28/5 Flashcards
State the typical presentation of the following skin conditions and how they are managed:
1. Erthyema multiforme - associated with allergic reaction to medicine or infection
2. Pitryasis rosea - occuring after URTI
3. Steven-Johnson syndrome
- Erthyematous target lesions
- Single ‘herald patch’ - single, discoid patch followed by several smaller smaller leisons “christmas tree’ pattern
- reassure and discharge - self-limitng - Desquamating rash and mucosal involvement when becoming toxic epidermal necrolysis (TEN)
- caused by drugs - management is supportive
ABCDE of melanoma
How is it investigated and managed?
What is Breslow’s thickness a measure of?
Asymmetry
Border - irregular
Colour - irregular
Diameter >0.6cm
Evolution of symptoms
+ extra features e.g. itch/bleeding
Invx - breslow’s thickness - granular layer to the deepest layer
Excision with safe margain dependant on breslow’s thickness
What is lichen planus?
5 Ps
Planur (flat-topped)
Purple
Pruritic
Papular
Polygonal (multiple sides)
Can have a white-lace pattern on buccal mucosa - Wickham striae
Management of psoriasis
Conservative
- typical conservative
- education around condition and patient information leaflets
- is an association with arthiritis so to look for signs of that and come back if so
Medical
- potent topical steroid (betnovate) + topical vit D
- phototherapy
- immunosuppresants e.g. methotrexate
- biologics - anti-TNF - infliximab
Neurofibromatosis acronym
What neuro condition can it cause?
What type of inheritance does it follow?
CRABBING
Cafe-au-lait spots
Relative with NF1
Axillary or inguinal freckles
Bony dysplasia
Bowing of a long bone
Iris hamartomas (Lisch nodules)
Neurofibromas (2+)
Glioma of optic nerve
Epilepsy
Autosomal dominant
Order of steroid potency
Help Every Budding Dermatologist
Hydrocortisone
Eumovate (clobetasone)
Betnovate (betamethasone)
Dermovate (clobetasol)
Steroid side effects - systemic
CORTICOSTEROIDS
Cushing’s syndrome
Osteoporosis
Retardation of growth
Thin skin, bruising, striae
Immunosuppression/infection
Cataracts and glaucoma
Obesity
Suppresion of HPA axis
Tired muscles (muscle weakness and atrophy)
Emotional disturbance
Rise in BP and lipids
Oedema
Increased hair growth
DM
Stomach upset and ulcers
ATHLETICS for steroids
A - used to reduce inflam and suppress the immune system (different from the steroids that people take at the gym and athletes)
T - morning with food (can cause sleep distrubances and irritate the stomach lining)
H - sometimes given lots of tablets a day - should take them all at once
L - some long-term, some short-term depends
E - reduces autoimmune response and symptoms
T - BP, BMI, body weight, lipid and K+, HbA1c, eye exams every 6-12months
I - CORTICOSTEROIDS
C - just be cautious in people who already have sx of CORTICOSTEROIDS
S - remember sick day rules (double dose when unwell + carry steroid emergency card)
DDx of psoriasis
Tinea corporis
Eczema
Lichen planus
Pityriasis rosea
Conservative management of dermatological conditions
Conservative
- Avoid irritants e.g. soap or perfume
- Use soap substitutes - aqueous cream
- Emollients e.g. dibrobase - copious amounts multiple times a day particularly after washing when skin is still wet
What is the treatment for genital warts?
Topical podophyllotoxin (plant-based anti-viral that stops replication - phyll = plants = flowery looking warts)
Can also do cryotherapy
Important to know that it can reappear
Medically what can be given to help with itch?
Anti-histamines (non-sedating)
- Cetirizine
- Fexofenadine
- Loratidine
Fox stays up all night = non-sedating
What is erythroderma?
Derm emergency - caused by eczema, psoriasis or drugs
Invx
- redness of more than 90% of body
Manage
ABCDE with IV fluids (MUST MAINTAIN FLUID LOSS)
Stop drugs
Cover in liquid paraffin and eumovate
Step management of acne
- Topical benzonyl peroxide
- Abx e.g. doxycycline or lymecycline
- Vit A analogue
- Isoretinonin (roaccutane) - make sure to exclude pregnancy/long-term contraception
Management of roseasea
Topical ivermectin, topical azealic acid, topical metronidzole
