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Derm Flashcards

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1
Q

What is acne vulgaris?

A

Common condition characterised by inflammation of hair follicles and sebaceous glands.

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2
Q

What are three main factors that contribute to the development of acne?

A

Increase sebum production
Common change seen in normal puberty due to changes in hormone expression

Presence of Cutibacterium acnes

Blocked pores

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3
Q

What bacterial species contributes to the development of acne?

A

Presence of Cutibacterium acnes

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4
Q

Clinical features of acne vulgaris

A

Presence of open and closed comedones
May be associated with surrounding inflammation
Acne can lead to scarring and post-inflammatory hyperpigmentation

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5
Q

Management of mild to moderate acne

A

Offer 12-week course of one of the following:
Topical adapalene with topical benzoyl peroxide
Topical tretinoin with topical clindamycin
Topical benzoyl peroxide with topical clindamycin
Consider topical benzoyl peroxide as monotherapy if any of the combinations are contraindicated

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6
Q

Management of moderate to severe acne

A

Offer 12-week course of one of the following:
Topical adapalene with topical benzoyl peroxide
Topical tretinoin with topical clindamycin
Topical adapalene with topical benzoyl peroxide with oral lymecycline 408 mg OD or oral doxycycline 100 mg OD
Topical azelaic acid with either oral lymecycline 408 mg OD or oral doxycycline 100 mg OD

Consider benzoyl peroxide as monotherapy if any of the combinations are contraindicated

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7
Q

What can be considered as an alternative to antibiotics in females with moderate to severe acne?

A

Consider combined oral contraceptives as alternative to systemic antibiotics in females
NOTE: oral progesterone-only contraceptives and progestin implants may worsen acne
Co-cyprindiol has some antiandrogenic properties and may be a suitable option

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8
Q

When should patients who start systemic antibiotic therapy for acne be reviewed?

A

NOTE: all patients should be reviewed in at least 12 weeks to assess response to treatment

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9
Q

When should specialist dermatology referral be considered in acne vulgaris?

A

Diagnostic uncertainty
Acne conglobata
Nodulo-cystic acne
Acne that fails to respond to two completed courses of treatment
Acne with scarring
Significant psychological distress due to acne

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10
Q

What is alopecia areata? How does it present?

A

Autoimmune disease resulting in patches of non-scarring hair loss

Well-defined area of non-scarring hair loss
Usually round
No skin changes
Nail changes (e.g. pitting)

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11
Q

Management of alopecia areta

A

Most cases will resolve spontaneously without active treatment

Conservative Measures
Hairstyling
Wigs

If the patient fails to show signs of regrowth or has more than 50% hair loss, the following options may be considered:
Potent topical steroids (e.g. betamethasone valerate 0.1%)
Intralesional steroids
Systemic corticosteroids
Minoxidil
Calcineurin inhibitors

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12
Q

What medication can be considered in alopecia areata? When should it be considered?

A

If the patient fails to show signs of regrowth or has more than 50% hair loss, the following options may be considered:
Potent topical steroids (e.g. betamethasone valerate 0.1%)
Intralesional steroids
Systemic corticosteroids
Minoxidil
Calcineurin inhibitors

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13
Q

What is eczema? How does it present?

A

Dry and itchy skin primarily affecting the flexures
In infants, it more commonly affects the face

Prolonged itching can lead to lichenification

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14
Q

Where does eczema predominantly affect? How does this differ in infants?

A

Dry and itchy skin primarily affecting the flexures
In infants, it more commonly affects the face

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15
Q

What other conditions is eczema often associated with?

A

Allergic rhinitis
Asthma
Food allergy

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16
Q

How is mild eczema managed?

A

Emollients
Mild Potency Topical Corticosteroids

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17
Q

moderate eczema management

A

Emollients
Moderate Potency Topical Corticosteroids
Topical Calcineurin Inhibitors
Bandages

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18
Q

Severe eczema management

A

Emollients
Potent Topical Corticosteroids
Topical Calcineurin Inhibitors
Bandages
Phototherapy
Systemic Therapy

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19
Q

Examples of steroids used in eczema and their potency

A

Mild: Hydrocortisone 1%
Moderate: Betamethasone Valerate 0.025% or Clobetasone Butyrate 0.05%
Potent: Betamethasone Valerate 0.1%, Mometasone
If Very Severe: Oral Steroids

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20
Q

Example of mild steroid used in eczema

A

Mild: Hydrocortisone 1%

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21
Q

Example of moderate steroids used in eczema

A

Moderate: Betamethasone Valerate 0.025% or Clobetasone Butyrate 0.05%

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22
Q

Example of potent steroids used in eczema

A

Betamethasone Valerate 0.1%, Mometasone

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23
Q

What type of steroid may be used if very severe eczema?

A

Oral Steroids

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24
Q

When should topical calcineurin inhibitors be considered in eczema?

A

May be considered as second line in moderate-to-severe eczema in children over 2 years old who have not responded well to steroids

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25
When should antihistamines be considered in eczema?
Offer a 1-month trial of non-sedating antihistamines (e.g. cetirizine) if severe itching or urticaria Consider 7-14 day trial of sedating antihistamine (e.g. chlorphenamine) if flare is affecting sleep
26
How long should medication be continued for after a flare in eczema?
48 hours after symptoms resolve
27
Complications of eczema, how is it treated?
Bacterial Superinfection Swab the affected area Flucloxacillin Penicillin Allergy: Clarithromycin, Erythromycin
28
LIFE THREATENING COMPLICATION OF ECZEMA, HOW IS IT TREATED?
Eczema Herpeticum If widespread, start aciclovir and refer for same-day dermatological advice
29
What is Impetigo? How does it present?
A localised and contagious skin infection caused by Staphylococcus or Streptococcus Lesions usually found on the face Erythematous macules that have a characteristic golden crust
30
How do lesions in impetigo present?
Lesions usually found on the face Erythematous macules that have a characteristic golden crust
31
erythematous macules around the face with a characteristic golden crust
impetigo
32
Management of localised non bullous impetigo
Hygiene measures (e.g. wash with soap and water, avoid sharing towels) 1st Line: Hydrogen Peroxide 1% Cream (apply 2-3 times for 5 days) 2ndLine Fusidic Acid 2% (TDS for 5 days) Mupirocin 2% (TDS for 5 days)
33
Management of widespread non-bullous impetigo
1stLine Topical: Fusidic Acid 2% or Mupirocin 2% Oral: Oral Fluxloxacillin Alternative: Oral Clarithromycin or Oral Erythromycin
34
Management of bullous imeptigo
oral ABs
35
What is infantile seborrhoeic dermatitis? What is the cause? AKA?
Common skin disorder that usually affects the scalp, face and trunk. It is thought to be associated with Malassezia. Commonly known as Cradle Cap
36
Clinical features of cradle cap
Greasy, yellow scales on the scalp Flaky but not itchy
37
Management of cradle cap if scalp is affecteed
Recommend topical emollient to loosen scales before gently brushing off If the above is ineffective, consider topical imidazole cream: Clotrimazole 1% Cream (2-3 times daily for up to 4 weeks) Miconazole 2% Cream (2 times daily for up to 4 weeks)
38
Management of cradle cap if areas other than scalp are affected
Advise bathing infant daily using emollient as soap substitute Encourage frequent nappy changes and use of barrier emollients Consider topical imidazole (clotrimazole or miconazole) for up to 4 weeks Low potency topical corticosteroids may be considered in some circumstances
39
What is molluscum contagiosum? How does it present?
Viral skin infection manifesting with clusters of umbilicated papules Clusters of round, umbilicated papules Usually found in moist places (e.g. groin, armpit)
40
Management of molluscum contagiosum
Self-limiting condition Treatment not usually needed in immunocompetent patients The rash will likely fully resolve within 18 months If treatment is required, consider: Imiquimod 5% Cream Podophyllotoxin 0.5% Cryotherapy Offer hygiene advice to prevent spread Avoid sharing towels, clothing and bedding Avoid scratching or squeezing lesions Exclusion from school is NOT necessary
41
PACES: What advice should be given regarding molluscum?
Self limiting condition, no treatment needed, will fully resolve within 18 months Offer hygiene advice to prevent spread Avoid sharing towels, clothing and bedding Avoid scratching or squeezing lesions Exclusion from school is NOT necessary
42
Is exclusion from school needed for molluscum?
No
43
What is nappy rash? What causes it?
Rash that appears in the area that is usually covered by a nappy in babies. Causes Irritant dermatitis (MOST COMMON) Seborrhoeic dermatitis Candida Atopic eczema
44
Most common cause of nappy rash
Irritant dermatitis (MOST COMMON)
45
Clinical features of nappy rash
Erythematous skin around nappy area
46
Conservative management of nappy rash
High-absorbency nappies Leave nappies off for as long as possible to allow the skin to dry Clean the skin and change the nappy every 3-4 hours and as soon as possible after wetting/soiling Use fragrance-free and alcohol-free baby wipes
47
Management of nappy rash is mild erythema and asymptomatic
dvise use of barrier preparation to protect skin (should be applied thinly at each nappy change) e.g. Zinc and Castor oil ointment, white soft paraffin BP ointment
48
Management of nappy rash if inflamed and causing discomfort?
Hydrocortisone 1% cream (only if > 1 month old) until symptoms settle (max 7 days)
49
Management of nappy rash if persistent and candida infection suspected
Avoid barrier preparation Topical imidazole e.g. clotrimazole, econazole, miconazole
50
Management of nappy rash if persistent and bacterial infection suspected
Oral Flucloxacillin for 7 days Penicillin Allergy: Clarithromycin for 7 days
51
What is pediculosis? How does it present?
Infestation of the scalp by Pediculus humanus capitis (small insect) Itchy scalp Lice may be visible Crusting Areas of hair loss due to scratching
52
Management of head lice
Wet combing Four sessions over 2 weeks Physical insecticide E.g. dimeticone 4% gel, isopropyl myristate Chemical or Traditional insecticide E.g. malathion 0.5% aqueous liquid
53
What is pityriasis rosea? What is it associated with?
Benign, self-limiting infection of unknown cause. It is thought to be associated with HSV6 and HSV7
54
Clinical features of pityriasis rosea
Characterised by the appearance of a single large patch (known as a Herald patch), followed by the appearance of multiple smaller macules Patients may also complain of coryzal symptoms in the days leading up to the development of the rash
55
Herald patch
Pityriasis rosea
56
Management of pityriasis rosea
Self-limiting disease The rash usually resolves over 4-6 weeks
57
What is ringworm? What is it caused by?
Fungal skin infection giving rise to characteristic ring-shaped lesions. Primarily caused by Trichophyton and Microsporum.
58
Clinical features of ringworm
Usually presents with single circular red patch with raised scaly edge There may be multiple lesions that develop over time
59
Management of ringworm
Mild infections are treated with topical antifungals E.g. terbinafine cream, clotrimazole If marked inflammation, consider hydrocortisone 1% cream More severe infections will require systemic antifungals 1st line: oral terbinafine 2nd line: oral itraconazole, oral griseofulvin
60
Management of mild ringworm
Mild infections are treated with topical antifungals E.g. terbinafine cream, clotrimazole
61
Management of ringworm if marked inflammation
If marked inflammation, consider hydrocortisone 1% cream
62
Management of ringworm if severe infection
More severe infections will require systemic antifungals 1st line: oral terbinafine 2nd line: oral itraconazole, oral griseofulvin
63
Management of tinea capitis (ringworm infection of scalp)
Systemic antifungal therapy (e.g. griseofulvin or terbinafine) 2nd line: itraconazole or fluconazole Topical antifungal shampoo is recommended in some patients (e.g. selenium sulfide or ketoconazole topical)
64
What is scabies? How does it present?
Common highly contagious skin infection caused by Sarcoptes scabiei Typically affects the hands and feet (and can affect other body folds) Often symmetrical Linear burrows may be seen on the skin Excoriation marks Symptoms worse at night
65
Management of scabies in children over 2 months
For children over 2 months: 1st Line: Permethrin 5% 2nd Line: Malathion Aqueous 0.5
66
PACES: How should contacts of scabies be treated?
All members of household and close personal contacts within 1 month should be treated Bedding, clothing and towels should be decontaminated by washing at a high temperature and drying in a hot dryer Advise that itching may continue for 2-4 weeks after last treatment application
67
How should crusted scabies be treated?
Seek specialist advice
68
What are viral warts? What do they present with?
Benign growths of thickened skin caused by human papillomavirus (HPV) Rough papules with hyperkeratotic surface Often found on the fingers
69
Management of viral warts
Often does NOT require treatment Treatment should be considered if: Wart is painful (e.g. on soles of feet) Wart is cosmetically unsightly Treatment is persistent If treatment is indicated, consider one of: Topical salicylic acid applied daily for up to 12 weeks Cryotherapy with liquid nitrogen

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