Dermatology

Question 1

What is eczema?

Answer 1

Itchy, dry inflammatory skin condition

Question 2

What are the different types of eczema?

Answer 2

Atopic
Seborrhoeic 
Varicose 
Pomphylx 
Discoid 
Allergic contact dermatitis
Irritant contact dermatitis
Photosensitive eczema

Question 3

What is the most common type of eczema?

Answer 3

Atopic

Question 4

What is a typical presentation of atopic eczema?

Answer 4

Dry, itchy skin on cheeks of infant, flexural surfaces of children

Skin barrier dysfunction –> loss of water, penetration of irritants/allergens

Question 5

What causes atopic eczema?

Answer 5

Overactive immune response to environmental stimuli –> immune mediated defect in skin barrier function

Abnormality in filaggrin protein which binds keratin together

Question 6

What are common flares for eczema?

Answer 6

Infection, central heating, cold air, pets, teething, stress

Question 7

How can you treat eczema?

Answer 7

Emollients (creams, lotions, ointments) 
Topical steroids (for 1-2weeks BD + wkend dose)
Calcineurin inhibitors
UVB
Immunosuppression

Question 8

What are the steroids we can use on the skin in order of strength?

Answer 8

Mild - hydrocortisone
Moderate - eumovate (25x)
Potent - betnovate (100x)
Dermovate - 600x

Don’t use above eumovate on face

Question 9

What is a typical presentation of seborrheic eczema?

Answer 9

Face and scalp
<3m old
clears up by 12m
Gets infected by Malasseizia yeast –> cradle cap

Question 10

How do you treat seborrheic eczema?

Answer 10

Antifungal cream/shampoo
Emollients
Steroids

Question 11

How does discoid eczema present?

Answer 11

Annular itchy patches

Question 12

How does pomphylx eczema present?

Answer 12

Vesicles on palms/soles

Question 13

How does varicose eczema present?

Answer 13

Oedema/venous insufficiency/varicose veins –> irritation of skin
usually legs which are dry and inflamed/ulcerated

Question 14

How do you treat varicose eczema?

Answer 14

Emollients, topical steroids, compression stockings

Question 15

What is allergic contact dermatitis due to?

Answer 15

Sensitisation of an allergy (commonly diary, soy, wheat, dander, pollen etc.)

Question 16

How might you investigate an allergic contact dermatitis?

Answer 16

Blood test for IgE

Prick testing

Question 17

What features might be suggestive of a food allergy?

Answer 17

Anaphylaxis, GI probs, late reactions, failure to thrive, severe eczema unresponsive to Rx

Question 18

What is treatment for allergic contact dermatitis?

Answer 18

Dietary restrictions >8wks
Eliminate 1 food at a time
Dietician input
Reintroduce to see if allergic

Question 19

What causes irritant contact dermatitis?

Answer 19

Repeated contact with water, citrus, soaps, friction

Question 20

How can you identify photosensitive eczema?

Answer 20

T-shirt lines

Places not struck by sun unaffected

Question 21

What is impetigo? What does it present like?

Answer 21

Superficial bacterial infection

Pustules and honey-crusted erosions

Question 22

What causes impetigo?

Answer 22

Staph aureus

Question 23

How do you treat impetigo?

Answer 23

Fudicin/flucoxacillin

Question 24

What does molluscum contagiosum present like?

Answer 24

Pearly, papules, umbilicated centres
Takes 24m to heal
benign

Question 25

What causes molluscum contagiosum?

Answer 25

Molluscipox virus via direct contact

Question 26

How do you treat molluscum contagiosum?

Answer 26

Molutrex

Question 27

What do viral warts appear like?

Answer 27

Skin coloured, non cancerous growths | Known as veruccas on the foot

Question 28

What causes viral warts?

Answer 28

HPV transmitted by direct contact

Question 29

How do you treat viral warts?

Answer 29

Stimulate immune system against them using cryotherapy or topical paints (like salicyclic acid)

Question 30

What is the presentation of a viral exanthems like?

Answer 30

Viral illness assoc (headache, fever, malaise) | Maculopapular rash

Question 31

What are viral exanthems due to?

Answer 31

Reaction to toxin produced by organism/damage to skin by organism/immune response

Question 32

What diseases can cause viral exanthems?

Answer 32

Chickenpox, parovirus B12 (slapped cheek), measles, rubella, roseola (herpes virus 6)

Question 33

What does chickenpox present like?

Answer 33

Red papules progressing to vesicles starting on trunk Intensely itchy viral symptoms

Question 34

What causes chickenpox?

Answer 34

VZV - which is v contagious from 1-2d before symptoms till lesions crusted over

Question 35

What is rarely associated with chickenpox?

Answer 35

Pneumonia, encephalitis

Question 36

What does slapped cheek present like?

Answer 36

Erythematous rash over cheeks --> lace like network on trunk/limbs takes 6 weeks to fade

Question 37

What cell does parovirus target?

Answer 37

RCs in bone marrow

Question 38

What can parovirus lead to in vulnerable groups?

Answer 38

Aplastic crisis in those with haemolytic anaemia | Hydrops fetalis/IUD in pregnant woman

Question 39

What does hand foot and mouth present like?

Answer 39

Blisters on hands, feet, mouth Viral symptoms Epidemic in late summer/autum

Question 40

What usually causes hand foot and mouth?

Answer 40

Enterovirus - usually coxsackie A16

Question 41

What is orofacial granulomatosis?

Answer 41

Lip swelling/fissuring | May get cobble stone appearance

Question 42

What causes orofacial granulomatosis?

Answer 42

Crohns

Question 43

What is erythema nodosum/

Answer 43

Painful, erythematous nodules over shins | Slow resolution

Question 44

What can cause erythema nodosum?

Answer 44

``` Infections - strep throat, URTI Sarcoidosis IBD Drugs - OCP, sulphonamide, penicillin Mycobacterial infection Idiopathic ```

Question 45

What investigations might you want to do in erythema nodosum?

Answer 45

Serum ACE/check hx of lung probs for sarcoidosis | ASO titre for strep

Question 46

How do you treat erythema nodosum?

Answer 46

Steroids

Question 47

What is dermatitis herpetiformis?

Answer 47

Itchy blisters in clusters on scalp, shoulders, buttocks | Usually symmetrical

Question 48

What is dermatitis herpetiformis linked to?

Answer 48

Coeliac disease

Question 49

What investigations should you do in dermatitis herpetiformis?

Answer 49

Hx Coeliac screening Skin biopsy

Question 50

How do you treat dermatitis herpetiformis?

Answer 50

Emollients Gluten free diet Topical steroids Dapsone

Question 51

What is urticaria?

Answer 51

Wheals/hives Assoc. angioedema LASTS <24H

Question 52

What is chronic vs acute urticaria?

Answer 52

Chronic >6wks, acute <6wks

Question 53

What can cause urticaria?

Answer 53

Viral/bacterial infection, food/drug allergy, NSAIDs/opiates, vaccinations, idiopathic

Question 54

How do you treat urticaria?

Answer 54

Remove triggers Antihistamines (desloratadine) Ranitidine, Montelukast Omalizumab, cyclosporin