Dermatology Flashcards
How does cellulitis present?
On lower limb usually Swelling/tumor Erythematous/rubor Warm to touch/calor Pain in legs/dolor
Pt may be systemically unwell too - fever, malaise, rigors, previous abrasion to leg (so bacteria can enter).
How is cellulitis managed in primary care?
1) Abx - flucloxacillin 500-1000mg qds for 5-7 days
If penicillin allergy = clarithromycin 500mg bds 5-7 days or doxycycline 200mg for one day, then 100mg od for 5-7 days
2) Analgesia - ibuprofen or paracetamol for pain and fever.
3) Drink adequate fluids
4) Manage RF for cellulitis - e.g. breaks in the skin, skin blistering, venous ulcers
Ddx of unilateral redness and/or swelling of limb ?
Cellulitis DVT Septic arthritis Acute gout Ruptured Baker's cyst Thrombophlebitis Cutaneous abscess Erysipelas (like cellulitis but with raised, well demarcated borders).
see CKS NICE cellulitis for more.
RF for cellulitis ?
Break in skin Immunosuppressed Obese Pregnant Skin conditions Previous cellulitis Venous insufficiency
Complications of untreated cellulitis?
Necrotising fasciitis Sepsis Osteomyelitis Lymphagitis Endocarditis Meningitis Gas gangrene
How does impetigo present?
In children Thin blisters, fluid filled Red sores Blisters may have ruptured at presentation - get yellow/golden crust. Itchy, painful Common on face - on philtrum
How is impetigo managed?
Localised - give topical creams = hydrogen peroxide, fusidic acid cream
Short course abx - flucloxacillin/clarithromycin
Hygiene measures for the whole family
RF for impetigo
Young age
Breaks in skin
Close contact - schools
Poor hygiene
Complications of impetigo
Misdiagnosed = cellulitis
Contagious - remain home until lesions clear
Presentation of chicken pox.
Children
Red papule become fluid filled vesicles and rupture
Fever
Malaise
Management of chicken pox?
Not attend school until papule scab over.
Fluid, rest. Symptomatic treatment.
RF for getting chicken pox?
Infants,
Immunocompromised - HIV, chemo puts, transplant pts.
Pregnant women
Name of virus causing chicken pox?
Varicella-zoster virus
Complications of chicken pox?
Shingles - vesicular rash Encephalitis Sepsis Dehydration Bacterial infections of skin Pneumonia
Presentation of eczema?
Itchy, erythematous, scaly dry patches of skin.
On face, extensors and flexors.
Can be vesicular and weepy
Excoriation
Lichenification
Pt has Hx of atopy - eczema + asthma + hay fever
Management of eczema?
Avoid triggers
Emollients - oliatum, epaderm, dermal 500 lotion.
Bath wash and bandages
Topical steroids for flare ups - hydrocortisone 0.1-2.5%.
Antihistamines - fexofenadine
RF for eczema?
Hx of atopy, FH of atopy, skin irritants, temperature extremes
Complications of eczema
Secondary bacterial or viral skin infection
Psycho-social-emotional impacts
How does acne vulgarise present ?
Teenager
Comedones which are open or closed
Inflamed papules, pustules, nodules or cysts.
Present on face, chest, upper back.
Present with scarring
Managing acne vulgaris?
Advice - avoid over cleansing, use non-alkaline cleansing product.
Pharmacological - 12wk topical treatment e.g. topical adapalene (mild/mod) or azelaic acid with oral abx e.g. doxy (for mod/severe)
Woman who can’t take abx? Give cocp
Psych management
Refer to dermatologist
RF for acne vulgaris?
Age Hormonal changes FH Oily substances Friction/pressure on skin
Complications of acne?
Scarring
MH complications
Presentation of allergic contact dermatitis?
Contact wth something on skin - this is where rash appears.
Can present days after.
Red, itchy, swollen, blistered OR dry and bumpy.
Can move from fingers to eyelids due to touching.
Similar presentation to eczema
Management of allergic contact dermatitis?
Recognise triggers Emollients Topical steroids Oral abx for any secondary infections Tacrolimus ointment Azathioprine
RF for allergic contact dermatitis?
Age, occupation, hx of contact dermatitis
Complication of allergic contact dermatitis?
Can become generalised - erythroderma
How does urticaria present ?
Swelling/tumor in superficial dermis
Red or white in colour
Itchy wheals, elevated.
Local or generalised
Management of urticaria?
Avoid triggers
Symptom diary
Non-sedating antihistamine
Oral corticosteroid if symptoms need treatment = prednisolone 40mg/7days.
RF for urticaria?
Food allergies Drugs Cold exposure or hot shower Stress Environment
Complications of urticaria?
Anaphylaxis / Swelling in the throat
Angiodema
MH complications
RF for skin cancer?
Age, female, sun damage, sunburn, inheritance, ionising radiation, fair skin
How does basal cell carcinoma present?
Slow growing nodular lesion with necrotic/ulcerated centre.
Can see:
Blood vessels on surface
Shiny/pinky/pearly white
Translucent, and waxy texture.
May be red and scaly. May also be black or brown in a patch.
May bleed or become crusty.
How is basal cell carcinoma managed?
Needs prompt treatment
Surgical excision
Radiotherapy if surgery is not an option.
Topical treatment if risk is low.
Complication of skin carcinoma?
Local tissue invasion and destruction. Mets.
How does squamous cell cancer present?
Firm pink lump with a rough or crusted surface
Spiky horn which sticks up from surface.
Tender when touched.
Bleeds easily
Ulcers.
How is squamous cell carcinoma managed?
Prompt treatment
Surgical excision
Radiotherapy if surgery is not an option.
Mental health impact of skin disorders?
Depression, anxiety, low mood, low self esteem eczema - self harm, stress, need for CBT, feel trapped
Social aspect of skin disorders?
Stigmatisation Discrimination Isolation Lack of acceptance Embarrassment
What parts of the sociological theory on chronic illness relates to skin disorders?
Illness work
Identity work
How should you describe pigmented lesions?
The ABCDE rule for suspicious pigmented lesions
A, asymmetry
B for irregular border
C for colour variation
D for diameter greater than 6mm
E for evolution.
What are some risk factors for Melanoma? MMRISK mnemonic
M – moles – atypical >5;
M – moles- multiple > 50;
R – red hair;
I – inability to tan;
S – sunburn;
K – kindred ( family Hx)
What are signs of a squamous cell carcinoma? (capsule)
a firm, red nodule; a flat sore with a scanty crust; fast-growing.
What is there a small risk actinic keratosis might transform into if untreated?
squamous cell carcinoma
keep under surveillance
Alerting signs to development of SCC include lesions that persist in spite of treatment, are hyperkeratotic or become nodular.
