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2a > Derm > Flashcards

Derm Flashcards

1
Q

What are treatment options for symptomatic relief of itch?

A
  • Moisturise
  • Use emollients as substitute for body soap
  • Non-sedating oral antihistamine for 2-3 weeks e.g. cetirizine
  • If nocturnal itch give sedating oral antihistamine for 2-3 weeks
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2
Q

What are the 2 categories of dermatitis?

A
  • Atopic dermatitis
  • Contact dermatitis
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3
Q

What is atopic dermatitis also known as?

A

Eczema

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4
Q

What are chronic features of atopic dermatitis?

A
  • Scaling
  • Lichenification (thickened areas of skin)
  • Prurigo like lesions (nodules formed by scratching)
  • Xerosis (dry skin)
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5
Q

Give some atopic stigmata

A
  • Dennie Morgan folds (folds of lower eyelids)
  • Keratosis pilaris
  • Peri-orbital darkening (can look like black eye)
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6
Q

What is the stepwise management of atopic dermatitis?

A
  • Basic skin care
  • Topicals
  • Phototherapy - narrow band UVB/PUVA
  • Systemic therapy
  • Biologics
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7
Q

What are systemic treatment options for atopic dermatitis?

A
  • Course of prednisolone
  • Methotrexate
  • Ciclosporin
  • Azathioprine
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8
Q

How much emollient should under 12s use every 1-2 weeks?

A
  • 250-500g
  • Adults should use more
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9
Q

What should you warn all pts using emollients of?

A

Emollients are highly flammable - risk of severe/fatal burns

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10
Q

What is the equivalent area of a fingertip amount of topical steroid? How much steroid is this?

A
  • Two palms worth
  • 1.5g
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11
Q

What is the topical steroid potency ladder?

A
  • Hydrocortisone
  • Eumovate
  • Betnovate
  • Dermovate

HEAD but HEBD

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12
Q

What are potential side effects of topical steroids?

A
  • Skin thinning
  • Stretch marks
  • Hypopigmentation
  • Hair growth
  • Long term use of potent/v. potent can lead to cushings syndrome/adrenal insufficiency
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13
Q

What frequency are topical steroids prescribed during a flare?

A

OD

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14
Q

How long should you continue using a topical corticosteroid following a skin flare (e.g. eczema)?

A

Continue treatment for 48 hrs after flare is controlled

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15
Q

What are the two main types of contact dermatitis?

A
  • Irritant CD
  • Allergic CD
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16
Q

What is irritant CD? Where is it often seen? How does it present? How is it managed?

A
  • Non allergic reaction due to weak acids or alkalis
  • Hands
  • Presents with erythema. Crusting and vesicles are rare
  • Managed the same as atopic dermatitis
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17
Q

What is allergic CD? What is it often caused by? How does it present? How is it managed?

A
  • Type IV hypersensitivity reaction (delayed)
  • Hair dyes
  • Presents with acute weeping eczema
  • Managed the same as atopic dermatitis
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18
Q

Stasis dermatitis:
1. Age group?
2. Who is it more common in?
3. What is it often mistreated as?

A
  1. Middle/older age
  2. People with venous insufficiency
  3. Cellulitis
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19
Q

Nummular dermatitis:
1. AKA?
2. Age group?
3. How does it present?
4. Common complication?

A
  1. Discoid eczema
  2. Young people
  3. Coin shaped lesions
  4. Often get secondary infections
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20
Q

What is seborrhoeic dermatitis?

A

A hypersensitivity reaction to Malassezia yeast and seborrhoea

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21
Q

Seborrhoeic dermatitis in children:
1. Affected areas?
2. Management?

A
  1. Scalp, nappy area, face
  2. Reassure, topical emollient on the scalp -> brush gently with a soft brush and wash off with shampoo. Severe: topical imidazole cream
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22
Q

Seborrhoeic dermatitis in adults:
1. Affected areas?
2. Management?

A
  1. Scalp, periorbital, nasolabial folds
  2. Scalp: Ketoconazole 2% shampoo.
    Face and body: Topical antifungals and topical steroids
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23
Q

Eczema herpeticum:
1. Cause?
2. How does it present?
3. Management?

A
  1. HSV 1/2
  2. Rapidly progressing painful rash, monomorphic punched out erosions
  3. Admit, IV acyclovir
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24
Q

How could you define psoriasis?

A

An immune mediated inflammatory disorder

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25
Q

What are the subtypes of psoriasis? Which is most common?

A
  • Chronic plaque
  • Flexural
  • Palmar plantar
  • Scalp
  • Guttate
  • Sebopsoriasis
  • Nail
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26
Q

What are the peaks of age onset of psoriasis?

A
  • 20-30
  • 50-60
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27
Q

What can trigger psoriasis?

A
  • Infections (particularly guttate)
  • Alcohol
  • Local skin injury
  • Drugs
  • Stress
  • Obesity
  • Smoking
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28
Q

What drugs can trigger psoriasis?

A
  • BB
  • Lithium
  • Antimalarials
  • Abx
  • ACE-In
  • NSAIDs
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29
Q

Describe the appearance of plaque psoriasis

A

Well demarcated erythematous plaques with overlying silvery scale

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30
Q

What is Auspitz sign?

A

Small bleeding points on removal of successive layers of scale on psoriatic plaques

(seen in plaque psoriasis)

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31
Q

What is another name for flexural psoriasis? Appearance?

A
  • Inverse psoriasis
  • Shiny, smooth lesions. Often lack plaque
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32
Q

What features are seen in nail psoriasis? What is it associated with?

A
  • Nail pitting/onycholysis (nails comes away from bed)
  • Associated with psoriatic arthritis
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33
Q

Guttate psoriasis:
1. Age group?
2. Typical history?
3. Appearance?
4. Management?

A
  1. Children and young adults
  2. Strep infection 2-4 wks before
  3. ‘Tear drop’ papule on trunk and limbs
  4. Self limiting (3/4 months)
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34
Q

What is the stepwise management of psoriasis?

A
  • Topicals
  • Phototherapy - narrowband UVB/PUVA
  • Conventional systemics
  • Biologics
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35
Q

Are emollients used for psoriasis?

A

Emollients have less benefit in psoriasis

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36
Q

What is the topical management of plaque psoriasis?

A
  1. Potent topical corticosteroid + Vit D analogue (e.g. calcipotriol) OD
  2. No improvement after 8 wks - Vit D analogue BD
  3. No improvement after 8-12 wks - potent topical corticosteroid BD for up to 4 wks OR coal tar preparation OD/BD
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37
Q

Impetigo:
1. First line management of localised non-bullous impetigo
2. First line management of widespread non-bullous impetigo
3. First line management of bullous impetigo

A
  1. Hydrogen peroxide 1% cream for 5 days
  2. Topical fusidic acid 2% or mupirocin 2% for 5 days
  3. Oral flucloxacillin 500mg QDS for 5 days
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38
Q

What is melanoma?

A

Malignant neoplasm of melanocytes

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39
Q

What are risk factors for melanoma?

A
  • Older age
  • UV exposure
  • Fair skin
  • Moles
  • FHx
  • PHx melanoma
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40
Q

What is the weighted 7-point checklist for assessment of pigmented skin lesions? What indicates referral?

A

Major features (2 points each):
- Change in size
- Irregular shape
- Irregular colour

Minor features (1 point each):
- Largest diameter 7 mm or more
- Inflammation
- Oozing
- Change in sensation (including itch)

3 points or more = referral

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41
Q

What are the 4 melanoma subtypes? Which is most common? Which is the most common in darker skin?

A
  • Superficial spreading melanoma (most common overall)
  • Nodular melanoma
  • Lentigo malignant melanoma
  • Acral lentiginous melanoma (most common in darker skin)
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42
Q

How can melanoma be staged?

A

1 - confined to skin
2 - thicker tumours confined to skin
3 - lymph node involvement
4 - distant mets (30% 5 yr survival)

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43
Q

What is the management of suspected and confirmed melanoma?

A

GP:
- 2ww referral

Secondary care:
- Diagnostic excision with 2mm peripheral margin
- Sentinel lymph node biopsy depending on thickness
- Staging scans for more advanced
- Testing for bRAF mutation (found in 40-50% of melanomas and opens tx options with BRAF inhibitors)

44
Q

Is melanoma/non-melanoma skin cancers more common?

A

Non-melanoma skin cancer

45
Q

What are the two main non-melanoma skin cancers?

A
  • SCC
  • BCC
46
Q

What are 2 pre-cancerous skin changes?

A
  • Actinic keratosis
  • Bowen’s disease
47
Q

What is the management of Actinic keratosis and Bowen’s disease?

A
  • Field change - topical treatments
  • Discrete lesions - topicals, cryotherapy, C+C
48
Q

What are red flag features for malignant lesions (e.g. SCC)? Are these seen in pre-cancerous lesions?

A
  • Rapid growth
  • Raised base
  • Ulceration +/- bleeding
  • Pain

Not seen in pre-cancerous skin lesions (Actinic keratosis/Bowen’s disease)

49
Q

What are risk factors for SCC?

A
  • Chronic sun exposure
  • Immune suppression
  • Chronic wounds (e.g. long standing leg ulcers)
  • Smoking
  • HPV
  • Actinic keratosis and Bowen’s disease (low risk)
50
Q

What is the management of SCC?

A
  • Lesion <20mm - surgical excision with 4mm margins
  • Lesion >20mm - Mohs micrographic surgery
  • Radiotherapy - non melanomas are radiosensitive
51
Q

What are the typical features of BCC?

A
  • Slow growing
  • Skin coloured/pink/shiny
  • Rolled edges
  • Telangiectasia
  • Ulceration +/- bleeding
52
Q

What are the subtypes of BCC? Which is most common?

A
  • Nodular (most common)
  • Morphoeic/infiltrative - locally aggressive, can eat other structures
  • Pigmented - can be hard to tell from melanoma
  • Superficial
53
Q

What is the management of BCC?

A
  • Superficial BCCs - cautery/cryotherapy/topicals (due to less invasive nature)
  • Surgical removal
  • Radiotherapy
54
Q

List some common benign skin lesions

A
  • Viral warts
  • Molloscum contagiosum
  • Epidermoid cyst
  • Pilar cyst
  • Seborrhoeic keratosis
  • Dermatofibroma
  • Lipoma
55
Q

What causes viral warts?

A

HPV

56
Q

How are viral warts spread?

A

Direct skin contact

57
Q

What are some risk factors for viral warts?

A
  • Childhood eczema
  • Immune suppression
58
Q

What are treatment options for viral warts?

A
  • Soaking
  • Chemicals (salicylic acid)
  • Cryotherapy
  • C+C
  • Laser
59
Q

What causes molloscum contangiosum?

A

Pox virus (MCV)

60
Q

How do you differentiate epidermoid and pilar cysts?

A
  • Epidermoid have a central punctum
  • Pilar tend to be located on the scalp
61
Q

What are features of seborrhoeic keratosis? How common is it?

A
  • Brown/pink/skin colour lesions
  • ‘Struck on’ appearance
  • Warty/waxy surface

90% of >60 year old have

62
Q

What is the treatment of seborrhoeic keratosis?

A
  • None
  • If symptomatic - cryotherapy / C+C
63
Q

What are features of dermatofibroma? Where are the normally located

A
  • Solitary firm nodule (can feel like a frozen pea under the skin)
  • Overlying skin dimples on pinching
  • 5-10 mm
  • Normally located on arms and legs
64
Q

What is lipoma?

A

Benign tumour of adipocytes

65
Q

Where are lipoma normally found?

A
  • Neck
  • Shoulders
  • Trunk
  • Arms
66
Q

What are features of lipoma?

A

Smooth, mobile, painless lump

67
Q

What is a ddx of lipoma? How would it differ?

A

Liposarcoma
- Size >5cm
- Increasing size
- Pain
- Deep anatomical location

68
Q

List some common vascular skin lesions?

A
  • Spider telangiectasia
  • Cherry angioma
  • Pyogenic granuloma
69
Q

What is pyogenic granuloma? How do they present? Where are they normally located?

A
  • Acquired proliferation of blood vessels
  • Bleed a lot
  • Fingers and face
70
Q

What happens in acne vulgaris?

A

Obstruction of pilosebaceous follicles with keratin plugs which results in comedones, inflammation and pustules

71
Q

What bacteria is associated with acne vulgaris?

A

Anaerobic bacteria Propionibacterium acnes

72
Q

What medications are used to treat acne vulgaris?

A
  • Topical benzoyl peroxide
  • Topical retinoids
  • Oral retinoids
  • Topical antibiotics
  • Oral antibiotics
  • Oral contraceptive pill
73
Q

What is the function of benzoyl peroxide in the treatment of acne vulgaris?

A
  • Reduces inflammation
  • Helps unblock the skin
  • Toxic to P. acnes bacteria
74
Q

What is the function of topical retinoids in the treatment of acne vulgaris?

A
  • Retinoids are chemical related to vitamin A
  • Slow the production of sebum
75
Q

What is an example of a topical antibiotic prescribed for acne vulgaris? What is it often prescribed with?

A
  • Clindamycin
  • Prescribed with benzoyl peroxide to reduce bacterial resistance
76
Q

What is an example of an oral antibiotic prescribed for acne vulgaris?

A

Lymecycline

77
Q

What is the function of the oral contraceptive pill in the treatment of acne vulgaris? Which is most effective?

A
  • Can help female pts stabilise their hormones and slow the production of sebum
  • Co-cyprindiol (Dianette) - most effective due to its anti-androgen effects
78
Q

What is an example of an oral retinoid used for acne vulgaris? How does it work? What are some side effects? What is important in women of child bearing age?

A
  • Oral isotretinoin (Roaccuntane)
  • It works by reducing the production of sebum, reducing inflammation and bacterial growth
  • Side effects:
    • Dry skin and lips
    • Photosensitivity
    • Depression/agression/suicidal ideation
    • Rarely - SJS toxic epidermal necrolysis
  • High teratogenic - effective contraception required, must stop isotretinoin for at least a month before getting pregnant
79
Q

What is another name for fungal nail infections?

A

Onychomycosis

80
Q

What’s the most common causative organism of fungal nail infections?

A

Trichophyton rubrum (dermatophyte)

81
Q

What are RF for fungal nail infections?

A
  • Increasing age
  • DM
  • Psoriasis
  • Repeated nail trauma
82
Q

How can you investigate fungal nail infections? When should you do this?

A
  • Send nail clippings +/- scrapings of the affected nail for microscopy and culture
  • Should be done for all patients if anti fungal treatment is being considered
83
Q

What is the management of fungal nail infections?

A
  • Nothing if asymptomatic

If dermatophyte/candida is confirmed:
- Limited involvement (<50% of nail/<2 nails affected) -> topical amorolfine 5% nail lacquer. 6m for fingernails. 9-12m for toenails
- If more extensive involvement due to dermatophyte infection -> oral terbinafine. 6w-3m for fingernails. 3-6m for toenails

84
Q

When assessing a suspected drug eruption, what do you need to know?

A
  1. Clinical characteristics (type of lesion/distribution/associated signs)
  2. Red flags
  3. Chronological factors (all drugs and dates administered/date of eruption/make drug timeline/response to removal of suspected agent)
85
Q

What are red flags for drug reactions?

A
  • Mucosal involvement
  • Blistering/skin peeling off
  • Pain
  • Lymphadenopathy
  • Systemic upset (fever, abnormal LFTs/U+Es)
86
Q

How do you manage maculopapular/urticarial drug eruptions?

A
  • Stop suspected drug
  • Prescribe regular emollients - symptomatic relief
  • Topical corticosteroids - short term for symptomatic relief (only if needed)
  • Prescribe regular non-sedating antihistamines if urticaria
  • Monitor and discuss with derm if not improving after 48 hrs of treatment
87
Q

What are the severe drug eruptions?

A
  • SJS/TEN
  • DRESS
  • AGEP
88
Q

What is the association between SJS and Toxic Epidermal Necrolysis (TEN)?

A
  • They are a spectrum of the same pathology
  • SJS is less severe
  • In SJS epidermal detachment affects <10% of the BSA
  • In TEN detachment affects >30% of the BSA
89
Q

What is a key risk factors for SJS/TEN?

A
  • HIV
  • Both are 100 times more common in association with HIV
90
Q

What are the main causes of SJS/TEN?

A
  • They are almost always caused by drugs
  • Allopurinol
  • Anti-epileptics
  • Anti-retrovirals
  • NSAIDs
  • Sulfa- drugs
91
Q

How does SJS/TEN present?

A
  • New drug 7-21 days previously
  • Prodrome of respiratory tract symptoms, fever, pain
  • Dusky red lesions, atypical targets, erythematous plaques
92
Q

What signs is seen in SJS/TEN?

A
  • Nikolsky sign
  • Blisters and erosions appear when the skin is rubbed gently
93
Q

How do you differentiate typical/atypical target lesions on the skin?

A
  • Target lesions = 3 concentric target rings
  • Atypical targets = less that 2 rings
94
Q

What is the management of SJS/TEN?

A
  • Admit to derm/burns unit
  • Bulk of Rx is supportive
  • Nutritional care
  • Fluids
  • Analgesia
  • Ophthalmology input
  • Periodic cultures due to sepsis risk
  • If extensive denuded areas - biological dressings/skin equivalents

Don’t prescribe these pts any meds unless discussed with someone senior

95
Q

What is DRESS syndrome?

A

Drug reaction with eosinophila and systemic symptoms (DRESS)

96
Q

DRESS:
1. When does it present?
2. Give 2 key causes
3. How does it present?
4. What will bloods show?

A
  1. 15-40 days after exposure
  2. Anticonvulsants, sulphonamides
  3. High fever, morbilliform eruption +/- oedema/purpura/scaling
  4. Eosinophilia
97
Q

What is AGEP?

A

Acute generalised exanthematous pustulosis (AGEP)

98
Q

AGEP:
1. When does it present?
2. What is the main cause?
3. How does it present?
4. What do bloods show?

A
  1. <4 days after exposure
  2. Beta lacam antibiotics
  3. High fever, small pustules within larger areas of oedematous erythema
  4. Marked leukocytosis and raised neutrophils
99
Q

What is erythroderma?

A

Generalised erythema affecting > 90% of the skins surface

100
Q

What are the top 3 causes of erythroderma?

A
  1. Dermatitis (especially atopic)
  2. Psoriasis
  3. Drug eruption
101
Q

What is the management of erythroderma?

A
  • Discontinue unnecessary meds
  • Monitor and treat BP/HR/fluid/electrolytes/temp (can all be affected by barrier failure)
  • Maintain skin barrier with wet wraps/dressings and emollients
  • Treat underlying dermatosis e.g. dermatitis
  • Topical corticosteroids
102
Q

Which pts require an urgent referral to dermatology?

A
  • Systemically unwell
  • Mucosal involvement
  • Blistering
  • Suspected SJS/TEN/DRESS/AGEP
103
Q

Which pts need to be discussed with dermatology?

A
  • Lymphadenopathy
  • Pyrexia
  • Eosinophilia
  • Abnormal LFTs
104
Q

What is staphylococcal scalded skin syndrome?

A
  • Rare superficial blistering condition which is characterised by the detachment of the outermost skin layer (epidermis)
  • Triggered by exotoxin release from staph aureus bacteria
105
Q

How can you differentiate it from TEN?

A
  • Children <5 (normally)
  • Mucosa unaffected
  • Blistering is superficial epidermis (full thickness in TEN)

2a (12 decks)

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