dermatology 2

Question 1

lichen sclerosus presents as

Answer 1

well-defined, white, finely wrinkled plaque
often has purpuric areas, hyperkeratotic fissured areas that are ulcerated from scratching

Question 2

areas affected by lichen sclerosus

Answer 2

women: any part of the external genital and perianal area, vagina is spared
men: only glans penis

Question 3

symptoms of lichen sclerosis

Answer 3

very itchy, may be asymptomatic and picked up during CST
usually a clinical diagnosis, biopsy may be used to exclude malignancy in poor response to treatement

Question 4

untreated lichen sclerosus in females

Answer 4

chronic untreated lichen sclerosus can cause the vaginal opening to bcome stenosed, scarry may bury the clitoris
increased risk of SCC

Question 5

untreated lichen sclerosus in males

Answer 5

can cause phimosus, more commonly in children
increased risk of SCC

Question 6

aims of treatment for lichen sclerosus

Answer 6

topical corticosteroid treatment to relieve symptoms
aim to return the skin to as close to normal as possible, to prevent anatomical changes and transformation to SCC
manage with a specialist
in patients with co-existing menopausal vulval atrophy, topical oestrogen is useful as an adjunct to relieve dryness
examine patients regularly for carcinoma transformation

Question 7

clinical presentation of molluscum contagiousum

Answer 7

small pearly papules with central umbilication
lesions are usually painless and not itchy

Question 8

how is molluscum contaagiousum spread

Answer 8

direct skin contact or fomites (eg. bath sponges, bath towels, shared swimming equipment)
children should avoid sharing baths with siblings
sexual transmission of virus may occur in adults and can be associated with genital molluscum lesions

Question 9

molluscum contagiousum is caused by

Answer 9

a poxvirus

Question 10

natural history of molluscum contagiousum

Answer 10

resolves spontaneously in immunocompetant patients
lesions may persist for months, refer to a dermatologist if on cosmetically sensitive areas

Question 11

pitted keratolysis

Answer 11

common condition of the fet caused by overgrowth of bacteria that digest keratin

Question 12

treatment for warts

Answer 12

topical salicylic acid and liquid nitrogen therapy
treatment for warts can potentially cause scarring, consider referral to dermatologist for cosmetically sensitive areas

Question 13

advise on applying salicylic acid to warts

Answer 13

protect the surrounding skin with tape
prepare th surface of the wart with a file, pumice stone or emery board
ensure the healthy skin is not damaged as this can spread the virus
after applying salicylic acid, cover the wart with occlusive tape

Question 14

plane warts

Answer 14

occur on the face and distal limbs
treat with topical retinoids eg. tretinion, be aware topical retinoids are teratogenic

Question 15

pityriasis versicolor is caused by

Answer 15

malassezia furfur

Question 16

pityariasis versicolor

Answer 16

patched of hypo and hyper pigmentation
treat with topical antifungal cream eg. econazole

Question 17

tinea pedis

Answer 17

tinea of the feet
may present as maceration of the lateral toe webs

Question 18

tinea cruris

Answer 18

tinea of the groin

Question 19

tinea capitis

Answer 19

tinea of the scalp
mainly occurs in children, uncommon in adults

Question 20

keroin

Answer 20

acute form of tinea capitus
boggy, painful, inflammatory pustular mass with associated alopecia
urgently refer to a specialist
take scrapings and pluck hairs for culture and microscopy, start empirical oral antifungal

Question 21

treatment of tinea

Answer 21

topical treatment is appropriate for localised tinea
oral treatment may be needed for widespread disease, failure of response to topical therapy, reccurence, following corticosteroid use, scalp palms or soles
confirm diagnosis with microscopy and cultures before starting oral therapy using skin scrapings, subungual debris, nail clippings or plucked hair

Question 22

general advice to prevent transmission of scabies

Answer 22

all clothes, towels and bedding should be washed on hot cycle
if a school-aged child has scabies, notify the school
children can return to school when two treatments of scabies, one week apart, has been completed

Question 23

treatment for scabies

Answer 23

permethrin cream topically from the neck down
or
ivermectin oral

repeat after 7 days

Question 24

crusted scabies

Answer 24

high transmission form of scabies with high mite population
empiraly treat all family members
notifiable disease in some states
occurs in incapacitated or immunocompromised patients or in some aboriginal and torres straait islander communities

Question 25

pityriasis rosea

Answer 25

self limiting inflammatory condition caused by HHV 6 or 7
if there is severe itch, use topical corticosteroid

Question 26

sunburn

Answer 26

cool compresses and emollients may relieve symptoms
topical corticosteroids and topical non-steroidal anti-inflammatory drugs may be useful

Question 27

seborrhoeic keratoses

Answer 27

benign lesions that have a waxy or warty appearance
appear from 30, number of lesions increases with age

Question 28

solar lentigenes

Answer 28

‘sunburn freckles’
common on chronically sun-exposed skin
increase in number with age

Question 29

lentigo meligna

Answer 29

in situ melanoma
diagnosis by complete surgical excision

Question 30

antibiotic therapy for impetigo

Answer 30

mupirocin ointment or cream topical for localised skin sores
or
dicloxacillin or flucloxacillin for multiple skin sores

Question 31

shingles

Answer 31

reactivation of varicella-zoster virus
rash that presents with blisters in a dermatomal distribution on an erythematous base
blisters erupt over a week and heal over two weeks
if there is occular involvement, consult an opthalmologist

Question 32

rationale for treatment of shingles

Answer 32

reduces acute pain, duration of the rash, viral shedding and occular complications
whether antiviral therapy reduces the incidence of postherpetic neuralgia is contentious
use valaciclovir, famciclovir, aciclovir