Dermatology conditions

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Dermatology conditions
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Question 1

• Macule
• a flat, non palpable - area of altered skin
  colour or texture, usually smaller than 1cm in
  size
• Patch
• a non palpable - area of altered skin colour or
  texture, usually greater than 1cm in size
• Papule
• a small superficial elevation of up to 0.5 cm
  in diameter

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Question 1

• Nodule
• raised solid lesion, larger than 0.5 cm
• Plaque
• an elevated, disc-like lesion, larger than 2
  cm in size, but without any substantial depth
• Vesicle
• a circumscribed elevation of the skin, less than
  0.5 cm in diameter, and containing fluid
• Bulla
• a circumscribed elevation of the skin, over
  0.5cm in diameter and containing fluid

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Question 2

• A 45 year old lady presented to her GP
  complaining of a 3 month hx of a rash on her
  shin- what is it?
• Necrobiosis lipoidica

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Question 2

• Which condition is it associated with?
• Diabetes mellitus
• 85 of patients with NL will have or will develop
  DM
• More common in females
• More common in young or middle aged patients

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Question 2

• What other skin conditions are seen in diabetes?
• Granuloma annulare
• Diabetic dermopathy
• Predisposition to infection
• Vitaligo
• Neuropathic ulcers
• Eruptive xanthomas
• Fat atrophy

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Question 2

• What are the treatment options?
• if non-ulcerated NL
• topical corticosteroids (e.g. application of
  steroid creams under occlusive dressings)
• systemic corticosteroids
• Topical PUVA
• if ulcerated NL
• immunomodulating drugs such as cyclosporin and
  mycophenolate mofetil

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Question 3

• A 57 yr old lady with RA present to her GP with
  this rash on her shin- what is it?
• Pyoderma gangrenosum
• lesions begin in the dermis with secondary
  necrosis of the epidermis
• the first sign is a pustule with surrounding
  erythema
• with time an ulcer develops
• the walls of the ulcer are blue and well defined
• there may be systemic symptoms and signs such as
  
• fever
• myalgia
• arthralgia

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Question 3

• What other conditions are associated with this?
• Inflammatory bowel disease
• Arthritis- RA and seronegative arthritis
• Hameatological disease
• myelocytic leukaemia
• hairy cell leukaemia
• myelofibrosis
• myeloid metaplasia
• monoclonal gammopathy

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Question 4

• An obese 42 yr old gentleman present complaining
  of darkening skin under his axilla what is it?
• Acanthosis nigricans
• a rare condition characterised by a brown to
  black velvety papillomatous hyperplasia of the
  epidermis with intense hyperpigmentation
• most prominent in axillary, inguinal,
  infra-mammary and neck creases.
• In advanced forms, there may also be veruccous
  patches on the knuckles and other extensor
  surfaces, and hyperkeratoses of the palms -
  'tripe palms' - and soles.

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Question 4

• It can be associated with malignancy - name 2?
• gastric carcinoma
• lymphoma

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Question 4

• It can be associated with endocrine disorders -
  name 2?
• acromegaly
• Cushing's syndrome
• diabetes
• insulin resistance

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Question 5

• A 28 yr old lady on the COCP complaining of this
  painful dusky rash- what is it?
• Erythema nodosum
• represents an inflammation of sub-dermal adipose
  tissue (paniculitis).
• The female to male ratio is five to one

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Question 5

• Name 4 causes of erythema nodosum
• sarcoidosis - 30 to 40 of cases
• infectious causes
• streptococcal/viral throat infections - most
  common
• chlamydia - relatively common
• tuberculosis - relatively common
• mycoplasma
• yersinosis - more common in non-UK European
  countries
• rarely, histoplasmosis, leprosy, psittacosis,
  cat-scratch disease, lymphogranuloma venereum
• inflammatory causes
• inflammatory bowel disease
• Crohn's
• ulcerative colitis
• rarely, Behcet's disease
• drugs are a common cause
• sulphonamides
• oral contraceptive pill
• malignancy
• lymphoma, leukaemia

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Question 5

• What are the treatment options
• Investigations are aimed at trying to find an
  associated condition
• NSAIDS may be given for joint pain and painful
  skin nodules. Topical steroids are of no value.
• Systemic steroids are not generally required, and
  should not be given 'blind' in case they
  exacerbate underlying infection
• The condition may take weeks to regress
  (generally resolves within six weeks) and there
  may be recurrent attacks.

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Question 6

• A 34 yr old man presents with this symmetrical
  rash which started on his arms and has spread
  proximal to his hands- what is it?
• Erythema multiforme
• a term describing target lesions - circular
  lesions often with central blister with a
  symmetrical peripheral distribution, usually on
  limbs.
• If there are mouth, genital and eye ulcers and
  fever - Stevens-Johnson syndrome

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Question 6

• Name 4 causes?
• drugs
• barbiturates
• sulphonamides
• aspirin
• infections
• herpes simplex
• typhoid
• mycoplasma pneumoniae
• tuberculosis
• orf
• vitamin deficiencies
• niacin
• A
• C
• inflammatory disorders
• collagen vascular diseases
• inflammatory bowel disease

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Question 6

• What are the treatment options?
• secondary infection and dehydration should be
  prevented -
• itch may be a prominent feature - a combination
  of a potent topical steroid and an antihistamine
• the condition may take up to three weeks to
  resolve
• recurrent episodes of erythema multiforme are
  often due to herpes simplex an may respond to
  long-term treatment with aciclovir
• the role of oral steroids is controversial in
  this condition

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Steven johnson syndrome

• Stevens Johnson syndrome is a severe and
  sometimes fatal form of erythema multiforme.
• There is a higher incidence in children and young
  adults
• twice as common in males than females.
• There may be pulmonary, gastrointestinal, cardiac
  or renal involvement.
• It is caused by the same factors which cause
  erythema multiforme, but is seen more often as a
  response to drugs such as sulphonamide, some
  sedatives and penicillin.
• Treatment is symptomatics

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Question 7

• A 32 yr old lady presents complaining of severe
  itching- can you name 5 systemic disease that
  can cause this symptom
• liver disease
• chronic renal failure
• thyroid disease - hypo- or hyperthyroidism
• carcinomatosis (especially bronchial)
• iron deficiency
• diabetes mellitus
• parasites
• onchocerciasis
• schistosomiasis
• lymphoma
• pregnancy (pruritus gravidarum) -Often attributed
  to oestrogens
• pre-eruptive herpes zoster