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Dermatology Flashcards

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1
Q

What is ringworm also known as?

A

Tinea and dermatophytosis

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2
Q

What is the most common type of fungus that causes ringworm and how does it spread?

A

Trichophyton - spreads through contact with infected individuals, animals or soil.

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3
Q

What is Onychomycosis?

A

Fungal nail infection

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4
Q

How does onychomycosis present?

A

Thickened, discoloured and deformed nails (separation from nail bed)

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5
Q

How does ringworm present?

A

Itchy rash that is erythematous, scaly and well demarcated. In a ring where the edge is more prominent red then the centre

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6
Q

How does tinea capitis present?

A

Well demarcated hair loss. Itchy, dryness and erythema of the scalp.

More common in children then adults

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7
Q

How does tinea pedis (athletes foot) present?

A

White or red, flaky, cracked, itchy patches between the toes. Skin may be split or bleed.

More likely to occur when feet are sweaty and damp for prolonged periods of time or sharing changing rooms with someone with athletes foot.

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8
Q

What investigation could be done for fungal infections?

A

Usually a clinical diagnosis

But may be possible to scrape some of the scales off and send them for microscopy and culture

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9
Q

What is the treatment for ringworm?

A
  • Anti-fungal creams e.g. clotrimazole and miconazole
  • Combination of anti-fungal and corticosteroid may be used to settle the inflammation and itching - Daktacort (miconazole 2% and hydrocortisone 1% cream)
  • Oral anti-fungal may be used such as fluconazole and itraconazole
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10
Q

What can be used to treat tinea capitis?

A

Anti-fungal shampoos - ketoconazole

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11
Q

What can be used for the treatment of onychomycosis?

A

Amorolfine nail lacquer for 6-12 months

Resistant cases may require oral terbinafine - must monitor LFTS before and while taking

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12
Q

What advise should be given to a patient with fungal infection?

A

Wear loose breathable clothes
Keep affect area clean and dry
Avoid sharing towels, clothes and bedding
Use separate towel for feet with tinea pedis
Avoid scratching and spreading to other areas
Wear clean dry sock every day

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13
Q

What is Tinea incognito?

A

More extensive and less well recognised fungal infection that results from the use of steroids to treat an initial fungal infection.

This occurs when the initial presentation of ringworm is misdiagnosed as dermatitis and topical steroid prescribed. This improves the inflammation and itching but dampens immune response and fungal infection returns much worse after steroid stopped.

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14
Q

What is intertrigo?

A

Fungal infection occur under the breast. Usually candida and anti-fungal cream is prescribed.

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15
Q

How does eczema present in babies?

A

Usually occurs on face and extensors.

Cows milk allergy can make eczema worse

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16
Q

How does eczema present in older children or adults?

A

Erythematous rashes in flexure regions that are usually episodic but can be continuous in severe cases. May be pitting and ridging of the nails.

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17
Q

What are the complications of eczema?

A

Infections (bacterial and viral)
Psychosocial issues
Eczema herpeticum

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18
Q

What is the general advise that should be given for someone with eczema?

A

Moisturiser and avoid scratching

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19
Q

What is the management for eczema?

A

Emollients should be used on a daily bases multiple times all over the body
Topical steroids at the lowest strength to control flare ups - avoid on face expect hydrocortisone

Topical immunomodulators may be used for maintenance due to steroid sparing e.g. calcineurin inhibitors

Next step up is Oral anti-histamines and the phototherapy and immunosuppressants

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20
Q

What is the steroid ladder for topical steroids from least to most potent?

A

Mild: hydrocortisone 0.5%, 1% and 2.5%
Moderate: Eumovate (clobetasone butyrate 0.05%)
Potent: Betnovate (betamethasone 0.1%)
Very potent: Dermovate (clobetasol propionate 0.05%)

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21
Q

What should a patient be told on how to apply topical steroids in eczema?

A

Apply thin layer - 1 finger unit covering rough surface area of both hands

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22
Q

What effects of steroid should be the patient be informed about?

A

Thinning of skin

Stinging and burning initially but should settle with time

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23
Q

When would referral to dermatology be indicated in someone with eczema?

A

Diagnosis uncertain
Current medication not controlling symptoms
Facial eczema not responding to treatment
Recurrent secondary infections

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24
Q

What is the options other then emollients for eczema?

A

Lotions - least oil
Creams
Ointments

And the emollients - most oil

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25
What is the presentation of urticaria?
Red, raised, itchy rashes - patchy
26
What is important to establish in the history of urticaria?
Timing - acute < 6 weeks, chronic > 6weeks New things brought to food eaten - allergic
27
What is the treatment for mild urticaria with identifiable cause?
Avoid trigger Self-limiting
28
What are the treatment options for urticaria?
Non-sedating ant-histamines e.g. Cetirizine for 6 weeks Review and prescribe if symptoms persistent 3-6 months. Daily anti-histamine Short lived prescribe anti-histamine prn Severe urticaria - may require 7 day course of corticosteroids
29
What is an important differential diagnosis to rule out in suspected urticaria?
Angioodema
30
If the first line treatment is unsuccessful for urticaria, what is the next course of action?
- Increase the dose or try another non-sedating anti-histamine - Topical antipyretic treatment to relieve itch e.g. calamine lotion - sedating anti-histamine to take at night if sleep affected
31
When is referral indicated in urticaria?
- Under 16 that have severe symptoms requiring steroids - Painful persistent urticaria - symptoms not well controlled - second line LTRA (montelukast), cyclosporine, mycophenolate mofetil or tarcolimus - Acute severe urticaria thought to be due to food or latex allergy - Forms of chronic inducible urticaria
32
What is the pathophysiology of acne?
Increased production of sebum, trapping keratin and blockage of pilosebaceous unit. Leads to swelling and inflammation in the pilosebaceous units. Androgenic hormones increase production of sebum which is why seen in puberty. These are called comedones.
33
What is the bacteria that is thought to play an important role in acne?
Propionibacterium acnes
34
What are the differential diagnosis for acne?
Acne rosacea | Folliculitis - usually on the trunk
35
What should patients with acne be advised?
- Avoid over-cleaning skin - Use non-alkaline synthetic detergent cleansing product twice daily - avoid make-up and sunscreen - avoid picking and scratching as may lead to scarring - treatment will take time to work (6-8 weeks) and my irritate skin initially.
36
What are the treatment options for acne?
No treatment if mild and not affect quality of life of patient Topical benzoyl peroxide Topical retnoids - women of child bearing age need effective contraception as tetragenoic Topical antibiotics - clindamycin - to avoid bacterial resistant, prescribed alongside benzoyl peroxide Oral antibiotics - lymecycline Oral contraceptive - slows production of sebum
37
What is the most effective oral contraceptive pill for acne?
Co-cyprindol (Danette) - high risk of thromboembolism so discontinued after acne settled
38
When should a patient with acne be followed up?
In 12 weeks or symptoms gotten worse
39
When is referral to dermatology required in acne?
- Acne fulminans - mild to moderate acne has not responded to two completed courses of treatment - moderate to severe acne that has not responded to previous treatment that includes an oral antibiotic - acne with scarring - acne with persistant pigmentary changes - psychosocial distress or mental health disorder
40
What the different types of psoriasis?
Plaque psoriasis- most common form in adults Guttate psoriasis - second most common and commonly occurs in children. Small rasied papules often triggered by streptococcal throat infection, stress or medications. Often resolves spontaneously after 3/4 months Pustular psoriasis Erythrodermic psoriasis
41
What are some specific signs of psoriasis?
Auspitz sign - small points of bleeding when plaques are scrapped off Koebner phenomenon - development of psoriatic lesions to areas of skin affected by trauma Residual pigmentation of the skin after lesions resolve
42
What is the management options of psoriasis in adults?
Emollients Topical steroids Topical vitamin D analogues (calcipotriol) Topical dithranol Specialist: Topical calcineurin inhibitors (tarcolimus) only in adults Phototherapy with narrow band ultraviolet B light - esp in guttate psoriasis Potent steroid and vitamin D analogue - Dovobet, Enstilar Guided by specialist
43
Who should manage children with psoriasis?
Specialist
44
What are the association with psoriasis?
Nail psoriasis - pitting, thickening, discolouration, ridging and onycholysis Psoriatic arthritis Psychosocial implications Increase risk of CVD - obesity, hyperlipidaemia, hypertension, IBD and type 2 diabetes
45
When should referral to dermatology be considered in psoriasis?
There is uncertainty about the diagnosis Psoriasis is extensive - more then 10% of body Psoriasis is at least moderately severe Psoriasis is resistant to topical drug treatments in primary care or treatments not tolerated Nail disease that is severe - functional/cosmetic impact Significant impact of persons physical, psychological or social wellbeing
46
What is seborrhoeic dermatitis?
Inflammatory skin condition that affects the sebaceous glands. Cause erythema, dermatitis and crusted dry skin. Malassezia yeast play a role.
47
What is infantile seborrhoeic dermatitis (cradle cap)?
Crusty flaky scalp | Self-limiting resolves by 4 months but can last up to 12 months
48
What is the treatment for infantile seborrhoeic dermatitis?
First line: baby oil, vegetable oil or olive oil, gently brush scalp and then wash off Second line: white petroleum jelly (Vaseline) used over night to soften crusted area before washing in the morning Third line: topical anti-fungal creams - clotrimazole or miconazole for up to 4 weeks Then refer to dermatology
49
What is the treatment for seborrhoeic dermatitis of the scalp?
First line: ketoconazole shampoo - left for 5 mins before washing off. Topical steroids can be used for severe itching.
50
What is the treatment for seborrhoeic dermatitis of the face and body?
Commonly affects eyelids, nasolabial folds, ears, upper chest and back First line: anti-fungal cream - clotrimazole, miconazole for up to 4 weeks and topical steroids such as hydrocortisone for localised inflamed areas Severe or unresponsive refer to dermatology or paediatric
51
What are the three types of skin cancers?
Basel cell carcinoma Squamous cell carcinoma Malignant melanoma
52
What are the risk factors for squamous cell carcinoma?
- overexposure to UV light - previous non-melanoma skin cancer - family history - pale skin that burns easily - large number of mole or freckles - immunosuppressed
53
What is the management of all suspected skin cancers?
2ww referral suspected cancer pathway
54
What follow up should be arranged with pt with skin cancer after treatment by dermatology?
Skin examination every 3-6 months for next 5 years Aims: - look for signs of cancer returning - see if any problems following treatment - examine for signs of new cancer - make sure pt knows what to look out for - check pt knows how to protect skin from sun
55
Which condition needs to be considered that may make acne worse?
PCOS
56
What are the treatment options for head lice?
Physical insecticides Chemical insecticides Wet combing
57
What is the general advise for head lice?
Pt can still attend school Avoid head-to-head contact Examine weekly All members of family treated on same day
58
What are the causes of impetigo?
Streptococcus pyogenes and staphylococcus aureus Can spread is someone touches sores or fluid from sores - close contact Most common in children 2-5 yrs old Infections or injuries that break skin Poor personal hygiene
59
What is the treatment for impetigo?
Hydrogen peroxide Fusidic acid Flucloxacillin Clarithromycin
60
When does impetigo stop being contagious?
48 hrs after starting treatment | When patches dry out and crust over
61
What is the practical advise for impetigo?
Stay away from school/work until no longer contagious Keep clean and dry Cover then with loose clothing or gauze Wash hand freq Wash flannels, sheets and towels at high temp Wash or wipe down toys with detergent or warm water Don’t let child scratch to avoid scarring
62
What is the management for nappy rash?
Self-management - use high absorbency, make sure nappy fits, leave nappy off for as long as possible, change and clean every 3-4 hrs , fragrance free wipes, gentle drying, no soaps Mild erythema - OTC barrier cream Inflamed or discomfort - hydrocortisone 1% Should clear up in 3 days
63
If rash persists after initial management for nappy rash what are the next steps?
Topical imidazole cream - candida infection? Bacterial infection - antibiotics
64
What are the risk factors for scabies?
Poverty and overcrowding Institutional care, such as rest home, hospital and prisons Refugee camps Immunocompromised
65
What are the clinical feature of scabies?
Erythematous papules on the trunk and limbs, often follicular Urticated erthyema Vesicles on palms and soles Itchy
66
What is the practical management advise for scabies?
As about close contacts especially sexual contacts - GUM clinic Wash infected clothes, bedsheets and towels at high temp Avoid work and close contacts until treatment complete Sick note
67
What should be prescribed for scabies?
Topical insecticides eg. Permethrin 5% cream or Malathion 0.5% liquid S/E of permethrin - burning and stinging on application but settles Apply to clean dry skin Sign post - itching may persist for 2-4 week after last application but any longer to follow up

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