d e r m a t o l o g y

Question 1

what is acne vulgaris

Answer 1

inflammation of the pilosebacious follicle - increased production of sebum, trapping keratin and blockage of pilosebaceous units leading to swelling and inflammation

Question 2

why is acne worsened by puberty

Answer 2

androgenic hormones increase production of sebum

Question 3

swollen and inflammed skin units are called

Answer 3

comodones

Question 4

how is acne vulgaris managed

Answer 4

no tx if mild

topical benzoyl peroxide = reduces inflammation + unblocks skin and toxic to bacteria

topical retinoids - slow sebum production (need effective contraceptive)

topical abx e.g clindamycin prescribed with benzoyl peroxide to reduce bacterial resistance

oral abx - lymecycline

OCP can help F stabilise hormone and slow production of sebum = Dianatte/ Co cyprindiol

Question 5

retinoids require

Answer 5

follow up and monitoring + reliable contraception

retinoids are highly teratogenic

Question 6

which OCP is most effective for acne

Answer 6

co-cyprindiol/ dianette

anti androgenic effects

but has higher thromboembolism so stop treatment as soon as acne is controlled - not prescribed long term

Question 7

oral retinoids are used in

Answer 7

severe acne

last line option

isotretinoin but teratogenic

Question 8

what is eczema

Answer 8

chronic atopic condition caused by defects in the normal continuity of the skin barrier, leading to inflammation in the skin.

Question 9

how does eczema present

Answer 9

dry red itchy sore patches over flexor surfaces

face and neck

flare - remitting and relapsing

Question 10

how is eczema managed

Answer 10

mantainence = emollients

avoid triggers - certain washing powders, cleaning powders, stress

flares = thicker emollients + treat viral or bacterial infections

Question 11

what is the rule for emollient use

Answer 11

general rule is to use emollients that are as thick as tolerated and required to maintain the eczema.

Question 12

give examples of thin emollients

Answer 12

E45
Aveeno cream
Diprobase cream
Oilatum cream

Question 13

give examples of thick greasy emollients

Answer 13

50:50 ointment (50% liquid paraffin)
Hydromol ointment
Diprobase ointment

Question 14

describe the steroid ladder in eczema

Answer 14

mild = hydrocortisone
moderate = eumovate
potent = betnovate
very potent = dermovate

Question 15

treatment of bacterial infection in eczema

Answer 15

staph aureus

oral flucloxacillin

Question 16

SE of steroid use in eczema

Answer 16

an lead to thinning of the skin, which in turn make the skin more prone to flares, bruising, tearing, stretch marks, telangiectasia. + systemic absorption of steroid

Question 17

what is psoriasis

Answer 17

chronic immune condition that leads to skin changes are caused by the rapid generation of new skin cells, resulting in an abnormal buildup and thickening of the skin in those areas.

Question 18

describe the management of psoriasis

Answer 18

1. Topical steroids
2. Topical vitamin D analogues (calcipotriol)
3. Topical dithranol
4. Topical calcineurin inhibitors (tacrolimus) are usually only used in adults
5. Phototherapy with narrow band ultraviolet B light

Question 19

what is urticaria

Answer 19

hives = associated with patchy erythematous rash

associated with angioedema and flushing

acute vs chronic

Question 20

describe the pathophysiology of urticaria

Answer 20

release of histamine and other pro-inflammatory chemicals by mast cells in the skin. This may be part of an allergic reaction in acute urticaria or an autoimmune reaction in chronic idiopathic urticaria

Question 21

what are the causes of urticaria

Answer 21

Allergies to food, medications or animals
Contact with chemicals, latex or stinging nettles
Medications
Viral infections
Insect bites

Question 22

triggers of chronic urticaria

Answer 22

Sunlight
Temperature change
Exercise
Strong emotions
Hot or cold weather
Pressure

Question 23

management of urticaria

Answer 23

antihistamines - fexofenadine

oral steroids for short term severe flares

Question 24

what are the ddx for skin cancers

Answer 24

1. bcc
2. scc
3. malignant melanoma

Question 25

what are the risk factors of bcc

Answer 25

uv exposure
hx of severe sunburn in childhood
skin type i = always burns, never tans 
increasing age
immunosupression
male sex

Question 26

describe the presentation of bcc

Answer 26

nodular
superficial 
cystic 
morphoeic/sclerosing 
keratin and pigmented 

most common over head and neck

Question 27

describe the management of bcc

Answer 27

surgical exicision - allows for histological examination

radiotherapy when surgery is not appropriate

Question 28

what is scc

Answer 28

invasive malignant tumour of epidermal keratinocytes

Question 29

rx of scc

Answer 29

uv exposure
hx of frequent or severe sunburn
skin type i = always burns, never tans
increasing age
male
immunosuppression

Question 30

management of scc

Answer 30

surgical excision - treatment of choice
radiography if non-resectable

chemotherapy - for metastatic disease

Question 31

what is a malignant melanoma

Answer 31

invasive malignant tumpor or epidermal melanocytes

with potential to metastasise

Question 32

what are the risk factors of melanoma

Answer 32

excessive uv exposure
skin type i - always burns never tans
hex in first degree relative or previous hx of melanoma

Question 33

describe the abcde of melanoma presentation

Answer 33

asymmetrical shape
border irregularity 
colour irregularity 
diameter greater than 7mm
evolution of lesion = change in size or shape 
symptoms - bleeding and itching 

more common in legs in f and trunk in men

Question 34

describe the management of melanoma

Answer 34

surgical excision is definitive treatment

chemo for metastatic disease