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3B > Derm > Flashcards

Derm Flashcards

1
Q

What is the bacteria that plays a role in acne?

A

Propionibacterium acnes

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2
Q

What is acne vulgaris?

A

A common inflammatory skin disease which occurs in adolescents.
Characterised by obstruction of the pilosebaceous follicle with keratin plugs which results in comedones, inflammation and pustules

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3
Q

How would you start to treat mild acne?

A

Single topical therapy:

Topical retinoids // Benzoyl peroxide

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4
Q

What is the step wise progression to treat acne?

A

1) T - Topical retinoids // Benzoyl peroxide
2) TT - Topical retinoids // Benzoyl peroxide // topical abx (erythromycin)
3) PO abx erythromycin//doxy
4) PO isotretinoin (only under specialist supervision)

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5
Q

Define eczema

A

Chronic, pruritic inflammatory skin condition

Defect in skin barrier function + immune dysregulation post allergen exposure

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6
Q

What are the streatment steps in eczema?

A

1) basic treatment - emollients, avoid triggers and irritants
2) mild - low potency TCS
3) Mod - + topical calcineurin inhibitors
4) Garmets/wet wipes/paste bandages
5) V severe - systemic CS // phototherapy

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7
Q

What is psoriasis?

A

A chronic inflammatory skin condition due to hyperproliferation of keratinocytes

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8
Q

What are the types of psoriasis?

A 
Chronic plaque 
Guttate 
Pustular 
Erythrodermic 
Flexural 
Seborrhoeic
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9
Q

How do you treat chronic plaque psoriasis?

A

C: educate, avoid precipitants, emollients
T: VD analogues, TCS, coal tar preparaitons
Phototherapy UVB
M: Methotrexate // po retinoid (acitretin) // ciclospotin
Biologics TNFa blockers infliximab

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10
Q

Give an example of a VD analogue and how does it help in psoriasis?

A

Calcipotriol

Decreases cell proliferation

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11
Q

How do you treat seborrhoeic dermatitis if it is on the scalp?

A

Topical shampoos = ketoconazole

TCS

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12
Q

How do you treat seborrhoeic dermatitis if it is not on the scalp?

A

TCS + ketaconazole

May have a yeast infection which is driving the inflam

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13
Q

Give primary prevention steps for preventing skin cancers

A

Sun cream
Avoiding sunlight
Avoid tanning
Covering areas

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14
Q

Give the other names for:

1) Pre-malignant SSC
2) In-situ SSC

A

1) Pre-malignant SSC = actinic change

2) In-situ SSC = Bowen’s disease

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15
Q

Bullous pemphigoid is a blistering skin disease which mainly affects the elderly.
What is it caused by?

A

Autoabs against antigens between the epidermis and dermis causing a subdermal split in the skin

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16
Q

How is bullous pemphigoid treated?

A

C - wound dressings and monitoring for infection
T - TCS // TCI
M - Pred, combo of doxy + nicotinamide, immunosuppressive agents

17
Q

Give 2 of the main bacterial causes of cellulitis

A

Staph aureus

Strep pyogenes

18
Q

What abx would you give for cellulitis?

A

PO flucloxacillin

19
Q

What abx would you give for a septic patient with cellulitis who is severely ill?

A

IV Tazocin

20
Q

What is the cause of scalded skin syndrome?

A

Due to the production of a circulating epidermolytic toxin from benzylpenicillin-resistant (coag positive) staph
SSSS = staph scalded skin syndrome

21
Q

How is SSSS treated?

A

IV Abx - flucloxacillin
Analgesics
IV fluids
They usually have to be admitted

22
Q

Urticaria - itchy wheals wih swelling of the superficial dermis causing the epidermis to be raised.
How is it treated?

A

Anti-histamines

+ systemic corticosteroids

23
Q

Give some causes of erythema nodosum

A

IBD
TB
Throat infection - post strep
Sarcoidosis

24
Q

What is erythema multiforme?

A

It is a hypersensitivity reaction triggered by HSV

25
Q

Describe the characteristic lesion seen in erythema multiforme

A

Target lesions

Sharp margin, regular round shape with 3 concentric colours

26
Q

Give a similarity and a difference difference between Stephen Johnson syndrome and Toxic Epidermal Necrosis

A

They both have mucocutaneous necrosis with at least 2 mucosal sights, +ve Nikolsky sign

SJS - <10% total body area
10% mortality

TEN - >30% total body area 30% mortality

27
Q

What can be the cause of death in patients with Stepheb-Johnson syndrome or toxic epidermal necrosis?

A 
Dehydration 
Shock and multi-organ failure 
Sepsis 
VTE/DIC 
ARDS
28
Q

What are some of the LT complications that occur with SJS and TEN?

A 
SCARRING 
--> loss of nails, scarred genitalia 
Joint contractures 
Lung disease 
Eye problems can lead to blindness
29
Q

What is erythroderma?

A

It is exfoliative dermatitis involving >90% of the skin surface
The skin is inflamed oedematous and scaly
They are systemically unwell with lymphadenopathy and malaise

30
Q

What are the complications of erythroderma?

A

Hypothermia (temperature dysregulation)
Fluid loss –> electrolyte imbalance and dehydration
High output HF
Capillary leak syndrome
Secondary skin infection can lead to impetigo and cellulitis

31
Q

How is erythroderma managed?

A

It is a serious and potentially life threatening condition.
Admit
Restore fluid and electrolytes
C: Maintain skin moisture with wet wraps and dressings
T: TCS
Treat underlying cause - PO CT// methotrexate

32
Q

What is necrotising fasciitis?

A

it is a rapidly spreading bacterial infection of the deep fascia with secondary soft tissue necrosis
The bacteria multiple and release toxins and enzymes which cause thrombus in the vessels –> necrosis

33
Q

What are the organisms which cause necrotising fasciitis?

A 
GROUP A STREP 
Staph aureus 
Haemophilus 
E.coli 
Clostridium
34
Q

How would someone with necrotising fasciitis present?

A

Severe pain - disproportional to what you see
Flu-like symptoms
Area swelling with purpleish rash which becomes blacker when the necrosis occurs. Oedema. Crepitus in the skin due to gas in the tissues.
Severe pain until the necrosis destroyed the peripheral nerves and then they pain subsides

35
Q

How do you manage necrotising fasciitis?

A

Admit
Swabs/culture guided IV Abs
Start broad and then tailor depending on results (Vanc + taz)
–> urgent surgical debridement to remove all the necrotic tissue

36
Q

Up to 25% of patients with necrotising fasciitis die. What could be the causes of death?

A

Renal failure
Septicaemia
Muti-organ failure

3B (21 decks)

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