Dermatology

Question 1

Name the different types of Psoriasis

Answer 1

Chronic Plaque P (most common) 
Pustular P (second most common) 
Guttate P (follows Group B strep infection) 
Erythrodermic P (medical emergency)

Question 2

What other risks/conditions are associated with Psoriasis?

Answer 2

• increased CVD risk (because autoimmune - increase plasma viscosity)
• increased risk of other autoimmune conditions (HLA associated)
• Nail symptoms

Question 3

How is Psoriasis managed?

Answer 3

• Psoriatic Arthritis suspected - refer to Rheumatology
• > 30% body covered, nail symptoms, pustular or erythrodermic - refer to Dermatology
• mild-moderate Psoriasis - manage in Primary care
  
  • Emollient
  • Topical corticosteroid
  • Topical Vitamin D
• Trigger avoidance

Question 4

What is Pityriasis Rosea?

Answer 4

Viral rash - lasts 6-12 weeks
Patients well with this - usually affects teenagers
Starts with ‘herald patch’ - single oval shaped pink plaque with fine white scales near to edges, well defined border
Then spreads to become a more generalised rash

Question 5

What is Pityriasis vesicolor?

Answer 5

Fungal infection (malassezia) causing hypopigmented generalised rash - treat with topical antifungals (even antifungal shampoo) 
Patients are otherwise well with this

Question 6

What is a Seborrheic wart/Keratosis (aka basal cell papilloma)?

Answer 6

Benign skin lesion - tend to appear in adult life
Highly variable appearance
Usually brown ish colour

Question 7

What is a solar lentigo?

Answer 7

sometimes difficult to distinguish from flat seborrheic keratosis
Flat, pale brown ish, well circumcised patch
Found on sun exposed sites

Question 8

What is an actinic keratosis?

Answer 8

Crusty/scales patch of skin found on sun exposed areas such as scalp
PRECANCEROUS - can progress to SCC

Question 9

What is a Keratoacanthoma?

Answer 9

Clinically difficult to distinguish from SCC
Looks like little volcano
Solid core of keratin eruption from boil
Raised - may have rolled edges

Question 10

What is a lentigo maligna?

Answer 10

Early form of malignant melanoma

Question 11

Why should you not give Amoxicillin if you suspect EBV (glandular fever)?

Answer 11

Induces an itchy extensor maculopapular rash

Question 12

What are the different types of eczema?

Answer 12

• Atopic
• Pomphoylx
• Eczema Herpeticum (more a complication of Atopic - medical emergency!!)
• Discoid
• Varicose
• Seborrheic (adult/infantile - cradle cap - linked to natural yeast)
• Asteatotic
• contact eczema/dermatitis (allergic + more systemic or irritant which is more localised)

Question 13

Describe Atopic eczema lesions

Answer 13

Flexural, discrete, erythmatous, dry, lichenified, slightly raised,

Question 14

What are the 3 principles of treatment of eczema?

Answer 14

• trigger avoidance
• emollients
• topical steroids (apply 10-15 mins after emollient)

Question 15

Name the 6 types of alopecia

Answer 15

Alopecia areata - chronic inflammatory condition
- more severe forms of this = A. Totalis or universalis
Androgenetic alopecia (male pattern Baldness)
Telogen effluvium
Anagen effluvium

Question 16

What is Acne Vulgaris?

Answer 16

Pilosebaceous follicles found in face and upper trunk - secrete excess sebum in response to increased androgen production at puberty - these can get blocked trapping skin commensals within the follicles - pustules, comedones, papules

Question 17

What is Vitiligo?

Answer 17

Autoimmune attack of melanocytes

These people are at higher risk of other autoimmune conditions

Question 18

How does erythema mutiform present?

Answer 18

Hypersensitivity reaction to infections (particularly herpes simplex) - causes characteristic target lesions - can involve mucous membranes - treat conservatively
SJS is now regarded as a separate reaction (more related to medication use)

Question 19

What feature distinguishes acne rosacea from acne vulgaris?

Answer 19

R - absence of comidones, can still have red papules and pustules. Telangetasias commonly feature along with blushing and flushing - tends to affect fair, fat females in their forty’s. Blepharitis commonly associated

V - papules, pustules and comidones (open or closed) and nodules/pseudocysts - more common in adolescents, more scarring and skin more oily

Topical antibiotics to treat both eg. Metronidazole cream
Other treatments may vary slightly eg. Antiandrogens such as COCP in adolescent females

Question 20

What is the treatment for acne rosacea?

Answer 20

• review meds - eg. CCBs can worsen flushing
  Also topical corticosteroids can worsen flare ups - stop these
• Topical metronidazole or Azelaic acid cream
• Oral tetracycline 500mg BD (100mg OD Doxycycline if really impaired)

Question 21

What is the treatment for acne vulgaris?

Answer 21

• Topical antibiotics with benzoyl peroxide (to prevent resistance)
• Topical retinoids (isotretinoin)
• oral antibiotics
• COCP