Dermatology Presentations Flashcards
1
Q
What is SCC?
A
- 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
2
Q
Management of SCC
A
- 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
3
Q
GP management for SCC
A
- 2WW to pigmented lesion clinic
- Ensure this appointment is received
- Psychosocial support
4
Q
Safety netting for SCC
A
- If increasing in size rapidly and invading surrounding structures
- Lumps in neck
5
Q
What is BCC?
A
- 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
6
Q
Management for BCC
A
- Wide local excision
- Cryotherapy
- Iquimoid cream - topical chemo
- Curretage - scraping and scooping tissue
- Mohs micrographic surgery
- Radiotherapy
7
Q
Safety netting for BCC
A
- 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
8
Q
How does measles present?
A
- 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
9
Q
Rash for measles
A
Erythematous maculopapular rash, non pruiritic
10
Q
Dermatology terminology - common of PCDS
A
11
Q
Where to refer for suspected melanoma?
A
2WW pigmented lesion clinic
12
Q
Appearance of ringwoem
A
- Round
- Leading edge of infection
- Central clearing
- Crusted
- Rolled edge (raised)
13
Q
Ringworm vs pityriasis rosea
A
13
Q
Treatment ringworm (tinea corporis)
A
- Topical clotrimazole or miconazole if isolated (available OTC for specific age groups)
- Topical hydrocrotisone 1% if lots of inflam
- Oral terbinafine if extensive
14
Q
How long do fungal infections take to resolve?
A
- skin 3-4 weeks
- Nails can take 6 weeks-6 months of treatment
15
Q
Possible actual cause for “recurrent thrush” presentation
A
- Lichen sclerosis
16
Q
Tests involved in pruiritis screen
A
- FBC
- U&E
- LFT
- TFT - can cause dry skin
- CRP
17
Q
Causes of itchyness - most to least itchy
A
- Scabies
- Uraemia
- Lichen planus
- Lichen sclersosis
- Nodular prurigo
- Eczema
- Bites
18
Q
Scabies 1st line
A
Permethrin 5% cream
19
Q
Cream that can reduce itchiness, used in chicken pox
A
Calamine lotion
20
Q
Chicken pox presentation
A
- 2-3 weeks incubation (from contact)
- Blistering lesions - not all blistering tho
- Always have cough/URTI symptoms
21
Q
Management chicken pox
A
- Symptomatic treatment - paracetamol if pain, calamine lotion, chlorphenamine if over 1
- Self resolving unless immunocompromised etc then Aciclovir is offered
22
Q
Shingles presentation
A
- Single dermatomal distribution - dormant in dorsal root ganglia
- Resurface when immunocompromised
23
Q
Long term complication shingles
A
- Post herpetic neuralgia - prescribe aciclovir if present within 72hrs of rash if they are 50 years or older esp
24
What is Pompholyx?
Eczema and blisters
25
Causes of round lesions
* Psoriasis
* Fungal
* Eczema
* Pityriasis rosea - herald patch with inverted christmas tree pattern on back
* Target lesions - eg lymes
26
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
27
Lymes disease - presentation and treatment
* Target lesion
* After walking in long grass that deer are found - tick bite
* 3 weeks of Doxycycline
28
Causes of scaly lesions
* Ichthyosis
* Psoriasis
* Eczema
* Tinea
* Pityriasis rosea
29
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
30
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
31
RF associated with psoriasis
* Mortality and CVS risk - calculate QRISK
32
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
33
Scoring for psoriasis
PEST score
34
What does psoriasis often come along with?
* Dactilytis - sausage finger
* Achille tendonitis
* Plantar fascitis
35
Order of strengths of topical steroids - lowest to strongest
1. Hydrocortisone
2. Eumovate or Betnovate RD- clobetasone butyrate or reduced dose betamethasone valerate 0.025%
3. Betnovate -betamethasone valerate 0.1%
4. Dermovate - clobetasol propionate 0.05%
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