Dermatology Flashcards
how do you measure the extent of a burn
wallaces rule of 9’s
- head & neck - each arm - each anterior leg - each posterior leg - anterior chest - posterior chest - anterior abo - posterior abdo
what is the most accurate method of measuring the extent of a burn
lund and browden chart
red and painful burn which is dry with no blisters
superficial epidermal (1st)
pale pink burn which is painful, blistered and has a slow capillary refill
superficial dermal (2nd)
white burn with patches of non-blanching erythema, reduced sensation and pain on deep pressure
deep dermal (2nd)
white waxy, brown leathery or black burn with no blisters and no pain
full thickness (3rd)
give some initial management for burns
first aid
ANALGESIA
early intubation if burns to face/inhalation injuries
urinary catheter
IV fluids
management of superficial epidermal
analgesia and emollients
management of superficial dermal
no emollients, non-adherent dressing to keep the blister intact
management of severe full thicknesss burns
escharotomies
where are deep dermal, full thickness, superficial dermal more than 3% in adults or 2% in paeds, inhalational injuries, electrical or chemical burns managed
secondary care
burns more than 10% in adult or 5% in child or complex burn
burns unit
what causes oedema weeks after a burn
loss of plasma proteins
what is the formula for IV fluid calculation in burns patients
PARKLAND FORMULA
% SA of the burn x weight x 4
give half in first 8 hours and half in next 16
skin cancer presenting as a painless bleeding ulcer on sun exposed skin with RF of sunlight, smoking, leg ulcers, genetics, bowens disease, actinic keratosis
squamous cell carcinoma
management of skin cancers
surgery with wide excision
what factors contribute towards a poor prognosis in skin cancer
deep/large diameter or patient immunosuppressed
precancerous dermatosis
slow growing red scaly patches in sun exposed areas
managed with topical flurouracil
bowen’s disease (-> SCC)
premalignant condition with small crusty, scaly and itchy lesions in the sun
managed with topical flurouracil, diclofenac or surgery
actinic keratosis
benign tumour similar to an SCC
dome crater filled with keratin
keratocanthoma
skin cancer with a pearly white edge
BCC
most common BCC raised translucent papule on face with local destruction
nodular BCC
what are the 4 other BCC types
superficial: trunk in 50’s
morpheaform: flat irregular plaque
cystic: clear blue-grey
basosquamous: very invasive
most common type of malignant melanoma presenting as a slow growing mole in a young person
superficial spreading malignant melonoma
second most common malignant melanoma presenting as a red/black bleeding lump in sun exposed areas of middle aged which metastasises early
nodular malignant melanoma
least common malignant melanoma presenting as a growing mole in elderly
lentigo maligna
rare form of malignant melanoma in the nails, palms or soles of darker skinned individuals which exhibits hutchinsons sign
acral lentiginous
what are the surgical margins of malignant melanoma based on
breslow thickness
premalignant condition in smokers presenting with white hard spots on the mucous membranes of the mouth
leucoplakia
what are the two types of dermatitis
irritant: non allergic on hands from cleaning/cement
allergic: T4 hypersensitivity with weeping eczema
management of allergic dermatitis
patch test and steroid
20-45 year old woman presenting with clusters n the perioral region which worsen with steroids and are treated with ABx
perioral dermatitis
dermatitis around the anus
zinc deficiency
eczematous rash on the face associated with otitis externa and blepharitis treated with ketoconazole/steroids
seborrheic dermatitis
SE of ketoconazole
gynaecomastia
autoimmune condition causing IgA deposits in coeliac disease presenting with itchy vesicular lesions on extensors treated by removing gluten or dapsone
dermatitis herpetiformis
antibodies against desmosomes causing mucosal ulcers and skin blisters
managed with steroids and immunosuppressants
pemphigus vulgaris
blistering skin in the elderly treated with steroids
bullous pemphigold
pathophysiology of vitiligo
reduced melanocytes causes well demarcated depigmented skin
precipitated by trauma
management of vitiligo
suncream, make up, tacrolimus, steroids, phototherapy
what must you test for in patients who have been diagnosed with vitiligo or alopecta acreta
other autoimmune diseases
which organism causes impetigo
staph aureus/pyrogens
presentation of impetigo
golden crusted lesions
treatment of impetigo
hydrogen peroxide
(or fusidic acid/oral fluclox/eryth if extensive)
school exlcusion for impetigo
until lesions crusted or 48 hours after abx as contagious
pink pearly white papules with central umbilication on the trunk and flexors which self-resovle in 18m
molluscum contagiosum
virus which causes molluscum contagiosum
pox
widespread pruritis and linear burrows which are spread by skin to skin contact
scabies
management for scabies
2 doses of PERMETHRIN at least 1 week apart for the whole family
how long can the itch last after successful therapy for scabies
4-6w
management of verruca
salicyclic acid
management of headlice
malathion
management of hyperhidrosis
topical aluminium chloride
most common site for keloid scars
sternum
where are sebaceous cysts commonly found
scalp
central punctum
common eczematous itchy rash in pregnancy
atopic eruption of pregnancy
pruritis in abdominal striae which spares the peri umbilicus in the 3rd trimester
management
polymorphic eruption of pregnancy
emollient / steroid
pruritic blistering lesions around the umbilicus in the 2nd/3rd trimester
management
pemphigoid gestationis
oral steroid
itchy white spots on the vulva of elderly women
management
lichen sclerosis
potent topical steroid (clobetasol)
Purple Pruritic Papular Polygonal rash on flexor surfaces, genitals and palms with oral involvement, Wickham’s striae and koebner phenomenon
management
Lichen planus
potent topical steroid (clobetasol) or benzylamine mouthwash
inflammation of the SC fat causing tender, red and nodular lesions on shins associated with strep, TB, sarcoidosis, pregnancy, malignancy, COCP and penicillin
management
erythema nodosum
self resolves in 6w
hypersensitivity reaction triggered by herpes, SLE, malignancy, penicillin, NSAID, sulph, carbamazepine, COCP, allopurinol causing TARGET LESIONS
erythema multiforme
requirement of erythema multiforme major
mucosal involvement
severe end of the spectrum which causes erythema multiforme to stevens johnson syndrome
patients are systemically unwell with positive nikolyskys
toxic epidermal necrolysis
management of toxic epidermal necrolysis
ICU - Fluids - Immunoglobulin - Immunosuppression
chronic and painful inflammatory skin condition in women under 40 years with DM, PCOS or smoking presenting with red nodules in the axilla which can rupture and cause rope like scarring
hidradenitis suppurativa
management of hidradenitis suppurativa
good hygiene, weight loss, stop smoking, steroid, flucloxacillin
complications of hidradenitis suppurative
sinus tracts, fistula, comedomes, lymphatic obstruction
rare condition causing skin ulceration, fever and myalgia assoaciated with IBD, RA, SLE, biliary cirrhosis, lymphoma and myeloproliferative disorders
treated with steroids and immunosuppression
pyoderma gangrenosum
surgery with pyoderma gangrenosum
postpone
benign small red spot which can bleed/ulcer associated with trauma, pregnancy, crohns, UC and treated with steroids or surgery
pyogenic granuloma
which virus causes shingles
herpes zoster
how does shingles present
prodrome: fever, lethargy, headache, burning pain
rash: red and macular in T1-L2
management of shingles
aciclovir in 72 hours to prevent post herpetic neuralgia
steroids NSAID paracetamol if severe pain
3 risk factors for shingles
age HIV immunosuppression
which bacteria causes acne
propionibacterium acnes
classification and treatment of acne
mild-moderate-severe
stepwise
1. topical retinoids/benzylperoxide
2. oral ABx (tetracyclines) or COCP
3. Isotrenitoin
how do you initiate isotrenitoin
under specialist treatment
if scarring
main side effect of isotretinoin
dry skin
which medications do you need to avoid when managing acne in pregnancy
retinoids
tetracyclines
isotrenitoin
herpes simplex or coxsackie virus causing a rapidly progressive painful rash in children with ‘monomorphic punched out erosions’
eczema herpeticum
treatment of eczema herpeticum
IV aciclovir
which type of eczema presents as small puritic blisters on the palms and soles in humidity or high temperatures
pompholyx eczema
management of pompholyx eczema
cool compress, emollients, steroids
flushing and telangiectasia of the face exacerbated by sunlight associated with papules and pustules and BLEPHARITIS
rosacea
management of rosacea
suncream/hats
laser therapy for telangiectasia
topical metronidazole/brimodine
tetracyclines if severe
what does trauma (koebner phenomenon), alcohol, withdrawal of systemic steroids, BB, NSAID, ACEi, infliximab and anti-malarials exacerbate
psoriasis
3 main medications in the management of psoriasis
emollients, topical steroid, vitamin D analogue
how should you use steroids in psoriasis
4 week break between steroid doses
if you’ve been on strong steroids for 8 weeks then vitamin D analogue only
which therapy for psoriasis can predispose SCC
PUVA light therapy
which medication can be used in psoriasis to reduce the number of long term flares
calcipotriol
tear drop scaly patches on the trunk and limbs 2-3 weeks after strep throat infection which resolves in 2-3 months (can use steroid or UVB)
guttate psoriasis
herald patch then multiple red raised oval lesions 1-2w later with a fir tree appearance which resolves in 6w
sometimes associated with resp infection
pityriasis rosea
superficial fungal infection affecting the trunk causing hypopigmented lesions after sun exposure
pityriasis versicolour
management of pityriasis versicolour
ketoconazole shampoo
management of onychomycosis (fungal nail infection)
nail clipping or scraping
oral terbinafine
RF for onychomycosis (fungal nail infection)
DM
itchy peeling skin on the feet
management
tinea pedis
topical terbinafine
what is tinea corporis
managment
ringworm
oral fluconazole
fungal infection of the scalp caused by trichophyton which glows green under woods lamp and treated with oral terbinafine or ketoconazole shampoo
tinea capitis
symmetrical brown, velvet plaques on the neck axilla and groin associated with T2DM, GI cancer, COCP, PCOS, cushings, obesity, thyroid and acromegaly
acanthosis nigricans
vascular birthmark which self resolves
salmon patch
management of a strawberry naevis
propranolol if large and bleeding
management of a child with new onset purpura
immediate referral for ALL or meningococcal disease
management of healthcare workers who are not naturally immune to varicella
vaccinate
management of facial hirsitism
topical eflornithine
management of severe urticaria
ST oral steroid and antihistamine
side effect of steroids in darker pigmented skin
patchy depigmentation
what is a curlings ulcer
stress ulcer in burns patients causing haematemesis
