GP conditions - dermatology

Question 1

What is eczema, its cause, common affected areas and presentation

Answer 1

• Chronic atopic condition
• Caused by defects in the normal continuity of the skin barrier leading to inflammation in the skin
• Dry, red, itchy and sore patches of skin
• Usually over flexor surfaces
• Periods of well control with problematic flares

Question 2

What is used in to prevent flares of eczema (maintenance)

Answer 2

• Emollients

Question 3

How is a mild flare of eczema managed

Answer 3

• Liberal and frequent use of emollients
• Mild topical corticosteroids (1% hydrocortisone)

Question 4

How is a moderate flare of eczema managed

Answer 4

• Liberal and frequent use of emollients
• Moderately potent topical corticosteroids (eumovate/clobetasone butyrate 0.05%)

Question 5

How is a severe flare of eczema managed

Answer 5

Step up :

• Liberal and frequent use of emollients
• Potent topical corticosteroid (betnovate (betamethasone valerate 0.1%)
• Topical calcineurin inhibitors (tacrolimus)
• Bandages
• Phototherapy
• Oral steroids

Question 6

What is the most common caused of infected eczema

Answer 6

Staphylococcus aureus

Question 7

How is a secondary bacterial infection of eczema in ppl who are not systemically unwell managed

Answer 7

• Emollients and topical corticosteroids
• Do not routinely offer abx

Question 8

What is the first choice topical abx for infected eczema if appropriate

Answer 8

• Fusidic acid 2%
• 3 times a day for 5 to 7 day

Question 9

what oral abx is used for infected eczema if appropriate ?

Answer 9

• Flucloxacillin (500mg 4 times a day for 5 to 7 days).
• Clarithromycin if penicllin allergy (250mg twice as day for 5 to 7 days)
• Erythromycin if penicliin allergy and pregnant (250mg to 500mg four times a day for 5 to 7 days)

Question 10

how does infected eczema present

Answer 10

Weeping pustules, crusts, rapidly worsening eczema, fever and malaise

Question 11

Eczema herpeticum : what is it, cause, presentation

Answer 11

• Viral skin infected
• Caused by HSV or VZV
• Presentation : pt with eczema develops widespread, painfulm vesicular rash with systemic symptoms (fever, lethargy, irritability and reduced oral intake).
• Lymphadenopathy

Question 12

How does the rash in eczema herpeticum present

Answer 12

• Widespread
• Erythematous, painful and sometimes itchy
• Vesicles containing pus

Question 13

How is eczema herpeticum managed

Answer 13

• Mild / moderate = oral aciclovir
• Severe = IV aciclovir

Question 14

what can be used for severe itching in eczema flares and that affecting sleep

Answer 14

1. Non sedating antihistamines (e.g. cetirizine, loratidine)
2. Sedating antihistamines (chlorphenamine, short course !)

Question 15

Define a bulla and a vescile

Answer 15

• Bulla : circumscribed collection of free fluid (>1cm)
• Vesicle : circular collection of free fluid (1cm or smaller)

Question 16

Define a pustule

Answer 16

Vesicle containing pus

Question 17

Define a macule and a patch

Answer 17

• Macule : circular, flat discolouration (<1cm) = browm, blue, red or hypo pigmented
• Patch : circumscribed flat discoloration (>1cm)

Question 18

Define a papule and a nodule

Answer 18

• Papule : superficial, solid, elevated, <0.5cm, colour varies.
• Nodule : circular, elevated, solid lesion, >1cm.

Question 19

Define a plaque

Answer 19

• Superficial, elevated solid flat, topped lesion (>1cm)

Question 20

What is the cause of venous/stasis eczema ?

Answer 20

• Underlying venous disease causing poor tissue perfusion

Question 21

Who does venous eczema affect and where on the body ?

Answer 21

• Middle aged / elderly patients
• Legs : valves in the veins stop working blood leaks backwards. Increased pressure causes fluid to leak into the surrounding tissue.

Question 22

How does venous eczema present ?

Answer 22

• Early : capillary veins and haemosiderin deposition around ankles = brown hyperpigmentation
• Later : eczema (itching, dry scaly area, erythematous and purpuric) +/- lipodermasclerosis +/- ulceration

Question 23

how is venous eczema managed ?

Answer 23

• Emollients +/- mild to moderate steroids
• Manage underlying venous insufficient - postural drainage/compression stockings

Question 24

who does a seborrheic wart usually affect and how does it present ?

Answer 24

• > 60 yrs
• Warty nodule, usually pigmented, ‘stuck on/bunch of grapes appearance’
• Reassurance only needed