Derm Cases Flashcards
History
Onset and duration
Evolution of skin lesions
Symptoms = severity, impact on QoL
Focuses systems review
Skin cancer risk factors
PMHx (and dermatological)
Medications (including OTC/herbal)
Examinations
Be systematic
- patient consent
- undress down to underweaer
- patient sanding in a well-lit warm room
- examine whole skin surface
- nails, hair, scalp, buccal mucosa and genitals where appropriate
- palpate normal skin and lesions
Describing skin rashes
Focus on the smallest unit FIRST e.g. vesicle (primary lesions)
Multiple hyper pigmented patches in upper back with some patches coalescing in the middle
Hyperpigmented
distributed in the upper back
40 yo man started on new antibiotic for suspected cellulitis. 2 days later he developed a widespread itchy rash
papulomacular erythematous rash in the upper chest, neck and lower chin
morbilliform (measles-like) rash
Drug rashes
Commonest
- morbilliform, ‘maculopapular drug rash referral’
- urticaria
Rarer, more serious
- DRESS (Drug reaction with eosinophilic and systemic involvement)
- SJS/TEN
- AGEP (acute generalised exanthemous pustulosis)
- Fixed drug eruption
- Photosensitivity
- Vasculitic
- Many more
SJS vs TEN
10% is SJS
30% is TEN
10-30% SJS/TEN
SJS/TEN Mx
STOP DRUG!
Sx tx
- soap substitute
- emollient
- topical steroids (e.g. betnovate, eumovate for itchy and annoying skin)
+/- PO steroids
systemic = ciclosporin, methotrexate, infliximab
closely monitor = deranged fluids, temperature and electrolytes
urticaria
SJS/TEN
mucosal involvement
Nikolsky positive (also seen in bullies pemphigoid, acne vulgaris) = If the test result is positive, the very thin top layer of skin will shear off, leaving skin pink and moist, and usually very tender. A positive result is usually a sign of a blistering skin condition. People with a positive sign have loose skin that slips free from the underlying layers when rubbed.
eye → keratitis → cornea affected (contact/refer to ophthalmology)
What is DRESS Syndrome
Drug Reaction with Eosiniophilia and Systemic Symptoms
Common culprits: allopurinol, anti-epileptic medications, abx
Clinical findings:
- high fever
- morbilliform eruption
- haematological abnormalities
- lymphadenopathy
- systemic involvement = hepatitis, myocarditis, encephalitis, gastroenteritis, pancreatitis, myositis, uveitis
erythema multiform
65 year old man with a lesion on his face
pearly telengiectasia umbilicated nodule on right side of nose bridge
BCC
mx = non-melanolytic skin cancer (BCC/SCC) → white margin excision aka 4-6mm
Mohs excision is 2mm
topical, surgical (curettage, excision), Mohs, radiotherapy
BCC vs SCC
SCC = can ulcerate, hyperkeratotic, grows faster (develops over months rather than a year)
Psoriasis
Guttate psoriasis
Chronic inflammatory skin conditions
Types:
- guttate
- chronic plaque psoriasis
- palmoplantar
- pustular
- erythrodermic
- seborrheic
psoriasis mx
Psoriasis features
eczema herpeticum
eczema herpeticum ix and mx
bullous pemphigoid
bullous pemphigoid vs pemphigus vulgaris
bullous pemphigoid usually in older people
topical
- soap substitute and emollients
- prevent secondary infection
- potent steroids (clobetasol propinate)
oral
- prednisolone
- doxycycline
- MMF
Pemphigus vulgaris
erythroderma
steroid potency ladder
