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Derm Flashcards

1
Q

What is impetigo

A

Superficial bacterial skin infection usually caused by either Staphylcoccus aureus or Streptococcus pyogenes

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2
Q

Who is impetigo common in

A

common in children, particularly during warm weather

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3
Q

Where do impetigo lesions tend to occur

A

The infection can develop anywhere on the body but lesions tend to occur on the face, flexures and limbs not covered by clothing.

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4
Q

How is impetigo spread

A

Spread is by direct contact with discharges from the scabs of an infected person.

The bacteria invade the skin through minor abrasions and then spread to other sites by scratching.

Infection is spread mainly by the hands, but indirect spread via toys, clothing, equipment and the environment may occur.

The incubation period is between 4 to 10 days.

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5
Q

Appearance of impetigo

A

‘golden’, crusted skin lesions typically found around the mouth

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6
Q

Mx of limited localised impetigo

A

Hydrogen peroxide 1% cream

Topical antibiotic creams(fusidic acid)

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7
Q

What should be used in localised impetigo if there is resistance to fusidic acid

A

Topical mupirocin

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8
Q

Mx of extensive impetigo

A

Oral flucloxacillin

Oral erythromycin if penicillin-allergic

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9
Q

Advice regarding school exclusion for patients with impetigo

A

Children should be excluded from school until the lesions are crusted and healed or 48 hours after commencing antibiotic

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10
Q

Areas typically affected by rosacea

A

Nose, cheeks and forehead

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11
Q

Appearance of rosacea

A

Flushing is often first symptom

Telangiectasia are common

Later develops into persistent erythema with papules and pustules

rhinophyma

ocular involvement: blepharitis

sunlight may exacerbate symptoms/

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12
Q

General advice for rosacea

A

Reduce common triggers that cause facial flushing.

Avoid oil-based facial creams. Use water-based make-up.

Never apply a topical steroid to the rosacea as although short-term improvement may be observed (vasoconstriction and anti-inflammatory effect), it makes the rosacea more severe over the next weeks (possibly by increased production of nitric oxide).

Protect yourself from the sun

Keep your face cool to reduce flushing: minimise your exposure to hot or spicy foods, alcohol, hot showers, hot baths, and warm rooms.

Some people find they can reduce facial redness for short periods by holding an ice block in their mouth, between the gum and cheek

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13
Q

Management of mild symptoms of rosacea

A

Topical metronidazole

Topical brimonidine gel may be considered for patients with predominant flushing but limited telangiectasia

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14
Q

Management of severe rosacea

A

Systemic antibiotics(oxytetracycline)

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15
Q

What is shingles

A

Shingles is an acute, unilateral, painful blistering rash caused by reactivation of the Varicella Zoster Virus (VZV) in the dorsal root ganglion or cranial nerve ganglia

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16
Q

Triggers for shingles

A 
Emotional stress
Immunosuppression
Chemotherapy
High dose steroid therapy
Recent illness or surgery
Skin injury
Sunburn
Trauma)
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17
Q

What type of nerves are affected in shingles

A

As the VZV affects the dorsal and/or cranial nerve ganglia, the sensory nerves are what are affected in the course of the disease, hence the characteristic single dermatome distribution

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18
Q

Phases of shingles

A

prodromal phase, the infectious rash, and the resolution phase

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19
Q

Rash features in shingles

A

Usually affecting a single dermatome in a band-like distribution
Unilateral, rarely crossing the midline
Initially is erythematous and macular in nature
Progression to erythematous papules, and eventually vesicles or bullae by day 7(lasts 7-10 days)
Vesicles become pustular or haemorrhagic near the end of this phase, right before crusting over

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20
Q

Supportive mx of shingles

A 
Mild analgesia 
Amitrptyline/duloxetine/gabapentin in moderate-severe pain 
Calamine lotion 
Topical capsaicin 
Cool compress
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21
Q

When do NICE recommend anti-virals in shingles

A

Within 72 hrs of rash if:

Immunocompromised patients
Non-truncal rash involvement (e.g. affecting face, neck, limbs, perineum)
Moderate-severe pain or rash

age>50

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22
Q

How long after a shingles rash onset can antivirals still be considered an option

A

one week after rash onset

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23
Q

Use of corticosteroids in shingles

A

If a patient is on anti-viral treatment –> oral corticosteroids
Used in the first 2 weeks following rash onset

This should only be used in conjunction with anti-viral treatment, and in immunocompetent adults with localised shingles if the pain is severe

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24
Q

Most common complication of shingles

A

Post-herpetic neuralgia

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25
When should patients with shingles be referred/admitted
Herpes zoster ophthalmicus or eye involvement | Immunocompromised people
26
Risk factors for shingles
increasing age HIV: strong risk factor, 15 times more common other immunosuppressive conditions (e.g. steroids, chemotherapy)
27
Most common form of skin cancer
BCC
28
Subtypes of BCC
Sub types include nodular, morphoeic, superficial and pigmented.
29
Growth of BCC
Typically slow growing with low metastatic potential
30
Mx of BCC
Standard surgical excision, topical chemotherapy and radiotherapy are all successful. As a minimum a diagnostic punch biopsy should be taken if treatment other than standard surgical excision is planned.
31
Most common type of BCC
Nodular
32
Appearance of BCC
sun-exposed sites, especially the head and neck account for the majority of lesions initially a pearly, flesh-coloured papule with telangiectasia may later ulcerate leaving a central 'crater'
33
Mx options for BCC
``` Surgical removal Curettage Cryotherapy Topical creams Radiotherapy ```
34
Topical cream options for BCC
Imiquimod | Fluorouracil
35
Risk factors for SCC
``` Sunlight exposure/UVA Actinic keratoses Immunosuppression(organ transplant/HIV) Smoking Long-standing leg ulcers Genetic conditions ```
36
Mx of SCC
Surgical excision - wide local excision | Mohs micrographic surgery in high-risk patients and in cosmetically important sites
37
What is Bowen's disease
Squamous cell carcinoma in situ - erythematous scaling patch or elevated plaque arising on sun-exposed skin in an elderly patient
38
What is a pyogenic granuloma
These present as friable overgrowths of granulation at sites of minor trauma. They may be ulcerated and bleeding on contact is common.
39
Mx of pyogenic granuloma
They may be treated with curettage and cautery, formal excision may be used if there is diagnostic doubt.
40
Major criteria for diagnosis of malignant melanoma
Change in size Change in shape Change in colour
41
Mx of malignant melanoma
Excision biopsy Further treatments include sentinel lymph node mapping, isolated limb perfusion and block dissection of regional lymph node groups
42
How are margins of excision determined in melanoma excision
Linked to breslow thickness
43
What is dermatitis herpetiformis
Chronic itchy clusters of blisters. | Linked to underlying gluten enteropathy (coeliac disease).
44
Features of dermatofibroma
Benign lesion. Firm elevated nodules. Usually history of trauma. Lesion consists of histiocytes, blood vessels and fibrotic changes.
45
Most common cause of acanthuses nigricans
Insulin resistance
46
Features of dermatitis herpetiformis
itchy, vesicular skin lesions on the extensor surfaces (e.g. elbows, knees, buttocks)
47
Causes of erythroderma
``` eczema psoriasis drugs e.g. gold lymphomas, leukaemias idiopathic ```
48
Two main types of contact dermatitis
Irritant contact dermatitis Allergic contact dermatitis
49
What type of hypersensitivity is allergic contact dermatitis
Type IV
50
Features of allergic contact dermatitis
Uncommon - often seen on the head following hair dyes. Presents as an acute weeping eczema which predominately affects the margins of the hairline rather than the hairy scalp itself. Cement is a common cause
51
Features of toxic epidermal necrolysis(TEN)
systemically unwell e.g. pyrexia, tachycardic | positive Nikolsky's sign: the epidermis separates with mild lateral pressure
52
Drugs known to induce TEN
``` phenytoin sulphonamides allopurinol penicillins carbamazepine NSAIDs ```
53
Mx of TEN
Stop precipitating factor Supportive care IV immunoglobulins first line
54
What is bullous pemphigoid
Bullous pemphigoid is an autoimmune condition causing sub-epidermal blistering of the skin. This is secondary to the development of antibodies against hemidesmosomal proteins
55
Features of bullous pemphigoid
itchy, tense blisters typically around flexures the blisters usually heal without scarring there is usually no mucosal involvement (i.e. the mouth is spared)*
56
What does a skin biopsy show in bullous pemphigoid
immunofluorescence shows IgG and C3 at the dermoepidermal junction
57
Mx of bullous pemphigoid
referral to a dermatologist for biopsy and confirmation of diagnosis oral corticosteroids are the mainstay of treatment topical corticosteroids, immunosuppressants and antibiotics are also used
58
What is pyoderma gangrenosum
Pyoderma gangrenosum is a rare, non-infectious, inflammatory disorder. It is an uncommon cause of very painful skin ulceration. It may affect any part of the skin, but the lower legs are the most common site.
59
What might be seen on biopsy in pyoderma gangrenosum
neutrophilic dermatoses are skin conditions characterised by dense infiltration of neutrophils in the affected tissue and this is often seen on biopsy
60
Causes of pyoderma gangrenosum
``` Idiopathic(50%) IBDs Rheumatological(RA,SLE) Haem(MDS, lymphoma) PBC ```
61
Mx of pyoderma gangrenosum
Oral steroids as 1st line | Other immunosuppressive therapy(ciclosporin)
62
What is seborrhoeic dermatitis thought to be due to
Seborrhoeic dermatitis in adults is a chronic dermatitis thought to be caused by an inflammatory reaction related to a proliferation of a normal skin inhabitant, a fungus called Malassezia furfur
63
Features of seborrhoeic dermatitis
eczematous lesions on the sebum-rich areas: scalp (may cause dandruff), periorbital, auricular and nasolabial folds otitis externa and blepharitis may develop
64
Conditions associated with seborrhoeic dermatitis
HIV | Parkinson's disease
65
Management of seborrhoeic dermatitis on scalp
over the counter preparations containing zinc pyrithione ('Head & Shoulders') and tar ('Neutrogena T/Gel') are first-line the preferred second-line agent is ketoconazole selenium sulphide and topical corticosteroid may also be useful
66
Management of face and body seborrhoeic dermatitis
topical antifungals: e.g. ketoconazole topical steroids: best used for short periods difficult to treat - recurrences are common
67
Which factors can exacerbate psoriasis
trauma alcohol drugs steroid withdrawal
68
Drugs which can exacerbate psoriasis
beta blockers, lithium, antimalarials (chloroquine and hydroxychloroquine), NSAIDs and ACE inhibitors, infliximab
69
Indicators of atopic dermatitis/eczema
Visible flexural eczema involving the skin creases, such as the bends of the elbows or behind the knees Personal history of flexural eczema Personal history of asthma or allergic rhinitis
70
Mx of mild eczema
Generous amounts of emollients | Topical hydrocortisone 1%
71
Mx of moderate eczema
Emollients Betamethasone valerate 0.025% Consider trial of cetirizine if itch or urticaria
72
Preventative treatment in eczema
Maintenance regimen of topical corticosteroids Topical calcineurin inhibitors(tacrolimus) as second line
73
When should hospital admission be made for eczema
Eczema herpeticum(widespread herpes simplex virus)
74
Antibiotic of choice in infected eczema
Flucloxacillin
75
Causes of folliculitis
Bacteria - staph aureus Hot tub folliculitis (pseudomonas) Eosinophilic folliculitis(HIV/AIDS)

General practice (26 decks)

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