Passmed Derm Flashcards
A 38-year-old man presents with a sudden onset rash. He is otherwise well in himself and has no notable past medical history. You see from his notes he has had recent tonsillitis for which he received amoxicillin. On examination, there are multiple papules on his trunk and proximal extremities. There is a fine scale on several of these lesions. What is the most likely diagnosis?
Drug eruption
Pityriasis Rosea
Guttate psoriasis
Nummular dermatitis
Guttate
Children and adolescents. It may be precipitated by a streptococcal infection 2-4 weeks prior to the lesions appearing
Tear drop lesions on trunk and limbs
56-year-old gentleman presents to the dermatology clinic. Over the last few weeks, he has noticed a new, enlarging lesion on his cheek which sometimes bleeds. On examination, he has Fitzpatrick skin type I, multiple melanocytic naevi over his body, and the lesion in question is a large, black, dome-shaped lump, of 1cm diameter, located on his right cheek. What is this lesion most likely to represent?
Nodular melanoma BCC SCC Lentigo melanoma Superficial spreading melanoma
Nodular
tends to affect people over the age of 50, with fairer skin, and to occur in chronically sun-exposed areas
The lump may be ulcerated, bleeding, itch or sting and may have a smooth, crusty, rough or warty surface.
Compare superficial spreading and nodular melanoma
Superficial
-Most common
Younger people
-Apperance - A growing mole
Nodular
- Middle aged
- Red or black lump or lump which bleeds or oozes
A 62-year-old female is referred to dermatology by her GP due to a lesion over her shin. It initially started as a small red papule which later became a deep, red, necrotic ulcer with a violaceous border. What is the likely diagnosis?
erythema nodosum
pretibial myxoedema
pyoderma gangrenosum
necrobiosis lipoidica diabeticorum
pyoderma gangrenosum
Erythema nodosum
How does it present?
Usual causes?
symmetrical, erythematous, tender, nodules which heal without scarring
Strep, sarcoid, IBD, Drugs Eg penicillin /COCP
Pretibial myxoedema
Seen when? Presents how?
Graves
shiny, orange peel skin - symmetrical and erythematous
How does pyoderma gangrenosum present?
initially small red papule
later deep, red, necrotic ulcers
What is this describing?
large variation in colour from flesh to light-brown to black
have a ‘stuck-on’ appearance
keratotic plugs may be seen on the surface
mx?
Seborrhoeic keratoses
reassurance about the benign nature
curettage / cryosurgery
Who is affected by Acral lentiginous melanoma ?
Where?
Commonest in people with dark skin
enlarging discoloured skin patch on the palms, fingers, soles or toes
What is due to over exposure by infrared radiation Eg Hot water bottle on back?
Erythema ab igne
Key Ix in someone presenting with erythema nodosum?
CXR
- exclude Sarcoidosis and TB which are causes
Features of pityruasis rosea ? mx?
Initial Herald patch
-> erythematous, OVAL, scaly patches
Self limiting 4-12 weeks
itchy papules on chest and back
nail dystrophy
Darier’s disease
[keratosis follicularis]
itchy, vesicular skin lesions on the extensor surfaces (e.g. elbows, knees, buttocks)? Ix?
Dermatitis hepetiformis Skin biopsy - IgA on immunofluorescence
Pyoderma gangrenosum 2 Associations?
Mx?
Idiopathic in 50% inflammatory bowel disease: ulcerative colitis, Crohn's rheumatoid arthritis, SLE myeloproliferative disorders lymphoma, myeloid leukaemias monoclonal gammopathy (IgA) primary biliary cirrhosis
Oral steroids
-> ciclosporin / infliximab
