Dermatology Flashcards
What is eczema?
Chronic atopic condition which causes inflammation of the skin. This causes dry, red, itchy patches of skin, commonly over the flexor surfaces.
How does eczema commonly present?
Patches of dry, red, itchy, sore skin over the flexor surfaces (e.g. I sided of elbows). There is often periods of remission with flare ups
What can trigger eczema flare ups?
Stress Atopy - pollen Certain clothing - synthetic Certain foods Fragrances - particularly in soaps Hormones Heat and sweating
How can eczema be managed?
Avoid scratching and scrubbing skin. Avoid triggers if possible - e.g. certain cleaning products. Use emollients - act as a skin barrier - e.g. E45, Diprobase. Can be creams or ointments Steroid creams (only for a short period of time in a flare up) - e.g. hydrocortisone or betamethasone (betnovate)
What is the stepladder of steroid creams for eczema?
Hydrocortisone
Betnovate (betamethasone)
Eumovate (clobetasone butyrate)
Dermovate (clobetasol proprionate)
http://gmmmg.nhs.uk/docs/guidance/GM-Steroid-Ladder.pdf
What lifestyle advice can be given to someone with eczema?
Don’t use soap on body. Moisture regularly Don’t itch and scratch Leave time in between applying steroid and emollient to let it sink into the skin. Try to wear cotton / silk clothing Avoid triggers
How does infected eczema present?
Yellow crusting Redness and inflammation Blistered skin Increased itchiness Pain / burning sensation Not helped by steroid creams
https://www.healthline.com/health/infected-eczema
What organism most commonly causes infected eczema?
Staph aureus
What is eczema herpeticum?
A viral skin infection caused by the herpes simplex virus or the varicella zoster virus. It usually occurs in a patient with a pre-existing skin condition.
How is infected eczema managed?
Steroid - to reduce inflammation
Antibiotics ( topical - such as fusidic acid)
How does eczema herpeticum present?
A widespread, painful, vesicular (vesicles containing pus) rash with systemic symptoms such as fever, lethargy, irritability and reduced oral intake. There is also often lymphadenopathy.
Commonly presents in a person with pre-existing eczema.
How is eczema herpeticum managed?
Aciclovir - oral but if severe then IV.
What is acne vulgaris?
Acne - condition commonly affecting people during puberty that causes red, inflamed and sore spots (differ in the type of lesion’ on the skin.
What is the pathophysiology of acne vulgaris?
Chronic inflammation with or without infection in the skin. There is increased production of sebum (commonly stimulated by increased androgens during puberty) in the hair follicles and sebaceous glands. This traps keratin and causes a blockage which leads to swelling and inflammation.
What are macules?
Flat, discoloured mark on the skin that is less than 1cm.
What are papules?
Small raised area of skin that is less than 1cm
What are pustules?
Small raised lumps that contain white/yellow pus (whiteheads)
What are comedomes?
Skin coloured papules that are due to blocked pilosebaceous glands.
What are blackheads?
Open comedones with black pigmentation in the centre
What are ice pick scars?
Small indentations in the skin that remain after acne lesions heal
What are hypertrophic scars?
Small lumps in the skin that remain after acne lesions heal
How can acne vulgaris be managed?
- Topical benzoyl peroxide - antiflammatory that helps unblock the skin and toxic to cutibacterium acnes
- Topical retinoids - slows production of sebum (teratogenic)
- Topical antibiotics - e.g. clindamycin
- Oral antibiotics - e.g. lymecycline
- combined oral contraceptive pill - stabilises female hormone (not progesterone only)
- Oral retinoids - e.g. isotretinoin - last line option if severe. Highly teratogenic.
What are some side effects of oral isotretinoin (retinoids)?
Dry skin and lips
Photosensitivity of the skin
Depression, anxiety, aggression and suicidal ideation
Rarely - Stevens Johnsons syndrome
Not appropriate in pregnancy - must be on appropriate contraceptives
What is psoriasis?
A chronic autoimmune condition that causes a dry, flaky, scaly that appear raised, rough and slightly red. It affects the extensor surfaces such as the elbows and knees. This is due to a rapid generation of new skin cells which build up and thicken the skin.
What are the types of psoriasis?
Plaque psoriasis
Guttate psoriasis
Pustular psoriasis
Erythrodermic psoriasis
Describe plaque psoriasis
Thickened erythematous plaques with silver scales on extensor surfaces. Plaques are 1-10cm in diameter. This is normally in adults.
Describe guttate psoriasis
Commonly occurs in children. Lots of small raised papules across the trunks and limbs - these are slightly erythematous and scaly. Over time the papules can turn into plaques. Often resolves in 3-4 months.
What commonly triggers guttate psoriasis?
Often triggered by a streptococcal throat infection, stress or medications.
Describe pustular psoriasis
Rare severe form - pustules form under erythematous skin. The pus is non- infectious. Patient can be systemically unwell and is often an emergency that requires hospital admission.
Describe erythrodermic psoriasis
Rare severe form - extensive erythematous inflamed areas covering most surfaces of the skin. The skin comes away in large patches (exfoliation) resulting in raw, exposed areas. Treat as an emergency and requires admission.
How can psoriasis be managed?
Emollients
Topical steroids with topical vit D (calcipotriol)
Topical dithranol
Topical calcineurin inhibitors (usually only in adults)
Phototherapy (particularly in guttate psoriasis)
In extreme cases there may be systemic treatments (e.g. in psoriatic arthritis- methotexate)
oral tablets - biologics, steroids etc. - done by secondary care
What is nail psoriasis?
Nail dystrophy resulting in
- putting
- thickening
- discolouration
- ridging
- onycholysis (separation of the nail from the nail bed)
What conditions are associated with psoriasis?
Nail psoriasis
Psoriatic arthritis
Psychosocial implications
What six viral diseases cause an exanthem (eruptive widespread rash)?
Measles Scarlet fever Rubella Dukes' disease Parovirus B19 Roseola infantum
What is an exanthem?
A eruptive widespread rash
How does measles present?
Typically affects children. Symptoms 10-12 days after exposure - Fever - Conjunctivitis - Koplik spots (spots inside the cheeks) - rash - widespread erythematous, macular rash with flat lesions
What are Koplik spots and what disease do they normally occur in?
Small white spots on the buccal mucosa (inside the cheeks) that are often surrounded by redness.
They only occur in measles.
Describe the rash that occurs in measles.
Widespread erythematous, macular rash with flat lesions. It often starts on the face (particularly behind the ears) before spreading to the rest of the body
How is measles managed?
Self limiting after 7-10 days of symptoms.
Isolate until symptoms resolve.
Notifiable disease so report to public health
What are some complications of measles?
Pneumonia Diarrhoea Dehydration Meningitis Encephalitis Hearing loss Vision loss Death
What is scarlet fever?
A condition caused by an exotoxin produced by streptococcus pyogens (commonly from tonsillitis). It is characterised by a widespread rash.
How does scarlet fever present?
Mainly in children.
- rash - red/pink, blotchy, macular rash with a rough ‘sandpaper’ like texture.
- red flushed cheeks
- fever
- lethargy
- sore throat
- strawberry tongue
- cervical lymphadenopathy
How is scarlet fever managed?
Antibiotics - phenoxymethylpenicillin for 10 days
Notifiable disease so report to public health
What organism commonly causes scarlet fever?
Group A streptococcus
What is rubella?
A viral infection that is highly contagious and spread via resp droplets. Symptoms start 2 wks after exposure and presents with a erythematous macular rash (milder than in measles).
How does rubella present?
Mainly in children.
- Erythematous macular rash - starts on face then spreads to the rest of body. Normally lasts approx 3 days.
- mild fever
- joint pain
- sore throat
- lymphadenopathy
What are the main difference between measles and rubella?
- Measles is much more infections
- Measles is more severe and life threatening, however rubella needs extra caution in pregnancy.
- Measles virus specifically affects the respiratory tract.
What is the management for rubella?
Self limiting.
Notifiable disease.
Children should stay off school while rash present.
Avoid pregnant women.
When is rubella particularly dangerous?
In pregnancy as can lead to congenital rubella syndrome
What is congenital rubella syndrome?
A triad of - deafness - blindness - congenital heart disease It can also cause other complications
What does the MMR vaccine protect against?
Measles
Mumps
Rubella
How does parvovirus B19 present?
Normally in children.
Starts with non specific viral symptoms - fever, lethargy, muscle aches etc.
2-5 days rash develops - diffuse bright red on both cheeks.
A few days later a reticular mildly erythematous rash appears on the trunk and limbs
What is parvovirus B19 also known as?
Slapped cheek syndrome
Fifth disease
How is parvovirus B19 managed?
Self limiting
Fluids and analgesia.
What are some possible complications of parvovirus b19?
- aplastic anaemia
- meningitis or encephalitis
- pregnancy complications
- rarely hepatitis, myocarditis or nephritis
What does a ‘reticular’ rash mean?
a rash that is in a net / lace like pattern
What is aplastic anaemia?
A condition where the body (bone marrow and stem cells) stop producing enough new RBCs
What is roseola infantum and how does it present?
A viral infection caused by human herpesvirus 6 or 7.
Presents with high fever, mild non itchy rash, sore throat, swollen lymph nodes. it is common in children and resolves itself.
