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Phase 3B > Dermatology Primary Care > Flashcards

Dermatology Primary Care Flashcards

1
Q

What is the pathophysiology of acne vulgaris?

A

Increased sebum production (exacerbated by androgens), occlusion of follicular ducts by hyperkeratinisation, and bacterial colonization of ducts, which breaks down triglycerides, producing free fatty acids that cause dermal inflammation.

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2
Q

Which bacteria colonizes follicular ducts in acne vulgaris?

A

Proprionibacterium acnes

p.acnes

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3
Q

Name four risk factors for acne vulgaris.

A

P.acnes infection
Puberty and menstrual cycles (increased androgens)
High glycaemic load diets
Stress

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4
Q

Which areas of the body does acne vulgaris present?

A

Areas rich in sebaceous glands: face, back, sternal area

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5
Q

What are the three cardinal features of acne vulgaris?

A 
Open or closed comedomes
Inflammatory papules (ruptured comedomes)
Pustules
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6
Q

What is an alternative name for comedomes?

A

Open - blackheads

Closed - whiteheads

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7
Q

What are three other features of acne vulgaris?

A

Premenstrual exacerbation
Seborrhoea
Deep dermal inflammation and keyloid scarring.

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8
Q

Name the 5 main variants of acne.

A 
Infantile
Steroid
Conglobata
Acne excoriee
Acne fulminans
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9
Q

What are the symptoms of acne fulminans, other than severe necrotic crusted lesions?

A

Malaise, pyrexia, arthralgia

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10
Q

What is the management of acne fulminans?

A

Urgent prednisolone and analgesics

Oral isoretinoin

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11
Q

What drugs are known to cause or exacerbate acne?

A 
Anabolic steroids
Corticosteroids
Isoniazid
Ciclosporin
Anti-epileptics
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12
Q

What is the first line treatment of mild to moderate acne?

A

Topical retinoid or antibiotic, with benzoyl peroxide.
e.g. adapalene 0.1%/isoretinoin
e.g. clindamycin 1%
Both with benzoyl peroxide

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13
Q

What is the 2nd line treatment for acne vulgaris?

A

Addition of PO antibiotic: doxycycline

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14
Q

Why should macrolide antibiotics such as erythromycin be avoided in the treatment of acne?

A

High levels of p.acnes resistance

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15
Q

The COCP is an alternative 2nd line treatment for acne in women; how does it work?

A

Anti-androgen activity.

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16
Q

What are the indications for referral to a dermatologist for treatment with PO isotretinoin (roaccutane)?

A

No response to two different abx
Scarring
Severe psychological distress
Severe variant such as fulminans or conglobata.

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17
Q

What are the side effects of isotretinoin?

A

Mucosal dryness
Teratogenic
Depression rarely

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18
Q

What is the pathophysiology of atopic eczema?

A

Atopic individuals who have a mutation in the epidermal barrier protein filaggrin are predisposed to dysfunction in the skin barrier.

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19
Q

Which cells are overactive in atopic eczema and what antibody is produced?

A

Overactive Th2 lymphocytes

Produce IL4 and IL5 Stimulate IgE production

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20
Q

What are some exacerbating factors for atopic eczema?

A

Stress
Detergents
Food allergens

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21
Q

What is the distribution of atopic eczema?

A

Flexures

Infants - face to body

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22
Q

What are five signs of atopic eczema?

A 
Erythematous scaly patches
Vesicles
Excoriations
Lichenification
Post-inflammatory hypo/hyperpigmentation
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23
Q

Name two complications of atopic eczema.

A

Secondary infection with s.aureus

Eczema herpeticum

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24
Q

What is the treatment of eczema herpeticum?

A

PO or IV aciclovir

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25
Q

What is the triple combination treatment of atopic eczema?

A

Topical steroid
Emollients
Bath oil/soap substitute

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26
Q

What are three side effects of topical steroids?

A

Skin atrophy
Telangiectasia
Adrenal suppression

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27
Q

What is the management of fissured digits in eczema?

A

Haelan tape (Fludroxycortide)

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28
Q

What type of cream is initiated in secondary care for atopic eczema?

A

Topical immunomodulators such as tacrolimus ointment or pimecrolimus cream

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29
Q

What antibiotic is prescribed for secondary infection of atopic eczema?

A

PO flucloxacillin 7-10d

/Erythromycin

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30
Q

What is pompholyx eczema?

A

Itchy vesicles/blisters on palm and sides of fingers.

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31
Q

When should patch testing be considered?

A

Irritant/allergic dermatitis suspected

Hand eczema.

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32
Q

What is the classification of dermatophytosis (tinea infections)?

A 
Corporis (body)
Capitis (scalp)
Pedis (feet)
Cruris (groin)
Unguium (nails)
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33
Q

How are tinea infections diagnosed?

A

Microscopy of skin and nail specimens - hyphae and spores

Woods UV light for tinea capitis

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34
Q

What is the treatment of tinea infection?

A

Clotrimazole/miconazole cream

Capitis and Unguium require systemic agents such as terbinafine OD

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35
Q

Name four risk factors for candidiasis infection?

A

Broad spectrum antibiotics
Immunocompromise
Pregnancy
Diabetes mellitus

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36
Q

How does oral candidiasis present?

A

Pseudomembranous - curd like white patches in the mouth

Acute erythematous - can have marked erythema and soreness

37
Q

What is the treatment of oral candidiasis?

A

Miconazole gel or nystatin suspension

38
Q

What are the symptoms of oesophageal candidiasis?

A

Dysphagia/retrosternal pain

Usually oropharyngeal candidiasis too

39
Q

What is oesophageal candidiasis associated with?

A

Treatment of haematological malignancies

40
Q

How is oesophageal candidiasis diagnosed?

A

Therapeutic trial of fluconazole

Endoscopy

41
Q

What is the treatment of oesophageal candidiasis?

A

Admission

PO fluconazole, can escalate to IV fluconazole

42
Q

Name four types of candida skin infection.

A

Napkin dermatitis
Balanitis
Intertrigo
Chronic paronychia/onychomycosis

43
Q

How are topical candida skin infections managed?

A

Topical imidazole cream e.g. clotrimazole

If itchy, add mild corticosteroid

44
Q

What is pityriasis versicolor?

A

Flaky velvety discoloured patches/macular lesions, with mild itching, appear mainly on the chest and back
Proliferation of malassezia fungi and change to a pathological mycelial form

45
Q

What are three risk factors for pityriasis versicolor?

A

Hyperhidrosis
Occlusive clothes
Immune suppression

46
Q

How is pityriasis versicolor diagnosed?

A

Clinical

Examination using Wood’s light

47
Q

What is the treatment of pityriasis versicolor?

A

Clotrimazole cream or shampoo

48
Q

What factors exacerbate pruritus ani?

A

Sweating
Heat
Incontinence
Bowel movement

49
Q

What are some secondary causes of pruritus ani?

A

Primary skin conditions
Infection e.g. candida, threadworm
Anal disease e.g. fissure

50
Q

How is pruritus ani managed?

A

Bismuth subgallate/zinc oxide
Hydrocortisone 1%
Chlorphenamine

51
Q

When do you refer patients to colorectal surgeons for exclusion of anorectal pathology in the case of pruritus ani?

A

Self care measures and symptomatic treatment do not settle symptoms after 6 weeks
Negative blood tests

52
Q

Give five causes of pruritus vulvae?

A 
Sensitive vulval skin
Primary skin conditions
Urinary or faecal incontinence
Menopause
Pregnancy
53
Q

What are four signs of herpes skin infection?

A

Herpetic whitlows
Cold sores
Vesiculation
Tingling irritating prodrome of around 4-6 hours

54
Q

What should you do if not sure that a patient has a herpes skin infection?

A

Take a swab of blister fluid for virology

55
Q

What is the treatment of herpes simplex skin infection?

A

Symptomatic treatment unless immunocompromised or atopic eczema.
Aciclovir 400mg 5x daily

56
Q

What is the treatment of human papilloma virus (warts)?

A

Cryotherapy or topical salicyclic acid

57
Q

What is the treatment of scabies?

A

5% permethrin cream

58
Q

What are four signs of scabies?

A 
Burrows
Finger web crusting
Nodules
Blisters
VERY ITCHY
59
Q

What is the treatment of lice?

A

Dimeticone 4% lotion

Malathion 0.5% lotion

60
Q

What is urticaria?

A

Skin rash occurring in reaction to an antigen

61
Q

What is urticaria pigmentosa?

A

Generalised eruption of cutaneous mastocytosis

62
Q

What are the signs and symptoms of urticaria pigmentosa?

A 
Hives and Darier's sign
Diarrhoea
Tachycardia and Vascular collapse
Nausea and vomiting
Headache
63
Q

What is the histology of urticaria vasculitis?

A

Cutaneous lesions resemble urticaria but histologically shows features of vasculitis.

64
Q

How is urticarial vasculitis diagnosed?

A

Clinical
Skin biopsy and histology
Low complement/anti-C1q antibodies

65
Q

What is the cause of seborrheic eczema?

A

Overgrowth of malassezia furfur and strong cutaneous reaction

66
Q

What are some presentations of seborrheic eczema?

A

Cradle cap
Erythematous scaling
Dandruff
Blepharitis

67
Q

What is the treatment of seborrheic eczema?

A

Daktacort preparation

Ketoconazole shampoo

68
Q

How are allergic and irritant dermatitis diagnosed?

A

Patch testing

69
Q

What are some common allergens for allergic contact dermatitis?

A 
Nickel
Chromates
Lanolin
Rubber
Plants
70
Q

What are some signs of varicose eczema?

A

Scaling/crusting in gaiter area

Signs of stasis - hyperpigmentation, oedema, atrophie blanche, venous leg ulcers

71
Q

What is the treatment of varicose eczema?

A

Ankle exercises, elevation, compression to control oedema
Emollients and moderately potent corticosteroid
Ichthammol/zinc bandages

72
Q

How does discoid/nummular eczema present?

A

Well defined, v itchy, papules/plaques that may be scaly or vesicular.
Symmetrical distribution on trunk and limbs

73
Q

What is the treatment of nummular eczema?

A

Triple therapy except the corticosteroid is potent/very potent.

74
Q

Define impetigo.

A

Superficial infection of the skin.

75
Q

What is the usual causative organism in impetigo?

A

S.aureus

Strep pyogenes

76
Q

What is the treatment of non-bullous and bullous/resistant impetigo?

A

Non-bullous - fusidic acid TD 7d

Bullous - PO flucloxacillin

77
Q

What is the name for infections of the dermis and deep dermis and subcutaneous tissue?

A

1) Erysipelas

2) Cellulitis

78
Q

How do you differ between erysipelas and cellulitis?

A

Cellulitis has poorly demarcated borders

79
Q

What are the two types of melanocytic naevi?

A

Congenital and acquired

80
Q

What is a seborrheic wart?

A

Common benign hyperkeratotic skin lesion associated with ageing

81
Q

What is seen on dermoscope in seborrheic warts?

A

Thickened epidermis
Gyri and sulci
Milia like cysts

82
Q

What is the treatment of seborrheic warts?

A

Cryotherapy when there is cosmetic dislike or repeated irritation

83
Q

Define photosensitivity and photoaggravation

A

1) conditions triggered by light

2) disorders worsened by light but not due to abnormal sensitivity

84
Q

What occurs with polymorphic light eruption?

A

Hours-days after light exposure, itchy red papules, vesicles, and plaques appear on exposed sites.
Itchy and burning

85
Q

How is polymorphic light eruption managed?

A

Prevention - sun avoidance and protection

Treatment of acute attack - potent topical steroids, short course oral steroids

86
Q

What is solar urticaria?

A

The skin swells within minutes of exposure to natural sunlight or an artificial light source emitting UV radiation

87
Q

What are the causes of acanthosis nigricans?

A

GI cancer
Diabetes or obesity
PCOS, acromegaly, Cushing’s

88
Q

How do you differentiate between a sebaceous cyst and a lipoma?

A

Both are smooth and compressible

Sebaceous cyst - central punctum, more superficial, overlying skin is not mobile
Lipoma - no punctum, deeper, overlying skin is mobile

Phase 3B (20 decks)

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