Skin and eyes Flashcards
what is acne fulminans
very severe acne associated with systemic symptoms - responds to oral steroids
which antibiotic can be used in pregnancy for acne
erythromycin - NB an antibiotic should be used for max 3 months
pathophysiology of atopic eczema
IgE-mediated, T-cell autoimmune response
treatment of persistently inflamed areas of eczema
topical steroids - use with emollients ratio 10:1
mild = 1% hydrocortisone
moderate = 0.025% betamethasone
potent = betamethasone 0.1%
dermovate most potent - don’t use on face/genitals
serious complication of eczema
eczema herpeticum - give IV acyclovir and probably also fluclox if ulcerations infections
this can cause herpes encephalitis and blindness
drugs which can exacerbate psoriasis
- beta blockers
- anti malarials
- NSAIDs
- ACE inhibitors
genes associated with psoriasis
HLA-B27
B13
CW6
what is guttate psoriasis
transient psoriatic rash, frequently triggered by strep infection
what is PASI
psoriasis area and severity index
1st line management for psoriasis
potent corticosteroid OD + vitamin D analogue OD (calipotriol, calcitriol)
up to 4 weeks as initial treatment
2nd line management for psoriasis
if no improvement after 8 weeks of 1st line treatment
give vitamin D analogue BD (short acting dithranol)
3rd line management for psoriasis
if no improvement after 8-12 weeks
potent corticosteroid BD for up to 4 weeks
when to refer for warts
- persistent unresponsive to treatment in primary care
- multiple warts in immunocompromised
- facial warts
most common type of BCC
nodular - initially pearly with telangiectasia, may ulcerate later leaving a central crater
what is Mohs micrographic surgery
for BCC - excision of lesion and tissue borders progressively until specimens are microscopically free of tumour
for high risk/recurrent
what can be used for low risk BCC lesions
topical imiquimod or fluorouracil
when to use radiotherapy in BCC
if recurrent, incomplete excision, invasion of bone/cartilage
what 2 skin conditions increase the risk of SCC
actinic keratoses
Bowen’s disease (carcinoma in situ)
genetic condition increasing the risk of SCC
xeroderma pigmentosum
virus increasing the risk of SCC
HPV
surgical management of SCC
excision:
- if <20mm diameter do 4mm margins
- if >20mm diameter do 6mm margins
- Mohs in high risk patients/cosmetically important sites
ABCDE symptoms of melanoma
- asymmetrical shape
- border irregularity
- colour irregularity
- diameter >6mm
- evolution of lesion
bleeding/itching
type of melanoma common on lower limbs
superficial spreading
type of melanoma common on the trunk
nodular
type of melanoma common on the face
lentigo maligna
type of melanoma common on the palms, soles and nail beds
acral lentiginous (no clear relation with UV exposure)
when to refer in melanoma
weighted checklist - score of 3+
MAJOR (2 points each)
- change in size
- irregular shape
- irregular colour
MINOR (1 point each)
- largest diameter 7mm+
- inflammation
- oozing
- change in sensation
when to do sentinel node biopsy for melanoma
if Breslow thickness >1mm
most common type of leg ulcer and most common cause
venous (80%)
- most due to venous hypertension, secondary to chronic venous insufficiency
signs of venous insufficiency
leg pain heavy legs aching itching oedema brown pigmentation lipodermatosclerosis eczema haemosiderin deposition
which type of leg ulcer is painful
arterial - particularly at night, relieved by dangling legs out of bed, may be areas of gangrene
features of chronic ischaemia incl low ABPI measurements
investigations for venous leg ulcers
doppler USS to look for reflux
duplex USS to look at anatomy/flow of vein
investigations for arterial leg ulcers
ABPI
<0.9 = likely PAD <0.8 = refer <0.5 = urgent referral >1.2 = stiff, calcified arteries
when to consider Marjolin’s ulcer
if in areas of scar tissue - malignant
management of venous leg ulcers
- 4 layer compression banding after exclusion of arterial disease
- if >10cm or fail to heal after 12 weeks - might need skin graft
- debridement and cleaning
management of arterial leg ulcers
- lifestyle
- platelets
- revascularisation if critical limb ischaemia
how can keloid scars be treated
intralesional steroids/excision
most commonly affects sternum, shoulder, earlobe and cheek
what can spider telangiectasia indicate
oestrogen
pregnancy
liver disease
what is Kaposi’s sarcoma
connective tissue cancer due to HHV 8 and immunosuppression e.g. HIV
treat with radiotherapy and resection
how can Kaposi’s sarcoma affect GI/respiratory tract
haemoptysis and pleural effusion
what does a herald patch indicate
pityriasis rosea
treatment of pityriasis rosea
emollients, steroids, antihistamines
but usually clears without treatment in 3 months
management of acute angle closure glaucoma
- urgent referral
- acetalozamide 500mg IV over 10 mins (reduce aqueous secretions)
- topical pilocarpine (pupillary constriction)
- topical beta blockers, prednisolone
- surgery - peripheral iridotomy (both eyes)
what drugs can cause cataracts
long-term corticosteroids
complications following cataracts surgery
- posterior capsule opacification (thickening of lens capsule)
- retinal detachment
- posterior capsule rupture
- endophthalmitis (inflammation of aqueous/vitreous humour)
cause of dendritic corneal ulcers
herpes - use acyclovir
investigations for corneal ulcers
- fluorescein staining
- urgent diagnostic smear/gram stain and scrape
management of corneal ulcers
- refer immediately
- until cultures known, use chloramphenicol drops alternated with ofloxacin drops
- admit if diabetes/ immunosuppressed
usual cause of infection in a stye
staphylococcal infection in lash follicle - may also include glands of Moll and Zeis
when should gonococcal conjunctivitis be suspected
if within first 48 hours of live - purulent discharge, swelling of eyelids
treatment of gonococcal conjunctivitis
cephalosporin
notifiable
when does chlamydial conjunctivitis usually present
end of first week of life (7-10 days)
how is chlamydial conjunctivitis diagnosed
specific monoclonal antibody test - performed on conjunctival secretions
organisms causing bacterial conjunctivitis
h. influenzae
gram +ve cocci
organism causing viral conjunctivitis
adenovirus - preauricular lymph nodes
when is chloramphenicol immediately started for conjunctivitis
- sexual disease suspected
- contact lens wearers
- immunocompromised
1st and 2nd line treatments for allergic conjunctivitis
1st line = topical/systemic antihistamines
2nd line = topical mast-cell stabilisers
mild non-proliferative diabetic retinopathy
1 or more micro aneurysm
moderate non-proliferative diabetic retinopathy
- micro aneurysms
- blot haemorrhages
- hard exudates
- cotton wool spots, venous beading/looping and mild intraretinal microvascular abnormalities
severe NPDR
- blot haemorrhages and micro aneurysms in 4 quadrants
- venous beading in at least 2 quadrants
- IRMA in at least 1 quadrant
type of diabetes more likely to cause proliferative retinopathy
T1DM - 50% blind in 5 years
type of diabetes more likely to cause maculopathy
T2DM
stages 1-4 of hypertensive retinopathy
1 = arteriolar narrowing and tortuosity, increased light reflex (silver wiring)
2 = arteriovenous nipping
3 = cotton wool exudates, flame and blot haemorrhages
4 = papilloedema
conditions associated with acute anterior uveitis
Crohn’s/UC
ankylosing spondylitis
sarcoidosis
Bechet’s disease
management of acute anterior uveitis
- cycloplegics to dilate pupil
- steroid eye drops
what can be done to distinguish between episcleritis and scleritis
phenylephrine drops
phenylephrine blanches conjunctival and episcleral but not scleral - if redness improves after phenylephrine = is episcleritis
treatment of scleritis (PAINFUL unlike episcleritis)
- necrotising = eye surgery
- less severe = NSAIDs, corticosteroids, antibiotics
at what age should a squint be investigated
any squint beyond 12 weeks
