derm 2 Flashcards

1
Q

herpes (shingles)

A

herpes zoster infection- reactivation of varicellar zoster.

presents with dermatomal pain, eruption of grouped vesicles.

pain preceeds rash, lasts 4-5 weeks.

RF: over 50, female, HIV, chronic sted use, chaemo/ malignency.

Ix: usually a clinical diagnosis
can swab + PCR.

Rx: usually self limiting but consider antiviral in all pts

famciclovir 500mg 8hrly 7/7
OR
valaciclovir 1000mg 8hrly 7/7

2nd- aciclovir 800mg 5DS 7/7

Refer if eye involvement (opthalmologist) - quicker start of antivirals.

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1
Q

headlice (pediculosis capitis)

A

an obligate ectoparasite that lives on human beings and feeds on human blood

RF: socially active- young children (3-12)
female, close living conditions.

eggs can be visible on hair 1cm from scalp.

Ix/Dx: doscivery of live young or adult louse. usually vis if 6mm from scalp.
on magnification they have dark eyespots.

may see excessive itching

Rx: pediculide- dimeticone topical or permethrin topical.
2nd line mechanical removal (wet combing)
can use petroleum jelly as an occlusive.

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2
Q

impetigo.

A

Impetigo contagious, blistering skin infection. typically in children.
Staphylococcus aureus and Streptococcus pyogenes.

It has two forms: non-bullous and bullous. Bullae are fluid-filled lesions of >0.5 cm in diameter. single lesions often.

non bullous more common

RF: humidity, poor hygiene, chronic colonisation, prior skin disease

Mx: topical abx— hydrogen peroxide d-tds 3/52.
2’- mupirocin topical
Or fusidic acid.

if widespread, deeper or MRSA give oral.

complications: post strep glomurolonephritis
sepsis, cellulitis, osteomyolitis.

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3
Q

what is a melanocytic naevi

A

a benign mole

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4
Q

discuss melanoma

A

malignant tumour arising from melanocites.

most common cancer in young adults.

RF: sun exposure, FH, prev melanoma,
slight predisposition to male. fair skin, sunbed, increacing numbers of naevi, immunosupression. age.

may present as changing, bleeding etc

Ix: ugly duckling sign,
dermoscopy, biopsy- breslow indicator of prognosticity.

Rx: generally 99% cure rate with excision.
margin if confined to epidermis- 0.5-1cm
once 1cm need 2cm margin.

adjuvinant therapy- —pembrolizumab or nivolumab is stage 1-2.

stage 3-4— pembrolizumab + surgery (node etc)

17% get metastatic disease.

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5
Q

abcde assessment for melanoma + staging of melanoma

A

Asymmetry or lesion
Boarder irregularity, Bleeding
Colour variability
Diameter >6
Evolution – changing.

Breslow thickness
T1 if under 1mm
T2 1-2mm
T3 2-4mm
T4- >4mm + ulce

Add B to staging if an ulcer present.

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6
Q

necrotising fascitis

A

a severe life threatening skin infection.
bacteria introduced to skin- infection extends through fascia NOT into underlying muscle.

tracks along fascial planes– extends beyond area of cellulitis.

S+S: fever, tachycardia, hypotension– actions of bacterial toxins

severe pain– anaesthesia at site of infection. pedema and erythema- oedema byond erythema.

toxins cause microthrombi- occluding the soft tissue causing the cell death.

high mortality 10-40%.

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7
Q

types of nec fash

A

type 1 - polymicrobial by anaerobes- clostirium, e coli, klebsiella, proteus, enterobacter.

type 2- monobacterial – strep pyogenes. occ s aureus

other rarer ones- freshwater or saltwater/ oyster eposure etc.

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8
Q

Ix + Rx nec fash

A

Ix: clinical diagnosis- do not delay surg refferal.

innspection and debridement or-‘finger test’ performed at bedside (no resistance, no bleed, necrotic tissue + dishwater)

cultures is most specific.

Rx: rapid debridement
empirical abx therapy.

reconstructive surgery down the line.

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9
Q

discuss neurofibromatosis type 1

A

autosomal dominant genetic disorder.
progressive over lifetime.

leads to neuro defecits, motor delay, incoordination, vision/ school problems. gastro problems- very wide ranging and debilitating.

may be subtle if presenting young.

defining features: cafe au lait spots.
multiple neurofibromas
iris lisch nodules

RF: parent with NF-1
severe crush trauma (can lead to local neurofibromas)

Ix: MRI/CT for tumour imaging
PET scan
biopsy
ginetic testing for mutation confirmation

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10
Q

management of NF type 1

A

pheochromocytoma- (adrenal mass) – surgical removal.

generally surgical removal of tumours if possible.

generally patients die from malignancy

whole tumour removal by amputation is done.

can get additional chaemo.

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10
Q

discuss NF type 2

A

much more rare than type 1

tumours develop along the nerves- espechially vestibulochchlear

S+S: tinnitus, hearing loss, balance issues – all progressive. hallmark is that it is bilateral.

can get tumours in the brain.

autosomal dominant. can display mosaicism in 1 in 3.

Ix: symptom investigation
genetic testing.

Rx: symptomatically.

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10
Q

discuss eczema

A

dry itching skin, erythema, scaling, vesicles or lichenification.

can affect all age groups, but most commonly before 5y/o. 10-20% of children.

assoc with other atopic diseases.

RF: filaggerin gene mutation
<5
FH, allergic rhinitis, atopy.

Ix: clinical diagnosis.
consider IgE levels, skin prik testing, elimination diet.

Rx: 1st line- emmolients.
intermittent topical steds (hydrocortison topical 0.2-2%)
consider topical abx or oral abx.

2nd line- systemic immunosuppresive agent- pred, ciclosporin.

in chronic consider a topical cacineurin inhibitor: pimecrolimus or tac.

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11
Q

discuss pemphigus vulgaris

A

autoimmune condition- causing blistering of skin.

type 2 hypersensitivity. - ab’s against desmosones (1 and 2 proteins)

layers of skin seperate under attack and blisters form.

progresses- lesions enlarge and bahave physicologically like a burn.

mortality 5-15%- deemed potentially fatal.

RF: 50-60, women.

S+S: initially oral blisters. these then spread to other mucous sites + normal skin. spared soles and palms.
Nikolsky sign- (induction of blistering in normal skin) - indicative.

Ix: punch biopsy from site near blister.

Rx:
steds
rituximab

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12
Q

pemphigus vulgaris vs bullous phemphigoid

A

tombstoning on histology visible on PV.

PV split is between keratinocites and basal layer

BP- split occurs between epidermis and dermis.

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13
Q

psoriasis

A

systemic immune mediated inflammatory skin disease. may have nail + joint involvement. 75-90% of people have scalp
involvement.

HLA-CW6

chronic plaque psoriasis is most common form. erythrodermic needs admission.

common disease 1.3-2.8% of ppl affected.

S+S: chronic plaque lesions- red, silvery-white scaley, circumscribed. - elbows, knees, extensor surfaces.

multifactoral disease with ginetic basis.

RF: genetic/ FH, infection, local trauma

14
Q

Ix + Mx of psoriasis + any associated conditions

A

Ix: clinical diagnosis
biopsy if unsure.

Rx: lifestyle advice.
moisturising emolient
topical steds - hydrocortisone 2.5%. 2-4x a day
2’- tac topical

if severe- add phototherapy, DMARD e.g methotrexate,

add topical vit d if initial not good response.

associated conditions:
cardiovasc
psoriatic arthritis
depression
lymphoma

15
Q

discuss two of the less common types of psoriasis

A

guttate- generally triggered by streptococcal infection. children and adolecents most commonly affected.

many small papules. - phototherapy 1st line- then normal rx

pustular- HLA-B27 associated. rare- serious. pustules develop quick on wide area of skin.
may appear every few days or weeks in cycles. Can be triggered- e.g withdrawal of steroids.
may need admission as more severe —-
fluds
either intense topical or
systemic

acitretin 25-50mg orally OD

16
Q

pyoderma granulosum

A

an autoinflammatory dermatosis— painful ulcers.

neutrophilic infiltration.

quite rare- and presents same as many things- consider if a non healing ulcer.

S+S: painful non healing ulcer.
exagerrated response after trauma.

pustules–> edore into ulcers–> large necrotic central ulcer. — quite big lesions.

small but significant chance of reocurrence.

Ix: biopsy + culture.
identify inflam bowel, rheumatoid conditions if present

Rx: systemic – ciclosporin, prednisolone.
urgent refferal to specialist.

17
Q

discuss rosacea (steve disease)

A

chronic inflam skin condition

affects face convexities

one diagnostic or two major features needed for diagnosis.

D- phymatous changes, persistent erythema

M- flushing erythema, papules, pustules, telangiectasia, eye symptoms.

minor- skin burning/ stinging, dry skin, oedema.

can get ocular rosacea- discomfort, tearing, dryness, itch, photophobia, blurr.

may progress, or may remit and relapse.

unsure of cause.

Rx: topical brimonidine
topical ivermectin. - if papules and pustules

if severe ivermectin + oral doxy 40mg OD.

18
Q

scabies

A

an intensley itchy skin infestation caused by sarcoptes scabiei

classical scabies- 1-15 mites per host
crusted (norwegian)- thousands-millions in exfoliating skin. - immunodef, unable to itch.

S+S: itching 3/52 post infestation initially.
erythematous papules- periumbilical, waist, genetalia, breasts, but, axilla, fingers.

RF: close contact
social depravation, institutionization.
winter.

can lead to 2’ cellulitis.

Ix: clinical – skin scrapings can be used.
ink test to check for burrows.

Rx: permethrin 5% cream. of everyone contacts household members, everyone.
GUM refferal for contact tracing if needed.

itch may continue for 4 weeks after rx.

19
Q

stevens johnson syndrome/ TEN

A

severe and fatal form of erythema multiforme.
may initially be mild, but progress to bad bad.

less than 10% skin detachment. SJS- TEN greater than 30%. mixed between the 2.

seen in all ages. preference to younger adults/ kids.
male 2:1 female.

abx assoc with >1/4.

Ix: biopsy, culture, FBC, - symptomatic investigation and management.

Rx: consider burn centre/ icu.
withdraw offending drug.
VTE- LMWH
skin management- quite complex.

20
Q

viral warts

A

verrucae vulgaris- caused by HPV infection

affects most people in their lifetime- most common in children and young adults.

generally not too bad- but need distinguishing from SCC- key information point immunosuppression.

S+S: elevated, round, kyperkeratotic skin papules. grey/brown. - occur at sights prone to trauma (knees elbows)

RF: water immersion, occupation with meat or fish, nail biting, under 35, immunodef.

Ix: clinical diagnosis.
consider biopsy if sus.

Rx: watch and wait- most go away over time.
1st line- debridement + salicylic acid. (consider duct tape occlusion)
Or
Cryotherapy
OR
silver nitrate.

local immunotherapy (imiquimod) 2nd line.

if immunocomprimised start with debride + salicylic + local immunotherapy.