Common Rashes Flashcards
Acne, Rosacea, Lichen Planus and pityriasis rosea
1
Q
What is acne?
A
Acne is an inflammatory condition of the pilosebaceous unit
= Leading to comedones, papules, pustules, and nodules
2
Q
Which age group is most commonly affected by acne?
A
Acne is most common in ages 12-24
3
Q
How do androgens contribute to acne?
A
Androgens increase sebum production and alter sebum composition, promoting bacterial growth and inflammation
4
Q
What is the primary lesion in acne?
A
The micro comedo
5
Q
What role does follicular hyperkeratinisation play in acne?
A
It blocks the pilosebaceous unit, leading to comedone formation
= blackheads and whiteheads
6
Q
What are the two main types of acne lesions?
A
- Non-inflammatory (comedones)
= blackheads and whiteheads - Inflammatory
= papules, pustules, cysts, nodules
7
Q
Where does acne typically occur?
A
face, upper back, and anterior chest
8
Q
What is the first-line treatment for mild acne?
A
(1) Topical retinoid + benzoyl peroxide OR
(2) topical retinoid + antibiotic
9
Q
When should oral antibiotics be considered?
A
If acne is moderate to severe or not responding to topical treatment after 3 months.
10
Q
What is the strongest treatment for severe acne?
A
Isotretinoin (Roaccutane), used if unresponsive to antibiotics
11
Q
What is the difference between blackheads and whiteheads?
A
- Blackheads (open comedones)
→ Keratin and sebum oxidise, turning black. - Whiteheads (closed comedones)
→ Keratin and sebum are trapped under the skin
12
Q
What are the major contraindications for isotretinoin?
A
- Pregnancy (teratogenic)
- Severe depression
- Liver disease
13
Q
Why must females take contraception while on isotretinoin?
A
Isotretinoin is highly teratogenic and can cause severe birth defects
14
Q
What systemic treatments are available for children under 12 years?
A
Erythromycin or clarithromycin
= twice daily (BD)
15
Q
How long should acne treatment be continued before assessing effectiveness?
A
At least 3 months before changing therapy
16
Q
What systemic treatments are available for patients over 12 years old?
A
- Lymecycline (once daily, OD)
- Doxycycline (once daily, OD)
- Erythromycin or clarithromycin (twice daily, BD)
17
Q
Why is doxycycline preferred over tetracycline for acne treatment?
A
Doxycycline is less likely to cause GI side effects compared to tetracycline and has a longer half-life
18
Q
What is rosacea?
A
A chronic inflammatory skin disease triggered by factors like alcohol, stress, and temperature changes
19
Q
Which gender is more commonly affected by rosacea?
A
More common in females
20
Q
What is the typical age range for rosacea onset?
A
30-40’s
21
Q
What is the pathophysiology of rosacea?
A
Chronic skin inflammation triggered by factors that increase body temperature
= cause unknown
22
Q
What are common triggers for rosacea flare-ups?
A
Sunlight, alcohol, hot drinks, stress, spicy food
23
Q
What are the typical areas of the face affected by rosacea?
A
Nose, cheeks, and forehead
= sparing of nasolabial folds
24
Q
What are the key clinical features of rosacea?
A
(1) Recurrent facial flushing
(2) Visible blood vessels
(3) Erythema with papules and pustules
(4) especially on the nose, chin, cheeks, and forehead
25
How can you differentiate rosacea from lupus?
Pustules are present in rosacea but not in lupus
26
What is the first-line treatment for rosacea?
(1) Topical ivermectin - MAIN
or metronidazole
27
What is the second-line treatment for rosacea?
Topical therapies combined with oral antibiotics like doxycycline
28
What is the third-line treatment for rosacea?
Isotretinoin
29
What are common complications of rosacea?
1. Rhinophyma
= thickening of the skin
2. Telangiectasia
= small, dilated blood vessels visible on the skin
others - blepharitis, keratitis, conjunctivitis (eyes)
30
In severe cases of rosacea, the sebaceous gland hypertrophy is concentrated on the nose. What is this known as?
Rhinophyma
31
What treatment options are available for telangiectasia or rhinophyma in rosacea?
LASER THERAPY
32
Which mite is commonly found in the sebaceous follicles of individuals with rosacea?
Demodex folliculorum
33
Which topical antibiotic is used in the treatment of acne?
Clindamycin
34
What are the side effects of Isotretinoin?
1. Dry lips, skin, eyes, and nose bleeds
2. skin fragility
3. hair thinning
4. hyperlipidemia
5. abnormal liver function
5. mood changes
35
A 16-year-old female has presented to the GP for a follow-up appointment regarding her Acne Vulgaris. She has been using a combination of topical treatments for the past couple of months. On examination, she still has evidence of moderate Acne Vulgaris on her forehead, cheeks and upper back.
Which treatment option would be the next most appropriate step in managing this patient's Acne Vulgaris?
Oral antibiotic
36
A 16-year-old teenager attends his general practice with concerns regarding his appearance due to spots on his cheeks and forehead associated with oily skin. On examination, there are multiple blackheads and whiteheads, but no papules or pustules
What is the most appropriate initial pharmacotherapy?
Topical retinoid + topical antibiotic
37
Describe mild acne and its treatment
Scattered comodones, papules and pustules
= Tropical Retinoid + benzoyl peroxide OR retinod + topical antibiotic
38
Describe moderate acne and its treatment
numerous papules, pustules and mild atrophic scarring
= benzoyl peroxide + retinod + topical antibiotic
39
Describe severe acne and its treatment
numerous papules, pustules, severe atrophic scarring, cysts, nodules
= isotretinion treatment
40
An 18-year-old female visits the GP with a two month history of comedones, papules and pustules on her forehead, cheeks and jawline. They first appeared on her chin then progressed to involve most of the face. She has no history of any skin conditions and takes no regular medications. Based on the appearance of her skin and the presence of several nodules, the GP decides to prescribe treatment for severe acne.
What is the most appropriate treatment option? and why isn't the answer oral isotretinoin?
Topical retinoid, topical benzoyl peroxide and oral doxycycline
= Oral isotretinoin is an effective treatment for severe acne, however it can only be prescribed by a dermatologist. Patients would need to have tried standard topical treatments and oral antibiotics first before consideration of oral isotretinoi
41
A 16-year-old adolescent presents with multiple inflamed, pus-filled papules, nodules, and comedones on the face, back, and chest. He states it is starting to affect his self-esteem.
What is the first-line treatment for this condition?
Topical retinoid and topical antibiotic
42
What is Lichen Planus?
The most common lichenoid disorder, characterised by damage to the basal epidermis
43
What is the aetiology of Lichen Planus?
A chronic inflammatory disease of unknown origin, associated with Hepatitis C
44
What is the classic clinical presentation of Lichen Planus?
(1) Itchy, flat-topped violaceous papules on flexor surfaces
= wrists, forearms, ankles, legs
(2) Oral lesions can present as lacy white lesions on the inside of the cheek
45
What are the key features of the Lichen Planus rash?
(1) Purple
(2) Pruritic
(3) Papular
(4) Polygonal rash
(5) Usually on flexor surfaces
46
What is the typical distribution of Lichen Planus lesions?
Flexor surfaces of
(1) wrists
(2) forearms
(3) ankles
(4) legs
Lesions can also develop at sites of trauma
47
What are the findings in a biopsy of Lichen Planus?
(1) Irregular sawtooth acanthosis
(2) Hypergranulosis and orthohyperkeratosis
(3) Band-like upper dermal infiltrate of lymphocytes
(4) Basal damage with formation of cytoid bodies
48
How is Lichen Planus typically managed?
Topical steroids and antihistamines
49
What are some lichenoid disorders that resemble Lichen Planus?
Discoid lupus and drug rashes
50
What are life-threatening variants of lichenoid disorders?
1. Erythema multiforme
= caused by HSV, characterised by target lesions
2. Toxic epidermal necrolysis
= marked vascular interface changes, target lesions
51
What are target lesions?
Annular-shaped macules with
1. A raised red rim
2. A central area
3. a wedge of normal skin inbetween
52
What is Lichen Sclerosus?
A condition resembling Lichen Planus, often affecting the genital area
53
Which nail changes are seen in patients with lichen planus?
Fine ridging, grooving, dystrophy
54
What is the most important aspect of management of lichen planus?
Control of the pruritus
55
What nail signs are associated with lichen planus?
Longitudinal ridges
56
What are the clinical features of cutaneous lichen planus?
Cutaneous lichen planus is characterised by the 6 Ps:
Purple
Pruritic (itchy)
Polygonal (multiple sides)
Planar (flat-topped)
Papules/plaques
57
How long does lichen planus typically last?
3 months - 2 years
58
A 28-year-old man attends the GP complaining of a rash, which he has had for 2 months. He says the rash is itchy and he complains of a burning sensation in his mouth on eating.
On examination, there are several irregular purplish plaques on the palmar aspects of the wrist covered by lacy white lines.
What is the most likely diagnosis?
Lichen planus
59
The treatment of choice for a lichen planus rash is what?
Potent topical steroids, with benzydamine being used for oral involvement
60
A 71-year-old female presents with intense itching of the vulva. This started 3 months ago and has worsened over the last 2 weeks. She also reports burning and dysuria. She denies post-menopausal bleeding and
On examination there are several atrophic, white patches of skin over the labial folds. There is some evidence of excoriation.
Urinalysis is negative.
What is the most likely diagnosis and why?
Lichen sclerosus
= Lichen sclerosus is a chronic, inflammatory dermatological condition that typically affects the genitalia. It is benign but carries an increased risk of vulval cancer and requires monitoring. Lichen sclerosus is characterised by atrophy of the epidermis with the formation of white plaques. The most common presenting symptom is vulval itching
61
What is the treatment for lichen sclerosus?
topical steroids and emollients
62
What is the hallmark feature of Pityriasis Rosea?
A large, coin-shaped herald patch with a collarette of scale
63
What does the rash of Pityriasis Rosea look like?
Small, erythematous, scaly patches in a Christmas tree pattern
64
What causes Pityriasis Rosea?
Linked to viral infections and sometimes drugs
65
How does the pityriasis rosea rash progress? and where is the rash located?
Starts with a herald patch, followed by smaller patches
located on the trunk
66
Is treatment necessary for pityriasis rosea?
No, it resolves on its own
67
What does the herald patch look like?
Large, round, erythematous, with a scale border
68
What is the distribution of pityriasis rosea commonly known as?
Christmas tree distribution
69
Which viruses have been most commonly linked with the development of pityriasis rosea?
Human herpes viruses 6 and 7
70
A 21-year-old man presents to his GP with a rash covering his trunk and the tops of his legs. The lesions are small and scaly; however, you notice one larger patch on the lower part of his abdomen. He reports that he had a cold a few weeks before and that the rash is not itchy.
Given this brief history, what is the most likely diagnosis?
Pityriasis rosea
71
A 29-year-old woman presents to the GP with a new rash that has developed over the past week. It started as a single patch on her thigh but over the past 48 hours, the rash is now all over her back and abdomen. Other than suffering influenza 2 weeks ago, she has no other past medical history. On examination, there is a red, discoid plaque with a scaly periphery on her right thigh, with multiple smaller lesions over her abdomen and back. The rash is very itchy and it is starting to interfere with her job as a nail technician.
Given the most likely diagnosis, what is the most appropriate management? and why?
Prescribe topical mild corticosteroid
= NICE guidelines recommend topical corticosteroids for symptomatic relief of itching
72
Acne Treatment: Stepwise Approach in order
First-line (mild acne)
✅ Topical treatments
(1) Benzoyl peroxide
(2) Topical retinoids
= eg, adapalene, tretinoin
(3) Topical antibiotics
= eg, clindamycin, erythromycin
Second-line (moderate acne)
✅ Oral antibiotics (3–6 months)
(1) Tetracyclines
eg, doxycycline, lymecycline
(2) Macrolides
= eg, erythromycin, if tetracyclines are contraindicated
(3) Combined contraceptive pill (females only)
(4) Dianette, Yasmin – anti-androgen effects reduce oil production
Third-line (severe or resistant acne)
✅ Oral isotretinoin (Roaccutane) (dermatology referral)
= Most effective treatment – shrinks oil glands, unclogs pores, reduces inflammation
= Requires monitoring (risk of depression, teratogenic, dry skin)
73
A 40-year-old woman presents with facial erythema and flushing. On examination, you note multiple small papules and pustules on her cheeks and forehead, which she states are exacerbated when she is outside for prolonged periods in the sun
What does she have, and what is the first-line treatment for the underlying condition?
rosacea
= topical ivermectin
74
A 17-year-old female is seen by her GP due to worsening acne of her face and back. She has tried multiple over-the-counter therapies with no effect.
What bacteria found on the skin is known to contribute to the development of acne?
Propionibacterium acnes
75
A 24-year-old man who is normally well presents with a new skin rash. He has no personal or family history of skin conditions but reports he had a viral illness shortly before noticing the first lesion. It started a couple of weeks ago with a lesion he noted on the hip, which is a patch approximately 4cm in diameter, mildly erythematous, with some mild scaling around the edge. He awoke this morning to find multiple smaller similar lesions, mainly on his back. The lesions are asymptomatic.
How should this condition be managed?
The man has pityriasis rosea so therefore no treatment needed
76
A 23-year-old woman presents to the general practitioner with a worsening rash on her face and upper back which is causing a significant impact on her self confidence. She is currently five months pregnant and describes experiencing similar lesions during her teenage years. She is otherwise well with no allergies. The rash has not responded to topical benzoyl peroxide.
Examination identifies numerous erythematous papules and pustules distributed across the patient's face and upper back.
Which of the following management options is most appropriate?
A. Oral doxycycline
B. Oral erythromycin
C. Oral minocycline
D. Topical isotretinoin
E. Topical metronidazole
B
= tetracyclines (including doxycycline) are contraindicated in pregnancy as they affect skeletal development and cause tooth discolouration
77
You are working in general practice and see a 24-year-old male with a likely diagnosis of pityriasis rosea. What most commonly precedes this condition?
Viral infection
78
Oral doxycycline is only paired in combination with what for acne treatment?
topical benzoyl peroxide or topical tretinoin
79
A 45-year-old woman is seen in the GP clinic. She complains of a rash predominantly over her cheeks and nose which is worse in sunlight and if she drinks alcohol. It has started over the last 1 year. On examination, she has erythematous, raised cheeks with uneven texture, widespread telangiectasia and severe inflammatory pustules. Despite having already taken measures to wear sun-cream and avoid alcohol, she feels the rash is worsening and is now permanent.
What regimen should the GP prescribe as first-line treatment for this patient?
severe so therefore both Topical ivermectin and oral doxycycline
80
Topical betamethasone is what
A potent topical steroid
81
A 45-year-old woman presents with itchy, violaceous papules on the flexor aspects of her wrists. She is normally fit and well and has not had a similar rash previously. Given the likely diagnosis, what other feature is she most likely to have?
A. Onycholysis
B. Raised ESR
C. Mucous membrane involvement
D. Pain in small joints
E. Microscopic haematuria
C
= white lace-like patches (Wickham's striae)
82
A 15-year-old male returns to the dermatology clinic for review. He has a history of acne and is currently treated with oral lymecycline. There has been no response to treatment and examination reveals evidence of scarring on his face.
What is the next most suitable treatment?
Oral isotretinoin
83
What to do when a patient presents with 1. Scarring
2. Hyperpigmentation
3. Widespread pustules
4. Severe acne
Refer to dermatology specialist
84
While working in general practice you see a 21-year-old female with pityriasis rosea. How long does the associated rash last?
6-12 weeks
85
A 32-year-old woman who is currently 28 weeks pregnant attends her GP practice with 'bad skin'. When she enters the room you notice several open and closed comedones on her face, and upon further examination, there are further pustular lesions on her back and chest. She had attended 4 weeks earlier with the same complaint and had been started on topical benzoyl peroxide by one of your colleagues.
The patient has a history of acne vulgaris in her teens, treated with isotretinoin.
Which is the most appropriate treatment to add?
Oral erythromycin
85
Which topical treatment is used for predominant erythema/ flushing in rosacea and how does it work?
Brimonidine gel
= It is an alpha-adrenergic agonist that temporarily reduces redness. Worked within 30 mins and peaks around 3-6 hours before the face turns back to red
86
A 43-year-old woman has a 6-month history of intermittent flushing and erythema across her cheeks and nose caused by hot drinks, exercise and extreme temperatures. She is frustrated by the impact of her symptoms on her usual daily activities. There are no pustules or papules, and minimal telangiectasia present.
Given the most likely diagnosis, what is the most appropriate management option?
Brimonidine gel
= cause of flushing
87
You are working in general practice and see a 17-year-old girl with an 8-day history of a lesion on her lower torso. This is a single 3cm oval plaque, pink in colour, with a scale trailing just inside the edge of the lesion. She has then had a subsequent 2-day history of generalised, non-pruritic, rash down her torso. This rash consists of lots of fine scales patches and plaques which follow the pattern of langer's lines.
What is the above describing?
Herald patch
= Pityriasis rosea
88
'size of 50 pence piece'
This suggests what?
Pityriasis rosea
