Dermatology Flashcards
How does cellulitis present?
On lower limb usually Swelling/tumor Erythematous/rubor Warm to touch/calor Pain in legs/dolor
Pt may be systemically unwell too - fever, malaise, rigors, previous abrasion to leg (so bacteria can enter).
How is cellulitis managed in primary care?
1) Abx - flucloxacillin 500-1000mg qds for 5-7 days
If penicillin allergy = clarithromycin 500mg bds 5-7 days or doxycycline 200mg for one day, then 100mg od for 5-7 days
2) Analgesia - ibuprofen or paracetamol for pain and fever.
3) Drink adequate fluids
4) Manage RF for cellulitis - e.g. breaks in the skin, skin blistering, venous ulcers
Ddx of unilateral redness and/or swelling of limb ?
Cellulitis DVT Septic arthritis Acute gout Ruptured Baker's cyst Thrombophlebitis Cutaneous abscess Erysipelas (like cellulitis but with raised, well demarcated borders).
see CKS NICE cellulitis for more.
RF for cellulitis ?
Break in skin Immunosuppressed Obese Pregnant Skin conditions Previous cellulitis Venous insufficiency
Complications of untreated cellulitis?
Necrotising fasciitis Sepsis Osteomyelitis Lymphagitis Endocarditis Meningitis Gas gangrene
How does impetigo present?
In children Thin blisters, fluid filled Red sores Blisters may have ruptured at presentation - get yellow/golden crust. Itchy, painful Common on face - on philtrum
How is impetigo managed?
Localised - give topical creams = hydrogen peroxide, fusidic acid cream
Short course abx - flucloxacillin/clarithromycin
Hygiene measures for the whole family
RF for impetigo
Young age
Breaks in skin
Close contact - schools
Poor hygiene
Complications of impetigo
Misdiagnosed = cellulitis
Contagious - remain home until lesions clear
Presentation of chicken pox.
Children
Red papule become fluid filled vesicles and rupture
Fever
Malaise
Management of chicken pox?
Not attend school until papule scab over.
Fluid, rest. Symptomatic treatment.
RF for getting chicken pox?
Infants,
Immunocompromised - HIV, chemo puts, transplant pts.
Pregnant women
Name of virus causing chicken pox?
Varicella-zoster virus
Complications of chicken pox?
Shingles - vesicular rash Encephalitis Sepsis Dehydration Bacterial infections of skin Pneumonia
Presentation of eczema?
Itchy, erythematous, scaly dry patches of skin.
On face, extensors and flexors.
Can be vesicular and weepy
Excoriation
Lichenification
Pt has Hx of atopy - eczema + asthma + hay fever
Management of eczema?
Avoid triggers
Emollients - oliatum, epaderm, dermal 500 lotion.
Bath wash and bandages
Topical steroids for flare ups - hydrocortisone 0.1-2.5%.
Antihistamines - fexofenadine
RF for eczema?
Hx of atopy, FH of atopy, skin irritants, temperature extremes
Complications of eczema
Secondary bacterial or viral skin infection
Psycho-social-emotional impacts
How does acne vulgarise present ?
Teenager
Comedones which are open or closed
Inflamed papules, pustules, nodules or cysts.
Present on face, chest, upper back.
Present with scarring
Managing acne vulgaris?
Advice - avoid over cleansing, use non-alkaline cleansing product.
Pharmacological - 12wk topical treatment e.g. topical adapalene (mild/mod) or azelaic acid with oral abx e.g. doxy (for mod/severe)
Woman who can’t take abx? Give cocp
Psych management
Refer to dermatologist
RF for acne vulgaris?
Age Hormonal changes FH Oily substances Friction/pressure on skin
Complications of acne?
Scarring
MH complications
Presentation of allergic contact dermatitis?
Contact wth something on skin - this is where rash appears.
Can present days after.
Red, itchy, swollen, blistered OR dry and bumpy.
Can move from fingers to eyelids due to touching.
Similar presentation to eczema
Management of allergic contact dermatitis?
Recognise triggers Emollients Topical steroids Oral abx for any secondary infections Tacrolimus ointment Azathioprine
