Derm 1 Flashcards
Rosacea
- How are the following managed:
a) mild symptoms
b) flushing but limited telangiectasia
c) severe disease
d) rhinophyma (red, bulbous nose)
e) prominent telangectasia - What other daily management is recommended?
- a) topical metronidazole
b) topical brimonidine
c) oral oxytetracycline
d) referral to ENT
e) laser therapy
2. daily application of sunscreen
Acne vulgaris treatment
- Describe
a) mild
b) moderate
c) severe acne - Describe how management is gradually stepped up?
- When can retinoids not be given (topical or oral [e.g. isotretinoin])?
- a) open + closed comedones +/- sparse inflammatory lesions
b) extensive non-inflammatory lesions (papules + pustules)
c) extensive inflammatory lesions: nodules, pitting, scarring
- 1) topical retinoids or benzoyl peroxide
2) add topical ABx
3) add oral ABx (tetracycline or if pregnant erythromycin)
OR
can add COCP
NOTE: 3) can only be given for a maximum of 3 months
4) isotretinoin
3. pregnancy
Burns Management
- What immediate first aid should be carried out?
- What may be required in circumferential burns inhibiting function (e.g. torso burn inhibiting breathing, leg burn inhibiting walking)
- When are IV fluids required?
- When should you refer to secondary care?
- irrigate wound for 10-30 mins within 20 mins of injury
place layers of clingfilm on burn but do not wrap around - escharotomy
- > 15% body surface area in adults or >10% in children
- unless heat caused first degree burn then refer
Burn severity
Describe the following burns
- first degree (superficial dermal)
- second degree
a) superficial dermal
b) deep dermal - third degree (full thickness)
- red + painful
- a) pink, painful + blisters
b) white +/- non-blanching erythema and reduced sensation
3. white / brown / black no blisters no pain
- Describe how psoriasis is managed.
2. What can be added in secondary care?
topical vit D + topical potent steroid -> one applied in the morning the other at night
for max 4 weeks
at 8 weeks review:
if no improvement try vit D twice daily
at 8 weeks review again:
if no improvement try twice daily potent topical steroid (max 4 weeks) or coal tar once/twice daily)
- phototherapy or systemic treatment (methotrexate first line)
Describe the management of
- scalp psoriasis
- face, flexural or genital psoriasis
- potent corticosteroid once daily for 4 weeks
if doesn’t work try new formulation of topical steroid and/or salicylic acid to remove scale prior to application
- mild/moderate corticosteroid once/twice daily for 2 weeks
Lichen planus
- What is it?
- What CFs are seen?
- What drugs can cause it?
- How is it managed?
- unknown aetiology but most-probably immune-mediated
- itchy papular rash with white lines appearance on the surface
- 50% have oral involvement with white lacy buccal rash
- thinning of nail plate + longitudinal ridging - gold
- thiazides
- quinine
Lichen planus
- What is it?
- What CFs are seen?
- What drugs can cause it?
- How is it managed?
- unknown aetiology but most-probably immune-mediated
- itchy papular rash with white lines appearance on the surface
- 50% have oral involvement with white lacy buccal rash
- thinning of nail plate + longitudinal ridging - gold
- thiazides
- quinine
- topical steroids
What can causes guttate psoriasis?
streptococcal infection
What can make psoriasis worse?
- trauma
- alcohol
- steroid withdrawal
drugs:
- ACE
- antimalarials: hydroxychloroquine
- lithium
- NSAIDs
- infliximab
- beta blockers
Seborrhoeic dermatitis
- What is it?
- What CFs are seen?
- What conditions is it associated with?
- chronic dermatitis due to inflammatory response to skin commensal the fungi malassezia furfur
- eczematous lesions seen on scalp, auricular, periorbital, nasolabial folds
+/- otitis externa or blepharitis - HIV
- Parkinson’s
NOTE: can treat with topical antifungals and topical steroids
Herpes zoster
- What CFs are seen?
- How is it managed?
- burning pain for 2-3 days followed by erythematous then macular then vesicular rash in dermatomal pattern
- antiviral (reduces incidences of post-herpetic neuralgia)
- paracetamol and NSAIDs are first line analgesics
- > try amitriptyline if doesn’t work
What treatment can be given to improve the healing rate for venous ulceration?
pentoxifylline (peripheral vasodilator)
Eczema herpeticum
- What causes it?
- What CFs are seen?
- How is it treated?
- herpes simplex 1 or 2
- rapidly progressing, painful rash with “punched-out” lesions
(often in a child with atopic dermatitis) - admit for IV acyclovir as life threatening
Pityriasis vesicolor
- What is it?
- What CFs are seen?
- How is it treated?
- superficial infection with malassezia furfur
- hypo pigmented / pink / brown lesion most likely on the trunk
+/- scale and mild itch - ketoconazole shampoo
if doesn’t work biopsy to confirm diagnosis and give oral itraconazole
