Dermatology Flashcards by Bethany Fryar

What are some differential diagnoses of an itchy rash in a child?

Scabies
Atopic dermatitis 
Seberrhoeic dermatitis
Chickenpox
Urticaria
Fungal infections

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How is scabies managed?

Scabicidal cream permethrin applied all over the body
All household members treated
Launder all clothing and bedding
Antihistamines for the itching

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Fifth disease is caused by what?

Parvovirus B19

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What is the concern regarding contracting rubella during pregnancy?

Congenital Rubella syndrome (triad of deafness, blindness and congenital heart disease)

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Koplik spots are pathognomonic for what?

Measles (white spots on buccal mucosa)

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Which virus presents in children with a sudden high fever lasting a few days, and a rash that appears 1-2 days after the fever has settled?

Roseola aka sixth disease

Caused by human herpes virus 6

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As well as a purpuric rash, Henoch-Schonlein Purpura has a classic triad of which 3 symptoms?

Arthralgia
Abdominal symptoms
Haematuria

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What is the likely diagnosis for an erythematous, raised lesion developing in the first few weeks of life?

Strawberry naevus aka capillary hemangioma

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What are strawberry naevus?

Haemangioma which occurs during infancy, usually on the face or scalp
Present within first few weeks of life and increase in size until about 6-9 months old when they regress over a few years

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Molluscum contagisoum is due to what?

Molluscum contagiosum virus, a member of the Poxvirus family

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What management plan would you give for a patient with molluscum contagiosum?

Reassure that it is self limiting

Avoid sharing towels and clothes etc as it is contagious

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Rose pink macules in a Christmas tree distribution on the trunk is characteristic of what rash?

Pityriasis rosea

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A 12 year old child presents with itchy tear drop scaly papules on her trunk. She had a streptococcal throat infection 3/52 ago. What is the most likely cause of her rash?

Guttate psoriasis

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What condition is an indication for high dose aspirin in children?

Kawasaki disease

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Koplick spots are pathognomonic for which infection?

Measles

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What causes Scarlet fever?

Group A beta haemolytic strep, commonly Strep pyogenes

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How is scarlet fever managed?

Penicillin V 10 days

As it is the only childhood maculopapular rash caused by bacteria

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How does Scarlet fever typically present?

Strawberry tongue
Sandpaper rash
Red, flushed cheeks

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What is the management of Kawasaki disease?

IV immunoglobulin
High dose aspirin, then taper to a lower dose
ECHO (due to risk of coronary artery aneurysm)

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What are some complications of Scarlet fever?

Post strep glomerulonephritis
Rheumatic fever
Reactive arthritis

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What will blood tests show in Kawasaki disease?

Low WCC
Raised ESR
Raised CRP
Raised platelets (hence why aspirin is given as tx to be anti platelet)

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What is the cause of slapped cheek syndrome?

Parvovirus B19

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Which viral exanthemas presents with a red rash on the cheeks follow by an itchy maculopapular lace like rash on the trunk and limbs?

Fifth disease/ slapped cheek syndrome

Wickham’s striae are seen in which condition?

Lichen planus, especially oral

Which topical steroids are suitable for use on delicate areas of skin?

Hydrocortisone (least potent) | Eumovate

Which is the most potent topical steroid?

Dermovate

What causes acne?

``` Increased androgens (during puberty) stimulate sebaceous gland hyperplasia and increased serum production Infection of sebaceous gland by Propionibacterium Acnes Inflammation leads to comedones, pustules ```

What topical therapies would you use to manage acne?

Topical benzoyl peroxide Topical retinoids Topical Abx

What manage would you give to acne that is persistent despite trying all of the topical therapies?

Oral Abx Oral COCP if female and contraception required Oral isotretinoin

What topical treatments can help rosacea?

Emollient soap substitutes Topical ivermectin first line Or topical metronidazole Avoid steroids as this can worsen

What antibiotic can help acne rosacea?

``` Topical metronidazole Oral tetracycline (erythromycin if pregnant) ```

Can steroids be used in rosacea?

No | They can induce rosacea and worsen it

What are common causative organisms of cellulitis?

Staphylococcus aureus | Strep pyogenes

What organism commonly causes erysipelas?

Strep pyogenes

How can cellulitis and erysipelas be distinguished between on visual inspection?

Erysipelas has sharp borders with raised edges | Cellulitis has a more ill-defined edge

Which antibiotic is used to treat erysipelas?

Penicillin V

Which antibiotic is used to treat cellulitis?

Fluxocacillin

What would you use to treat impetigo?

Topical fusidic acid Abx if few lesions | Oral flucloxacillin if extensive

Topical fusidic acid is the 1st line treatment for what?

Impetigo

What are some risk factors for squamous cell carcinoma?

Solar keratoses, Bowen’s Disease, albinism, immunosuppression Chronic UV exposure, type 1 and 2 skin Male, increasing age

Where does melanoma commonly metastasise to?

``` BBLLL Brain Bone Liver Lungs Lymph ```

How does lichen planus present?

Itchy rash Typically on palms and soles, genitals and flexor surfaces of arms 6 P’s: planar, polygonal, purple, pruritis, papules or plaques Sometimes covered with “white lace pattern” = Wickham’s striae

What is Wickham’s striae?

Lichen planus covered in a white lace pattern | Common if oral involvement

Where does lichen planus commonly occur?

Palms and soles Genitals Flexors of arms Oral (Wickham’s striae)

What is the main treatment for lichen planus?

Topical steroids

What are some drugs known to induce Steven Johnson’s/ TEN?

``` Penicillin Phenytoin Allopurinol NSAIDs Carbamazepine ```

What is the difference between Stevens Johnson syndrome and toxic epidermal necrolysis?

SJS involves <10% of total skin surface | TEN involves >30% of total skin surface

What is Nikolsky’s sign?

Seen in SJS/ TEN | Epidermal layer of skin easily sloughs off when pressure is applied

What drugs can exacerbate psoriasis?

Beta blockers NSAIDs ACE Also trauma and alcohol

Pityriasis rosea rash will typically take how long to resolve?

6-12 weeks, self limiting

A young adult presenting with a red patch following a URTI and a few days later lots of red scaly patches is typically of what?

Pityriasis rosea | Self limitng

What drug is recommended prophylaxis for cluster headache?

Verapamil | Acutely 100% O2 and SC Triptan

Which type of melanoma is seen more in dark skinned individuals?

Acral lentiginous melanoma

Which disease is associated with dermatitis herpetiformis?

Coeliac disease | Due to IgA deposits, very itchy

What causes impetigo?

Usually staph aureus or strep pyogenes

What does Breslow thickness measure?

Invasion of melanoma