Dermatology 1 Flashcards by H JP

Acanthosis nigricans are associated with which conditions? (9)

T2DM
GI ca
Obesity
PCOS
Acromegaly
Cushing’s
Hypothyroidism
Prader Willi
COCP

How well did you know this?

Not at all

Perfectly

Severe acne associated with systemic upset =
Mx (2)

Acne fulminans
Hospital admission and PO steroids

How well did you know this?

Not at all

Perfectly

Classification of acne

Mild - comedones
Moderate - papules and pustules, widespread lesions
Severe nodules, pitting, scarring, extensive inflammatory lesions

How well did you know this?

Not at all

Perfectly

Mild- moderate acne mx (4)

12 week course of OD in the evening
1. topical adapalene with topical benzoyl peroxide
OR
2. topical tretinoin with topical clinda
OR
3. topical benzoyl peroxide with topical clinda
OR
4. Topical bonzoyl peroxide as monotherapy if above is CI

How well did you know this?

Not at all

Perfectly

Moderate to severe acne mx (6)

12 weeks course of
1. Top adapalene with benzoyl peroxide
OR
2. Top tretinoin with top clinda

OR
3. option 1 + PO lymecycline 408mg OR PO doxy 100mg OD

OR
4. Topical azelaic acid BD + PO lymecycline 408mg or PO dozy 100mg OD

OR
5. COCP

OR
6. Monotherapy benzylperoxide

How well did you know this?

Not at all

Perfectly

Alternative abx of choice in acne treatment

If not lymecycline or doxy then consider trimethoprim or erythro

How well did you know this?

Not at all

Perfectly

When to refer to a dermatologist for acne? (5)

Nil response to two completed courses of treatment (mild-mod)
Mod-severe
If has not responded to previous treatment with PO abx
Scarring
Persistent pigmentary changes
Psychological distress

How well did you know this?

Not at all

Perfectly

How do you follow up a patient with acne?
If completely clear
If has only improved

FU 12 weeks after treatment
If completed cleared
- consider stopping abx but cont the topical treatment

If improved
- cont for a further 12 weeks
(Do not continue abx for more than six months)

How well did you know this?

Not at all

Perfectly

Who should get maintenance therapy for acne?
How is it treated?
When do you review the maintenance therapy?

History of frequent relapse after treatment

Topc adapalene and benzoyl peroxide or topical monotherapy

Review again in 12 weeks

How well did you know this?

Not at all

Perfectly

Tetracyclines should be avoided in? (3)
Why is minocycline avoided?

Pregnancy
Breastfeeding women
Children <12yo

Irreversible pigmentation

How well did you know this?

Not at all

Perfectly

Mx of actinic keratoses (6)

Fluorouracil cream (2-3 weeks) (skin will become red and inflamed)
Topical HC to settle the inflammation
Topical diclofenac
Topical imiquimod
Cryo
Curretage

How well did you know this?

Not at all

Perfectly

Localised, well demarcated patches of hair loss =
At the edge of hair loss what might you see?

Alopecia areata
Exclamation mark hairs

How well did you know this?

Not at all

Perfectly

Alopecia areata mx (4)

Topical/ intralesional steroids
Topical minoxidil
Phototherapy
Dithranol

How well did you know this?

Not at all

Perfectly

Examples of:
Sedating anti-histamine (1)
Non sedating (2)

Chlorpheniramine

Loratadine
Cetirizine (can cause drowsiness still however)

How well did you know this?

Not at all

Perfectly

Side effects of aqueous cream

As a leave on emollient it can cause skin irritation
Can be used as a soap substitute

How well did you know this?

Not at all

Perfectly

What can be used to treat athlete’s foot? (3)

Topical imidazole, undecenoate or terbinafine

How well did you know this?

Not at all

Perfectly

Eczematous, itchy red rash in pregnancy =

Atopic eruption of pregnancy

How well did you know this?

Not at all

Perfectly

Pearly, fleshy coloured papule with telangiectasia
May later ulcerate leaving a central crater =

Mx (2)

Basal cell carcinoma

Routine referral to derm
Surgery

How well did you know this?

Not at all

Perfectly

Describe features of BCC (5)

Slow growing
Most common is nodular
Sun exposed sites
Pearly, flesh coloured
Central crater

How well did you know this?

Not at all

Perfectly

Describe Bowen’s disease
Speed in growth
Location

Mx (3)

Red scaly patches
Slow growing
Sun exposed

Mx
1. topical 5-fluorouracil BD for 4/52 + topical steroids due to inflammation
2. Cryo
3. Excision

How well did you know this?

Not at all

Perfectly

What drugs can cause bullous disorders? (2)

Barbiturates
Furosemide

How well did you know this?

Not at all

Perfectly

Autoimmune condition
Itchy tense blisters around the flextures
No mucosal involvement (mouth is spared)
=

Bullous pemphigoid

How well did you know this?

Not at all

Perfectly

bullous pemphigoid Mx (3)

Mx
1. Derm referral
2. Biopsy
3. PO steroids

How well did you know this?

Not at all

Perfectly

Classic differentiating feature between pemphigoid and pemphigus

Pemphigoid = mucosal spared, tense blisters, itchy
Pemphigus = mucosal ulceration, flaccid, easily ruptured vesicles, not itchy

How well did you know this?

Not at all

Perfectly

Mucosal ulceration Autoimmune Ashkenazi Jewish population Flaccid easily ruptured vesicles Not itchy = which condition? What is seen on biopsy? Mx (2)

Pemphigus vulgaris Acantholysis Steroids + immunosuppressants

erythematous, papular lesions firm red, blue, or purple papule typically 1-3 mm in size non-blanching not found on the mucous membranes more common in advancing age = Mx

Cherry angioma Benign, no treatment

Painful nodule on the ear Caused by persistent pressure on the ear M>F Increasing age =

Chondrodermatitis nodularis helicis

How does allergic contact dermatitis usually present? Usually caused by what? What type of hypersensitivity is it? Mx

Type IV Acute weeping eczema affecting the margins of the hairline Usually following hair dyes Mx steroids (potent)

Rare psycho dermatological condition characterised by self inflicted skin lesions =

Dermatitis artefacta

Dermatitis herpetiformis is associated with which condition? Location

Coeliac disease Extensor surface, elbows, knees, buttocks

itchy, vesicular skin lesions on the extensor surfaces (e.g. elbows, knees, buttocks) Coeliacs Mx (2)

Dermatitis herpetiformis Mx 1. Gluten free diet 2. Dapsone

solitary firm papule or nodule, typically on a limb typically around 5-10mm in size overlying skin dimples on pinching the lesion

Dermatofibroma

typically present as round or oval plaques on the extremities the lesions are extremely itchy central clearing may occur giving a similar appearance to tinea corporis =

Discoid eczema

Eczema herpeticum is caused by Seen in which age range? Seen with which condition? Presenting with?

Herpes simplex virus 1 or 2 Children Atopic eczema Rapidly progressing painful rash

monomorphic punched-out erosions (circular, depressed, ulcerated lesions) usually 1–3 mm in diameter are typically seen. seen in children with atopic eczema and often presents as a rapidly progressing painful rash. = Mx

Eczema herpeticum Admission + IV aciclovir

Burns Heat mx Electric mx Chemical mx

1. Within 20 mins irrigate with cool water for 10-30 minutes, cover with cling film in layers 2. remove from source 3. brush any powder off then irrigate with water

Classification of burns Superficial Partial thickness - superficial Partial thickness - deep Full thickness

Superficial/ first degree: - red and painful Partial thickness - superficial/ second - pale pink, painful, blistered Partial thickness - deep/ second - white, but may have non-blanching erythema, reduced sensation Full thickness - third degree - white/ brown/ black, no pain

What percentage of burns requires IVF for children + adults

10%, 15%

Topical steroids by potency

Mild: Hydrocortisone Mod: Betamethasone 0.025% (betnovate RD) + clobetasone 0.05% (eumovate) Potent: Fluticasone (cutivate) + betamethasone 0.1% (betnovate)

Explain the finger tip rule

1 finger tip unit = 0.5g, sufficient to treat two flats of adult hands

Fingertip units Hand and fingers front and back A foot (all over) Front of chest and abdomen

Hand and fingers front and back 1 A foot (all over) 2 Front of chest and abdomen 7

Fingertip units Back and buttocks Face and neck An entire arm and hand An entire leg and foot

Back and buttocks 7 Face and neck 2.5 An entire arm and hand 4 An entire leg and foot 8

Topical steroids that should be prescribed in grams for an adult for a single daily application for 2 weeks Face and neck Both hands Scalp Groin and genitalia

15-30g

Topical steroids that should be prescribed in grams for an adult for a single daily application for 2 weeks Both arms Both legs Trunk

Both arms 30-60g Both legs 100g Trunk 100g

reticulated, erythematous patches with hyperpigmentation and telangiectasia. A typical history would be an elderly women who always sits next to an open fire =

Erythema ab igne

Erythema ab igne is caused by over-exposure to? If the cause is not treated it can lead to?

Infra-red exposure Squamous cell skin ca

target lesions initially seen on the back of the hands / feet before spreading to the torso upper limbs are more commonly affected than the lower limbs pruritus is occasionally seen and is usually mild = usually triggered by?

erythema multiforme infections

Name five causes of erythema multiforme

Viruses (herpes simplex virus) Bacteria e.g mycoplasma SLE Sarcoidosis Malignancy

Name six medications that can cause erythema multiforme

Penicillin Sulphonamides Carbamezapine Allopurinol NSAIDs COCP

inflammation of subcutaneous fat typically causes tender, erythematous, nodular lesions usually occurs over shins, may also occur elsewhere (e.g. forearms, thighs) usually resolves within 6 weeks lesions heal without scarring =

Erythema nodosum

Causes of erythema nodosum (6) Name three drugs

Infection - e.g strep, TB, brucellosis Sarcoidosis IBD Behcet's Malignancy Pregnancy Drugs penicillin, sulphonamides, COCP

bacterial infection that affects the skin. It usually appears in the folds of the skin. It's more commonly seen in warm or humid climates flat, slightly scaly, pink or brown rash usually found in the groin or axilla Examination with Wood's light reveals a coral-red fluorescence. caused by Corynebacterium minutissimum = Mx (2)

Erythrasma Mx topical miconazole OR PO erythro

Causes of red man syndrome/ erythroderma (5)

Eczema Psoriasis Gold Lymphomas/ Leukemias

Dermatophyte infection mx (2) Length of treatment for fingernails versus toenails

PO terbinafine OR PO itraconazole 6 weeks - 3 months therapy fingernails 3-6 months for toenails

Candida nail infection mx Mild (1) Severe (1) Length of treatment for topical treatment fingernails versus toenails

Mild: amorolfine topical Severe: PO itraconazole Six months fingernails 9-12 months toenails

seen most commonly on the skin of children, teenagers, or young adults. papular lesions that are often slightly hyperpigmented and depressed centrally typically occur on the dorsal surfaces of the hands and feet, and on the extensor aspects of the arms and legs or knuckles = ?

Granuloma annulare

tear drop papules on the trunk and limbs common in children and adolescents precipitated by strep infection 2-4 weeks prior to lesions appearing acute onset over days = Resolves spontaneously within?

guttate psoriasis 2-3 months

Herald patch followed 1-2 weeks later by multiple erythematous, slightly raised oval lesions with a fine scale confined to the outer aspects of the lesions May follow a characteristic distribution with the longitudinal diameters of the oval lesions running parallel to the line of Langer. This may produce a 'fir-tree' appearance No prodrome = ? Mx

Pityriasis rosea Self limiting - resolved after 6 weeks

Causes of periorificial dermatitis Mx (1)

Usually caused by topical/ inhaled steroids So can worsen condition if given this to treat Mx topical/ PO abx

Pellagra is caused by deficiency in? Features (3) Can be caused by which drug?

Niacin 3 D's, dementia, dermatitis, diarrhoea Isoniazid

itchy, red patches which are lesions tend to be of different colours = Is a rare form of which cancer?

Mycosis fungoides - rare for of T cell lymphoma

pinkish or pearly white papules with a central umbilication appear in clusters, palms and soles sparing In children lesions are commonly seen on the trunk and in flexures, but anogenital lesions =

Molluscum contagiosum

Molluscum contagiosum Mx School?

Self limiting - resolution within 18 months Contagious, avoid sharing towels, clothing, baths etc No exclusion necessary

Melasma causes (3)

Pregnancy COCP HRT

Hyperpigmented macules in sun-exposed areas, particularly the face.

Melasma

What is the single most important factor in determining the prognosis of a patient with malignant melanoma?

Breslow depth/ depth of a tumour >4mm 50% 5 year survival rate

white patches that may scar itch is prominent may result in pain during intercourse or urination lesions around the genitalia Mx (2) Increased risk of?

Lichen sclerosus Mx topical steroids + emollients Vulval ca

What is leukoplakia? Ix Mx

Pre-malignant condition White hard spots on mucous membranes Common in smokers Ix biopsy to r/o SCC Regular FU as increased risk of SCC (1%)

Skin lesions that appear at the site of injury is called the? Name five conditions where this may be seen?

Koebner phenomenon Psoriasis Vitiligo Warts Lichen planus + sclerosus Molluscum contagiosum

Said to look like a volcano or crater initially a smooth dome-shaped papule rapidly grows to become a crater centrally-filled with keratin Mx

Keratoacanthoma Mx urgently excised as it is difficult to exclude SCC

Strawberry naevus Develops when? Increases in size until age? Regresses over what time period? 95% resolved by age? Mx if visual field obstruction?

Develops rapidly in the first month of ife Increase in size until 6-9 months Regress over the next few years, 95% resolve before age 10 Propranolol

Port wine stains Description Colour Unilat/bilat Mx (2)

Unilateral, deep red or purple in colour Birthmarks Often darken and become raised over time Do not resolve - so cosmetic camouflage or laser therapy

Venous ulceration is usually seen? Ix Normal range Mx (2)

Medial malleolus ABPI 0.9-1.2 Compression bandaging PO pentoxifylline

Angiomas on the lips are called?

Venous lakes

Dermatology 1 Flashcards

(74 cards)