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GP FELLOWSHIP RNZGP > Dermatology > Flashcards

Dermatology Flashcards

1
Q

Melasma Management (options)

A
  1. Kligman’s formula: gold standard (hydroquinone, tretinoin & dexamethasone ) BD 3 weeks
  2. Hydroquinone 2% BD 2-4 months
  3. Topical Tretinoin 0.025% daily
  4. Cease hormonal contraception
  5. Sun safety (spf 50+)

NOTE: NO LASER

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2
Q

Nodular cancery looking lesion on ear

A

-Squamous cell carcinoma
-Keratoacanthoma
-Nodular BCC
-Nodular melanocytic melanoma
-Chondrodermatitis nodularis helicis
-Atypical fibroxanthoma

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3
Q

Mild Acne topical options

Mainly comedomal with some inflammatory pustules

A

Benzoyl peroxide plus adapalene 2.5%/0.1% gel daily 6 weeks
Increase to 2.5%/0.3% if not effective but tolerated

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4
Q

Mild acne options topical

Not much inflammation

A

Adapalene 0.1% up to 0.3% gel daily 6 weeks

tretinoin 0.025% daily 6 weeks

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5
Q

Oral acne agents

A

Doxycycline 50mg daily but can increase to 100mg daily

Minocycline 50mg daily

COCP with cyproterone formulation

Spironolactone (alternative or addition to COCP) NOTE: contraindicated in pregnancy 25mg up to 100mg daily

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6
Q

Counselling for isotretinoin

A
  • Teratogenic, must be on contraception
  • Sun sensitivity: must use SPF and avoid sun exposure
  • Causes skin dryness (mucosal surfaces eg lips, nose- nose bleeds)
  • May cause myalgia and joint stiffness
  • Tetracyclines contraindicated due to intercranial hypertension
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7
Q

Intertrigo DDx

A

Tinea Cruris

Erythrasma

Flexural psorasis

Seborrheic dermatitis

Candidiasis

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8
Q

Advantan fatty ointment generic name?

A

Methylprednisolone aceponate 0.1%

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9
Q

Antihistamine example

A

Loratadine 10mg daily

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10
Q

Allergy (allergic contact dermaitis management)

A

Advantan FO (methylprednisolone aceponate) daily

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11
Q

Best combo for mild acne:

1) mostly comedomal
2) Inflammatory acne
3) both

A

1) Peroxide & retinoid
Benzoyl peroxide & Adapalene (2.5% & 0.1-3%)

2) Use a combo with Clindamycin in it
Eg Benzoyl peroxide and clinda (5%/1%)

3) retinoid plus clind
Tretinoin 0.025%& Clinda 1%

All nocte 6 weeks then review

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12
Q

Pityriasis rosea

A

HHV6-7
young adults

Herald patch - looks like ringworm
Then fir tree pattern of eruption

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13
Q

Topical therapy for tinea

A

Terbinafine 1% daily or BD for 7-14 days

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14
Q

Oral therapy for tinea

A

Terbinafine 250mg daily for 2 weeks

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15
Q

Shingles pharmacology

A

Valaciclovir 1g TDS 7 days

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16
Q

Single most likely diagnosis

A

Erythema Multiforme

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17
Q

Causes of Erythema Multiforme

A

Infections: HSV, mycoplasma pneumonia, TB

Medications: Penicillins, anti-epileptics

Malignancy: hodgkins disease

Systemic: SLE

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18
Q

Erythema Multiforme Treament

A

Betamethasone dipropionate 0.05% daily for 2 weeks
(diprosone /eleuphrat)

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19
Q

Diagnosis?

A

Keratosis pilaris

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20
Q

Diagnosis

A

Sebaceous hyperplasia

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21
Q

Very/ultra potent topical steroid examples

A

Betamethasone dipropionate (0.05%) in optimised vehicle (diprosone OV)

Clobetasol propionate (0.05%)

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22
Q

Potent topical steroid examples

A

Betamethasone dipropionate 0.05% (diprosone, eluphrat)

Methylprednisolone Aceponate 0.1%
(advantan) *** some say just moderate

Mometasone furoate 0.1%
(Elocon, mometasone)

Betamethasone valerate 0.05-0.1%

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23
Q

Differentials

A
  • Venous stasis dermatitis/eczema
  • Lipodermatosclerosis
  • Irritant/allergic contact dermatitis
  • Lymphoedema
  • pre-tibial myxoedema
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24
Q

Erythema Multiforme Causes

A
  • Infection: Herpes simplex virus
  • Neoplastic: Hodgkin’s disease
  • Medications: penicillins, sulphonamides
  • Systemic disease: lupus
  • Idiopathic
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25
Q

Erythema Multiforme treatment

A
  • Emolient
  • Remove trigger
  • Potent topical corticosteroid: Betamethasone dipropionate 0.05% daily for 2 weeks
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26
Q

Pruritis general causes

A
  • Renal failute (uraemia)
  • Hyperbilirubinaemia, cholestasis
  • Diabetes
  • Thyroid disease (hypo/er)
  • IDA
  • Psychogenic
  • Hyperparathyroidism
  • Malignancy - lung, brain, colon
  • Haematological malignancy (lymphoma)
  • Paraneoplastic syndrome
  • MS
  • Scabies
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27
Q

Impetigo in endemic settings (2 first line agents)

A

Bactrim:
Trimethoprim + Sulfamethoxazole (4+20 mg/kg up to 160+800) BD 3 days

OR

benzathine benzylpenicillin IM stat 0.6ml to 2.3mL for >20kg

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28
Q

Psoriasis on trunk and limbs stepwise treatment

A

LPC (Liqor picis carbonis) 4-8% + salicylic acid 3% BD 1 month

Acute flare, tar not enough
Methylpresnisolone aceponate 0.1% daily

Not responding 3 weeks
Betamethasone Dipropionate 0.05% daily

Also can use Calcipotriol & betamethamethasone (Daivobet )

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29
Q

What am I and what would you treat it with

A

A) Seborrheic dermatitis

B) Hydrozole

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30
Q

More severe seborrheic dermatitis treatment

A

Methylprednisolone aceptonate 0.1% CREAM daily

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31
Q

Pruritis steroid of choice for
a) trunk
b) face

A

a) Betamethasone valerate 0.02% BD 2 weeks
b) hydrocort 1% BD 2 weeks

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32
Q

Chicken pox contact: when to give vaccine

A

> 1 yr & <5 days since exposure

Or household contacts of immunodeficient contacts

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33
Q

What am I ?

A

Fixed drug eruption

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34
Q

Neonatal cephalic pustulosis (neonatal acne) treatment

A

Self limiting but if appearance a concern then
- Clotrimazole 1% BD or Ketoconazole 2% BD

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35
Q

What am I ?
How old would I be (typically) ?
How to treat ?

A

Infantile acne

3-4 months

Topical Benzoyl peroxide 2.5%, topical clindaymycin

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36
Q

Onychomycosis treatment

A

Terbinafine 250mg daily until clinical clearance

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37
Q

Flexural psoriasis treatment

A

Advantan FO daily until clear
(no longer than 2 weeks if in nappies)

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38
Q

Causes of intertrigo

A
  • Flexural psoriasis
  • Seborrheic dermatitis
  • Atopic dermatitis
  • Candiasis
  • Erythrasma
  • Tinea cruris
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39
Q

Causes of erythema nodosum

A

Drugs
- COCP
- NSAIDS
- Amox

Inflammatory
- IBD
- Sarcoidosis
- Lymphoma

Infectious
- Strep
- TB
- Chlamydia

Pregnancy

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40
Q

Erythema nodosum treatment

A

IF SEVERE
- prednisolone 25mg daily for 2 weeks then taper

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41
Q

Granuloma annulare treatment

A

SELF LIMITING BUT
- If persistent for months
- tender
- Interferes with function

Betamethasone dipropionate 0.05% BD 4-6 weeks

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42
Q

What am I ?

A

Oral hairy leukoplakia

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43
Q

Hyperhydrosis management (step wise)

A

1) Topical antiperspirant (Aluminium chlorohydrate) daily

2) Iontophoresis **

3) Anticholinergics

4) Botox

***(contraindicated with pacemakers)

44
Q

Vitiligo Treatment

A

Betamethasone dipropionate 0.05% daily 3 months

**if on face & small areas
Pimecrolimus 1% BD 3 months

45
Q

What am I?

A

Annular erythema

46
Q

Perioral dermatitis treatment

A

1) Ivermectin 1% topically daily
2) Doxycycline 50mg Daily for 8 weeks

47
Q

Scabies treatment (pharm)

A

Permethrin 5% cream neck down overnight
OR
Ivermectin orally (if over 15kg and NOT safe in pregnancy or breastfeeding)

48
Q

Scabies when to return to school

A

After two treatments (1 week apart) are complete

49
Q

What am I ?

A

Dermatofibroma

50
Q

Scalp Seborrheic Dermatitis (initial and then if not responding)

A

Antiyeast shampoo eg Nizoral (ketoconazole) 2% twice a week

ADD
Betamethasone Dipropionate 0.05% lotion at night for 7 nights

If scale?
Consider adding:
1) Coal tar 1% to above if thick scale
2) LPC 3%/3%

51
Q

DDX for shingles rash

A
  • HSV
  • Allergic contact dermatitis
  • Folliculitis
  • Insect bites
  • Pyoderma gangrenosum (less likely)
52
Q

What am I

A

Keratosis Pilaris

53
Q

How to treat keratosis pilaris

A

Urea 10% cream daily

ADD

salicylic acid 3% in sorbelene cream daily

Adapalene 0.025%

54
Q

Keratoacanthoma recommended excision margin

A

3-5mm

55
Q

Psoriasis: what other comorbid condition are you thinking about

A

Cardiovascular

56
Q

PSORIASIS: triggers

A

ACEi
NSAIDS
Smoking
Stress
obesity
Lithium
pregnancy

57
Q

Scalp psoriasis management

A

Potent Topical streroid LOTION then step up to very potent

Scale: LPC (2%) and salicylic acid 2%

Switch between

58
Q

Nail psoriasis treatment

A

Daivobet (calcipotriol & betamethasone)

59
Q

Erythrasma treatment

A

Fusidate sodium 2% ointment topically (fucidin) BD for 2 weeks

No more than 2 weeks

60
Q

Tinea corporis treatment

A

Terbinafine 1% daily of BD for 7-14 days

61
Q

Tinea Capitus management

A
  • Referral to Dermatologist
  • Terbinafine 250mg daily for 4 weeks
62
Q

Tinea Capitus complication

A

Kerion

63
Q

Flexoral Seborrheic Dermatitis treatment

A

Hydrocortisone 1% clotrimazole 1%

64
Q

Spa Folliculitis pharmacology

A

Ciprofloxacin
(covering pseudomonas)

65
Q

Scabies advice and non pharmacological treatment

A

Repeat treatment in 7 days

Treat family members and close contacts

Wash bedding in hot water and seal in plastic bag for 8 days

66
Q

What am I?

A

Dermatitis herpetiformis

67
Q

What am I ?

A

Perniosis

68
Q

Treatment of Chillblains (perniosis)

A
  • Potent topical corticosteroid BD
  • If severe: then GTN ointment OR Nifedipine
69
Q

What am I ?

A

Herpetic Whitlow

70
Q

What Am I?

A

Cutaneous Lichen Planus

71
Q

What am I?

A

Pittyriasis Versicolor

Miconazole 2% shampoo

72
Q

What am I?

A

Pyogenic granuloma

73
Q

Cryotherapy caution

A

Hyperpigmentation (usually temporary)

Hypo-pigmentation (often permanent)

74
Q

Pygenic granuloma treatment

A
  • Cryotherapy
  • Curettage
  • Imiquimod
  • surgical excision
  • Ablative laser therapy
  • watchful waiting
75
Q

Periorificial dermatitis (OR rosacea) 1st line treatment (pharmacological)

Then if fails what next?

A

Ivermectin 1% cream
or metronidazole

Doxycycline 50-100mg daily - 3-8 weeks

76
Q

Alopecia areata managmnet

A

betamethasone dipropionate 0.05% LOTION daily

77
Q

What am I?

A

Sebaceious hyperplasia

78
Q

What am I ?

A

Superficial BCC

79
Q

Imiquimod better for which skin cancer

A

BCC

80
Q

Superficial low risk BCC management options

A
  • Excison (3-5mm margin)
  • Double freeze thawing cryotherapy
  • Imiquimod (aldara ) cream
  • photodynamic therapy
81
Q

What am I?

A

Lentigo meligna

82
Q

What am I?

A

Blue naevi

83
Q

What am I… In an adult what is the concern

A

Spitz naevi (kind looks like pyogenic granuloma)

In children not a concern
In an adult very difficult to distinguish from melanoma

84
Q

What am I?

A

Solar lentigo

85
Q

What am I?

A

Ink spot lentigo

86
Q

What am I ?

How to treat

A

Grover’s disease

Betamethasone valerate 0.02%

87
Q

Treatment of Rosacea (imflammatory pustules and papules)

a) First line
b) Second line

A

a) Topical Ivermectin 1%

b) Doxcycline 50mg daily for 8 weeks but often longer

88
Q

What am I ?

A

Granuloma annulare

89
Q

2 major differentials for pytriasis rosea

A

Secondary syphilis
Guttate psoriasis

90
Q

What am I ?

How to treat & counselling points

A

Pityriasis versicolor

Treatment:
Ketoconazole 2% shampoo daily 5 days
Fluconazole orally if fails

Pigmentation changes might persist
Avoid excessive sweating

91
Q

What are some differentials (4)

A

Venous congestion causing lipodermatosclerosis

Post thrombotic syndrome

Pre-tibial Myxoedema (Graves)

92
Q

What am I ?

What treatment is NOT recommended?

A

Pyoderma Gangrenosum

Do not debride….
Just needs rheumatologist to immunosupress

93
Q

“Smelly foot”

A

Pitted keratolysis

Treat with Topical Clindamycin

94
Q

What am I ?

A

Fibroepithelial polyp

95
Q

Female pattern Hair loss (FPHL) vs telogen effluvium
a) time frame
b) pattern

A
  • Timeframe
    FPHL- more than 4 months
    TE- 3-4 month post stressor
  • Pattern
    FPHL- more frontal
    TE- diffuse
96
Q

Features of female pattern hair loss (FPHL)

A
  • Preserved frontal hair line
  • Loss of terminal hairs in frontal scalp
  • Normal density in occipital region
  • Widening of central part (christmas tree pattern)
  • Negative hair pull test
  • Normal scalp
97
Q

Treatment of female pattern hair loss

A

Minoxidil (Score:1)
Spironolactone (Score:1)
Cyproterone acetate (Score:1)

98
Q

What am I

A

Digital Myxoid cyst

99
Q

Erythema nodosum treatment

A
  • Bed rest
  • Compression
  • Elevation
  • NSAID
    IF severe then Prednisone 25mg for 14 days then taper
100
Q

4 Main types of dressing categories

A
  • Hydrogels:
    eg solosite wound gel
    add moitsure
  • Films
    Eg opsite (think c section cover)
    Neutral
  • Hydrocolloids
    Eg Comfeel
    Low to moderate exudate (OPEN wounds)
  • Absorbent fibres/ foams
    eg kaltostat
    Absorb exudate
101
Q

What am I ? What to do ?

A

Pearly penile papules

Reassure

102
Q

Cervical lesion.. what is it ?

A

Nabothian cyst
Reassure

103
Q

Treatment options for Pyogenic Granuloma

A
  • Curettage and cautery
  • Surgical excision
  • Ablative laser therapy
  • Cryotherapy
  • Watchful waiting
104
Q

What am I ?

A

Fordyce spots

105
Q

Acitinic Keratosis treatment

A

Cryotherapy

Flourouracil 5% cream daily for 2-4 weeks on face 3-6 weeks on limbs

imiquimod 5% topically 3 times per week on non-consecutive days for 4 weeks

106
Q

Oral candidiasis treatment

A

Miconazole 2% gel 2.5mL QID 7-14 days

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