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EXAM 2021 > DERM > Flashcards

DERM Flashcards

1
Q

Acne

A
  1. BOTH TYPES: benzyl peroxide 0.25-5%, 2nd daily then daily.
  2. if commedomal mainly –> topiacl retiond
    1. then increase retinoid strength (0.025-0.1%)
    2. then combo BP and retinoid
    3. then PO dozy if male; add OCP (Brenda or Yaz) / spiro if female or oral abx.
    4. THEN refer after 12 week trial.
  3. ​if inflam mainly w papules and pustules
    1. topical clinda/BP
    2. then po doxy/cocp/spiro
  4. inflammatory
    1. mild: topica clinda
    2. mod inflam +/- commedomal: po doxy/topical retinoid +/ COCP
  5. non pharam
    1. avoid
      1. oil based moisturisers
      2. hot/humid environment
      3. makeup/grease
    2. low irritant soap free cleanser.
    3. dont squeeze/pick as scarring.
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2
Q
A

Periorifacial dermatitis

  • ddx seb K, rosacea, dermatitis,a cne.
  • itchy/tender/scaly/papular aroudn eyes, moth nose.
  • spares skin at top of lip and nasolabial fold
  • RF:
    • female, ICS/topical CS worsen, not washing face, cosmetics
  • Mx
    • stop trigger, slow wean steroids.
    • then consider PO doxy OD 8 / 52. vs. metro cream 0.75% 4-6 weeks
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3
Q
A

​Rosacea

  • forehead, chin, cheek, nose.
  • telangiectasia/ papules / flushing
  • RF:
    • celtic skin. 30-60 yo
  • worse w sun/flushing/steroids
  • Mx
    • minimise flushing/etOH
    • avoid steroids
    • soap free cleanser.
    • metro 0.75% gel BD 6 weeks vs. doxy
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4
Q

Hydradenitis suppuritvia

A
  • discharging sinus, recurrent, in apocrine gland
  • RF: obesity, DM, pilonidal sinus, FHx , IBD
  • Mx:
    • non pharma
      • dont squeeze!
      • weight loss
      • dont swab or remove/I+D as it scars and doesnt heal
      • loose clothing
      • healthy diet
    • Med:
      • doxy
      • BP wash, topical clinda.
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5
Q
A

ANNULAR

  • discoid lupus (cutaneous SLE)
  • large, red , scaley, annular plaque.
  • sun exposed areas + sun sensitive
  • spares knuckles and nasolabial folds
  • facial usually
  • malar butterfly rash
  • scarring baldness
  • RF
    • womn, 20-50, Fhx of same
  • non pharma
    • sun protection, smoking cessation
  • pharma
    • biopsy/diagnose
    • mometasone 0.1%
    • watch - might change over to SLE
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6
Q
A

Numular /discoid eczema

  • evolves quickly, clear edge. intense itch. no central clearing like (CLE/tinea). asymmetrical (psoriasis is symm). dry/scaley often. can be exudative
  • RF: atopy
  • Non pharma
    • low irritant, emollient, reduce friction, reduce stress,
  • pharma
    • sedating antihistmaine nocte
    • betamet .1% 2/52.
    • of not worked then 0.05% stronger.
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7
Q
A

Granuloma annulare

  • annular rash
  • central clearing
  • painful
  • on hands/fingers dorsal
  • RF: autoimmune. lymphoma. HIV. female.
  • Mx:
    • can seolf reolve over months.
    • betamet 0.05% BD for 4-6 weeks
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8
Q
A

pityriasis rosea

  • herald patch, then 2 weeks later:
    • rash all over trunk + extends outwards like a christmas tree
    • salmon
    • macular
    • follows langhers lines
  • preceeding viral infection (HHV 6)
  • non pharma
    • self resolved
  • pharma
    • if itchy: betametason.
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9
Q

Types

  • erythrodermic: red scaly eruption over body–> ED
  • guttate: GAS related, tear drops, 2-3 weeks psot infection.
  • plque psoriasis / scalp
A
  • silver scale, annular, all over body, symmetrical, well demarkated
  • can hve nail involvements (pitting, onycholysis, ridges) then more likely to have joint involvement also.
  • can also have in scalp (tinea willc ause hair loss, psoriasis wont)
  • Mx:
    • non pharma
      • stress management, weight loss, reduce flares (etOH/overweight)
      • avoid NSAIDS
      • thick emollients to prevent cracking
      • other trigger: HIV, lithium, FHx.
      • medication review.
    • pharma
      • nocte tar solution (LPC 6%) +/- salicylic acid/urea (3%) to remove scale
      • then mane steroid cream if required, gently wean down
        • momet 0.1% lotion. for scalp + tar shampoo
        • elsewhere: momet 0.1% 2-6 weeks. then betamet 0,05% OVI if not helped
      • and consider derm. for DMARD
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10
Q

eczema

A
  • RF: Atopy/fhx, new trigger
  • OE
    • Extensor surfaces as infant, then older goes to flexor.
    • Itchy, Scaley/dry., Lichenified, rapidly evolving erhteymatous rash
  • Rx:
    • NON PHARMA
      • Moisturise – ointment, vs. lotion. Vs. cream
      • Oat baths / Bath oil
          • bathe less frequently w only luke warm water.
        • Soap free clenser.
      • Moisturise as soon as shower + regularly through day
      • Low irritatnt/avoid triggers/low irritatnt substances
    • PHARM
      • Face: hydrocort 1%
      • Arms:/other: mometasone 0.1%
      • Anything stronger: methylpred for face; betamethasone disproproatonate 0.05%
      • Consider wet wraps – steroid/moisturie/wet wrap w cotton gloves
      • Nocte antihistmianes for itch.
    • Ongoing : derm for phototherapy/picremolius/mtx/etc.
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11
Q

Hair loss

A
  • tinea = black dot/snapped, green on wood lamp, pull out easily.
  • lupus = scarring hair loss, erythema + scaling
  • trichtillomania = diff length hairs, frontopareital.
  • male pattern= thinning, vellous area. genetic.
    • Rx w hair piece/trial topical minoxidil foam / finasteride
  • telegon effluvium = stress/iatrogenic. regrowth at edges.
  • anagen effluvium = CTx/drug related.
  • alopecia areata = localised bald patch, completely abscent, exclamation mark hairs. nail pitting = bad prognosis
  • scarring alopecia = often w out follicular orifice , very smooth w dermatoscope
  • seb derm = patchy scale + itch w erthema. localised temporal hair loss.
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12
Q

ridging of nails

A
  • chronic paronychia
  • beaus lines (transverse)
  • vertical + fine = aging.
  • lichen planus = concave ridging , split distally
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13
Q

pitting of nails

A

psoriasis

pompholyx

alopecia arreata

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14
Q

leuconychia

A
  • fungal dermatophytic
  • whole nail = DM, iron def, CLF, CKD, protein malabsorption
  • truama
  • CT
  • lead
  • arsenic
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15
Q

onycholysis

A

keep nails short

avoid inserting anythign underneath

keep dry

sap free

?candida: fluconazole 150mg OD for 3/12.

if green: pseudo: BD vinegar soaks.

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16
Q

new skin lesion

A

3 rules

1) asymmetrical size or colour
2) abnormal network (lace is thicker than the holes)
3) regression - white/blue

  • Appearance
  • Border
  • Colour
  • Diameter
  • Elevation
17
Q

SCC

A
  • Sx: slow growth, central ulceration , sometimes itchy
  • OE:nasty looking scab… always check localised LN/hepatosplenomegaly
  • Rx: excisional biopsy. good margin 4mm.
18
Q
A

Superficial BCC

DDx IEC

usually younger female pt.

purpley/red/few CM, sometimes plaquey with microerosiosn (red dose).

Rx: cryo, aldara (5 cdays a week, 6 weks), vs. curette/cauterise. vs. excise.

19
Q
A

Nodular BCC

  • always check eye lids and around face. gradual growth, sometimes itchy
  • usually older than IEC presentations
  • pearly, nodular, fine telangiectasisa
  • can also have central ulcration.
  • Rx: excise.
20
Q
A
  • AK
  • immunodef, or sundamaged skin when older.
  • occupational RF also
  • scalp/feet/hands/forehead.
  • flat/ scaley plque, sometimes warty or ertyehmatous base.
  • cryo: if thin: single for 5 seconds. then observation
  • if thick: currette/phototherapy.
  • field Rx: aldara 3-4 weeks; vs. BD effudix 2-4 weeks

predisposes to squamous cell carcinoma

21
Q

IEC

A

slowly growing plaque

often of LL

ddx superficial BCC. sometimes see coiled blood vessels ond ermatoscopy.

Rx:

  1. effudix - BD 4-6 weeks
  2. aldara - 3-5 times/week up to 6 weeks
  3. cryo - can ulcer quite badly
  4. excise
  5. phototherapy
22
Q

Actinitic chelitis

A

RF: smoker, HPV, etOH, immunosup, sun

chronic dry patch on lip

patchy, thickenning, dryness diffusely or localised.

Mx: cryo, EC, laser.

can predispose to Sqcc/iec.

23
Q
A
  • Lichen simplex chronicus
  • chronic itching, often associated w a separate initiatl condition
  • thickenning, intensely itchy, dry w excoration marks
  • Ix: clinical, biopsy if any concerns (IEC).
  • Rx:
    • mometason 0.1% ointment BD until clear, can occlude it also a few hours
    • betamet 0.05% OPV +/- occlusion.
    • if severe itch: TCA, injectable steroid.
  • non pharma:
    • solicylic acid/LPC if lichenified
    • emollient
24
Q
A
  • asteatotic eczema
  • dry/old
  • Rx: moisturise!
    • dont over bathe
    • no soap
    • thick emollient a few times/day.
    • if inflammed: mild steroid like methylpred.
25
Q

Pityriasis

A
  1. rosea
    1. post viral
    2. herald patch
    3. betamet for itch
  2. versicolour
    1. atsi
    2. fungal
    3. green under woods lamp
    4. rx w ketaconazole shampoo +/- fluconazole PO (not much evdience in kids)
  3. alba
    1. hypopigmented, facial often in excema prone child
    2. moistuurise, mild steroid
    3. avoid sun
26
Q

facial rash

A
  1. dermatomyositis
    1. includes nasolabial folds
    2. helical rash
  2. rosacea
    1. flushing, nasal
  3. seb derm
    1. includes nsolabial folds
    2. rx: topcal (miconazole / hydrocort); scalp (ketoconazole shampoo, momet lotion).. if thick lpc/urea nocte
  4. periorifacial derm
    1. includes nasolabial fold
    2. spares vermillion border
    3. worse w steroid.
  5. cutaneous lupus (discoid)
    1. spares nasolabial folds
    2. malar /butterfly
27
Q
A
  • lichen planus
  • RF: HCV/HIV
    • genetic
    • vzv
  • can cause baldness, itchy ++ nail ridging also.
  • white lines on it – > striae on purple/violet background
  • Rx:
    • biopsy to exclude IEC usually.
    • betamet 0.1%, topical retinoid.
    • can self resolve by 6-9 months but often will be too itchy.
28
Q

1/6

measles

A

viral, fever often w cough

2-3 days later koplik (white spots)

1-2 days after that, rash morbiliform. macular. confluent in regions. not itchy.

rash goes from ears / face to elsehwere

Ix: swabs/bloods. public health notification

complciations ++

cnojunctivitis, pneumonitis. myocarditis, thrombocytopenia, bleeding. GN, seizures/ecephalisit.

pregnancy risK; preterm labour.

29
Q

2/6

rubella

A
  • viral illness, mild. or asymptomatic
  • rash
  • more pink in colour
  • face then body.
  • assocaited lymphadenopathy: occipital/periauricaulr
  • complications
    • bad for pregnacy
      • blind/deaf/fetal loss/stillbirth
      • encephalitis
30
Q

3/6

kawasaki

A

need 4/5 + fever > 5 days

  1. conjunctivitis (limbic sparing)
  2. polymorphous erythematuos rash within first few days - TRUNKAL
  3. strawberry tongue/dry cracked bleedign lips
  4. hyperaemia + painful oedema hands/feed + desquamatous in 2nd week
  5. lymphadenopathy

baseline bloods / hospital + but also assess CRP, ESR, BC looking for aneamia/thrombocytosis. can get anuerysms… so ECG

  • IVIg for Rx. aspirin. specialists
31
Q

4/6

roseola infantum

A
  • HV6.
  • mildly unwell
  • often high temp w URTI Sx, then fever and as it resolved –> morbiliform rash on trunk. pniky. soemtimes haloey. non itchy.
  • febrile convulsion SFX.
  • self resolved. viral
32
Q

5/6

chicken pox

A

you know this.

mums: bad if mum not immune

if not immune: exposure means hospital, IVIg.

33
Q

6/6

A

parvovirus

  • i.e. erythema infectiosum, aka slapped cheek.
  • prodrome, non specific
  • day 1-3 slapped cheeck
    • after day 7 then get maculopapular rash on proximal arms/trunk; central clearing, lace like pattrn (reticular)
    • worse w temp/friction/heat
  • rash will then come and go for months
  • pregnant exposure: PCR + bloods
    • risk: severe anaemia, hydrops fetalis, miscarriage.
    • worse damage at < 20 weeks more risk.
    • exposure: 1: 100 fetal loss. death from hydrops 1/1000.
    • infection: 1/20 fetal loss. death from hydrops 1/100
34
Q

erythema…

A
  1. infectiosum
    1. slapped cheek
  2. nodosum
    1. IBD/pregnancy/mycoplasma/sarcoid/nsaisd, chlaydia. COCP/GAS/female: tender, palpable, LL lumbs
  3. multiforme (pic)
    1. HSV. get target lesions. symmetrical
    2. rapidly develops, 100s of lesios in 24 hours.
    3. kobner phenomenon + itchy
    4. self resolves. Rx trigger.
  4. toxicum neonatum
    1. day 4-14 comm . face then truk. comes and goes. common in 50% of kids. no Rx required.
35
Q
A

HSP

RF: GAS preceeding

Sx: unwell, URTI, abdo pain, arthritis, haemturia, palpable purapura.

OE: palpable purapura.

Mx: pain manaegment. monitor weekly. weekly 1/12 UA + BP first month; then fortnightly to 3 months, then 6 monthly/12 monthly.

complications: CKD, intersucceptoin, orchitis.

36
Q

dermatomyositis

A
  • muscle weakness
  • cutenaous eruptions
  • helical mask type erythema
  • papules on dorsal on IPJ
  • sun exposed erythema.

urgent Derm review.

37
Q
A

kaposi sarcoma

  • associated conditions to watch out for: HIV, Herpes virus, immunodef. DM.
  • sometimes just genetic (mediteranian / mid european descent).
  • can also be on MM, not just on foot. painless.
  • Dx: biopsy
  • Rx: not curable. cosemitc Rx only. can go RTx etc. if they dont improve/reoccur.
38
Q

axillae rash

A
  1. acanthosis nigricans (DM/obesity, ddx gastric adenocarinoma)
  2. erythrasma - often also in groinb/etween toes. well defined edge. DM associated, or excessive sweating/immune issues. self limiting, only Rx if not self resolving/superimposed coinfection: clinda, BP, Salicylic acid.
  3. nfmatosis: crow sign (freckling of underarms). also see lots of neurofibromas, > 6 cafe au lait spots, and lische nodusel of the iris.
  4. intetrigo (candidal)
  5. tinea.

EXAM 2021 (10 decks)

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