Skin Flashcards
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
Chicken pox
isolate until crusts dry over
illness lasts around 5-10 days
incubation period 10-21 days
Complications in immunocompromised and pregnant
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?
Measles
Contagious 2 days before sx and 5 days after rash.
Notify public health
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?
Kawasaki disease
coronary artery aneurysm
IVIG +/- aspirin
Echo
78 yo. Slow growing lesion, occassional bleeding.
Dx?
Rx?
Image from AFP article
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.
60 yo
poorly defined scar on forearm. (image from AFP)
Dx?
Management options?
f/u
BCC (morphoeic)
Biopsy any unexplained scar
rx options:
excision
curettage and diathermy
liquid nitrogen
imiquimod or fluorouracil
radiotherapy
55 yo woman
slowly expanding red patch.
Hasnt responded to rx for psoriasis for past 4 years
Dx?
Rx:
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.
70yo
lesion on arm.
Failed rx for tinea, psoriasis and eczema
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
78 yo man
lesion grew over past 2 months
tender
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
Elderly man
SCC
What is this lesion?
DDx?
Keratoacanthoma
ddx: SCC
5 yo Indigenous boy
Dx?
Rx?
Scabies and secondary bacterial infection (impetigo)
Rx:
- Impetigo:
As extensive, cephalexin 25mg/kg po bd for 10 days
Soften crusts with soap and water
- Scabies:
permethrin 5% whole body from neck down. Wash off 12-24 hours
Supply enough for repeat dose in 1 week
- 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
- 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
6 yo indigenous boy
itchy skin rash
on examination has small linear papules that seemed to “track”down his right arm.
dx?
ddx?
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.
45 yo
1 wk of pruritic, spreading rash after returning from Thailand.
Nil fevers, rigors or chillds
Dx?
Cutaneous larva migrans
caused by larva of animal hookworms, contact through contaminated soil
rx: single dose ivermectin (21mg or 200mcg/kg)
Lesion?
Nodular BCC
Lesion?
Superficial BCC
Excision
cryotherapy
photodynamic therapy
imiquimod cream. 3-5 times a week for 6-16 weeks
fluorouracil cream. BD for 6-12 weeks
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?
Mycosis fungoides. Most common cause of cutaneous T cell lymphoma
Ddx:
Granuloma annulare
psoriasis
tinea
ezcema
sarcoidosis
Fast growing, shiny red mass. Painless
Dx?
Ddx?
Rx?
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
1 month old
Painful rash
Ddx?
Herpes simplex
DDx vesicular neonatal eruptions:
bullous impetigo
candida
dermatitis herpetiformis
syphilis
pemphigus vulgaris
child abuse
70 yo with dementia
itchy
Dx?
Rx?
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
Types of steroids
Ultrapotent: betamethasone diproprionate (in optimised vehicle) 0.05%
Potent: betamethasone diproprionate 0.05%
betamethasone valerate (celestone)
methyprednisolone aceponate 0.1%
Weak: Hydrocortisone 1%
Vulval rashes:
Erythematous?
Pallor?
Erosions?
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.
What is this lesion?
Ddx:
Amelanotic melanoma
ddx of red to pink macule or papule:
solar keratosis
dermal naevus
Hypopigmented common naevus
Reddish, firm nodule.
Dx?
DDx?
Amelanotic melanoma
ddx:
haemangioma
scc, keratoacanthoma
BCC
spitz naevus
pyogenic granuloma
4 yo
itchy rash.
present since baby.
Dx:
Rx?
Atopic dermatitis
Rx:
Pt education/explain diagnosis
topical steroid - use appropriate strength and amount
protect and moisturise skin
avoid irritants/triggers
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
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.
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
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
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
