derm Flashcards
NICE criteria for dx atopic dermatitis
Itchy skin + 3/5 of
- visible flexural eczema (eryhtematous, itchy, poorly demarcated rash) face, or scalp - cheeks/ extensors if <18m
- Hx of felxural eczema
- Hx dry skin
- Hx atopy (in dividual/ 1st degree relative if <4yo)
- onset <2yo (dont use in <18m)
3 complicaitions of eczema
Eczema herpeticum - emergency, HSV inffection 2o to atopic dermatitis
superficial bacterial infection (stap/strep)
erythroderma (emergency) - widespread erythema >90% skin surface Leads to: heat and fluid loss –> hypothermia and systemic Sx
what type of hypersensitivity is atopic dermatits
Typ1 hypersensitivity - IgE mediated
give stepwise topic mx in eczema
- emmolient (Aveeno, E45, Diprobase)
- Steroids -
- mild: hydrocortisone, Mod: eumovate, Potent betnovate, V. potent: Dermovate
how do the following subtypes of psoriasis present
- plaque psoriasis
- flexural
-guttate
- pustular
plaque - most common, well-demarcated red, scaly patches on extensor surfaces, sacrum, scalp
flexural - smooth patches on skin
(affects skinfolds (armpits, under breasts, genital areas - smooth, shiny scaling)
guttate - strep infection triggered rash, multiple red, teardrop leasions
pustular - palms & soles
2 non-skin features of psoriasis
nails: pitting, onycholysis (separation of the nail from the nail bed)
subungual hyperkeratosis, loss of the nail
arthritis
molluscum contangiosum advice
self-limiting (12-18m)
but contagious, so dont share towels etc
school exclusion not required
what is the difference in presentation between lichen planus and lichen sclerosus
Lichen
planus: purple, pruritic, papular, polygonal rash on flexor surfaces. Wickham’s striae over surface. Oral involvement common
sclerosus: itchy white spots typically seen on the vulva of elderly women
Mx options for actinic keratosis ( give 3)
prevention of further risk: e.g. sun avoidance, sun cream
fluorouracil cream: typically a 2 to 3 week course. The skin will become red and inflamed - sometimes topical hydrocortisone is given following fluorouracil to help settle the inflammation
topical diclofenac: may be used for mild AKs. Moderate efficacy but much fewer side-effects
remeber actinic keratosis on sun exposed areas of the body
x2 differences in appearance between Plaque psoriasis and eczema
found in similar areas but
plaque posriasis:
- well defined borders
- silvery scale
Eczema
- poorly defined borders
- no silvery scale
give 2 main causes of impetigo
strep pyogenes & staph aureus** most common
1st line mx in impetigo if
- systemically well
- extensive disease (systemically unwell)
well: Hydrogen peroxide 1% cream (antiseptic) (Fusidic acid 2% - antibiotic, 2nd line)
unwell: oral fluclox (erythromycin 2nd line)
what bacteria is a golden crust associated with
staph aureus
should children be kept off school if they have impetigo?
yes - contagious
describe
- mild
-mod
-sev acne
mild - open & closed comedones, may have sparse inflammatory lesions
mod - widespread non-inflammatory lesions & neumerous papules & pustules
sev - extensive inflammatory lesions, with nodules/pitting/scarring
give the stepwise max for acne (5)
single topical therapy - topical retinoids/benzoyl peroxide)
topical combination therapy ( topical antibiotic, benzoyl peroxide, topical retinoid
- oral Abx (tetracyclines - lymecycline, doxycycline erythmomycin in pregnancy ) - max use 3 months
co-prescribe topical retinoid/benzoyl peroxide - COCP in women (diannette aka co-cyrindiol)
- oral isotretinoin ( specialist)
x eczema complication
bacterial infection of eczema
eczema herpeticum
bacterial - oral Abx (e.fg. fluclox)/ admit if severe
eczema herpeticum - oral aciclovir ( IV if severe)
stepwise mx in eczema
maintenance
flares
maintenance
- avoid irritation
- emollients (thin creams e.g. E45, Diprobase cream, aveeno cream, cetraben cream) (thick, greasy e.g. hydromol ointment, diprobase ointment, cetraben ointment)
flares
steroid
steroid ladder
Mild - hydrocortisone (0.5-2.5%)
Mod - Eumovate
Potent - Betnovate
V. potent Dermovate
features of a BCC (x4)
most common type - nodular
- sun-exposed sites (head and neck)
- initially a pearly, flesh-coloured papule
- telangiectasia
- may later ulcerate - leaving a dcentral ‘crater’
what cream can be used in actinic keratosis management which may cause redness and inflammation of skin
fluorouracil cream: 2 -3 week course.
topical hydrocortisone is given following fluorouracil to help settle the inflammation
define bowens disease
precancerous dermatosis - precursor to SCC (5-10% chance of becoming SCC)
describe the features of Bowens disease (x4)
red, scaly patches
10-15 mm
slow-growing
sun-exposed areas
Mx for bowens disease
topical 5-fluorouracil cream (BD, 4wks)
causes significant inflammation/erythema - so give Topical steroids (hydrocortisone) - like actinic keratoses Mx, but this is 2-3 wks
what are the 4 main types of melanoma
superficial spreading (70% - arms, legs, backs, chest , yougn people) - mole w/ diagnostic features
nodular 2nd commonest (sun exposed skin, middle aged - red/black bleeding/oozing lump)
lentigo maligna less common - chronically sun-exposed skin, older people - mole w/ diagnostic features
acral lentiginous - rare
(Nails, palms, soles - in darker skinned people) - subungual pigmentation (Hutchinsons sign) or on palms/feet
