Dermatology

Question 1

How do the types of eczema present?

Answer 1

atopic - itchy, associated with atopy

contact - allergic and irritant (type 1/4 hypersensitivity reaction)

discoid - disc shaped, bilateral, asymmetrical, post-injury
exudative or dry type.

dyshidrotic - vesicles of bullae. triggers; triggers, high temps& sweating (come back form holiday with this rash)

herpeticum -

seborrhoeic - cradle cap (infants), malasseazia furfural (adults - hypopigmentation)

Question 2

What are the complications of eczema? how to treat them?

Answer 2

Superimposed staph infectoin - impetiginization - Give Oral fluclox

Eczema herpeticum - Admit for IV acyclovir

Question 3

Differentials for pagets disease of the breast?

Answer 3

1. eczema

2. Pagets disease of the breast - have high suspcion if middle aged woman (especiallyif not responding to eczema rx)

Question 4

management of eczema?

Answer 4

Topicals
Phototherapy - UVA/UVB
Systemic therapy - Steroids

o Mild
1▪ EMOLLIENT eg Diprobase &, Epiderm

1b▪ Consider mild topical hydrocortisone cream (1%) or ointment
▪ Keep nails short
▪ Avoid allergens

o Moderate
-> Moderate potent topical steroids (eumovate aka clobetasone 0.05%) for inflammation, start with mild if on face
2nd line: topical Tacrolimus (calcineurin inhibitors) (>2y/o)

o Severe
▪ Give potent steroid – betamethasone aka betnovate (0.1%) note if its 0.025 then its moderate not potent.

If 2 adequate trials of immunosuppresion hasnt helped -> biological therapies eg methotrexate

Question 5

Give details of phototherapy?

Answer 5

UVB - stronger. can cause Burns

PUVA - psoralen UVA (for the hand eczema)

Question 6

management of basal cell carcinoma?

Answer 6

1. surgical excision
   1b. curettage, cautery

• > if cosmetics important; Mohs surgery
  2. radiotherapy - elderly, extensive, surgery innapropriate.

Question 7

complications of basal cell carcinoma?

prognosis?

Answer 7

Can be locally aggressive, but rarely metastasises.

prognosis; <2% chance of reccurence

Question 8

How would we treat a tinea infection?

Answer 8

Terbinafine

Either topical 1% or oral.

Question 9

What are the components of the fever pain score for tonsilitis?

Answer 9

Fever in past 24 hours
Onset 3 or less days ago

Purulent tonsils
Inflamed tonsils

No cough or Coryza

4+ consider abx
2-3 delayed abx

Question 10

Treatment for pityriasis versicolor?

Answer 10

1st - ketoconazole Topical 2%

2nd - oral fluconazole

Question 11

How do we Mx gallstones?

Answer 11

Acute
Symptoms
1. Analgesia (diclofenac po/pr, IM if severe) + lap cholecystectomy (+antispasmodic)

• Avoid triggering foods

Arrange emergency admission for people who are systemically unwell with a suspected complication of gallstone disease, such as acute cholecystitis, cholangitis, or pancreatitis.

No symptoms
2. Watch and wait or prophylactic Cholecystectomy

Question 12

Erythema multiforme

aetiology and presentation ?

Answer 12

aetiology - HSV - most common - allergy reaction

presentation -
raised, red, target-like rash on the skin or mucous membranes.
typically on both hands
limited to 1 mucous membrane

Question 13

mx of erythema multiforme?

Answer 13

Topical emollient
Topical steroid - moderate

Pain relief

Treat underlying cause;
PO Acyclovir for Herpes

Question 14

what happens to skin in SJS/TEN

Answer 14

detachment of epidermis from the papillary dermis at the epidermal-dermal junction,

manifesting as a papulomacular rash and bullae

Question 15

presentation of SJS/TEN

Answer 15

maculae, blisters/bullae

as meds are started

Question 16

presentation of dermatitis herpetiformis?

Answer 16

Dermatitis herpetiformis (DH) is an AUOIMMUNE skin condition linked to coeliac disease.

vesicles on elbow, knees and buttocks

itchy

may or may not have other sx of coeliac

Question 17

ivx and mx of D herpetiformis?

Answer 17

Ivx:
Skin biopsy

Mx;
Treat coeliac