Dermatology Flashcards
(71 cards)
1
Q
Define Acne Vulgaris.
A
Disorder of pilosebaceous follicles found in the face and upper trunk.
- An opportunistic bacteria (normal skin flora) plays a role → Propionibacterium acnes
2
Q
What are the levels of acne?
A
- Comedones - follicles impacted and distended by incompletely desquamated keratinocytes and sebum → Blackheads (open) or Whiteheads (closed)
- Papules and pustules
- Nodulocystic and scarring
3
Q
What are the signs and symptoms of dermatology?
A
- Greasy face
- Comedones, papules, pustules, nodules
- Psychological impact → low self-esteem
4
Q
What is the management of acne vulgaris?
A
- Advice
- Cleaning face → avoid over-cleaning the skin (twice a day with gentle soap is ok)
- Make-up → use emollients and cleansers, non-comedogenic preparations
- Face → avoid picking and squeezing scars due to the risk of scarring
- Medications = stepwise approach - review every 8-12w
- Mild to Modeerate
- Topical retinoid ± benzoyl peroxide (BPO)
- Topical antibiotic (clindamycin) + benzoyl peroxide (BPO)
- Azelaic acid 20%
- Moderate not responding to topicals:
- Oral antibiotic (max 3m) + BPO / retinoid
- 1st line = tetracyclines
- 2nd line = macrolides
- COCP + BPO / retinoid
- Oral antibiotic (max 3m) + BPO / retinoid
- Severe = Dermatologist referral = Oral isotretinoin = Roaccutane
- Mild to Modeerate
- Once cleared, maintain with topical retinoids or azelaic acid (20%)
5
Q
What are the side effects of roaccutane?
A
- Dryness
- Pruritis
- Conjunctivitis
- Muscle aches
- Teratogenic
- Must be on 2 forms of contraception
- Deranged LFTs
- Low mood and Suicidal ideation
6
Q
What is roaccutane?
A
Synthetic form of Vitamin A.
7
Q
What are the indications for a dermatologist referral for acne vulgaris?
A
- Nodulocystic acne / scarring
- Severe form - acne conglobata, acne fulminans
- Severe psychological distress
- Diagnostic uncertainty
- Failing to respond to medications
8
Q
Define Milia.
A
White pimples on nose and cheeks, from retention of keratin and sebaceous material of the pilosebaceous follicle.
9
Q
What are the signs and symptoms of milia?
A
- Neonatal - affects up to 50% of new-borns
- Often nose, but also mouth, palate, scalp, face, upper trunk
- Heal spontaneously within a few weeks
- Primary:
- Around eyelids, cheeks, forehead, genitalia
- Should clear in a few weeks
- Associated with trauma
10
Q
What is the management of milia?
A
Self-limiting
11
Q
Define Molluscum Contagiosum.
A
Common viral infection (molluscum contagiosum / pox virus) transmitted by skin-to-skin transmission.
12
Q
What are the signs and symptoms of molluscum contagiosum?
A
- ≥1 small pink skin-coloured or pearly papules, ulcerated/umbilicated
- Painless but may be itchy occasionally
- Commonly found on the chest, abdomen, back, armpits, groin, back of knees
13
Q
What is the management of molluscum contagiosum?
A
- Acute = Self-resolving → 6-9 months - normally within the year
- No need to avoid school
- Wear long-sleeve clothes and don’t share towels
- Chronic (>2 years) = Cryotherapy
14
Q
Define Eczema.
A
Chronic, relapsing, inflammatory skin condition characterised by an itchy red rash.
15
Q
What are the common triggers for eczema?
A
- Irritants
- Contact allergens
- Extremes of temperature
- Abrasive fabrics
- Sweating
- Dietary factors (10%)
- Inhaled allergens - pollens, dust mite
16
Q
Where is eczema commonly found?
A
- Infant = face and trunk
- Older child = extensors of limbs
- Young adult = localises to flexures
17
Q
What is the classification of eczema?
A
18
Q
What are the appropriate investigations for suspected eczema?
A
- Consider food allergies → blood or skin prick testing
- Consider contact dermatitis → patch testing
19
Q
What is the management of eczema?
A
- Mild
- Emollients
- Mild topical corticosteroids
- Moderate
- Emollients
- Moderate topical corticosteroids
- Topical calcineurin inhibitors
- Bandages
- Severe
- Emollients
- Potent topical corticosteroids
- Systemic therapy
- Phototherapy
- Topical calcineurin inhibitors
- Bandages
- Antihistamines
- Severe itching / urticaria = non-sedating antihistamine (e.g. fexofenadine, cetirizine)
- Sleep disturbance = 7-14-day trial of a sedating antihistamine (e.g. promethazine)
20
Q
What is the management of infected eczema?
A
- Skin swab and culture
- Oral flucloxacillin - erythromycin if pen-allergic
21
Q
What is the management of eczema herpeticum?
A
- Oral aciclovir
- If around eyes = same day referral to ophthalmologist
- Health education
- Rapidly worsening eczema, clustered blisters, punched-out erosions = Emergency
22
Q
What are the indications for a specialist referral for eczema?
A
- Immediate
- Eczema herpeticum
- Urgent referral (<2 weeks)
- Severe atopic eczema not responded to optimum therapy within 1-week
- Bacterially infected eczema treatment failure
- Non-urgent referral (>2 weeks)
- Diagnosis uncertain
- Atopic eczema on face not responding
- Contact allergic dermatitis causing significant social and psychological problems
- Severe recurrent infections
23
Q
What counselling should be given to parents with a child with eczema?
A
- Explain the diagnosis - characterised by dry, itchy skin
- Explain it is very common and many children grow out of it
- Explain the management (and use of steroids if necessary)
- Encourage frequent, liberal use of emollients - and as a soap substitute)
- Explain the association with other atopic conditions
- Advise avoidance of triggers - e.g. types of clothes, detergents, soaps, animals
- Avoid scratching
- Safety net about signs of infection or eczema herpeticum
-
Information and Support
- Itchywheezysneezy.co.uk – excellent website demonstrating how to apply emollients
- British Association of Dermatologists (BAD) – has an information leaflet on atopic eczema
- National Eczema Society – has fact sheets
24
Q
What are the causes of impetigo?
A
- Common skin infection
- Staphylococcus aureus
- Streptococcus pneumonia
25
What are the signs and symptoms of impetigo?
Golden-yellow crusted appearance - Honeycomb scab
26
What is the diagnosis?
Impetigo
27
What is the diagnosis?
Milia
28
What is the diagnosis?
Molluscum Contagiosum
29
What is the management of impetigo?
* Localised, non-bullous = **Topical H2O2 1% cream** → **Topical fusidic acid (2%) antibiotic**
* Widespread, non-bullous = **Oral flucloxacillin** or **Topical fusidic acid (2%) antibiotic**
* Bullous, systemically unwell = **Oral flucloxacillin**
* **School exclusion** - until lesions crusted over or 48 hours after Abx started
30
What is the most common form of nappy rash?
* Most commonly a form of **contact dermatitis**
* Babies 3-15 months of age
* Follows damage to normal skin barrier – urine, faeces, friction, pre-existing conditions, damp predisposition
31
What are the signs and symptoms of irritant nappy rash?
* Erythematous macules and papules in genital area
* Well-demarcated variety of erythema, oedema, dryness, scaling
* Sparing skin folds → just skin in contact with nappy is erythematous
32
What are the signs and symptoms of candida albicans nappy rash?
* Erythematous macules and papules in genital area - with small satellite spots or superficial pustules
* Sharply demarcated erythema
* Check for oral candidiasis
33
What are the signs and symptoms of seborrhoeic nappy rash?
* Erythematous macules and papules in genital area
* Cradle cap and bilateral salmon pink patches
* Desquamating flakes
* Skin folds
34
What is the management of nappy rash?
* **Health education**
* Refer to NHS choices nappy rash leaflet/website)
* Nappy type → high-absorbency nappies that fit properly, disposable preferable to towel nappies
* Leave nappy off as much as possible to help skin drying
* Clean/change every 3-4 hours / ASAP after soiling
* Use water, or fragrance-free or alcohol-free baby wipes
* Dry gently after cleaning
* Bath the child daily (do NOT use soap, bubble bath, lotions or talcum powder)
* If mild erythema and the child is asymptomatic
* Advise on the use of **barrier preparation at each change** (available OTC)
* Zinc and Castor oil ointment BP, Metanium ointment, white soft paraffin BP ointment
* If moderate erythema and discomfort
* If \>1-month-old = **hydrocortisone 1% cream OD** (max 7 days)
* If rash persists and Candida
* **Advise against the use of barrier protection**
* **Topical imidazole cream** *(clotrimazole, econazole, miconazole)*
* If rash persists and/or Bacterial infection
* Prescribe **oral flucloxacillin** (clarithromycin if pen-allergic) for 7 days
* Arrange to **review the child**
35
Define Seborrhoeic Dermatitis?
Dandruff presents in first 6 weeks - resolves over following weeks.
36
What are the signs and symptoms of seborrhoeic dermatitis?
* Flaking skin on scalp (infants)
* Erythematous, yellow, crusty, adherent layer (cradle cap) that can spread to behind ears, face, flexures → non-itchy - Pityriasis versicolor *(associated with Malassezia yeasts)*
37
What is the cause of Pityriasis versicolor?
Malassezia furfur
38
What are the appropriate investigations for suspected seborrhoeic dermatitis?
* Clinical diagnosis
* Skin scrapings for Malassezia
* Culture of swabs
39
What is the management of seborrhoeic dermatitis?
* **Spontaneous resolution (by 8m)**
* 1st line if scalp affected = **regular washing with baby shampoo and gentle brushing to remove scales**
* Soaking crusts overnight with white petroleum jelly or slightly warmed vegetable/olive oil, and shampooing in the morning / soften scales with baby oil, gentle brush, wash off with baby shampoo
* Emulsifying ointment can be used if these measures don’t work
* If other areas of skin affected, bathe infant ≥1/day using emollient as a soap substitute
* 2nd line if scalp affected = **topical imidazole cream** (e.g. clotrimazole, econazole, miconazole)
* Consider specialist advice if it lasts \>4 weeks
* 3rd line if severe = **mild topical steroids** (e.g. 1% hydrocortisone)
40
Define Tinea.
Fungal infection in which dermatophyte fungi invade dead keratinous structures.
41
What are the signs and symptoms of tinea?
* Ringed appearance ± kerion (severe inflamed ringworm patch), red or silver rash
* Tinea capitis – scalp
* Tinea pedis – feet
42
What is the diagnosis?
Tinea
43
What is the management of Tinea (*Faciei, Corporis, Cruris or Pedis)?*
* Mild = **topical antifungals** (e.g. terbinafine cream, clotrimazole)
* Moderate = **hydrocortisone 1% cream**
* Severe = **oral antifungals**
* 1st line = oral terbinafine
* 2nd line = oral itraconazole
* **Advice** - very contagious so take steps to prevent spread
* Wear loose-fitting cotton clothing
* Wash affected areas of skin daily
* Dry thoroughly after washing
* Avoid scratching
* Do not share towels
* Wash clothes and bed lined frequently
* No need for school exclusion
44
What is the management of Tinea Capitis?
* **Oral antifungal** (e.g. griseofulvin or terbinafine)
* **Advice** - very contagious so take steps to prevent spread
* Wear loose-fitting cotton clothing
* Wash affected areas of skin daily
* Dry thoroughly after washing
* Avoid scratching
* Do not share towels
* Wash clothes and bed lined frequently
* No need for school exclusion
45
What is the cause of scabies?
Sarcoptes scabiei
46
What are the signs and symptoms of scabies?
* Intense itching, especially at night
* Raised rash or spots
47
What is the diagnosis?
Scabies
48
What is the management of Scabies?
* **Antibiotics → Permethrin**
* **Advice** - very contagious so take steps to prevent spread
* Wear loose-fitting cotton clothing
* Wash affected areas of skin daily
* Dry thoroughly after washing
* Avoid scratching
* Do not share towels
* Wash clothes and bed lined frequently
* No need for school exclusion
49
What is Mongolian Blue Spot?
Blue/black macular discolouration at base of the spine and on buttocks
* Far more common in Afro-Caribbean or Asian infant
50
What is management of Mongolian Blue Spot?
Self-limiting → fade slowly over the first few years (by 4yo)
51
What is Naevus flammeus?
* Vascular malformation which present at birth
* **Port-wine stain in distribution of trigeminal nerve**
* Associated with
* Sturge-Weber syndrome - GNAQ mutation à intracranial lesions
* Flat patch → becomes bumpy
* Epilepsy, contralateral hemiplegia, intellectual disability
* Parkes Weber syndrome
* Kippel-Trénaunay syndrome
* Proteus syndrome
52
What is Naevus simplex?
* Vascular malformation which present at birth
* Pink or red patch at birth
* Goes redder when the infant cries
* *AKA: Salmon patches, Stalk bites, Angel's kiss*
53
What are the appropriate investigations for vascular malformations?
* Mainly clinical diagnosis
* 1st = USS
* 2nd = MRI (Sturge-Weber)
54
What is the management of vascular malformations?
* Conservative
* Naevus flammeus = life-long
* Naevus simplex = usually fade in first few years
55
What are the signs and symptoms of Erythema Toxicum?
* Maculo-papular-pustular lesions - last for 1 day at a time
* **Wax and wane** over the **first few days/weeks of life**
* Begins on the face and spreads to the limbs
56
What are the appropriate investigations for suspected erythema toxicum?
* Exclude congenital infections
57
What is the management of suspected erythema toxicum?
* Self-limiting
* Benign - affects 50% of new-borns
58
What are the risk factors for Infantile Haemangioma?
* LBW
* Prematurity
* Female
* Multiple gestation
59
What are the signs and symptoms of superficial infantile haemangioma (85%)?
* **Bright red** area of skin that **feels warm**
* Not present at birth → appear in few days/weeks → rapidly grow → regress over 1-2 years
* Located - upper eyelids, midforehead, nape of neck
60
What are the signs and symptoms of deep infantile haemangioma (15%)?
* **Blue** in colour that forms a **lump**
* Not present at birth → becomes evident after a few weeks
* May just look like a lump of normal skin
61
What are the signs and symptoms of mixed infantile haemangioma?
Bright red area on blue area/lump
62
What are the syndromes associated with infantile haemangiomas?
* **Kasabach-Merritt**
* *Haemangioma with thrombocytopenia*
* **PHACES syndrome**
* *Posterior fossa malformations*
* *Haemangioma*
* *Arterial anomalies*
* *Cardiac anomalies / Co-arctation of the aorta*
* *Eye anomalies*
* *Sternal anomalies*
* **LUMBAR syndrome**
* *Lower body or lumbosacral haemangioma*
* *Urogenital anomalies or ulceration*
* *Myelopathy*
* *Bony deformities*
* *Anorectal and arterial anomalies*
* *Renal anomalies*
63
What are the appropriate investigations for suspected infantile haemangioma?
* **Clinical diagnosis**
* **USS → MRI / MRA** - gold-standard to diagnose complex vascular tumours if the lesions are:
* Deep
* Single large capillary haemangioma
* Multiple haemangiomas
* Near the eye
64
What is the management infantile haemangiomas?
* **Conservative**
* Try not to catch it
* Use Vaseline and avoid irritants)
* Medical photography + review in 3 months
* **Topical or intra-lesional steroid**
* **Topical timolol** if small and near
* Eyes
* Lips (often becomes ulcerated)
* Nappy area
* Nasal tip
* Ear
* Larger lesions = **Oral propranolol**
* Ulceration (10-20%) = **Antibiotics and Analgesia**
65
What are the reasons for referral of an infantile haemangioma?
* Function threatening - *periocular, nasal tip, ear, lips, genetalia*
* Large facial, anogenital, perineal
* Lumbosacral
* Ulcerating
* “Beard” distribution (laryngeal haemangioma) → ENT referral
* Multiple lesions (\>5 = USS liver)
66
What are the types of congenital haemangioma?
* **Rapidly involuting congenital haemangiomas (RICH)**
* Maximum size by birth → involute by 12-18 months
* **Non-involuting congenital haemangiomas (NICH)**
* Continue to grow as baby grows
* Do not shrink after birth (unlike infantile haemangiomas and RICH)
* **Partially involuting congenital haemangiomas (PICH)**
* Combination RICH and NICH types
67
What are the signs and symptoms of congenital haemangioma?
* Present at birth
* **Raised or flat, pink or purple**
* Transient thrombocytopenia
* Rarer than infantile haemangioma
68
What are the appropriate investigations for suspected congenital haemangioma?
* USS
* Medical photography
69
What is the management of congenital haemangioma?
* Conservative
* Embolisation - if they need to be removed
70
What are the complications of haemangiomas?
* Infantile = Ulceration
* Congenital = Heart failure - *if large enough to generate high blood flow*
71
What is the grading of acne vulgaris?
* Mild
* \<20 comedones
* \<15 inflammatory lesions
* Or total lesion count \<30
* Moderate
* 20-100 comedones
* 15-50 inflammatory lesions
* Or total lesion count 30-125
* Severe
* \>5 pseudocysts
* \>100 comedones
* \>50 inflammatory lesions
* Or total lesion count \>125
