Derm stuff you forget Flashcards
Which surfaces do eczema and plaque psoriasis tend to effect?
Psoriasis - extensor surfaces
Eczema - flexor surfaces
What things can exacerbate psoriasis?
Trauma
Drugs (BLANC - beta blockers, lithium, alcohol, NSAIDs, chloroquine)
Withdrawal of steroids
Strep infection (guttate type)
Describe guttate psoriasis
2nd most common, seen more in kids.
Acute onset - small, tear-shaped papules on trunk and limps, slightly scaly and non-blanching. Papules -> plaques.
Often triggered by strep throat
Self-limiting over 3-4ms.
Describe the management for psoriasis
Mild disease - emollients.
1st line - topical steroids OD for up to 4wks to settle flare.
2nd line - if no improvement, try stronger steroid, coal tar or short acting dithranol.
Options in 2o care - phototherapy, oral methotrexate, biologics.
Name a mild, moderate, potent and very potent topical steroid
Mild - hydrocortisone
Moderate - Eumovate
Potent - Betnovate
Very potent - Dermovate
Describe the management of eczema, referencing flares and maintenance
Flares treated with thicker emollients and topical steroids
Maintenance - emollients used as often as possible.
Describe eczema herpeticum agent, demographic, Px and Tx
It is primary infection of eczema skin by HSV1 or 2
More common in children w/ atopic eczema.
Px w/ rapidly progressing painful rash with punched out lesions.
Needs hospital admission and IV aciclovir as life-threatening.
What is an open and closed comedome?
What is a papule and pustule?
A comedone is a non-inflamed pilosebaceous unit.
- open = blackheads (oxidation of trapped material)
- closed = whiteheads (white due to thin covering layer of skin)
If comedones become inflamed they can become papules and pustules.
- papule is small, raised, red, bumps.
- pustules are similiar but contain pus.
Describe mild, moderate, severe acne
- Mild - open and closed comedones without inflammatory lesions.
- Moderate - comedones with numerous papules and pustules.
- Severe - extensive inflammatory lesions and scarring.
Describe the management of acne.
Mild/moderate - combination of 2 of topical retinoids (adapalene/tretinoin), topical benzoyl peroxide, topical clindamycin.
Moderate/severe - try OCP in women, or oral abx - doxycycline (max 3m).
2o care may try oral retinoids.
Tx of acne rosacea
Predominant flushing - topical brimonidine (alpha agonist)
Mild/moderate - topical ivermectin 1st line (or topical metronidazole)
Moderate/severe - above + oral doxycycline.
NB ivermectin is an antiparasitic medication
4 RF for all skin cancers
UV exposure (main one)
Fitzpatrick skin types 1-2 (fair skin)
Increasing age
Immune suppression
How should BCC, keratocanthoma, SCC and MM be referred?
- BCC - malignant but can be referred routinely.
- Keratocanthoma - benign but needs urgent referral (2ww) as indistinguishable from SCC.
- Melanoma and SCC need urgent referral (2ww)
Name to pre-malignant conditions for SCC
Actinic keratosis (most common precursor)
Bowen disease
Describe SCC appearance
Irregular keratinous nodule (resembles a wart), frequently ulcerates,
Rapidly grows
May be painful, tender, itchy and made bleed.
How is actinic keratosis treated?
Can remit spontaneously.
Encourage moisturises
Lesion specific treatment - Cryotherapy, keratolytic cream (5-flourouracil/Efudix)
Describe BCC appearance
Slowly growing plaque/nodule. Rolled edges with central depression.
Skin is pink or pigmented (often shiny/pearly).
Telangiectasia on dermoscopy.
What does Tinea mean?
Tinea is a group of fungal conditions of the skin. Caused by Trichophyton (dermatophytes)
What are the types of Tinea and how do they present?
Generally, itchy rash which is erythematous, scaly, well-demarcated. Target lesion.
Tinea capitis - well-demarcted hair loss w/ itching and erythema.
Tinea pedis - athletes foot. White/red, flaky cracked, itchy patches between the toes.
Onychomycosis - thickened, discoloured nails.
How do you treat tinea?
Creams like clotrimazole and miconazole.
Oral fluconazole generally 2nd line but 1st line for fungal nail and tinea capitis.
Tinea/pityriasis versicolor cause, RF, appearance, Tx
Skin infection with yeasts/fungi.
More common in tropical environments, summer and adolescents.
Demarcated, scaly, oval hypo or hyperpigmented macules that form patches. Noticed when tanning. Slight itching.
Clinical diagnosis.
Tx w/ topical antifungal (ketoconazole)
Pityriasis rosea cause, RF, appearance, Tx
Cause not understood, maybe HHV 6/7.
Most common in young adults.
Prodromal Sx of flu-like sx, rash starts with herald patch (pink/red scaly oval lesion usually on torso). Actual rash is small pink spots in christmas tree pattern. Slight itch, may be headache, lethargy.
No Tx as resolves within 3m without long term Cx. Not contagious.
What is intertrigo?
a rash in the flexures due to high temp/sweat/friction.
Can be infective (usually asymmetric and unilateral) w/ thrush, tinea, impetigo or boils.
Can be inflammatory (symmetrical) w/ psoriasis, seborrhoeic dermatitis, etc.
How does intertrigo present?
Overweight/obese or lymphoedema.
Skin is inflamed, red, uncomfortable, may be peeling, may be a foul odour.
