Dermatology

Question 1

What is BCC?

Answer 1

Basal cell carcinoma::: slow growing :::: locally invasive :::: malignant :::: irregular growth :::: sun exposure :::: white ppl

Question 2

What is the classic description of BCC?

Answer 2

small, translucent, pearly, raised areas with telangiectasia
rodent ulcer - indurated edge and ulcerate centre

Question 3

What are the different types of BCC?

Answer 3

Nodular - solitary, shiny red with large telangiectasia

Superficial - erythematous well-demarcated scaly plaques

Morphoeic - thickened yellow plaques, poorly defined borders

Pigmented - brown, blue or greyish

Basosquamous - mixed BCC and SCC

Question 4

What is SCC? How does it present?

Answer 4

Squamous cell carcinoma ::: malignant tumour ::: can metastasise ::: UV light exposure

Presentation:
- usually indurated nodular keratinising or crusting tumour, may ulcerate
- non-healing growth or ulcer
- very variable clinical appearance

Question 5

What is the management of SCC?

Answer 5

2ww referral

Surgical excision with 4mm margin is lesion <20mm in diameter, 6mm if >20mm in diameter

Question 6

What are some indications of poor prognosis in SCC?

Answer 6

• poorly differentiated tumour
• > 20mm in diameter
• > 4mm deep
• immunosuppression

Question 7

What bacteria causes inflammation in acne?

Answer 7

Propionibacterium acnes

Question 8

How does acne present?

Answer 8

open or closed comedones (blackheads and whiteheads)
papules, pustules, nodules, cysts

Question 9

What is the pathophysiology of acne?

Answer 9

• increased sebum production
• follicular hyperkeratinisation
• colonisation with P. acnes
• inflammation

Question 10

What is the management of mild to moderate acne vulgaris?

Answer 10

a 12-week course of topical combination therapy should be tried first-line:
- a fixed combination of topical adapalene with topical benzoyl peroxide
- a fixed combination of topical tretinoin with topical clindamycin
- a fixed combination of topical benzoyl peroxide with topical clindamycin

topical benzoyl peroxide may be used as monotherapy if these options are contraindicated or the person wishes to avoid using a topical retinoid or an antibiotic

Question 11

What is the management of moderate to severe acne?

Answer 11

a 12-week course of one of the following options:
- a fixed combination of topical adapalene with topical benzoyl peroxide (same as mild)
- a fixed combination of topical tretinoin with topical clindamycin (same as mild)
- a fixed combination of topical adapalene with topical benzoyl peroxide + either oral lymecycline or oral doxycycline
- a topical azelaic acid + either oral lymecycline or oral doxycycline

avoid tetracyclines in pregnant and breastfeeding women

COCP

oral isotretinoin under specialist supervision

Question 12

What is the management of eczema?

Answer 12

topical emollients
soap substitutes
avoid triggers

topical steroids :
- Mild: Hydrocortisone 0.5%, 1% and 2.5%
- Moderate: Eumovate (clobetasone butyrate 0.05%)
- Potent: Betnovate (betamethasone 0.1%)
- Very potent: Dermovate (clobetasol propionate 0.05%)