Dermatology Medicine 💆🏽✅ Flashcards
Tx for high risk BCC
Surgical removal
Tx for low risk BCC
Cutterage
Tx options for BCC
Sx, cutterage, cryotherapy, topical imiquimod/FU, radiotherapy
Best Tx for most SCC
Mohs Surgery
SCC less than 20 mm, do what Sx
Mohs Sx, with 4mm margins
SCC more than 20 mm, do what Sx
Mohs Sx, with 6mm margins
Aggressive Bowens lesion, Tx
Mohs excision and chemo
Therapy given to all Bowen lesion patients
Topical FU BD for 4 weeks (give CSs if patient gets Inflamation from it).
When is cryotherapy or excision used for Bowen lesions Tx
Low risk cases (will still receive the FU topically)
How to Dx melanoma and it’s importance
excisional Skin biopsy with 1-3 mm margins. Get Breslow thickness
Worse Px areas to get melanoma
TANS (thorax, upper arm, scalp)
Breslow stage I melanoma Mx (consider the safety margin)
1cm
Breslow stage II melanoma Mx (consider the safety margin)
1-2 cm
Breslow stage III melanoma Mx (consider the safety margin)
2cm
Breslow stage IV melanoma Mx (consider the safety margin)
2cm
Insitu melanoma Mx (consider the safety margin)
Removal with 0.5-1cm margin
Main management for Kaposi’s sarcoma
A.R.T
Investigations for astinic keratosis
Clinical, but still do biopsy to rule out SCC
Management for all actinic keratosis
Sun avoidance, topical FU and CS, (rest depends on severity
Add-ons for mild actinic keratosis
Topical diclofenac (being a dic spending too long in the sun). Add to FU
Add-ons for more severe actinic keratosis
Topical imiquimod (imi joke)
What is acne fulminans
Severe acne with systemic symptoms
Mx of acne fulminans
Admit and PO steroids
Three types/stages of acne
Inflammatory acne:.. always add what Tx
Abx
Mild acne Tx
Topical retinoids +- benzylperoxide +- topical Abx
Moderate Acne mx
Topical retinoids +- benzylperoxide +- oral Abx
Severe acne Mx
PO ISOtretinoin + PO CS +- PO Abx
For women who have hornonal Acne, give what?
COCP
IDd acne with propionobac… can Tx how?
3mo Abx
Topical Abx choices for Acne
Clinda, erythro, dapsone
Oral Abx for acne, options
Doxy, iymecycline
Main worry in cellulitis patients
Sepsis
Eron classification
How to Mx cellulitis
Patient with cellulitis: there are no signs of systemic toxicity and patient has no comorbidities. Eron classification class and management
Class one. Give oral flucloxacillin, or clarithromycin if allergic, erythromycins pregnant
Patient with cellulitis: Patient systemically unwell (not in shock) or well but has a comorbidity. How to manage and what stage
Class two. IV antibiotics and monitor, may need admission
Patient with cellulitis: Person is systemically unwell, such as confusion tachycardia, tachypnoea, hypotension. Or has life-threatening vascular compromise. What class is this and how would you manage
Class three, admit patient and give IV antibiotics. Co Amoxiclav Or clindamycin for cephtrioxane
Patient with cellulitis: Patient has sepsis necrotising fasciitis. How to manage, and what class is this
Class 4. Admit patient and give IV antibiotics
Indications to admit a patient with cellulitis
ERON class 3 or four, rapidly deteriorating, frail, less than one year old, immuno compromised, lymphoedema, facial cellulitis
Aside from ERON class treatment for cellulitis, what support of therapy should be given to all patients
Fluids, heparin, wound management, analgesia, elevate limb, draw around lesion, treat lymphoedema
Drugs responsible for causing Steven Johnson syndrome
Penicillin, sulphurs, lamotrigine , carbamazepine, phenytoin, allopurinol, NSAID, OCP
Difference between Steven Johnson and TEN
Steven Johnson involves less than 10% of skin, TEN involves more than 30%
Aside from usual investigations, two investigations which are crucial for Steven Johnson syndrome
Skin biopsy (definitive diagnosis) and blood cultures to ruled out toxic shock/scalded skin syndrome.
Overview of management for Steven Johnson
Urgent admission, ABCD approach, withdraw causative agent (very important), fluid intake orally/IV ringers or isotonic saline. Immuno suppressants are not great
Treatment for Urticaria. And if severe?
Oral antihistamine second generation. If severe give PO prednisolone. If chronic with eosinophilia give Omalizumab
Management of a patient with urticaria and airway Involvement
Adrenaline, airway protection, IV antihistamine
First line treatment for eczema
Emollience plus or minus topical corticosteroids. Can add antibiotics if infected
How to admin medication for eczema
Emollient, wait for 30 minutes, steroid. Or can do wet wrapping
If severe eczema what medication can you give
Oral cyclosporine (eczyclosporine)
First line treatment for plaque psoriasis
Topical corticosteroids and topical vitamin di analogues (calcipotriol) once daily for four weeks.
Step up, second line, for plaque psoriasis
Vitamin di analog twice daily
Third line step up for plaque psoriasis
Corticosteroids twice daily
Aside from steroids/vitamin D analogues what 4 other medications are good for plaque psoriasis
Coal Tar, UVB, Tacrolimus Good for face and skinfolds
If patient has plaque psoriasis involving the face this is a strong indication to start what medication
Topical corticosteroids
Patient with plaque psoriasis and arthritis, medication first line
Methotrexate
Indications for systemic therapy in psoriasis
Pustular, topical has failed, hospitalised, elderly, extensive, arthritis
Treatment for dermatomyositis and polymyositis
High-dose corticosteroids and the taper until symptoms improve
Main treatment for Henoch schoelein Purpura
Analgesia (paracetamol), hydration, rest, monitor
Henoch Sholan purpura, treatment for mild nephritis
Oral corticosteroids, consider ACEi
Henoch Sholan purpura, treatment for moderate nephritis
Oral oral IV steroids and Consider ACEI
Henoch Sholan purpura, treatment for severe nephritis
IV Cyclophosphamide and consider ACEI. Patient may need transplant
When to hospitalise an HSP patient
Need IV fluids, GI bleed, severe abdominal pain, AMS, severe arthritis, severe renal disease
macule, patch, vs papule, vs plaque
what is purpura
Purpura is a condition of red or purple discoloured spots that do not blanch under pressure.
The spots are usually caused by bleeding underneath the skin, secondary to platelet disorders,
vascular disorders, coagulation disorders, etc
