Random Derm

Question 1

What are the side effects of oral isotretinoin?

Answer 1

Teratogenic- women need to be on two forms of contraception whilst on it- need to be on it for 1 month after treatment has finished

Depression

Dry skin, eyes, mouth and lips= MOST COMMON

Hair thinning

Nosebleeds

Raised triglycerides

Photosensitivity

Intracranial HTN- cannot combine with tetracyclines

Question 2

What needs to be monitored in a patient on isotretinoin?

Answer 2

3 monthly FBC, LFTs and lipids

Question 3

What are exacerbating factors for psoriasis?

Answer 3

Alcohol
Trauma
Withdrawal of systemic steroids
Medications- Beta blockers, lithium, ACEis, NSAIDs, anti-malarials (quines), infliximab

Question 4

What is guttate psoriasis?

Answer 4

Form of psoriasis seen in children and young adults

Often have a preceding strep infection 2-4wks earlier

Question 5

What are the symptoms of guttate psoriasis?

Answer 5

Tear drop papules on trunk and limbs

Question 6

What is the management of guttate psoriasis?

Answer 6

It is self limiting and normally resolves within 6-12 weeks
Can treat as per psoriasis guidelines
UVB therapy
Tonsillectomy if recurrent episodes

Question 7

What is pityriasis rosea?

Answer 7

Self-limiting skin condition that is common in young adults

Thought to be due to HHV-7 virus (herpes)

Question 8

What are the symptoms of pityriasis rosea?

Answer 8

No prodrome- minority complain of URTI previously
Herald patch normally on trunk
Followed by erythematous scaly, oval plaques across the body- fir tree appearance
Self-limiting and resolves in 6-12 weeks

Question 9

What are the different types of psoriasis?

Answer 9

Plaque- on extensor surfaces and erythematous scaly plaques

Flexural- smooth instead of scaly and on flexure surfaces

Guttate- preceding strep infection, tear drop plaques

Pustular- commonly on hands and feet

Can have associated nail changes (pitting and onycholysis) and associated arthritis

Question 10

What is the management of psoriasis?

Answer 10

Regular emollients to aid with itching

1) Combination of potent topical corticosteroid (clobetasol propionate) and Vitamin D analogue (calcipotriol)
- for 4 weeks
- apply one in morning and one in evening
2) If no improvement then Vit D twice daily for 4 weeks
3) If no improvement then Corticosteroid twice daily for 4 wks

Refer to secondary care

Phototherapy-

• UVB=main one 3 times a week
• can use UVA and psoralen but increases risk of SCC

Systemic therapy

• methotrexate=1st line, good if associated joint problems
• ciclosporin
• systemic retinoids
• biological treatments