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Derm > Derm > Flashcards

Derm Flashcards

1
Q

Melanoma Mx

Superficial spreading melanoma (may show mild modularity)

Lentigo maligna melanoma and lentiginous melanoma (sun damaged sites)

Acral lentiginous malignant melanoma (on soles and palms)

Amelanotic melanoma (more aggressive)

A

Mx

excisional biopsy 2mm margin

wide margin excision of confirmed melanoma

Melanoma in situ: 5 mm, and wider margins if appropriate

Melanoma < 1 mm: 10 mm

Melanoma 1–2 mm: 10 – 20 mm

Melanoma 2–4 mm: 10 – 20 mm

Melanoma > 4 mm: 20 mm

surgical removal of lymph nodes if involved (refer surgeon)

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2
Q

Melanoma

Superficial spreading melanoma (may show mild modularity)

Lentigo maligna melanoma and lentiginous melanoma (sun damaged sites)

Acral lentiginous malignant melanoma (on soles and palms)

Amelanotic melanoma (more aggressive)

A

RF

many moles (>100 moles >2mm in size)

family history

Sx

Ex

Glasgow 7-point checklist

Major features (2 marks each)

Change in size

Irregular shape

Irregular colour

Minor features (1 mark each)

Diameter >7 mm

Inflammation

Oozing

Change in sensation

The ABCDEs of Melanoma

A Asymmetry

B Border irregularity

C Colour variation

D Diameter over 6mm

Evolving (Enlarging, changing)

Breslow thickness (how deep invasion)

Clark level (1-5 invasion into dermis)

Stage 0 in situ

Stage 1 <2mm

Stage 2 >2mm

Stage 3 - spread to lymph nodes

Stage 4 - metastatic Ix

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3
Q

Acanthosis nigricans

A

RF

insulin resistance/PCOS obesity malignancy black or hispanic ancestry

Sx

Ex

symmetrical hypertrophic papillomatous velvety hyper pigmentation plaques in flexural and intertriginous areas

Ix glucose fasting blood insulin Mx

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4
Q

Acne vulgaris

A

RF

teenagers

Sx affects face, neck, shoulders, back, chest associated with oil glands and hair follicles

MILD, MODERATE, SEVERE

Ex

SUPERFICIAL COMEDONES, PAPULES, PUSTULES DEEPER NODULES, PSEUDOCYSTS MAY BE INFLAMED

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5
Q

Acne vulgaris mx

A

Mx

Treat comedones and inflammation

Mild acne - BENZYL PEROXIDE 5% Inc to epiduo gel (benzoyl peroxide + adapalene) daily for 6 weeks (for comedonal)

Inc to combination (benzoyl peroxide + clindamycin gel) daily for 6 weeks (for inflammation)

Moderate to severe acne - doxycycline 50-100mg daily for 6 weeks (anti-inflammatory antibiotics). (not in pregnancy)

or erythromycin 250-500mg bd for 6 weeks

females can try OCP and/or spironolactone

If no good effect, refer dermatologist for oral isotretinoin

AVOID RETINOIDS IN WOMEN ABOUT TO BECOME PREGNANT, PREGNANT OR BREASTFEEDING. TERATOGENIC}

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6
Q

Actinic Keratosis / solar keratosis

A

RF

pre-cancerous SCC

Sx

Ex

SCALY,WARTY, HORNY, OR THICKENED PLAQUE/PAPULE

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7
Q

Actinic Keratosis / solar keratosis Mx

A

Mx

Diclofenac gel 3% (solaraze) bd for 3 months

cryotherapy

5-fluorouracil (efudix) bd for 3-4 weeks for solar keratosis (min 6 weeks for Bowens)

imiquimod (aldara) 3 times per week for 4 weeks. Continue if need for another 4 weeks (max-16 weeks)

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8
Q

Alopecia areata (autoimmune alopecia)

  • round bald patches and exclamation mark hairs
A

RF

can start in childhood

family history

other autoimmune disease

chromosomal disorders

patients have higher incidence of thyroid disease, vitiligo and atopic eczema

Sx

ROUND BALD PATCHES APPEAR SUDDENLY

EXCLAMATION MARK HAIRS

onset triggered by viral infection, trauma, hormone, emotional/physical stressors

affects scalp, eyebrows, eyelashes, beard regrows eventually

Alopecia totalis - all scalp hair is lost

Alopecia universalis - all hair on body is lost

ophiasis - wave shape, affects occipital and lateral scalp

Diffuse alopecia areata - sudden diffuse alopecia. grows back white “turning white overnight”

Alopecia areata of nails - affects 10-50% of people with alopecia aerate

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9
Q

Alopecia areata (autoimmune alopecia) mx

  • round bald patches and exclamation mark hairs
A

Mx

Inv for thyroid, atopy, vitiligo, other autoimmune disorders

topical steroids potent or ultra potent (betamethasone diproprionate bd for 3-4 months)

minoxidil foam/oil bd

dithranol ointment (specialist)

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10
Q

Androgenetic alopecia in women (female pattern hair loss

A

RF

genetic susceptibility to androgens

postmenopausal women

Sx

bursts of hair loss

Ex

DIFFUSE HAIR THINNING SCALP MID-FRONTAL AREA SCALP

Ix

most women have normal levels androgens

more common after menopause suggesting oestrogen involvement

male and female hormones,

thyroid

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11
Q

Androgenetic alopecia in women (female pattern hair loss) mx

A

Mx

DDX chronic telogen effluvium

minoxidil bd for >6months

spironolactone (block androgens) for >6months

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12
Q

Angiokeratoma (dilated capillaries)

A

RF

Sx

benign

Ex

RED TO PURPLE PAPULE (black if thrombosed)

MAY HAVE ROUGH SCALY SURFACE

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13
Q

Angiokeratoma (dilated capillaries) mx

A

No management required

Surgical excision if questioning melanoma

Surgical excision if bleeding becomes issue

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14
Q

Angular cheilitis

A

RF

salia causing irritant contact dermatitis

overhang upper lip

dry chapped lips

licking lips

proliferation of bacteria (impetigo) or yeast (candida/thrush) or virus (cold sores/herpes)

Sx

inflammatory condition affecting corners of mouth

Ex

painful cracks/fissures blisters, erosions, oozing, crusting redness bleeding

Ix

swabs for candida, staph aureus and herpes simplex

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15
Q

Angular cheilitis mx

A

Mx

lip balm/ emollients

topical antiseptics

topical antistaph antibiotics

oral anti fungal (daktarin gel)

topical steroid

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16
Q

Arterial leg ulcer

A

Poor blood circulation to lower limbs often due to atherosclerosis.

FEET, HEELS AND TOES

PAINFUL, esp night

RELIEVED BY HANGING LIMB OVER EDGE BED (gravity causes more blood to flow to legs)

“PUNCHED OUT” BORDER

ABPI <0.9 likely arterial disease. <0.5 is severe

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17
Q

Asteatotic eczema

A

RF

elderly

loss of epidermal lubrication

Sx

Ex

‘CRAZY-PAVING’ APPEARANCE OF CRACKED FISSURED SKIN Ix

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18
Q

Asteatotic eczema mx

A

Mx

topical emollients topical steroids

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19
Q

Atopic dermatitis / eczema

A

RF

family history atopy (asthma, eczema hayfever)

Sx

Ex

ITCHY, INFLAMED SKIN ESP FLEXURES

ACUTE - RED RASH may be blistered and swollen

CHRONIC - LONGSTANDING IRRITABLE AREA, OFTEN DARKER AND THICKENED (LICHENIFICATION) AND SCRATCHED

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20
Q

Atopic dermatitis / eczema mx

A

Mx

soap-free cleanser

soft cool clothes

protect from irritants

emollients liberal and often

topical steroids for flares - ADVANTAN FATTY OINTMENT PIMECROLIMUS cream for flares antibiotics for infection (flucox or erythromycin) Systemic steroids, methotrexate, phototherapy

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21
Q

BCC (Basal Cell Carcinoma) nodular, morpheic and infiltrative

A

RF

sun exposure

Sx

Ex

pearly rolled edge telangiectasia central ulceration

Ix

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22
Q

BCC Mx

(Basal Cell Carcinoma) nodular, morpheic and infiltrative

A

Mx

excision (3-5mm margin)

cryotherapy for superficial lesions

imiquimod three to five times each week, for 6–16 week

5-fluorouracil twice daily for 6–12 weeks

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23
Q

Blue naevus (melanocytic naevus )

A

unchanged through life

rarely, cellular blue naevi can change into malignant blue naevi (type of melanoma)

Mx

biopsy if need to exclude melanoma

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24
Q

Bowen’s disease

(SCC insitu / IEC intraepithelial squamous cell carcinoma)

A

RF

Sx

sun exposed areas (face, ears, hands, lower limbs, under nail)

Ex

SCALY RED/ORANGE PLAQUE

Ix

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25
Q

Bowen’s disease

(SCC insitu / IEC intraepithelial squamous cell carcinoma) mx

A

Mx

Excision (3-10mm margins)

5 fluorouracil cream bd for 4 weeks

imiquimod 3-5 times per week for 4-16 weeks

cryotherapy

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26
Q

Bullous pemphigoid

A

RF

>50y

neurologic disease e.g. parkinsons, stroke, dementia

psoriasis

drug reaction - frusemide, immunotherapies, gliptins, antibiotics

Sx

Autoimmune,

subepidermal blistering disease

Ex

LARGE TENSE BULLAE (FLUID-FILLED BLISTERS) AND ITCH RUPTURE TO FORM CRUSTED EROSIONS

Ix

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27
Q

Bullous pemphigoid mx

A

Mx

Refer Hospital for wide-spread infection to organise dressings and treat erosions

Ultrapotent topical steroids

systemic steroids

tetracycline antibiotics

antibiotics for secondary infection

pain relief

May need to treat for several years

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28
Q

Candidiasis

Oral candidiasis (oral thrush)

Angular cheilitis

Vulvovaginal candidiasis

Balanitis

Intertrigo

Napkin dermatitis (nappy rash)

chronic paronychia (nail fold infection)

Onychomycosis (nail plate infection - moth eaten)

Chronic mucocutaneous candidiasis

A

RF

suppressed immune system

infancy or old age

warm climate

antibiotic treatment

Sx

normally resides digestive tract.

can affect mouth, anus, genitals, skin

Ex

Ix skin swabs mcs scrapings fingernails

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29
Q

Candidiasis mx

Oral candidiasis (oral thrush) Angular cheilitis Vulvovaginal candidiasis Balanitis Intertrigo Napkin dermatitis (nappy rash) chronic paronychia (nail fold infection) Onychomycosis (nail plate infection - moth eaten) Chronic mucocutaneous candidiasis

A

Mx

antifungals

oral - miconazole gel 2%, 2.5 ml topically, then swallowed QID after food. Continue 1 week after resolution

angular cheilitis - daktarin gel

vulvovaginal - fluconazole 150mg oral single dose OR clotrimazole 2% vaginally 3 nights OR clotrimazole 1% vaginally for 6 nights

balanitis - fluconazole 150mg oral single dose OR clotrimazole 1%/miconazole 2%, bd for 2 weeks post resolution (use hydrocortisone 1% bd at same time)

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30
Q

Cellulitis and erysipelas

Cellulits - bacterial infection of low dermis and subcutaneous tissue

Erysipelas - bacterial infection superficial (upper dermis)

A

RF

Staph aureus and strep progenies (group A strep) and others

Sx

Ex

WARM, PAINFUL, ERYTHEMATOUS, SWOLLEN, EXPANDING FROM WOUND FEVER, CHILLS, RIGORS (BACTEREMIA)

ERYSIPELAS IS WELL DEMARCATED WITH SHARP RAISED BORDER. BRIGHT RED AND SWOLLEN

Ix

Bloods - leukocytosis,

elevated CRP

Bacterial swab for culture and sensitivity

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31
Q

Cellulitis and erysipelas mx

Cellulits - bacterial infection of low dermis and subcutaneous tissue

Erysipelas - bacterial infection superficial (upper dermis)

A

Mx

Mark with pen and monitor

Antibiotics

If severe, immediate referral to hospital

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32
Q

Chancroid

A

RF

HIV

Sx

Ex

PAINFUL GENITAL ULCER (papule that ulcerate)

fluctuant lymphadenitis (bubo formation)

Ix

Haemophilus ducreyi (G- coccobacillus)

ulcer swab and bubo aspirates or PCR

inv for HIV and syphilis

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33
Q

Chancroid mx

A

Mx

AZITHROMYCIN 1G single dose

contact tracing - sexual partners within 10 days prior traced and treated (even if asymptomatic)

lymph node I&D

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34
Q

Cherry angiomas (hemangioma) Benign vascular skin lesion. Proliferating endothelial cells.

A

RF infants adults >40 Sx Ex ASYMPTOMATIC FIRM RED, BLUE OR PURPLE PAPULE (BLACK IF THROMBOSED) flat at birth, progressively elevated and boggy Ix dermoscopy - red clods or lobular pattern

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35
Q

Cherry angiomas (hemangioma) mx Benign vascular skin lesion. Proliferating endothelial cells.

A

No treatment required Surgical excision if querying melanoma Remove for cosmetic reasons

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36
Q

Chill blains (perniosis) Mx

A

Mx

warm extremities

topical glycerine trinitrate

topical betamethasone (for itch)

nifedipine

resolve 1-3 weeks

can become chronic

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37
Q

Chill blains (perniosis)

A

erythematous lesion remaining after exposure to cold, wet, non-freezing fingers, toes, ears (acral sites) blanchable red or purple discolouration itchy/burning localised swelling can become blistered infected or ulcerated localised form of vasculitis cold hands and feet Ix histopathology to confirm

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38
Q

Chondrodermatitis nodularis helices

A

RF pressure site eg sleeping on hard pillow exposure to sun or cold connective tissue disease Sx inflammatory condition affecting skin and cartilage of helix and anti helix ear Ex solitary firm oval-shaped nodule on ear painful/tender Ix

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39
Q

Chondrodermatitis nodularis helices mx

A

Mx benign padding around ear when sleeping petroleum jelly/antiseptic and light dressing if needed protect from sun/cold usually resolves within few months can recur

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40
Q

Contact dermatitis Allergic Contact Dermatitis - follows contact with offending agent e.g. nickel (earrings), chemicals, plants Irritant Contact Dermatitis - eruption of vesicles at site of contact. often extremities Chemical burn Contact stomatitis/chelitis (mouth or lips) Protein contact dermatitis Systemic contact dermatitis (ingestion) - rare

A

RF Sx ITCHY Ex HIGHLY VARIABLE APPEARANCE - erythema, swelling, viesicles/bullae, scale, dry, lichenification, pigmentation, excoriation, crusting, pustules (if bacterial infection) Ix

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41
Q

Contact dermatitis mx Allergic Contact Dermatitis - follows contact with offending agent e.g. nickel (earrings), chemicals, plants Irritant Contact Dermatitis - eruption of vesicles at site of contact. often extremities Chemical burn Contact stomatitis/chelitis (mouth or lips) Protein contact dermatitis Systemic contact dermatitis (ingestion) - rare

A

Mx PATCH TEST to identify contact allergens avoid contact allergens avoid soap, wear gloves, dry skin after washing topical corticosteroids and emollients if severe, systemic corticosteroids

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42
Q

Cutaneous drug reactions

A

Pemphigoid - Frusemide -(tense fluid filled lesions 1-2cm arms and legs) Hyper pigmented skin lesions on back - Fixed drug eruption (neurology drug) Urticaria (and cough) - ACEI Lichen planus - Beta-blockers, methyldopa, quinine, lithium, gold, spironolactone Stretch marks - steroids (pred) Psoriasis (induce or exacerbate) - Beta-blockers, Nsaids Photosensitivity and purplish pigmentation - amiodarone Photosensitivity - cardiology drugs - ACEI, ARBs, amiodarone, thiazide, Pemphigus - beta-blockers, ACEI, penicillins, cephalosporins, Nsaids Stephens-Johnson Syndrome / Toxic epidermal necrolysis - rare, acute, potentially fatal. Sheets of skin and mucus loss. Caused by antibiotics 40% cases. other meds - sulphonamide, cotrimoxazole, anti-convulsants, allopurinol, paracetamol, saids INR increase - miconazole gel (daktarin) absorbs through mucosa or is swallowed SLE drug induced - tetracyclines, hydralazine, proacainamide Skin necrosis - warfarin (ulceration thigh, breast, buttock) Pale and cyanosed (methaemoglobinaemia) - primaquine, sulphonamides, nitrates, antimalarials, lidocaine Griseofulvin - Do not father child within 6 months completing griseofulvin.

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43
Q

Cutaneous larva migrant

A

RF Walking sand or around animal faeces Sx HOOKWORM LARVAE Ex RED ITCHY TRACKS AND LINES Ix

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44
Q

Cutaneous larva migrant mx

A

Mx Larvae will eventually die Antihelminth - mebendazole and ivermectin. Topical. IF fails, give oral antihistamines for itch topical corticosteroids to relieve itch antibiotics for secondary bacterial infection

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45
Q

Cutis marmorata

A

RF children (generally improves with age) Sx Ex pinkish blue mottled or marbled appearance when subject to cold temperatures Ix

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46
Q

Cutis marmorata mx

A

Mx warming restores skin to normal appearance

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47
Q

Dermatitis herpetiformis

A

RF

COELIAC DISEASE

M>F

Sx

Ex

ITCHY VESICLES AND URTICARIAL PAPULES (BUTTOCK, OTHERS)

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48
Q

Dermatitis herpetiformis mx

A

Mx

Gluten free diet

Dapsone

Anti inflammatories

Corticosteroids

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49
Q

Dermatofibroma

A

RF Sx Ex OVERLYING SKIN DIMPLES ON PINCHING Ix Mx benign recurrence common

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50
Q

Dermatofibromas

A

benign fibrous nodule overlying skin dimples with pinching lesion

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51
Q

Digital myxoid/mucoid pseudocyst

A

Ex SHINY PAPULE END FINGER OR TOE, CLOSE TO NAIL

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52
Q

Digital myxoid/mucoid pseudocyst mx

A

Mx I&D jelly-like, sticky fluid cryotherapy steroid injection often recur

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53
Q

Dysplastic naevi (funny looking mole)

A

Melanoma can grow within dysplastic naevi complete excisions biopsy to exclude melanoma >5 dysplastic naevi increases risk melanoma familial dysplastic naevi - need regular skin checks

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54
Q

EBV / infectious mononucleosis / glandular fever

A

RF adolescents and young adults sharing saliva - kissing, glasses pubs Sx Ex FEVER, PHARYNGITIS, LYMPHADENOPATHY, malaise, splenomegaly Ix FBC - LYMPHOCYTOSIS E/LFTs ultrasound abdo - splenomegaly Serology - IgM, IgG ( monospot test)

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55
Q

EBV / infectious mononucleosis / glandular fever mx

A

Mx NO CONTACT SPORTS (Splenic rupture risk) for 3-4 weeks, up to 8 weeks / u/s spleen negative Risks - fulminant hepatitis, encephalitis, thrombocytopaenia, haemolytic anaemia

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56
Q

Eczema (acute, subacute and chronic

A

RF family history atopy (asthma, allergic rhinitis) exposure smoke Sx diagnosed <5y food allergies Ex DRY ITCHY SKIN IN FLEXURES INFLAMMATORY babies can have vesicles and papule and scaling chronic relapsing course lichenification - sign of chronic eczema Ix IgE, allergy testing skin biopsy if needed

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57
Q

Eczema (acute, subacute and chronic mx

A

Mx emollients topical corticosteroids (Advantan fatty ointment) oral antibiotics if infected topical calcineurin inhibitors (primecrolimus), phototherapy, immunosuppressive agents (ciclosporin) refer dermatology if recalcitrant

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58
Q

Epidermal/ epidermoid cysts

A

RF Sx upper part of hair follicle encapsulated in epidermis (filled with keratin and lipid-rich debris) Ex FIRM PAPULE OR NODULE WITH CENTRAL PUNCTUM FOUL SMELLING, CHEESY EXUDATE SQUEEZED FROM CYST Ix

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59
Q

Epidermal/ epidermoid cysts mx

A

Mx benign if infected, antibiotics and I&D EXCISION ENSURING REMOVAL OF CAPSULE

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60
Q

Erythema infectiosum / Slapped cheek / Parvo B19 / Fifth disease

A

RF children Sx incubation period 7-10 days mild fever and headache to rash few days later child is infectious before rash (no exclusion after rash present) Ex RASH WITH FIRM HOT RED CHEEKS FOR 2-4 DAYS, FOLLOWED BY PINK LACY RASH LIMBS and sometimes trunk. Rash can persist for 6 weeks Ix serology for antibodies nasopharyngeal PCR FBC (anemia) obstetric u/s and doppler for hydrous fetalis

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61
Q

Erythema infectiosum / Slapped cheek / Parvo B19 / Fifth disease mx

A

Mx Complications - polyarthropathy in infected adults, abortion in pregnant women, encephalitis, haemolytic anaemia

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62
Q

Erythrasma (skin folds)

A

skin folds, arms groin, between toes warm, wet moist environments Corynebacterium minutissimum well defined pink or brown patches with fine scaling and superficial fissures. Ix wood lamp - coral pink skin scraping

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63
Q

Erythrasma (skin folds)mx

A

Mx antiseptic topical antibiotics benzyl peroxide if bad infection - oral antibiotics phototherapy antibacterial soap to prevent recurrence

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64
Q

Erythrodermic psoriasis

A

RF psoriasis drugs inflammatory skin condition Sx Ex GENERALISED REDNESS OF SKIN Ix Mx REFER HOSPITAL IMMEDIATELY. LIFE-THREATENING

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65
Q

Extramammary Paget Disease of skin - apocrine gland-rich areas of anogenital/vulval and axilla (rarely) rare intraepithelial adenocarcinoma

A

apocrine gland-rich areas of anogenital/vulval and axilla (rarely) rare intraepithelial adenocarcinoma Primary - of cutaneous origin Secondary - associated with a primary adenocarcinoma elsewhere in body RF >50, peak at 65 male and female Ex UNILATERAL, RED/PINK SCALY PLAQUE ON VULVA (WOMEN) OR PERIANALLY (MEN) slow growing with irregular, poorly defined margins itchy - excoriation nd lichenification burning, pain, irritation leukoplakia NODULES INDICATE INVASIVE DISEASE

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66
Q

Extramammary Paget Disease of skin - mx apocrine gland-rich areas of anogenital/vulval and axilla (rarely) rare intraepithelial adenocarcinoma

A

Mx biopsy investigate for underlying internal malignancy - lymph node u/s or fine needle aspirate CEA cervical and breast screening pelvic imaging for underlying cancer colonoscopy (for perianal disease) cystoscopy for periurethral disease PSA and exam for men surgical excision +/- lymphadenopathy imiquimod cream (if not surgical candidate) radiotherapy high recurrence rate. long follow up

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67
Q

Flexural (inverse) psoriasis

A

RF Psoriasis Sx Ex LOCALISED TO SKIN FOLDS AND GENITALS TENDS NOT TO HAVE SCALE (moisture in flexure regions) SHINY AND SMOOTH DEEP RED COLOUR AND WELL DEFINED BORDERS (characteristic of psoriasis) Ix

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68
Q

Flexural (inverse) psoriasis mx

A

Mx topical steroids (+/- anti fungal agent to control thrush) calcipitriol (vitD) bd calcineurin inhibitors (tacrolimus cream) emolllients, antiseptics, antifungals phototherapy

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69
Q

Folliculitis (Inflamed hair follicles) Spa pool folliculitis is due to Pseudomonas aeruginosa Malassezia folliculitis is itchy acne-like condition upper trunk young adult. Tx topical anti fungal Herpes Simplex folliculitis. Self-Resolve Herpes Zoster folliculitis - antivirals Molluscum contagiosum Dermodex mite infestation - older/immunocompromised Scabies Irritant folliculitis - regrowing hairs - after shaving/waxing/plucking

A

RF Staph aureus occlusion chemicals topical steroids immunosuppression drugs inflammatory skin conditions Sx Ex TENDER RED SPOTS OFTEN WITH SURFACE PUSTULE Ix Swab pustules for mcs

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70
Q

Folliculitis (Inflamed hair follicles) Mx Spa pool folliculitis is due to Pseudomonas aeruginosa Malassezia folliculitis is itchy acne-like condition upper trunk young adult. Tx topical anti fungal Herpes Simplex folliculitis. Self-Resolve Herpes Zoster folliculitis - antivirals Molluscum contagiosum Dermodex mite infestation - older/immunocompromised Scabies Irritant folliculitis - regrowing hairs - after shaving/waxing/plucking

A

Mx cleaning antibiotics - topical or oral

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71
Q

Freckles and lentigines

A

RF fair skin sun exposed sites Sx Ex BROWN SPOTS Ix dermoscopy

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72
Q

Freckles and lentigines mx

A

Mx excision of concerning features on dermoscopy sun protection retinoids creams chemical peels cryotherapy

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73
Q

Furuncles (boil) and carbuncles (cluster of boils) Infection of hair follicle (deep folliculitis) Large boils for abscesses

A

RF Staph aureus Sx Ex One or more tender red lumps or pustules, located over hair follicle Ix

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74
Q

Furuncles (boil) and carbuncles (cluster of boils) mx Infection of hair follicle (deep folliculitis) Large boils for abscesses

A

Mx monitor for cellulitis antiseptic/antibacterial soap regularly antibiotic ointment to inside nostrils antibacterial/antiseptic to boil oral antibiotics incision and drainage

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75
Q

Genital herpes simplex

A

RF immunosuppressed high risk sexual behaviour HIV Sx prodromal tingling and burning Ex vesicles progressing to painful ulcers Ix HSV PCR - HSV1 or HSV2 infections

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76
Q

Genital herpes simplex mx

A

Mx valaciclovir 500mg bd for 5-10 days episodic treatment commence at prodromal symptoms - valaciclovir 500mg bd for 3 days if several recurrences per year, commence suppressive therapy - valaciclovir 500mg daily. (continuous or intervals) Symptom treatment - analgesia, topical lidocaine ads

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77
Q

Genital warts

A

RF STI - HPV (6 and 11) infection 16-25 many sexual partners immunocompromised Sx asymptomatic Ex sessile, exophytic papilloma, 1-3mm may form into larger plaques Ix DDX - molluscum contagiosum, pearly penile papules, condyloma latum

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78
Q

Genital warts mx

A

Mx podophyllotoxin topical b d for 3 days, then no treatment for 4 days. Repeat up to 4 cycles. cryotherapy surgical excision

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79
Q

Granuloma annulare

A

inflammatory skin condition

annular, smooth, discoloured, papules and plaques

plaques slowly change size, shape, position

tender when knocked

granulomas on histology

F>M

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80
Q

Granuloma annulare mx

A

Mx

most resolve in few months

topical corticosteroids

intralesional steroid injections

cryotherapy

immiquimod

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81
Q

Grovers disease / Heat rash / Transient acantholytic dermatosis

A

RF hot, humid environments men over 50 medication cause - anastrazole,..nib, cetuximab, mercury, d-penicillamine Sx seasonal variation comes and goes (from days to decades) Ex ITCHY TRUNCAL RASH (mid chest and central back) Ix

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82
Q

Grovers disease / Heat rash / Transient acantholytic dermatosis mx

A

Mx remain cool, no sweating topical corticosteroids calamine lotion

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83
Q

Guttate psoriasis (shower of red scaly teardrops fallen on body)

A

RF CHILDREN AND YOUNG ADULTS STREPTOCOCCAL INFECTION OF THROAT OR UPPER AIRWAYS genetic predisposition psoriasis Sx RAPID ONSET Ex SMALL RED SCALY PLAQUES SPREAD WIDELY Ix

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84
Q

Guttate psoriasis (shower of red scaly teardrops fallen on body) mx

A

Mx treat underlying strep infection with antibiotics topical steroids, coal tar, calcipotriol phototherapy spontaneously clears within 3-4 months

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85
Q

Haemangiomas of infancy (strawberry naevus)

A

RF infants F>M Sx benign vascular skin tumour Ex Rapid growth 3 months. Growth arrest by 5 months. Receding over several years. Ix

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86
Q

Haemangiomas of infancy (strawberry naevus) mx

A

Mx Propranolol topical timolol Lazer removal plastic surgery

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87
Q

Halo naevus

A

Benign Mole with white ring around it Central naevus fades from dark brown to brown to pink and eventually disappears Rarely, can be triggered by melanoma elsewhere. Do full skin check Mx Sunscreen pale area (no melanocytes)

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88
Q

Hand, foot and mouth disease (Coxsackie virus

A

RF children <10 Sx incubation period 3-7 days spread by contact with blister fluid or sneezing and coughing or faeces (up to several weeks post recovery) Ex RASH/BLISTERS ON HANDS, FEET AND MOUTH for 7-10 days

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89
Q

Hand, foot and mouth disease (Coxsackie virus mx

A

Mx timeout till all blisters have dried

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90
Q

Henoch Schonlein Purpura (vasculitis - inflammation small blood vessels of skin) Deposition of IgA immunoglobulin within blood vessel walls Mx

A

Mx monitor kidney function rash fades over 1 week can recur. small % have persistent disease NSAIDs for joint pain if kidney involvement - steroids and immunosuppressive meds, IVIG

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91
Q

Henoch Schonlein Purpura (vasculitis - inflammation small blood vessels of skin) Deposition of IgA immunoglobulin within blood vessel walls

A

RF children <10 prodromal urti - hemolytic streptococci on throat swab prodromal 2-3 weeks fever, headache, muscle/joint aches, abdo pain medication associations - ACEI, ARBs, clarithromycin, NSAIDs Sx Ex VASCULITIC RASH (PALPABLE PURPURA) BUTTOCKS AND LOWER LIMBS. also elbows, knees JOINT PAIN ABDO PAIN KIDNEY IMPAIRMENT Ix RENAL - blood and urine. regular monitoring kidney function blood pressure throat swab - haemolytic streptococci serology - haemolytic streptococciI’m

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92
Q

Herpes simplex HSV I - oral and facial infections mainly HSV2 2 - genital and rectal mainly (sexually transmitted)

A

RF active lesion infectious for 7-12 days asymptomatic shredding of virus in saliva and genital secretions. Incubation period 2-12 days Sx spread by skin to skin contact children 1-5y, presents as gingivostamatitis. fever, restlessness, excessive dribbling, painful to eat and drink, foul breath. Gums swollen, red, bleed easy. Whitish vesicles evolve to yellow ulcers on tongue, throat, palate and inside cheeks. Local lymphadenopathy. Females arises on vulva and in vagina. painful or difficult to pass urine. infection of cervix may progress to severe ulceration. after initial infection, may be no further clinical manifestations throughout life. If viral immunity is insufficient, recurrent infections are common. Ex LOCALISED BLISTERING VESICLES Ix viral swab PCR

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93
Q

Herpes simplex mx

HSV I - oral and facial infections mainly

HSV2 2 - genital and rectal mainly (sexually transmitted)

A

Mx

antivirals -

initial infection - valaciclovir 500mg bd for 5-10 days episodic infection - valaciclovir 500mg be for 3 days suppressive therapy - valaciclovir 500mg daily complications - eye infection, throat infection, eczema patients may get eczema herpeticum with widespread blisters and fever, erythema multiform, cranial/facial nerves, disseminated infection

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94
Q

Herpes zoster (shingles)

A

RF

CHICKEN POX (Varicella zoster) INFECTION IN CHILDHOOD VIRUS DORMANT IN NERVE ROOT GANGLIA

Sx

Ex

PAINFUL VESICULAR RASH IN DERMATOMAL DISTRIBUTION

Ix viral swab PCR

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95
Q

Herpes zoster (shingles) mx

A

Mx

treat with antivirals <72 hours since presentation rash valaciclovir 1g tds for 7 days

paracetamol and NSAID, ice packs, proterective dressing

lidocaine 5%patch (up to 3) after shingles healed. Wear for 12 hrs followed by patch-free interval OR pred 50mg mane for 7 days

if ocular involvement urgent referral ophthalmologist

post herpetic neuralgia -

amitriptyline 10-25mg night (max 150mg)

gabapentin 75mg night. titrate up (max 300mg bd)

SSRI

vaccination zostavax (live vaccine) age 70-79 (>12 months post infection

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96
Q

Hidradenitis suppurativa

A

RF

puberty,20-40y

F>M

can resolve at menopause

obesity, insulin resistance

Sx

CHRONIC INFLAMMATION APOCRINE GLAND (axilla, groin, vulva, buttocks folds beneath breasts)

AUTOINFLAMMATORY

Ex

RECURRENT, PERSISTENT BOIL-LIKE NODULES AND ABSCESSES - PURULENT DISCHARGE, SINUSES, SCARRING. Open double headed comedones painful firm papule and nodules pustules, abscesses draining sinuses hypertrophic and atrophic scars

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97
Q

Hidradenitis suppurativa mx

A

Mx

benzoyl peroxide wash

topical clindamycin 1%+benzoyl peroxide topical

antibiotics - fusidic acid, metronidazole, dapsone tetracycline antibiotics

combined antibiotics for 3 months - clindamycin+rifampicin or tetracycline+rifampicin IV ertapenem

hormone therapies - oestrogen, anti-androgen

systemic steroids

refer dermatology for biologicals

lazer

refer surgeon for surgical option

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98
Q

Hyperhydrosis ( palmer, axillary, general)

A

RF

excessive uncontrolled sweating

primary or secondary (stroke, neuropathy, brain tumour, chronic anxiety, obesity, diabetes, thyroid)

Ix

glucose, thyroid

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99
Q

Hyperhydrosis ( palmer, axillary, general) mx

A

Mx

absorptive padding

topical antiperspirants/ aluminium salts

anti-cholinergic drugs - oxybutynin 2.5-7.5mg daily

beta blockers/CBT for anxiety

botox injections

surgical removal of axillary sweat glands

localised primary hyperhydrosis tends to improve with age

100
Q

Hypersensitivity syndromes

A

Erythema marginatum - rheumatic fever

Erythema nodosum (red nodules on shins)- fat inflammation (hypersensitivity reaction). Autoimmune disease (inflammatory bowel,coeliac, SARCOIDOSIS, lupus), infection (strep, Tb), drugs (anti-inflammatories, sulfonamide, penicillin, codeine), malignancy, pregnancy

Erythema multiforme (target lesions)- hypersensitivity reaction to infection usually HSV, drugs (anti-inflammatories and penicillin)

Dermatitis herpitiformis - Coeliac - itchy vesicles and urticarial papules

Pretibial myxoedema (shins - edema or plaques) in hyperthyroid disorders (Graves)

101
Q

Hypertrophic and keloid scars

A

RF

Sx

Hypertrophic scar may settle with time

Keloid scar will not self-resolve, may prove resistant to treatment

Ex

HYPERTROPHIC SCAR CONTAINED TO DAMAGED SKIN SITE

KELOID SCAR EXTENDING BEYOND DAMAGED SKIN/WOUND SITE

Ix

102
Q

Hypertrophic and keloid scars mx

A

Mx

silicone scar reducing patches

intralesional corticosteroid injections (repeated every few weeks)

intralesional 5 fluorouracil

lazer

103
Q

Ichthyosis vulgaris (fish scale disease)

A

RF

European prevalence family history

Sx

Protein filaggrin mutation causes defective filaggrin

associated with keratosis pilaris and atopic dermatitis Ex

DRY SCALY SKIN

skin folds spared painful fissuring palm and soles

Ix

104
Q

Ichthyosis vulgaris (fish scale disease) mx

A

Mx

exfoliation and moisturising bathing salt water (to reduce scale)

salicylic acid, urea to exfoliate and moisturise skin

oral retinoids

brush hair to remove scales from scalp

105
Q

image test

A
106
Q

Impetigo / School sores

A

RF

Staph aureus and Strep pyogenes(groupA step)

children, esp boys

Sx

Bullous impetigo due to staphylococcal exfoliative toxins

Ex

PUSTULES AND HONEY-OLOURED CRUSTED EROSIONS, MAINLY FACE AND HANDS

Ix

bacterial swabs (if needed)

107
Q

Impetigo / School sores mx

A

Mx

resolves within 2-4 weeks, no scarring

post streptococcal glomerulonephritis,

rheumatic fever

cleanse wound and remove crusts gently antiseptic wash 2-3 times per day cover affected areas

oral antibiotics if severe (fever, >3 lesions, not resolving) time out until 24 hours antibiotics completed. cover sores with waterproof dressing until sores are dry.

OR crusts have dried out. to prevent recurrence -

antibacterial to nostrils (carrier site), daily wash antibacterial soap or bleach bath, cut nails

108
Q

Ingrown toenail (onychocrytposis)

A

RF

ill fitting shoes clipping nails into corners

Sx

edge nail grows into corner skin

Ex

109
Q

Ingrown toenail (onychocrytposis) mx

A

Mx

warm water soak wash foot

cotton-wick insertion to lift nail edge

topical or oral antibiotics

wedge resection (+/- electrocautery or phenol ablation cells beneath nail bed)

antibiotics post surgical. dressing for few weeks until healed

110
Q

Kaposi’s sarcoma (endothelial cell disease of blood vessels. Vascular hyperplasia) Mx

A

Mx inv for HIV cryotherapy lazer

111
Q

Kaposi’s sarcoma

(endothelial cell disease of blood vessels. Vascular hyperplasia)

A

RF

HIV

organ transplant

Sx

Ex

PURPLE/RED MACULES, PAPULES, NODULES ANYWHERE ON SKIN OR MUCOSA, OFTEN LOWER LEGS

LESIONS CAN ULCERATE

Ix

skin biopsy

112
Q

Kawasaki disease (vasculitis)

A

RF

CHILDREN <5

Sx

Ex

HIGH SWINGING FEVER 5 DAYS

RASH MACULOPAPULAR (measles like)

FIRM SWELLING HANDS AND FEET.

DESQUAMATION PEELING PALMS AND SOLES

STRAWBERRY TONGUE. RED CRACKED LIPS. RED MOUTH

CONJUNCTIVITIS

LYMPHADENOPATHY, often unilateral.

Ix

ECG

113
Q

Kawasaki disease (vasculitis) mx

A

Mx

self limiting. resolves in 4-8 weeks

Risk factor coronary artery damage (dilatation or narrowing)

antipyretic and analgesia

IVIG

low dose aspirin

follow up ECG at 6-8 weeks

114
Q

Keratoacanthoma

A

RF

Sx

FAST GROWING “VOLCANO”

Ex

solid keratin core

Ix

115
Q

Keratoacanthoma mx

A

Mx

Excision (check for SCC within)

may shrink and resolve itself

116
Q

Keratolysis exfoliativa

A

RF

young active adults

family history

Sx

Ex

FOCAL SKIN PEELING PALMS (AND SOMETIMES SOLES) recurs within few weeks

Ix

Mx

avoid exposure to irritants

emollient

hand cream containing urea

117
Q

keratosis pilaris

A

RF

familial

ATOPIC DERMATITIS

Sx

Ex

UPPER ARMS AND THIGHS

HYPERKERATOTIC FOLLICULAR PAPULES

118
Q

keratosis pilaris mx

A

Mx

exfoliation (pumice stone/exfoliating sponge

non soap cleansers

moisturise

topical retinoids

laser

119
Q

Kerion (abscess caused by fungal infection)

A

RF

children scalp

contagious

Sx

Ex

BOGGY SWELLING OVER SCALP WITH MULTIPLE PUSTULES AND ALOPECIA

Ix

hair samples and scrapings for microscopy and fungal culture

120
Q

Kerion (abscess caused by fungal infection) mx

A

Mx

oral anti fungal agents for 6-8 weeks

terbinifine 250mg daily for 6-8 weeks

itraconazole

griseofulvin

antibiotics if secondary infection

121
Q

Leg ulcer mx

A

Mx

monitor for infection / cellulitis - yellow crust or green/yellow pus, unpleasant smell.

Surrounding redness, warmth, swelling (cellulitis).

Antibiotics to treat.

refer vascular surgeon

regular wound debridement and dressing compression dressings

XRAY FOR BONE INVOLVEMENT if required

Swabs for secondary infection

ABPI

122
Q

Lichen planus (chronic inflammatory skin and mucosal surfaces)

A

RF

>40

genetic predisposition

injury to skin

drug reaction - quinine, gold

Sx

Ex

VIOLACEOUS POLYGONAL PAPULES ANKLES AND WRISTS ORAL - PAINLESS WHITE STREAKS / PAINFUL ULCERS/DIFFUSE REDNESS/PEELING GUMS Ix

123
Q

Lichen planus (chronic inflammatory skin and mucosal surfaces) Mx

A

Mx

DDX - lichen planes pigmentosus in dark skinned people face and neck as dark to violaceous macule.

potent topical steroids

pimecrolimus cream

topical retinoids

intralesional steroid injections

Cutaneous lesions clear within coupe years

Mucosal lesions persist for decade or longer

May recur

124
Q

Lichen sclerosis (genital and perianal areas)

A

RF women >50 pre puberal children family history autoimmune disorders Sx buried clitoris (phimosis) shrunken labia minora introital stenosis entrance to vagina men - foreskin difficult to retract (phimosis), painful erection, then, crooked urinary stream due to meatal stenosis Ex WHITE CRINKLED OR THICKENED PATCHES OF SKIN THAT TEND TO SCAR NEVER INVOLVES VAGINAL MUCOSA Ix SCC risk to women

125
Q

Lichen sclerosis (genital and perianal areas) mx

A

Mx refer gynae non soap cleanser topical steroids surgery if cancerous disease usually persists for years

126
Q

Lichen simplex chronicus Well demarcated, erythematous, hyper pigmented, patches or plaques of thickened lichenified (thick and leathery) skin. Scalp, neck, pubis, vulva, scrotum, ankles, extensor forearms as result of chronic rubbing and scratching. Primary process or secondary to dermatosis.

A

RF atopy environmental irritants psychiatric disorder Sx Ex Ix skin biopsy swabs and scraping

127
Q

Lichen simplex chronicus mx Well demarcated, erythematous, hyper pigmented, patches or plaques of thickened lichenified (thick and leathery) skin. Scalp, neck, pubis, vulva, scrotum, ankles, extensor forearms as result of chronic rubbing and scratching. Primary process or secondary to dermatosis.

A

Mx emollients and topical corticosteroids add topical calcineurin inhibitors (pimecrolimus) topical antipruritics (capsaicin spray) cryotherapy light therapy systemic corticosteroids surgical excision

128
Q

Lipoma

A

RF fat cell tumour benign Liposarcoma is rare fatty malignancy Mx watch and wait skin biopsy to exclude liposarcoma (if concerns) surgical excision if interfering with daily activities, pain or cosmetic liposuction

129
Q

Malar rash of SLE Mx

A

Mx potent topical corticosteroids calcineurin inhibitors (tacrolimus ointment) oral corticosteroids antimalarials methotrexate IvIG refer rheumatologist

130
Q

Malar rash of SLE

A

violaceous erythema rash in butterfly distribution on face autoimmune inflammatory condition affects skin, joints, kidneys photosensitive rashes mucosal eruptions - lips, mouth, nose, genitals Ix Raised ANA level Raised anti-dsDNA antibody level Presence of anti-Sm Positive antiphospholipid antibody (lupus anticoagulant, false positive rapid plasma reagin, high-titre anticardiolipin antibody, positive anti–2-glycoprotein I) Low complement levels Positive direct Coombs’ test

131
Q

Male pattern baldness

A

RF androgens sensitivity (dihydrotestosterone( family history Sx Ex RECEDING FRONTAL HAIR LINE THAT PROCESSES TO BALD PATCH TOP OF HEAD Ix

132
Q

Male pattern baldness mx

A

Mx minoxidil solution 5 alpha reductase inhibitors (finasteride) hair transplant

133
Q

Measles

A

RF children Sx Incubation period 10-12 days Child feels better 2days after rash appears, sick for <1 week. cough persists 2 weeks Ex PRODROMAL FEVER, COUGH RUNNY NOSE, SORE/RED EYES, LETHARGY DISTINCTIVE MACULOPAPULAR RASH AFTER 2-3 DAYS - RED AND BLOTCHY, STARTS HEAD, SPREADS TO BODY. lasts 5-6 days KOPLIK SPOTS (MOUTH MUCOSA) 1-2 DAYS BEFORE RASH (punctate blue-white spots) Ix serum IgM/ IgG for measles (covered by medicare) nasopharyngeal swab for measles PCR (NOT covered by medicare)

134
Q

Measles mx

A

Mx Highly contagious droplets (coughing and sneezing) Timeout - exclude until 4 days after onset of rash MMR vaccine 12 months and 18 months Risk of encephalitis or secondary infection - ear infection, pneumonia, diarrhoea and vomiting NOTIFIABLE

135
Q

Melasma

A

RF pregnancy OCP Sx hyper pigmentation Ex HYPERPIGMENTATION MASK (AROUND CHEEKS, EYES, FOREHEAD) Ix

136
Q

Melasma mx

A

Fades after pregnancy Skin lightening creams

137
Q

Miliaria (prickly heat/ sweat rash)

A

RF NEONATES 1 week old (immature sweat ducts) adults with fever hot humid environment Sx blocked or inflamed eccrine sweat ducts Ex

138
Q

Miliaria (prickly heat/ sweat rash)mx

A

Mx cool compress calamine lotion antiseptic and anti-staph for secondary infection mild topical steroids

139
Q

Milkers nodules and Orf (parapox virus infection)

A

farmers and meat industry workers Mx resolve spontaneously

140
Q

Molluscum contagiosum (viral)

A

RF children Sx Ex UMBILICATION CENTRAL PEARLY PAPULES CHEESY MATERIAL RELEASED WHEN SQUEEZED Ix

141
Q

Molluscum contagiosum (viral) mx

A

Mx showers, not baths. Nails short. Contagious risk cross-contamination can take 18 months or years to resolve if affecting eyes, may need surgical excision time out poster does not exclude

142
Q

Nail plate disorders

A

Nail Disorders Nail fold infarcts - RA (active vasculitis) Nail pitting - psoriasis Beau’s lines - trauma (nail grows out completely in 5 months) Candida paronychia - wet working conditions. red, swollen nail fold, nail detachment, sometimes pus Paronychia - swelling of nail fold, acute, tender, inflamed. Staph aureus Dermatophytosis - ONYCHOMYCOSIS (fungal infection) with moth eaten appearance of nail plate. diabetes Pustular psoriasis - nail plate lifted by sterile pustules Psoriasis - pitting Psoriatic nail dystrophy ‘Ram’s horn’ (overgrowth/thickening of one side of nail plate) - Onychogryphosis. (benign, painless, surgical removal) Koilonychia - spoon shaped nails - anemia, iron deficiency Clubbing - cirrhosis, crohns, ulcerative colitis, bronchiectasis lung cancer, mesothelioma, pulmonary fibrosis, CF, cardio disease

143
Q

Nappy rash (irritant dermatitis)

A

erythematous macule and papule in genital area (can spread over abdomen and thighs) Ix skin swab to determine bacterial (impetigo) or fungal (candida) Mx keep dry barrier creams (zinc oxide) hydrocortisone bd for inflammation anti fungal bd for cadida

144
Q

Necrobiosis lipoidica

A

rare, granulomatous disease affecting shins of insulin-dependent diabetics

145
Q

Necrobiosis lipoidica mx

A

Mx watch and wait topical steroids, oral ciclosporin, biological agents (imabs) phototherapy ulcerated lesions need aggressive treatment

146
Q

Neurofibromatosis (Type 1) (von Recklinghausen’s disease) Mx

A

Mx refer specialist surgical removal of symptomatic lesions 10% risk of malignant change Neurofibromatosis Type 2 - bilateral vestibular schwannomas (acoustic neuroma)

147
Q

Neurofibromatosis (Type 1) (von Recklinghausen’s disease)

A

RF autosomal dominant Sx Ex CAFE AU LAIT SPOTS NEUROFIBROMAS (fleshy lesions) IRIS LISCH NODULES areas of depigmentation Ix MRI/CT - tumour growth, optic gliomas, brain tumours, hydrocephalus, paraspinal neurofibromas, peripheral nerve sheath tumours

148
Q

Neuropathic / Diabetic leg ulcer

A

Arterial occlusion and nerve damage. Reduced awareness of pressure and rubbing. LOCATED PRESSURE POINTS (heels, tips toes, bony protrusions) PAINLESS Callus forms, then breaks down and ulcerates RISK OF GANGRENE (if patient not aware). PATIENTS NEED TO CHECK FEET REGULARLY Chronic ulcers also due to skin cancer, sclerosis, vasculitis, pyoderma grangenosum

149
Q

Nummular/discoid eczema

A

RF 50-70y Staph aureus infection localised injury dry skin or meds that cause dry skin chronic alcoholism Sx chronic relapsing condition. May eventually resolve exudative - oozy papules, blisters and plaques dry - erythematous dry plaques Ex ITCHY CIRCULAR PLAQUES OF VARYING SIZES ON ANY PART OF BODY Ix

150
Q

Nummular/discoid eczema mx

A

Mx emollients topical steroids or oral steroids oral antibiotics oral antihistamines phototherapy refer specialist for methotrexate

151
Q

Onycholysis (nail plate separating from nail bed) Mx

A

Mx fingernails take 4-6 months to completely regrow. Toenails take twice as long.

152
Q

Onycholysis (nail plate separating from nail bed)

A

Sx Ex area of white opaque nail (separated) Ix nail clipping (bacterial and fungal culture) blood tests = check thyroid

153
Q

Onychomycosis (fungal infection nails)

A

RF increased age Sx caused by dermatophytes, yeasts, moulds fingernails or toenails affected Ex Variety of colours - black, yellow, white, brown moth eaten appearance most Ix nail clippings and scrapings for fungal mcs

154
Q

Onychomycosis (fungal infection nails) mx

A

Mx

topical antifungals may be not effective

terbinifine 250mg daily for 6 weeks for fingernails

terbinifine 250mg daily for 12 weeks for toenails

lazers photodynamic therapy

155
Q

Paget’s disease of Skin/Breast/Nipple

A

Mammary Paget Disease of Skin/ Breast/ Nipple - rare for of breast cancer associated with underlying intraductal breast cancer located near areola RF 50-60 women rare in male Sx Ex WELL-DEFINED, IRREGULAR RED PATCH THAT SLOWLY ENLARGES, MAYBE UP TO 15CM may be scaly or crusted nipple can be itchy, painful, burning, thickened, retracted can be ulceration, bleeding discharge

156
Q

Paget’s disease of Skin/Breast/Nipple mx

A

Mx biopsy refer inv for breast cancer (in situ or invasive intraductal carcinoma) - u/s/mammogram/MRI refer surgical excision +/- axillary node resection radiotherapy/chemotherapy tamoxifen poor prognosis (esp men

157
Q

Papular urticaria, (reaction to insect bites e.g. fleas, bed bugs, mosquitos)

A

RF children (desinsitisation not yet developed to bite) Sx no urticaria Ex CROPS OF ITCHY RED PAPULE AND VESICLES may be secondary bacterial infection (due to scratching) Ix

158
Q

Papular urticaria, (reaction to insect bites e.g. fleas, bed bugs, mosquitos) mx

A

Mx antihistamine for itch topical steroid antiseptic for prevention secondary infection

159
Q

Paronychia (acute and chronic) (inflammation skin around finger or toenail). Whitlow Mx

A

Mx check for cellulitis. can involve infection underlying tendon chronic paronychia can cause nail dystrophy (distored ridged nail plate) soak warm water several times per day topical antiseptic for localised minor infection oral antibiotics acyclovir for herpes simplex surgical I&D abscess surgical nail removal (to drain pus) chronic paronychia - dry and clean hands. emollients. treat microbes cultured, topical corticosteroids for 2-4 weeks for flares. Tacrolimus. Antiseptic/antifungals for several months. Oral anti fungal agents

160
Q

Paronychia (acute and chronic) (inflammation skin around finger or toenail). Whitlow

A

RF Sx bacterial infection if herpes simplex infection = herpetic whitlow (multiple vesicles) Ex Ix swabs for bacteria viral PCR nail clipping for fungal

161
Q

Pediculosis (lice)

A

RF children hair close contact e.g. school, sleeping together Sx louse dung (black dots) tiny hemorrhagic papule (bites) live mites 3mm egg cases (nits) attached to hairs

162
Q

Pediculosis (lice) mx

A

Mx don’t share hats, brushes insecticide foams, shampoos. Repeat in 1 week wet hair with vinegar to loosen nits combing with fine tooth comb hot wash towels, sheets, pillowcases, clothing, brushes topical insecticides - e.g. permethrin resistant cases - oral trimethoprim/sulhamethoxazole or oral ivermectin (not registered)

163
Q

Pemphigoid

A

RF Elderly FRUSEMIDE Sx Ex TENSE BLISTERS 1-2cm ARMS AND LEGS

164
Q

Pemphigoid mx

A

Mx steroids DDX - pemphigus vulgarise (younger age, flaccid blisters)

165
Q

Perioral dermatitis

A

RF children women 15-45 Sx PATIENT OFTEN USING TOPICAL OR INHALED CORTICOSTEROIDS OR RAPID WITHDRAWAL FACIAL STEROIDS VS STEROID-INDUCED ROSACEA, PERIORAL DERMATITIS SPARES CHEEKS AND FOREHEAD cosmetics, sunscreens, makeup hormone changes BURNING IRRITATION Ex ITCHY TENDER RED PAPULES/PAPULOPUSTULES AROUND MOUTH (and genitals occasionally) Ix

166
Q

Perioral dermatitis mx

A

Mx discontinue face creams (including steroids) slower withdrawal from steroids wash face with water alone until cleared non soap cleanser liquid or gel sunscreen MAY TAKE SEVERAL WEEKS FOR NOTICEABLE IMPROVEMENT topical erythromycin, clindamycin, metronidazole, pimecrolimus, azelaic acid oral anti-inflammatory antibiotics for 6-12 weeks - tetracycline, (erythromycin for pregnancy and children) or isotretinoin Periocular dermatitis occurs around eyes

167
Q

Pilonidal sinus

A

RF male 20-40 Sx pilonidal cyst is non-inflamed lump Ex SINUS TRACT IN SACROCOCCYGEAL REGION If sinus becomes infected a pilonidal abscess may form Ix

168
Q

Pilonidal sinus mx

A

Mx sinus or cyst without issues does not require treatment if painful, erythematous, discharging, fever, refer surgeon follow up packing open wound

169
Q

Pityriasis versicolour (fungal infection)

A

RF Malassezia infection hot humid climates Sx Ex FLAKY DISCOLOURED PATCHES OR HYPOPIGMENTED AREAS ON CHEST AND BACK Ix Dermoscopy fungal scraping skin for fungal mcs

170
Q

Pityriasis versicolour (fungal infection) mx

A

Mx topical anti fungals ketaconazole cream/shampoo selenium sulfide terbinafine gel Apply before bed for 3 nights (3 days to 2 weeks) oral agnets (itraconazole and fluconazole) if topicals fail often recurs

171
Q

Pityriasis alba

A

RF CHILDREN atopic dermatitis / dry skin Sx Ex HYPOPIGMENTATION AND FINE SCALE IN PATCHES ON FACE, CHEEKS, CHIN (1-20 USUALLY) Ix

172
Q

Pityriasis alba mx

A

Mx self-resolves after 1 year (few months up to 2-3 years) moisturiser to treat dryness

173
Q

Pityriasis rosea (viral rash

A

RF Teenagers and young adults often can affect anyone prodromal urti Sx LASTS 6-12 WEEKS Ex HERALD PATCH (SINGLE PLAQUE) 1-20 DAYS BEFORE GENERALISED RASH SECONDARY RASH PATCHES AND PLAQUES CHEST AND BACK (smaller than herald patch) FIR TREE FORMATION MINIMAL ITCH Ix

174
Q

Pityriasis rosea (viral rash) mx

A

Mx pregnancy - may cause miscarriage, premature delivery soap free wash moisturiser gentle exposure sunlight (without burning

175
Q

Plant dermatitis / phyotdermatitis

A

RF Sx Some plants only cause rash if sun shining on it (photocontact dermatitis) Stinging nettles cause contact urticaria allergy contact dermatitis can cause facial swelling and blistering of exposed parts rash appears 4 hours to 10 days after exposure Ex LARGE BLISTERS

176
Q

Plant dermatitis / phyotdermatitis mx

A

Mx self-limiting topical steroids oral steroids if severe ice pack/cold showers to relieve itch avoid soap (irritates) patch test by experts maybe

177
Q

Polymorphous light eruption (PMLE)

A

RF young women phototherapy for psoriasis or dermatitis can cause it Sx Photosensitive rash of varied forms standard sunscreens may not prevent it Ex CROPS OF 2-5MM PINK OR RED PAPULES Ix

178
Q

Polymorphous light eruption (PMLE) mx

A

Mx rash settles after few days with no further sun exposure may recur with further sun exposure oral antihistamines for itch topical corticosteroids oral corticosteroids

179
Q

Pompholyx

A

RF Sx Ex ITCHY VESICULAR ERUPTIONS HANDS AND FEET Ix Mx dry clean skin. wear gloves topical antibiotics for infection topical steroids often recurrent

180
Q

Porphyria cutaneous tarda

A

RF deficiency/block in enzyme pathway to haem synthesis causes build up precursor proteins hereditary liver disease (alcohol, hepatitis, iron overload) oestrogen / hormone treatments Sx Ex INCREASINGLY FRAGILE SKIN BACK OF HANDS AND FOREARMS (other sun exposed sites may be affected) scleroderma like changes neck, face, chest blisters, crusted erosions Ix urine - woods lamp - pink fluorescence due to excess porphyrins present skin biopsy serum, urienand faces for porphyrin levels LFTS, FBC, Iron studies, HepB, HepC, HIV lupus and diabetes haemochromatosis

181
Q

Porphyria cutaneous tarda mx

A

Mx treat underlying liver / excess iron issues venesection (excess iron) sun protection antimalarials low dose (elderly with anemia) to allow excretion of porphyrins more easily

182
Q

Prurigo nodularis

A

RF family history atopy iron deficieny, anaemia, chronic renal failure, celiac, HIV Sx Ex VERY ITCHY FIRM LUMPS, SYMMETRICAL DISTRIBUTION LOWER ARMS AND LEGS other areas can also be affected new nodules appear from time to time existing nodules may regress spontaneously to leave scars Ix

183
Q

Prurigo nodularis mx

A

Mx biopsy blood tests - abc, e/lfts, tft, celiac resistant to treatment emollients oral antihistamine ultrapotnet topical steroids corticosteroid injections coal tar calcipqotriol capsaicin cream cryotherapy antibiotics for infected lesions phototherapy TCA gabapentin/pregaalin naltrexone oral steroids methotrexate isotretinoin

184
Q

Psoriasis vulgarise (plaque)

A

RF childhood peaks at 15-25y and 50-60y family history (1/3 patients have daily members with psoriosis) Sx chronic inflammatory skin condition Ex PAPULOSQAMOUS ITCHY RED/PINK PLAQUES WITH SILVER/WHITE SCALING,SYMMETRICALLY DISTRIBUTED EXTENSOR SURFACES AND SCALP NAIL PITTING Ix

185
Q

Psoriasis vulgarise (plaque) mx

A

Psoriasis vulgarise (plaque

186
Q

Pubic lice

A

insecticide eg prioderm cream shampoo 1% to all hairy parts of body except eyelids and scalp. Wash off after 5-10 minutes. Comb with fine tooth comb Repeat 7 days later Remove lice from eyelashes with forceps or vaseline bd for 3 weeks wash underwear and bed linen treat sexual parters even if deny itching

187
Q

Pustular psoriasis (localised or generalised)

A

RF

Rare

Can be reaction to sudden withdrawal oral steroids

drug causes - lithium, aspirin, indomethacin, iodide, beta blockers

preceding infection

psoriasis

Ex

FLARES OF WIDESPREAD STERILE PUSTULES ON RED AND TENDER SKIN

PUSTULES COALESCE TO FORM LAKES OF PUS

SUCCESSIVE CROPS OF PUSTULES MAY APPEAR AND ERUPT EVERY FEW DAYS OR WEEKS

188
Q

Pustular psoriasis (localised or generalised) mx

A

Mx

Remission within days or weeks

Relapses common

test for bacterial infection

topical steroids and emollients

DEATH CAN RESULT FROM CARDIORESPIRATORY FAILURE DURING ACUTE ERUPTIONS

REFER HOSPITAL

FBC may show anaemia, neutrophilia, lymphopenia

CRP elevated

disturbed protein and electrolyte balance

high output cardiac failure

renal and liver impairment

peripheral neuropathy

malabsorption of nutrient and drugs

189
Q

Pyoderma gangrenosum (not infection. does NOT cause gangrene Mx

A

Mx debride necrotic tissue small ulcers - topical steroids, tacrolimus, intralesional steroid injections ciclosporin solution special dressings oral anti-inflammatories eg doxycycline compression dressing if tolerated to reduce swelling systemic treatment with oral pred, ciclosporin, biological agents (infliximab etc) surgical skin graft when infection has settled

190
Q

Pyoderma gangrenosum (not infection. does NOT cause gangrene

A

auto inflammatory disesase rapidly enlarging, very painful, ulcer associated inflammatory bowel disease Ix swab wound for micro-organisms (these are not the cause of ulcer)

191
Q

Pyogenic granuloma (benign proliferation of capillary blood vessels)

A

RF 6y-young adult pregnancy OCP trauma hormones meds/immunosupperssion infection Sx Ex PAINLESS RED FLESHY NODULE GROWS RAPIDLY OVER FEW WEEKS FINGERS OR FACE oral mucosa dermoscopy - keratinised border / white collarette. vascular structures. Ix

192
Q

Pyogenic granuloma (benign proliferation of capillary blood vessels) mx

A

Mx rarely self-resolve imiquimod cream 5% cryotherapy surgical excision laser recurrence common

193
Q

Rosacea

A

RF 30-60y celtic origin fair skin, blue eyes Sx Aggravated by topical steroids and face creams Aggravated by sun, hot/spicy food, drink frequent flushing/blushing Ex CHRONIC RED RASH CENTRAL FACE (spots, papules, pustules) TELANGIECTASIA, SWELLING, DRY AND FLAKY VS acne (rosaea has no comedones or nodules) LARGE UNSHAPELY NOSE WTIH PROMINENT PORES (SEBACEOUS HYPERPLASIA/RHINOPHYMA) OCULAR ROSACEA ON EYELIDS

194
Q

Rosacea mx

A

Mx Avoid oil based products on face Avoid topical steroids on face sunscreen tetracycline antibiotics for 6-12 weeks topical metronidazole azelaic acid bd ivermectin cream (control demodex mites) oral isotretinoin tacrolimus (calcineurin inhibitor)

195
Q

Roseola infantum (herpes 6 and 7) /Sixth disease

A

RF children 6months - 3 years Sx incubation period 9-10 days spread in saliva or respiratory drops (sneeze/cough) no longer contagious after rash appears and fever breaks Ex HIGH FEVER LASTING 3-5 DAYS, RUNNY NOSE, IRRITABILITY, FATIGUE AS FEVER SUBSIDES, RASH APPEARS ON TRUNK (rarely spreads to neck, face, arms, legs) RASH IS SMALL ROSE-PINK OR RED RAISED SPOTS, SOME WITH HALO NON-ITCHY, PAINLESS MAY FADE WITHIN FEW HOURS OR LAST FOR 2 DAYS

196
Q

Roseola infantum (herpes 6 and 7) /Sixth disease mx

A

Mx Usually mild and self-limiting <1week complication - febrile seizure

197
Q

Ross river fever (RRV disease, arbovirus)

A

RF infected mosquitos bites Sx some people asymptomatic some people symptoms 7-10 days after bitten by infected mosquito majority recover in few weeks some people symptoms such as joint pain and tiredness for many months Ex FEVER,CHILLS, HEADACHE, JOINT AND MUSCLE ACHES RASH disappears after 7-10 days Ix serology IgG/IgM

198
Q

Ross river fever (RRV disease, arbovirus)mx

A

Mx protect from mosquito bites no vaccine available

199
Q

Rubella / German measles

A

RF

children

pregnant women <10weeks pregnant - cause damage foetus (blindness, deafness, heart problems, brain damage, growth problems, swelling brain, liver, lungs)

Sx

Incubation period 14-21 days

contagious from 1 week before until 1 week after rash

some people asymptomatic mild illness recovery in 3 days

Ex

MILD FEVER AND RASH AND SWOLLEN LYMPH GLANDS joint pain, headache, runny nose, sore red eyes

Ix serum antibodies

200
Q

Rubella / German measles mx

A

Mx NOTIFIABLE MMR at 12 months and 18 months

201
Q

Scabies (mites burrowing into skin) Sarcoptes Scabiei

A

RF ATSI close living Sx highly contagious Ex BURROWS AND ITCH, ERYTHEMA IN WEBBING OF FINGERS Ix

202
Q

Scabies (mites burrowing into skin) Sarcoptes Scabiei mx

A

Mx

Mx

permethrin 5% cream applied topically neck down. Leave 8 hrs (overnight). Repeat in 7 days

if recalcitrant (or crusted scabies), can trial oral ivermectin 200mcg with fatty food weekly

Itch can persist 2-4 weeks post treatment (no new burrows)

Itch can persist 2-4 weeks post treatment (no new burrows

203
Q

SCC (Squamous Cell Carcinoma

A

RF Sx can become invasive Ex CRUSTY, ULCERATED LESION (HARDER THAN SURROUNDING SKIN) irregular keratinous nodule Ix Mx excision (3-10mm margin) or urgent referral dermatologist

204
Q

Sebaceous hyperplasia

A

RF middle aged and elderly Sx Ex LARGE SEBACEOUS GLANDS (Often on forehead and cheeks) central hair follicle. vascular. Ix Mx benign lazer isotretinoin

205
Q

Seborrheic dermatitis

A

RF Dandruff (pityriasis capitis) is an uninflamed form of seborrheic dermatitis INFANTILE FORM (CRADLE CAP) <3 months. usually resolves by 6-12 months Adult form - late adolescence elderly M>F Sx MALASSSEZIA FUR FUR INFECTION Ex AFFECTS FACE, SCALP, TRUNK ILL-DEFINED LOCALISED SCALY PATCHES OR RASH Ix Malassezia is normal component of skin flora so presence on skin scraping is not diagnostic

206
Q

Seborrheic dermatitis mx

A

Mx SKIN - KETACONAZOLE SHAMPOO/CREAM (ZINC PYRITHIONE OF SELENIUM SULPHIDE) MILD CORTICOSTEROIDS TO REDUCE INFLAMMATION CALCINEURIN INHIBITORS (TACROLIMUS ) HAVE FEWER SIDE EFFECTS ON FACIAL SKIN SALICYLIC ACID TO REMOVE SCALE SCALP - KETA ONAZOLE SHAMPOO STEROID SCALP APLICATIONS CALCINEURIN INHIBITORS COAL TAR CREAM BABY - BABY SHAMPOO AND GENTLE BRUSHING WHITE PETROLATUM

207
Q

Seborrhoeic keratoses

A

Sx Ex WAXY, WARTY PAPULE OR PLAQUE LOOKS “STUCK ON’ Ix Mx benign

208
Q

Skin tags

A

RF obesity diabetes Sx skin folds Ex papules. can be in groups Ix Mx benign

209
Q

Spider naevus (angioma/telangectasia) (dilated blood vessels/vascular malformation)

A

RF pregnancy cirrhosis / alcohol abuse ocp thyrotoxicosis Sx face, neck, upper chest, and others Ex COMPRESSION CENTRAL ARTERIOLE CAUSES DISAPPEARANCE OF RADIAL CAPILLARIES. RAPIDLY REFILLS WHEN COMPRESSION RELIEVED Ix

210
Q

Spider naevus (angioma/telangectasia) (dilated blood vessels/vascular malformation) mx

A

Mx electrocautery

211
Q

Subungual haematoma

A

RF injury to nail (crush) or ill-fitting shoes Sx Ex red/purple/brown/black lesion beneath nail may be onycholysis (nail lifting from bed) grows out with growing nail CF melanoma which appears two dark lines continual growth

212
Q

Subungual haematoma mx

A

Mx consider X-ray to assess for underlying fracture hot needle incision to decompress if painful send for surgical opinion if ?melanoma nail plate may fall off (onycholysis) or be removed

213
Q

Swimmers itch

A

RF swimming natural waters Sx Allergic reaction to aquatic larvae penetrating skin First exposure may not result in reaction. Repeated exposure, sensitivity to larvae develop Ex TINY RED SPOTS AT SITE OF PENETRATION OF LARVAE INTO SKIN. (Rash initial itch and tingling settles quickly). HOURS LATER, INTENSE ITCHING. PAPULE FORM, Occasionally hives.BLISTERS may develop Ix

214
Q

Swimmers itch mx

A

Mx Untreated, rash settles within several weeks Rinse skin with rubbing alcohol Calamine lotion antihistamine mild topical corticosteroid. Oral steroids for severe reaction antibiotics for secondary skin infections

215
Q

Syphilis

A

RF MSM (men sex with men) ATSI Sx 3 stages - primary - CHANCRE (painless genital ulcer) and inguinal lymphadenopathy. heals few weeks. secondary - RASH (palms and soles, trunk), fever, malaise, headache, lymphadenopathy early latent (<2 years) - recent infection,positive serology with no sx late latent (>2 years) - no longer infectious to sexual partners. women can pass infection to unborn foetus. tertiary - months or years later in 1/3 cases if not treated. Skin lesions (GUMMAS), NEUROLOGICAL, CARDIOVASCULAR Ex Ix Treponema pallidum swab of ulcer NAAT (PCR) Serology (repeat in 2 weeks if negative, but clinically suspicious) EIA (enzyme immunoassay) screening. {some labs still use TPPA or TPHA} IF reactive, RPR and TPHA/TPPA as confirmatory testing. [EIA, TPPA positive for life] RPR to test re-infection or treatment success (Rapid plasma reagin) Test MSM annually (up to 4 times per year) HIV positive MSM up to 4 times per year or at each CD4/viral load monitoring Antenatal. repeat in late pregnancy if risk e.g. ATSI Routine immigration testing Sexual contact with person with syphilis Signs infective syphilis INV for HIV, hepB, viral swab for herpes if ulceration

216
Q

Syphilis mx

A

Mx refer sexual health specialist refer specialist if pregnant Infectious (primary, secondary, early latent) benzathing penicillin 1.8g IMI stat Non-infectious (late latent) benzathing penicillin 1.8g IMI weekly for 3 weeks possible reaction to tx (Jarisch-Herxheimer reaction lasts several hours) no sexual contact 7 days. NO contact with partners from last 3 months and 6 months until partners post treatment Contact tracing — 3 mths (primary), 6 mths (secondary), late latent (long term partners only) Presumptively treat all sexual contacts regardless of serology with benzathine penicillin 1.8g IMI Repeat RPR at 3 months, 6 months and 12 months post treatment

217
Q

Telogen effluvium (temporary hair loss due to excessive shedding of resting [telogen] hairs after shock to the system

A

RF triggers to shock system - childbirth illness psychological stress weight loss medications Sx actively growing hairs (anagen hair) 85% follicles.(grows for 4 years) resting hairs (telogen hair) 15% follicles (rests for 4 months) lose 100 hairs per day normally arrest in hair growth also arrest in nail growth (Beau line at time of shock to system) Ex ENTIRE SCALP HAIR THINNING +/- OTHER BODY HAIR BEAU’S LINES NAILS

218
Q

Telogen effluvium (temporary hair loss due to excessive shedding of resting [telogen] hairs after shock to the system mx

A

Mx handle hair gently correct underlying deficiency e.g. thyroid, b12, iron nutrition

219
Q

TINEA (Dermatophyte (ringworm) fungus infection skin) Pedis - foot Cruris - groin Corporis - body Manuum - hand Capitis - head Barbae - beard Faciei - face Ungulum - nail

A

RF warm moist environments communal showers (wear thongs) Sx itch, pain, Ex ring shaped red patch with raised scaly leading edge on body, grows outward Ix scraping and nail clippings for fungal mcs

220
Q

TINEA (Dermatophyte (ringworm) fungus infection skin) mx Pedis - foot Cruris - groin Corporis - body Manuum - hand Capitis - head Barbae - beard Faciei - face Ungulum - nail

A

Mx topical antifungals (ketaconazole, selenium sulfide) oral antifungals (terbinifine, itraconazole, griseofulvin)

221
Q

Toxic erythema of the newborn

(erythema toxicum neonatorum)

A

RF

newborn

Sx

rash erythematous macule, papule and pustules on face, trunk, limbs

waxes and wanes over several days

infant otherwise well

222
Q

Toxic erythema of the newborn Mx

(erythema toxicum neonatorum)

A

Nil required

223
Q

Trichotillomania

A

RF

children more common (pre-school and puberty)

OCD

anxiety

repetitive behaviours (nail-biting, skin piking, lip biting)

Sx

pulls out one’s own hair eyelashes and eyebrows may also be pulled may ingest hairs (hairballs can be life-threatening)

Ex

areas of hair loss (alopecia)

Ix

exclude alopecia areata, fungal infection

224
Q

Trichotillomania mx

A

Mx

reassurance, education psychology/psychiatry behaviour modification children often grow out of it

225
Q

Tuberous sclerosis

A

genetic disorder

hamartomas (benign overgrowth of mature cells)

skin lesions, epilepsy, developmental delay/behavioural issues angiofibroma (facial rash of pink and red spots) ungual fibromas (under nails)

shagreen patch (orange-peel connective tissue naevi)

ash leaf marks (pale ovoid lesions. 3 at birth is diagnostic )

Mx lazer for facial lesions

refer specialist

226
Q

Urticaria

A

RF

contact irritant eg plant insect bite viral infection

Sx

COMES AND GOES

Ex

ERYTHEMATOUS WHEALS

227
Q

Urticaria mx

A

Mx

antihistamine

oral corticosteroids (if severe)

228
Q

Varicella ( Zoster)

A

RF

children

Sx

SHORT PRODROME

FEVER,

LETHARGY,

ANOREXIA

FOLLOWED BY ERUPTION RASH OVER NEXT 3-5 DAYS

incubation period 10-21 days (most commonly 14-16)

infectious from 1-2 days before rash until lesions fully crusted over

Ex

CROPS OF SMALL PAPULE BECOME VESICLES (WITH ERYTHEMATOUS MARGINS) THAT RUPTURE AND CRUST OVER

fully crusted in 10 days

Ix

229
Q

Varicella ( Zoster) mx

A

Mx

self-limiting

analgesia,

fluids,

calamine lotion

risk factors - bacterial infection, encephalitis, pneumonia, hpeatitis, arthritis,

Reye syndrome

vaccination MMRV at 18 months age. (second injection recommended, but not funded). Can be given with other live vaccines on same day or wait 4 weeks.

>14/adults require 2 doses vaccine

230
Q

Venous leg ulcer

Incompetent valves

A

Pooling of blood lower leg increases venous pressure, causes fibrin deposits around capillaries, which is barrier to flow of oxygen and nutrients to muscle and skin. Death of tissue cells leads to ulceration.

INNER PART ANKLES,

BELOW KNEE

PAINLESS unless infected

MORE COMFORTABLE WHEN ELEVATED

mottled brown/black staining and/or dry itchy reddened skin (venous eczema) thickened skin

231
Q

Viral exanthem

A

RF viral infection - reaction to toxin produced by organism Sx Ex GENERALIZED RASH WITH SYSTEMIC SYMPTOMS (FEVER, MALAISE, HEADACHE, ABDO PAIN) Ix blood test for antibodies viral swab for PCR

232
Q

Viral exanthem mx

A

Mx

paracetamol for fever emollients for itch

233
Q

Vitiligo (depigmentation disorder

A

RF autoimmune disorders bone marrow and stem cell transplant patients Sx LOSS OR DESTRUCTION OF MELANOCYTES SKIN INJURY CAN PRECIPITATE DEPIGMENTATION Ex WELL DEFINED, MILKY WHITE PATCHES (DEPIGMENTATION) ON SKIN Ix

234
Q

Vitiligo (depigmentation disorder mx

A

Mx

Skin protection from injury

sun protection

makeup

corticosteroid creams

calcineurin inhibitors (tacrolimus ointment) for eyelids face groin

phototherapy

methotrexate

235
Q

Warts / Verruca

A

RF

HPV

children

eczema

immunosuppressed

Sx

Ex

PAPILLOMATOUS, HYPERKERATOTIC SURFACE. TINY BLACK DOTS ARE BLOOD VESSELS

On soles - plantar warts

Ix

236
Q

Warts / Verruca mx

A

Mx contagious - direct skin to skin contact autoinnoculation incubation period as long as 12 months will regress <2 years cryotherapy and paring salicylic acid and paring topical retinoids

237
Q

Xanthelasma

A

medial cantthus of upper or lower eyelids yellow macule/papule/plaque of lipid hypercholesterolemia, dyslipidemia can also get tendon xantheloma

238
Q

Xanthelasma mx

A

Mx treat underlying dyslipidemia or hypercholesterolemia manage primary biliary cirrhosis

239
Q

Corn / Callus

A

RF

Footwear - pressure points and friction

Sx

painful sometiems

Inv

thickened skin

240
Q

Corns / Calluses Mx

A

Mx

correct fitting footwear

protection pads

soaking and pumice stone

corn pads

salycylic acid and paring

241
Q

Atypical dysplastic melanocytic naevus

A

RF

Phototype 1 or 2 (light skin, red hair freckles)

Familial

People with 5 or more dysplastic naevi have higher risk of developing melanoma

Sx

mole with unusual features (irregular or blurry borders, irregular margins and odd shapes, multiple colours, flat and bumpy components)

242
Q

Atypical dysplastic naevus Mx

A

excisional biopsy (2mm margins) - difficult to distinguish from melanoma

benign lesion - does not need removal

advise patient of inc risk for melanoma if >5 dysplastic naevus

teach patient to self-check skin

advise if any changes to any lesions

regular thorough skin checks with gp or dermatologist

educate on safe sun protection practices

243
Q

Erythema rashes

A

Erythema multiform (target lesions) - hypersensitivity reaction hsv, mycoplasma pneumonia. Self-resolves. supportive treatment

Erythema nodosum (panniculitis) - preg, strep, drugs, malignancy (leukemia, lymphoma), idiopathic. Rest, leg elevation, nsaids. if severe, give pred 25mg daily for 2 weeks, then taper.

Erythema marginatum (rheumatic fever) -

Dermatitis herpetiformis - coeliac. itchy vesicles. dapsone, corticosterois

244
Q

Hair Loss

A

Androgenic alopecia - male pattern baldness, familial. Bilateral temple thinning. Tx-finasteride 1mg daily, spiornolactone 50-100mg (max 200mg daily) women, minoxidil topical .

Alopecia areata - patchy circles. Tx-betamethasone diproprionate

Telogen effluvium - overall thinning 3 months post shock (birth, med, crisis, wt loss). Reassurance will cease in 6-9 months. New hair will grow back. Arrest in cycle.

Trichotillomania - pulling out own hair/eyelashes. psychology. may grow out of it.

245
Q

Emollients -

  • soap substitutes
  • bath oil
  • moisturizer - glycerine, cetomacrogols, soft white parrafin/ liquid parrafin, fatty cream, wool fat lotion, urea creams
  • used to relieve dryness, itching and scale formation
A

Derm (1 decks)

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