Dermatology

Question 1

What is psoriasis?

Answer 1

A chronic, relapsing inflammatory skin condition which causes increased skin turnover and epidermal thickening

Question 2

What does psoriasis present with?

Answer 2

Red, scaly plaques found on extensor surfaces and scalp

You get psoriatic arthritis in 10%

Question 3

What are the risk factors for psoriasis?

Answer 3

Genetics- FHx or HLA- CW6 gene
Meds- beta blockers, antimalarials, lithium
Stress, alcohol, smoking, trauma, sunlight

Question 4

What is the management of psoriasis?

Answer 4

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

Question 5

What are examples of steroids used?

Answer 5

Mild= 1% hydrocortisone
Moderate = eumovate (clobetasone)
Potent= betnovate (beclametasone)
Very potent= dermovate (clobetasol)

Question 6

What is acne?

Answer 6

Common inflammatory skin disorder commonly affecting ages 14-19 
Pathophysiology…
- hyperkeratinisation of follicle 
- increased sebum production 
- overgrowth of P. Acnes

Question 7

What are the lesions of acne?

Answer 7

They can either be inflammatory or non inflammatory

Non inflammatory= closed comedones (white heads), open comedones (black heads)

Inflammatory= pustules, papules, nodules

Question 8

What is the management of acne?

Answer 8

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

Question 9

What is eczema?

Answer 9

Itchy skin condition characterised by erythema, dry skin, scaling

Question 10

What are the complications of eczema?

Answer 10

Susceptible to infection
S aureus, strep (weeping, pustules, crusting)
Fever malaise

HSV (eczema herpeticum)
Pain, fever, lethargy
Clustered blisters and punched out erosions

Question 11

What is the management of eczema?

Answer 11

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

Question 12

What skin infections are caused by staphylococcus?

Answer 12

Folliculitis
Cellulitis
Bullous impetigo 
Staphylococcal scalded skin syndrome
Toxic shock syndrome

Question 13

What are the skin infections caused by streptococcus?

Answer 13

Vasculitis
Erythema nodosum 
Scarlet fever
Cellulitis
Necrotising fasciitis 
Erysipelas

Question 14

What is the presentation of impetigo?

How do you treat it?

Answer 14

Golden crust +/- oozing blisters
Affects young children

Soak crust with soap and water
Topical antiseptic/ antibiotics
Systemic abx if widespread

Question 15

How long should the child stay off school with impetigo?

Answer 15

No school for 48 hours after startinf Abx or until after the wounds have crusted

Question 16

What is bullous impetigo caused by and how do you treat?

Answer 16

Staph aureus

Treated with oral flucloxacillin

Question 17

What does staphylococcal scalded skin syndrome present like and how do you treat?

Answer 17

Erythema and sheets of peeling skin, malaise and fever
Occurs in children less than 5

Admit (emergency)
Supportive (fluids and analgesia)
IV flucloxacillin, erythromycin

Question 18

What are the features of toxic shock syndrome?

How do you treat it?

Answer 18

Septic shock
Widespread macular erythema
Desquamation, mucosa, oedema, ulceration
Management is supportive (fluids and analgesia), IV flucloxacillin/erythromycin

Question 19

What is erysipelas?

How do you manage it?

Answer 19

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

Question 20

What is necrotising fasciitis?

Answer 20

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)

Question 21

What symptoms do you get with cellulitis?

What is the management?

Answer 21

Erythema
Heat plus pain
Gross oedema

Management= bloods, ELEVATE, flucloxacillin
One limb

Question 22

What is scarlet fever?
How does it present
What is the management

Answer 22

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

Question 23

What are the causes of erythema nodosum?

Answer 23

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