Rash Flashcards
John - 18 scaly plaques at elbows, knees and shins for 8 weeks scaly scalp for 1 year joint pains smoker 40 units of alcohol a week nail pitting and onycholysis
diagnosis?
psoriasis
katy - 21
acute onset widespread rash over past 2 days
using E45
tonsilitis 2 weeks ago - treated with oral penicillin
diagnosis?
guttate psoriasis
(the trigger to the condition is often a streptococcal (bacterial) sore throat followed within two to three weeks by the skin eruption)
is there a cure for psoriasis?
no
name 3 environmental causes of psoriasis
stress
drugs
infection
what is the commonest form of psoriasis?
chronic plaque psoriasis (psoriasis vulgaris)
psoriasis is symmetrical
true or false?
true
name the common site of psoriasis
extensors (elbow and knee)
scalp, sacrum, hands, feet and trunk
nails
psoriasis is sharply __________, scaly, ____________ plaques
psoriasis is sharply DEMARCATED, scaly, ERYTHEMATOUS plaques
psoriasis that develops in an area of skin trauma (stretch mark or scar) is known as what phenomenon?
Koebner phenomenon
removal of surface scale reveals tiny bleeding points (dilated capillaries in elongated dermal papillae) is known as what psoriatic sign?
Auspitz sign
name 4 psoriatic nail changes
onycholysis
nail pitting
dystrophy
subungal hyperkeratosis
name some psoriatic co-morbidities
arthritis obesity, hypertension, diabetes crohns cancer depression uveitis
name the 5 topical therapies for psoriasis
vitamin D analogues - calcipotriol or calcitriol coal tar dithranol steroid ointments emollients
name the 2 other treatments for psoriasis
phototherapy - UVB and PUVA
immunosuppression - MTX
biologics
shona - 19
oily skin - blackheads
pustules and papules
diagnosis?
acne vulgaris
acne vulgaris is a chronic ____________ disease of the _____________ unit
acne vulgaris is a chronic INFLAMMATORY disease of the PILOSEBACEOUS unit
acne pathogenesis:
- increased _____ production
- dermal ____________
- bacterial colonisation of ____
- poral _________
acne pathogenesis:
- increased SEBUM production
- dermal INFLAMMATION
- bacterial colonisation of DUCT
- poral OCCLUSION
comedones:
open =
closed =
open = blackhead closed = whitehead
where is acne distributed?
face
upper back
anterior chest
name the 3 grades of acne
mild - scattered
moderate - numerous + mild scarring
severe - cysts + significant scarring
name the 3 topical treatments of acne vulgaris
benzoyl peroxide
topical vitamin A derivatives (retinoid)
topical antibiotics
name the 2 systemic treatments of acne vulgaris
oral antibiotics
isotretinoin (oral retinoid)
Wilma - 36
increasing redness of face over 1-2 years
aggravated by wine and curry
recurrent papule and pustules of central fat and chin
father has red face and enlarged nose
diagnosis?
rosacea
rosacea treatment?
oral antibiotic - tetracycline
consider isotretinoin
where does rosacea affect (be specific)
nose cheeks and forehead
rosacea has papules, pustules and erythema with __ comedones
rosacea has papules, pustules and erythema with NO comedones
rosacea is prominent facial ________ exacerbated by sudden ______ in ___________, alcohol and _____ food
rosacea is prominent facial FLUSHING exacerbated by sudden CHANGE in TEMPERATURE, alcohol and SPICY food
an enlarged nose is known as what?
rhinophyma
conjunctivitis/gritty eyes are seen in rosacea
true or false
true
what is the management of rosacea?
reduce aggravating factors (topical steroids)
topical therapies - metronidazole
oral therapy - tetracycline and isotretinoin
telangiectasia management?
vascular laser
rhinophyma management?
surgery/laser shaving
karen - 40 8 week history of very itchy rash on lower legs, flexor wrists, abdo and thighs discomfort in mouth PMH of eczema and asthma med - inhalers
diagnosis?
lichen planus
what is the special striae in lichen planus called?
Wickham’s striae
what colour of buccal mucous and what nail are seen in lichen planus?
white reticular network or buccal mucosa and nail ridges
Lichenoid eruptions are characterized by damage and ____________ between the _________ and ______
Lichenoid eruptions are characterized by damage and infiltration between the epidermis and dermis
name the 2 commonest types of Lichenoid eruptions
lichen planus and lichenoid drug eruption
lichen planus has violaceous (____/______) flat-topped shiny papules typically affecting the volar wrists/________, shins and ______
lichen planus has violaceous (PINK/PURPLE) flat-topped shiny papules typically affecting the volar wrists/FOREARM, shins and ANKLES
how long does lichen planus last?
12-18 months
lichen planus treatment?
topical or oral steroids (extent of disease)
name the 2 bullous disorders
bullous pemphigoid
pemphigus
identify where the split is in the following bullous disorders:
(a) bullous pemphigoid
(b) pemphigus
(a) bullous pemphigoiD - split is Deeper - through DEJ
(b) pemphiguS - split is more Superficial - intra-epidermal
‘the top layers of the skin slip away from the lower layers when slightly rubbed’
what sign is this?
Nikolsky’s sign
indicates plane of cleavage within the epidermis
indicate whether or not nikolsky’s sign is positive or negative in:
(a) bullous pemphigoid
(b) pemphigus
indicate whether or not nikolsky’s sign is positive or negative in:
(a) bullous pemphigoid - negative
(b) pemphigus - positive
choose the following which apply to bullous pemphigoid:
young/old patients? small/large tense bullae on skin? blisters that burst and leave/don't leave erosions? scarring/non scarring? itchy/non-itchy? Nikolsky sign positive/negative? mucosal lesions likely/unlikely?
choose the following which apply to bullous pemphigoid:
old patients large tense bullae on skin blisters that burst and leave erosions non scarring itchy Nikolsky sign negative mucosal lesions unlikely
in early disease, bullous pemphigoid is seen as urticated itchy plaques rather than bullae
true or false?
true
mucosal involvement (eyes and genitals) in pemphigus vulgaris is not common
true or false?
false
mucosal involvement and pemphigus vulgaris is VERY common
which has a higher mortality rate:
pemphigus or bullous pemphigoid?
pemphigus - by far
name the investigations performed in pemphigus/pemphigoid
dkin biopsy + direct immunofluorescence
or
indirect immunofluorescence
outline the treatment of pemphigoid and pemphigus
systemic steroids
immunosuppressive agents
pemphigoid: tetracycline antibiotics
topicals: emollients, steroids, antisepsis/hygiene measures
