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Neuro and special senses block > Dermatology > Flashcards

Dermatology Flashcards

1
Q

What are the CF of acne vulgaris?

A
  • Closed and open comedones
  • Pustules and papules
  • Cysts
  • Atrophic scars
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2
Q

What is the pathophysiology of acne?

A

Androgens increase sebum production
There is keratinocyte proliferation
Cutibacterium acnes allowed to colonise
Inflam of pilosebaceous unit

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3
Q

What is the topical management of acne?

A
  • Keratolytics - benzoyl peroxide, retinoids eg. adapalene , salicylic acid
  • Abx - clindamycin and erthromycin
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4
Q

What are the oral drugs can GPs prescribe for acne?

A

Systemic abx:
- Oxytetracycline - 500mg BD
- Lymecycline - 408mg OD
- Erythromycin and trimethoprim more rarely
Cyproterone acetate = dianette COCP, anti androgen

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5
Q

What is the final option for acne management?

A

Isotretinoin = roaccutane. Vit A derivative, decreases sebum.
90% of peoples skin clears and is a cure in 50%.

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6
Q

What are the SEs of isotretinoin?

A
  • Teratogenic, women must be on effective contraception
  • Hyperlipidaemia and liver dysfunction = bloods
  • Myalgia
  • Depression
  • Reduced concentration
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7
Q

What are the clinical features of atopic eczema?

A
  • Erythematous, dry skin, often in flexures
  • Itchy and hx of scratching
  • Excoriations and bleeding/weeping
  • Associated infection
  • Lichenification
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8
Q

What is the management of atopic eczema?

A
  • Emollients - as often as possible, in direction of hair growth to all skin
  • Steroid use
  • Calcineurin inhib
  • Systemics
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9
Q

What are the different steroids that can be used in eczema management?

A

Mild - hydrocortisone 0.5%, 1% and 2.5%
Mod - eumovate
Potent - betnovate
Very potent - dermovate
They can all come in creams or ointments, ointments don’t sting and are more moisturising so preferred if pt willing to use.

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10
Q

What are the different calcineurin inhibitors and what do you need to know?

A

Tacrolimus 0.03% >2 yo
Tacrolimus 0.1% >16 yo
Pimecrolimus
Used when steroids haven’t controlled sx and steroid sparing
- Sting
- Avoid in HSV infection
- Need sun protection as there is a theoretical increase in skin cancer
- Can be used prophylactically

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11
Q

What systemics can be used in eczema management?

A
  • UV light - UVB
  • Ciclosporin
  • Methotrexate
  • Dupilumab
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12
Q

What are some additional advice and options are there for eczema?

A
  • Garments - keep ointments on and cause rapid improvement in eczema
  • Soap substitutes and bath oils
  • Baths to wash off flakes and cream residue
  • Swab infections
  • Sedating antihistamines but no evidence for histamine in eczema
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13
Q

What are the complications of eczema?

A
  • S.aureus infection - crusty, oozing rash = impetiginized eczema
  • Eczema herpeticum = disseminated HSV infection = fever and clusters of itchy blisters/punched out erosions life threatening
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14
Q

What are the clinical features of psoriasis?

A
  • Plaques
  • Silver scaling - hyperproliferation of the epidermis
  • Scalp, extensors, trunk
  • Not really itchy
  • Nail changes
  • Joint pain - psoriatic arthritis - exam joints and nails
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15
Q

What is guttate psoriasis?

A

Small raindrop scales, usually no bigger than 1cm. Triggered by streptococcal throat infection.

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16
Q

What are the nail changes in psoriasis?

A
  • Nail pitting
  • Onycholysis
  • Hyperkeratosis
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17
Q

What is the management of psoriasis?

A
  • Emollients
  • Steroids
  • Vit D analogues
  • Calcineurin inhib
  • Systemic treatments
  • Tar preps and dithranol not used anymore really
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18
Q

What are the systemics used in management of psoriasis?

A
  • Phototherapy - UVB and PUVA in comincation w psoralen
  • Ciclosporin
  • Methotrexate
  • Acitretin = retinoid
  • Biologicals eg. adalimumab
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19
Q

What is impetigo?

A

Staph infection around the peri oral facial area - golden crust. Can be bullous or non bullous.
Can have systemic features - lethargy, fever, diarrhoea.
Is contagious so need to advice no school/work until lesions crusted or 48 hours abx.

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20
Q

What is the treatment of impetigo?

A

Localised - fusidic acid, 4 times a day for 2 weeks
Widespread - fluclox/penicillin or erythromycin

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21
Q

What are the CF of cellulitis?

A
  • Infection reaching the hypodermic layer
  • Commonest on the legs - can be caused by tinea pedis in toes of affected limbs
  • Poorly defined margin
  • Red, hot, swollen, painful
  • Normally a portal of entry
  • Systemically unwell - fever and malaise
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22
Q

What is the treatment of cellulitis?

A

Oral/IV penicillin
10-14 days - stay as inpatient, normally elderly people

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23
Q

Erysipelas vs cellulitis

A

Cellulitis affects the deeper skin and erysipelas is a superficial infection.
Erysipelas has a well defined margin.

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24
Q

What are the different dermatophytes and what areas do they affect?

A

Tinea corporis - trunk
Tinea cruris - groin folds
Tinea pedia - feet
Tinea capitis - scalp
Tinea unguim - toes

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25
Q

What are the features of a tinea lesion?

A
  • Asymmetrical
  • Central sparing
  • Annular
  • Irregular border = active border but well defined
  • Scaly border
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26
Q

What is an eczematous ID reaction?

A

Hypersensitivity reaction to fungal antigens - eczema like lesions all over the body

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27
Q

What is the management of dermatophyte skin infections?

A

Topical miconazole, can add topical steroid if super itchy. Apply anti fungal at least 2cm margin around lesion and cover whole area.
Tinea capitis - oral terbinafine, get LFTs
Tingea unguium - 3-6 months terbinafine

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28
Q

What is actinic keratoses?

A

Dry scaly patches of skin caused by sun damage. Confined to the basal layer of the epidermis and are a precursor for SCC.
Found on face ears and hands commonly (sun exposed sites).

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29
Q

What is the treatment of actinic keratoses?

A
  • 4-16 weeks imiquimod cream
  • 2-4 weeks 5-fluorouracil cream - chemo cream and makes things worse before better
  • Cryotherapy
30
Q

What is Bowen disease?

A

SCC in situ - slowing enlarging erythematous scaly plaques. In the epidermis w/o invasion through the basement membrane.

31
Q

What is the treatment of Bowen’s?

A
  • Surgical excision
  • Cryotherapy
  • Fluorouracil cream
  • Imiquimod cream
32
Q

What are some differentials for SCC?

A
  • BCC
  • Bowen’s disease
  • Keratocanthoma
  • Actinic keratosis
  • Cutaneous horn
33
Q

What are the features of a SCC?

A
  • Nodular
  • Frequently ulcerating - described as never healing
  • Growing a lot and quickly
  • Itchy/painful
  • Bleeding
  • Poorly differentiated
34
Q

What is the treatment of SCC?

A
  • Surgical excision w wide margins
  • When hard to find the depth can do Moh’s micrography
  • Radiotherapy
35
Q

What are the RF of SCC?

A
  • Sun exposure
  • Pre malignant skin conditions
  • Chronic inflam
  • Immunosuppression
  • FH
36
Q

What are the RF for BCC?

A
  • Increasing age
  • Previous BCC
  • Sun damage and sunburn
  • Type 1 skin type
  • FH
37
Q

What are the features of a lesion that is a BCC?

A
  • Nodular
  • Slow growing - years
  • Pearly rolled edge
  • Surface telangiectasia
  • Pink/skin colour
  • Can ulcer/bleed
38
Q

What are the features of superficial BCC?

A
  • Slightly scaly, irregular plaque
  • Thing translucent rolled border
  • More common BCC in younger people
39
Q

What is the treatment of BCC?

A
  • Excision w 3-5mm margin of normal skin
  • May require skin graft
  • Moh’s micrography for high risk ares eg. around nose lips and eyes
  • Curettage, cautery, cryotherapy
  • Imiquimod for superficial BCC
40
Q

What is advise to pt who have been treated w BCC and SCC?

A
  • Avoid the sun in the middle of the day
  • Shade and covered clothing
  • SPF50+ every day
  • Avoid sun beds
  • Regularly check for new lesions
41
Q

What is melanoma?

A

Uncontrolled growth of melanocytes w the potential to metastasise

42
Q

What are the RF of melanoma?

A
  • Increasing age - 45-64 most common age group
  • Previous skin cancer of any time
  • Many naevi
  • FH
  • Type 1 skin
43
Q

What are the features of melanoma?

A
  • Most commonly on skin but can also grow on eye, brain, mouth, vagina
  • Change in colour - black, brown, red, blue
  • Begins flat but can become thickened and raised
  • Change in size and shape
  • Itchy or tender, can bleed and crust
44
Q

What is Breslow thickness?

A

Measuring the thickness of an invasive melanoma:
Vertically in mm from top of granular layer to deepest point of tumour involvement - indicates how likely tumour is to spread

45
Q

What is the treatment of melanoma?

A
  • Excision w wide margin, up to 20mm
  • If local LM enlargement due to mets = removal, if not enlarged = sentinel node biopsy
  • Immunotherapy, other monoclonal ab
  • Chemo for met disease
46
Q

What is shingles?

A

Localised, dermatomal, painful blistering rash caused by reactivation of varicella sozter virus.
Have chicken pox and the virus then remains dormant in the dorsal root ganglia for years before reactivated.

47
Q

What are the CF of herpes zoster/shingles?

A
  • 1st sign = localised pain w/o tenderness or skin change
  • Fever and headache
  • Lymphadenopathy
  • Blistering rash - red papules and blisters/pustules
  • Recover is complete w/i 2-4 weeks normally
48
Q

What are the complications of herpes zoster?

A
  • Eye complications - if tip of the nose has a rash more likely to get eye involvement - trigeminal nerve involvement (Hutchingson’s sign), causes keratitis and corneal damage
  • Ramsay Hunt syndrome - facial nerve palsy w vesicles in the ear
  • Post herpetic neuralgia
49
Q

What is the treatment of herpes zoster?

A
  • Prevention - vaccine
  • Conservative = rest, analgesia, abx for secondary infection
  • Aciclovir 800mg 5 times daily for 7 days if start w/i 1-3 days of onset
50
Q

What is the treatment of post herpetic neuraliga?

A
  • Early use antiviral meds
  • Local anaesthetic applications
  • Topical capsaicin
  • Amitriptylline
  • Gabapentin and pregabalin
  • Transcutaneous electrical nerve stim
  • Botox
51
Q

What are the CF of dermatitis?

A
  • Inflammatory erythematous rash of papules, vesicles and plaques
  • Swelling
  • Can ooze, weep and bleed
  • Normally a reactive rash made worse by application of what caused it
52
Q

What are the CF of chronic eczema?

A
  • Lichenification - skin thickening w accentuation of sin creases
  • Hyperkeratosis
  • Fissuring and excoriation
  • Hyperpigmentation
53
Q

How do you confirm a wart diagnosis?

A

Remove surface layer skin w a scalpel and multiple pin point bleeding points = wart.

54
Q

What is the management of warts?

A
  • Duct tape
  • File off wart then salicylic acid
  • Cryotherapy - commonly reoccurs
55
Q

What are the CFs of molloscum contagiosum?

A
  • Shiny, smooth umbilicated papule
  • Common in children, esp if have pets
  • Can erode and crust
  • In adults affects immunocomp eg. HIV
  • Transmission more common in wet conditions eg. swimming
56
Q

What is the treatment of molloscum contagiosum?

A

Self limiting virus but advice:
- Antiseptic washes eg. hydrogen peroxide cream
- No sharing towels, clothing or baths
- Avoid squeezing spots
- Can give abx if suspect bacterial infection
- Cover affected areas

57
Q

What are the CFs of scabies?

A
  • Extreme itchy, worse at night
  • Multiple household members w same sx
  • Linear burrows
  • Erythematous papules
  • Excoriations
  • Esp in interdigital spaces and wrists
58
Q

What is the management of scabies?

A
  • Permethrim cream everywhere and then wash off after 8-12 hours once and then again after a week
  • Treat whole household, close friends and sexual contacts
  • Wash bedlinen
  • Itch will remain for a few weeks after treatment
59
Q

What is bullous pemphigoid?

A

Autoimmune subepidermal blistering disease, most common in elderly people.
More prevalent in pt w neurological disease eg. dementia, stroke and IPD

60
Q

What are the CF of bullous pemphigoid?

A
  • Erythematous non specific itchy rash precedes blisters
  • Annular lesions
  • Vesicles and bullae
61
Q

What are the ix into bullous pemphigoid?

A
  • Skin biopsy of skin adjacent to blister - direct immunoflourescence = ab along BM
  • Indirect immunoflourescence for circulating ab
62
Q

What is the management of bullous pemphigoid?

A
  • Potent topical steroids eg. clobetasol
  • Emollients to help relieve itch
  • Systemic steroids
  • Tetracycline abx can be better steroid sparing
  • Abx for secondaring bacterial infection
  • Analgesia
  • Immunosuppressants eg. methotrexate, azathioprine
63
Q

What is a chancre?

A

Treponema pallidum or primary syphilis infection.
Painless ulcer that is self limiting

64
Q

What does pityriasis rosea look like? What are the sx of the rash?

A

1st = large circular or oval herald patch, on chest abdo or back
2nd = ~2w later = smaller scaly oval red patches over chest and back
Itchy!
Flu sx a few days before get the rash

65
Q

What causes pityriasis rosea?

A

HSV, vaccines, drug induced reactions

66
Q

What is the management of pityriasis rosea?

A

Self limiting in 6-10w
Control itching = moisturiser, soap substitute
Sun light can help
Can try steroids and antihistamines but not always needed
Calamine lotion and zinc oxide for severe itching

67
Q

What is rosacea?

A

Chronic inflam condition affecting central face = persistent facial redness, telangiectasia, inflam papules and pustules
30-60 years

68
Q

What is the management of rosacea?

A

Lifestyle - avoid triggers eg. hot, spicy food, sun, cosmetic products, vasodilators, alcohol, dairy
Moisturise ++
Suncreams
Avoid topical steroids - make it worse
A adrenergic agonists eg. topical brimonidine and oral B blockers stop flushing

69
Q

What are the CF of lichen planus?

A

Violaceous skin lesions, purple, shiny papules often over wrist
Oral - lacy reticulated pattern
Vulval - white lacy pattern in mucous membrane
Relapses and remits

70
Q

What is the treatment of lichen planus?

A

Can be self limiting but topical steroids, calcineurin inhib and retinoids
If widespread = systemic steroids and DMARD

71
Q

What is the management of guttate psoriasis?

A

Treat associated strep infection w abx
PUVB
Emollients
Normally clears w/i 3-4 months without treatment
25% becomes chronic plaque psoriasis : (

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