Dermatology 1 Flashcards
Acanthosis nigricans are associated with which conditions? (9)
T2DM
GI ca
Obesity
PCOS
Acromegaly
Cushing’s
Hypothyroidism
Prader Willi
COCP
Severe acne associated with systemic upset =
Mx (2)
Acne fulminans
Hospital admission and PO steroids
Classification of acne
Mild - comedones
Moderate - papules and pustules, widespread lesions
Severe nodules, pitting, scarring, extensive inflammatory lesions
Mild- moderate acne mx (4)
12 week course of OD in the evening
1. topical adapalene with topical benzoyl peroxide
OR
2. topical tretinoin with topical clinda
OR
3. topical benzoyl peroxide with topical clinda
OR
4. Topical bonzoyl peroxide as monotherapy if above is CI
Moderate to severe acne mx (6)
12 weeks course of
1. Top adapalene with benzoyl peroxide
OR
2. Top tretinoin with top clinda
OR
3. option 1 + PO lymecycline 408mg OR PO doxy 100mg OD
OR
4. Topical azelaic acid BD + PO lymecycline 408mg or PO dozy 100mg OD
OR
5. COCP
OR
6. Monotherapy benzylperoxide
Alternative abx of choice in acne treatment
If not lymecycline or doxy then consider trimethoprim or erythro
When to refer to a dermatologist for acne? (5)
- Nil response to two completed courses of treatment (mild-mod)
- Mod-severe
If has not responded to previous treatment with PO abx - Scarring
- Persistent pigmentary changes
- Psychological distress
How do you follow up a patient with acne?
If completely clear
If has only improved
FU 12 weeks after treatment
If completed cleared
- consider stopping abx but cont the topical treatment
If improved
- cont for a further 12 weeks
(Do not continue abx for more than six months)
Who should get maintenance therapy for acne?
How is it treated?
When do you review the maintenance therapy?
History of frequent relapse after treatment
Topc adapalene and benzoyl peroxide or topical monotherapy
Review again in 12 weeks
Tetracyclines should be avoided in? (3)
Why is minocycline avoided?
Pregnancy
Breastfeeding women
Children <12yo
Irreversible pigmentation
Mx of actinic keratoses (6)
- Fluorouracil cream (2-3 weeks) (skin will become red and inflamed)
- Topical HC to settle the inflammation
- Topical diclofenac
- Topical imiquimod
- Cryo
- Curretage
Localised, well demarcated patches of hair loss =
At the edge of hair loss what might you see?
Alopecia areata
Exclamation mark hairs
Alopecia areata mx (4)
Topical/ intralesional steroids
Topical minoxidil
Phototherapy
Dithranol
Examples of:
Sedating anti-histamine (1)
Non sedating (2)
Chlorpheniramine
Loratadine
Cetirizine (can cause drowsiness still however)
Side effects of aqueous cream
As a leave on emollient it can cause skin irritation
Can be used as a soap substitute
What can be used to treat athlete’s foot? (3)
Topical imidazole, undecenoate or terbinafine
Eczematous, itchy red rash in pregnancy =
Atopic eruption of pregnancy
Pearly, fleshy coloured papule with telangiectasia
May later ulcerate leaving a central crater =
Mx (2)
Basal cell carcinoma
Routine referral to derm
Surgery
Describe features of BCC (5)
Slow growing
Most common is nodular
Sun exposed sites
Pearly, flesh coloured
Central crater
Describe Bowen’s disease
Speed in growth
Location
Mx (3)
Red scaly patches
Slow growing
Sun exposed
Mx
1. topical 5-fluorouracil BD for 4/52 + topical steroids due to inflammation
2. Cryo
3. Excision
What drugs can cause bullous disorders? (2)
Barbiturates
Furosemide
Autoimmune condition
Itchy tense blisters around the flextures
No mucosal involvement (mouth is spared)
=
Bullous pemphigoid
bullous pemphigoid Mx (3)
Mx
1. Derm referral
2. Biopsy
3. PO steroids
Classic differentiating feature between pemphigoid and pemphigus
Pemphigoid = mucosal spared, tense blisters, itchy
Pemphigus = mucosal ulceration, flaccid, easily ruptured vesicles, not itchy
Mucosal ulceration
Autoimmune
Ashkenazi Jewish population
Flaccid easily ruptured vesicles
Not itchy
= which condition?
What is seen on biopsy?
Mx (2)
Pemphigus vulgaris
Acantholysis
Steroids + immunosuppressants
erythematous, papular lesions
firm red, blue, or purple papule
typically 1-3 mm in size
non-blanching
not found on the mucous membranes
more common in advancing age
=
Mx
Cherry angioma
Benign, no treatment
Painful nodule on the ear
Caused by persistent pressure on the ear
M>F
Increasing age
=
Chondrodermatitis nodularis helicis
How does allergic contact dermatitis usually present?
Usually caused by what?
What type of hypersensitivity is it?
Mx
Type IV
Acute weeping eczema affecting the margins of the hairline
Usually following hair dyes
Mx steroids (potent)
Rare psycho dermatological condition characterised by self inflicted skin lesions =
Dermatitis artefacta
Dermatitis herpetiformis is associated with which condition?
Location
Coeliac disease
Extensor surface, elbows, knees, buttocks
itchy, vesicular skin lesions on the extensor surfaces (e.g. elbows, knees, buttocks)
Coeliacs
Mx (2)
Dermatitis herpetiformis
Mx
1. Gluten free diet
2. Dapsone
solitary firm papule or nodule, typically on a limb
typically around 5-10mm in size
overlying skin dimples on pinching the lesion
Dermatofibroma
typically present as round or oval plaques on the extremities
the lesions are extremely itchy
central clearing may occur giving a similar appearance to tinea corporis
=
Discoid eczema
Eczema herpeticum is caused by
Seen in which age range?
Seen with which condition?
Presenting with?
Herpes simplex virus 1 or 2
Children
Atopic eczema
Rapidly progressing painful rash
seen in children with atopic eczema and often presents as a rapidly progressing painful rash.
monomorphic punched-out erosions (circular, depressed, ulcerated lesions) usually 1–3 mm in diameter are typically seen.
Mx
Eczema herpeticum
Admission + IV aciclovir
Burns
Heat mx
Electric mx
Chemical mx
- Within 20 mins irrigate with cool water for 10-30 minutes, cover with cling film in layers
- remove from source
- brush any powder off then irrigate with water
Classification of burns
Superficial
Partial thickness - superficial
Partial thickness - deep
Full thickness
Superficial/ first degree:
- red and painful
Partial thickness - superficial/ second
- pale pink, painful, blistered
Partial thickness - deep/ second
- white, but may have non-blanching erythema, reduced sensation
Full thickness - third degree
- white/ brown/ black, no pain
What percentage of burns requires IVF for children + adults
10%, 15%
Topical steroids by potency
Mild: Hydrocortisone
Mod: Betamethasone 0.025% (betnovate RD) + clobetasone 0.05% (eumovate)
Potent: Fluticasone (cutivate) + betamethasone 0.1% (betnovate)
Explain the finger tip rule
1 finger tip unit = 0.5g, sufficient to treat two flats of adult hands
Fingertip units
Hand and fingers front and back
A foot (all over)
Front of chest and abdomen
Hand and fingers front and back
1
A foot (all over)
2
Front of chest and abdomen
7
Fingertip units
Back and buttocks
Face and neck
An entire arm and hand
An entire leg and foot
Back and buttocks
7
Face and neck
2.5
An entire arm and hand
4
An entire leg and foot
8
Topical steroids that should be prescribed in grams for an adult for a single daily application for 2 weeks
Face and neck
Both hands
Scalp
Groin and genitalia
15-30g
Topical steroids that should be prescribed in grams for an adult for a single daily application for 2 weeks
Both arms
Both legs
Trunk
Both arms 30-60g
Both legs 100g
Trunk 100g
reticulated, erythematous patches with hyperpigmentation and telangiectasia. A typical history would be an elderly women who always sits next to an open fire
Erythema ab igne
Erythema ab igne is caused by over-exposure to?
If the cause is not treated it can lead to?
Infra-red exposure
Squamous cell skin ca
target lesions
initially seen on the back of the hands / feet before spreading to the torso
upper limbs are more commonly affected than the lower limbs
pruritus is occasionally seen and is usually mild
=
usually triggered by?
erythema multiforme
infections
Name five causes of erythema multiforme
Viruses (herpes simplex virus)
Bacteria e.g mycoplasma
SLE
Sarcoidosis
Malignancy
Name six medications that can cause erythema multiforme
Penicillin
Sulphonamides
Carbamezapine
Allopurinol
NSAIDs
COCP
inflammation of subcutaneous fat
typically causes tender, erythematous, nodular lesions
usually occurs over shins, may also occur elsewhere (e.g. forearms, thighs)
usually resolves within 6 weeks
lesions heal without scarring
=
Erythema nodosum
Causes of erythema nodosum (6)
Name three drugs
Infection - e.g strep, TB, brucellosis
Sarcoidosis
IBD
Behcet’s
Malignancy
Pregnancy
Drugs penicillin, sulphonamides, COCP
bacterial infection that affects the skin. It usually appears in the folds of the skin. It’s more commonly seen in warm or humid climates
flat, slightly scaly, pink or brown rash usually found in the groin or axilla
Examination with Wood’s light reveals a coral-red fluorescence.
caused by Corynebacterium minutissimum
=
Mx (2)
Erythrasma
Mx topical miconazole OR PO erythro
Causes of red man syndrome/ erythroderma (5)
Eczema
Psoriasis
Gold
Lymphomas/
Leukemias
Dermatophyte infection mx (2)
Length of treatment for fingernails versus toenails
PO terbinafine OR PO itraconazole
6 weeks - 3 months therapy fingernails
3-6 months for toenails
Candida nail infection mx
Mild (1)
Severe (1)
Length of treatment for topical treatment fingernails versus toenails
Mild: amorolfine topical
Severe: PO itraconazole
Six months fingernails
9-12 months toenails
seen most commonly on the skin of children, teenagers, or young adults.
papular lesions that are often slightly hyperpigmented and depressed centrally
typically occur on the dorsal surfaces of the hands and feet, and on the extensor aspects of the arms and legs or knuckles
= ?
Granuloma annulare
tear drop papules on the trunk and limbs
common in children and adolescents
precipitated by strep infection 2-4 weeks prior to lesions appearing
acute onset over days
=
Resolves spontaneously within?
guttate psoriasis
2-3 months
Herald patch followed 1-2 weeks later by multiple erythematous, slightly raised oval lesions with a fine scale confined to the outer aspects of the lesions
May follow a characteristic distribution with the longitudinal diameters of the oval lesions running parallel to the line of Langer. This may produce a ‘fir-tree’ appearance
No prodrome
= ?
Mx
Pityriasis rosea
Self limiting - resolved after 6 weeks
Causes of periorificial dermatitis
Mx (1)
Usually caused by topical/ inhaled steroids
So can worsen condition if given this to treat
Mx topical/ PO abx
Pellagra is caused by deficiency in?
Features (3)
Can be caused by which drug?
Niacin
3 D’s, dementia, dermatitis, diarrhoea
Isoniazid
itchy, red patches which are
lesions tend to be of different colours
=
Is a rare form of which cancer?
Mycosis fungoides - rare for of T cell lymphoma
pinkish or pearly white papules with a central umbilication
appear in clusters, palms and soles sparing
In children lesions are commonly seen on the trunk and in flexures, but anogenital lesions
=
Molluscum contagiosum
Molluscum contagiosum
Mx
School?
Self limiting - resolution within 18 months
Contagious, avoid sharing towels, clothing, baths etc
No exclusion necessary
Melasma causes (3)
Pregnancy
COCP
HRT
Hyperpigmented macules in sun-exposed areas, particularly the face.
Melasma
What is the single most important factor in determining the prognosis of a patient with malignant melanoma?
Breslow depth/ depth of a tumour
>4mm 50% 5 year survival rate
white patches that may scar
itch is prominent
may result in pain during intercourse or urination
lesions around the genitalia
Mx (2)
Increased risk of?
Lichen sclerosus
Mx topical steroids + emollients
Vulval ca
What is leukoplakia?
Ix
Mx
Pre-malignant condition
White hard spots on mucous membranes
Common in smokers
Ix biopsy to r/o SCC
Regular FU as increased risk of SCC (1%)
Skin lesions that appear at the site of injury is called the?
Name five conditions where this may be seen?
Koebner phenomenon
Psoriasis
Vitiligo
Warts
Lichen planus + sclerosus
Molluscum contagiosum
Said to look like a volcano or crater
initially a smooth dome-shaped papule
rapidly grows to become a crater centrally-filled with keratin
Mx
Keratoacanthoma
Mx urgently excised as it is difficult to exclude SCC
Strawberry naevus
Develops when?
Increases in size until age?
Regresses over what time period?
95% resolved by age?
Mx if visual field obstruction?
Develops rapidly in the first month of ife
Increase in size until 6-9 months
Regress over the next few years, 95% resolve before age 10
Propranolol
Port wine stains
Description
Colour
Unilat/bilat
Mx (2)
Unilateral, deep red or purple in colour
Birthmarks
Often darken and become raised over time
Do not resolve - so cosmetic camouflage or laser therapy
Venous ulceration is usually seen?
Ix
Normal range
Mx (2)
Medial malleolus
ABPI
0.9-1.2
Compression bandaging
PO pentoxifylline
Angiomas on the lips are called?
Venous lakes
