What is atopic eczema?
An inflammatory process affecting the skin
Loss of melanocytes from the stratum basale
Thinning of the epidermis
Atopic eczema is not the most common form of eczema.
What percentage of the population does eczema affect?
5%
15%
35%
60%
What is the most common age of onset of atopic eczema?
Childhood
Middle age
Aged 60+
What conditions are often associated with atopic eczema?
Hayfever
Asthma
IBS
Meningitis
Histologically, which layer of skin thickens in the chronic stage of eczema?
Epidermis
Dermis
Subcutis
In which stage of eczema is the skin likely to be weepy?
Acute
Chronic
The vesicles that are present during the acute stage of atopic eczema are found....
intraepidermally
intradermally
between the epidermis and dermis
Where does infantile atopic eczema usually first present?
Cheeks
Nappy area
Flexures (e.g. crook of elbow)
Extensor surfaces (e.g. back of elbow)
What area of the body does infantile atopic eczema usually spare?
Face
Hands and feet
Torso
Where does eczema tend to localize to in school-age children?
Flexures
Extensor surfaces
Hand and feet
Between the digits
What is lichenification?
Thick, leathery skin due to extensive scratching or rubbing of the area
Thin, papery skin due to the skin drying out
Thickening of the skin due to the skin drying out
Skin that has lost its pigment due to excess scratching or rubbing
Which of the following are common triggers for atopic eczema?
Cleaning products
Dust mites
Animal fur
Pollens
Salt water
What can be used to break the itch-scratch cycle commonly seen in eczema?
Mittens or gloves
Steroids
Antihistamines
Oral antibiotics
How times a day are emollients usually prescribed for a person with eczema?
Once a day
Twice a day
Three times a day
As required
How can using soap substitutes help in the treatment of eczema?
Reduce irritation
Moisturize the skin
Prevent bacteria from entering the affected areas
How should steroids be used in the treatment of eczema?
Intermittently to control flare ups, but not on more the 7 days in a month
Constantly
As required, but not for more than a month at a time
What treatments can a dermatologist offer for eczema that a GP cannot?
Topical steroids
Systemic treatments
UV light therapy
Calcineurin inhibitors
What are calcineurin inhibitors?
Immunomodulating drugs that block calcineurin receptors
Immunomodulating drugs that prevent the production of calcineurin
Immunomodulating drugs that decrease the effects of calcineurin by binding to it and changing its shape
What does calcineurin do?
Activates inflammation within the skin
Causes immune cells within the skin to proliferate
Aggravates the skin causing inflammation
Steroids can cause stretch marks or striae on the skin.
What is the most common bacterial infection that accompanies eczema?
Staphylococcal infection
E. Coli infection
Streptococcal infection
What is the most common viral co-infection that accompanies eczema?
Herpes infection
Rhotavirus infection
Coronovirus infection
When is hyper- or hypo- pigmentation most likely to occur in eczema?
Following treatment with steroids
After an acute phase
After scarring has healed
Eczema does not cause scarring. True or false?
Where does psoriasis most often occur on the body?
Flexor surfaces
Extremities
Which of these descriptions most accurately describes psoriasis?
Well-defined, inflamed plaques which appear white and scaly
Poor-defined, inflamed plaques which appear white and scaly
Well-defined, inflamed plaques which appear golden and crusty
Poorly-defined, inflamed plaques which appear golden and crusty
What percentage of the population is affected by psoriasis?
0.1-0.5%
1-2%
5-7%
10-15%
What is the peak age of onset for psoriasis?
15 years old
28 years old
40 years old
67 years old
Psoriasis only affects women. True or false?
Psoriasis usually affects extensor surfaces, but where else can it commonly affect?
Sacrum
Scalp
Ears
Palms of the hands and soles of the feet
Lips
Axillary region
The distribution of psoriasis is usually symmetrical. True or false?
Histologically, what occurs in psoriasis?
Disordered maturation of keratinocytes
Increased epidermal transit time of keratinocytes
Thickening of the epidermis
Hyperplasia of keratinocytes in the stratum corneum
Benign proliferation of Langerhan cells within the epidermis
How does coal tar help to treat psoriasis?
Slows the growth of keratinocytes
Restores the skins appearance
Reduces the irritation of the skin
Thins the epidermis
Slows hair growth
Why is coal tar not well tolerated?
It can make the skin red and itchy
It can stain clothes, bedding and light-coloured hair
It causes hair loss
Not very much improvement is seen after short-term use
How is salicylic acid useful in treating psoriasis?
It softens the plaques and helps lift them off the skin to reveal normal skin underneath
It reduces blood pressure which helps to prevent psoriasis flare-ups
It moisturizes the skin
What is the mechanism of action of vitamin D analogues used in the treatment of psoriasis?
Reduces proliferation of keratinocytes and stimulates epidermal cell differentiation
Reduces proliferation of melanocytes and stimulated epidermal cell differentiation
Increases proliferation of keratinocytes and stimulates epidermal cell differentiation
Reduces proliferation of keratinocytes and reduces epidermal cell differentiation
What treatments can dermatologists offer for psoriasis that GPs cannot?
UV phototherapy
Systemic medications
Monoclonal antibodies
Emollients
Coal tar
Which wavelength of UV light is used in UV phototherapy?
UV A
UV B
UV C
Why are oral retinoids given before a course of UV phototherapy?
To enhance the effects of the UV phototherapy
To sedate the patient
To ensure the patient does not experience and nausea or vomiting
To reduce the risk of DNA damage to skin cells
What is the course of treatment for UV phototherapy?
2-3 times per week for 3-4 months
6 times per week for a month
Once per week for one year
What is the cause of acne vulgaris?
Over-activity of pilo-sebaceous glands
Over-activity of apocrine sweat glands
Over-activity of eccrine sweat glands
Under-activity of pilo-sebaceous glands
What causes the over stimulation of the sebaceous glands?
Hormonal stimulation
Diet
Sympathetic nervous stimulation
Parasympathetic nervous stimulation
How does the over stimulation of the sebaceous glands then lead to acne?
The hair follicles become "plugged" with secretions
Inflammation occurs within the hair follicles
Hair growth is too fast due to increased sebum leading to the follicle becoming blocked
Where on the body is acne most common?
Upper chest and back
Hands
Why is acne most common on the face, upper chest and upper back?
Because the highest population of sebaceous glands is found here
Because these areas are often exposed
Because these areas are most often touched with dirty hands
How many grades of severity are there for acne vulgaris?
3
4
6
7
What do topical retinoids do?
Dry skin out
Prevent stimulation of sebaceous glands
Reduce the viscosity of sebum
How should systemic retinoids not be given to?
Pregnant women
Anyone under the age of 12
Anyone taking oral antibiotics
How is the oral contraceptive pill useful in treating acne?
It controls the hormones to prevent over stimulation
It makes sebum less viscous preventing "plugging" of the hair follicles
It makes hair follicles larger so that they become "plugged" less easily
It is used in women and girls to give a placebo effect
Both oral and topical antibiotics can be used to treat acne vulgaris. True or false?
What type of infection is impetigo?
Bacterial
Viral
Fungal
Which bacteria are most commonly responsible for impetigo?
Staphylococcus aureus
Staphylococcus pyogenes
E. coli
All Streptococcal bacteria
What feature is very characteristic of impetigo?
Golden-yellow crust
Severe inflammation
Purple-ish flecks within the rash
What two treatments are most commonly used to treat impetigo?
Fucidin cream
Oral flucloxadin
Topical penicillin
Methotrexate
Topical dexamethasone
What virus usually causes viral warts?
Human papilloma virus
Rhotar virus
Astrovirus
Herpes simplex virus type I
How are viral warts most commonly transmitted?
In water
By sharing clothes or bedding
By touching the wart and then touching areas of damaged skin
Viral warts are often self-resolving. True or false?
Which of the following is not a treatment for viral warts?
Duct taping and filing down
Salicylic acid
Cryotherapy
Topical antibiotics
Tinea and roundworm are different skin conditions. True or false?
What is tinea caused by?
A bacteria
A virus
A fungus
What is the usually given as treatment for tinea?
Topical anti-fungals
Topical corticosteroids
Systemic treatment is never used for tinea infection. True or false?
What causes actinic keratosis?
Sun exposure
Benign proliferation of melanocytes
Hormonal over-stimulation
Wear and tear of the skin over time
In what age group is actinic keratosis most common?
Over sixties
Forties to fifties
Teenagers
Infants
Why must actinic keratosis be closely observed?
Because it can develop into skin cancer
Because as it increases in size it can become very painful
Because if a person has more than three lesions they may have liver cirrhosis
What skin cancer is actinic keratosis most likely to develop into?
Melanoma
Squamous cell carcinoma
Basal cell carcinoma
What treatments are there for actinic keratosis?
Cryptherapy
Systemic retinoids
Which type of skin cancer is considered to be the least serious?
Where on the body does basal cell carcinoma most commonly present?
Head and neck
Hands and arms
Any sun exposed area
What is the appearance of a basal cell carcinoma lesion?
Shiny, translucent nodule
Dark, asymmetrical lesion
Inflamed, crater-shaped lesion
Why is basal cell carcinoma not referred under the two week wait rule?
Because it very rarely metastasizes
Because nothing can be done to remove this cancer
Because too many people get this type of cancer for the NHS to deal with
Squamous cell carcinoma only arises from actinic keratosis. True or false?
What is squamous cell carcinoma caused by?
Cumulative sun-exposure
Over stimulation by hormones
Smoking
Some recreational drugs
What features of a skin lesion would make it suspicious?
One solid colour only
Asymmetry
Clear borders
Diameter bigger than 6mm
Additional features, e.g. itching or bleeding
