Dermatology Flashcards
what are the life-threatening causes of rash?
7
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:
8
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
A 36-year-old lady presents with localised, well demarcated patches of hair loss and small, broken ‘exclamation mark’ hairs. Which of the following blood tests is most important to do in this case?
TFTs
Alopecia areata - AI condition
scalp is red with white scales. dx?
scalp psoriasis
tx scalp psoriasis?
high potency topical corticosteroids is 1st line
2. MTX
seborrhoeic dermatitis of the scalp. tx?
Ketoconazole and over the counter shampoos
if long term steroid use, what is advice re breaks?
4 week steroid breaks in between courses
typically on the lower limbs
initially small red papule
later deep, red, necrotic ulcers with a violaceous border
may be accompanied systemic symptoms e.g. Fever, myalgia dx?
pyoderma gangrenosum
tx - po pred
causes pyoderma gangrenosum?
idiopathic in 50% inflammatory bowel disease: ulcerative colitis, Crohn's rheumatoid arthritis, SLE myeloproliferative disorders lymphoma, myeloid leukaemias monoclonal gammopathy (IgA) primary biliary cirrhosis
A 2-yo with a history of atopic eczema is brought to the local GP surgery. Her eczema is usually well controlled with emollients but her parents are concerned as the facial eczema has got significantly worse overnight. She now has painful clustered blisters on both cheeks, around her mouth on her neck. Her temperature is 37.9ºC. What is the most appropriate management?
eczema herpeticum
admit for IV antivirals - emergency
cause of eczema herpeticum ?
HSV1-2
man comes in with larger leg lesions and petechiae over past few days, likely dx?
vasculitis
formula is used to calculate the volume of IV fluid required for resuscitation over the first 24 hours after the burn?
Parkland
assessing extent of burns?
Lund+Browder chart
burns: when to refer?
> 2% TBSA kids
>3% TBSA adults
what are common complications of seborrhoeic dermatitis?
blepharitis and otitis externa
Seborrhoeic dermatitis is more common in individuals with which disease?
Parkinsons , HIV
A 14-year-old rugby player presents complaining of a lesion he has noticed for 2 weeks on his back. On examination of his back, there is a round red ring lesion of approximately 1.5cm in diameter with a central area of clearing. The edge of the rash is elevated and scaly on palpation. Which of the following organisms is the likely cause of this lesion?
fungus - tinea corporis
which condition presents with hypopigmented, itchy patches? can appear scaly:
pityriasis versicolor
what type of condition is pityriasis versicolor?
fungal infection
malassezia furfur
mx pityriasis versicolor?
topical ketoconazole
shampoo
what can precipitate pompholyx eczema?
humidity
basal cell papillomas aka?
multiple seborrhoeic keratoses
benign epidermal skin lesions on elderly people
30-F with BMI 32. recurrence of boils in her axilla. numerous previous eps requiring antibiotics, had an incision and drainage on one occasion. one episode of such boils on her vulva a few years ago. On this occasion, you notice large red lumps in her right axilla. There is some scarring of the skin and you also notice a little hole with pus discharging out of it.
What is the most likely diagnosis?
hidradenitis supporativa
chronic, painful, inflammatory skin disorder is characterized by nodules, pustules, sinus tracts, and scars in intertriginous areas
complication of hidradenitis suppurativa?
sinus tracts and fistulae
The use of antivirals for shingles in HI positive patients is to:
reduce the risk of post-herpetic neuralgia
A 35-year-old female presents with tender, erythematous nodules over her forearms. Blood tests reveal high Calcium. dx?
sarcoid, erythema nodosum
desquamating rash - skin slippage - think?
TENS/SJS
systemic itch ddx:
renal pruritis - CKD cholestatic - bile salt mediated haematological - polycythaemia vera endocrine - DM, hyper/othyroid malignant - HL psych - promethazine (give)
macula vs patch: what does this mean?
flat area of altered colour
macula < 1.5cm
patch >1.5cm
papule vs nodue: meaning?
solid raised palpable lesion
papule <0.5cm
nodule >0.5cm
vesicle vs bulla: meaning?
raised, clear, fluid-filled lesions
vesicle <0.5cm
bulla >0.5cm
pustule vs abscess: meaning?
pus-containing lesion
pustule <0.5cm
abscess localised accumulation of pus
Wheal definition?
Oedematous papule or plaque caused by dermal oedema
follicular refers to?
face, chest and axillae
seborrhoeic refers to?
face and scalp
eczema: management step-wise:
Identify & avoid triggers Emollients Topical Steroids (HEBDO) Topical calcineurin inhibitors Bandaging and dressings
HEBDO eczema mx:
Hydrocortisone Eumovate Betnovate Dermovate Oral
what can topical steroids near the eyes cause?
glaucoma or cataracts
pre-malignant and malignant conditions (skin ca):
Actinic keratosis Bowen’s disease (squamous cell carcinoma in situ) Squamous cell carcinoma Basal cell carcinoma Malignant melanoma
reducing sun exposure is what type of PH prevention?
primary prevention
4 types of melanoma:
superficial spreading (1), nodular, lentigo maligna, acral
risk factors for melanoma: (2)
sunburn
genetic
Rx: melanoma (2):
surgery
chemotherapy
(if invasive - wide local excision +SNL biopsy)
which skin ca:
Occurs in middle-old age
Usually on head/neck
Raised, pearly or translucent papule with telangiectasia, central ulceration & rolled edge?
Basal cell carcinoma
Rx: BCC:
topical imiquimoid. cryotherapy.
surgery <2cm - wide local excision
>2 - mok’s micographic sx
radiotherapy
which skin cancer:
May develop on background of solar keratosis (actinic), Bowen’s disease (leukoplakia) or de novo
Begin as nodules on a firm indurated base, ulcerating as they enlarge
Common on backs of hands and face (especially lower lip & ear)?
Squamous cell carcinoma
Rx: SCC:
surgery
3 main groups of fungal infections + 1 eg for each?
dermatophytes (tinea/ringworm)
yeast (candidiasis)
moulds (aspergillus)
nose, cheeks and forehead
flushing, erythema, telangiectasia → papules and pustules ->
acne rosacea
acne in pregnancy - mx
oral erythromycin
A 60-year-old man asks you to have a look at a ‘sore’ on his right ear.
been there 6/12. not painful. dx?
actinic keratosis
A 17-year-old girl comes to see you at the GP surgery. She complains of excess hair.
She has very fine layer of soft un-pigmented hair that covers her entire body, apart from her palmar and plantar surfaces. cause?
malnutrition - lanugo hair
65-F -> GP as she has noticed some small spots on her shoulder. She describes small lesions with a number of tiny blood vessels radiating from the middle. You can press down on them, causing them to go white and then refill from the centre. cause?
spider navei liver failure
Spider naevi can be differentiated from telangiectasia by ?
pressing down on them, watching them fill. Spider naevi fill from the centre, telangiectasia from the edge
8-M -> GP practice with a red macular rash covering his trunk and back. He has been feeling lethargic for the last two weeks. His mother recalls seeing a larger patch appear on his back initially a week ago, which was then followed by smaller red macules elsewhere on his trunk. His observations are all normal. What is the most likely diagnosis?
pityriasis rosea
herald patch
follows viral inf
no tx - 6-12/52
33-F itchy rash on both elbows. It has been worsening for the past week. Multiple polygonal, flat-topped papular lesions that each measure 5mm diameter on the flexural surface of her elbows, bilaterally. She has no other rash on the rest of her body. diagnosis?
lichen planus
‘violaceous’, mucus membrane involvement
dry, fine-scaled, pale patches on the face. It is self-limiting - dx?
pityriasis alba
Venous ulceration is most characteristically seen above the:
medial malleolus
32 M sore and itchy skin on his hands and wrists. He has noticed it gets better when he is not in work and wonders if it is something he is coming into contact with at work causing the irritation. Which ix?
patch testing
An area of rapidly worsening painful eczema is an early sign of?
eczema herpeticum
59-F -> ED after the sudden appearance of widespread blistering, sore mouth and skin tenderness. 3/7 hx high fevers and malaise. No PMH except amoxicillin for an ear infection two weeks ago. Systemically unwell, 39.2ºC, hr 187, bp 100/54, rr 22, SpO2 98%.
Widespread erythematous bullae and vesicles covering almost half the body surface. Lesions are also present on the oral mucosa and beginning to affect the eyes. Nikolsky’s sign is positive. dx?
TEN
Nikolsky’s sign:
gentle lateral pressure on what appears to be an uninvolved site causes the area of sloughing to extend
A 34-F trips over and falls into a bonfire whilst intoxicated. Burns to her arms, torso and face. 25% body surface area. She is otherwise stable. The burns to the torso are superficial, her left forearm has a full thickness burn and the burns to her face are superficial. No airway compromise. She has received 1000ml of intravenous Hartman’s solution, with a further 1000ml prescribed to run over 4 hours. mx?
Transfer to regional burn centre once stabilised
A 20-M in a warehouse fire. He has sustained 60% burns to his torso and limbs. The limb burns are partial thickness but the torso burns are full thickness. He was intubated by paramedics at the scene and is receiving intravenous fluids. His ventilation pressure requirements are rising. mx?
escharotomy
An 18-year-old man accidentally pours boiling water onto his left arm. The area is erythematous and has a blister measuring 5cm. The wound is extremely painful.
mx?
discharge with review in outpatients
Keloid scars are most common on??
sternum
enlarged, raised and red scars which are itchy at the site of injury.
what is referred to rodent cell ca?
BCC
BCC: TURP acronym?
Telangiectasia - edge
Ulceration - central
Rolled edges
Pearly
define psoriasis:
chronic autoimmune condition characterised by keratinocyte hyperproliferation
nail changes: onicholysis, leukonychia, thickening, pitting, discolouration all seen in?
psoriasis
Auspitz sign?
appearance of small bleeding points after successive layers of scale have been removed from the surface of psoriatic papules or plaques
4 key things of acne:
increased sebum production
block sebaceous glands, traps keratin
comedone formation -> infection with Propionibacterium acne
when to refer in acne vulgaris?
after 3 tx tried
psych impact
if pt requests
++ scarring
isotretinoin can be used in refractory acne vulgaris when scarring - it has to be used for 6/12 - what should pts be told when going on it?
no alcohol, need contraception as super teratogenic, increase suicidal thoughts, increased exposure to sunlight, dry skin
eczema patho:(3)
chroic atopic condition - defect in epidermal barrier
T-cell upregulation - hypersensitivity reaction - inflammation (IgE - eosinophil). Exacerbating factors
melanoma A-E:
Asymmetrical Borders irregular Colour changes Diammeter >6mm Evolving
ix melanoma:
2ww excisional biopsy >2mm.
histology dx
(breslow thickness - PROG, ulcer, mitotic index)
Isoniazid, an anti-TB medication, may induce?
pellagra
Four D’s of pellagra (vitamin B3 deficiency):?
diarrhoea
dermatitis
dementia
death
A pyogenic granuloma may mimic amelanotic melanoma but can be differentiated???
based on hx of trauma in PG
large purplish lesion appears at the site which bleeds on contact.
65F->GP 3/12 hx of weight loss and feeling generally unwell. She has also noticed the skin under her armpits has become darker and slightly thicker. What is the most common malignancy associated with acanthosis nigricans?
GI adenocarcinoma
also seen in t2dm
hirsuitism causes:
PCOS - commonest - rx co-cyprindiol cushing's congenital adrenal hyperplasia androgen therapy obesity
ix venous ulcer?
ABPI
emollient use:
2-3x/day initially up to every hour if needed
in direction of hair
leave to soak in rather than rubbing in
after washing
2/52 baby ->GP. She has noted a bright red, well-circumscribed and lobulated lesion developing on her right temple. This wasn’t noted at birth but is now 5 mm in diameter. What is the most appropriate management?
reassure it will likely resolve after 3/12
strawberry naevus
lichen planus is suspected. What is the most appropriate treatment?
topical clobetasone butyrate
vitiligo tx?
sunblock for affected areas of skin
camouflage make-up
topical corticosteroids may reverse the changes if applied early
there may also be a role for topical tacrolimus and phototherapy
22M longstanding problem of bilateral excessive axillary sweating. He is otherwise well but the condition is affecting his confidence and limiting his social life. What is the most appropriate management?
topical aluminium chloride
hyperhidrosis
Dermatophyte nail infections - mx?
oral terbinafine
A 59-year-old man complains of pruritus and lethargy. On examination he has spoon shaped nails and a smooth tongue. cause of itch?
IDA
A 57-year-old woman presents with pruritus. She states she has been gaining weight despite eating less and complains of constant nausea. On examination she is pale. cause of itch?
CKD
A 52-year-old woman presents with pruritus and lethargy. She has recently put on weight and is complaining about dry skin. cause of itch?
hypothyroidism
75-M ‘sore’ on his lip. This has been present for around four months and has been getting slowly worse. His past medical history includes ischaemic heart disease and chronic obstructive pulmonary disease. He still smokes around 20 cigarettes per day. dx?
squamous cell carcinoma
pruritic condition associated with last trimester? abdominal striae - periumbilical sparing
polymorphic eruption of pregnancy
emollients, top, po steroids
often develop in peri-umbilical region, later spreading to the trunk, back, buttocks and arms
usually presents 2nd or 3rd trimester and is rarely seen in the first pregnancy. pruritic blistering lesions. dx?
pemphigoid gestationis
po corticosteroids
8F have noticed a small growth on the sole of her foot for the last 3/12 that has become painful. Small, firm, hyperkeratotic growth with tiny overlying black dots. dx, tx?
plantar wart = verruca
salicylic acid top
76M longstanding patch of rough, itchy skin on his scalp which has not changed in size. 1cm area of erythema and some scaling which is rough in texture, with evidence of surrounding sun damage. There is no ulceration or bleeding. dx? tx?
actinic keratosis
diclofenac
top fluorouracil cream
The most common dermatosis in pregnancy is
atopic eruption of pregnancy
-face, neck, chest, extensors
Which complication most associated with psoralen + ultraviolet A light (PUVA) therapy?
SCC
which melanoma Invade aggressively and metastasise early?
nodular
A 52-year-old man asks you to look at the side of his tongue. The white patches have been present for the past few months and are asymptomatic. He is a smoker who is known to have type 2 diabetes mellitus. dx?
oral leukoplakia
asx so not candidiasis
lichen planus:
purple, pruritic, papular, polygonal rash on flexor surfaces. Wickham’s striae over surface. Oral involvement common
also genitals and palms - white-lace like pattern
lichen sclerosus:
itchy white spots typically seen on the vulva of elderly women
OR
uncircumcised man, who has developed a tight white ring around the tip of the foreskin and phimosis
tx - 1. topical clobetasol propionate
A 41-year-old woman requests a repeat prescription for citalopram. She also mentions she is constantly itchy and bruises easily. On examination she has reddened palms and a distended abdomen. cause of itch?
liver disease
A 27-year-old woman presents with itch and lethargy. She is having difficulty sleeping due to night sweats and is wondering if she may be ‘going through the change’. A chest x-ray is normal. cause itch>
lymphoma
A 61-year-old man presents with pruritus. He has had recurrent episodes of painful swelling in the MTP joints and a history of peptic ulcer disease. On examination he has a ‘ruddy’ complexion - cause itch?
polycythaemia
A 20-year-old woman presents to her GP complaining of a persistent facial rash. On examination, you note erythema of the nose, cheeks and forehead. There are some scattered papules. She has not noticed any particular triggers but does think it is slightly worse in the summer. dx, tx?
acne rosacea
top metronidazole
worse after alcohol, sun
You notice a flat purple lesion on the babies cheek which has been present since birth. This does not seem to be painful. All other examinations are normal.?
port wine stain
impetigo - returning to school?
no longer contagious which is when all lesions have crusted over or 48h after treatment starts
Red or black lump, oozes or bleeds, sun-exposed skin??
nodular melanoma
drug causes of spider navi?
cocp
Stress ulcers in burns patients are referred to as?
curlings ulcers -> haematemesis
A 21-year-old woman with a history of eczema presents with a change in the colour of her skin affecting the hands and feet symmetrically: white patches - dx?
vitiligo
AI - addisions associations
An 82-year-old Caucasian gentleman presents with a waxy, scar-like plaque over his left eyelid. He reports it to have been slowly increasing in size over the last two years. You diagnose morphoeic basal cell carcinoma (BCC). mx?
morphoeic BCC usually is associated more extensive spread than nodular BCC as it is more aggressive and often presents later. poorly defined edges
Mohs microgaphic surgery
A 19-year-old man comes for review after burning himself with an iron. On examination he has a 4 by 3 cm area of pale pink skin the left forearm. In the middle of the area there are two small, fluid filled blisters. What is the most accurate description for this type of injury?
partial thickness (superficial dermal) burn
can cause pulmonary, hepatic, cerebral and spinal AVMs??
Hereditary haemorrhagic telangiectasia
also epistaxis
A 27-year-old man with a history of depression and coeliac disease presents with an itchy rash on his buttocks: dx?
dermatitis herpetiformis
symmetrical vesicular rash - can be arms and legs
IV fluids needed in which burns pts?
adult: second or third degree burns that cover 15% body surface area or more. In children, IV fluids are recommended when burns cover 10% body surface area.
55M new skin lesion to the forehead. On examination there is a 6mm diameter scaly patch which does not appear indurated or ulcerated. He works as a gardener. He has a past medical history of type 1 diabetes and renal transplant, and his medications include insulin, aspirin, simvastatin, and tacrolimus. What is the most appropriate course of action?
refer urgent to derm - may be SCC as renal transplaant and immunosuppressed
Marjolin’s ulcer?
SCC in an area of previous chronic inflammation
Children with new-onset purpura (petechial rash) should be mx?
refer immediately to paeds to r/o ALL, meningococcal sepsis
Management of venous ulceration -?
compression bandaging
red, scaly patches
often 10-15 mm in size
slow-growing
often occur on sun-exposed areas such as the head (e.g. temples) and neck, lower limbs
bowens disease
pre-malignant for SCC
A neonate is brought to your surgery because his mother has noticed some skin lesions on his face. On examination there are multiple tiny white papules on the nose. What is the most likely diagnosis?
milia - self resolve after a few weeks
half of babies
Open and closed comedones, pustules and nodules are all characteristic lesions of?
acne vulgaris
acanthosis nigrans pathology?
insulin resistance → hyperinsulinemia → stimulation of keratinocytes and dermal fibroblast proliferation via interaction with insulin-like growth factor receptor-1 (IGFR1)
acanthosis nigrans associations?
insulin-resistant DM obesity PCOS COCP GI malignancies - gastric and pancreatic ca
A 19-year-old female who has just started work as a cleaner presents with a rash on her hands. On examination there is a generalised erythematous rash on the dorsum of both hands. There is no evidence of scaling or vesicles. What is the most likely diagnosis?
irritant contact dermatitis
43F dermatology evolving lesion on her right lower leg. First noticed 4 months ago, and it has increased in size and changed in colour during this time. 2cm by 1.5 cm asymmetrical pigmented lesion, comprised of several shades of brown. She has Fitzpatrick skin type II and uses sunbeds approximately every 4 months. dx?
superficial spreading melanoma - features of a changing mole ABCDE approach (asymmetry, border irregularity, colour variation, diameter >6mm and evolving)
melanoma - develops slowly, on chronically sun-exposed skin (the face, neck and arms).?? can be asx
lentigo maligna
patients with psoriatic arthropathy will have nail changes ?
onycholysis
distal interphalangeal joint involvement and dactylitis of the ring finger
cx burns?
curling’s ulcer
rhabdo
compartment syndrome
hypoalbuminaemia -> oedema
sub-epidermal blistering of the skin
itchy, tense blisters typically around flexures
the blisters usually heal without scarring
there is usually no mucosal involvement (i.e. the mouth is spared) - dx, mx?
bullous pemphigoid
oral corticosteroids
Features - said to look like a volcano or crater
initially a smooth dome-shaped papule
rapidly grows to become a crater centrally-filled with keratin dx>
keratocanthroma benign but need to
SCC r/o
should self resolve with scarring
which meds cause patchy depigmentation in patients with darker skin?
topical corticosteroids
infrared radiation and is commonly associated with hot water bottles or open fires
?
erythema ab igne
non-blanching
large variation in colour from flesh to light-brown to black
have a ‘stuck-on’ appearance
keratotic plugs may be seen on the surface
older man
dx?
seborrhoeic keratosis
oral antibiotic of choice to treat erythrasma? (flat, slightly scaly, pink or brown rash usually found in the groin or axillae. )
erythromycin
An 8-year-old boy presented with a painless swelling on the superotemporal aspect of his orbit. It was smooth on examination, produced no visual disturbances. Following excision it was found to be lined by squamous epithelium and hair follicles. dx?
dermoid cyst
isotretinoin sfx?
dry skin teratogenic af low mood* raised triglycerides hair thinning ICH epistaxis photosensitivity
A 22-year-old man presents to the GP with a mass on his lower back. On examination, there is a 6cm mobile rubbery mass on his lower back just lateral and superior to the sacrum. The mass is not painful and there are no accompanying symptoms. mx?
USS lipoma as >5mm
reassurance
derm drug -> gynaecomastia?
ketoconazole
Diabetes, waxy yellow shin lesions - ?
necrobiosis lipoidica diabeticorum
impetigo mx:
topical fusidic acid if hydrogen peroxide not suitable
endocrine cause of acne vulgaris?
pcos
Afro-Caribbean origin = skin type?
6
A 32-year-old lady attends with a facial rash for several weeks. She has an erythematous rash which looks greasy and has a fine scale over her face affecting her cheeks, nasolabial folds, eye brows, nasal bridge and scalp. What is the most likely diagnosis?
seborrhoeic dermatitis
Erysipelas is localised skin infection caused by ?
strep pyogenes (superficial cellulitis)
erythematous, papular lesions typically 1-3 mm in size non-blanching not found on the mucous membranes very red?
cherry haemangioma
benign - reassure
rx for prominent telangiectasia in acne rosacea?
laser therapy
SLE skin changes:
hair loss, photosensitivity, butterfly rash, levido reticularis
A 43-year-old man presents to his GP with a persistent skin lesion overlying the right second metacarpophalangeal joint:
granuloma annulare
Wallace’s Rule of Nine: Each of the following is 9% of the body when calculating surface area % if a burn:
Head + neck, each arm, each anterior part of leg, each posterior part of leg, anterior chest, posterior chest, anterior abdomen, posterior abdomen
You are a doctor reviewing a 45-year-old man who has presented with large superficial, flaccid vesicles and bullae present on his trunk, alongside mucosal ulceration and oral involvement. On examination, the vesicles and bullae rupture easily on touch and are painful and there is an associated itch. dx, ix?
pemphigoid vulgaris
anti-desmosome abs
