derm

Question 1

NICE criteria for dx atopic dermatitis

Answer 1

Itchy skin + 3/5 of
- visible flexural eczema (eryhtematous, itchy, poorly demarcated rash) face, or scalp - cheeks/ extensors if <18m
- Hx of felxural eczema
- Hx dry skin
- Hx atopy (in dividual/ 1st degree relative if <4yo)
- onset <2yo (dont use in <18m)

Question 2

3 complicaitions of eczema

Answer 2

Eczema herpeticum - emergency, HSV inffection 2o to atopic dermatitis
superficial bacterial infection (stap/strep)
erythroderma (emergency) - widespread erythema >90% skin surface Leads to: heat and fluid loss –> hypothermia and systemic Sx

Question 3

what type of hypersensitivity is atopic dermatits

Answer 3

Typ1 hypersensitivity - IgE mediated

Question 4

give stepwise topic mx in eczema

Answer 4

1. emmolient (Aveeno, E45, Diprobase)
2. Steroids -
   - mild: hydrocortisone, Mod: eumovate, Potent betnovate, V. potent: Dermovate

Question 5

how do the following subtypes of psoriasis present
- plaque psoriasis
- flexural
-guttate
- pustular

Answer 5

plaque - most common, well-demarcated red, scaly patches on extensor surfaces, sacrum, scalp

flexural - smooth patches on skin
(affects skinfolds (armpits, under breasts, genital areas - smooth, shiny scaling)

guttate - strep infection triggered rash, multiple red, teardrop leasions

pustular - palms & soles

Question 6

2 non-skin features of psoriasis

Answer 6

nails: pitting, onycholysis (separation of the nail from the nail bed)
subungual hyperkeratosis, loss of the nail

arthritis

Question 7

molluscum contangiosum advice

Answer 7

self-limiting (12-18m)

but contagious, so dont share towels etc

school exclusion not required

Question 8

what is the difference in presentation between lichen planus and lichen sclerosus

Answer 8

Lichen
planus: purple, pruritic, papular, polygonal rash on flexor surfaces. Wickham’s striae over surface. Oral involvement common

sclerosus: itchy white spots typically seen on the vulva of elderly women

Question 9

Mx options for actinic keratosis ( give 3)

Answer 9

prevention of further risk: e.g. sun avoidance, sun cream
fluorouracil cream: typically a 2 to 3 week course. The skin will become red and inflamed - sometimes topical hydrocortisone is given following fluorouracil to help settle the inflammation
topical diclofenac: may be used for mild AKs. Moderate efficacy but much fewer side-effects

remeber actinic keratosis on sun exposed areas of the body

Question 10

x2 differences in appearance between Plaque psoriasis and eczema

Answer 10

found in similar areas but

plaque posriasis:
- well defined borders
- silvery scale

Eczema
- poorly defined borders
- no silvery scale

Question 11

give 2 main causes of impetigo

Answer 11

strep pyogenes & staph aureus** most common

Question 12

1st line mx in impetigo if

• systemically well
• extensive disease (systemically unwell)

Answer 12

well: Hydrogen peroxide 1% cream (antiseptic) (Fusidic acid 2% - antibiotic, 2nd line)

unwell: oral fluclox (erythromycin 2nd line)

Question 13

what bacteria is a golden crust associated with

Answer 13

staph aureus

Question 13

should children be kept off school if they have impetigo?

Answer 13

yes - contagious

Question 14

describe
- mild
-mod
-sev acne

Answer 14

mild - open & closed comedones, may have sparse inflammatory lesions

mod - widespread non-inflammatory lesions & neumerous papules & pustules

sev - extensive inflammatory lesions, with nodules/pitting/scarring

Question 15

give the stepwise max for acne (5)

Answer 15

single topical therapy - topical retinoids/benzoyl peroxide)

topical combination therapy ( topical antibiotic, benzoyl peroxide, topical retinoid

3. oral Abx (tetracyclines - lymecycline, doxycycline erythmomycin in pregnancy ) - max use 3 months
   co-prescribe topical retinoid/benzoyl peroxide
4. COCP in women (diannette aka co-cyrindiol)
5. oral isotretinoin ( specialist)

Question 16

x eczema complication

bacterial infection of eczema

eczema herpeticum

Answer 16

bacterial - oral Abx (e.fg. fluclox)/ admit if severe

eczema herpeticum - oral aciclovir ( IV if severe)

Question 17

stepwise mx in eczema

maintenance

flares

Answer 17

maintenance
- avoid irritation
- emollients (thin creams e.g. E45, Diprobase cream, aveeno cream, cetraben cream) (thick, greasy e.g. hydromol ointment, diprobase ointment, cetraben ointment)

flares
steroid
steroid ladder
Mild - hydrocortisone (0.5-2.5%)
Mod - Eumovate
Potent - Betnovate
V. potent Dermovate

Question 18

features of a BCC (x4)

Answer 18

most common type - nodular

• sun-exposed sites (head and neck)
• initially a pearly, flesh-coloured papule
• telangiectasia
• may later ulcerate - leaving a dcentral ‘crater’

Question 19

what cream can be used in actinic keratosis management which may cause redness and inflammation of skin

Answer 19

fluorouracil cream: 2 -3 week course.

topical hydrocortisone is given following fluorouracil to help settle the inflammation

Question 20

define bowens disease

Answer 20

precancerous dermatosis - precursor to SCC (5-10% chance of becoming SCC)

Question 21

describe the features of Bowens disease (x4)

Answer 21

red, scaly patches
10-15 mm
slow-growing
sun-exposed areas

Question 22

Mx for bowens disease

Answer 22

topical 5-fluorouracil cream (BD, 4wks)

causes significant inflammation/erythema - so give Topical steroids (hydrocortisone) - like actinic keratoses Mx, but this is 2-3 wks

Question 23

what are the 4 main types of melanoma

Answer 23

superficial spreading (70% - arms, legs, backs, chest , yougn people) - mole w/ diagnostic features

nodular 2nd commonest (sun exposed skin, middle aged - red/black bleeding/oozing lump)

lentigo maligna less common - chronically sun-exposed skin, older people - mole w/ diagnostic features

acral lentiginous - rare
(Nails, palms, soles - in darker skinned people) - subungual pigmentation (Hutchinsons sign) or on palms/feet

Question 24

apart from webs of the hands, where else does scabies present

Answer 24

axillae,, extensor surfaces, upper back, lower trunk, genitals, peri-anal

presents - inear burrows on the side of fingers, interdigital webs and flexor aspects of the wrist
in infants, the face and scalp may also be affected
secondary features are seen due to scratching: excoriation, infection

Question 25

what pt group gets crusted scabies

Answer 25

hyperinfestation in immunocompromised

Presents: Extremely thick, hiyerkeratotic, scaly, fissured skin

• Inflammation with >1million mites (normally 10-20)
• High eosinophil count, IgE and IgG
• High risk of 2ᴼ infection and sepsis (partly due to underlying immune suppression)

Question 26

1st & 2nd line Mx in scabies

Answer 26

permethrin 5% is first-line
malathion 0.5% is second-line

treat whole household at the same time

Question 27

instructions for applying permethrin & malathion

Answer 27

creams for scabies

apply to skin
allow to dry and leave on the skin for 8-12 hers (permethrin), or for 24hrs (malathion)

wash off

reapply if insecticide is removed during the treatment period, e.g. If wash hands, change nappy, etc
repeat treatment 7 days later

( day 1 and day 8)

Question 28

tx in norwegian scabies

Answer 28

norwegian = crusted

oral Ivermectin & isolation

Question 29

what type of hyperwsensitivty reaction causes contact dermatitis

Answer 29

Type VI

Type IV hypersensitivity reactions are also known as delayed-type hypersensitivity as the reaction occurs 48-72 hours after exposure to an antigen. They are T-cell mediated and do not involve antibodies

Question 30

what type of Gell and Coombs hypersensitivity raction causes anaphylaxis

Answer 30

Type I - IgE mediated

Question 31

which of the sx of rosacea typically presents initilally

Answer 31

flushing is often first symptom

typically affects nose, cheeks and forehead
telangiectasia are common
later develops into persistent erythema with papules and pustules
rhinophyma
ocular involvement: blepharitis
sunlight may exacerbate symptoms

Question 32

what ophtho condition is associated with rosacea

Answer 32

blepharitis