Week 3: Dermatology management and examples Flashcards
describing lesions
non-pigment: SCAM
- size/shape
- colour
- associated secodnary change
- morphology/margin
pigmented: ABCDE
management of atopic eczema
- Avoid exacerbating agents
- Topical therapies
- Steroids for flare-ups
- Topical immunomodulators (e.g. tacrolimus,) can be used a steroid sparing agent
- Oral therapies- antihistamines for symptomatic relief
- Flucloxacillin for bacterial infections
- Antivirals for herpes
- Phototherapy and immunosuppressants (oral prednisolone, azathioprine)
management of acne vulgaris
- General measures (change food), treatment needs to be changed for at least 6 weeks
- Topical therapies (mild acne)
- Benzoyl peroxide
- Topical antibiotics
- Topical retinoid)
- Oral therapies (mod to sev)
- Oral antibiotics e.g. doxy
- Anti-androgens in women
- Severe acne- oral retinoid
management of psoriasis
- General measures: avoid precipitating factors
- Topical therapies (localised/mild)
- Vitamin D analogues
- Topical corticosteroids
- Coal tar preparations, dithranol, topical retinoids, keratolytic and scalp presentations
- Phototherapy (extensive disease) i.e. UVB and photochemotherapy I,e, psoralen+UVA
- Oral therapies (for extensive and severe psoriasis or psoriasis with systemic involvement
- Methotrexate
- Retinoids
- Ciclosporin
- Mycophenolate mofetil
- Fumaric acid esters
- Biological agents (e.g. infliximab)
management of emergency dermatology
- Antihistamines for urticaria
- Corticosteroids for severe acute urticaria and angioedema
- Adrenaline, corticosteroids and antihistamines for anaphylaxis
- Urticaria is normally uncomplicated
management of cellulitis
flucloxacillin, supportive care
management of necrotising fascitis
IV abx and surgical debridement
management of superficial fungal infection
- Treat underlying factors e.g. underlying immunosuppressive conditions
- Topical antifungal (terbinafine cream)
- Oral antifungal (e.g. itraconazole) for severe, widespread or nail infection
- Avoid topical steroids
management of basal cell carcinoma
- Surgical excision- allows histological examination and margins
- Mohs micrographic surgery for high risk, recurrent tumours
- Radiotherapy when surgery not appropriate
- Other e.g. cryotherapy, curettage and cautery and topical treatment (imiquimod) when small and low-risk lesion
management of squamous cell carcinoma
- Surgical excision
- Mohs micrographic surgery
- Radiotherapy for large, non-respectable tumours
management of malignant melanoma
- Surgical excision
- Radiotherapy
- Chemotherapy for metastatic disease
emollient indication
- to rehydrate skin and re-establish surface lipid layer
- useful for dry, scaling conditions .e.g eczema and psoriasis
name some steroids in order of their potentcy
mildy potent -→ very potent
Topical
- hydrocortisone
- clobetasone butyrate
- betamethasone valerate (betnovate)
- clobestasol proprionate (dermovate)
Oral
- prednisolone
steroid indication
anti-inflammatory and proliferative
- useful for allergic and immune reactions, inflammatory skin conditions, vasculitis
oral acyclovir indication
herpes simples and herpes zoster virus
oral antihistamiens can be classified into
non-sedative- cetirizine and loratadine
sedative- chlorpheniramine and hydroxyzine
indication of antihistamines
block histamine receptors producing an anti-pruritic effect
- type 1 hypersensitivity reactions and eczema
- can have anticholinergic effect e.g. dry mouth, blurred vision, urinary retention and constipation*
name some topical antibiotics
fusidic acid
mupirocin
neomycin
name some oral antibiotics for skin infecttions
penicillin e.g. fluclox, cephalosporins, gentamicin, macrolide, nitrofurantoin, tetracyclines, vancomycin, metronidazole, quinolone, trimethoprim
indication of antibiotics
useful for skin infections and acne
name an oral retinoid
isotretinoin -Roaccutane
indication for oral retinoids
acne, psoriasis, disorders of keratinisation
topical antiseptics for prevention of skin infection
chlorhexidine
diagnose
contact dermatitis
- Bilateral erythematous scaly patches situated on the hips
- Borders are poorly defined
- Itchy
- Caused by copper studs allergic contact dermatitis
diagnose
- Inflammatory reaction to a scratch
- Bilateral, diffuse erythematous papules (some individual nad some in a linear pattern)
- Small plaques over flexor surface of forearm
- Smooth and shiny surface
- Very itchy
diagnose
- Multiple individual and coalescing erythematous plaques with targetoid appearance
diagnose
- Multiple individual and coalescing erythematous plaques with targetoid appearance
- Examine joints- psoriatic arthiritis
describe
- Multiple vesicles and pustules
- cold sore
describe
- Bullae and erosions
diagnose
erythema nodosum
by tender, red bumps, usually found symmetrically on the shins.
causes
- infection
- disease
- drug
diagnose
Malignant melanoma
A not symmetrical
B irregular
C irregular
D >8mm
E
diagnose
- Multiple well demarcated patches of alopecia effecting the scalp
- Affected area shows normal skin without erythema or scales
diagnose
- Inflammation round the outer ring
- excoriations
Flat erythematous and annular
diagnose
contact dermatitis
- crusting and scaling of the hands
- emollient
diagnose
acne vulgaris
- raised lesion, closed comedones, white head
- doxy, rocatotane, UV
diagnose
Plaque psoriasis
- raised inflammatory erythematous patches on the extensors of the elbow with silvery scaling
diagnose
fungal skin infection
- well demarcated, inflammatory erythematous sore under the breast
diagnose
Cambell de morgan spot
- red and raised uniform border
diagnose
squamous cell carcinoma
- asymmetrical irregularly raised and no clear margins
- non-uniform colour
- light red nodule with rough surface
- can resemble warts
- grow slowly
- sometimes with central ulceration
diagnose
basal cell carcinoma
A shiny, skin-colored bump that’s translucent, meaning you can see a bit through the surface. The bump can look pearly white or pink on white skin. On brown and Black skin, the bump often looks brown or glossy black. Tiny blood vessels might be visible, though they may be difficult to see on brown and Black skin.
diagnose
ulcerated basal cell carcinoma
diagnose
acne vulgaris
- open comedones- black heads
diagnose
Eczema
- excoriations in flexor area
diagnose
allergic reaction to henna- inflammatory erythema
