1. Emollients 2. Topical steroid (hydrocortisone) 3. Phototherapy UVB 4. Systemic Immunosuppressants 5. Biologics Treat infections as necessary Avoid irritants

- Sedative Anti-histamines - Emollients: Menthol (Dermacool), Capsaicin, Camphor, Phenol, Crotamiton (Eurax cream) - Antidepressants, e.g. doxepin - Phototherapy - Opiate antagonists, ondansetron - Treat underlying disease

Derm Y2 Flashcards by Laiba Fatima

Shingles

Due to: Varicella ZOSTER virus

Presents:

Neuralgic “tingly” pain greater with age
Erythema
Common in elderly/ immunocompromised
Dermatomal

If pain presents more than 4 weeks then it’s known as Post Herpetic neuralgia

Oral Aciclovir

VZV used in chickenpox vaccine can be used in elderly to reduce shingles risk by 36% and Post Herpetic neuralgia by 67%

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Chickenpox

Due to: VARICELLA zoster virus

Presents:

Generalised rash and fever
Sensory nerve roots

Supportive

Live attenuated vaccine is available for chickenpox (not widely used in UK)

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Neonatal VZV

Secondary to chickenpox in mother in a late pregnancy

Prevention with Varicella Zoster Immunoglobulin in susceptible women

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Ramsay-Hunt Syndrome

Presents:
- pain in vesicles, auditory canal and throat
7th CN - facial pasly
8th CN- deafness, vertigo, tinnitus

Aciclovir

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Herpes Simplex Type 1

Presents:

Primary gingivostomatitis
Pre-school children
Extensive ulceration in and around mouth
Lasts around a week
50% Genital herpes

MIld: Supportive
Severe: Aciclovir

Cold sore: Topical antiviral

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Herpes Simplex Type 2

Presents:

50% Genital herpes - warts
Some Gingivostomatitis
Encephalitis (common in neonates)

Aciclovir <72hours

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Human Papilloma Virus

Presents:
T1-4: Warts/ verrucas
T6 &11: Genital warts
T16 & 18: Cervical cancer

Gardasil vaccine: protects against T6, 11, 16; 18

Cervarix vaccine: protects against T16 & 18

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Herpangina

Due to enterovirus (coxsackie and echovirus)

Presents:
- Blistering rash at the back of the mouth

Self-limiting

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Rubella

Vaccination

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Erythema infectiosum / “Slapped cheek disease”

Caused by: Erythrovirus (Parvovirus B19)

Child: crash on face, lacy rash on body
Adult: polyarthritis in joints/ hands, no rash

Self limiting
Reassure patient
Symptomatic relief with over-counter meds

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Orf

Due to virus caught from sheep with scabby mouths (ikr wtf)

Presents:
- Firm, fleshy nodule on hand of farmer

Self-limiting

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Syphilis

Due to: bacterium Treponema pallidum

Presents:
Primary- Chancre (painless ulcer) at infection site
Secondary- red rash over body especially palms and soles, mucous membrane “snail track” ulcers
Tertiary: CNS, Cardiovascular

Penicillin G injections

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Lyme disease

Due to: Borrelia burgdorferi from ticks

Presents:
Early- erythema migrans
Late- heart block, nerve palsies, arthritis

Amoxicillin or Doxycycline

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Scabies

Caused by “Sarcoptes scabiei”
Chronic crusted form is termed “Norwegian Scabies” adn is highly infectious.

Associated with an intensely itchy rash affecting finger-webs, wrists and genital area

Malathion lotion
Benzyl benzoate (avoid in children)

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Erythropoietic protoporphyria

6 monthly LFTs and RBC porphyrins

Photoprotection measures

Prophylactic TL-01 phototherapy
Anti-oxidants: beta-carotene, cysteine, high dose Vitamin C
Avoid iron

If leads to liver failure:

oral charcoal
cholestyramine
ALA synthase inhibition

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Prophyria cutanea tarda

Presents as: 
Blisters, fragility
Hyperpigmentation
Hypertrichosis
Solar urticaria
Morphoea

Treat underlying disease:

Alcohol
Viral Hepatitis
Oestrogens
Haemochromatosis

Not doing this will lead to risk of liver cirrhosis/ hepatoma

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Atopic Eczema

Emollients
Topical steroid (hydrocortisone)
Phototherapy UVB
Systemic Immunosuppressants
Biologics

Treat infections as necessary
Avoid irritants

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Pruritus (itching)

Sedative Anti-histamines
Emollients: Menthol (Dermacool), Capsaicin, Camphor, Phenol, Crotamiton (Eurax cream)
Antidepressants, e.g. doxepin
Phototherapy
Opiate antagonists, ondansetron
Treat underlying disease

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Dry skin

Moisturising agents

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Viral Warts / verrucas

Self limiting
Keratolytic agents (salicylic acid)
Formaldehyde
Glutaraldehyde
Silver nitrate
Cryotherapy (liquid nitrogen)

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Anaphylaxis

Adults: 300µg adrenaline
Children: 150µg adrenaline

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Contact dermatitis

A non-immunological process where contact with agents that abrade, irritate and traumatize skin directly.

Examples:

Nickel in belt buckle
Latex/ thiuram in rubber gloves
Colophony in elastoplast
Fragrance in deodorants
Chromate in footwear
Garlic
PPD in black henna tattoo
Diethylthiourea in wrist splint
Dermabond surgical glue
English Ivy
Golden fillings etc
Nappy rash
Licking lips

Remove the irritant

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Lichen Planus (non-infective inflammatory dermatoses)

Mild: Topical corticosteroid (potent/ very potent)
Severe: Oral steroids

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Keloid scars

Topical corticosteroid

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Eczema Herpeticulum

Oral antiviral

Candida intertrigo (infection)

Nystatin (oral) Clotrimazole cream Oral fluconazole

Hyperkeratotic Eczema

Keratolytic agents (salicylic acid)

Keratin plaques Usually found in scalp

Keratolytic agents (salicylic acid)

Genital warts

Podophyllin

Necrotising fasciitis

Surgical Debridement

Lice (pediculosis) Otherwise known as "Vagabond's Disease" ``` Pediculus capitis (head louse) Pediculus corporis (body louse) Phthirus pubis (pubic louse) ``` Associated with an intense itch

Malathion lotion

Erythema multiforme Caused by: Herpes simplex virus Mycoplasma pneumoniae bacterium Many triggers including drug reactions and some infections

Treat underlying cause

Molluscum contagiosum Presentation: Fleshy, firm, umbilicated, pearlescent nodules 1 to 2 mm diameter Self-limiting but take months to disappear Common in children Can also be sexually transmitted

Self-limiting Treat underlying cause Cryotherapy (Liquid Nitrogen)

Herpangina Blistering rash of back of mouth Caused by: enterovirus (echovirus, coxsackie virus)

Self limiting

Hand, foot and mouth disease Presentaion: Typically children Family outbreaks Caused by enteroviruses (especially coxsackie virus)

Supportive

Zika Virus Spread by mosquito Aedes aegypti ``` Presentation: Mild fever Rash (mostly maculopapular) Headaches Arthralgia Myalgia Non-purulent conjunctivitis ```

Supportive No NSAIDS until Dengue fever is ruled out to reduce risk of haemorrhage

Dermatitis Herpetiformis Rare Autoimmune bullous disease Strong association with coeliac disease Presentation: Intensely itchy lesions-symmetrical Elbows, knees and buttocks-often excoriated Hallmark is papillary dermal microabscesses

Dapsone (diaminodiphenyl sulfone) Sulfapyridine Treat underlying cause e.g. Gluten free diet

Rosacea Red face (nose & cheeks) ``` Causes: Sunlight Alcohol Spicy foods Stress ```

Avoidance of alcohol/ spicy food/ hot temperatures - Topical Metronidazole, Ivermectin (to reduce demodex mite) - Oral tetracycline long term Others: Telangiectasia (vascular laser) Rhinophyma (surgery/ laser shaving) Avoid steroids!

Basal Cell Carcinoma (BCC) ``` Presentation: - very common - slow growing lump or non-healing ulcer - painless and often ignored - ‘pearly’ or translucent - visible, arborising blood vessels - central ulceration (“rodent ulcer”) - can present as scaly plaque ‘superficial’ - can be infiltrative ‘morphoeic’ - locally invasive, but rarely metastasize > 40 yrs, but can be 3rd or 4th decade ```

Surgical excision

Pemphigus Vulgaris PemphiguS – split more Superficial, intra-epidermal Presentation: - Typically affects scalp, face, axillae, groins - Flaccid vesicles/bullae – thin roofed - Lesions rupture to leave raw areas - Increased infection risk - Nikolsky sign positive - Mucosal involvement (eyes, genitals)

Systemic steroids Immunosuppressive agents Aids: Emollients, topical steroids, topical antisepsic / hygiene measures

Squamous Cell Carcinoma (SCC) Presentation: - about 20% of all skin cancers - hyperkeratotic (crusted) lump or ulcer - arises on sun-damaged skin - grows relatively fast, may be painful &/or bleed - majority are well differentiated low risk - minority are poorly differentiated high risk - risk of metastasis about 5% - poor prognosis once metastatic - precursor lesions: actinic keratoses and Bowen’s disease (carcinoma-in-situ)

Surgical excision

Naevoid basal cell carcinoma (Gorlin's syndrome) Features: - early onset/multiple BCCs - palmar pits - jaw cysts - ectopic calcification

Oh jesus cut them out

Malignant Melanoma Types: 1. Superficial Spreading Melanoma (SSM) 2. Acral/ mucosal lentiginous melanoma (A/MLM) 3. Lentigo Maligna Melanoma (LMM) 4. Nodular Melanoma ``` Features: Most common on sun-exposed sites scalp, face, neck, arm, trunk, leg Commoner in females (2:1) May arise at any site Rare in childhood Incidence peaks in middle-age ```

Surgical excision SN biopsy is positive then do a lymphadenectomy

Venous Ulcer

- Control pain - ABPI - Non-adherent dressing - De-sloughing agent if necessary eg hydrogel/ honey - 4 layer compression bandaging – may need to increase compression gradually if pain a problem - Leg elevation

Inflammatory Psoriasis

Emollients (diprobase)

Chronic plaque Psoriasis

Tried emoolients- didn't work 1. Calcitrol (Vit D analogue) 2. Coal tar 3. Dithranol 4. Tazarutene (retinoid) 5. Phototherapy UVB if topicals fail

Scalp Psoriasis

Emollients always 1. Tar-based shampoo 2. Salicylic acid (keratolytic) 3. Potent topical steroid + Calcitrol (Vit D analogue)

Psoriasis on face, flexures, genitals

1. Mild topical steroid (hydrocortisone 1%) | 2. Calcitrol/ tacalcitrol for long term use

Severe + Resistant Psoriasis

1. Acitretin 2. Ciclosporin 3. Methotrexate all of these are teratogenic

c-Kit Melanoma mutation

Dasatimib | Imatinib

B-Raf Melanoma mutation

Vemurafenib | Dabrafenib

MEK Melanoma mutation

Trametinib

Melanoma treatment using T-cell activation to kill tumours

Ipilimumab Tremelimumab Pembrolizumab

Molluscum Contagiosum

Self-limiting

Erythema multiforme

Self-limiting | Potentially steroids if terribly severe but rare.

Acne

1st line: single topical therapy (topical retinoids, benzoyl peroxide) 2nd line: topical combination therapy (topical antibiotic, benzoyl peroxide, topical retinoid) 3rd line: oral antibiotics: e.g. Oxytetracycline, doxycycline, erythromycin if pregnant 4th line: Isotretinoin* * Check bloods regularly * Put on contraception * Pregnancy test before starting

Bullous Pemphigoid Large tense bullae

Systemic steroids Immunosuppressive agents Tetracycline Aids: Emollients, topical steroids, topical antisepsic / hygiene measures

Tuberose Sclerosis Rare genetic condition that causes development of benign tumours

No cure :( | Relieve symptoms

Neurofibromatosis Type 1

No cure Reduce symptoms Surgical removal of tumours Chemotherapy for optic gliomas

Neurofibromatosis Type 2

No cure | Surgical removal of tumours

Schwannomatosis

No cure | Surgical removal of tumours

Bowen's Disease Bowen's disease is a very early form of skin cancer that's easily treatable. The main sign is a red, scaly patch on the skin. It affects the squamous cells – which are in the outermost layer of skin – and is sometimes referred to as squamous cell carcinoma in situ.

Photodynamic therapy Cryotherapy Chemotherapy

Leg ulcer

1. Control pain 2. Non-adherent dressing 3. De-sloughing agent (hydrogel/ honey) 4. 4 layer compression 5. Elevate leg

Dermatophyte (fungal) infections Tinea pedis etc...

Small areas of skin/nails: - Clotrimazole (Canesten cream) - Nail paint (amorolfine) Extensive infections + scalp + nails: - Terbinafine (oral) - Itraconazole (oral)

Lichen planus

Potent topical steroids | Oral steroids

Epidermolysis Bullosa

None, most die in infancy ;(

Impetigo | Caused by: Staph aureus/ Strep pyogenes

1st: Topical fusidic acid 2nd: Oral flucloxacillin / topical retapamulin

Scarlet Fever

Penicillin

Hirtuism

Weight loss Facial: topical eflornithine Moderate-severe: co-cyprindiol (combined oral contraceptive)