Derm

Question 1

1st line management of acne?

Answer 1

Topical combination therapy (topical retinoid, benzyl P)

(topical adapalene with Benzyl P)

(topical retinoid with topical clinda)

(topical clinda with topical benzyl P)

NOTE: ADAPALENE is a topical retinoid

Question 2

TOPICAL Benzyl P can be used first line as montotherapy if people wish to avoid ABx / retinoid

Question 3

What ABx for acne in pregnancy?

Answer 3

Erythromycin

Question 4

What is a known complication of long term ABx in acne and Rx?

Answer 4

Gram -ve folliculitis.

Use high dose trimethoprim

Question 5

Mild acne definition?

Answer 5

Open and closed comedones with or without sparse inflammatory lesions

Question 6

Moderate acne definition?

Answer 6

Widespread, numerous pustules and papules

Question 7

Severe acne definition?

Answer 7

Extensive inflam lesions with nodules, pitting and scarring

Question 8

Acne rosacea 1st line Rx?

Answer 8

Topical ivermicten (alternative include metronidazole or azeleic acid)

Question 9

What can be used for flushing in acne rosacea?

Answer 9

Topical brimonidine (topical alpha adrenergic agonist)

Question 10

Use moderate to severe papule or pustules in rosacea ?

Answer 10

Topical ivermicten and oral doxycycline

Question 11

Management of eczema herpeticum and cause?

Answer 11

HSV 1 / HSV 2

Rapidly progressing painful rash in people with eczema

Admit for IV aciclovir

Question 12

HLA associations of psoriasis?

Answer 12

B13 / B17

Question 13

What causes guttate psoriasis?

Answer 13

Strep infection.

2-4 weeks prior

‘Tear drop scaly papules’ Usually self resolve

Question 14

1st line Rx of psoriasis

Answer 14

Potent steroid and Vit D analogue (calcipotriol). (OD one in am, one in PM)

For up to 4 weeks

Question 15

2nd line treatment of psoriasis (if no response after 8 weeks)

Answer 15

Vitamin D analogue BD

Question 16

3rd line Rx psoriasis?

Answer 16

Potent steroid BD for 4/52 or coal tar daily

Question 17

Management of psoriasis in secondary care?

Answer 17

Methotrexate 1st line.

Also Narroband UVB, PUVA (RISK OF SCC)

Question 18

Management of scalp psoriasis

Answer 18

NICE recommend potent steroid for 4 weeks

NOTE: NICE recommend a 4 week break between steroid courses.

Question 19

Face, flexural or genital psosirais ?

Answer 19

Mild/mod steroid for 2/52

Question 20

Duration of use of steroids as per nice:

Answer 20

Can use potent up to 8 weeks

Very potent up to 4 weeks

Hydro. (mild)
Eumovate (mod)
Betnovate (pot)
Dermovate (v. pot)

Question 21

How do Vit D analogues work in psoriasis?

Answer 21

they work by ↓ cell division and differentiation → ↓ epidermal proliferation

Question 22

Nail signs in psoriasis?

Answer 22

Pitting, Onycholysis (when nail separates from nail bed). Loss of mail. Keratosis