Derma Flashcards
Management of impetigo
- limited, localised non bulbous disease
- extensive non bulbous or bulbous impetigo
- limited =
hydrogen peroxide cream 1% - 1st line (antiseptic)
Fusiliers acid 2% or umpire in - 2nd line (antibiotic)
Extensive =
Oral flucloxacillin
Oral erythromycin - if allergic to penicillin
Children excluded from school until lesions are crusted and healed or 48 hrs after start of antibiotic treatment
Bulbous impetigo
Organism
Impetigo - fluid filled blisters >1cm
Staph aureus
*non bulbous impetigo more common
Treatment of eczema herpeticum
Acyclovir
Painful rash associated with fever + hx of eczema
Impetigo vs HSV
HSV = recurrent cold sores, prodromal pain , clear fluid vesicles
ADULTS
Impetigo - children
Acne rosacea
Nose cheeks foreheads Flushing esp after alcohol or sunlight Later develops - persistent erythema w/ papules + pustules If eyes involved - blepharitis Rhinophyma - nose disfigurement
Treatment acne rosacea
Topical metronidazole - mild sx
More severe disease - oxytetracycline, tetracycline (systemic ABx )
Treatment tinea capitis
Complication of tinea capitis
Oral terbinafine , itraconazole, fluconazole
Systemic antifungal because of risk of scarring
Children — Griseofulvin
Comp - alopecia
What dermatological condition is linked to coeliac disease
Dermatitis herpetiformis
- severely itchy rash over scalp sacrum elbows knees in pt wt/ coeliac disease
Indications of IM adrenaline (6)
Wheeze, SOB, hoarseness of voice
Stridor, shock, swelling (facial tongue cheek)
Skin disorders of pregnancy
Polymorphic eruption of pregnancy (PEP)
= PUPP - pruritic urticaria papules and plaques of pregnancy
Pemphigoid gestationis
Polymorphic eruption of pregnancy (PEP)
= PUPP - pruritic urticaria papules and plaques of pregnancy
Features
Management
Itchy urticaria like rash , usually in 3rd trimester , primi
1st appear as abdominal striae, no blisters and spare umbilicus
Emollients
Mild topical steroids
Oral steroids
Pemphigoid gestationis
Features
Treatment
Pruritic blistering lesions
Periumbilical - spread to trunk, back , buttocks , arms
2-3 trimester - rarely seen in 1st
Tx - oral corticosteroids
Erythema multiforme
Causes
Common site
Site - back of hands, feet - spreads to trunk
Cause =
Virus - HSV - most common
Idiopathic
Bacteria - mycoplasma pneumonia , streptococcus
Drugs - penicillin , sulphonamide, carbamazepine, NSAIDs allopurinol COCP
Connective tissue disease - SLE
Sarcoidosis
Malignancy
Treatment of erythema multiforme
Symptomatic
Oral antihistamines, analgesics
Local skin care and mouthwash - warm saline/xylocaine/diphenhydramine, kaopectate
Consider topical steroids
History of camping w/ target lesions
Lyme disease
Erythema migrants
Pink rings, non itchy , barely raised
Seen in rheumatic fever
Erythema marginatum - part of jones major criteria
Erythema nodosum seen in
Painful tender nodules on shins
IBD - UC,CD
Penicillin
Sarcoidosis
TB
Erythema infectiosum / slapped cheek
Treatment
Parvovirus B 19
Rest + analgesia
Chronic infrared radiation exposure (heat)
Causes what skin manifestation
Erythema Ab Igne
Rashes on flexor surfaces
Lichen planus - not contagious
Scariest - contagious
Contagious skin conditions
Scabies
Molluscum contagiosum
Impetigo - very!
Management of Mongolian blue spot
Dermal Melanosis
Reassure
Fades with time (few years)
Xanthelasma
Management
Occur w/ or w/o hyperlipidemia
Check fasting lipid levels
If hyperlipidemic - formally assess CVD risk
Lesions can be left alone
Refer private clinic if removal
Acne vulgaris
Colonising organism
Treatment
Obstruction of pilosebaceous follicle
Proprionibacterium (anaerobic)
T - topical benzoyl peroxide - reduces resistant proprioni in its on antibiotics
Acne management
- Single topical therapy - retinoids , benzoyl peroxide
- Combo therapy - topical ABx, benzoyl, retinoids
- Oral ABx - tetracycline ,doxy , “cyclines”
Oral isotretinoin - under supervision
Avoid tetra in pregnancy and <12 - use erythromycin in pregnancy
Retinoids CI pregnancy
Alternative sin acne treatment in pregnant women
COCPs ( alt to ABx)+ topical agents
Or
Gram negative folliculitis as complication of long term ABx use in acne
How do you treat?
High dose oral trimethoprim
Side effects of oral isotretinoin
Isotretinoin = 13 cis retinoids acid
Dry eyes, mouth , nose
Nose bleeds
Red circular itchy rash
Ringworm likely = dermatophytosis
Tx - clotrimazole cram
Linear tracks on skin (burrows) + severe itching on flexures of skin
Wrist finger webs , elbow, axillary, genitalia
Tx
Scabies
1st line - topical permethrin 5%
2nd line - malathion .5%
Hint = elderly in nursing home
Treat all family members even if asymptomatic
Rash after URTI
- pityriasis rosea
-Guttate psoriasis
Both resolve spontaneously
Guttate psoriasis
Classically preceded by strept throat infection 2-4 weeks prior
Tear drop scaly papules on trunk and limbs
Resolve spontaneously w/in 2-3 months
Or use topical psoarisis agents
Pityriasis rosea
Features
Treatment
Recent resp infection
Herald patch 1-2 weeks later - slightly raised oval lesions w/ fine scale confined to outer aspect
Characteristic distribution - parallel to lager lines - fir tree appearance
Resolves in 6 weeks
Non sedating antihistamines
Cetrizine loratidine
sedating antihistamines
Chlorpheniramine
Management of lipoma
Reassure
If doubts about liposarcoma - size >5 cm , increased size, painful or in a deep anatomical location - do US
If US suspicious- MRI +/- surgical removal
Ritters/Lyell disease
Organism -
Cause
= staphylococcal scalded skin syndrome (SSSS)
Caused by release of 2 exotoxins
-epidermolytic toxins A &B from toxigenix strains of staph aureus
Ritter/Lyell - when it happens in infants / newborns
SSSS - children < 5
Signs and symptoms of SSSS
Fever, irritability
Widespread redness
Fluid filled blisters within 24-48 hrs - rupture easily
Nilosky sign +ve (gentle strokes of skin = exfoliation)
Dx of SSSS
Tx
Tzanck smear
Skin biopsy = intraepidermal cleavage at granular layer
Bacterial culture
Tx - hospitalisation
IV flucloxacillin and supportive treatment
Recovery writhing 5-7 of treatment
Bullous pemphigoid
Cause
Common in
Features
Autoimmune - 2ry to development of antibodies against BP180 BP 230
Elderly >60
Blisters around dlexures, mouth spared
Heal w/o scarring
Bullous pemphigoid
Investigation
Treatment
Skin biopsy - immunofluorescence = igG and C3 at dermoepidermal jn
Tx - oral corticosteroids
Refer to derma for biopsy and confirmation
2ry infection can occur causing delirium
Paronychia/ whitlow
Organism
Treatment
Staph aureus
Topical fusidic acid - minor
Oral flucloxacillin / clarithromycin- severe (both considered 1st line)
Treatment of impetigo
Hydrogen peroxide - antiseptic = 1st line
2nd line - antibiotics - fucidic acid or mupirocin
Extensive impetigo - oral flucloxacillin
Herald patch
The biggest lesion in Pityriasis rosea
