ILA 5 - Itch and Skin disorders Flashcards
12 week old baby presents non-distressed with dry red patches on their bottom. You suspect nappy rash.
a) What do you do?
b) Rash is spreading. Also on mother’s breast and baby isn’t feeding. What do you do now?
a) Self-care advice (frequent nappy changes, increase time without nappy on, avoid alcohol wipes, avoid irritant soaps, clean with water, emollients, etc.)
b) - Antifungal cream for baby’s bottom and mother’s breast
- Oral antifungal mouthgel for baby
2 year old has a sore itchy rash in the flexures of the elbows and wrists.
a) Likely diagnosis
b) What is your initial management?
c) 2nd line management
Patient returns in one week, unwell, with rapidly spreading rash and painful clustered blisters.
d) How should you manage?
a) Atopic eczema
b) Emollient
c) Topical corticosteroid (eg hydrocortisone 1%) +/- antihistamine if itchy
d) Admit for IV antiviral treatment (?eczema herpeticum)
A trainee hairdresser presents with a red itchy rash of the hands.
a) Likely diagnosis
b) What’s the 1st line management ?
a) Contact dermatitis
b) Avoid offending agent, gloves, emollients
3 year old has several red lesions on the face with yellow crusting. They are happy and apyrexial.
a) Diagnosis
b) How do you manage?
a) Impetigo
b) Topical fusidic acid 5 days. Hygiene to avoid spread. Off school while active lesions
20 year old pregnant woman presents with mild acne on the face.
a) What features must be present to diagnose acne?
b) Define ‘mild’ acne
c) Usual 1st line management (non-pregnant)
d) How would you manage this case?
e) If topical management fails - other treatments of acne
a) Comedones - open (blackheads) or closed (whiteheads)
b) Comedones with mild or no inflammation (redness, pustules) and no scarring
c) Topical retinoid + benzoyl peroxide
d) Topical erythromycin + benzoyl peroxide (not abx alone due to risk of AB resistance)
e) Oral abx (eg doxycycline, erythromycin), COCP, oral retinoids (under expert supervision)
Essential monitoring for patients on isotretinoin
- Liver function and serum lipids
- Women: contraception and regular pregnancy review
30 year old presents with red scaling lesions on the elbows and behind ears.
a) Likely diagnosis
b) 1st line management
c) Topical treatments
d) Systemic treatments
a) Chronic plaque psoriasis
b) Emollients
c) Topical corticosteroids, vitamin D analogues, coal tar.
- Note: best to give CS + vit D together (e.g.
d) Methotrexate, phototherapy, biologics (TNF inhibitors), dimethyl fumarate
40 year old woman presents with facial redness and telangiectasia.
a) Likely diagnosis
b) 1st line treatments
c) 2nd line treatments
a) Acne rosacea
b) Medication review (amiodarone and steroids can worsen it) and avoidance of triggers (heat, stress, etc.), topical metronidazole
c) Oral macrolide or tetracycline
56 year old woman presents with itchy red scaling of scalp.
a) 2 possible diagnoses
b) Management
a) seborrhoeic dermatitis, scalp psoriasis
b) Ketoconazole, antidandruff shampoos, coal tar shampoos, topical corticosteroid (eg Betacap)
3 year old has itchy red rash in finger webspaces and on legs.
a) Diagnosis
b) Treatment
c) Instructions for treatment
a) Scabies
b) Permethrin cream
c) - Apply to whole body
- Apply again after one week
- Treat whole house
- Wash towels and bed linen at high heat
- Treat any sexual contacts in last month
Woman 25 weeks pregnant, itching on hands and soles.
a) Diagnosis
b) LFTs? - so order what tests?
a) Obstetric cholestasis
b) Often normal. Order bile acids - will be raised
70 year old man, burning pain on one side of chest; progresses to vesicular eruption
a) Diagnosis
b) Other possible manifestations of this disease
c) Management
d) Most common complication
a) Shingles (Herpes-Zoster)
b) - Trigeminal nerve (ophthalmic shingles): affects tip of nose (Hutchinson’s sign) and can cause blindness
- Facial nerve (Ramsay Hunt): vesicles in the ear, facial paralysis, hearing changes and vertigo
c) - Oral aciclovir
- NSAIDs/paracetamol for pain
d) Post-herpetic neuralgia
Anxious man, doesn’t want to leave the house. Itching with copious scratching and excoriation.
a) Diagnosis
a) Psychogenic itch
60 year old lady, obese, diabetic, high cholesterol. Itchy. Doesn’t drink alcohol. Raised LFTs
a) Likely cause of itch
a) Liver disease - NAFL
75 year old lady with itch, frosty looking skin. High urea and creatinine.
a) What is the name for her frosty skin?
b) Usual cause
a) Uraemic frost
b) Chronic kidney disease
