Dermatology Flashcards
What is psoriasis?
A chronic, relapsing inflammatory skin condition which causes increased skin turnover and epidermal thickening
What does psoriasis present with?
Red, scaly plaques found on extensor surfaces and scalp
You get psoriatic arthritis in 10%
What are the risk factors for psoriasis?
Genetics- FHx or HLA- CW6 gene
Meds- beta blockers, antimalarials, lithium
Stress, alcohol, smoking, trauma, sunlight
What is the management of psoriasis?
Depends on the severity and impact on the patient
Education- avoid lifestyle triggers like stress, smoking, alcohol
First line- topical treatments Emollients ie: 45 Coticosteroids and vit D analogues Keratolytics like 5% salicylic acid Coal tar products are used on scalp
Second line is photopherapy
(Secondary care)
Third line is systemic treatments
What are examples of steroids used?
Mild= 1% hydrocortisone
Moderate = eumovate (clobetasone)
Potent= betnovate (beclametasone)
Very potent= dermovate (clobetasol)
What is acne?
Common inflammatory skin disorder commonly affecting ages 14-19 Pathophysiology… - hyperkeratinisation of follicle - increased sebum production - overgrowth of P. Acnes
What are the lesions of acne?
They can either be inflammatory or non inflammatory
Non inflammatory= closed comedones (white heads), open comedones (black heads)
Inflammatory= pustules, papules, nodules
What is the management of acne?
It dependa on the severity, psychological impact and response to previous treatments
Topical Tx= 1st line for mild/moderate
Retinoids= unblocks pores, antibicaterials= benzyl peroxide
Antibiotics= erythromycin/ clindamycin
Oral isoretinoin (roaccutane) = retinoid (decrease sebum made) for….
Severe or Tx resistant subtypes
Visible scarring or risk of bad scarring
Significant psychological distress
Hormonal Tx (Dianette)
Used in Tx resistant subtypes
Visible scarring or risk of bad scarring
Significant psychological distress
Scar treatment Microdermabrasion Laser resurfacing Punch biopsy/ excision Intralesional steroids- keloid scars
What is eczema?
Itchy skin condition characterised by erythema, dry skin, scaling
What are the complications of eczema?
Susceptible to infection
S aureus, strep (weeping, pustules, crusting)
Fever malaise
HSV (eczema herpeticum)
Pain, fever, lethargy
Clustered blisters and punched out erosions
What is the management of eczema?
First line= avoid irritants, emollients (liberally as often as needed)
Topical steroids= for active areas
Second line= topical calcineurin inhibitors ie: tacrolimus
Third line= photopherapy and emollients and topical steroids
Immunosuppressants= ciclosporin, methotrexate, azathioprine
Additional treatments= systemic abx, antihistamines
What skin infections are caused by staphylococcus?
Folliculitis Cellulitis Bullous impetigo Staphylococcal scalded skin syndrome Toxic shock syndrome
What are the skin infections caused by streptococcus?
Vasculitis Erythema nodosum Scarlet fever Cellulitis Necrotising fasciitis Erysipelas
What is the presentation of impetigo?
How do you treat it?
Golden crust +/- oozing blisters
Affects young children
Soak crust with soap and water
Topical antiseptic/ antibiotics
Systemic abx if widespread
How long should the child stay off school with impetigo?
No school for 48 hours after startinf Abx or until after the wounds have crusted
What is bullous impetigo caused by and how do you treat?
Staph aureus
Treated with oral flucloxacillin
What does staphylococcal scalded skin syndrome present like and how do you treat?
Erythema and sheets of peeling skin, malaise and fever
Occurs in children less than 5
Admit (emergency)
Supportive (fluids and analgesia)
IV flucloxacillin, erythromycin
What are the features of toxic shock syndrome?
How do you treat it?
Septic shock
Widespread macular erythema
Desquamation, mucosa, oedema, ulceration
Management is supportive (fluids and analgesia), IV flucloxacillin/erythromycin
What is erysipelas?
How do you manage it?
A specific form of cellulitis caused by strep (cellulitis can be caused either by strep or staph)
It causes unilateral, beefy red plaques
Penicillin V
What is necrotising fasciitis?
A very serious bacterial infection of the soft tissue and fascia, the bacteria multiply and release toxins and enzymes which result in thrombosis in the blood vessels, the result in destruction of soft tissues and fascia
Rapidly spreading erythema and necrosis
Also get systemic sepsis- high fever, intense pain and vomiting
Causes= group A strep, +/- s aureus, +/- others
Management= surgical debridement, IV Abx (vancomycin +/- gentamicin)
What symptoms do you get with cellulitis?
What is the management?
Erythema
Heat plus pain
Gross oedema
Management= bloods, ELEVATE, flucloxacillin
One limb
What is scarlet fever?
How does it present
What is the management
Toxin mediated strep skin infection following strep throat
Presentation= widespread pink/ red papules, preceding sore throat, fever, lymphadenopathy, strawberry tongue, sandpaper rash
Management is with oral penicillin
What are the causes of erythema nodosum?
NODOSUM
NO= no cause found in 60% of cases
D= drugs (abx- sulfanamides, amoxicillin)
O= oral contraceptives
S= sarcoidosis
U= Ulcerative colitis, Crohns, Bechetsv
Micro= TB, HSV, EBV, HIV, HepB, HepC, campylobacter
