common dermatological conditions

Question 1

define macule vs papule?

What about a bulla or a nodule?

Answer 1

Macule–> FLAT area of altered colour (ex freckles)

Papule–> solid RAISED lesion <0.5cm in diameter

nodule–> solid RAISED lesion >0.5cm in diameter

bulla–>raised, clear fluid filled lesion >0.5 cm in diameter

Question 2

types of skin infection based on pathogen type (ex virus etc:)

Answer 2

· Bacterial

• Impetigo
• Cellulitis/erysipelas

· Fungal

• Tinea (mold – dermatophyte/ringworm)
• Candida (yeast)
• Pityriasis versicolor (yeast

Viral

• Shingles - Herpes zoster
• Chicken pox - Varicella zoster
• Warts – HPV

· Parasite

• Scabies

Question 3

Acne Vulgaris

definition

Cx

Answer 3

inflammatory disease of pilosebaceous follicle

Cx:

1. hormonal
2. increased sebum production
3. abnormal follicular keratinisation
4. bacterial colonisation
5. inflammation

Question 4

Acne Vulgaris

• Types
• locations
• complications

Answer 4

face, chest & upper back

Complix

• Post-inflam hyperpigmentation
• Scarring
• Deformity
• Psychological and social effects

Question 5

Acne vulgaris

Mx

referral?

Answer 5

Retinoids r contraindicatd in breastfeeding & pregnacny

advice, topical therapies, oral therapies,

Referral: Refer to dermatology if multiple Tx have failed

Oral retinoids (roaccutane) (for severe acne)

Question 6

Psoriasis

types , cause, triggers

Answer 6

Chronic inflammatory skin condition due to hyperproliferation of Keratinocytes & inflammatory cell infiltration

cx: gentic,enviromentsl, immunological

STREP in LAB

streptocoocus, trauma,retroviral,endocrine, pred, withdrawl, infliximab, nsaids, lithium, ace inhib, b blockers

Question 7

Symptoms and signs of Psorasis

Answer 7

• well demarcated erythematous White and grey scaly plaques, itchy, burning, painful
• 50% nail involvment pitting, onchylosis oil drop sign,
• AUSPITZ sign
• if athropathy involved ( check for those)

Question 8

ComplicX of Psoriasis

Answer 8

1. Erythroderma : exfoliative dermatitis involving at least 90% of the skin surface
2. Psychological and social effects

Question 9

Psoarisis Mx

referal?

Answer 9

General Measure:

1. Tx is only to relieve symp than cure
2. given them Psoriasis info leaflet
3. nail care: cutt nails, acetone free nail varnish, avoid manicure
4. avoid triggers, dont smoke, check medications.
5. Use emollients (epimax) reduce scale
6. seek medical advice ofr unexplained swelling/joint pain

Topical treatment: may take several wks to work, if stopped suddenly may increase risk of relapse.

steroids (hydrocortisone, eumovate) vit D analogue, coal tar preparations, topical retinoids, keratolytics and scalp preparations.

REFFERAL: if after 4 weeks no symp improvment, severe Psoriasis & effecting phycologically>>REFER DERMOTOLOGY for 2nd line Tx

• Phototherapy
• Oral therapies (if severe extensive or systemic inlvolve): mycophenate mofetil, methotrexate, calcinuren inhibitors,retinoids,

Question 10

Allergic rashes & urticaria pathophys

Answer 10

• Urticaria is due to a local increase in permeability of capillaries & small venules
• A large number of inflammatory mediators (including prostaglandins, leukotriene & chemotactic factors) play a role but histamine derived from mast cells are the major mediator
• This can be induced by immunlogical and non-immunological mechanisms

Question 11

Urticaria

symp

Ix

Answer 11

Pruritic wheals

Can progress to angioedema and anaphylaxis – see respiratory emergencies

Ix

if cause cannot be identified from Hx, symptom diaries can help to determine the frequency duration and severity of urticarial symptoms

Question 12

allergic rashes and Urticaria

Severe acute uritcaria/angioedema:

Mx

Answer 12

General measures: avoid trigger factors, avoid trigger medications (nsaids), it is self-limiting w/out Tx

Uriticaria: non-sedating anit-histamines ex: cetrizine

Severe acute uritcaria/angioedema: treat as above & add Oral corticosteroids 40mg pred for 7 days

Anaphylaxis: IM adren 1:1000 (repeat every 5 mins)

cholophenamine

hydrocortisone

Question 13

Answer 13

Molluscum contagiosum

pearly papules with central umbillication

2ndry viral infection in eczema

complication

Question 14

Candidiasis

symp, Ix, Mx,

if topical treatment not work?

Answer 14

White plaques on mucosal areas – can be scraped off · Erythema with satellite lesions in flexures

Ix: Skin swabs for MC&S (for yeasts)

Mx: as above for topical tx, If topical tx is ineffective, the infection is widespread or the person is significantly immunocompromised —-> Oral fluconazole

Question 15

what is this showing?

Answer 15

The Auspitz sign in psoriasis

scratch and removal of scales causes capillary bleeding

Question 16

what is this?

Cx, symp, locations, Ix, Tx

Answer 16

Pityriasis versicolor

Cx: by Malassezia furfur (yeast)

symp: Pale brown/pale patches that fail to tan on sun exposure · Can be scaly/pruritis (Usually asymptomatic)

• can be hyperpigmented, hypopigmented or eryhtmatous
• affects the trunk, neck, and/or arms, and is uncommon on other parts of the body

Ix: Skin swabs for MC&S (for yeasts)

Tx:

General measures

• Advice that it is not contagious as the yeast that causes it is normally present on human skin and infection is not due to poor hygiene
• Treatment is usually highly effective, but may need to repeated as recurrence is common (especially in summer)
• Skin discolouration may persist for several weeks or months following successful eradication
• Vigorous exercise an hour after taking the medication may help sweat it onto the skin surface, where it can effectively eradicate the fungus.
• Bathing should be avoided for a few hours

Medication

• If an extensive area is involved, prescribe an antifungal shampoo
  
  • Ketoconazole 2% shampoo
  • Selenium sulphide 2.5% shampoo
• If only small areas are involved, prescribe an antifungal cream
  
  • Imidazole cream – clotrimazole, econzole

Do not prescribe oral corticosteroids

Question 17

Pityriasis versicolor

Mx

Answer 17

General advice:

1. it is NOT contagious (that yeast is normally on skin anyways)
2. not due to poor hygiene
3. Tx is effective but need to be repeated as recurrence is common (in summer mainly)
4. skin discolouration may stay for several wks or mnths following successful eradication

DO NOT PRESCRIBE ORAL CORTICOSTEROIDS!!

Medication:

Extensive area effected–>antifungal shampoo

• Ketoconazole 2% shampoo
• Selenium sulphide 2.5% shampoo

Small area effected–> antifungal cream

• Imidazole cream – clotrimazole, econzole

Question 18

Chicken pox

cause, symptoms, Mx

if immunocompromised?

Answer 18

caused by Varicella Zoster (herpes virus)

• starts of as erythematous papules, ITCHY
• papules become vesicles they may burst
• vesicles crust & scab
• assoc: fever, aches, pains, loss of apetite

General advice:

• most infectious period is 1-2 days before rash appears
• drink loads of fluids
• cutt nails to avoid damage when scratching

symptomatic Tx

• Analgesia
• topical CALAMINE lotion (for itch)
• Chlorphrenamine (for itch in less 1 yr old)

Antivirals:

Oral aciclovir for immunocomporomised adults or teens less than 14 yrs

Question 19

Warts

symp, Tx

Answer 19

HPV

vary in size

General advice:

self-limiting

Treatment:

• Cryoptherapy-need several session, (can be painful, blisters, infective, scarring & pigmentation)
• Topical salicylic acid up tp 3 mnths (can cause skin irritation)

Question 20

Scabies

Cx, Epid, symp,tx

Answer 20

Sarcoptes Scabei

Can affect any age group – commonly young/elderly

• Itching is main symptom affecting whole body except head and neck
• Itch worse at night
• Scratch marks and tiny red spots, pustules can develop if crusts become infected
• Mites found in folds of skin webspace and toes, palms of hands, wrists, ankles and soles of feet, groins, and breasts. This leaves tiny spots and coloured lines on skin

Treatment:

General measures

All members of household, sexual partners itching past month and other close personal contacts should be treated, even if asymptomatic

Bedding, clothing and towels should be washed

Medication

Topical insecticide – PERMETHRIN 5% cream

Itching may persist after treatment for up to 2 weeks Medication

Question 21

what skin infection should NOT be given oral steroid and why?

Answer 21

Psorasis

it can flare it up

Question 22

what is this?

Answer 22

complication of eczema

painful monophorphic punched out erosions

Question 23

what is this a manifestation of?

Answer 23

Oil drop sign (onchylosis) in Psoriasis

seperation of nail bed from nail plate

Question 24

Eczema

describe, epid, causes, location , types, presentation

Answer 24

or dermatitis is a genetic defect in the skin barrier caused by loss of fuction of fliggarin protein.

Epi: mainly is less than 12 yrs old, develops early childhood gets better in teens

Loc: infants >> extensor regions and face/ Adults: flexors and face

Cx: Atopy (asthma, allergic rhinitis), foods, stress, heat, sweating, allergins, pet fur, moulds, dustmite,pollen

Symp: vesicular, itchy, weepy

Types: mild, moderate, severe, infective

Question 25

Atopic Eczema Mx Follow up

Answer 25

General measures: 1. dont over clean the face as its not a hygenic problem 2. Eczema info leaflet 3. Sign posting: national eczema society, websites: itchysneezywheezy.co.uk 4. calculate ESI score at every follow up appoit 5. Use spoon when scooping out emollients (epimax) 6. emmoliants instead of Bath soap substitutes 7. Avoid triggers **Topical therapies** 1. Steroids\> flare ups (hydrocortisone for face, betnavate an dermavate for trunks and limbs) 2. Antihistimines (if sleep is affected) chlorphenamine 3. if infective \> antiviral or antibiotics **2nd line Topical immunosupressants and oral** 1. Oral prednislone 30mg (short course 1 wk bs) 2. Tacrolimus (steroid sparing) 3. Azathiorpine \*tpmt gabl\*, Methotrexate Compl DLQY score \>\> extent of physocological impact on Ptx

Question 26

what medication is contraindicated in Preganacy and breast feeding

Answer 26

Topical retinoids

Question 27

what is this? epidx, Cx, symp, Ix

Answer 27

Impetigo is a skin infection that's very contagious but not usually serious, common in young kids Skin swab MC&S, if inconclusive diagnosis or recurrence despite tX

Question 28

impetigo types

Answer 28

Systemic signs possible in severe cases Fever, Malaise, Weakness

Question 29

Impetigo Tx , advice

Answer 29

**General measure:** * Reassure patient that impetigo usually heals completely w/out scarring * Reassure that serious complicx are RARE * Wound cleansing with soap & water * Wash hands regularly, esp after touching a patch of impetigo * Avoid scratching * Avoid sharing towels, personal care products **Medical Tx** *_Nonbullous impetigo_* with single lesions/small areas 1. Topical fusidic acid 2. Topical mupirocin if known to be caused by MRSA *_Bullous impetigo or severe,_* *_widespread nonbullous impetigo_* 1. Oral flucloxacillin 2. Oral clarithromycin (penc allergic) **2nd line: coamoxiclav** ***Advice patient to return if no _improvement_ 5 days after tx or if condition is _worsening/systemic features_ develop***

Question 30

cellulitis vs erysipelas Rfx, present, complx,

Answer 30

*spreading bacterial infection of the skin caused by S**trep pyogenes & Staph aureus*** * Cellulitis (l pic) – involves **_deep_** subcutaneous tissue * Erysipelas(R pic) – acute **_superficial_** form of cellulitis and involves dermis and upper subcutaneous tissue **Risk factors**: • Immunosuppression • Wounds • Leg ulcers • Minor skin injury **symp**: May be associated with _lymphangitis_

Question 31

how is cellulitis vs erypsiles

Answer 31

Erysipelas is distinguished from cellulitis by a **well-defined**, red **raised** border

Question 32

cellulitis/erypsiles Ix how to access severity of cellulits

Answer 32

**Do not t**ake blood or swabs routinely in people with mild cellulitis – swab for MC&S if unresolving *_Eron Classification_*: NICE assessment of **severity of cellulitis** * Class I - **no** systemic toxicity or comorbidity * Class 2 – **systemic** toxicity or comorbidity * Class 3 – **significant** toxicity or significant comorbidity * Class 4 – **sepsis** or life threatening

Question 33

cellulitis/erypsiles Tx, referrel? when to seek medical advice

Answer 33

**General measures:** * Mark the area of cellulitis if possible before treatment for future comparison * Rest & Leg elevation for comfort & to relieve oedema * Sterile dressings * Fluids * Analgesia – regular paracetamol/ibu profen for fever * Avoid **compression** garments **Medication:** Flucloxacillin (co-amoxiclav for facial cellulitis) Clarithromycin penicillin allergy ***2nd line***: add phenoxymethyl penicillin OR coamoxiclav alone Arrange review after 48 hours Seek medical advice if cellulitis becomes worse, antibiotic is not tolerated or if systemic symptoms develop/worsen ***REferrel:** Admit patient for IV antibiotics if class **3 or 4.** consider admission if frail, very young, immunocom.*

Question 34

Shingles singles in facial nerve? Ix

Answer 34

caused by Varicella zoster (Herpes virus), reactivation of chicken pox virus * Erythematous vesicles and pustules that dry out forming crusts and scabs * The scabs drop off within 2-3 weeks * Covers a well-defined area of skin on one side of the body w/out crossing the midline * Pain may persist long after the rash had cleared – usually goes away in 6 months Shingles in facial nerve – **Ramsey hunt syndrome** **Ix:** Clinical diagnosis, If in doubt, scrapings from blister for MC&S / viral swab test for PCR

Question 35

Shingles Mx

Answer 35

General measures * Explain that only a person who has not had chickenpox/varicella vaccine can catch chickenpox from them. * They are infectious until all the vesicles have crusted over * Avoid contact with people who have not had chickenpox * Avoid sharing clothes/ towels * Wear loose fitting clothes to reduce irritation * Cover lesions that are under clothes while the rash is weeping * Keep it clean * Avoid work **Medication:** * Analgesia – paracetamol, codeine * Oral aciclovir within 72 hours for : 1. Age \>50 o Immunocompro mised 2. Non-truncal involvement 3. Moderate or severe pain 4. Moderate or severe rash

Question 36

Rosacea (doha) epid, cx, symp

Answer 36

1. More common in women bur more severe in men 2. Affects fair skinned individuals 3. Chronic condition that can persist for a long time – severity fluctuates **Cx:** Not fully understood 0 genetics, immune system and environmental factors. Involved **triggers**: • Alcohol • Exercise • High and low temperatures • Hot drinks • Spicy foods • Stress • Sun 1. Usually affects the face 2. Starts with a tendency to blush easily 3. After a while, central areas of the face become a permanent deeper shade of red, with small dilated blood vessels, papules and pustules 4. Occasionally, there is swelling of the facial skin (lymphoedema) around the eyes 5. Occasionally, an overgrowth of the sebaceous glands on nose may cause the nose to become enlarged, bulbous and red – rhinophyma

Question 37

Acne Rosacea Tx

Answer 37

**_Cannot be cured_** **General measures** * Reassurance * Sunscreen * Avoid triggers * If skin is dry, use emolients * Review medication as Ca2+ can aggravate flushing symptoms **For mild or moderate papulopustular acne rosacea:** • * Metronidazole * Azelaic acid **For moderate to severe papulopustular acne rosacea:** * Oral tetracycline * Erythromycin \>\> If erythema is predominant symptom: * Brimonidine 0.5% gel

Question 38

Describe the rash if theyre transient (\<24 hours)?

Answer 38

GENERALISED SYMMETRICAL rash, consisting of WELL DEFINED, ERYTHEMATOUS, URTICATED PAPULES AND PLAQUES if we know they are transient (\<24 hours) we can call them **WHEALS**

Question 39

Describe the 2 causes, epidemiolgy, common areas, secondary symptoms

Answer 39

**Pityriasis rosea** is a viral rash which lasts about 6–12 weeks, starts of as a single rash **(herald patch)** then after 1-20 days may devlop into a generalized secondary rash. young adults and teens mainly on chest and back may be very itchy, but in most cases, it doesn't itch at all. malaise and headache * •IMAGE 1: A Single, localized, oval erythematous/pink plaque approx 2–5 cm in diameter, with a scaly **collaret** trailing on the edge of the lesion àHERALD PATCH* * •IMAGE 2: Generalized, erythematous, well defined macules/plaques, which are a mix of oval and annular shaped*