Derm Flashcards
1
Q
Chronic plaque psoriasis 1st, 2nd, 3rd line?
How do emollients help?
A
1st - potent steroid and vit D analogue applied once daily each one in morning and one in evening (up to 4 weeks for initial treatment)
2nd - if no improvement after 8 weeks - VitD analogue twice daily
3rd - if no improvement after 8-12 weeks - potent steroid applied twice daily or coal tar preparation applied once/twice daily. Dithranol another option.
Emollients help reduce scale loss and pruritis
2
Q
Secondary care management of chronic plaque psoriasis?
A
Phototherapy - UVB or PUVA
Systemic - methotrexate 1st line, cyclosporin, retinoids, biologics
3
Q
Treatment of scalp psoriasis?
A
Potent steroids for 4 weeks
If no improvement, consider using something to break up adherent scale (salicylic acid/oils) and a different formulation of potent steroid (shampoo/mousse)
4
Q
Treatment of facial, flexural or genital psoriasis?
A
Mild-mod steroid 1-2 times daily for max of 2 weeks
5
Q
Potential side effects of topical steroids? When might systemic symptoms start to occur?
How long should courses be?
How long between courses?
A
Skin atrophy, striae, rebound symptoms
1-2 weeks on face/flexures/genitalia
8 weeks max for mild-mod steroids
4 weeks max for potent
4 weeks between courses
6
Q
Vit D analogues (Calcipitriol):
- How do they work?
- Can they be used long term?
- Can they be used in pregnancy?
- SE?
A
Reduce cell division and differentiation - reduce scale but not erythema
Yes they can be used long term (unlike steroids)
No not in pregnancy
No SE
7
Q
How does dithranol work?
SE?
A
Inhibits DNA synthesis
Burning and staining - wash off after 30 mins
8
Q
How does coal tar work?
A
Not fully understood - probably inhibits DNA synthesis
9
Q
How long must a kid with impetigo be excluded from school?
A
Until 48 hours after commencing treatment
10
Q
Person with Crohn’s has end ileostomy and develops deep, painful ulcer at stoma site - cause?
A
Pyoderma gangrenosum - most common on lower limbs but can occur anywhere - assoc w Crohn’s
11
Q
Red papule with surrounding capillaries which blanch on pressure?
Causes?
A
Spider naevi
Liver disease, COCP, pregnancy (increased oestrogen)
12
Q
Enlarged, red, itchy scar at injury site?
Most common location to occur?
Skin type?
Rx?
A
Keloid scar
Sternum
Darker skins
Intra-lesional steroids or excision
13
Q
Is rosacea photosensitive?
Treatment initially?
If severe telangiectasia?
When to refer to derm?
A
Can exacerbate symptoms
- topical metronidazole (limited papules and pustules, no plaques)
- Oral oxytetracycline if more severe
Brimonidine gel helps with flushing and telangiectasia
Laser therapy
If rhinophyma
14
Q
pathophysiology of acne vulgaris?
A
Follicular hyperproliferation causing keratin plug of pilosebaceous unit - obstruction and colonisation by proprionobacterium acnes
Inflammation
Sebaceous gland can be controlled by androgen
15
Q
Open and closed comedones?
Mild, mod and severe acne?
What is acne fulminans?
A
Open - blackhead
Closed - whitehead
Mild - open/closed comedones with/without sparse inflammatory lesions
Mod - Widespread non-inflammatory lesions with numerous papules and pustules
Sev - Extensive inflammatory lesions including nodules, pitting and scarring
Fulminans - severe acne assoc w systemic upset e.g. fever. Hospital admission often required
16
Q
Acne treatment ladder?
A
- topical retinoid/benzoyl peroxide
- Combination topical therapy - retinoid/benzoyl peroxide/abx
- Oral antibiotic - tetracycline (or erythromycin in pregnancy, breastfeeding, young) WITH topical retinoid or benzoyl peroxide - at least 3 months
- WOMEN only - COCP or co-cyrindiol (dianette) - increased risk of VTE compared to COCP, 3 months max
- Oral isotretinoin
17
Q
5 treatment options for AK?
A
5-FU (2-3 week course, skin becomes inflamed, sometimes hydrocortisone with)
Topical diclofenac
Topical imiquimod
Cryotherapy
Curettage and cautery
18
Q
Prognosis of alopecia areata?
6 treatment options for alopecia areata?
A
50% hair will grow back in 1 year, 90% will eventually
- topical/intralesional steroid
- topical minoxidil
- phototherapy
- dithranol
- contat immunotherapy
- wigs
19
Q
Antihistamines which receptor?
Sedating antihistamine?
Non-sedating?
What other side effects might they have?
A
H1
Sedating - chlorphenamine
Non-sedating - cetirizine/loratadine
Antimuscarinic (urinary retention, dry mouth)
20
Q
Fungus causing athlete’s foot?
A
Tricophyton
21
Q
3 types of BCC?
typical description?
Type of referral?
Management options?
A
Nodular, superficial, infiltrative
Pearly skin coloured papule with telangiectasia which ulcerates in centre, with picket fence border
Routine referral
Leave alone
Surgical removal - conventional or Mohs
Topical: imiquimod/5-FU
22
Q
Chance of SCC with AK?
Bowen’s disease?
A
1/1000
5-10%
23
Q
Antibodies in bullous pemphigoid?
Do blisters heal?
Ix?
Rx?
A
anti-hemidesmosome
Yes, usually without scarring
IF - IgG and C3 at DEJ
Rx - Oral corticosteroids mainstay
Topical corticosteroids, immunosuppressants and abx also used
24
Q
What are cherry haemangioma’s?
4 features?
Management?
A
Campbell de Morgan spots
Benign skin lesion causing abnormal proliferation of capillaries - more common with advancing age
Erythematous, papular lesion
1-3mm in size
Non-blanching
NOT on mucous membranes
None
25
Management of contact dermatitis (both types)?
Allergen/irritant avoidance
Emollients
Topical steroids when flares
26
HSV type causing eczema herpeticum?
| Rx?
Either 1 or 2
Admit for IV aciclovir
27
Atopic eczema distributon in infants vs children and adults?
| Yellow, weeping crust over eczema?
infants - face and extensor surfaces (napkin area and flexural surfaces spared)
Older - flexural surfaces esp wrist, cubital fossa, popliteal fossa and ankles
GAS infection
28
Treatment for atopic eczema?
Emollients - lots and lots
Itch - antihistamines (good to give regularly to build up good levels in blood)
Flare: steroids
Topical calcineurin inhibitors can be used (Tacrolimus) as steroid sparing agents if needed long-term
When no response to potent steroids:
Light therapy (PUVA or UVB)
Immunosuppression
29
Most common cause of erisypelas?
| When is Rx given IV?
Strep Pyogenes
Facial - cavernous sinus drainage - need to avoid
Also give IV if Staphylococcal Scalded Skin Syndrome
30
Erythema ab igne?
| Risk?
Skin disorder caused by infrared radiation (heat) exposure - classically old woman next to open fire
Looks a bit like livedo reticularis
Can develop SCC
31
Erythema multiforme usual progression?
Causes?
What is erythema multiforme major?
Rx?
Target lesions starting on back of hands (or feet) and spreading to torso
Pruritis can occur but is mild
```
Causes:
Usually drugs - penicillin, sulphonamides, carbamazepine, COCP NSAIDs, allopurinol
Viruses - HSV, orf
SLE
Malignancy
```
Major - more severe form, mucosal involvement
Rx: supportive - treat underlying cause
32
Apart from shins, where else can erythema nodosum happen?
Causes?
How long to heal?
Forearms, thighs
```
No cause (60%)
Infection - strep, TB
Sarcodosis
IBD
Behcet's
Malignancy
Pregnancy
Drugs - penicillins, COCP
```
Heals in 6 weeks without scarring
33
What is erythrasma?
Cause?
Ix?
Rx?
Asymptomatic, flat, pink/brown, slightly scaly rash in groin/axillae
Overgrowth of diptheroid corynebactrium
Wood's light - coral-red fluorescence
Topical antibiotic/miconazole
Oral erythromycin if widespread
34
What is erythroderma/exfoliative dermatitis?
| Causes?
Widespread inflammatory lesion affecting >95% body followed by widespread exfoliation, with generalised lymphadenopathy
Lots of causes:
- drugs - too many
- atopy
- Psoriasis
- Leukaemias
35
What is red man syndrome?
Whole body erythema as a result of vancomycin hypersensitivity
36
What is granuloma annulare?
Where does it occur?
Cause?
Papular lesion that is hyperpigmented and depressed (or clear) cetrally
Dorsal hands/feet, extensors of arms/legs
Unknown
37
Guttate psoriasis?
| Management?
Widespread small 'tear drop' scaly papules on trunk and limbs 2-4 weeks following sore throat (strep infection)
Most resolve spontaneously in 2-3 months
Topical agents as per psoriasis
UVB phototherapy
38
Inheritance of HHT?
AD
39
Hiradenitis suppuritiva?
inflammatory nodules, pustules, sinus tracts and scars in intertrigous areas (e.g. axillae, groin, perineum) - suspect in post-pubertal pts with recurrent furuncles or boils
Chronic inflammatory occlusion of pilosebaceous units that obstruct apocrine glands and prevent keratinocytes from shedding. Nodules can result in plaques, sinus tracts and rope-like scarring
Rx:
Stop smoking, weight loss, good hygiene
Acute - intra-lesional steroids/flucloxacillin
Long-term - topical clindamycin or oral tetracycline
If still persistent - surgical excision
40
DDx of hiradenitis suppuritiva? (3)
Acne vulgaris - this primarily occurs on face, back and upper chest, not intertrigous areas
Follicular pyodermas (folliculitis/furuncles/carbuncles) - these are transient and respond rapidly to abx
Granuloma inguinale (donovanosis) - STI caused by klebsiella granulomatis - enlarging ulcer that bleeds in inguinal area
41
Difference between hirsutism and hypertrichosis?
Hirsutism - androgen-dependent hair growth in women
Hypertrichosis - androgen-independent hair growth
42
Causes of hirsutism?
Most commonly PCOS
Also:
- Cushing's
- CAH
- Androgen therapy
- obesity (insulin resistance)
- androgen-secreting ovarian tumour
- Drugs - phenytoin, corticosteroids
Management:
- weight loss
- COCP/co-cyprindiol (co-cyprindiol 3 months max VTE)
- topical eflornithine for facial (not in pregnancy)
43
Causes of hypertrichosis?
Drugs: minoxidil, ciclosporin, diazoxide
congenital hypertrichosis lanuginosa/terminalis
porphyria cutanea tarda
anorexia nervosa
44
```
2 causes of impetigo?
1st line treatment for simple impetigo?
If no/not good enough response to hydrogen peroxide?
If MRSA?
If widespread?
```
Staph Aureus, Strep Pyogenes
topical hydrogen peroxide
topical fucidic acid
MRSA - topical mupirocin
Widespread - oral fluclox (or erythromycin)
Excluded from school until lesions healed/crusted over OR 48 hours after commencing abx
45
2 complications of impetigo?
| What causes it?
Bullous - splitting in granular layer causing blisters that burst to look like burns (localised SSSS)
SSSS - widespread erythema and desquamation causing epidermis loss. Similar to SJS/TENS but unlike them doesn't involve mucosa. IV abx, extensive emollients and fluids
exotoxin A/B release
46
Keratoacanthoma?
| Management?
Benign epithelial tumour more common in elderly
initially smooth dome-shaped papule that rapidly grows to become a crated centrally filled with keratin
Spontaneous regression within 3 months but scars. However, should be excised immediately to rule out SCC - this also prevents scarring
47
5 types of melanoma?
Superficial spreading - long radial growth phase, most common
Nodular - straight into vertical growth phase, bad prognosis
Acral lentigous - on palms/soles/subungal
Amelanotic - no pigment
Lentigo maligna - melanoma in-situ - very slowly progressive but may at some stage develop into malignant
48
What is koebner phenomenon seen in?
Psoriasis
Lichen planus
Lichen sclerosus
Molluscum contagiosum
49
What is koebner phenomenon seen in?
Psoriasis
Lichen planus
Lichen sclerosus
Molluscum contagiosum
50
Management of lichen planus?
Potent topical steroids mainstay
Benzydamine mouthwash for oral
Oral steroids/immunosuppression for extensive
51
Lichen sclerosus management?
| Follow-up?
Topical steroids and emollients
Skin biopsy if not responding or suspicion of neoplastic change - risk of VIN or vulval cancer
52
Smooth, mobile, painless subcut mass?
Rx?
Features suggestive of sarcomatous change?
Lipoma
Nothing
```
>5cm
Increasing size
Pain
Deep anatomical location
(Liposarcoma rare)
```
53
Management of suspected melanoma?
| Exception?
Excision biopsy - remove entire lesion
Lentigo maligna - can be large - take biopsies from darkest areas - topical imiquimod can give histological clearance
54
As well as breslow thickness, what else should be done in workup of melanoma in some cases?
Sentinel node mapping and block dissection of regional lymph nodes
55
Breslow thickness relation to and excision margins?
<1mm - 1cm
1-2mm - 2 cm
2-4mm - 2-3cm
>4mm - 3cm
```
<1mm = >95% 5-year survival
>4mm = <50%
```
56
Most molluscum contagiosum can just be left - when is referral needed? (3)
HIV with extensive lesions - HIV specialist
Eyelid margin or ocular - ophthalmologist
Adults with Anogenital - GUM to ensure it's not something else
57
What is mycosis fungoides?
Rare cutaneous form of T-cell lymphoma
Itchy red patches
Lesions tend to be different colours, unlike eczema/psoriasis where they are generally the same colour
58
What vitamin deficiency causes pellagra?
| What drug can cause it?
B3 - niacin
(3D's - dermatitis, diarrhoea, dementia/depression)
Isoniazid - stops the conversion of tryptophan to niacin
Most common in alcoholics
59
Antibodies in pemphigus vulgaris?
Sign?
Biopsy?
Rx?
Anti-desmoglein 3
```
Nikolsky sign - spread of bullae followng appliction of shear pressure
Painful lesions (not itchy like pemphigoid)
```
Acantholysis
IF - chicken wire
Rx - steroids 1st line
Immunosuppression
60
Periorificial dermatitis?
Cause?
Rx?
Clustered papules, papulovesicles and paplopustules in perioral/perinasal/periocular regions
Lips are SPARED
Usually caused by topical/inhaled steroids
Stop steroids
Topical/oral abx
61
How long for pityriasis rosea to clear up?
6-12 weeks
62
Fungus causing pityriasis versicolor?
| Rx?
Malassezia furfur
(may be mild scale)
Topical antifungal or ketoconazle shampoo
63
4 skin manifestations of SLE?
Photosensitive butterfly rash
Discoid lupus
Alopecia
Livedo reticularis
64
What can precipitate pompholyx?
| Rx?
Humidity (sweating) and high temperatures
(Eczema - small blisters/vesicles on palms and soles - often intensely itchy - may burst)
Cool compresses
Emollients
Topical steroids
65
Internal causes of itch?
Liver disease - stigmata of liver disease, alcohol excess
Iron deficiency anaemia - pallor, koilonychia, atrophic glossitis, angular stomatitis, post-cricoid webs
Polycythaemia - itchy after warm bath, 'ruddy' complexion, gout, peptic ulcer disease
CKD - lethargy, pallor, oedema, hypertension
Lymphoma - night sweats, lymphadenopathy, hepatosplenomegaly, fatigue
Hyper/hypo-thyroid
Diabetes
Pregnancy
Senile pruritis
66
Nail changes in psoriasis? (4)
Present in 80-90% with arthropathy
- Pitting
- Onycholysis
- Subungal hyperkeratosis
- Loss of nail
67
4 subtypes of psoriasis?
| 4 exacerbating factors?
Plaque - most common - extensor, scalp, sacrum
Flexural - skin is smooth
Guttate - transient, post-strep
Palmoplantar pustlosis
Trauma (Koebner)
Alcohol
Withdrawal of systemic steroids
Drugs - B-blocker, lithium, antimalarial, NSAIDS, ACEI
68
DDx purpura in kids? (6)
ALL and meningococcal septicaemia - must rule out
Congenital bleeding disorders
ITP
HSP
NAI
69
DDx purpura in adults? (5)
ITP
Marrow failure (leukaemia, myelodysplasia, bone mets)
Senile purpura
Nutritional def (B12, folate, C)
Drugs (quinine, antiepileptics, antithrombotics)
Raised SVC pressure e.g. from chronic bad cough may cause upper body petechiae but not purpura
70
Pyoderma gangrenosum?
Initially small red papule, develops into deep, red, necrotic ulcer with violaceous border
Idiopathic 50%
Assoc w IBD, SLE, RA, blood cancers and PBC
Oral steroids
71
Pyogenic granuloma?
Who in?
Management?
Usually after trauma in young/pregnant women
Initially small red/brown spot, within days-weeks is raised spherical lesion, may bleed profusely or ulcerate (haemangioma)
Oral mucosal lesions common in pregnancy
Pregnancy-assoc spontaneously resolve post-partum
Otherwise, curettage and cauterisation
72
SE retinoids? (7)
| What drug cannot be prescribed with it?
```
Teratogenicity - 2 forms of contraception (COCP, condoms)
Dry skin, eyes, mouth
Low mood
Raised triglycerides
Nose bleeds
Photosensitivity
Raised intracranial hypertension
```
DO NOT use with tetracyclines - raised ICP
73
```
Cause of itch with scabies?
Where else is affected in infants?
Management?
Who else needs treated?
How long might itch last?
Who gets Norwrgian (crusted) scabies?
Rx for this?
```
Type IV hypersensitivity reaction
Scalp and face
(as well as webs and flexors)
1. Permethin
2. Malathion
Apply, leave on for 12 hours (24 malathion), wash off, reapply 7 days later
All close contacts, treat at same time - also launder/iron clothes/bedsheets on 1st day of treatment to kill off mites
4-6 weeks
HIV pts
Ivermectin
74
Where are sebaceous cysts found?
What will they typically contain?
Rx?
Anywhere
Punctum
Excision - wall must be excised also to avoid recurrence
75
```
Fungus in seborrhoeic dermatitis?
Rash?
Assoc w?
Scalp Rx?
Face/body Rx?
```
Malassezia furfur (same as pityriasis versicolor)
Eczematous lesions in sebum-rich areas - scalp (dandruff), periorbital, airicular, nasolabial folds
HIV, Parkinsons
Scalp - Zinc (head & shoulders) or Tar (neutrogena) shampoo
- Ketoconazole shampoo 2nd line
Face/body:
1. topical ketoconazole
2. topical steroids (for short periods)
Recurrence common
76
Seborrhoeic keratosis Rx?
Reassurance - leave on
Options or removal:
- Curettage
- Cryosurgery
- Shave biopsy
77
Shingles:
- rash?
- antiviral?
- analgesia?
- infectivity time?
- how long does post herpetic neuralgia last?
burning pain for 2-3 days then erythematous, macular rash which quickly becomes vesicular
Doesn't cross midline but may be some 'bleeding' into other areas
- Aciclovir within 72 hours onset
- paracetamol and NSAIDs 1st line, neuropathic 2nd line e.g. amitriptyline
Oral steroids in first 2 weeks in pts with normal immunity and localised if severe pain not responding to above
- infections until vesicles have crusted - usually 5-7 days after onset
Avoid immunocompromised and pregnant
Mostly cured in 6 months
78
When might shingles cause facial palsy?
Ramsay Hunt Syndrome
| Ear lesions and facial paralysis, can cause vertigo and deafness as well
79
Purple cutaneous nodule in immunosuppressed pt?
Kaposi Sarcoma
80
Excision margins for SCC?
If <2cm - 4mm margins
If >2cm - 6mm margins
Mohs microsurgery in high-risk pts or cosmetically important sites
81
Causes of SJS/TEN?
```
Penicillins
Sulphonamides
Lamotrigine, carbamazepine, phenytoin
Allopurinol
NSAIDs
COCP
```
Nikolsky sign +ve in TEN often
Admit for supportive and fluid replacement
In TEN may be ICU, with immunosuppression/IVIG
82
Strawberry naevus progression?
| If Rx required eg blocking visual field?
Capillary haemangioma
Not present at birth, usually develops rapidly in first month of life
Increases in size until about 6-9 months, then starts to regress. 95% resolve by 10 years of age
May bleed, ulcerate or obstruct visual fields
If Rx required:
1. Propanolol
2. Topical timolol
3. Oral steroids
83
```
Rx for:
Athlete's foot?
Tinea corporis/cruris?
Tinea capitis?
Candidiasis?
```
Topical terbinafine 7 days
Topical terbinafine 14 days
Oral terbinafine 2-4 weeks + clotrimazole shampoo twice weekly for 2 weeks
Clotrimazole cream 14 days
84
Rx fungal nail infection?
Send away clippings first for confirmation, then:
Oral terbinafine 6 weeks - fingers
12 weeks - toes
If non-dermatophyte:
Oral itraconazole
85
Normal ABPI range?
What range can be given compression?
Low Rx in venous ulcer?
0.9-1.2
Compression can be safely given between 0.8-1.3
<0.8 - refer for specialist vascular assessment
>1.3 - likely calcification in diabetics
4 layer compression bandaging
86
How to tell if angioedema?
Non-pitting swelling
Usually transient caused by mast cell degranulation in IgE-related process
Resolves in 1-2 days
87
```
Which HPV viruses cause:
- warts?
- genital warts?
- oral and cervical cancer?
Treatment of warts?
```
Warts: 1-4
Genital warts: 6/11
Cancer: 16/18/33
Rx: Salicylic acid, cryotherapy, podophyllum, imiquimod
Podophyllum/cryotherapy 1st line genital
88
Young kid, fever for a few days, then oral vesicles and ulcers, with grey vesicles on hands and feet?
Causes?
Rx?
Hand, foot and mouth disease
Coxsackie virus or enterovirus
None, self-limiting, 10 days
89
What is tinea incognito?
When fungal infection is treated with steroids making it spread and look different
90
Rx for crab lice?
| Head lice?
Crab lice - same as scabies, household contacts don't need treatment though
Head lice - Dimeticone lotion or malathion
91
What is herpetic whitlow?
Paronychia - painful lesions common in healthcare workers and dentists
92
What is xeroderma pigmentosum?
Group of AR disorders causing deficiency of DNA repair mechanisms of skin
Most die in teenage years of skin cancer
93
Acute intermittent porphyria presentation?
| Enzyme deficiency?
Intermittend acute abdo, psychosis and seizures
Usually female around 30 y/o.
PBG deaminase
94
Porphyria cutanae tardis presentation?
Enzyme deficiency?
Woods lamp?
Middle aged men, common with liver disease (alcohol, hep, cirrhosis, haemochromatosis)
Blistering lesion on sun exposed sites that heal with scarring and hyperpigmentation
Uroporphyrinogen decarboxylase
Shines pink instead of blue
95
Erythropoeitic porphyria presentation?
| Enzyme deficiency?
AD disorder seen in children
May be no rash but will be painful burning and itching when exposed to sun - kid may scream in sun
Ferrochealatase
96
What drugs commonly cause photosensitivity? (5)
```
Tetracyclines
Ciprofloxacins
Diuretics
Amiodarone
NSAIDs
```
97
Polymorphic light eruption presentation?
| Rx?
Women around 30, erythema with varying morphology, papules and blisters and severe itch several hours after sun exposure (Type IV hypersensitivity)
Topical steroids
UVB desensitisation
98
Presentation of chronic actinic dermatitis?
| Rx?
Type IV hypersensitivity reaction to sun
Men >50, eczematous rash on sun exposed sites, often assoc w allergic contact dermatitis
Normal eczema treatment and sun protection
99
Solar urticaria presentation?
| Rx?
Type 1 hypersensitivity causing immediate erythema, urticaria and itch in response to sun exposure, which subsides in a few hours
Sun avoidance and antihistamines
100
What are actinic lentiges?
Also called sun/liver spots
Flat brown macule as protective mechanism from melanocyte proliferation in older people in sun-exposed sites
101
Congenital melanocytic naevi?
Typically appear at, or soon after birth, usually >1cm, risk of malignant transformation
102
Junctional melanocytic naevi?
Circular macules - may have heterogenous colour - most naevi on palms/soles/mucous membranes are this type
103
Compound naevi?
Domed, pigmented nodules up to 1cm diameter, arise from junctional naevi, usually have uniform colour and are smooth
104
Spitz naevi?
Typically form in first few months of childhood - may be pink/red but may be pigmented - rapid growth that resembles melanoma
Usually excised as a precaution
105
```
Acanthosis?
Acantholysis?
Hyperkeratosis?
Papillomatosis?
Spongiosis?
Parakeratosis?
Lichenification?
```
thickening of epidermis
separation of individual epidermal cells
Thickened keratin layer
Rough skin due to hyperplasia of dermal papillary projections
oedema in epidermis
nuclei in keratinocytes
Exaggerated skin markings
106
```
Macule?
Patch?
Papule?
Nodule?
Plaque?
```
Flat hyperpigmented <1cm
Flat hyperpigmented >1cm
Raised, well defined, <0.5cm
Raised, well defined, >0.5cm
Raised, flat topped, grows horizontally, >1cm
107
```
Vesicle?
Bulla?
Pustule?
Cyst?
Blister?
```
Fluid filled <0.5cm
Fluid filled >0.5cm
Pus-filled lesion
Semi-solid material filled lesion
Collection of fluid within/below epidermis
108
Erosion?
Ulcer?
Fissure?
Superficial break in epidermis
Deep skin break that extends to dermis
Horizontal split in epidermis
109
Purpura?
Petechiea?
Ecchymoses?
Purpura is the general name given to discolouration of skin/mucous membranes from bleeding from small vessels
Petechiae - purpura <2mm across
Ecchymoses - larger bruises
(in between these just called purpura)
Palpable purpura - purpura that can be felt - often due to vasculitis
110
Cream?
Semisolid emulsification of oil in water - contains preservatives - non-greasy
111
Ointment?
Semi-solid grease, no preservatives, greasy but limit transdermal water loss
112
Lotion?
Liquid formulations suspended in water or alcohol (alcohol can cause stinging) - generally used to treat dry, hairy areas e.g. scalp
113
Gel?
Semisolid thickened aqueous solution, used for hairy areas or face
114
Paste?
Semisolid made of finely powdered materials e.g. zinc oxide - cool and hydrate skin but difficult to apply
115
When to refer to secondary care for burns?
Superficial burns covering >3% TBSA (2% in kids)
All deep dermal/3rd degree burns
Superficial dermal burns of face, hands, feet, perineum, neck
Electrical or chemical burn
Inhalation injury
Suspected NAI
116
Initial management of burns?
```
Put in ice cool water for 10-30 mins then cover in clingfilm - layered not wrapped
analgesia
clean wound
emollient - leave blisters in tact
non-adherent dressing
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If chemical - brush off any powder and rinse off with water - do not attempt to neutralise
117
Widespread sunburn-like rash over body, including lips, with fever and sepsis?
What can cause this in women?
Staph toxic shock syndrome
Tampon use
118
Nail changes in psoriasis?
| What systemic thing are psoriasis patients more at risk of?
Pitting, onycholysis, subungal hyperkeratosis
Cardiovascular disease
