W6: Acne & Rosacea, Acute & Emergency, Eczema, Psoriasis Flashcards
Describe the epidemiology, pathophysiology & common presentations of acneiform eruptions
(1) PAPULOPUSTURAL ACNE: inflamm.
*ACNE FULMINANS: sidden + eruption, systemic joints
=>isotretinoin+prednisolone
- NODULAR CYSTIC ACNE: pain++, large nodular
- COMEDOMAL ACNE
*ACNE KELOIDALIS NUCHAE: skinV-VI, 2º inflamm bacterial infection = chronic folliculitis
=> topical steroid + abx wash
Acne Vulgaris Management
TOPICAL:
=> benzoyl peroxide !bleaches
=> clindomycin, erythromycin (under 12)
=> Retinoids
combos: DUAC (BPO+clindamycin) TRECLIN (tretinoin + clindamicin) EPIDUO GEL (BPO + Adapalene) !DRY SKIN
systemic:
=> TETRACYCLINES; ERYTHROMYCIN; TRIMETHOPRIN
=> Anti-Androgens + Contraceptive pill
=> Isoretinoin (resistant only) !teratogenic
=> UVB
=> Dapsone
Acne Rosacea
ace of clubs, chronic, PSU inflamm, flushing, fair skin
Describe clinical features of acne vulgaris and rosacea
(1) ERYTHEMA-TELANGIECTATIC
PHYMATOUS: nose, M>F
=> ablative tx
PAPULO-PUSTULAR: rosacea+acne; nil comedomes
OCULAR
=> RETRONIDAZOLE
=> Azeleic Acid
=> Ivermectin
=> Brimonidine
Principles of Acute Skin Failure
Sepsis, hypo/hyper thermia, fluid loss d/t peripheral vasodilation
Acute (and chronic) urticaria
itching; oedema
ACUTE URTICARIA: viral, idiopathic, IgE-med.
(1) AuImm = systemic
=> antihistamine
=> oral steroid
CHRONIC URTICARIA
=> antihistamine
=> antileukotriene: tranexamic acid
=> Imm Mod: Omalizumab
Stevens-Johnson syndrome / toxic epidermal necrolysis spectrum
often 2º to drugs w/ delayed onset, imm suppr Hx, prodromal flu>rashdev
systemic symptoms, papules, haemorrhagic, epitheliual detachment
+oral involvement
+ocular involvement
> scarring, blindness, nail+hair loss, joints
=> steroids => nutrition =>Ig => anti-TNF => Abx
blistering eruption
PEMPHIGUS - superfiicial splitting, Ab atttack of desmosomes, NIKOLSKY+, younger,
=> imm supp.
PEMPHIGOID - elderly, basal epidermal junction
=> imm supp
Erythroderma
ERYTHEMA MULTIFORME: HJV, mycoplasma, hypersens as a result of infection
- target lesions
- self-resolve, distal->proximal dev.
UNSTABLE PSORIASIS: systemic, 90% of body red, ?strept throat, new drugs?
=>emolients
=> underlying trigger?
=> monitor fluids, nutrition, humidity
=>topical corticost.
Eczema with secondary infection (including eczema herpeticum)
ECZEMA HERPETICUM: children systemic = monomorphic blisters punched out erosions, pain++ nil itch
=> aciclovir
=> emolient
=>abx
+cellulitis/impetigo
Staphylococcal scalded skin syndrome
superficial peeling, macular rash, children + imm compr. adults,
- d/t toxin produ. stimulate response at flexural site
- biopsy, blood culture
=> IV Abx
Principles of managing dermatological emergencies
Treat underlying cause: drug? infection?
Monitor barrier: emollient? corticosteroids? humidity + temp? nutrients? hydration?
Describe the classification of dermatitis
inflamm nature @ flexurals; itchy skin condition in the last 12mos.
evinronmental vs FILAGGRIN GENE
ATOPIC DERM.
erythema, scale, papules, vesicles, leakage > fissuring+exudate !infection
CONTACT DERM.
- allergy: Type IV hypersens, delayed
- irritant
SEBORRHOEIC DERM.
-hair sites, self resolve
*malassezia yeast, scaly epidermis - dandruff
*sebaceous gland: red scaling | severe - HIV?
=> anti yeast
Internal Eczema
discoid: circular plaques, middle aged, trauma
vesicular: palm, sole itchy, acute
asteatotic: dry skin elderly, hot climate
venous
Topical and systemic management of atopic derm.
topical steroids, emolient, antihistamines, calcineurin inhib.
systemic:
- UV Tx
- imm suppr (azathiprine)
- biologics
Describe the clinical presentations of psoriasis including associated nail and joint involvement.
chronic imm-med = sharply demarcated plaques w/micaceous scale.
- widely disseminated papules + plaques
- ONYCHOLYSIS = splitting form nail bed + ptting and oil spots
- Koebner phenomenon (lesions @ trauma)
- Scalp
- Joint Psoriasis
Flexural/Inverse Psoriasis
Infective trigger, less scales
Palmo-Plantar Psoriasis
RF: smoking
Thick scaly plaque, inflamm bone.
Guttate Psoriasis
Younger. Infective trigger
Pink papules w/ fine scale. Self resolve or prog. to chronic.
Chronic Plaque Psoriasis
Symmetric. Scaly.Extensor surface. Spreads
Pustular Psoriasis
Pregnancy: taper steroids, hypocalcaemia, infection
Sterile pustules. Red tender.
Erythodermic Psoriasis
RED MAN SYNDROME: temp. dysreg. + oedema
=> fluid balance
=> thick ointment
Psoriasis Mgmt
(1) => emolients => vit D3 analogues => coal tar cream => topical steroid => salicylic acid
(2) => crude coal tar => UVB => Dithranol => Oral retinoids => Imm Suppr.
Non Melanoma Skin Ca
Basal: slow, local, rare mets.
- nodular: rolled edge
- superficial
- pigmented
- morphoeic BCC: scarred
Squamous Cell Carcinoma: ↑mets risk, faster, well-differentiated
- Keratocanthoma: hair follicle eruption
=>Excision +/-RT
+Follow up
=> MOH Sx (excise around border allows mapping)
=> VISMODEGIB: inhibits hedgehog pathway signalling = shrinks
Melanoma Skin Ca (RF and Red Flags)
RF: UV, genetic, burn, fair skin, familial melanoma
ABCDE 🚩multi-colour, 7mm+, evolved
Describe the characteristics of pre-malignant and malignant tumours
contained by epidermal border
MELANOMA IN-SITU: lentigo maligna
=>excision
actinic keratoses: progresses to epidermal SCC,
*scaly areas. chronic scabbing.
=>DICLOFENAC GEL
BOWENS DISEASE: irregular scaly erythemations. intraepiderma SCC.
=> Cyrotx.
=> curretage
=> Photo Rx
=> IMIQUIMOD: imm mod. stimulate cytokine.
Principles of treatment of patients with skin cancer
Melanoma
=> sx excision + surveillance
+ immunotherapy: BRAF MUT. TARGETTING.
Cutaneous Lymphoma: => topicals => PUVA (sens to UV) => UVB => RT => Interferon
Cutaneous Lymphoma
cut. t lymphoma: MYCOSIS FUNGOIDES commonest. LT plaque can dev into tumour and into mets.
* commonly 2º to breast, colon, lung*
SEZARY SYNDROME: red man.
=>extracorporeal photophoresis
Viral warts
hpv
=>induce imm response via cryotx. or wart paints
=> curettage (severe)
Epidermoid and pilar cysts
epidermoid/sebaceous - commonest
source of 2º infection d/t rupture
=>excision
=> Abx, steroid, drainage
Seborrhoeic keratoses
Leser–Trélat sign: GI adenocar. / paraneoplastic
warty growths, multiple, +/- cherry angiomas
=>cryotx.
=> curettage
Dermatofibroma
dimple sign, pale centre+pigmented rim.
- asympt.
- malignancy
Lipoma
common, asympt.
- angiolipoma
- liposarcoma
difficult to excise
Common vascular lesions
angioma: liver disease spider naevi cherry angio and venous lakes
pyogenic granuloma: rapid, bleeds, trauma sites
*hand and face, 5% pregnancy
=> currette
=>cautery
