Derm management Flashcards
(30 cards)
Chronic psoriasis plaque management
Topical corticosteroids + Vit D analogue (calcipotriol, calcitriol, tacalcitol) 1x daily 4 wks
4 week break
2nd line - vit D analogue 2x daily
4 week break/no improvement
3rd line - Potent steroid 2x daily / coal tar prep 2x daily
Secondary care
Phototherapy - Narrow band UVB light 3x/wk/PUVA - risk of SCC
Oral methotrexate - if joint involvement
Mx scalp psoriasis
Topical corticosteroids - 1x daily 4/wk
no improvement after 4wks - use different preparation
Face, flexural, genital psoriasis mx
mild/moderate corticosteroid use 1/2 x daily for 2 weeks
Exacerbations of plaque psoriasis
Trauma
Alcohol
Drugs:
Beta-blockers
ACEi
NSAIDs
Li
Antimalarials
Tinea Corporis (fungal skin infection by dermatophytes) mx
trial of antifungal - terbinafine
no improvement - take scrapings
Exacerbations of acne rosacea
Sunlight
Alcohol
Exercise
When to do excisional biopsy?
Atypical lesion suspicion of melanoma
Need adequate margins
What condition may predispose to SCC on genitals?
Lichen Sclerosis
Pyoderma gangrenosum mx
Oral steroids
Ciclosporin + infliximab difficult cases
Associations of pyoderma gangrenosum
IBD
Rheum - SLE/RA
Haematological - myeloproliferative disorders, lymphoma, myeloid leukaemia
Primary biliary cirrhosis
Features pyoderma gangrenosum
Lower limbs typically
Sudden onset - begins as small pustule, red bump, blood blister
Skin ulcer with purple edges
May see gas/ muscle pain/deep ulceration
Which condition is associated with isoniazid use?
Pellagra
Pellagra?
Niacin deficiency
Diarrhoea, dermatitis, dementia
Common in alcoholics
Associations of Seborrhoeic dermatitis?
HIV
Parkinson’s
Features of sebhorrhoeic dermatitis?
eczematous lesions in nasolabial folds, auricular folds, scalp, around eye
Otitis externa
Blepharitis
Mx seborrhoeic dermatitis?
Scalp mx:
Zinc pyrithione - head + shoulders
Tar
2nd line = Ketoconazole
Body mx:
Ketoconazole
Topical steroids - short periods
What is seborrhoeic dermatitis?
Inflammatory reaxn to fungal multiplication in skin
Malassezia furfur
Common site of venous ulceration
Medial malleolus
Mx venous ulceration
4-layer compression bandaging
Oral pentoxyphylline - vasodilator improves healing rate
Ix in venous ulceration
ABPI - to ensure can go through with compression + assess arterial flow which may inhibit healing
Cause of 90% fungal nail infection
Trichophyton rubrum
10% - candida infections
Features + mx fungal nail
Rough, opaque nail
mx - nothing if pt ok
>50% damage, >2 nails, white - give amorifine 5% nail laquer
extensive damage - oral terbinafine
candida - oral itraconazole
Acne rosacea mx
redness = topical brimonidine gel
Mild/moderate disease
1st line = topical ivermectin //metronidazole, azelaic acid
Severe
topical ivermectin, oral doxycycline
Mx for scabies
Pt + all close contacts - topical 5% permethrin - 2x in different weeks
leave on for 8-12 hrs before washing
2nd line - malathione 0.5%
itchiness continues 4-6wks later
