Dermatology Flashcards
What is eczema
Chronic atopic condition
Inflammation in skin
Tends to run in families
Usually presents in infancy
How might a patient with eczema present
Dry, red, itchy, sore patches of skin
On flexor surfaces, face, and neck
What is the maintenance management for eczema
Emollients (artificial barrier over skin)
Soap substitutes
Avoid environmental triggers
What is the management for eczema flares
Thicker emollients
Topical steroids
Antibiotics (rarely needed)
Zinc impregnated bandages
Phototherapy
Systemic immunosuppressants (corticosteroids, methotrexate)
What is eczema herpecticum
Viral infection of skin
Due to: herpes simplex, varicella zoster
How might a patient with eczema herpecticum present
Widespread, painful, vesicular rash
Fever
Lethargy
Irritability
Reduced oral intake
Lymphadenopathy
What are the investigations for eczema herpecticum
Viral swab of vesicles
What is the management for eczema herpecticum
Aciclovir (IV in severe cases)
What are the complications of eczema herpecticum
Can be life threatening if not treated properly
Can get bacterial superinfection
What is psoriasis
Chronic autoimmune condition
Recurrent psoriatic skin lesions
Skin dry, flaky, scaly, slightly erythematous
Raised and rough plaques
Over extensor surfaces
Due to rapid generation of new skin cells
What are the types of psoriasis
Plaque (most common form)
Guttate (mostly in children, triggered by strep throat infection)
Pustular (can be systemically unwell, medical emergency)
Erythrodermic (skin can come away in large patches, medical emergency)
How might a patient with psoriasis present
Auspitz sign: small points of bleeding when plaques scraped off
Koebner phenomenon: psoriatic lesions to areas of skin affected by trauma
Residual pigmentation (after lesions resolve)
What is the management for psoriasis
Topical steroids
Topical vitamin D analogues
Topical dithranol
Phototherapy
Systemic treatment (methotrexate, cyclosporin)
What are the complications of psoriasis
Nail psoriasis (pitting, thickening, discolouration, ridging, separation from bed)
Psoriatic arthritis
What is acne vulgaris
During puberty and adolescence
Chronic inflammation of pilosebaceous units under skin
Due to: increased production of sebum, trapping of keratin, blockage of pilosebaceous unit
Exacerbated by androgenic hormones
How might a patient with acne vulgaris present
Macules (flat marks on skin)
Papules (small lumps on skin)
Pustules (small lumps containing yellow pus)
Comedones (blocked pilosebaceous units)
Black heads (open comedones with black pigmentation)
What is the management for acne vulgaris
Topical benzoyl peroxide (reduced inflammation, unblocks skin)
Topical retinoids (slow production of sebum, highly teratogenic)
Topical/oral antibiotics
COCP
What is first disease
Measles
Highly contagious
Symptoms 10-12 days after exposure
Presentation: fever, coryza, conjunctivitis, koplik spots (grey white spots on buccal mucosa)
Rash starts on face, spreads to rest of the body
Self resolves in 7-10 days
Notifiable disease
Complications: pneumonia, diarrhoea, dehydration, encephalitis, meningitis, hearing loss, death
What is 2nd disease
Scarlet fever
Due to group A strep
Pink, blotchy, macular rash
Rough ‘sandpaper’ skin
Starts on trunk, spreads outwards
Presentation: fever, lethargy, flushed face, sore throat, strawberry tongue, cervical lymphadenopathy
Antibiotics (penicillin V)
Notifiable disease
What is 3rd disease
Rubella
2 week incubation
Erythematous, macular rash
Starts on face, spreads to body
Presentation: mild fever, joint pains, sore throat, lymphadenopathy
Notifiable disease
Should stay off school for 5 days from rash starting, and away from pregnant women
Complications: thrombocytopenia, encephalitis, congenital rubella syndrome (deafness, blindness, congenital heart disease)
What is 4th disease
Duke’s disease
Non-specific viral rash
What is 5th disease
Slapped cheek syndrome
Parvovirus B19 infection
Affects trunk and limbs
Self resolves in 1-2 weeks
Complications: aplastic anaemia, encephalitis, meningitis, pregnancy complications, hepatitis, myocarditis, nephritis
What is 6th disease
Roseola infantum
Due to herpesvirus 6
1-2 week incubation
High fever for 3-5 days, disappears suddenly
Coryzal symptoms
Rash 1-2 days after fever
Rash on arms, legs, face, trunk (not itchy)
Fully recover in a week
Complications: febrile convulsions
What is erythema multiforme
Erythematous rash due to hypersensitivity reaction
Mostly due to viruses or medications
How might a patient with erythema multiforme present
Widespread, itchy, erythematous rash
Characteristic target lesions
Can cause stomatitis
Mild fever
Muscle and joint pains
Headache
Flu-like symptoms
What is the management for erythema multiforme
Resolves spontaneously in 1-4 weeks
If severe: IV fluids, analgesia, steroids
What is urticaria
Aka hives
Small, itchy lumps on skin
Can be associated with angioedema and flushed skin
Due to release of histamines by mast cells
Can be acute or chronic
What are the causes of urticaria
Food allergies
Medication allergies
Animal allergies
Contact with chemicals
Viral infections
Insect bites
What is the management for urticaria
Antihistamines (fexofenadine)
Oral steroids
What are chicken pox
Due to varicella zoster virus
Generalised vesicular rash
Highly contagious
Incubation 10-21 days
Stop being contagious when lesions have crusted over
How might a patient with chicken pox present
Widespread, erythematous, raised, vesicular blistering lesions
Starts on trunk or face, then spreads
Fever
Itching
Generalised fatigue and malaise
What is the management for chicken pox
Usually mild and self limiting
Aciclovir (immunocompromised, adults, neonates)
Calamine lotion/antihistamines for itching
Children should stay off school and away from pregnant women
What are the complications of chicken pox
Bacterial superinfection
Dehydration
Conjunctival lesions
Pneumonia
Encephalitis
Shingles
Ramsay Hunt syndrome
What is hand, foot and mouth disease
Due to coxsackie A virus
3-5 day incubation
How might a patient with hand, foot and mouth disease present
Viral upper respiratory tract infections
After 1-2 days, small mouth ulcers
Blistering red spots across body
Spots most noticeable on hands, feet and mouth
Can be itchy
What is the management for hand, foot and mouth disease
No treatment
Resolves in 10 days
Supportive management
What are the complications of hand, foot and mouth disease
Dehydration
Bacterial superinfection
Encephalitis
What is molluscum contagiosum
Due to poxvirus
Direct contact spread
How might a patient with molluscum contagiosum present
Rash
Small, flush-coloured papules
Have central dimpling
Appear in crops
What is the management for molluscum contagiosum
Spontaneously resolves (can take 18 months for papules to disappear)
Antibiotics if have bacterial superinfection
Surgical removal of papules
How might a patient with pityriasis rosea present
Characteristic herald patch rash
Faint red, scaly, oval lesions
Usually on torso
Follow lines of ribs
General flu-like symptoms
What is the management for pityriasis rosea
Usually resolves in 3 months
Not contagious (can carry on with normal activity)
What is seborrhoeic dermatitis
Inflammatory skin condition affecting sebaceous glands
Can cause cradle cap
Due to malassezia yeast
What is infantile seborrhoeic dermatitis
Cradle cap
Crusty, flaking skin
Usually resolves by 4 months
Management: baby oil, white petroleum jelly, anti-fungal creams
What is seborrhoeic dermatitis of the scalp
Get dandruff
Management: ketoconazole shampoo, topical steroids
What is ringworm
Fungal infection of skin
Aka tinea
How might a patient with ringworm present
Itchy, erythematous, scally, demarcated rash
Ring shaped area, spreads outwards
What is the management for ringworm
Antifungal creams/shampoos
Oral antifungals
Advice: wear loose clothing, keep area clean and dry, avoid sharing towels, avoid scratching and spreading to other areas
What is nappy rash
Contact dermatitis in nappy area
Due to: friction between skin and nappy, contact with urine and faeces
Most common at 9-12 months
What are the risk factors for nappy rash
Delayed nappy changing
Irritant soaps
Vigorous cleaning
Certain types of nappies (poorly absorb)
Diarrhoea
Oral antibiotics
Pre-term babies
What is the management for nappy rash
Switch to highly absorbent nappies
Change nappies asap
Water or gentle products for cleaning
Make sure area dry before putting nappy on
Maximise time not wearing a nappy
What are the complications of nappy rash
Candida infection
Cellulitis
Erosion or ulceration of skin
What are scabies
Mites that burrow under skin
Cause skin infection and intense itching
Up to 8 weeks before rash appears
How might a patient with scabies present
Itchy, small red spots
Possible track marks (usually between fingers)
What is the management for scabies
Permethrin cream (cover whole body, leave for 8-12 hours then wash off, repeat after 1 week)
What is the management for headlice
Dimeticone 4% lotion: leave on for 8 hours, wash off, repeat in 1 week
Fine comb (systemically comb lice out)
What are the differentials for a non-blanching rash
Meningococcal septicaemia
Henoch-Schonlein purpura
Idiopathic thrombocytopenic purpura
Acute leukaemia
Haemolytic uraemic syndrome
Viral illness
What are the investigations for non-blanching rashes
Bloods
Blood cultures
Lumbar puncture
Blood pressure
Urine dip
What is erythema nodosum
Red lumps on shins
Due to inflammation of subcutaneous fat
A hypersensitivity reaction
Causes: streptococcal throat infection, gastroenteritis, mycoplasma pneumonia, TB, pregnancy, medications (COCP, NSAIDs), inflammatory bowel disease, sarcoidosis, lymphoma, leukaemia
What are the investigations for erythema nodosum
Bloods
Throat swab
Chest X-ray
Stool microscopy and culture
Faecal calprotectin
What is the management for erythema nodosum
Rest and fluids
Consider steroids
Most resolve in 6 weeks
What is impetigo
Superficial bacterial skin infection
Usually due to staph aureus
Get a ‘golden crust’ appearance
Contagious (keep off school)
Non-bullous: around nose and mouth, treat with topical fusidic acid, antiseptic cream, oral flucloxacillin
Bullous: in < 2s, fever and generally unwell, treat with flucloxacillin
What are the complications of impetigo
Cellulitis
Sepsis
Scarring
Post-streptococcal glomerulonephritis
Staph scalded skin syndrome
Scarlet fever
What is staphylococcal scalded skin syndrome
Staph aureus that produces epidermolytic toxins (protease enzymes)
Usually in < 5s
How might a patient with staphylococcal scalded skin syndrome present
Generalised patches of erythema on skin
Skin becomes thin and wrinkled
Formation of bullae (burst and leave sores, erythematous skin below)
Nikolsky sign: gently rubbing skin causes it to peel away
What is the management for staphylococcal scalded skin syndrome
IV antibiotics
What is Steven-Johnson syndrome
Disproportionate immune response causes epidermal necrosis
Blistering and shedding of top layer of skin
What are the causes of Steven-Johnson syndrome
Medications: anti-epileptics, antibiotics, allopurinol, NSAIDs
Infections: herpes, mycoplasma pneumoniae, cytomegalovirus, HIV
How might a patient with Steven-Johnson syndrome present
Fever, cough, sore throat, sore mouth, sore eyes, itchy skin
Purple/red rash spreading across skin
Skin starts to blister
Skin breaks away and leaves raw tissue underneath
What is the management for Steven-Johnson syndrome
Supportive care
Steroids
Immunoglobulins
Immunosuppressants
What are the complications of Steven-Johnson syndrome
Secondary infection
Permanent skin damage
Visual compromise
