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Yr 5 - Derm > Eczema, Psoriasis & Impetigo > Flashcards

Eczema, Psoriasis & Impetigo Flashcards

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Dermatology Board Prep flashcards
1
Q

What is the most common form of psoriasis?

A

Chronic plaque psoriasis

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2
Q

Clinical features of psoriasis?

A

Erythematous plaques covered with a silvery-white scale

Typically on the extensor surfaces such as the elbows and knees.

Also common on the scalp, trunk, buttocks and periumbilical area

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3
Q

What is Auspitz’s sign?

A

If the scale in psoriasis is removed, a red membrane with pinpoint bleeding points may be seen.

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4
Q

1st line mx of chronic plaque psoriasis?

A

Potent corticosteroid applied once daily

plus

Vitamin D analogue applied once daily for up to 4 weeks

N.B. Regular emollients may help to reduce scale loss and reduce pruritus

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5
Q

How should corticosteroid & vitamin D analogue be applied in psoriasis?

A

These should be applied separately, one in the morning and the other in the evening

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6
Q

2nd line mx of chronic plaque psoriasis?

A

If no improvement after 8 weeks then offer a vitamin D analogue twice daily

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7
Q

Complications of psoriasis?

A

1) Psoriatic arthropathy (around 10%)

2) Increased incidence of metabolic syndrome

3) Increased incidence of cardiovascular disease

4) Increased incidence of venous thromboembolism

5) Psychological distress

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8
Q

What is atopic dermatitis AKA?

A

Eczema

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9
Q

What is the cardinal symptom of eczema?

A

Pruritus

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10
Q

Diagnostic criteria for eczema?

A

An itchy skin condition in the last 12 months

Plus three or more of
1) Onset below age 2 years
2) History of flexural involvement
3) History of generally dry skin
4) Personal history of other atopic disease
5) Visible flexural dermatitis

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11
Q

What age of onset is required to diagnose eczema?

A

Onset <2 y/o

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12
Q

What is involved in mx of eczema?

A

1) Emollients

2) Topical steroids

3) Topical calcineurin inhibitors

4) Antimicrobials

5) Phototherapy

6) Systemic therapies

7) Biologic therapy

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13
Q

When are topical steroids indicated in eczema?

A

Acute flares & moderate to severe eczema

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14
Q

Give an example of a lower potency topical corticosteroid that can be used on delicate areas such as the face or genitals?

A

Hydrocortisone 1%

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15
Q

Give an ecample of a topical calcineurin inhibitor

A

Tacrolimus

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16
Q

Role of topical calcineurin inhibitors in eczema?

A

An alternative to steroids.

They are particularly useful in areas where long-term steroids use is contraindicated, such as the face or skin folds.

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17
Q

What is eczema herpeticum?

A

Widespread 2ary HSV-1 or 2 infection, which typically affects people with atopic dermatitis or eczema.

Can also affect those with other inflammatory condiitons.

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18
Q

Risk factors for eczema herpeticum?

A

1) Early-onset or more severe atopic dermatitis

2) Head and neck or large body surface area involved dermatitis

3) High total serum IgE/ peripheral eosinophilia

4) Atopic comorbidities such as asthma and food allergies

5) History of Staphylococcus aureus skin infection

6) Other associations include younger age and non-white ethnicity, particularly African American and Asian.

It can also be triggered by trauma or cosmetic procedures e.g. lasers, skin peels, dermabrasion.

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19
Q

Clinical features of eczema herpeticum?

A

1) Areas of rapidly worsening, painful eczema

2) Vesicular rash

3) Punched-out erosions (circular, depressed, ulcerated lesions) usually 1-3mm that are uniform in appearance (monomorphic)

4) Possible fever, lethargy, lymphadenopathy or distress

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20
Q

Referral indicated in any cases where eczema herpeticum is suspected?

A

1) Referral to a specialist paediatric dermatologist

2) Eczema herpeticum involving the skin around the eyes should be referred for same-day ophthalmology review

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21
Q

Referral regarding eczema herpeticum involving the skin around the eyes?

A

Refer for same day opthalmology review

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22
Q

How can eczema herpeticum affect the eyes?

A

HSV may spread to the eye resulting in herpes keratitis.

This can result in scarring –> prompt ophthalmological referral.

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23
Q

Investigations if herpetic keratitis is suspected?

A

Staining with fluorescein –> stained dendritic ulcer is diagnostic

24
Q

Mx of eczema herpeticum?

A

Derm emergency!

Oral or IV aciclovir

25
Q

Mx of ocular involvement in eczema herpeticum?

A

Ganciclovir ointment

N.B. A corneal transplant may be indicated in cases of postherpetic scarring that significantly affects vision

26
Q

What % of 50% of patients with eczema herpeticum experience recurrence?

A

50%

27
Q

What is the most common complication of eczema herpeticum?

A

2ary bacterial infection:

1) Staph. aureus –> impetigo

2) Strep –> cellulitis

28
Q

Complications of eczema herpeticum?

A

1) 2ary bacterial infection

2) Scarring

3) Herpetic keratitis

4) Organ failure and dissemination

29
Q

What are the 2 main types of contact dermatitis?

A

1) irritant contact dermatitis

2) allergic contact dermatitis

30
Q

What is irritant contact dermatitis?

A

Non-allergic reaction due to weak acids or alkalis (e.g. detergents).

Often seen on the hands.

Erythema is typical, crusting and vesicles are rare

31
Q

What is allergic contact dermatitis?

A

Type IV hypersensitivity reaction.

Often seen on the head following hair dyes.

32
Q

How does allergic contact dermatitis typically present?

A

Presents as an acute weeping eczema which predominately affects the margins of the hairline rather than the hairy scalp itself.

33
Q

Mx of allergic contact derm?

A

Potent topical steroid

34
Q

What substance is a frequent cause of contact derm?

A

Cement

The alkaline nature of cement may cause an irritant contact dermatitis whilst the dichromates in cement also can cause an allergic contact dermatitis

35
Q

What is impetigo?

A

A superficial BACTERIAL infection.

36
Q

What 2 organisms typically cause impetigo?

A

1) Staph. aureus

2) Strep. pyogenes (GAS)

37
Q

Spread of impetigo?

A

Direct contact with discharges from the scabs of an infected person

38
Q

Features of impetigo?

A

1) ‘golden’, crusted skin lesions typically found around the mouth

2) very contagious

39
Q

Mx of impetigo?

A

1) hydrogen peroxide 1% cream –> if NOT systemically unwell or at a high risk of complications

2) topical abx e.g. fusidic acid

40
Q

1st line mx of impetigo?

A

Hydrogen peroxide 1% cream

41
Q

Mx of extensive disease in impetigo?

A

Oral flucloxacillin (or erythromycin if allergic)

42
Q

School exclusion in impetigo?

A

Until the lesions are crusted and healed or 48 hours after commencing antibiotic treatment.

43
Q

What are some factors that predispose to pressure ulcers?

A

1) malnourishment

2) incontinence: urinary or faecal

3) lack of mobility

4) pain (leads to a reduction in mobility)

44
Q

What score is widely used to screen for patients who are at risk of developing pressure areas?

A

Waterlow score

45
Q

Describe a Grade 1 pressure ulcer

A

Non-blanchable erythema of intact skin. Discolouration of the skin, warmth, oedema, induration or hardness may also be used as indicators, particularly on individuals with darker skin

46
Q

Describe a Grade 2 pressure ulcer

A

Partial thickness skin loss involving epidermis or dermis, or both.

The ulcer is superficial and presents clinically as an abrasion or blister

47
Q

Describe a Grade 3 pressure ulcer

A

Full thickness skin loss involving damage to or necrosis of subcutaneous tissue that may extend down to, but not through, underlying fascia.

48
Q

Describe a Grade 4 pressure ulcer

A

Extensive destruction, tissue necrosis, or damage to muscle, bone or supporting structures with or without full thickness skin loss

49
Q

Mx of a pressure ulcer?

A

1) a moist wound environment (encourages ulcer healing)

2) hydrocolloid dressings and hydrogels

3) wound swabs frequently

50
Q

What can guttate psoriasis be precipitated by?

A

Strep infection 2-4 weeks prior to the lesions appearing

51
Q

1st line mx of moderate-severe psoriatic arthritis?

A

Standard DMARDs e.g. methotrexate, leflunomide or sulfasalazine

52
Q

What is tinea corporis?

A

A superficial fungal infection of the skin, often referred to as ringworm.

53
Q

Cause of tinea corporis?

A

It is NOT caused by a worm.

The condition is primarily caused by dermatophytes, a group of FUNGI that thrive on keratin, a protein found abundantly in the skin, hair, and nails.

54
Q

Clinical features of tinea corporis?

A

Presents as erythematous, scaly plaques with an active, advancing, and often pruritic border.

The centre of the lesion may clear up as it expands, resulting in a characteristic ring-like appearance, hence the name ringworm.

55
Q

Mx of tinea corporis?

A

Topical antifungal medication such as clotrimazole or terbinafine.

56
Q
A

Yr 5 - Derm (8 decks)

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