dermatology Flashcards
Why is there erythema in psoriatic plaques?
Dilatation of blood vessels in the epidermis
Always offer to look at hair, scalp, nails and examine joints with psoriasis
How does venous (stasis/varicose) eczema present?
Skin changes that occur on the lower legs in people with chronic venous insufficiency/venous hypertension
Characterized by red, itchy, scaly, or flaky skin, which may have blisters and crusts on the surface and lipodermatosclerosis may occur
Risks: obese, immobility, varicose veins, DVT, cellulitis
Complications: pain, infection, secondary eczema, contact dermatitis, permanent skin discolouration, skin ulceration
What is erythema multiforme and how is it managed?
Acute self-limiting inflammatory condition usually trigger by drugs and infections like HSV. Mucosal involvement is absent or to one mucosal surface
Starts as small red spots, usually on hands and feet that spreads to trunk and turn into target lesions. May be itchy
Need to rule out Steven Johnson’s syndrome
Mx: if drug responsible withdraw drug, HSV antiviral, analgesics, steroid cream, reassure not contagious
What is milliara rubra?
Prickly heat/sweat rash
Itchy papulovesicles in sweaty/heated areas often found in neonates or tropical environments
Treat by staying in AC environment, sleeping and dressing in cool clothes, cold compresses etc
How does a basal cell carcinoma present?
- Pearly nodule with rolled telangiectactic edge usually on face or sunexposed site
May have a central ulcer
Can also present as red scaly plaque with raised smooth edge
difference between bcc and scc
Basal cell usually has rolling edges but squamous arises from acitinic keratoses and has irregular borders
What lifestyle advice can you give to someone with psoriasis?
- Weight loss, smoking cessation, alcohol reduction
- Manage stress and anxiety as these are triggers
Tell them to seek advice if they get joint pain or swelling as may be sign of arthritis
Assess CVD risk every 5 years and help keep VTE risk down
Signpost to PAPAA
How does a patient with urticaria present?
Superficial swelling of the epidermis that becomes angio-oedema once swelling has spread to the dermis
Red, raised itchy rash with wheals
Chronic if >6 weeks (chronic spontaneous, autoimmune, chronic inducible)
how do you treat urticaria?
Rule out anaphylaxis and angiooedema
Remove triggers e.g NSAIDs
- UAS Score
If mild reassure self limiting
If symptoms offer non sedating antihistamine (loratadine, cetirizine, fexofenadine) for up to 6 weeks then consider if needed daily for 3-6 months if chronic
If severe consider oral corticosteroids alongside antihistamine for 7 days
How does acne rosacea appear and how is it managed non-pharmacologically?
Episodes of facial flushing, erythema, telangectasia, papules and pustules +/- eye symptoms. Relapsing and remitting
Mx:
Refer for support to British Skin Foundation
Avoid triggers e.g keep diary to find triggers
High factor suncream and sunglasses
Use non-oily emollients and soap free cleansers
Use green and yellow camouflage makeup
Offer referral to skin camouflage service
What are some risk factors for tinea infection?
Hot humid environments
Wearing tight-fitting clothing
Obesity
Hyperhidrosis
How is tinea corporis/cruris managed?
Conservative
Wear loose fitting clothes to avoid moisture in creases
Maintain good hygeine, do not itch, do not share towels, wash bedding daily
Pharmacological
Topical antifungal e.g terbinafine, clotrimazole, miconazole, or econazole
Consider hydrocortisone alonside above for 7 days
If severe or extensive with +ve skin microbiology prescribe oral terbinafine, itraconazole or griseofulvin
What advice should you give to a patient at risk of developing skin cancer e.g red hair, over 100 moles?
Avoid sun from 11am-3pm
Minimum SPF 15 half an hour before the sun and reapplied every 2 hours
Wear hats and clothes that cover the skin
Regular skin checks
Take photos of skin lesions to check for changes
what are the four types of melanoma?
Superficial spreading
Nodular
Lentigo
Acral lentiginous (can be subungual with Hutchinson’s sign)
