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derm Flashcards

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1
Q

What is eczema herpeticum and how is it managed?

A

Monomorphic punched-out erosions (circular, depressed, ulcerated lesions)
HSV 1/2
Commonly affect people with eczema
IV aciclovir

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2
Q

Diagnosis?
shiny, painless areas of yellow/red skin typically on the shin of diabetics
often associated with telangiectasia

Management?

A

Necrobiosis lipoidica diabeticorum
Associated with T1/T2DM

Management:
Steroids
Topical tacrolimus
Photochemotherapy

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3
Q

Most common causeses of erythema nodusum?

A

Pregnancy
IBD
Strepinfection
Sulphonamides
Sarcoid
OCP
Penicillins

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4
Q

Where is erythema nodosum usually found?
Painless or not?

A

Shins

Get symmetrical, red, tender nodules

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5
Q

What does pretibial myxoedema look like?

A

Shiny, symmetrical, orange peel

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6
Q

Management of venous ulcers

A

Compression bandaging.
Need APBI first

Oral pentoxifylline, a peripheral vasodilator, improves healing rate

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7
Q

ABPI interpretation

A

An ABPI ratio of:
Less than 0.5 = severe arterial disease. Compression c/I.
Refer vascular urgently

> 0.5 to less than 0.8 = arterial disease or mixed arterial/venous disease.
Compression should generally be avoided. Refer vascular.

Between 0.8 and 1.3 = no evidence of significant arterial disease.
Compression ok.
> 0.8 is your m8

Greater than 1.3 may suggest the presence of arterial calcification

For values above 1.5, the vessels are likely to be incompressible, and the result cannot be relied on to guide clinical decisions.
Referral to a vascular may be required to determine the person’s suitability for compression therapy.

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8
Q

Rosacea management

A

High factor suncream & camouflage creams.

If predominant flushing:
20-40mg propranolol BD/TDS

If predominant erythema:
Topical brimonidine gel (topical alpha-adrenergic agonist) PRN.
Reduces redness within 30 mins and lasts 3-6 hours.

The next options are 8-12 week trials.
If mild - mod papules/pustules:
-Topical ivermectin is first-line
alternatives: topical metronidazole/azelaic acid - these are ok in pregnancy

Mod-severe papules/pustules:
-Combination of topical ivermectin + oral doxycycline 40mg MR
** dose is different to acne.

laser therapy under specialist if not improving, prominent telangiectasia/
rhinophyma

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9
Q

Difference between Pemphigoid gestationis and polymorphic eruption of pregnancy

A

Pemphigoid gestationis:
Itchy, blistering, usually starts periumbilical and often involves palms and soles. Usually need oral steroids.

Polymorphic eruption of pregnancy - intensely itchy. Last trimester. Affects abdo and thighs. Emollients, topical steroids

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10
Q

What is mild, moderate and severe acne?

A

Mild: predominantly non-inflamed lesions (open and closed comedones) with few inflammatory lesions.

Moderate: more widespread with an increased number of inflammatory papules and pustules.

Severe: widespread inflammatory papules, pustules and nodules or cysts. Scarring may be present.

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11
Q

How to manage mild - mod acne?

A

12-week course. Options:
AB
BC
CI

Topical adapalene (retinoid) + topical benzoyl peroxide

Topical benzoyl peroxide + topical clindamycin

Topical topical clindamycin
isotretinoin +

Topical BPO can be used as monotherapy if c/is.

creams if dry/ sensitive skin

gel if greasy skin

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12
Q

How to manage mod-severe acne

A

A
AB
CI

Adapalene + BPO ON +/- doxy 100 or lymecycline 408

Topical clinda + Isotretinoin ON

Topical azaelic acid BD and PO abx

Topical and oral antibiotics should not be used in combination.

Trimethoprim/ erythromycin can be used if tetracyclines no good

If women don’t want PO abx could consider COCP in women instead of abx.

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13
Q

How long can someone be on abx for acne?

A

Only continue a treatment option that includes an antibiotic (topical or oral) for more than 6 months in exceptional circumstances.

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14
Q

Lichen Planus features + management

A

PLANUS = PURPLE
Wickhams striae (white lines on top).

itchy, papular rash
palms, soles, genitalia and flexor surfaces of arms

Koebner phenomenon may be seen (new skin lesions appearing at the site of trauma)

oral involvement in around 50% of patients: typically a white-lace pattern on the buccal mucosa

Management: topical steroids. If bad might need PO steroids/ UV tx/ DMARDS

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15
Q

What acne treatments are c/I in pregnancy/ those wanting to start a family and breastfeeding?

A

Topical retinoids and oral tetracyclines

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16
Q

What acne treatment would you use for someone who has mild/ mod acne and is pregnant/breastfeeding?

A

Topical BPO and topical clindamycin.

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17
Q

Psoriasis management

A
  1. Potent steroid and vit D analogue OD. Up to 4 weeks.
  2. If no improvement after 8 wks, Vit D analogue twice a day
  3. If no improvement after 8-12 weeks then potent corticosteroid BD for up to 4 weeks, or a coal tar preparation applied once or twice daily
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18
Q

First line for scalp psoriasis

A

Potent topical steroids 2 weeks

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19
Q

How to differentiate between pemphigoid and pemphigus

A

No mucosal involvement in pemphigoid

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20
Q

How to manage impetigo

A

topical hydrogen peroxide 1% now 1st line

Topical fuscidic acid next, or topical mupirocin if MRSA/ fuscidic resistance

If bad then oral fluclox/erythromycin

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21
Q

Is necrobiosis lipodica painless or painful

A

Painless

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22
Q

Is erythema nodosum painless or painful

A
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23
Q

Seborrhoeic dermatitis
What is this?
management ?
Associated conditions?

A

Erythematous areas around sebum rich shin. Caused by fungus.

ketoconazole 2% shampoo

Associated with blepharitis and otitis externa.
Also HIV and Parkinsons

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24
Q

‘volcano’ like spot on her left arm

Dx?
Mx?

A

Keratocanthoma
Urgent term ref. If it is this, its benign but difficult to exclude SCC

Spontaneous regression within 3 months is common

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25
pityriasis versicolor management
Ketaconazole shampoo
26
What is tinea corporis
Ringworm
27
How is tinea capitis treated? Complications if not treated?
Oral anti fungal e.g. terbinafine and ketoconazole shampoo for 2 wks. raised, pustular, spongy/boggy mass called a kerion may form
28
What does dermatitis herpetiformis look like and what is it associated with? What is it caused by? Management?
Intensely itchy bumps and blisters in a rash like form Associated with coeliacs. Caused by deposition of IgA in the dermis Dapsone, GF diet
29
When would you use a skin patch test over a skin prick test
If irritant suspected. Patch test can test for this e.g. nickel but skin prick test can't
30
Erythema multiforme characteristic appearance?
Target lesions
31
What is erythema multiforme major usually triggered by? Steven johnson triggers?
EMM usually viral infection triggered e.g. Herpes SJS usually drug reaction
32
Name of a stress ulcer that can occur after burns
Curlings ulcer
33
1st line treatment for hyper hydrosis
Topical aluminium chloride Can use glycopyrronium later on in itonophoresis tx -specialist)
34
How to differentiate spider naevi from telangiectasia
Spider naevi fill from the centre, telangiectasia from the edge
35
What is anagen effluvium How is it different to telogen effluvium
Anagen - where you get hair loss 2-3 weeks after precipitant Telogen - 2-3 months after Lots of the hair is lost
36
Is alopecia areata well circumscribed?
Yes
37
What is androgenetic alopecia AKA
male pattern baldness
38
What is trichotillamania?
Psych condition where people pull hair out Where you get multiple broken hairs at different lengths and eyebrows missing.
39
Scalp ringworm infection
Griseofulvin and ketoconazole shampoo. Topical alone no good.
40
Features of pityriasis rosea
Herald patch Management supportive (THIS IS CAUSED BY HERPES VIRUSES)
41
Cyst in a child in outer eyebrow
Dermoid (teratoma).
42
When would you start shingles treatment
If within 72h of rash onset and pt over 50 If immunocompromised If non-truncal or eye involvement.
43
Difference between erysipelas and cellulitis
Borders well demarcated in erysipelas
44
Most common organism in chronic otitis media
pseudomonas
45
Difference between Boil and carbuncle Which should be referred for same day incision
A boil (AKA furuncle) - infection of hair follicle where there is purulent extension into the subcutaneous tissue, in which a small abscess forms. It is a deep-seated inflammatory nodule. A carbuncle occurs when several adjacent boils join beneath the skin. It is an inflammatory mass that drains pus through many follicular orifices. Same day incision: Big boils All carbuncles.
46
What is Panton-Valentine leukocidin S. aureus (PVL SA) associated with
Rare. Associated with recurrent boils and carbuncles, and serious complications including necrotizing pneumonia, necrotizing fasciitis, osteomyelitis, septic arthritis, and purpura fulminans
47
When would you swab a boil/carbuncle
If its not getting better If recurrent Multiple lesions DM/immunocomp/Is known to be colonized with MRSA/ lives somewhere with recurrent skin infection outbreaks
48
Boil/ carbuncle management in primary care
Heat compress Abx if: - Has a fever/ Cellulitis - The lesion is on the face. - Pain or severe discomfort. -There are other comorbidities (such as diabetes or immunosuppression). Flucloxacillin first line Erythromycin preferred in pregnancy and breastfeeding Clarithromycin if pen allergic
49
How to manage hidradenitis
Px antibacterial wash e.g. octenasin/hibscrub Abx for acute flare - usually fluclox/clari for 10-14d Chronic - 3m antibiotics. If not improving or severe then refer. Might consider biologics. ** Its associated with psoriatic arthropathy - joint exam is recommended annually
50
How does pityriasis versicolor differ from pityriasis rosea
Rosea = VIRUS (herpes) - get herald patch Versiclor - caused by FUNGUS
51
what is conglobate acne
rare and severe form of acne Mostly men – extensive inflammatory papules, suppurative nodules (which may coalesce to form sinuses) and cysts on the trunk and upper limbs.
52
What is acne fulminans
Acne fulminans is a sudden severe inflammatory reaction that precipitates deep ulcerations and erosions, sometimes with systemic effects (such as fever, arthralgia and myalgia).
53
What acne treatments are contraindicated in pregnancy
retinoids (adapalene) and oral tetracyclines
54
Self care advice for acne
Avoid over-cleaning the skin Use a non-alkaline (skin pH neutral or slightly acidic) synthetic detergent cleansing product twice daily on acne-prone skin. Avoid oil-based skin care products, make-up and sunscreens Wash off make-up at the end of the day. Treatments may irritate the skin, especially at the start of treatment. To reduce the risk start with alternate-day or short-contact application (for example washing off after an hour).
55
What acne treatments wouldn't you use on their own
topical abx oral abx topical + oral abx.
56
What would you refer to derm to be seen in same day
Acne fulminans
57
What would you refer to derm
Acne conglobata Nodulo cystic acne If mod-severe and tried 1 round tx inc PO abx If mild - mod and tried 2 rounds tx If scarring/ pigment chnages/ psychological distress.
58
How to follow up acne
Review at 12 weeks If cleared stop PO abx but continue topical tx. If partial improvement continue PO abx for further 3m. Total abx max 6m. Can consider continuing BPO/ Azelaeic acid/ adapalene mono therapy and rv every 12 weeks.
59
What drug class is adapalene
Topical retinoid THEREFORE c/I IN PREGNANCY!
60
Can co-cyprindiol (Dianette) be used in acne tx
Yes but short term only. It shouldn't be used for contraception because high risk of VTE. Should be discontinued 3-4 cycles after acne has cleared
61
When would you refer someone with rosacea to derm
any hint of rinophymea. If not responding to treatment
62
What skin condition might predispose to vulval cancer
Lichen sclerosus
63
What is lichen sclerosus
Usually affects older females. Vulval white patches ITCH is predominant Increased risk of vulval cancer
64
What is BXO Treatment? Complications?
Balanitis xerotica obliterans Male equivalent of lichen sclerosus. High potency topical steroids and circumcision May get strictures that might need surgery Small risk of malignant transformation with this
65
What is lichen simplex? Management?
Thickened skin. As a result of contact scratching. Very itchy Steroids and antihistamines
66
What is staph scalded skin and who does it usually affect
Usually affects under 5s. Painful and blistering skin condition caused by the toxins from s aureus. Tx = IV abx. Need to consider insensible losses in kids so might end up in ICU and needing ivi
67
SJS features
The rash is typically PAINFUL maculopapular with target lesions may develop into vesicles or bullae Nikolsky sign is positive in erythematous areas - blisters and erosions appear when the skin is rubbed gently Might get fever and arthralgia Supportive management
68
TEN features
Blistering rash PAINFUL positive Nikolsky's sign IVIG/ immunosuppressants
69
Differences between SJS and TEN
SJS affects less than 10% BSA TEN Affects >30% TEN has higher mortality Rash is painful - this might help you differentiate SJS//TEN from another skin condition
70
What is erythroderma
when 95% of the skin is involved in a rash
71
What are compression stockings used for
to prevent and treat venous ulcers.
72
What skin issues might someone with venous circulation issues in the legs get
Venous ulcers lipodermatosclerosis Venous eczema
73
How to manage lipodermatosclerosis
compression is key (as long as ABPI >0.8)
74
What distribution does venous eczema commonly affect
Gaiter area
75
Where does eczema present in adults and children
Adults can be flexures Infants - Face/scalp/ extensor surfaces. Nappy area usually spared
76
What is keratosis pilaris
Little red raised bumps - commonly get on back of arms. Can get in eczema and other things.
77
Eczema categories
Mild - areas of dry skin, INFREQUENT itching (+/- small areas of redness) Moderate - areas of dry skin, FREQUENT itching, and redness +/- excoriation and localized skin thickening. Severe - WIDESPREAD areas of dry skin, incessant itching, and redness +/- excoriation, extensive skin thickening, bleeding, oozing, cracking, and alteration of pigmentation.
78
How long does NICE say to continue steroids in an eczema flare
for 48h after its cleared up
79
What dose of hydrocortisone for face
Usually 1%
80
What is erythema toxicum neonatorum
NOT TOXIC. Little rash babies get. Presents in first 2-5d of life. Don't do anything about it and it clears
81
What is tinea unguium What causes it Investigation Management
AKA onychomycosis. Fungal toenail infection Caused by trichophyton rubrum (90%) Candida (10%) Nail clipping/ scrapings BEFORE anti fungal Management If no sx and not bothered no need to treat if limited and superficial involvement - topical amorolfine 5% nail lacquer. 6 months for fingernails and 9 - 12 months for toenails if more extensive involvement due to a DERMATOPHYTE infection: PO terbinafine - 6 weeks for fingernail infections, toes 12-24 weeks If Due to CANDIDA infection: oral itraconazole is recommended first-line
82
Causes of bullous/ non bullous impetigo
Non bullous - s aureus or s pyogenes Bullouse - s aureus
83
What is ecthyma
a deep form of impetigo causing deeper skin erosions into the dermis
84
Impetigo management
Non bullous: 1st line: HPO 2nd: Fuscidic acid- If widespread go straight for this If resistance to fuscidic acid mupirocin Skin swab if recurrent Bullous impetigo: PO fluclox Clari if pen allergic Erythromycin if pregnant
85
What is yellow nail syndrome
Slow growing yellow nail + resp issues + lymphoedema
86
What is erythema multiforme and what causes it How is it different to erythema multiform major?
Target lesions. Starts on hands then goes to torso. Caused by loads of things including TB, cancer, other infections, lupus, sarcoidosis Erythema multiforme major = mouth involvement
87
how to treat tinea capitis
oral anti fungal - griseofulvin or terbinafine can consider topical in addition to stop it spreading to contacts, Contacts should have skin/ hair sampling
88
When to treat shingles and what with
Within 72h of onset of rash If under 50 and mild sx with no RF no need to treat Antivirals.
89
what might trigger guttate psoriasis
strep infection/URTI
90
What is Koebner phenomenon and what does it exist in
Psoriasis - new lesions at the site of trauma
91
What is Auspitz sign
observation of pinpoint bleeding when adherent psoriatic scales are scraped away.
92
What is the most severe subtype of psoriasis? What is the possible life threatening subtype?
Pustular. Can be generalised or palms or soles. Will be associated with systemic upset too. Erythrodermic psoriasis can be life threatening - Affects > 90% body
93
What to do if you suspect erythrodermic or pustular psoriasis
If Erythrodermic and pustular and widespread --> Same day admission If Pustular and localised --> refer derm and ask what to do whilst waiting to be seen
94
How to manage trunk/ axial limb chronic plaque psoriasis
Emollient Potent topical steroid plus a topical vitamin D preparation (both applied once a day, but at different times of day). * don't usually use very potent in primary care * Potent steroids can be used for max 8 weeks Review within 4 weeks. If not helped either continue for another 4 weeks or stop steroid and do topical Vit D BD mono therapy for 12 weeks. If still not getting anywhere try coal tar OD/BD If tx resistant try dithranol and refer derm.
95
In the context of psoriasis, when would you used cream/ lotion/ gel/ ointment
Creams, lotions, or gels are suitable for widespread psoriasis. Ointments are suitable for areas of skin with thick scale. Lotions, solutions, or gels are suitable for hair-bearing areas.
96
If a patient has psoriasis should you assess cardio risk?
Yes every 5 years
97
How long can potent steroids be used in psoriasis
Max 8 weeks (review after 4). Can have a 4 week break then restart if needed.
98
When would you refer to derm for psoriasis
>10% BSA Emotionally impacting Tx resistant Moderately severe on Physician's Global Assessment
99
What to do if you suspect psoriatic arthritis
Urgent rheum referral
100
What might derm do if you refer a pt for psoriasis
topical calcineurin inhibitors (tacrolimus) Phototherapy Systemic tx e.g. methotrexate, ciclosporin, acitretin (usually if phototherapy hasn't worked) Biologics (mabs/ etanercept)
101
How to manage scalp psoriasis
potent steroid Potent steroid and vitamin D analogue Vit D analogue alone BD Coal tar shampoo but shouldn't be used alone for scalp
102
How to manage face/ flexural/ genital psoriasis
Just use steroids Mild or moderately potent steroids and only for 2 weeks. Would then need a treatment break for a month before using again
103
When would you refer guttate psoriasis
if > 10% BSA ref urgently for consideration of phototherapy
104
How to treat nail psoriasis
refer derm
105
Which psych medication might worsen psoriasis
Lithium
106
Which cardio medication might worsen psoriasis
beta blockers, NSAIDs, ACEi
107
How to manage mild eczema Moderate? Severe?
Mild eczema - mild steroid Moderate eczema - moderate steroid (unless on face then use mild and aim for 5d tx only). For prevention consider maintenance steroids or topical calcinurin inhibitor (latter is specialist) Severe - px potent steroid (not if u12) unless face/flexures then can go moderate - aim for max 5d on these areas Can consider PO pred esp if psychological distress.
108
In the context of eczema what would you refer urgently to be seen in 2weeks
sever eczema that hasn't responded to tx within a week.
109
1st line for eczema with added infection
fluclox. Clari if allergic
110
What is a common later complication of psoriasis
metabolic syndrome
111
What scoring system for hirsutism How is hirsutism managed
Ferriman-Gallwey scoring system consider using COCP- such as co-cyprindiol (Dianette) or ethinylestradiol and drospirenone (Yasmin). **Co-cyprindiol should not be used long-term due to the increased risk of venous thromboembolism facial hirsutism: topical eflornithine - contraindicated in pregnancy and breast-feeding
112
How are keloids managed
Refer for consideration of intra-lesional steroids e.g. triamcinolone
113
What is Telogen Effluvium and how is this different to alopecia areata
Alopecia areata = AA = Autoimmune and Areas Telogen effluvium = generalised and usually triggered by something Anlagen = usually due to insult like chemo
114
How is alopecia areata managed
Consider potent/ v potent steroids Refer derm for biologics.
115
Difference between Lentigo maligna and solar lentigo
Ones benign the other isnt.
116
How to tell between Bowens and AK
Bowens = well demarcated and red. AK usually Ill defined and and sand paper texture
117
how to treat perioral dermatitis
Steroids might worsen Need abx topical or oral e.g. doxy
118
What drug can you use on venous ulcers
Oral pentoxyphilline (peripheral vasodilator)
119
What is Leser- Trelat sign
Eruption of multiple seb Ks. Can be paraneoplastic syndrome and commonly associated with GI ca
120
What is a recurrent rash in the same site likely to be
Herpes simplex NOT shingles
121
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