Clinical dermatology cases

Question 1

What are the key areas to consider in any skin condition?

Answer 1

Distribution
Morphology
Secondary features (e.g arthritis)

Question 2

Psoriasis often starts in childhood. T/F

Answer 2

False - psoriasis is largely a disease of adulthood

Question 3

Psoriasis is a chronic condition. T/F

Answer 3

True

Question 4

What are the causes of psoriasis?

Answer 4

Genetic, stress, infection, Koebner phenomenon

Question 5

What is the commonest form of psoriasis?

Answer 5

Chronic plaque psoriasis/psoriasis vulgaris

Question 6

What are the typical features of plaque psoriasis rash?

Answer 6

Symmetrical distribution
Scaly, erythematous plaques (+/- silvery scale)
Sharp borders

Question 7

Which sites does plaque psorasis commonly affect?

Answer 7

Extensors
Nails
Hands, feet
Trunk
Scalp
Sacrum

Question 8

List the types of psoriasis

Answer 8

Guttate
Palmoplantar pustulosis
Nail disease
Erythrodermic/widespread pustular

Question 9

What does guttate psoriasis look like?

Answer 9

Small, circular plaques

Question 10

What are the features of psoriatic nail disease?

Answer 10

Pitting, onycholysis, dystrophy, subungal hyperkeratosis

Question 11

How common is erythrodermic/widespread pustular psoriasis?

Answer 11

Uncommon

Question 12

What is the koebner phenomenon?

Answer 12

Psoriasis arising from an area of trauma

Question 13

What are the common treatments for psoriasis?

Answer 13

Vitamin D analogues
Coal tar
Topical steroids

Question 14

List some vitamin D analogues

Answer 14

Calcipotriol

Calcitriol

Question 15

What are the specialist treatments for psoriasis?

Answer 15

Narrowband UVB and PUVA
Retinoids
Immunosuppressants 
Fumaric acid ester
Immune modulators

Question 16

Alcohol can trigger psoriasis. T/F

Answer 16

True

Question 17

Obesity and psoriasis can be linked. T/F

Answer 17

True

Question 18

Guttate psoriasis often follows which respiratory infection?

Answer 18

Steptococcus

Question 19

What is acne vulgaris?

Answer 19

Chronic inflammatory disease of the pilosebaceous unit

Question 20

When does acne vulgaris present?

Answer 20

In adolescents (younger in females, older in makes)

Question 21

Is there a genetic component to acne vulgaris?

Answer 21

Yes

Question 22

What is the pathogenesis of acne vulgaris?

Answer 22

Pore occlusion –>
Colonisation of duct –>
Dermal inflammation –>
Increased sebum production

Question 23

What are the common sites of acne vulgaris?

Answer 23

Face, upper back and chest

Question 24

What is found in acne?

Answer 24

Comedones, pustules, papules, cysts

Question 25

What are the secondary features of acne?

Answer 25

Atrophic scars, ice-picking, hypertrophic

Question 26

How is acne graded?

Answer 26

Mild - scattered papules, pustules and comedones Moderate - numerous papules, pustules and mild scarring Severe - cysts, nodules, significant scarring

Question 27

How is acne treated locally?

Answer 27

Benzoyl peroxide Topical vitamin A/retinoids Topical antibiotics

Question 28

How is acne treated systemically?

Answer 28

``` Antibiotics Oral retinoids (isotrenitoin) ```

Question 29

What is a side effect of isotrenitoin?

Answer 29

Initial flare of acne

Question 30

What is a retinoid used in acne?

Answer 30

Adapalene

Question 31

Where is rosacea usually distributed?

Answer 31

Nose, chin, cheeks and forehead

Question 32

How does rosacea typically present?

Answer 32

Papules, pustules, erythema without comedones | Facial flushing

Question 33

What can exacerbated rosacea?

Answer 33

Temperature UV exposure Dietary (spicy food) Alcohol

Question 34

In which age group does rosacea typically present?

Answer 34

Middle aged

Question 35

What is rhinopyma?

Answer 35

Thickening of the sebaceous tissue of the nose

Question 36

How can you reduce the aggravating factors in rosacea?

Answer 36

Dietary avoidance Wear sunscreen Avoid topical steroids (make worse in long term)

Question 37

What is steroid rosacea?

Answer 37

Rosacea induced by potent topical steroids

Question 38

Which antibiotics may be prescribed in rosacea?

Answer 38

Topical metronidazole | Oral tetracycline

Question 39

When might isotretinoin be used in rosacea?

Answer 39

Low doses can be used in severe rosacea

Question 40

How can telangectasia be treated?

Answer 40

Vascular laser

Question 41

How can rhinopyma be treated?

Answer 41

Surgically | Laser shaving

Question 42

What is the memory aid to differentiate between bullous pemphigoid and pemphigus vulgaris?

Answer 42

Bullous pemphigoid - split is Deeper through DEJ | Pemphigus vulgaris - split is Superficial, Intra-epidermal

Question 43

In which age group does bullous pemphigoid typically present?

Answer 43

Elderly

Question 44

What is the typical distribution of bullous pemphigoid?

Answer 44

Localised to one area | Widespread on the trunk and proximal limbs

Question 45

What is the typical appearance of bullous pemphigoid blisters?

Answer 45

Large, tense bullae (normal or erythematous skin) --> bursts to leave erosions

Question 46

Does bullous pemphigoid scar?

Answer 46

No

Question 47

How may bullous pemphigoid first present?

Answer 47

Itchy, erythematous plaques/papules

Question 48

Is bullous pemphigoid Nikolsky negative or positive?

Answer 48

Negative

Question 49

Mucosal lesions are typical in bullous pemphigoid. T/F

Answer 49

False

Question 50

What is the typical distribution of pemphigus vulgaris?

Answer 50

Scalp, face, axillae and groin

Question 51

What is the typical appearance of pemphigus vulgaris?

Answer 51

Flaccid, thin roofed vesicles/bullae --> ruptures to leave raw areas

Question 52

Is infection risk increased in bullous pemphigoid or pemphigus vulgaris?

Answer 52

Pemphigus vulgaris

Question 53

Is pemphigus vulgaris Nikolsky negative or positive?

Answer 53

Positive

Question 54

Mucosal lesions are typical in pemphigus vulgaris. T/F

Answer 54

True

Question 55

Where are the mucosal blisters in pemphigus vulgaris found?

Answer 55

Eyes, genitals

Question 56

What is the prognosis for 1) pemphigoid and 2) pemphigus

Answer 56

If treated both conditions are chronic but self-limiting over a period of months-years. Untreated pemphigus has a high mortality rate due to the infection risk.

Question 57

What investigations are indicated in suspected cases of pemphigus and pemphigoid?

Answer 57

Skin biopsy with direct immunofluorescence | Indirect immunofluorescence

Question 58

How is pemphigus and pemphigoid treated?

Answer 58

Systemic steroids (mainstay) Immunosuppression (methotrexate, azathioprine) Tetracycline antibiotics (pemphigus specific) Topical emollients Topical steroids