Derm Flashcards
what is the difference between SJS and TEN
SJS is LESS THAN 10% of skin involvement
TEN is >30% skin involvement
what can cause SJS/TEN
Drug reaction
Never Press Skin As it Can Peel (nikolsky sign)
NSAID
Phenytoin
Sulphonamide
Allopurinol
IVIG
Carbamazepine
Penicillin
what does SJS look like
scalded skin over extensive area
systemically unwell
what is Nikolsky sign
epidermis separates at mild pressure
hoow doo you manage SJS
stop precipitating factor, ITU, IVIG
what is seborrhoeic dermatitis
chronic dermatitis caused by proliferation of a normal skin inhabitant, the fungus Malassezia furfur
How does seborrhoeic dermatitis present
eeczematous lesion of sebum rich areas (dandruff on scalp)
mx for seborrheic erma
Zinc (head and shoulders) and tar (neutrogena T) for scalp disease
topical antifungalls if on body
what does impetigo look like
gold crust appearance
what is the bacteriuim that causes impetigo
staph aureus
how do you manage impetigo
hygiene measures
topical HYDROGEN PEROXIDE 1% cream> 2% fusidic acid cream
give oral fluclox if widespread
How do you manage mild acne first line
benzoyl peroxide and / or topical retinoid and / or topical abx
what abx can you give for acne
topical clindamycin 1%
what is second line for mild acne
azelaic acid
how do you manage severe acne firist line that does not respond to topical
Oral ABX (max 3m) + BPO / retinoid
Abx is lymecycline or docy
what do you refer to dermatologist for if they have acne
for isotrenitoin oral
side effects of roaccutane
dryness, teratogenic
hair thinning
photosensitivity
low mood and suicide ideation
what is the acne that middle aged people get called
acne rosacea
describe acne rosacea
middle aged peopple
flushing
symmetrical rash on nose, cheeks, foreheaad and telangectasia
persistent pustopapular erythema
how do you manage acne rosacea
Mild/moderate: topical metronidazole
Severe: oral tetracycline
what causes pytiriasis versiccolor
malassezia furfur
what does pytiriasis versiccolor look like
hypopygmented patches
mild pruritus
after a SUNTAN
TRUNK affected
how is pytiriasis versiccolor different to vitiligo
vitiligo is in pripheeries and a lot more confluent
how can you reverse vitiligo
with topical steroids
but only if applied early
what causes pityriasis rosea
HHV7
sx of pityriasis rosea
recent viral infection
herald patch on trunk
erythematous oval scaly patches (fir tree appearance(
how do you treat pityriasis rosea
you dont its self limiting
what are the types of psoriasis that you can get
plaque - most common, with well demarcated red scaly patches
guttate
pustural
flexural
what is guttate psoriasis due to
strep infection
what does guttate psoriasis look like
teardrop lesions on the back
how do you manage psoriasis
corticosteroid and vit D analogue
consider emollients
phototherapy, photochemotheray
where does psoriasis occur
ON EXTENSOR surfaces
where does eczema occur
on FLEXOR surfaces
sx of eczma
dry skin
itching
redness
may become infected
how do you manage eczema
emollients
topical corticosteroids
fluclox oral if infected
how do you manage scabies
Permethrini x2, wash off after 8 hours
treat al household contacts
how do you manage headlice
malathion (which is second line for scaabies)
what does tinea look like
ringed appearance
kerion
red or silver rsh
tinea management
topiocal or oral antifungals
e.g. TERBINAFINE , clotrimazole
how do you mnag shingles
analgesia (paracetamol + NSAID)
antivirals (PO acyclovir)
describe lichen planus
purple pruritic papular polygona rash
itchy
on palms, soles, genitalia, flexor surfaces of arms
hhow do you manage lichen planus
TOPICAL steroids (clobetasone)
what is lichen sclerosus
itchy white spots seen on vulva of elderly
hwow do you manage cellulitis
FLUCLOX if mild
CO AMOX if sevre
how do you tell erysepelas apart from cellulitis
erysipelas is well demarcated
list the steroid ladder
Help Carol Become a Medic
1. Hydrocortisone
2. Clobetasone butyrate
3. Betamethasone
4. Mometasone
what causes bullous pemphigoid
ANTIBODIES againsst BM (at dermoepidemal junctin)
sx of bullous pemphigoid
TENSE bullae
itchy
NO oral involvement
Ix bullous pemphigoid
immunofluorescence (IgG, C3 at dermoepidermal junction)
how do you maage bullous pemphigoid
oral corticosteroids
Pemphigus vulgaris cause
Antibodies against desmosomes (superficial)
sx pemphigus vulgaris
flaccid blisters
ORAL involvement
whatg is an actinic keratosis
pre-malignant skin condition for SCC
how does actinic keratosis present
small, crusty/scaly, on sun exposed area
Who and how do you manage actinic keratosis
GP if simple, urgent 2ww if immunosuppressed
- fluorouracil cream + topical hydrocort
- topical diclofenac
- topical imiquinod
which areas are 9% of body for burns fluid calc
Head+neck
each arm
each anterior leg
each posterior leg
anterior chest
post chest
ant abdo
post abdo
whaat is hidroadenitis suppurativa
chronic inflamm occlusion of pilosebaceious units > prevent keratinocytes from properly shedding
how does hidroadenitis suppurativa present
recurrent boiils in intertriginous areas (axilla, neck, thighs, ingluinal, breast) > plaques, scarring
how do you manage hidroadenitis suppurativa
good hygiene, loose clothing, smoking cessation
Acute: steroids, fluclox
chronic: clindamycin (topical), lymecycline (PO)
how long should the corticosteroid breaks be (at least) in psoriasis
4 weeks
causes of erythema multiforme
infection (90%)
- HSV ***most common
- mycoplasma
drugs
- NSAID
- penicillins
- sulphonamides, sulphonylureas
- nitrofurantoiin
describe erythema multiforme appearance
target lesions
initially on back of hands / feet, then torso
upper limbs more likely than lower limbs
pruritus occasionally
what is erythroderma
rash that involves >95% of the body
causes of erythema nodosum
SORE SHINS
Streptococci, mycoplasma, EBV
OCP
Rickettsia
Eponymous Behcets
Sulphonamides, penicillins
Hansen’s disease (leprosy)
IBD
NHL
Sarcoid and TB
what is the single most important prognostic factor for melanoma
breslow thickness
side effectss of topical corticosteroids
thin sskin
skin depigmentation (esp if dark skin)
excessive hair growth
what exacerbates psoriasis
trauma
alcohol
drugs (beta blockers, lithium, antimalaria, NSAID, ACEi, infliximab)
withdrawal from steroids
what does a BCC look like
rodent ulcer: pearly papule with telangectasia
ulcerates at the center to leave a crater
where do pygenic granulomas occur
after a small skin lesion e.g. a cut
what is a pyogenic granuloma
reactive proliferation of capillary blood vessel
what do pyogenic granulomas do if you touch them
bleed on contact
how long are shingles infectious for
until they have crusted over (usually around one week)
how long must you exclude from school someone wiht shingles
until lesions fully crust ovr OR 48 hours from start of antibiotics
explain features of dermatitis herpetiformis
itchy vescicular lesions on EXTENSOR SURFACES (knees, buttocks, elbows)
what is hirsutism
male like hair pattern in women (= androgen dependent hair growth)
most common cause of hirsutism
PCOS
also cushings, CAH, androgen therapy
causes of acanthosis nigricans
T2DM / obesity , PCOS, acromegaly, Cushing’s
GI cancer
how do you manage pyoderma gangrenosum
ORAL steroids first
becuase it has high potential to spread rapidly
