derm Flashcards
What is eczema herpeticum and how is it managed?
Monomorphic punched-out erosions (circular, depressed, ulcerated lesions)
HSV 1/2
Commonly affect people with eczema
IV aciclovir
Diagnosis?
shiny, painless areas of yellow/red skin typically on the shin of diabetics
often associated with telangiectasia
Management?
Necrobiosis lipoidica diabeticorum
Associated with T1/T2DM
Management:
Steroids
Topical tacrolimus
Photochemotherapy
Most common causeses of erythema nodusum?
Pregnancy
IBD
Strepinfection
Sulphonamides
Sarcoid
OCP
Penicillins
Where is erythema nodosum usually found?
Painless or not?
Shins
Get symmetrical, red, tender nodules
What does pretibial myxoedema look like?
Shiny, symmetrical, orange peel
Management of venous ulcers
Compression bandaging.
Need APBI first
Oral pentoxifylline, a peripheral vasodilator, improves healing rate
ABPI interpretation
An ABPI ratio of:
Less than 0.5 = severe arterial disease. Compression c/I.
Refer vascular urgently
> 0.5 to less than 0.8 = arterial disease or mixed arterial/venous disease.
Compression should generally be avoided. Refer vascular.
Between 0.8 and 1.3 = no evidence of significant arterial disease.
Compression ok.
Greater than 1.3 may suggest the presence of arterial calcification
For values above 1.5, the vessels are likely to be incompressible, and the result cannot be relied on to guide clinical decisions.
Referral to a vascular may be required to determine the person’s suitability for compression therapy.
Rosacea management
High factor suncream & camouflage creams.
If predominant erythema/flushing:
- Topical brimonidine gel (topical alpha-adrenergic agonist) PRN.
Reduces redness within 30 mins and lasts 3-6 hours.
If mild - mod papules/pustules:
-Topical ivermectin is first-line
alternatives: topical metronidazole/azelaic acid
Mod-severe papules/pustules:
-Combination of topical ivermectin + oral doxycycline
laser therapy under specialist if not improving, prominent telangiectasia/
rhinophyma
Difference between Pemphigoid gestationis and polymorphic eruption of pregnancy
Pemphigoid gestationis:
Itchy, blistering, usually starts periumbilical and often involves palms and soles. Usually need oral steroids.
Polymorphic eruption of pregnancy - intensely itchy. Last trimester. Affects abdo and thighs. Emollients, topical steroids
What is mild, moderate and severe acne?
mild: open and closed comedones with or without sparse inflammatory lesions
moderate acne: widespread non-inflammatory lesions and numerous papules and pustules
severe acne: extensive inflammatory lesions, which may include nodules, pitting, and scarring
How to manage mild - mod acne?
12-week course. Options:
Topical adapalene (retinoid) + topical benzoyl peroxide
Topical benzoyl peroxide + topical clindamycin
Topical tretinoin + topical clindamycin
Topical BPO can be used as monotherapy if c/is.
How to manage mod-severe acne
Add oral abx to topical adapalene & topical benzoyl peroxide OR to
topical azelaic acid. Usually doxy/lymecycline. Erythromycin may be used in pregnancy.
a topical retinoid or BPO should always be co-prescribed with oral abx to reduce the risk of antibiotic resistance.
Topical and oral antibiotics should not be used in combination.
How long can someone be on abx for acne?
Only continue a treatment option that includes an antibiotic (topical or oral) for more than 6 months in exceptional circumstances.
Lichen Planus features
itchy, papular rash most common on the palms, soles, genitalia and flexor surfaces of arms
rash often polygonal in shape, with a ‘white-lines’ pattern on the surface (Wickham’s striae)
Koebner phenomenon may be seen (new skin lesions appearing at the site of trauma)
oral involvement in around 50% of patients: typically a white-lace pattern on the buccal mucosa
nails: thinning of nail plate, longitudinal ridging
What acne treatments are c/I in pregnancy/ those wanting to start a family and breastfeeding?
Topical retinoids and oral tetracyclines
What acne treatment would you use for someone who has mild/ mod acne and is pregnant/breastfeeding?
Topical BPO and topical clindamycin.
Psoriasis management
- Potent steroid and vit D analogue OD. Up to 4 weeks.
- If no improvement after 8 wks, Vit D analogue twice a day
- If no improvement after 8-12 weeks then potent corticosteroid BD for up to 4 weeks, or a coal tar preparation applied once or twice daily
First line for scalp psoriasis
Potent topical steroids 2 weeks
How to differentiate between pemphigoid and pemphigus
No mucosal involvement in pemphigoid
How to manage impetigo
topical hydrogen peroxide 1% now 1st line
Topical fuscidic acid next, or topical mupirocin if MRSA/ fuscidic resistance
If bad then oral fluclox/erythromycin
Is necrobiosis lipodica painless or painful
Painless
Is erythema nodosum painless or painful
Seborrhoeic dermatitis
What is this?
management ?
Associated conditions?
Erythematous areas around sebum rich shin. Caused by fungus.
ketoconazole 2% shampoo
Associated with blepharitis and otitis externa.
Also HIV and Parkinsons
‘volcano’ like spot on her left arm
Dx?
Mx?
Keratocanthoma
Urgent term ref. If it is this, its benign but difficult to exclude SCC
Spontaneous regression within 3 months is common
