MRCP Derm Flashcards
NF1
multiple cutaneous nodules
cafe au lait spots
axillary freckling
Chr 17
Ulcerating papule involving nasal septum
mucocutaneous leishmania
Bullous penphigoid
old patient
blister in limbs
autoimmune ab against hemidesmodome between epidermis and dermis
Lupus pernio
sarcoidosis
purple lesion outside the nose
Visceral leishmania
hepatosplenomegaly
Shiny pearly edged with central telangiectasia
BCC (rodent ulcer)
Erythema nodosum
painful
red nodule
extensor surface
Erythema multiforme
target lesion
acral sites
Scabies rash in…. treated with…
burrows (linear crusted lesion)
web spaces
permethrin cream
Nail dystrophy and scaly plaques
psoriasis
Erythema migrans
Lyme target lesion
NF2
Chr 22
bilateral acoustic neuroma
multiple tumour in brain and spinal cord
Acne vulgaris
pilosebaceous disorder
XS sebum
commensal bacterium (propionibacterium) in hair follicle
comedone form (blocked duct)
Management of acne
Mild to moderat:
1) 12 weeks of topical first:
- topical adapalene +bezoyl persoxide
- topical retinoin +clindamycin
- topical benzoyl peroxide + clindamycin
moderate to severe:
1) 12 weeks of:
- topical adapalene +bezoyl persoxide
- topical retinoin +clindamycin
- topical adapalene + benzoyl + PO lymecycline/doxy
Failed topical:
- oral antibiotic - tetracycline for 3 months
If 2 abx fail for oral isotretinoin
Pregnancy:
- avoid tetracycline
- avoid retinoid
- can use erythromycin
Isoretinoin -> teratogenic
Melasma
increased skin pigmentation over sun exposed areas
Lentigo maligna
melanoma confined to epidermis
Vitiligo
skin depigmentation
autoimmune destruction of melanocytes
Orf
Poxvirus
pustular dermatitis
hands
from sheeps
Dermatitis herpetiformis
Coeliac
IgA deposit
HUS
buttock and lower leg purpura
Alopecia areata
single or multiple
discrete round baldness
BTOB
exclamation mark hairs- short hair
nail pitting
Lichen planus
itchy
polygonal, flat rash
wrist and ankles
lacy white network in mouth- Wickham striae
Management for lichen planus
topical/oral steroid
Pityriasis rosea
herald patch
christmas tree rash in trunk
self limiting
Dermatitis artefacta
linear rash
self inflicted rash
common in psych patients
Pityriasis versicolor
tinea versicolor
malassesia furfur
ketoconazole shampoo
Pemphigus antibodies
- envoplakin - paraneoplastic
- periplakin
- bullous pemphigoid antigen 1
- desmoplakin
- plectin
- alpha2 macroglobulin like 1
Pemphigus vulgaris ab
desmoglein 3
Anti HU
PARANEOPLASTIC CEREBELLAR DEGENERATION
Pyoderma gangrenosum
blood blister–> become ulcer –> painful —> deep necrotic
associated with autoimmune conditions
PBC
anti mitochondrial
Donovan body
granuloma inguinale
- due to klebsiella granulomatis
- painless nodule –> ulcer
- STI
- treat with doxy/co-trimox
Buboes
Lymphogranuloma venerum
- chlamydia strain
- painless ulcer
- painful enlarged inguinal LN (buboes)
Urticaria managmenet
First non sedating antihistamine
- loratadine/cetrizine
- 6 weeks after acute ep
sedating antihistamine
- chlorphenamine at night on top of above
prednisolone if severe/resistant
- 40mg for 7days
Secondary care:
- leukotriene (montelukast)
- cyclosporine
- tacrolimus
Molluscum
bacterial infection
sharing towels
topical abx/oral
sebaceous cyst
painless
can become inflamed and painful
fluid filled
slow growing
Management of pyoderman gangrenosum
First line: oral steroids
Other: immunosuppressant
- peristomal –> topical tacrolimus
Topical fail
- cyclosporine
Lichen sclerosis
genitalia
elderly female
atrophy of epidermis with white plaque
itchy
scarring
Melanoma ABCDE criteria
Asymmetry
Border- irregular
Colour- diff shades
Diameter- >6mm
Evolving- changing shape/size/colour/bleeding
Acute intermittent porphyria
Autosomal dominant
Defect in porphobilinogen deaminase (for haem)
Toxic accumulation of delta aminolaevulinic acid + porphobilinogen
abdo pain
hypertension
psych disturbance
- IV haem arginate for acute attack
4 Ps of AIP
Painful abdo
Polyneuropathy
Psychiatric symptoms
Port wine (red) urine on standing
HLA CW6
Psoriasis
HLA DR3
T1DM
HLA DR4
T1DM
RA
SLE
Autoimmune hepatitis
Heliotrope rash
dermatomyositis
Mycoplasma rash
erythema multiforme
- target lesion
Toxic epidermal necrolysis
MOST severe drug eruption
extensive skin loss with mucosa
Tinea
tinea capitis - scalp
tinea corporis - trunk, legs or arms
tinea pedis - feet
tinea crurus - groin or thigh
Tinea corporis (ringworm)
Trichophyton rubrum and Trichophyton verrucosum (e.g. From contact with cattle)
well-defined annular, erythematous lesions with pustules and papules
may be treated with oral fluconazole
Eczema management with superimposed bacterial infection
- topical abx and topical steroid
Eczema herpeticum management
rapidly progressing painful rash
IV aciclovir
Eczema managmenet
Mild:
- emollient, mild topical steroid (hydrocortisone)
Moderate:
- emollient, moderate topical steroid (betamethasone)
Severe:
- emollient, potent topical steroid (bethamethasone or dermovate)
Topical abx for bacterial skin infx with eczema
fusidic acid
mupirocin
neomycin
potency of topical steroid
Hydrocort
Eumovate (clobetasone)
Betnovate (betamethasone)
Dermovate (clobetasol)
Pyoderma gangrenosum strongly associated with…
IBD
RA
Haem: myeloid leukaemia, mylofibrosis, myeloma
Diabetes
Malassezia furfur (yeast)
hypopigmented scaly areas
chest back abdo
Mx: topical antifungal (cotrimazole)
Rosacea improved with…
avoiding alcohol
Rosasea
nose cheek forehead
flushing
telangiectasia
englarged red nose
Skin lesion with amiodarone
sun exposure–> red rash
Erysipelas
localised skin infection
strep pyogenes
superficial cellulitis
Mx: fluclox
Pseudoxanothma elasticum
hereditory elastic tissue disorder
calcification
plucked chicken appearance skin
mitral valve prolapse
small cell lung cancer skin condition
dermatomyositis
Porphyra curanea tarda
Defect in uroporphyrinogen decarboxylase due to hepatic damage
sun exposed sites
blister
hyperpigmentation
PCT for porphyria cutanea tarda
Porhyria Cutanea Tarda -> PCT PCT
Pigmentation
Cutaneous changes
Trichosis- hairy
Pink fluorescent urine
Chloroquine
Take blood- venesection
SCC
Sun exposed skin areas
areas of keratosis/bowmens/chronic wound —> marjolin ulcer
10% metastatise via lymphatics
Breslow thickness of melanoma
prognostic factor –> depth of lesion
American Leishmania
risk of later mucocutaneous disease
Management for molluscum
Usually not recommended…
If treating:
1. squeezing/piercing
2. cryotherapy
Pellagra
Triad (3D)
- diarrhoea
- dermatitis
- dementia
Mnagement of pellagra
niacin (B3)
Necrobiosis lipoidica
Complication of diabetes
necrosis of dermal collagen and connective tissue
shin- erythematous plaques–> yellow waxy –> atriphy and telangiectasia
Mx: poor response to treatment
Vitiligo associated with…
autoimmune disease
associated with alopecia areata
Nelson syndrome
bilateral adrenal resection for cushing’s disease
causing pituitary adenoma development due to loss of -ve feedback
Buzz words for PCT
blistering rash
sun exposed
alcohol XS triggers
Reactive eruption
erythema multiforme (drug reaction)
Angioedema with ACEi
acquired
Onycholysis
separating from nail bed
psoriasis
thyrotoxicosis
drugs: tetracyclines
Skin lesion seen in … syphillis
secondary
Tinea capitis
scalp
exposed to animals
trichophyton
microsporum canis - green fluorescence on wood lamp
IL 17 targetted in…
psoriasis
Toxic epoidermal necrolysis
TEN
drug induced
eosinophilia
Causative Drugs:
- allopurinol
- aspirin
- NSAID
- lamotrigine
- lansoprazole
- penicillin
Pityriasis lichenoides et varioliformis acuta (PLEVA)
erythema rapidly into multiple pus filled papule
Associated:
- toxoplasmosis
- EBV
- HIV
- CMV
- Parvovirus
- s.aures
- GAS
Mx: topical tacrolimus
Leprosy skin lesion
hypopigmentation
sensory loss
Ix: skin biopsy
Sweet syndrome
neutrophilic dermatosis
fever
red plaques
raised white blood cell count
mx: oral steroid
Diagnosis of pyoderma gangrenosum
biopsy of ulcer margin
Erythroderma
Erytho-der-ma = red-man
due to eczema and psoriasis
Isotretinoin precaution
avoid pregnancy during and for 1 month after treatment
Dermatitis herpetiformis managmenet
gluten-free diet
dapsone
Discoid lupus
scaly erythema plaque
sun exposed area
alopecia
hyper/hypopigmentation post inflammation
ANA -ve
Paraneoplastic pemphigus due to…
non hodgkin lymphoma
Ulcers
arterial: lateral lower limb, painful, deep, punched out
venous: medial lower limb, weepy, shallow, sloped edge
Allergy testing
patch test
Koebner phenomenon
lichen planus - rash developing at site of skin injury
Melasma causes
pregnancy
COCP
Granuloma annulare
a/w DM
pinkish plque
annular
Darier disease
warty papule
plaques in seborrhoeic areas
palpmar pits
nail dystrophy
Mx: oral isotretinoin
isoretinoin action
reduce sebum prodcution and keratinisation
Acanthosis nigracans
benign
- insulin resistance
malignant
- cancer
Recurrent skin infection secondary to…
PVL producing staph aureus
Treatment for paraneoplastic pemphigus
high dose prednisolone
second line:
retuximab
azathioprine
mycophenolate
Add on IVIG if above limited response
Staphylococcal scaled skin syndrome
TEN but spares mucosal membrance
Lichen sclerosis management
topical clobetasol
if fail for biopsy
Melanoma signs
asymmetrical pigmentation
irregular shape and border
multiple colours
bleeding without trauma
PBC
anti mitochondrial
cutaneous t cell lymphoma
itchy scaly patch
trunk and extremitis
Mx: phototherapy
photosensitising medications
doxycycline
amiodarone
Which antihypertensive exacerbate psoriasis
bisoprolol
Which medications flare psoriasis
lithium
antimalarial
NSAID
Investigation for scabies
Ink test
Pemphigus vulgaris
IgG
superficial split
Bullous pemphigoing
limb and trunk
skin biopsy: eosinophil
Subtypes of cutaneous T cell lymphoma
- sezary syndrome
- widespread erythroderma - mycosis fungoides
- patches of erythroderma
present with erythroderma
Complication of pseudoxanthoma elasticum
UGIB
