Dermatology 2 Flashcards
Chronic condition affecting the head of the penis
Middle aged/ elderly men
Uncircumcised
Erythematous, well demarcated shiny patches
Mx (3)
Zoon’s balanitis
Circumcision
CO2 laser therapy and topical steroids
Acrodermatitis - red crusted lesions in the acral distribution (distal limbs), periorifical and perianal
Alopecia
Short stature
Hypogonadism
Hepatosplenomegaly
Cognitive impairment
= which condition?
Zinc deficiency
Associated conditions with vitiligo (5)
Mx (3)
T1DM
Addison’s
Autoimmune thyroid disease
Pernicious anaemia
Alopecia areata
Sunblock
Camouflage make up
Topical steroids
Name two large vessel vasculitis
Medium vessel (2)
Small vessel (4)
Temporal arteritis
Takyasu’s
Polyarteritis nodosa
Kawasaki
Granulomatosis with polyangitis
Churg Strauss
Henoch-Schonlein purpura
Goodpasture’s
Who is the shingles vaccine offered to?
All patients age 70-79
Name six drugs known to induce TEN
Mx
Phenytoin
Sulphonamides
Allopurinol
Penicillin
Carbamezapine
NSAIDs
IVIG
What it tinea capitis?
If untreated can lead to a?
Mx (2)
Scalp ringworm
Kerion - raised, pustular, spongy/ boggy mass
Mx PO terbinafine + topical ketoconazole shampoo for first 2 weeks
What is tinea corpororis?
Mx (1)
Fungal infection on trunk, legs or arms
Mx PO fluconazole
SJS characteristic lesion
Target lesions, can develop into vesicles/ bullae with mucosal involvement
SCC RF (4)
Smoking
Sun exposure
Bowen’s disease
Immunosuppression
Difference between spider naevi and telangiectasia
Spider naevi fill from the centre
Telangiectasia fill from the edge
Difference between a vesicle and a bullae
<5mm = vesicle fluid filled
>5mm = bullae fluid filled
Malar rash is seen in?
What area is spared?
SLE
Nasolabial sparing
Name four skin manifestations of SLE (4)
Malar rash
Discoid lupus
Alopecia
Livedo reticularis
Pruritic condition associated with last trimester
Lesions often appearing first in abdominal striae
=
Mx
Polymorphic eruption of pregnancy
Emollients, topical and PO steroids
Mx atopic eruption of pregnancy
Nil
Pruritic blistering lesions often developing in peri-umbilical region, spreading to trunk, back, buttocks and arms
Usually presents in 2nd and 3rd trimester
Rarely seen in first pregnancy
=
Mx
Pemphigoid gestationis
Mx PO steroids
Shiny, painless areas of yellow/red/brown skin typically on the shin - seen in diabetics
Often with surrounding telangiectasia
Necrobiosis lipoidica
Name four common skin disorders associated with diabetes
Necrobiosis lipoidica
Vitiligo
Neuropathic ulcers
Granuloma annulare
May be acquired or congenital
Describes a thickening of the skin of the palms and soles
Acquired causes include reactive arthritis
=
Keratoderma
Name four conditions that can cause keratoderma
Psoriasis
Dermatitis
Reactive arthritis
SLE
Affects people who sweat excessively
Patients may complain of damp and excessively smelly feet
Usually caused by Corynebacterium
Heel and forefoot may become white with clusters of punched-out pits
=
Pitted keratolysis
Crops of sterile pustules affecting the palms and soles
The skin is thickened, red. Scaly and may crack
More common in smokers
=
Palmoplantas pustulosis
Affects children. More common in atopic patients with a history of eczema
Soles become shiny and hard. Cracks may develop causing pain
Worse during the summer
=
Juvenile plantar dermatosis
Shingles
How long are they infectious for?
How do you reduce the risk of spread
Until the vesicles have crusted over
Usually 5-7 days following onset
Covering lesions reduces the risk
Analgesia for shingles (3)
Paracetamol
NSAIDs
Amitriptyline
When do you give antivirals for shingles?
Within 72 hours
Unless <50yo with mild truncal rash with mild pain
Shiny orange peel skin
Pretibial myxoedema
Shin lesions:
Initially small red papule
later deep, red, necrotic ulcers with a violaceous border
Pyoderma gangrenosum
Mx seborrhoeic dermatitis (2)
- Head & Shoulders & Neutrogena T/Gel
(Both contain zinc) - topical ketoconazole
Scabies mx (2)
Who should be treated?
permethrin 5% is first-line (8-12 hours)
malathion 0.5% is second-line (24 hours)
Repeat 7/7 later
all household and close physical contacts should be treated at the same time, even if asymptomatic
Mx crusted scabies
Ivermectin
pink and blotchy, and commonly found on the forehead, eyelids and nape of the neck
Vascular birthmark
=
Course of rash
Salmon patch
AKA stork mark
Fades over a few months
typically affects nose, cheeks and forehead
flushing is often first symptom
telangiectasia are common
later develops into persistent erythema with papules and pustules
rhinophyma
=
Mx (3)
Rosacea
Mx
Topical metronidazole
Topical brimonidine if predominant flushing
PO oxytetracycline
Adverse effects of retinoids (8)
- Teratogenecity
- Depression
- Hair thinning
- Dry skin/eyes/mouth/lips
- Raised triglyc
- Nose bleeds
- Intracranial HTN
- Photosensitivity
Causes of pyogenic granuloma (2)
Trauma
Pregnancy
Mx pregnancy - resolve spontaneously, otherwise currettage
most common sites are head/neck, upper trunk and hands. Lesions in the oral mucosa are common in pregnancy
initially small red/brown spot
rapidly progress within days to weeks forming raised, red/brown lesions which are often spherical in shape
the lesions may bleed profusely or ulcerate
=
Pyogenic granuloma
Causes of pyoderma gangrenosum (6)
Mx
IBD
RA
SLE
Idiopathic 50%
Lymphomas and leukemias
PO steroids
Purpura is usually caused by
Low platelets (ITP)
Pruritus particularly after warm bath
‘Ruddy complexion’
Gout
Peptic ulcer disease
=
Polycythaemia
most commonly affects trunk
patches may be hypopigmented, pink or brown. May be more noticeable following a suntan
scale is common
mild pruritus
=
Mx
Pityriasis versicolor
Mx topical ketoconazole
What is pompholyx?
Precipitated by? (2)
Type of eczema affecting the hands and feet
Sweating and high temperatures
small blisters on the palms and soles
pruritic
often intensely itchy
sometimes burning sensation
once blisters burst skin may become dry and crack
=
Mx (3)
Pompholyx
Cool compress
Emollients
Topical steroids
classically presents with photosensitive rash with blistering and skin fragility on the face and dorsal aspect of hands (most common feature)
hypertrichosis
hyperpigmentation
=
Mx (2)
Porphyria cutenea tarda
Mx chloroquine, venesection
Name three factors that may exacerbate psoriasis
Trauma
Alcohol
Withdrawal of steroids
Name four drugs that can exacerbate psoriasis
BB
Lithium
Antimalarials
NSAIDs
What can trigger guttate psoriasis?
Strep infection
Psoriasis Mx
All patient should use?
1st line treatment (2)
Length of time
If no improvement over what time period?
2nd line
If no improvement after further 8-12 weeks
3rd line (2)
4th line
Regular emmolients
1. Potent steroids OD + vit D analogue OD
- 4 weeks
If no improvement after 8 weeks
2. Vitamin D analogue BD
If no improvement after 8-12 weeks
3. Top steroid BD
- 4 weeks
OR
Coal tar prep OD/BD
- Dithranol
Secondary care rx of psoriasis (3)
- Phototherapy
- PO MTX
- Ciclosporin
Mx scalp psoriasis
Mx face/flexural/ genital psoriasis
Top potent steroids OD 4 weeks
Mil to mod OD for 2 weeks
How long should you use potent steroids for?
Very potent steroids?
Break time?
No longer than 8 weeks
Very potent for no longer than 4 weeks
Try and have a break of at least 4 weeks between each treatment
Two examples of vitamin D analogues
Maximum weekly amount for adults in grams
Calcipotriol
Calcitriol
100g
itchy, papular rash most common on the palms, soles, genitalia and flexor surfaces of arms
rash often polygonal in shape, with a ‘white-lines’ pattern on the surface (Wickham’s striae)
Koebner phenomenon may be seen (new skin lesions appearing at the site of trauma)
oral involvement in around 50% of patients: typically a white-lace pattern on the buccal mucosa
nails: thinning of nail plate, longitudinal ridging
Mx (2)
Lichen planus
Mx topical steroids, denzydamine mouthwash if oral
Lichen planus can be caused by which drugs (3)
Gold
Quinine
Thiazides
Presentation is usually in boys aged between 5-14 years
Appears following sun exposure
Itchy red bumps turning into blisters and crusts on light exposed parts of the ears
Occurs in spring usually
=
Mx (3)
Juvenile spring eruption
Sunscreen, emollients, antihistamines
‘golden’, crusted skin lesions typically found around the mouth
very contagious
=
Caused by what bacteria?
Mx (3)
School
Impetigo
Staph Aur or strep pyogenes
Mx
Hydrogen peroxide 1% cream
Topical fusidic acid or mupirocin
PO fluclox/ erythro if pen allergic
School exclusion until lesions are crusted and healed or 48 hours after starting abx treatment
Hyperhydrosis mx (3)
Topical aluminium chloride preparations
Iontophoresis
Botulinium toxin
Hirsutism
Assessment/ scoring system name
What score indicates moderate or severe
Ferriman-Gallwey
>15
It is characterized by the development of inflammatory nodules, pustules, sinus tracts, and scars in intertriginous areas. It should be suspected in pubertal or post-pubertal patients who have a diagnosis of recurrent furuncles or boils, especially in intertriginous areas.
Hidradenitis suppurativa
Hidradenitis suppurativa RF (5)
Mx (2)
FH
Smoking
Obesity
T2DM
PCOS
Mx
1. Steroids
2. Fluclox
What is Osler Weber Rendu syndrome (alternative name)
Hereditary haemorrhagic telangiectasia
HHT - Hereditary haemorrhagic telangiectasia
Diagnostic criteria
3 or more of:
Epistaxis
Telangiectases (lips, oral cavity, fingers, nose)
Visceral lesions e.g GI telang with or without bleeding, AVM
FH
