Dermatology Flashcards
Melasma Management (options)
- Kligman’s formula: gold standard (hydroquinone, tretinoin & dexamethasone ) BD 3 weeks
- Hydroquinone 2% BD 2-4 months
- Topical Tretinoin 0.025% daily
- Cease hormonal contraception
- Sun safety (spf 50+)
NOTE: NO LASER
Nodular cancery looking lesion on ear
-Squamous cell carcinoma
-Keratoacanthoma
-Nodular BCC
-Nodular melanocytic melanoma
-Chondrodermatitis nodularis helicis
-Atypical fibroxanthoma
Mild Acne topical options
Mainly comedomal with some inflammatory pustules
Benzoyl peroxide plus adapalene 2.5%/0.1% gel daily 6 weeks
Increase to 2.5%/0.3% if not effective but tolerated
Mild acne options topical
Not much inflammation
Adapalene 0.1% up to 0.3% gel daily 6 weeks
tretinoin 0.025% daily 6 weeks
Oral acne agents
Doxycycline 50mg daily but can increase to 100mg daily
Minocycline 50mg daily
COCP with cyproterone formulation
Spironolactone (alternative or addition to COCP) NOTE: contraindicated in pregnancy 25mg up to 100mg daily
Counselling for isotretinoin
- Teratogenic, must be on contraception
- Sun sensitivity: must use SPF and avoid sun exposure
- Causes skin dryness (mucosal surfaces eg lips, nose- nose bleeds)
- May cause myalgia and joint stiffness
- Tetracyclines contraindicated due to intercranial hypertension
Intertrigo DDx
Tinea Cruris
Erythrasma
Flexural psorasis
Seborrheic dermatitis
Candidiasis
Advantan fatty ointment generic name?
Methylprednisolone aceponate 0.1%
Antihistamine example
Loratadine 10mg daily
Allergy (allergic contact dermaitis management)
Advantan FO (methylprednisolone aceponate) daily
Best combo for mild acne:
1) mostly comedomal
2) Inflammatory acne
3) both
1) Peroxide & retinoid
Benzoyl peroxide & Adapalene (2.5% & 0.1-3%)
2) Use a combo with Clindamycin in it
Eg Benzoyl peroxide and clinda (5%/1%)
3) retinoid plus clind
Tretinoin 0.025%& Clinda 1%
All nocte 6 weeks then review
Pityriasis rosea
HHV6-7
young adults
Herald patch - looks like ringworm
Then fir tree pattern of eruption
Topical therapy for tinea
Terbinafine 1% daily or BD for 7-14 days
Oral therapy for tinea
Terbinafine 250mg daily for 2 weeks
Shingles pharmacology
Valaciclovir 1g TDS 7 days
Single most likely diagnosis
Erythema Multiforme
Causes of Erythema Multiforme
Infections: HSV, mycoplasma pneumonia, TB
Medications: Penicillins, anti-epileptics
Malignancy: hodgkins disease
Systemic: SLE
Erythema Multiforme Treament
Betamethasone dipropionate 0.05% daily for 2 weeks
(diprosone /eleuphrat)
Diagnosis?
Keratosis pilaris
Diagnosis
Sebaceous hyperplasia
Very/ultra potent topical steroid examples
Betamethasone dipropionate (0.05%) in optimised vehicle (diprosone OV)
Clobetasol propionate (0.05%)
Potent topical steroid examples
Betamethasone dipropionate 0.05% (diprosone, eluphrat)
Methylprednisolone Aceponate 0.1%
(advantan) *** some say just moderate
Mometasone furoate 0.1%
(Elocon, mometasone)
Betamethasone valerate 0.05-0.1%
Differentials
- Venous stasis dermatitis/eczema
- Lipodermatosclerosis
- Irritant/allergic contact dermatitis
- Lymphoedema
- pre-tibial myxoedema
Erythema Multiforme Causes
- Infection: Herpes simplex virus
- Neoplastic: Hodgkin’s disease
- Medications: penicillins, sulphonamides
- Systemic disease: lupus
- Idiopathic
Erythema Multiforme treatment
- Emolient
- Remove trigger
- Potent topical corticosteroid: Betamethasone dipropionate 0.05% daily for 2 weeks
Pruritis general causes
- Renal failute (uraemia)
- Hyperbilirubinaemia, cholestasis
- Diabetes
- Thyroid disease (hypo/er)
- IDA
- Psychogenic
- Hyperparathyroidism
- Malignancy - lung, brain, colon
- Haematological malignancy (lymphoma)
- Paraneoplastic syndrome
- MS
- Scabies
Impetigo in endemic settings (2 first line agents)
Bactrim:
Trimethoprim + Sulfamethoxazole (4+20 mg/kg up to 160+800) BD 3 days
OR
benzathine benzylpenicillin IM stat 0.6ml to 2.3mL for >20kg
Psoriasis on trunk and limbs stepwise treatment
LPC (Liqor picis carbonis) 4-8% + salicylic acid 3% BD 1 month
Acute flare, tar not enough
Methylpresnisolone aceponate 0.1% daily
Not responding 3 weeks
Betamethasone Dipropionate 0.05% daily
Also can use Calcipotriol & betamethamethasone (Daivobet )
What am I and what would you treat it with
A) Seborrheic dermatitis
B) Hydrozole
More severe seborrheic dermatitis treatment
Methylprednisolone aceptonate 0.1% CREAM daily
Pruritis steroid of choice for
a) trunk
b) face
a) Betamethasone valerate 0.02% BD 2 weeks
b) hydrocort 1% BD 2 weeks
Chicken pox contact: when to give vaccine
> 1 yr & <5 days since exposure
Or household contacts of immunodeficient contacts
What am I ?
Fixed drug eruption
Neonatal cephalic pustulosis (neonatal acne) treatment
Self limiting but if appearance a concern then
- Clotrimazole 1% BD or Ketoconazole 2% BD
What am I ?
How old would I be (typically) ?
How to treat ?
Infantile acne
3-4 months
Topical Benzoyl peroxide 2.5%, topical clindaymycin
Onychomycosis treatment
Terbinafine 250mg daily until clinical clearance
Flexural psoriasis treatment
Advantan FO daily until clear
(no longer than 2 weeks if in nappies)
Causes of intertrigo
- Flexural psoriasis
- Seborrheic dermatitis
- Atopic dermatitis
- Candiasis
- Erythrasma
- Tinea cruris
Causes of erythema nodosum
Drugs
- COCP
- NSAIDS
- Amox
Inflammatory
- IBD
- Sarcoidosis
- Lymphoma
Infectious
- Strep
- TB
- Chlamydia
Pregnancy
Erythema nodosum treatment
IF SEVERE
- prednisolone 25mg daily for 2 weeks then taper
Granuloma annulare treatment
SELF LIMITING BUT
- If persistent for months
- tender
- Interferes with function
Betamethasone dipropionate 0.05% BD 4-6 weeks
What am I ?
Oral hairy leukoplakia