Corrections 2 Flashcards
What is balanitis xerotica obliterans?
The male equivalent to lichen sclerosis in women
Complication of balanitis xerotica obliterans?
In an uncircumcised male, it can cause phimosis which is when the foreskin is too tight and can not be pulled back past the glans.
This is due to the scarring that occurs from BXO.
Bullous pemphigoid vs pemphigus vulgaris?
Mucosal involvement –> pemphigus vulgaris
No mucosal involvement –> bullous pemphigoid
What is the most common cause of nappy rash?
Irritant dermatitis –> due to irritant effect of urinary ammonia and faeces
What is lichen planus?
a skin disorder of unknown aetiology, most probably being immune-mediated.
Features of lichen planus?
1) itchy, papular rash most common on the palms, soles, genitalia and flexor surfaces of arms
2) rash often polygonal in shape, with a ‘white-lines’ pattern on the surface (Wickham’s striae)
3) Koebner phenomenon may be seen (new skin lesions appearing at the site of trauma)
4) oral involvement in around 50% of patients: typically a white-lace pattern on the buccal mucosa
5) nails: thinning of nail plate, longitudinal ridging
Mainstay of treatment of lichen planus?
Topical potent steroids
What can cause rusty-red pigmentation of the calves in venous insufficiency?
Haemosiderin deposition
What is the typical distribution of atopic eczema in infants?
Face & trunk
What is the typical distribution of atopic eczema in younger children?
Extensor surfaces
What is the typical distribution of atopic eczema in older children?
Flexor surfaces (typical)
What is a strong risk factor for singles?
HIV & other immunosuppressive conditions (e.g. steroids, chemotherapy)
What is shingles (AKA herpes zoster)?
An acute, unilateral, painful blistering rash caused by reactivation of the VZV
What are the most commonly affected dermatomes in shingles?
T1-L2
Features of shingles?
1) prodromal period
- burning over the affected dermatome
- pain
- fever, headache, lethargy
2) rash:
- initially erythematous, macular rash over the affected dermatome
- quickly becomes vesicular
- well demarcated by the dermatome
Mx of shingles?
1) analgesia: paracetamol & NSAIDs
2) antivirals e.g. aciclovir
Wat is a key benefit of prescribing antivirals in shingles?
Reduced incidence of post-herpetic neuralgia
How long are people with shingles infective?
they are infectious until the vesicles have crusted over, usually 5-7 days following onset
What is the most common complication of shingles?
Who is this more common in?
Post herpetic neuralgia
More common in older patients
give 3 complications of shingles
1) post-herpetic neuralgia
2) herpes zoster ophthalmicus
3) herpes zoster oticus (Ramsay Hunt syndrome)
What are some exacerbating factors for psoriasis?
1) trauma
2) alcohol
3) drugs e.g. beta blockers, lithium, antimalarials, NSAIDs & ACEi
4) withdrawal of systemic steroids
What infection may trigger guttate psoriasis?
Streptococcal
What is a herald patch?
Pityriasis rosea is a rash that often begins as an oval spot on the face, chest, abdomen or back.
This is called a herald patch and is specific to pityriasis rosea.
What is topical adapalene?
Topical retinoid
How long a break in between topical steroid courses should you aim for in psoriasis?
4 weeks
1st line mx of scalp psoriasis?
NICE recommend the use of potent topical corticosteroids used once daily for 4 weeks
Describe the rash typically seen in SLE
Livedo reticularis –> a purplish, non-blanching, reticulated rash caused by obstruction of the capillaries resulting in swollen venules.
Mx of eczema herpeticum?
IV antivirals
What is toxic epidermal necrolysis (TEN)?
A potentially life-threatening skin disorder that is most commonly seen secondary to a drug reaction.
What are some drugs known to induce TEN?
phenytoin
sulphonamides
allopurinol
penicillins
carbamazepine
NSAIDs
What is the antibiotic of choice to treat erythrasma?
Erythromycin
Mx of erythema nodosum?
no active treatment, arrange routine follow-up.
Mx of lichen planus?
Topical steroids e.g. clobetasone butyrate
2nd line mx of plaque psoriasis that hasn’t responded to 8w of potent steroid OD & vitamin D analogue OD?
Vitamin D analogue twice daily (BD)
What is the gold standard for diagnosing contact dermatitis (e.g. nickel allergy)?
Skin patch test
A positive reaction typically presents as redness and swelling at the site where the allergen was applied.
Mx of SCC?
Surgical excision & biopsy
What is erythema multiforme?
A hypersensitivity reaction that is most commonly triggered by infections.
Features of erythema multiforme?
- target lesions
- initially seen on the back of the hands / feet before spreading to the torso
- mildly itchy
What is the most common cause of erythema multiforme?
HSV
What drugs can cause erythema multiforme?
penicillin, sulphonamides, carbamazepine, allopurinol, NSAIDs, COCP, nevirapine
What is erythema ab igne?
a skin disorder caused by over exposure to infrared radiation e.g. hot water bottles
1st line mx of pyoderma gangrenosum?
Oral steroids
Mx of children with new onset purpura?
Refer immediately for investigations to exclude ALL and meningococcal disease
How long a break between courses of topical corticosteroids in patients with psoriasis should you aim for?
4 weeks
1st line mx for rosacea with severe papules and/or pustules?
Topical ivermectin + oral doxycycline
Mx of otitis externa?
Topical antibiotic + topical steroid (e.g. neomycin + dexamethasone ear spray)
What is a strong risk factor for shingles?
HIV
1st line mx of impacted ear wax?
1 week olive oil drops then review
What is a branchial cyst?
typically a benign lesion that is situated in the lateral neck, superficial to the sternocleidomastoid muscle.
What is the Koebner phenomenon?
describes skin lesions that appear at the site of injury
What conditions is the Koebner phenomenon seen in?
- psoriasis
- vitiligo
- warts
- lichen planus
- lichen sclerosus
- molluscum contagiosum
Mx of perioral dermatitis?
Doxycycline
What can be used on a long-term basis for mx of psoriasis?
Calcipotriol
What is often the most effective treatment for prominent telangiectasia in rosacea?
Laser therapy
Mx for chronic sinusitis?
Nasal irrigation with saline solution
Sensitivity to which medication can be associated with nasal polyps?
Aspirin
Mx of vitiligo?
- sunblock for affected areas
- camouflage make up
- topical steroids
- topical tacrolimus
- phototherapy
What can exacerbate plaque psoriasis?
- trauma
- alcohol
- drugs: beta blockers, lithium, antimalarials (chloroquine and hydroxychloroquine), NSAIDs and ACE inhibitors, infliximab
- withdrawal of systemic steroids
What can trigger guttate psoriasis?
Strep infection
What condition features an itchy, papular rash with ‘white-lines’ pattern on the surface (Wickham’s striae)?
Lichen planus
Features of lichen planus?
1) itchy, papular rash
2) rash often has ‘white-lines’ pattern on the surface (Wickham’s striae)
3) Koebner phenomenon may be seen
4) oral involvement in around 50% of patients: typically a white-lace pattern on the buccal mucosa
5) nails: thinning of nail plate, longitudinal ridging
Typical location of rash in lichen planus?
palms, soles, genitalia and flexor surfaces of arms
What is the mainstay of mx of lichen planus?
Potent topical steroids e.g. topical betamethasone
Oral –> benzydamine mouthwash or spray
Mx of pityriasis versicolor?
Topical ketoconazole
What is the most common side effect of isotretinoin?
Dry skin
What is Curling’s ulcer?
Acute gastric ulcers that develop in response to severe physiological stress, such as burns.
1sat line for hyperhidrosis?
aluminium chloride –> can be given in the form of roll-ons applied at nighttime
What is leukoplakia?
A premalignant condition which presents as white, hard spots on the mucous membranes of the mouth.
It is more common in smokers.
Can ketoconazole cause gynaecomastia?
Yes
Where are keloid scars most common?
Sternum
Mx of epistaxis that has failed all emergency management?
Sphenopalatine ligation in theatre
What is the cause of the majority of sudden-onset sensorineural hearing loss?
Idiopathic in nature
Mx of a nasal septal haematoma?
- surgical drainage
- intravenous antibiotics
If not treated –> can result in ‘saddle-nose’ deformity
Approx 5 year survival in the following Breslow thickness:
a) <0.75mm
b) 0.76-1.50mm
c) 1.51-4mm
d) >4mm
a) 95-100%
b) 80-96%
c) 60-75%
d) 50%
1st & 2nd line mx of scalp psorasis?
1st line –> potent topical corticosteroids used once daily for 4 weeks
2nd line –> if no improvement after 4 weeks then either use a different formulation of the potent corticosteroid (for example, a shampoo or mousse) and/or a topical agents to remove adherent scale (for example, agents containing salicylic acid, emollients and oils) before application of the potent corticosteroid
Mx of face, flexural and genital psorasis?
a mild or moderate potency corticosteroid applied once or twice daily for a maximum of 2 weeks
When can systemic side effects be seen with topical steroids?
When potent corticosteroids are used on large areas e.g. > 10% of the body surface area
How long a break should you aim for before starting another course of topical corticosteroids?
4 week break
How long should potent corticosteroids and very potent corticosteroids be used for at one time?
Potent: no more than 8 weeks at a time
Very potent: no more than 4 weeks at a time
Can vitamin D analogues be used long-term?
Yes (unlike steroids)
How do vitamin D analogues tend to help in psoriasis?
they tend to reduce the scale and thickness of plaques but not the erythema
Vitamin D analogues in pregnancy?
Avoid
Eczema herpeticum is a primary infection of the skin caused by HSV, and uncommonly what virus?
Coxsackie virus
1st line mx of scabies?
Permethrin 5%
2nd line mx of scabies?
Malation 0.5%
What is the only treatment shown to be of real benefit in venous ulceration?
Compression bandaging
What can perioral dermatitis be made worse by?
Topical steroids
What is topical adapalene?
Topical retinoid
Brown pigmentation (haemosiderin), lipodermatosclerosis (champagne bottle legs), and eczema are all signs of what?
Chronic venous insufficiency
