Dermatology Flashcards
1
Q
What is classified as moderate acne
A
Widespread non-inflammatory lesions and numerous papules and pustules
2
Q
What is classified as severe acne
A
Extensive inflammatory lesions, which may include nodules, pitting, and scarring
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
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
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
6
Q
What antibiotic used for acne in pregnancy/breastfeeding?
A
Erythromycin
7
Q
Why is minocycline not used in acne anymore
A
Possibility of irreversible pigmentation
8
Q
How long can you continue acne treatment including antibiotic (topical or oral)
A
6 months unless exceptional circumstances
9
Q
Can antibiotics be used as monotherapy?
A
No, always co-prescribe topical retinoid or benozyl peroxide to avoid antibiotic resistance
10
Q
Complication of long term antibiotic use in acne
A
Gram negative folliculitis
11
Q
Treatment for gram negative folliculitis occurring as complication from long term abx use in acne
A
High dose oral trimethoprim
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
13
Q
What COCP useful in acne
A
Dianette (co-cyprindiol)
14
Q
Advantage of dianette in acne
A
Anti-androgen properties
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
16
Q
Role of oral isotretinoin in acne
A
Only under specialist supervision
17
Q
Definite referral criteria acne
A
- Conglobate acne
- Nodulo-cystic acne
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
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
20
Q
What is erythema nodosum
A
Inflammation of SC fat, typically causing tender, erythematous, nodular lesions
21
Q
Causes of erythema nodosum
A
Infection
Systemic disease
Malignancy/lymphoma
Drugs
Pregnancy
22
Q
Infections causing erythema nodosum
A
Streptococci
Tuberculosis
Brucellosis
23
Q
Systemic disease causing erythema nodosum
A
Sarcoidosis
Inflammatory bowel disease
Behcet’s
24
Q
Drugs causing erythema nodosum
A
Penicillins
Sulphonamides
COCP
25
First line treatment chronic plaque psorasis
Potent corticosteroid OD + vitamin D analogue OD, up to 4 weeks as initial treatment
Applied seperately, one in morning one in evening
26
Second line treatment chronic plaque psoriasis
Vitamin D analogue BD
27
Third line treatment chronic plaque psorasis
Potent corticosteroid BD (up to 4 weeks), or coal tar OD-BD
28
Other treatment options in primary care chronic plaque psoriasis
Short-acting dithranol
29
Secondary care management options chronic plaque psoriasis
- Phototherapy
- Photochemotherapy
- Systemic therapy
30
What kind of phototherapy given in chronic plaque psorasis
Narrowband UVB light, if poss 3 times a week
31
What kind of photochemotherapy chronic plaque psoriasis
Psoralen and UVA light (PUVA)
32
Adverse effects of phototherapy in chronic plaque psoriasis
Skin ageing
Squamous cell carcinoma
33
Systemic therapies used in chronic plaque psoriasis
Methotrexate (first line)
Ciclosporin
Systemic retinoids
Biological agents - infliximab, etanercept, adalimumab
34
First line treatment scalp psorasis
Potent topical corticosteroids OD for 4 weeks
35
Second line treatment scalp psoriasis
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
36
Treatment for face, flexural, and genital psoriasis
Mild to moderate potency corticosteroid applied OD-BD max 2 weeks
37
SEs topical steroids
Skin strophy
Striae
Rebound symptoms
38
Examples of vitamin D analogues
Calcipotriol
Calcitriol
Tacalcitol
39
Advantages of vit D analogues
Adverse effects uncommon
Unlike corticosteroids can be used long term
Unlike coal toar and dithranol do not smell or stain
40
Disadvantage of vit D analogues
Tend to reduce scale and thickness of plaques but not erythema
Avoid in pregnancy
41
Adverse effects of dithranol
Burning and staining (wash off after 30 mins)M
42
Mild potency corticosteroid e.g.
HydrocortisoneM
43
Moderate potency corticosteroid e.g.
Clobetasone
Alclometasone
Hydrocortisone butyrate
44
Potent corticosteroid e.g.
Beclometasone
Betamethasone
Fluticasone
Mometasone
45
Very potent corticosteroid e.g.
Clobetasol
46
Appearance of actinic ketatoses
Small, crusty or scaly
Pink, red, brown, or same colour as skin
47
Rule of 9's for burns
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
48
Criteria for referral to secondary care burns
- 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
49
When are IV fluids required burns
Over 10% TBSA children, 15% in adults
50
Parkland formula
Volume of fluid = TBSA burn x weight (kg) x 4
Half fluid given in first 8 hours (from time of burn)
51
What is erythema multiforme
Hypersensitivity reaction
52
Features of erythema multiforme
- Target lesions
- Initially seen on back of hands/feet before spreading to torso
- Upper limbs > lower limbs
53
Causes of erythema multiforme
- Viruses
- Idiopathic
- Bacteria
- Drugs
- Connective tissue disease
- Sarcoidosis
- Malignancy
54
Most common cause of erythema multiforme
Herpes simplex virus
55
Bacteria causing eythema multiforme
Mycoplasma
Streptococcus
56
Drugs causing erythema multiforme
Penicillin
Sulphonamides
Carbamazepine
Allopurinol
NSAIDs
OCP
Nevirapine
57
What is erythema multiforme major
More severe form, with mucosal involvement
58
Causes of hypertrichosis
Drugs
Congenital
Porphyria cutanea tarda
Anorexia nervosa
59
Drugs causing hypertrichosis
Minoxidil
Ciclosporin
Diazoxide
60
Causative organisms impetigo
Staph aureus
Strep pyogenes
61
First line treatment for limited, localised impetigo
Hydrogen peroxide 1%
62
Other treatment options for limited, localised impetigo
- Topical fusidic acid
- Topical mupirocin (if fusidic acid resistance suspected or MSRA)
63
Treatment for extensive impetigo
Oral fluclox
Oral erythromycin if pen allergic
64
Features of lichen planus
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
Nail changes in lichen planus
Thinning of nail plate
Longitudinal ridging
66
Causes of lichenoid drug eruptions
Gold
Quinine
Thiazides
67
What is lichen sclerosus
Inflammatory condition, usually affecting genitalia, leading to atrophy of epidermis with white plaques forming
68
Demographic lichen sclerosus
Elderly females
69
Features of lichen sclerosus
- White patches that may scar
- Itch prominent
- May result in pain during intercourse or urinary
70
What is livedo reticularis?
Purplish, non-blanching, reticulated rash caused by obstruction of the capillaries resulting in swollen venules
71
Causes of livedo reticularis
- Idiopathic (most common)
- Polyarteritis nodosa
- Systemic lupus erythematosus
- Cryoglobulinaemia
- Antiphospholipid syndrome
- Ethlers-Danlos syndrome
- Homocystinuria
72
What is pemphigus vulgaris
Autoimmune disease cause by antibodies directed against desmoglein 3
73
Pemphigus vulgaris demographic
More common in Ashkenai Jewish
74
Features of pemphigus vulgaris
Mucosal ulceration common, seen in 50-70%
Flaccid, easily ruptured vesicles and bullae, painful
Nikolsky's sign
75
What is Nikolsky's sign
Spread of bullae following application of horizontal, tangential pressure to the skin
76
Treatment of pemphigus vulgaris
Steroids first line
Immunosuppressants
77
Cause of pityriasis rosea
Not fully understood, HHV-7 may play role
78
Features of pityriasis rosea
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
Cause of pityriasis versicolor
Superficial cutaneous fungal infection caused by Malassezia furfur
80
Features of pityriasis versicolor
Most commonly affects trunk
Patches may be hypopigmented, pink, or brown
Scale common
Mild pruritis
81
Predisposing factors pityriasis versicolor
Immunosuppression
Malnutrition
Cushing's
82
What is pyoderma gangrenosum
Neutrophilic dermatosis causing very painful skin ulcerationM
83
Site of pyoderma gangrenosum
May affect any part of skin, but lower legs most commonE
84
Causes of pyoderma gangrenosum
- Idiopathic (50%)
- Inflammatory bowel disease
- Rheumatological
- Haematological
- Granulomatosis with polyangiitis
- Primary biliary cirrhosis
85
Rheumatological causes of pyoderma gangrenosum
Rheumatoid arthritis
SLE
86
Haematological causes of pyoderma gangrenosum
Myeloproliferative disorders
Lymhoma
Myeloid leukaemia
Monoclonal gammopathy
87
Features of pyoderma gangrenous
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
Features of pyogenic granuloma
Initially small red/brown spot, rapidly progresses to raised, red/brown lesions spherical in shape, may bleed profusely or ulcerate
89
Risk factors for pyogenic granuloma
- Trauma
- Pregnancy
- Women/young adults
90
Treatment for rosacea with predominant flushing but limited telangiectasia
Topical brimonidine gel
91
First line treatment for rosacea with mild to moderate papules and/or pustules
Topical ivermectin
92
Alternative treatment for rosacea with mild to moderate papules and/or pustules
Topical metronidazole
Topical azelaic acid
93
Treatment for rosacea with moderate to severe papules/pustules
Combination of topical ivermectin and oral doxycycline
94
When to refer in rosacea
If symptoms not improved with optimal management in primary care
Patients with rhinophyma
95
First line treatment scabies
Permethrin
96
Second line treatment scabies
Malathion
97
Features of seborrheoic keratosis
'Stuck on' appearance
Keratotic plugs may be seen on surface
98
What is pretibial myxodema
Symmetrical, erythematous lesions, causing shiny orange peel skin
99
What is pretibial myxodema seen in
Graves disease
100
What is necrobiosis lipoidica diabecticorum
Shiny, painless areas of yellow/red skin typically on shin of diabetics
101
Analgesia in shingles
Paracetamol and NSAIDs first line
If not responding, neuropathic agents e.g. amitriptryline
102
Role of steroids in shingles
Can be considered in first 2 weeks in immunocompetent adults with localised shingles if pain is severe and not responding to other analgesics
103
Role of anti-virals in shingles
Antivirals if within 72 hours (unless <50 years and 'mild' truncal rash with mild pain and no underlying risk factors)
104
What malignancy is acanthosis nigricans associated with
Gastric cancer
105
What malignancy is acquired ichthyosis associated with
Lymphoma
106
What malignancy is acquired hypertrichosis lanuginosa associated with
GI and lung cancer
107
What malignancy is dermatomyositis associated with
Ovarian and lung cancer
108
What malignancy is erythema gyratum repens associated with
Lung cancer
109
What malignancy is erythroderma associated with
Lymphoma
110
What malignancy is migratory thrombophlebitis associated with
Pancreatic cancer
111
What malignancy is necrolytic migratory erythema associated with
Glucagonoma
112
What malignancy is pyoderma gangrenosum associated with
Myeloproliferative disorders
113
What malignancy is Sweet's syndrome associated with
Haematological malignancy, e.g. myelodysplasia
114
What malignancy is tylosis associated with
Oesophageal cancer
115
What is tylosis
Hyperkeratosis of palms and soles, with thickening and fissuring of the skin
116
Most common skin condition associated with pregnancy
Atopic eruption of pregnancy
117
Features of atopic eruption of pregnancy
Eczematous, itchy red rash
118
Features of polymorphic eruption of pregnancy
Pruritic, lesions often first appear in abdominal striae, associated with last trimester
119
Features of pemphigoid gestationis
Pruritic blistering lesions
Often develop in peri-umbilical region, later spreading to trunk, back, buttocks, and arms
120
When does pemphigoid gestationis present?
2nd or 3rd trimester
Rarely seen in first pregnancy
121
Causes of Stevens-Johnson syndrome
- Pencillins
- Sulphonamides
- Lamotrigine
- Carbamazepine
- Phenytoin
- Allopurinol
- NSAIDs
- OCP
122
Features of SJS rash
Maculopapular with target lesions, may develop into vesicles or bullae
Nikolsky sign positive in erythematous areas
Mucosal involvement
Systemic symptoms - fever, arthralgia
123
Causes of spider naevi
Liver disease
Pregnancy
COCP
124
Spider naevi vs telangiectasia
Press and watch fill - spider naevi fill from centre, telangiectasia from edge
125
What is toxic epidermal necrolysis
Potentially life threatening skin disorder commonly seen secondary to drug reaction
126
Features of toxic epidermal necrolysis
Skin develops scalded appearance over extensive area
Systemically unwell - pyrexia, tachycardia
Positive Nikolsky's sign
127
Drugs causing TEN
- Phenytoin
- Sulphonamides
- Allopurinol
- Penicillins
- Carbamazepine
- NSAIDs
128
Treatment for SJS
- Stop precipitant
- Supportive care
- IV immunoglobulin
- Immunosuppressive agents (ciclosporin and cyclophosphamide), plasmapheresis
129
Treatment of venous ulceration
Compression bandaging, usually four layer (only treatment shown to be of benefit)
130
Features of zinc deficiency
Acrodermatitis
Alopecia
Short stature
Hypogonadism
Hepatosplenomegaly
Geophagia (ingesting clay/soil)
Cognitive impairment
131
Features of acrodermatitis caused by zinc deficiency
- Red crusted lesions
- Acral distribution - peri orificial
