Derm

Question 1

What is acne vulgaris ?

Answer 1

Acne vulgaris (acne) is an extremely common condition, often affecting people during puberty and adolescence. Most people are affected at some point during their lives, and symptoms can range from mild to severe.

Question 2

Explain the pathophysiology of acne vulgaris?

Answer 2

Acne is caused by chronic inflammation, with or without localised infection, in pockets within the skin known as the pilosebaceous unit. The pilosebaceous units are the tiny dimples in the skin that contain the hair follicles and sebaceous glands. The sebaceous glands produce the natural skin oils and a waxy substance known as sebum.

Acne results from increased production of sebum, trapping of keratin (dead skin cells) and blockage of the pilosebaceous unit. This leads to swelling and inflammation in the pilosebaceous unit. Androgenic hormones increase the production of sebum, which is why acne is exacerbated by puberty and improves with anti-androgenic hormonal contraception. Swollen and inflamed units are called comedones.

The Propionibacterium acnes bacteria is felt to play an important role in acne. This is a bacteria that colonises the skin. It is thought that excessive growth of this bacteria can exacerbate acne. Many of the treatments of acne aim to reduce these bacteria.

Question 3

Presentation of acne

Answer 3

There is significant variation in the severity of acne. It presents with red, inflamed and sore “spots” on the skin, typically distributed across the face, upper chest and upper back.

There are few terms used to describe the appearance of the lesions:

Macules are flat marks on the skin
Papules are small lumps on the skin
Pustules are small lumps containing yellow pus
Comedomes are skin coloured papules representing blocked pilosebaceous units
Blackheads are open comedones with black pigmentation in the centre
Ice pick scars are small indentations in the skin that remain after acne lesions heal
Hypertrophic scars are small lumps in the skin that remain after acne lesions heal
Rolling scars are irregular wave-like irregularities of the skin that remain after acne lesions heal

Question 4

Aim of treatment of acne

Answer 4

The aim of treatment is to reduce the symptoms of acne, reduce the risk of scarring and minimise the psychosocial impact of the condition. Always explore the psychosocial burden and any potential anxiety and depression that may be associated with the condition.

Question 5

Acne Treatment is initiated in a stepwise fashion based on the severity and response to treatment:

Answer 5

No treatment may be acceptable if mild
Topical benzoyl peroxide reduces inflammation, helps unblock the skin and is toxic to the P. acnes bacteria
Topical retinoids (chemicals related to vitamin A) slow the production of sebum (women of childbearing age need effective contraception)
Topical antibiotics such as clindamycin (prescribed with benzoyl peroxide to reduce bacterial resistance)
Oral antibiotics such as lymecycline
Oral contraceptive pill can help female patients stabilise their hormones and slow the production of sebum

Question 6

Acne Tx: Oral retinoids

Answer 6

Oral retinoids for severe acne (i.e. isotretinoin) is an effective last-line option, although it is only prescribed by a specialist after other methods fail. This needs careful follow-up and monitoring and reliable contraception in females. Retinoids are highly teratogenic.

Question 7

What is the most effective combined oral contraceptive for acne?

Answer 7

Co-cyprindiol (Dianette) is the most effective combined contraceptive pill for acne due to it’s anti-androgen effects. It has a higher risk of thromboembolism, so treatment is usually discontinued once acne is controlled and it is not prescribed long term.

Question 8

Tx for acne; Oral isotretinon

Answer 8

Oral isotretinoin (Roaccutane) is very effective at clearing the skin. It is a retinoid, and works by reducing production of sebum, reducing inflammation and reducing bacterial growth. It can only be prescribed under expert supervision by a dermatologist. It is strongly teratogenic (harmful to the fetus during pregnancy). Patients need to have effective and reliable contraception and must stop isotretinoin for at least a month before becoming pregnant.

Question 9

SE of Isotretinoin

Answer 9

Dry skin and lips
Photosensitivity of the skin to sunlight
Depression, anxiety, aggression and suicidal ideation. Patients should be screened for mental health issues prior to starting treatment.
Rarely Stevens-Johnson syndrome and toxic epidermal necrolysis

Question 10

Complications for acne

Answer 10

post-inflammatory scarring, hyperpigmentation, psychosocial impact (self-esteem, depression).

Question 11

Epidemiology of acne

Answer 11

affects around 80-90% of teenagers, 60% of whom seek medical advice
acne may also persist beyond adolescence, with 10-15% of females and 5% of males over 25 years old being affected

Question 12

What is atopic dermatitis (eczema)?

Answer 12

A chronic, relapsing inflammatory skin condition characterized by pruritus, erythema, and dry skin, often associated with atopy.

Question 13

What is the difference between atopic dermatitis and eczema?

Answer 13

Eczema is a general term for skin inflammation, while atopic dermatitis is a specific type of eczema linked to atopy (e.g., asthma, allergic rhinitis).

Question 14

Atopic dermatitis is most commonly seen in __________ but can persist into adulthood.

Answer 14

children

Question 15

What are the common triggers for atopic dermatitis?

Answer 15

Irritants (e.g., soaps, detergents), allergens (e.g., dust mites, pollen), weather changes, stress, infections, and certain fabrics.

Question 16

Atopic dermatitis has a strong genetic component and is commonly associated with mutations in the __________ gene.

Answer 16

filaggrin

Question 17

What is the underlying pathophysiology of atopic dermatitis?

Answer 17

Dysfunction of the skin barrier (filaggrin mutation) leads to increased transepidermal water loss, immune dysregulation, and inflammation.

Question 18

The two key immune pathways involved in atopic dermatitis are the __________ and __________ pathways.

Answer 18

Th2, Th22

Question 19

What are the key features of atopic dermatitis?

Answer 19

Pruritus, dry skin, erythema, excoriation, lichenification, and sometimes weeping or crusting lesions.

Question 20

How does the distribution of atopic dermatitis differ between infants, children, and adults?

Answer 20

Infants: Face and extensor surfaces.

Children: Flexural areas (e.g., elbows, knees).

Adults: Hands, face, and flexural areas.

Question 21

A hallmark symptom of atopic dermatitis is intense __________, leading to the itch-scratch cycle.

Answer 21

pruritus

Question 22

What is the main diagnostic approach for atopic dermatitis?

Answer 22

Clinical diagnosis based on history and examination; no specific tests required.

Question 23

In severe or atypical cases, __________ testing may be used to identify allergens.

Answer 23

patch or IgE

Question 24

What are the four main principles of atopic dermatitis management?

Answer 24

1. Emollients, 2. Topical corticosteroids, 3. Avoiding triggers, 4. Treating infections.

Question 25

Emollients should be applied __________ to maintain skin hydration.

Answer 25

frequently (at least twice daily)

Question 26

What is the stepwise approach for treating atopic dermatitis in the UK?

Answer 26

First-line: Emollients + mild topical steroids (e.g., hydrocortisone). Second-line: Moderate or potent steroids (e.g., betamethasone) for flares. Third-line: Calcineurin inhibitors (e.g., tacrolimus) for sensitive areas. Severe cases: Systemic immunosuppressants (e.g., ciclosporin, dupilumab).

Question 27

When should topical steroids be applied in relation to emollients?

Answer 27

Topical steroids should be applied after emollients, with a 30-minute gap.

Question 28

Wet wrap therapy can be used in __________ cases to enhance treatment absorption and reduce scratching.

Answer 28

severe

Question 29

What are common complications of atopic dermatitis?

Answer 29

Skin infections (e.g., Staphylococcus aureus, herpes simplex), lichenification, psychological distress, and sleep disturbance.

Question 30

Eczema herpeticum is a serious complication caused by __________ infection in atopic dermatitis patients

Answer 30

herpes simplex virus (HSV)

Question 31

What is the most common type of contact dermatitis?

Answer 31

Irritant contact dermatiits

Question 32

What is irritant contact dermatitis?

Answer 32

non-allergic reaction due to weak acids or alkalis (e.g. detergents).

Question 33

What is the presentation of irritant contact dermatitis?

Answer 33

Often seen on the hands. Erythema is typical, crusting and vesicles are rare

Question 34

What type of hypersensitivity reaction is allergy contact dermatiits?

Answer 34

type IV hypersensitivity reaction

Question 35

What is allergic contact dermatitis?

Answer 35

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. Topical treatment with a potent steroid is indicated

Question 36

How does cement cause contact dermatitis?

Answer 36

Cement is a frequent cause of contact dermatitis. The alkaline nature of cement may cause an irritant contact dermatitis whilst the dichromates in cement also can cause an allergic contact dermatitis

Question 37

What is contact dermatitis?

Answer 37

Contact dermatitis is an inflammatory skin reaction caused by direct contact with an irritant or allergen, leading to erythema, pruritus, and skin damage.

Question 38

What are the two main types of contact dermatitis?

Answer 38

Irritant contact dermatitis (ICD): Caused by direct damage to the skin from irritants (e.g., soaps, detergents). Allergic contact dermatitis (ACD): Delayed hypersensitivity reaction to allergens (e.g., nickel, latex).

Question 39

What are common causes of irritant contact dermatitis?

Answer 39

Soaps, detergents, solvents, prolonged water exposure, acids, alkalis, and frequent handwashing.

Question 40

What are common allergens that cause allergic contact dermatitis?

Answer 40

Nickel (jewellery), fragrances, latex, hair dyes (paraphenylenediamine), and preservatives.

Question 41

he most common occupational cause of contact dermatitis is exposure to __________.

Answer 41

wet work (e.g., healthcare, hairdressing)

Question 42

What is the underlying mechanism of irritant contact dermatitis?

Answer 42

Direct damage to the skin barrier by irritants, leading to inflammation and disruption of the epidermis.

Question 43

Allergic contact dermatitis typically takes __________ hours to develop after allergen exposure.

Answer 43

24–72

Question 44

How does the appearance of irritant vs. allergic contact dermatitis differ?

Answer 44

Irritant: More localized, burning sensation, often seen on hands. Allergic: Well-demarcated, pruritic, often with vesicles or weeping.

Question 45

Chronic contact dermatitis can lead to skin thickening and __________.

Answer 45

lichenification

Question 46

How is contact dermatitis diagnosed?

Answer 46

Mainly clinical, but patch testing can confirm allergic contact dermatitis.

Question 47

What are the key principles of managing contact dermatitis?

Answer 47

Avoidance of the irritant/allergen. Emollients to restore the skin barrier. Topical steroids for inflammation. Education on skin protection.

Question 48

Mild contact dermatitis is managed with topical __________ steroids such as hydrocortisone.

Answer 48

corticosteroids

Question 49

When are systemic treatments used for contact dermatitis?

Answer 49

In severe cases, oral corticosteroids (e.g., prednisolone) or immunosuppressants (e.g., azathioprine) may be needed.

Question 50

What preventative strategies can reduce the risk of occupational contact dermatitis?

Answer 50

Wearing gloves, using barrier creams, minimizing irritant exposure, and applying frequent emollients.

Question 51

What are potential complications of contact dermatitis?

Answer 51

Secondary bacterial infection (e.g., Staphylococcus aureus) Chronic lichenification and skin thickening Psychosocial impact (e.g., stress, work-related issues)

Question 52

What is psoriasis?

Answer 52

Psoriasis is a chronic autoimmune condition that causes recurrent symptoms of psoriatic skin lesions. There is a large variation in how severely patients are affected with psoriasis. There appears to be a genetic component but no clear genetic inheritance has been established. Around a third of patients have a first degree relative with psoriasis. The symptoms start in childhood in a third of patients.

Question 53

Presentation of psoriasis

Answer 53

Patches of psoriasis are dry, flaky, scaly, faintly erythematous skin lesions that appear in raised and rough plaques, commonly over the extensor surfaces of the elbows and knees and on the scalp. These skin changes are caused by the rapid generation of new skin cells, resulting in an abnormal buildup and thickening of the skin in those areas.

Question 54

Plaque psoriasis

Answer 54

features the thickened erythematous plaques with silver scales, commonly seen on the extensor surfaces and scalp. The plaques are 1cm – 10cm in diameter. This is the most common form of psoriasis in adults.

Question 55

Guttate psoriasis

Answer 55

the second most common form of psoriasis and commonly occurs in children. It presents with many small raised papules across the trunk and limbs. The papules are mildly erythematous and can be slightly scaly. Over time the papules in guttate psoriasis can turn into plaques. Guttate psoriasis is often triggered by a streptococcal throat infection, stress or medications. It often resolves spontaneously within 3 – 4 months.

Question 56

Pustular psoriasis

Answer 56

a rare severe form of psoriasis where pustules form under areas of erythematous skin. The pus in these areas is not infectious. Patients can be systemically unwell. It should be treated as a medical emergency and patients with pustular psoriasis initially require admission to hospital.

Question 57

Erythrodermic psoriasis

Answer 57

a rare severe form of psoriasis with extensive erythematous inflamed areas covering most of the surface area of the skin. The skin comes away in large patches (exfoliation) resulting in raw exposed areas. It should be treated as a medical emergency and patients require admission.

Question 58

___ psoriasis is more common in children.

Answer 58

In children the distribution and presentation of psoriasis may differ from adults. Guttate psoriasis is more common in children, often triggered by a throat infection. Plaques of psoriasis are likely to be smaller, softer and less prominent. There are a few specific signs suggestive of psoriasis: Auspitz sign Koebner phenomenon Residual pigmentation The diagnosis can be made based on the clinical appearance of the lesions.

Question 59

What is Auspitz sign?

Answer 59

Auspitz sign refers to small points of bleeding when plaques are scraped off

Question 60

What is Koebner phennomenon?

Answer 60

Koebner phenomenon refers to the development of psoriatic lesions to areas of skin affected by trauma

Question 61

What is Residual Pigmentation?

Answer 61

Residual pigmentation of the skin after the lesions resolve

Question 62

Tx options for psoriasis

Answer 62

Management depends on the severity of the condition. Psoriasis in children is usually managed and followed up by a specialist. It can be difficult to treat and psychosocial support is very important. The treatment options include: Topical steroids Topical vitamin D analogues (calcipotriol) Topical dithranol Topical calcineurin inhibitors (tacrolimus) are usually only used in adults Phototherapy with narrow band ultraviolet B light is particularly useful in extensive guttate psoriasis

Question 63

What can you try if inital tx doesnt work for psoriasis?

Answer 63

Rarely, where topical treatments fail with severe and difficult to control psoriasis, children may be started on unlicensed systemic treatment under the guidance of an experienced specialist. This might include methotrexate, cyclosporine, retinoids or biologic medications. There are two products that contain both a potent steroid and vitamin D analogue that are commonly prescribed and worth being aware of. These not licensed in children and will be guided by a specialist. Dovobet Enstilar

Question 64

What are some associations with psoriasis?

Answer 64

Nail psoriasis describes the nail changes that can occur in patients with psoriasis. These include nail pitting, thickening, discolouration, ridging and onycholysis (separation of the nail from the nail bed). Psoriatic arthritis occurs in 10 – 20% of patients with psoriasis and usually occurs within 10 years of developing the skin changes. It typically affects people in middle age but can occur at any age. Psychosocial implications of having chronic skin lesions, which may affect mood, self esteem and social acceptance and cause depression and anxiety. Other co-morbidities that increase the risk of cardiovascular disease are associated with psoriasis, particularly obesity, hyperlipidaemia, hypertension and type 2 diabetes.

Question 65

What are fungal skin infections?

Answer 65

Fungal skin infections are caused by dermatophytes, yeasts, or moulds, leading to inflammation, itching, and scaling of the skin.

Question 66

What are the three main types of fungi responsible for fungal skin infections?

Answer 66

Dermatophytes (e.g., Trichophyton, Microsporum, Epidermophyton) – cause tinea infections. Yeasts (e.g., Candida, Malassezia) – cause candidiasis and pityriasis versicolor. Moulds – rare, usually affect immunocompromised individuals.

Question 67

Dermatophyte infections are commonly known as __________ infections.

Answer 67

tinea

Question 68

What are common risk factors for fungal skin infections?

Answer 68

Warm, moist environments, poor hygiene, immunosuppression, diabetes, obesity, prolonged antibiotic or corticosteroid use.

Question 69

How do dermatophyte fungi cause skin infections?

Answer 69

They invade and digest keratin in the skin, hair, and nails, leading to inflammation and characteristic scaling.

Question 70

Yeast infections, such as candidiasis, occur due to overgrowth of __________, which is a normal commensal organism.

Answer 70

Candida albicans

Question 71

What are the different types of tinea infections and their affected areas?

Answer 71

Tinea pedis (Athlete’s foot): Feet, particularly between toes. Tinea corporis (Ringworm): Trunk, arms, legs. Tinea capitis: Scalp. Tinea cruris (Jock itch): Groin and inner thighs. Tinea unguium (Onychomycosis): Nails.

Question 72

What are the typical features of tinea infections?

Answer 72

Annular (ring-shaped) erythematous plaques with central clearing, scaling, and itching.

Question 73

Tinea capitis often presents with __________ hair loss and scaling on the scalp.

Answer 73

patchy

Question 74

What are common sites affected by cutaneous candidiasis?

Answer 74

Skin folds (axilla, groin, under breasts), intertriginous areas, and nails.

Question 75

What are the key features of candidiasis?

Answer 75

Red, moist patches with satellite lesions, often with maceration in skin folds.

Question 76

Oral candidiasis presents as white, curd-like plaques on the __________ that can be scraped off.

Answer 76

tongue

Question 77

What are the key clinical features of pityriasis versicolor?

Answer 77

Hypopigmented or hyperpigmented macules on the trunk, with fine scaling and mild itching.

Question 78

Pityriasis versicolor is caused by overgrowth of __________ yeast on the skin.

Answer 78

Malassezia

Question 79

What diagnostic tests can confirm fungal skin infections?

Answer 79

Microscopy with KOH preparation – Identifies fungal hyphae. Fungal culture – Identifies specific fungal species. Wood’s lamp examination – Some fungi fluoresce under UV light.

Question 80

A Wood’s lamp examination can help diagnose __________, as some species fluoresce green.

Answer 80

tinea capitis

Question 81

What are the first-line treatments for most fungal skin infections?

Answer 81

Topical antifungals (e.g., clotrimazole, terbinafine, miconazole).

Question 82

When are systemic antifungals required for fungal skin infections?

Answer 82

In severe, widespread, or nail/scalp infections (e.g., oral terbinafine or itraconazole for tinea capitis and onychomycosis).

Question 83

Tinea capitis requires systemic treatment, usually oral __________.

Answer 83

terbinafine

Question 84

What lifestyle measures help prevent recurrence of fungal infections?

Answer 84

Keeping skin dry, wearing breathable clothing, avoiding shared towels, and treating asymptomatic carriers in households.

Question 85

What are potential complications of untreated fungal skin infections?

Answer 85

Secondary bacterial infections (e.g., cellulitis), chronic inflammation, nail dystrophy (onychomycosis), and scarring alopecia (tinea capitis).

Question 86

Chronic, untreated fungal infections can lead to secondary __________ infections.

Answer 86

bacterial

Question 87

What is ringworm

Answer 87

Ringworm is a common superficial fungal infection which affects the skin. The infection is colloquially called “ringworm” because lesions are often circular-shaped. Despite this name, ringworm is not a parasitic worm infection. Ringworm can also be referred to as tinea or dermatophytosis. Ringworm is more common in hot and humid environments.

Question 88

causes of ringworm

Answer 88

Ringworm (tinea) is caused by dermatophytes (a type of fungus). Depending on the location, the condition can be referred to as:1,2,3 Tinea capitis (affecting the scalp) Tinea pedis (affecting the feet) Tinea cruris (affecting the groin) Tinea corporis (affecting any other skin site) In the community, ringworm of the feet may be called “athlete’s foot”, while ringworm of the groin may be called “jock itch”. Common species of dermatophyte include T. rubrum, T. interdigitale and T. tonsurans. Zoonotic species such as M. canis, T. verrucosum, T. equinum and T. erinacei may be present in those that interact with animals.1

Question 89

risk factors for ringworm

Answer 89

Ringworm is spread by skin-skin contact or contact with an infected surface. Risk factors include: Male sex Contact with an infected person Frequent use of communal shower facilities Not drying feet adequately (risk of tinea pedis) The most at-risk groups include children attending daycare and early school and households of an infected person. Medical risk factors are those primarily relating to an immunocompromised state or skin condition affecting the skin’s barrier, and include:1,2 Previous tinea infections Diabetes mellitus Hyperhidrosis Xerosis (dry skin) Ichthyosis

Question 90

Symptoms for ringworm

Answer 90

Itch: An asymmetrical rash consisting of solitary circular erythematous patches with a raised scaly leading edge and a clearing centre (hypopigmentation within the ring)

Question 91

Ix for ringworm

Answer 91

Ringworm is a clinical diagnosis. A skin scraping of the leading edge may be taken to confirm the diagnosis, especially in cases which do not respond to initial anti-fungal treatment. Skin scrapings can be sent for microscopy, culture and sensitivities. Any topical therapy must be removed before collecting scrapings. Hair and nail cuttings may also be used. A Wood’s lamp can examine hair as affected hairs will fluoresce green. Treatment-resistant or atypical presentations may require a skin biopsy.

Question 92

Tx for ringworm

Answer 92

The first line of management is topical therapy: Topical terbinafine 1%: formulated as a cream (body, scalp, feet, nails), gel (body, scalp, groin), spray (interdigital, body, scalp) or liquid (interdigital). Used once or twice daily for one to two weeks. Econazole (or a similar azole) cream: applied once or twice daily for two weeks.

Question 93

Oral therapy for ringworm

Answer 93

Oral therapy is the next-line treatment option if the infection is severe, affecting multiple sites, recurrent, or not responding to topical treatment.4 The first option is oral terbinafine 250mg daily for adults. For children under 20kg, the dose is 62.5mg daily. For those 20 – 40 kgs, it is 125mg daily. The length of treatment is dependent on the site of infection: Scalp: four weeks Fingernails: six weeks Toenails: 12 weeks Other body sites: two weeks The next option is griseofulvin (for tinea of the hair and scalp only) for 4-6 weeks and up to 1 year: Scalp/hair/groin: 500mg daily Feet/nails: 1 g daily The last line of therapy is oral fluconazole or itraconazole.

Question 94

What are warts?

Answer 94

Warts are benign epidermal growths caused by human papillomavirus (HPV) infection, leading to hyperkeratosis and papillomatosis.

Question 95

What virus causes warts?

Answer 95

Human papillomavirus (HPV).

Question 96

How are warts transmitted?

Answer 96

Direct skin-to-skin contact, autoinoculation, and contact with contaminated surfaces (e.g., communal showers, swimming pools).

Question 97

What are risk factors for developing warts?

Answer 97

Immunosuppression (e.g., HIV, organ transplant patients). Skin trauma (e.g., shaving, nail-biting). Prolonged moisture exposure. Young age (common in children and adolescents).

Question 98

How does HPV cause warts?

Answer 98

HPV infects basal keratinocytes, leading to uncontrolled keratinocyte proliferation, hyperkeratosis, and formation of a raised lesion.

Question 99

What are the different types of warts and their typical locations?

Answer 99

Common warts (Verruca vulgaris): Hands, fingers, knees. Plantar warts (Verruca plantaris): Soles of feet, often painful. Flat warts (Verruca plana): Face, hands, legs (smooth, flat-topped). Genital warts (Condylomata acuminata): Anogenital region. Periungual warts: Around fingernails and toenails.

Question 100

How do common warts typically appear?

Answer 100

Firm, rough, hyperkeratotic papules with a cauliflower-like surface.

Question 101

What is a distinguishing feature of plantar warts compared to corns?

Answer 101

Plantar warts disrupt skin lines, whereas corns do not.

Question 102

What symptoms may be associated with warts?

Answer 102

Generally asymptomatic, but plantar warts can be painful with walking.

Question 103

How are warts diagnosed?

Answer 103

Clinical diagnosis based on characteristic appearance.

Question 104

When should a biopsy be considered for a wart?

Answer 104

f there is suspicion of malignancy, rapid growth, ulceration, or atypical features.

Question 105

What are the first-line treatments for common warts?

Answer 105

Topical salicylic acid (keratolytic). Cryotherapy (liquid nitrogen).

Question 106

How does salicylic acid work in wart treatment?

Answer 106

It breaks down keratin, softening the wart and promoting exfoliation.

Question 107

How does cryotherapy work for warts?

Answer 107

Freezes the wart, causing cell damage and an immune response to clear HPV.

Question 108

When are more invasive treatments used for warts?

Answer 108

For persistent or resistant warts, options include: Electrocautery. Laser therapy. Surgical excision.

Question 109

Why is surgical excision not commonly used for wart removal?

Answer 109

High recurrence rate and risk of scarring.

Question 110

What are alternative treatments for resistant warts?

Answer 110

Topical immunotherapy (e.g., imiquimod, diphencyprone). Intralesional bleomycin. Photodynamic therapy.

Question 111

What are potential complications of warts?

Answer 111

Pain and discomfort (especially plantar warts). Secondary bacterial infection. Recurrence. Psychological distress (e.g., embarrassment, social stigma).

Question 112

What is urticaria?

Answer 112

Urticaria are also known as hives. They are small itchy lumps that appear on the skin. They may be associated with a patchy erythematous rash. This can be localised to a specific area or widespread. They may be associated with angioedema and flushing of the skin. Urticaria can be classified as acute urticaria or chronic urticaria.

Question 113

Pathophysiology of urticaria

Answer 113

Urticaria are caused the release of histamine and other pro-inflammatory chemicals by mast cells in the skin. This may be part of an allergic reaction in acute urticaria or an autoimmune reaction in chronic idiopathic urticaria.

Question 114

Causes of acute urticaria

Answer 114

Acute urticaria is typically triggered by something that stimulates the mast cells to release histamine. This may be: Allergies to food, medications or animals Contact with chemicals, latex or stinging nettles Medications Viral infections Insect bites Dermatographism (rubbing of the skin)

Question 115

Chronic urticaria

Answer 115

Chronic urticaria is an autoimmune condition, where autoantibodies target mast cells and trigger them to release histamines and other chemicals. It can be sub-classified depending on the cause: Chronic idiopathic urticaria Chronic inducible urticaria Autoimmune urticaria

Question 116

Chronic idiopathic urticaria

Answer 116

Chronic idiopathic urticaria describes recurrent episodes of chronic urticaria without a clear underlying cause or trigger.

Question 117

Chronic inducible urticaria

Answer 117

Chronic inducible urticaria describes episodes of chronic urticaria that can be induced by certain triggers, such as: Sunlight Temperature change Exercise Strong emotions Hot or cold weather Pressure (dermatographism)

Question 118

Autoimmune urticaria

Answer 118

Autoimmune urticaria describes chronic urticaria associated with an underlying autoimmune condition, such as systemic lupus erythematosus.

Question 119

Management of urticaria

Answer 119

Antihistamines are the main treatment for urticaria. Fexofenadine is usually the antihistamine of choice for chronic urticaria. Oral steroids may be considered as a short course for severe flares. In very problematic cases referral to a specialist may be required to consider treatment with: Anti-leukotrienes such as montelukast Omalizumab, which targets IgE Cyclosporin

Question 120

Why do venous ulcers occur?

Answer 120

Venous ulcers occur due to the pooling of blood and waste products in the skin secondary to venous insufficiency.

Question 121

Where do venous ulcers occur?

Answer 121

Occur in the gaiter area (between the top of the foot and bottom of the calf muscle)

Question 122

What are venous ulcers associated with?

Answer 122

Are associated with chronic venous changes, such as hyperpigmentation, venous eczema and lipodermatosclerosis

Question 123

When do venous ulcers occur?

Answer 123

Occur after a minor injury to the leg

Question 124

How do venous ulcers compare to arterial ulcers?

Answer 124

Are larger than arterial ulcers Are more superficial than arterial ulcers Are less painful than arterial ulcers

Question 125

Presentation of venous ulcers

Answer 125

Have irregular, gently sloping border Are more likely to bleed

Question 126

Tx of venous ulcers

Answer 126

Have pain relieved by elevation and worse on lowering the leg

Question 127

Management of venous ulcers

Answer 127

The management here is based on the NICE CKS (last updated January 2021). Patients may require referral to: Vascular surgery where mixed or arterial ulcers are suspected Tissue viability / specialist leg ulcer clinics in complex or non-healing ulcers Dermatology where an alternative diagnosis is suspected, such as skin cancer Pain clinics if the pain is difficult to manage Diabetic ulcer services (for patients with diabetic ulcers) Patients require input from experienced nurses, such as the district nurses or tissue viability nurses. Good wound care involves: Cleaning the wound Debridement (removing dead tissue) Dressing the wound Compression therapy is used to treat venous ulcers (after arterial disease is excluded with an ABPI). Pentoxifylline (taken orally) can improve healing in venous ulcers (but is not licensed). Antibiotics are used to treat infection. Analgesia is used to manage pain (avoid NSAIDs as they can worsen the condition).