dermatology

Question 1

Psoriasis treatment

Answer 1

• Emollients + lifestyle
• Coal tar
• Dithranol (long remission, smelly/messy)
• Vit D analouges (calcipitriol)
• Tacrolimus (good for flexures)
• Steroids
• phototherapy

Question 1

-

raised lesion (volcano) with a central keratin filled crater

what is it and how do we manage

Answer 1

likely a keratoacanthoma
needs urgent referral to derm as unable to distringuise from SCC

most spontaneously regress in 3/12

Question 2

when do we worry about molluscum contagiosum

Answer 2

when it involves the eye/orbit

can cause a conjunctivitis or keratitis that can be serious and threaten eyesight

Question 3

what is lichen planus and how do we treat it

Answer 3

itchy, papular rash most common on the palms, soles, genitalia and flexor surfaces of arms
Rash often polygonal, with a ‘white-lines’ pattern on the surface (Wickham’s striae)

treat with potent steroids

Question 4

how long can scabies rash itch for, even after treatment

Answer 4

itching can persist for up to 6 weeks after successful treatment due to a delayed hypersensitivity reaction (type IV) to the mites, even if all the mites have been killed.

Retreatment should only be considered if new burrows or rashes appear, or if living mites are found upon examination.

Question 5

spider naevi association

Answer 5

idiopathic 10-15% people with have >1

Other associations
- liver disease
- pregnancy
- COCP

Question 6

time line of shingles

Answer 6

Burning, tingling, itching, systemic symptoms 1-4 days
Rash (infectious) 7-10 days
Resolution/Healing 2-4 weeks

post herpatic neuralgia is common (1/3 patients) and lasts months-years after

Question 7

When should you give valaciclovir/ antivirals for shingles

Answer 7

within 72 hours of rash onset

Still consider giving up to seven days if the patient has an increased risk of severe shingles or complications, e.g. severe rash, severe pain, older age or immunocompromised

limited benefit of steroids

Question 8

conditions that occur if there is shingles in the cranial nerves

Answer 8

Herpes zoster opthalmicus: opthalmic branch of trigeminal nerve, hutchison sign indicate orbital involvement

Ramsy Hunt: genticulate ganglion of facial nerve, usually presents with lesions in the ear + side of the tongue and facial paralysis. Other symptoms may include loss of taste and, if the vestibulocochlear nerve is affected, vertigo and tinnitus.

Question 9

medications that can trigger erythema nodosum

Answer 9

oral contraceptive pill,
aspirin
trimethoprim
amoxicillin

also from:

Throat infections (streptococcal disease or viral infection)
TB
Chlamydia infection
Fungal infection
Parasitic infection
HSV, IV
Campylobacter and Salmonella infection
IBD
malignancy
Sarcoidosis
lymphoma/leukaemia