Derm Flashcards
What is MONGOLIAN BLUE SPOT? Prognosis?
- Type of birthmark present at birth (or soon after)
- Flat blue-grey in colour (same colour across the whole area – no lighter or darker like a bruise)
- Non-painful and does not change in shape or size
- Due to melanocytes remaining in the dermis rather than epidermis during embryological development
- Most commonly at base of spine, buttocks, lower back
- Common in Asian, Native America, Hispanic, East Indian and African descent
- Takes many years to fade
Transfer cards from ID cards
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Make sure not to confuse Mongolian blue spots for…?
Bruises as evidence of abuse
What are different therapies for acne?
Mild:
- Topical retinoid eg Adapalene
- +- Benzyl peroxide
- Topical Antibiotics:
- Clindamycin (1%) AND benzoyl peroxide OR Adapalen
- Azelaic acid 20%
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Moderate / not responding to topicals:
1. Oral abx:
- Lymecycline or Doxycycline
- (max 3 months on each)
\+- Benzyl p OR Adapalene
- monotherapy discouraged to prevent resistance
- Alternative antibiotic (if 1. didn’t work)
- COCP + topicals
- alternative for girls. avoid POP
Severe:
Eg no response to 2 abx or significant scarring ->
1. Dermatology referral
1a. Isotretinoin (Roaccuttane)
1b. all the same drugs in step 1 perhaps at higher concentrations?
benzoyl peroxide - decrease sebum production and comedones
o Topical retinoids – need to avoid sunlight (leads to increased irritation)
o Advise: treatment effective but take up to 8 weeks to work and may irritate skin especially at the start
---------------------------------------- FU: review each treatment at 3months. If good response: continue till 4 months Then maintenance with topical BP/Azaelaic acid
Conservative advice
o Keep face clean, 2x daily is enough, avoid picking or squeezing to avoid scarring
o Low quality evidence re diet
How do we ivx and manage ring worm?
Ivx:
Potassium hydroxide microscopy - see hyphae
Wood’s light – bright green/yellow fluorescence + microscopic examination for fungal hyphae - limited value
Mx;
If on body or feet, face
Topical antifungals = or (if more severe give systemic)
• HIGHLY CONTAGIOUS
Tinea capitis, ungium - systemic therapy eg oral terbinafine
+ topical adjuncts eg antifungal shampoos
Describe the molluscum rash in kids and complications?
Aetiology?
Prognosis?
Rx?
One or multiple small pink skin-coloured or pearly bumps often umbilicated aka a central dell
Complications : 1/3 get pruritis, infection or scarring related to treatment.
Aetiology: Molluscum C virus - a pox virus
Prognosis: spontaneously resolves in 6-12 months
Mx: conservative in child. Can use cryotherapy or curettage as in adults
What would be visualised on microscopy and HnE stain of molluscum?
Henderson Patterson bodies found in keratinocytes
They are intracytoplasmic esinophillic inclusions
What is the aetiology of nappy rash?
Very common:
when nappies filled with urine or poop left on for too long - because ammonia is produced which can burn the skin
Most commonly - Irritant contact dermatitis
Complications:
Secondary infections with candida, staph, strep
Ivx for nappy rash?
describe it
clinical diagnosis
Flexures are spared.
Patchy rash.
Erythema, if severe erosions and ulcers.
May itch and cause pain.
May be associated with cradle cap or atopic dermatitis.
Check for Oral candida
Swab for culture n sensitivity if 2ndary bacterial infection suspected
how does candida nappy rash / candida dermatitis present?
well/ sharply demarcated rash
around bum, genitalia, upper thighs
The rash includes creases - so does NOT spare skin fold
Causes discomfort.
Beefy red papules.
Whitish scaling.
Pustules and
“SATELLITE lesions” seen around the margins of the main red area.
May be associated with oral lesions.
Enquire if the baby had recently had antibiotic therapy.
Mx for nappy rash?
• Keep babies dry and clean, change nappies when wet, clean with water and soft cloth, allow to air dry,
apply protective emollients (sudocream, bepanthen), disposable nappies preferred to cloth
- Avoid irritants
- Allow nappy free times
if candida - topical antifungals like nystatin or clotrimazole (candida nappy cream)
resistant cases - topical imidazole
can try oral antifungals
refer to specialist if resistant
What is scarlet fever?
Its a disease that causes a sore throat, fever, headaches, swollen lymph nodes, and a characteristic rash.
is basically strep throat
what is the aetiology of scarlet fever?
Caused by group A strep infection, also known as Streptococcus pyogenes
Airborne spread - from respiratory droplets
it produces an erythrogenic toxin
how does scarlet fever present?
Rash: Sandpaper like dermatitis; Craniocaudal spread (head to body) Blanches; Worse in Flexures, Perioral pallor (none around mouth)
White Strawberry tongue -> red strawbeerry tongue a few days later due to desquamation (red & bumpy)
Pastia Lines - pink or red lines formed of confluent petechiae are found in skin creases, particularly the crease in the antecubital fossa then armpits
Then also the sx of Strep throat:
- Sore throat, painful swallowing
- Enlarged and reddened tonsils with exudate
- lymphhadenopathy
complications of scarlet fever / strep throat?
- acute rheumatic fever
- uncommon; developing nations
- Post strep glomerulonephritis
- Post strep reactive arthritis
how can we differentiate scarlet from Kawasaki?
Kawasaki disease: Children with this disease also present a strawberry tongue and undergo a desquamative process on their palms and soles.
However, these children tend to be younger than 5 years old, their fever lasts longer (at least five days),
and they have additional clinical criteria (including signs such as conjunctival redness and cracked lips), which can help distinguish this from scarlet fever
what is the definition of exanthem ?
An exanthem is a widespread rash occurring on the outside of the body and usually occurring in children.
what is enanthem / enanthema ?
Enanthem or enanthema is a rash (small spots) on the mucous membranes.
It is characteristic of patients with viral infections causing hand foot and mouth disease, measles, and sometimes chicken pox
bacterial infections such as Scarlet fever may cause it too
