Derm Flashcards
treatment for mild acne
1st line: topical retinoid and/or benzyol peroxide +/- topical Abx (never prescribed alone)
2nd: azelaic acid 20%
treatment for moderate acne
oral abx + benzoyl peroxide/retinoid
abx: 1st line- tetra cycles; 2nd line- macrolides
abx alternative: COCP
treatment for chronic plaque psoriasis
topical potent steroid + vitamin D analogue e.g. calcipotriol
example of potent corticosteroid
betamethasone
what is the most common site for hidradenitis supparativa [2]
armpit
also groin
risk factors for hidradenitis suppurativa [5]
obesity
DM
PCOS
smoking
female
conservative mx of hidradenitis suppurativa [3]
Encourage good hygiene and loose-fitting clothing
Smoking cessation
Weight loss in obese
mx of acute flares of hidradenitis suppurativa
steroids
flucloxacillin
incision and drainage of boils
mx of rosacea with just erythema/flushing and limited telangiectasia
topical brimonidine gel
mx of mild to mod rosacea
topical ivermectin
alternative: topical metronidazole if ivermectin is inappropriate
mx of moderate to severe rosacea
topical ivermectin + oral doxycycline
common presentation in rosacea [4]
what are symptoms worsened by? [4]
telangiectasia
flushing
face affected
rhinophyma
worsened by sun exposure, spicy food, stress, alcohol
what can untreated erythema ab igne possibly lead to?
squamous cell carcinoma
what is suggestive of severe rosacea [2]
pustules that have scarred
rhinophyma
how do you distinguish the malar rash seen in SLE with rosacea
malar rash in SLE does not involve the nasolabial fold and never involves the chin
rosacea often involves the nasolabial folds and can involve the chin
skin features of hidradenitis suppurativa [4]
pustules
nodules
sinus tracts
scars (rope like scarring)
these are painful
simple measures/adjuncts of rosacea [2]
sun screen
camouflague cream
how is rosacea treated in pregnant or breastfeeding women
metronidazole instead of ivermectin
how are prominent telangiectasia in rosacea treated
laser therapy
what ocular manifestation is seen in rosacea [3]
blepharitis (sticky, inflamed eye lids)
keratitis
conjunctivitis
describe the lesions in tinea corporis
well-circumscribed annular erythematous plaques with an advancing scaly border and central clearing
treatment for tinea corporis, faciei, crursi or pedis
for mild, moderate and severe
mild: topical terbinafine, clotrimazole, miconazole
moderate: hydrocortisone cream
severe: oral
long term treatment for psoriasis
vitamin D analogue e.g. calcipotriol
what is Koebners phenomenon and which condition is it seen in?
Formation of new skin lesions at sites of injury
seen in psoriasis
how does shingles present?
A prodromal period of burning pain for 2-3 days which may interfere with sleep
followed by the development of a blistering (or vesicular) rash confined to a specific dermatome
in someone over 50
what is a strong infective risk factor for shingles
HIV
Shingles management [3]
avoid the pregnant and immunosuppressed
analgesia (paracetamol, NSAID, amitriptyline)
antivirals e.g. ORAL aciclovir, famciclovir or valacyclovir within 72 hours
how long are shingles patients infections
until lesions crust over which is around 5-7 days from onset of rash
what analgesia are used in shingles (3 lines)
first: paracetamol and NSAIDs
second: amitriptyline
third: corticosteroids in immuncompotent people
which melanoma is the most aggressive
nodular
which melanoma is most common and 2nd most common
most common: superficial spreading
second: nodular
treatment of suspected melanoma
excisional biopsy with margins
3 complications of shingles
post-herpetic neuralgia
herpes zoster opthalmicus
herpes zoster oticus (Ramsay Hunt syndrome)
most important prognostic factor of melanoma
depth (Breslows thickness)
> 4mm has 50% 5 year survival
which mutation is seen in 50% of malignant melanomas
how can they be potentially treated
BRAF
BRAF inhibitors e.g. vemurafenib
which antivirals are preferred in the treatment of shingles?
why are they preferred and therefore first line?
famciclovir or valacyclovir
studies have shown that treatment with famciclovir and valacyclovir reduced the likelihood of postherpetic pain when compared to treatment with aciclovir.
which drugs can precipitate psoriasis [6]
beta blockers
lithium
antimalarials (chloroquine and hydroxychloroquine)
NSAIDs like aspirin
ACE inhibitors
infliximab
what infective organisms precipitates guttate psoriasis
streptococcal infection
features of moderate acne
widespread non-inflammatory lesions and numerous papules and pustules
features of severe acne
extensive inflammatory lesions, which may include nodules, pitting, and scarring
treatment of eczema herpeticum
admit for IV aciclovir
refer to opthalmologist if around the eye
how can transmission of tinea capitis be reduced
Topical ketoconazole shampoo should be given for the first two weeks to reduce transmission
how is Microsporum canis causing tinea capitis diagnosed
green fluorescence under Wood’s lamp
most common cause of tinea capitis
Trichophyton tonsurans
treatment of tinea capitis [2]
terbinafine for Trichophyton tonsurans infections
griseofulvin for Microsporum infections.
a physiological cause of erythema nodosum
pregnancy
when should the next course of steroid treatment for psoriasis start
after a 4 week gap from the previous course to prevent skin atrophy
describe a lentigo maligna melanoma
who does it affect most
slow growing melanoma in chronically sun exposed areas typically in older peope
which melanoma is a red or black lump or lump which bleeds or oozes
nodular melanoma
rapidly growing
what may help with refractory pain in shingles if simple analgesia and neuropathic analgesia do not help,
oral prednisolone
only for acute shingles, has to be alongside antiviral treatment
which fungus causes seborrhoeic dermatitis
Malassezia furfur
where are the lesions in seborrhoeic dermatitis often found [4]
scalp, periorbital, auricular and nasolabial folds,
two complications of seborrhoeic dermatitis
blepharitis
otitis externa
two associated conditions with seborrhoeic dermatitis
HIV
Parkinson’s disease
first line treatment of scalp seborrhoeic dermatitis
1st line : 2% ketoconazole shampoo
2nd line: zinc pyrithione (‘Head & Shoulders’) and tar (‘Neutrogena T/Gel’)
- may be used if ketoconazole is not appropriate or acceptable to the person
alternative: selenium sulphide and topical corticosteroid may also be useful
first line treatment of face and body seborrhoeic dermatitis
topical antifungals: e.g. ketoconazole
topic steroid for short periods may also be used
infective causes of erythema nodosum [3]
streptococci
tuberculosis
brucellosis
systemic diseases that cause erythema nodosum [3]
sarcoidosis
inflammatory bowel disease
Behcet’s
drugs that cause erythema nodosum [3]
penicillins
sulphonamides
combined oral contraceptive pill
which condition increases the risk of Cardiovascular disease
psoriasis
which cancer are renal transplant patients at risk of?
squamous cell carcinoma due to T-cell ablating immunosuppression
risk factors for SCC [6]
- excessive exposure to sunlight / psoralen UVA therapy
- actinic keratoses and Bowen’s disease
- immunosuppression e.g. following renal transplant, HIV
- smoking
- long-standing leg ulcers (Marjolin’s ulcer)
- genetic conditions e.g. xeroderma pigmentosum, oculocutaneous albinism
4 good prognostic factors of SCC
well differentiated
<20 mm diamter
< 2mm depth
no associated disease
4 bad prognostic factors of SCC
poorly differentiated
>20mm diameter
>4mm depth
associated disease
4 features of SCC
- sun-exposed sites such as the head and neck or dorsum of the hands and arms
- rapidly expanding painless, ulcerate nodules
- cauliflower-like appearance
- areas of bleeding
4 causes of acanthosis nigracans
type 2 diabetes mellitus
gastrointestinal cancer
obesity
polycystic ovarian syndrome
where are actinic keratoses usually found
typically on sun-exposed areas e.g. temples of head
as multiple lesions
first line management of actinic keratoses [2]
sun protection and topic fluorouracil cream for 2-3 weeks
other: topical diclofenac, topical imiquimod, cryotherapy, curettage and cautery
which premalignant lesion is a result of chronic sun exposure [2]
actinic keratoses and keratoacanthoma
difference between SJS and TEN
SJS : <10% skin involvement
TEN: >30% skin involvement
what is Nikolsky’s sign?
epidermis separates with mild lateral pressure
management of TENS, SJS [4]
- stop precipitant
- admit to ITU
- IVIG, plasmapharesis
- immunosuppression
what is the definition of erythroderma
name some causes and complications
any rash involving >95% of the body
eczema, psoriasis, drugs, lymphoma
complications like dehydration, infection and high-output heart failure
causative agent of impetigo
staph aureus
other: strep pyogenes
treatment of localised non bullous impetigo [1st and 2nd line]
hydrogen peroxide 1% cream
2nd: topical fusidic acid 2%
treatment of widespread, non-bulbous impetigo [2]
oral flucloxacillin or topical fusidic acid
treatment of bullous impetigo and systemically unwell
oral flucloxacillin
what is the school exclusion criteria for impetigo
until lesions have crusted over or 48 hours after abx have been started
what must be given to women on roaccutane
2 forms of contraception as it is very teratogenic
causative agent of pityriasis versicolor
malassezia furfur
treatment of pityriasis versicolor
topical metronidazole
vitiligo vs pityriasis versicolor
p.v- affects the trunk and more discrete patches
vitiligo- affects the peripheries and more confluent
which diseases are associated with vitiligo [3]
T1DM, Addisons, alopecia
treatment of vitilgo[4]
- sunblock
- camouflage make up
- topical corticosteroids
- phototherapy
causative agent of pityriasis rosea
HHV-7
hx: recent viral infection, herald patch present
mx: self limiting
most common type of psoriasis
plaque
what part of the body does pustular psoriasis affect mainly
palms and soles of feet
flexural vs plaque psoriasis
flexural psoriasis has smooth skin
treatment options in secondary care for psoriasis [2]
phototherapy or photo chemotherapy
systemic medication e.g. MTX
examples of emollient used in eczema
Dermol, e45
what is mild eczema and how is it treated
infrequent itching
mx: emollients and mild topical steroids
what is moderate eczema and how is it treated
frequent itching and redness
mx: emollients and moderate topical steroid
what is severe eczema and how is it treated
incessant itching, widespread rash, redness
mx: emollients, potent topical steroid, consider phototherapy, systemic therapy
how is infected eczema treated
first take skin swab and culture
oral flucloxacillin (allergy–>erythromycin)
steroid ladder: Help Every Busy Dermatologist
Hydrocortisone
Eumovate (clobetasone butyrate)
Betnovate (betamethasone)
[Elocon- mometasone furoate]
Dermovate (clobetasol propionate)
For which severities of ezcema can topical calcineurin inhibitors be used?
name examples
for moderate to severe
pimecrolimus and tacrolimus respectively
what are the reason for urgent referral for eczema (<2 weeks)
severe atopic eczema not responding to optimal treatment within 1 week.
treatment of bacterial eczema has failed
what does eczema herpticum look similar to?
impetigo
therefore important to cover for both, give abx and aciclovir
treatment of scabies
permethrin
treat all household contacts with two doses
treatment of head lice
malathion
causative agent of fungal nail infection
trichophytum rubrum
investigation of fungal nail infection
nail clippings and MC&S
treatment of dermatophyte nail infection [1st and 2nd line]
1st line: terbinafine
2nd line: itraconazole
need to check LFTs before starting
treatment of candida nail infection [mild and severe]
mild –> topical antifungals e.g. amorolfine
severe –> oral itraconazole
what are Wickham’s striae seen in lichen planus
white lines in the mouth
describe lichen planus [4P]
purple, pruritic, papular, polygonal on flexor surfaces
describe lichen sclerosis
itchy white spots usually on the vulva of elderly women
treatment of lichen planus [body and oral]
Body–> topical clobetsone butyrate
Oral –> benzydamine mouthwash
treatment of lichen sclerosus
1st line: clobetasol propionate (dermovate)
2nd: tacrolimus + biopsy
treatment of severe cellulitis [4]
co-amoxiclav
cefurozime
clindamycin
ceftriaxone
class IV Eron classification of cellulitis
sepsis, necrotising fasciitis
causative agent of erysipelas
strep pyogenes
erysipelas vs cellulitis
well-demarcated superficial skin infection
poorly demarcated deep skin infection
causative agent of erythrasma
corynebacterium minutissimum
investigation of erythrasma
wood’s slit lamp –> coral red fluorescence
treatment of erythrasma
topical miconazole
treatment of pyoderma gangrenosum
oral steroids
AB in bullous pemiphigoid
against basement membrane (dermoepidermal junction)
AB in pemphigus vulgaris
against desmosomes
treatment of bullous pemphigoid
corticosteroids
difference between bullous pemphigoid and pemphigus vulgaris
B.P: tense blisters, no oral involvement
P.V: flaccid blisteres, oral involvement
two infective causes of erythema multiforme
HSV
mycoplasma
rash causes by rheumatic fever
erythema marginatum
rash caused by glucagonoma
migratory necrolytic erythema
rash in Lyme disease
erythema chronicum migrans (bulls-eye)
1st line treatment of urticaria
non-sedating antihistamines e.g. loratidine or cetirizine
treatment of severe or resistant urticaria
short course of oral prednisolone
what type of drug is adapalene
retinoid
erythema marginatum vs erythema multiform
marginatum: annular lesions
multiforme: target lesion
describe urticaria
pale, pink raised skin. Variously described as ‘hives’, ‘wheals’, ‘nettle rash’
pruritic
when should COCP be considered in the treatment of acne
in a woman with moderate to severe acne that had tried all other treatments particularly antibiotics
what do Marjolin ulcers originate from
squamous cell carcinomas
treatment of venous ulceration
what medication can improve healing rate
compression bandaging
oral pentoxifylline, a peripheral vasodilator, improves healing rate
small, broken ‘exclamation mark’ hairs are seen in which condition
alopecia areata (autoimmune condition)
ringworm is a parasite: true or false?
false
its a fungus
first-line mx for hyperhidrosis
topical aluminium chloride preparations are first-line. Main side effect is skin irritation
iontophoresis: particularly useful for patients with palmar, plantar and axillary hyperhidrosis
botulinum toxin: currently licensed for axillary symptoms
surgery: e.g. Endoscopic transthoracic sympathectomy. Patients should be made aware of the risk of compensatory sweating
treatment of keloid scars
early keloids may be treated with intra-lesional steroids e.g. triamcinolone
how is dermatitis herpetiformis diagnosed
skin biopsy: direct immunofluorescence shows deposition of IgA in a granular pattern in the upper dermis
anti fungal that causes moobs
ketoconazole
If initial topical treatment for athlete’s foot fails, oral _________ treatment is indicated
If initial topical treatment for athlete’s foot fails, oral antifungal treatment is indicated
e.g. terbinafine
common sites for keloid scars
common sites (in order of decreasing frequency): sternum, shoulder, neck, face, extensor surface of limbs, trunk
actinic keratosis vs Chondrodermatitis nodularis helicis
painless vs painful
which one grows faster: SCC or BCC
SCC
