Derm Y2 Flashcards
Shingles
Due to: Varicella ZOSTER virus
Presents:
- Neuralgic “tingly” pain greater with age
- Erythema
- Common in elderly/ immunocompromised
- Dermatomal
If pain presents more than 4 weeks then it’s known as Post Herpetic neuralgia
Oral Aciclovir
VZV used in chickenpox vaccine can be used in elderly to reduce shingles risk by 36% and Post Herpetic neuralgia by 67%
Chickenpox
Due to: VARICELLA zoster virus
Presents:
- Generalised rash and fever
- Sensory nerve roots
Supportive
Live attenuated vaccine is available for chickenpox (not widely used in UK)
Neonatal VZV
Secondary to chickenpox in mother in a late pregnancy
Prevention with Varicella Zoster Immunoglobulin in susceptible women
Ramsay-Hunt Syndrome
Presents:
- pain in vesicles, auditory canal and throat
7th CN - facial pasly
8th CN- deafness, vertigo, tinnitus
Aciclovir
Herpes Simplex Type 1
Presents:
- Primary gingivostomatitis
- Pre-school children
- Extensive ulceration in and around mouth
- Lasts around a week
- 50% Genital herpes
MIld: Supportive
Severe: Aciclovir
Cold sore: Topical antiviral
Herpes Simplex Type 2
Presents:
- 50% Genital herpes - warts
- Some Gingivostomatitis
- Encephalitis (common in neonates)
Aciclovir <72hours
Human Papilloma Virus
Presents:
T1-4: Warts/ verrucas
T6 &11: Genital warts
T16 & 18: Cervical cancer
Gardasil vaccine: protects against T6, 11, 16; 18
Cervarix vaccine: protects against T16 & 18
Herpangina
Due to enterovirus (coxsackie and echovirus)
Presents:
- Blistering rash at the back of the mouth
Self-limiting
Rubella
Vaccination
Erythema infectiosum / “Slapped cheek disease”
Caused by: Erythrovirus (Parvovirus B19)
Child: crash on face, lacy rash on body
Adult: polyarthritis in joints/ hands, no rash
Self limiting
Reassure patient
Symptomatic relief with over-counter meds
Orf
Due to virus caught from sheep with scabby mouths (ikr wtf)
Presents:
- Firm, fleshy nodule on hand of farmer
Self-limiting
Syphilis
Due to: bacterium Treponema pallidum
Presents:
Primary- Chancre (painless ulcer) at infection site
Secondary- red rash over body especially palms and soles, mucous membrane “snail track” ulcers
Tertiary: CNS, Cardiovascular
Penicillin G injections
Lyme disease
Due to: Borrelia burgdorferi from ticks
Presents:
Early- erythema migrans
Late- heart block, nerve palsies, arthritis
Amoxicillin or Doxycycline
Scabies
Caused by “Sarcoptes scabiei”
Chronic crusted form is termed “Norwegian Scabies” adn is highly infectious.
Associated with an intensely itchy rash affecting finger-webs, wrists and genital area
Malathion lotion Benzyl benzoate (avoid in children)
Erythropoietic protoporphyria
6 monthly LFTs and RBC porphyrins
Photoprotection measures
- Prophylactic TL-01 phototherapy
- Anti-oxidants: beta-carotene, cysteine, high dose Vitamin C
- Avoid iron
If leads to liver failure:
- oral charcoal
- cholestyramine
- ALA synthase inhibition
Prophyria cutanea tarda
Presents as: Blisters, fragility Hyperpigmentation Hypertrichosis Solar urticaria Morphoea
Treat underlying disease:
- Alcohol
- Viral Hepatitis
- Oestrogens
- Haemochromatosis
Not doing this will lead to risk of liver cirrhosis/ hepatoma
Atopic Eczema
- Emollients
- Topical steroid (hydrocortisone)
- Phototherapy UVB
- Systemic Immunosuppressants
- Biologics
Treat infections as necessary
Avoid irritants
Pruritus (itching)
- Sedative Anti-histamines
- Emollients: Menthol (Dermacool), Capsaicin, Camphor, Phenol, Crotamiton (Eurax cream)
- Antidepressants, e.g. doxepin
- Phototherapy
- Opiate antagonists, ondansetron
- Treat underlying disease
Dry skin
Moisturising agents
Viral Warts / verrucas
Self limiting Keratolytic agents (salicylic acid) Formaldehyde Glutaraldehyde Silver nitrate Cryotherapy (liquid nitrogen)
Anaphylaxis
Adults: 300µg adrenaline
Children: 150µg adrenaline
Contact dermatitis
A non-immunological process where contact with agents that abrade, irritate and traumatize skin directly.
Examples:
- Nickel in belt buckle
- Latex/ thiuram in rubber gloves
- Colophony in elastoplast
- Fragrance in deodorants
- Chromate in footwear
- Garlic
- PPD in black henna tattoo
- Diethylthiourea in wrist splint
- Dermabond surgical glue
- English Ivy
- Golden fillings etc
- Nappy rash
- Licking lips
Remove the irritant
Lichen Planus (non-infective inflammatory dermatoses)
Mild: Topical corticosteroid (potent/ very potent)
Severe: Oral steroids
Keloid scars
Topical corticosteroid
Eczema Herpeticulum
Oral antiviral
Candida intertrigo (infection)
Nystatin (oral)
Clotrimazole cream
Oral fluconazole
Hyperkeratotic Eczema
Keratolytic agents (salicylic acid)
Keratin plaques
Usually found in scalp
Keratolytic agents (salicylic acid)
Genital warts
Podophyllin
Necrotising fasciitis
Surgical Debridement
Lice (pediculosis)
Otherwise known as “Vagabond’s Disease”
Pediculus capitis (head louse) Pediculus corporis (body louse) Phthirus pubis (pubic louse)
Associated with an intense itch
Malathion lotion
Erythema multiforme
Caused by:
Herpes simplex virus
Mycoplasma pneumoniae bacterium
Many triggers including drug reactions and some infections
Treat underlying cause
Molluscum contagiosum
Presentation:
Fleshy, firm, umbilicated, pearlescent nodules
1 to 2 mm diameter
Self-limiting but take months to disappear
Common in children
Can also be sexually transmitted
Self-limiting
Treat underlying cause
Cryotherapy (Liquid Nitrogen)
Herpangina
Blistering rash of back of mouth
Caused by: enterovirus (echovirus, coxsackie virus)
Self limiting
Hand, foot and mouth disease
Presentaion:
Typically children
Family outbreaks
Caused by enteroviruses (especially coxsackie virus)
Supportive
Zika Virus
Spread by mosquito Aedes aegypti
Presentation: Mild fever Rash (mostly maculopapular) Headaches Arthralgia Myalgia Non-purulent conjunctivitis
Supportive
No NSAIDS until Dengue fever is ruled out to reduce risk of haemorrhage
Dermatitis Herpetiformis
Rare
Autoimmune bullous disease
Strong association with coeliac disease
Presentation:
Intensely itchy lesions-symmetrical
Elbows, knees and buttocks-often excoriated
Hallmark is papillary dermal microabscesses
Dapsone (diaminodiphenyl sulfone)
Sulfapyridine
Treat underlying cause e.g. Gluten free diet
Rosacea
Red face (nose & cheeks)
Causes: Sunlight Alcohol Spicy foods Stress
Avoidance of alcohol/ spicy food/ hot temperatures
- Topical Metronidazole, Ivermectin (to reduce demodex mite)
- Oral tetracycline long term
Others:
Telangiectasia (vascular laser)
Rhinophyma (surgery/ laser shaving)
Avoid steroids!
Basal Cell Carcinoma (BCC)
Presentation: - very common - slow growing lump or non-healing ulcer - painless and often ignored - ‘pearly’ or translucent - visible, arborising blood vessels - central ulceration (“rodent ulcer”) - can present as scaly plaque ‘superficial’ - can be infiltrative ‘morphoeic’ - locally invasive, but rarely metastasize > 40 yrs, but can be 3rd or 4th decade
Surgical excision
Pemphigus Vulgaris
PemphiguS –
split more Superficial, intra-epidermal
Presentation:
- Typically affects scalp, face, axillae, groins
- Flaccid vesicles/bullae – thin roofed
- Lesions rupture to leave raw areas
- Increased infection risk
- Nikolsky sign positive
- Mucosal involvement (eyes, genitals)
Systemic steroids
Immunosuppressive agents
Aids: Emollients, topical steroids, topical antisepsic / hygiene measures
Squamous Cell Carcinoma (SCC)
Presentation:
- about 20% of all skin cancers
- hyperkeratotic (crusted) lump or ulcer
- arises on sun-damaged skin
- grows relatively fast, may be painful &/or bleed
- majority are well differentiated low risk
- minority are poorly differentiated high risk
- risk of metastasis about 5%
- poor prognosis once metastatic
- precursor lesions: actinic keratoses and Bowen’s disease (carcinoma-in-situ)
Surgical excision
Naevoid basal cell carcinoma (Gorlin’s syndrome)
Features:
- early onset/multiple BCCs
- palmar pits
- jaw cysts
- ectopic calcification
Oh jesus cut them out
Malignant Melanoma
Types:
- Superficial Spreading Melanoma (SSM)
- Acral/ mucosal lentiginous melanoma (A/MLM)
- Lentigo Maligna Melanoma (LMM)
- Nodular Melanoma
Features: Most common on sun-exposed sites scalp, face, neck, arm, trunk, leg Commoner in females (2:1) May arise at any site Rare in childhood Incidence peaks in middle-age
Surgical excision
SN biopsy is positive then do a lymphadenectomy
Venous Ulcer
- Control pain
- ABPI
- Non-adherent dressing
- De-sloughing agent if necessary eg hydrogel/ honey
- 4 layer compression bandaging – may need to increase compression gradually if pain a problem
- Leg elevation
Inflammatory Psoriasis
Emollients (diprobase)
Chronic plaque Psoriasis
Tried emoolients- didn’t work
- Calcitrol (Vit D analogue)
- Coal tar
- Dithranol
- Tazarutene (retinoid)
- Phototherapy UVB if topicals fail
Scalp Psoriasis
Emollients always
- Tar-based shampoo
- Salicylic acid (keratolytic)
- Potent topical steroid + Calcitrol (Vit D analogue)
Psoriasis on face, flexures, genitals
- Mild topical steroid (hydrocortisone 1%)
2. Calcitrol/ tacalcitrol for long term use
Severe + Resistant Psoriasis
- Acitretin
- Ciclosporin
- Methotrexate
all of these are teratogenic
c-Kit Melanoma mutation
Dasatimib
Imatinib
B-Raf Melanoma mutation
Vemurafenib
Dabrafenib
MEK Melanoma mutation
Trametinib
Melanoma treatment using T-cell activation to kill tumours
Ipilimumab
Tremelimumab
Pembrolizumab
Molluscum Contagiosum
Self-limiting
Erythema multiforme
Self-limiting
Potentially steroids if terribly severe but rare.
Acne
1st line: single topical therapy (topical retinoids, benzoyl peroxide)
2nd line: topical combination therapy (topical antibiotic, benzoyl peroxide, topical retinoid)
3rd line: oral antibiotics: e.g. Oxytetracycline, doxycycline, erythromycin if pregnant
4th line: Isotretinoin*
- Check bloods regularly
- Put on contraception
- Pregnancy test before starting
Bullous Pemphigoid
Large tense bullae
Systemic steroids
Immunosuppressive agents
Tetracycline
Aids: Emollients, topical steroids, topical antisepsic / hygiene measures
Tuberose Sclerosis
Rare genetic condition that causes development of benign tumours
No cure :(
Relieve symptoms
Neurofibromatosis Type 1
No cure
Reduce symptoms
Surgical removal of tumours
Chemotherapy for optic gliomas
Neurofibromatosis Type 2
No cure
Surgical removal of tumours
Schwannomatosis
No cure
Surgical removal of tumours
Bowen’s Disease
Bowen’s disease is a very early form of skin cancer that’s easily treatable. The main sign is a red, scaly patch on the skin. It affects the squamous cells – which are in the outermost layer of skin – and is sometimes referred to as squamous cell carcinoma in situ.
Photodynamic therapy
Cryotherapy
Chemotherapy
Leg ulcer
- Control pain
- Non-adherent dressing
- De-sloughing agent (hydrogel/ honey)
- 4 layer compression
- Elevate leg
Dermatophyte (fungal) infections
Tinea pedis etc…
Small areas of skin/nails:
- Clotrimazole (Canesten cream)
- Nail paint (amorolfine)
Extensive infections + scalp + nails:
- Terbinafine (oral)
- Itraconazole (oral)
Lichen planus
Potent topical steroids
Oral steroids
Epidermolysis Bullosa
None, most die in infancy ;(
Impetigo
Caused by: Staph aureus/ Strep pyogenes
1st: Topical fusidic acid
2nd: Oral flucloxacillin / topical retapamulin
Scarlet Fever
Penicillin
Hirtuism
Weight loss
Facial: topical eflornithine
Moderate-severe: co-cyprindiol (combined oral contraceptive)
