Dermatology

Question 1

What is the first line treatment for psoriasis?

Answer 1

• Emollients

- Potent topical corticosteroid + vitamin D analogue (calcipotriol)-> both OD

Question 2

What treatments can be used in psoriasis?

Answer 2

• Psoriasis
• Topical corticosteroids
• Topical vitamin D analogues-> calcipotriol
• Coal tar preparations
• Phototherapy
• Oral immunosuppressants

Question 3

How does guttate psoriasis present?

Answer 3

• Often after an URTI (strep infection)
• Acute onset
• Tear drop shaped scaly rash on back + chest-> itchy but not painful

Question 4

How does erythema multiforme present?

Answer 4

• Triggered by infections
• Target shape rash
• Back of hands or feet then spread to torso

Question 5

How does pityriasis rosea present?

Answer 5

• Herald patch-> single ovoidal lesion initially

- Few weeks later-> multiple, erythematous, raised, oval

Question 6

What causes seborrhoeic dermatitis?

Answer 6

Malassezia furfur-> normal skin inhabitant proliferates + causes inflammatory reaction

Question 7

How does seborrhoeic dermatitis present?

Answer 7

Eczematous lesions-> scalp, periorbital, auricular, nasolabial

Question 8

What is the most common type of melanoma?

Answer 8

Superficial spreading

Question 9

How does superficial spreading melanoma present?

Answer 9

• Growing mole with irregular ABCDE features
• Arms, legs, back, chest
• Young people

Question 10

How does nodular melanoma present?

Answer 10

• Red/black lump
• Might bleed or ooze
• Sun exposed skin
• Middle aged people

Question 11

How does lentigo maligna melanoma present?

Answer 11

• Growing mole with irregular ABCDE features
• Chronically sun exposed skin
• Older people

Question 12

How does acral lentiginous melanoma present?

Answer 12

• Nails, palms or soles
• Subungual pigmentation (Hutchinson’s sign)
• African and Asian people/descent

Question 13

How is erythema nodosum managed?

Answer 13

• No active treatment

- Arrange routine follow up

Question 14

What malignancy is often associated with acanthosis migricans?

Answer 14

Gastrointestinal adenocarcinoma

Question 15

What are the features of lichen planus?

Answer 15

• Itchy papular rash
• Usually on palms, soles, genitalia + flexor surfaces of arms
• Polygonal
• Wickham’s striae-> white lines on surface
• Oral involvement-> white lace on buccal mucosa
• Nails-> thinning of plate, longitudinal ridging

Question 16

How is lichen planus managed?

Answer 16

• Potent topical steroids
• Oral-> benzydamine mouthwash or spray
• Severe-> oral steroids/immunosuppression

Question 17

What is pyoderma gangrenosum associated with?

Answer 17

• Idiopathic
• IBD
• RA
• SLE
• Haem disorders-> lymphoma, leukaemias etc

Question 18

How does pyoderma gangrenosum present?

Answer 18

• Lower limb
• Minor injury-> small pustule/blister-> large ulcer
• Ulcer-> purple, violaceous, deep, necrotis
• Fever + myalgia

Question 19

How is pyoderma gangrenosum managed?

Answer 19

• Oral steroids
• Ciclosporin + infliximab
• Surgery-> after progression controlled on immunosuppression

Question 20

How does erythema nodosum present?

Answer 20

• Inflammation of SC fat
• Tender, erythematous, nodular lesions
• Over shins, forearms or thighs
• Resolves in 6 weeks ish
• Heals without scarring

Question 21

What can cause erythema nodosum?

Answer 21

• Streptococci
• TB
• Sarcoidosis
• IBD
• Behcet’s
• Malignancy
• Lymphoma
• Penicillins
• COCP
• Pregnancy