Rashes Clinical Cases

Question 1

Causes of psoriasis?

Answer 1

Multifactorial

• environment- stress, drugs, infection
• Genetic

Question 2

Commonest form of psoriasis?

Answer 2

Psoriasis Vulgaris

Question 3

Distribution of psoriasis?

Answer 3

Symettrical

Common sites: extensors (elbows/knees), scalp, sacrum, hands, feet, tree, trunk

Question 4

Other psoriasis signs?

Answer 4

Koebner phenomenon- psoriasis develops in area of skin trauma

Auspitz sign: removal of surface scale reveals tiny bleeding points

Question 5

Psoriatic nail disease?

Answer 5

Onycholysis
Nail pitting
Dystrophy
Subungal hyperkeratosis

Question 6

Life psoriasis does not reduce life expectancy. True or false?

Answer 6

FALSE

reduced by about 4 years in patients with severe psoriasis primarily oweing to increased CVD

Question 7

Managing psoraisis?

Answer 7

• Aim to control chronic disease
• Recognize psychological impact
• Recognize co-morbidities

Question 8

Topical therapies for psoraisis?

Answer 8

Vitamin D analogues:

• Calcipotriol (localized plaques rather than flexures)
• Calcitriol (less rritatings, better for flexures

Coal tar
Dithranol - if few localized plaques and patient complies
Steroid ointments
Emollients for everyone

Question 9

Other treatments for psoriasis?

Answer 9

Phototherapy

Systemic treatments

Question 10

Initial management of acne?

Answer 10

Oral AB: doxycycline, topical retinoid

Question 11

Second line management of acne?

Answer 11

Oral isotretinoin
(usually causes initial flare 2-3 weeks then steady improvement over 16 weeks) (Causes congenital defects and has many side effects)
-Patient counselled on side effects

Question 12

What is acne vulgaris?

Answer 12

Chronic inflammatory disease of pilosebaceous unit

Question 13

What is an open comedone?

Answer 13

Blackhead

Question 14

White head is a ——— comedone?

Answer 14

Closed

Question 15

Secondary features of acne vulgaris?

Answer 15

Scars
Atrophic, ice pick
Texture changes
Hypertrophic

Question 16

Acne treatment?

Answer 16

• Avoid oily substance, triggers
• Topical treatment
• Systemic treatment (AB’s for atleast 6 months)
• Isotretinoin (oral retinoid)

Question 17

Example of topical acne treatments?

Answer 17

Benzoyl peroxide
Topical Vitamin A derivatives
Topical AB

Question 18

Symptoms of rosacea?

Answer 18

Nose, chin, cheeks and forehead redness

• Papules, pustules and erythema with no comedones
• Prominent facial flushing exacerbated by sudden change in temp, alcohol & spicy food
• Enlarged, unshapely nose
• Conjunctivitis/gritty eyes

Question 19

Rosacea management?

Answer 19

Reduce aggravating factors
-Dietary triggers, sun exposure, avoid topical steroids

Topical therapies: metronidazole

Oral therapy:
oral tetracycline
isotretinoin

Question 20

What are lichenoid eruptions characterized by?

Answer 20

Damage and infiltration between epidermis and dermis

Question 21

Pathophysiology of lichen planus?

Answer 21

T cell mediated inflammation targeting an unknown protein within the skin and mucosal keratinocytes

Question 22

What is Wickham’s striae?

Answer 22

Fine lace-like pattern on surface of papules and buccal mucosa

Question 23

Management of lichen planus?

Answer 23

Emollients
Treat symptomatically -topical steroids, oral steroids
UVB phototherapy or PUVA

Question 24

What is pathophysiology of bullous disorders?

Answer 24

Autoimmune diseases where damage to adhesion mechanisms in the skin results in blistering at various levels

Question 25

Differentiating between bullous pemphigoid and pemphigus?

Answer 25

Bullous pemphigoiD: split is Deeper, through DEJ

PemphiguS: Split more Superficial, intra-epidermal

Question 26

What is associated with dermatitis herpertiformis?

Answer 26

Gluten sensitive enteropathy (Coeliac disease)

Question 27

What do you get the Nikolsky sign in?

Answer 27

Pemphigus vulgaris

Question 28

What is the Nikolsky’s sign?

Answer 28

Top layers of the skin slip away from the lower layers when slightly rubbed
Indicates plane of cleavage within the epidermis

Question 29

Characteristics of bullous pemphigoid?

Answer 29

• Localized to one area, widespread on the trunk and proximal limbs
• Large tense bullae on normal skin on erythematous base

Question 30

Where does pemphigus vulgaris typically affect?`

Answer 30

Scalp, face, axillae, groins

Mucosal involvement: eyes/genitals

Question 31

Pemphigus vulgaris has what positive?

Answer 31

Nikolsky sign

Question 32

Skin investigations for bullous pemphigoid?

Answer 32

• Skin biopsy with direct immunofluorescence

- Indirect immunoflrorescence

Question 33

Treatment of pemphigus and pemphigoid?

Answer 33

Systemic steroids
Other immunosuppressive agents
In pemphigoid: tetracycline ABs
Topicals: emollients, topical steroids, topical antisepsis/hygiene measures