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level: Derma

Questions and Answers List

level questions: Derma

QuestionAnswer
flat lesions§ Macule – flat circumscribed area of skin <0.5cm Patch – flat circumscribed areas of skin >0.5cm
Lumpy lesions smallPapule raised but less than .5
Lumpy lesions bigNodule greater than .5
Plaque on skinLarger superficial topped lesions
Fluid filled lesionVesicle – fluid filled lesion <0.5cm Bulla – fluid filled lesion >0.5cm
what is a pus filled lesion calledPustule
A weal is araised erythematous lesion with surrounding flare/oedema
Lithication isa thick topped thickening of the skin secondary to scratching
Scale is a– visible and palpable flakes due to aggregation/abnormal shedding of epidermal cells
Ulcer –a loss of epidermis (often with loss of underlying dermis and subcutis)
Inflammatory dermatosesEczema Atopic Contact dermatitis Urticaria and angioedema Psoriasis Lichen planus
Eczema isdermatitis
Endogenous eczema isatopic or sebbhoreic
Atopic eczemaerythema Scaling Lichenification Pruritus Secondary infection (Staph. Aureus)
Tx of eczemaEmollients Topical corticosteroids Antibiotics (anti-staph. Aureus) Phototherapy Immunosuppression Ciclosporin (Gum hypertrophy) Methotrexate Azathioprine
Seborrheic eczemaFacial rash Erythema Scaling ‘cradle cap’ Pityriasis capitis (bad dandruff)
Contact dermatitisAllergic contact dermatitis Immune mediated Type IV hypersensitivity Allergens Latex (+ type I reactions) Acrylates Metals Cinnamates (toothpaste) Balsam of peru (toothpaste)
Urticaria and angiodemaType I (type II) hypersensitivity Mast cell mediated erythema Erythema Oedema Pruritus (urge to itch) Drugs Aspirin/NSAID Opiates
PsoriasisCommon (1-2% population) Family history ++ Erythema Silver scale Extensors Hard to distinguish on the face between psoriasis and eczema
Lichen planus: skinVery itchy Usually wrists Symmetrical Purple/violaceous, shiny Polygonal and flat topped Wickham striae (white lines) Cause unknown Self-limiting Rx: topical steroids
Lichen planus in mouthtx soluble prednisolone try toothpaste without sodium lauryl sulphate
FolliculitisStaphylococcal Outer part of follicle Painful pustules Hair in centre (ingrown hair)
Erysipelas/cellulitisStreptococcal Dermal infection Systemic upset Well demarcated Tender Unilateral Urgent treatment with antibiotics
Herpes simplexHHV-1 and 2 Grouped vesicles Painful Prodrome
Herpes zosterVaricella-zoster Painful Dermatomal Prodrome
Blistering diseasesErythema multiforme (SIS -TEN) Pemphigus Bullous pemphigoid
Erythema multiformeAsymptomatic rash Acral distribution Symmetrical target lesions Usually found in the oral cavity Self-limiting HSV Drugs Idiopathic (50%) Good to take a viral swab from to confirm whether is it HSV related or not
Pemphigus (superficial)Widespread, flaccid, superficial blisters Painful erosions Caused by circulating auto-antibodies that disrupt the desmosomal attachment between the skin and the keratinocytes Usually trunk Extensive de-nucleation No scarring Autoimmune process Px = immunosuppression Long term steroids can lead to:
Pemphigoid (deep)Very itchy Tense deep blisters Initially thighs Clear à haemorrhagic Crusting No scarring Autoimmune process Rx = immunosuppression
Cicatricial pemphigoid: oralRare form of bullous pemphigoid Characterised by painful subepithelial blistering and scarring
non urgentcancer of the skinBasal cell not too urgent
squamous cell carcinomamore serious ulceration urgent referral
Malignant melanomaHistory of change Irregular colour irregular border Urgent referral
Lentigo malignaIn situ melanoma Sun exposed skin Flat pigmented lesion Irregular colour Irregular border Urgent referral
Benign pigmented lesionsLabial melanotic macule Provoked by sun exposure More common in fair skinned people May also occur in dark skinned individuals Melanotic macules are harmless
Multiple lesions may be a sign of a widespread skin condition, such as:Addison disease Peutz-Jegers syndrome Rare inherited disease characterised by gastrointestinal polyps in association with pigmentation affecting skin and mucous membranes Laugier-Hunziker syndrome Harmless rare sporadic disorder characterised by flat brown marks on the lips and inside the mouth, and frequently brown stipes on the nails
Mucocele of the lipForm when mucous or saliva escapes into surrounding tissues
Botox contra indic.Aminoglycoside antibiotics (may increase effect of botulinum toxin) Chloroquine and hydroxychloroquine (may reduce effect) Blood thinning agents e.g. warfarin or aspirin (may result in bruising) pregnant etc...