Dermatology

Question 1

NICE step ladder for atopic eczema <12

Answer 1

Mild;
- Emollients
- Mild potency topical corticosteroids

Moderate;
- Emollients
- Moderate potency topical corticosteroids
- Topical calcineurin inhibitors
- Bandages

Severe;
- Emollients
- Potent topical corticosteroids
- Topical calcineurin inhibitors
- Bandages
- Phototherapy
- Systemic therapy (prednisolone)

Question 2

List some topical calcineurin inhibitors and when they would be indicated

Answer 2

Tacrolimus or pimecrolimus

Only to be used in moderate-severe atopic eczema that has failed to respond to topical corticosteroids and where there is serious risk of adverse effects from further steroid use

Question 3

What syndrome is characterised by a triad of eczema, thrombocytopenia and recurrent infections?

Answer 3

Wiskott-Aldrich syndrome

Question 4

Name a mild potency topical steroid

Answer 4

1% Hydrocortisone

Question 5

Name a moderate potency topical steroid

Answer 5

Eumovate (0.05% clobetasone butyrate)

Question 6

Name a high potency topical steroid

Answer 6

0.1% mometasone furoate (Elocon)

Question 7

What super added infections can be seen with atopic eczema?

Answer 7

Herpes simplex = eczema herpeticum

Staph aureus

Group A beta-haemolytic strep

Molluscum contagiosum (pox virus)

Question 8

What investigations can be done to confirm scabies infection?

Answer 8

Dermatoscopy - can see burrows and sometimes mites
Ink burrow test
Skin scrapings

Question 9

Treatment for scabies

Answer 9

<2 months refer to a specialist

> 2 months;
1) 5% permethrin cream = 1st line
2) malathion aqueous 0.5% if permethrin not tolerated (e.g. those with crysanthemum allergy)

Question 10

What systems are affected in HSP?

Answer 10

Skin;
- Blanchable maculopapular rash which then progresses to red petechiae / purpura

Kidneys;
- Haematuria
- Nephritis (IgA mediated)

Joints;
- Usually knees and ankles

GI;
- Abdo pain
- Bloody diarrhoea
- Intussusception

Question 11

Typical timescale for resolution of HSP?

Answer 11

Usually resolves fully in 4 weeks without treatment

Question 12

What season is HSP most commonly seen in?

Answer 12

Winter

Question 13

How long can the mites survive away from the skin in scabies?

Answer 13

36 hours

Question 14

Advice to give r.e. scabies infection

Answer 14

Clothing / furnishings that cannot be washed at high temperatures should be placed in a sealed bag for 72 hours to allow eradication of mites

Question 15

At what age would you expect a strawberry naevus / capillary haemangioma to stop growing?

Answer 15

Proliferative growth phase ends around 6-10 months where it would then enter a stabilisation phase and slow, spontaneous resolution

Question 16

Erythematous, hot cheeks …

Answer 16

If systemically unwell think erysipelas (group A strep) - needs IV Abx

If systemically well think slapped cheek / fifth disease / erythema infectiosum (parvovirus b19)

Question 17

Fine, pink macular rash which starts on the face and spreads to the trunk with cervical lymphadenopathy?

Answer 17

Rubella