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Clinical Medicine > Dermatology > Flashcards

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

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2
Q

Triggers/Exacerbations of Acne Rosacea

A 
Alcohol
Exercise
High or low temp
Spicy foods
Hot drinks
Stress
Natural sunlight
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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

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4
Q

Presentation of mild acne vulgaris

A

Seborrhoea and comedones

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5
Q

Presentation of mild-moderate acne vulgaris

A

Seborrhoea and comedones

Papules and Pustules

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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

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7
Q

Management of mild acne

A

Over the counter creams

Topical Benzoyl perioxide or Isotretinoin

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8
Q

Effect of Benzoyl Peroxide in Acne Vulgaris

A

Reduces Propionibacterium acne

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9
Q

Management of mild to moderate acne vulgaris

A

Topical antibiotics +/- adjunct

Clindamycin +/- Benzoyl peroxide

Erythromycin +/- zinc

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10
Q

Managament of moderate to severe acne vulgaris

A

Systemic antibiotic - Oxytetracycline

Systemic anti androgen & oestrogen (Females only)

Systemic Roaccutane (Isotretinoin)

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11
Q

Monitoring requirements with Roaccutane

A

LFTs and fasting lipids before starting, 1 month after then every 3 months

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12
Q

Important advice for patients starting roaccutane

A

Teratogenic - reliable contraception throughout
Avoid UV exposure - use sunscreen and emolient
Avoid waxing/epilating

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13
Q

ADRs of Roaccutane

A

Common: dry skin, hair loss, muscle aches

Notable: ED, reduced libido, mood change

Serious: Teratogenic

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14
Q

Presentation of impetigo

A

Child or adult who has regular contact with children

Thin walled, easily ruptured vesicles with yellow-crusty exudate

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15
Q

Infectious organism in impetigo

A

Staph aureus

May also be strep

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16
Q

Management of Impetigo

A

Removal of crust with saline soak
Topical Abx - fusidic acid or hydrogen peroxide
Systemic Abx - Flucloxacillin or erythromycin

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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.

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18
Q

Management of ecthyma

A

Topical antibiotics - Fusidic acid or hydrogen peroxide

Systemic antibiotics - flucloxacillin or erythromycin

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19
Q

Infectious organism in Ecthyma

A

Staph aureus

May also be strep

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20
Q

Folliculitis

A

Acute pustular infection of multiple hair follicles. Seen in hair bearing areas.

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21
Q

Furnuncle

A

Acute abscess formation in adjacent hair follicles. Tender, red pustules that suppurate and heal with scarring.

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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.

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23
Q

Infectious organism in folliculitis

A

Staph aureus

May also be strep

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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

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25
Q

Presentation of Scalded Skin Syndrome

A

Acute toxic illness in infants.

Shedding of sheets of epidermis assoc with local infection

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26
Q

Pathology of Scalded skin syndrome

A

Staph aureus releases epidermolytic toxins which damage desmoglein.
Desmoglein normally holds cells together so epidermis separates.

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27
Q

Management of scalded skin syndrome

A

Systemic flucloxacillin or erythromycin

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28
Q

Erysipelas Vs Cellulitis

A

Both are Group A beta haemolytic strep infection of the skin
Erysipelas affects the face.
Cellulitis usually affects the legs.

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29
Q

Presentation of erysipelas

A

Facial rash - well demarcated, raised, erythematous, oedematous, tender
Systemically unwell

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30
Q

Management of erysipelas

A

Systemic Penicillin V or erythromycin

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31
Q

Presentation of cellulitis

A

Painful, erythematous and oedematous rash
Usually affects the leg
May be an associated minor skin defect (entry site of infection)

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32
Q

Management of cellulitis

A

Systemic flucloxacillin/phenoxymethylpenicillin/erythromycin

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33
Q

Presentation of necrotising fasciitis

A

Ill defined erythema on head or limbs following trauma
Associated with fever
Rapidly becomes necrotic

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34
Q

Streptococcal skin infections

A

Erysipelas
Cellulitis
Necrotising Fasciitis

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35
Q

Staphylococcal skin infections

A

Impetigo
Ecthyma
Folliculitis
Scalded skin syndrome

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36
Q

Skin changes in primary syphilis

A

Primary Chancre
Painless, ulcerated, button-like papule on site of inoculation. Usually genitals. 3 weeks after sexual contact. Resolves spontaneously within 3-10 weeks.

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37
Q

Skin changes in secondary syphilis

A

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.

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38
Q

Skin changes in tertiary syphilis

A

Painless nodules with scaling in arcuate patterns on face or back.

Subcutaneous Granulomatous Gumma - Ulcerate, scar and may never heal

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39
Q

Seborrhoeic Keratoses

A 
Warty (rough) surface
Stuck on appearance
Multiple 
No malignant potential 
Keratotic plugs may be seen on surface.
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40
Q

Actinic Keratoses

A

Solitary or multiple lesions on sun exposed areas.
Erythematous, scaly macule/plaque/papule
Few mm to 2cm diameter.

1% progress to SCC

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41
Q

Management of Seborrhoeic Keratosis

A

Reassurance about benign nature.

Curettage, cryosurgery and shave biopsy for cosmetic reasons.

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42
Q

Management of Actinic Keratoses

A

Sunscreens and skin protection

Topical therapy:
Diclofenac (Solaraze)
5-FU (Efudix)
Immune modulator (Aldara)

Rarely, excision/cryotherapy/curettage)

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43
Q

Benign Naevi

A 
End of mole lifecycle 
Round 
Well demarcated 
Smooth
Dome-shaped 
Variable pigment
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44
Q

Keratoacanthoma

A

“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.

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45
Q

Management of Keratoacanthoma

A

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.

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46
Q

Presentation of Bullous Pemphigoid

A

Elderly
Tense, thick-walled blisters over an erythematous rash
Rarely affects the mouth
IgG in basement membrane

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47
Q

Management of bullous pemphigoid

A

Prednisolone 30-60mg/day or steroid sparing tx (azathioprine)
Self limiting

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48
Q

Presentation of pemphigus

A

Elderly
Flaccid, thin walled blisters over normal skin (blisters have usually burst when presenting)
Commonly affects mouth

IgG in epidermis

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49
Q

Management of pemphigus

A

Prednisolone 100-300mg/day or steroid-sparing tx (azathioprine)

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50
Q

Features of Dermatitis Herpetiformis

A

Autoimmune, blistering skin condition associated with coeliac disease. Caused by IgA deposition in the dermis.

Itchy, vesicular lesions on extensor surfaces (elbows, knees, buttocks)

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51
Q

Management of Dermatitis Herpetiformis

A

Gluten free diet

Dapsone (antibacterial)

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52
Q

Secondary Care referral in burns

A

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

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53
Q

Pathophysiology of Compartment syndrome in severe burns

A

Release of inflammatory cytokines causing extravasation of fluids from burn site - hypovolaemic shock and increased haematocrit

Sequestration of fluid into 3rd space

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54
Q

Complications of severe burns

A

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

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55
Q

Management of superficial epidermal burns

A

Analgesia and emollients

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56
Q

Management of Superficial dermal burns

A 
Cleanse wound
Leave blisters intact
Non adherent dressing 
Avoid topical creams
Review in 24 hours
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57
Q

Burns patients at risk of dehydration

A

Adults with 15+% burns

Children with 10+% burns

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58
Q

24 hour fluid requirement in burns patients

A

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

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59
Q

Escharotomy

A

Division of burnt tissue
Indicated for:
- Circumferential, full thickness burns to torso or limbs

Improves ventilation or relieves compartment syndrome

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60
Q

Presentation of erythroderma

A

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

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61
Q

Aetiology of erythroderma

A

Usually eczema or psoriasis +/- abrupt withdrawal of topical steroids

May also be due to drug eruption, leukaemia, lymphoma or Sezary syndrome

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62
Q

Management of erythroderma

A

Hospital admission

Regular obs
Keep warm - 30-32C room
Fluid balance and monitoring

Emollients and topical steroids

Treat underlying cause

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63
Q

Pathology of acute eczema

A

Oedema in epidermis causes keratinocytes to separate.
Formation of epidermal vesicles.
Dermal vessels dilate so inflammatory cells can invade dermis and epidermis

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64
Q

Pathology of chronic eczema

A

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.

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65
Q

Criteria for diagnosis of atopic eczema

A

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

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66
Q

Presentation of atopic eczema in infants

A

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

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67
Q

Presentation of atopic eczema in children

A

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)

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68
Q

Presentation of atopic eczema in adults

A

Ill-defined, erythematous, pruritic rash on flexures or hands
Stress associated

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69
Q

Eczema Herpeticum

A

HSV infection seen in patients with eczema

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70
Q

Molluscum contagiosum

A

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
Q

Management of Eczema

A

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
Q

Seborrhoeic Dermatitis

A

Overgrowth of commensal yeast - Malassezia

Scaly eruption on scalp and eyebrows. Treat with mild topical steroids and anti yeast shampoos

73
Q

Discoid Eczema

A 
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
Q

Venous Eczema

A

Lower legs
Haemosiderin pigmentation around angles +/- fibrosis of dermis

Tx: Emollients +/- steroid ointment

75
Q

Class I topical Steroids

A

Very potent
Dermovate/Clobetasol propionate 0.05%

For acute flare ups. Avoid on face and skin flexures.

76
Q

Class II topical steroids

A

Mometasone furoate/Elocon

For acute flare ups. Avoid on face and skin flexures.

77
Q

Class III topical steroids

A

Clobetasone butyrate 0.05%/Eomovate

For short bursts/courses

78
Q

Class IV topical steroids

A

Hydrocortisone 1%

Face, flexures and small infants

79
Q

Benefits of topical immunomodulators e.g. Tacrolimus

A

Reduce local T cell activation, therefore antiinflammatory effect without causing skin thinning or atrophy.

Steroid-sparing

80
Q

Description of rash seen in Tinea

A

Annular lesions (ring-shaped)
Plaques, with scaling and erythema, especially at the edges.
May have inflammatory papules and pustules.

81
Q

Tinea corporis

A

Ringworm affecting trunk or limbs

82
Q

Tinea Manuum

A

Ringworm affecting hand

Unilateral, powdery scaling of palm

83
Q

Tinea cruris

A

Ringworm affecting groin

84
Q

Tinea capitis

A

Ringworm affecting scalp and hair.

Causes alopecia

85
Q

Tinea unguium

A

Ringworm affecting nails esp. big toe

86
Q

Tinea pedis

A

Athlete’s foot

Usually between 4th and 5th toe

87
Q

Management of Tinea/Ringworm

A

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
Q

Duration of treatment for fingernail tinea

A

6 weeks

89
Q

Duration of treatment for toenail tinea

A

3 months

90
Q

Monitoring with Terbinafine

A

LFTs before treatment and 4-6 weekly

91
Q

Management of seborrhoeic dermatitis

A

Scalp - shampoo (coal tar, ketoconazole)

Face/Trunk/Flexures - topical imidazole +/- hydrocortisone OR Oral itraconazole

92
Q

Pityriasis Rosea

A

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
Q

Pityriasis versicolor

A

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
Q

What is thrush?

A

Genital candida albicans

95
Q

Presentation of thrush

A

Pruritic, sore, vulvovaginitis with white plaques
White discharge
Males & females may be affected.

96
Q

Intertrigo

A

Candida albicans infection of the submammary, axillary or inguinal folds.
Gives a moist, glazed, macerated appearance

97
Q

Management of cutaneous candida

A

Keep areas dry with dusting powder. Stop systemic antibiotics.

Topical imidazole (Cream, powder, pessary)

Systemic Itraconazole or fluconazole

98
Q

Management of thrush

A

Clotrimazole/Enoconazole pessary OR

Itraconazole/Fluconazole PO

99
Q

Presentation of Lichen Planus

A

Rash: Pruritic, Purple, Papular on palms, soles, genitalia and flexor surfaces.
White lace pattern on surface

100
Q

Management of lichen planus

A

Self limiting

Oral steroids improve symptoms

101
Q

Lichen planus-like drug eruption

A

Hyperpigmented rash in response to gold, quinine or thiazides.
Increased eosinophils on histology

102
Q

Presentation of lichen sclerosus

A

Porcelain white atrophic lesions of the genitalia.
Pruritic and sore
Women > men (10:1)
Can progress to SCC

103
Q

Management of lichen sclerosus

A

Steroid cream to reduce itch and prevent scarring
Circumcision of males
Follow up due to increased risk of vulval cancer (SCC)

104
Q

Risk Factors for malignant melanoma

A 
FHx
UV exposure
Skin type I or II
DNA repair defects
Immunosuppression
105
Q

Criteria for diagnosis of melanoma

A

Major

  • Change in size
  • Change in shape
  • Change in colour

Minor

  • Diameter > 6mm
  • Inflammation
  • Oozing or bleeding
  • Itch or sensation
106
Q

Hutchinson’s sign

A

Pigmentary spread from nail to proximal nail fold
Highly suggestive of melanoma
Check for history of nail trauma

107
Q

Description of Superficial Spreading Melanoma

A 
50% of all british cases
Female preponderance
20-60 yrs 
Lower leg
Asymmetrical
Different colours
108
Q

Description of Nodular Melanoma

A 
25% of british patients 
Male preponderance 
20-60 yrs 
Trunk 
May be pigmented 
Nodule - Proud to the skin
109
Q

Description of lentigo maligna melanoma

A

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
Q

Description of acral lentiginous melanoma

A 
1 in 10 of British cases
Usually dark skinned 
Palms, soles and nail beds
Often diagnosed late
Poor survival
111
Q

Which has a poorer prognosis, vertical or horizontal growth in melanoma?

A

Vertical

112
Q

Breslow Thickness

A

Distance from granular layer to deepest portion of the skin that contains melanoma cells.
Increases thickness = increased likelihood of mets and death.

113
Q

Management of melanoma

A

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
Q

Presenting complaint for BCC

A 
Skin lesion
Long history (>1 yr)
Slow growing 
No pain or itch
Intermittent bleeding, scab formation
Poor healing 
\+/- Ulceration
115
Q

Nodular BCC

A 
Well defined papule or nodule 
Shiny, rolled edges
Telangiectasia 
Progressive ulceration 
On head or neck
116
Q

Superficial BCC

A 
Patch or plaque
Pearly margins
Telangiectasia 
Trunk or limbs 
(Resembles psoriasis)
Likely to be incompletely excised
117
Q

Types of BCC

A

Nodular
Superficial
Pigmented - difficult to distinguish from melanoma
Morphoeic - difficult to diagnose

118
Q

Management of Superficial BCCs

A

Immunomodulatory cream (Imiquimod, 5-FU), curettage, cryotherapy. (photodynamic therapy if large)

119
Q

Management of nodular BCCs

A

Excision with 4mm margin

120
Q

Management of morphoeic BCC on the nose (ill-defined edges)

A

Mohs surgery

121
Q

Bowen’s disease

A 
Elderly females 
Well demarcated, scaling, erythematous plaques
Usually on legs 
Slow growing
Asymptomatic
Often misdiagnosed as psoriasis
122
Q

Presentation of SCC

A

Hyperkeratotic, crusting lesion on ear or lip
Indurated or firm
+/- Ulceration

Associated with HPV, scarring and chronic ulceration

123
Q

Management of Bowen’s disease

A

Sunscreens

Topical therapy:
Diclofenac (Solaraze)
5-FU (Efudix)
Immune modulator (Aldara)

Physical Destruction (Cryo/Curettage)

Photodynamic Therapy

Excision

124
Q

Management of SCC

A

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
Q

Polymorphic eruption of pregnancy

A

Pruritic rash
Initially affects abdominal striae

Periumbilical sparing.

During last trimester

Mx: Emollients THEN topical steroids THEN oral steroids

126
Q

Pemphigoid gestationis

A

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
Q

Intrahepatic Cholestasis of pregnancy

A

Pruritus due to elevated serum bile acids. Resolves 1-2 days after delivery.

Mx: Ursodeoxycholic acid

128
Q

Atopic Eruption of Pregnancy

A

Pruritic rash in patients with history of atopy

During 1st and 2nd trimester.

Treat as in eczema

129
Q

Immune cells associated with psoriasis

A

T cells

130
Q

Rash seen in psoriasis

A

Well-defined, disc-shaped, erythematous plaques with white scale.
Involves elbows, kness, hair margin and sacrum.

131
Q

Guttate psoriasis

A

Acute, symmetrical eruption
Teardrop lesions with little scale
Usually on trunk and limbs
Following streptococcal throat infection

132
Q

Palmoplantar pustulosis

A

Yellow-brown sterile pustules on palm or soles.
Middle-aged women
Smokers

133
Q

Nail changes in psoriasis

A

Pits
Onycholysis
Oily or salmon pink discolouration
Subungual hyperkeratosis

Often associated with arthropathy

134
Q

Management of psoriasis

A

Topical therapy

  • Calciprotriol (Vit D analogues)
  • Steroids
  • Coal tar
  • Dithranol
  • Vit A analogues

Phototherapy - UVB or PUVA

Systemic Therapy

  • Ciclosporin or azathioprine
  • Isotretinoin
135
Q

Topical therapy which can be combined with UVB

A

Calcipotriol, Coal tar or dithranol

136
Q

Problems with coal tar

A

Smelly and messy

137
Q

Problems with Dithranol

A

Purple-brown staining of skin so must protect surrounding skin with white, soft paraffin
Must be washed off after 30 mins

138
Q

First line treatment of psoriasis

A

Topical Calcipotriol (Vit D analogue)

139
Q

PUVA

A

Psoralin + UVA

140
Q

Presentation of scabies

A

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
Q

Management of scabies

A

Treat all contacts.

Topical Permethrin cream (leave on for 12-24 hrs)

Oral ivermectin if topical treatment is not effective.

142
Q

Pediculosis

A

Lice - pubic, head or body

143
Q

Presentation of pubic lice

A

Sexually transmitted
Young adults
Intense itching → excoriation and secondary infection.

144
Q

Presentation of head lice

A

Itchy head
Head-to-head contact
School children
Nits (egg cases) can be seen

145
Q

Presentation of body lice

A

Diffuse itch

Body louse is seen in vagrants living in unhygienic conditions, spread by infested bedding/clothing.

146
Q

Management of lice

A

Topical Malathion or permethrin

Treat sexual partners if pubic.
Wet combing if head.
Tumble dry clothing if body.

147
Q

Presentation of Venous Leg Ulcers

A

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
Q

Presentation of Arterial Leg ulcers

A

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
Q

ABPI in venous peripheral vascular disease

A

> 0.8

150
Q

ABPI in arterial peripheral vascular disease

A

< 0.5

OR > 1.3 if arterial calcification has occurred.

151
Q

Management of venous leg ulcers

A

Compression therapy
Pain control
Local wound care

ABPI must be > 0.8 to begin compression therapy.

152
Q

Management of arterial leg ulcers

A

Pain control

Referral for vascular surgery - consider amputation if severe

153
Q

Virus responsible for common viral warts

A

HPV 2, 27 and 57

154
Q

Presentation of common viral warts

A

Dome-shaped papules or nodules, with papilliferous surface. Surface interrupts skin lines.

Often associated with nail or skin biting.

155
Q

Presentation of plane viral warts

A

Smooth, flat topped papules, occasionally brown

156
Q

Virus responsible for plane viral warts

A

HPV 3 and 10

157
Q

Management of common viral warts

A 
Topical Salicylic and lactic acids (Avoid in atopic eczema)
Topical Glutaraldehyde (Avoid in atopic eczema)

Cryotherapy - painful, may cause blistering.

158
Q

HPV responsible for plantar viral warts

A

1,2, 4, 27 and 57

159
Q

Presentation of plantar viral warts

A

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
Q

Management of plantar viral warts

A

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
Q

Verruca

A

Mosaic plantar warts. Fine, red-brown threads in the lesion (thrombosed capillaries)

162
Q

HPV responsible for Anogenital viral warts

A

6 and 11

163
Q

Presentation of Anogenital viral warts

A

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
Q

Management of HPV

A 
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
Q

Presentation of HSV Type I

A

Childhood
Often subclinical

Vesicles on lips and mucous membranes quickly erode and are painful.

Fever, malaise and local lymphadenopathy.

166
Q

Herpetic Whitlow

A

Painful HSV I vesicle or pustule on a finger. May be seen in a dentist who has treated someone with HSV I

167
Q

Presentation of HSV II

A

After sexual contact in young adults.

Vulvovaginitis or penile or perianal regions.

168
Q

Management of pregnant female with HSV II

A

Requires C-section if pregnant women is culture positive for genital HSV.

169
Q

Complications of HSV

A

Eczema herpeticum - widespread HSV in patients with atopic eczema
Carcinoma of cervix
Erythema multiforme (HSV is the most common cause of recurrent EM)

170
Q

Management of HSV

A

Aciclovir

Barrier contraception if type II

171
Q

Presentation of HZV

A

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
Q

Management of VZV

A

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
Q

Management of post-herpetic neuralgia

A

Topical caspaicin

Clinical Medicine (9 decks)

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