cards

Question 1

classification of acne

Answer 1

Mild: open and closed comedones +/- inflammatory lesions
Moderate: widespread non inflammatory lesions and numerous papules and pustules
Severe: extensive inflammatory lesions +/- nodules, pitting, scarring

Question 2

Mng of mild ot moderate acne

Answer 2

a 12-week course of topical combination therapy should be tried first-line:
a fixed combination of topical adapalene with topical benzoyl peroxide
a fixed combination of topical tretinoin with topical clindamycin
a fixed combination of topical benzoyl peroxide with topical clindamycin
topical benzoyl peroxide may be used as monotherapy if these options are contraindicated or the person wishes to avoid using a topical retinoid or an antibiotic

Question 3

mng of moderate to severe acne

Answer 3

a 12-week course of one of the following options:
a fixed combination of topical adapalene with topical benzoyl peroxide
a fixed combination of topical tretinoin with topical clindamycin
a fixed combination of topical adapalene with topical benzoyl peroxide + either oral lymecycline or oral doxycycline
a topical azelaic acid + either oral lymecycline or oral doxycycline
important points about oral antibiotic usage:
tetracyclines should be avoided in pregnant or breastfeeding women and in children younger than 12 years of age. Erythromycin may be used in pregnancy
minocycline is now considered less appropriate due to the possibility of irreversible pigmentation
only continue a treatment option that includes an antibiotic (topical or oral) for more than 6 months in exceptional circumstances
a topical retinoid (if not contraindicated) or benzoyl peroxide should always be co-prescribed with oral antibiotics to reduce the risk of antibiotic resistance developing. Topical and oral antibiotics should not be used in combination
Gram-negative folliculitis may occur as a complication of long-term antibiotic use - high-dose oral trimethoprim is effective if this occurs
combined oral contraceptives (COCP) are an alternative to oral antibiotics in women
as with antibiotics, they should be used in combination with topical agents
Dianette (co-cyprindiol) is sometimes used as it has anti-androgen properties. However, it has an increased risk of venous thromboembolism compared to other COCPs, therefore it should generally be used second-line, only be given for 3 months and women should be appropriately counselled about the risks
oral isotretinoin: only under specialist supervision
pregnancy is a contraindication to topical and oral retinoid treatment

Question 4

examples of type 1 HSN

Answer 4

Anaphylaxis
atopy

Question 5

Exmaples of t2 HSN

Answer 5

• Autoimmune haemolytic anaemia
• ITP
• Goodpasture’s syndrome
• Pernicious anaemia
• Acute haemolytic transfusion reactions
• Rheumatic fever
• Pemphigus vulgaris / bullous pemphigoid

Question 6

examples of type 3 HSN

Answer 6

• Serum sickness
• Systemic lupus erythematosus
• Post-streptococcal glomerulonephritis
• Hypersensitivity pneumonitis (especially acute phase)

Question 7

Examples of type 4 HSN

Answer 7

• Tuberculosis / tuberculin skin reaction
• Graft versus host disease
• Allergic contact dermatitis
• Scabies
• Extrinsic allergic alveolitis (especially chronic phase)
• Multiple sclerosis
• Guillain-Barre syndrome

Question 8

Features of keratoaacanthoma

Answer 8

Said to look like a volcano or crater
Initally a smooth, dome shaped papule. Rapdily grows to become a crater filled with keratin