DERM - Random Conditions

Question 1

Acne Rosacea

Presentation
Aetiology
Diagnosis
Ocular Rosacea
Management

Answer 1

1. ) Presentation - affects centrofacial regions
   - cheeks, chin, nose, central forehead
   - flushing is often the first symptom
2. ) Aetiology - genetic and environmental risk factors:
   - ↑age, paler skin, UV radiation, heat or cold temp
   - smoking, alcohol, spicy food, stress, exercise
3. ) Diagnosis - 1 diagnostic or 2 major features
   - diagnostic: phymatous changes, persistent erythema
   - major: flushing erythema, papules/pustules, eye symptoms (ocular rosacea), telangiectasia
4. ) Ocular Rosacea - additional eye symptoms
   - discomfort, irritation, tearing, foreign body sensation
   - dryness, itching, photophobia, or blurred vision
   - conjunctivitis, blepharitis, keratitis, anterior uveitis
   - refer to ophthalmologist if serious eye complication
5. ) Management
   - self-care: avoid triggers, skincare, sun protection, etc.
   - mild sx: topical metronidazole
   - persistent erythema: topical brimonidine gel
   - papules/pustules: topical ivermectin or oral doxy
   - severe: oral oxytetracycline
   - laser therapy used for telangiectasia and rhinophyma

Question 2

3 types of fungal infections

Candida Albicans
Malassezia
Dermatophytes

Answer 2

1. ) Candida Albicans - yeast, commonly present as:
   - nappy rash, vulvovginal rash, oral candidiasis, candida intertrigo (skin folds)
2. ) Malassezia - basidiomycetous yeasts, presents as:
   - seborrhoeic dermatitis, steroid acne, malassezia folliculitis, pityriasis versicolor (vesicular rash)
3. ) Dermatophytes - fungi requiring keratin for growth
   - aka ringowrm infections, can spread via contact
   - tinea: capitis (scalp), barbae (hair), pedis (foot) cruris (groin), copora (everywhere else)

Question 3

Diagnosis and Management of Fungal Infections

Clinical Features
Onychomycosis
Self Care
Topical Treatments
Oral Treatments

Answer 3

1. ) Clinical Features - used to make diagnosis
   - scaly, itchy, slightly raised, erythematous
   - annular patches with central clearing
   - enlarge outwards, asymmetrical
2. ) Onychomycosis - nail infections
   - caused by dermatophytes, yeasts or moulds
   - clipping and scrapings are taken for M/C
   - increased prevalence with ↑age
3. ) Self Care
   - keep skin clean and wash daily, use own towel
   - dry between toes and skin folds, can use hair dryer
4. ) Topical Treatments - used for 1-2 wks after rash has cleared, can reoccur so repeated treatment needed
   - Whitfield ointment (acidic ointment)
   - antifungals: nystatin, clotrimazole, ketoconazole
   - antifungal shampoos for scalp conditions
5. ) Oral Treatments - used for hair, scalp, and nails
   - candida: nystatin, amphotericin B
   - dermatophyte: griseofulvin, terbinafine
   - both: itraconazole, fluconazole
   - nail infection: 1°terbinafine, 2°itraconzaole