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Dermatology Flashcards

1
Q

How are steroids used in eczema?

A

Use the weakest steroid cream which controls symptoms

Mild:
Hydrocortisone 0.5-2.5%

Moderate:
Betnovate RD (betamethasone valerate 0.025%)
Eumovate (clobetasone butyrate 0.05%

Potent:
Cutivate (luticasone proprionate 0.05%)
Betnovate (betamethasone valerate 0.1%)

Very potent:
Dermovate (clobetasol proprionate 0.05%)

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2
Q

How is eczema managed?

A

General emollients +/- steroids

Continue treatment for 48h after flare has been controlled (aim max 5 days)

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3
Q

When should you refer eczema to secondary care?

A
  • Uncertain diagnosis
  • Uncontrolled eczema (>1/2 flares monthly)
  • Facial eczema poor reponse
  • Contact allergic dermatitis suspected
  • Recurrent secondary infection
  • Significant social or psychological problems

Eczema herpeticum - rapidly progressing painful rash with monomorphic punched out erosions (ulcerated)
Admit for IV aciclovir

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4
Q

What is pompholyx? How is it managed?

A

aka dyshidrotic eczema

  • Affects hands and feet
  • Precipitated by humidity and high temperatures
  • Intensly itchy blisters on palms and soles

Management:
- Cool compresses and emolients +/- topical steroids

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5
Q

How is psoriasis managed?

A

1st line:
Potent corticosteroid OD + vit D analogue (one in morn one in eve) for up to 4 weeks as initial treatment

2nd line (no improvement after 8 weeks):
Vitamin D analogue BD

3rd line (no improvement after 8-12 weeks):
Potent steroid BD for up to 4 weeks or coal tar preparation OD

Can also use short-acting dithranol

Use alongside emollients

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6
Q

How is scalp psoriasis managed?

A

Potent topical corticosteroids OD for 4 weeks

If nil improvement use a different formulation (eg. shampoo/mousse) or agents to remove scale (eg. salicylic acid) before application of the steroid

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6
Q

How are face, flexural and genital psoriasis managed?

A

Mild-moderate potency corticosteroid OD/BD for a maximum of 2 weeks

Reduced time as these areas are prone to steroid atrophy

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7
Q

How long should steroids be used for?

A

Potent - 8 weeks max
Very potent - 4 weeks max

Should have a 4 week break before starting another course

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8
Q

How do
a) vitamin D analogues work?
b) dithranol work?

A

a) eg. calcipotriol (dovonex), calcitriol, tacalcitol

  • Work be decreasing cell division and differentiation to decrease epidermal proliferation
  • Can be used long time
  • Avoid in pregnancy

b) - Inhibits DNA synthesis
- Wash off after 30 mins as can burn/stain

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9
Q

What is the pathophysiology of psoriasis?

A
  • Multifactorial and not fully understood
  • Associations with HLA-B13-B17 and -CW6
  • Abnormal T cell activity stimulates keratinocyte proliferation
  • Can be worsened be environmental factors eg. trauma, strep infection
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10
Q

What are the different types of psoriasis?

A
  1. Plaque psoriasis: the most common sub-type resulting in the typical well-demarcated red, scaly patches affecting the extensor surfaces, sacrum and scalp
  2. Flexural psoriasis: in contrast to plaque psoriasis the skin is smooth
  3. Guttate psoriasis: transient psoriatic rash frequently triggered by a streptococcal infection. Multiple red, teardrop lesions appear on the body
  4. Pustular psoriasis: commonly occurs on the palms and soles
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10
Q

What are the complications/associations of psoriasis?

A
  • Psoriatic arthropathy
  • Metabolic syndrome
  • CV disease
  • VTE risk increased
  • Psychological distress
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11
Q

What nail changes are seen with psoriatic arthropathy?

A
  • Pitting
  • Oncholysis
  • Subungual hyperkeratosis
  • Loss of nail
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12
Q

Which factors can exacerbate psoriasis?

A
  • Trauma
  • Alcohol
  • Drugs - B-blockers, lithiu, antimalarials, NSAIDs, ACEis, infliximab
  • Withdrawal of systemic steroids
  • Strep infection (guttate)
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13
Q

What is Auspitz sign?

A

Red membrane with pinpoint bleeding - seen after remove of scale in psoriasis

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14
Q

What are the 2 types of contact dermatitis?

A
  1. Irritate - non-allergic due to weak acids or alkalis. Often on hands. Erythema typical
  2. Allergic - type 4 hypersensitivity reaction due to hair dye. Often on scalp, acute weeping eczema. Treat with potent steroid.

Cement can cause BOTH

Diagnose with skin patch test

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15
Q

What is urticaria? How is it managed?

A

Allergic (or non-allergic) swelling of the skin

Treat with non-sedating antihistamines
Prednisolone if severe

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16
Q

What is dermatitis herpetiformis?

A

`Autoimmune blistering skin disorder associated with coeliac

Caused by deposition of IgA in granular pattern in upper dermis (can be seen on skin biopsy with immunofluorescence)

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17
Q

How is dermatitis herpetiformis managed?

A
  • Gluten-free diet
  • Dapsone (antibiotic)
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18
Q

What is impetigo?

A

A bacterial skin infection by staph aureus or strep pyogenes

Common in children, spread by direct contact with discharge from scabs - incubation period 4-19

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19
Q

How is impetigo managed?

A

1st line - Hydrogen peroxide 1% cream
2nd line - Topical fusidic acid
3rd line - Topical mupirocin

Extensive disease - oral fluclox (erythromycin if pen allergic)

Exclude childern from school until lesions are crusted and healed or 48h after commencing abx

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20
Q

What is seborrhoeic dermatitis?

A

Chronic dermatitis secondary to proliferation of a fungas called malassezia furfur

Features:
- eczematous areas on sebum rich areas
- otitis externa and blepharitis

Associations:
- HIV
- PD

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21
Q

How is seborrhoeic dermatitis managed?

A

SCALP:
1st line - Ketoconazole 2% shampoo
2nd line - zinc/tar preparations
3rd line - selenium, topical corticosteroids

FACE/BODY:
1st line - topical antifungals
2nd line - short course topical steroids

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22
Q

What is tinea? What are the 3 main types?

A

Dermatophyte fungal infections:
- Tinea capitis (scalp)
- Tinea corporis (trunk, leg, arms)
- Tinea pedis (feet)

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23
Q

What are the features of tinea capitis? How is it treated?

A
  • Commonly caused by trichophyton tonsurans
  • Can be due to microsporum canis from cats/dogs
  • Diagnose with scalp scrapings
  • If untreated may become a kerion (spongy/boggy mass)

Management:
- Oral antifungals; terbinafine for TT and griseofulvin for MC infections
- Topical ketoconazole for first 2 weeks to reduce transmission

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24
Q

What are the features of tinea corporis? How is it managed?

A
  • Caused include trichophyton rubrum/verrucosum (cattle)
  • Well defined annular erythematous lesions with pustules and papules

Management:
- Oral fluconazole

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25
Q

What are the features of tinea pedis (athletes foot)? How is it managed?

A
  • Itchy, peeling skin between toes

Management:
- Topical terbinafine

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26
Q

How is a Wood’s lamp used in tinea diagnosis?

A

Lesions due to trichophyton species do not readily fluoresce under a Woods lamp

Management:
- topical terbinafine/-zole
- mild steroid if inflammed

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27
Q

What is onchomycosis? How is it managed?

A
  • Fungal nail infection, usually due to dermatophytes )eg. trichophyton)
  • Can be caused by candida
  • Investigate with nail clippings and scrapings

Management:
- No treatment if asymptomatic
- If confirmed organism, start topical treatment with amorolfine nail lacquer for 6-12 months
- If more extensive dermatophyte involvement start oral terbinafine (check LFTs) for 3-6 moths
- If more extensive candida involvement start oral itraconazole weekly

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28
Q

What are the features of scabies? How is it managed?

A

Features:
- Caused by sarcoptes scabiei mite which burrows into the skin, laying its eggs in the stratum corneum
- Itch is due to a delayed type 4 hypersensitivity reaction
- Widespread pruritus, linear burrows

Management:
1st line - permethrin 5%
2nd line - malathion 0.5%
Treat household and close physical contacts at same time and apply all over - allow to dry and leave on skin before washing off. Repeat treatment 7d later.

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29
Q

What are the features of bullous pemphigoid?

A
  • Sub-epidermal blistering of skin due to development of antibodies against hemidsemosomal proteins BP180/BP 230 (autoimmune)
  • Common in older patients
  • Itchy, tense blisters around flexures
  • Absence of mucosal involvement
  • Skin biopsy shows IgG and C3 at dermoepidermal junction
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30
Q

How is bullous pemphigoid managed?

A
  • Refer to dermatology for biopsy and diagnosis
  • Oral corticosteroids +/- immunosuppresants
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31
Q

What are the features of pemphigus vulgaris?

A
  • AI disease caused by antibodies against desmoglein 3
  • More common in Ashkenazi Jewish population
  • MUCOSAL ULCERATION and skin blistering
  • Skin biopsy shows acantholysis (absent in bullous pemphigoid)
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32
Q

How is pemphigus vulgaris managed?

A
  • Steroids +/- immunosuppresants
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33
Q

What is chondrodermatitis nodular helicis? How is it managed?

A
  • Common benign painful nodule that develops on the ear
  • Due to persistne pressure eg. sleep position, headset

Management:
- Foam ear protectors to reduce pressure
- Cryotherapy, steroid injection, collagen injection
- High recurrence rate

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34
Q

What is a dermatofibroma? How is it managed?

A

AKA histiocytoma
- Common benign fibrous skin lesion
- Usually secondary to trauma
- 5-10mm firm papule typically located on limb

Management:
- Nil required ?surgical

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35
Q

What are keloid scars? How are they managed?

A
  • Tumour-like lesions that arise from the connective tissue of a scar
  • More common in those with dark skin and in young adults

Management:
- Reduce incidence by making incisions along relaxed skin tension lines
- Intra-lesional steroids eg. triamcinolone if early
- Excision if severe

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36
Q

What is a keratoacanthoma? How is it managed?

A
  • Benign epithelial tumour
  • Initially smooth then grows to crater/volcano

Management:
- Spontaneous regression within 3 months is common
- Urgently excise all lesions to exclude SCC

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37
Q

What is an actinic keratosis? How is it managed?

A
  • Common premalignant skin lesion secondary to sun expoure
  • Tend to be crusty or scaly

Management:
- 2-3 week course of topical fluorouracil (may require topical steroids for inflammation)
- Topical diclofenac if mild
- Topical imiquimoid
- Cryo/curettage

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38
Q

What is a seborrhoeic keratosis? How is it managed?

A
  • Epidermal skin lesion seen in older people
  • Stuck on appearance (less crusty than AKs)

Management:
- Reassurance
- Can remove if annoying

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39
Q

What are the 3 main types of skin cancer?

A
  1. Basal cell carcinoma
  2. Squamous cell carcinoma
  3. Melanoma
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40
Q

What are the features of BCC? How is it managed?

A

Features:
- Rodent ulcers, slow growing and locally invasive
- Most common type is nodular
- Initially pearly, flesh coloured papule with telangectasia, but may ulcerate later leaving a crater

Management:
- Refer routinely to Derm
- Surgical/curettage/cryotherapy/topical creams/radiotherapy

41
Q

What are the features of SCC and the risk factors?

A

Features:
- Rapidly expanding painless ulcerate nodules, cauliflower appearance with bleeding
- Rare to metastasize

Risk factors:
- Sun exposure
- AKs and Bowens disease
- Immunosuppression
- Smoking
- Marjolin’s ulcers
- Genetic conditions

42
Q

How are SCCs managed?

A

<20mm - excise with 4mm margin
>20mm - excise with 6mm margine

Mohns micrographic surgery if high-risk or cosmetically important site

43
Q

When should a ?MM be referred 2WW?

A

Weighted 7 point checklist (refer if 3 or more)

Major features (2):
- Change in size
- Irregular shape
- Irregular colour

Minor features (1):
- Largest diameter 7mm or more
- Inflammation
- Oozing
- Change in sensation

Also refer if pigmented nail changes, persistent skin condition, any doubt or biopsy confirmed

44
Q

What is the most prognositc indicator in malignant melanoma?

A

Breslow thickness
<0.75mm - 95-100% survival
0.76-1.50mm - 80-96% survival
1.51-4mm - 60-75% survival
>4mm - 50% survival

45
Q

How is malignant melanoma managed?

A
  • Surgery
  • Radiotherapy
  • Targeted drugs/immunotherapy
46
Q

How is acne characterised?

A

Mild: open and closed comedones with or without sparse inflammatory lesions
Moderate: widespread non-inflammatory lesions and numerous papules and pustules
Severe: extensive inflammatory lesions, which may include nodules, pitting, and scarring

47
Q

How is mild to moderate acne managed?

A

1st line - 12 week course of either:
- Topical adapalene + topical benzoyl peroxide
- Topical tretinoin + topical clindamycin
- Topical benzoyl peroxide + topical clindamycine

48
Q

How is moderate to severe acne managed?

A

1st line - 12 week course of either:
- Topical adapalene + topical benzoyl peroxide
- Topical tretinoin + topical clindamycin
- Topical adapalene + topical benzoyl peroxide + ORAL LYMECYCLINE/DOXYCYCLINE
- Topical azelaic acid + ORAL LYMECYCLINE/DOXYCYCLINE

Avoid tetracyclines if pregnant (erythromycin instead)/breastfeeding/below 12
If containing abx should stop after 6 months

2nd line - COCP (dianette 3 months, high VTE risk), oral isotretinoin (specialist)

49
Q

What complication may occur due to long term abx use in acne and how is it managed?

A

Gram-negative folliculitis > high dose oral trimethoprim

50
Q

What is conglobate acne?

A

A rare and severe form of acne found in men which presents with extensive inflammatory papules, suppurative nodules +/- sinuses, and cysts on the trunk

REFER TO DERM!

51
Q

What are the features of pityriasis rosea? How is it managed?

A
  • Acute self limiting rash in young adults
  • Likely due to HHV-7 virus
  • Herald patch seen on trunk, followed by erythematous oval scaly patches producing a ‘fir tree apperance’

Management:
- Self limiting, goes away after 6-12 weeks

52
Q

What are the features of pityriasis versicolor? How is it managed?

A
  • Superfical cutaneous fungal infection due to malassezia furfur
  • Hypopigmented patches that come out in the sun, mildly itchy

Management:
- Topical ketoconazole
- 2nd line oral itraconazole

53
Q

What is vitiligo? How is it managed?

A
  • Autoimmune condition causing loss of melanocytes and depigmentation
  • Assoc with T1DM, addisons, thyroid, pernicious anaemia, alopecia areata
  • May be preciptated by trauma (Koebner phenomenon)

Management:
- Sunblock
- Make up
- Steroids may reverse changes if applied early
- Specialist initiation of topical tacrolimus and phototherapy

54
Q

What are the subtypes of alopecia?

A

Scarring:
- Trauma, burns
- Radiotherapy
- Lichen planus
- Discoid lupus
- Tinea capitis

Non-scarring:
- Male pattern baldness
- Drugs
- Iron and zinc deficiency
- Alopecia areata
- Telogen effluvium (hair loss during stress)
- Trichotillomania

55
Q

What is alopecia areata? How is it managed?

A
  • Autoimmune condition causing PATCHY DEMARCATED hair loss

Management:
- Steroids, minozidil, phototherapy, dithranol, contact immunotherapy, wigs

56
Q

What is a pyogenic granuloma? How is it managed?

A
  • A benign, vascular skin lesion that grows rapidly over weeks or months and may bleed
  • Common in young adults and pregnant women
  • Initially a small red spot and rapidly grows to a spherical brown lesion which bleeds/ulcerates

Management:
- Lesions in pregnancy often resolve post-partum
- Otherwise, curettage/cauterisation/cryotherapy/excision

57
Q

What is lichen planus?

A
  • Immune-mediated disorder causing itchy PAPULAR rash on PALMS, soles, genitals, and flexors
  • Polygonal rash with white lines on surface (wickham’s striae)
  • Often have oral involvement (white lace pattern) and nail thinning
  • Can be caused by gold,quinine, thiazides

PURPLE, PRURITIC, PAPULAR, POLYGONAL RASH

58
Q

How is lichen planus managed?

A
  • Potent topical steroids
  • Benzydamine mouthwash for oral lichen planus
  • May require oral steroids or immunosuppression
59
Q

What is lichen sclerosis?

A
  • Porcelain-white atrophic patches on penis or vulva
60
Q

How is lichen sclerosis managed?

A

Cannot be cured; manage symptoms with topical steroids

61
Q

What are the DDx for shin lesions?

A
  • Erythema nodosum
  • Pretibisal myxoedema
  • Pyoderma gangrenosum
  • Necrobiosis lipodica diabeticorum
62
Q

What are the features of erythema nodosum?

A
  • Symmetrical, erythematous, tender nodules which heal without scarring within 6 weeks
  • Due to inflammation of subcutaneous fat
  • Secondary to strep infection, sarcoidosis, IBD, drugs (penicillin, sulphonamides, COCP), malignancy, pregnancy, TB
63
Q

What are the features of pretibial myxoedema?

A
  • Symmetrical, erythematous lesions seen in Graves disease
  • Shiny, orange peel skin
64
Q

What are the features of pyoderma gangrenosum?

A
  • Initially small red papule, later deep red/necrotic ulcer with a violaceous border
  • Idiopathic in 50%
  • Seen in IBD, connective tissue disorders, myeloproliferative disorders
65
Q

What are the features of necrobiosis lipoidica diabeticorum?

A
  • Shiny painless areas of yellow/red skin on shin of diabetics
  • Often associated with telangectasia
66
Q

What is erythema multiforme?

A
  • Hypersensitivity reaction commonly triggered by infection
  • Target lesions seen on hands/feet before spreading to torso and upper limbs
  • Due to viruses (HSV), bacteria, drus, connective tissue disorders, sarcoidosis, malignancy
  • Severe form (major) associated ith mucosal involvement
67
Q

What is Steven-Johnson Syndrome? Which drugs cause it?

A
  • Severe systemic reaction (<10% TBSA) almost always due to a drug
  • Penicillin, sulphonamides, antiepileptics, allopurinol, NSAIDs, COCP
  • Maculopapular with target lesions that blister and mucosal involvement
  • Associated with systemic symptoms
  • Must admit to hospital for supportive treatment
68
Q

What is toxic epidermal necrolysis? How is it managed?

A
  • Life threatening skin disorder secondary to drug reaction
  • SYSTEMIC SYMPTOMS (>30% TBSA)
  • Positive Nikolskys signs (epidermis separates with mild pressure)

Management:
- Stop precipitating factors
- Manage in ICU
- IV immunoglobulin

69
Q

What is livedo reticularis?

A

Purplish, non-blanching reticulated rash caused by obstruction of capillaries and swollen venules

Usually idopathic, can be due to PAN, SLE, antiphospholipid syndrome, EDS, homocystinuria

70
Q

What is mycosis fungoides?

A
  • A rare form of T-cell lymphoma affecting the skin
  • Causes itchy red patches varied in colour
71
Q

What is pellagra?

A

DERMATITIS (brown scaly rash). DIARRHOEA, DEMENTIA, DEATH

Secondary to niacin deficiency often in context of isoniazid therapy or alcoholism

72
Q

What are the features of shingles?

A
  • Reactivation of VZV causing acute, unilateral, painful blistering rash
  • T1-L2 dermatomes affected
  • Painful prodrome for 2-3 days before development of rash
73
Q

How is shingles managed?

A
  • Avoid pregnant women/immunosuppressed until vehicles have crusted over
  • NSAIDs/paracetamol/amitryptiline
  • Oral steroids if immunocompetent
  • Recommend antivirals unless patient <50 and mild case
74
Q

Which skin disorders are associated with diabetes?

A
  • Necrobiosis lipoidica
  • Candidal infection
  • Neuropathic ulcers
  • Vitiligo (T1)
  • Lipoatrophy
  • Granuloma annulare (papular, hyperpigmented, depressed)
75
Q

Which malignancy are the following skin disorders associated with?
a) acanthosis nigricans
b) acquired ichythosis
c) acquired hypertrichosis lanuginosa
d) dermatomyositis
e) erythroderma

A

a) gastric cancer
b) lymphoma
c) GI and lung cancer
d) ovarian and lung cancer
e) lymphoma

76
Q

Which malignancy are the following skin disorders associated with?
a) migratory thrombophelbitis
b) pyoderma gangrenosum
c) sweets syndrome
d) tylosis (yellow feet)

A

a) pancreatic cancer
b) myeloproliferative disorders
c) haem maligancy
d) oesophageal cancer

77
Q

Which skin disorders are associated with pregnancy?

A

Atopic eruption of pregnancy
- Most common, presents as itchy erythematous rash
- No treatment needed

Polymorphic eruption of pregnancy
- Intense itch in last trimester
- Lesions on abdominal striae
- Emollients, mild steroids

Pemphigoid gestationis
- Pruritic blistering lesions
- Peri-umbilical initially
- 2/3 trimester
- Oral steroids

78
Q

How do you differentiate spider naevi and telangectasia?

A

Press on them!
- Spider naevi fill from the centre
- Telangectasia fill from the edge

Spider naevi - liver disease, pregnancy, COCP

79
Q

What is hereditary haemorrhagic telangectasia?

A

AD condition diagnosis by 3 or more of the following:
1. Epistaxis
2. Telangectasia
3. Visceral lesions (AVMs)
4. 1st degree relative

80
Q

How is HHT managed?

A
  • Iron supplemets
  • Treat nosebleeds
  • Blood transfusions
  • Laser treatment of telangectasia
  • Surgical/emoblisation of AVMs
81
Q

What is erythema ab igne? How is it managed?

A
  • Skin disorder secondary to infrared radiation exposure
  • ‘Elderly women sitting next to an open fire’
  • Reticulated, erythematous patches with hyperpigmentation and telangectasia

Management:
- Avoid further exposure
- Topical tretinoin or laser
- If not treated can develop into SCC

82
Q

What causes hirsutism and how is it managed?

A

Cushings, adrenal problems, obesity, steroids, phenytoin

Assess with Ferriman-Gallwey score

COCP/cosmetic
Can give topical eflornithine for facial hirsutism, CI in pregnancy/breastfeeding

83
Q

What causes hypertrichosis?

A
  • Drugs: minoxidil, ciclosporin, diazoxide
  • Congenital
  • Porphyria cutanea tarda
  • Anorexia nervosa
84
Q

How is hyperhidrosis managed?

A
  • Topical aluminium chloride
  • Iontophoresis
  • Botox for axillary
  • Endoscopic transthoracic sympathectomy
85
Q

How are burns managed initially?

A

Immediate:
- ABCDE
- Remove from source
- Within 20 minutes, irrigate with cold water for 10-30 mins
- Cover burn using layered cling film

Refer to secondary care if :
- Deep dermal or full thickness
- Superficial with more than 2/3% TBSA
- Delicate areas
- Inhalation injuries
- Electrical/chemical burn

86
Q

How is severity of burns assessed?

A

Extent:
- Wallaces rule of nines
- Lund and Browder chart
- TBSA (palm = 1%)

Depth:
1. First degree (superficial epidermis) - no blisters
2. Second degree (partial thickness) - blistered, slow CR if superficial dermal, white with non blancing erythema if deep dermal
3. Third degree (full thickness) - white/brown waxy/leathery no blisters or pain

87
Q

What is the pathophysiology of severe burns?

A
  1. Local tissue loss and cytokine release
  2. Fluid loss and third spacing > shock
  3. CV effects and catabolic response
  4. Immunosuppression and sepsis
88
Q

How are severe burns managd?

A
  1. Airway - early intubation if deep burns to face/neck
  2. IV fluids
  3. Insert urinary cathter
  4. Analgesia
  5. May requre escharotomy (3rd deg), excision or skin grafting
89
Q

How do you give IV fluids in severe burns?

A

Give if:
- >10% TSBA in children
- >15% TBSA in adults

Calculat with Parkland fluid and give half total amount in first 8 h

90
Q

What are the complications of burns?

A

Haemolysis
Hypovolaemic shock
Infection
ARDS
Curlings (peptic ulcer that occurs due to hypovolaemia > necrosis)
Compartment syndrome
Scarring

91
Q

What benign skin conditions are seen in babies?

A

Portwine stain > treat with laser therapy or cosmetics

Strawberry hemangioma > propranolol if treatment required (obstructing visual fields or airway, bleeding, ulcerated)

92
Q

How are venous ulcers managed?

A
  • Check ABPI to ensure not arterial
  • Compression bandage
  • Oral pentoxifylline (peripheral vasodilator)
93
Q

What are retinoids uses and their adverse effects?

A

Uses:
- Severe acne

Adverse effects:
- Teratogenic
- Dry skin
- Low mood
- Raised triglycerides
- Hair thinning
- Intracranial hypertension (dont combine with tetracyclines)
- Photosensitivity

94
Q

What are the features of zinc deficiency?

A
  • Acrodermatitis (red crusted lesions perianal/periorificial)
  • Alopecia
  • Short stature
  • Hypogonadism
  • Hepatosplenomegaly
  • Geophagia (ingesting clay/soil)
  • Cognitive inpairment
95
Q

What are the features of rosacea? How is it managed?

A
  • Erythematous papule/pustular rash on the noses cheeks and forehead
  • Common to have telangectasia
  • May have blepharitis
  • May develop rhinopyma (bulbous nose)

Management:
- High factor suncream
- Topical brimonidine for flushing
- Topical ivermectin for papules/pstules
- Add in oral doxy if severe

96
Q

Which drugs exacerbate psoriasis?

A

Beta blockers
Lithium
Antimalarials
ACEis
Infliximab
NSAIDs

BLAAIN

97
Q

What are the different options for allergy tests and when are they used?

A

Skin prick test:
- Easy and inexpesive
- Can test multiple allergies in one session, wheal develops if allergy
- Useful for food allergies and pollen

Radioallergosorbent test (RAST):
- Blood test or skin prick to determine amount of IgE that reacts with allergens
- Useful for food allergies, inhaled allergens and wasp/bee venom
- Can be used for anaphylaxis

Skin patch test:
- Useful for contact dermatitis
- Patch removed 48h later and interpreted by a dermatologist

98
Q

What is acne conglobata?

A
  • Severe form of acne characterised by burrowing and interconnecting abscesses and irregular scars
  • Comedones and nodules
  • Associated with hydradenitis suppuritiva
99
Q

What is a dermoid cyst?

A
  • Cystic teratoma containing developmentally mature skin
    Often found in young children on lateral aspect of eyebrow
  • Benign
  • If in midline should do MRI to exclude intracranial excision
100
Q

What is a sebaceous cyst?

A
  • aka epidermoid cyst
  • Closed sac or cyst below the surface of the skin that has a lining resembling the infundibulum of a hair follicle
  • Fills with sebum
  • May need I&D
101
Q

What is an pilar cyst?

A
  • Keratin-filled cyst that originates from the outer hair root sheath
  • Commonly found on scalp in middle aged females
102
Q

What is erysipelas?

A
  • A superficial form of cellulitis involving the dermis and upper subcutaneous tissues
  • Borders are WELL DEMARCATED
  • Usually due to streptococcus pyogenes
  • Treat with flucloxacillin

MSRA (24 decks)

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