Dermatology

Question 1

SCC

Answer 1

• irregular, ill-defined red nodule with scale and ulceration
• sun exposed areas

Question 2

BCC

Answer 2

• small, skin-coloured or pink nodule with a central depression
• pearly rolled edge and surface telangiectasia

Question 3

Bullous pemphigoid

Answer 3

• elderly women
• itchy, tense, fluid-filled bullae
• no mucosal involvement

pemphigus = superficial blisters, pemphigoid = deep blisters

Question 4

Erythema multiforme

Answer 4

• annular, concentric ring erythematous skin eruption

- drug related or viral illness.

Question 5

Discoid eczema/Nummular dermatitis

Answer 5

round circumscribed plaques

Question 6

Pompholyx eczema

Answer 6

• precipitated by humid, warm conditions and typically affects the palms and soles
• vesicular lesions are also typical for this type of eczema.

Question 7

Shingles

Answer 7

• Diagnosed clinically
• Dermatomal vesicular rash which is painful, tingly and itchy
• Typical course: prodrome (described above) and then new vesicles continue to form over three to five days and progressively dry and crust over.

Question 8

Guttate psoriasis

Answer 8

• multiple, small tear-drop shaped scales

- common in AI conditions

Question 9

Pityriasis rosea

Answer 9

• Hx of viral infection
• preceded by a large herald patch
• many oval red patches across the chest and back.

Question 10

Tinea corporis

Answer 10

• ring shaped lesion with a central clearing

Question 11

Pityriasis rosea

Answer 11

• Hx of viral infection
• preceded by a large herald patch- a single, large, discoid (coin-shaped), erythematous patch.
• many oval red patches across the chest and back develop after the herald patch
• self-limiting

Question 12

Impetigo

Answer 12

• golden crusty lesions and vesicles
• staph aureus
• fever UNCOMMON
• Children should be excluded from school until lesions have crusted or healed, or for 48 hours after starting antibiotics.

Mx- Hydrogen peroxide 1% cream can also be used as first line treatment in localised cases.

Question 13

Pyogenic Granuloma

Answer 13

• reactive overgrowth of capillary blood vessels
• single, shiny, red nodule of up to 1cm “raspberry-like”.
• benign lesion, discomfort and bleeding
• rapidly growing
• common sites- hands/fingers
• Causes: minor trauma, infection and pregnancy

Question 14

Erythema nodosum

Answer 14

• painful red, rounded lumps on the shins and around ankles

Question 15

Lyme Disease

Answer 15

• spread by tick bites
• red swollen area surrounding the bite
• systemic symptoms: fevers, arthralgia and myalgia

Diagnosis: serology

Question 16

Actinic Keratosis

Answer 16

• pre-cancerous (SCC), crusty, thick area of skin
• commonly on sun exposed areas
• asymptomatic, can be itchy

Question 17

Lichen planus

Answer 17

Cutaneous lichen planus is characterised by the 6 Ps:

Purple
Pruritic (itchy)
Polygonal (multiple sides)
Planar (flat-topped)
Papules/plaques

Treatment of lichen planus and lichenoid eruption are topical corticosteroids. Most lesions will spontaneously resolve after 12 months.

Systemic immunosuppressants can be used for resistant cases

Question 18

Eczema Herpeticum

Answer 18

• complication of Atopic Eczema
• HSV
• widespread red, monomorphic blisters and erosions
• systemically unwell with fever and malaise
• immediate treatment with antivirals (IV Aciclovir)

Question 19

Psoriasis

- Mx

Answer 19

All patients should use an emollient to reduce scale and itch
1st: potent topical corticosteroid OD (eg Betnovate) + topical vitamin D OD (eg Dovonex) applied at different times
2nd: stop the topical corticosteroid, apply topical vitamin D twice daily
3rd: stop the topical vitamin D, apply potent topical corticosteroid twice daily
Dithranol + tar are alternatives

Question 20

Psoriasis

- Systemic treatment

Answer 20

1st: methotrexate
2nd: ciclosporin (1st line if rapid disease control needed/palmoplantar pustulosis/are considering conception)
3rd: acitretin

Question 21

Topical steroid potencies

Answer 21

Topical corticosteroids are available in 4 different potencies (remembered by the mnemonic “Help Every Budding Dermatologist”)

Mild- Hydrocortisone 0.5%
Moderate- Eumovate (clobetasone butyrate 0.05%)
Potent- Betnovate (betamethasone valerate 0.1%)
Very potent- Dermovate (clobetasol propionate 0.05%)

Question 22

What bloods do you need to check if pt with acne is on oral retinoid

Answer 22

lipids