Psoriasis

Question 1

Retinoid

Answer 1

Form of vitamin A

Reduces skin turnover

Question 2

Fumaric acid ester

Answer 2

Used in psoriasis treatment

Disrupts lymphocytes

Question 3

distinctive acute skin eruption characterised by small drop-like, salmon-pink papules which usually have a fine scale

Answer 3

Guttate psoriasis

RECENT URTI SECONDARY TO GABHS OFTEN PRECEDES ERUPTION BY 2-3 WEEKS

Question 4

Which type of psoriasis may be preceded by an URTI caused by Group A beta haemolytic strep?

Answer 4

Guttate psoriasis

Question 5

Most commonly associated with streptococcal infection?

Answer 5

Guttate psoriasis

Question 6

Chronic inflammatory disease of the pilosebaceous unit

Answer 6

Acneee

Question 7

Which bacterium colonises the duct in acne?

Answer 7

P. acnes

Question 8

Open comedone

Answer 8

Black head

Question 9

Closed comedone

Answer 9

White head

Question 10

Acne grading

Answer 10

Mild- scattered papules and pustules, comedones

Moderate - numerous papules, pustules &
mild atrophic scarring

Severe - as above, cysts, nodules and significant scarring

Question 11

Benzoyl peroxide

Answer 11

Acne topical treatment

-keratolytic and antibacterial

Question 12

Systemic treatment for Acne

Answer 12

Antibiotics
Isotretinoin (oral retinoid) – effect on sebaceous gland activity. Lot of side effects including initial aggravation of acne

Question 13

Topical treatment for acne

Answer 13

CET (clindamycin, erythromycin, tetracycline)
Benzoyl peroxide – keratolytic, antibacterial
Topical vitamin A derivatives (retinoid): eg adapalene – drying effect
topical antibiotics – antibacterial and anti-inflammatory

Question 14

Isotretinoin is an oral retinoid which can be used to treat acne. Name a side effect?

Answer 14

Can cause initial aggravation of acne§

Question 15

How could you treat flare caused by isotretinoin?

Answer 15

Steroids and dapsone (anti-inflammatory)

Question 16

What exacerbates rosacea?

Answer 16

Change in temperature
Alcohol
Spicy foods

-you could ask about this when taking a history

Question 17

Papules, pustules and erythema with no comedones

Answer 17

Rosacea

Question 18

How to reduce aggravating factors of rosacea?

Answer 18

Reduce aggravating factors:
dietary triggers
sun exposure – wear high factor sunscreen
avoid topical steroids

Question 19

Management for Rosacea?

Answer 19

Antibiotics:
Topical metronidazole
Oral tetracycline long term
Isotretinoin low dose if severe
Telangiectasia : vascular laser
Rhinophyma: surgery/ laser shaving

Question 20

Rhinophyma

Answer 20

Enlarged nose (often in men) associated with Rosacea

Question 21

Difference between bullous pemphigoid and bullous pemphigus?

Answer 21

Bullous pemphigoiD –
split is Deeper, through DEJ.

PemphiguS –
split more Superficial, intra-epidermal

Question 22

Bullous pemphigoid and niklosky sign?

Answer 22

Bullous pemphigoid is niklosky sign NEGATIVE

niklosky sign is when you rub skin e.g. with eraser and if positive then blister will form within minutes

Question 23

Does bullous pemphigoid affect mucosa?

Answer 23

Unlikely

Question 24

Bullous pemphigoid and areas affected on the body?

Answer 24

localized to one area, or widespread on the trunk and proximal limbs

Question 25

Pemphigus vulgaris and niklosky sign?

Answer 25

Pemphigus vulgaris is niklosky sign positibe

Question 26

Pemphigus vulgaris and muscosal involvement?

Answer 26

Mucosal involvement is very common in pemphigus vulgaris

Question 27

Pemphigus vulgaris

Answer 27

Typically affects scalp, face, axillae, groins Flaccid vesicles/bullae – thin roofed Lesions rupture to leave raw areas Increased infection risk Nikolsky sign positive Mucosal involvement (eyes, genitals) : very common

Question 28

Pemphigus vulgaris prognosis?

Answer 28

Chronic self- limiting course Duration varies from months to years Most patients achieve remission on treatment within 3 – 6 months Pemphigus very high mortality if untreated Pemphigoid up to 20% mortality I year treated

Question 29

Investigation for pemphigus vulgaris?

Answer 29

Skin biopsy with direct immunofluorescence | Indirect immunofluorescence