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Rapid Reference - Dermatology > Trunk > Flashcards

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1
Q

What is psoriasis

A

A chronic, non-infectious inflammatory dermatosis characterised by well-demarcated erythematous plaques topped by silvery scales

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2
Q

What are some triggers of psoriasis

A 
Environmental factors 
Infection 
stress
trauma 
drugs (b blockers and lithium)
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3
Q

Where are the common sites for psoriasis to occur

A

Elbows, knees, trunk, scalp margin or sacrum

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4
Q

Describe the clinical features of psoriasis

A 
plaques 
2-severalcm diameter
red
covered by waxy white scales 
sometimes itch
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5
Q

What sort of nail involvement is seen in psoriasis

A

Thimble pitting
onycholysis
oily or salmon pink discolouration of the nail bed
subungual hyperkeratosis

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6
Q

What are the first line treatments for psoriasis

A

Topical therapy:

Vitamin D analogues (calcipotriol and tacalcitol)

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7
Q

What are the benefits of using Vitamin D topical analogues

A

They do not smell or stain,

easy to apply and do not have the risk of skin atrophy seen with topical steroids

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8
Q

What are some advantages of topical corticosteroids

A

clean
non-irritant
easy to use

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9
Q

What are topical steroids the treatment of choice for

A

face
genitalia
flexures
stubborn plaques on hands, feet and scalp

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10
Q

What are some moderately potent steroids

A

Clobetasone (eumovate)

betamethasone (Betnovate RD)

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11
Q

What is the name of a coal tar cream

A

Alphosyl

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12
Q

What are the disadvantages of coal tar

A

They are messy and smelly and patients don’t like them

Stain skin, hair, linen and clothes

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13
Q

When are keratolytics and scalp preparations used

A

thick plaques and scalp psoriasis

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14
Q

Give some examples of systemic therapies for psoriasis

A 
Ohototherapy 
Methotrexate 
Retinoids 
Ciclospororin 
Biologicals
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15
Q

How often and for how long is phototherapy used

A

3 times a week for a 6 week course

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16
Q

What are retinoids effective in

A

thinning hyperkeratotic plaques

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17
Q

What is a common side effect of retinoids

A

Cracked lips

Teratogenic

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18
Q

What are side effects of cyclosporin (Neoral)

A

Hypertension and nephrotoxicity

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19
Q

What are some examples of biologicals

A

efalizumab (Raptiva)

infliximab (Remicade)

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20
Q

How do biologics work in psoriasis

A

They block inflammatory receptors involved in psoriasis

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21
Q

What is pityriasis rose

A

An acute, self -limiting disorder often affecting adolescents and young adults

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22
Q

What is characteristic of pityriasis rose

A

Scaly oval papules and plaques mainly on the trunk

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23
Q

Why does pityriasis rosea occur

A

In response to a viral infection

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24
Q

What is the general eruption usually preceded by in Pityriasis rosea

A

a herald patch (2-5cm diameter)

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25
Describe the appearance of individual plaques in pityriasis rose
Oval, pink with a delicate peripheral collateral of scale
26
Where on the body is pityriasis rosea found
Usually parallel to the lines of the ribs, radiating away from the spine
27
How long does it take for the condition to clear
1-2 months
28
Is pityriasis rosea
Yes - mild to moderate (can give steroids)
29
What is tinea (pityriasis) versicolor
chronic fungal infection characterised by pigment changes
30
What is the causative organism in tinea (pityriasis) versicolor
Pityrosporum orbiculare (yeast)
31
Who is affected by tinea versicolor
young adults often in more tropical countries
32
What are the clinical features of tinea versicolor in an untanned white Caucasian
brown or pinkish oval or round superficially scaly patches
33
What are the clinical features of tinea versicolor in a tanned or racially pigmented skin
hypopigmentation
34
What is the treatment for tinea versicolor
TOpical application of clotrimazole (Canesten) or miconazole (daktarin) cream twwice daily
35
How common is recurrence of tinea versicolor
Very common
36
What is viral exanthema
An eruption associated with the general features of a viral illness
37
Who is viral exanthema most commonly seen in
children or adolescents
38
Describe the appearance of viral exanthema
erythematous macules and papules blotchy appearance
39
What are some associated general features of viral exanthema
Arthralgia malaise sore throat
40
What is viral exanthema sometimes confused with
a drug eruption
41
Describe the appearance of Measles
Kiplik's spots of white papules on the buccal muscosa | erythematous macules on the face, trunk and limbs
42
Describe the appearance of Rubella
discrete red merciless on face then trunk. Cervical lymphadenopathy
43
Describe the appearance of hand, foot and mouth disease
red edged vesicles appear on the hands and feet with mouth ulcers and mild fever. They fade in 7 days
44
What is the treatment for most viral exanthema
Emollient (E45) or a cooling agent (calamine lotion)
45
Describe the appearance of chickenpox
24 hour prodrome followed by crops of papulovesicles centred o the trunk that become crusted with lesions at different stages at the same time
46
All drug eruptions are allergic in origin. True or False
False
47
What is the commonest drug eruption
toxic erythema
48
How does toxic erythema present
morbilliform (measles like) urticarial resemble erythema multiforme sometimes fever followed by peeling of the skin
49
What are some drugs that commonly cause drug eruptions
Amoxicillin PPI carbamazepine
50
How long does it take for a rash from a drug eruption to clear
1-2 weeks after stopping the drug
51
What is the name of the drug eruption that appears with round red or purplish plaques that recur at the same site each time
Fixed drug eruption
52
What drugs are responsible for fixed drug eruption
NSAIDs phenolphthalein quinine
53
What is a serious and life-threatening drug eruption
Toxic epidermal necrolysis (TEN)
54
Describe the appearance of a TEN
red swollen separates as in a scald
55
What is the treatment for a drug eruption
Withdraw the drug | Simple emollients or topical steroids to help ease itch or scaling
56
What is meant by generalised pruritus
Itch with no primary rash
57
What are some blood disorders that can cause generalised pruritus
``` Polycythaemia or iron deficiency liver disease (cholestasis) ```
58
What are some other causes of generalised pruritus
Malignancy - Hodgins disease neurological disorders renal failure thyroid dysfunction
59
What is the treatment for generalised pruritus
Underlying disorder | Sedative antihistamines or antipruritic for symptomatic relief
60
What is pemphigoid
Autoimmune condition in which cicrulating IgG autoantibodies locate to an antigen at the derma-epidermal junction and induce inflammation that leads to sub epidermal bulla formation
61
Who is most commonly affected by pemphigoid
Elderly
62
Describe the appearance of pemphigoid
Tnese large blisters arise on red and normal-looking skin often of the limbs, trunk and flexures
63
What is the treatment for pemphigoid
Oral prednisolone (starting at 20-40mg/day and reducing to 10mg asap)
64
How should a patient presenting with blistering eruptions be managed
dermatological emergency - urgent referral
65
What is herpes zoster
an acute , self limiting, vesicular eruption that occurs in a dermatomal distribution and mostly afflicts the elderly
66
What causes shingles
A recrudescence of Varicella zoster virus which lis dormant in the dorsal root ganglion following childhood chickenpox
67
What are the clinical features of herpes zoster
pain, tenderness or paraesthesia often precede the onset of redness and vesicles in a dermatome by 3-5 days. Vesicles become pustular then crusts form, which fall off in 2-3 weeks leaving scars
68
What dermatomes are most commonly involved in shingles
Thoracic dermatomes | Trigeminal in elderly
69
What occurs in a third of over 60s with shingles
Post-herpetic neuralgia
70
What is the treatment for mild shingles
Rest analgesia calamine lotion (dry vesicles) topical antibiotic (Fucidin)
71
What is the treatment for severe shingles
Oral aciclovir or famciclovir for 7 days
72
What is the treatment for Post-herpetic neuralgia
Topical capsaicin routine analgesics amitriptyline
73
What is the clinical appearance of a candidate infection (thrush)
Adherent white plaques with a discharge
74
Who is napkin dermatitis seen in
children under 1 year
75
What causes napkin dermatitis
irritant eczema due to contact with urine and faeces, characterised by glazed erythema
76
What is characteristic of Lichen sclerosis
white patches on the vulva or penis
77
What is helpful in treating napkin dermatitis
disposable super-absorbent nappies to dry and keep the area dry
78
What is melanocytic naevi
Moles
79
What are melanocytic naevi composed of
naevus cells derived from melanocytes during embryonic development
80
Where are moles located
in the dermis or the demo-epidermal junction
81
What might provoke new naevi
sun exposure or pregnancy
82
What are some reasons for excising naevi
``` Concern about malignancy (increase in size or colour) Cosmetic reasons (usually on face or neck) Repeated inflammation (bacterial infection often in hairy facial naevi) Recurrent trauma (naevi on back catch on bra strap) ```
83
What is a seborrhoeic keratosis
Basal cell papilloma
84
Describe the clinical features of a seborrhoeic keratosis
usually pigmented, benign tumours comprising a proliferation of keratinocytes Round or oval Stuck on appearance Keratin plugs and well defined edges small papule at first, often lightly pigmented or yellow become darkly pigmented warty nodules 1-6cm in diameter
85
What is the treatment for seborrhoeic keratosis
Liquid nitrogen cryosurgery | thicker ones are usually best removed by curettage or shave bios
86
What is a skin tag
common pedunculate benign fibroepithelial polyp
87
Where are common sites of skin takes
neck axillae groin eyelids
88
In what populations are skin tags commonly seen
elderly middle aged obese
89
What is the treatment for skin tags
Removal by snipping the stalk with scissors or cutting through it with a hyfrecator cryosurgery
90
What is molluscum contagiosum
discrete pearly-pink umbilicate papule
91
What causes molluscum contagiosum
DNA poxvirus
92
What are the clinical features of molluscum contagiosum
Dome-shaped papulsed with a puncture Commonest on the trunk, face and neck if squeezed a cheesy material is expressed
93
How are molluscum contagiosum spread
contact - including sexual transmission or towels
94
What is the treatment for molluscs contagious
Not always necessary | Removal by expressing contents with forceps, curettage or cryosrugery
95
What might many mollusca be an indication of
underlying immunosuppression (HIV)

Rapid Reference - Dermatology (4 decks)

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