Week 10 - Dermatology

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mewinstanley@googlemail.com
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125791
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Week 10 - Dermatology
Updated:
2012-02-03 05:02:50
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glasgow medicine dermatology third year
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Dermatology week
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  1. Name & describe all the layers of skin
    • Epidermis → Stratum corneum/ granulosum/ spinosum/ basale
    • Basement Membrane
    • Dermis
    • Subcutaenous Tissue → BV & hair follicles
  2. What are the functions of skin?
    • Protection
    • Barrier
    • Trauma
    • pressure
    • T variation
    • Micro-organisms
    • radiation/chemicals

    • Regulation
    • Body T → sweat & hair
    • Changes in peripheral circulation
    • fluid balance
    • Vit D synth

    • Sensation
    • Encapsulated nerve endings → Meissner [light touch] Ruffini [vibration & stretching] & Pacini [mechanoceptors]
    • Free nerve endings → Merkel cells [localised pressure]
  3. Presentation of Psoriasis?
    (incl guttate & erythrodermic Psoriasis)
    • Psoriasis
    • Chronic relapsing remitting scaling skin disease
    • any age and place [common 20-30 && 50-60]

    • Appearance
    • salmon coloured plaques
    • well demarcated
    • Hyperkeratosis on top of plaque
    • ^ @ sites of trauma
    • Nails → pitting, upturned, white

    • Guttate Psoriasis
    • Smaller version of standard plaques
    • younger PMH sore throat
    • progress to full blown psoriasis

    • Erythrodermic
    • severe & sudden onset
  4. What is the immune mechanism of Psoriasis?
    • T cell mediated
    • Abnormal infiltration of T cells
    • Release of inflammatory cytokines → INF, IL & TNF
    • ^keratinocyte proliferation
  5. Mx of Psoriasis
    Dependant on → severity, Pt wants & cope with, ?arthopathy

    • Tx
    • Topical cream & ointments → moisutrisers & steroids
    • Slow keratinocyte proliferation → Vit D analogues, coal tar, topical retinoids [tarzotene]
    • Phototherapy → non-specific immunosuppressant, short respite
    • Systemic therapy → acitretin, methotrexate, ciclosporin, biologic [infliximab/ rituximab]
  6. What Conditions are associated with Psoriasis?
    • Psoriatic Arthirtis
    • Metabolic syndrome
    • Liver disease/ alcohol misuse
    • Depression
  7. How does eczema present?
    • interchangeable w dermatitis
    • atopic itchy inflammatory skin condition

    • Appearance
    • background erythema
    • broken skin [spontaneous/scratching]
    • Face in infants
    • Flexural sites in adults
    • Secondary infections common [S. aureus, HSV]
    • Lychenification → exaggerated skin markings
  8. Describe the subtypes of Eczema?
    Endogenous

    • Atopic
    • Poor fillagrin expression [filament prot, buind to keratin]
    • Standard eczema

    • Seborrhoeic
    • chronic scaly inflamm 'dandruff'
    • face, scalp, eyebrows & upper chest
    • Severe in HIV
    • Mx → medicated shampoo

    Discoid

    • Venous Dermatitis
    • underlying venous disease
    • affects lower legs → incompitatnt lower veins → stretched skin → dermatitic response
    • Mx → correct vascular, moisturiser, mild steroid, compression

    Pompholyx

    Exogenous

    • Contact Dermatitis
    • precipitated by noxious agent → T4 hypersensitivity

    • Photoreaction
    • Allergy/Drugs
  9. Mx of Eczema?
    • Emollients
    • Topical Steroids
    • [emollient first, then steroid]
    • Also → bandages, antihistamines
    • Tx any complications
  10. What is the CF, Prognosis & Mx of BCC?
    Basal Cell Carcinoma

    • CF
    • most common skin cancer
    • 80% head & neck
    • Subtypes (BCC is Not Suitable Pour Moi!)
    • Nodular → raised [>5mm], pearly + telangectasia, well demarcated, central ulceration
    • Superficial → raised pearly edge, telangectasia, ulcerated & depressed centrally
    • Pigmented → not common, pearly raised edge, pigment [melanocytes]
    • Morphoeic/Scarred/Sclerotic → dificult to Dx/Mx, shiny pale skin, BV @ edge, central depression

    • Prognosis
    • usually good
    • Recurring/young age? PTCH Mt
    • rarely mets

    • Mx
    • Single incision → 3-4mm margin, local anaesthetic
    • Curatage & cautery → scrape it off
    • Cryotherapy → freeeze thaw = cell death, older Pts
    • Mohs Micrographic surgery
  11. What is the CF, Prognosis & Mx of SCC
    • Squamous Cell Carcinoma
    • induced by UV & chronic injury [burns]
    • originates from keratinocytes

    • CF
    • Premalignant → actinic keratoses, bowens disease
    • Appearance → crusty keratin plaque, background inflammation
    • Site → any exposed to UV, ears & lips = ^^risk

    • Prognosis
    • Good, but potentially disfiguring surgery

    • Mx
    • Gold standard → surgical excision, 4mm margin [cure 95%]
    • Curettage & cautery → older Pt [cure ~70%]
    • Pre-malignant → topical imiquimod/5-flouracil
  12. What is the CF, Prognosis & Mx of MM
    • Malignant Melanoma
    • Malignant tumour of melanocytes

    • CF
    • 75% of SCa deaths
    • Site → Skin [UV], also eye & bowel
    • Growth → radial then vertical, depth determines prognosis
      Subtypes → various, lentigo maligna [pre-malignant]

    • Prognosis
    • related to Breslow Depth [stratum Granulosum → deepest malignant cell]
    • 97% for <1mm
    • 71% for >4mm

    • Mx
    • Surgical → cm for each mm of Breslow
    • ?Mets → Chemo [limb isolation]
    • Lt follow-up
    • Assess lymph nodes
  13. Outline the features of a malignant melanoma?
    ABCDE

    • Asymmetry
    • Border Irregularity
    • Colour variability
    • Diameter >6mm
    • Evolving over time
  14. 4 Tumour syndromes with cutaeneous Pc
    • Gorlins
    • multiple BCC, jaw cysts, FH BrCa

    • Brook-Speigler
    • multiple BCC, trichoepitheliomas

    • Gardner syndrome
    • soft tiss tumours, polyps, Bowel Ca

    • Cowdens Syndrome
    • multiple hamartomas, thyroid Ca, Bowel Ca
  15. Describe Cellulitis & the optimal Mx
    • Cellulitis
    • spreading infection of Dermis & subcut tissue
    • lower limbs
    • RF → broken skin, lymphoedema, fungal inf
    • CF → erythema, bullae, heat, spreading, painless, ?SIRS
    • Orgs → Staph aureus, B-haemolytic strep, ~gram neg [diabetic]

    • Mx
    • Flucloxacillin/ Pen V [clinda/vancomycin if Pen allergic]
    • IV → flucloxacillan & Ben Pen
    • Mark area, monitor progress
    • ?MRSA → Vancomycin
  16. Describe the following Soft Tissue Infections
    -Eysipelas
    -Impetigo
    -Necrotising Fascitis
    -Abscess
    • Erysipelas [Erys-EYE-pelas]
    • similar to Cellulitis, but dermis
    • CF → face/EYEs, well demarcated raised edge, Recurrance
    • Orgs → Strep Pyogenes [group A strep] Staph Aureus

    • Impetigo [Duffys manky face]
    • CF → infected epidermis, perioral, golden crust, ^^transmissable
    • Orgs → Staph Aureus
    • Mx → remove crust, Flucloxacillan, beware HSV

    • Necrotising Fascitis [Medical Emergency]
    • rapid spreading infection of subcut fascia
    • toxin mediated - superantigens & cytokines
    • CF → initially ^^PAIN, becoming painless [necrosis], rapid spread, SIRS, dusky skin w necrosis, ?crepitations
    • Orgs → mixed [aerobes & anaerobes]
    • Mx → Rapid surgical assess & debridement of all necrotic tissue, tissue grams stain → rationalised Ab, initially broad cover

    • Abscess [Trapped pus in membrane, Ab may not penetrate]
    • CF → precipitation factor [trauma/IVDU], pain & swelling
    • Orgs → mixed infection [if IVDU could be anything]
    • Mx → drainage [Eli you boy!] C&S, consider U/S
  17. Give examples of the cutaenous features of Thyroid Disease. [3]
    Hypothyroid → dry skin

    • Graves [hyperthyroid]
    • Thyroid Dermopathy → non-specific thickening, lower legs
    • Thyroid Acropachy → digital clubbing & thickening
  18. Give examples of the cutaeneous features of Diabetes. [5]
    • Necrobiosis lipoidica → shins [purple → waxy yellow] microvascular occlusion, can predate
    • Diabetic Dermopathy → scarred itchy hyperpigmented shins [?ulcerated]
    • Scleredema → puffy oedematous skin, erythema [intrascapular, neck]
    • Leg Ulcers
    • Granuloma Annulare → raised circular area on skin
  19. Give the cutaeneous features of Vit B deficiency.
    • Vit B
    • B6 → Pyridoxine → Dermatitis
    • B12 → Cobalamin → Angular Stomatitis
    • B3 → Niacin → Pellagra [Dementia, Dermatitis, Diarrhoea]
  20. Give the cutaeneous features of Zinc Deficiency.
    • Zinc
    • Acrodermatitis enteropathica [Inherited]
    • head & neck → pustules, bullae & scaling
    • Infants → inherited/poor maternal transfer [breast milk]
    • Adults → Alcoholism/malabsorption/IBD
    • Tx → Zinc rapid improvement
  21. Give the cutaeneous features of Vit C deficiency.
    • Scurvy
    • Punctate purpura/bruising → legs
    • Corkscrew spiral curly hairs
    • non-healing wounds
    • Inflamed gums
  22. Describe Erythema Nedosum & some associated diseases.
    • Erythema Nedosum
    • Tender red nodules under skin
    • Causes → strep throat, Pregnancy/OCP, Sarcoid, Drug RXN
  23. Describe Pyoderma Gangrenosum & some associated diseases.
    • Pyoderma Gangrenosum
    • Uncommon ulcerative condition. [?necrosis]
    • Distinctive purple edge
    • Causes → IBD, RA, Myeloma

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