derm

Question 1

what is bullous impetigo

Answer 1

superficial blistering skin condition caused by staph a

give flucloxacillin

Question 2

what happens in albinism to eyes

Answer 2

no fixation reflex because no pigment
pendular nystagmus
photophobia

Question 3

what is epidermolysis bullosa

Answer 3

genetic condition causing blistering of skin and mucous membranes
can cause fusing of digits following damage and healing

Question 4

causes of nappy rash

Answer 4

irritant (contact) dermatitis (SPARES THE FLEXURES)
atopic eczema
candida infection
seborrhoeic dermatitis

rare cause - langerhans cell histiocytosis

Question 5

mx nappy rash

Answer 5

advice - high absorbency nappy, leave nappy off as long as poss, change every 3-4 hours.
wash frequently

mild erythema - barrier preparation at every nappy change (zinc and castor oil)
rash is inflamed - hydrocortisone
if candida - antifungal NO BARRIER PROTECTION
bacterial rash - flucloxacillin

Question 6

what causes infantile seborrhoeic dermatitis

Answer 6

fungus

Question 7

features of seb. dermatitis

Answer 7

starts on head (cradle cap)
moves down body into flexures
NOT ITCHY (unlike eczema)

Question 8

mx seb dermatitis

Answer 8

ointments to remove crusts

imidazole if persistent

Question 9

how does atopic eczema present

Answer 9

ITCHY
usually in young children
scratch flexures
most cases resolve in adolescence

Question 10

mx atopic eczema

Answer 10

mild (small areas of dry skin, infrequent itch, no impact on life) - emollient + hydrocortisone until >48 hours after flare up

moderate - (areas of dry skin, redness, frequent itch, moderate impact on psych wellbeing + sleep) - admit if eczema herpeticum, emollient, moderate steroid til >48 hours after flare (consider calcineurin inhibitor)

severe - bleeding, thickening, oozing, cracking - emollient, potent steroid for flare ups, consider calcineurin inhibitor

bandages - can help with lichenification
anithistamines - if really bad itch

Question 11

complications of atopic eczema

Answer 11

infected eczema w/ bacteria

eczema herpeticum

Question 12

mx molluscum

Answer 12

don’t need to tx if immunocompetent (disappears in 18 months)
don’t squeeze papules - makes it worse
don’t share towels

Question 13

dx of ringworm

Answer 13

find dermatophyte on skin scraping
confrim w/ culture

NB - IF TINEA CAPITIS GIVE SYSTEMIC ORAL ANTIFUNGAL

Question 14

features of scabies

Answer 14

itch for 2-6 weeks worse at night or in hot weather
in children vesicles + papules between fingers and toes
in infants vesicles + papules on palms and soles

diagnose by viewing burrows

Question 15

where are viral warts found and what causes them

Answer 15

HPV

on fingers and soles

Question 16

mx scabies

Answer 16

insecticide to whole body twice two weeks apart
up to ears in child (do face in infants)

advice;
tx members of house
bedding + clothing decontaminated

Question 17

presentation of guttate psoriasis

Answer 17

oval patches on trunk/limbs after viral or streptococcal ear/throat infection
lasts for 3-4 month
most recur within 3-5 years

Question 18

mx guttate psoriasis

Answer 18

1. phototherapy (narrow band UVB)

2. emollient to reduce itch can add corticosteroid + vit D if scales problematic

Question 19

features of pityriasis rosea

Answer 19

no known cause
get herald patch (pink) on trunk or limbs then smaller pink patches in fir tree pattern following posterior ribs

NO TX

Question 20

difference between granuloma annulare and ringworm

Answer 20

G.A has raised flesh coloured non-scaling edge

ringworm has scaling edge

Question 21

what are open and closed comedones called

Answer 21

open - blackhead

closed - whitehead

Question 22

advice for acne vulgaris

Answer 22

avoid overcleaning
neutral pH makeups and creams
don’t pick scars
healthy diet

Question 23

mx mild-moderate acne

Answer 23

mild:
single topical treatment eg. benzyl peroxide or benzyl peroxide + clindamycin

moderate/ unresponsive acne:
consider oral Abx for 3 months
topical retinoid
consider antiandrogens
COCP + topical agents can be used as alternative for systemic treatments in girls
*if 2 courses of abx haven’t worked refer to derm for consider for roaccutane

severe:
refer to dermatologist
oral isotretinoin
high dose oral abx (6 months +)
systemic corticosteroids

follow up:
continue tx for 12 weeks if it works
if acne almost cleared can do maintenance w/ topical retinoids