Clinical dermatology cases Flashcards
What are the key areas to consider in any skin condition?
Distribution
Morphology
Secondary features (e.g arthritis)
Psoriasis often starts in childhood. T/F
False - psoriasis is largely a disease of adulthood
Psoriasis is a chronic condition. T/F
True
What are the causes of psoriasis?
Genetic, stress, infection, Koebner phenomenon
What is the commonest form of psoriasis?
Chronic plaque psoriasis/psoriasis vulgaris
What are the typical features of plaque psoriasis rash?
Symmetrical distribution
Scaly, erythematous plaques (+/- silvery scale)
Sharp borders
Which sites does plaque psorasis commonly affect?
Extensors Nails Hands, feet Trunk Scalp Sacrum
List the types of psoriasis
Guttate
Palmoplantar pustulosis
Nail disease
Erythrodermic/widespread pustular
What does guttate psoriasis look like?
Small, circular plaques
What are the features of psoriatic nail disease?
Pitting, onycholysis, dystrophy, subungal hyperkeratosis
How common is erythrodermic/widespread pustular psoriasis?
Uncommon
What is the koebner phenomenon?
Psoriasis arising from an area of trauma
What are the common treatments for psoriasis?
Vitamin D analogues
Coal tar
Topical steroids
List some vitamin D analogues
Calcipotriol
Calcitriol
What are the specialist treatments for psoriasis?
Narrowband UVB and PUVA Retinoids Immunosuppressants Fumaric acid ester Immune modulators
Alcohol can trigger psoriasis. T/F
True
Obesity and psoriasis can be linked. T/F
True
Guttate psoriasis often follows which respiratory infection?
Steptococcus
What is acne vulgaris?
Chronic inflammatory disease of the pilosebaceous unit
When does acne vulgaris present?
In adolescents (younger in females, older in makes)
Is there a genetic component to acne vulgaris?
Yes
What is the pathogenesis of acne vulgaris?
Pore occlusion –>
Colonisation of duct –>
Dermal inflammation –>
Increased sebum production
What are the common sites of acne vulgaris?
Face, upper back and chest
What is found in acne?
Comedones, pustules, papules, cysts
What are the secondary features of acne?
Atrophic scars, ice-picking, hypertrophic
How is acne graded?
Mild - scattered papules, pustules and comedones
Moderate - numerous papules, pustules and mild scarring
Severe - cysts, nodules, significant scarring
How is acne treated locally?
Benzoyl peroxide
Topical vitamin A/retinoids
Topical antibiotics
How is acne treated systemically?
Antibiotics Oral retinoids (isotrenitoin)
What is a side effect of isotrenitoin?
Initial flare of acne
What is a retinoid used in acne?
Adapalene
Where is rosacea usually distributed?
Nose, chin, cheeks and forehead
How does rosacea typically present?
Papules, pustules, erythema without comedones
Facial flushing
What can exacerbated rosacea?
Temperature
UV exposure
Dietary (spicy food)
Alcohol
In which age group does rosacea typically present?
Middle aged
What is rhinopyma?
Thickening of the sebaceous tissue of the nose
How can you reduce the aggravating factors in rosacea?
Dietary avoidance
Wear sunscreen
Avoid topical steroids (make worse in long term)
What is steroid rosacea?
Rosacea induced by potent topical steroids
Which antibiotics may be prescribed in rosacea?
Topical metronidazole
Oral tetracycline
When might isotretinoin be used in rosacea?
Low doses can be used in severe rosacea
How can telangectasia be treated?
Vascular laser
How can rhinopyma be treated?
Surgically
Laser shaving
What is the memory aid to differentiate between bullous pemphigoid and pemphigus vulgaris?
Bullous pemphigoid - split is Deeper through DEJ
Pemphigus vulgaris - split is Superficial, Intra-epidermal
In which age group does bullous pemphigoid typically present?
Elderly
What is the typical distribution of bullous pemphigoid?
Localised to one area
Widespread on the trunk and proximal limbs
What is the typical appearance of bullous pemphigoid blisters?
Large, tense bullae (normal or erythematous skin) –> bursts to leave erosions
Does bullous pemphigoid scar?
No
How may bullous pemphigoid first present?
Itchy, erythematous plaques/papules
Is bullous pemphigoid Nikolsky negative or positive?
Negative
Mucosal lesions are typical in bullous pemphigoid. T/F
False
What is the typical distribution of pemphigus vulgaris?
Scalp, face, axillae and groin
What is the typical appearance of pemphigus vulgaris?
Flaccid, thin roofed vesicles/bullae –> ruptures to leave raw areas
Is infection risk increased in bullous pemphigoid or pemphigus vulgaris?
Pemphigus vulgaris
Is pemphigus vulgaris Nikolsky negative or positive?
Positive
Mucosal lesions are typical in pemphigus vulgaris. T/F
True
Where are the mucosal blisters in pemphigus vulgaris found?
Eyes, genitals
What is the prognosis for 1) pemphigoid and 2) pemphigus
If treated both conditions are chronic but self-limiting over a period of months-years. Untreated pemphigus has a high mortality rate due to the infection risk.
What investigations are indicated in suspected cases of pemphigus and pemphigoid?
Skin biopsy with direct immunofluorescence
Indirect immunofluorescence
How is pemphigus and pemphigoid treated?
Systemic steroids (mainstay)
Immunosuppression (methotrexate, azathioprine)
Tetracycline antibiotics (pemphigus specific)
Topical emollients
Topical steroids
