Dermatology Flashcards
What lesion feels larger than it appears on extremities of younger people
Dermatofibroma
Skin lesion in elderly with greasy scaly appearance
Seborrheic keratosis
What is balanitis xerotica obliterans
Lichen sclerosis on the penis
Smooth painless lump in groin which does not have a cough impulse
Lipoma
Management of nec fasc
IV abx
Surgical debridement
Most common site for nec fasc
Perineum
Which medication increases risk of nec fasc
SGLT-2i
Presentation of nec fasc
Appears like cellulitis but main things to look for
- severe pain that does not match appearance
- purple
- very tender
- necrosis
What are the types of nec fasc
Type 1- mix of anaerobes and aerobes- v comorbid on trunk
Type 2- strep pyogenes- young on limbs
Type 3- clostridium seen in IVDU
What causes SJS
A severe systemic reaction to a drug in particular;
- penicillin
- sulphonamides
- lamotrigine, carbamezapine, phenytoin
- allopurinol
- NSAIDs
- COCP
How does SJS appear
Macuopapular rash with target lesions
May develop into blisters and erosions- nikolsky positive
Oral ulcesr
Joint pain
Management of SJS and TEN
ITU transfer
Lots of fluid
IVIG and ciclopsorin, plasmapharesis
Causes of pyoderma gangrenosum
Idiopathic most commonly
IBD
Rheum conditions
- RA
- SLE
Haem cancers
How does pyoderma gangrenosum appear
Initially may be a small pustule or blister
Then skin breaks down to ulcerate
Purple and nasty looking border
Can be systemic
Ulcerated lesion on lower leg with purple border
Pyoderma gangrenosum
What is management of pyoderma gangrenosum
First line oral prednisolone
Ciclosporin or infliximab may be used second line
What drugs may trigger psoriasis
NSAIDS
Beta blockers
Lithium
Chloroquines
ACEi
Alcohol
Side effects of isoretinoin
Dry skin and lips- most common
Increased triglycerides
Thin hair
Intracranial HTN
Depression
Management of pityriasis versicolor
Ketoconazole shampoo
What causes pityriasis versicolor
Malassezia furfur
Vasculitis
How does osler weber rendu present
Telengiectasia in the mouth or nose- seen as red spots
Epistaxis
GI telengiectasia- bloody stool
AVM in lungs, spine and liver
Family history
Management of impetigo
If mild and contained
- hydrogen peroxide then fusidic acid second line
If systemic or widespread
- oral fluclox
What is onycholysis
Separation of the nail from the nail bed
Management of scabies
Whole household to be given 2 doses of permethrin with 1 week inbetween
How can rosacea appear
Can appear as blushing with reddening
Telengiectasia visible
Pustules and papules is what it can develop into
Can involve eyelids
Who does rosacea occur in
Middle aged women
Fair skin
Management of rosacea
If just erythema and flushing then topical brimonidine or topical metronidazole
If putules and papules
- mild= topical ivermectin
- severe= topical ivermectin and oral doxy
Always encourage suncream
How can seborrheic keratoses appear
From stuck on slightly raised lesions to almost mole like (see photo)
First line for plaque psoriasis
Potent topical steroid OD after applying vitamin D OD
Reassess in 8-12 weeks
Second line for plaque psoriasis
Increase frequency of vitamin D to BD
Reassess in 8-12 weeks
Other than COCP what can use to treat hirsutism
Topical eflornithine
Management of acne vulgaris
Step up
1. topical benzoyl peroxide
2. combination with topical abx or retinoid
3. add oral abx
4. if women consider COCP
What antibiotic is used for acne
Tetracycline
Erythomycin if pregnant or breastfeeding
What are features of lipoma
Smooth
Mobile
Painless
What suggests liposarcoma over lipoma
Over 5cm
Growing
Pain
Deep location
How does shingles present
PAIN initially over area
Then develop erythematous rash which may become vesicular
What is a painful rash most often
Shingles
Management of shingles
Avoid pregnant and immunocompromised people for 5-7 days until lesions crusted
If present within within 72 hours then aciclovir
Only give steroids if refractory to simple analgesia
With shingles how long should avoid pregnant and immunocompromised people
5-7 days until has crusted over
Management of patient with bullous pemphigoid
Oral steroids and biopsy
Pemphigus vulgaris vs bullous pemphigoid
Pemphigoid= tense blisters, no mucosal involvement
Pemphigus= flaccid blisters, mucosal involvement
Most suitable long term option for psoriasis
Vitamin D and emollients
What would cause raised linear dark lesion over a scar
Keloid
Presentation of keloid
Raised dark lesions on a scar
Darker skinned people
Family history
What is management of a keloid
Intra-lesional steroids
What use for pain refractory shingles
Steroids if in acute phase
What is a non-healing ulcer over a scar
Squamous cell carcinoma
Presentation of lichen planus
Itchy lesions (can be asymptomatic)
Raised pink/purple papules
Polygonal in shape
White lines visible on rash
Wichkams striae in mouth
Koebner phenomenam- develop over scars
Management of lichen planus
Potent topical steroids- betnovate (betamethasone valerate)
How remember steroid strength
Helps every budding dermatologist
Hydrocortisone- mild
Eumovate- moderate
Betnovate- potent
Dermovate- very potent
What is eumovate
Clobetasone butyrate 0.05%
What is betnovate
Betamethasone valerate 0.1%
What is dermovate
Clobetasol propionate 0.05%
Presentation of seborrheic dermatitis
Yellow scaly rash on face, nasolabial folds, hair, upper back and chest
Blepharitis and otitis externa common
What are complications of seborrheic dermatitis
Blepharitis
Otitis externa
What is management of scalp seborrheic dermatitis
1st line- t gel or head and shoulders containing zinc
2nd line- ketoconazole shampoo
What is management of face and body seborrheic dermatitis
Topical ketoconazole
If severe in an area use topical steroids
How does fungal nail disease present
Unsightly nails
Yellow, thickened and opaque nails
Causes of fungal nail infections
Most commonly tricophytum rubrum
Can also be candida
How treat fungal nail disease
If asymptomatic and not bothered- can do nothing
If contained to small part of nail then- topical amorolfine nail lacquer
If extensive then oral antifungal
- terbinafine for tricophytum
- itraconazole for candida
What is used for minor fungal nail disease
Amorolfine nail lacquer
What is used for extensive tricophytum nail disease
Oral terbinafine
What is used for extensive candida nail disease
Oral itraconazole
What cancer are people most at risk of in renal cancer immunosuppression
Skin cancer- SCC most commonly
How diagnose contact dermatitis
Skin patch testing
How does actinic keratosis present
Crusty and scaly lesions
Can be pink, red or brown
On sun exposed areas
Management of actinic keratosis
Sun cream
Topical fluoracil, diclofenac and immiquimoid
What is problem of topical fluoracil
Skin can become very inflammed- give topical steroids
What is most aggressive melanoma
Nodular
What is an acral lentinginous melanoma
Mole on feet and hands
Get pigmentation under nails
What is pomphloyx eczema
Where get blisters and fissures when returning from a hot and humid country
Sweating precipitates this
What is it when get eruption blistering and fissures on hands and feet when returning from high temperatures
Pompholyx
Presentation of dermatofibroma
Solitary nodule on limbs
Feels larger under skin than appears
Overlying skin dimples when pinching
Often following trauma
Presentation of dermatitis herpetiformis
Itchy vesicular rash on the extensor surfaces
Knees, elbows and buttocks
What is management of acne with severe scarring
Referral to specialist for prescription of tretinoin
What causes an ulcer to develop at site of stoma in IBD
Pyoderma gangrenosum
Causes of erythema nodosum
TB
Strep
Sarcoid
Brucellosis
Cancer
Pregnancy
Drugs- penicillin, COCP and sulphonamides
What malignancies is acanthosis nigricans associated with
Pancreatic
Gastric
Where does acanthosis nigricans tend to affect in cancer as a paraneoplastic syndrome
The tongue
What is a dark velvety coating over the tongue coincidnig with abdominal cancer symptoms
Acanthosis nigricans maligna
Is a paraneoplastic syndrome associated with GI cancers
Presentation of erythema ab igne
In an older woman who has been sat by a fire or has hot water bottles
Mottled erythema which appears mottled and lace like
Non-tender and blanching
What can erythema ab igne progress to
SCC
Management options for head lice
Dimeticone
Malathion
What is an intra-epithelial squamous cell carcinoma
Bowens disease
How does bowens disease appear
Red scaly patches
1-1.5 cm wide
Management of bowens disease
Topical fluoracil- may have to give steroids too as causes a lot of inflammation
How differentiate a telengiectasia from a spider naevi
Spider naevi refill from the centre whereas telengiectasia refill from the edges
What presents with dimpled lesions around a scar
Molloscum contagiosum
Get koebner phenomena
How does guttate psoriasis present
Tear drop itchy scaly papules on trunk and limbs
Prodrome of strep infection
Management of guttate psoriasis
No need if asymptomatic
Same as normal psoriasis if symptomatic
- steroids
- VIt D
- phototherapy if severe
What organism is thought to be behind pityriasis rosea pathology
HHV7
Presentation of pityriasis rosea
Potentially recent viral infection
Herald patch on torso
Develops into mutlipe oval shaped marks with central lighter colour
Often inXmas tree distribution along the lines of langer
Where are sebaceous cysts commonly seen
SCALP
Trunk
Arms
Face
Back
Severe rosacea
What do if a healthworker does not have antibodies for VZV
Vaccinate them
What is rash on legs with reddish-blue discolouration made worse by cold
Livedo reticularis
What is cause of livedo reticularis
SLE
What is management if someone immunosuppressed presents with a new skin lesion
Anything suspicious of cancer should be reffered urgently due to risk of SCC posed by immunosuppression
What drug can cause pellagra
Isoniazid
What is management of keratoacanthoma
Urgent referral to rule out SCC
What is first line for hyperhidrosis
Topical aluminium chloride
How differentiate acne vulgaris from acne rosacea
There is a typical erythematous and flushing appearance to the face in rosacea
Comedones in acne vulgaris
Management of alopecia areata
Screen for hypothyroidism and vitamin deficiencies
Treatment options include
- minoxidil
- topical corticosteroids
Will grow back eventually
What are cherry haemangiomas
AKA campbell de Morgan spots are benign skin lesions which contain an abnormal proliferation of capillaries. Very normal part of aging
How do campbell de morgan spots appear
erythematous, papular lesions
typically 1-3 mm in size
non-blanching
not found on the mucous membranes
What is hidradenitis suppurativa
Chronic inflammatory condition where get inflammatory pustules and nodules which become inflammed and lead to sinus tracts, abscess and scarring
Where does hidradenitis suppurativa occur
Intertriginous areas
- axilla- most common
- inguinal area
- inner thigh
- perianal skin
- neck
Presentation of hidradenitis suppurativa
Development of pustules and nodules in intertriginous areas
These may become infected and release pus
Sinuses develop
Scarring occurs- rope like
hidradenitis suppurativa
Who does hidradenitis suppurativa occur in
Women
Under 40
Fat
Smoker
Management of chronic hidradenitis suppurativa
Loose fitting clothes
Lose weight
Topical clindamycin or oral lymecycline/clindamycin
Management of acute hidradenitis suppurativa
Topical steroids
May need oral fluclox and in some cases incision and drainage
Concerning causes of itch
Polycythaemia
Liver disease
Lymphoma
IDA
CKD
Presentation of perioral dermatitis
clustered erythematous papules, papulovesicles and papulopustules
most commonly in the perioral region but also the perinasal and periocular region
area around lip spared
What can worsen perioral dermatitis
Steroids
Management of perioral dermatits
Topical or oral abx
Causes of erythema multiforme
HSV- most common
Mycoplasma
Drugs- SNAPP
SLE
Sarcoid
Presentation of erythema multiforme
target lesions
initially seen on the back of the hands / feet before spreading to the torso
upper limbs are more commonly affected than the lower limbs
pruritus is occasionally seen and is usually mild
Erythema multiforme
Presentation of zinc deficiency
Hypogonadism
Short
Hair loss
Acrodermatitis around anus and mouth
What is acrodermatitis
Red crusted lesions- seen in zinc deficiency
What is biopsy take for a melanoma
Excisional biopsy
What is onchomycosis
Fungal infection
How is leukoplakia diagnosed
Diagnosis of exclusion
- key features include hard spots on toungue and mouth which are hard to get off
What can leukoplakia develop into
Squamous cell carcinoma
What do if patient presents with leukoplakia
Biopsy to exclude SCC
Features of candidiasis in mouth
White patches
Can be rubbed off
Can be painful/symptomatic
What happens if give steroids for too long on skin
Skin depigmentation
Skin atrophy
What is a pyogenic granuloma
Areas of ulceration with bleeding at site of minor trauma
Presentation of pyogenic granuloma
Ulcerated lesion
Bleeding on contact
Previous trauma
How does athletes feet (tinea pedis) present
Scaling and flaking between the toes
Very itchy
Tinea pedis/athletes foot
Management of athletes foot
Topical miconazole
How best to manage telengiectasia in rosacea
Laser therapy
Presentation of nodular melanoma
Red or black lump or lump which bleeds or oozes
What is when a worker or cleanrer prsents with erythematous rash on hands
Irritiant contact dermatitis
Management first line for flexural vs extensor psoriasis
Extensor- topical corticosteroid plus topical vit D
Flexural- mild hydrocortisone alone
Causes of hirsutism
PCOS
Cushings
CAH
Androgen therapy
Phentyoin
What cancer can UVA therapy lead to
SCC
What long term disease are psoriasis patients at greater risk of
Cardiovascular disease
What is erythema multiforme major
A severe form of erythema multiforme with mucosal involvement and patients are far more ill
Presentation of erythema multiforme major
Ulceration of the mouth
Sloughing of tissue off
Erythema multiforme lesions
What lesion dimples when pinched
Dermatofibroma
Presentation of pityriasis versicolor
Lesions do not need to be hypopigmented, they can be pink or brown
Scales seen
Itchy
How does lichen sclerosis present in men
Tight white ring around the penis on foreskin
Phimosis
What is the koebner phenomena seen in
psoriasis
vitiligo
warts
lichen planus
lichen sclerosus
molluscum contagiosum
How long can wait in between courses of topical hydrocortisone
4 weeks
What causes erysipelas
Strep pyogenes
Management of erysipelas
Flucloxacillin
What is diagnosis if itchy rash over nasolabial fold, back and axilla but cultures show staph aureus
Seborrheic dermatitis
Skin always grows staph aureus
What abx is used for acne if pregnant or breastfeeding
Erythromycin
Management of erythema nodosum
No active treatment
Self resolves in 6 weeks
What are 2 conditions with particularly high rates of seborrheic dermatitis
HIV
Parkinsons
What can cause erythroderma
Eczema
Psoriasis
Blood cancers
Management of erythroderma
Admit to hospital
Monitor for complications
- infection
- HF
- dehydration
What give if athletes foot fails to respond to a topical imidazole
Prescribe a course of oral terbinafine
What causes spider naevi
Liver disease
Pregnancy
COCP
What often comes first in shingles
Pain
Can you use topical retinoins in pregnancy
NO
Complications of burns
ARDS
Secondary infection
Hypoalbuminaemia
Compartment syndrome
DIC
Curlings ulcer
What need to do if extensive burns to neck and face area
Consider early intubation
First aid for burns
Cool water irrigation
Cling film in layers over it
What can be used to determine body coverage from burns
Estimate using the Wallaces rule of 9s
Most accurate is the lund and browder chart
How does the rule of 9s work
Head and neck=9%
Each arm=9%
Anterior leg=9%
Posterior leg=9%
Anterior chest=9%
Posterior chest=9%
Anterior andomen=9%
Posterior abdomen=9%
Palmar surface= 1%
What is most accurate way of measuring body coverage by burns
Lund and browder
How assess burns
New terminology
Superficial epidermal = first
Partial thickness (superficial dermal) = 2nd
Partial thickness (deep dermal) = 2nd
Full thickness = 3rd
How do superficial epidermal burns appear
Red and painful, dry, no blisters
How do partial thickness (superficial dermal) burns appear
Pale pink, painful, blistered. Slow capillary refill
How do partial thickness (deep dermal) burns appear
Typically white but may have patches of non-blanching erythema. Reduced sensation, painful to deep pressure
How do full thickness burns appear
White (‘waxy’)/brown (‘leathery’)/black in colour, no blisters, no pain
What burns need referral to secondary care
Deep dermal and full thickness
Inhalation injury
Electrical or chemical burns
Superficial dermal affecting face, feet, hands, genitalia or any fold
Superfical dermal over 3% in adults
Superficical dermal over 2% in kids
Superfical burns to which part of body warrant secondary care
Face
Hands
Feet
Genitalia
Folds
Management of superfical epidermal burns
Analgesia
Emollients
Management of superfical dermal burns
Cleanse wound
Leave blisters
Non adherant dressing
Avoid topical creams
Review in 24 hours
Management of deep dermal and full thickness burns
A- if around neck think early intubation
B
C- IV fluids if over 15% TBSA, put in catheter
Consider excision and skin grafts for severe burns
When consider escharotomies
Circumfrential burns to torso and limbs
Relieving compartment syndrome and oedema in limbs
If someone is ventilated due to burns and ventilation pressures are increasing what need to do
Escharotomy
Differentiating superficial epidermal from partial thickness (superficial dermal)
Partial thickness is pale pink and blisters
What is a curlings ulcer
Gastric ulcer caused by intravascular depletion leading to ischaemia
If burn is painless what is classifcation
Full thickness
Management of bedbugs
Hydrocortisone
Fumigation and pest control main eradication method
Bedbugs presentation
Hostel stay- poor hygiene exposure
Intensely pruritic ‘lumps’ which have appeared on her arms and legs
Papules and wheals
Vitiligo management options
Sunblock
Steroids
Ciclosporin
Seborrheic keratoses
What can do for bothersome seborrheic keratoses
Freezing them
Lichen sclerosis management
Topical potent steroids- clobestalol propionate
Risk of lichen sclerosis
Progression to SCC
Lipoma
Third line for plaque psoriasis
Increase steroids to BD
OR
Add coal tar preparation
If third line options for plaque psoriasis fail what do
Refer to secondary care
Secondary care options for plaque psoriasis
UVB therapy
Methotrexate
Ciclosporin
Retinoids
Biologics- ustekinumab
Scalp psoriasis first and 2nd line
1st line- Topical potent steroid
2nd line- change formulation to shampoo etc
Genital and face psoriasis management
Topical potent steroids
When refer acne to dermatology
Scarring
Evidence of pigmentation problems
No response to 2 topical treatments
No response to oral abx
Contribution to mental health
When have to do an USS on lipoma
Over 5cm
Pain
Deep
Growing
First line for shingles
Aciclovir
Only steroids if pain continues despite simple analgesia and aciclovir
What is adapalene
Topical retinoid
What are 2 types of betnovate
Betnovate RD- moderate potency 0.025% betamethasone valerate
Betnovate- potent 0.1% betamethasone valerate
BCC features
Rolled edges
Telengiectasia
Slow growing
Central ulceration/crater
BCC management
Routine referral for removal
Hair loss in patches differentials
Alopecia areata
Tinea capitis
Differentiate by looking at scalp skin- in tinea will be scaly or inflammed
Where does erythema ab igne sites
Back
Legs
Wherever have applied hot water bottle so will be site of pain
Symptomatic urticaria management
Oral cetirizine
If refractory then can give short course of prednisolone
