Dermatology Flashcards
What is the stepwise management of chronic plaque psoriasis?
- Potent corticosteroid + Vit D OD for up to 4 weeks
- > 8 weeks and no improvement - give vit D BD
- 8-12 weeks no improvement then offer potent corticosteroid BD up to 4 weeks OR coal tar O/BD
What are some secondary care management methods for chronic plaque psoriasis?
Phototherapy
-UV B
-psoralen + UV A
What are some side effects of phototherapy?
Skin ageing, SCC
What are the systemic therapy options in the management of chronic plaque psoriasis?
- Methotrexate
- Ciclosporine
- Systemic retinoids
- Biological agents
How is scalp psoriasis managed?
- Potent topical corticosteroid OD for 4 weeks +/- adjuncts if no improvement
For which type of psoriasis is the following management used? Mild or moderate corticosteroid O/BD for 2 weeks
Facial/Flexural/Genital
How do vitamin D analogues work?
Reduce cell division and differentiation which leads to reduced epidermal proliferation
How are capillary haemiangiomas managed in children?
Propranolol
Which virus causes molluscum contagiousum and which family of viruses does it belong to?
Molluscum contagiousium virus
Poxviridae family
Which condition is often seen along with molluscum
Atopic eczema
How does molluscum present?
Pink white papules with central umbilication up to 5mm in diameter
Which part of the body is not affected by molluscum
Palms and soles
What is the management option for eczema and itching related to molluscum
Emollient or mild topical corticosteroid
Which patients with molluscum should be referred
HIV +ve (GUM)
Eyelid margin or ocular lesions (Ophthal)
Anogenital lesions (GUM)
Which drug class commonly causes SJS
Anti-epileptics
Which common medications can cause SJS
Penicillin
Sulphonamides
Anti-epileptics
Allopurinol
NSAIDs
OCP
Which malignancy is most common in post renal transplant patients
SCC
What should the margins be in SCC excision
< 20mm 4mm
>20mm 6mm
What are the management options for Actinic Keratoses
- Topical fluorouracil
- Topical diclofenac
- Topical imiquimod
- Cryo/curettage
What is the causative agent of serborrhoeic dermatitis?
Malassezia furfur
What are the classic features of seborrhoeic dermatitis?
Eczematous lesions in the scalpe, periorbital, auricular and nasolabial folds
Otitis external and blepharitis
What are some skin disorders associated with pregnancy
Atopic eruption
Polymorphic eruption
Pemphigoid gestationis
Which is the commonest skin disorders associated with in pregnancy
Atopic eruption
When is polymorphic eruption of pregnancy seen and how does it present
Third trimester
Pruritis
Abdominal striae
How is polymorphic eruption managed?
Emollients, mild topical or oral steroids
How do pemphigoid gestationis present?
Pruritic blistering lesions
How does pemphigoid gestationis spread?
Peri-umbilical outwards in the 2nd/3rd trimester
How is pemphigoid gestationis treated?
Oral corticosteroids
What are some side effects of topical corticosteroid treatment?
Skin depigmentation
Skin atrophy
Excessive hair growth
Which are the mild and moderate topical corticosteroids
Mild - hydrocortisone Moderate - betamethasone, clobetasone
Potent and very potent corticosteroids
Potent - fluticasone, betamethasone
Very potent - clobetasol
Which are the most common medications associated with the development of erythema nodosum
Penicillins
Sulphonamides
COCP
What are some causes of erythema nodosum
Strep
TB
Brucellosis
Sarcoidosis
IBD
Behcets
Malignancy
Pregnancy
Which common cardiac drug is known to exacerbate plaque psoriasis
Beta-blockers
Which antihypertensives are known to exacerbate psoriasis?
ACEi
Which drugs can exacerbate psoriasis
Beta blockers
NSAIDs
ACEi
Lithium
Infliximab
Antimalarials
When should antivirals be prescribed in Shingles?
Within 72 hours of onset of symptoms
Which is the first line antiviral for herpes zoster?
Oral Famciclovir or Oral Valacyclovir
Which are they. Most commonly affected dermatomes in shingles
T1-L2
If the pain is not improving with neuropathic or OTC meds, in shingles, what else may be used?
Oral corticosteroids if in the first 2 weeks in immunocompetent adults
How does lichen planus present?
Itchy, popular rash - palms, soles, genitalia and flexors
Wickhams striae are seen in which condition?
Lichen planus
What is Koebner phenomenon
New skin lesions in lichen planus
How is lichen planus managed?
Potent topical steroids
How is oral lichen planus managed?
Benzydamine mouthwash
How are bullous pemphigoid and pemphigus vulgaris differentiated?
No mucosal involvement = bullous
Mucosal involvement = pemphigus vulgaris
What is the different in blister type between pemphigoid and pemphigus
Pemphigoid - tense
Pemphigus - flaccid
Dermatitis herpetiformis is associated with what?
Gluten sensitivity and coeliac disease
Which group of people is pemphigus vulgaris more common in?
Ashkenazi Jewish
How is pemphigus vulgaris managed?
Steroids + immunosuppressants
How does livedo reticularis present?
Purplish, none blanching, reticulated
Which conditions are associated with Vitiligo?
Autoimmune conditions such as thyroid disease, pernicious anaemia, SLE, alopecia, T1DM, Addisons
Which mediations might be used in the management of Vitiligo?
Topical corticosteroids
What are the criteria for mild, moderate and severe acne?
Mild: open and closed commodores with little to no inflammation
Moderate: widespread non-inflamm lesions + papule and pustules
Severe: inflammatory lesions, nodules, pitting, scarring
For mmild to moderate acne, what is the treatment?
12 week course of retinoid/retinoic acid + antibiotic or benzoyl peroxide
Which groups cannot take tetracylines?
Preggos
Beastfeeding
< 12y
What is a complication of long term topical antibiotic use in acne?
Gram negative folliculitis
Port Wine stain can be associated with which other condition?
Sturge Weber
Tear dropped shape rash =
Guttate psoriasis
Macular papular vesicular rash with crusting =
Chickenpox VZV
Which condition classily precedes Guttate psoriasis?
Strep throat
How does briminodine work?
Alpha adrenergic agonist
Which drugs are used in the management of acne rosacea?
- Topical Ivermectin or metronidazole or azalaic acid
- Topical ivermectin + doxy if severe
- Flushing - briminodine
Which conditions are associated with Vitiligo?
T1DM, Addisons, Autoimmune thyroid problems, pernicious anaemia, alopecia
What is the difference between scarring and none scarring alopecia?
Scarring involves destruction of the hair follicle
Which conditions are linked to scarring alopecia
Lichen planus, discoid lupus, tinea capitis
which drugs can cause none scarring alopecia?
Cytotoxic drugs, colchicine, OCP, heparin, carbimazole
What is the difference between a Curling’s ulcer and a Cushing’s ulcer
Curlings - after burns
Cushing’s - after severe head trauma
Herald patch =
Pityriasis rosea
Raised pearly white umbilical lesions =
Molluscum
Which skin conditions are associated with diabetes?
Necrobiosis lipoidica
Candida
Staph
Neuropathic ulcers
Vitiligo
Lipoatrophy
Granuloma annulare
Target lesions =
Erythema multiforme
How can pityriasis be diagnosed?
Woods light showing yellow green fluorescence
Which drugs cause erythema nodosum
Penicillins, sulphonamides, COCP
What are the common causes of impetigo?
S. aureus
S. pyogenes
How is impetigo treated?
- Hydrogen peroxide 1% if not unwell
- Topical fusidic acid
- Topical mupirocin if (2) fails or MRSA
- Oral fluclox in extensive disease (erythro if pen allergy)
Which is the most common type of BCC
Nodular
Which antihistamines are none sedating?
Loratadine
Cetirizine
Which areas can plaque psorias commonly affecyt
Extensors
Scalp
Shins
Trunk
Itchy papulovesicular rash =
Dermatitis herpetiformis
Which is the best skin test for contact dermatitis?
Patch testing
