Dermatology Flashcards

1
Q

What is classified as moderate acne

A

Widespread non-inflammatory lesions and numerous papules and pustules

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2
Q

What is classified as severe acne

A

Extensive inflammatory lesions, which may include nodules, pitting, and scarring

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3
Q

First line treatment for mild to moderate acne

A

12 week course of topical combination therapy:
- Fixed combo topical tretinoin with topical clinda
- Fixed combo topical benzoyl peroxide with topical clinda or topical adapalene

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4
Q

When can topical benozyl peroxide be used as monotherapy?

A

If combo contraindicated, or person wishes to avoid using topical retinoid or an antibiotic

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5
Q

First line treatment for moderate to severe acne

A

12 week course of:
- Fixed combo topical adapalene with topical benzoyl peroxide (+/- oral lymecycline or oral doxy)
- Fixed combo topical tretinoin with topical clinda
- Topical azelaic acid + oral lymecycline/doxy

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6
Q

What antibiotic used for acne in pregnancy/breastfeeding?

A

Erythromycin

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7
Q

Why is minocycline not used in acne anymore

A

Possibility of irreversible pigmentation

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8
Q

How long can you continue acne treatment including antibiotic (topical or oral)

A

6 months unless exceptional circumstances

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9
Q

Can antibiotics be used as monotherapy?

A

No, always co-prescribe topical retinoid or benozyl peroxide to avoid antibiotic resistance

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10
Q

Complication of long term antibiotic use in acne

A

Gram negative folliculitis

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11
Q

Treatment for gram negative folliculitis occurring as complication from long term abx use in acne

A

High dose oral trimethoprim

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12
Q

Role of COCP in acne

A

Can be used as alternative to PO Abx in women
Should be used in combination with topical agents

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13
Q

What COCP useful in acne

A

Dianette (co-cyprindiol)

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14
Q

Advantage of dianette in acne

A

Anti-androgen properties

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15
Q

Limitation of dianette in acne

A

Increased risk of VTE compared to other COCP, so should generally only be used second line, only for 3 months, and with counselling

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16
Q

Role of oral isotretinoin in acne

A

Only under specialist supervision

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17
Q

Definite referral criteria acne

A
  • Conglobate acne
  • Nodulo-cystic acne
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18
Q

What is conglobate acne?

A

Rare and severe form, mostly in men, extensive inflammaotry papules, suppurative nodules that may coalesce to form sinuses, cysts on trunk

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19
Q

When to consider referral for acne

A
  • Mild to moderate acne not responding to two completed courses of treatment
  • Moderate to severe acne not responded to treatment including oral antibiotic
  • Acne with scarring
  • Acne with persistent pigmentary changes
  • Acne causing distress or contributing to persistent psychological distress or mental health disorder
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20
Q

What is erythema nodosum

A

Inflammation of SC fat, typically causing tender, erythematous, nodular lesions

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21
Q

Causes of erythema nodosum

A

Infection
Systemic disease
Malignancy/lymphoma
Drugs
Pregnancy

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22
Q

Infections causing erythema nodosum

A

Streptococci
Tuberculosis
Brucellosis

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23
Q

Systemic disease causing erythema nodosum

A

Sarcoidosis
Inflammatory bowel disease
Behcet’s

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24
Q

Drugs causing erythema nodosum

A

Penicillins
Sulphonamides
COCP

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25
Q

First line treatment chronic plaque psorasis

A

Potent corticosteroid OD + vitamin D analogue OD, up to 4 weeks as initial treatment

Applied seperately, one in morning one in evening

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26
Q

Second line treatment chronic plaque psoriasis

A

Vitamin D analogue BD

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27
Q

Third line treatment chronic plaque psorasis

A

Potent corticosteroid BD (up to 4 weeks), or coal tar OD-BD

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28
Q

Other treatment options in primary care chronic plaque psoriasis

A

Short-acting dithranol

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29
Q

Secondary care management options chronic plaque psoriasis

A
  • Phototherapy
  • Photochemotherapy
  • Systemic therapy
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30
Q

What kind of phototherapy given in chronic plaque psorasis

A

Narrowband UVB light, if poss 3 times a week

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31
Q

What kind of photochemotherapy chronic plaque psoriasis

A

Psoralen and UVA light (PUVA)

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32
Q

Adverse effects of phototherapy in chronic plaque psoriasis

A

Skin ageing
Squamous cell carcinoma

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33
Q

Systemic therapies used in chronic plaque psoriasis

A

Methotrexate (first line)
Ciclosporin
Systemic retinoids
Biological agents - infliximab, etanercept, adalimumab

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34
Q

First line treatment scalp psorasis

A

Potent topical corticosteroids OD for 4 weeks

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35
Q

Second line treatment scalp psoriasis

A

Alternative preparation of potent corticosteroid, e.g. shampoo or mousse, and/or topical agents to remove adherent scale (e.g. agents containing salicyclic acid, emollients, oils) before application of potent corticosteroid

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36
Q

Treatment for face, flexural, and genital psoriasis

A

Mild to moderate potency corticosteroid applied OD-BD max 2 weeks

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37
Q

SEs topical steroids

A

Skin strophy
Striae
Rebound symptoms

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38
Q

Examples of vitamin D analogues

A

Calcipotriol
Calcitriol
Tacalcitol

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39
Q

Advantages of vit D analogues

A

Adverse effects uncommon
Unlike corticosteroids can be used long term
Unlike coal toar and dithranol do not smell or stain

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40
Q

Disadvantage of vit D analogues

A

Tend to reduce scale and thickness of plaques but not erythema
Avoid in pregnancy

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41
Q

Adverse effects of dithranol

A

Burning and staining (wash off after 30 mins)M

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42
Q

Mild potency corticosteroid e.g.

A

HydrocortisoneM

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43
Q

Moderate potency corticosteroid e.g.

A

Clobetasone
Alclometasone
Hydrocortisone butyrate

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44
Q

Potent corticosteroid e.g.

A

Beclometasone
Betamethasone
Fluticasone
Mometasone

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45
Q

Very potent corticosteroid e.g.

A

Clobetasol

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46
Q

Appearance of actinic ketatoses

A

Small, crusty or scaly
Pink, red, brown, or same colour as skin

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47
Q

Rule of 9’s for burns

A

Each 9% SA:
- Head and neck
- Each arm
- Each anterior part of leg
- Each posterior part of leg
- Anterior chest
- Posterior chest
- Anterior abdomen
- Posterior abdomen

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48
Q

Criteria for referral to secondary care burns

A
  • All deep dermal and full thickness burns
  • Superficial dermal burns of more than 3% TBSA adults, 2% in children
  • Superficial dermal burns involving face, hands, feet, perineum, genitalia, any flexure, circumferential burns limbs, torso, or neck
  • Inhalation injury
  • Electrical or chemical burn
  • Suspicion of NAI
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49
Q

When are IV fluids required burns

A

Over 10% TBSA children, 15% in adults

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50
Q

Parkland formula

A

Volume of fluid = TBSA burn x weight (kg) x 4

Half fluid given in first 8 hours (from time of burn)

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51
Q

What is erythema multiforme

A

Hypersensitivity reaction

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52
Q

Features of erythema multiforme

A
  • Target lesions
  • Initially seen on back of hands/feet before spreading to torso
  • Upper limbs > lower limbs
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53
Q

Causes of erythema multiforme

A
  • Viruses
  • Idiopathic
  • Bacteria
  • Drugs
  • Connective tissue disease
  • Sarcoidosis
  • Malignancy
54
Q

Most common cause of erythema multiforme

A

Herpes simplex virus

55
Q

Bacteria causing eythema multiforme

A

Mycoplasma
Streptococcus

56
Q

Drugs causing erythema multiforme

A

Penicillin
Sulphonamides
Carbamazepine
Allopurinol
NSAIDs
OCP
Nevirapine

57
Q

What is erythema multiforme major

A

More severe form, with mucosal involvement

58
Q

Causes of hypertrichosis

A

Drugs
Congenital
Porphyria cutanea tarda
Anorexia nervosa

59
Q

Drugs causing hypertrichosis

A

Minoxidil
Ciclosporin
Diazoxide

60
Q

Causative organisms impetigo

A

Staph aureus
Strep pyogenes

61
Q

First line treatment for limited, localised impetigo

A

Hydrogen peroxide 1%

62
Q

Other treatment options for limited, localised impetigo

A
  • Topical fusidic acid
  • Topical mupirocin (if fusidic acid resistance suspected or MSRA)
63
Q

Treatment for extensive impetigo

A

Oral fluclox
Oral erythromycin if pen allergic

64
Q

Features of lichen planus

A

Itchy, papular rash most common on palms, soles, genitalia, flexor surfaces of arms
Often polygonal in shape, with ‘white lines’ pattern on surface
Koebner phenomenon may be seen
Oral involvement in 50% of patients - white lace pattern on buccal mucosa

65
Q

Nail changes in lichen planus

A

Thinning of nail plate
Longitudinal ridging

66
Q

Causes of lichenoid drug eruptions

A

Gold
Quinine
Thiazides

67
Q

What is lichen sclerosus

A

Inflammatory condition, usually affecting genitalia, leading to atrophy of epidermis with white plaques forming

68
Q

Demographic lichen sclerosus

A

Elderly females

69
Q

Features of lichen sclerosus

A
  • White patches that may scar
  • Itch prominent
  • May result in pain during intercourse or urinary
70
Q

What is livedo reticularis?

A

Purplish, non-blanching, reticulated rash caused by obstruction of the capillaries resulting in swollen venules

71
Q

Causes of livedo reticularis

A
  • Idiopathic (most common)
  • Polyarteritis nodosa
  • Systemic lupus erythematosus
  • Cryoglobulinaemia
  • Antiphospholipid syndrome
  • Ethlers-Danlos syndrome
  • Homocystinuria
72
Q

What is pemphigus vulgaris

A

Autoimmune disease cause by antibodies directed against desmoglein 3

73
Q

Pemphigus vulgaris demographic

A

More common in Ashkenai Jewish

74
Q

Features of pemphigus vulgaris

A

Mucosal ulceration common, seen in 50-70%
Flaccid, easily ruptured vesicles and bullae, painful
Nikolsky’s sign

75
Q

What is Nikolsky’s sign

A

Spread of bullae following application of horizontal, tangential pressure to the skin

76
Q

Treatment of pemphigus vulgaris

A

Steroids first line
Immunosuppressants

77
Q

Cause of pityriasis rosea

A

Not fully understood, HHV-7 may play role

78
Q

Features of pityriasis rosea

A

Herald patch, usually on trunk
Followed by erythematous, oval, scaly patches following characteristic distribution with longitudinal diameters of oval lesions running paralllel to the line of Langer, may produce fir tree appearance

79
Q

Cause of pityriasis versicolor

A

Superficial cutaneous fungal infection caused by Malassezia furfur

80
Q

Features of pityriasis versicolor

A

Most commonly affects trunk
Patches may be hypopigmented, pink, or brown
Scale common
Mild pruritis

81
Q

Predisposing factors pityriasis versicolor

A

Immunosuppression
Malnutrition
Cushing’s

82
Q

What is pyoderma gangrenosum

A

Neutrophilic dermatosis causing very painful skin ulcerationM

83
Q

Site of pyoderma gangrenosum

A

May affect any part of skin, but lower legs most commonE

84
Q

Causes of pyoderma gangrenosum

A
  • Idiopathic (50%)
  • Inflammatory bowel disease
  • Rheumatological
  • Haematological
  • Granulomatosis with polyangiitis
  • Primary biliary cirrhosis
85
Q

Rheumatological causes of pyoderma gangrenosum

A

Rheumatoid arthritis
SLE

86
Q

Haematological causes of pyoderma gangrenosum

A

Myeloproliferative disorders
Lymhoma
Myeloid leukaemia
Monoclonal gammopathy

87
Q

Features of pyoderma gangrenous

A

Starts quite suddenly as small pustule, red bump, or blood blister
Skin then breaks down resulting in ulcer, edge purple, violaceous and undermined. Ulcer itself deep and necrotic.
May have systemic symptoms e.g. fever, myalgiaW

88
Q

Features of pyogenic granuloma

A

Initially small red/brown spot, rapidly progresses to raised, red/brown lesions spherical in shape, may bleed profusely or ulcerate

89
Q

Risk factors for pyogenic granuloma

A
  • Trauma
  • Pregnancy
  • Women/young adults
90
Q

Treatment for rosacea with predominant flushing but limited telangiectasia

A

Topical brimonidine gel

91
Q

First line treatment for rosacea with mild to moderate papules and/or pustules

A

Topical ivermectin

92
Q

Alternative treatment for rosacea with mild to moderate papules and/or pustules

A

Topical metronidazole
Topical azelaic acid

93
Q

Treatment for rosacea with moderate to severe papules/pustules

A

Combination of topical ivermectin and oral doxycycline

94
Q

When to refer in rosacea

A

If symptoms not improved with optimal management in primary care
Patients with rhinophyma

95
Q

First line treatment scabies

A

Permethrin

96
Q

Second line treatment scabies

A

Malathion

97
Q

Features of seborrheoic keratosis

A

‘Stuck on’ appearance
Keratotic plugs may be seen on surface

98
Q

What is pretibial myxodema

A

Symmetrical, erythematous lesions, causing shiny orange peel skin

99
Q

What is pretibial myxodema seen in

A

Graves disease

100
Q

What is necrobiosis lipoidica diabecticorum

A

Shiny, painless areas of yellow/red skin typically on shin of diabetics

101
Q

Analgesia in shingles

A

Paracetamol and NSAIDs first line
If not responding, neuropathic agents e.g. amitriptryline

102
Q

Role of steroids in shingles

A

Can be considered in first 2 weeks in immunocompetent adults with localised shingles if pain is severe and not responding to other analgesics

103
Q

Role of anti-virals in shingles

A

Antivirals if within 72 hours (unless <50 years and ‘mild’ truncal rash with mild pain and no underlying risk factors)

104
Q

What malignancy is acanthosis nigricans associated with

A

Gastric cancer

105
Q

What malignancy is acquired ichthyosis associated with

A

Lymphoma

106
Q

What malignancy is acquired hypertrichosis lanuginosa associated with

A

GI and lung cancer

107
Q

What malignancy is dermatomyositis associated with

A

Ovarian and lung cancer

108
Q

What malignancy is erythema gyratum repens associated with

A

Lung cancer

109
Q

What malignancy is erythroderma associated with

A

Lymphoma

110
Q

What malignancy is migratory thrombophlebitis associated with

A

Pancreatic cancer

111
Q

What malignancy is necrolytic migratory erythema associated with

A

Glucagonoma

112
Q

What malignancy is pyoderma gangrenosum associated with

A

Myeloproliferative disorders

113
Q

What malignancy is Sweet’s syndrome associated with

A

Haematological malignancy, e.g. myelodysplasia

114
Q

What malignancy is tylosis associated with

A

Oesophageal cancer

115
Q

What is tylosis

A

Hyperkeratosis of palms and soles, with thickening and fissuring of the skin

116
Q

Most common skin condition associated with pregnancy

A

Atopic eruption of pregnancy

117
Q

Features of atopic eruption of pregnancy

A

Eczematous, itchy red rash

118
Q

Features of polymorphic eruption of pregnancy

A

Pruritic, lesions often first appear in abdominal striae, associated with last trimester

119
Q

Features of pemphigoid gestationis

A

Pruritic blistering lesions
Often develop in peri-umbilical region, later spreading to trunk, back, buttocks, and arms

120
Q

When does pemphigoid gestationis present?

A

2nd or 3rd trimester
Rarely seen in first pregnancy

121
Q

Causes of Stevens-Johnson syndrome

A
  • Pencillins
  • Sulphonamides
  • Lamotrigine
  • Carbamazepine
  • Phenytoin
  • Allopurinol
  • NSAIDs
  • OCP
122
Q

Features of SJS rash

A

Maculopapular with target lesions, may develop into vesicles or bullae
Nikolsky sign positive in erythematous areas
Mucosal involvement
Systemic symptoms - fever, arthralgia

123
Q

Causes of spider naevi

A

Liver disease
Pregnancy
COCP

124
Q

Spider naevi vs telangiectasia

A

Press and watch fill - spider naevi fill from centre, telangiectasia from edge

125
Q

What is toxic epidermal necrolysis

A

Potentially life threatening skin disorder commonly seen secondary to drug reaction

126
Q

Features of toxic epidermal necrolysis

A

Skin develops scalded appearance over extensive area
Systemically unwell - pyrexia, tachycardia
Positive Nikolsky’s sign

127
Q

Drugs causing TEN

A
  • Phenytoin
  • Sulphonamides
  • Allopurinol
  • Penicillins
  • Carbamazepine
  • NSAIDs
128
Q

Treatment for SJS

A
  • Stop precipitant
  • Supportive care
  • IV immunoglobulin
  • Immunosuppressive agents (ciclosporin and cyclophosphamide), plasmapheresis
129
Q

Treatment of venous ulceration

A

Compression bandaging, usually four layer (only treatment shown to be of benefit)

130
Q

Features of zinc deficiency

A

Acrodermatitis
Alopecia
Short stature
Hypogonadism
Hepatosplenomegaly
Geophagia (ingesting clay/soil)
Cognitive impairment

131
Q

Features of acrodermatitis caused by zinc deficiency

A
  • Red crusted lesions
  • Acral distribution - peri orificial