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Dermatology Flashcards

1
Q

What is the cause of acne vulgaris?

A

Chronic inflammation
With or without localised infection
Increased production of sebum, trapping of keratin

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2
Q

What is the management of acne?

A 
Topical benzoyl peroxide to reduce inflammation
Topical retinoids slows sebum 
Topical antibiotics e.g. clindamycin
Oral antibiotics e.g. lymecycline
Oral contraception
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3
Q

What is the risk of oral retinoids?

A

Careful follow up
Need reliable contraception
Highly teratogenic

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4
Q

What is roaccutane?

A

Oral isotretinoin - retinoid

Reduces production of sebum, inflammation

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5
Q

What are some of the side effects of roaccutane?

A

Dry skin and lips
Photosensitivity
Depression, anxiety, aggression, suicidal ideation
Rare - Stevens-Johnson, toxic epidermal necrolysis

Highly teratogenic, stop one month before becoming pregnant

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6
Q

What is eczema?

A

Chronic atopic condition
Defects in skin barrier
Inflammation of the skin

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7
Q

What is the presentation of eczema?

A

Infancy
Dry red itchy sore patches
Over flexor surfaces - inside of elbows, knees

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8
Q

What is key to the maintenance of eczema?

A 
Create artificial barrier over skin to compensate
Use of emollients 
Do not scratch and scrub
Use of soap substitutes 
Avoid triggers, enviromental, stress
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9
Q

What is the management of flares?

A 
Thicker emollients
Topical steroids
Wet wraps 
Treat infections
IV antibiotics, oral steroids

Zinc impregnated bandages
Topical tacrolimus
Phototherapy
Immunosuppressants - corticosteroids, methotrexate, azathioprine

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10
Q

What are some examples of some emollients that can be used for eczema?

A

Thin creams:
E45, diprobase, oilatum, Aveeno, cetraben

Thick:
50:50 liquid paraffin
Hydromol, diprobase ointment

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11
Q

What is the steroid ladder for eczema?

A

Mild - hydrocortisone
Moderate - eumovate
Potent - betnovate
Very potent - dermovate

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12
Q

What is a common cause of bacterial infection in eczema?

A

Staphylococcus aureus
Treatment with flucloxacillin
May need admission, IV antibiotics

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13
Q

What is eczema herpeticum?

A

Viral skin infection due to herpes simplex virus or varicella zoster virus

Usually occurs in patient with pre-existing skin condition e.g. eczema or dermatitis

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14
Q

What is the presentation of eczema herpeticum?

A

Widespread painful vesicular rash - vesicles containing pus, sometimes itchy
Fever, lethargy, irritability
Reduced oral intake
Lymphadenopathy

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15
Q

What is the management of eczema herpeticum?

A

Viral swabs

Aciclovir - oral or IV

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16
Q

What is the cause of bullies impetigo?

A

Staph aureus infection
Blistering rash
Treated with systemic antibiotics e.g. penicillinase resistant penicillin

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17
Q

What are the causes of napkin rashes?

A 
Common 
Contact dermatitis
Infantile seborrhoeic dermatitis
Candida infection
Atopic eczema

Rare
Langerhans histiocytosis
Wiskott-Aldrich syndrome

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18
Q

What occurs in a nappy rash?

A

Irritant dermatitis if nappies not changed enough or diarrhoea
Irritant effect of urine
Affects buttocks, perineal region, lower abdomen and top of thighs. Flexures spared.
Use of emollients or mild corticosteroids.
Candida can cause rash, use topical anti fungal agent

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19
Q

What is infantile seborrhoeic dermatitis?

A

Cradle cap
Crusted flaky scalp
Self limiting condition - 4 months-12 months

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20
Q

What is the treatment for cradle cap?

A

Baby oil, brush scalp
White petroleum jelly
Anti-fungals next step for up to 4 weeks - clotrimazole or miconazole

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21
Q

What is seborrhoeic dermatitis of the scalp?

A

Dandruff or oily scale brown crusting
More common in adults and adolescents

Use ketoconazole shampoo
Topical steroids if severe itching

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22
Q

What occurs in seborrhoeic dermatitis of the face and body?

A

Red flaky crusted itchy skin
Affects eyelids, nasolabial folds, ears, chest, back.

Treat with clotrimazole or miconazole antifungals
Up to 4 weeks

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23
Q

What are some itchy rashes?

A 
Atopic eczema
Chickenpox
Urticaria/allergic reactions
Contact dermatitis
Insect bites/papular urticaria
Scabies
Fungal infections
Pityriasis rosea
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24
Q

What are causes of exacerbation of eczema?

A 
Bacterial infection
Viral infection
Ingestion of allergen e.g. egg
Contact with irritant
Environment
Change in medication
Psychological stress
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25
When are skin rashes examples of systemic disease?
``` SLE or dermatomyositis facial rash Purpura over buttocks, lower limbs, elbows - HSP Erythema nodosum and erythema multiforme Stevens-Johnson Urticaria ```
26
What occurs in Steven-Johnsons?
Bullous form of erythema multiforme Involves mucous membranes Eye involvement - conjunctivitis, corneal ulceration, uveitis
27
What are causes of erythema nodosum?
``` Streptococcal infection Primary tuberculosis IBD Drug reaction Idiopathic Sarcoidosis - common association in adults, rare in children ``` Tender nodules over legs Fever and arthralgia
28
What are the causes of erythema multiforme?
Herpes simplex Mycoplasma pneumoniae Drug reaction Idiopathic
29
What is psoriasis?
Chronic autoimmune condition causes psoriatic skin lesions
30
What are the types of psoriasis?
Plaque psoriasis - thickened erythematous plaques with silver scales on extensor surfaces and scalp Guttate psoriasis - common in children, small raised papule across trunk/limbs Often triggered by strep throat infection Pustular psoriasis - pustules under erythematous skin, med emergency Erythrodermis psoriasis
31
What is the presentation of psoriasis?
Guttate more common, triggered by throat infection Plaques of psoriasis smaller, softer, less prominent.
32
What is Auspitz sign?
Bleeding when plaques scraped off
33
What is Koebner phenomenon?
Development of psoriatic lesions on skin affected by trauma
34
What is residual pigmentation?
Pigmentation of the skin after the lesions resolve
35
What is the management of psoriasis?
``` Topical steroids Topical vit D analogues - calcipotriol Topical dithranol Topical calcineurin inhibitors e.g. tacrolimus Phototherapy ``` Dovobet, Enstilar
36
What are common signs and associations with psoriasis?
Nail psoriasis - nail pitting, thickening, discolouration, ridging, onycholysis Psoriatic arthritis Psychosocial implications, increased risk of CVD, obesity, hyperlipidaemia, HTN, type 2 diabetes
37
What are the viral exanthems?
``` First disease: Measles Second disease: Scarlet Fever Third disease: Rubella (AKA German Measles) Fourth disease: Dukes’ Disease Fifth disease: Parvovirus B19 Sixth disease: Roseola Infantum ```
38
What are the features of the measles rash?
Koplik spots on muccosa Rash on face, behind ears, 3-5 days after fever, macular Fever, coryza, conjunctivitis
39
What are the complications of measles?
``` Pneumonia Diarrhoea Dehydration Encephalitis Meningitis Hearing loss Vision loss Death ```
40
What are the features of Scarlet fever?
Group A strep - tonsillitis, due to the endotoxin ``` Red-pink macular rash Sandpaper skin Fever Lethargy Flushed face Sore throat Strawberry tongue Cervical lymphadenopathy ```
41
What is the treatment for scarlet fever?
Phenoxymethylpenicillin 10 days | No school until 24 hours after starting antibiotics
42
What is the Rubella rash?
Milder erythematous macular rash, starts on face, spreads to rest of body Cervical lymphadenopathy
43
What are the complications of parvovirus B19?
Aplastic anaemia Encephalitis or meningitis Pregnancy complications including fetal death Rarely hepatitis, myocarditis or nephritis
44
Who is at risk of complications with slapped cheek syndrome/B19?
immunocompromised patients pregnant women patients with haematological conditions such as sickle cell anaemia, thalassaemia, hereditary spherocytosis and haemolytic anaemia
45
What are causes of acute urticaria?
Stimulation of release of mast cells and histamine Allergies to food, medications or animals Contact with chemicals, latex, stinging nettles Medications Viral infections Insect bites Dermatographism - rubbing of the skin
46
What are causes of chronic urticaria?
Autoimmune condition Autoantibodies target mast cells, release histamines Chronic idiopathic Chronic inducible: sunlight, temp, exercise, strong emotions, hot or cold weather, pressure Autoimmune chronic urticaria is associated with an underlying autoimmune condition e.g. SLE
47
What is the management of urticaria?
Antihistamines Fexofenadine Oral steroids Anti-leukotrienes e.g. montelukast Omalizumab - targets IgE Cyclosporin
48
What are the features of chickenpox?
``` Widespread erythema Raised vascular blisters Trunk or face Spreads outwards affecting whole body Fever, itching, malaise ```
49
What are the complications of chickenpox?
``` Bacterial superinfection Dehydration Conjunctival lesions Pneumonia Encephalitis (presenting as ataxia) ```
50
What is the management of chickenpox?
Mild self limiting Aciclovir if immunocompromised, neonates, those at risk of infection Calamine or chlorphenamine for itching
51
What is molluscum contagiosum?
Small flesh coloured papules, central dimple Due to viral poxvirus Crops of lesions Spread through contact or sharing items Resolves without treatment Specialist treatment for those with extensive lesions or immunocompromised e.g. topical potassium hydroxide, benzoyl peroxide, surgical removal or cryotherapy
52
What is tinea capitis?
Ringworm of the scalp Well demarcated hair loss Itching, dryness, erythema of scalp More common in kids
53
What is tinea pedis?
Ringworm of feet Athletes foot White/red Flaky cracked itchy patches Between the toes Skin may split and bleed
54
What is tinea cruris?
Ringworm of the groin
55
What is tinea corporis?
Ringworm on the body
56
What is onchyomycosis?
Fungal nail infection | Thickened discoloured deformed nails
57
What is the presentation of ringworm rash?
Itchy rash Erythematous scaly Well demarcated Check toenails in presenting with ringworm, may be because fungal nail infection has spread to the skin
58
What is the management of ringworm?
Microscopy and culture of scrapings from scales Anti-fungals Creams - clotrimazole Shampoo - ketoconazole for tinea capitis Oral antifungals e.g. fluconazole Nail lacquer for 6-12 months Mild topical steroid to settle inflammation Wear loose breathable clothing, keep clean and dry, avoid sharing towels etc Avoid scratching
59
What is tinea incognito?
Fungal skin infection results from use of steroids to treat initial fungal infection Steroid improves inflammation but dampens immune response
60
What is scabies?
Tiny mites burrow under skin, causes infection Lay eggs in skin, can take up to 8 weeks for symptoms Track marks where burrow Rash in finger webs
61
What is the management of scabies?
Permethrin cream applied to whole body when cool Left on for 8-12 hours Repeat 1 week later to kill all eggs Treat whole household Oral ivermectin single dose after 1 week if difficult to treat/crusted scabies (immunocompromised patients)
62
What is the management of headlice?
Dimeticone lotion, fine combs, detection combing
63
What are the differentials for non blanching rashes?
``` Meningococcal sepsis Other bacterial sepsis Henoch Schonlein Purpura Idiopathic thrombocytopenia purpura Acute leukaemia Haemolytic uraemia syndrome Mechanical - strong coughing, vomiting or breath holding causes superior vena cava distribution Traumatic - NAI Viral illness ```
64
What are key investigations in a non blanching rash?
Full blood count: Anaemia can suggest HUS or leukaemia. Low white cells can suggest neutropenic sepsis or leukaemia. Low platelets can suggest ITP or HUS. Urea and electrolytes: High urea and creatinine can indicate HUS or HSP with renal involvement. C-reactive protein (CRP): This is a non-specific indication of inflammation or infection and can be useful but not definitive in excluding sepsis. Erythrocyte sedimentation rate (ESR): This is a non-specific indication of inflammatory illness such as a vasculitis (HSP) or infection. Coagulation screen, including PT, APTT, INR and fibrinogen can diagnose clotting abnormalities. Blood culture: This can be useful but not definitive in diagnosing or excluding sepsis. Meningococcal PCR: This can confirm meningococcal disease, although this should not delay treatment. Lumbar puncture: To diagnose meningitis or encephalitis. Blood pressure: Hypertension can occur in HSP and HUS. Hypotension can occur in septic shock. Urine dipstick: Proteinuria and haematuria can suggest HSP with renal involvement, or HUS.
65
What is impetigo?
``` Superficial bacterial skin infection Staph aureus Golden crust - staph infection Contagious Due to break in skin Bullous or non bullous ```
66
What is non-bullous impetigo?
Occurs around nose/mouth Exudate from lesions dries - golden crust Treatment with topical fusidic acid, oral flucloxacillin if wide spread/more severe
67
What is bullous impetigo?
Always due to staph aureus Toxins create vesicles Then burst - crust Lesions painful and itchy More common in neonates and children under 2 Feverish and unwell Swabs and treatment with flucloxacillin
68
What is staphylococcus scalded skin syndrome?
Severe bullous impetigo infection leads to widespread lesions Generalised patches of erythema on skin Skin thin and wrinkled Bullae burst, leaves sore burnt looking skin Nikolsky sign - gentle rubbing of skin can cause it to peel away IV antibiotics and fluids
69
What are the complications of impetigo?
``` Cellulitis if the infection gets deeper in the skin Sepsis Scarring Post streptococcal glomerulonephritis Staphylococcus scalded skin syndrome Scarlet fever ```
70
What are modes of HPV transmission in children?
Non sexual, directly Maternal transmission? Sexual abuse - anogenital warts ?safeguarding
71
What are the clinical manifestations of HPV infection?
Oral HPV infections Juvenile onset laryngeal papillomas Anogenital warts
72
What strains of HPV cause cervical cancer?
HPV 16 and HPV 18
73
What strains of HPV cause genital warts and laryngeal papillomatosis?
HPV 6 and HPV 11
74
What are risk factors for persistent genital HPV infections?
Early age first sexual intercourse Multiple partners Smoking Immunosuppression

Paediatrics (17 decks)

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