Dermatology

Question 1

What are the characteristic features of acne vulgaris?

Answer 1

Open comedones (blackheads)
Closed comedones (whiteheads)
Increased sebum production
Nodules / cysts
Inflammation

Question 2

What system is used to grade acne vulgaris severity?

Answer 2

Leeds Revised Acne Grading System.

Question 3

What is the management of mild acne?

Answer 3

Mild = non-inflammatory comedones

• Patient education
• Single therapy with (in typical order of preference)
• Benzoyl peroxide
• Topical retinoid (tretinoin)
• Topical antibiotic (erythromycin, clindamycin)

Question 4

What is the management of moderate acne?

Answer 4

Moderate = inflammatory papules and pustules

• Dual therapy with…
• Topical benzoyl peroxide / retinoid
  + topical antibiotic

If topical treatment is difficult (e.g. lesions on back), then offer:
-Topical benzoyl peroxide / retinoid
+ oral antibiotic (tetracyline, doxycycline, lymecycline)

Question 5

What is the management of severe acne?

Answer 5

Severe = predominantly papulopustular with nodules and scarring

REFER TO SPECIALIST CARE (e.g. to start PO isotretinoin)
Whilst awaiting, dual therapy with topical benzoyl peroxide + oral ABx

Question 6

What are the features of acne rosacea?

Answer 6

Facial flushing, persistent erythema, telangiectasia, inflammatory papules, pustules, oedema, rhinophyma.

Question 7

What is the management of mild acne rosacea?

Answer 7

Topical metronidazole or azelaic acid

Question 8

What is the management for moderate / severe acne rosacea?

Answer 8

Oral antibiotic (tetracycline, oxytetracycline, doxycyline, lymecycline, erythromycin)

Question 9

What treatment is effective for the erythema of acne rosacea?

Answer 9

Brimonidine 0.3% gel

Question 10

What are the skin findings of chronic plaque psoriasis?

Answer 10

Well-demarcated, erythematous plaques, with white surface scale. Most commonly seen on extensor surfaces, but also scalp and genitals.

Question 11

What tools can be used to assess impact of psoriasis on quality of life?

Answer 11

Dermatology Life Quality Index (DLQI)

Psoriasis Disability Index (PDI)

Question 12

What is the management for psoriasis on the trunk and limbs?

Answer 12

Emollient
Vitamin D + steroid (e.g. Dovobet, Enstilar)
Max 8 weeks before 4 week steroid break

Consider salicylic acid if +++ scale
Coal tar if treatment failure

Question 13

What is the management of psoriasis on the scalp?

Answer 13

Coal tar 2% shampoo is first line

Consider salicylic acid if +++ scale

Question 14

What are specialist interventions for psoriasis?

Answer 14

Dianthrol
Phototherapy
Systemic immunosuppression

Question 15

Wha are the features of a BCC?

Answer 15

Pearly, rolled edges
Central ulcer
Telangiectasia

Question 16

What are features of a SCC?

Answer 16

Rapidly growing
Painful
Hyperkeratotic
Nodular
Crusting
Ulcerating
Cutaneous horn

Question 17

What are the features of a melanoma?

Answer 17

Asymmetry
Border (irregular)
Colour (multiple)
Diameter (>5mm)
Evolving