- Topical corticosteroid - Glucocorticosteroids (hydrocortisone) - Retinoids In face & Children: - Calcineurin inhibitors

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

Derm Flashcards by Seth Allen

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

Oral Aciclovir

VZV used in chickenpox vaccine can be used in ages >70

How well did you know this?

Not at all

Perfectly

Chickenpox

Due to: VARICELLA zoster virus

Presents:

Generalised rash and fever
Sensory nerve roots

Supportive

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

How well did you know this?

Not at all

Perfectly

Neonatal VZV

Secondary to chickenpox in mother in a late pregnancy

Prevention with Varicella Zoster Immunoglobulin in susceptible women

How well did you know this?

Not at all

Perfectly

Ramsay-Hunt Syndrome

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

Aciclovir

How well did you know this?

Not at all

Perfectly

Herpes Simplex Type 1

Presents:

Primary gingivostomatitis
Pre-school children
Extensive ulceration in and around mouth
Lasts around a week

MIld: Supportive
Severe: Aciclovir

Cold sore: Topical antiviral

How well did you know this?

Not at all

Perfectly

Herpes Simplex Type 2

Presents:

Genital warts
Gingivostomatitis
Encephalitis (common in neonates)

Aciclovir

How well did you know this?

Not at all

Perfectly

Human Papilloma Virus

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

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

Cervarix vaccine: protects against T16 & 18

How well did you know this?

Not at all

Perfectly

Herpangina

Due to enterovirus (coxsackie and echovirus)

Presents:
- Blistering rash at the back of the mouth

Self-limiting

How well did you know this?

Not at all

Perfectly

Rubella

Vaccination

How well did you know this?

Not at all

Perfectly

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

Self limiting
Reassure patient
Symptomatic relief with over-counter meds

How well did you know this?

Not at all

Perfectly

Orf

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

Presents:
- Firm, fleshy nodule on hand of farmer

Self-limiting

How well did you know this?

Not at all

Perfectly

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

Penicillin injections

How well did you know this?

Not at all

Perfectly

Lyme disease

Due to: Borrelia burgdorferi from ticks

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

Amoxicillin

Doxycycline

How well did you know this?

Not at all

Perfectly

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

Malathion lotion
Benzyl benzoate (avoid in children)

How well did you know this?

Not at all

Perfectly

Erythropoietic protoporphyria

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

How well did you know this?

Not at all

Perfectly

Prophyria cutanea tarda

Presents as: 
Blisters, fragility
Hyperpigmentation
Hypertrichosis
Solar urticaria
Morphoea

Treat underlying disease:

Alcohol
Viral Hepatitis
Oestrogens
Haemochromatosis

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

How well did you know this?

Not at all

Perfectly

Psoriasis

Different Types: 
Vulgaris = typical 
Guttate
Palmoplantar pustular
Erythrodermic

Presentation: Sharply demarcated, scaly, erythematous plaques.

Common sites involved:
Extensors (elbow, knee), scalp, sacrum, hands, feet, trunk, nails

Signs: Koebners, Auspitz

Topicals:

Coal tar
Vitamin D analogue
Calcipotriol
Calcitrol
Keratolytic agents (salicylic acid)
Topical steroid
Dithranol
Emollients

Systemics:

Glucocorticoids
Retinoids
Methotrexate

Phototherapy (UVB & PUVA)

How well did you know this?

Not at all

Perfectly

Atopic Eczema

Topical corticosteroid
Glucocorticosteroids (hydrocortisone)
Retinoids

In face & Children:
- Calcineurin inhibitors

How well did you know this?

Not at all

Perfectly

Pruritus (itching)

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

How well did you know this?

Not at all

Perfectly

Dry skin

Moisturising agents

How well did you know this?

Not at all

Perfectly

Viral Warts

Keratolytic agents (salicylic acid)
Formaldehyde
Glutaraldehyde
Silver nitrate
Cryotherapy (liquid nitrogen)

Anaphylaxis

Adults: 300µg adrenaline
Children: 150µg adrenaline

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

Remove the irritant

Lichen Planus (non-infective inflammatory dermatoses)

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

Keloid scars

Topical corticosteroid

Eczema Herpeticulum

Oral antiviral

Candida (thrush)

Nystatin Clotrimazole cream Oral fluconazole

Dermatophytes (ringworm) Caused by bacterium: - Trichophyton rubrum (70%) from humans - Trichophyton mentagraphytes (20%) from humans - Microsporum canis (10%) from cats & dogs ``` Known as Tinea "X" depending on where the infection is: Tineacapitis = scalp Tineabarbae = beard Tineacorporis = body Tineamanuum = hand Tineaunguium = nails Tineacruris = groin Tineapedis = foot (athlete’s foot) ```

MILD Clotrimazole cream Terbinafine cream For scalp infections: Oral Terbinafine Oral Itraconazole For Nails: Topical nail paint (amorolfine) Clotrimazole cream

Pityriasis versicolor

Ketoconazole

Pruritis ani

Camphor | Phenol

Hyperkeratotic Eczema

Keratolytic agents (salicylic acid)

Horns & Calluses

Keratolytic agents (salicylic acid)

Keratin plaques Usually found in scalp

Keratolytic agents (salicylic acid)

Genital warts

Podophyllin

Necrotising fasciitis

Surgical Debridement & Antibiotics

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

Malathion lotion

Erythema multiforme Caused by: Herpes simplex virus Mycoplasma pneumoniae bacterium Many triggers including drug reactions and some infections

Treat underlying cause

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

Self-limiting Treat underlying cause Cryotherapy (Liquid Nitrogen)

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

Self limiting

Hand, foot and mouth disease Presentaion: Typically children Family outbreaks Caused by enteroviruses (especially coxsackie virus)

Supportive

Zika Virus Spread by mosquito Aedes aegypti ``` Presentation: Mild fever Rash (mostly maculopapular) Headaches Arthralgia Myalgia Non-purulent conjunctivitis ```

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

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

Dapsone (diaminodiphenyl sulfone) Sulfapyridine Treat underlying cause e.g. Gluten free diet

Rosacea Red face (nose & cheeks) ``` Causes: Sunlight Alcohol Spicy foods Stress ```

Stop doing weird shit Topical therapies: Metronidazole, Ivermectin (to reduce demodex mite) Systemic therapies: - Oral tetracycline long term - Isotretinoin low dose if severe Others: Telangiectasia (vascular laser) Rhinophyma (surgery/ laser shaving)

Acne Vulgaris Mild- scattered papules and pustules, comedones Moderate - numerous papules, pustules & mild atrophic scarring Severe - as in Shona, cysts, nodules and significant scarring

1st: Oral antibiotic & topical retinoid 2nd: Isotretinoin Topicals: Benzoyl peroxide (keratolytic) Vit A derivative (retinoid) Antibiotics Systemics: Antibiotics (doxycycline) Isotretinoin Additional: Dapsone to reduce inflammation BLOODS, PREGO TEST AND CONTRACEPTION if put on isotretinoin

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 ```

Surgical removal

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)

Systemic steroids | Topicals: emollients, topical steroids, topical antisepsic / hygiene measures

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)

Surgical removal

Naevoid basal cell carcinoma (Gorlin's syndrome) Features: - early onset/multiple BCCs - palmar pits - jaw cysts - ectopic calcification

Oh jesus cut them out

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 ```

Primary Excision - Elliptical - Snip - Shave - Punch If Sentinel Node biopsy Positive= regional lymphadenectomy Advanced Disease: - Chemo - Radiotherapy - Immunotherapy - Genetic therapies If melanoma has BRAF mutation: dabrafenib and vemurafenib Acral melanomas with c-kit mutations: imatinab

Venous Ulcer

- 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