Dermatology Rashes Flashcards
What is the treatment for cavernous haemangiomas?
- Not present at birth cavernous haemangiomas appear in the first two weeks of life.
- lesions are usually on the face, neck, trunk
- well circumscribed and lobulated
Treatment:
- NO surgical excision, treat if they inhibit normal development (e.g. impair normal binocular visual development)
- systemic or local steroids
- sclerosants
- interferon
- laser treatment
What is the treatment for alopecia areata?
an autoimmune condition causing discrete areas of hair loss
Treatment:
- cortisone injections into the affected areas
- use of topical cortisone creams
A young child is brought into the clinic with severe eczema
Which of the following is true concerning his treatment?
- might benefit from a diet free of cow’s milk
- should be given a course of oral steroids
- should be treated with the aim to complete cure
- should not be immunised against measles
- should not be immunised against pertusis
a - Cows milk restriction.
it can precipitate severe eczema, and trial of soy-based formula may have beneficial effects on the infant.
- complete cure is not practical. Amelioration of symptoms using preventative measures and topical preparations may minimuse
- most infants grow out of the condition by 2-3 years
- no evidence to avoid immunizations
- oral steroids are last resort and only used in infants with severe eczema.
How do you determine the wide excision margins after initial excision biopsy of a melanoma? What is some further treatment if metastasis is diagnosed?
- Initial excision with 2mm border
- Breslow thickness
- melanoma in situ - 5mm surgical margin
- melanoma <1mm = 1cm margin
- mealona 1-4mm = 1-2cm
- melanoma >4mm = 2cm
- <0.75mm breslow thickness lymph node spread risk is very low, hence only need wide margins.
- >1mm consider lymph node SLN procedures.
- Stage with CT and PET in stage 3 disease (mets). MRI of brain for brain mets may not be detected on PET
- isolated systemic then resect
- 50% are BRAF + - vemurafenib and dabrafenib target this oncogene.
- SCCs more common
- other;
- ipilimumab - stimulates T cells
What is the treatment of psoriasis?
- topical
- keratolytics
- moisturisers
- topical steroids
- vitamin D
- Vitamin A (retinoids)
- tar (LPC, CCT)
- anthralin
- Phototherapy
* narrowband UVB or PUVA (topical) - Systemic
- retinoids
- methotrexate
- cyclosporin
- Biologics
- e.g. anti TNF - infliximab/etanercept
- humira in kids - compassion giving at RCH.
*
What is the diagnosis? What is the management?
Molluscum Contagiosum
- umbilication in the centre (dimple)
- flesh coloured papules
Management:
- assessment and education (contact, water spread)
- conservative
- taping/irritants
- cantharidin (technique is important)
- curettage/cyrotherapy/duofilm
- drugs
What are the different kinds of cutenous warts? how does management differ between them?
Types:
- filiform or digitate warts
- common warts
- flat (plane) warts
- periungual or subungual
- plantar warts
Treatment:
- topical salicyclic acid (all)
- add silver nitrate and glutaraldehyde in plantar and common warts possibly
- cryotherapy 2nd line in most
- systemic:
- cimetidine
- topical/intralesional
- fluorouracil
- physical destruction:
- blunt dissection, curettage
What would be the reasons for treating hemangiomas with propranolol? What is the mechanism? What other considerations?
A E I O U (S)
- aesthetic
- exsanguination
- infection
- obstruction/pressure
- eye
- larynx
- ulceration
- systemic
- heart, hypothyroid, brain, spinal dysraphism, other)
Propranolol:
- vasocontriction
- down regulation of RAF-mitogen-activated protein kinase
- triggering endothelial apoptosis
Management:
- screening physical
- dose regimen
- monitor (BP, glucose, HR)
lasers are adjuvants - in early macular change
What is the treatment for this child? What is their condition?
- ensure the patient gets thyroid function tests (T4)
- an autoimmune disorder that targets melanocytes
- clinical signs for severe segmental vitiligo:
- leukotrichia
- scratches turn white
- little dots
- trichome
Cream vs ointment (penetrate skin better but folliculitis/discomfort)
- primecrolimus/clobetasol for body 1x 7 days on 7 days off
- tacrolimus one for the face 2x a day
UVB phototherapy
prednisolone (stop spread)
What is this disease? How do you treat it? What is the diagnostic criteria?
Kawasaki Disease:
- clinical features:
- 5 day fever +:
- conjunctivitis (white rim around iris)
- oral mucositis (red cracked lips, strawberry tongue)
- polymorphous rash
- unilateral cervical lymphadenopathy
- 5 day fever +:
- complications:
- coronary artery aneurysm
- thrombocytosis
- treatment
- aspirin (thrombocytopenia)
- IVIG - pooled immunoglobulin
- do ECHO
- blood product and cousel them of the risk
What is this disease? What is the cause?
Hand Foot and Mouth Disease:
- caused by coxsackie A16 or enterovirus 71
- 4 day incubation period after contact with bodily secretions
- presents:
- low grade fever
- maculopapular rash (on bum as well)
- mucosal mouth (more at the back rather than HSV at the front)
- management
- supportive
What is this disease? How should you treat it?
Roseola
- often caused by HHV 6 or 7
- 9-12mths of age get it.
- associated with an abrupt high fever and once it stops you get a rash along the neck, trunk and then to the face and extremities for 1-2 days, lasts 3-5 days
- nonspecific complaints of URTI, GIT, meningeal
- treatment is supportive
- complications:
- febrile convulsions
What is the diagnosis? What is the concern in these patients?
Parvovirus B19
- ‘slapped cheek’ in first 3 days
- 7 days of maculopapular rash
- fades away with central clearing for reticular rash
- prodrome:
- fever
- headache
- coryzal symptoms
- spread via droplets
- in pregnancy its teratogenic:
- serology - IgG antibodies or IgM antibodies
- complications
- arthritis
- myocarditis
- anaemia (aplastic crisis)
What is this condition? How do you manage it?
Scarlet Fever
- wound or throat infected with GAS
- Presentation:
- strawberry tongue
- rash 12-72 hours after fever
- exotoxin
- complications:
- shock
- rheumatic fever (immune mediated)
- diagnosis:
- rapid antigen testing
- streptolysin O antiDNase B
- management:
- antibiotics (penicillin)
- if you think TSS add clindamycin (stops spread of toxin)
What is the infection? What is the treatment? What other symptoms would this child have?
Measles:
- virus spread by droplets or direct contact
- really infectious, need 95% vaccine rate to cure it
- Prodrome:
- 3Cs + K - conjunctivitis, coryzal, cough + Koplik spots
- Rash:
- 3-4 days later erythematous blotchy (morbilliform)
- diagnosis
- IgM detectable 1-2 days after or NPA
- complications:
- pneumonia
- OM
- encephalitis
- SSPE - subacute sclerotic panencephalitis
- Prevention
- MMRV vaccine within 72 hrs of exposure
- normal human immunoglobulin 7 days if you can’t i.e. pregnant (1 dose then give her)
