Derm - Inflammatory skin conditions Flashcards
Describe the clinical features seen in chronic plaque psoriasis.
- symmetrical, well-demarcated erythematous plaques with overlying silvery scale
- located on extensor surfaces + scalp + sacrum + navel
- may be pruritic or painful
- Auspitz sign (capillary bleeding on gentle removal of scale)
- +/- nail signs e.g. pitting, onycholysis
How would you manage someone presenting with a flare-up of psoriasis?
- emollients
Mild-moderate:
2. topical mild-moderate corticosteroid e.g. HYDROCORTISONE 2.5% or EUMOVATE
PLUS
topical vitamin D analogue e.g. CALCIPOTRIOL
OR
combined preparation e.g. Dovobet, Enstilar
Severe - refer to dermatology for:
- phototherapy (UVA + psoralen or narrow-band UVB)
- METHOTREXATE OR oral retinoid e.g. ACITRETIN OR APREMILAST (PDE-4 inhibitor)
- CICLOSPORIN
- biologics e.g. ADALIMUMAB or INFLIXIMAB IV
A 17yo boy presents with widespread scaly erythematous plaques (<1cm) on his back. He recalls a throat infection a couple of weeks ago.
What is the likely diagnosis? What are the Mx options?
Guttate psoriasis
Mx
- conservative e.g. emollients + reassurance that lesions usually self-resolving within 3-4/12
- phototherapy
- methotrexate or acitretin
- ciclosporin
Suggest possible side effects of phototherapy
- red sore skin (sunburn)
- skin dryness
- folliculitis
- worsened skin disease
- premature skin ageing
- skin cancer
Suggest possible side effects of calcipotriol
- skin burning
- dermatitis
- erythema
- itching
- paraesthesia
- photosensitivity
Suggest possible side effects of methotrexate
- teratogenic
- GI problems
- mouth ulcers
- liver + lung fibrosis
- BM suppression
Describe the different skin lesions that may be seen in acne vulgaris.
- open + closed comedones
- papules + pustules
- nodules + cysts
- scarring
How would you treat someone presenting with mild acne?
- topical retinoid e.g. ADAPALENE, ISOTRETINOIN
2. AZELAIC ACID
How would you treat someone presenting with mild-moderate acne but with pustules/cysts?
- ADAPALENE+ BENZOYL PEROXIDE (EpiDuo)
- CLINDAMYCIN + BENZOYL PEROXIDE (Duac)
- topical agent + 3/12 oral Abx
- tetracyclines e.g. LYMECYCLINE, DOXYCYCLINE (CI in pregnancy and children <12 due to yellow teeth)
- macrolides e.g. ERYTHROMYCIN, CLARITHROMYCIN (P. acnes resistance)
- TRIMETHOPRIM (P. acnes resistance)
What are the treatment options for someone presenting with severe acne?
Topical agent +
- Dianette COCP if woman
- ISOTRETINOIN PO
- high dose Abx
- short course oral steroids
Suggest possible side-effects of oral isotretinoin.
- teratogenic (must be on 2 forms of contraception)
- mucocutaneous reaction (dry skin, lips + eyes)
- fragile skin
- increased risk infection + slower wound healing
- photosensitivity
- raised LFTs/cholesterol
- myalgia
- lack of concentration, depression +/- self-harm, suicidal ideation
A 60yo woman presents with central facial erythema + telangiectasia + papules/nodules.
What is the likely diagnosis? What are the treatment options?
Acne rosacea
1. topical METRONIDAZOLE gel/cream
topical AZELAIC ACID
2. oral TETRACYCLINE 4/12
3. oral ISOTRETINOIN
4. +/- laser therapy (telangiectasia) or surgery (rhinophyma)
A 16yo boy presents with multiple widespread scaly erythematous lesions <1cm diameter on trunk + proximal limbs. He recalls a larger path on his abdomen appearing first.
What is likely diagnosis + how would you manage?
PITYRIASIS ROSEA
Mx
- none usually required (self-limiting within 2-3/12)
- if pruritis: emollients, hydrocortisone 1% cream and/or antihistamine
