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MD2 Foundation > Common Dermatological Conditions > Flashcards

Common Dermatological Conditions Flashcards

1
Q

What questions do you focus on in a dermatological history?

A 
Childhood complaints
Family history
Other medical history; eg: hay fever
What else have you tried?
What makes it worse?
When did it start?
What did it seem related to?
Are you systemically unwell?
Known allergies
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2
Q

Is there a genetic association in atopic eczema?

A

Yes, there’s a genetic predisposition

Elicit from family history

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3
Q

What is the atopic triad?

A

Asthma
Hay fever
Eczema

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4
Q

What are the clinical features of atopic eczema?

A 
Moderate itchiness
Erythematous
Diffuse
Flexural - on thinnest skin
Worse in winter because dry
Worse in summer because of heat
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5
Q

What are the environmental triggers of atopic eczema?

A 
Irritants
Allergy
Heat
Infection
Itch-scratch cycle
Stress and anxiety
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6
Q

Where is atopic eczema found on an infant, compared to adults?

A

Often on extensor surfaces, rather than flexural surfaces

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7
Q

What is discoid eczema?

A

Eczema in annular disk-like patches

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8
Q

What does discoid eczema mimic?

A

Psoriasis

Tinea

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9
Q

What does discoid eczema respond to?

A

Potent topical steroids

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10
Q

What is asteatotic eczema?

A

Cobblestoned dry skin

Worse on front of legs of elderly patients

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11
Q

What does asteatotic eczema respond to?

A

Emollients - keeps barrier intact to avoid infections

Topical steroids

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12
Q

What is pompholyx?

A

Vesicular hand (and foot) eczema

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13
Q

What can precipitate pompholyx?

A

Excessive washing

Sweating

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14
Q

How is pompholyx treated?

A

Potent topical steroids

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15
Q

How is pompholyx prevented?

A 
Avoidance of
- Detergents
- Soaps
- Irritants
Regular emollients
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16
Q

What is diffuse erythrodermic eczema?

A 
Severe eczema - >90% of body surface area
Significant morbidity
Usually infected with Staphylococcus
Can be
- Tachycardic
- Hypotensive
- Septic shock
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17
Q

What is the treatment of diffuse erythrodermic eczema?

A

Hospital admittance
Intense topicals
Systemic immunosuppression

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18
Q

What are the complications of eczema?

A

Bacterial superinfection
Eczema herpeticum
Contact dermatitis

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19
Q

What happens in bacterial superinfection of eczema?

A

Eczematous skin lacks natural antibacterial peptides

Often superinfected with S aureus - produces golden crust

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20
Q

What is the treatment for bacterial superinfection of eczema?

A

Systemic anti-Staph antibiotics

30 mL of bleach in 30-40 L bath > bathe children > can decrease high Staph load

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21
Q

What is eczema herpeticum?

A

Secondary infection by HSV pf eczematous skin

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22
Q

What are the clinical features of eczema herpeticum?

A 
Dermatomal pattern
Intensely painful vesicles
Sudden onset
Worsening of pre-existing eczema
Punched out erosions
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23
Q

Why is eczema herpeticum an emergency?

A

Risk of corneal scarring

Needs urgent assessment by ophthalmologist

24
Q

What is the treatment for eczema herpeticum?

A

Systemic antiviral treatment

25
Q

What is the difference between allergic and irritant contant dermatitis?

A 
Allergic = your own immune system reacting to a substance
Irritant = affects everyone; eg: dipping your hands in hydrochloric acid
26
Q

What is used to diagnose allergic contact dermatitis?

A

Patch testing

27
Q

What are the general measures for the treatment of atopic eczema?

A

Avoid soap
Regular emollient
Warm, not hot showers

28
Q

What are the specific treatments for atopic eczema?

A

Topical steroid to inflamed areas
Mild steroid for face/non-steroidal anti-inflammatory creams
Treat infection with systemic antibiotics

29
Q

What are the other treatment options for atopic eczema?

A

Wet dressings
Phototherapy with UVB
Systemic immunosuppression

30
Q

In whom is psoriasis more common: children or adults?

A

Adults

31
Q

What is the distribution pattern of psoriasis?

A

Symmetrical
Around joints
- Affects joints too

32
Q

What are the clinical features of psoriasis?

A 
Genetic predisposition
Age of onset
- 20s
- 50s
Extensor rash
Symmetrical
Silvery scale
Well demarcated
Itchy, but not primary complaint, like in eczema
Erythematous/salmon pink
33
Q

Describe flexural and genital psoriasis

A 
Affects only certain flexural surfaces, like
- Under breasts
- Around groin
- Around gluteal cleft
Flatter and less scaly
34
Q

Describe palmar-plantar psoriasis

A

Painful
Can develop quite deep fissures
Bacterial infections through damaged skin barrier
Extreme swelling can lead to infarcts
- Grossly swollen hands medical emergencies
- Sometimes surgical emergencies

35
Q

What are sterile pustules?

A

Full of pus, but just part of inflammatory response, not response to infection

36
Q

What is post-streptococcal guttate psoriasis?

A

1-2 weeks after Streptococcus URTI/tonsillitis
Sudden generalised onset of small plaque psoriasis
Most will clear with treatment
Recurs if Streptococcus infection again

37
Q

What is the treatment for post-streptococcal guttate psoriasis?

A

Very responsive to phototherapy

38
Q

What is generalised pustular psoriasis?

A 
Acute pustular flare of psoriasis
Often accompanied by systemic symptoms
- Fever
- Chills
Loss of 
- Barrier function
- Thermoregulation
- Protein
Risk of
- Pre-renal impairment
- High output cardiac failure
- Sepsis
Hospital admission to stabilise
39
Q

How do you treat psoriasis?

A 
Depends on severity and comorbidities
Topical
Phototherapy
Systemic
Often used in combination
40
Q

What are the topical treatments of psoriasis?

A 
Steroids
Tars
Calcipotriol
Dithranol
Keratolytics
Emollients
41
Q

What are the phototherapy treatments of psoriasis?

A

Narrowband UVB treatment

42
Q

What are the systemic treatments of psoriasis?

A

Oral acitretitin
Methotrexate
Cyclosporin A
Biological treatments

43
Q

What are the causes of acne?

A 
Starts in adolescence
- Increasing sebum production
Can be flared by
- Hormonal factors
- Picking
- Emotional stress
Medications
- Lithium
- Anabolic steroids
- Topical corticosteroids
Topical occlusion
- Oily makeup
- Moisturisers
- Headwear
- Hairstyling
44
Q

What are the four parts of acne?

A

Abnormal keratinisation of sebaceous duct
Colonisation with Propionobacterium acnes
Increase in androgen levels > increased sebum production
Inflammation

45
Q

What are blackheads?

A

Open comedone

- Oxidised sebum

46
Q

What are whiteheads?

A

Closed comedone

47
Q

What is hormonal acne?

A

Premenstrual flare

Mainly on lower face

48
Q

What is the treatment of hormonal acne?

A

Anti-adrogenic OCP +/- anti-androgen

49
Q

What may hormonal acne associated with other features like hirsutism and androgenetic alopecia suggest?

A

PCOS

50
Q

What is rosacea

A

2 parts - both can occur at same time/in isolation

  • Vascular reactivity = redness and flushing
  • Inflammatory rosacea = papules and pustules
51
Q

What triggers vascular reactivity in rosacea?

A 
Sunlight
Alcohol
Hot foods and drinks
Spicy foods
Emotion
Heat
Topical steroids can worsen
52
Q

What are the long-term complications of rosacea?

A 
Vascular dilatation
- Redness
- Telangiectasia
Tissue hypertrophy
- Rhinophyma
53
Q

What is the management of rosacea?

A 
Avoid triggers
Vascular rosacea
- Vascular laser
Inflammatory rosacea
- Topical metronidazole gel
- Topical azaleic acid
- Systemic antibiotics
- Systemic isotretinoin
Rhinophyma
- Ablative laser
- Surgery
54
Q

What are the clinical features of scabies?

A 
Intensely itchy rash
Starts on 
- Hands
- Interdigital spaces
- Feet
Itch worse at night
Spreads to
- Genital areas
- Generalised body rash
Spares face and head in adults
Other close contacts develop itch after few weeks
55
Q

How is scabies treated?

A 
Treat all close contacts at same time
- Sexual contacts
- Household contacts
Index case retreated after 1 week
Post-scabies itch takes weeks to settle
5% permethrin
Apply cream all over from neck down
Leave on overnight
Wash off in morning
Treat clothing
- Hot wash
- Tumble dry

MD2 Foundation (42 decks)

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