Dermatology

Question 1

What are the treatment options for eczema

Answer 1

Emollients
Thin- E45, aveeno etc
Thick- diprobase, cetraban (more greasy if more severe)

Topical steroids - steroid ladder
Mild- hydrocortisone 0.5-2.5%
Moderate- euvomate
Potent- betnovate
Very potent- Dermovate

Question 2

What are the causes, presentation and management of eczema herpeticum

Answer 2

HSV (HSV 1 usually) or VZV

Widespread painful vesicular rash, systemic symptoms and reduced oral intake
lymphadenopathy
Vesicles of pus

Management
Viral swabs and Aciclovir
Children can become very unwell very quickly with this

Question 3

What are the features of guttae psoriasis

Answer 3

Post strep infection
Stress of medicatons can cause
Small raised papules across trunk and limbs
Resolves in 3-4 months

More common in children

Question 4

What is the management of psoriasis

Answer 4

Topical steroids
Topical vit D analogues
Topical dithranol
Phototherapy

Question 5

What is the stepwise management of acne

Answer 5

Topical benzoyl peroxide
Topical antibiotics- clindamycin + benzoyl peroxide
OCP - dianette
Oral antibiotics -lymecycline
Topical retinoids (women need contraception)

Oral retinoids (isotretinoin) last line specialised - dry skin, photosensitivity, depression, anxiety suicidalm stephen johnson symdrome/ toxic epidermal necrolysis

Question 6

What are the features of measles

Answer 6

10-12 days post exposure
Fever, cold and CONJUNCTIVITIS

Koplik (grey) spots on buccal mucosa - diagnostic

Rash starts on face behind ears 3-5 after fever
Spreads to rest of body
Macular rash with flat lesions

Self resolving 7-10 days - kept isolate till 4 days post symptoms

Question 7

What are the features of Scarlet fever

Answer 7

Group A strep- tonsillitis

Red pink blotchy rough sandpaper rash

Red flushed cheeks

Fever, lethargy, strawberry tongue, sore throat, cervical lymphadenopathy

Pen V for 10 days
Kept off school 24 hours after abx started

Question 8

What are the features of Rubella

Answer 8

2 weeks post exposure
Milder rash than measles
Rash starts on face then goes to body
Rash lasts 3 days
Mild fever, joint pain and sore throat
Enlarged lymph nodes

Stay off for 5 days after rash appears and avoid pregnant women

Question 9

What are the features of Parvovirus b19

Answer 9

Mild fever, coryza, muscle aches and lethargy

Slapped cheek
Rash affecting trunk and limbs- raised and itchy - net like (reticular)

Self limiting and fades over 1-2 weeks
Infectious before rash forms- don’t need to stay off school once they have the rash

Complications in pregnant woman and immunocompromised patients/ patients with haemolytic anaemias/ thalassaemias - can cause aplatic anaemia

Question 10

What are the features of Roseola Infantum

Answer 10

Human herpes virus HHV-6 or HHV 7

1-2 after infection with a HIGH FEVER (40)
Lasts for 3-5 then disappears
Coryzal symptoms, sore throat/ lymph nodes
Once fever settles rash comes for 1-2 days

Full recovery within 1 week and don’t need to be kept off

Can cause febrile convulsions

Question 12

What are the features of erythema multiforme

Answer 12

Caused by viral infections and medications
HSV and mycoplasma pneumonia

Target lesions wide spread and itchy
Can cause stomatitis

Identify underlying cause
XCR for mycoplasma pneumonia

Question 12

What is the management of Urticaria

Answer 12

Antihistamines
Fexofenadine for chronic
Oral steroids for severe flares

Question 12

What are the features of hand foot and mouth disease

Answer 12

Coxsaxkie A virus
Incubation 3-5 days
URTI and temp
Small mouth ulcers
Blistering red spots over body

Supportive treatment resolves in 7-10 days
Highly contagious- do not share towels, bedding , handwashing etc

Question 12

What are the features of chicken pox

Answer 12

VZV
Vesicular rash blistering lesions
Starts on trunk or face and spreads outwards over 2-5 days
Not contagious once lesions have scabbed over

fever 1st then itch then general fatigue

Highly contagious

Can lie dormant in sensory dorsal root ganglion cells and cause shingles/ ramsay hunt later in life

Self limiting

Can give acicvlovir in immuncomp patients or adolescents/ adults presenting within 24 hrs

Itching- give calamine lotion and chlorphrenamine

Question 12

What are the features of pityasis rosea

Answer 12

Generalised self limiting rash
HHV-6/7
usually adolescents

Herald patch - faint red scaly lesion somewhere on torso
Then spreads into smaller scaly oval lesions in a christmas tree shape- following lines of ribs

Itch, low grade fever, headache, lethargy

Resolves witbout treatment in 3 months

Question 13

What are the features of ringworm

Answer 13

Tinea capitis- on head- itchy, loss of hair, red scalp

Tinea pedis- athletes food

Onychomycosis- nail infections

Management
Scrapings for microscopy and culture

Antifungal creams - clotrimazole/ micronazole
Oral antifungals- Fluconazole/ itraconazole

Fungal nail infectins- amorolfine nail lacquer or terbinafine

Question 13

What are the features of seborrhoeic dermatitis

Answer 13

Crusted dry skin around scalp, nasolabial folds and eyebrows

cradle cap - usually resolves by 4-12 months - apply baby oil or olive oil and brush scalp- white petroleum jelly overnight
Can also use topical antifungals - clotrimazole

Malassezia yeast

On the scalp- use ketoconazole shampoo for 5 mins before washing off

On body and face- clotrimazole or miconzole

Question 13

What are the features of molluscum contagiosum

Answer 13

Poxvirus
Small flesh coloured papules with a central dimple
Resolve themselves in up to 18 months
Avoid scratching/ picking

Avoid sharing towels to minimise spread

If extensive/ on eyelids/ genitals- topical potassium hydroxide/ cryotherapy

Question 14

What is the management of nappy rash

Answer 14

Highly absorbent nappies
Regular nappy changes
Water products in nappy area
Maximise time not wearing nappy

Question 15

What is the management of scabies

Answer 15

Itchy red small spots with track marks between tinger beds

Permethrin cream applied to the whole body completely covering skin

Do it when skin is cool- not after a shower
Leave cream on for 8-12 hours and then wash off
Repeat one week later

Oral ivermectin if it is difficult to treat or crusted

All household members and close contacts must be treated

Hot wash of clothes, bed clothes and towels

Itching can continue for up to 4 weeks post treatment

Question 16

What is the treatment for headlice

Answer 16

Dimeticone4% lotion applied to the hair and left to dry

Kept on for 8 hours and washed off

Repeat 7 days later

Special fine combs to comb nits out of hair to check for treatment success

Question 17

What are some causes of a non blanching rash

Answer 17

Meningococcal septicaemia/ bacterial sepsis - other systemic signs

Henoch-Schonlein purpura- Legs and bum with abdo and joint pain

Idiopathic thrombocytopenic purpura- well child otherwise

Acute leukaemias

Haemolytic uraemic syndrome- low urine output and anaemia signs- think recent diarrhoea

Mechanical- strong coughing

Traumatic- NAI

Viral illness

Need an
FBC, U&E, CRP, ESR, coag, Blood culture, Meningococcal PCR, lumbar puncture, BP and urine dip

Question 18

What are the features of erythema nodosum

Answer 18

Red lumps on shins
Inflammation of subcut far

Causes
Strep throat infections
Gastroenteritis
Mycoplasma pneumonia
TB
OCP, NSAIDS
IBD
Sarcoid
Lymphoma
Leukaemia

Self resolves but look for causes
Inflam markers crp/ esr
Throat swab for strep
CXR
Stool mircoscopy and culture
Faecal calprotectin

Question 19

What are the features and management of impetigo

Answer 19

Bacterial skin infection - staph aureus
Golden crust
Contagious - off school during infection

Non bullous- nose or mouth- dry golden crust - give topical fusidic acid and an antiseptic cream

If extensive can give oral fluclox

Hand hygiene towels, cutlery- off school until lesions have healed or 48 hrs on abx

Bullous impetigo - fluid filled vesicles that burst to form golden crust
More common in under 2s
Systemic symptoms - can cause severe infection
Oral fluclox and swabs of vesicles

Question 20

What are the features of staph scalded skin syndrome

Answer 20

Damaged skin breaks down after a staph infection
Usually effects under 5s

Patches of erythema - thin and wrinkled skin
Fluid filled blisters form which burst and are painful
Look like scalds/ burns

Nikolsky sign- skin peelign away when touched

Admission and IV abx, fluid and electrolyte balance as prone to dehydration

Question 21

What are the features of Stephen Johnson Syndrome and toxic epidermal necrolysis

Answer 21

Blistering and shedding of top alter of skin

SJS- less than 10% skin
TEN - more than 10% skin

Causes
Anti-epileptics, abx, allopurinol, NSAIDs
HSV, CMV, HIV, mycoplasma pneumonia

Fever, cough sore throat, sore eyes and mouth, itchy skin

Purple/ red rash over skin that blisters and skin starts to break away

Can affect eyes, urinary tract, lungs

Management
Steroids, immunoglobulins and immunosuppresant meds