Dermatology Flashcards
Give 4 risk factors for malignant melanoma
- sun exposure
- severe sunburn in childhood
- fair hair and skin
- many naevi
- fhx
- solar keratosis
What is the ABCDE of signs for a malignant melanoma?
Assymetry, irregular Boarder, Colour irregularity, Diameter >7mm, Evolving
What are the referral criteria for a malignant melanoma? (major and minor criteria)
Major criteria (2pts): change in size, irregular shape, irregular colour Minor criteria (1pt): >7mm, inflammation, oozing, sensation change Need 3 or more points for 2WW
What is the prognosis like for malignant melanoma?
5yr survival for men is 73% and 85% for women, so good
What does a seborrhoeic keratosis look like? What are they?
- flat or crusty topped or wart looking lesions that seem stuck onto the skin, usually pigmented, well circumscribed, soft texture, may be itchy or inflamed after minor trauma but usually asymptomatic
- they are benign hyperketatotic skin lesions associated with ageing
What do basal cell carcinomas look like? where do they appear and how fast to they grow?
- slow growing lesions usually on face/ sun exposed areas
- early lesions look translucent and pearly with rolled edges and telangiectasia
- late lesions have a ‘rodent ulcer’ appearance
How should suspected BCCs be managed by a GP?
- routine referal if suspect BCC or excision in primary care
- 2ww if delay may have significant impact due to lesion size or shape or think may be SCC
- small BCCs can be treated with imiquimod cream
- prognosis very good as they rarely metastasise
How do squamous cell carcinomas present?
- indurated nodular keratinising or crusted lesions which may ulcerate
- may present as non healing ulcer
- no pigment change
- found on sun exposed areas
How should SCCs be managed by a GP?
- All should get 2WW
- most lesions can be excised in primary care
- large lesions of those in cosmetically sensitive or risky areas may have part of it biopsied before later surgery
- node biopsy and MRI may be indicated in advanced disease due to met risk, but will be initiated by secondary care
- Prognosis is good as few metastasise but if they have metastasised they are quite aggressive with 5yr survival 25-40%
How does measles present?
- prodromal illness (cough, runny nose) for 3 days
- many have fever
- rash starts on face and spreads across body over 3-4 days
- rash is redish- brown, macules which coalesce to patches and can cover whole body, sometimes itchy
- rash will go within 3-4 days in order of appearance
- koplik spots on buccal mucosa
How should measles be managed by a GP?
- notifiable disease
- salivary swabs for measles specific immunoglobulin M for diagnosis
- paracetamol and ibuprofen
- advise good oral intake, stay at home to prevent spread of infection, monitor carefully
- Any infants, pregnant women or immunocompromised people who may have been exposed need post exposure prophylaxis with MMR vaccine or immunoglobulins
Give 3 complications of measles
- pneumonia
- encephalitis
- diarrhoea
- increased risk of miscarriage and prematurity and pneumonitis in pregnancy (which is why pregnant ppl should stay away)
How does rubella present?
- more mild prodromal illness followed by rash
- usually no fever
- rash is red- pink discrete macules that coalsece, starting behind ears and on face and then trunk and extremities
How should rubella be managed in primary care?
- notifiable disease
- health protection unit will provide serological PCR testing kit for diagnosis
- no specific management- keep child away from school for 4 days after rash appears, encourage oral intake, paracetamol etc
- must keep away from pregnant women
- watch out for complications of encephalopathy, arthralgia and thrombocytopenia (bleeding)- all rare
Why must pregnant women be kept away from children with measles?
causes serious birth defects if exposed in the first trimester
How is a pregnancy managed if the women is IgM positive
for rubella in the first 16 weeks of pregnancy?
pregnancy is terminated
How does erythema infectosum/ slapped cheek/ 5th disease present? What does the rash look like?
- prodromal illness (headache, rhinitis, sore throat, fever, malaise)
- 7-10 days after illness resolves a rash appears on the cheek (spares the nose)
- rash is red, macular/ morbiliform and not itchy
- rash on cheeks may disappear after a few days
- may get rash on extensor surfaces of extremities at same time as or after the cheek rash
What virus causes slapped cheek/ erythema infectosum and how is it transmitted?
parovirus b19
transmitted by resp secretions
Describe the incubation and infectious period of slapped cheek/ erythema infectosum?
- incubation period 4-20 days
- infective from 10 days pre rash
- not infective when rash present
How should slapped cheek/ erythema infectosum be managed?
- no investigations needed unless pregnancy, immunocompromised or suspect aplastic crisis (rare)
- no specific treatment
- avoid pregnant people- 5% risk of miscarriage or fetal complications
- should all resolve within a couple of weeks
How does roseola infantum present?
- high fever for 3-4 days with promdromal illness, diarrhoea and often swollen eyelids
- in younger infants (age 6 months- 1 yr)
- rash appears after fever
- rash is small pink spots on body then arms and legs, not usually on face
What virus causes roseola infantum?
- human herpes virus 6 or 7
How should roseola infantum be managed in primary care?
- just reassure
- mild infection with no long term problems, just reassure
How does hand foot and mouth disease present?
- prodromal illness (fever, malaise, loss of appetite, sore mouth, throat and abdo pain)
- mouth lesions (yellow ulcers with red haloes) appear after prodrome
- skin lesions on hands and feet- start as 2-5mm macules but become vesicles, itchy and painful
- usually in infants and children younger than 10
What virus causes hand foot and mouth disease?
coxasckievirus or enterovirus
How should hand foot and mouth be managed by the GP?
- supportive treatment only
- lidocaine oral gel can ease pain from ulcers
- good hygiene to prevent spread
- refer to hopsital if signs of significant dehydration or neurological signs
- dont need to be kept away from school or pregnant women (no risk)
Give 3 complications of hand foot and mouth disease?
- secondary infection to scratched skin
- painful stomatitis leads to dehydration
- meningism
- cardioresp failure
(all rare)
How does scarlet fever present?
- sudden onset sore throat + fever and exudate on tonsils, headache, abdo pain common with it
- rash appears 12-48 hrs later
- rash appears on neck, chest, scapula and then legs and trunk later
- rash is red, macular and has a coarse sandpaper like texture
- tongue may start white and furry with red sports and then become red and inflamed with prominent papillae (strawberry tongue)
- usually in children <10
What causes scarlet fever?
exotoxin from strep pyogenes
How is scarlet fever diagnosed?
clinical diagnosis based on signs and symptoms
- can do throat swab if unsure with 90% sensitivity
How is scarlet fever managed by the GP?
- phenoxymethylpenicillin for 10 days
- refer to hospital if difficulty swallowing or severe complication arises
- notify PHE
- can do back to school after 24 hrs of abx
Give 3 complications of scarlet fever
When are these complications more likely?
- mastoiditis
- peritonsilar abscess
- pneumonia
- meningitis
- post strep glomerular nephritis
- osteomyelitis
- septic arthritis
- rheumatic fever
These are more common in children who have had chicken pox recently
