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Dermatology Flashcards

1
Q

What is the name of flat pigmented lesions?

A

Macule (<0.5cm), Patch (>0.5cm)

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2
Q

What is the name of raised pigmented lesions?

A

Papule (<0.5cm), nodule (>0.5cm)

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3
Q

What are pertinent predisposing factors for atopic dermatitis?

A

Atopy
IgE and TH2 dysregulation
Filaggrin LOF
Defensin deficiency

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4
Q

What are the clinical features of atopic dermatitis?

A

Patchy erythematous, poorly defined, scaly, itch, rash.

Dry skin with excoriations

Lichenification

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5
Q

What is the typical distribution for atopic dermatitis in babies?

A

Face, then elbows and knees (from crawling)

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6
Q

What is the typical distribution for atopic dermatitis in Early childhood?

A

Elbow and knee flexures

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7
Q

What is the typical distribution for atopic dermatitis in Adults?

A

More localised
Mostly hands and face
Flexural

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8
Q

What is the non-pharmacological management of atopic dermatitis?

A 
Avoid triggers (wool and synthetic, soap and hot bath, hot/cold/dry weather, sand)
Use emollients (sorbolene and 50/50 parafin)
Wet wraps if bad
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9
Q

What is the pharmacological treatment for atopic dermatitis?

A

Appropriate strength steroid for skin site and severity:
Mild –> face, genitals, flexures

Moderate –> trunk, limbs

Potent –> palms, soles, elbows, knees

Very potent –> nodules and lichenification

Topical calineurin inhibitor for sensitive areas

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10
Q

for atopic dermatitis, where are MILD corticosteroids used?

A

Face
Genitals
Flexures

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11
Q

for atopic dermatitis, where are MODERATE corticosteroids used?

A

Trunk

Limbs

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12
Q

for atopic dermatitis, where are POTENT corticosteroids used?

A

Palms
Soles
Elbows
Knees

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13
Q

for atopic dermatitis, where are VERY POTENT corticosteroids used?

A

Nodules

Lichenification

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14
Q

What is the typical management plan for infection in atopic dermatitis?

A

Swab for MCS
Topical mupirocin 2%
Dilute chlorine baths

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15
Q

What are the clinical features of seborrheic dermatitis in INFANTS?

A

Starts in first few weeks of life
Erythematous, well defined rash with greasy scales
Localised to the scalp, face, neck, axillae, and nappy area

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16
Q

What is the management of seborrheic dermatitis in INFANTS?

A 
Gentle bathing in warm water
Emollients
Weak topical steroids
Antibiotics (MCS, or mupirocin)
Antifungals if needed
2% salicylic acid aqueous cream if on scalp
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17
Q

What are the clinical features of seborrheic dermatitis in ADULTS?

A

Chronic, fluctuating condition
Emotional and physical stress trigger
Erythematous, flaky, greasy scales on the medial cheek, nose, and nasolabial folds
Scales and mild itching of the scalp, ears, and medial eyebrows
Groin and axillae involvement

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18
Q

What is the management of seborrheic dermatitis in ADULTS?

A

Anti-dandruff shampoo (ketakonazole, sulfide, miconazole) to control Malessezia on scalp

Topical steroids, topical antifungals, or weak tar creams for non-scalp

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19
Q

What is the pathogenesis of seborrheic dermatitis?

A

Malassezia overgrowth

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20
Q

What is the clinical presentation of Nummular eczema?

A 
Any age
Physical or emotional stress
Very itchy round or oval lesions with well defined edges
Rapid lichenification
Bacterial superinfection
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21
Q

How is nummular eczema differentiated from psoriasis and tinea?

A

Psoriasis:
Less itchy
Adherent silvery scale
Usually localised to knees and elbows

Tinea:
Central clearing
Red scaly edge

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22
Q

What is the management for Nummular eczema?

A

Potent topical steroids
Very potent or intralesional for lichenified lesions
Wet wraps
Antibiotics for superinfection

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23
Q

What are the clinical features of stasis dermatitis?

A 
Below the knees
Haemosiderin staining
Firm oedema
Varicose veins
Venous ulcers
Erythema
Weeping
Crusting
Cellulitis
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24
Q

What is the management of stasis dermatitis?

A

For dryness:
Avoid soap, apply greasy moisturiser, and limit bath length and temperature

For Inflammation:
Weak to moderate topical corticosteroids

For acute exacerbations:
Short duration potent topical corticosteroids
Wet wraps
Antibiotics

For venous insufficiency:
Compression bandages and stockings
Foot elevation at night

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25
What is the age of onset for psoriasis?
Bimodal - 15-25 and 50-60
26
What are the clinical features of psoriasis?
Symmetrically distributed, well defined red plaques with silvery scales primarily on the extensor surface Non-itchy to mildly itchy Auspitz sign - Small bleeding points after plaque is removed Nail changes - Pitting, ridging, onycholysis, hyperkeratosis
27
How is psoriasis severity measured?
Psoriasis area and severity index
28
What are the nail changes associated with psoriasis?
Pitting Ridging Onycholysis Hyperkeratosis
29
What are the common variants of psoriasis?
``` Scalp Guttate Palmoplantar pustular Chronic plaque Inverse Erythrodermic ```
30
What is scalp psoriasis?
Diffuse or well circumscribed plaques on the scalp
31
What is guttate psoriasis?
Acute onset widespread plaques 2-3 weeks following a strep infection. Self resolves
32
What is palmoplantar pustular psoriasis?
Associated with steroid discontinuation | Scaling, redness, and pustules on the palms and soles of feet
33
What is chronic plaque psoriasis?
Classical psoriasis
34
What is inverse psoriasis?
Located on the flexural surfaces Sharply defined patches No to little scaling
35
What is erythrodermic psoriasis?
Rare - but dermatological emergency Red inflamed areas which can involve the whole skin History of psoriasis Can cause systemic illness Requires oral therapy
36
What is the pathogenesis of psoriasis?
No completely known, but probably involves the immune system. T-cell, IL`B, TNFa, IL17A
37
What medications can trigger psoriasis?
Beta blockers, hydroxychloroquine, lithium, NSAIDS, Corticosteroid withdrawal
38
What are the histopathological features of psoriasis?
``` Elongated rete edges Thinning of the stratum granulosum Parakeratosis Dilated capillaries in the dermal papillae Micro abscesses in the epidermis ```
39
What are the investigations for psoriasis?
Biopsy - not always needed FBC, UEC+CrCL, LFT, BHCG Streo tests (throat swab, serum ASOT titre) for guttate
40
What is the management for psoriasis?
Stress and SNAPW Screen for infection Salicylic acid, baths, and increased sun If mild or localised --> topical therapy If moderate or extensive --> Phototherapy If severe or treatment resistant --> systemic treatment Expectation setting --> 6 weeks for results Refer to derm if phototherapy is needed Go to hospital if erythrodermic psoriasis
41
What are the 5 topical treatments for psoriasis?
Corticosteroids - Anti-inflammatory Intermittent pulsed use Tar-(LPC) - Anti-inflammatory + antiproliferative Works well, but very slow Calcipotriol - antiproliferative + anti keratinocyte Needs high dosage, slow to work, good for maintenance. Combined with corticosteroid cream in acute Dithranol - Antiproliferative Fastest acting. Can have concentration or application time dosage. Can't use on face or flexures Tazarotene - Retinoid Hyperkeratotic plaques, very irritating
42
Describe phototherapy for psoriasis?
Narrow band UVB therapy at wavelength 311nm 2-3 times per week Inhibits immune and inflammatory pathways in the skin
43
What are the four systemic therapies for psoriasis?
Methotrexate + folic acid Acitretin - Highly teratogenic need to wait two years after cessation for pregnancy Cyclosporin - Quick rebound of symptoms after cessation. Not long term Biological therapy PASI>15 and significant involvement of the face, hands, and feet Failed other non-topical therapies
44
What is the management of acne (for osces)
1. Assess impact and desire for treatment 2. Assessment of severity 3. Modification of excacerbating lifestyle factors 4. Investigations (hormonal, PCOS) 5. Topical treatment 6. antibiotics 7. Derm referral 8. Hormonal treatment 9. Isotretinoin
45
What is the pharmacological management for mild comedonal acne?
Topical retinoid (Adapalene, Tretinoin, Isotretinoin, Tazarotene) alone
46
What is the pharmacological management for mild papulopustular acne?
Topical retinoid with either a topical antiseptic (benzoyl peroxide) OR Topical antibiotics (clindamycin, erythromycin) and a salicylic acid cleansing agent.
47
What is the pharmacological management of moderate acne, or non-responsive mild acne?
Topical retinoid (Adapalene, Tretinoin, Isotretinoin, Tazarotene) AND Oral antibiotics (tetracyclines, erythromycin), OR Anti androgenic (OCP, spironolactone, cyproterone acetate) in females.
48
What is the pharmacological management of severe acne
Oral isotretinoin – must be prescribed by a dermatologist.
49
What is pityriasis rosea?
Post-viral rash associated with HHV6/7 | Mainly affects teenagers and young adults
50
What are the clinical features ff Pityriasis rosea?
Herald patch, followed by development of smaller oval red patches Mostly on the back and chest Lasts 6-12 weeks
51
What is the treatment of Pityriasis rosea?
Conservative, lotions, bathing etc Topical steroids for itch 7-day course of acyclovir can reduce length, but it is not routinely recommended
52
What is Rosacea and how does it present?
A chronic rash affecting the central face, associated with flushing, telagiectasia and pustules. Some patients also get Rhinophyma or Morbihan disease (facial lymph obstruction)
53
What are some differentials for Rosacea?
SLE, Acne, Menopause, Seborrheic dermatitis
54
What is the management for Rosacea?
Conservative therapy (mild soap and oil free sunscreen) ``` Topical: Twice per day until rash improves, then once per day for 6-12 weeks -Metronidazole cream -Clindamycin lotion or cream -Erythromycin gel -Azelaic acid gel ```
55
What are the types of inducible urticaria?
``` Cold urticaria Symptomatic dermographism Cholinergic urticaria Delayed pressure urticaria Contact urticaria Solar urticaria Heat urticaria Vibratory urticaria Vibratory angioedema Aquagenic urticaria ```
56
What are the clinical features of urticaria?
Wheals | Angioedema (+++eyelids, perioral)
57
What are the investigations for Urticaria?
Skin prick Radioallergeosorben tests (RAST) CAP fluoroimmunoassay
58
What is the management for urticaria?
1. Less sedating antihistamine (Cetirizine, desloratadine, fexofenadine, levocetirizine, loratadine) 2. Sedating antihistamine at night (Cyproheptadine, dexchlorpheniramine, pheniramine, promethazine, alimemazine) 3. Ranitidine at night 4. Doxepin at night
59
What are the three main presentations of impetigo?
1. Crusted or non-bullous impetigo Most common Golden yellow crust with erosions. Itchy but not painful. Sometimes pustular Staph (most common), or strep (more common in Indigenous populations). Can be both Satellite lesions 2. Bullous impetigo Rapidly eroding blisters Brown crust Always staph 3. Ulcerative impetigo Ulcers Always strep
60
What are some complications of strep impetigo?
Post-strep glomerulonephritis Deep ulceration
61
What are the relevant investigations for impetigo?
Swab (MCS) | Nasal or perineal swab for chronic strep carrier
62
What is the treatment for impetigo?
Localised and non-severe: Mupirocin 2% Widespread / severe: Dicloxacillin or flucloxacillin (Cephalexin --> Trimethoprim+Sulfa if allergic) Decolonisation Mupirocin 2% nasal School exclusion until crusts are dry
63
What is the difference between cellulitis and weysipelas?
Cellulitis is an infection of the dermis and subcutaneous tissue Erysipelas is a superficial form of cellulitis which effects the dermis only. (more defined edges)
64
What are the common causes of cellulitis?
Group A strep Staph Aureus - near wound Strep pyogenes - periorbital
65
Outline the pharmacological treatment for cellulitis in the ABSENCE OF SYSTEMIC SYMPTOMS
-strep (non-purulent): Phenoxymethylpenicillin or procain benzylpenicillin -Staph (purulent, or penetrating trauma): Docloxacillin or flucloxacillin -If allergic, cephalexin, clindamycin, or Trimethoprim+sulfamethoxazole
66
Outline the pharmacological treatment for cellulitis in the PRESENCE OF SYSTEMIC SYMPTOMS
-Strep (non-purulent): Benzylpenicillin -Staph (purulent, penetrating trauma): Flucloxacillin - If allergic: Cefazolin or Vacomycin
67
Outline the pharmacological treatment for PRESEPTAL cellulitis
Flucloxacillin or dicloxacillin If allergic: Cefalexin, clindamycin, or augmentin
68
Outline the pharmacological treatment for POSTSEPTAL cellulitis
Cefotaxime Ceftriaxone + Flucloxacillin If allergic: Vancomycin + Ceftriaxone or ciprofloxacin
69
Outline the pharmacological management for cellulitis with MRSA
Trimethoprim + sulfamethoxazole Clindamycin Vancomycin
70
What is the panton-valentine leucocidin (PVL) gene
Virulence gene in some CA-MRSA strains which leads to more significant infections like necrotising pneumonia and necrotising fasciitis
71
What is paronychia?
Infection of the paronychium (area surrounding the nail bed)
72
What is the management of paronychia?
Drainage with sterile needle

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