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DERM QS > Acne, eczema, psoriasis, molluscum > Flashcards

Acne, eczema, psoriasis, molluscum Flashcards

1
Q

Describe the pathophysiology of acne

A

Follicular epidermal hyperproliferation = KERATIN PLUG causes obstruction of the pilosebaceous = follicle colonisation by anaerobic Propionibacterium acnes = inflammation

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2
Q

What are the 2 types of comedone?

A

o Open top: blackhead

o Closed top: whitehead

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3
Q

What are the features of acne?

A 
Comedones
Papules
Pustules
Nodules 
Cysts 
Scars: ice-pick, hypertrophic (keloid)
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4
Q

What is drug-induced acne and give e.g. of a drug?

A

Monomorphic

- get pustules in steroid use

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5
Q

What is acne fulimans?

A

Severe + systemic upset

Hospital admission required

Responds to oral steroids

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6
Q

Classify acne

A

1- Mild: open + closed comedones +/- sparse inflammatory lesions

2- Moderate: widespread non-inflammatory lesions + many papules, pustules

3- Severe: extensive inflammatory lesions +/- nodules, pitting, scarring

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7
Q

What is the step-up Mx of acne?

A

Single topical therapy: Topical retinoid, benzoyl peroxide

Topical combo therapy: Topical Abx, benzoyl peroxide, topical retinoid

Oral abx (max 3m):
Tetracyclines, erythromycin

COCP: Alternative to oral abx

Oral isotretinoin (Roaccutane): Is a retinoid
Only under specialist supervision
CI to topical + oral retinoid = PREGNANCY
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8
Q

Give 3 e.g. of oal abx used for acne and when should they be avoided?

A

Tetracyclines: lymecycline, oxytetracycline, doxycycline

Avoid in PREGNANT/BREASTFEEDING + <12y

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9
Q

Which oral abx for acne are safe in pregnancy?

A

Erythromycin

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10
Q

What is one complication of long-term abx use in acne?

A

Gram -ve folliculitis

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11
Q

What should you prescribe for gram -ve folliculitis?

A

High-dose oral trimethoprim

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12
Q

What is cause of eczema?

A

Atopic

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13
Q

What gene is involved in eczema?

A

Filaggrin gene mutation

Primary defect in skin barrier

Immunological changes secondary to enhanced antigen penetration through a deficient epidermal layer

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14
Q

Name some triggers for an eczema flare-up

A 
Soap/ detergents
Overheating
Rough clothing
Skin infection
Pets
Aeroallergens (pollen)
Food
House-dust mites
Stress
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15
Q

What are the variations of eczema distribution with age?

A

Infants: Cheeks and trunk

Older children/adults: flexures

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16
Q

Describe flare-ups

A

Red, vesicles, weepy, crusty

Excoriations, lichenification

17
Q

What are the clinical requirements for diagnosis?

A 
Itchy skin +1 of:
o	Onset < 2 years
o	Hx of dry skin
o	Atopy hx / hx in 1st degree relative
o	Past flexural involvement
o	Visible flexural dermatitis / or on cheeks, forehead or outer side of limbs in < 4 years
18
Q

Describe eczema distribution in asian and black african?

A

On extensor surfaces rather than flexor

19
Q

What is eczema herpaticum?

A

Widespread lesions that coalesce into large, denuded, bleeding areas that extend over entire body

Can have serious sequelae: Eye and meningeal involvement = scarring

RF: early-onset, severe atopic eczema, marked IgE elevantion, peripheral eisoniphilia, filaggrin gene mutations

20
Q

Name a mild topical steroid + dose + brand name

A

Hydrocortisone 0.5-2.5%

Canestan

21
Q

Name 2 moderate topical steroid + dose + brand name

A

Betamethasone 0.025%
(Betnovate)

Clobetasone butyrate
(Eumovate)

22
Q

Name 2 potent topical steroid + dose + brand name

A

Fluticasone propionate 0.05%
(Cutivate)

Betamethasone valerate 0.1%
(Betnovate)

23
Q

Name a very potent topical steroid + dose + brand name

A

Clobetasol propionate 0.05%

Dermovate

24
Q

What is Psoriasis?

A

Hyperproliferation of keratinocytes and inflammatory cell infiltration

25
Q

What is psoriasis associated with?

A

T cell mediated : stimulates keratinocyte proliferation

HLA B13, B17, Cw6

Environmental: infections eg strep. Skin trauma or stress

Drugs: beta blockers, lithium, nsaids, anti malarials, ace-i

26
Q

Which type of psoriasis can a strep infection cause?

A

Guttate psoriasis

27
Q

Describe chronic plaque psoriasis

What is Auspits sign?

A

Most common type

Symmetrical

Dry raised erythematous skin lesions aka plaques

Flaky silvery white scales

May be itchy or painful

Typically affects extensor surfaces eg elbows, knees and scalp

Auspits sign: Bleed on scale removal or picking

28
Q

What is the Mx for chronic plaque psoriasis?

A
  1. Potent Corticosteroid + Vit D analogue applied OD (up to 4 weeks) – applied separately (one morning/one evening)
  2. No improvement >8w - Vit D analogue applied BD
  3. No improvement >8-12w - Potent corticosteroid BD or coal tar preparation BD
29
Q

Describe pustular psoriasis and what is the Mx?

A

Typically affects palms of hands, fingertips and soles of feet

Pus filled blisters hours after redness and tenderness of skin

More serious form of psoriasis and requires urgent treatment under dermatological supervision

Mx: Oral retinoid

30
Q

What is guttate psoriasis?

A

More common in children and young adults

Typically triggered by streptococcal infection 2-4w prior

Rain/tear drop like plaques affecting trunk, arms and legs

Large no. of small plaques <1cm

31
Q

Name the main DDx for guttate psoriasis

A

Pityriasis Rosea

32
Q

What is the Mx for Guttate Psoriasis?

A

Spontaneous resolution within 2-3m

Topical agents as per psoriasis

UVB phototherapy

Tonsillectomy if recurrent episodes

33
Q

What is generalised/ erythodermic psoriasis?

A

MEDICAL EMERGENCY – urgent referral to hospital

Triggered by rapid withdrawal of steroids

Diffuse, wide-spread severe psoriasis >90% body SA affected

Systemic upset: fever, malaise, tachycardia, lymphadenopathy

34
Q

What is the general Mx for psoriasis?

A

Avoid triggers: stress, alcohol, drugs, smoking, skin trauma

Regular emollients: help soften skin and stop itch

35
Q

What is the secondary care Mx for psoriasis?

A

Phototherapy

Systemic therapy

  • 1st line: oral methotrexate
  • Others: ciclosporin, systemic retinoids, biologics
36
Q

What causes molluscum contagiosum and how is it transmitted?

A

Molluscum contagiosum virus (MCV)

Transmitted through close contact/ contaminated surfaces (towels)

37
Q

What are the features of molluscum contagiosum?

A

Pinkish/ pearly papules + white dot in centre

Appear in clusters anywhere in the body - except palms and soles

Lesions contagious

Scratching = infection

38
Q

What is the Mx of molluscum contagiosum?

A

Self-limiting

Spontaneous resolution ~18m

No exclusion from school, gym, swimming

DERM QS (2 decks)

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