Passmed Flashcards
What is ‘acne’ Rosacea?
Chronic skin rash involving the central face which most often presents at 30-60 years old
What is the cause of rosacea?
Environmental Genetic- celtic origin Vascular Inflammatory chronic exposure to UV radiation
What are the features of rosacea?
Affects nose, cheek, forehead flushing is often the first symptom Telangiectasia Flushing is often the first symptom Rhinophyma (large red bulbous nose) Can cause ocular involvement- blepharitis Sunlight exposure can make it worse
What is the management of rosacea?
topical metronidazole may be used for mild symptoms
Ie: when there is limited papules or patches but no plaques
topical brimonidine gel may be considered for patients with predominant flushing but limited telangiectasia
more severe disease is treated with systemic antibiotics e.g. Oxytetracycline
recommend daily application of a high-factor sunscreen
camouflage creams may help conceal redness
laser therapy may be appropriate for patients with prominent telangiectasia
patients with a rhinophyma should be referred to dermatology
What is the management of chronic plaque psoriasis?
regular emollients may help to reduce scale loss and reduce pruritus
first-line: NICE recommend:
a potent corticosteroid applied once daily plus vitamin D analogue applied once daily
should be applied separately, one in the morning and the other in the evening)
for up to 4 weeks as initial treatment
second-line: if no improvement after 8 weeks then offer:
a vitamin D analogue twice daily
third-line: if no improvement after 8-12 weeks then offer either:
a potent corticosteroid applied twice daily for up to 4 weeks, or
a coal tar preparation applied once or twice daily
short-acting dithranol can also be used
What is the secondary care management of psoriasis?
Phototherapy
narrowband ultraviolet B light is now the treatment of choice. If possible this should be given 3 times a week
photochemotherapy is also used - psoralen + ultraviolet A light (PUVA)
adverse effects: skin ageing, squamous cell cancer (not melanoma)
Systemic therapy
oral methotrexate is used first-line. It is particularly useful if there is associated joint disease
ciclosporin
systemic retinoids
biological agents: infliximab, etanercept and adalimumab
ustekinumab (IL-12 and IL-23 blocker) is showing promise in early trials
What is erythema multiforme?
Hypersensitivity reaction, most commonly triggered by infections
It can be minor of major
The more severe form is major which is associated with mucosal involvement
Causes=
. Viruses- HSV, orf (disease of sheep and goats caused by parapox)
. Idiopathic
. Bacteria- mycoplasma, streptococcus
. Malignancy
. Sarcoidosis
. Drugs- penicillin, sulphonamides, carbamazepine, allopurinol, NSAIDS, oral contraceptives, nevirapine
What is a keratocanthoma?
A benign epithelial tumour Common in advancing age Rare in young peoppe Festures- initially a smooth dome shaped papule Rapidly grows to become a crater Spontaneous regression within 3 months
What is lichen sclerosis?
An inflammatory condition which usually affects the genitalia and is more common in elderly females
Lichen sclerosus leads to atrophy of the epidermis with white plaques forming
Treat with topical steroids (clobetasol propionate) and emollients
What is the management of lichen sclerosus?
Topical steroids (clobetasol propionate) and emollient
What is alopecia acreata?
A presumed autoimmune condition causing localised, well dermacated patches of hair loas, their may be small broken ‘exlamation mark’ hairs
What is it important to test for in alopecia acreata?
It is important to screen for other auto-immune conditions
Such as: thyroid disease, diabetes, pernicious anaemia
useful tests- FBC, HbA1C, TFTs, B12 level
What are the treatment options for alopecia acreata?
Topical or intralesional corticosteroids Topical minoxidil Photopherapy Dithranol Contact immunotherapy Wigs
What are cafe au lait spots?
Macular and light brown birthmarks
They do not fade with age
Can increase in size with weight gain
What is infantile haemangioma?
Benign condition due to proliferating endothelial cells
They can keep growing up to 18 months and begin involute over the next 3-10 years
What are mangolian blue spots?
A type of birthmark which are benign and macular, the discolouration with resolve by four years of age
What are port wine stains?
Capillary malformations seen at birth
They persist throughout life
What are salmon patches?
Congenital capillary malformations seen at birth
They are often flat, small patches of pink or red skin with poorly defined borders
They tend to resolve by 18 months
They can be seen in around half of newborn babies
They are also known as stork bites/marks
Pink and blotchy
Commonly found on forehead, eyelids, nape of neck
What is erythroderma?
A term used when more than 95% of skin is involved in a rash of any kind
What are the causes of erythroderma?
Eczema Psoriasis Drugs- gold Lymphomas Leukaemias Idiopathic
What do dermatologists need to look out for in erythroderma?
Signs of dehydration (note that dry mucous membranes would be expected and nausea)
High output heart failure (SOB is an emergency)
Infection
What is erythrodermic psoriasis?
This may result from progression of chronic disease to an exfoliative phase with plaques covering most of the body, associated with mild systemic upset
More serious form= acute deterioration, which may be triggered by a variety of factors like withdrawal of systemic steroids patients need to be admitted ti hospital.
What is the koebner phenomenon? What does it occur in?
Skin lesions which appear at the site of injury Occurs in... - psoriasis - vitiligo - warts - lichen planus - lichen sclerosus - mollascum contagiosum
What are the drugs known to cause toxic epidermal necrolysis?
Phenytoin Sulphonamides Allopurinol Penicillins Carbamazepine NSAIDS
How do you treat toxic epidermal necrolysis?
Stop the precipitating factor
Supportive care
- often in ICU
- volume loss and electrolyte derangements are possible complications
- intravenous immunoglobulins have been shown to be effective and are commonly used first line
Other treatments= Immunosuppresive agents (ciclosporin and cyclophosphamide) Plasmapheresis
What is pyoderma gangrenosum?
Rare inflammatory skin disease where painful pustules or nodules become ulcers that progressively grow
It isn’t infectious
What are the causes of pyoderma gangrenosum?
Idiopathic in 50% IBD RA, SLE Myeloproliferative disorders Lymphoma, myeloid leukaemias Monoclonal gammopathy (IgA) Primary billiary cirrhosis
What is the management of pyoderma gangrenosum?
The potential for rapid progression is high in most patients and therefore most patients advocate oral steroids as first line treatment
Other immunosuppresive therapy- ciclosporin and infliximab have a role in difficult cases
What are the features of acne rosacea?
Typically affects the nose, cheeks and forehead
Flushing is often the first symptom
Telangiectasia is common
Later develops into persistent erythema with papules and pustules
Rhinophyma
Ocular involvement- blepharitis
Sunlight may exacerbate symptoms
What is the management of acne rosacea?
Topical metronidazole may be used for mild symptoms- limited no. Of papules and pustules, but no plaques
Topical brumonidine for predominant flushing
More severe disease is treated with systemic abx
Recommend daily suncream
Camouflage cream
Laser therapy (not on nhs) for prominent telangiectasia
What is pityriasis rosea.
An acute self limiting rash which tends to affect young adukts
The aetiology is not fully understood thought that the herpes hominis virus 7 plays a role
What are the features of pityriasis rosea?
In the majority there is no prodome, however in a minority there may be a hx of a recent viral infection
Herald patch (usually on the trunk) Followed by erythematous, slightly raised oval lesions with a fine scale confined to the outer aspects of the lesions May produce a fir tree appearance
How do you differentiate between guttate psoriasis and pityriasis rosea?
In guttate psoriasis there is a classical prodome of a streptococcal sore throat for 2-4 weeks
Whereas in pityriasis rosea only some patients report resp tract infections
Tear drop appearance in guttate psoriasis, herald patch in pityriasis rosea
Most cases of guttate psoriasis will resolve within 2-3 months, UVB, photopherapy
Pityriasis rosea is self limiting and resolves after around 6 weeks
