Derm 1 Flashcards
Other treatments:
- Oral antivirals
- Antihistamines
- Topical abx
- Antiseptics
- Antivirals: acyclovir. Can cause GI upset, deranged lfts, neurolog reactions, haematological disorders
- Antihistamines: non sed (cetirizine, fexofenadine), sed (chlorphenamine) block hist rec producing anti pruritic effect. Can cause sedation, antichol effects (dry mouth, blurred vision, urin ret, constip)
- Topical abx: fusidic acid. Can cause irritation, gi upset, candidiasis, c diff
- Antiseptics: chlorhexidine. Can cause irritation/ skin allergy
Types of treatment:
- Emollients
- Topical steroids
- Oral steroids
- Oral retinoids
- Biologics
- Emollients: soap substitutes (dermal 500), aq cream (diprobase, cetraben, hydromol, e45), emulsifying ointment (epidermis), liquid paraffin and white soft paraffin. Rehydrates skin by forming new layer to prevent water loss. But can cause irritation/allergy
- Topical steroids: mild: (hydrocortisone), mod (clobetasone butyrate), potent (betamethasone validate), v potent (clobetasol). Is an anti-inflammatory + antiproliferative. But can cause skin thinning, telangiectasia, allergic contact dermatitis, or may mask skin infections
- Oral steroids: pred. Can cause immunosupp, cushings syndrome, htn, diab, osteoporosis, cataracts, psychosis
- Oral retinoids: isotretinoin. Can cause dry skin/lips/eyes, deranged lfts, hypercholesterolaemia, myalgia, arthralgia, teratogenic (contract 1 month before, 1 month after, if acitretin 3 years after)
- Biologics: infliximab, adalimumab. Can locally cause redness/swelling/bruising, systemically allergic, flu symptoms, infections, hepatitis, cancers
Folliculitis:
- Definition
- Risk factors
- Causes
- Symptoms
- Management
- Complications
Folliculitis:
- Definition: inflamm of pilosebaceous follicles
- Risk factors: thick hair, sweating, shaving against grain
- Causes: aures, candida
- Symptoms: itchy pustules
- Management: chlorhexadine, oral fluxclox
- Complications: abscess, cs thrombosis
Scabies:
- Definition
- Risk factors
- Symptoms
- Investigations
- Management
- Complications
Scabies:
- Definition: infestation of parasite sarcoptes scabei mites in stratum corneum
- Risk factors: contact skin to skin, crowded, winter
- Symptoms: itching especially at night, interdigital / axillary folds with papules/vesicles and linear burrow marks
- Investigations: skin scrapings microscopy
- Management: all contacts with permethrin and repeat in 1 week, school 24 hours after treatment, itching up to 4 weeks so take crotamitton cream (hypersens type 4 reaction), if not compliant then oral ivermectin
- Complications: cellulitis, sepsis
Cellulitis:
- Definition
- Risk factors
- Causative organisms
- Symptoms
- Classes
- Management
- Complications
Cellulitis:
- Definition: bacterial infection of dermal and deep subcut tissues
- Risk factors: immunocomp, dvt, thrombophlebitis, venous insuff
- Causative organisms: strep pyogenes, s aures
- Symptoms: rubor, callor, dollor, tumour, fever
- Class: eron classification
1. no systemic toxicity
2. sys tox or comorbidity
3. signif tox/ comorb - admit
4. sepsis - admit - Management: oral fluclox 5-7 days (clarith if allergy, if near face coamox, erythomycin if preg). elevate, line, analgesia, emollients, dec weight, admit if eron 3/4
IV abx if eron 3/4, rapidly deteriorating, <1, frail, immunocomp, lymphad, facial - Complications: nec fascia, abscess, sepsis
Erysipelas if more superficial limited version. Localised skin infection of strep pyogenes.
Malignant melanoma:
- Definition + types
- Risk factors
- Symptoms
- Signs
- Investigations
- Management
- prognostic markers
Malignant melanoma:
- Definition + types: malig tumour of melanocytes. Superficial spreading, nodular, lentigo, acral lentiginous
- Risk factors: >100 moles, fx, uv exposure, fitz 1, immunosupp
- Symptoms: A-E
- Signs: lymphadenopathy
- Investigations: dermatoscope shows aggregates of brown dots + globules, excisional biopsy w 2mm margin
- Management: immunotherapy pembrolizumab
- Prognostic markers: breslow thickness (strat granulosum -> deepest point), ulceration, subtype, mitotic rate
Benign melanocytic lesions:
- Definition
- Risk factors
- Types
SCC:
- Definition
- Risk factors
- Symptoms
- Management
SCC:
- Definition: epidermal keratinocytes
- Risk factors: uv exposure, chronic inflamm (marjolin’s ulcer), immunosupp, bowens, actinic keratosis
- Symptoms: rapidly expanding painless lesion with necrotic centre and raised skin with tethering edges
- Management: surgical excision with 4mm margin if <20mm and 6mm if >20mm. Mohs micrographic surgery if high risk + cosmetically important sites
Actinic keratosis: atypical keratinocytes in epidermis due to chronic uv exposure + typically immunosuppressed. Crusty lesions. Needs 5FU for a month with hydrocortisone
Bowens: precancerous SCC. Red scaly patches. Needs 5FU for 4 weeks + steroids.
BCC:
- Definition
- Risk factors
- Symptoms
- Management
BCC:
- Definition: most common
- Risk factors: uv exposure, psorasis, fitz 1, immunosupp, xeroderma pigmentosum
- Symptoms: slow growth pearly white nodule, telangiectasia
- Management: only 2ww if concern that delay will have impact, WLE 3-5mm, if low risk topical 5FU + imiquimod
Psoriasis:
- definition
- causes
- triggers
- symptoms
- signs
- complications
- types
- mx
Psoriasis:
- definition: inflamm skin disorder where hyperproliferation keratinocytes in epidermis
- causes: trauma, tonsilitis, genetics, stress
- triggers: nsaids, acei, lithium, antimalarials, b blockers, trauma, alcohol, withdrawing steroids
- symptoms: scale salmon plaque on extensors, itchy, oncholysis/pitting (assoc with arrthropathy)
- signs: auspitz sign, koebner phenomenon
- complications: cvs disease, erythridermic psoriasis, psychological (DLQI effect on qol questionnaire), arthropathy, vte
- types:
1. chronic plaque
2. guttate: more common in children especially 2-4 weeks post strep infection. Tear drop papules. Most resolves spont in 3 months if not same treatment as psoriasis
3. nail
4. sebhorrhoeic
5. pustular
- mx
1. emollients
2. vit d analogues + clobetasone butyrate OD for 4 weeks
3. if no improvement for 8 weeks then just vit d analogues BD (dec cell division hence epiderm prolif)
4. 8-12 then steroid BD or coal tar
If no improvement then referral secondary care for PUVA + uvb (skin ageing, scc), methotrexate
Acne vulgaris:
- definition
- symptoms
- mx
- complications
Acne vulgaris:
- definition: inflamm of pilosebaceous follicles due to inc sebum, inc androgens and abnormal follicular keratinisation - propionibacterium acnes
- symptoms: open and closed comedomes - mild, papules, pustules - mod
- mx:
1. 6 weeks don’t overclean, no oil based, no scatching
2. topical benzoyl peroxide + adapalene 12 weeks, or tretinoin + clindamycin, benzyl + clind
3. oral deoxy + cocp
4. oral retinoids (dec sebum production): dry skin, photosens, depression, sjs
refer if not responded to 2 courses, scarring, pigment changes, mental health
- complications: scarring, hyperpig, social, acne fulminans
Burns:
- wallaces rules of nines
- depth of burns
- mx
Burns:
- wallaces rules of nines: head + neck, each arm, ant leg, each post leg, ant chest, post chest, ant abdomen, post abdomen
- depth of burns
1. superficial epidermal: 1st degree: red + painful
2. partial thickness (superficial dermal): 2nd: pale pink, blister
3. partial thickness (deep dermal): 2nd: white, non blanch erythema, reduced sensation
4. full thickness: 3rd: white/brown/back, no blisters, no pain
- mx: refer secondary for 3/4, 2 weeks >3% adults or 2% child or any electrical/chemical. If 2 cleanse, dressing, avoid creams, review in 24 hours. If severe early intubation, iv fluids if >15% adult/10% child with half fluid in 8 hours
- complic: curlings ulcers
Lichen sclerosis:
- definition
- symptoms
- mx
Lichen sclerosis:
- definition: inflamm condition affecting genitalia where atrophy of epidermis. Inc risk vulval ca
- symptoms: white plaques, itch
- mx: steroids, emollients
Impetigo:
- definition
- causative organisms
- symptoms
- mx
- complic
Impetigo:
- definition: superf bact infection
- causative organisms: aures (always in bullous), pyogenes
- symptoms: can be non bullous pustules, or bullous which burst + crust over
- mx: if non bullous then topical hyd peroxide 5 days or topical fusidic acid. If bullous then oral fluclox 5 days or if extensive disease. School 48 hours after abx + lesions crusted over
- complic: cellulitis, glomeruloneph, staph scalded skin syndrome
Eczema:
- symptoms
- mx
- complications
Eczema:
- symptoms: itchy erythem rash extensors in children/flexors in children
- mx:
1. emollients, zinc impreg bandages, frag free soap
2. hydrocortisone -> betamethasone valerate -> clobetasone butyrate
3. topical tacrolimus
- complications: thermoreg impairment, cellulitis, molluscum contag, herpeticum
