Dermatology 🧴 Flashcards
F
1
Q
What is psoriasis?
A
A chronic inflammatory condition of the skin characterised by scaly erythematous and pruritic plaques
2
Q
What are the 5 types of psoriasis?
A
Chronic plaque psoriasis
Flexural psoriasis
Guttate psoriasis
Pustular psoriasis
Generalised psoriasis
3
Q
What is chronic plaque psoriasis?
A
Symmetrical plaques on the extensor surfaces of the limbs, scalp and back
4
Q
What is flexural psoriasis?
A
Smooth erythematous plaques without scale in flexures
5
Q
What is guttate psoriasis?
A
Multiple small, tear shaped lesions on the trunk after a streptococcal infection in children
6
Q
What is pustular psoriasis?
A
Multiple petechiae and pustules on the palms and soles
7
Q
What is generalised psoriasis?
A
Psoriasis with erythroderma and systemic illness
8
Q
What are the risk factors for psoriasis?
A
Skin trauma
Withdrawal of steroids
Drugs
- NSAIDs
- Beta blockers
- Lithium
- Anti-malarials
Stress
Alcohol
Smoking
Cold/dry weather
Obesity
Family history
9
Q
What signs are specific to psoriasis?
A
Auspitz sign
Koebner phenomenon
Residual pigmentation after lesions resolve
10
Q
What is the auspitz sign?
A
Small points of bleeding when the plaques are scraped off
11
Q
What is the Koebner phenomenon?
A
The development or psoriatic lesions in an area of skin affected by trauma
12
Q
What is the first line topical treatment of psoriasis?
A
Topical corticosteroid and topical vitamin D applied at different times
13
Q
What is the second line topical treatment of psoriasis?
A
After 4 weeks of first line treatment:
Continue topical treatment of vitamin D and corticosteroid for further 4 weeks
14
Q
What is the third line topical treatment of psoriasis?
A
After a further 4 weeks of treatment:
Stop topical corticosteroid
Apply vitamin D preparation twice daily
15
Q
What is the first line systemic treatment of psoriasis?
A
Methotrexate
16
Q
What is the second line systemic treatment of psoriasis?
A
Ciclosporin
17
Q
What biologics can be used to treat psoriasis?
A
Infliximab
Etanercept
Adalimumab
18
Q
What nail changes are seen in psoriasis?
A
Nailbed pitting
Onycholysis - separation of nail from nailbed
Subungual hyperkeratosis - thickening of nailbed
19
Q
What is the most common type of psoriasis?
A
Chronic plaque psoriasis
20
Q
How long should be left between courses of topcial corticosteroids?
A
4 weeks
21
Q
What therapy is given for psoriasis before trialling systemic oral therapies?
A
Phototherapy 3 times a week
22
Q
What is the management of guttate psoriasis?
A
Reassurance
Topical corticosteroid if symptomatic
23
Q
What is the presentation of guttate psoriasis?
A
Teardrop papules on the trunk and limbs
24
Q
What is necrotising fasciitis?
A
A life-threatening bacterial infection characterised by rapidly spreading necrosis of the fascia and subcutaneous tissues.
25
What is the most common cause of necrotising fasciitis?
Streptococcus pyogenes
26
What is type 1 necrotising fasciitis?
Cause is polymicrobial - a mix of anaerobes and aerobes
27
What is type 2 necrotising fasciitis?
Caused by streptococcus pyogenes
28
What types of patients does type 1 necrotising fasciitis typically appear in?
Diabetics
Patients with cancer
Immunocompromised
29
What are the risk factors for necrotising fasciitis?
Recent trauma
Burns
Skin infection
Diabetes
SGLT-2 inhibitors
IVDU
Immunosuppression
30
What is the early presentation of necrotising fasciitis?
Intense pain out of proportion to visible findings
Skin puncture or injury
Flu-like symptoms
Erythema, warmness, swelling and tenderness
Hypersensitive skin
Fever
31
What are the advances signs of necrotising fasciitis?
Gas or crepitus
Skin necrosis
Purple/blue skin discolouration
Fever
Reduced sensation
Hypotension
Tachycardia
32
What is the management of necrotising fasciitis?
Immediate surgical debridement
IV broad spectrum antibiotics
Fluid resuscitation/ replacement
Amputation in severe/late cases
33
What are the complications of necrotising fasciitis?
Fournier's gangrene
Sepsis
Death
Long-term disability
34
What is the pathophysiology of acne vulgaris?
Chronic inflammation with or without localised infection (in the pilosebaceous units - hair follicles and sebaceous glands)
- Increased production of sebum traps keratin, and leads to the blockage of the pilosebaceous unit
- Androgenic hormones increase the production of sebum
35
What are the risk factors for acne vulgaris?
Teenagers/young adults
Family history
Medications
- Androgens
- Corticosteroids
36
What are the clinical features of acne vulgaris?
Mild - non-inflamed lesions (open and closed comedones - whiteheads and blackheads)
Moderate - more widespread with increased number of inflammatory papules and pustules
Severe - widespread inflammatory papules, pustules and nodules or cysts. Scarring may be present
37
What investigations may be useful in patients with acne vulgaris?
Endocrine screen - if suspected hyperandrogenism
- Testosterone
- LH and FSH
38
What is the first line management of acne vulgaris?
Topical retinoid +/- benozyl peroxide
Topical antibiotic - clindamycin (prescribed with benzoyl peroxide)
Topical azelaic acid 20%
39
What is the second-line treatment of acne vulgaris?
Oral tetracycline (prescribed with benozyl perioxide or topical retinoid)
COCP - co-cyprindiol
40
What is the third-line management of acne vulgaris?
Oral isotretinoin - indicated if there is scarring, or if unresponsive to 2 or more different antibiotics
41
What are the complications of acne vulgaris?
Acne fulminans
Post-inflammatory changes
Retinoid side effects
Gram-negative folliculitis (due to long term antibiotic use)
42
What are the side effects of retinoids?
Dry skin and lips
Photosensitivity of skin
Depression, anxiety, and suicidal ideation
Steven-Johnson syndrome and topical epidermal necrolysis
43
What is scabies?
A parasitic infection caused by the human scabies mite, Sarcoptes scabiei
44
What is the pathophysiology of scabies infection?
Protein and faeces produced by the mites causes a type 4 hypersensitivity reaction
45
What are the risk factors for scabies?
Developing countries
Crowded conditions
Adolescence
Female sex
Winter months
46
What are the clinical features of scabies?
Intense pruritis, particularly at night
Linear burrows on the side of fingers, interdigital webs and flexor aspects of the wrists
Excoriation
Symmetrical erythematous papules
47
What investigations can be used to diagnose scabies?
Ink burrow test
- black or blue ink is applied to the papules and wiped away - the ink will track down the mite burrow
Skin scrapings
48
What is the first-line management of scabies?
Permethrin 5% cream
- All contacts and household members should receive treatment
Topical crotamiton cream (anti-itching agent)
49
What is the second-line treatment of scabies?
Malathion aqueous 0.5%
50
What is crusted scabies?
Also known as Norweigan scabies
- Serious infestation with scabies in patients that are immunocompromised
- They present with scaly plaques like psoriasis
51
What is the management of crusted scabies?
Oral ivermectin and isolation
52
What advice should be given to patients diagnosed with scabies?
Avoid having sex or physical contact until treatment is completed
Avoid sharing bedding or clothing
Bedding, clothing and towels should be washed at a high temperature
Patients should hoover carpets and wash furniture
53
What is pityriasis versicolor?
A common superficial fungal infection caused by the malassezia species
54
What are the features of pityriasis versicolor?
Itching
Rash that worsens with sun exposure
Hypo or hyperpigmentation
Well demarcated, round or oval scaly patches
Most commonly affects the trunk
55
What are the risk factors for pityriasis versicolor?
Hot and humid climates
Excessive sweating
Oily skin
Immunocompromised states
Common in teenagers and young adults
Cushing's
Malnutrition
56
What investigations can confirm the diagnosis of pityriasis versicolor?
Wood's lamp examination - the patches of pityriasis versicolor will fluoresce a yellow-green colour
Microscopy of skin scraping - 'spaghetti and meatballs' appearance
57
What is the first line management of pityriasis versicolor?
Topical antifungals
- Ketoconazole
- Selenium sulfide shampoos
Sunprotection
- Minimises contrast between affected and unaffected skin
58
What is the second line management of pityriasis versicolor?
Oral antifungals - fluconazole or itraconazole
59
What is malignant melanoma?
A malignant tumour arising from the melanocytes in the skin.
60
What are the subtypes of malignant melanoma?
Superficial spreading
Nodular
Lentigo maligna
Acral lentiginous
61
What is the most common type of malignant melanoma?
Superficial spreading
62
What is a superficial spreading melanoma?
A flat pigmented lesion with asymmetrical or irregular borders. Grows horziontally.
63
What is nodular melanoma?
A red-brown nodule that may ulcerate and bleed easily. Grows vertically.
64
What is lentigo maligna?
An irregularly shaped macule that has slow horizontal growth. Commonly seen on the faces of elderly patients.
65
What is acral lentiginous melanoma?
Seen on the nails, palms or soles, typically in people with darker skin pigmentation
66
What are the risk factors for malignant melanoma?
Increasing age
Family history
Pale skin
Red/blonde hair
UV exposure
Previous skin cancer
Immunosuppression
67
What are the presenting features of a malignant melanoma?
ABCDE
- Asymmetry
- Border - irregular
- Colour - non-uniform
- Diameter - >6mm
- Evolution - changing shape, size and colour
68
What is the diagnostic criteria for malignant melanoma?
Lesions that score 3 or more points are suspicious.
Major criteria (2 points each):
- Change in size
- Irregular shape or border
- Irregular colour
Minor features (1 point each):
- Largest diameter 7mm or more
- Inflammation
- Oozing or crusting of the lesion
- Change in sensation
69
What investigations are used in the diagnosis of malignant melanoma?
Dermoscopy
Excision biopsy
Sentinel lymph node biopsy
70
What is the staging of malignant melanoma?
Stage 0 - confined to epidermis
Stage 1 - breslow thickness < 2mm, no nodal involvement or metastasis
Stage 2 - breslow thickness 1-2mm with ulceration, or >2mm with or wihtout ulceration, no nodal involvement or metastasis
Stage 3 - Any thickness, involvement of nearby skin or local lymph nodes
Stage 4 - any thickness, distant lymph node involvement, or metastasis to other organs
71
What is the management of early stage melanoma?
Full thickness excision
Topical imiquimod
72
What is the management of advanced stage melanoma?
Lymph node dissection or lymphadenectomy
Radiotherapy
Resection of metastasis
Chemotherapy
73
Where does melanoma commonly metastasise to?
Lymph nodes
Brain
Bones
Liver
Lung
GI tract
74
What is the most significant prognostic factor for malignant melanoma?
Depth of the lesion (Breslow thickness)
75
How are burns classified?
Superficial - affects the epidermis only
Superficial dermal - epidermis and upper dermis
Deep dermal - epidermis, upper and deep dermal layers
Full thickness - extension to the subcutaneous tissues
76
What is the classification of a severe burn?
>10% BSA in a child
>15% BSA in an adults
77
What methods are available for assessing the extent of burns?
Wallace 'rule of nines'
Lund-browder chart
Palmar 1% rule
Mersy Burns app
78
What are the clinical features of an epidermal burn?
Red
Dry
Blanching
No blisters
79
What are the clinical features of a superficial dermal burn?
Pale pink
Painful
Blistered
Slow cap refill
80
What are the clinical features of a deep partial thickness burn?
Cherry red/white
Non-blanching
Reduced sensation
Painful to deep pressure
81
What are the features of a full thickness burn?
White/brown/black
Non-blanching
No blisters
No pain
82
What investigations are used in the diagnosis of burns?
Examination and calculation of BSA affected
Fluid status assessment
ABG
U&E - fluid loss and pre-renal AKI
83
What is the initial management of a burns patient?
ABCDE assessment
Remove source of heat
Irrigate burn with cool water
Cover burn using cling film, layered
Fluid resuscitation (using Parkland equation)
Analgesia
84
What is the risk to the airway with smoke inhalation?
Smoke inhalation can cause airway oedema
Early intubation should be considered
85
What is the Parkland formula?
Total BSA of the burn X weight (kg) X 4
- Half of the fluid is administered in the first 8 hours
86
What are the complications of burns?
Infection and sepsis
Hypovolaemic shock
Inhalation injury
Carbon monoxide poisoning
Scar formation
Limb ischaemia
Hypothermia
Psychological trauma
87
What is contact dermatitis?
A skin reaction caused by an external agent
88
What is irritant contact dermatitis?
Direct toxicity by an agent
89
What is allergic contact dermatitis?
A delayed hypersensitivity reaction that requires prior sensitisation to an allergen
90
What is the presentation of contact dermatitis?
Erythema
Pruritis
Burning
Vesicles
91
What features are more common in irritant contact dermatits?
Burning
Acute onset
Slow to resolve
92
What features are more common in allergic contact dermatitis?
Pruritis
Vesicles
24-72 hour onset
Resolves within a few days
93
What is the first line investigation for contact dermatitis?
Skin patch testing
94
What is the first line management of irritant contact dermatitis?
Avoidance of irritants
Skin emollients
95
What is the second line management of irritant contact dermatitis?
Topical corticosteroids - hydrocortisone, betamethasone
96
What is the first line management of allergic contact dermatitis?
Avoidance of allergen
Topical corticosteroids
97
What is the second line management of allergic contact dermatitis?
Topical calcineurin inhibitors (tacrolimus, pimecrolimus)
98
What is the third line management of allergic contact dermatitis?
Oral corticosteroids
Phototherapy
Immunosuppressants
99
What is cellulitis?
A bacterial infection that affects the dermis and deeper subcutaneous tissues
100
What is the most common causes of cellulitis?
Streptococcus pyogenes
Staphylococcus aureus
101
What are the risk factors for cellulitis?
Break in the cutaneous barrier
Immunocompromise
Other skin conditions
History of cellulitis
Obesity
Venous insufficiency
Lymphoedema
102
What are the clinical features of cellulitis?
Red, hot, painful area of the skin
Systemic upset
- Fever
- Malaise
- Nausea
103
How is cellulitis diagnosed?
Cellulitis is a clinical diagnosis
Investigations that may be helpful:
- FBC and CRP
- Swab
104
What is the Eron classification system of cellulitis?
Class 1
- No signs of systemic toxicity
- No uncontrolled comorbidities
Class 2
- Systemically unwell or systemically well with significant comorbidities that may delay resolution
Class 3
- Significant systemic upset or unstable comorbidities or limb threatening infection
Class 4
- Sepsis
105
When is admission required for cellulitis?
Admission is considered to Eron class 2, and required for class 3 and 4
106
What is the first line antibiotic for cellulitis?
Flucloxacillin
107
What are the criteria for urgent hospital admission and IV antibiotics?
Eron class 3 or 4
Severe or rapidly deteriorating cellulitis
Very young or frail
Immunocompromised
Significant lymphoedema
Facial cellulitis
Suspected orbital or periorbital cellulitis
108
What is the first line antibiotic for cellulitis if near the eyes or nose?
Co-amoxiclav
109
What antibiotics can be used for cellulitis if the patient is penicillin allergic?
Clarithromcin
Erythromycin (in pregnancy)
Doxycycline
110
What antibiotic is given in addition to regular treatment for suspected MRSA?
Vancomycin
111
What parasitic infection causes headlice?
Pediculus humanus capitis cause the infestation called pediculosis capitis
112
How are head lice spread?
Through direct head to head contact
113
What is the presentation of head lice?
Itchy scalp
Feeling of something moving in the hair
Oval shaped white eggs on scalp
Excoriation marks on scalp, neck and behind ears
114
How is head lice diagnosed?
Detection combing
Visible inspection
115
What is the management of head lice?
First line - dimeticone 4% lotion applied to the hair and left to dry
- Repeat 7 days later
Fine combs can be used in combination to comb head lice out of the hair
116
Who in the household needs to be treated for head lice?
Only those affected
117
What is impetigo?
Impetigo is a skin infection caused by staphylococcal and streptococcal bacteria
118
What is the most common causative organism of impetigo?
Staphylococcus aureus
119
What other organism can cause impetigo?
Streptococcus pyogenes
120
What is the classification of impetigo?
Non-bullous
Bullous
121
What is characteristic of non-bullous impetigo?
Itchy rash with golden crusting
Fever
School age child
122
What is the presentation of bullous impetigo?
Vesicles which grow to become flaccid, fluid filled bullae
Honey crusted lesions after bullae rupture
Systemic features
- Fever
- Diarrhoea
- Lymphadenopathy
123
What is the first line medical management of non-bullous impetigo?
Hydrogen peroxide cream
then
Topical fusidic acid (antibiotic)
124
What is the second line medical management of non-bullous impetigo?
Flucloxacillin
125
What is the management of bullous impetigo?
Oral flucloxacillin (clarithromycin or erythromycin second line)
126
What are the differentials of impetigo?
HSV infection
Eczema herpeticum
Contact dermatitis
127
What is the definitive investigation for impetigo?
Skin swab for MC&S
128
What are the risk factors for BCC?
Male
UV exposure - sun exposure and sunbeds
Fair skin - fitzpatrick type 1 and 2
Xeroderma pigmentosium
Immunosuppression
Arsenic exposure
129
What are the two types of BCC and which is more common?
Nodular - most common
Superficial
130
What are the features of nodular BCC?
Found on skin exposed to the sun
Commonly affects the face, neck, ears and chest
Pearly, indurated flesh-coloured papule
Rolled border
Covered in telangiectasia
Can ulcerate and leave a central crater
Slow growing
131
What are the features of superficial BCC?
Flat, scaly plaque
Usually found on the trunk
132
What investigations are used in the diagnosis of BCC?
Clinical diagnosis, but can consider a biopsy
133
What is the surgical management of BCC?
Conventional surgical excision
Mohs surgery - tumour is removed layer by layer
Curettage and cautery
134
What alternative management options are available for BCC?
Radiotherapy
Cryotherapy
Topical therapy - imiquimod and fluorouracil
135
What is the pre-cancerous form of cutaneous SCC?
Actiinic keratosis
136
What are the types of invasive cutaneous SCC?
Cutaneous horn - produced by excess keratin production
Marjolin ulcer - cutaneous SCC which develops within a scar or ulcer
Keratoacanthoma - rapidly developing keratinised nodule
137
What are the risk factors for SCC?
Sun exposure
History of sunburn
Use of tanning beds
Chronic skin inflammation or injury
HPV infection
Immunosuppression
138
What are the investigations used in the diagnosis of SCC?
Dermoscopy
Skin biopsy
139
What are the clinical features of SCC?
Itchy, tender or painful lesions
Ulcerating lesions
Lesions on sun-exposed areas
- Ears, face, forearms, lower legs
140
What are the signs of an SCC on examination?
Scaly or erythematous lesions
Crusted lesions
Bleeding lesions
Irregular borders
141
What are the management options for SCC?
Surgical excision
Aggressive cryotherapy
Topical 5-fluorouracil
Imiquimod
Radiotherapy
142
What is seborrhoeic dermatitis?
A chronic, relapsing skin condition that causes red, flaky and itchy skin lesions, in areas that are sebum rich
143
What is the presentation of seborrhoeic dermatitis?
Ill-defined, greasy, flaky scales
Erythematous background
Dandruff
Itching
144
Where does seborrhoeic dermatitis typically occur?
Forehead
Nasolabial folds
Behind the ear
Back and chest
Scalp
145
What conditions are associated with seborrhoeic dermatitis?
HIV
Parkinson's disease
146
What is the first line management of seborrhoeic dermatitis?
Topical antifungals - ketoconazole 2% shampoo
Topical corticosteroids - hydrocortisone
147
What is the most common type of eczema?
Atopic dermatitis
148
What are the other types of eczema?
Contact dermatitis
Dyshidrotic eczema
Discoid eczema
Seborrhoeic dermatitis
Venous dermatitis (stasis dermatitis)
149
What are the clinical features of atopic dermatitis?
Pruritis
Dry skin
Erythema
Vesicles and pustules in acute flares
Lichenification
Excoriations
150
Where does atopic dermatitis typically occur on the body?
In infants:
- Face and extensor surfaces
In adults:
- Flexural surfaces
151
How is eczema diagnosed?
Eczema is a clinical diagnosis
152
How is the severity of eczema classified?
Mild
- Areas of dry skin
- Infrequent itching
Moderate
- Areas of dry skin
- Frequent itching
- Erythema
Severe
- Widespread areas of dry skin
- Incessant itching and erythema
- Extensive skin thickening
- Bleeding, oozing or cracking may be present
153
What is the first line management of mild eczema?
Emollients - use liberally
Mild corticosteroids:
- Hydrocortisone 1% for areas of redness
154
What is the first line management of moderate eczema?
Emollients - use liberally
Moderate corticosteroids:
- Eumovate (clobetasone butyrate 0.05%)
- Betnovate (betamethasone valerate 0.025%) - for inflamed areas only
155
What is the first line management of severe eczema?
Emollients - use liberally
Potent corticosteroids:
- Betnovate (betamethasone valerate 0.1%)
- Dermovate (clobetasol propionate 0.05%)
156
What is the steroid latter from least to most potent?
Hydrocortisone - 0.5%, 1% and 2.5%
Eumovate - clobetasone butyrate 0.05%
Betnovate - betamethasone 0.1%
Dermovate - clobetasol propionate 0.05%
157
What thin emollients are available for treatment of eczema?
E45
Diprobase cream
Oilatum
Aveeno
Cetraben cream
Epaderm cream
158
What thick emollients are available for treatment of eczema?
50:50 ointment
Hydromol
Diprobase ointment
Cetraben ointment
Epaderm ointment
159
What secondary care treatments may be used in refractory cases?
Topical tacrolimus
UV therapy
Systemic immunosuppression
- Methotrexate
- Azathioprine
160
When are biologic therapies used for treatment of eczema?
Bioliogic therapies (dupilumab or baricitinib) are used when patients do not respons to 1 traditional systemic therapy
161
What are the complications of eczema?
Psychosocial impact - poor mood, poor sleep, disruption of daily activities
Eczema herpeticum
Opportunistic bacterial infection
162
What is eczema herpeticum?
A severe disseminated infection caused by HSV-1 or HSV-2 in patients with eczema
163
What is the presentation of eczema herpeticum?
Painful eczema on the face and neck
Monomorphic punched out lesions
Widespread lesions that coalesce into large bleeding areas
Fever
Lymphadenopathy
Malaise
164
What is the presentation of bacterial infection in eczema?
Typical impetigo
- Golden-brown sores and blisters
Worsening of eczema
165
What is the management of bacterial infection in eczema?
Antibiotics if systemically unwell
- First line topical - topical fusidic acid 2% for 5 to 7 days
- First line oral antibiotic - flucloxacillin for 5 to 7 days
- Alternative oral antibiotic - clarithromycin for 5 to 7 days
166
What is the treatment of eczema herpeticum?
Urgent emergency admission to hospital
Antiviral drugs - IV aciclovir
167
What are the complications of eczema herpeticum?
Blindness
Septic shock
Meningitis
Encephalitis
168
What are fungal skin infections?
Superficial dermatophyte infections, affecting the skin's outer layers
169
What are dermatophytes?
A dermatophyte is a type of fungus that causes skin, hair and nail infections in humans and animals
170
What is tinea corporis?
Ringworm of the body
171
What is tinea corporis caused by?
Trichophyton rubrum and Trichophyton interdigitale
172
What is tinea cruris?
A form of cutaneous fungal skin infection that affects the groin, pubic region and adjacent thigh
173
How is cutaneous fungal infection spread?
Direct contact with an infected person or animal
Indirect contact (e.g shared towels)
Contact with soil
174
What are the risk factors for cutaneous fungal infection?
Exposure to infection
Local immunosuppression (steroid use)
Systemic immunosuppression
Diabetes mellitus
Obesity
Optimal conditions for fungal growth - occlusive clothing, hyperhidrosis, warm/humid climates
175
What are the clinical features of cutaneous fungal infections?
Patchy skin lesions - red or pink edge surrounding an area of central clearning
Lesions are itchy or scaly
Lesions commonly found in the skin folds
176
How is cutaneous fungal infection diagnosed?
Clinical diagnosis
- Bacterial swab may be taken
177
What is the conservative management of cutaneous fungal infection?
Wearing loose fitting clothing
Regular washing and fully drying skin
Not sharing towels
Washing clothing and linen regularly
178
What is the medical management of cutaneous fungal infection?
Topical antifungals - topical terbinafine or imidazole
For significant inflammation:
- Topical corticosteroid for 7 days
For severe or widespread disease:
- Oral terbinafine
179
What is the major contraindication to terbinafine?
Hepatic impairment
- LFTs should be checked prior to treatment, and after 4-6 weeks
180
What are the complications of cutaneous fungal infection?
Secondary bacterial infections
Spread to the dermis and subcutaneous layers of the skin via the hair follicles
Spread to the hands via scratching
Tinea incognito - occurs when a tinea infection is mistakenly treated with steroids
181
What is acne rosacea?
A skin condition characterised by episodic or persistent facial flushing
182
What is the presentation of acne rosacea?
Facial flushing
Telengiectasia
Papules and pustules
Rhinophyma (enlarged, red and bumpy nose)
Blepharitis
183
What are the differentials of acne rosacea?
Seborrhoeic dermatitis
Acne vulgaris
Lupus erythematous
184
What can worsen the symptoms of acne rosacea?
Sunlight
185
What is the management of erythema/flushing in acne rosacea?
Topical brimonidine
Oral propranolol
186
What is the management of telangiectasia in acne rosacea?
Laser therapy
187
What is the management of papulopustular acne rosacea?
First line - topical ivermectin
Second line - topical metronidazole or topical azelaic acid
188
What is the management of severe papulopustular acne rosacea?
Oral doxycycline and topical ivermectin
189
When should patients with acne rosacea be referred to secondary care?
Patients with a rhinophyma
When symptoms have not improved despite optimal management in primary care
190
What is urticaria?
Urticaria is characterised by the rapid development of itchy, erythematous, raised wheals
191
What can urticaria be triggered by?
Allergens
Physical stimuli - pressure, heat, cold
Infections
Autoimmune processes
Stress
192
What is the pathophysiology of urticaria?
Histamine is released from mast cells and basophils, leading to increased vascular permeability and the formation of wheals
193
What is the clinical presentation of urticaria?
Pruritus
Erythematous wheals with well defined borders
Wheals vary in size and shape
Rapid onset and resolution
Angioedema
194
What are the differentials of urticaria?
Dermatitis
Drug eruptions
Erythema multiforme
Vasculitis
Autoimmune disorders e.g SLE
195
What investigations may aid the clinical diagnosis of urticaria?
Allergy testing (skin or patch)
Inflammatory markers
Urinalysis (if vasculitis suspected)
Skin biopsy
Symptom diary
196
What is the first line management of urticaria?
Non-sedating antihistamines (cetirizine, loratidine)
197
What is the second line management of urticaria?
Higher dose antihistamines
Leukotriene receptor antagonists
198
What are genital warts caused by?
HPV infection
199
Which types of HPV most commonly cause genital warts?
HPV 6 and 11
200
What are the features of genital warts?
Small fleshy protuberences that are slightly pigmented
Lesions may bleed or itch
201
What are the risk factors for genital warts?
Not vaccinated against HPV
Earlier sexual intercourse
Increasing number of lifetime sexual partners
Immunocompromised
Unprotected sex
202
How are genital warts transmitted?
Mostly through skin to skin contact during sexual intercourse
203
How are genital warts diagnosed?
Mostly clinical diagnosis - can be confirmed with a biopsy
204
What is the first line treatment of genital warts?
Topical podophyllum
Cyrotherapy
205
What is the second line treatment of genital warts?
Imiquimod cream
206
What is folliculitis?
An inflammatory condition of the hair follicles, presenting with papules or pustules
207
What is the most common cause of folliculitis?
Staphylococcus aureus
208
What is the clinical presentation of folliculitis?
the presence of papules and pustules
209
What are the differentials of folliculitis?
Acne vulgaris
Impetigo
Contact dermatitis
Herpes simplex
Rosacea
210
What is the management of folliculitis?
Topical antibiotics
Oral antibiotics
211
What is vitiligo?
An autoimmune condition that results in loss of melanocytes, and depigmentation of the skin
212
What conditions is vitilgo associated with?
Type 1 diabetes
Addison's disease
Autoimmune thyroid disorders
Pernicious anaemia
Alopecia areata
213
What are the features of vitiligo?
Well demarcated patches of depigmented skin
214
What is the management of vitiligo?
Sunblock for affected areas
Topical steroids - may reverse changes if applied early
Camouflage makeup
215
What is discoid lupus?
A autoimmune benign skin disorder
216
What are the features of discoid lupus?
Erythematous, raised rash
Sometimes scaly
Common on face, neck, ears and scalp
Lesions heal with scarring that may cause alopecia
217
What is the management of discoid lupus?
Topical steroid cream
Oral antimalarials
Avoid sun exposure
218
What investigation is diagnostic of discoid lupus?
Skin biopsy
219
What can discoid lupus lesions develop into?
Squamous cell carcinoma
220
What is toxic epidermal necrolysis?
A potentially life-threatening skin disorder that is commonly seen secondary to a drug reaction
221
What are the features of toxic epidermal necrolysis?
Extensive rash
Scalded appearance
Systemically unwell
Positive Nikolsky's sign
222
What is Nikolsky's sign?
A positive nikolsky sign is where a very thin top layer of skin is able to be sheared off
223
What drugs are known to induce TEN?
Phenytoin
Sulphonamides
Allopurinol
Penicillins
Carbamazepine
NSAIDs
224
What is the management of TEN?
Stop precipitating factor
Supportive care
IVIg
Immunosuppressive agents - ciclosporin and cyclophosphamide
Plasmapheresis
225
What is lichen planus?
An inflammatory disorder characterised by the appearance of purple papules or plaques
226
What are the triggers for lichen planus?
Hepatitis C
Allergic contact dermatitis
Localised skin injury
Skin infection
227
What is the presentation of cutaneous lichen planus?
Purple plaques or papules that are:
- Pruritic
- Planar
- Polygonal
Wickham's striae
228
Where are cutaneous lichen planus lesions usually found?
Flexor aspects of wrist and ankles
229
What are the features of oral lichen planus?
Mucosal ulceration
Wickham's striae
230
What are Wickham's striae?
White lacy lines found on the skin / oral mucosa
231
What are the differentials of lichen planus?
Psoriasis
Oral candidiasis
Eczema
Pityriasis rosea
232
What investigations are used in the diagnosis of lichen planus?
Hepatitis C testing
Patch testing
Biopsy
233
What is the management of lichen planus?
Topical corticosteroids
Oral steroids
Methotrexate or hydroxychloroquine
UV-B light therapy
