dermatology

Question 1

How does eczema present?

Answer 1

Acute - itchy rash with dry + scaling patches, papules and vesicles on erythematous base, ± weeping, usually on flexor surfaces
Chronic = may also see excoriation and lichenification, nail changes (ridging and pitting)

Question 2

Management of eczema

Answer 2

Topical emollients, topical steroids for flare up, antihistamines for symptomatic relief of itching, severe and non-responsive - immunosuppressant, phototherapy

Question 3

What is pathological cause of acne vulgaris

Answer 3

Inflammatory disease of pilosebaceous follicle, causes are hormonal (80% - androgen, seen in teens)

Question 4

How does acne vulgaris present?

Answer 4

Non-inflammatory - Mild acne - open and closed comedones (black and whiteheads)
Inflammatory - moderate and severe - papules, pustules, nodules and cysts
Commonly affects face, chest, upper back

Question 5

How to manage acne vulgaris

Answer 5

rx at least 6 weeks for an effect
rx benzoyl peroxide + topical retinoids 
Step up add topical antibiotic (cLinda)
Step up switch to PO doxy/lyme, PO anti-androgens in girls
Severe - oral retinoids

Question 6

Types of psoriasis

Answer 6

Plaque (most common), guttate, flexural, pustular

Question 7

How does guttate psoriasis present?

Answer 7

Usually 2-4wks following streptococcal infection, tear drop scaly papules on trunk and limbs. Resolves spontaneously within 2-3m.

Question 8

How does plaque psoriasis present?

Answer 8

Well demarctated erythematous scaly plaques on extensor surfaces. Can be itchy, burning or painful. Nail signs - pitting onycholysis. Assoc arthritis.

Question 9

Management of psoriasis

Answer 9

1st line OD topical potent corticosteroids and vitamin D analogue OD (one in morning, one in evening) 8wks
2nd - vitamin D analogue BD
3rd - potent topical corticosteroids BD or coal tar preparation
Extensive and severe consider systemic rx - PO methotrexate, retinoids, biological agents e.g. infliximab. Phototherapy

Question 10

give an example of a mildly potent corticosteroid

Answer 10

hydrocortisone (0.5%-2.5%)

Question 11

give an example of a moderately potent corticosteroid

Answer 11

eumovate

Question 12

give an example of a potent corticosteroid

Answer 12

betnovate

Question 13

give an example of a very potent corticosteroid

Answer 13

dermovate

Question 14

how should a patient apply emollients?

Answer 14

apply just after patting skin dry from bath/shower while still slightly damp, rub down in direction of hair follicle not up/down as this can cause irritation, apply multiple times a day, can be every 2hrs during flare up

Question 15

how should a patient apply corticosteroids?

Answer 15

apply sparingly onto clean skin, at least 15 minutes after applying emollients. 1 finger tip unit covers 2 palms worth of skin surface area in adult.

Question 16

side effects of topical corticosteroids

Answer 16

thinning skin, stinging/burning on application (should ease with use), permanent striae, reversible depigmentation, worsening of acne, hypertrichosis

Question 17

counsel a patient on risks of oral retinoids

Answer 17

powerful vitamin A analogue, side effects are dry skin/eyes/nostrils with increased tendency to bleeding, fragile and more photosensitive skin, hypercholesterolaemia and hypertriglyceridaemia, depression ± self-harm/suicidal ideation. TERATOGENIC - need to be on pregnancy prevention plan (use of contraception, ideally barrier + 1 other)

Question 18

what severity, and thus treatment would you consider for a patient with acne vulgaris presenting with open and closed comedones only

Answer 18

mild acne - topical retinoid (e.g. adepalene) ± topical benzoyl peroxide

Question 19

what severity, and thus treatment would you consider for a patient with acne vulgaris presenting with open and closed comedones, papules and pustules?

Answer 19

moderate acne vulgaris - topical retinoid + PO doxycycline/lymecycline for up to 3m

Question 20

what severity, and thus treatment would you consider for a patient with acne vulgaris presenting with extensive papules pustules nodules and cysts

Answer 20

severe acne vulgaris - trial 2 PO abx with topical retinoids before considering PO isotretinoin (roaccutane) unless scarring is present could consider roaccutane straight away. Also consider use of COCP in young women.