Dermatology Flashcards
what are the life-threatening causes of rash?
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meningococcal septicaemia anaphylaxis necrotizing fasciitis TEN/SJS urticaria - anaphylaxis staph scalded skin syndrome
what disease and causative organisms cause superficial epidermal infection typically around childrens faces?
impetigo
staph 90%, strep pyogenes
which 2 presentations of cellulitis are you most worried about - need referral/senior help?
necrotizing fasciitis
orbital cellulitis
when pain experienced is disproportionate to rash and also presence of systemic involvement?
nec fasc
fever + non-blanching purpuric rash + arthralgia, malaise, headache, neck stiffness, photophobia - dx?
meningococcal septicaemia
tx for meningococcal septicaemia in hospital?
IV Ceftriaxone 4G STAT
likeliest pathogen in meningococcal septicaemia?
neisseria meningitidis
meningitis with a complication of adrenal failure is called??
Waterhouse-Friderichsen syndrome
flat lesions, initially evolving -> itchy scabs.
Macules+papules+vesicles+pustules+scabs - dx?
chickenpox
chickenpox has a centripetal distribution - what does this mean?
spreading outwards from trunk
chickenpox causative organism?
varicella-zoster virus
pain and blistering rash which does not cross the midline +/- malaise - dx?
shingles
multidermatomal shingles is indicative of ________?
immunocompromise
when will the infectious period of shingles/chickenpox begin and end?
48hours before the presence of the rash - until all lesions crust over (5-7 days after)
which organism causes shingles?
herpes zoster virus
tx of shingles and when to initiate?
valaciclovir 1G TDS for 7 days
start within 72h onset of rash
shingles type illness + face pain + external auditory canal vesicles + ipsilateral facial palsy is called?
Ray-Hunt syndrome
complete recovery in <50%
prodrome of fever, coryzal illness, cough then a rash from face/neck to trunk/limbs - dx?
measles
measles have pathognmonic spots called ____? what colour are these and where are they noticed?
Koplik spots
grey
buccal mucosa 2 days prior to rash
measles: what type of rash is seen?
maculopapular rash
rash WITH fever and coryzal symptoms (+arthralgia in adults)
discrete macular rash from face -> trunk/limbs - dx?
rubella
if get rubella in first trimester of pregnancy - what complications are expected?
90% foetal abnormalities
deafness and cataracts
prodrome viral illness -> rash +/- itch
widespread maculopapular rash - dx?
viral exanthema - the viral rash
disease course viral exanthema?
self-limiting resolves over 7days
non-itching rash on cheeks. Feels burning hot. Erythematous. Later moves to trunk and limbs - dx?
Fifth disease/Erythema Infectiosum (slapped cheek fever)
reticulate erythema means ???
net-like rash
on proximal limbs and trunk in fifth disease
organism causing Fifth disease/Erythema Infectiosum (slapped cheek fever)?
parvovirus b19
small, painful vesicles around mouth, genitals. vesicles or pastules - which dx?
herpes simplex virus
if rash around mouth - which organism ?
HSV1
If rash around genitals - which organism?
HSV2
tx of HSV?
if primary infection - aciclovir 200mg/5h PO
if flare-up - topical aciclovir 5% apply to affected area /4hrly
small, non-itchy spots on trunk and limbs (+groin in adults)
- small translucent papules, appear fluid-filled, actually solid
- central depression (punctum) - which dx?
Molluscum Contagiosum
which organism causes molluscum contagiosum?
poxvirus
tx of molluscum contagiosum?
usually none, if older/adult - potassium hydroxide 5%
what are dermatophytes?
pathogenic fungi causing a wide range of diseases
mild, itchy, asymmetrical rash which spreads with a slightly raised, scaly edge, often leaving a clear centre - dx?
tinea corporis (‘ringworm’)
dermatophyte infection of the face?
tinea faciei
ringworm type infection in the groin with lesion more red and plaque-like with a well demarcated border ?
tinea cruris
in webspacecs of toes, itchy skin which is fissured and macerated. if elsewhere on foot is often more diffuse and scaly but still as itchy. +/- pustules - dx?
athletes foot - tinea pedis
rx - topical imidazole then oral antifungal
dermatophyte infection treatment?
(trichophyton rubrum) onychomyocosis
topical antifungals like terbinafine, clotrimazole, miconazole..
more widespread infections: PO terbinafine, itraconazole
organism causing nappy rash, in body folds (intertrigo) and mimicking tinea pedis - interdigital webbed spaces?
candida albicans
yeast
erythematous rash, with a ragged peeling edge which may contain pustules.
commonly of mouth and GU tracts and presents with small white plaques/discharge - dx?
candida albicans
candida albicans tx?
skin hygeine - clean and dry topical antifungal - clotrimazole nystatin drops (mouth) clotrimazole pesseries (vag) persistent - PO fluconazole
intensely itchy rash, often worse at night
papular rash found in interdigital webspaces of the hands and feet, ankles, wrists, genitals, axillae, umbilicus - dx?
scabies
mite infection
linear skin burrows are pathognomonic of ?
scabies
type IV hypersensitivity reax
tx of scabies?
permethrin / malathion - whole body
tx close contacts.
wash all clothes and bedding. itch may persist 4wks
severe may require PO tx
scabies organism?
sarcoptes scabiei
blood sucking parasites found on head and skin - orgs?
lice pediculosis capitis (head) pediculosis corporis (body - not GU)
pubic lice organism?
phthiriasis pubis or ‘crabs’
tx of lice?
malathion / permethrin (resistance common)
tx close contacts and clothing and bedding
6 different types of eczema?
- atopic
- contact
- venous stasis
- seborrheic
- dyshidrotic eczema
- Nummular eczema
what is the atopic triad?
asthma
eczema
hayfever
(food allergies too but not part of triad)
commonest sites of eczema?
skin creases, hands, elbows, backs of knees, face and scalp
what is meant by the itch-scratch cycle?
Scratching damages skin barrier, leading to worse Sx, leading to more scratching
disrupted sleep
what does lichenification indicate re eczema severity?
severe eczema
which organism is usually responsible for infected eczema?
saureus
tx of infected eczema (moderate and severe):
2 topical Abx = fusidic acid or mupirocin cream
Systemic Abx = Erythromycin or flucloxacillin (14 day course in severe)
5 examples of eczema triggers:
irritants - detergents env- cold dry weather cows milk wool irritating skin hormonal changes - period infections
managing itch in eczema:
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avoid triggers rub/pinch/pat skin rather than scratch keep nails short wear cotton gloves to sleep keep skin covered with light clothing moisturise frequently cleansers with low pH cold compress
tx of mild eczema:
emollients
mild topical corticosteroids
tx of moderate eczema:
emollients
moderate topical corticosteroids
topical calcineurin-inhibitors
bandages and dressings
tx of severe eczema:
emollients potent topical corticosteroids topical calcineurin-inhibitors bandages and dressings PHOTOtx systemic therapy
eg of mild corticosteroid for eczema?
hydrocortisone 0.1-2.5%
flucinolone acetonide .0025%
eg of very potent corticosteroid for eczema?
clobetasol propionate
eg of topical calcineurin inhibitors for eczema?
tacrolimus
pimercrolimus
(topical)
what is dishydrotic eczema also known as?
pompholyx
what is pompholyx commonly associated with?
hayfever
tx dishydrotic eczema?
soak hands and feet in cold water 15mins qds afterwards moisturise
‘Coin-shaped’ spots on the skin, itchy or not itchy, dry and scaly or wet and open, anywhere on the body - which type of eczema is this?
nummular
tx nummular eczema?
strong steroid cream
Skin will appear, red, itchy, greasy, swollen with white crusty flakes - which eczema?
seborrheic dermatitis
which drugs can exacerbate infections of psoriasis?
BBs
lithium
what is the dx if the lesions bleed when scratched?
psoriasis
which psoriasis occurs generalised and is an emergency?
pustulised
which psoriasis occurs 2-3 weeks post strep throat infection?
guttate psoriasis
rx - reassurance and topical tx if symptomatic
treatment of psoriasis:
topical emollients and steroids + vit D analogues (first line)
retinoid, coal tar, mtx, phototx
treatment of urticaria:
antihistamines
tender, erythematous nodules or plaques typically on the shins indicates:???
erythema nodosum - no tx - f/u
can also be forearms
commonest and other common causes of erythema nodosum?
strep commonest
mycoplasma pneumoniae, TB, EBV
sarcoid, IBD, AI disease, preg
target lesion indicates:
erythema multiforme
erythema multiforme major is when what additional feature present?
rash involvement of mucous membrane typically the mouth
can be ‘major’
which infection is indicated with erythema multiforme?
mycoplasma pneumoniae
HSV commonest cause
widespread blisters, with skin shredding, erythematous macules, mucosal erosions affecting <10% total body suerface area?
SJS
widespread blisters with skin shredding, erythematous macules, mucosal erosions affecting >10 (usually >30%) of the total body SA?
TEN
causes of TEN and SJS - infections -
HSV
mycoplasma pneumoniae
CMV
HIV
causes of SJS/TEN - drugs:
anti-epileptics
Abx - penicillins
Allopurinol
NSAIDS
tx SJS, TEN?
steroids, IVIGs, immunosuppression by specialists
The steroid ladder from weakest to most potent in eczema: 4
Mild: Hydrocortisone 0.5%, 1% and 2.5%
Moderate: Eumovate (clobetasone butyrate 0.05%)
Potent: Betnovate (betamethasone 0.1%)
Very potent: Dermovate (clobetasol propionate 0.05%)
what is eczema herpeticum?
skin infection in pts with eczema caused by HSV, VZV
erythema multiforme drugs causes:
drugs: penicillin, sulphonamides, carbamazepine, allopurinol, NSAIDs, oral contraceptive pill, nevirapine
what is koebner phenomenon?
causes lesions of molluscum contagiosum to appear at sites of injury
also psoriasis and other conditions
where does pompholyx eczema tend to appear?
palms and soles very itchy
uniform area of erythema across the bridge of his nose and extending across his cheeks. Upon this erythema you note there are about a dozen small pustules and papules. Lastly, you note the presence of superficial telangiectasia across the bridge of the nose and a small amount around the labia of the nose.
dx?
acne rosacea
cx - blepharitis
tx rosacea?
- topical metronidazole
2. if resistant or severe PO tetracycline
if rosacea and severe telangietasia - tx?
laser tx
tx acne vulgaris?
PO retinoids
topical benzoyl peroxide, top clinda, PO doxy, COCP
noticed a patch of pigmented skin on her toe, which has been slowly enlarging over the past five months. On examination, she has pigmentation of the nail bed of her great toe, affecting the adjacent cuticle and proximal nail fold. Which subtype of melanoma would you expect to present in this manner?
acral lentiginous melanoma
Hutchinson’s sign
Inpatient treatment for erythroderma must be monitored for complications such as??
dehydration, infection, high output heart failure
what is erythroderma?
> 95% skin covered in rash of any kind
what is a birthmark that typically resolves and is vascular?
salmon patch
A 29-year-old man presents with a lump in his scalp. It is located approximately 4cm superior to the external occipital protuberance. It feels smooth and slightly fluctuant and has a centrally located small epithelial defect. What is the most likely underlying diagnosis?
sebaceous cyst
what are most frequently located in the scalp and have an associated central punctum.?
sebaceous cysts