Dermatology

Question 1

Describe SCC and its associations

Answer 1

• Slow Growing
• Crusty
• In elderly
• Sun exposure

Question 2

All Melanoma pts are on a 5-year watchlist.

How is a BCC referred?

Answer 2

Slow metastases, so 2wk wait referral doesn’t apply

Question 3

How long can viral raises remain on body

Answer 3

7-10 days

Question 4

When doing a skin exam, outline LOOK

Answer 4

• Hair, Nails, Mucous membranes, Lymph nodes

* Lesion Position, Size, Number, Symmetry, Colour, Border regularity

Question 5

When doing a skin exam, outline TOUCH/ PALPATE

Answer 5

• Tenderness, Wam, Blanching or not, Scaling, Bleeding easily?

Question 6

What are 2 structures of Describing Skin lesions ?

Answer 6

• Asymmetry, Border, Colour, Diameter
• Site of Distribution (Generalised, F, E, Photosensitive)
• Surface features (Scale, Crust, Exc, Erosion, Ulcer)
• Configuration (Discrete, Confluent, Linear, target)
• Colour (Red, Purpuric, Brown/Black, Hypopigment)
• Morphology (Annular, Wheal, Discoid, Comedone)

Question 7

Outline the Non-pharmaceutical management of Eczema

Answer 7

Self care: Avoid scratching and triggers. May need dietary changes

Question 8

List 6 aspects of Pharmaceutical Eczema Management

Answer 8

1. Emollients
2. Topical CSs
3. Topical Pimecrolimus/ Tacrolimus in sensitive sites, and not responding to simple treatment
4. Antihistamines
5. Bandages/ Body suits to allow healing
6. Stronger treatments from Dermatologist;
   - Allergy testing, Phototherapy
   - Topical Calcineurin Inhibitors, Immunosuppressant tablets
   - Alitretinoin or Dupilumab
   - Very potent Topical CS

Question 9

Outline use of Topical CS in Eczema management

Oral CS tablets rarely used for 5-7day courses

Answer 9

• Use if inflammation

- Usually x1/day, 30mins after applying Emollient, Continue use upto 48hrs after flare-up cleared

Question 10

Compare the 3 types of Emollients

Give 1 example for each

Answer 10

Lotions;

• Least oil, More frequent application
• Aveeno lotion

Creams;

• Middle
• E45 cream

Ointments;

• Most oil, most effective
• Hydromol

Question 11

Outline use of Emollients in Eczema management

Answer 11

• Use all time, even if no symptoms
• Don’t rub, but stroke with grain
• Pat skin dry after shower and apply whilst moist
• Don’t scoop out with finger

Question 12

List ADRs of Topical CSs

Increased risk if used for many mths/ In large amounts/ In sensitive areas

Answer 12

• Mild stinging for <1min

- Rare: Skin Thinning/ Colour changes, Acne, Hirsutism

Question 13

List 4 Topical CS strengths and give examples of each

Answer 13

Mild: Hydrocortisone 0.1-2.5%

Moderate: Betamethasone Valerate 0.025% (Betnovate-RD)

Strong/ Potent: Betamethasone 0.1%

Very Strong/ Potent: Clobetasol propionate

Question 14

How can Urticaria/ Hives present?

Can be Acute or Chronic, < or > 6wks

Answer 14

• Epidermal swelling

- Red, raised itchy/ stinging rash (can be spots)

Question 15

List 3 important aspects oh history related to Urticaria

Answer 15

• Relation to menstrual cycle
• Previous treatment effectiveness
• Causes/ triggers (Stress, Allergies, Exercise, Foods etc)

Question 16

How is Urticaria managed?

Acute is likely to be self-limiting

Answer 16

• Advice on trigger avoidance
• Non-sedating antihistamine daily for upto 6wks
• If severe, Oral CS for upto 7 days. If symptoms improve, consider daily antihistamines for 3-6mths

Question 17

In Urticaria management, if treatment response is inadequate, what do you consider?

Answer 17

• Gradual dose increase of 1st line antihistamine upto x4 licensed dose
• Alternative non-sedating antihistamine
• Add sedating antihistamine for night use
• Adding topical anti-itch agent (Calamine)
• Refer if suspected Vasculitis Urticaria (Vessel inflammation)

Question 18

Describe Pityriasis Rosea

How is it treated?

Answer 18

• Few wks after infection. Self-limiting (3-12wks)

- Emollients, Steroid creams, Antihistamines, UVB Light therapy