Dermatology Flashcards

Question

What are the features of Bowen's Disease?

Answer 1

Red, scaly patches, slow growing, 10-15mm Sun-exposed areas such as the head (e.g. temples) and neck, lower limbs

Answer 2

Topical 5-fluorouracil, BD, 4 weeks Often results in significant inflammation/erythema so topical steroids are often given to control this Cryotherapy Excision

Answer 3

An autoimmune condition causing sub-epidermal blistering of the skin. This is secondary to the development of antibodies against hemidesmosomal proteins BP180 and BP230.

Answer 4

Itchy, tense blisters typically around flexures (usually heal without scarring) No mucosal involvement (i.e. the mouth is spared)

Answer 5

immunofluorescence shows IgG and C3 at the dermo-epidermal junction Referral to a dermatologist for skin biopsy (immunofluorescence shows IgG and C3 at the dermo-epidermal junction Oral corticosteroids, Topical corticosteroids, immunosuppressants and antibiotics are also used

Answer 6

Benign skin lesions which contain an abnormal proliferation of capillaries. Erythematous, papular lesions, 1-3mm in size Non-blanching Not found on the mucous membranes

Answer 7

Benign, No treatment required.

Answer 8

Most common form of psoriasis Erythematous plaques covered with a silvery-white scale Extensor surfaces such as the elbows and knees. Also common on the scalp, trunk, buttocks and periumbilical area Clear delineation between normal and affected skin plaques (1-10cm) If the scale is removed, a red membrane with pinpoint bleeding points may be seen (Auspitz's sign)

Answer 9

Irritant contact dermatitis (common) Allergic contact dermatitis (uncommon)

Answer 10

Erythema is typical, crusting and vesicles are rare

Answer 11

Type IV hypersensitivity reaction. Often seen on the head following hair dyes. Cement causes it on the hands. Acute weeping eczema affecting the margins of the hairline. Topical treatment with a potent steroid is indicated.

Answer 12

Autoimmune blistering skin disorder associated with coeliac disease. It is caused by the deposition of IgA in the dermis. More than 90% of patients exhibit small bowel biopsy findings consistent with some degree of gluten-sensitive enteropathy.

Answer 13

Itchy, vesicular skin lesions on the extensor surfaces (e.g. elbows, knees, buttocks)

Answer 14

Skin biopsy: direct immunofluorescence shows deposition of IgA in a granular pattern in the upper dermis Gluten-free diet Dapsone (antibiotic)

Answer 15

Benign fibrous skin lesions are caused by the abnormal growth of dermal dendritic histiocyte cells, often following a precipitating injury. Common areas include the arms and legs.

Answer 16

Solitary firm papule or nodule, typically on a limb (5-10mm) Overlying skin dimples on pinching the lesion

Answer 17

Benign, No treatment required.

Answer 18

Severe primary infection of the skin by HSV1/2 It is more commonly seen in children with atopic eczema and often presents as a rapidly progressing painful rash.

Answer 19

Monomorphic punched-out erosions (circular, depressed, ulcerated lesions) (1-3mm)

Answer 20

As it is potentially life-threatening children should be admitted for IV aciclovir.

Answer 21

Topical Steroids Mild: Hydrocortisone 0.5-2.5% Moderate: Betamethasone valerate 0.025% (Betnovate RD) Clobetasone butyrate 0.05% (Eumovate) Potent: Fluticasone propionate 0.05% (Cutivate) Betamethasone valerate 0.1% (Betnovate) Very Potent: Clobetasol propionate 0.05% (Dermovate)

Answer 22

Fingertip rule 1 finger-tip unit (FTU) = 0.5 g, sufficient to treat a skin area about twice that of the flat of an adult hand Hand and fingers (front and back): 1.0 FTU A foot (all over): 2.0 FTU Front of chest and abdomen: 7.0 FTU Back and buttocks: 7.0 FTU Face and neck: 2.5 FTU An entire arm and hand: 4.0 FTU An entire leg and foot: 8.0 FTU

Answer 23

localised skin infection caused by Streptococcus pyogenes. (More superficial, limited version of cellulitis) Flucloxacillin

Answer 24

Erythema ab igne is a skin disorder caused by overexposure to infrared radiation. If the cause is not treated then patients may go on to develop squamous cell skin cancer Reticulated, erythematous patches with hyperpigmentation and telangiectasia.

Answer 25

Fungal nail infection that involves any part of the nail, or the entire nail unit. Toenails are significantly more likely to become infected than fingernails

Answer 26

Dermatophyte: Trichophyton rubrum Yeasts: Candida Non-dermatophyte moulds

Answer 27

Dermatophyte or Candida infection confirmed Limited involvement (≤50% nail affected, ≤ 2 nails affected, more superficial white onychomycosis): topical treatment with amorolfine 5% nail lacquer; 6 months for fingernails and 9-12 months for toenails More extensive involvement due to a dermatophyte infection: oral terbinafine is currently recommended first-line; 6 weeks - 3 months therapy is needed for fingernail infections whilst toenails should be treated for 3 - 6 months. More extensive involvement due to a Candida infection: oral itraconazole is recommended first-line; 'pulsed' weekly therapy is recommended

Answer 28

Osler-Weber-Rendu syndrome, hereditary haemorrhagic telangiectasia (HHT) is an autosomal dominant condition characterised by multiple telangiectasia over the skin and mucous membrane

Answer 29

Epistaxis Telangiectases: multiple at characteristic sites (lips, oral cavity, fingers, nose) Visceral lesions: for example gastrointestinal telangiectasia (with or without bleeding), pulmonary arteriovenous malformations (AVM), hepatic AVM, cerebral AVM, spinal AVM Family history: a first-degree relative with HHT 2 = possible diagnosis of HHT 3 = definite diagnosis of HHT

Answer 30

Chronic, painful, inflammatory skin disorder. Development of inflammatory nodules, pustules, sinus tracts, and scars in intertriginous areas. Chronic inflammatory occlusion of folliculopilosebaceous units obstructs the apocrine glands and prevents keratinocytes from properly shedding from the follicular epithelium. Axilla is the most common site

Answer 31

Hygiene and loose-fitting clothing Smoking cessation Weight loss in obese Acute flares can be treated with steroids (intra-lesional or oral) or flucloxacillin. Surgical incision and drainage may be needed in some cases. Long-term disease can be treated with topical (clindamycin) or oral (lymecycline or clindamycin and rifampicin) antibiotics. Lumps that persist despite prolonged medical treatment are excised surgically.

Answer 32

Hirsutism = androgen-dependent hair growth Hypertrichosis = androgen-independent hair growth

Answer 33

PCOS Cushing's syndrome Congenital adrenal hyperplasia Androgen therapy Obesity: thought to be due to insulin resistance Adrenal tumour Androgen-secreting ovarian tumour Drugs: phenytoin, corticosteroids

Answer 34

Ferriman-Gallwey scoring system: 9 body areas are assigned a score of 0 - 4, a score > 15 is considered to indicate moderate or severe hirsutism

Answer 35

Weight Loss Waxing/bleaching - not available on the NHS Combined oral contraceptive pills such as co-cyprindiol (Dianette) or ethinylestradiol and drospirenone (Yasmin). Co-cyprindiol should not be used long-term due to the increased risk of VTE Facial hirsutism: topical eflornithine - contraindicated in pregnancy and breast-feeding

Answer 36

Drugs: minoxidil, ciclosporin, diazoxide Congenital hypertrichosis lanuginosa, congenital hypertrichosis terminalis Porphyria cutanea tarda Anorexia nervosa

Answer 37

Hyperhidrosis describes the excessive production of sweat. First Line: Topical aluminium chloride (can cause skin irritation) Iontophoresis: particularly useful for patients with palmar, plantar and axillary hyperhidrosis Botulinum toxin: currently licensed for axillary symptoms Surgery: Endoscopic transthoracic sympathectomy. Patients should be made aware of the risk of compensatory sweating

Answer 38

Fungal infection of the scalp (scalp ringworm)

Answer 39

Fungal infection of the trunk, legs and arms (Ringworm)

Answer 40

A raised, pustular, spongy/boggy mass called a kerion may form Scalp scrapings Oral antifungals: Terbinafine for Trichophyton Griseofulvin for Microsporum infections. Topical ketoconazole shampoo for first 2 weeks = reduced transmission

Answer 41

Trichophyton verrucosum (e.g. From contact with cattle) Well-defined annular, erythematous lesions with pustules and papules Oral Flucanozole

Answer 42

A local or generalised superficial swelling of the skin. Most commonly caused by allergic reaction

Answer 43

Pale, pink raised skin. Variously described as 'hives', 'wheals', 'nettle rash' pruritic First Line: Non-sedating antihistamines (e.g. loratadine or cetirizine). Should be continued for up to 6 weeks following an episode of acute urticaria Sedating antihistamine (e.g. chlorphenamine) can be used at night Prednisolone is used for severe or resistant episodes

Answer 44

Squamous cell carcinoma is a common variant of skin cancer. Metastases are rare but may occur in 2-5% of patients. Excessive exposure to sunlight/psoralen UVA therapy Actinic keratoses and Bowen's disease Immunosuppression e.g. following renal transplant, HIV Smoking Long-standing leg ulcers (Marjolin's ulcer) Genetic conditions e.g. xeroderma Pigmentosum, oculocutaneous albinism

Answer 45

Sun-exposed sites of the body Rapidly expanding painless, ulcerate nodules May have a cauliflower-like appearance there may be areas of bleeding Surgical excision with 4mm margins if lesion <20mm in diameter. If tumour >20mm then margins should be 6mm. Mohs micrographic surgery may be used in high-risk patients and cosmetically important sites.

Answer 46

Good Prognosis Well-differentiated tumours <20mm diameter <2mm deep No associated diseases Poor Prognosis Poorly differentiated tumours >20mm in diameter >4mm deep Immunosuppression

Answer 47

Caused by mites (Sarcoptes scabiei) and spread by prolonged skin contact. The scabies mite burrows into the skin, laying its eggs in the stratum corneum. The intense pruritus associated with scabies is due to a delayed-type IV hypersensitivity reaction to mites/eggs which occurs about 30 days after the initial infection.

Answer 48

Widespread pruritus Linear burrows on the side of fingers, Interdigital webs and flexor aspects of the wrist In infants, the face and scalp may also be affected Secondary features are seen due to scratching: excoriation, infection

Answer 49

Permethrin 5% is first-line Malathion 0.5% is second-line Patient guidance Pruritus persists for up to 4-6 weeks post eradication Avoid close physical contact with others until treatment is complete All household and close physical contacts should be treated at the same time, even if asymptomatic Launder, iron or tumble dry clothing, bedding, towels, etc., on the first day of treatment to kill off mites

Answer 50

Ulcers that typically develop over bony prominences such as the sacrum or heel. Malnourishment Incontinence: urinary and faecal Lack of mobility Pain (leads to a reduction in mobility)

Answer 51

Waterlow score BMI body, nutritional status, skin type, mobility and continence

Answer 52

Grade 1: Non-blanchable erythema of intact skin. Discolouration of the skin, warmth, oedema, induration or hardness may also be used as indicators, particularly on individuals with darker skin. Grade 2: Partial thickness skin loss involving epidermis or dermis, or both. The ulcer is superficial and presents clinically as an abrasion or blister Grade 3: Full-thickness skin loss involving damage to or necrosis of subcutaneous tissue that may extend down to, but not through, underlying fascia. Grade 4 Extensive destruction, tissue necrosis, or damage to muscle, bone or supporting structures with or without full-thickness skin loss

Answer 53

Diagnosis Fine-toothed combing of wet or dry hair Management Treatment is only indicated if live lice are found Malathion, wet combing, dimeticone, isopropyl myristate and Cyclomethicone Household contacts of patients with head lice do not need to be treated unless they are also affected School exclusion is not advised for children with head lice

Answer 54

Impetigo is a superficial bacterial skin infection usually caused by either Staphylococcus aureus or Streptococcus pyogenes Direct contact with discharges from the scabs of an infected person. Infection is spread mainly by the hands Indirect spread via toys, clothing, equipment and the environment may occur.

Answer 55

'golden', crusted skin lesions typically found around the mouth very contagious

Answer 56

Limited, localised disease Hydrogen peroxide 1% cream Topical antibiotic creams: Topical fusidic acid, Topical mupirocin should be used if fusidic acid resistance is suspected MRSA is not susceptible to either fusidic acid or retapamulin. Topical mupirocin should, therefore, be used in this situation Extensive disease Oral flucloxacillin, Oral erythromycin if penicillin-allergic Children should be excluded from school until the lesions are crusted and healed or 48 hours after commencing antibiotic treatment

Answer 57

Liver disease: History of alcohol excess Stigmata of chronic liver disease: spider naevi, bruising, palmar erythema, gynecomastia etc Evidence of decompensation: ascites, jaundice, encephalopathy Iron deficiency anaemia Pallor Other signs: koilonychia, atrophic glossitis, post-cricoid webs, angular stomatitis Polycythaemia Pruritus particularly after a warm bath, 'Ruddy complexion', Gout, Peptic ulcer disease Chronic kidney disease Lethargy & pallor, Oedema & weight gain, Hypertension Lymphoma Night sweats, Lymphadenopathy, Splenomegaly, hepatomegaly, Fatigue

Answer 58

Hypersensitivity reactions triggered by infections

Answer 59

Target lesions are initially seen on the back of the hands/feet before spreading to the torso Upper limbs are more commonly affected than the lower limbs Pruritus is occasionally seen and is usually mild The more severe form, erythema multiforme major is associated with mucosal involvement.

Answer 60

Viruses: herpes simplex virus (the most common cause) Idiopathic Bacteria: Mycoplasma, Streptococcus Drugs: penicillin, sulphonamides, carbamazepine, allopurinol, NSAIDs, oral contraceptive pill, nevirapine Connective tissue disease e.g. Systemic lupus erythematosus Sarcoidosis Malignancy

Answer 61

Inflammation of subcutaneous fat typically causes tender, erythematous, nodular lesions Usually occurs over shins, but may also appear elsewhere (e.g. forearms, thighs) Usually resolves within 6 weeks lesions heal without scarring

Answer 62

Infection Streptococci Tuberculosis Brucellosis Systemic disease Sarcoidosis Inflammatory bowel disease Behcet's Malignancy/lymphoma Drugs Penicillins Sulphonamides COCP Pregnancy

Answer 63

Guttate psoriasis may be precipitated by a streptococcal infection 2-4 weeks before the lesions appear. Features Teardrop papules on the trunk and limb Pink, scaly patches or plaques of psoriasis Acute onset over days

Answer 64

Resolve spontaneously within 2-3 months Topical agents as per psoriasis UVB phototherapy Tonsillectomy may be necessary with recurrent episodes

Answer 65

Acute, self-limiting rash which tends to affect young adults. Herpes hominis virus 7 (HHV-7) may play a role. Features Usually no prodrome, Some might have a history of a recent viral infection Herald patch (usually on the trunk) followed by erythematous, oval, scaly patches (fir tree appearance)

Answer 66

Self-limiting usually disappears between 6-12 weeks

Answer 67

cleanse wound. Puncture wounds should not be sutured closed unless cosmesis is at risk Co-amoxiclav If penicillin-allergic then doxycycline + metronidazole is recommended

Answer 68

Common organisms include: Streptococci spp. Staphylococcus aureus Eikenella Fusobacterium Prevotella Co-amoxiclav The risk of viral infections such as HIV and hepatitis C should also be considered.

Answer 69

Topical hydrocortisone is suitable for controlling itch Definitive Management is a pest management company and fumigation of the house. Bed bug numbers may be controlled by hot-washing bed linen and using mattress covers.

Answer 70

Caused by the spirochaete Borrelia burgdorferi and is spread by ticks.

Answer 71

Erythema migrans - Bulls-eye rash, 1-4 weeks after bite, 5cm Headache Lethargy Fever Arthralgia

Answer 72

Cardiovascular - Heart block - Peri/myocarditis Neurological - Facial nerve palsy - Radicular pain - Meningitis

Answer 73

Diagnosed clinically if erythema migrans is present (ELISA) antibodies to Borrelia burgdorferi are the first-line test If negative and Lyme disease is still suspected in people tested within 4 weeks from symptom onset, repeat the ELISA in 4-6 weeks. If more than 12 weeks of symptoms immunoblot test for Lyme disease should be done

Answer 74

Remove Tick Doxycycline for early disease. Amoxicillin is an alternative if doxycycline is contraindicated (e.g. pregnancy) Erythema migrans should be commenced on antibiotics without the need for further tests Ceftriaxone if disseminated disease Side Effect: Jarisch-Herxheimer reaction is sometimes seen after initiating therapy: fever, rash, tachycardia after the first dose of antibiotic (more commonly seen in syphilis, another spirochaetal disease)

Answer 75

Wallace's Rule of Nines: head + neck = 9%, each arm = 9%, each anterior part of leg = 9%, each posterior part of leg = 9%, anterior chest = 9%, posterior chest = 9%, anterior abdomen = 9%, posterior abdomen = 9% Lund and Browder chart: the most accurate method The palmar surface is roughly equivalent to 1% of total body surface area (TBSA). Not accurate for burns > 15% TBSA

Answer 76

ABC Burns caused by heat: remove the person from the source. Within 20 minutes of the injury rinse the burn with cool (not iced) water for between 10 and 30 minutes. Cover the burn using cling film, layered, rather than wrapped around a limb Superficial epidermal: symptomatic relief - analgesia, emollients etc superficial dermal: cleanse wound, leave blister intact, non-adherent dressing, avoid topical creams, review in 24 hours Electrical burns: switch off the power supply, and remove the person from the source Chemical burns: brush any powder off then rinse with water. Attempts to neutralise the chemical are not recommended

Answer 77

Superficial epidermal (First degree) Red and painful, dry, no blisters Partial thickness (superficial dermal) (Second degree) Pale pink, painful, blistered. Slow capillary refill Partial thickness (deep dermal) (Second degree) Typically white but may have patches of non-blanching erythema. Reduced sensation, painful to deep pressure Full thickness (Third degree) White ('waxy')/brown ('leathery')/black, no blisters, no pain

Answer 78

All deep dermal and full-thickness burns. Superficial dermal burns of more than 3% TBSA in adults, or more than 2% TBSA in children Superficial dermal burns involving the face, hands, feet, perineum, genitalia, or any flexure, or circumferential burns of the limbs, torso, or neck Any inhalation injury Any electrical or chemical burn injury suspicion of non-accidental injury

Answer 79

The initial aim is to stop the burning process and resuscitate the patient. Airway Assessment - Smoke inhalation can cause airway oedema - Early intubation should be considered e.g. if deep burns to the face or neck, blisters or oedema of the oropharynx, stridor etc IV fluids (children 10% Surface Area, 15% Adult Surface Area) - Parkland formula: volume of fluid = total body surface area of the burn % x weight (Kg) x4. Half of the fluid is administered in the first 8 hours. A urinary catheter should be inserted. Analgesia should be given. Complex burns, burns involving the hand perineum and face and burns >10% in adults and >5% in children should be transferred to a burns unit. Circumferential burns affecting a limb or severe torso burns impeding respiration may require escharotomy to divide the burnt tissue. Complex burns may require excision and skin grafting. Excision and primary closure are not generally practised as there is a high risk of infection.

Answer 80

A skin disorder of unknown aetiology, most probably being immune-mediated. Features - Itchy, papular rash most common on the palms, soles, genitalia and flexor surfaces of arms - Rash with a 'white-lines' pattern on the surface (Wickham's striae) - Koebner phenomenon (new skin lesions appearing at the site of trauma) - Oral involvement in around 50% of patients: typically a white-lace pattern on the buccal mucosa - Nails: thinning of the nail plate, longitudinal ridging

Answer 81

Gold Quinine Thiazides

Answer 82

Potent topical steroids are the mainstay of treatment Benzydamine mouthwash or spray for oral lichen planus Extensive lichen planus: oral steroids or immunosuppression

Answer 83

Chronic skin disease of unknown aetiology. Features - Nose, cheeks and forehead - Flushing - Telangiectasia - Develops into persistent erythema with papules and pustules - -Rhinophyma - Ocular involvement: blepharitis sunlight may exacerbate symptoms

Answer 84

Daily application of high SPF Predominant flushing but limited telangiectasia - Topical brimonidine gel (alpha adrenergic agonist) Mild-to-moderate papules and/or pustules - Topical ivermectin is first-line - Topical metronidazole or topical azelaic acid Moderate-to-severe papules and/or pustules - Combination of topical ivermectin + oral doxycycline Laser therapy for patients with prominent telangiectasia patients with a rhinophyma

Answer 85

Chronic dermatitis caused by an inflammatory reaction related to the proliferation of a normal skin inhabitant, a fungus called Malassezia furfur.

Answer 86

Features - Eczematous lesions on the sebum-rich areas: scalp (may cause dandruff), periorbital, auricular and nasolabial folds - Otitis externa and blepharitis may develop Associated conditions: HIV Parkinson's disease

Answer 87

Ketoconazole 2% shampoo OTC preparations containing zinc pyrithione ('Head & Shoulders') and tar ('Neutrogena T/Gel') Selenium sulphide and topical corticosteroid

Answer 88

Topical Ketoconazole Topical steroids: best used for short periods

Answer 89

Seborrhoeic dermatitis in children. Affects the scalp ('Cradle cap'), nappy area, face and limb flexures. Erythematous rash with coarse yellow scales.

Answer 90

Reassurance: usually resolves within a few weeks Topical emollient onto the scalp to loosen scales, brush gently with a soft brush and wash off with shampoo. If severe/persistent a topical imidazole cream may be tried

Answer 91

Liver disease Iron deficiency anamiea Polycythaemia CKD Lymphoma Hyper/Hypothyroidism Diabetes Pregnancy 'senile' pruritus Urticaria Skin disorders: eczema, scabies, psoriasis, pityriasis rosea

Answer 92

Tumour-like lesions that arise from the connective tissue of a scar and extend beyond the dimensions of the original wound

Answer 93

Dark skin Young adults, rare in the elderly Common sites (in order of decreasing frequency): sternum, shoulder, neck, face, extensor surface of limbs, trunk

Answer 94

Early keloids may be treated with intra-lesional steroids e.g. triamcinolone Excision is sometimes required

Answer 95

Benign tumour of adipocytes. - Malignant transformation to liposarcoma is very rare Features - Smooth, mobile, painless

Answer 96

Size >5cm Increasing size Pain Deep anatomical location

Answer 97

Venous leg ulcers Most due to venous hypertension, secondary to chronic venous insufficiency Features - Oedema, brown pigmentation, lipodermatosclerosis, eczema - Above the ankle, painless Deep venous insufficiency is related to previous DVT and superficial venous insufficiency is associated with varicose veins Doppler ultrasound looks for the presence of reflux and duplex ultrasound looks at the anatomy/ flow of the vein

Answer 98

4-layer compression banding after exclusion of arterial disease or surgery Skin grafting if it fails to heal after 12 weeks or >10cm2

Answer 99

Squamous cell carcinoma Occurring at sites of chronic inflammation e.g; burns, osteomyelitis after 10-20 years Mainly occur on the lower limb

Answer 100

Chronic wounds are caused by insufficient blood supply to the affected area, typically resulting from peripheral arterial disease (PAD). Atherosclerosis Risk factors are same as CVD Other contributing factors include thrombosis, embolism, and trauma

Answer 101

Lower extremities, particularly over bony prominences (lateral malleolus, toes, and anterior tibial) Appearance - Small, round, and have well-defined edges. The ulcer base may appear pale, dry, or necrotic. Pain: - Very painful, particularly at night or when the leg is elevated. Surrounding Skin - Shiny, thin, and hairless. Pulses - Peripheral pulses (dorsalis pedis and posterior tibial) are often diminished or absent. Temperature - Cool to the touch.

Answer 102

Physical examination of the ulcer and assessment of peripheral pulses. Ankle-Brachial Pressure Index (ABPI): - ABPI measures blood pressure in the ankle: blood pressure in the arm (Ratio) An ABPI of less than 0.9 is indicative of PAD. Doppler Ultrasound: - Assess blood flow in the arteries and to detect areas of stenosis or occlusion. Magnetic Resonance Angiography (MRA) or Computed Tomography Angiography (CTA) Lipid profile, Blood glucose levels

Answer 103

Risk factor modification: - Lifestyle changes, including smoking cessation, dietary modifications, and regular exercise. - Control of comorbid conditions such as diabetes, hypertension, and hyperlipidemia. Revascularisation: - Angioplasty, stenting, or bypass surgery Pharmacotherapy - Antiplatelet agents (e.g., aspirin, clopidogrel) and statins Wound care - Debridement: Removal of necrotic tissue to promote healing. - Dressings: Hydrocolloid, alginate, or foam dressings. - Infection control: Topical or systemic antibiotics Monitoring for complications, including: osteomyelitis

Answer 104

Neuropathic ulcers Commonly over the plantar surface of the metatarsal head and the plantar surface of the hallux The plantar neuropathic ulcer is the condition that most commonly leads to amputation in diabetic patients Due to pressure Management includes cushioned shoes to reduce callous formation

Answer 105

Erythematous nodules or pustules which ulcerate Associated with inflammatory bowel disease/RA Can occur at stoma sites

Answer 106

Compression bandaging,4 layer Oral pentoxifylline, a peripheral vasodilator, improves the healing rate

Answer 107

Vaginal dryness, dyspareunia and occasional spotting. The vagina may appear pale and dry Post menopasual women

Answer 108

Vaginal lubricants and moisturisers - if these do not help then topical oestrogen cream can be used.

Answer 109

Vaginal itching Usually has an underlying cause - Latex condoms, lubricants - Atopic dermatitis - Seborrhoeic dermatitis - Lichen planus - Lichen sclerosis - Psoriasis: seen in around a third of patients with psoriasis

Answer 110

Take showers rather than baths Clean the vulval area with an emollient such as Epaderm or Diprobase (OD) Treat underlying causes

Answer 111

Nail pitting - Psoriasis - Alopecia areata Blue nails - Wilson's disease Leuconychia - Hypoalbuminaemia - Fungal disease, lymphoma Half and half - distal portion brown and proximal portion pale - chronic renal failure Nail patella syndrome Yellow nail syndrome - associated with congenital lymphoedema, pleural effusions, bronchiectasis and chronic sinus infections

Answer 112

Affects both fingers and toes and does not reflect the severity of psoriasis but there is an association with psoriatic arthropathy - around 80-90% of patients with psoriatic arthropathy have nail changes. Nail changes that may be seen in - psoriasis - pitting - onycholysis (separation of the nail from the nail bed) - subungual hyperkeratosis - loss of the nail

Answer 113

Itchy, erythematous rash repeated scratching may exacerbate affected areas In infants, the face and trunk are often affected In younger children, eczema occurs on the extensor surfaces In older children, a more typical distribution is seen, with flexor surfaces affected and the creases of the face and neck

Answer 114

Avoid irritants Simple emollients - Large quantities should be prescribed (e.g. 250g / week), roughly in a ratio of with topical steroids of 10:1 If a topical steroid is also being used the emollient should be applied first followed by waiting at least 30 minutes before applying the topical steroid creams soak into the skin faster than ointments Wet wrapping - Large amounts of emollient (and sometimes topical steroids) applied under wet bandages In severe cases, oral ciclosporin

Answer 115

Cellulitis is a bacterial infection that affects the dermis and the deeper subcutaneous tissues. Most commonly caused by infection with Streptococcus pyogenes or less commonly Staphylococcus aureus. Features - Shins - Unilateral - Erythema - Well-defined margins - Blisters and bullae may be seen with more severe disease - Swelling - Systemic upset - Fever - Malaise - Nausea

Answer 116

Eron Classification system 1 There are no signs of systemic toxicity and no uncontrolled co-morbidities 2 Either systemically unwell or systemically well but with a co-morbidity (for example PAD, chronic venous insufficiency, or morbid obesity) which may complicate or delay the resolution of infection 3 Significant systemic upset such as acute confusion, tachycardia, tachypnoea, hypotension, or unstable co-morbidities that may interfere with a response to treatment or a limb-threatening infection due to vascular compromise 4 The person has sepsis syndrome or a severe life-threatening infection such as necrotizing fasciitis.

Answer 117

Has Eron Class 3 or 4cellulitis. Has severe or rapidly deteriorating cellulitis (for example extensive areas of skin). Is very young (under 1 year of age) or frail. Is immunocompromized. Has significant lymphoedema. Has facial cellulitis (unless very mild) or periorbital cellulitis.

Answer 118

Eron Class 1/2 First-line treatment: Oral flucloxacillin Allergy: oral clarithromycin, erythromycin (in pregnancy) or doxycycline Eron Class 3/4 Admit Oral/IV co-amoxiclav, Oral/IV clindamycin IV cefuroxime or IV ceftriaxone

Answer 119

Superficial spreading (most frequent) Nodular (most aggressive) Lentigo maligna Acral lentiginous (Rare)

Answer 120

Superficial spreading ( Arms, legs, back and chest, young people), (Growing moles, change in size, change in shape, change in colour) Nodular (sun-exposed skin, middle-aged people), (Red or black lump or lump which bleeds or oozes) Lentigo maligna (Chronically sun-exposed skin, older people), (Growing moles, change in size, change in shape, change in colour) Acral lentiginous (Nails, palms or soles, People with darker skin pigmentation), (Subungual pigmentation (Hutchinson's sign) or on palms or feet)

Answer 121

The main diagnostic features (major criteria): - Change in size - Change in shape - Change in colour Secondary features (minor criteria) - Diameter >= 7mm - Inflammation - Oozing or bleeding - Altered sensation

Answer 122

Excision biopsy. Histopathological assessment Specialised treatment: - Sentinel lymph node mapping, isolated limb perfusion and block dissection of regional lymph node groups

Answer 123

The invasion depth of a tumour (Breslow depth) is the single most important factor in determining the prognosis of patients with malignant melanoma Breslow Thickness : Approximate 5 year survival < 0.75 mm = 95-100% 0.76 - 1.50 mm = 80-96% 1.51 - 4 mm = 60-75% > 4 mm = 50%

Answer 124

Common and chronic skin disorder. Red, scaly patches on the skin.

Answer 125

Plaque psoriasis: - well-demarcated red, scaly patches affecting the extensor surfaces, sacrum and scalp Flexural psoriasis: - skin is smooth Guttate psoriasis: - transient psoriatic rash frequently triggered by a streptococcal infection. Multiple red, teardrop lesions appear on the body Pustular psoriasis: - occurs on the palms and soles

Answer 126

Psoriatic arthropathy (around 10%) Increased incidence of metabolic syndrome (UC, Chrons) Increased incidence of CVD, Hypertension Increased incidence of VTE Non-melanoma skin cancer Other cancers (liver, lung, upper GI) Psychological distress/ Depression

Answer 127

Trauma Alcohol Drugs: beta-blockers, lithium, antimalarials (chloroquine and hydroxychloroquine), NSAIDs and ACE inhibitors, infliximab Withdrawal of systemic steroids Streptococcal infection may trigger guttate psoriasis.

Answer 128

Regular emollients to reduce scale loss and reduce pruritus First-line: - Potent corticosteroid applied once daily plus vitamin D analogue applied once daily - Should be applied separately, one in the morning and the other in the evening for up to 4 weeks as initial treatment Second-line: If no improvement after 8 weeks then offer: - Vitamin D analogue twice daily Third-line: if no improvement after 8-12 weeks then offer either: - Potent corticosteroid applied twice daily for up to 4 weeks, or a coal tar preparation applied once or twice daily - Short-acting dithranol can also be used

Answer 129

Diagnostic uncertainty Severe or extensive, more than 10% of the body surface area is affected If any type of psoriasis cannot be controlled with topical therapy If acute guttate psoriasis requires phototherapy Nail disease has a major functional or cosmetic impact Any major impact on a person's physical, psychological or social wellbeing Children and young people with any type of psoriasis should be referred to a specialist at presentation Patients with erythoderma or generalised pustular psoriasis should be referred on the same day.

Answer 130

Methotrexate Ciclosporin if: - Need rapid or short-term disease control (for example a psoriasis flare) - Palmoplantar pustulosis - Considering conception (both men and women) and systemic therapy cannot be avoided Biological - Adalimumab (SC) - Etanercept (SC) - Infliximab (IV) - Ustekinumab (SC)

Answer 131

Potent topical corticosteroids used once daily for 4 weeks If no improvement after 4 weeks - Different formulations of the potent corticosteroid (shampoo or mousse) - - - Topical agents to remove adherent scale (agents containing salicylic acid, emollients and oils) before application of the potent corticosteroid

Answer 132

Yeast infection is a red, itchy rash that usually appears in moist areas or skin folds

Answer 133

For adults: - topical Clotrimazole, econazole, miconazole, or ketoconazole. For children: - Topical clotrimazole, econazole, or miconazole

Answer 134

Topical salicylic acid (15–50%) applied daily for up to 12 weeks Cryotherapy with liquid nitrogen