Derm Flashcards by Sam Naylor

Crusted scabies in patient with HIV

Norwegian scabies… extremely infectious

Isolate. Oral Ivermectin

How well did you know this?

Not at all

Perfectly

Dermatitis herpetiformis

Intensely itchy rash on buttocks and top of thigh, assx w coeliac

If gluten free diet doesn’t resolve, can use dapsone with relief of itch within a few days

Oral and potent steroids are used second line

How well did you know this?

Not at all

Perfectly

Chickenpox exposure management in pregnancy

Give immunoglobulin if all of

Significant exposure
Increased risk of severe reaction - immunosuppressed, neonates or pregnant
No antibodies
Rash not already developed

In <20 week preg if they’re not immune, give VZIG asap if within 10 days after exposure

if > 20 weeks and not immune then either VZIG or antivirals (aciclovir or valaciclovir) should be given days 7 to 14 after exposure

> 20 weeks and gets it, then oral aciclovir. Under 20 than consider with caution

How well did you know this?

Not at all

Perfectly

salmon-pink, maculopapular rash

Adult onset Stills disease

feat: Arthralgia, pyrexia, Elevated ferritin

How well did you know this?

Not at all

Perfectly

Target lesions

Erythema multiforme

Most commonly caused by herpes simplex virus
Followed by Mycoplasma pneumoniae

How well did you know this?

Not at all

Perfectly

Patient with end stage renal failure, raised calcium and PTH,painful necrotic skin lesions. What are they?

Calciphylaxis

.,.deposition of calcium within arterioles causing microvascular occlusion and necrosis of the supplied tissue

Warfarin is contraindicated

confirmed on skin biopsy. PTH is sensitive but not specific for calciphylaxis

How well did you know this?

Not at all

Perfectly

Tense fluid filled blisters. Management?

Bullous pemphigoid: PO steroids

How well did you know this?

Not at all

Perfectly

Young patient with hypothyroidism presents with round bald patches on scalp
Diagnosis and management

Alopecia areata
Autoimmune, triggered by viral
Monitor… Half get spontaneous regrowth in months

Can sometimes give topical steroids, dithranol, triamcinolone acetonide injections

How well did you know this?

Not at all

Perfectly

Non healing sterile (culture negative) ulcer

Diagnosis

Pyoderma granulosum
Painful,assx with RA
Pred 60mg OD usually resolves it

How well did you know this?

Not at all

Perfectly

Most common trigger of erythema Multiforme

Hsv in ~50%

target lesions, initially seen on the back of the hands / feet before spreading to the torso

next most common mycoplasma

How well did you know this?

Not at all

Perfectly

Management for bullous pemphigoid

Derm ref for biopsy
- immunofluorescence shows IgG and C3 at the dermoepidermal junction
Oral corticosteroids, usually heal without scarring

How well did you know this?

Not at all

Perfectly

11mm eryhrmatous papule with minimally everted edges, slight scale, no telangiectasia

SCC

Can be side effect of treatment for melanoma w vemurafenib paradoxically

How well did you know this?

Not at all

Perfectly

Difference between birthmark that is from birth Vs adolescence

Aka epidermal naevi

Adolescence is more like to have linear pattern

How well did you know this?

Not at all

Perfectly

Management of actinic keratosis

small, crusty or scaly, lesions … pink, red, brown or the same colour as the skin on exposed areas

fluorouracil cream: typically a 2 to 3 week course.

How well did you know this?

Not at all

Perfectly

Patient presents w white patch on the side of the tongue with a corrugated appearance. Cannot be scraped off

Oral hairy leukoplakia

Ebv in HIV; AIDS defining

Benign
best Tx is antiretrovirals, resolve as CD4 goes up

How well did you know this?

Not at all

Perfectly

velvety hyperpigmented skin in axilla is called ? and associated with?

acanthosis nigricans

gastric Ca, obesity, insulin resistance, hypothyroidism

How well did you know this?

Not at all

Perfectly

Crohn’s stoma presents with soreness

well-demarcated, full-thickness skin ulceration around stoma. A little slough and Punched-out appearance w violaceous border

pyoderma gangrenosum
- a recognised complication of Crohn’s. and commonly involves peristomal skin ?Koebner phenomenon.

PO prednisolone

How well did you know this?

Not at all

Perfectly

skin conditions w reactive arthritis

Urethritis
Circinate balanitis (painless vesicles on the coronal margin of the prepuce)
Keratoderma blenorrhagica (waxy yellow/brown papules on palms and soles)

How well did you know this?

Not at all

Perfectly

painful oral ulceration, flaccid blisters and erosions

diagnosis and what investigation?

pemphigus vulgaris

Ix: direct immunofluorescence of skin
Tx steroids

How well did you know this?

Not at all

Perfectly

pemphigus vulgaris investigation to diagnosis

Direct immunofluorescence of skin

How well did you know this?

Not at all

Perfectly

two month hx of 1cm, firm keratotic nodule on the back of his right hand, BG of renal transplant

sun-exposed, rapid growing, immunosuppressed,

SCC
excise and histology

what causes pityriasis versicolor

the yeast Malassezia furfur

what dressing do you use for ulcers?

Hydrocolloid dressings

or Antibacterial and silver-impregnated if local infection
Alginate dressings exudative wounds

Dressings used w exudative wounds

Alginate dressings

or Antibacterial and silver-impregnated if local infection

lace-like purplish mottled skin appearance. Causes?

livedo reticularis - SLE, Polyarteritis nodosa, antiphos syndrome, chol embolism, Amantadine (PD drug) SE

malar rash and arthralgia | ANA positive , dsDNA negative

Drug-induced lupus | May have anti-histone antibodies ( 80-90%)

Macpap rash on palms and soles Diarrhoea Post liver transplant

Graft Vs host

pregnant penetrating injury then small red/brown spot then raised, red/brown lesion, spherical in shape

Pyogenic granuloma preg is a risk factor often resolve spontaneously post-partum

necrobiosis lipoidica diabeticorum management

topical steroids painless rash on shins typically in diabetics

pt w T-cell cutaenous lymphoma develops pruritis, erythroderma typically affecting the palms, soles and face,

Sezary syndrome

Coumarin skin necrosis mechanism

when first started, biosynthesis of protein C is reduced ...leading to temporary PROcoagulant state Can be avoided by bridging w heparin

patient on long term 20mg Pred develops chickenpox. MAnagement

>14d 20mg pred is immunosuppressed or >7d 40mg so treat w IV aciclovir NSAIDs may increase risk of secondary bacterial infection

Rash in Microscopic polyangiitis

palpable purpura

superimposed worsening erythema and signif pain following chickenpox infection... what cause?

Invasive group A Streptococcus, a β-haemolytic Streptococcus, has been implicated as the cause for necrotizing fasciitis in patients with chickenpox.

person w Crohn's develops non-melanoma skin cancer.. why?

Azathioprine increased risk of non-melanoma skin cancer

Patient with end stage renal failure, raised calcium and PTH, painful necrotic skin lesions. What test to confirm diagnosis?

Calciphylaxis, confirmed on skin biopsy. PTH is sensitive but not specific for calciphylaxis

Calciphylaxis prognosis

mortality rate associated with calciphylaxis is as high as 60–80% (!) Better if distal lesions, worse if proximal

pt notices a 'slate-grey' appearance after starting a med

Amiodarone

What is positive Nikolsky's sign?

the appearance of epidermis separating with mild lateral pressure in toxic epidermal necrolysis and Pemphigus vulgaris

Treatment for guttate psoriasis

Self resolve in 2-3 months but can use UVB therapy Can do tonsillectomy if recurrent (Tonsillitis is a common streptococcal inf, which can trigger guttate psoriasis)

diagnosis for symmetrical erythematous lesions on shins with shiney orange peel texture

pretibial myxoedema (seen in Graves)

Old burn or scar... Patient presents with painless ulcerated lesion.. what is it?

SCC in 80% of cases. And is more dangerous -likely to metastasise

Small blisters on the palms and soles Pruritic, sometimes burning sensation Diagnosis

Pompholyx...AKA Dyshidrosis Type of eczema often triggered by hot climates. Cold compress, emollients, topical steroids... But quite resistant to treatment

Treatment for keloid scar

Triamcinolone (topical steroids) if early

Patient develops oval erythematous plaque then generalised pruritic rash. Diagnosis and what virus is linked to it?

Pityriasis rosea Herpes hominis virus 7 (HHV-7) is thought to play a role in the aetiology self-limiting - usually disappears after 6-12 weeks

Patient with herpes... What sign indicates ocular involvement is likely?

Vesicles on the tip of the nose, or vesicles on the side of the nose...Hutchinson's sign - strongly predictive for ocular involvement...

pinpoint petechial 'blueberry muffin' skin lesions

congenital cytomegalovirus

Small, red-brown macules that may coalesce into larger patches with sharp borders; may be asymptomatic or pruritic; fluoresces coral-red on Wood lamp examination

Erythrasma Overgrowth of diphtheroid Corynebacterium minutissimum, often due to humid environments Coral red florescence on Wood's light Topical miconazole (Acnathosis nigracans is: Hyperpigmentation with velvety, thickened skin, predominantly on posterior neck and body folds)

photosensitive rash with blistering and skin fragility on the face and dorsal aspect of hands

Porphyria cutanea tarda inherited defect in uroporphyrinogen decarboxylase OR caused by hepatocyte damage e.g. alcohol, hepatitis C, oestrogen urine: elevated uroporphyrinogen and pink fluorescence of urine under Wood's lamp Mx: chloroquine

Skin biopsy of tender nodules on legs

Erythema nodosum - neutrophil panniculitis

patient had chickenpox recently then presents w painful rash, hypotensive, fever, AKI Diagnosis / management

Chickenpox is a risk factor for invasive group A streptococcal soft tissue infections including necrotising fasciitis NSAIDs may increase the risk of developing this Tx: Surgery