Derm Flashcards
What is the management of acne?
1st line = topical retinoids/benzoyl peroxide
2nd line = Oral tetracycline/erythromycin + topical retinoid/benzoyl peroxide
3rd line = oral isotretinoin (must be prescribed by derm)
Describe eczema herpeticum?
An area of rapidly worsening painful eczema. Lesions may be fluid filled/blood stained with a central umbilication
Mx = admit for urgent IV aciclovir
Describe erythema multiforme?
A hypersensitivity reaction e.g. to penicillins or infection
Sx = target lesions on the hands/feet which spread to the torso. No or mild itch
Describe granulomatosis with polyangitis?
Haemoptysis, cough wheeze, epistaxis, crusty nasal secretions, sinusitis, saddle shaped nose, hearing loss and glomerulonephritis.
Describe goodpasture’s syndrome?
Haemoptysis, glomerulonephritis and rapidly deteriorating kidney function
Describe Henoch-Scholein Purpura?
In children post-infection
Purpuric rash over the buttocks and extensor surfaces of the legs, abdo pain and polyarthritis
Describe Polyarteritis Nodosa?
Vasculitic rash and malaise with weight loss and joint pain. Seen in those with a Hx of Hep B infection
Name 4 causes of erythema nodosum?
TB, Sarcoidosis, Infection and Pregnancy
What is the most common cancer seen in those who have had a renal transplant?
Squamous cell carcinoma
What is the management of chronic plaque psoriasis?
Potent topical corticosteroids (e.g. beclametasone) and vitamin D analogues (e.g calcipotriene)
What is normal ABPI? What does an abnormal result indicate?
Normal = 0.9-1.2
<0.9 = arterial disease
What is the most common causative organism in fungal toe infection?
Trichophyton Rubrum
Sx, Ix and Mx of fungal toe infection?
Sx = thickened, rough or opaque nails
Ix = nail clippings/scrapings
Mx = amorolfine 5% nail lacquer. If unsuccessful or extensive infection give oral terbinafine
Describe Guttate Psoriasis?
Tear drop scaly papules on the trunk and limbs. Occurs 2-4 weeks after a strep sore throat and lasts 2-3 months.
Describe Pityriasis Rosea?
Herald patch followed 1-2 weeks later by multiple erythematous raised oval lesions with a fine scale. Follows URTI and lasts 6-12 weeks
Describe Erythema ab Igne?
Reticulated erythematous patches with hyperpigmentation and telangiectasia secondary to heat (e.g. hot water bottle or fire).
If untreated may lead to squamous cell skin cancer
Describe the appearance of plaque psoriasis?
Erythematous papules covered with a silvery-white scale. If the skin is removed a red membrane with bleeding may be seen
Describe seborrheic dermatitis?
A fungal skin infection causing eczematous lesions of the scalp/eyebrows, and periorbital/auricular/nasolabial folds
Mx of seborrheic dermatitis?
Scalp = Head and shoulders and T-gel
Face/Body = Topical ketoconazole
How do you manage urticaria?
1st line = non-sedating anti-histamines
If severe give oral prednisolone
What is Tinea Capitis? How do you treat it?
A fungal infection causing scarring alopecia in children
Mx = oral terbinafine and topical ketoconazole
How do we manage ringworm?
Oral fluconazole
What is Pompholyx?
Eczema of the hands and feet. It is intensely itchy and burning with blisters on the palms/soles. The rash is exacerbated by humidity and high temperatures
What is the most important prognostic factor in melanoma?
The invasion depth of the tumour
When can we use oral steroids to treat pain in shingles?
If <2 weeks since symptom onset and there is severe pain which is not relieved by simple analgesia or neuropathic analgesia
How can burns cause oedema?
They can cause hypoalbuminaemia which leads to oedema
What is the gold standard for TB diagnosis?
Sputum culture
What condition can serum ACE help us diagnose?
Sarcoidosis
Name the drug causes of erythema nodosum?
Penicillins, COCP and Sulphonamides
What findings are seen in acne vulgaris?
Comedones (whitehead if top is closed, blackhead if top is open), papules and pustules
What should you do with healthworkers who are not immune to VZV?
Vaccinate them
What are the complications of toxic epidermal necrolysis?
Fluid loss and electrolyte derrangement
True or false, iron deficiency anaemia can cause pruritis?
True
True or false palmar erythema may be seen in liver disease?
True
Sx of Polycythaemia?
Pruritits after a hot bath, ruddy complexion, splenomegaly, HTN, hyperviscostity, bleeding, gout and peptic ulcer disease
Describe dermatofibromas?
Benign skin lesions which occur secondary to injury, no Mx is needed
Nail changes in psoriasis?
Pitting, onycholysis, subungual hyperkeratosis and loss of nail
How much of a break should we aim for between courses of topical steroids in psoirasis?
At least 4 weeks
Mx of Scabies?
Permethrin 5% applied to the whole body, leave to dry for 8-12 hours then remove. Repeat 7 days late.
Do this in all close contacts.
Malathion 1% is second line
What is it called when you have fine unpigmented hair? What can it be associated with?
Lanugo hair, associated with chronic malnutrition
What should you do with all children presenting with new onset purpura?
Refer to hospital to exclude ALL and meningococcal disease
Shingles Mx?
PO antivirals and advise that they are infectious until all lesions have crusted over (5-7 days)
Describe atopic eruption of pregnancy?
Most common skin condition of pregnancy, Eczematous itchy red rash
No Mx neededd
Describe polymorphic eruption of pregnancy?
Seen in the 3rd trimester it is an itchy lesion 1st appearing in the abdominal striae. Mx = emollients or steroids (topical or PO depending on the severity)
Describe Pemphigoid Gestationis?
Seen in the 2nd/3rd trimester is a pruritic blistering lesion which starts peri-umbilical and then spreads to the trunk, back, buttocks and arms
Mx = PO steroids
Describe 1st degree burns?
Superficial epidermal
Red, painful and dry with no blisters
Describe 2nd degree burns?
Partial thickness (superficial dermal) = pale pink, painful, blistered with a slow capillary refill
Partial thickness (deep dermal) = white, may have patches of non-blanching erythema, reduced sensation and pain only to deep pressure
Describe 3rd degree burns?
Full thickness
White (waxy)/brown (leathery)/black. No blisters, no pain
Describe salmon patches?
Small, flat patches of red/pink skin with poorly defined borders. Resolve by 18 months
Mx of scalp psoriasis?
Potent topical corticosteroids. If no resolution of symptoms by 8 weeks give topical vitamin D analogues
What is the Koebner phenomenom?
New skin lesions occur at the site of cutaneous injury
Seen in psoriasis and vitiligo
Describe seborrheic keratoses?
Benign epidermal skin lesions seen in older people. Have a stuck on appearance and may vary in colour
No Mx required
How do we manage facial hirsutism?
Eflomithine
Where are arterial and venous ulcers typically found?
Venous ulcers = above the medial malleolus
Arterial ulcers = above the lateral malleolus
When do we use a skin patch vs skin prick test to diagnose hypersensitivity reactions?
Skin patch to diagnose skin reactions e.g. nickel
Skin prick to diagnose systemic reaction e.g. nuts
Where are venous ulcers typically found? How do you investigate and treat?
They are typically seen above the medial malleolus
Ix with ABPI to assess arterial flow
Mx = compression bandaging +/- oral pentoxifylline
Mx impetigo?
1st line = hydrogen peroxide 1%
2nd line = topical fusidic aid, use mupirocin if resistance e.g. in MRSA
School exclusion until all lesions are crusted over and healed or 48 hrs after starting Abx treatment
What happens to dermatofibromas when you pinch them?
They dimple
Describe lichen scleorisis?
Itchy white patches on the vulva of elderly women.
In men it may cause a tight white ring around the tip of the foreskin leading to phimosis
Sx and Mx of Rosacea?
Facial flushing, telangiectasia, erythema with papules and pustules along side thickening of the skin e.g. over the nose
Mx = high factor sun cream
If only erythema and flushing = TOP brimonidine gel
If mild/moderate papules/pustules = TOP ivermectin
If mode/severe papules/pustules = TOP ivermectin + PO doxycycline
If these fail you can offer laser therapy for telangiectasia
What is a lipoma?
A smooth, mobile and painless lump found in the s/c tissue
If >5cm, growing, painful or in a deep anatomical location US to exclude lipoma
What is an important complication of ketoconazole?
Gynaecomastia
What is Molluscum Contagiosum?
A viral lesion seen in childhood associated with Koebner’s phenomenon (lesions seen at the site of injury)
Mx of lichen sclerosis?
TOP strong steroids (e.g. clobetasol propionate) and emollients
What is dermatitis herpetiformis?
Chronic itchy blister clusters seen in those with coeliac’s disease (they may also be malnurished)
What is a pyogenic granuloma?
Over growth of blood vessels leading to red nodules at the site of trauma - these will often bleed
Describe Keratoacanthomas?
Friable (will bleed/come away when touching) lesions seen in older people. They look like a volcano (have a smooth dome but the crater is filled with keratin). They will slough off on their own but lead to scarring.
2WW these patients to exclude squamous cell carcinomas
Describe Buerger’s Disease?
Limb claudication, absent foot pulses and tortuos corkscrew collateral veins seen in smokers
Describe Takayasu’s arteritis?
Upper limb claudication, absent upper limb pulses and raised ESR in young women
What is an important complication of psoriatic arthritis?
Cardiovascular disease
What is Nikolysky’s sign?
Gentle pressure on normal skin will cause the damaged area of skin and sloughing to extend. This is seen in toxic epidermal necrolysis
What is the commonest form of pneumonia in alcoholics?
Klebsiella
Describe Pyoderma Gangrenosum?
Very painful areas of rapidly enlarging skin ulceration following minor injury. The lesions will have undefined borders and are typically found on the lower leg
Mx = oral steroids
Which conditions can Pyoderma Gangrenosum be associated with?
RA, SLE, UC, Crohn’s, PBC, lymphoma and AML/CML
What is the most accurate way to assess burns?
Lund Browder chart
Mx of plantar warts (verruca’s)?
Salicylic acid
What are actinic keratoses?
Dry scaly patches of skin which have been damaged by the sun
Mx = cryosurgery or TOP fluorouracil
Which neurological condition is associated with seborrheic dermatitis?
Parkinson’s
