Dermatology Flashcards
1
Q
Cutaneous adverse drug reactions
A
- Antibiotics maculopapular erythematous
- Erythema= flushing
- Morbilliform= measles like
- Maculo= distinct flat areas
- Papular= raised lesions
- Urticaria (nettle rash)
- Erythema multiforme (Stevens-Johnson syndrome and toxic epidermal necrolysis are life-threatening)
- Sulphonamides, allopurinol, meloxicam, piroxicam, CBZ, lamotrigine, phenytoin and phenobarbitone
2
Q
Penicillin allergy
A
3
Q
Cutaneous adverse drug reactions
A
- Fixed drug eruptions- flat and purple-brown
- Usually only 1 lesion on first exposure. If repeated lesion re-occurs in the same place. Possible only ADR where rechallenge is safe
- Systemic lupus erythematosus (SLE) butterfly rash on face
- Acneform- androgens in women
- Photosensitivity- doxycycline, phenothiazines
- Hair disorders- anticonvulsants- alopecia
4
Q
Fixed drug eruption
A
5
Q
Redman syndrome- vancomycin
A
6
Q
Acne vulgaris
A
- Chronic inflammatory disorder of the sebaceous glands
- Common- affects 80% of the population between 11-30 years
- The increasing resurgence in women in 4th & 5th decade
- Often confined to face (99%), but also back (60%) and chest (15%)
- Concern- can lead to scarring
- Acne effects chest and back rosacea doesn’t important to distinguish between the two
7
Q
Acne- aetiology
A
- Increased sebum production (Often related to puberty)
- Obstruction of the pilosebaceous cyst (comedone)
- The colonisation of the anaerobe Propionibacterium acnes
- Inflammation
- MILD- comedones closed (whiteheads), open (Blackheads)
- MODERATE- open and closed comedones, papules and pustules
- SEVERE- papules, pustules, nodules and cysts
- Can lead to scarring
8
Q
Scarring
A
*
9
Q
treatment of acne
A
- Self-help
- Tropical agents- benzoyl peroxide (essentially peels skin exposes anaerobic bacteria to air = they die) it is very important to gradually increase time you have this on skin for start at 2 minutes and increase to 30 and place on entire area you get spots not just the spot itself, azelaic acid, retinoids, antibiotics
- Comedones- retinoid first
- Inflammatory- benzoyl peroxide first
- Moderate and likely to scar: Oral antibiotics (Tetracyclines/Macrolides) & topical BPO or retinoid
- Cyproterone acetate + ethinylestradiol
- Oral isotretinoin
10
Q
Oral isotretinoin- consultant dermatologist
A
- Teratogenicity- a pregnancy test must be negative up to three days before treatment, every month during treatment and for five weeks after stopping. Treatment should be started on day 2-3 of the menstrual cycle. Barrier methods should not be used alone and progestogen-only contraceptives are not sufficiently effective
- Prescription- Only 30 days may be prescribed at a time. It can’t be faxed and is only valid for seven days. Course- up to 16 weeks
- Avoid exposure to UV light. Use high factor sunscreen and lip salve from the start of treatment
- Can increase both triglycerides, increasing the risk of pancreatitis and ChE, with lowering HDL
- May raise liver transaminase, avoid in hepatic impairment
11
Q
Acne vulgaris- skin care tips
A
- Wash face BD with mild cleanser/antibacterial face wash with lukewarm water, pat dry
- Don’t scrub face or use facial scrubs
- Use light oil-free/ non-comedogenic moisturiser
- When applying topical acne treatment- apply thin film to whole area not just individual spots- washing hands before and after applying
- Make up- use non-comedogenic
- Shaving- wash face in acne wash before- use light moisturiser as a shaving lotion
12
Q
Rosacea
A
- Latin for roses
- Spectrum of facial skin and vascular changes, characterised by
- Flushing- Erythema
- Burning/Tingling sensation
- Telangiectasia
- Skin papules/Lesions
- Rhinophyma
- Central face- usually spares the peri-oral/ peri-orbital area
- Can be continuous or variable flushing episodes
- Avoids folds of the nose
13
Q
A
14
Q
rosacea
A
- Typically presents from 30-60s most common 40s and 50s
- More common in women than men
- Rhinophyma more common in men
- More common in Caucasians, rare in Asians and Africans
- Prevalence about 12%
- Cause uncertain- damage to dermal connective tissue, linked to migraine, susceptibility to Demodex mite
15
Q
Rosacea- 4 types
A
- Erythemato-terlangiecatctic- redness of the central face (Transient or permanent) affected skin feels rough, sometimes telangiectasia, may tingle/burn
- Papulo-pustular- Acne vulgaris, Papules and pustules mainly over cheecks and nose (also forehead, chin and around eyes)
- Phymatous- Lump/swelling, usually of nose (commoner in men)
- Ocular- co-ecists with rosacea
16
Q
Seborrhoeic dermatitis
A
- Nasolabial folds
- Eyebrows, hairline, behind ears; also scalp and upper trunk
- Scaly patches, greasy appearance, rather than discreet lesions
- Yeast- treat with antifungal
17
Q
Treatment of rosacea
A
- Sunscreen- 30 SPF
- Avoidance of irritants and other triggers
- Avoid topical steroids- aggravate rosacea
- Camouflage
- Topical
- Systemic
- Laser therapy (Persistent erythema)
- Surgical debulking (Rhinophyma)
18
Q
Erythematous-telangiectatic- treatment
A
- Topical
- Brimonidine tartrate 3mg/g
- Reduces erythema by cutaneous vasoconstriction
- Systemic
- Non-cardioselective BB propranolol 40mg BD or clonidine 50mcg BD
19
Q
Papular-pustular treatment
A
- Topical
- Ivermectin 10mg/g cream
- Inhibits inflammatory cytokines, control demodex mites
- Metronidazole 0.75% gel
- Azelaic acid 15% gel
- Systematic
- Oxytetracycline 500mg BD, lymecycline 408mg OD
- OR doxycycline 40mg OD, erythromycin 500mg BD
20
Q
Ocular rosacea treatment
A
- Lid hygiene and artificial tears
- Oral tetracyclines
- Refer to ophthalmology
21
Q
Rosacea- skin care tips
A
- Emollients
- Avoid overheating, keep rooms cool, avoid hot showers/baths
- Reduce facial redness for short periods by holding an ice block in moth, between the gum + cheek
- Limit alcohol intake
- Avoid hot, spicy foods
- Avoid washing with soap, astringent. cleansers and wipes
- Wash face with emollient wash
- Avoid oil-based skin products
- Use light, non-greasy moisturisers to soothe stinging and burning
- Protect face all year round with SPF 30 sun cream
22
Q
Eczema
A
- Dermatitis- interchangeable term
- Inflammatory condition of the epidermis
- In UK, affects 20% of children and 8% of adults
- Atopic eczema has a strong genetic component, FH of dermatitis, hayfever or asthma
23
Q
Other types
A
- Irritant contact dermatitis
- Allergic contact dermatitis
- Discoid eczema
- Seborrhoeic dermatitis
- Venous eczema
- Otitis externa
24
Q
Scoring systems
A
- EASI (Eczema Area and Severity Index)
- DLQI (Dermatology life quality index)
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Treatment of atopic eczema
* Self-help (Warm water, pat dry, avoid soap, cotton avoid irritants)
* Emollients
* Topical corticosteroids
* Topical immunomodulators
* Oral systemic
* Biology
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Emmollients
* Cornerstone of management
• Apply liberally
• Apply often
• Differentformulationsfordifferentareas • Givepatientschoice
* How to apply
* CARE – make fabrics flammable
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Topical corticosteroids
* Potency
* USE OD
* 10-15 minutes after emollient
* Finger-tip units
* Used for flares
* Maintenance
* Side effect concerns
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Other topicals
* Bandages- ichthammol and zinc oxide, or coal tar
* Dry-wrap dressings
* Pimecrolimus
* Tacrolimus
* Phototherapy
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Systematic treatments
* Antibiotics
* Antihistamines
* Systematic steroids- short course
* Licensed- ciclosporin
* Unlicensed- MTX, azathioprine, mycophenolate
* Biological- dupilumab- mAb, blocks signalling from IL-4 and 13
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Hand eczema
* Emollients
* Topical steroids
* Alitretinoin
* PUVA
* Systemic immuno-suppressants
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Psoriasis
* Chronic Immune-Mediated Inflammatory Disease (IMID)
* Systemic disorder
* UK prevalence 1.3-2.2%
* Usually develops before the age of 50, uncommon in children
* Strong genetic component, multifactorial
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Psoriasis- a systematic disorder
* Psoriatic arthritis- 25%-34%
* Obesity
* Metabolic syndrome
* Atherosclerotic vascular disease
* Infalmmatory bowel disease
* Malignancy
* Depression
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Chronic plaque psoriasis
* Most common form (90%)
* Scaling and epidermal thickening
* Red, clearly defined borders and salivery scales
* Lesions usually symmetrical
* Typically scalp, extensor surfaces such as elbows, knees, buttocks and lower back
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Other types
* **Scalp**
* **Palmoplantar**
* **Guttate-** small, red separate spots on the skin usually after streptococcal infection
* **Flexural-** submammary, groin, axillary, genital and natal cleft
* **Pustular-** sudden breakout of pus-filled blisters
* **Erythrodermic-** widespread erythroderma in people in pre-existing or unstable psoriasis
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Nail changes
* Occur in 50% of patients
* More common in patients with psoriatic arthritis
* Difficult to treat
36
Scoring systems
* BSA
* PASI (Psoriasis Area and Severity Index)
* DLQI (Dermatology Life Quality Index)
* PEST (Psoriasis Epidemiological Screening Tool)
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Systematic treatment- oral/non-biologicals
* MTX
* Acitretin- retinoid
* Ciclosporin- inhibits release of lymphokines
* Apremilast- Phosphodiesterase Type-4 inhibitor
* Dimethyl fumarate- immunomodulator
38
Systemic treatment- biologicals
* Etanercept- TNF a-inhibitor
* Infliximab- TNF a-inhibitor
* Adalimumab- TNF a-inhibitor
* Secukinumab0 Interleukin inhibitor, IL-17A
* Usekinumab- mAb, Interleukin inhibitor, IL-2 and 23
39
Melanoma- Glasgow 7 point checklist
* **Major features**
* Changes in size
* Irregular shape
* Irregular colour
* **Minor features**
* Diameter \>7mm
* Inflammation
* Oozing
* Change in sensation
40
The ABCDEs of melanoma
* A-symmetry
* B-order irregularity
* C-olour variation
* D-iameter over 6mm
* E-volving (enlarging, changing)
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