Dermatology OSCE Flashcards
impetigo
It seems that your child has something called impetigo. This is a bacterial infection with a bug called Staph aureus. The first line treatment is a topical antibiotic called fusidic acid. If it were extremely extensive disease, we would given oral antibiotic (fluclox) but in this case topical will do fine.
This infection is highly contagious, so your child will need to stay home from school for at least 2 days after you start the treatment, at which point lots of the lesions should start to heal.
scabies
this sounds like a scabies infection. Scabies are a little bug that burrows into skin. they then crawl underneath the skin and lay eggs, which cause a reaction in the skin to cause the itch and the red lines.
In order to confirm this, I am going to take some skin scrapings (doesn’t hurt) by using a scalpel and a drop of oil and running it over the surface of your skin. I will send this to the lab to confirm the presence of the bug.
the treatment is called permethrin, which is an insecticide.
if even one bug survives, everyone in your house can get infected again which means we give quite strict advice to make sure they don’t come back:
- put treatment on the entirety of your dry skin (including face and scalp) and leave for 8-12 hours before washing. if you have to wash your hands, then reapply insecticide.
- repeat in a week
- treat whole household
- avoid close contact with anyone else until treatment is over
- launder, iron, tumble dry ALL bedding and clothes
it’s a bit of a mission but it is worth getting rid of them once and for all. It is worth mentioning that by the end of the treatment next week the bugs will be gone, but you may still be itchy for 4-6 weeks.
acne vulgaris
acne is a condition where the sebaceous glands in your skin, that create the natural oils, become blocked. This forms comedones. A bug then proliferates in the blockage (P.acnes) and causes inflammation and the red spots.
there is good treatment for acne. There are things you can to do help yourself, and things we can give you to help.
In everyone, we advise that this has nothing to do with the food you eat, or your hygiene. It is usually down to the fact that your body produces more sebum than most. Hence, we advise gentle washing with soap and water like you would anywhere else and adherence to our management plan. Do not use comedogenic makeup or sunscreen.
We can give you:
- topical benzoyl + topical clindamycin and i’ll see you in a month
- add topical retinoid (+COCP)
- add oral antibiotic (doxycycline)
- send to dermatologist to see whether oral retinoid is needed. This has big side effects including dry eyes, mouth, skin, hair thinning, low mood, raised triglycerides, teratogenicity (2 contraceptions)
eczema
There is no test that will confirm this, but this looks like eczema. In some patients, we can do some allergy testing to see if that is a contributing cause.
In terms of management, there are both things that you can do and things that we can do to help you.
Firstly, it is important that you avoid irritants. you must avoid soap as well and instead we can give you some soap substitutes (dermol 500). using emollients regularly (2x/day) and as oily as you can manage is helpful to create a barrier for your skin.
Apart for the emollients, the other thing to try first is topical steroids (eu=face, bet=body, derm=hands). finger tip unit = 2 palms. wait 30 after emollient to apply.
In the area that are really thickened (lichenified), I will give you salicylic acid to put on as well.
We will try this for a good month or two and I will see you again.
If this doesn’t work, there are other things like UV radiation and immunosuppressive mediation to give you (ciclosporin) which we can discuss in further visits. At that point, depending on how you are going with the steroids and whether you have any side effects, I may switch it to a protopic .
Are you having trouble sleeping because of the itch? Ok, I can give you drowsy antihistamines which should help.
psoriasis
this looks and sounds like psoriasis, which is an autoimmune condition causing red scaly plaques on your skin.
I’d like to assess how this is affecting you by asking you to fill out a DLQI score.
there are a number of things I can do for you here at the GP, and a number of things they can do for you later down the line if I have to refer you
We will try each step and evaluate every month to see how you are doing:
- emollients + potent topical steroid (morning) + vit D analogue (night)
- use vit D BD
- use steroid BD or try coal tar
At the dermatologist, they can think about:
- phototherapy (3x/week)
- systemic therapy (methotrexate, ciclosporin, infliximab)
