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Neurology and Special Senses > Other Dermatology > Flashcards

Other Dermatology Flashcards

1
Q

Where can tinea rashes appear?

A

Capitis - scalp
Corporis - trunk, legs and arms
Pedis - feet

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2
Q

What organism causes tinea wapitis?

A

Trichophyton tonsurans

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3
Q

What organism causes tinea corporals?

A

Trichophyton rubrum

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4
Q

How does tinea capitis present?

A

Kerion forms if untreated:

- raised, pustular spongy mass

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5
Q

How does tinea corporis appear?

A

Well-defined annular erythematous lesions with pustules and papules

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6
Q

How does tinea pedis present?

A

Itchy peeling skin between toes

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7
Q

How is tinea capitis managed?

A

Oral antifungals - terbinafine

Topical ketoconazole shampoo

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8
Q

How is tinea corporis and pedis managed?

A

Topical terbinafine or imidazole

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9
Q

What complications are associated with tinea infections?

A

Secondary infections - impetigo and cellulitis

Hair loss in tinea capitis

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10
Q

Where can candidal infections appear?

A

Oral

Oesophageal

Skin

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11
Q

How does oral candida present?

A

Curd like white patches on tongue

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12
Q

What is oral candida associated with?

A

Smoking
Steroid inhaler
Dentures
Oral Abx use

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13
Q

How is oral candida managed?

A

Topical miconazole

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14
Q

How does oesophageal candida present?

A

Dysphagia

Retrosternal pain

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15
Q

What is oesophageal candida associated with?

A

Haematological malignancy

HIV

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16
Q

How is oesophageal candida managed?

A

Refer to secondary care - oral abx or IV fluconazole

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17
Q

How do skin candidal infections present?

A

Soreness and itching
Red moist skin area with ragged edges
Yellow white scale on surface

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18
Q

What is associated with candidal skin infections?

A

Obesity

Moist skin

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19
Q

How are candidal skin infections managed?

A

Topical Imidazole cream

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20
Q

What are the presentations of oral herpes simplex (HSV1)?

A 
Cold sore (90% HSV1)
Gingivo stomatitis
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21
Q

Give examples of some imidazole antifungals

A

Clotrimazole
Ketoconazole
Miconazole

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22
Q

How do cold sores present?

A

Fever and Malaise prodrome
Itching/tingling precede lesion
Crusts of vesicles and rupture and crust over - on lips

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23
Q

How long do cold sores last?

A

10-14 days

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24
Q

How does gingivostomatitis present?

A

Fever and malaise prodrome
Sore mouth and throat

Crops of painful vesicles on an erythematous base that ruptures and ulcerates

Affect oral and pharyngeal mucosa

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25
Q

What usually happens to herpes simplex following primary infection?

A

Sit dormant in trigeminal nerve ganglion

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26
Q

When is herpes simplex at its most contagious?

A

Time of vesicle rupture to point of scabbing over

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27
Q

How is herpes simplex managed?

A

Supportive - NSAID’s and paracetamol

Topical aciclovir - over the counter

Advice

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28
Q

What advice is given regarding a herpes simplex infection?

A

No kissing
Don’t touch vesicles
Avoid sharing lipstick
Careful with contact lenses

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29
Q

What complications are associated with herpes simplex?

A

Dehydration - reduced oral intake
Lip adhesions
Herpetic Whitlow - common in thumb suckers
Eye complications - herpetic keratitis

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30
Q

What is herpetic whitlow?

A

Painful blisters on fingers or thumb

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31
Q

What causes chicken pox?

A

Varicella zoster

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32
Q

How is chicken pox spread?

A

Direct contact
Droplets - resp route
Can be caught from someone with shingles

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33
Q

When is chicken pox infective?

A

4 days before rash

5 days after rash first appear or once vesicles have crusted

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34
Q

What is the incubation period for chicken pox?

A

10-21 days

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35
Q

What happens to varicella zoster following a chicken pox infection?

A

Persist in sensory nerve root ganglion

Can be reactivated to cause shingles

36
Q

How does chicken pox present?

A

Prodrome of nausea, myalgia and anorexia
General malaise
Initial fever - 38/39 degrees for upto 4 days
Itchy rash - begin on head, trunk and proximal limb

Macular –> papular –> vesicular –> crust

37
Q

How is chicken pox managed?

A

Paracetamol - fever
Calamine lotion or chlorphenamine - itch
Advice - trim nails, stay hydrated and cool cotton clothes
Exclude from school for 5 days since rash onset

38
Q

What complications are associated with chicken pox?

A

Bacterial superinfection
Neurological complications - Reyes

Complications more common in adults
- pneumonia and encephalitis

39
Q

What risks to the mother are associated with chicken pox in pregnancy?

A

Pneumonia and other complications

40
Q

What risks to the fetus are associated with chicken pox in pregnancy?

A

<28wks - fetal varicella syndome

1-4 wks before delivery - Varicella of newborn

Rash 7 days before/after birth - Severe infection, can be fatal

41
Q

How does fetal varicella syndrome present?

A

Skin scarring in dermatomal fashion

Eye complications - cataracts

Limb hypoplasia

Learning difficulties

42
Q

How is chicken pox in pregnancy managed?

A

If any doubt - check maternal blood for varicella antibodies

Maternal VZIG (varicella zoster immunoglobulin)

Oral aciclovir if presents within 24 hrs of rash

43
Q

What is a wart?

A

Small rough growth caused by an infection of keratinocytes by certain strains of HPV

A verruca is a wart on the sole of the foot

44
Q

What are the types of wart?

A

Common
Plane
Filiform
Plantar (verucca)

45
Q

How do common warts appear?

A

Firm, rough, raised

Cauliflower looking

Knuckles, knees and fingers

46
Q

How do plane warts appear?

A

Round, flat topped, yellow

Back of hands

47
Q

How do filiform warts appear?

A

Long and slender

Face and neck

48
Q

How do plantar warts appear?

A

Central dark dots
Painful
Palms and soles of feet

49
Q

How are warts managed?

A

Cryotherapy or salicylic acid if requested by patient - painful/unsightly

50
Q

What causes molluscum contagiousum?

A

MCV virus - molluscum contagiousum virus

51
Q

How does molluscum contagiousum present?

A 
Symptomless lesions
Develop over few weeks
Dome shaped, flesh coloured papules with central umbilication
3-5mm
Seen in clusters
Don't affect palms or soles
52
Q

How is molluscum contagiousum managed?

A

Spontaneously resolve - usually take 18 months

Avoid squeezing and scratching

No school/swimming exclusion

Itching - emollient and hydrocortisone
Infected - fusidic acid

53
Q

What is erythema nodosum?

A

Inflammation of subcutaneous fat

54
Q

What are some causes of erythema nodosum?

A 
NO - idiopathic
D - drugs - penicillin/sulphonamides
O - oral contraceptive/pregnancy
S - Sarcoidosis/TB
U - UC/Crohns/Behcet's disease
M - microbiology - streptococcus, mycoplasma, EBV
55
Q

How does erythema nodosum present?

A

Tender, erythematous nodular lesions

Occur over shins but can occur elsewhere

Lesions heal without scarring

56
Q

How is Erythema nodosum managed?

A

Supportive management

Usually resolve within 6 weeks

57
Q

How do actinic keratoses present?

A

Small crusty/scaly lesions on sun exposed areas - e.g. temples of head

Pink/red/brown

Multiple lesions may be present

58
Q

How are actinic keratosis managed?

A

Prevent further risk - sun avoidance/sun cream

Fluorouracil cream - 2-3 week course

Topical diclofenac - mild cases

Topical imiquimod

Cryotherapy

Curettage and cautery

59
Q

What issues can fluorouracil cream cause in management of actinic keratosis?

A

Skin may become red and inflamed

Manage with hydrocortisone

60
Q

What is Bowens disease?

A

Type of intraepidermal squamous cell carcinoma

More common in elderly females

3% chance of developing invasive skin cancer

61
Q

How does Bowen’s disease present?

A

Red scaly patches

Sun exposed areas - lower limbs

62
Q

How is Bowen’s disease managed?

A

topical 5-FU cream
Imiquimod
Cryotherapy and Excision

Must be referred

63
Q

Where do pressure sores typically develop?

A

Over bony prominences - sacrum or heel

64
Q

What are some predisposing factors to pressure sores?

A

Malnourishment
Incontinence
Lack of mobility
Pain - reduced mobility

65
Q

How are pressure sores scored?

A

Grade 1 - 4

66
Q

How would you screen for patients at risk of developing pressure sores?

A

Waterlow score

Includes factors such as BMI, nutritional status, skin type, mobility and continence

67
Q

How would a grade 1 pressure sore appear?

A

Non blanch able erythema of intact skin
Skin discoloured
Warmth, oedema, induration or hardness may be seen

68
Q

How would a grade 2 pressure sore appear?

A

Partial thickness skin loss - epidermis and/or dermis

Ulcer superficial and presents as abrasion or blister

69
Q

How would a grade 3 pressure sore appear?

A

Full thickness skin loss - damage to/necrosis of subcutaneous tissue

May extend down to underlying fascia

70
Q

How would a grade 4 pressure sore appear?

A

Extensive destruction
Tissue necrosis
Damage to muscle, bone or supporting structures

71
Q

How are pressure sores managed?

A

Moist environment - encourage healing
Hydrocolloid dressing and hydrogels

Avoid soap - dry out

Infection - wound swabs shouldn’t be routine. Systemic antibiotics if clinically necessary (e.g. surrounding cellulitis)

Consider referral to tissue viability nurse

Surgical debridement may be beneficial

72
Q

What is eczema herpeticum?

A

Infective Rash that develops 5-12 days after HSV infection

Commonly in children with atopic eczema but can occur in other skin breaks

73
Q

How does eczema herpeticum present?

A

Unwell - fever and lymphadenopathy

Blisters - blood stained

Often around face and mouth

Occur in clusters

Painful +- itchy

74
Q

How is eczema herpeticum managed?

A

Admit to hospital

Oral/IV aciclovir

75
Q

What is toxic epidermal necrolysis?

A

Life threatening dermatological disorder characterised by widespread erythema, necrolysis and skin sloughing

76
Q

What causes toxic epidermal necrolysis?

A

Mostly a reaction to drugs:

  • phenytoin
  • sulphonamides
  • allopurinol
  • penicillins
  • carbamazepine
  • NSAID’s
77
Q

How does toxic epidermal necrolysis present?

A

Prodrome of fever and URTI symptoms

Involve mucous membranes initially

1 Ill defined erythematous macular/papular rash
2 Bullae form and join
3 skin slough

78
Q

What is Nikolsky’s sign?

A

When seemingly normal skin is rubbed in a patient with toxic epidermal necrolysis, the epidermis with separate away

79
Q

How is toxic epidermal necrolysis managed?

A

Withdraw causative agent

Transfer to ITU

Supportive treatment - fluids, electrolytes, dressings and creams

80
Q

What complications are associated with toxic epidermal necrolysis?

A

Dehydration and hypovolaemic shock
Sepsis
PE
DIC

Mortality of upto 55%

81
Q

What ADR’s are associated with topical corticosteroids?

A

Rare if mild/moderate preparation used

Thinning
Bruising
Stretch marks
Folliculitis
Pimples
Loss of skin pigment
Hair growth at site of application
Burning or stinging common in first few days but usually resolve
82
Q

What adverse effects are associated with methotrexate?

A 
Mucositis
Myelosuppression
Pneumonitis
Pulmonary fibrosis
Liver fibrosis
83
Q

What are the rules surrounding methotrexate use and pregnancy?

A

Women - avoid pregnancy for at least 6 months after treatment stopped

Men - use effective contraception for at least 6 months after treatment stop

84
Q

How should methotrexate be prescribed?

A

Weekly

Folic acid 5mg once weekly co-prescribed - more than 24hrs after methotrexate dose

Methotrexate Monday’s Folate Fridays

85
Q

How should patients on methotrexate be monitored?

A

FBC
U&E
LFT

Before treatment
Weekly until stabilised
Every 2-3 months thereafter

86
Q

What interactions with methotrexate should you be aware of?

A

Avoid trimethoprim/co-trimoxazole - increase risk of marrow aplasia

High dose aspirin increase risk of methotrexate toxicity secondary to reduced excretion

87
Q

Should a patient have a methotrexate toxicity, how should it be managed?

A

Folinic acid

Neurology and Special Senses (28 decks)

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