Dermatology Flashcards
Treatment of solar keratosis?
Fluorouracil cream and topical hydrocortisone
Imiquimod
Cyrotherapy/shave/curettage/excision
What are the two most common types of malignant melanoma?
Superficial spreading
Nodular
What is the first step in treatment for acne?
1st line =
2nd line =
First line = topical retinoid +/- benzoyl peroxide
Second line = azelaic acid
What is the second step in treatment for acne?
Either topical retinoid + benzoyl peroxide
Or antibiotic + benzoyl peroxide
3rd step in acne treatment?
Systemic antibiotics + benzoyl peroxide
What kind of antibiotics are used in acne treatment?
Tetracyclines e.g. erythromycin
What is an alternative treatment for moderate-severe acne in women?
The combined pill Dianette
What treatment is likely to be given for severe acne in secondary care?
Oral isotretinoin
Or high dose Abx e.g. lymecycline, trimethoprim
Rarely short courses of oral corticosteroids
Allergic contact dermatitis is a type ? hypersensitivity reaction?
IV - delayed T cell mediated reaction
3 features of ACD rash?
- pruritic
- erthematous, scaly rash
- develops with contact, after delay of hours- days
How is ACD diagnosed?
Skin patch testing
Acute management of acute contact dermatitis?
Avoid stimulus
Liberal emmolients, topical corticosteroids
Identify and treat any secondary infection
Second line treatments for acute contact dermatitis after topical corticosteroids?
Phototherapy, immunosuppressants (cyclosporin, methotrexate)
When would you notify the Health and Safety Executive about contact dermatitis?
When it is occupational
Up to 80% of contact dermatitis is …?
Irritant contact dermatitis
T/F - ICD doesn’t require sensitisation to a stimulus to cause inflammation, whereas ACD does?
True
ICD typically presents within …. hours after exposure to an irritant?
48 hours
What feature of an erythematous scaly rash on the hands might point towards ICD?
Stinging/burning
Webspace involvement
A 4 year old come to the GP with their mother, with an itchy dry rash in the elbow crease, with scratch marks.
What is the most likely diagnosis?
What type of cell drives this disease?
Atopic dermatitis
T helper 2 cells
What complication of eczema are the following:
a) weeping, crusted lesions
b) painful, monomorphic vesicles in clusters
a) secondary bacterial infection
b) eczema herpeticum
Outline the long-term management of standard eczema
- Education, avoid triggers
- Emollients
- Topical low potency steroids for inflamed skin
What is the treatment for infrequent eczema flare-ups?
Stronger topical steroid
Consider sedating antihistamine if sleep disturbed
Treatment for refractory eczema?
Phototherapy
Oral immunosuppressants (methotrexate, azathioprine)
Wet wraps
Treatment for eczema herpeticum?
Systemic acyclovir
A patient presents with pruritic round and oval plaques with some crusting, on her arms and legs. What type of eczema is this?
Discoid/nummular eczema
A 45 year old man presents with an erythematous scaly rash affecting the nasolabial folds and bears. He complains of having ‘dandruff’ coming from his beard and moustache, as well as his normal dandruff from his head. He has a PMH of HIV, for which he is on ARTs and viral load is undetectable.
What is the likely diagnosis?
What 2 conditions is this more common in?
What are the first line treatment options?
Seborrhoeic dermatitis
HIV and Parkinsons Disease
Ketoconazole 2% shampoo, selenium sulphide shampo or anti-dandruff shampoo (coal tar or salicyclic)
For the face –> imidazole
In infants, what is the term used to describe seborrhoeic dermatitis on the scalp?
How is it treated?
Cradle cap
Wash scalp with baby shampoo and brush scalp with soft brush. Second line treatment= imidazole topical
What type of eczema is associated with chronic venous insufficiency?
The erythematous rash affects what region of the body?
Venous eczema
The gaiter regions
What examination is it important to perform in venous eczema?
Peripheral vascular examination, especially palpating perdal pulses
What do you need to measure before recommending compression stockings?
Ankle-brachial index to exclude arterial insufficiency
What investigation confirms the diagnosis of venous insufficiency
Venous duplex ultrasound
Give 3 pieces of advise to give to someone with venous eczema?
- Elevate the legs when sitting
- Regular application of emollients
- Use of compression stockings
What is the common exacerbating factor for psoriasis?
Stress
What is the Koebner phenomenon?
Other than psoriasis, when is it seen?
Psoriasis lesions occur at sites of skin trauma (including sunburn!)
Lichen planus
Which 4 drug types may cause psoriasis?
beta blockers, lithium, NSAIDs, antimalarials
Which type of psoriasis is characterised by well-demarcated erythematous plaques covered in silvery white scales, commonly over extensor surfaces (also scalp, retroauricular, perianal, periumbilical?
Chronic plaque psoriasis
Scaly, raindrop shaped plaques on the trunk, commonly following streptococcal URTI occurs in what type of psoriasis?
Guttate psoriasis
Name 3 associated nail changes in psoriasis?
- Pitting
- Thickening of nail plate
- Ridging
- Onycholysis
- Subungal hyperkeratosis
- Oil spots
What scoring system is used to quantify psoriasis disease severity?
What questionnaire could be used to assess impact on the patient?
Psoriasis Area and Severity Index
Dematology Life Quality Index
Outline the stepwise treatment for psoriasis, including 1st, 2nd, 3rd line.
- Lifestyle advice e.g. avoid triggers
- Application of emollients
- Combo potent topical steroid and calcipotriol
- 2nd line = phototherapy, cyclosporin, methotrexate, acitretin
- 3rd line = biologics e.g. etanercept, infliximab, adalimumab
What type of phototherapy is used for psoriasis?
Narrow band UVB
A 24 year old female presents to her GP with an oval rash across her trunk and limbs, with mild pruritis. When asked, she mentions that several days ago she noticed a salmon-coloured patch.
What is the condition?
What is the name of the pattern seen with this rash?
What is the management?
Pityriasis rosea
Christmas tree pattern
Reassure patient rash usually settles without treatment, within 2-3 months. Symptomatic relief for itch.
Lichen planus is associated with:
a) Hep A
b) Hep B
c) Hep C
d) Hep D
e) Hep E
Hep C
What condition presents with pruritic flat-topped papules and plaques covered by Wickham striae?
Which body parts are most affected?
Lichen planus
Ventral wrists, forearms, ankles, legs, oral cavity, genitalia
What is the first line treatment of lichen planus?
Second line?
3rd line?
Potent/very potent topical steroids
Intralesional/systemic steroids
Phototherapy, cyclosporin, acitretin
What treatment can be used to manage oral lichen planus?
Steroid inhaler
A patient on the ward develops a smooth, non-scaly plaques surrounded by erythema, following abdominal examination by the junior doctor.
What is this likely to be and what caused it in this case?
Urticaria
Triggered probably by contact with latex in gloves during abdo examination
What is first-line therapy for urticaria?
Non-sedating antihistamine
What may be given in severe acute urticaria?
Short course of oral corticosteroids
Patients with possible urticarial vasculitis require which two investigations?
- Skin biopsy
- vasculitic screen
What are the 4 main pathogenic features of acne vulgaris?
- Follicular kyperkeratinisation
- Propionibacterium acnes colonisation
- Increased sebum production
- Inflammatory process involving innate and acquired immunity
Give 3 side effects of oral isotretinoin?
Dry skin/mucous membranes, teratogenicity, photosensitivity, vision changes, mood changes, deranged LFT, elevated triglyceride and cholesterol level, benign intracranial hypertension, acne flare
A patient comes to the GP complaining of recurring episodes of facial flushing, and redness and papulopustular lesions affecting the central face. On examination there are also telangiectasia in the central face, with sparing of periocular skin.
What is the likely diagnosis?
Give 3 aggravating factors.
Rosacea
Sunlight, caffeine, alcohol, spicy food, exercise, topical steroids, drugs that cause vasodilatation
Do you get comedones in rosacea?
No, unlike in acne vulgaris
What is rhinophyma?
Thickened, enlarged skin with irregular nodular surface affecting the nose
What is first line therapy for papulopustular lesions in rosacea?
Second line?
Topical metronidazole or azelaic acid
Oral antibiotics (tetracycline, erythromycin)
Treatment for facial flushing in rosacea?
Treatment for erythrotelangiectatic symptoms?
Ocular symptoms e.g. gritty eyes, blepharitis?
Non-selective beta blocker or clonidine
Topical brimonidine and laser therapy
Lid hygiene and artificial tears
Rhinophyma responds to ?
CO2 laser ablation