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Sam's 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 ages >70

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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
A

MIld: Supportive
Severe: Aciclovir

Cold sore: Topical antiviral

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6
Q

Herpes Simplex Type 2

Presents:

  • Genital warts
  • Gingivostomatitis
  • Encephalitis (common in neonates)
A

Aciclovir

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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 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

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

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

A

Topicals:

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

Systemics:

  • Glucocorticoids
  • Retinoids
  • Methotrexate

Phototherapy (UVB & PUVA)

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18
Q

Atopic Eczema

A
  • Topical corticosteroid
  • Glucocorticosteroids (hydrocortisone)
  • Retinoids

In face & Children:
- Calcineurin inhibitors

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19
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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20
Q

Dry skin

A

Moisturising agents

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21
Q

Viral Warts

A 
Keratolytic agents (salicylic acid)
Formaldehyde
Glutaraldehyde
Silver nitrate
Cryotherapy (liquid nitrogen)
22
Q

Anaphylaxis

A

Adults: 300µg adrenaline
Children: 150µg adrenaline

23
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

24
Q

Lichen Planus (non-infective inflammatory dermatoses)

A

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

25
Q

Keloid scars

A

Topical corticosteroid

26
Q

Eczema Herpeticulum

A

Oral antiviral

27
Q

Candida (thrush)

A

Nystatin
Clotrimazole cream
Oral fluconazole

28
Q

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)
A

MILD
Clotrimazole cream
Terbinafine cream

For scalp infections:
Oral Terbinafine
Oral Itraconazole

For Nails:
Topical nail paint (amorolfine)
Clotrimazole cream

29
Q

Pityriasis versicolor

A

Ketoconazole

30
Q

Pruritis ani

A

Camphor

Phenol

31
Q

Hyperkeratotic Eczema

A

Keratolytic agents (salicylic acid)

32
Q

Horns & Calluses

A

Keratolytic agents (salicylic acid)

33
Q

Keratin plaques

Usually found in scalp

A

Keratolytic agents (salicylic acid)

34
Q

Genital warts

A

Podophyllin

35
Q

Necrotising fasciitis

A

Surgical Debridement & Antibiotics

36
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

37
Q

Erythema multiforme

Caused by:
Herpes simplex virus
Mycoplasma pneumoniae bacterium

Many triggers including drug reactions and some infections

A

Treat underlying cause

38
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)

39
Q

Herpangina

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

A

Self limiting

40
Q

Hand, foot and mouth disease

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

A

Supportive

41
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

42
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

43
Q

Rosacea

Red face (nose & cheeks)

Causes:
Sunlight
Alcohol
Spicy foods
Stress
A

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)

44
Q

Acne Vulgaris

Mild- scattered papules and pustules, comedones

Moderate - numerous papules, pustules &
mild atrophic scarring

Severe - as in Shona, cysts, nodules and significant scarring

A

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

45
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 removal

46
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

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

47
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 removal

48
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

49
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

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

50
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

Sam's Holy Grail (Treatments) (8 decks)

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