Rashes

Question 1

where is psoriasis found?

Answer 1

extensor surfaces
scalp, sacrum, hands, feet, trunk
nails

Question 2

is psoriasis usually symmetrical or asymmetrical?

Answer 2

symmetrical

Question 3

describe a psoriasis lesion

Answer 3

sharply demarcated
scaly
erythematous
plaques

Question 4

name some types of psoriasis

Answer 4

guttate
palmoplantar pustular
nail disease
erythrodermic/widespread pustular (rare)

Question 5

what is the koebner phenomenon?

Answer 5

thickening of the skin after trauma

Question 6

what is oncholysis?

Answer 6

nail coming away from the nail bed

Question 7

what topical treatments can be used in psoriasis?

Answer 7

• vit. D analogues (calcipotriol/calcitriol)
• coal tar
• steroid ointments

Question 8

when are topical treatments enough in psoriasis?

Answer 8

when psoriasis is mild - moderate

Question 9

aside from topical treatments, what else can be used in psoriasis?

Answer 9

• phototherapy (narrowband UVB/PUVA)

- systemic treatments

Question 10

what systemic treatments can be used in psoriasis?

Answer 10

• retinoid
• immunosuppresion (methotrexate, ciclosporin)
• fumaric acid ester
• immune modulators

Question 11

what does retinoid do & what are the side effects?

Answer 11

reduces skin cell turnover

S/E: increase cholesterol, problems with fertility in females even 3 yrs after stopping therapy

Question 12

what is the main side effect of long term immunosuppression?

Answer 12

cancer

Question 13

what does fumaric acid ester do & what are the side effects?

Answer 13

disrupts lymphocytes, very effective & not immunosuppressant
S/E: can effect kidneys, GI side effects (nausea/bowel discomfort)

Question 14

what are immuno modulators?

Answer 14

biological agents e.g. TNF blockers

Question 15

where can pain be felt by patients with psoriasis?

Answer 15

joints, hands & feet (rheumatoid)

Question 16

what 4 nail features could you expect to see in someone with psoriasis?

Answer 16

• oncholysis
• pitting
• dystrophy
• subungal hyperkeratosis

Question 17

what is acne vulgaris?

Answer 17

chronic inflammatory disease of the pilosebaceous unit

Question 18

when is acne vulgaris likely to present?

Answer 18

females - 14-17

mailes- 16-19

Question 19

what is the morphology of acne vulgaris?

Answer 19

comedones - open & closed
pustules
papules
cysts

Question 20

what is the distribution of acne vulgaris like?

Answer 20

related to sites with most sebaceous glands

face, upper back, anterior chest

Question 21

what secondary features can be found in acne vulgaris?

Answer 21

scars - atrophic, ice-pick, texture changes, hypertrophic

Question 22

what is mild acne described as?

Answer 22

scattered papules & pustules, comedones

Question 23

what is moderate acne described as?

Answer 23

numerous papules, pustules & mild atrophic scarring

Question 24

what is severe acne described as?

Answer 24

as in moderate acne + cysts, nodules & signifiant scarring

Question 25

how is acne treated?

Answer 25

- avoid oily substances & triggers - topical treatments - systemic treatments

Question 26

what topical treatments are given in acne?

Answer 26

benzoyl peroxide - keratolytic, antibacterial topical Vit. A derivatives - e.g. adapalene (drying effect) topical antibiotics - antibacterial & anti-inflammatory

Question 27

what systemic treatments are given in acne?

Answer 27

antibiotics | isotretinoin

Question 28

what does isotretinoin do?

Answer 28

oral retinoid effects sebaceous gland activity los of side effects including initial aggravation of acne

Question 29

what can be given in a isotretinoin flare of acne?

Answer 29

oral steroids & dapsone as anti-inflammatory

Question 30

where is rosacea usually seen?

Answer 30

nose, chin, cheeks & forehead

Question 31

what is seen in rosacea?

Answer 31

papules, pustules & erythema with no comedones | prominent facial flushing

Question 32

what is rosacea exacerbated by?

Answer 32

sudden in change in temperature, alcohol & spicy food

Question 33

when does rosacea usually present?

Answer 33

30s/40s

Question 34

how is rosacea managed?

Answer 34

- reduce aggrevating factors - antibiotics - isotretinoin low dose if severe - telangiectasia: vascular laser - rhinophyma: surgery/laser shaving

Question 35

what are the aggravating factors in rosacea?

Answer 35

dietary triggers sun exposure topical steroids

Question 36

when is bullous pemphigoid seen?

Answer 36

in elderly patients

Question 37

where on the body is bullous pemphigoid seen?

Answer 37

localised to one area or widespread on the trunk & proximal limbs

Question 38

what is seen on the skin in bullous pemphigoid?

Answer 38

large tense bullae on normal skin or erythematous base

Question 39

what might the presenting feature be in bullous pemphigoid?

Answer 39

itchy erythematous plaques & papules

Question 40

what is the nikolsky sign?

Answer 40

put your finger on the blister & press it to the side, if blister ruptures then positive, if not then negative

Question 41

is the nikolsky sign negative or positive in bullous pemphigoid?

Answer 41

negative

Question 42

where does pemphigus vulgaris usually affect?

Answer 42

scalp, face, axillae, groins

Question 43

what is seen in pemphigus vulgaris?

Answer 43

flaccid vesicles/bulllae (thin roofed) mucosal involvement lesions rupture to leave raw areas positive nikolsky sign

Question 44

how are pemphigoid & pemphigus treated?

Answer 44

systemic steroids immunosuppressive agents: azathioprine, ciclosporin, mycophenolate topicals: emollients, topical steroids

Question 45

what else can be give in pemphigoid?

Answer 45

tetracycline antibiotics, nitotinamide