Dermatology Flashcards
Itchy rash face scalp eyebrows
seborrhoeic dermatitis
Red rash affecting face, with flushing, non-pruritic.
Can cause blepharitis/conjunctivitis
Acne Rosacea
1st line Tx for Acne Rosacea
Topical Ivermectin
(Brominidine gel, an alpha agonist, can be used PRN for flushing)
Red rash with silver scale/plaque
Psoriasis
Treatment for extensor psoriasis
Potent topical steroid + Vitamin D analogue (latter reduces plaque thickness)
Treatment for flexural psoriasis (incl groin/axilla/face)
Mild topical steroid only
(since skin thinner in flexures, so is plaque, so vitamin D no benefit)
Treatment for keloid scarring?
Intralesional steroid (triamcinolone)
Fungal nail infection involving <50% nail or 2 or fewer nails?
Topical anti fungal nail cream
Fungal nail infection involving >50% nail or more than 2 nails?
Oral terbenafine
There are 4 skin conditions that affect the shins. What are they?
-Erythema Nodosum (IBD, sarcoidosis)
-Pyoderma Gangrenosum (idiopathic, IBD)
-Pretibial myxoedema
-?Necrobiosis lipidium diabeticorum
Treatment escalation for psoriasis?
1) 4 weeks potent steroid OD and vit D analogue (calpotriol)
2) 8 weeks calpotriol only BD
3) 4 weeks potent steroid BD and continue calpotriol
4) PUVA (psoralen light UV sensitising cream + UVA therapy)
What does PUVA increase risk of?
Squamous Cell Cancer only
Peeling of epidermal layer under pressure, affecting >30% of skin area, following drug
Toxic Epidermal Necrolysis (TEN)
Seborrhaic dermatitis - what is it caused by?
How is it treated?
What are complications?
Caused by fungal infection (malassazia furfur)
Treat with ketoconazole
eyes and ears - blepharitis and otitis externa
What is acne rosacea?
How does it present?
What is the first symptom usually?
Difference between acne rosacea and malar rash in SLE?
Treatment escalation in acne rosacea?
Central Red rash affecting face - unknown cause
First flushing
Rash
telangiectasia
papules and pustules can form after
No other symptoms of SLE or systemic symptoms
Brominidine gel for flushing
Topical ivermectin +/- metronidazole or if papules/pustules doxycycline
camouflage cream to help hide
if no help, refer for laser
Most common side effect of isotretinoin?
dry skin
What nail changes can happen in psoriasis?
onycholysis, loss of nail, subungual hyperkeratosis
Are steroids used in acne rosacea?
NO!
Depigmentation, precipitated by hot, humid weather?
Pityriasis Versicolour
(fungal infection - malassezia furfur)
Which mineral deficiency causes angular cheilosis?
Zinc
Causes of hirsutism?
most common is PCOS
- Cushing’s
- Adrenal tumour
- CAH
NB// can be normal with women ageing, as post-menopausal oestrogen level is relatively low to androgen level
What do you treat strawberry navi (capillary hemangiomas) with if indicated?
Topical propranolol
What is the difference between cellulitis and necrotising fasciitis? (and erysipelas)
Cellulitis affects dermis, whereas nec fasc affects deeper connective tissue (fascia) and can extend into muscle. It requires emergency surgical debridement. Significant mortality.
Treatment of scalp psoriasis?
Potent topical steroid only - try 4 weeks. If no help try different formulation e.g cream/mousse
Management of shingles?
If within 72hrs, aciclovir
Advise infectious until crusted over
Advise no contact with pregnant or immunosuppressed people
What triggers pityriasis rosacea?
viral infection (HHV6/7)
What triggers Guttate psoriasis?
bacterial infection
e.g. strep throat
What is bullous pemphigoid?
autoimmune condition affecting elderly patients
causing BLISTERS that do NOT have mucosal involvement (whereas pemphigus vulgaris does have mucosal involvement)
Management of bullous pemphigoid?
Life-threatening
Urgent derm referral
Most useful investigation prior to managing suspected venous ulcer
ABPI (normal 0.9 - 1.2)
Characteristics of lichen planus?
purple
polygonal
papules
can get white striae inside mouth known as Wickham’s striae
Treatment of lichen planus?
Topical steroids
Management of alopecia areata?
Topical steroids and refer to derm
Advise most patients hair eventually grows back
Which treatment options for acne vulgaris are contraindicated in pregnancy?
Retinoids, even topical retinoids
(isotretinoin, dapalene)
What is the management of impetigo?
1st - topical BPO
2nd - topical fusidic acid
Which antihistamines are non-sedating?
loratidine
cetirizine
What are the skin issues in pregnancy?
Polymorphic eruption of pregnancy vs pemphigus gestations
(essentially area of polymopric urticarial rash on abdomen and legs vs individual blisters)
3rd one is atopic dermatitis of pregnancy (eczema)
What are the causes of erythema nodosum?
TB, Sarcoidosis, IBD, Pregnancy, COCP/Sulfsalazine/penicillins
Which common medications can make plaque psoriasis worse?
Beta blockers, ACEi, NSAIDs
What can cause erythema multiforme?
Is it itchy?
Viral, bacterial
Idiopathic
Drugs
No not itchy
Management of BCC in GP?
Routine derm referral
Unless near eyes - urgent 2ww
Ultimately surgical removal
Management of pityriasis versicolor?
Given it’s a fungal infection, treat with anti-fungal
i.e. ketoconazole shampoo
Which specific cancer can acanthosis nigricans be associated with?
Gastric adenocarcinoma
What is tylosis and which cancer is it associated with?
Keratisation of palms and soles (looks a bit like kaposi sarcoma but isn’t)
OESOPHAGEAL CANCER
Prognosis and management of guttate psoriasis
NB// guttate comes from latin word for ‘tear’
Usually resolves by itself.
If lesions symptomatic, can use topical steroid
What are the systemic complications of burns?
Hypovolaemia and third spacing of fluid, causing shock and ARDS
Infection of burned area
Stress ulcer called Curling’s ulcer (not Cushing’s which is associated with head injury)
Management of actinic keratoses?
Effudix (5FU cream)
makes area inflamed and worse after 7 days but does get better
avoid sun on area, especially when using effudix
toxic to cats and dogs - don’t let them lick it
What is tuberous sclerosis and what are the signs?
AD disease causing benign tumour growths - has several skin manifestations
Ash leaf spots (flat pale rectangle.long leaf shape patch)
Shagreen patches on back (look like areas of burn scarring)
Adenoma sebaceum (greasy spot on nose, looks a bit like acne rosacea)
