Derm

Question 1

Explain the pathophys of acne

Answer 1

1. Seborrhea (inc sebum production)
2. Narrowed follicle blocks sebum - comedo formation
3. Sebum stagnates and P. Acnes colonises follicle
4. Leading to inflammation of pilosebaceous unit

Question 2

How does acne present

Answer 2

• Open and closed comedones (dilated sebaceous follicle)

- Papules and pustules

Question 3

What is the treatment for acne?

Answer 3

1. topical benzoyl peroxide or retinoid
2. Add topical antibiotic
3. Oral antibiotic - tetracyclines (Contraindicated in preg)
4. COCP for women
5. Oral isotretinoin

Question 4

What must be given alongside oral antibiotics for acne to prevent antibiotic resistance?

Answer 4

topical retinoid/benzoyl peroxide

Question 5

what might occur as a complication of long term Abx use for acne

Answer 5

gram neg folliculitis

Question 6

how is gram negative folliculitis treated

Answer 6

high dose oral trimethoprim

Question 7

which Abx for acne in pregnancy

Answer 7

erythromycin

Question 8

briefly explain the pathophys of eczema

Answer 8

1. loss of function mutations in filaggrin
2. defects in skin barrier
3. allows irritants, allergens and microbes to enter
4. immune response triggered, leading to inflammation

Question 9

how does eczema present

Answer 9

dry erythematous itchy skin, poorly defined rash

particularly on flexor surfaces

Question 10

how is eczema managed

Answer 10

• avoid irritants
• emollients
• topical steroids - weakest for shortest period required to calm flare down
• wet wrapping
• sedative antihistamines if itchy
• immunosuppressants - tacrolimus, ciclosporin azathioprine

Question 11

what are the side effects of topical steroids

Answer 11

• thin skin, striae, bruising, more prone to flares
• acne
• telangiectasia

Question 12

list in order of potency topical steroids

Answer 12

weak: hydrocortisone
moderate: eumovate (clobetasone butyrate)
potent: betnovate (betamethasone)

very potent: dermovate (clobetasol propionate)

Question 13

which organism most commonly causes infection in eczema and how is it treated

Answer 13

s. aureus, oral fluclox or topical fucidic acid

Question 14

which organism causes eczema herpeticum

Answer 14

herpes simplex virus (HSV1)

Question 15

what are the symptoms of eczema herpeticum

Answer 15

painful widespread vesicular rash (may contain pus)
fever
lethargy
irritability
reduced oral intake
lymphadenopathy

Question 16

describe the rash associated with eczema herpeticum

Answer 16

vesicular rash, vesicles may contain pus

vesicles leave behind monomorphic punched out lesions with a red base (ulcerated)

Question 17

how is diagnosis of eczema herpeticum confirmed

Answer 17

viral swabs - treat based on clinical picture, dont wait for results to come back

Question 18

how is eczema herpeticum treated

Answer 18

mild/moderate - oral aciclovir
severe - admit for IV aciclovir
children should be admitted

Question 19

what is a complication of eczema herpeticum

Answer 19

bacterial superinfection
scarring from blisters
herpetic keratitis - can lead to blindness

Question 20

What is BCC also known as

Answer 20

rodent ulcers

Question 21

Do BCC metastasise

Answer 21

extremely rare

Question 22

where do BCC usually present

Answer 22

sun exposed areas, head and neck

Question 23

how do BCC usually present

Answer 23

pearly, flesh-coloured papule with telangiectasia, which may ulcerate and leave a central “crater”

Question 24

How is BCC managed

Answer 24

surgical removal
curettage and cautery
cryotherapy
topical cream - imiquimod and fluorouracil
radiotherapy

Question 25

what are the RFs for BCC

Answer 25

exposure to UV light
lighter skin
radiotherapy
immunodeficiency
long term exposure to arsenic

Question 26

what is the pathophys of cellulitis

Answer 26

inflammation of skin and subcutaneous tissues due to streptococcus pyogenes or s. aureus

Question 27

how does cellulitis present

Answer 27

commonly presents on shins
erythema, swelling, warmth, pain
may be systemic signs of inflammation - fever

Question 28

what Abx for cellulitis

Answer 28

fluclox

if allergic, clarithromycin or erythromycin in pregnancy

Question 29

what treatment of severe cellulitis

Answer 29

co-amox, clindamycin, cefuroxime, ceftriaxone

Question 30

what are the two types of contact dermatitis

Answer 30

allergic

irritant

Question 31

how is contact dermatitis investigated

Answer 31

patch testing

Question 32

how does contact dermatitis present

Answer 32

red rash
wheals/blisters/urticaria
itchy burning skin

Question 33

what type of hypersensitivity reaction is contact dermatitis?

Answer 33

type IV

Question 34

give an example of allergic contact dermatitis and its treatment

Answer 34

following hair dye, scalp line inflamed with acute weeping eczema, treat with potent topical steroids

Question 35

what can cause irritant contact dermatitis

Answer 35

due to detergents