Dermatology Flashcards
1
Q
Features of Acne Rosacea
A
Middle aged, fair skinned, female
Facial flushing
Telangiectasia
Late: Persistent erythema with papules and pustules
+/- Rhinophyma
+/- Blepharitis
2
Q
Triggers/Exacerbations of Acne Rosacea
A
Alcohol Exercise High or low temp Spicy foods Hot drinks Stress Natural sunlight
3
Q
Management of Acne Rosacea
A
Avoid triggers & high factor suncream
Topical metronidazole if mild
Systemic oxytetracycline/erythromycin if severe
Refer to ophthom if eye involvement
Beta blockers for flushing
4
Q
Presentation of mild acne vulgaris
A
Seborrhoea and comedones
5
Q
Presentation of mild-moderate acne vulgaris
A
Seborrhoea and comedones
Papules and Pustules
6
Q
Presentation of moderate to severe acne vulgaris
A
Seborrhoea and comedones
Papules and Pustules
Nodules and scarring
Evidence of depression or acne excoriee
7
Q
Management of mild acne
A
Over the counter creams
Topical Benzoyl perioxide or Isotretinoin
8
Q
Effect of Benzoyl Peroxide in Acne Vulgaris
A
Reduces Propionibacterium acne
9
Q
Management of mild to moderate acne vulgaris
A
Topical antibiotics +/- adjunct
Clindamycin +/- Benzoyl peroxide
Erythromycin +/- zinc
10
Q
Managament of moderate to severe acne vulgaris
A
Systemic antibiotic - Oxytetracycline
Systemic anti androgen & oestrogen (Females only)
Systemic Roaccutane (Isotretinoin)
11
Q
Monitoring requirements with Roaccutane
A
LFTs and fasting lipids before starting, 1 month after then every 3 months
12
Q
Important advice for patients starting roaccutane
A
Teratogenic - reliable contraception throughout
Avoid UV exposure - use sunscreen and emolient
Avoid waxing/epilating
13
Q
ADRs of Roaccutane
A
Common: dry skin, hair loss, muscle aches
Notable: ED, reduced libido, mood change
Serious: Teratogenic
14
Q
Presentation of impetigo
A
Child or adult who has regular contact with children
Thin walled, easily ruptured vesicles with yellow-crusty exudate
15
Q
Infectious organism in impetigo
A
Staph aureus
May also be strep
16
Q
Management of Impetigo
A
Removal of crust with saline soak
Topical Abx - fusidic acid or hydrogen peroxide
Systemic Abx - Flucloxacillin or erythromycin
17
Q
Presentation of ecthyma
A
Circumscribed, ulcerated and crusted infected lesions that heal with scarring.
May have a recent insect bite or neglected minor injury.
Usually on legs
May be a drug addict or debilitated.
18
Q
Management of ecthyma
A
Topical antibiotics - Fusidic acid or hydrogen peroxide
Systemic antibiotics - flucloxacillin or erythromycin
19
Q
Infectious organism in Ecthyma
A
Staph aureus
May also be strep
20
Q
Folliculitis
A
Acute pustular infection of multiple hair follicles. Seen in hair bearing areas.
21
Q
Furnuncle
A
Acute abscess formation in adjacent hair follicles. Tender, red pustules that suppurate and heal with scarring.
22
Q
Carbuncle
A
Deep abscess formed in a group of follicles, giving a painful, suppurating mass. May cause systemic upset. Usually back of neck.
23
Q
Infectious organism in folliculitis
A
Staph aureus
May also be strep
24
Q
Management of folliculitis
A
Improve hygiene & avoid shaving/waxing
Use of antiseptic washes
Swab for bacterial culture
Topical antibiotics - fusidic acid, hydrogen peroxide
Systemic antibiotics - Flucloxacillin or erythromycin
Surgical drainage of carbuncles
25
Presentation of Scalded Skin Syndrome
Acute toxic illness in infants.
| Shedding of sheets of epidermis assoc with local infection
26
Pathology of Scalded skin syndrome
Staph aureus releases epidermolytic toxins which damage desmoglein.
Desmoglein normally holds cells together so epidermis separates.
27
Management of scalded skin syndrome
Systemic flucloxacillin or erythromycin
28
Erysipelas Vs Cellulitis
Both are Group A beta haemolytic strep infection of the skin
Erysipelas affects the face.
Cellulitis usually affects the legs.
29
Presentation of erysipelas
Facial rash - well demarcated, raised, erythematous, oedematous, tender
Systemically unwell
30
Management of erysipelas
Systemic Penicillin V or erythromycin
31
Presentation of cellulitis
Painful, erythematous and oedematous rash
Usually affects the leg
May be an associated minor skin defect (entry site of infection)
32
Management of cellulitis
Systemic flucloxacillin/phenoxymethylpenicillin/erythromycin
33
Presentation of necrotising fasciitis
Ill defined erythema on head or limbs following trauma
Associated with fever
Rapidly becomes necrotic
34
Streptococcal skin infections
Erysipelas
Cellulitis
Necrotising Fasciitis
35
Staphylococcal skin infections
Impetigo
Ecthyma
Folliculitis
Scalded skin syndrome
36
Skin changes in primary syphilis
Primary Chancre
Painless, ulcerated, button-like papule on site of inoculation. Usually genitals. 3 weeks after sexual contact. Resolves spontaneously within 3-10 weeks.
37
Skin changes in secondary syphilis
4-10 weeks after onset of chancre. Non itchy, pink or copper-coloured papular eruption on trunk, limbs, palms and soles. Resolves within 1-3 months. Serology is now positive.
38
Skin changes in tertiary syphilis
Painless nodules with scaling in arcuate patterns on face or back.
Subcutaneous Granulomatous Gumma - Ulcerate, scar and may never heal
39
Seborrhoeic Keratoses
```
Warty (rough) surface
Stuck on appearance
Multiple
No malignant potential
Keratotic plugs may be seen on surface.
```
40
Actinic Keratoses
Solitary or multiple lesions on sun exposed areas.
Erythematous, scaly macule/plaque/papule
Few mm to 2cm diameter.
1% progress to SCC
41
Management of Seborrhoeic Keratosis
Reassurance about benign nature.
Curettage, cryosurgery and shave biopsy for cosmetic reasons.
42
Management of Actinic Keratoses
Sunscreens and skin protection
Topical therapy:
Diclofenac (Solaraze)
5-FU (Efudix)
Immune modulator (Aldara)
Rarely, excision/cryotherapy/curettage)
43
Benign Naevi
```
End of mole lifecycle
Round
Well demarcated
Smooth
Dome-shaped
Variable pigment
```
44
Keratoacanthoma
“Volcano” or “crater”
Smooth, dome shaped papule develops rapidly over 6-8 weeks.
Rapidly grows to become a crater, centrally filled with keratin.
Commonly, spontaneously regresses within 3 months.
45
Management of Keratoacanthoma
Spontaneous regression within 3 months is common. Often leaves a scar.
Should be urgently excised as difficult to distinguish from SCC. removal may prevent scarring.
46
Presentation of Bullous Pemphigoid
Elderly
Tense, thick-walled blisters over an erythematous rash
Rarely affects the mouth
IgG in basement membrane
47
Management of bullous pemphigoid
Prednisolone 30-60mg/day or steroid sparing tx (azathioprine)
Self limiting
48
Presentation of pemphigus
Elderly
Flaccid, thin walled blisters over normal skin (blisters have usually burst when presenting)
Commonly affects mouth
IgG in epidermis
49
Management of pemphigus
Prednisolone 100-300mg/day or steroid-sparing tx (azathioprine)
50
Features of Dermatitis Herpetiformis
Autoimmune, blistering skin condition associated with coeliac disease. Caused by IgA deposition in the dermis.
Itchy, vesicular lesions on extensor surfaces (elbows, knees, buttocks)
51
Management of Dermatitis Herpetiformis
Gluten free diet
| Dapsone (antibacterial)
52
Secondary Care referral in burns
Deep dermal and full thickness burns (not pink, unusual sensation)
Superficial burns >3% in adults or 2% in children
Superficial burns affecting face, hands, feet, perineum, genitalia, flexor surface, circumferential burns
Inhalation, electrical or chemical burns
Suspected non accidental injury
53
Pathophysiology of Compartment syndrome in severe burns
Release of inflammatory cytokines causing extravasation of fluids from burn site - hypovolaemic shock and increased haematocrit
Sequestration of fluid into 3rd space
54
Complications of severe burns
Compartment syndrome
ARDS - ventilation limited in circumferential burns of torso
Curling's ulcer - acute peptic stress ulcer
Secondary infection
Catabolic response - protein loss from wound
55
Management of superficial epidermal burns
Analgesia and emollients
56
Management of Superficial dermal burns
```
Cleanse wound
Leave blisters intact
Non adherent dressing
Avoid topical creams
Review in 24 hours
```
57
Burns patients at risk of dehydration
Adults with 15+% burns
| Children with 10+% burns
58
24 hour fluid requirement in burns patients
Vol of fluid = % SA of burn x weight (kg) x 4
50% given in the first 8 hours
50% given in the next 16 hours
59
Escharotomy
Division of burnt tissue
Indicated for:
- Circumferential, full thickness burns to torso or limbs
Improves ventilation or relieves compartment syndrome
60
Presentation of erythroderma
Redness and scaling
Affecting > 90% of skin surface
Systemically unwell - pyrexia and malaise
Patient feels cold but skin feels hot - shivering
Males > females (2:1)
Middle aged or elderly
61
Aetiology of erythroderma
Usually eczema or psoriasis +/- abrupt withdrawal of topical steroids
May also be due to drug eruption, leukaemia, lymphoma or Sezary syndrome
62
Management of erythroderma
Hospital admission
Regular obs
Keep warm - 30-32C room
Fluid balance and monitoring
Emollients and topical steroids
Treat underlying cause
63
Pathology of acute eczema
Oedema in epidermis causes keratinocytes to separate.
Formation of epidermal vesicles.
Dermal vessels dilate so inflammatory cells can invade dermis and epidermis
64
Pathology of chronic eczema
Acanthosis - Thickening of prickle cell layer in epidermis
Hyperkeratosis - thickening of stratum corneum
Some corneocytes retain their nuclei.
Rete ridges (epidermo-dermal border) are elongated, dermal vessels dilated, inflammatory mononuclear cells infiltrate the skin.
65
Criteria for diagnosis of atopic eczema
Evidence of itchy skin or parental report of scratching/rubbing + 3 or more of the following:
History of skin crease involvement
History of asthma or hay fever (or 1st degree relative if under 4 yrs)
History of generally dry skin in the last year
Onset under 2 yrs
Visible rash on flexures
66
Presentation of atopic eczema in infants
Ill-defined, erythematous, pruritic rash on flexures.
Usually <6 months onset
Itchy, vesicular, exudative eczema on the face, head and hands
Secondary infection
Affects sleep
67
Presentation of atopic eczema in children
Ill-defined, erythematous, pruritic rash on flexures.
Flexor surfaces
Face - erythema and infraorbital folds
Lichenification/Fissuring - palmar markings increased
Hyperpigmentation if dark skinned
Interference with sleep
May have oozing rash if infection (Staph aureus)
68
Presentation of atopic eczema in adults
Ill-defined, erythematous, pruritic rash on flexures or hands
Stress associated
69
Eczema Herpeticum
HSV infection seen in patients with eczema
70
Molluscum contagiosum
Viral infection seen in patients with eczema.
Asymptomatic, dome-shaped lesions, central umbilication, widespread. Caused by DNA pox virus. Resolve spontaneously or treat with imiquimod cream, curettage or cryotherapy.
71
Management of Eczema
Lifestyle - short nails, avoid triggers, diet
1 )Topical - emollients, Steroids, Calcineurin inhibitors (Tacrolimus), Coal tar
2) Phototherapy - narrowband UVB
3) Oral antihistamines (Chlorpheniramine)
4) Azathioprine, Ciclosporin
72
Seborrhoeic Dermatitis
Overgrowth of commensal yeast - Malassezia
| Scaly eruption on scalp and eyebrows. Treat with mild topical steroids and anti yeast shampoos
73
Discoid Eczema
```
Itchy, Coin-shaped lesions on the limbs
Middle aged or elderly men
May clear after a few weeks
Secondary infection common
Management: Potent topical steroids + antimicrobial/antibiotic
```
74
Venous Eczema
Lower legs
Haemosiderin pigmentation around angles +/- fibrosis of dermis
Tx: Emollients +/- steroid ointment
75
Class I topical Steroids
Very potent
Dermovate/Clobetasol propionate 0.05%
For acute flare ups. Avoid on face and skin flexures.
76
Class II topical steroids
Mometasone furoate/Elocon
For acute flare ups. Avoid on face and skin flexures.
77
Class III topical steroids
Clobetasone butyrate 0.05%/Eomovate
For short bursts/courses
78
Class IV topical steroids
Hydrocortisone 1%
Face, flexures and small infants
79
Benefits of topical immunomodulators e.g. Tacrolimus
Reduce local T cell activation, therefore antiinflammatory effect without causing skin thinning or atrophy.
Steroid-sparing
80
Description of rash seen in Tinea
Annular lesions (ring-shaped)
Plaques, with scaling and erythema, especially at the edges.
May have inflammatory papules and pustules.
81
Tinea corporis
Ringworm affecting trunk or limbs
82
Tinea Manuum
Ringworm affecting hand
| Unilateral, powdery scaling of palm
83
Tinea cruris
Ringworm affecting groin
84
Tinea capitis
Ringworm affecting scalp and hair.
| Causes alopecia
85
Tinea unguium
Ringworm affecting nails esp. big toe
86
Tinea pedis
Athlete's foot
| Usually between 4th and 5th toe
87
Management of Tinea/Ringworm
Minimise humidity/sweaty conditions
Microbiology scrapings
Topical therapy if affecting body, feet or groin
- Terbinafine
- Imidazole (Clotrimazole & miconazole)
Systemic therapy if affecting scalp, nails, hands or body)
- Terbinafine
- Itraconazole
88
Duration of treatment for fingernail tinea
6 weeks
89
Duration of treatment for toenail tinea
3 months
90
Monitoring with Terbinafine
LFTs before treatment and 4-6 weekly
91
Management of seborrhoeic dermatitis
Scalp - shampoo (coal tar, ketoconazole)
Face/Trunk/Flexures - topical imidazole +/- hydrocortisone OR Oral itraconazole
92
Pityriasis Rosea
Herald patch then many smaller plaques on trunk, arms or thighs. Run along Langer lines giving a 'fir-tree appearance'
Associated with HHV7
Self limiting
93
Pityriasis versicolor
Overgrowth of commensal yeast Malassezia
Causes hyper or hypopigmented areas of skin which do not tan.
Treat with ketoconazole.
- Topical if localised
- Oral if diffuse
After treatment, rash loses scale, become hypopigmented and fails to tan for a year or 2.
94
What is thrush?
Genital candida albicans
95
Presentation of thrush
Pruritic, sore, vulvovaginitis with white plaques
White discharge
Males & females may be affected.
96
Intertrigo
Candida albicans infection of the submammary, axillary or inguinal folds.
Gives a moist, glazed, macerated appearance
97
Management of cutaneous candida
Keep areas dry with dusting powder. Stop systemic antibiotics.
Topical imidazole (Cream, powder, pessary)
Systemic Itraconazole or fluconazole
98
Management of thrush
Clotrimazole/Enoconazole pessary OR
| Itraconazole/Fluconazole PO
99
Presentation of Lichen Planus
Rash: Pruritic, Purple, Papular on palms, soles, genitalia and flexor surfaces.
White lace pattern on surface
100
Management of lichen planus
Self limiting
| Oral steroids improve symptoms
101
Lichen planus-like drug eruption
Hyperpigmented rash in response to gold, quinine or thiazides.
Increased eosinophils on histology
102
Presentation of lichen sclerosus
Porcelain white atrophic lesions of the genitalia.
Pruritic and sore
Women > men (10:1)
Can progress to SCC
103
Management of lichen sclerosus
Steroid cream to reduce itch and prevent scarring
Circumcision of males
Follow up due to increased risk of vulval cancer (SCC)
104
Risk Factors for malignant melanoma
```
FHx
UV exposure
Skin type I or II
DNA repair defects
Immunosuppression
```
105
Criteria for diagnosis of melanoma
Major
- Change in size
- Change in shape
- Change in colour
Minor
- Diameter > 6mm
- Inflammation
- Oozing or bleeding
- Itch or sensation
106
Hutchinson's sign
Pigmentary spread from nail to proximal nail fold
Highly suggestive of melanoma
Check for history of nail trauma
107
Description of Superficial Spreading Melanoma
```
50% of all british cases
Female preponderance
20-60 yrs
Lower leg
Asymmetrical
Different colours
```
108
Description of Nodular Melanoma
```
25% of british patients
Male preponderance
20-60 yrs
Trunk
May be pigmented
Nodule - Proud to the skin
```
109
Description of lentigo maligna melanoma
15% of UK cases
Sun damaged skin
Face
Elderly (>60 yrs)- spent many years in an outdoor occupation
Develops from a longstanding lentigo maligna
110
Description of acral lentiginous melanoma
```
1 in 10 of British cases
Usually dark skinned
Palms, soles and nail beds
Often diagnosed late
Poor survival
```
111
Which has a poorer prognosis, vertical or horizontal growth in melanoma?
Vertical
112
Breslow Thickness
Distance from granular layer to deepest portion of the skin that contains melanoma cells.
Increases thickness = increased likelihood of mets and death.
113
Management of melanoma
Excision - margins depend on degree of invasion
Sentinel lymph node biopsy - removal of draining lymph node, for prognosis
Lymph node dissection (no evidence to suggest this improves survival)
114
Presenting complaint for BCC
```
Skin lesion
Long history (>1 yr)
Slow growing
No pain or itch
Intermittent bleeding, scab formation
Poor healing
+/- Ulceration
```
115
Nodular BCC
```
Well defined papule or nodule
Shiny, rolled edges
Telangiectasia
Progressive ulceration
On head or neck
```
116
Superficial BCC
```
Patch or plaque
Pearly margins
Telangiectasia
Trunk or limbs
(Resembles psoriasis)
Likely to be incompletely excised
```
117
Types of BCC
Nodular
Superficial
Pigmented - difficult to distinguish from melanoma
Morphoeic - difficult to diagnose
118
Management of Superficial BCCs
Immunomodulatory cream (Imiquimod, 5-FU), curettage, cryotherapy. (photodynamic therapy if large)
119
Management of nodular BCCs
Excision with 4mm margin
120
Management of morphoeic BCC on the nose (ill-defined edges)
Mohs surgery
121
Bowen's disease
```
Elderly females
Well demarcated, scaling, erythematous plaques
Usually on legs
Slow growing
Asymptomatic
Often misdiagnosed as psoriasis
```
122
Presentation of SCC
Hyperkeratotic, crusting lesion on ear or lip
Indurated or firm
+/- Ulceration
Associated with HPV, scarring and chronic ulceration
123
Management of Bowen's disease
Sunscreens
Topical therapy:
Diclofenac (Solaraze)
5-FU (Efudix)
Immune modulator (Aldara)
Physical Destruction (Cryo/Curettage)
Photodynamic Therapy
Excision
124
Management of SCC
Excision 6mm margin at high risk sites (4mm at low risk)
Mohs if high risk and ill-defined
Radiotherapy - for older patients
Curettage and cautery - small, low risk
125
Polymorphic eruption of pregnancy
Pruritic rash
Initially affects abdominal striae
Periumbilical sparing.
During last trimester
Mx: Emollients THEN topical steroids THEN oral steroids
126
Pemphigoid gestationis
Pruritic blistering lesions
Often develop in periumbilical region (spreads to trunk, back, buttocks and arms)
During 2nd or 3rd trimester
Similar to bullous pemphigoid - C3 and IgG at dermoepidermal junction.
Associated with low birth weight and premature labour
Mx: Oral steroids
127
Intrahepatic Cholestasis of pregnancy
Pruritus due to elevated serum bile acids. Resolves 1-2 days after delivery.
Mx: Ursodeoxycholic acid
128
Atopic Eruption of Pregnancy
Pruritic rash in patients with history of atopy
During 1st and 2nd trimester.
Treat as in eczema
129
Immune cells associated with psoriasis
T cells
130
Rash seen in psoriasis
Well-defined, disc-shaped, erythematous plaques with white scale.
Involves elbows, kness, hair margin and sacrum.
131
Guttate psoriasis
Acute, symmetrical eruption
Teardrop lesions with little scale
Usually on trunk and limbs
Following streptococcal throat infection
132
Palmoplantar pustulosis
Yellow-brown sterile pustules on palm or soles.
Middle-aged women
Smokers
133
Nail changes in psoriasis
Pits
Onycholysis
Oily or salmon pink discolouration
Subungual hyperkeratosis
Often associated with arthropathy
134
Management of psoriasis
Topical therapy
- Calciprotriol (Vit D analogues)
- Steroids
- Coal tar
- Dithranol
- Vit A analogues
Phototherapy - UVB or PUVA
Systemic Therapy
- Ciclosporin or azathioprine
- Isotretinoin
135
Topical therapy which can be combined with UVB
Calcipotriol, Coal tar or dithranol
136
Problems with coal tar
Smelly and messy
137
Problems with Dithranol
Purple-brown staining of skin so must protect surrounding skin with white, soft paraffin
Must be washed off after 30 mins
138
First line treatment of psoriasis
Topical Calcipotriol (Vit D analogue)
139
PUVA
Psoralin + UVA
140
Presentation of scabies
Ill-defined, eczematous, urticated, papular, hypersensitivity reaction on trunk (mite may be visible as a white dot at the end of a burrow)
History of close physical contact
Generalised itch, worse at night
Rubbery nodules if genitalia affected
141
Management of scabies
Treat all contacts.
Topical Permethrin cream (leave on for 12-24 hrs)
Oral ivermectin if topical treatment is not effective.
142
Pediculosis
Lice - pubic, head or body
143
Presentation of pubic lice
Sexually transmitted
Young adults
Intense itching → excoriation and secondary infection.
144
Presentation of head lice
Itchy head
Head-to-head contact
School children
Nits (egg cases) can be seen
145
Presentation of body lice
Diffuse itch
| Body louse is seen in vagrants living in unhygienic conditions, spread by infested bedding/clothing.
146
Management of lice
Topical Malathion or permethrin
Treat sexual partners if pubic.
Wet combing if head.
Tumble dry clothing if body.
147
Presentation of Venous Leg Ulcers
Lesion on gaiter area of leg. History of varicose veins or DVT
Short term: Varicose veins, pitting oedema, varicose eczema, haemosyderin deposition
Long term: Champagne bottle appearance, atrophie blanche (porcelain scarring)
148
Presentation of Arterial Leg ulcers
Lesion on dorsum of foot or toes. History of vascular disease, HTN, DM or arteriosclerosis.
```
Punched out ulcer
Dusky or cold foot
Diminished pulses
Delayed cap refill
+/- Gangrene
```
149
ABPI in venous peripheral vascular disease
> 0.8
150
ABPI in arterial peripheral vascular disease
< 0.5
OR > 1.3 if arterial calcification has occurred.
151
Management of venous leg ulcers
Compression therapy
Pain control
Local wound care
ABPI must be > 0.8 to begin compression therapy.
152
Management of arterial leg ulcers
Pain control
| Referral for vascular surgery - consider amputation if severe
153
Virus responsible for common viral warts
HPV 2, 27 and 57
154
Presentation of common viral warts
Dome-shaped papules or nodules, with papilliferous surface. Surface interrupts skin lines.
Often associated with nail or skin biting.
155
Presentation of plane viral warts
Smooth, flat topped papules, occasionally brown
156
Virus responsible for plane viral warts
HPV 3 and 10
157
Management of common viral warts
```
Topical Salicylic and lactic acids (Avoid in atopic eczema)
Topical Glutaraldehyde (Avoid in atopic eczema)
```
Cryotherapy - painful, may cause blistering.
158
HPV responsible for plantar viral warts
1,2, 4, 27 and 57
159
Presentation of plantar viral warts
Dome shaped papules or nodules on the foot.
| Pressure when walking can cause them to grow into the dermis - painful and covered with callus
160
Management of plantar viral warts
Notoriously resistant to treatment.
```
Topical Salicylic and lactic acids (Avoid in atopic eczema)
Topical Glutaraldehyde (Avoid in atopic eczema)
Topical formaldehyde (Avoid in atopic eczema)
```
Cryotherapy - painful, may cause blistering.
161
Verruca
Mosaic plantar warts. Fine, red-brown threads in the lesion (thrombosed capillaries)
162
HPV responsible for Anogenital viral warts
6 and 11
163
Presentation of Anogenital viral warts
Dome shaped papules around the anus or genitals.
| May be small or may coalesce to form 'cauliflower-like' condylomata acuminata. May bleed or itch
164
Management of HPV
```
Topical treatments for multiple, non keratinised warts:
Podophyllotoxin cream (avoid in pregnancy)
Imiquimod cream (avoid in pregnancy, may cause local reaction)
```
Cryotherapy for solitary, keratinised warts.
Proctoscopy or colposcopy - identify any anal or cervical neoplasia. HPV 16, 18 and 33 predispose to cervical cancer. Examination of sexual partners.
165
Presentation of HSV Type I
Childhood
Often subclinical
Vesicles on lips and mucous membranes quickly erode and are painful.
Fever, malaise and local lymphadenopathy.
166
Herpetic Whitlow
Painful HSV I vesicle or pustule on a finger. May be seen in a dentist who has treated someone with HSV I
167
Presentation of HSV II
After sexual contact in young adults.
Vulvovaginitis or penile or perianal regions.
168
Management of pregnant female with HSV II
Requires C-section if pregnant women is culture positive for genital HSV.
169
Complications of HSV
Eczema herpeticum - widespread HSV in patients with atopic eczema
Carcinoma of cervix
Erythema multiforme (HSV is the most common cause of recurrent EM)
170
Management of HSV
Aciclovir
| Barrier contraception if type II
171
Presentation of HZV
Initially, Pain, tenderness or paraesthesiae on the dermatome
3-5 days later, eruption of erythema and grouped vesicles
Vesicles become pustular, form crusts then separate within 2-3 weeks causing scarring
172
Management of VZV
Mild - rest, analgesia, bland drying preparations
Topical antiseptic or antibiotic if 2o infection e.g. Staph. aureus
Oral aciclovir if severe (may reduce post-herpetic neuralgia)
Oral prednisolone reduces post-herpetic neuralgia if given in early stages (avoid if immunosuppressed)
173
Management of post-herpetic neuralgia
Topical caspaicin
