Week 5/6 - Dermatology Flashcards
1
Q
Acne Vulgaris
What is it?
Presentation
Treatment (mild, moderate, severe)
Referral to Dermatology
A
- ) What is it? - chronic inflammatory skin condition
- blockage and inflammation of the pilosebaceous unit - ) Presentation - often the face, also back and chest
- mild: non-inflammatory lesions (comedones)
- moderate: inflammatory (papules, pustules, nodules) - ) Treatment - review each treatment after 8-12wks
- mild: topical retinoids or benzoyl peroxide
- moderate: add oral antibiotcs (lymecycline or doxy..) for max 3 months. COCP can be an alternative
- severe: refer to derm for treatment w/ isotretinoin - ) Referral to Dermatology
- severe, visible/risk of scarring or hyperpigmentation
- multiple treatments failed, psychological distress
2
Q
Acne Rosacea
Presentation Aetiology Diagnosis Ocular Rosacea Management
A
- ) Presentation - affects centrofacial regions
- cheeks, chin, nose, central forehead
- flushing is often the first symptom - ) Aetiology - genetic and environmental risk factors:
- ↑age, paler skin, UV radiation, heat or cold temp
- smoking, alcohol, spicy food, stress, exercise - ) Diagnosis - 1 diagnostic or 2 major features
- diagnostic: phymatous changes, persistent erythema
- major: flushing erythema, papules/pustules, eye symptoms (ocular rosacea), telangiectasia - ) Ocular Rosacea - additional eye symptoms
- discomfort, irritation, tearing, foreign body sensation
- dryness, itching, photophobia, or blurred vision
- conjunctivitis, blepharitis, keratitis, anterior uveitis
- refer to ophthalmology if serious eye complication - ) Management
- self-care: avoid triggers, skincare, sun protection, etc.
- persistent erythema: topical brimonidine gel
- mild-mod papules/pustules: 1° topical ivermectin, OR topical metronidazole or topical azelaic acid
- mod-severe papules/pustules: topical ivermectin + PO doxycycline
- telangiectasia: laser therapy +/- topical tacrolimus
3
Q
Skin Cancers
Basal Cell Carcinoma (BCC)
Squamous Cell Carcinoma (SCC)
Malignant Melanoma (MM)
Weighted 7-point Checklist for MM
A
- ) BCC - most common, locally invasive, rarely fatal
- slow growing plaque or nodule, skin-coloured - ) SCC - can metastasise but still unlikely to be fatal
- often due to UV from sunlight and tanning beds
- present as enlarging scaly or crusted lumps
- large variation, located in sun-exposed sights
- referral to 2WW cancer pathway
- differential: keratoacanthoma - ) MM - cancerous growth of melanocytes
- least common, 90% 5 year survival rate
- spreads via lymph nodes to: liver, lung, bone
- naevi (atypical moles) is a risk factor - ) Weighted 7-point Checklist for MM - major features score 2 points, minor features score 1 point
- major: enlarging, irregular shape, irregular colour
- minor: >7mm diameter, inflammation, oozing, change in sensation
- refer (2WW) if score of >3
4
Q
3 types of fungal infections
Candida Albicans
Malassezia
Dermatophytes
A
- ) Candida Albicans - yeast, commonly present as:
- nappy rash, vulvovginal rash, oral candidiasis, candida intertrigo (skin folds) - ) Malassezia - basidiomycetous yeasts, presents as:
- seborrhoeic dermatitis, steroid acne, malassezia folliculitis, pityriasis versicolor (vesicular rash) - ) Dermatophytes - fungi requiring keratin for growth
- aka ringowrm infections, can spread via contact
- tinea: capitis (scalp), barbae (hair), pedis (foot) cruris (groin), copora (everywhere else)
5
Q
Diagnosis and Management of Fungal Infections
Clinical Features Onychomycosis Self Care Topical Treatments Oral Treatments
A
- ) Clinical Features - used to make diagnosis
- scaly, itchy, slightly raised, erythematous
- annular patches with central clearing
- enlarge outwards, asymmetrical - ) Onychomycosis - nail infections
- caused by dermatophytes, yeasts or moulds
- clipping and scrapings are taken for M/C
- increased prevalence with ↑age - ) Self Care
- keep skin clean and wash daily, use own towel
- dry between toes and skin folds, can use hair dryer - ) Topical Treatments - used for 1-2 wks after rash has cleared, can reoccur so repeated treatment needed
- whitfield ointment (acidic ointment)
- antifungals: nystatin, clotrimazole, ketoconazole
- antifunfal shampoos for scalp conditions - ) Oral Treatments - used for hair, scalp, and nails
- candida: nystatin, amphotericin B
- dermatophyte: griseofulvin, terbinafine
- both: itraconazole, fluconazole
6
Q
Eczema
A
Vfvffv
7
Q
Psoriasis
A
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8
Q
Chicken Pox (varicella-zoster virus )
Pathophysiology
Clinical Features
Management
Complications
A
- ) Pathophysiology - primary infection with VZV
- incubation is 10-21 days, spread via respiratory route
- highly infectious: 4 days before the rash, until 5 days after the rash first appeared (vesicles dry/crusted over)
- can be caught from shingles (reactivation of the dormant virus in a dorsal root ganglion) - ) Clinical Features
- fever initially for 2 days before developing a rash
- rash: clusters of itchy erythematous vesicles starting on the torso and face then becoming widespread
- macular –> papular –> vesicular –> scabbed vesicles
- other sx: malaise, headache, nausea, myalgia - ) Management - self-limiting
- topical calamine lotion to bathe the lesions
- paracetamol for flu-like symptoms, avoid aspirin (Reye’s) and ibuprofen (↑risk of necrotising fasciitis)
- keep cool, adequate fluid intake, trim nails
- return to school only when vesicles are crusted over
- VZIG in immunocompromised and newborns with peripartum exposure, IV aciclovir if chickenpox develops - ) Complications
- necrotising fasciitis: secondary infection of blisters
- encephalitis, cerebellar ataxia, pneumonia, myocarditis,
9
Q
Fifth Disease
(aka slapped cheek syndrome, erythema infectiosum, Parvovirus 19)
Clinical Features
Management
Childhood Exanthems
A
- ) Clinical Features
- fever, headache, rhinorrhoea
- rash: erythema, maculopapular, on cheeks +/- trunk - ) Management - self limiting
- fluids, analgesia, rest
- minimise spread while symptomatic however, usually not infectious 1 day after the rash appears - ) Childhood Exanthems - viruses causing red rashes
- others: measles (1st), scarlet fever (2nd), rubella (3rd)
10
Q
Nappy Rash
Pathophysiology Clinical Features Differential Diagnosis Practical Advice Treatment
A
- ) Pathophysiology - irritant contact dermatitis in the nappy area caused by friction and contact with urinary ammonia and faeces in a dirty nappy
- very very common, most between 9-12mths of age
- the breakdown in skin and warm moist environment can lead to infection w/ candida or strep/staph - ) Clinical Features
- sore, red, inflamed skin in the nappy area, there may be a few red papules beside the affected areas of skin
- usually spares the skin creases and flexures
- may be distressed as it is uncomfortable and itchy
- severe/prolonged rash –> erosions and ulcerations
- candida infection: involves skin folds, scaly borders, circular patterns, satellite lesions, oral thrush
- seborrhoeic dermatitis: rash with falkes - ) Differential Diagnosis
- allergic contact dermatitis, atopic eczema, psoriasis
- if the rash persists or becomes moist w/ white or red pimples in skin folds, it may be an infection instead
- streptococcal or seborrhoeic dermatitis - ) Practical Advice - should resolve in 3 days
- use nappy with high absorbency e.g. disposable gel matrix nappies compared to non-disposable nappies
- clean and change nappy every 3-4hrs
- leave nappies off as long as possible to help dry skin
- apply barrier cream (e.g. Zinc and castor oil)
- avoid irritants such as soap or bubble baths - ) Treatment - if baby is in distress and rash is inflamed
- hydrocortisone 1% cream once a day for up to 7 days
- candida: topical imidazole, stop barrier creams
11
Q
Impetigo
Clinical Features
Causes and Risk Factors
Management
A
- ) Clinical Features - bacterial infection (S.aureus or S.pyogenes)
- thin-walled vesicles releasing exudate, usually around the mouth and nose
- bullous impetigo also contains bullae
- more common in children, very contagious esp in schools - ) Causes and Risk Factors
- poor nutrition, crowding, contact sports, diabetes
- breaks in skin: insect bites, scabies, eczema, herpes - ) Management
- non-bullous: topical hydrogen peroxide for 5 days for ‘people who are not systemically unwell or at a high risk of complications’
- bullous/severe: oral flucloxacillin for 5 days
- stay away from school/work until lesions are dry and crusted over or >48hrs after starting Abx
12
Q
Measles (First Disease)
Infection
Clinical Features
Management
Complications
A
- ) Infection - rubeola virus (first disease)
- incubation period is 10-12 days, highly contagious
- spreads via droplets from the mouth or nose
- infective 4 days before and 5 days after the rash - ) Clinical Features
- high fever, rhinitis (coryza), cough, red eyes (conjunctivitis), malaise
- koplik spots: white/grey spots in mucous membrane, appears before the rash
- rash: maculopapular, widespread, confluent
- rash begins behind the ears then spreads to trunk - ) Management
- self-limiting: takes around a week to resolve
- rest, hydration, simple analgesia
- notify local health protection team and PHE
- receive testing kits to confirm cases (oral sample)
- avoid school/work for >4days after the rash appears - ) Complications
- encephalitis –> subacute sclerosing panencephalitis
- transient hepatitis, otitis media, diarrhoea
- bronchopneumonia, croup
- stillbirth or miscarriage if during pregnancy
13
Q
Scarlet Fever (Second Disease)
Pathophysiology
Clinical Features
Management
Complications
A
- ) Pathophysiology - reaction to toxins produced by Group A haemolytic streptococci (usually S. pyogenes)
- peak incidence in children aged 4 (2-6 range)
- respiratory spread: inhaling, ingesting, direct contact
- incubation of 2-4 days - ) Clinical Features
- fever (lasting 24-48hrs), malaise, headache, N+V
- sore throat, strawberry tongue, cervical lymphadenopathy
- fine punctate coarse ‘sandpaper-like’ rash, starting on the torso and sparing the palms and soles
- flushed appearance with circumoral pallor
- desquamation occurs later in the course of the illness, particularly around the fingers and toes - ) Management
- a throat swab is taken for a definitive diagnosis but you treat with abx before waiting for the results
- oral penicillin V (azithromycin if allergic) for 10 days
- children can return to school 24hrs after starting abx
- scarlet fever is a notifiable disease - ) Complications
- otitis media: the most common complication
- rheumatic fever: often occurs 20 days after infection
- acute glomerulonephritis: 10 days after infection
- invasive complications (e.g. bacteraemia, meningitis, necrotizing fasciitis) are rare but life-threatening)
14
Q
Kawasaki Disease
Pathophysiology
Clinical Features
Investigations
Management
A
- ) Pathophysiology - rare, systemic, medium-sized vessel vasculitis with no clear cause or trigger
- affects children typically <5yrs, more common in boys and in Asian children (particularly Japanese)
2.) Clinical Features
- persistent high fever (>39ºC) for more than 5 days
- widespread erythematous maculopapular rash and desquamation (skin peeling) on the palms and soles
- other features: strawberry tongue, cracked lips
cervical lymphadenopathy, bilateral conjunctivitis
- children will be unhappy and unwell
- ) Investigations
- FBC: anaemia, leukocytosis and thrombocytosis
- raised inflammatory markers (particularly ESR)
- LFTs: hypoalbuminemia and elevated liver enzymes
- urinalysis: can show raised WBCs without infection
- ECHO: can demonstrate coronary artery pathology - ) Management
- high dose aspirin to reduce the risk of thrombosis
- IVIG to reduce risk of coronary artery aneurysms
- close follow up with echocardiograms to monitor for evidence of coronary artery aneurysm
15
Q
Hand, Foot, and Mouth Disease
Pathophysiology
Clinical Features
Management
A
- ) Pathophysiology - caused by the intestinal viruses most commonly coxsackie A16 and enterovirus 71
- incubation period is usually 3-5 days, very contagious and typically occurs in outbreaks at nursery - ) Clinical Features
- typically starts with viral URTI symptoms such as fever, tiredness, sore throat, dry cough
- mouth ulcers (can be painful) appear after 1-2 days
- blistering red vesicles then develop on the palms of the hands and soles of the feet and around the mouth - ) Management - self-limiting after 7-10 days
- general advice about hydration and analgesia
- avoid transmission: avoid sharing towels, bedding, wash hands and careful handling of dirty nappies
- reassurance no link to disease in cattle
- children do not need to be excluded from school
- complications (rare): dehydration, bacterial superinfection, encephalitis
