DERM Flashcards
1
Q
Acne
A
- BOTH TYPES: benzyl peroxide 0.25-5%, 2nd daily then daily.
- if commedomal mainly –> topiacl retiond
- then increase retinoid strength (0.025-0.1%)
- then combo BP and retinoid
- then PO dozy if male; add OCP (Brenda or Yaz) / spiro if female or oral abx.
- THEN refer after 12 week trial.
- if inflam mainly w papules and pustules
- topical clinda/BP
- then po doxy/cocp/spiro
- inflammatory
- mild: topica clinda
- mod inflam +/- commedomal: po doxy/topical retinoid +/ COCP
- non pharam
- avoid
- oil based moisturisers
- hot/humid environment
- makeup/grease
- low irritant soap free cleanser.
- dont squeeze/pick as scarring.
- avoid
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
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
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.
- non pharma
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
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.
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
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.
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
- non pharma
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.
- NON PHARMA
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.
12
Q
ridging of nails
A
- chronic paronychia
- beaus lines (transverse)
- vertical + fine = aging.
- lichen planus = concave ridging , split distally
13
Q
pitting of nails
A
psoriasis
pompholyx
alopecia arreata
14
Q
leuconychia
A
- fungal dermatophytic
- whole nail = DM, iron def, CLF, CKD, protein malabsorption
- truama
- CT
- lead
- arsenic
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.
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:
- effudix - BD 4-6 weeks
- aldara - 3-5 times/week up to 6 weeks
- cryo - can ulcer quite badly
- excise
- 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
- rosea
- post viral
- herald patch
- betamet for itch
- versicolour
- atsi
- fungal
- green under woods lamp
- rx w ketaconazole shampoo +/- fluconazole PO (not much evdience in kids)
- alba
- hypopigmented, facial often in excema prone child
- moistuurise, mild steroid
- avoid sun
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.
30
Q
3/6
kawasaki
A
need 4/5 + fever > 5 days
- conjunctivitis (limbic sparing)
- polymorphous erythematuos rash within first few days - TRUNKAL
- strawberry tongue/dry cracked bleedign lips
- hyperaemia + painful oedema hands/feed + desquamatous in 2nd week
- lymphadenopathy
baseline bloods / hospital + but also assess CRP, ESR, BC looking for aneamia/thrombocytosis. can get anuerysms… so ECG
- IVIg for Rx. aspirin. specialists
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
- infectiosum
- slapped cheek
- nodosum
- IBD/pregnancy/mycoplasma/sarcoid/nsaisd, chlaydia. COCP/GAS/female: tender, palpable, LL lumbs
- multiforme (pic)
- HSV. get target lesions. symmetrical
- rapidly develops, 100s of lesios in 24 hours.
- kobner phenomenon + itchy
- self resolves. Rx trigger.
- toxicum neonatum
- 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.
