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The Holy Grail (Treatments) > Derm > Flashcards

Derm Flashcards

1
Q

Shingles

Due to: Varicella ZOSTER virus

Presents:

  • Neuralgic “tingly” pain greater with age
  • Erythema
  • Common in elderly/ immunocompromised
  • Dermatomal

If pain presents more than 4 weeks then it’s known as Post Herpetic neuralgia

A

Oral Aciclovir

VZV used in chickenpox vaccine can be used in elderly to reduce shingles risk by 36% and Post Herpetic neuralgia by 67%

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2
Q

Chickenpox

Due to: VARICELLA zoster virus

Presents:

  • Generalised rash and fever
  • Sensory nerve roots
A

Supportive

Live attenuated vaccine is available for chickenpox (not widely used in UK)

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3
Q

Neonatal VZV

Secondary to chickenpox in mother in a late pregnancy

A

Prevention with Varicella Zoster Immunoglobulin in susceptible women

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4
Q

Ramsay-Hunt Syndrome

Presents:
- pain in vesicles, auditory canal and throat
7th CN - facial pasly
8th CN- deafness, vertigo, tinnitus

A

Aciclovir

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5
Q

Herpes Simplex Type 1

Presents:

  • Primary gingivostomatitis
  • Pre-school children
  • Extensive ulceration in and around mouth
  • Lasts around a week
  • 50% Genital herpes
A

MIld: Supportive
Severe: Aciclovir

Cold sore: Topical antiviral

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6
Q

Herpes Simplex Type 2

Presents:

  • 50% Genital herpes - warts
  • Some Gingivostomatitis
  • Encephalitis (common in neonates)
A

Aciclovir <72hours

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7
Q

Human Papilloma Virus

Presents:
T1-4: Warts/ verrucas
T6 &11: Genital warts
T16 & 18: Cervical cancer

A

Gardasil vaccine: protects against T6, 11, 16; 18

Cervarix vaccine: protects against T16 & 18

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8
Q

Herpangina

Due to enterovirus (coxsackie and echovirus)

Presents:
- Blistering rash at the back of the mouth

A

Self-limiting

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9
Q

Rubella

A

Vaccination

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10
Q

Erythema infectiosum / “Slapped cheek disease”

Caused by: Erythrovirus (Parvovirus B19)

Child: crash on face, lacy rash on body
Adult: polyarthritis in joints/ hands, no rash

A

Self limiting
Reassure patient
Symptomatic relief with over-counter meds

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11
Q

Orf

Due to virus caught from sheep with scabby mouths (ikr wtf)

Presents:
- Firm, fleshy nodule on hand of farmer

A

Self-limiting

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12
Q

Syphilis

Due to: bacterium Treponema pallidum

Presents:
Primary- Chancre (painless ulcer) at infection site
Secondary- red rash over body especially palms and soles, mucous membrane “snail track” ulcers
Tertiary: CNS, Cardiovascular

A

Penicillin G injections

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13
Q

Lyme disease

Due to: Borrelia burgdorferi from ticks

Presents:
Early- erythema migrans
Late- heart block, nerve palsies, arthritis

A

Amoxicillin or Doxycycline

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14
Q

Scabies

Caused by “Sarcoptes scabiei”
Chronic crusted form is termed “Norwegian Scabies” adn is highly infectious.

Associated with an intensely itchy rash affecting finger-webs, wrists and genital area

A 
Malathion lotion
Benzyl benzoate (avoid in children)
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15
Q

Erythropoietic protoporphyria

A

6 monthly LFTs and RBC porphyrins

Photoprotection measures

  • Prophylactic TL-01 phototherapy
  • Anti-oxidants: beta-carotene, cysteine, high dose Vitamin C
  • Avoid iron

If leads to liver failure:

  • oral charcoal
  • cholestyramine
  • ALA synthase inhibition
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16
Q

Prophyria cutanea tarda

Presents as: 
Blisters, fragility
Hyperpigmentation
Hypertrichosis
Solar urticaria
Morphoea
A

Treat underlying disease:

  • Alcohol
  • Viral Hepatitis
  • Oestrogens
  • Haemochromatosis

Not doing this will lead to risk of liver cirrhosis/ hepatoma

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17
Q

Atopic Eczema

A
  1. Emollients
  2. Topical steroid (hydrocortisone)
  3. Phototherapy UVB
  4. Systemic Immunosuppressants
  5. Biologics

Treat infections as necessary
Avoid irritants

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18
Q

Pruritus (itching)

A
  • Sedative Anti-histamines
  • Emollients: Menthol (Dermacool), Capsaicin, Camphor, Phenol, Crotamiton (Eurax cream)
  • Antidepressants, e.g. doxepin
  • Phototherapy
  • Opiate antagonists, ondansetron
  • Treat underlying disease
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19
Q

Dry skin

A

Moisturising agents

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20
Q

Viral Warts / verrucas

A 
Self limiting
Keratolytic agents (salicylic acid)
Formaldehyde
Glutaraldehyde
Silver nitrate
Cryotherapy (liquid nitrogen)
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21
Q

Anaphylaxis

A

Adults: 300µg adrenaline
Children: 150µg adrenaline

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22
Q

Contact dermatitis

A non-immunological process where contact with agents that abrade, irritate and traumatize skin directly.

Examples:

  • Nickel in belt buckle
  • Latex/ thiuram in rubber gloves
  • Colophony in elastoplast
  • Fragrance in deodorants
  • Chromate in footwear
  • Garlic
  • PPD in black henna tattoo
  • Diethylthiourea in wrist splint
  • Dermabond surgical glue
  • English Ivy
  • Golden fillings etc
  • Nappy rash
  • Licking lips
A

Remove the irritant

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23
Q

Lichen Planus (non-infective inflammatory dermatoses)

A

Mild: Topical corticosteroid (potent/ very potent)
Severe: Oral steroids

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24
Q

Keloid scars

A

Topical corticosteroid

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25
Q

Eczema Herpeticulum

A

Oral antiviral

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26
Q

Candida intertrigo (infection)

A

Nystatin (oral)
Clotrimazole cream
Oral fluconazole

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27
Q

Hyperkeratotic Eczema

A

Keratolytic agents (salicylic acid)

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28
Q

Keratin plaques

Usually found in scalp

A

Keratolytic agents (salicylic acid)

29
Q

Genital warts

A

Podophyllin

30
Q

Necrotising fasciitis

A

Surgical Debridement

31
Q

Lice (pediculosis)
Otherwise known as “Vagabond’s Disease”

Pediculus capitis (head louse)
Pediculus corporis (body louse)
Phthirus pubis (pubic louse)

Associated with an intense itch

A

Malathion lotion

32
Q

Erythema multiforme

Caused by:
Herpes simplex virus
Mycoplasma pneumoniae bacterium

Many triggers including drug reactions and some infections

A

Treat underlying cause

33
Q

Molluscum contagiosum

Presentation:
Fleshy, firm, umbilicated, pearlescent nodules
1 to 2 mm diameter
Self-limiting but take months to disappear
Common in children
Can also be sexually transmitted

A

Self-limiting
Treat underlying cause
Cryotherapy (Liquid Nitrogen)

34
Q

Herpangina

Blistering rash of back of mouth
Caused by: enterovirus (echovirus, coxsackie virus)

A

Self limiting

35
Q

Hand, foot and mouth disease

Presentaion:
Typically children
Family outbreaks
Caused by enteroviruses (especially coxsackie virus)

A

Supportive

36
Q

Zika Virus

Spread by mosquito Aedes aegypti

Presentation: 
Mild fever
Rash (mostly maculopapular)
Headaches
Arthralgia
Myalgia
Non-purulent conjunctivitis
A

Supportive

No NSAIDS until Dengue fever is ruled out to reduce risk of haemorrhage

37
Q

Dermatitis Herpetiformis

Rare
Autoimmune bullous disease
Strong association with coeliac disease

Presentation:
Intensely itchy lesions-symmetrical
Elbows, knees and buttocks-often excoriated
Hallmark is papillary dermal microabscesses

A

Dapsone (diaminodiphenyl sulfone)
Sulfapyridine

Treat underlying cause e.g. Gluten free diet

38
Q

Rosacea

Red face (nose & cheeks)

Causes:
Sunlight
Alcohol
Spicy foods
Stress
A

Avoidance of alcohol/ spicy food/ hot temperatures

  • Topical Metronidazole, Ivermectin (to reduce demodex mite)
  • Oral tetracycline long term

Others:
Telangiectasia (vascular laser)
Rhinophyma (surgery/ laser shaving)

Avoid steroids!

39
Q

Basal Cell Carcinoma (BCC)

Presentation: 
- very common
- slow growing lump or non-healing ulcer
- painless and often ignored
 - ‘pearly’ or translucent
 - visible, arborising blood vessels 
 - central ulceration (“rodent ulcer”)
 - can present as scaly plaque  ‘superficial’
 - can be infiltrative  ‘morphoeic’ 
 - locally invasive, but rarely metastasize
 > 40 yrs, but can be 3rd or 4th decade
A

Surgical excision

40
Q

Pemphigus Vulgaris

PemphiguS –
split more Superficial, intra-epidermal

Presentation:

  • Typically affects scalp, face, axillae, groins
  • Flaccid vesicles/bullae – thin roofed
  • Lesions rupture to leave raw areas
  • Increased infection risk
  • Nikolsky sign positive
  • Mucosal involvement (eyes, genitals)
A

Systemic steroids
Immunosuppressive agents

Aids: Emollients, topical steroids, topical antisepsic / hygiene measures

41
Q

Squamous Cell Carcinoma (SCC)

Presentation:

  • about 20% of all skin cancers
  • hyperkeratotic (crusted) lump or ulcer
  • arises on sun-damaged skin
  • grows relatively fast, may be painful &/or bleed
  • majority are well differentiated low risk
  • minority are poorly differentiated high risk
  • risk of metastasis about 5%
  • poor prognosis once metastatic
  • precursor lesions: actinic keratoses and Bowen’s disease (carcinoma-in-situ)
A

Surgical excision

42
Q

Naevoid basal cell carcinoma (Gorlin’s syndrome)

Features:

  • early onset/multiple BCCs
  • palmar pits
  • jaw cysts
  • ectopic calcification
A

Oh jesus cut them out

43
Q

Malignant Melanoma

Types:

  1. Superficial Spreading Melanoma (SSM)
  2. Acral/ mucosal lentiginous melanoma (A/MLM)
  3. Lentigo Maligna Melanoma (LMM)
  4. Nodular Melanoma
Features: 
Most common on sun-exposed sites scalp, face, neck, arm, trunk, leg
Commoner in females (2:1)
May arise at any site
Rare in childhood
Incidence peaks in middle-age
A

Surgical excision

SN biopsy is positive then do a lymphadenectomy

44
Q

Venous Ulcer

A
  • Control pain
  • ABPI
  • Non-adherent dressing
  • De-sloughing agent if necessary eg hydrogel/ honey
  • 4 layer compression bandaging – may need to increase compression gradually if pain a problem
  • Leg elevation
45
Q

Inflammatory Psoriasis

A

Emollients (diprobase)

46
Q

Chronic plaque Psoriasis

A

Tried emoolients- didn’t work

  1. Calcitrol (Vit D analogue)
  2. Coal tar
  3. Dithranol
  4. Tazarutene (retinoid)
  5. Phototherapy UVB if topicals fail
47
Q

Scalp Psoriasis

A

Emollients always

  1. Tar-based shampoo
  2. Salicylic acid (keratolytic)
  3. Potent topical steroid + Calcitrol (Vit D analogue)
48
Q

Psoriasis on face, flexures, genitals

A
  1. Mild topical steroid (hydrocortisone 1%)

2. Calcitrol/ tacalcitrol for long term use

49
Q

Severe + Resistant Psoriasis

A
  1. Acitretin
  2. Ciclosporin
  3. Methotrexate

all of these are teratogenic

50
Q

c-Kit Melanoma mutation

A

Dasatimib

Imatinib

51
Q

B-Raf Melanoma mutation

A

Vemurafenib

Dabrafenib

52
Q

MEK Melanoma mutation

A

Trametinib

53
Q

Melanoma treatment using T-cell activation to kill tumours

A

Ipilimumab
Tremelimumab
Pembrolizumab

54
Q

Molluscum Contagiosum

A

Self-limiting

55
Q

Erythema multiforme

A

Self-limiting

Potentially steroids if terribly severe but rare.

56
Q

Acne

A

1st line: single topical therapy (topical retinoids, benzoyl peroxide)
2nd line: topical combination therapy (topical antibiotic, benzoyl peroxide, topical retinoid)
3rd line: oral antibiotics: e.g. Oxytetracycline, doxycycline, erythromycin if pregnant
4th line: Isotretinoin*

  • Check bloods regularly
  • Put on contraception
  • Pregnancy test before starting
57
Q

Bullous Pemphigoid

Large tense bullae

A

Systemic steroids
Immunosuppressive agents
Tetracycline

Aids: Emollients, topical steroids, topical antisepsic / hygiene measures

58
Q

Tuberose Sclerosis

Rare genetic condition that causes development of benign tumours

A

No cure :(

Relieve symptoms

59
Q

Neurofibromatosis Type 1

A

No cure
Reduce symptoms
Surgical removal of tumours
Chemotherapy for optic gliomas

60
Q

Neurofibromatosis Type 2

A

No cure

Surgical removal of tumours

61
Q

Schwannomatosis

A

No cure

Surgical removal of tumours

62
Q

Bowen’s Disease

Bowen’s disease is a very early form of skin cancer that’s easily treatable. The main sign is a red, scaly patch on the skin. It affects the squamous cells – which are in the outermost layer of skin – and is sometimes referred to as squamous cell carcinoma in situ.

A

Photodynamic therapy
Cryotherapy
Chemotherapy

63
Q

Leg ulcer

A
  1. Control pain
  2. Non-adherent dressing
  3. De-sloughing agent (hydrogel/ honey)
  4. 4 layer compression
  5. Elevate leg
64
Q

Dermatophyte (fungal) infections

Tinea pedis etc…

A

Small areas of skin/nails:

  • Clotrimazole (Canesten cream)
  • Nail paint (amorolfine)

Extensive infections + scalp + nails:

  • Terbinafine (oral)
  • Itraconazole (oral)
65
Q

Lichen planus

A

Potent topical steroids

Oral steroids

66
Q

Epidermolysis Bullosa

A

None, most die in infancy ;(

67
Q

Impetigo

Caused by: Staph aureus/ Strep pyogenes

A

1st: Topical fusidic acid
2nd: Oral flucloxacillin / topical retapamulin

68
Q

Scarlet Fever

A

Penicillin

69
Q

Hirtuism

A

Weight loss
Facial: topical eflornithine
Moderate-severe: co-cyprindiol (combined oral contraceptive)

The Holy Grail (Treatments) (13 decks)

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