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ICSM Year 6 COPY Helen Lashwood > Medicine - Dermatology > Flashcards

Medicine - Dermatology Flashcards

1
Q

How can you differentiate between SJS and TEN?

A 
SJS = up to 10% skin involvement
TEN = \>30% skin involvement
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2
Q

What is Nikolsky’s sign?

A

Epidermis separates with mild lateral pressure - secondary to adverse drug reaction

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3
Q

How should SJS or TEN be managed?

A

Stop the cause
Transfer to ITU
IV Ig
Immunosuppression (eg ciclosporin and cyclophosphamide)

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4
Q

Which drugs are most likely to cause SJS?

A

Never Press Skin As It Can Peel
NSAIDs
Phenytoin
Sulphonamides
Allopurinol
IV Ig
Carbemazapine
Penicillins

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5
Q

What is erythroderma?

A

Any rash involving >95% of the body

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6
Q

Recall 3 possible complications of erythroderma

A

Dehydration
High output heart failure
Infection

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7
Q

What is the cause of adult seborrhoeic dermatitis?

A

Fungus called malassezia furfur

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8
Q

What 2 skin conditions can be caused by malassezia furfur?

A

Seborrhoeic dermatitis
Pityriasis versicolor

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9
Q

What are the 1st and 2nd line options for treating scalp seborrhoeic dermatitis?

A

1st line = zinc pyrithione (‘head and shoulders’)
2nd line = ketoconazole

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10
Q

Which pathogen is the most common cause of impetigo?

A

Staphylococcus aureus

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11
Q

What are the 3 classes of impetigo and their respective management?

A

Localised, non-bullous: topical H2O2 1% cream / topical fusidic acid

Widespread, non-bullous: oral flucloxacillin or topical fusidic acid

Widespread, bullous: oral flucloxacillin

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12
Q

How long should children with impetigo be excluded from school?

A

Until lesions crusted over or 48 hours after antibiotics started

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13
Q

What are the lay terms for open and closed comedones?

A 
Open = blackheads 
Closed = whiteheads
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14
Q

Recall some conservative management options for acne

A

Avoid over-cleaning face - bd with gentle soap is okay
Make up - use emollients and cleansers, non-comedonegenic preparations
Avoid picking and squeezing

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15
Q

How long should each acne medication be tried for to give it chance to work?

A

8 weeks

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16
Q

Recall the stepwise medical management of acne

A

Mild acne:
1st line: topical retinoid and or benzyl peroxide +/- topical clindamycin (which is never prescribed alone)

2nd line: azelaic acid 20%

Moderate (if not responding to topicals) acne:
- oral tetracycline + BPO/retinoid
OR
- oral COCP + BPO/retinoid

Dermatologist referral:
- Oral isotretinoin (roaccutane)

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17
Q

Once acne has cleared, how should this be maintained?

A

Topical retonoids and azelaic acid

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18
Q

What is Roaccutane?

A

Synthetic vitamin A

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19
Q

What pregnancy prevention plan should be in place for Roaccutane?

A

2 forms of contraception as it is very teratogenic

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20
Q

Recall some side effects of Roaccutane

A

Dry skin, raised triglycerides, hair-thinning, intracranial HTN, photosensitivity, low mood and suicidal ideation

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21
Q

What accumulated dose should you aim for with Roaccutane?

A

Body weight in kg x 100 mg

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22
Q

What is the progression of symptoms of rosacea?

A 
1st = flushing 
2nd = symmetrical facial rash with telangiectasia 
3rd = persistent pustulopapular erythema
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23
Q

How should rosacea be managed?

A 
Mild-moderate = topical metronidazole 
Severe = oral tetracycline
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24
Q

What is the aetiology of hidradenitis supparativa?

A

Chronic inflammatory occlusion of folliculopilosebaceous units that obstructs the apocrine glands and prevents keratinocytes from properly shedding the follicular epithelium

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25
In lay terms, what is hidradenitis supparativa?
Abscesses that form near hair follicles in places where we tend to sweat more
26
What are the 2 biggest risk factors for hidradenitis supparativa?
Smoking and obesity
27
Rarely, what inflammatory disease is associated with hidradenitis supparativa?
Crohn's
28
How can hidradenitis supparativa be managed?
Conservative: weight loss, stop smoking, hygeine Acutely: steroids PO, flucloxacillin, I&D Chronically: topical clindamycin
29
What pathogen causes pityriasis versicolor?
Malassezia furfur
30
How does pityriasis versicolor appear?
Hypopigmented patches on trunk Mild pruritis
31
How is pityriasis versicolor managed?
Topical ketoconazole
32
How does vitiligo appear?
Well demarctaed, depigmented skin patches usually affecting the peripheries
33
Recall some associations of vitiligo (don't need to know in detail)
T1DM, Addison's, autoimmune thyroid, pernicious anaemia, alopecia areata
34
How can vitiligo be managed?
``` Sunblock Topical corticosteroids (reverses changes if applied early) ```
35
What pathogen causes pityriasis rosea?
HHV-7
36
Describe the presentation of pityriasis rosea
Recent viral infection --\> herald patch Then erythematous, oval scaly patches
37
How should pityriasis rosea be managed?
It is self-limiting (6-12w) so no need
38
Broadly describe the 4 types of psoriasis
Plaque - most common, is well-demarcated red and scaly - affects scalp, back, extensors Guttate - following a strep infection, "tear drop" lesions Pustular - affects palms and soles Flexural - skin is smooth
39
Recall some factors that exacerbate psoriasis
Trauma EtOH Certain drugs
40
Which drugs can exacerbate psoriasis?
INFLAME Infliximab NSAIDs For HTN (beta blockers) Lithium ACE inhibitors Malarial drugs EtOH
41
How should chronic plaque psoriasis be managed in primary care? (give 1st, 2nd and 3rd line)
1st line: 4w trial of OM potent corticosteroid and ON vitamin D analogue 2nd line: after 8w (so 4w break): OM potent corticosteroid and BD vitamin D analogue 3rd line: 4w trial of BD potent corticosteroid OR coal tar Use emollients as an adjunct
42
What is the maximum duration of use of topical potent and very potent steroids before a break is needed?
Potent = 8w Very potent = 4w
43
How can chronic plaque psoriasis be managed in secondary care?
``` Phototherapy/photochemotherapy Systemic immunosuppression (eg infliximab, etanercept, ustekinumab) ```
44
Describe the distribution of eczema in infants vs children vs young adults
Infants: face and trunk Child: extensors Young adult: flexures
45
Describe the different severities of eczema in terms of physical symptoms
Mild: infrequent itching, some areas of dry skin and a little redness Moderate: frequent itching, lots of redness and some excoriation Severe: widespread dryness, incessant itching, redness, excoriation, thickening, cracking, alteration of pigmentation
46
How should eczema be investigated?
Consider food allergy and contact dermatitis Skin prick tests Patch tests
47
How long should flares of eczema be treated for?
Treat ASAP and for 48 hours after resolution of symptoms
48
Recall the management of mild, moderate and severe eczema
Mild: emollients, mild potency topical corticosteroids Moderate: emollients, moderate potency topical corticosteroids, topical calcineurin inhibitors and bandages Severe: emollients, potent topical corticosteroids, topical calcineurin inhibitors, bandages and phototherapy
49
How should infected eczema (not herpeticum) be managed?
Skin swab and culture Flucloxacillin PO
50
How should eczema herpeticum be managed?
Oral aciclovir If around eyes, same day referral to ophthalmologist Looks similar to impetigo so ALSO treat for that with oral aciclovir
51
How should topical emollients and steroids be applied
Emollients applied liberally Wait 30 mins then apply steroids
52
Recall 2 examples of topical calcineurin inhibitors that can be used to manage eczema
Mild-moderate - pimecrolimus Moderate - severe - tacrolimus
53
Recall some points for PACES counselling for eczema
Explain diagosis (dry, itchy skin) Explain epidemiology (very common, many grow out of it) Explain management Encourage frequent, liberal use of emollients and use of emollients as a soap substitute Advise avoidance of triggers Avoid scratching if poss (eg mittens for infants) Safety ned about signs of infection Info: itchysneezywheezy.co.uk shows how to apply emollients
54
What type of pathogen causes tinea?
Dermatophyte fungi
55
What pathogen causes tinea?
Trichophytum rubrum
56
How should scabies be managed?
Permethrin - full body treatment that you wash off after 8-12 hours - treat all household/close contacts
57
How should headlice be managed?
Malathion
58
How should tinea be managed?
Mild --\> topical antifungals (terbinafine) Mod--\> hydrocortisone 1% Severe--\> oral antifungals (eg terbinafine) If tinea capitis --\> oral antifungal
59
How long should children with tinea be excluded from school?
No need
60
Recall 2 risk factors for shingles
Increasing age Immunosuppression
61
Describe the symptoms of shingles
Prodromal burning pain over the affected dermatome for 2-3 days +/- fever, headache, lethargy Rash begins erythematous, macular --\> vesicular
62
For how long is shingles infectious?
Until vesicles have crusted over (about 5-7 days)
63
How should shingles be managed?
PO aciclovir if \<72 hours from symptom onset and \>50y/in lots of pain/ immunocompromised Analgesia: paracetamol/ NSAIDs --\>amitriptyline Emergency referral if serious complications suspected
64
Recall 3 possible complications of shingles
Post-herpetic neuralgia Herpes zoster ophthalmicus (affects ocular division of CNV) Herpes zoster oticus (Ramsay Hunt syndrome)
65
What are the 2 pre-malignant conditions for squamous cell carcinoma known as?
Actinic keratoses and keratocanthomas
66
Where do actinic keratoses appear?
sun-exposed areas
67
How can actinic keratoses be managed medically?
Fluorouracil + topical hydrocortisone Topical diclofenac/imiquimod
68
What are some surgical options for managing actinic keratoses?
Cryotherapy Curettage and cautery
69
What is a keratocanthoma?
Pre-malignant skin condition (for SCC) with rapid growth (around 1 week)
70
How should keratocanthomas be managed?
Excision
71
What is the causative organism in fungal nail infections 90% of the time?
Trichophytum rubrum (dermatophyte)
72
How can fungal nail infections be investigated?
Nail clipping MC&S
73
How should fungal nail infections be managed?
Must first confirm infection by MC&S in order to commence treatment - Can do nothing (if pt not bothered) - Can do PO terbinafine (2nd line itraconazole) - finger = 6w-3m - toe = 3-6m - If candida infection --\> topical antifungals
74
How does lichen planus appear?
Rash is: Purple Pruritic Papular Polyglonal Also can get thin, white lines in the mouth
75
Where does lichen planus tend to affect?
Flexor surfaces
76
Recall some causes of lichen planus
Gold Thiazides Quinine
77
How should lichen planus be managed?
Topical steroids
78
How does lichen sclerosus appear?
Itchy white spots typically on the vulva of elderly womenn
79
How should lichen sclerosus be managed?
1st: clobetasol proprionate ointment 2nd: tacrolimus and biopsy
80
Which 2 pathogens are most likely to cause cellulitis?
Strep pyogenes Staph aureus
81
What classification system is used for cellulitis?
Eron classification
82
How should cellulitis be managed?
Mild/mod: flucloxacillin Severe: co-amox
83
Describe the 4 severities of cellulitis under the Eron classification
I - no signs of systemic toxicity, person has no uncontrolled comorbidities II - systemically unwell OR systemically well with an uncontrolled comorbidity III - significant systemic upset such as acute confusion, tachycardia/tachypnoea, hypotension, unstable comorbidity IV - sepsis/ necrotising fasciitis
84
What is the cause of erysipelas?
Strep pyogenes
85
How should erysipelas be managed?
PO flucloxacillin
86
What is the cause of erythrasma?
corynebacterium minitissimu
87
How can erythrasma be investigated?
Wood's slit lamp --\> coral-red fluorescence
88
How should erythrasma be managed
Topical miconazole
89
Recall some causes of pyoderma gangrenosum
IBD Connective tissue disorders Myeloproliferative disorders
90
Describe the classical natural history of pyoderma gangrenosum
Small red papule --\> later deep, red, necrotic ulcers with a violaceous border
91
How should pyoderma gangrenosum be managed?
PO steroids
92
In what patient population is necrobiosus lipoidica diabeticorum seen and how does it appear?
Diabetics Shiny, painless area of yellow/red skin on shins
93
What are antibodies directed against in bullous pemphigoid?
Basement membrane (dermo-epidermal junction)
94
How can bullous pemphigoid be managed?
Oral corticosteroids
95
How can bullous pemphigoid and pemphigus vulgaris be differentiated?
Bullous pemphigoid = tense blisters with no oral involvement Pemphigus vulgaris = flaccid blisters with oral involvement
96
What are antibodies directed against in pemphigus vulgaris?
Desmosomes
97
What is this? (Source: Derm Net NZ)
Guttate psoriasis
98
What is this? (source: Derm Net NZ)
Pityriasis versicolor
99
What is this? (source: Derm net NZ)
Impetigo
100
What is this? (source NHS)
Hidradenitis supparativa
101
What is this? (source: Derm Net NZ)
Vitiligo
102
What is this? (source: Derm Net NZ)
Pityriasis rosea
103
What is this? (source: NHS)
Plaque psoriasis
104
What is this?
Guttate psoriasis
105
What is this? (Source: Derm Net NZ)
Pustular psoriasis
106
What is this? (Source: Derm Net NZ)
Flexural psoriasis
107
What is this? (Source: Derm Net NZ)
Tinea corporis
108
What is this? (Source: Derm Net NZ)
Scabies
109
What is this? (Source: Derm Net NZ)
Actinic keratosis
110
What is this? (Source: Derm Net NZ)
Keratocanthoma
111
What is this? (Source: Derm Net NZ)
Lichen planus
112
What is this? (Source: Derm Net NZ)
Erysipelas
113
What is this? (Source: Derm Net NZ)
Erysipelas
114
What is the recommended margin for excision of a malignant melanoma?
When the breslow thickness is known = 2mm
115
Recall 3 causes of Koebner's phenomena
Vitiligo Psoriasis Lichen planus
116
Which type of skin lesion commonly appears in response to traume eg an insect bite?
Dermatofibroma

ICSM Year 6 COPY Helen Lashwood (20 decks)

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