Dermatology Presentations Flashcards
What is SCC?
- Common variant skin cancer
- Arises from squamous cells -flat, thin cells found in epidermis (top layer)
- RF inc sun exposure, tanning beds, immunosupression, genetic conditions eg Xeroderma pigmentosum
- Typically present on sun exposed areas
- Rapidly expand, ulcerated nodules
- Cauliflower appearance sometimes
- Some bleed
Management of SCC
- Surgical excision with 4mm margin (6mm in high risk lesions)
- Mohs micrographic surgery - tissue removed and examined under microscope in real time to ensure all cancerous cells are removed
- Radiotherapy
- Curretage and cautery
- Topical 5-fluorouracil or imiquimod
- Cryo if lesion small risk (flat and sueprficial)
- Plastic surgery involve if difficult to remove
GP management for SCC
- 2WW to pigmented lesion clinic
- Ensure this appointment is received
- Psychosocial support
Safety netting for SCC
- If increasing in size rapidly and invading surrounding structures
- Lumps in neck
What is BCC?
- Most common type of non-melanoma skin cancer worldwide
- Arise from epidermis - lowest layer
- Commonly caused by exposure to UV light
- More risk if fairer and easily burn
- Can vary greatly in appearance
- Curable in most cases
- Rarely spread
Management for BCC
- Wide local excision
- Cryotherapy
- Iquimoid cream - topical chemo
- Curretage - scraping and scooping tissue
- Mohs micrographic surgery
- Radiotherapy
Safety netting for BCC
- 50% of people will develop 2nd BCC within 3yrs of first
- Prevent further lesions by preventing sunburn
- At increased risk of other cancers eg melanomas
- Do regular self skin checks and annual skin checks
- Look for change in shape, colour, size 7mm or more, irregular
How does measles present?
- Intial cough and fever - URTI symptoms
- Then rash
- Rash starts behind ears and on face
- Then spreads (like chicken pox progression)
- VERY infectious - contacts?
- Check for Koplik spots in buccal mucosa
- Only affects unvaccinated usually
Rash for measles
Erythematous maculopapular rash, non pruiritic
Dermatology terminology - common of PCDS
Where to refer for suspected melanoma?
2WW pigmented lesion clinic
Appearance of ringwoem
- Round
- Leading edge of infection
- Central clearing
- Crusted
- Rolled edge (raised)
Ringworm vs pityriasis rosea
Treatment ringworm (tinea corporis)
- Topical clotrimazole or miconazole if isolated (available OTC for specific age groups)
- Topical hydrocrotisone 1% if lots of inflam
- Oral terbinafine if extensive
How long do fungal infections take to resolve?
- skin 3-4 weeks
- Nails can take 6 weeks-6 months of treatment
Possible actual cause for “recurrent thrush” presentation
- Lichen sclerosis
Tests involved in pruiritis screen
- FBC
- U&E
- LFT
- TFT - can cause dry skin
- CRP
Causes of itchyness - most to least itchy
- Scabies
- Uraemia
- Lichen planus
- Lichen sclersosis
- Nodular prurigo
- Eczema
- Bites
Scabies 1st line
Permethrin 5% cream
Cream that can reduce itchiness, used in chicken pox
Calamine lotion
Chicken pox presentation
- 2-3 weeks incubation (from contact)
- Blistering lesions - not all blistering tho
- Always have cough/URTI symptoms
Management chicken pox
- Symptomatic treatment - paracetamol if pain, calamine lotion, chlorphenamine if over 1
- Self resolving unless immunocompromised etc then Aciclovir is offered
Shingles presentation
- Single dermatomal distribution - dormant in dorsal root ganglia
- Resurface when immunocompromised
Long term complication shingles
- Post herpetic neuralgia - prescribe aciclovir if present within 72hrs of rash if they are 50 years or older esp
What is Pompholyx?
Eczema and blisters
Causes of round lesions
- Psoriasis
- Fungal
- Eczema
- Pityriasis rosea - herald patch with inverted christmas tree pattern on back
- Target lesions - eg lymes
Pityriasis rosea vs versicolour
- Versicolour is fungal infection - looks like change to skin pigmentation COLOUR rather than red rash
- Need antifungals
- Rosea is just self limiting
Lymes disease - presentation and treatment
- Target lesion
- After walking in long grass that deer are found - tick bite
- 3 weeks of Doxycycline
Causes of scaly lesions
- Ichthyosis
- Psoriasis
- Eczema
- Tinea
- Pityriasis rosea
Nappy rash vs candida
- Nappy rash commonly caused by ammonia in urine irritating skin
- Spared skin sections which do not touch ruine
- Fluffier edges compared to candida
What is psoriasis which is just back droplets and not plaques?
- Guttate psoriasis - 1/3 have no FH and do not go on to develop plaques
RF associated with psoriasis
- Mortality and CVS risk - calculate QRISK
Management psoriasis
- Topical emolients
- Topical corticosteroid
- Topical Vitamin D preparations - eg Calcipotriol (Dovonex or Enstillar foam)
- Topical calcineurin inhibitors (eg Tacrolimus)
- Narrow band UVB phototherapy
- Systemic drugs eg methotrexate, ciclosporin
- Biologics eg anti-TNFa
Scoring for psoriasis
PEST score
What does psoriasis often come along with?
- Dactilytis - sausage finger
- Achille tendonitis
- Plantar fascitis
Order of strengths of topical steroids - lowest to strongest
- Hydrocortisone
- Eumovate or Betnovate RD- clobetasone butyrate or reduced dose betamethasone valerate 0.025%
- Betnovate -betamethasone valerate 0.1%
- Dermovate - clobetasol propionate 0.05%
