Acne, Rosacea, Skin Cancers and Precursors Flashcards
Acne vulgaris
-epidemiology
-pathophysiology
-presentation
-diagnosis
-management
-referral
10-20s in both genders
Proliferation of propioninibacterium acnes within follicles => inflammation
Increased sebum production from androgens creates a favourable environment for Pacnes
Comedones, inflammation and pustules
Scarring - icepick, hypertrophic (raised)
Clinical diagnosis
Initial - 12wk TOP
-adapalene + benzoyl peroxide
-clindamycin + tretinoin
-clindamycin + benzoyl peroxide
If severe add
-PO lymecycline or doxycycline
or TOP azelaic acid + 1 PO ABx
Refer to specialist for PO isotretinoin if
-scarring, persistent pigment changes
-no change to 2 treatment courses
-no change with PO ABx
-persistent psychological distress
Acne vulgaris
-prescribing cautions
Avoid tetracyclines if
-pregnant or breastfeeding => use erythromycin or
-children U12
Reducing risk of resistance
-Don’t use PO and TOP ABx together
-Give ABx with TOP retinoid or benzoyl peroxide
-Give COCP with TOP agent
Avoid retinoids if pregnant
-unless using 2 forms of contraception
Basal cell carcinoma
-risk factors
-presentation
-investigations
-management
Sun exposed sites - H+N
Rolled edges with crater
Very slow progression, so routine referral is sufficient
Surgical removal
Cryotherapy
RT
TOP fluorouracil
Bowen’s disease
-risk factors
-presentation
-diagnosis
-management
Precancerous precursor to squamous cell carcinoma
Elderly
Sun exposed areas
Red scaly patch
Slow growing
Diagnosed and managed in primary care if diagnosis
-TOP 5 fluorouracil with TOP steroids to manage inflammation and redness
-cryotherapy
-exicision
Rosacea
-epidemiology
-presentation
-diagnosis
-management
40-50s females
Nose, cheek and forehead
Flushing => persistent redness, papules, pustules
Telangiectasia
Blepharitis
Worsened by sunlight
Clinical diagnosis
Suncream, camouflage cream
1st line - TOP ivermectin
Metronidazole/azelaic acid
Severe, papules, pustules
-TOP ivermectin + PO doxy
Malignant melanoma
-risk factors
-presentation
-management
-prognosis
Sunexposure
Asymmetry
Borders poorly defined
Colours - many
Diameter 7mm+
Exudate - oozing, bleeding
Excision biopsy - margin of excision related to Breslow thickness of lesion
Breslow thickness => lower 5 year survival
Cautions with TOP CS
TOP CS - skin atrophy, striae, rebound symptoms
4wk break before starting another round of TOP CS
Systemic SE seen when used on 10%+ BSA
Potent CS - max 8wks
V potent CS - max 4wks
Squamous cell carcinoma
-risk factors
-presentation
Sunexposure, UVA therapy
Actinic keratoses, Bowen’s disease
Immunosuppression post renal transplant, HIV
Smoking
Chronic leg ulcers
Sunexposed sites
Rapidly expanding, painless, ulcerating nodules
Cauliflower
Some bleedimg
Surgical excision
Actinic keratoses
-what is it
-presentation
-mamagement
Common premalignant skin lesion from chronic sun exposure
Small, crusty, scaly lesions
Pink/red/brown/skin coloured
Sunexposed areas
Avoid the sun, suncream
Fluorouracil cream - 2-3wks, can cause skin inflammation
-TOP hydrocortisone used afterwards
TOP diclofenac
TOP imiquimod
Cryotherapy
Curettage and cautery