Skin Flashcards

1
Q

5 yo. 2 days of

Headache

fever

reduced appetite

then papules turning to blisters appearing on face, mouth, trunk.

Now spread to arms and legs

A

Chicken pox

isolate until crusts dry over

illness lasts around 5-10 days

incubation period 10-21 days

Complications in immunocompromised and pregnant

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2
Q

4 yo, not vaccinated. fever, malaise, loss of appetite, conjuntivitis, cough,

3 days laterwhite spots on mouth

then red blotchy rash on face that becomes more generalised.

Not itchy

Child looks unwell

Dx?

A

Measles

Contagious 2 days before sx and 5 days after rash.

Notify public health

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3
Q

2 yo. Very irritable.

5 days of fever >39 degrees

red, cracked lips

strawberry tongue

erythema and oedema hands and feets then desquamation

cervical lymphadenopathy

polymorphous skin rash

Dx?

Complications?Rx?

A

Kawasaki disease

coronary artery aneurysm

IVIG +/- aspirin

Echo

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4
Q

78 yo. Slow growing lesion, occassional bleeding.

Dx?

Rx?

Image from AFP article

A

Nodular BCC

Common on face

pearly raised edge with surface telangiectasia

May develop central ulcer

Slow growing and bleed occassionally

Rx: RACGP - ears, eyes, nose and lips are potential danger areas - more aggressive. Need excision or referral.

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5
Q

60 yo

poorly defined scar on forearm. (image from AFP)

Dx?

Management options?

f/u

A

BCC (morphoeic)

Biopsy any unexplained scar

rx options:

excision

curettage and diathermy

liquid nitrogen

imiquimod or fluorouracil

radiotherapy

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6
Q

55 yo woman

slowly expanding red patch.

Hasnt responded to rx for psoriasis for past 4 years

Dx?

Rx:

A

Bowen disease or intrepithelial scc. Superficial SCC

one or more irregular, scaly plaques, often red.

usually sun exposed sites

thin lesions like Bowen: can use shave biopsy for diagnosis

fluorouracil can be used for Bowen disease.

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7
Q

70yo

lesion on arm.

Failed rx for tinea, psoriasis and eczema

A

Superficial BCC

typically presents as well defined red patch on body or limbs

may have appearance of psoriasis, eczema or tinea

stretching the lesion may reveal a small pearly edge

biopsy to confirm

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8
Q

78 yo man

lesion grew over past 2 months

tender

A

SCC

2nd most common skin cancer

quick growing keratotic lesion

Often arise within pre-existing actinic keratosis

important finding is tenderness of the lesion

cured with treatment

50% at high risk develop second scc within 5 yrs of the first. Also at increased risk melanoma

Annual skin checks

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9
Q

Elderly man

A

SCC

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10
Q

What is this lesion?

DDx?

A

Keratoacanthoma

ddx: SCC

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11
Q

5 yo Indigenous boy

Dx?

Rx?

A

Scabies and secondary bacterial infection (impetigo)

Rx:

  1. Impetigo:

As extensive, cephalexin 25mg/kg po bd for 10 days

Soften crusts with soap and water

  1. Scabies:

permethrin 5% whole body from neck down. Wash off 12-24 hours

Supply enough for repeat dose in 1 week

  1. Manage contacts:

minimise exposure to others (school, playgroup) until 2 doses given

treat all family and household contacts with permethrin even if asymptomatic

hot wash or bag linen, clothes, towels for 1 wk

  1. Follow up

review in 24-48 hours to ensure impetigo improving, if not consider benzylpenicillin inj

advise carer to return if sx not resolved 2 wks after completing treatment. Itch can persist for 3 wks

If symptoms beyond 3 week, oral ivermectin

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12
Q

6 yo indigenous boy

itchy skin rash

on examination has small linear papules that seemed to “track”down his right arm.

dx?

ddx?

A

Lichen Striatus

DDx:

lichen planus

lichen nitidus

lichen simplex

annular lichenoid dermatitis

unilateral laterothoracic exanthema.

Benign condition, lasting few months to 2 years. Can treat symptoms of itch if wanted.

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13
Q

45 yo

1 wk of pruritic, spreading rash after returning from Thailand.

Nil fevers, rigors or chillds

Dx?

A

Cutaneous larva migrans

caused by larva of animal hookworms, contact through contaminated soil

rx: single dose ivermectin (21mg or 200mcg/kg)

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14
Q

Lesion?

A

Nodular BCC

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15
Q

Lesion?

A

Superficial BCC

Excision

cryotherapy

photodynamic therapy

imiquimod cream. 3-5 times a week for 6-16 weeks

fluorouracil cream. BD for 6-12 weeks

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16
Q

69 yo

20 year history of an episodic rash on his arms, legs and trunk.

He stated that the rash started with crops of raised, itchy, nonscaly reddybrown lesions, which would ulcerate and then regress over a 6 week period.

Dx?

DDx?

A

Mycosis fungoides. Most common cause of cutaneous T cell lymphoma

Ddx:

Granuloma annulare

psoriasis

tinea

ezcema

sarcoidosis

17
Q

Fast growing, shiny red mass. Painless

Dx?

Ddx?

Rx?

A

Pyogenic granuloma

ddx:

haemangioma

spitz naevis

BCC

non pigmented melanoma

kaposi sarcoma

skin metastasis

Usually rx with surgical excision as better cure and to rule out skin cancer/melanoma

can also use curettage and cauterisation

cryotherapy

silver nitrate

imiquimod

18
Q

1 month old

Painful rash

Ddx?

A

Herpes simplex

DDx vesicular neonatal eruptions:

bullous impetigo

candida

dermatitis herpetiformis

syphilis

pemphigus vulgaris

child abuse

19
Q

70 yo with dementia

itchy

Dx?

Rx?

A

Bullous pemphigoid

autoimmune.

usually over 50, particularly over 80 yo

More prevalent in elderly with neuro disease

may be associated internal malignancy

drug, injury or infection can trigger

rx:

ultrapotent topical steroids for limited disease

systemic steroid

antibiotics for secondary infection

pain relief

may need to dress blisters and erosions

steroid sparing: methotrexate, azathioprine

20
Q

Types of steroids

A

Ultrapotent: betamethasone diproprionate (in optimised vehicle) 0.05%

Potent: betamethasone diproprionate 0.05%

betamethasone valerate (celestone)

methyprednisolone aceponate 0.1%

Weak: Hydrocortisone 1%

21
Q

Vulval rashes:

Erythematous?

Pallor?

Erosions?

A

DDx itchy erythematous rash:

Dermatitis (eczema). Potent topical corticosteroid

Lichen simplex chronicus (chronic dermatitis)

Psoriasis

Tinea cruris

Pallor:

Lichen sclerosis (very itchy) - ultrapotent corticosteroid (image)

Vitiligo (asymptomatic)

Erosions:

HSV - pain

Lichen planus - pain.

22
Q

What is this lesion?

Ddx:

A

Amelanotic melanoma

ddx of red to pink macule or papule:

solar keratosis

dermal naevus

Hypopigmented common naevus

23
Q

Reddish, firm nodule.

Dx?

DDx?

A

Amelanotic melanoma

ddx:

haemangioma

scc, keratoacanthoma

BCC

spitz naevus

pyogenic granuloma

24
Q

4 yo

itchy rash.

present since baby.

Dx:

Rx?

A

Atopic dermatitis

Rx:

Pt education/explain diagnosis

topical steroid - use appropriate strength and amount

protect and moisturise skin

avoid irritants/triggers

25
Toenail issues: Dx: Rx:
onychomycosis ddx: bacterial infection psoriasis lichen planus viral warts melanoma rx: Clippings for mc.s Terbinafine 250mg oral for 12 wks (or longer) for toenails Laser therapy
26
10 week old boy cough unwell 3 days ago, worse today increased work of breathing widespread wheeze and crepitations +/- fever Dx: Rx:
Bronchiolitis. Viral LRTI, children under 12 months resolves over 7-10 days Rx: Mild (sa02 \>93%): managed at home mod - severe need admission for O2.
27
What are the signs and symptoms of coeliac disease? What is this rash? Dx? Associated conditions?
• Fatigue • Iron deficiency and anaemia • Nutritional deficiencies • Altered bowel habits (including diarrhoea and/or constipation) • Abdominal pain or bloating • Flatulence • Irritability and depression • Weight loss or gain • Developmental delay (in children) • Failure to thrive (in children) • Bone or joint pain and stiffness • Dental enamel defects • Mouth ulcers • Itchy and blistery skin rash (dermatitis herpetiformis - see image). Dx: - Endomysial antibody (EMA) (IgA) or Transglutaminase antibody, (TTG) (IgA) have high specificity - Anti-gliadin antibodies (AGA) (IgG & IgA) IgA levels Strong assoc HLA - DQ2, DQ8 Assoc: osteoporosis, FTT
28
What are some screenings recommended for Indigenous Australians?
Immunisations Anaemia Growth monitoring kidney disease - check scabies, impetigo, USS for 1st UTI. ACR if diabetes or kidney disease dental health eye health hearing loss sexual health asthma diabetes -all over 18yrs mental health drug and etoh, smoking overweight/obesity exercise
29
30
Management of psoriasis Drug and non drug
psychological impact lifestyle advice (eg stress management, exercise, weight loss, smoking cessation, reduced alcohol intake Medication review (some meds make psoriasis worse Avoid soaps gentle sunshine emollients Meds: liquor picis carbonis (LPC) = coal tar solution. & salicylic acid calcipotriol potent steroid - betamethasone, mometasone, methylprednisolone Dithranol (not used as much, can stain) UVB light therapy Methotrexate/biologicas