Term
Name 6 Diabetes-linked Skin Diseases
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Definition
“Diabetics Never Get Very Exciting Appetisers”
D iabetic Dermopathy aka Diabetic Shin Spots
N ecrobiosis Lipoidica Diabeticorum
G ranuloma Annulare (generalised type only)
V itiligo in 4%
X anthomas
A canthosis Nigricans |
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Term
What are the 4 key causes of exfoliative dermatitis (erythroderma)?
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Definition
Eczema
Psoriasis
Cutaneous T-cell lymphoma
Drug reactions (less common) |
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Term
What skin disease may cause a generalised rash similar to erythroderma, but one can find that there islands of spared skin, and prominent follicular plugging. The palms and soles are yellow and hyperkeratotic, the nails are thickened and discoloured.
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Definition
Pityriasis rubra pilaris (this is one differential diagnosis to erythroderma)
This may respond to retinoids or methotrexate. |
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Term
Name two forms of “pityriasis” with infective causes and two without.
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Definition
Infective – Pityriasis versicolor (malassezia furfur), pityriasis rubra (viral)
Non-infective – Pityriasis alba, Pityriasis rubra pilaris |
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Term
What skin disease is described below:
Usually presents as hypopigmented macules that fail to tan. Treatment is indicated if a fine scale is present. Selenium sulfide or imidazole creams are effective. Even skin pigmentation may take upto 2 years to achieve.
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Definition
Pityriasis versicolor.
Selenium sulfide is used twice a week for 4 weeks. Each application is washed off after 24 hours. |
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Term
MCR1 is a receptor site on melanocytes. It is bound by a-MSH but also by ACTH.
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Definition
| True. This is the reason why in Addison’s disease and pregnancy (where ACTH levels rise), pigmentation becomes increased. |
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Term
What clinical sign is described as follows:
Lace-like erythema associated with telangiectasia, mottled
hyperpigmentation and later epidermal atrophy.
(Histologically there is epidermal basal layer damage)
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Definition
Poikiloderma.
May be found in Erythema ab igne, Poikiloderma of civatte(radiation induced), Mycosis fungoides, Graft-vs-host disease, Dermatomyositis and Lupus Erythematosus |
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Term
Which of the following is not a sensible treatment for Melasma?
Tretinoin, Azelaic acid, Oral contraceptive pill, SPF50 sunblock
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Definition
| OCP. This may worsen the appearance as it induces melanogenesis. |
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Term
Name the disease associations of Erythema Nodosum.
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Definition
“TOP BLISS”
T B
O ral contraceptive pill
P regnancy
B ehcets disease
L ymphoma
I nflammatory bowel disease
S treptococcal Infection
S arcoidosis |
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Term
What serum blood test may help to identify sarcoidosis?
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Definition
ACE
(Note: this is also raised in leprosy) |
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Term
What may trigger Erythema Multiforme?
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Definition
(All infection and antibiotic related)
Viral infections, Herpes simplex, Mycoplasma, Sulphonamides, Penicillins, Idiopathic. |
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Term
What is the dermatological sieve?
(A quick check on the common associations of rashes)
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Definition
“ACID”
A utoimmune
C ancers
I nfections
D rugs |
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Term
Mycosis fungoides.
True or false.
This is a T-cell lymphoma of CD8 type.
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Definition
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Term
In the American Cancer Society’s ABCDE Rules, what does “E” stand for?
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Definition
E is for elevation
(a) - Asymmetry
(b) - Border irregularity
(c) - Colour irregularity
(d) - Diameter greater than 6 mm
(e) - Elevation/evolution |
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Term
Melanoma. True/false. For a 3 mm depth lesion, a 3 cm excision margin appropriate.
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Definition
True. As a guide, 1 cm margin per 1 mm depth, upto a maximum of 3 cm. |
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Term
Psoriasis. When in life does this more commonly present?
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Definition
| 2-3rd decades, second peak in 5-6th decades |
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Term
Psoriasis. What type of T-helper lymphocyte predominants in early lesions.
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Definition
| Th-1. Improvement in pregnancy occurs as Th-1 levels drop and Th-2 levels increase. |
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Term
Early onset Psoriasis. What is the evidence for a genetic predisposition?
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Definition
30% of sufferers have an affected relative. 72% concordance in monozygotic twins.
HLA-CW6 positive in 85%, also HLA-DR4, DR7, B13 implicated. |
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Term
What is the national prevalence of psoriasis?
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Definition
2-3%.
5% in Faroe islanders and near zero in Native Americans and Inuits. |
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Term
Psoriasis – Histological features. Name 3.
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Definition
Epidermal acanthosis
Parakeratosis
Microabscess of Munro formation (sterile, neutrophil derived)
Decreased keratinocyte migration time (28 days, down to 4 days)
Vascular proliferation with high reaching dermal papillae
Increased production of transforming growth factor alpha TGF-a |
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Term
Which is the cytokine profile usually seen in Psoriasis patients?
IL2, IL12, Interferon-g
or
IL4, IL5, IL13
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Definition
>IL2, IL12, Interferon-g
(IL4, IL5, IL13 seen in atopic eczema) |
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Term
Can any drugs trigger psoriasis?
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Definition
| Yes, namely Beta-blockers, Lithium and Anti-malarials |
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Term
Acute eczema – Histological features.
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Definition
Epidermal Spongosis
T-helper cell infiltration
Reduced epidermal cell adhesion – contributes to vesicle formation |
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Term
Chronic eczema – Histological features
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Definition
The epidermis is acanthotic.
At the dermal level is a mixed infiltrate of macrophages, eosinophils and lymphocytes. |
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Term
Name 5 Conditions that may Koebnerise.
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Definition
Psoriasis
Vitiligo
Viral warts
Lichen Planus
Lichen Sclerosus |
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Term
Psoriatic arthropathy. True/false.
A large knee effusion may suggest the diagnosis.
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Definition
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