Dermatology Flashcards
What are the treatment options for eczema
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
What are the causes, presentation and management of eczema herpeticum
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
What are the features of guttae psoriasis
Post strep infection
Stress of medicatons can cause
Small raised papules across trunk and limbs
Resolves in 3-4 months
More common in children
What is the management of psoriasis
Topical steroids
Topical vit D analogues
Topical dithranol
Phototherapy
What is the stepwise management of acne
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
What are the features of measles
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
What are the features of Scarlet fever
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
What are the features of Rubella
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
What are the features of Parvovirus b19
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
What are the features of Roseola Infantum
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
What are the features of erythema multiforme
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
What is the management of Urticaria
Antihistamines
Fexofenadine for chronic
Oral steroids for severe flares
What are the features of hand foot and mouth disease
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
What are the features of chicken pox
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
What are the features of pityasis rosea
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
What are the features of ringworm
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
What are the features of seborrhoeic dermatitis
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
What are the features of molluscum contagiosum
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
What is the management of nappy rash
Highly absorbent nappies
Regular nappy changes
Water products in nappy area
Maximise time not wearing nappy
What is the management of scabies
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
What is the treatment for headlice
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
What are some causes of a non blanching rash
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
What are the features of erythema nodosum
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
What are the features and management of impetigo
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
What are the features of staph scalded skin syndrome
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
What are the features of Stephen Johnson Syndrome and toxic epidermal necrolysis
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
