Derm Flashcards
Eye involvement in molluscum contagiosum warrants what?
Urgent ophthal referral
What conditions are associated with spider naevi?
- Liver disease
- Pregnancy
- COCP
What does a Granuloma annulare look like and where are they located?
Papular lesions that are often slightly hyperpigmented and depressed centrally.
Typically occur on the dorsal surfaces of the hands and feet, and on the extensor aspects of the arms and legs
Management of scalp psoriasis?
NICE recommend the use of potent topical corticosteroids used once daily for 4 weeks. 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
Symptoms of CKD?
Lethargy & pallor
Oedema & weight gain
Hypertension
What is telogen effluvian?
Stress induced hair loss
Normal location for venous ulcers?
Above medial malleolus
Features of pemphigoid gestationis
pruritic blistering lesions
often develop in peri-umbilical region, later spreading to the trunk, back, buttocks and arms
usually presents 2nd or 3rd trimester and is rarely seen in the first pregnancy
(oral corticosteroids are usually required)
Signs/Symptoms of lymphoma?
Night sweats
Lymphadenopathy
Splenomegaly, hepatomegaly
Fatigue
Management of chronic plaque psoriasis?
NICE recommend a step-wise approach for chronic plaque psoriasis
regular emollients may help to reduce scale loss and reduce pruritus
first-line: NICE recommend:
a potent corticosteroid applied once daily plus vitamin D analogue applied once daily
should be applied separately, one in the morning and the other in the evening)
for up to 4 weeks as initial treatment
second-line: if no improvement after 8 weeks then offer:
a vitamin D analogue twice daily
third-line: if no improvement after 8-12 weeks then offer either:
a potent corticosteroid applied twice daily for up to 4 weeks, or
a coal tar preparation applied once or twice daily
short-acting dithranol can also be used
Causes of Steven johnson syndrome?
penicillin sulphonamides lamotrigine, carbamazepine, phenytoin allopurinol NSAIDs oral contraceptive pill
Difference in surface area covering in SJS and TEN?
SJS <10% body covering
TEN >30% body covering
Where do keloid scars form?
common sites (in order of decreasing frequency):
sternum, shoulder, neck, face, extensor surface of limbs, trunk
Difference in pityriasis rosea and guttate psoriasis?
Guttate psoriasis = Rash followed by sore throat (strep throat) in teenagers
Pityriasis Rosea = URTI and HERALD PATCH, rash along skin tension lines
What is scarring alopecia and what are the causes?
It is hair loss caused by destruction of hair follicle.
trauma, burns radiotherapy lichen planus discoid lupus tinea capitis*
Management of acne rosacea?
Topical metronidazole may be used for mild symptoms (i.e. Limited number of papules and pustules, no plaques)
Topical brimonidine gel may be considered for patients with predominant flushing but limited telangiectasia
More severe disease is treated with systemic antibiotics e.g. Oxytetracycline
Essentially:
mild/moderate: topical metronidazole
severe/resistant: oral tetracycline (doxycycline).
Management of keloid scars?
Early keloids may be treated with intra-lesional steroids e.g. triamcinolone
Excision is sometimes required
Is there mucosal involvement in Bullous pemphigoid and pemphigoid vulgaris?
No mucosal involvement (in exams at least*): bullous pemphigoid
Mucosal involvement: pemphigus vulgaris
Features of Vitiligo?
well-demarcated patches of depigmented skin
the peripheries tend to be most affected
trauma may precipitate new lesions (Koebner phenomenon)
Difference in incision and drainage and surgical excision?
I&D - relieve Sx temporarily by draining cyst.
Surgical excision - remove permanently.
Risk factor for angular cheilitis?
Oral thrush: infancy, old age, diabetes, systemic corticosteroid or antibiotic use
Dentures, especially if they are poor fitting, and there is associated gum recession
Poor nutrition: coeliac disease, iron deficiency, riboflavin deficiency, zinc deficiency
Systemic illness, particularly inflammatory bowel disease (ulcerative colitis and Crohn disease)
Sensitive skin, especially atopic dermatitis
Genetic predisposition, for example in Down syndrome
Oral retinoid medication: isotretinoin for acne, acitretin for psoriasis.
Causes of erythema nodosum?
Infection:
- streptococci
- tuberculosis
- brucellosis
Systemic disease:
- sarcoidosis
- inflammatory bowel disease
- Behcet’s
Malignancy/lymphoma
Drugs
- penicillins
- sulphonamides
- combined oral contraceptive pill
Pregnancy
Progression of erythema nodosum?
Resolve within 6 weeks
What are Milia
Milia are small, benign, keratin-filled cysts that typically appear around the face. They may appear at any age but are more common in newborns.
When should you prescribe antiretrovirals in shingles?
Within 72hrs.
Associated conditions with Vitiligo?
type 1 diabetes mellitus
Addison’s disease
autoimmune thyroid disorders
pernicious anaemia
alopecia areata
Treatment for Capillary hemangiomas (Strawberry Naevus)
If treatment is required (e.g. Visual field obstruction) then propranolol is increasingly replacing systemic steroids as the treatment of choice. Topical beta-blockers such as timolol are also sometimes used.
Investigation of possible Contact dermatitis?
Patch testing
Risks of oral minocycline?
Drug induced lupus and hyperpigmentation.
What is leukoplakia?
Leukoplakia is a premalignant condition which presents as white, hard spots on the mucous membranes of the mouth. It is more common in smokers.
What is Necrobiosis lipoidica?
Shiny, painless areas of yellow/red/brown skin typically on the shin
Often associated with surrounding telangiectasia
Nail changes in Psoriasis?
pitting
onycholysis (separation of the nail from the nail bed)
subungual hyperkeratosis
loss of the nail
What is Acquired ichthyosis associated with?
Lymphoma
What is Acquired hypertrichosis lanuginosa associated with?
Gastrointestinal and lung cancer
What is Dermatomyositis?
Ovarian and lung cancer
What is Erythema gyratum repens associated with?
Lung cancer
What is erythroderma associated with?
Lymphoma
What is Migratory thrombophlebitis associated with?
Migratory thrombophlebitis
What is Necrolytic migratory erythema associated with?
Glucagonoma
What is Pyoderma gangrenosum associated with?
Myeloproliferative disorders.
What is sweets syndrome associated with?
Haematological malignancy e.g. Myelodysplasia - tender, purple plaques
What is Tylosis associated with?
Oesophageal cancer
Management of vitiligo?
sunblock for affected areas of skin
camouflage make-up
topical corticosteroids may reverse the changes if applied early
there may also be a role for topical tacrolimus and phototherapy, although caution needs to be exercised with light-skinned patients
Features of erythema multiforme?
Target lesions - (looks like a ring with gap in middle)
initially seen on the back of the hands / feet before spreading to the torso.
Upper limbs are more commonly affected than the lower limbs
Pruritus is occasionally seen and is usually mild
Causes of Erythema multiforme?
Viruses: herpes simplex virus (the most common cause), Orf*
Idiopathic
Bacteria: Mycoplasma, Streptococcus
drugs: penicillin, sulphonamides, carbamazepine, allopurinol, NSAIDs, oral contraceptive pill, nevirapine
Connective tissue disease e.g. Systemic lupus erythematosus
Sarcoidosis
Malignancy
What is Curlings ulcer?
Curling’s ulcer is a recognised complication of severe burns. It is a gastric ulcer caused by necrosis of the gastric mucosa, usually due to hypovolaemia. They carry a high rate of bleeding and mortality.
Flexural psoriasis treatment?
a mild or moderate potency corticosteroid applied once or twice daily for a maximum of 2 weeks
Management of eczema herpeticum?
Admit to hospital for IV aciclovir
Features of pretibial myxoedema?
symmetrical, erythematous lesions seen in Graves’ disease
shiny, orange peel skin
Features of Necrobiosis lipoidica diabeticorum?
shiny, painless areas of yellow/red skin typically on the shin of diabetics
often associated with telangiectasia
When should you refer a BCC urgently?
If it is on/near the eyes/nasal cartilages or an area that could cause permanent damage
Treatment for lichen planus?
potent topical steroids are the mainstay of treatment
benzydamine mouthwash or spray is recommended for oral lichen planus
extensive lichen planus may require oral steroids or immunosuppression
Management of guttate psoriasis?
Watch and wait, treat if lesions symptommatic
