clinical Flashcards
acne vulgaris symptoms and signs
Open and closed comedones inflammation papules pustules nodules cysts pseudocysts
acne vulgaris treatment
Topical retinoids benzoyl peroxide topical antibiotics azelaic acid antibiotics tablets combined oral contraception Isotretinoin tablet
acne fulminans symptoms and signs
Cystic acne nodular suppurative systemic fever arthralgia myalgia hepatosplenomegaly
Rosacea symptoms and signs
Polymorphic facial centrally vascular changes episodic flushing erythema, burning pustules oedema, fibrosis, glandular hyperplasia recurrent blush telangiectasia deeper red colour, deep cystic nodules papules ocular dryness, tearing, pain, chalazia and corneal damage
rosacea treatment
Avoid irritants metronidazole azelaic acid cream ivermectin cream tetracyclines surgery for rhinophymas
erythroderma signs
> 90-95% skin inflamed
erythroderma treatment
Fluid balance nutrition temperature regulation emollients oral and eye care treat infection manage itch remove offending drugs
SJS symptoms and signs
Fever, malaise, arthralgia, rash, blisters, maculopapular, erosions, mouth ulceration, haemorrhagic crusting
SJS treatment
Stop culprit drug and supportive therapy
toxic epidermal necrolysis symptoms and signs
Prodromal febrile illness, ulceration of mucous membranes, rash blistering, then confluent with desquamation. + nikolsky sign
toxic epidermal necrolysis and SJS complication
Pigmentation changes eye disease blindness nail and hair loss joint contractures
erythema multiforme symptoms and signs
Distal to proximal stating in palms and soles
pink blistering macules
erythema multiforme treatment
Self-limiting, treat symptoms and underlying cause.
Drug reaction with eosinophilia and systemic symptoms - symptoms and signs
Eosinophilia
deranged liver function
fever
rash
Drug reaction with eosinophilia and systemic symptoms - treatment
Stop drug
symptomatic support
systemic steroids
use of immunosuppression
pemphigus symptoms and signs
Flaccid blisters face, axillae, groin \+ nikolsky sign mucousal erosion erosive stomatitis
pemphigus treatment
Systemic steroids, dress erosions, supportive therapy
pemphigoid symptoms and signs
Intact epidermis forms roof of blister
intact and tense
pemphigoid treatment
Topical steroids, may require systemic if diffuse
erythrodermic psoriasis and pustular psoriasis symptoms and signs
Rapid generalised erythema with clusters of pustules
fever, elevated WCC
red man syndrome
erythrodermic psoriasis and pustular psoriasis treatment
Avoid steroids, initiate systemic therapy.
thick greasy emollients
bloods
fluid balance
eczema herperticum symptoms and signs
Monomorphic blisters punched out erosions, painful. Fever and lethargy
eczema herperticum treatment
Treatment dose of aciclovir
mild topical steroid
staphylococcal scalded skin syndrome symptoms and signs
Prominent in flexures blistering desquamation fever irritability erythema rash with tenderness
staphylococcal scalded skin syndrome and treatment
IV antibiotics
resolves 5-7 days with treatment
urticaria symptoms and signs
Erythema and swelling. Dermal oedema. Itching, burning
urticaria treatment acute
Oral anti-histamines
short course of oral steroids
avoid opiate + painkillers
urticaria treatment chronically
chronically; anti-histamine, anti-leukotrine, tranexamic acid for angioedema and finally cyclosporin, omalizumab
seborrheic keratoses symptoms and signs
Variable warty growths. Looks stuck on, patients often have multiple with cherry angiomas
seborrheic keratoses treatment
Cryotherapy
curettage
leser trelat symptoms and signs
Abrupt onset of widespread seborrheic keratosis
leser trelat complications
GI adenocarcinoma
viral warts cause
HPV
viral warts symptoms and sign
Rough hyperkeratotic surface
pain
discomfort
clusters from mosaics
viral warts treatment
Self-limiting
cryotherapy
curette
salicylic acid
cysts symptoms and signs
Encapsulated lesion containing fluid or semi fluid material
firm and fluctuant
cysts treatment
Excision
inflammation treat with antibiotics
intralesional steroids
incision and drain
dermatofibroma symptoms and signs
Fibrous nodule
firm, tethered to skin, mobile over fat. Pale, pink/brown. Dimple sign positive. Can be itchy or tender but often asymptomatic
lipoma signs and symptoms
Smooth rubbery subcutaneous mass
asymptomatic
angioma signs and symptoms
Bleed
cherry
spider naevi
venous lakes
angioma treatment
excision and laser
pyogenic granuloma signs and symptoms
Rapidly growing red raw granuloma, bleeds easily. Found on head and hands
pyogenic granuloma treatment
curettage and cautery
actinic keratoses signs
rough scaly patches
actinic keratoses treatment
Cryotherapy
imiquimod
diclofenac gel
curettage
bowen’s disease symptoms and signs
Dysplasia
irregular scaly erythematous plaque
bowen’s disease treatment
Cryotherapy, curettage,
photodynamic therapy
imiquimod
eczema atopic dermatitis signs
Itchy skin past 12 months + Flexural involvement <2yrs old dry skin atopic disease family history
eczema atopic dermatitis symptoms
erythema, scale, papules, vesciles, exudate, crusting excoriation acute
chronic – plaques, lichenification, fissuring
chronic eczema dermatitis symptoms
chronic – plaques, lichenification, fissuring
eczema dermatitis diagnostic criteria
Modified Hanifin and Rajka criteria
eczema dermatitis causes/pathophysiology
Filaggrin gene
atopic family history
epidermal barrier dysfunction
environmental factors
inflammation, acanthosis, spongiosis
treatment for eczema atopic dermatitis
Emollients soap substitutes removal of causitive factors intermittent topical steroids antihistamines antimicrobials calcineurin inhibitors Severe- UV + azathioprine ciclosporin mycophenolate-mofetil methotrexate
allergic contact dermatitis test
patch testing
seborrheic dermatitis signs and symptoms
Pattern – rad sharp margined lesions, greasy scales
scalp
proximal features
dandruff
seborrheic dermatitis cause
malassezia yeast
treatment for seborrheic dermatitis
ketoconazole topical anti-yeast
additional investigation for seborrheic dermatitis
HIV testing
pompholyx/vesicular eczema signs and symptoms
Palms and soles itchy <40 crops of vesicles desquamation
asteatosis eczema
Very dry skin, cracked scales, shins, excessive soap exposure
asteatosis eczema cause
loss of oil barrier
venous eczema treatment
compression stocking
acanthosis symptoms and treatments
Flexural hyperkeratosis hyperpigmentation papules velvety weight loss lip involvement
acanthosis complications
GI adenocarcinoma
psoriasis symptoms and signs
Sharply demarcated erythroderma micaceous scale acanthosis pustules onycholysis, pitting, oil spots on nails, scalp, Koebner phenomenon Woronoff’s ring
psoriasis investigations and indexes
Skin biopsy if atypical
psoriasis area severity index
QOL index
psoriasis treatment
Emollients soap substitutes vitamin D3 analogues topical steroids salicylic acid coal tar creams UVB sun bed retinoid methotrexate ciclosporin biologics
carcinoid syndrome symptoms
Episodic flushing
facial telangiectasia
no sweating
carcinoid syndrome may reflect what underling conditions
Liver metastatic
bronchial, ovarian cancer
erythema gyratum repens symptoms and signs
Concentric erythematous lesions
acquired hypertrichosis lanuginose symptoms and signs
Acute onset of lanugo hairs at face and body
acquired hypertrichosis lanuginose complications
colorectal, lung, breast
bazex syndrome symptoms and signs
Hyperkeratosis of extremities
resembles psoriasis
bazex syndrome underlying cancers
SCC, bronchial, oropharyngeal, GI, gastric, colon, biliary, adenocarcinoma
Paget’s disease symptoms and signs
Extension of ductal adenocarcinoma
eczema plaque at nipple
Paget’s disease underlying cancer
bladder, colon, adenocarcinoma
dermatomyositis symptoms and signs
Inflammatory myopathy + rash periorbital heliotrope rash gottron’s papules over bony prominences shawl sign photosensitive poikiloderma scalp erythema
treatment for hypothermia
Insulate
slow rewarming with blanket
internal rewarming with hot drink
fast rewarming with water immersion and extracorporeal circulation
treatment for heat exhaustion
Cool environment remove clothing tepid water fan give fluids oral or IV
basal cell carcinoma symptoms and signs
Slow growing
locally invasive
telangiectasia
arborizing vessels
investigation for basal cell carcinoma
dermoscopy
basal cell carcinoma treatment
Excision
if not possible then curettage
if not RT or surgery then Vismodegib
SSC symptoms and signs
Fast growing
tender
scaly
ulceration
SSC treatment
excision and RT
melanoma symptoms and signs
Change in size shape colour >5mm oozing/bleeding mild itch, altered sensation
melanoma investigations
dermoscopy
lymph node biopsy
melanoma treatment
Surgical excision
chemo
immunotherapy
mycosis fungoides symptoms and signs
Patch; flat red dry oval lesion, itchy
plaques; thick, itchy
tumour; irregular ulcerating lumps
mycosis fungoides and sezary syndrome investigation
blood for sezary cells and CT
mycosis fungoides and sezary syndrome treatment
Topical steroids P-UVA localised RT interferon bexarotene low dose methotrexate chemo skin electron beam therapy extracorporeal photopheresis bone marrow transplant
sezary syndrome symptoms and signs
Red man syndrome itchy thickened skin scaly red lymph node involvement
impetigo signs and symptoms
Children
Macule-vesicle – erosion with yellow crust
impetigo treatment
Topical wound care
topical antibiotics
folliculitis treatment
Antibacterial wash
antibacterial ointment
folliculitis investigation
bacterial culture
erysipelas signs and symptoms
Young, debilitated, old, cutaneous ulcers
erythema with well-defined margins
hot, tense, indurated, face + lower extremities, chills, fever, malaise, nausea
erysipelas investigation
leukocyte count shift left
erysipelas treatment
10-14 days penicillin
cellulitis signs and symptoms
Rubor Calor dolor tumour non-palpable borders child; head and neck adult; distal
cellulitis treatment
antibiotics
syphilis stages and symptoms
1- Painless ulcer
2 – widespread rash, flue, red papules, patches, palms and soles
3 – granulomatous lesion gumma
syphilis investigations
Non-specific non-treponemal antibody test
specific anti-treponemal antibody test
syphilis treatment
penicillin
HSV symptoms an signs
Orolabial or genital infection
erythema
vesicles and ulceration
HSV treatment
anti-virals
chicken pox signs and symptoms
Red macules-vesicles, pustules – crusts, fever malaise, dew drops on a rose petal, facial then centrally
chicken pox treatment
calamine lotion
shingle symptoms and sign s
Localised blistering and painful rash
dermatomal distribution
singles treatment
infection, prevention, pain relief
shingles complication
post herpertic neuralgia
molloscum contagiosum signs and symptoms
<10
warm climates
firm umbilicated pearly papules, waxy surface in skinfolds
molloscum contagiosum treatment
Liquid nitrogen
curettage
chemovesicants
molloscum contagiosum cause
pox virus
dermatophytosis symptoms and signs
Post pubertal
nail, groin, scalp, foot
waves with clear centres, dead skin and dry skin, loss of hair
candida symptoms and signs
Erythematous patches
satellite pustules
inguinal creases
pityriasis versicolour symptoms and signs
Excessive sweating, high temperature oily skin, multiple oval patches with mild scale, red, brown, white
pityriasis versicolour cause
malassezia
pityriasis versicolour treatment
topical antimycotic
scabies signs and symptoms
Close contact
overcrowding
passionate itch disturbing sleep
irregular tracks
scabies cause
Sarcoptes scabiei
head lice symptoms and signs
Itch irritation
behind neck and ears, red brown spots
scabies treatment
anti-scabietic topical cream
head lice treatment
2 applications of insecticide, physical methods. Treat all family and school
