dermatology Flashcards
How does eczema present?
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)
Management of eczema
Topical emollients, topical steroids for flare up, antihistamines for symptomatic relief of itching, severe and non-responsive - immunosuppressant, phototherapy
What is pathological cause of acne vulgaris
Inflammatory disease of pilosebaceous follicle, causes are hormonal (80% - androgen, seen in teens)
How does acne vulgaris present?
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
How to manage acne vulgaris
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
Types of psoriasis
Plaque (most common), guttate, flexural, pustular
How does guttate psoriasis present?
Usually 2-4wks following streptococcal infection, tear drop scaly papules on trunk and limbs. Resolves spontaneously within 2-3m.
How does plaque psoriasis present?
Well demarctated erythematous scaly plaques on extensor surfaces. Can be itchy, burning or painful. Nail signs - pitting onycholysis. Assoc arthritis.
Management of psoriasis
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
give an example of a mildly potent corticosteroid
hydrocortisone (0.5%-2.5%)
give an example of a moderately potent corticosteroid
eumovate
give an example of a potent corticosteroid
betnovate
give an example of a very potent corticosteroid
dermovate
how should a patient apply emollients?
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
how should a patient apply corticosteroids?
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.
side effects of topical corticosteroids
thinning skin, stinging/burning on application (should ease with use), permanent striae, reversible depigmentation, worsening of acne, hypertrichosis
counsel a patient on risks of oral retinoids
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)
what severity, and thus treatment would you consider for a patient with acne vulgaris presenting with open and closed comedones only
mild acne - topical retinoid (e.g. adepalene) ± topical benzoyl peroxide
what severity, and thus treatment would you consider for a patient with acne vulgaris presenting with open and closed comedones, papules and pustules?
moderate acne vulgaris - topical retinoid + PO doxycycline/lymecycline for up to 3m
what severity, and thus treatment would you consider for a patient with acne vulgaris presenting with extensive papules pustules nodules and cysts
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.
