Dermatology

Question 1

Discuss Telogen Effluvium

Answer 1

Increased shedding of hair

• diffuse, non-scarring hair loss 2-3 months after inciting event
  - major surgery
  - serious illness or emotional stress
  - childbirth
  - protein or caloric malnutrition
  - drugs
• hair bulb is club-shaped and depigmented on light miscroscopy

Question 2

Discuss anagen effluvium

Answer 2

Decreased growth

• hair is tapered or broken off with associated shedding
• chemotherapy major cause
• interruption in hair growth leading to acute extensive hair loss

Question 3

Discuss andronergic alopecia

Answer 3

Male/female Pattern Baldness
- male: slowly advancing frontotemporal and vertex hair loss
- female: less pronounced hair thinning affect front and crown regions sparing of occiput
Treatment
- Finasteride: first line for men through competitive inhibition of type II-5-alpha reductase resulting in decreased conversion of dihydrotestosterone
- Rogaine: topical solution used for both that causes growth through vasodilation and increased blood flow

Question 4

Discuss trichtillomania

Answer 4

Compulsive Hair Pulling

• individuals pull hair from scalp
• irregular shape areas of hair loss with hair at different lengths

Question 5

Discuss alopecia areata

Answer 5

Autoimmune Hair Loss
- autoimmune hair loss of any hair bearing area
- present as round bald patches that may be preceded by pruritis or burning sensation
- exclamation point hair
Treatment
- counseling
- intra-lesional injection or topical steroid (triamcinolone 2.5-5mg/mL q4-6 weeks for 6 months)
- topical immunotherapy

Question 6

Discuss traction alopecia

Answer 6

Acquired hair loss
- from prolonged tension of the hair
Treatment
- stop tension

Question 7

Discuss the definition for acne vulgaris

Answer 7

Definition

• pilosebaceous gland disorder with inflammation, follicular hyperkeratinization and sebum production
• have inflammatory and non-inflammatory lesions

Question 8

Discuss the treatment for acne vulgaris

Answer 8

• if not effective move down
• maintenance with minimum topical retinoid
  Comedomes
• Topical retinoid
  Mild Inflammatory Papules and Pustules
• Topical retinoid plus benzoyl peroxide
  Moderate Inflammatory Papules and Pustules
• Topical retinoid plus benzoyl peroxide plus topical antibiotic (tetracycline, doxycyline, erythromycin)
  Moderate Inflammatory Papules and Pustules with Nodule
• Topical retinoid plus benzoyl peroxide plus oral antibiotic
  Severe Inflammatory Papules and Pustules
• Topical retinoid plus benzoyl peroxide plus oral antibiotic
  Severe Inflammatory Papules and Pustules with Nodules
• Oral isotretinoin

Question 9

Discuss the distribution of atopic dermatitis/eczema by age

Answer 9

Infants and Young Children (0-2)
- Pruritic, red, scaly and crusted lesions on extensor surfaces and cheeks or scalp
Older Children and Adolescents (2-16)
- Less exudation and often demonstrate lichenified plaques in flexural distribution (antecubital, popliteal, volar aspect of wrist, ankles, neck)
Adults
- more localized and lichenified
- skin flexures

Question 10

Discuss the signs and symptoms of eczema

Answer 10

• Hyperlinearity of palms
• keratosis pillars
• Xerosis
• Hand dryness

Question 11

Discuss the treatment of eczema

Answer 11

- daily emollient use
Acute Flare
- topical corticosteroids
- topical cacineurin inhibtor: tacrolimus
Maintenance
- use of topical corticosteroid or calcineurin inhibitor at sign of flare
- long term calcineurin inhibitor
Severe, Refractory Disease
- Methotrexate
- Oral steroids
- Phototherapy
Adjuvant Therapy
- Avoidance of triggers
- treat bacterial super infection
- Antihistamines
- Psychological intervention

Question 12

Discuss the pathophysiology, presentation, investigation and management of actinic keratosis

Answer 12

Pathophysiology
- proliferation of atypical keratinocytes
- common with increasing age
- risk of SCC
Presentation
- Ill-defined, scaly erythematous papules or plaques
- In areas of sun exposure
- Sandpaper like, gritty
Investigation
- Biopsy only if treatment resistant
Management
- Cryotherapy
- electrodissection and curettage
- 5-FU cream for 2-3 weeks
- Imiquimod cream for 8-10 weeks
- Exision

Question 13

Discuss the pathophysiology, presentation, investigation and management of basal cell carcinoma

Answer 13

Pathophysiology
- Non-melanoma skin cancer
- most common malignancy in humans
Presentation
- Noduloulcerative type (typical)
- skin colored papule with rolled, translucent telangiectatic border and depressed/eroded/ulcerate centre
- Pigmented Variant
- flecks of pigment in translucent lesion with surface telangiectasia
- Superficial variant
- flat, tan to red-brown plaque with scaly, pearly border and fine telangiectasia at margin
- least aggressive
- Sclerosing Variant
- flesh colored, shiny papule with indistinct borders and indurated
Investigation
- biopsy
Management
- Imiquimod 5% cream or cryotherapy for those on trunk
- Shave excision + electrodissection for most types
- Mohs
- 95% cure if <2cm in diameter

Question 14

Discuss the pathophysiology, presentation, investigation and management of squamous cell carcinoma

Answer 14

Pathophysiology
- second most common
Presentation
- indurated erythematous nodule with surface scale/crust and possible ulceration
- more rapid enlargement then basal
- found on face, scalp, forearms and dorsum of hands
Investigation
- Biopsy
Management
- surgical excision
- Mohs
- Lifelong follow up

Question 15

Discuss the high risk features for skin cancer

Answer 15

Very High Risk if Any of the Following
- Immunosuppressed after organ transplantation
- Personal history of skin cancer
- 2 or more first degree relatives with melanoma
- More than 100 nevi or 5+ atypical
- Received more than 250 PUVA treatment
- received radiotherapy as a child
High Risk if Two of the Following
- First degree relative with melanoma
- many nevi
- one or more atpical nevi
- naturally blond or red hair
- tendency to freckle
- skin that burns easily