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GP Year 4 > Dermatology > Flashcards

Dermatology Flashcards

1
Q

what is the best prognostic indicator of melanoma mortality

A

Breslow Thickness

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2
Q

What are the 5 year survival of individual breslow thickness with regards to melanoma?

A

4 mm = 50%

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3
Q

what are the clarke level invasion with regards to melanoma?

A 
level 0 = carcinoma in situ 
level 1 = thin melanoma < 2mm thick 
level 2 = thick melanoma > 2mm thick 
level 3 = melanoma involves the LN 
level 4 = metastases are involved
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4
Q

what are the prognostic factors of melanoma

A 
Breslow thickness 
Clarke level 
mitotic rate per mm2 
ulceration 
lymphovascular invasion
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5
Q

what is the excisional margin of melanoma with regards to their thickness?

A

melanoma carcinoma in situ = < 1 mm thick = < 1 cm margin
melanoma 1 - 4 mm thick = 1 - 2 cm margin
melanoma > 4mm thick = 2 cm margin

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6
Q

what are the bio-markers associated with melanoma?

A

BRAF,

MEK

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7
Q

what are the classification of melanoma, their associations and their epidemiology?

A 
superficial spreading melanoma (70%): more common subtype of melanoma, related to intermittent sun exposure, thin, curable tumors of less than 1mm thickness 
nodular melnoma (15%): rapid growth, 15% of all invasive melanomas, more common in older people and men 
lentigo maligna (in situ melanoma) (5%): most common in sun exposed areas, begin as a tan brown macule, enlarges and develops darker, assymetric foci, color variegation 
acral lentiginous (10%）：darker skinned people, palms/soles/under nails, usually risen from trauma
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8
Q

outline the management for mild plaque psoriasis (preventive, acute, maintenance)

A

preventive measures: avoid skin damage and stress, take rest and holidays, reassurance
address psychological effects of having psoriasis
pharmacological treatment: topical steroids, tars, calcipotriol, dithranol

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9
Q

what is the difference in clinical features between rosacea and acne?

A

rosacea lacks the presence of comedones c.f acne vulgaris

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10
Q

what is the management of rosaceas

A

avoid aggrevating factors such as alcohol, sun, warm environments, hot tea and coffee, spicy food, topical steroids

use mild soap free cleanser and a non irritant sun block

mild roscaea: (topical agents) metronidazole, clindamycin cream, erythromycin gel

severe rosacea: doxycycline, erythromycin (oral)

other treatments:
rhinophyma = co2 laser therapy w/ dermatologist
telengiectasia and erythema can be removed w/ laser

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11
Q

what are the 3 treatment approach to treating acne

A

comedolysis
decrease bacterial activity
decrease sebaceous gland activity

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12
Q

treatment for mild acne

A

if just comedones = topical retinioids

if pastulopapular = use topical antibiotics such as clindamycin, erythromycin OR topical antiseptics (benzoyl peroxide)

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13
Q

treatment for moderate acne

A

oral a/b: doxycycline or erthyromycin (first line), minocycline (has more side effects)

in females, hormonal treatment can be considered. They are OCP that contain anti-androgenic progestagens, spironolactone, cyproterone acetate

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14
Q

treatment for severe acne/nodulocystic acne

A

specialist referal for prescription of oral isotertinoin

scarring can be cured by laser treatment

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15
Q

what are some drugs that can cause acne

A 
steroids 
lithium 
anti epileptics 
Oral contraceptives 
iodides/bromides
quinine
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16
Q

what’s the management of peri-oral dermatitis

A

mild cases: topical erythromycin OR metronidazole gel, pimecrolimus, azelaic acid
if more severe: doxycycline oral 50mg BD, or ethryromycin oral for 6 - 8 weeks

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17
Q

what is the treatment for resistant localized psoriasis plaque

A

intralesional corticosteroid 1:1 normal saline injection w/ local anesthetic

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18
Q

what is the treatment of widespread plaque psoriasis

A

pharmacological mx: dithranol, tar, topical corticosteroids, phototherapy. others are: methotrexate, acitretin, cyclosporin, biological agents

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19
Q

what is the treatment for scalp psoriasis

A

tar shampoo, topical corticosteroid lotions

if severe, can use tar/dithranol pomades, tar shampoo, systemic therapy

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20
Q

what is the treatment for genital psoriasis

A

topical corticosteroids, tars

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21
Q

what is the gene associated with psoriasis

A

HLA-B27 gene

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22
Q

what are common agents that cause allergic contact dermatitis

A 
Nickel
Chrome 
epoxy resin 
fragrances and perfurmes 
latex 
plants 
neomycin 
preservatives
rubber accelerators
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23
Q

what are common agents that cause irritant contact dermatitis

A 
common and oftenly used agents: 
acids
alkalis 
detergents
soaps
oils 
solvents
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24
Q

describe the distribution and morphology of irritant contact dermatitis

A

distirbution: usually areas in contact w/ irritating substances - most oftnely hands, eyelids
morphology: erythema, chapped skin, dryness and mild fissuring. +/- pruritus

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25
Q

what condition usually has a preceding herald patch in up to 80% of the patient population

A

Pityriasis rosea

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26
Q

describte the distribution and morphology of pityriasis rosea

A

christmas tree like on the trunk and back (+ upper arms, upper legs, lower neck)
old swimming suit distribution
morphology: oval, salmon pink spots, copper colored eruptions, that has scaly margins

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27
Q

treatment of pityriasis rosea

A

non pharm: bathe with soothing bath oil, use neutral pH soap
pharm: itch - calamine lotion, topical steroid 1% cream, methold 1% in aqeous cream. if itch is severe, use potent topical or oral steroid.
UV therpay

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28
Q

describe distribution and morphology of a secondary syphillis rash

A

usually occurs 6 - 8 week after the presence

morphology: faint, pink maculopapular rash. it can be dull red, round on flexor surfaces.
distribution: flexor surfaces, palms, soles, can be around the whole body

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29
Q

what is the diagnostic test for syphillis? what is its treatment?

A 
T pallidum hemagluttanin assay, FTA-ABS (fluorescent antibody- antibody test) 
IM benpen (first line) and oral azithromycin (second line)
30
Q

describe the distribution and morphology of infective mononucleosis rash.

A 
commonly associated with cervical lymphadenopathy and a sore throat (important to rule out HIV infection) 
primary rash; pinkish, maculopapular 
secondary rash (drug rash w/ ampicillin, amoxicillin): sometimes has a purplish brown tinge
31
Q

what is the time period in which SJS/TEN usually presents

A

usually average of 14 days - but re-exposure may cause the onset of symptoms as little as 48 hours

32
Q

describe the morphology/distribution of SJS

A

morphology: ill defined coalescing erythematous macules w/ purpuric centres or may present w/ diffuse erythema
distribution: mucocutaneous eruptions that are usually oral, facial, urogenital

33
Q

describe the clinical course of SJS

A

prodrome: acute onset febrile illness and malaise, possibly myalgia and arthralgia
acute: cutaneous lesions that start at face, thorax then begins spreading. slowly progresses to formation of vesicles and bullaes, and sloughing of skin

34
Q

describe mophology of erythema multiforme

A

target lesions with dusky central disc/bullae, and an infiltrated pale ring. erythematous edematous halo

35
Q

describe the management of toxic epidermal necrolysis

A

stop causative drug and all non life sustaining drugs
admit burn units, ICU
give supportive treatment: wound care, fluids and nutrition, ocular care, prevention of infection
give systemic steroids and high dose IVIG
future drug avoidance

36
Q

describe urticaria distribution and morphology

A

pruritic, circumscribed, raised/papular, erythematous eruption with central pallor. may coalesce with other lesions and disappear within 24 hours

37
Q

what is the prognosis of pityriasis rosea

A

mild, self limiting illness with spontaneous remission in about 2 - 10 weeks

38
Q

what is the most common cause of erythema nodosum

A

sarcoidosis

39
Q

what are the other causes of erythema nodosum

A 
sarcoidosis 
crohn's disease 
infections: TB, staph, viral infections 
chlamydia 
malignancy
drugs: tetracycline, sulphonamides, oral contraceptives
40
Q

what is the treatment of erythema nodosum

A

investigate causes and treat cause

mild: rest and give NSAIDs
severe: systemic steroids

41
Q

describe the mophology and distribution of erythema nodosum

A

morphology: bright red, nodular, painful
distribution: most oftenly shins, but can also be found on the thighs and arms

42
Q

what are the 4 types of rosacea

A

ocular
erythematous telangiectasia
papulopustular
fimeatous

43
Q

what is ramsay hunt syndrome?

A

shingles in the facial nerve CN 7

44
Q

describe the morphology and distribution of shingles

A

morphology: vesicular eruptions, erythematous
distribution: dermatomal distribution

45
Q

describe the morphology and distribution of scabies

A

morphology: intensely pruritic, erythematous, papular. often scattered, red, small, monomorphous
distribution: found on hand webbings, wrists

46
Q

what is the management of scabies

A

symptomatic relief: anti histamines
acute treatment: permethrin cream 5%, benzyl benzoate 25% emulsion. applied topically full body.
for children, use sulphur 5% cream OD for 2 - 3 days, then use crotamiton 10% cream
Prevention: wash bedsheet, clothings, hang in sun

47
Q

what is the management of tinea

A

prevention: keep toes dry, carefully dry feet after bathing, use anti fungal between toes, remove flaky skins form beneath toes, wear light socks made of natural absorbent fibres, change socks and shoes daily, wear open sandals with porous soles and uppers when infected
pharmacological: clotrimazole, ketoconazole, terbinafine, cream/gel. If severe, add oral terbinafine, griseofulvin.

48
Q

what is angular chelitis associated wtih?

A

chronic wetness of the lips

B12/folate deficiency

49
Q

how do you differentiate between geographical tongue and candidiasis

A

geographical tongue that cannot be scraped off

50
Q

what are the side effects of oral isotretinoin?

A 
GI upset 
skin, mucosal, eye dryness 
headaches 
epistaxis
myalgia, arthralgia, sport intolerance 
lethargy
cannot be given with doxycycline (oral) as it can cause benign intracranial hypertension
51
Q

what are the indications for oral isotertinoin?

A

severe acne
nodulocystic acne
scarring acne
patient in severe psychological distress

52
Q

what are the indications for referral to specialist?

A

PCOS caused acne
not sure about diagnosis
patient requires oral isotretinoin
trouble tolerating medications

53
Q

what is the treatment for infantile acne?

A

infant sebaceous glands stimulated from testosterone from babies acne which respond to intrauterine hormones
topical retinoids and/or anitbiotics (similar to mild acne treatment)

54
Q

what agent can be used when acne has crusting?

A

keratolytic = salicylic acid 2%

55
Q

what are some lifestyle modifications for acne prevention/

A 
avoid greasy sunscreen/moisturizer
avoid hot bathes/steam rooms
avoid hot humid working situations 
stop squeezing or picking 
avoid over exposure to sun
56
Q

what is the clinical features of rosacea?

A

no comedones
commonly facial erythema w/ telengectisia and flushing
presence of pustules and papules
easy flushing, experiencing burning, stinging, itching
irritated by cream and sun exposure

57
Q

what are some complication of rosacea

A

rhinophyma and facial oedema

58
Q

what is the treatment of corticosteroid induced rosacea?

A

stop corticosteroid treatment immediately and use oral tetracyclines for 6 weeks

59
Q

what is the treatment of childhood rosacea?

A

use erythromycin as doxycycline is contraindicated in children less than 8 years old

60
Q

what is the duration in which it takes for treatment to act for rosacea?

A

takes 6 - 12 weeks for response. maintenance treatment is often required for the long term

61
Q

when would you refer atopic dermatitis to the dermatologist?

A

chronic, recurrent infections
severe eczema that cannot be controlled w/ topical therapy
not sure with the diagnosis

62
Q

what is the feature of asteatotic eczema? what is the management of asteatotic eczema?

A

dry skin, scaling, crazy ‘paving’ on the lower limbs
dryness management: avoid soap, use a soap substitute and use daily application of emollionts at least 2ice a day

if there is inflammation, use a mild - moderate topical corticosteroid w/ wet dressing and antibiotics

63
Q

what is the feature of stasis dermatitis? what is the most important part of treatment?

A

hyperpigmentation
swelling of the legs
dryness, scale and brown pigmentation (hemosiderin staining)
associated varicose veins, ulcerations

elevation and graded compression is most important + dry management (w/ wet dressings, daily emollioants twicea day, using a soap substitute)

64
Q

what is the feature of nummular/discoid eczema? and what is its management?

A

ITCHY, round/oval shaped with well defined edges (not much scaling)
common to have superinfection w/ s. auerues

treatment:
use potent topical corticosteroids + wet dressing (even in children)

if non responsive to topical treatment, oral antibiotics may be required

topical steroids/steroid injections for lichenified lesions

65
Q

what is the feature of pompholyx or dyshidrotic eczema?

A

found on soles and palms. characterstically bullous and vesicular. has severe attacks that can prevent patient from attending work. can be trigged by physical or emotional stress.

treatment:
potent topical steroid + wet dressing
rest is important
patient needs to protect their hands from irritating soap substances for the next 3 months
if severe attacks = refer to derm, may require 2 - 3 weeks course of oral prednisolone

66
Q

what is the features of child seborrheic dermatitis?

A

site: scalp, face, neck, groin, axillae, nappy areas
morphology: erytheatous w/ crusting (if superinfection), non itchy!! well defined lesions w/ greasy scale covering

management:
topical steroids (mild) + anti fungal/antibiotics if necessary
keratolytics can be used to get rid of scales

67
Q

what is the feature of adult seborrheoic dermatitis?

A

erythema and fine greasy scale in cheeks, nose and nasolabial folds
sites: scalp, central face, eyebrows/lids, chests, flexures, axillae, genital regions
triggers; physical stress, emotional stress

management:
topical steroids (mild) + topical anti fungals if necessary
if scalp involvement, use anti-fungal shampoos containing selenium sulphide, ketonazole, miconazole

68
Q

what is the treatment for atopic dermatitis?

A

patient education about its chornicity, prgnosis,
lifestyle modifications by avoiding triggers and using emollionts on a daily basis
possible allergen testing and allergen avoidance
pharmacological treatment: mild topical steroid first OR TIMS (pimecrolimus, tacrolimus)
preventions; use wet dressing over topical emollients and anti-inflammatory agents
address psychological issues

69
Q

what are the triggers for atopic dermatitis

A 
wool clothes, blankets, lambskins
synthetic fabrics 
soap, shampoo, bubble bath 
hot baths and very hot weather 
sand at the beach and sand in the sandpits
70
Q

name some examples of mild, moderate, potent topical corticosteroids

A

mild: hydrocortisone 1%, hydrocortisone acetate 1% and 0.05% cream, desonide 0.05%, clobetasone butyrate 0.05% cream
moderate: betamethasone valerate 0.02%, triamcinolone acetonide 0.02%
potent: betamethasone valerate 0.1%, betamethasone diproprionate 0.05% cream, ointment, lotion, methylprednisolone aceponate 0.1% cream, ointment, lotion

71
Q

what is the treatment for palmoplantar psoriasis (both pustular and hyperkeratotic forms)

A

pustular forms: tars, topical corticosteroids, tetracyclines, acitretin, calcipotriol, phototherapy. if severe methotrexate, cyclosporin
hyperkeratotic: keratolytics (salicylic acid), tars, calcipotriol, acitretin

72
Q

give some examples of treatment options for psoriasis?

A

emollients - used when irritating /scaling is a prominent feature
keratolytics (salicylic acid 2% - 10%）－　can be used to soften an dlift scale
corticosteroids - used to reduce itch in pulse treatment
tars (2% - 10% cream/ointment) - used as an anti-inflammatory or anti pruritic
calcipotriol - proliferation, differentiation of keratinocytes, useful for widespread psoriasis
dithranol - antiproliferative effect, especially useful for thick plaque psoriasis

GP Year 4 (14 decks)

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