Dermatology incorrects Flashcards
which subtype of melanoma is the most aggressive and metastises early?
Nodular melanoma
“nodular is not nice”
appears as a lump vs a growing mole for superficial spreading melanoma
seen in middle aged people vs superficial spreading in young
patient has tried topical benzoyl peroxide for acne but has not worked.
what is next step in management?
when do ORAL antibiotics get involved in management?
topical benzoyl peroxide + topical clindamycin!!
antibiotics should not be prescribed alone due to antibiotic resisitance, thats why you keep the benzoyl peroxide
For people with mild to moderate acne: CKS
a 12-week course of topical combination therapy should be tried first-line:
a fixed combination of topical adapalene with topical benzoyl peroxide
a fixed combination of topical tretinoin with topical clindamycin
a fixed combination of topical benzoyl peroxide with topical clindamycin
oral antibiotics only used for moderate to severe acne!!! or in pregnqncy eg oral erythromycin -> signs of scarring or hyperpigmentation
first line treatment for plaque psoriasis?
how long is the break between courses?
topical steroid (eg betnovate, betamethasone) + topical calcipotriol (vitamin D)
4-week breaks
what are the drugs used in patients with cellulitis that are penicillin allergic?
which is used in a penicillin allergic PREGNANT patient?
treatment for Severe cellulitis?
oral clarithromycin, erythromycin or doxycycline
erythromycin!!! -> in pregnancy
oral/IV co-amoxiclav!!!, oral/IV clindamycin, IV cefuroxime or IV ceftriaxone (all start w c )
picture of a squamous cell carcinoma to identify -> it was not a bcc as the telangiectasia was on surrounding skin rather than the edges of the skin lesion
immunosuppression following renal transplant increases the risk of what skin malignancy?
other risk factors for this malignancy?
squamous cell carcinoma
excessive exposure to sunlight / psoralen UVA therapy
actinic keratoses and Bowen’s disease
immunosuppression e.g. following renal transplant, HIV
smoking
long-standing leg ulcers (Marjolin’s ulcer)
genetic conditions e.g. xeroderma pigmentosum, oculocutaneous albinism
sore throat 2 weeks ago
now has a papular rash with FINE SCALE on anterior and posterior torso and parts of limbs
What is diagnosis?
next step in management?
guttate psoriasis!! (can occur following strep throat)
emollients and reassurance!!
scabies second line treatment?
how long can pruritus persist following successful treatment?
malathion!! -> first is premethrin
up to 6 weeks -> delayed hypersensitivity reaction
red hot swollen left shin points to cellulitis as DVT affects the CALF
next investigation for cellulitis?
no investigations - clinical dx
patient on aspirin, candesartan, clopidogrel, metoprolol and simvastatin
has exacerbation of psoriasis, what drugs caused this?
list all drugs causing exacerbation
aspirin and metoprolol
beta blockers, lithium!, antimalarials! (chloroquine and hydroxychloroquine), NSAIDs and ACE inhibitors!, infliximab
what skin cancer does PUVA (UVA light therapy increase risk of?
squamous cell carcinoma
impetigo treatment for localised vs extensive disease
localised = topical hydrogen peroxide!!! or 2nd line is topical fusidic acid
extensive disease = flucloxacillin!! (erythromycin if pen allergic)
urticaria management?
management for severe episodes?
non sedating antihistamine = loratidine cetirizine
prednisolone in severe episodes -> short course 5 days + cetirizine for 6 weeks
if patient presents with eczema herpeticum and impetigo, treat EH first
A 55 year old gentleman presents with a 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?
urgent referral to dermatology
although might just be actinic keratosis, squamous cell carcinoma may present atypically and due to the history of immunosuppression/renal transplant you MUST refer
scc = indurated (firm) . can be nodular or plaque like, frequently ulcerate
acitnic keratoses = soft
