Derm Flashcards
What is Polymorphic eruption of pregnancy?
Typically begins in the third trimester. It often starts within stretch marks on the abdomen, particularly around the umbilicus, before spreading to other areas. The rash is characterised by small red bumps and hives, and it can be very itchy.
Where do you see Wickham Striae?
Lichen planus
How do we treat lichen planus?
Potent topical steroids
How does lichen planus present?
planus: purple, pruritic, papular, polygonal rash on flexor surfaces. Wickham’s striae over surface. Oral involvement common
How do we treat plaque psoriasis?
NICE recommends a potent corticosteroid (for a maximum of 8 weeks) plus a vitamin D analogue, both once daily, for first-line treatment.
Define severe acne
In severe acne, there are nodules and cysts (nodulocystic acne), as well as a preponderance of inflammatory papules and pustules. There is a high risk of scarring (or scarring may already be evident), and there is likely to be considerable psychosocial morbidity.
How would you manage severe acne?
Consider prescribing an oral antibiotic in combination with a topical drug whilst waiting for an appointment. Benzoyl peroxide or a topical retinoid are recommended as adjunctive treatment for most people. Azelaic acid is an alternative, but avoid the use of topical antibiotics with oral antibiotics
What are milia?
Milia are small, benign, keratin-filled cysts that typically appear around the face. They may appear at any age but are more common in newborns.
What is pityriasis versicolor?
This condition is a common yeast infection of the skin, caused by the fungus Malassezia. The primary symptom includes hypopigmented or hyperpigmented macules and patches on the chest and back. These patches may be pink, tan, brown or white, and they often become more noticeable with tanning, as in this case. In addition, these lesions can sometimes be slightly scaly.
How does dermatitis herpetiformis present?
This patient’s presentation of an intensely itchy, symmetrical vesicular rash on the knees and back of arms is highly suggestive of dermatitis herpetiformis. Dermatitis herpetiformis is an autoimmune skin condition associated with coeliac disease, and it often presents as a pruritic, blistering rash on extensor surfaces such as the elbows, knees, and buttocks.
What is hereditary haemorrhagic telangiectasia?
Hereditary haemorrhagic telangiectasia often presents with multiple telangiectasia and bleeding from the rectum or more commonly, the nose. One of the criteria for diagnosis is the presence of the disease in a first degree relative, which the patient alludes to when the telangiectasia on their lips and tongue is noted.
What is a capillary haemangioma?
These appear as a small red patch which develops in the first month of life, increasing in size until around 9 months and becoming more vascular. They are not present at birth and regress spontaneously. Parents should be reassured that no treatment is needed and there is no sinister cause.
How do we treat impetigo?
Topical hydrogen peroxide, then topical fusidic acid
What is leukoplakia?
Leukoplakia is a premalignant condition which presents as white, hard spots on the mucous membranes of the mouth. It is more common in smokers.
Leukoplakia is said to be a diagnosis of exclusion. Candidiasis and lichen planus should be considered, especially if the lesions can be ‘rubbed off’
Biopsies are usually performed to exclude alternative diagnoses such as squamous cell carcinoma and regular follow-up is required to exclude malignant transformation to squamous cell carcinoma, which occurs in around 1% of patients.
How does guttate psoriasis present?
Guttate psoriasis is a subtype of psoriasis that typically affects children and young adults following infection with Streptococcus sp. (as seen here with this patient’s recent tonsillitis infection). The rash presents acutely with multiple small scaly and erythematous patches of skin appearing over the trunk and limbs. They often have a tear-drop shape.
What is acanthosis nigricans?
Acanthosis nigricans is a skin condition characterised by dark, thickened patches of skin that can appear in various parts of the body including the axilla. The image shows a velvety, hyperpigmented rash which is typical of acanthosis nigricans. It’s often associated with insulin resistance and can be an early sign of type 2 diabetes.
What is molluscum contagiousum?
Molluscum contagiosum is a common viral skin infection caused by the molluscum contagiosum virus (MCV). It presents as multiple small, raised, flesh-coloured or pearly white papules with a central dimple (umbilication). It usually affects children and spreads through direct skin-to-skin contact or via fomites.
How does erythema nodosum present?
It presents as tender, erythematous nodules typically located on the anterior shins but can also appear on the forearms.
How do we treat rosacea?
First-line management of this condition is with topical ivermectin
What is the Parkland formula used for?
Parkland formula is used to calculate the volume of IV fluid required for resuscitation over the first 24 hours after the burn
Name two non-sedating antihistamines
Loratadine and cetirizine
How do we treat venous ulceration
Compression bandaging
What is toxic epidermal necrolysis?
Toxic epidermal necrolysis (TEN). The patient’s presentation of widespread rash with fluid-filled blisters, fever, and recent initiation of phenytoin strongly suggests TEN. This condition is a severe cutaneous adverse reaction often triggered by medications such as antiepileptic drugs like phenytoin. In TEN, there is extensive detachment of the epidermis, leading to the formation of large fluid-filled blisters that easily separate upon pressure. The patient’s blood results also show signs of acute kidney injury (AKI) which can be a complication associated with TEN.
How does pityriasis versicolor present?
a skin condition caused by an overgrowth of Malassezia yeast. It is most common in young people, especially males. It causes multiple patches of skin discolouration, mainly to the trunk. The patches may appear pale brown, pink, or may appear depigmented especially in patients with dark skin. They may also be mildly flaky and itchy. The condition can often present after spending time in sunny, humid environments. It is treated with topical antifungals eg. ketoconazole shampoo.
What is erythema multiforme?
Erythema multiforme is an acute, immune-mediated skin condition that typically presents with target-like lesions on the skin and mucous membranes. In this patient, the history of a sore throat followed by fever, myalgia, and lethargy along with the appearance of a widespread erythematous rash with target lesions and mucosal involvement (conjunctivitis and oral ulceration) strongly suggest erythema multiforme major.
What are actinic keratoses?
Actinic, or solar, keratoses (AK) is a common premalignant skin lesion that develops as a consequence of chronic sun exposure
Features
small, crusty or scaly, lesions
may be pink, red, brown or the same colour as the skin
typically on sun-exposed areas e.g. temples of head
multiple lesions may be present
What is molluscum contagiosum, and how do we manage it?
This skin condition is caused by a pox virus and can be identified by its raised, pearly white, and umbilicated lesions. Supportive care is the mainstay of treatment for this condition, although specialist treatment may be required if the patient is immunocompromised. This condition normally clears up on its own within 18 months. Time off school is not necessary but, as the condition is infectious, it is advised to avoid sharing baths, towels, or clothing with others to prevent transmission.
Which medications cause erythema multiforme?
Drugs causing erythema multiforme - PANCaCes
Penicillin
Allopurinol
NSAIDs
Carbamazepine
COCP
How do we manage rosacea?
Rosacea: topical ivermectin is first-line for patients mild papules and/or pustules
Second line Oral oxytetracycline
How does rosacea present?
They describe flushing with a relationship to alcohol, as well as some ‘spots’ which can often be mistaken for acne vulgaris. In mild cases, the recommended treatment is topical ivermectin.
What are keloid scars?
Keloid scars are characterised by an overgrowth of granulation tissue at the site of a healed skin injury, which is then replaced by excessive amounts of collagen, resulting in a raised scar that extends beyond the site of original injury.How
How do we manage keloid scars?
Intra-lesional steroid injections, such as triamcinolone acetonide, are commonly used to treat keloids due to their anti-inflammatory properties and their ability to inhibit fibroblast proliferation and collagen synthesis.
How do we treat severe rosacea?
Rosacea: a combination of topical ivermectin + oral doxycycline is first-line for patients with severe papules and/or pustules
What is the most common SE of isotretinoin?
Dry skin
What is eczema herpeticum?
Eczema herpeticum is a potentially serious complication caused by the herpes simplex virus (Herpes simplex) infecting areas of broken skin affected by atopic eczema. This condition requires urgent assessment and treatment with antiviral medication (e.g., acyclovir) in a hospital setting to prevent complications such as secondary bacterial infections or dissemination of the virus.
What is the most common malignancy associated with acanthosis nigricans?
The most common malignancy associated with acanthosis nigricans is gastrointestinal adenocarcinoma
What is acanthosis nigricans?
hyperpigmentation and thickening of the skin in her groin and axilla are noted
What is the first-line treatment for venous ulcers?
Compression bandaging
What is the difference between bullous pemphigold and pemphigus vulgaris?
Blisters/bullae
no mucosal involvement (in exams at least*): bullous pemphigoid
mucosal involvement: pemphigus vulgaris
When is a BCC referred for urgent removal?
From my experience in primary care a BCC could be referred as 2WW if in the ‘T’ zone (i.e. around eyes & nose), otherwise the referral would be rejected or downgraded to non-urgent referral
How do we treat impetigo?
NICE now recommend hydrogen peroxide 1% cream for ‘people who are not systemically unwell or at a high risk of complications’
the change was announced in 2020 by NICE and Public Health England and seems aimed at cutting antibiotic resistance
the evidence base shows it is just as effective at treating non-bullous impetigo as a topical antibiotic
topical antibiotic creams:
topical fusidic acid
topical mupirocin should be used if fusidic acid resistance is suspected
MRSA is not susceptible to either fusidic acid or retapamulin. Topical mupirocin should, therefore, be used in this situation
What are keloid scars, and where are they most common?
Keloid scars are a result of an overgrowth of dense fibrous tissue that usually develops after the healing of a skin injury. The scar extends beyond the borders of the original wound, does not regress and tends to recur after excision. The sternum, along with other areas such as shoulders, upper arms and earlobes, is particularly prone to keloid formation due to high tension in these areas.
