Dermatology Flashcards
Cellulitis complications-
Persistent leg ulcers
Recurrent cellulitis
Sepsis
Necrotising fasciitis
Admit for cellulitis if…
Lymphoedema <1yrs Facial cellulitis Immunocompromised Rapidly deteriorating
Cellulitis treatment-
1st- Flucloxacillin
If penicillin allergy then macrolide or doxycycline in pregnancy.
If severe then ceftriaxone
Hand, Foot and Mouth-
Initial fever, lethargy, fatigue.
Then mouth ulcers
Then macules/papules on palms/soles of hand and feet.
Treat symptoms, contagious, good hygeine.
SCC RF-
Sunlight exposure
Smoking
Immunosuppression
Main- actinic keratosis- precursor for SCC
SCC Management-
<20mm then 4mm excision border
>20mm then 6mm excision border
Malignant melanoma RF-
Short bursts of sun exposure (holiday)
Malignant melanoma 2ww referral-
If scoring 3 points-
2 points for-
Change in size
Irregular in colour
Irregular in shape
1 point for- Inflammation Oozing >7mm Change in sensation
Malignant melanoma ABCDE
Asymmetry Borders irregular Colour irregular Diameter Evolution/Elevation
Malignant melanoma management-
Excise the entire lesion for biopsy
+ve for cancer then excise the borders
Look for any mets, lymph node involvement
BCC RF-
See telangiectasia and known as rodent ulcer
Sun
Blue eyes, fair skin
Previous BCC
Elderly male
BCC management
Excision
Curettage (scraping)
Cryotherapy (freeze with NO)
Topical cream
Dermatofibroma
Increase in fibrous tissue over skin.
Benign
Due to foreign object, I.e. ingrown hair
Cafe au lait macule
Birth mark
Can be light brown to darker brown pigment
Urticaria management
1st Non sedative antihistamine- cetirizine QDS.
If severe-oral corticosteroids.
Sedative antihistamine if problems sleeping- chloramphenicol.
Dermatology referral if painful and persistent urticaria, widespread acute, chronic (>6wks)
Fungal infection names
Appearance
Body- tinea corporis
Groin tinea cruris
Occurs with anything increasing sweat- tight clothes, obesity, humidity, hydrohidrosis
Appears scaly red edge with clear centre
Management of fungal infections-
Mild- topical terbinafine or imidazole
If inflamed- topical hydrocortisone
Severe-oral terbinafine or oral itraconazole
Still persists then send skin sample for microscopy.
Onychomycosis-
Fungal nail infection
Treatment-
Self care- shirt nails
1st- Nail liquid amorolifine
2nd- Terbinafine if dermatophyte infection, itraconazole if candida/ND infection.
Assess 3-6 months later.
If still persisting send off nails for microscopy
Acne Rosacea diagnostic findings-
Phylomatous changes
Persistent erythema
Acne rosacea treatment-
Topical metronidazole
If flushing also occurs then topical brimonidine.
If more severe then oral oxytetracycline.
Acne vulgaris complications-
Hyper/hypopigmentation
Scarring
Depression/Anxiety
Acne Vulgaris classification
Mild- Open/closed comedones (black/whiteheads), no inflammation.
Moderate- Widespread non inflammatory lesions, papules and pustules.
Severe- Widespread inflammation, scarring, cysts etc
Acne vulgaris treatment-
1st- Single therapy- Topixal Retinoids or benzoyl peroxidase.
2nd- Combined retinoids/BP/Abx
3rd- Oral Abx (tetracycline 3 months) or COCP in females.
4th- Roaccutane- need hospital to prescribe. Supervised under specialist.
Erythema nodusum causes-
Inflammation of subcut fat
Infections eg TB Systemic diseases eg Sarcoidosis, IBD Malignancy Drugs- penicillin, COCP Pregnancy
Erythema nodusum management-
Manage pain with colchicine, NSAIDs.
If rule out malignancy, sepsis or systemic infection then treat with systemic corticosteroids.
Eczema Management-
1) Emollient
2) If inflamed then corticosteroid (low potent to high- hydrocortisone, betamethasone, fluticasone).
3) Non sedative antihistamines
4) If sleep affected then sedative antihistamines
5) Oral corticosteroids
If oozing, weeping, pustules suggestive of bacterial infection- need Abx.
Psoriasis RF-
FHx Smoking/alcohol Hormone Infection Trauma
Better with sunlight
Psoriasis management-
NB Vit D will reduce proliferation of cells and therefore epidermis
1) Corticosteroid + Vit D analogue, both taken OD but at different times. (4wks)
2) Vit D analogue TDS
3) Oral Corticosteroid TDS (4wks)
4) Specialist referral
Secondary-
Phototherapy
Oral methotrexate
