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Dermatology Flashcards

1
Q

What is ringworm also known as?

A

Tinea and dermatophytosis

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2
Q

What is the most common type of fungus that causes ringworm and how does it spread?

A

Trichophyton - spreads through contact with infected individuals, animals or soil.

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3
Q

What is Onychomycosis?

A

Fungal nail infection

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4
Q

How does onychomycosis present?

A

Thickened, discoloured and deformed nails (separation from nail bed)

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5
Q

How does ringworm present?

A

Itchy rash that is erythematous, scaly and well demarcated. In a ring where the edge is more prominent red then the centre

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6
Q

How does tinea capitis present?

A

Well demarcated hair loss. Itchy, dryness and erythema of the scalp.

More common in children then adults

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7
Q

How does tinea pedis (athletes foot) present?

A

White or red, flaky, cracked, itchy patches between the toes. Skin may be split or bleed.

More likely to occur when feet are sweaty and damp for prolonged periods of time or sharing changing rooms with someone with athletes foot.

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8
Q

What investigation could be done for fungal infections?

A

Usually a clinical diagnosis

But may be possible to scrape some of the scales off and send them for microscopy and culture

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9
Q

What is the treatment for ringworm?

A
  • Anti-fungal creams e.g. clotrimazole and miconazole
  • Combination of anti-fungal and corticosteroid may be used to settle the inflammation and itching - Daktacort (miconazole 2% and hydrocortisone 1% cream)
  • Oral anti-fungal may be used such as fluconazole and itraconazole
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10
Q

What can be used to treat tinea capitis?

A

Anti-fungal shampoos - ketoconazole

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11
Q

What can be used for the treatment of onychomycosis?

A

Amorolfine nail lacquer for 6-12 months

Resistant cases may require oral terbinafine - must monitor LFTS before and while taking

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12
Q

What advise should be given to a patient with fungal infection?

A

Wear loose breathable clothes
Keep affect area clean and dry
Avoid sharing towels, clothes and bedding
Use separate towel for feet with tinea pedis
Avoid scratching and spreading to other areas
Wear clean dry sock every day

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13
Q

What is Tinea incognito?

A

More extensive and less well recognised fungal infection that results from the use of steroids to treat an initial fungal infection.

This occurs when the initial presentation of ringworm is misdiagnosed as dermatitis and topical steroid prescribed. This improves the inflammation and itching but dampens immune response and fungal infection returns much worse after steroid stopped.

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14
Q

What is intertrigo?

A

Fungal infection occur under the breast. Usually candida and anti-fungal cream is prescribed.

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15
Q

How does eczema present in babies?

A

Usually occurs on face and extensors.

Cows milk allergy can make eczema worse

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16
Q

How does eczema present in older children or adults?

A

Erythematous rashes in flexure regions that are usually episodic but can be continuous in severe cases. May be pitting and ridging of the nails.

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17
Q

What are the complications of eczema?

A

Infections (bacterial and viral)
Psychosocial issues
Eczema herpeticum

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18
Q

What is the general advise that should be given for someone with eczema?

A

Moisturiser and avoid scratching

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19
Q

What is the management for eczema?

A

Emollients should be used on a daily bases multiple times all over the body
Topical steroids at the lowest strength to control flare ups - avoid on face expect hydrocortisone

Topical immunomodulators may be used for maintenance due to steroid sparing e.g. calcineurin inhibitors

Next step up is Oral anti-histamines and the phototherapy and immunosuppressants

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20
Q

What is the steroid ladder for topical steroids from least to most potent?

A

Mild: hydrocortisone 0.5%, 1% and 2.5%
Moderate: Eumovate (clobetasone butyrate 0.05%)
Potent: Betnovate (betamethasone 0.1%)
Very potent: Dermovate (clobetasol propionate 0.05%)

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21
Q

What should a patient be told on how to apply topical steroids in eczema?

A

Apply thin layer - 1 finger unit covering rough surface area of both hands

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22
Q

What effects of steroid should be the patient be informed about?

A

Thinning of skin

Stinging and burning initially but should settle with time

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23
Q

When would referral to dermatology be indicated in someone with eczema?

A

Diagnosis uncertain
Current medication not controlling symptoms
Facial eczema not responding to treatment
Recurrent secondary infections

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24
Q

What is the options other then emollients for eczema?

A

Lotions - least oil
Creams
Ointments

And the emollients - most oil

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25
Q

What is the presentation of urticaria?

A

Red, raised, itchy rashes - patchy

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26
Q

What is important to establish in the history of urticaria?

A

Timing - acute < 6 weeks, chronic > 6weeks

New things brought to food eaten - allergic

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27
Q

What is the treatment for mild urticaria with identifiable cause?

A

Avoid trigger

Self-limiting

28
Q

What are the treatment options for urticaria?

A

Non-sedating ant-histamines e.g. Cetirizine for 6 weeks

Review and prescribe if symptoms persistent 3-6 months. Daily anti-histamine

Short lived prescribe anti-histamine prn

Severe urticaria - may require 7 day course of corticosteroids

29
Q

What is an important differential diagnosis to rule out in suspected urticaria?

A

Angioodema

30
Q

If the first line treatment is unsuccessful for urticaria, what is the next course of action?

A
  • Increase the dose or try another non-sedating anti-histamine
  • Topical antipyretic treatment to relieve itch e.g. calamine lotion
  • sedating anti-histamine to take at night if sleep affected
31
Q

When is referral indicated in urticaria?

A
  • Under 16 that have severe symptoms requiring steroids
  • Painful persistent urticaria
  • symptoms not well controlled - second line LTRA (montelukast), cyclosporine, mycophenolate mofetil or tarcolimus
  • Acute severe urticaria thought to be due to food or latex allergy
  • Forms of chronic inducible urticaria
32
Q

What is the pathophysiology of acne?

A

Increased production of sebum, trapping keratin and blockage of pilosebaceous unit. Leads to swelling and inflammation in the pilosebaceous units. Androgenic hormones increase production of sebum which is why seen in puberty. These are called comedones.

33
Q

What is the bacteria that is thought to play an important role in acne?

A

Propionibacterium acnes

34
Q

What are the differential diagnosis for acne?

A

Acne rosacea

Folliculitis - usually on the trunk

35
Q

What should patients with acne be advised?

A
  • Avoid over-cleaning skin
  • Use non-alkaline synthetic detergent cleansing product twice daily
  • avoid make-up and sunscreen
  • avoid picking and scratching as may lead to scarring
  • treatment will take time to work (6-8 weeks) and my irritate skin initially.
36
Q

What are the treatment options for acne?

A

No treatment if mild and not affect quality of life of patient

Topical benzoyl peroxide
Topical retnoids - women of child bearing age need effective contraception as tetragenoic
Topical antibiotics - clindamycin - to avoid bacterial resistant, prescribed alongside benzoyl peroxide
Oral antibiotics - lymecycline
Oral contraceptive - slows production of sebum

37
Q

What is the most effective oral contraceptive pill for acne?

A

Co-cyprindol (Danette) - high risk of thromboembolism so discontinued after acne settled

38
Q

When should a patient with acne be followed up?

A

In 12 weeks or symptoms gotten worse

39
Q

When is referral to dermatology required in acne?

A
  • Acne fulminans
  • mild to moderate acne has not responded to two completed courses of treatment
  • moderate to severe acne that has not responded to previous treatment that includes an oral antibiotic
  • acne with scarring
  • acne with persistant pigmentary changes
  • psychosocial distress or mental health disorder
40
Q

What the different types of psoriasis?

A

Plaque psoriasis- most common form in adults

Guttate psoriasis - second most common and commonly occurs in children. Small rasied papules often triggered by streptococcal throat infection, stress or medications. Often resolves spontaneously after 3/4 months

Pustular psoriasis

Erythrodermic psoriasis

41
Q

What are some specific signs of psoriasis?

A

Auspitz sign - small points of bleeding when plaques are scrapped off

Koebner phenomenon - development of psoriatic lesions to areas of skin affected by trauma

Residual pigmentation of the skin after lesions resolve

42
Q

What is the management options of psoriasis in adults?

A

Emollients
Topical steroids
Topical vitamin D analogues (calcipotriol)
Topical dithranol
Specialist:
Topical calcineurin inhibitors (tarcolimus) only in adults
Phototherapy with narrow band ultraviolet B light - esp in guttate psoriasis

Potent steroid and vitamin D analogue - Dovobet, Enstilar
Guided by specialist

43
Q

Who should manage children with psoriasis?

A

Specialist

44
Q

What are the association with psoriasis?

A

Nail psoriasis - pitting, thickening, discolouration, ridging and onycholysis

Psoriatic arthritis

Psychosocial implications

Increase risk of CVD - obesity, hyperlipidaemia, hypertension, IBD and type 2 diabetes

45
Q

When should referral to dermatology be considered in psoriasis?

A

There is uncertainty about the diagnosis
Psoriasis is extensive - more then 10% of body
Psoriasis is at least moderately severe
Psoriasis is resistant to topical drug treatments in primary care or treatments not tolerated
Nail disease that is severe - functional/cosmetic impact
Significant impact of persons physical, psychological or social wellbeing

46
Q

What is seborrhoeic dermatitis?

A

Inflammatory skin condition that affects the sebaceous glands. Cause erythema, dermatitis and crusted dry skin. Malassezia yeast play a role.

47
Q

What is infantile seborrhoeic dermatitis (cradle cap)?

A

Crusty flaky scalp

Self-limiting resolves by 4 months but can last up to 12 months

48
Q

What is the treatment for infantile seborrhoeic dermatitis?

A

First line: baby oil, vegetable oil or olive oil, gently brush scalp and then wash off

Second line: white petroleum jelly (Vaseline) used over night to soften crusted area before washing in the morning

Third line: topical anti-fungal creams - clotrimazole or miconazole for up to 4 weeks

Then refer to dermatology

49
Q

What is the treatment for seborrhoeic dermatitis of the scalp?

A

First line: ketoconazole shampoo - left for 5 mins before washing off. Topical steroids can be used for severe itching.

50
Q

What is the treatment for seborrhoeic dermatitis of the face and body?

A

Commonly affects eyelids, nasolabial folds, ears, upper chest and back

First line: anti-fungal cream - clotrimazole, miconazole for up to 4 weeks and topical steroids such as hydrocortisone for localised inflamed areas

Severe or unresponsive refer to dermatology or paediatric

51
Q

What are the three types of skin cancers?

A

Basel cell carcinoma
Squamous cell carcinoma
Malignant melanoma

52
Q

What are the risk factors for squamous cell carcinoma?

A
  • overexposure to UV light
  • previous non-melanoma skin cancer
  • family history
  • pale skin that burns easily
  • large number of mole or freckles
  • immunosuppressed
53
Q

What is the management of all suspected skin cancers?

A

2ww referral suspected cancer pathway

54
Q

What follow up should be arranged with pt with skin cancer after treatment by dermatology?

A

Skin examination every 3-6 months for next 5 years

Aims:

  • look for signs of cancer returning
  • see if any problems following treatment
  • examine for signs of new cancer
  • make sure pt knows what to look out for
  • check pt knows how to protect skin from sun
55
Q

Which condition needs to be considered that may make acne worse?

A

PCOS

56
Q

What are the treatment options for head lice?

A

Physical insecticides
Chemical insecticides
Wet combing

57
Q

What is the general advise for head lice?

A

Pt can still attend school
Avoid head-to-head contact
Examine weekly
All members of family treated on same day

58
Q

What are the causes of impetigo?

A

Streptococcus pyogenes and staphylococcus aureus

Can spread is someone touches sores or fluid from sores - close contact

Most common in children 2-5 yrs old

Infections or injuries that break skin

Poor personal hygiene

59
Q

What is the treatment for impetigo?

A

Hydrogen peroxide
Fusidic acid
Flucloxacillin
Clarithromycin

60
Q

When does impetigo stop being contagious?

A

48 hrs after starting treatment

When patches dry out and crust over

61
Q

What is the practical advise for impetigo?

A

Stay away from school/work until no longer contagious
Keep clean and dry
Cover then with loose clothing or gauze
Wash hand freq
Wash flannels, sheets and towels at high temp
Wash or wipe down toys with detergent or warm water
Don’t let child scratch to avoid scarring

62
Q

What is the management for nappy rash?

A

Self-management - use high absorbency, make sure nappy fits, leave nappy off for as long as possible, change and clean every 3-4 hrs , fragrance free wipes, gentle drying, no soaps

Mild erythema - OTC barrier cream

Inflamed or discomfort - hydrocortisone 1%

Should clear up in 3 days

63
Q

If rash persists after initial management for nappy rash what are the next steps?

A

Topical imidazole cream - candida infection?

Bacterial infection - antibiotics

64
Q

What are the risk factors for scabies?

A

Poverty and overcrowding
Institutional care, such as rest home, hospital and prisons
Refugee camps
Immunocompromised

65
Q

What are the clinical feature of scabies?

A

Erythematous papules on the trunk and limbs, often follicular
Urticated erthyema
Vesicles on palms and soles
Itchy

66
Q

What is the practical management advise for scabies?

A

As about close contacts especially sexual contacts - GUM clinic
Wash infected clothes, bedsheets and towels at high temp
Avoid work and close contacts until treatment complete
Sick note

67
Q

What should be prescribed for scabies?

A

Topical insecticides eg. Permethrin 5% cream or Malathion 0.5% liquid

S/E of permethrin - burning and stinging on application but settles

Apply to clean dry skin

Sign post - itching may persist for 2-4 week after last application but any longer to follow up

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