|
|
Term
| what does ABCDE stand for in skin cancer moles? |
|
Definition
Assymetry
Border
Colour
Diameter
Evolution |
|
|
Term
features of hereditary angioedema
what is the person deficient in?
what is the inheritance pattern?
is there a prophylaxis rx? |
|
Definition
C1 protease inhibitor deficiency
AD inheritance
ix: low C4 found in affected persons
mx: give C1 inhibitor concentrate of FFP if the former is not available
prophylaxis: anabolic steroid Donazol may help
pathophysiology: uncontrolled release of bradykinin resulting in oedema. |
|
|
Term
| what is the difference between urticaria and angio-oedema? |
|
Definition
angio oedema occurs when the deeper tissues, lower dermis and subcutaneous tissues become involved and are swollen
urticaria affects skin above the dermis |
|
|
Term
| what is the description of a urticarial rash? |
|
Definition
| a wheal with central pallor or blanching |
|
|
Term
| diagnostic criteria for atopic eczema |
|
Definition
itchy skin condition plus 3 or > of the following
history of itchiness
hx of asthma
dry skin in preceding year
visibal flexural eczema
onset before ages 2 |
|
|
Term
| in atopic eczema the genetic component is thought to involve mutation in the protein fillagrin. this is critical in which layer of the skin? |
|
Definition
|
|
Term
| what does NICE recommend when atopic eczema is not controlled by maximal corticosteroid therapy? |
|
Definition
| topical pimecrolimus and tacrolimus are options for atopic eczema not controlled by maximal topical corticosteroid treatment or if there is a risk of important corticosteroid side-effects (particularly skin atrophy). |
|
|
Term
| what is the difference between lotions, creams and ointments? |
|
Definition
the proportion of oil to water
lipid content lowest in lotion
highest in ointment and medium in creams. |
|
|
Term
| lotion creams and ointments which has the highest lipid content? |
|
Definition
ointments have the highest lipid content. they are the greasiest but keep you moisturised longer
lotions have the least and creams have intermediate lipid content. |
|
|
