Other skin changes Flashcards
Describe causes for chronic rash vs acute rash
Acute:
Chronic:
- Psoriasis
- Eczema
- Lichen planus
- SLE
- Lyme
Tx for athletes foot? [3]
Clinical knowledge summaries recommend a topical imidazole, undecenoate, or terbinafine first-line
Name and describe this skin lesion [1]
Pyoderma gangronusum
Dx? [1]
Cherry haemangiomas (Campbell de Morgan spots)
Describe what is meant Cherry angiomas? [1]
Describe their usual characteristics
Benign skin lesions which contain an abnormal proliferation of capillaries:
* erythematous, papular lesions
* typically 1-3 mm in size
* non-blanching
* not found on the mucous membranes
Dx? [1]
Risk factor for..? [1]
Erythema ab igne
If the cause is not treated then patients may go on to develop squamous cell skin cancer.
What are the features of erythema multiforme? [3]
Features
* target lesions
* initially seen on the back of the hands / feet before spreading to the torso
* upper limbs are more commonly affected than the lower limbs
* pruritus is occasionally seen and is usually mild
Which viral [1] and bacterial infection [2] causes are the most common cause of erythema multiforme?
viruses:
- herpes simplex virus
Bacteria:
- Mycoplasma, Streptococcus
The more severe form, erythema multiforme major is associated with [] involvement.
The more severe form, erythema multiforme major is associated with mucosal involvement.
What is meant by erythrasma? [1]
Erythrasma is a generally asymptomatic, flat, slightly scaly, pink or brown rash usually found in the groin or axillae.
It is caused by an overgrowth of the diphtheroid Corynebacterium minutissimum
Looks the same as acanthosis nigricans WITHOUT thickening/velvet like texture of the skin
How do you dx erythrasma? [1]
What is the treatment? [1]
Examination with Wood’s light reveals a coral-red fluorescence.
Topical miconazole or antibacterial are usually effective. Oral erythromycin may be used for more extensive infection
[] is a term used when more than 95% of the skin is involved in a rash of any kind.
Erythroderma is a term used when more than 95% of the skin is involved in a rash of any kind.
This image shows the generalised erythematous rash seen in patients with erythroderma, sometimes referred to as ‘red man syndrome’
Fungal nail infections:
Causative organisms:
- dermatophytes account for around 90% of cases mainly []
- yeasts account for around 5-10% of cases
e.g. []
Causative organisms
dermatophytes account for around 90% of cases mainly Trichophyton rubrum
yeasts account for around 5-10% of cases e.g. Candida
Investigation and mangement for fungal nail infections?
Investigation:
- nail clippings +/- scrapings of the affected nail for microscopy and culture
- should be done for all patients if antifungal treatment is being considered
Mangement:
- None if asymptomatic and unbothered
- if limited involvement (≤50% nail affected, ≤ 2 nails affected, more superficial white onychomycosis): topical treatment with amorolfine 5% nail lacquer; 6 months for fingernails and 9 - 12 months for toenails
- extensive: oral terbinafine is currently recommended first-line; 6 weeks - 3 months therapy is needed for fingernail infections whilst toenails should be treated for 3 - 6 months
Which drugs are used for fungal nail infection, for both fingernails and nails, if:
- Limited involvement
- Extensive involvement
- Extensive involvement due to Candida infection
Limited involvement: - Topical treatment with amorolfine 5% nail lacquer
- Fingernails: 6 months
- Toe nails: 9-12 months
Extensive involvement - : oral terbinafin
- Fingernails: 6 weeks-3 months
- Toe nails: 3-6 months
Candida:
- oral itraconazole is recommended first-line;
- ‘pulsed’ weekly therapy is recommended
Which four factors are in the criteria for hereditary haemorrhagic telangiectasia? [4]
epistaxis :
- spontaneous, recurrent nosebleeds
telangiectases:
- multiple at characteristic sites (lips, oral cavity, fingers, nose)
visceral lesions:
- for example gastrointestinal telangiectasia (with or without bleeding), pulmonary arteriovenous malformations (AVM), hepatic AVM, cerebral AVM, spinal AVM
family history:
- a first-degree relative with HHT
NB only 3 are needed for a definite diagnosis; 2 is a possible diagnosis
Describe what is meant by Hidradenitis suppurativa
Hidradenitis suppurativa
* Chronic, painful, inflammatory skin disorder.
* It is characterized by the development of inflammatory nodules, pustules, sinus tracts, and scars in intertriginous areas
* The axilla is the most common site
* Coalescence of nodules can result in plaques, sinus tracts and ‘rope-like’ scarring.
Treatment of acute and chronic Hidradenitis suppurativa?
Acute flares:
- can be treated with steroids (intra-lesional or oral) or flucloxacillin.
- Surgical incision and drainage may be needed in some cases.
Long-term disease:
- can be treated with topical (clindamycin) or oral (lymecycline or clindamycin and rifampicin) antibiotics.
Hyperhidrosis describes the excessive production of sweat.
What are 4 managment options? [4]
- topical aluminium chloride preparations are first-line. Main side effect is skin irritation
- iontophoresis: particularly useful for patients with palmar, plantar and axillary hyperhidrosis
- botulinum toxin: currently licensed for axillary symptoms
- surgery: e.g. Endoscopic transthoracic sympathectomy. Patients should be made aware of the risk of compensatory sweating
What is the treatment algorithm for impetigo? [3]
Tx:
- Hydrogen peroxide 1% cream for ‘people who are not systemically unwell or at a high risk of complications’
- topical antibiotic creams: topical fusidic acid; topical mupirocin should be used if fusidic acid resistance is suspected
- Extensive disease: oral flucloxacillin; oral erythromycin if penicillin-allergic
How do you treat keloid scars? [2]
Early keloids:
- triamcinolone
Excision is sometimes used (but can risk further keloid scarring)
Describe what is meant by a leukoplakia [1]
How can you distinguish it from candidiasis and lichen planus? [1]
What is there a risk of transformation to? [1]
Leukoplakia
- is a premalignant condition which presents as white, hard spots on the mucous membranes of the mouth.
- Differentiae from candiasis and lichen planus if they can be ‘rubbed off’
- Need a biopsy to exclude squamous cell carcinoma as this can transform in about 1% patients
Dx? [1]
Lichen planus - pruritic eruption on the shins
Skin disorder of unknown aetiology, most probably being immune-mediated.
Which sign helps to differentiate that a person is suffering from Lichen Planus? [1]
Wickham’s striae:
- rash often polygonal in shape, with a ‘white-lines’ pattern on the surface
