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
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.
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
What are the 6Ps of LP? [6]
Pruritic
Purple
Polygonal
Planar
Papules
Plaques
Management of LP? [2]
potent topical steroids are the mainstay of treatment
benzydamine mouthwash or spray is recommended for oral lichen planus
Describe what is meany by lichen sclerosus [1]
What are the characteristic features? [3]
It is an inflammatory condition that usually affects the genitalia and is more common in elderly females.
Lichen sclerosus leads to atrophy of the epidermis with white plaques forming.
Features:
* white patches that may scar
* itch is prominent
* may result in pain during intercourse or urination
What is mycosis fungoides? [1]
Mycosis fungoides is a rare form of T-cell lymphoma that affects the skin.
This patient is suffering from dermatitis due a deficiency in a vitamin - which one? [1]
Pellegra - B3 deficiency
The classical features are the 3 D’s - dermatitis, diarrhoea and dementia.
Dermatitis (brown scaly rash on sun-exposed sites - termed Casal’s necklace if around neck)
What is meant by Periorificial dermatitis? [1]
Management? [2]
A condition typically seen in women aged 20-45 years old. Topical corticosteroids, and to a lesser extent, inhaled corticosteroids are often implicated in the development of the condition.
Management:
* steroids may worsen symptoms
* should be treated with topical or oral antibiotics
