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DERM Flashcards

1
Q

Acne

A
  1. BOTH TYPES: benzyl peroxide 0.25-5%, 2nd daily then daily.
  2. if commedomal mainly –> topiacl retiond
    1. then increase retinoid strength (0.025-0.1%)
    2. then combo BP and retinoid
    3. then PO dozy if male; add OCP (Brenda or Yaz) / spiro if female or oral abx.
    4. THEN refer after 12 week trial.
  3. ​if inflam mainly w papules and pustules
    1. topical clinda/BP
    2. then po doxy/cocp/spiro
  4. inflammatory
    1. mild: topica clinda
    2. mod inflam +/- commedomal: po doxy/topical retinoid +/ COCP
  5. non pharam
    1. avoid
      1. oil based moisturisers
      2. hot/humid environment
      3. makeup/grease
    2. low irritant soap free cleanser.
    3. dont squeeze/pick as scarring.
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2
Q
A

Periorifacial dermatitis

  • ddx seb K, rosacea, dermatitis,a cne.
  • itchy/tender/scaly/papular aroudn eyes, moth nose.
  • spares skin at top of lip and nasolabial fold
  • RF:
    • female, ICS/topical CS worsen, not washing face, cosmetics
  • Mx
    • stop trigger, slow wean steroids.
    • then consider PO doxy OD 8 / 52. vs. metro cream 0.75% 4-6 weeks
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3
Q
A

​Rosacea

  • forehead, chin, cheek, nose.
  • telangiectasia/ papules / flushing
  • RF:
    • celtic skin. 30-60 yo
  • worse w sun/flushing/steroids
  • Mx
    • minimise flushing/etOH
    • avoid steroids
    • soap free cleanser.
    • metro 0.75% gel BD 6 weeks vs. doxy
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4
Q

Hydradenitis suppuritvia

A
  • discharging sinus, recurrent, in apocrine gland
  • RF: obesity, DM, pilonidal sinus, FHx , IBD
  • Mx:
    • non pharma
      • dont squeeze!
      • weight loss
      • dont swab or remove/I+D as it scars and doesnt heal
      • loose clothing
      • healthy diet
    • Med:
      • doxy
      • BP wash, topical clinda.
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5
Q
A

ANNULAR

  • discoid lupus (cutaneous SLE)
  • large, red , scaley, annular plaque.
  • sun exposed areas + sun sensitive
  • spares knuckles and nasolabial folds
  • facial usually
  • malar butterfly rash
  • scarring baldness
  • RF
    • womn, 20-50, Fhx of same
  • non pharma
    • sun protection, smoking cessation
  • pharma
    • biopsy/diagnose
    • mometasone 0.1%
    • watch - might change over to SLE
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6
Q
A

Numular /discoid eczema

  • evolves quickly, clear edge. intense itch. no central clearing like (CLE/tinea). asymmetrical (psoriasis is symm). dry/scaley often. can be exudative
  • RF: atopy
  • Non pharma
    • low irritant, emollient, reduce friction, reduce stress,
  • pharma
    • sedating antihistmaine nocte
    • betamet .1% 2/52.
    • of not worked then 0.05% stronger.
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7
Q
A

Granuloma annulare

  • annular rash
  • central clearing
  • painful
  • on hands/fingers dorsal
  • RF: autoimmune. lymphoma. HIV. female.
  • Mx:
    • can seolf reolve over months.
    • betamet 0.05% BD for 4-6 weeks
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8
Q
A

pityriasis rosea

  • herald patch, then 2 weeks later:
    • rash all over trunk + extends outwards like a christmas tree
    • salmon
    • macular
    • follows langhers lines
  • preceeding viral infection (HHV 6)
  • non pharma
    • self resolved
  • pharma
    • if itchy: betametason.
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9
Q

Types

  • erythrodermic: red scaly eruption over body–> ED
  • guttate: GAS related, tear drops, 2-3 weeks psot infection.
  • plque psoriasis / scalp
A
  • silver scale, annular, all over body, symmetrical, well demarkated
  • can hve nail involvements (pitting, onycholysis, ridges) then more likely to have joint involvement also.
  • can also have in scalp (tinea willc ause hair loss, psoriasis wont)
  • Mx:
    • non pharma
      • stress management, weight loss, reduce flares (etOH/overweight)
      • avoid NSAIDS
      • thick emollients to prevent cracking
      • other trigger: HIV, lithium, FHx.
      • medication review.
    • pharma
      • nocte tar solution (LPC 6%) +/- salicylic acid/urea (3%) to remove scale
      • then mane steroid cream if required, gently wean down
        • momet 0.1% lotion. for scalp + tar shampoo
        • elsewhere: momet 0.1% 2-6 weeks. then betamet 0,05% OVI if not helped
      • and consider derm. for DMARD
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10
Q

eczema

A
  • RF: Atopy/fhx, new trigger
  • OE
    • Extensor surfaces as infant, then older goes to flexor.
    • Itchy, Scaley/dry., Lichenified, rapidly evolving erhteymatous rash
  • Rx:
    • NON PHARMA
      • Moisturise – ointment, vs. lotion. Vs. cream
      • Oat baths / Bath oil
          • bathe less frequently w only luke warm water.
        • Soap free clenser.
      • Moisturise as soon as shower + regularly through day
      • Low irritatnt/avoid triggers/low irritatnt substances
    • PHARM
      • Face: hydrocort 1%
      • Arms:/other: mometasone 0.1%
      • Anything stronger: methylpred for face; betamethasone disproproatonate 0.05%
      • Consider wet wraps – steroid/moisturie/wet wrap w cotton gloves
      • Nocte antihistmianes for itch.
    • Ongoing : derm for phototherapy/picremolius/mtx/etc.
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11
Q

Hair loss

A
  • tinea = black dot/snapped, green on wood lamp, pull out easily.
  • lupus = scarring hair loss, erythema + scaling
  • trichtillomania = diff length hairs, frontopareital.
  • male pattern= thinning, vellous area. genetic.
    • Rx w hair piece/trial topical minoxidil foam / finasteride
  • telegon effluvium = stress/iatrogenic. regrowth at edges.
  • anagen effluvium = CTx/drug related.
  • alopecia areata = localised bald patch, completely abscent, exclamation mark hairs. nail pitting = bad prognosis
  • scarring alopecia = often w out follicular orifice , very smooth w dermatoscope
  • seb derm = patchy scale + itch w erthema. localised temporal hair loss.
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12
Q

ridging of nails

A
  • chronic paronychia
  • beaus lines (transverse)
  • vertical + fine = aging.
  • lichen planus = concave ridging , split distally
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13
Q

pitting of nails

A

psoriasis

pompholyx

alopecia arreata

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14
Q

leuconychia

A
  • fungal dermatophytic
  • whole nail = DM, iron def, CLF, CKD, protein malabsorption
  • truama
  • CT
  • lead
  • arsenic
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15
Q

onycholysis

A

keep nails short

avoid inserting anythign underneath

keep dry

sap free

?candida: fluconazole 150mg OD for 3/12.

if green: pseudo: BD vinegar soaks.

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16
Q

new skin lesion

A

3 rules

1) asymmetrical size or colour
2) abnormal network (lace is thicker than the holes)
3) regression - white/blue

  • Appearance
  • Border
  • Colour
  • Diameter
  • Elevation
17
Q

SCC

A
  • Sx: slow growth, central ulceration , sometimes itchy
  • OE:nasty looking scab… always check localised LN/hepatosplenomegaly
  • Rx: excisional biopsy. good margin 4mm.
18
Q
A

Superficial BCC

DDx IEC

usually younger female pt.

purpley/red/few CM, sometimes plaquey with microerosiosn (red dose).

Rx: cryo, aldara (5 cdays a week, 6 weks), vs. curette/cauterise. vs. excise.

19
Q
A

Nodular BCC

  • always check eye lids and around face. gradual growth, sometimes itchy
  • usually older than IEC presentations
  • pearly, nodular, fine telangiectasisa
  • can also have central ulcration.
  • Rx: excise.
20
Q
A
  • AK
  • immunodef, or sundamaged skin when older.
  • occupational RF also
  • scalp/feet/hands/forehead.
  • flat/ scaley plque, sometimes warty or ertyehmatous base.
  • cryo: if thin: single for 5 seconds. then observation
  • if thick: currette/phototherapy.
  • field Rx: aldara 3-4 weeks; vs. BD effudix 2-4 weeks

predisposes to squamous cell carcinoma

21
Q

IEC

A

slowly growing plaque

often of LL

ddx superficial BCC. sometimes see coiled blood vessels ond ermatoscopy.

Rx:

  1. effudix - BD 4-6 weeks
  2. aldara - 3-5 times/week up to 6 weeks
  3. cryo - can ulcer quite badly
  4. excise
  5. phototherapy
22
Q

Actinitic chelitis

A

RF: smoker, HPV, etOH, immunosup, sun

chronic dry patch on lip

patchy, thickenning, dryness diffusely or localised.

Mx: cryo, EC, laser.

can predispose to Sqcc/iec.

23
Q
A
  • Lichen simplex chronicus
  • chronic itching, often associated w a separate initiatl condition
  • thickenning, intensely itchy, dry w excoration marks
  • Ix: clinical, biopsy if any concerns (IEC).
  • Rx:
    • mometason 0.1% ointment BD until clear, can occlude it also a few hours
    • betamet 0.05% OPV +/- occlusion.
    • if severe itch: TCA, injectable steroid.
  • non pharma:
    • solicylic acid/LPC if lichenified
    • emollient
24
Q
A
  • asteatotic eczema
  • dry/old
  • Rx: moisturise!
    • dont over bathe
    • no soap
    • thick emollient a few times/day.
    • if inflammed: mild steroid like methylpred.
25
Pityriasis
1. rosea 1. post viral 2. herald patch 3. betamet for itch 2. versicolour 1. atsi 2. fungal 3. green under woods lamp 4. rx w ketaconazole shampoo +/- fluconazole PO (not much evdience in kids) 3. alba 1. hypopigmented, facial often in excema prone child 2. moistuurise, mild steroid 3. avoid sun
26
facial rash
1. **dermatomyositis** 1. **includes nasolabial folds** 2. helical rash 2. rosacea 1. flushing, nasal 3. **seb derm** 1. **includes nsolabial folds** 2. rx: topcal (miconazole / hydrocort); scalp (ketoconazole shampoo, momet lotion).. if thick lpc/urea nocte 4. **periorifacial derm** 1. **includes nasolabial fold** 2. spares vermillion border 3. worse w steroid. 5. _cutaneous lupus (discoid)_ 1. _spares nasolabial folds_ 2. _malar /butterfly_
27
* lichen planus * RF: HCV/HIV * genetic * vzv * can cause baldness, itchy ++ nail ridging also. * white lines on it -- \> striae on purple/violet background * Rx: * biopsy to exclude IEC usually. * betamet 0.1%, topical retinoid. * can self resolve by 6-9 months but often will be too itchy.
28
1/6 measles
viral, fever often w cough 2-3 days later koplik (white spots) 1-2 days after that, rash morbiliform. macular. confluent in regions. not itchy. rash goes from ears / face to elsehwere Ix: swabs/bloods. public health notification complciations ++ cnojunctivitis, pneumonitis. myocarditis, thrombocytopenia, bleeding. GN, seizures/ecephalisit. pregnancy risK; preterm labour.
29
2/6 rubella
* viral illness, mild. or asymptomatic * rash * more pink in colour * face then body. * assocaited lymphadenopathy: occipital/periauricaulr * complications * bad for pregnacy * blind/deaf/fetal loss/stillbirth * encephalitis
30
3/6 kawasaki
need 4/5 + fever \> 5 days 1. conjunctivitis (limbic sparing) 2. polymorphous erythematuos rash within first few days - TRUNKAL 3. strawberry tongue/dry cracked bleedign lips 4. hyperaemia + painful oedema hands/feed + desquamatous in 2nd week 5. lymphadenopathy baseline bloods / hospital + but also assess CRP, ESR, BC looking for aneamia/thrombocytosis. can get anuerysms... so ECG * IVIg for Rx. aspirin. specialists
31
4/6 roseola infantum
* HV6. * mildly unwell * often high temp w URTI Sx, then fever and as it resolved --\> morbiliform rash on trunk. pniky. soemtimes haloey. non itchy. * febrile convulsion SFX. * self resolved. viral
32
5/6 chicken pox
you know this. mums: bad if mum not immune if not immune: exposure means hospital, IVIg.
33
6/6
parvovirus * i.e. erythema infectiosum, aka slapped cheek. * prodrome, non specific * day 1-3 slapped cheeck * after day 7 then get maculopapular rash on proximal arms/trunk; central clearing, lace like pattrn (reticular) * worse w temp/friction/heat * rash will then come and go for months * pregnant exposure: PCR + bloods * risk: severe anaemia, hydrops fetalis, miscarriage. * worse damage at \< 20 weeks more risk. * exposure: 1: 100 fetal loss. death from hydrops 1/1000. * infection: 1/20 fetal loss. death from hydrops 1/100
34
erythema...
1. infectiosum 1. slapped cheek 2. nodosum 1. IBD/pregnancy/mycoplasma/sarcoid/nsaisd, chlaydia. COCP/GAS/female: tender, palpable, LL lumbs 3. multiforme (pic) 1. HSV. get target lesions. symmetrical 2. rapidly develops, 100s of lesios in 24 hours. 3. kobner phenomenon + itchy 4. self resolves. Rx trigger. 4. toxicum neonatum 1. day 4-14 comm . face then truk. comes and goes. common in 50% of kids. no Rx required.
35
HSP RF: GAS preceeding Sx: unwell, URTI, abdo pain, arthritis, haemturia, palpable purapura. OE: palpable purapura. Mx: pain manaegment. monitor weekly. weekly 1/12 UA + BP first month; then fortnightly to 3 months, then 6 monthly/12 monthly. complications: CKD, intersucceptoin, orchitis.
36
dermatomyositis
* muscle weakness * cutenaous eruptions * helical mask type erythema * papules on dorsal on IPJ * sun exposed erythema. urgent Derm review.
37
kaposi sarcoma * associated conditions to watch out for: HIV, Herpes virus, immunodef. DM. * sometimes just genetic (mediteranian / mid european descent). * can also be on MM, not just on foot. painless. * Dx: biopsy * Rx: not curable. cosemitc Rx only. can go RTx etc. if they dont improve/reoccur.
38
axillae rash
1. acanthosis nigricans (DM/obesity, ddx gastric adenocarinoma) 2. erythrasma - often also in groinb/etween toes. well defined edge. DM associated, or excessive sweating/immune issues. self limiting, only Rx if not self resolving/superimposed coinfection: clinda, BP, Salicylic acid. 3. nfmatosis: crow sign (freckling of underarms). also see lots of neurofibromas, \> 6 cafe au lait spots, and lische nodusel of the iris. 4. intetrigo (candidal) 5. tinea.
39

EXAM 2021 (10 decks)

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