Dermatology

Question 1

Acne Rosacea

Define
Main features
Management

Answer 1

Chronic skin condition that causes blushing or flushing and visible blood vessels in your face.

Features - Flushing red nose, cheeks, forehead, Telangiectasia, Blepharitis, Sunlight exposure triggers symptoms

Rhinophyma - Bumps on the nose

Management - Topical Metronidazole, High factor sunscreen, Systemic antibiotics for severe disease (oxytetracycline), Telangiectasia - Laser/topical b rimodine gel

Mild/moderate: topical metronidazole

Severe/resistant: oral tetracycline

Derm referral with rhinophyma presentation.

Question 2

Erythema ab igne

Define?
Causes?

Answer 2

A skin disorder caused by over exposure to infrared radiation.

Causes - common condition seen in the elderly who stood or sat closely to open fires or electric space heaters. hot-water bottle

Net-like appearance, mottled skin, area of hyperpigmentation or erythema with telangiectasia.

Remove heat source. Untreated = Development of SCC

Question 3

Most common place for venous ulcers?

Management?

Answer 3

Above medial malleolus

Compression bandaging -Four layer

Peripheral vasodilator - oral pentoxifylline (Improves healing rate)

Question 4

Pityriasis (Tinea) Versicolour?

Presentation
Management?

Answer 4

Fungal infection causing discolouration on superficial skin.

Patches of hypopigmentation, Pink/brown, Mainly affected the trunk.

Ketocanzole shampoo on affected areas

Oral fungal (Itraconazole - for non-responding)

Question 5

Erythema Nodosum

Causes?

Answer 5

Causes
Infection -TB, Strep, Brucellosis
Systemic disease - Sarcoidosis, IBD, Behcet’s
Drugs - Penicillin’s, sulphoanmides, COCP
Pregnancy

Presentation -
Occurs over shins, thighs, forearms
Tender, erythematous, nodular lesions
Resolves within 6 weeks + Lesions heal without scarring

Question 6

Persistent hoarseness in a smoker what must you rule out?

Answer 6

Raise suspicion of both lung cancer and laryngeal cancer.

Question 7

Management of SCC?

Answer 7

Surgical excision with 4mm margins if lesion <20mm diameter.

Tumour >20mm then margins should be 6mm.

Mohs micrographic surgery - Used in high-risk patients

Question 8

Which patients are at increased risk of developing a SCC?

Answer 8

Patients on ciclosporin + other immunosuppressants have a much higher risk of SCC

RFs - excessive sunlight exposure, smoking, long-standing leg ulcers (Marjolin’s), HIV, Xeroderma pigmentosum, Oculocutaneous albinism, actinic keratoses, Bowen’s disease.

Question 9

What features make a good prognosis + Poor prognosis of SCC?

Answer 9

Good Prognosis

• Well differentiated tumours
• <20mm diameter
• <2mm deep
• No associated diseases

Poor prognosis

• Poorly differentiated tumours
• > 20mm diameter
• > 4mm deep
• Immunosupression