Rashes

Question 1

what joint problem is associated with psoriasis

Answer 1

psoriatic arthritis

Question 2

describe the causes of psoriasis

Answer 2

multifactoral= genetic + environment (stress, drugs, infection)

Question 3

where are the most common sites to be affects by psoriasis

Answer 3

extensors (elbow, knee), scalp, sacrum, hands, feet, trunk, nails

Question 4

what is the koebner phenomenon

Answer 4

when psoriasis develops in area of skin trauma

Question 5

what is auspitz sign

Answer 5

removal of surface scale reveals tiny bleeding points (dilated capillaries in elongated dermal papillae(rete ridges))

Question 6

what is palmoplantar pustular

Answer 6

psoriasis type on feet/palms

Question 7

name a rare type of widespread psoriasis

Answer 7

erythrodermic or widespread pustular

Question 8

name 4 features of psoriatic nail disease

Answer 8

oncholysis (lifting of plate from bed)

nail pitting

dystrophy

subungal hyperkeratosis

Question 9

what are the biomarkers for psoriasis

Answer 9

raised markers for systemic inflammation

Question 10

name 6 co-morbidities of psoriasis

Answer 10

psoriatic arthritis, metabolic syndrome (obesity, hypertension, diabetes, lipid abnomralities), crohns disease, cancer, depression, uveitis

Question 11

why is life expectancy shorter in psoriasis patients

Answer 11

3x increased cardiovascular risk

Question 12

what are the topical therapies for psoriasis

Answer 12

vitamin D analogues (calcipotriol)

coal tar

dithranol

steroid ointments (beware rebound flare)

EMOLLIENTS (reduce hyperkeratosis, ant inflammatory, soften scales)

Question 13

what are treatments for psoriasis that doesn’t respond to topical treatment

Answer 13

phototherapy (narrowband UVB and PUVA)

systemic treatments

• immunosupression (methotrexate, cyclosporin)
• immune modulation (targeted biological agents)

Question 14

what is the initial management for acne vulgaris

Answer 14

bezoly peroxide (keratolytic, antibac)

topical retinoid (Vit A derivatives- dry skin)

topical antibiotic (antibac and anti inflam)

Question 15

what is the treatment for people with acne vulgaris who dont respond to topical treatment

Answer 15

add oral antibiotics (e.g. lymecycline/ doxycycline)
to
topical reinoid or benzoly peroxide

or
combined oral contraceptive in combo with topical agents

Question 16

when referred to hospital for acne what might a patient be prescribes

Answer 16

oral isotretinoin (systemic retinoid- usually cause flare before improvement, congenital defects)

Question 17

are people genetically susceptible to acne

Answer 17

yes

Question 18

what are comedones

Answer 18

open (blackhead) and closed (whitehead)

Question 19

what are the secondary features of acne vulgaris

Answer 19

scars

Question 20

describe the grading of acne

Answer 20

mild- scattered papules and pustules

moderate- numerous papules, pustules and mild atropic scarring

severe- cysts, nodules, significant scarring

Question 21

what is acne excoriae

Answer 21

picking spots, ruptures cysts deeply, increases risk of scarring

Question 22

describe the presentation of acne rosacea

Answer 22

age 30-60
nose, chin, cheeks and forehead

papules, pustules, erythema NO COMEDONES

prominent facial flushing exacerbated by change in temp, alcohol and spicy food

enlarged/ unshapely nose (rhinophyma)

conjuctivitis/ gritty eyes

Question 23

what cause it thought to be associated with acne rosacea

Answer 23

demodex mite

Question 24

how do you manage acne rosacea (plus telangiectasia and rhinophyma)

Answer 24

reduce aggravating factors (sun, avoid topical steroids)

topical
-metronidazole/ ivermectin (to reduce mite)

oral therapy

• long term tertacycline
• isotretinoin low dose if severe

for telangiectasia- vascular laser

for rhinophyma- surgery/ laser shaving

Question 25

what are lichenoid eruptions classified by

Answer 25

damage and infiltration between the epidermis and dermis

Question 26

describe the presentation of lichen planus

Answer 26

violaceous (pink/purple) flat topped shiny papules

typically affects wrists, forearms, shins and skin levels

wickams striae- fine lace like pattern on surface of papules and buccal mucosa

v itchy

Question 27

how is lichen planus

Answer 27

treat symptomatically- topical steroids/ oral steroids if extensive

Question 28

how can you differentiate between bullous disorders

Answer 28

bullous pemphigoiD- split is Deeper, through Dej

pemphiguS- split more Superficial, intra-epidermal

Question 29

what is nikolsky’s sign

Answer 29

when the top layers of the skin slip away from the lower layers when slightly rubbed

indicates plane of cleavage within the epidermis

Question 30

describe the presentation of bullous pemphigoid

Answer 30

elderly patients
localised to one area or widespread on the trunk and proximal limbs

large tense bullae on normal skin on erythematous base

blisters burst to leave erosions

non scarring

itchy erythematous plaques and papules may be presenting feature

nikolsky sign NEGATIVE

Question 31

describe the presentation of pemphigus vulgaris

Answer 31

scalp, face, axillae, groins

flaccid vesicles/ bullae- thin roofed

lesions rupture to leave raw areas

nikolsky sign positive

mucosal involvement very common (eyes, genitals)

Question 32

which bullous disorder has high mortality if not treated

Answer 32

pemphigus

Question 33

how do you treat bullous disorders

Answer 33

chronic self limiting course

systemic steroids
immunosuppressants

in pemphigoid tetracycline antibiotics (increased risk of infection)

topicals

• emmolients
• topical steroids
• topical antisepsis/ hygiene measures

Question 34

what investigations can be done to distinguish between bullous disorders

Answer 34

skin biopsy with direct immunofluorescence

indirect immunofluorescence