Derma Flashcards by AA J

Management of impetigo

limited, localised non bulbous disease
extensive non bulbous or bulbous impetigo

limited =
hydrogen peroxide cream 1% - 1st line (antiseptic)
Fusiliers acid 2% or umpire in - 2nd line (antibiotic)

Extensive =
Oral flucloxacillin
Oral erythromycin - if allergic to penicillin

Children excluded from school until lesions are crusted and healed or 48 hrs after start of antibiotic treatment

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Bulbous impetigo

Organism

Impetigo - fluid filled blisters >1cm
Staph aureus

*non bulbous impetigo more common

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Treatment of eczema herpeticum

Acyclovir

Painful rash associated with fever + hx of eczema

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Impetigo vs HSV

HSV = recurrent cold sores, prodromal pain , clear fluid vesicles
ADULTS

Impetigo - children

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Acne rosacea

Nose cheeks foreheads 
Flushing esp after alcohol or sunlight 
Later develops - persistent erythema w/ papules + pustules 
If eyes involved - blepharitis 
Rhinophyma - nose disfigurement

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Treatment acne rosacea

Topical metronidazole - mild sx

More severe disease - oxytetracycline, tetracycline (systemic ABx )

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Treatment tinea capitis

Complication of tinea capitis

Oral terbinafine , itraconazole, fluconazole
Systemic antifungal because of risk of scarring

Children — Griseofulvin

Comp - alopecia

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What dermatological condition is linked to coeliac disease

Dermatitis herpetiformis

- severely itchy rash over scalp sacrum elbows knees in pt wt/ coeliac disease

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Indications of IM adrenaline (6)

Wheeze, SOB, hoarseness of voice

Stridor, shock, swelling (facial tongue cheek)

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Skin disorders of pregnancy

Polymorphic eruption of pregnancy (PEP)
= PUPP - pruritic urticaria papules and plaques of pregnancy

Pemphigoid gestationis

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Polymorphic eruption of pregnancy (PEP)
= PUPP - pruritic urticaria papules and plaques of pregnancy

Features
Management

Itchy urticaria like rash , usually in 3rd trimester , primi
1st appear as abdominal striae, no blisters and spare umbilicus

Emollients
Mild topical steroids
Oral steroids

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Pemphigoid gestationis
Features
Treatment

Pruritic blistering lesions
Periumbilical - spread to trunk, back , buttocks , arms
2-3 trimester - rarely seen in 1st

Tx - oral corticosteroids

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Erythema multiforme
Causes
Common site

Site - back of hands, feet - spreads to trunk
Cause =
Virus - HSV - most common
Idiopathic
Bacteria - mycoplasma pneumonia , streptococcus
Drugs - penicillin , sulphonamide, carbamazepine, NSAIDs allopurinol COCP
Connective tissue disease - SLE
Sarcoidosis
Malignancy

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Treatment of erythema multiforme

Symptomatic
Oral antihistamines, analgesics
Local skin care and mouthwash - warm saline/xylocaine/diphenhydramine, kaopectate
Consider topical steroids

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History of camping w/ target lesions

Lyme disease

Erythema migrants

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Pink rings, non itchy , barely raised

Seen in rheumatic fever

Erythema marginatum - part of jones major criteria

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Erythema nodosum seen in

Painful tender nodules on shins

IBD - UC,CD
Penicillin
Sarcoidosis
TB

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Erythema infectiosum / slapped cheek

Treatment

Parvovirus B 19

Rest + analgesia

Chronic infrared radiation exposure (heat)

Causes what skin manifestation

Erythema Ab Igne

Rashes on flexor surfaces

Lichen planus - not contagious

Scariest - contagious

Contagious skin conditions

Scabies
Molluscum contagiosum
Impetigo - very!

Management of Mongolian blue spot

Dermal Melanosis

Reassure

Fades with time (few years)

Xanthelasma

Management

Occur w/ or w/o hyperlipidemia

Check fasting lipid levels
If hyperlipidemic - formally assess CVD risk

Lesions can be left alone
Refer private clinic if removal

Acne vulgaris
Colonising organism
Treatment

Obstruction of pilosebaceous follicle
Proprionibacterium (anaerobic)

T - topical benzoyl peroxide - reduces resistant proprioni in its on antibiotics

Acne management

1. Single topical therapy - retinoids , benzoyl peroxide 2. Combo therapy - topical ABx, benzoyl, retinoids 3. Oral ABx - tetracycline ,doxy , “cyclines” Oral isotretinoin - under supervision Avoid tetra in pregnancy and <12 - use erythromycin in pregnancy Retinoids CI pregnancy

Alternative sin acne treatment in pregnant women

COCPs ( alt to ABx)+ topical agents | Or

Gram negative folliculitis as complication of long term ABx use in acne How do you treat?

High dose oral trimethoprim

Side effects of oral isotretinoin

Isotretinoin = 13 cis retinoids acid Dry eyes, mouth , nose Nose bleeds

Red circular itchy rash

Ringworm likely = dermatophytosis | Tx - clotrimazole cram

Linear tracks on skin (burrows) + severe itching on flexures of skin Wrist finger webs , elbow, axillary, genitalia Tx

Scabies 1st line - topical permethrin 5% 2nd line - malathion .5% Hint = elderly in nursing home Treat all family members even if asymptomatic

Rash after URTI

- pityriasis rosea -Guttate psoriasis Both resolve spontaneously

Guttate psoriasis

Classically preceded by strept throat infection 2-4 weeks prior Tear drop scaly papules on trunk and limbs Resolve spontaneously w/in 2-3 months Or use topical psoarisis agents

Pityriasis rosea Features Treatment

Recent resp infection Herald patch 1-2 weeks later - slightly raised oval lesions w/ fine scale confined to outer aspect Characteristic distribution - parallel to lager lines - fir tree appearance Resolves in 6 weeks

Non sedating antihistamines

Cetrizine loratidine

sedating antihistamines

Chlorpheniramine

Management of lipoma

Reassure If doubts about liposarcoma - size >5 cm , increased size, painful or in a deep anatomical location - do US If US suspicious- MRI +/- surgical removal

Ritters/Lyell disease Organism - Cause

= staphylococcal scalded skin syndrome (SSSS) Caused by release of 2 exotoxins -epidermolytic toxins A &B from toxigenix strains of staph aureus Ritter/Lyell - when it happens in infants / newborns SSSS - children < 5

Signs and symptoms of SSSS

Fever, irritability Widespread redness Fluid filled blisters within 24-48 hrs - rupture easily Nilosky sign +ve (gentle strokes of skin = exfoliation)

Dx of SSSS | Tx

Tzanck smear Skin biopsy = intraepidermal cleavage at granular layer Bacterial culture Tx - hospitalisation IV flucloxacillin and supportive treatment Recovery writhing 5-7 of treatment

Bullous pemphigoid Cause Common in Features

Autoimmune - 2ry to development of antibodies against BP180 BP 230 Elderly >60 Blisters around dlexures, mouth spared Heal w/o scarring

Bullous pemphigoid Investigation Treatment

Skin biopsy - immunofluorescence = igG and C3 at dermoepidermal jn Tx - oral corticosteroids Refer to derma for biopsy and confirmation 2ry infection can occur causing delirium

Paronychia/ whitlow Organism Treatment

Staph aureus Topical fusidic acid - minor Oral flucloxacillin / clarithromycin- severe (both considered 1st line)

Treatment of impetigo

Hydrogen peroxide - antiseptic = 1st line 2nd line - antibiotics - fucidic acid or mupirocin Extensive impetigo - oral flucloxacillin

Herald patch

The biggest lesion in Pityriasis rosea