Rashes Flashcards
how long should patients with mild/moderate acne be treated before a review?
three months
what is the topical treatment for mild/moderate acne?
benzoyl peroxide
retinoids
topical antibiotic
what are three topical retinoids?
adapalene
isotretinoin
tretinoin
if patients under 12 have a poor response to topical treatment for mild/moderate acne what should be given?
erythromycin or clarithromycin
if patients over 12 have a poor response to topical treatment for mild/moderate acne what should be given?
doxycycline
erythromycin or clarithromycin
what medication could be considered in females with acne?
anti androgens
what management should be started for severe cystic acne with scarring?
systemic antibiotics
refer for systemic isotretinoin
how does discoid eczema appear on the skin?
in circular or oval patches
what is the most common site affected by contact eczema?
hand
what body part is associated with varicose eczema?
lower legs
what is varicose eczema associated with?
venous insufficiency
what body parts are affected by seborrheic dermatitis?
nose
eyebrows
ears
scalp
how does dyshidrotic eczema present?
tiny blisters on the hands and feet
very itchy
what are the general measures for managing dermatitis?
remove triggers
loose, cotton clothes
emollients
what is given for mild dermatitis?
mild topical steroids
what is given for moderate dermatitis?
moderate topical steroids
what is given for severe dermatitis?
a potent topical steroid
what options are available for managing dermatitis in secondary care?
phototherapy
systemic immunosuppressants
biological agents
how does psoriasis present?
symmetrical red scaly plaques that are well defined
what are some common sites for psoriasis?
scalp
elbows
knees
what is Auspitz sign?
bleeding when surface scale is removed
seen in psoriasis
what is the koebner phenomenon?
when psoriasis develops in areas of skin trauma
what five topical therapies for psoriasis are used?
vitamin D analogues coal tar dithranol steroid ointments emollients
what are two types of vitamin D analogues used in psoriasis?
calcipotriol (dovonex)
calcitriol
when is dithranol used in psoriasis?
localised plaques
what is a whitehead?
a closed comedone
what is a blackhead?
an open comedone
what is acne vulgaris?
chronic inflammatory disease of the pilosebaceous gland
what sites are commonly affected by acne?
face
upper back chest
what classifies mild acne?
scattered papules and pustules
comedones
what classifies moderate acne?
numerous papules and pustules
mild atrophic scarring
what classifies severe acne?
cysts
nodules
significant scarring
where does rosacea affect?
nose
chin
cheeks
forehead
what lesions are present in rosacea?
papules
pustules
erythema
what can exacerbate rosacea?
temperature changes
alcohol
spicy foods
what is rhinophyma and what skin condition is that associated with?
an enlarged misshapen nose
rosacea
what effects can rosacea have on the eyes?
conjunctivitis
gritty eyes
what are possible psychiatric complications of acne?
depression
anxiety
what is the timescale for management of mild to moderate acne in primary care?
topical treatment for 3/12 then review
if poor response after three months, consider systemic treatment
what is involved in the initial treatment for mild to moderate acne?
topical benzoyl peroxide
topical retinoids
topical antibiotics
name three retinoids
adapalene
isotretinoin
tretinoin
what systemic treatment can be considered after topical treatment for acne fails in patients under 12 in primary care?
erythromycin or clarithryomycin BD
what systemic treatment can be considered after topical treatment for acne fails in patients over 12 in primary care?
lymecycline 400mg OD
doxycycline 100mg OD
erythromycin/clarithromycin 500ng BD
what is the initial management for severe cystic acne with scarring?
systemic antibiotic therapy
refer for consideration of systemic isotretinoin
describe the appearance of discoid eczema
occurs in circular or oval patches
when does contact eczema occur?
when the body comes into contact with a specific substance
often affects the hands
what part of the body is affected by varicose eczema?
the lower legs
what is varicose eczema associated with?
venous insufficiency
what parts of the body are affected by seborrheic eczema?
nose
eyebrows
ears
scalp
how does dyshidrotic eczema present?
tiny blisters on the hands and feet
very itchy
what conditions make having eczema more likely?
allergies
asthma
hayfever
what are the general conservative management options for eczema?
remove triggers
wear loose cotton clothing
emollient use
what is the management for mild eczema?
mild topical steroid
what is the management for moderate eczema and name examples?
moderate topical steroid
e.g. betamethasone valerate 0.25% or clobetasone butyrate 0.05%
what is the management for moderate eczema on the face?
mild steroid on the face - can increase in potency if needed to moderate
what is the management for severe eczema and state an example?
potent topical steroid on inflamed areas e.g. betamethasone valerate 0.1%
when should adults with eczema be referred to secondary care?
failure to respond to moderate steroids sleep problems recurrent infection erythrodermic eczema contact allergy
when should children with eczema be referred to secondary care?
uncontrolled despite maintenance + flare treatment
psychological or social difficulties
diagnosis uncertain
what options are available for management of eczema in secondary care?
phototherapy
systemic immunosuppressants
biological agents
how does guttate psoriasis present?
post strep infection
widespread small plaques
what is another name for chronic plaque psoriasis?
psoriasis vulgaris
what are unstable psoriasis plaques and what can trigger this?
rapid extension fo new or existing plaques
stress, infection, drugs, withdrawal
what is the koebner phenomenon?
presence of new psoriatic plaques at the site of skin injury
describe flexural psoriasis
affects body folds and genitals
smooth, well defined
what microbe colonises flexural psoriasis?
candida
what is sebopsoriasis?
the overlap of seborrheic dermatitis and psoriasis
affects the scalp, face, ears and chest
what microbe colonises sebopsoriasis?
malassezia
what is auspitz sign in psoriasis?
bleeding when surface scale removed
what causes psoriasis?
multifactorial - genetic and environmental inputs
what sites are commonly involved in chronic plaque psoriasis?
extensors (elbow, knee) scalp sacrum hands feet trunk nails
describe the plaques in chronic plaque psoriasis
symmetrical
well demarcated
scaly
erythematous
name some nail signs seen in psoriasis
onycholysis
nail pitting
dystrophy
subungual hyperkeratosis
what biomarkers are raised in psoriasis?
those of systemic inflammation
name some comorbidities associated with psoriasis
psoriatic athritis metabolic syndrome crohn's cancer depression uveitis
how can severe psoriasis reduce life expectancy?
increased CVD risk reduces expectancy by 4 years
can psoriasis be cured?
no - important to ensure that the patient knows this and to set realistic goals
describe mild acne
scattered papules and pustules
comedones
describe moderate acne
numerous papules
pustules
mild atrophic scarring
describe severe acne
cysts
nodules
significant scarring
what parts of the body are affected by rosacea?
nose
chin
cheeks
forehead
what lesions are seen in rosacea?
papules
pustules
erythema
no comedones seen
what can exacerbate facial flushing in rosacea?
changes in temperature
alcohol
spicy foods
what change can affect the nose in rosacea?
rhinophyma - an enlarged, unshapely nose
what topical therapies can be given for rosacea?
metronidazole
ivermectin
what oral therapies can be given for rosacea?
long term oral tetracycline
low dose isotretinoin in severe disease
what can be used to treat telangiectasia in rosacea?
vascular laser
what can be done to manage rhinophyma in rosacea?
surgery
laser shaving
what characterises lichenoid eruptions?
damage and infiltration between the epidermis and the dermis
name the two most common types of lichenoid eruptions
lichen planus
lichenoid drug eruption
what is the pathology behind lichen planus?
T cell mediated inflammation targeting a protein in the skin + mucosal keratinocytes
describe the lesions seen in lichen planus
pink/purple flat topped shiny papules
wickham’s striae - white lacey pattern on the surface
itchy
what body parts are usually affected by lichen planus?
volar wrists/forearms
shins
ankles
how long does lichen planus usually last?
12-18 months
how is lichen planus managed?
emollients
topical steroids (oral if extenisve)
UVB phototherapy if severe
