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EXAM 2 > Derm 4.5 > Flashcards

Derm 4.5 Flashcards

1
Q

Intertriginous & peri-oral dermatitis, alopecia, taste impairment, diarrhoea, short stature, hypogonadism, hepatosplenomegaly, cognitive impairment, glucose intolerance - what deficiency?

A

Zinc

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2
Q

Pellagra, dermatitis, alopecia, oedema, glossitis, weakness, ataxia, paralysis, peripheral neuritis - what deficiency?

A

Niacin

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3
Q

rx of acne rosacea?

A
  • topical metronidazole if mild
  • systemic Abx eg Oxytetracycline if more severe
  • high sf
  • laser Rx if prominent telangiectasia
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4
Q

Mild topical steroid?

A

Hydrocortisone 0.5-2.5%

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5
Q

Moderate topical steroid?

A

Betamethasone 0.025% (Betnovate RD)

Clobetasone butyrate 0.05% (Eumovate)

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6
Q

Potent topical steroid?

A

Fluticasone propionate 0.05% (Cutivate)

Betamethasone valerate 0.1% (Betnovate)

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7
Q

V potent top steroid?

A

Clobetasol propionate 0.05% (Dermovate)

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8
Q

Rx for SCC of skin?

A
  • surgical excision with 4mm margins if lesion <20mm in diameter
  • if >20mm then margins should be 6mm
  • Mohs micrographic surgery in high-risk
  • of high risk, then do surgery & consider systemic Retinoids

Good prognosis = well differentiated, <20mm diameter, <2mm deep, no ass diseases

Poor = poorly differentiated, >20mm diameter, >4mm deep, immunosuppression

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9
Q

Psoriasis Rx?

A
  • regular emollients
    1st line = potent steroid OD + vit D analogue OD deparately, for 4weeks
    2nd line = vit D analogue BD if no improvement after 8wks
    3rd line = potent steroid BD for 4wks OR coal tar prep OD/BD, if no improvement after 8-12wks
  • short acting dithranol can also be used
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10
Q

Vitamin D analogues in psoriasis?

A
  • reduce cell division & differentiation
  • adverse effects uncommon
  • can be used long term
  • don’t smell/stain
  • reduce scale & thickness of plaques but not erythema
  • avoid in pregnancy
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11
Q

2ry care Rx for Psoriasis?

A

Phototherapy

  • narrow band UVB Rx of choice 3x/wk
  • PUVA photo chemotherapy
  • adverse effects: skin raging, SCC

Systemic Rx

  • 1st line MTX esp if joint disease
  • ciclosporin: palmoplantar, considering conception, rapid/short term disease control
  • systemic retinoids
  • biologics: infliximab, etanercept, adalimumab
  • Ustekinumab IL-12 & IL-23 blocker showing promise in early trials
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12
Q

Bullous pemphigoid = autoimmune condition causing sub-epidermal blistering of skin, 2ry to development of Ab against hemidesmosomal proteins BP180 & BP230
Features?
Skin Bx?
Rx?

A
  • more common in elderly
  • itchy, TENSE blisters typically around flexures
  • blisters HEAL without scarring
  • mouth spared classically
  • immunofluorescence shows IgG & C3 at dermoepidermal junction
  • oral steroids
  • top steroids, immunosuppressants & Abx also used
  • classic causes are: furosemide, penicillamine, captopril
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13
Q

crusty enlarging lumps on a background of acinic keratosis on sun-exposed skin. They may ulcerate and are often tender or painful
Dx?

A

SCC skin

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14
Q

ix for venous ulcers?

Rx?

A

ABPI to assess poor arterial flow which could impair healing
- normal is 0.9-1.2, if <0.9 arterial disease is suggestive, but can have false negative with arterial calcification

  • compression banding, 4layer
  • oral Pentoxifylline = peripheral vasodilator, improves healing rate
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15
Q

Vitiligo: AI condition which results in loss of melanocytes & depigmentation of skin, Sx develop age 20-30
Features?
Ass conditions?
Rx?

A
  • well-demarcated patches of depigmented skin
  • peripheral most affected
  • Koebner phenomenon
  • T1DM, Addison’s, AI thyroid, pernicious anaemia, alopecia areata
  • Rx = sunblock, camouflage make-up, top steroids, may be a role for top tacrolimus & phototherapy
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16
Q

Polymrphic eruption of pregnancy

  • when
  • where
  • Rx?
A
  • itchy rash with 3rd trimester
  • 1st in abdo striae
  • emollients, top steroids, oral if severe
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17
Q

Pemphigoid gestationis

  • what
  • where
  • when
  • Rx?
A
  • itchy BLISTERING lesions
  • peri-umbilical then spread to trunk, back, buttocks, arms
  • 2nd/3rd trimester (rarely ever in 1st pregnancy)
  • oral steroids usually needed
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18
Q

Hereditary haemorrhagic telangiectasia = auto dom telangiectasia on skin & mucous membranes
4 main Dx criteria?

A
  1. epistaxis: spontaneous, recurrent
  2. telangiectasia: at characteristic sites
  3. visceral lesions: GI, pulm, hepatic, cerebral, spinal AVM
  4. FHx: 1st degree relative
19
Q

Pemphigus vulgairs = AI disease caused by Ab against desmoglein 3, a cadherin type epithelial cell adhesion molecule, more common in Ashkenazi jewish
Features?

A
  • mucosal ulceration often PC
  • skin blistering - FLACCID early ruptured vesicles & bull, PAINful but not itchy - may develop months after initial mucosal Sx
  • acantholysis on Bx
20
Q

Erythema multiform = hypersensitivity reaction most commonly triggered by infections

  • features?
  • causes?
A
  • target lesions
  • initially on back of hands/feet before spreading to torso
  • UL more commonly affected than LL
  • pruritus occasionally seen & mild
  • HSV commonest, Orf
  • idiopathic
  • mycoplasma, streptococcus
  • penicillins, sulfonamides, carbamazepine, allopurinol, NSAIDS, OCP, nevirapine
  • SLE
  • sarcoid
  • malignancy
21
Q

4 main subtypes of melanoma?

A

superficial spreading 70%

nodular
- red/black lunp or lump which bleeds/oozes

lentigo maligna

acral lentiginous - subungual pigmentation or on palms/feet

22
Q

Ix & Rx of malignant melanoma?

A
  • Incomplete excision Bx of suspicious lesions

0-1mm thick - 1cm
1-2mm - 1-2cm
2-4mm - 2-3cm
>4mm - 3cm

23
Q

Cholestasis-induced pruritus Rx options?

A

rifampicin
sertraline
cholestyramine

24
Q

Erythema nodosum = inflammation of SC fat - tender, erythematous nodular lesions over shins usually, resolves within 6wks, heal without scarring
Causes?

A
  • streptococci, TB, brucellosis
  • sarcoid, IBD, Behcet’s
  • malignancy, lymphoma
  • penicillins, sulphonamides, COCP
  • pregnancy
25
Q

rx of guttate psoriasis?

- precipitated by strep infection 2-4wks prior

A
  • most resolve spontaneously 2-3months
  • topical agents as per psoriasis
  • UVB
  • tonsillectomy may help with recurrent episodes
26
Q

Pyoderma gangrenosum: typically on LL starts as small red papule later deep, red, necrotic with violaceous border +/- systemic Sx

  • Causes?
  • Rx?
A 
idiopathic 50%
IBD
RA, SLE
myeloproliferative disorders
lymphoma, myeloid leukaemias
IgA monoclonal gammopathy
PBC
  • oral steroids as potential for rapid progression
  • other immunosuppressants may have a role
27
Q

What is Palmar-plantar erythrodysesthesia

A
  • common side-effect of many chemo Rx, from days-months into Rx
  • tingling & numbness in fingers/palms then toes/soles
  • then erythematous rash which can desquamate, blister & ulcerate which can be ass with onycholysis
  • Rx depends on severit
28
Q

What is yellow nail syndrome?

associations?

A
  • slowing of nail growth leads to characteristic thickened & discoloured nails
  • congenital lymphoedema
  • pleural effusions
  • bronchiectasis
  • chronic sinus infections
29
Q

Prognostic markers ass with Severe eczema?

Rx of eczema?

A 
onset age 3-6months
severe disease in childhood
ass asthma/hayfever
small family size
high IgE serum levels
  • emollients
  • topical steroids
  • UV radiation
  • immunosuppressants eg ciclosporin topical, antihistamines, azathioprine
30
Q

Conditions ass with seborrhoea dermatitis?

Features?

A
  • HIV
  • PD
  • eczematous lesions on sebum-rich areas e.g. scalp, periorbital, auricular, nasolabial folds
  • otitis externa & blepharitis may develop
31
Q

Lichen planus - features?
causes of drug eruptions?
Rx?

A
  • itchy, papular, polygonal, white-lace pattern
  • Koebner phenomenon
  • oral involvement in 50%
  • thinning of nail plate, longitudinal ridging
  • Gold, Quinine, Thiazides
  • topical steroids
  • benzydamine mouthwash/spray for oral
  • extensive lichen Plans may need oral steroids/immunosuppression
32
Q

Main side-effect of Dapsone?

A

Haemolytic anaemia - need reg FBCs

- also peripheral neuropathy, rarely agranulocytosis

33
Q

Erythroderma - 95% skin involved

  • causes?
  • what is erythrodermic psoriasis?
A
  • eczema, psoriasis, drugs e.g. gold, lymphoma, leukaemia, idiopathic
  • progression of chronic disease to exfoliative phase with plaques covering most of body, ass with mild systemic upset
  • more serious form is acute deterioration that may be triggered by e.g. withdrawal of systemic steroids
34
Q

Pityriasis versicolor = superficial cutaneous fungal infection caused by Malassezia fur fur

  • features?
  • predisposing factors?
  • Rx?
A
  • commonly trunk, hypo pigmented/pink/brown patches more noticeable after a suntan, scale common, mild pruritus
  • yellow-green fluorescence under Woods lamp
  • in healthy, immunosuppression, malnutrition, Cushing’s
  • Rx = topical antifungal
  • consider other Dx or oral itraconazole if fails to respond
35
Q

rx for face/flexural/geinital psoriasis?

A

Mild/moderate potency steroid OD/BD for max 2 wks

36
Q

Steven-Johnson syndrome = severe systemic reaction affecting skin & mucosa almost always a drug reaction

  • when does it occur?
  • features?
  • causes?
  • Rx?
A
  • 1-4weeks after 1st drug exposure, on average day 14
  • maculopapular rash with target lesions, may develop vesicles/bullae
  • mucosal involvement
  • fever, arthralgia
  • penicillin, sulfonamide, lamotrigine, carbamazepine, phenytoin, allpurinol, Nsaids, OCP
  • hospital admission for supportive Rx
37
Q

Pellagra = nicotinic acid/niacin deficiency

- features?

A
  • can be a consequence of isoniazid Rx, more common in alcoholics
  • dermatitis bron scaly rash on sun-exposed sites
  • diarrhoea
  • dementia, depression
38
Q

Bowen’s disease = intraepidermal SCC more common in elderly females - 3% chance of developing invasive skin cancer

  • features?
  • Rx options?
A
  • red, scaly patches, often occur on sun-exposed areas e.g. LL
  • Top 5-FU or IMIQUIMOD
  • cryotherapy
  • excision
39
Q

Rx of actinic keratoses?

A
  • SPF, avoid sun etc
  • Fluorouracil cream 2-3wks (topical steroid can help inflammation that it will case)
  • topical diclofenac
  • topical Imiquimod
  • cryotherapy, curettage & cautery
40
Q

Exacerbating factors of psoriasis?

A 
trauma
ETOH
withdrawal of systemic steroids
beta-blockers
lithium
antimalarials
NSAIDs
ACE-I
infliximab
41
Q

Polymorphic light eruption = 1ry photosensitivity commonly occurs in young women
- when/what

A
  • usually each spring provoked by several hours outside on a sunny day
  • rash settles if further exposure avoided
42
Q

lesions due to Microsporum canis green fluorescence under Wood’s lamp*. However the most useful investigation is scalp scrapings
Dx?

A

Tinea capitis (scalp ringworm)

  • causes scarring alopecia
  • Rx oral Terbinafine for Trichophyton tonsurans infections; Griseofulvin for Microsporum infections
  • give topical Ketoconazole shampoo for the first 2 weeks to reduce transmission
43
Q

causes include Trichophyton rubrum and Trichophyton verrucosum (e.g. From contact with cattle)
well-defined annular, erythematous lesions with pustules and papules
Dx?
Rx?

A 
Tinea corporis (ringworm)
- oral fluconazole

EXAM 2 (10 decks)

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