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Dermatology Flashcards

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1
Q

Acne non-pharmacological management

A
  • Avoid heavy cleansing
  • Avoid cheap soaps/washes
  • Avoid excessive scrubbing/exfoliating

(All cause MORe irrigation to epidermis, blocks sebaceous glands)

  • Use non-comdeogenic and non-acnegenic creams, cosmetics and sunscreen instead
  • Do not squeeze/pick pimples
  • Balanced, healthy diet
  • Minimise exposure to hot/humid environments (steam, kitchens, spas)
  • Smoking cessation
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1
Q

Acne pathophysiology - 4 steps

A
  1. Abnormal increased proliferation of follicular keratinocytes –> follicular plug
  2. Increased sebum production from sebaceous follicles
  3. Proliferation of microorganisms within sebum
  4. Inflammation
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2
Q

Acne mild treatment (3 steps)

A
  1. OTC products - benzoyl peroxide 5%
  2. –> Topical retinoid (e.g adapelene 0.1% gel or cream, tretinoin 0.025% cream)
    Apply 2nd nightly for 2/52 then nightly
    Review after 6/52
    (TERATOGENIC!!!)
  3. –> Topical combination
    comedonal - Benzoyl peroxide+adapalene 2.5%+0.1% gel, once daily
    inflammatory - benzoyl peroxide+clindamycin 5%+1% gel, once daily
    R/v after 6/52
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3
Q

Acne moderate treatment (men, if pregnant, women)

A
  1. Doxycycline 50mg-100mg daily 6/52 then r/v
  2. Minocycline 50mg-100mg daily 6/52 then r/v

If pregnant
1. Erythromycin 250-500mg BD 6/52 then r/v

Women
1. COCP; ethinylestradiol+cyproterone

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4
Q

Acne severe treatment (1) + main risk + side effects (6)

A

Isotretinoin (refer Derm)

Main risk teratogenicity Cat X - recommend double contraception

A/e’s

  • Dry skin
  • Epistaxis
  • Photosensitivty
  • Myalgias
  • headaches
  • LFT derangement
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5
Q

Features on history to assess for skin cancer risk assessment

A
  • Ethnic background, skin phototype (Fitzpatrick skin type I-II high risk), red hair
  • Immunosuppression
  • Recent change in lesions
  • Symptomatic lesions (bleeding/pruritis?)
  • PHx of skin Cancer/removal of suspicious lesion
  • Tendency to sunburn
  • Occupational risk
  • Time spent outside/outdoors

>100 naevi or >10 dysplastic naevi

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6
Q

Tinea cruris management

A

Topical antifungal (terbinafine 1% gel) once or twice daily for 7-14 days

+/- hydrocortisone cream

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7
Q

Impetigo Rx in endemic settings

A

Bactrim 160/800mg BD 3 days

(IM Benzathine Benpen also 1st line, 1.2 million units)

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8
Q

Pyoderma gangrenosum associated conditions (3)

A
  • IBD
  • Rheumatoid arthritis
  • Myeloid blood dyscrasias (e.g leukaemia)
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9
Q

Melasma risk factors

A
  • UV exposure
  • Hormones (oestrogen/prog) - e.g during pregnancy/COCP/MHT
  • Soaps/cosmetics
  • Heat exposure
  • Can be a/w thyroid disease
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10
Q

Melasma Rx

A
  • Kligman’s formula (gold standard) - combo of hydroquinone/tretinoin/dexamethasone, BD for 3 weeks
  • Azelaic acid 5-20% BD
  • Tranexamic acid 2-5% BD
  • Hydroquinone cream 2-5 % daily
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11
Q
  • High fever 3-5 days (+/- URTI sx, lymphadenopathy) –> rash appears as fever subsides
  • Rash starts on trunk then spreads to neck, limbs and face
A

Roseola infantum (HHV6-7)

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12
Q

When can Hand Foot Mouth disease kids go back to school

A

Blisters stop being infective once dried (but can continue shedding in stools for a month)

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13
Q

Plaque psoriasis management options - broad (3)

A
  • Tar (6% LPC/3% salicylic acid cream) - generally 4 weeks
  • Corticosteroids - generally methylpred for 2-6 weeks
  • Calcipotriol - nails/palsm
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14
Q

Psoriatic nail changes (5)

A
  • Oil spots
  • Horizontal ridges
  • -Onycholysis*
  • -Subungal hyperkeratosis*
  • -Pitting - last 3 overlap with onychomycosis*
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15
Q

Onychomycosis treatment

A

Terbinafine 250mg daily 12 weeks toenails, 6 weeks fingernais

2nd-line alts - fluconazole, itraconazole

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16
Q

Vitiligo history (risk factors) (4)

A

PHx/FHx autoimmune disease - thyroid, coeliac, alopecia areata

-STRONG a/w thyroid disease - consider testing thyroid Ab

FHx vitiligo

Hx melanoma

Emotional stress

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17
Q

Impetigo non-endemic Rx

  • Localised
  • Multiple sores
  • Pen allergy delayed
  • Pen allergy immediate
A
  • Mupirocin 2% ointment TDS 5/7
  • Fluclo/diclox 500mg QID 7/7
  • Cefalexin 500mg QID 7/7
  • Bactrim 160/800 BD 3 days
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18
Q

Allergic contact dermatitis Ix options

Study These Flashcards
A
  • Usage test (apply substance to cub. foss BD for 7 days)
  • Patch testing - refer Derm
  • Skin scrapings for microscopy/fungal culture? tinea manuum?
19
Q

Contact dermatitis management principles (4)

Study These Flashcards
A
  • Avoidance –> Protection –> Substitution –> Treatment
  • Protection - PPE, gloves, barrier creams
  • Regular emollients after work
  • Topical steroids/calcineurin inhibitors
  • If severe/acute –> ?PO steroids 25-50mg daily for 1 week, taper over 2 weeks
20
Q

?Diagnosis

Abrupt onset hair loss, patchy

Age <40 y.o

PHx/FHx autoimmune disease/atopy?

Exclamation mark hairs

Positive hair pull test

Study These Flashcards
A

Alopecia areata

21
Q

?Diagnosis

Usually in kids

Gradual or abrupt onset

Localised hair loss

?Contact with animals/travel

Broken hairs, comma hairs

Study These Flashcards
A

Tinea capitis

(needs oral antifungals - terbinafine or griseofulvin. Start treatment before mCS results back)

22
Q

?Diagnosis

Abrupt onset

Diffuse hair thinning

2ndary to iron deficiency/thyroid disease/post-partum

Areas of hair regrowth

Positive hair pull test

Study These Flashcards
A

Telogen effluvium

23
Q
Study These Flashcards
A

Trichofolliculoma - rare benign adnexal tumour

DDx

  • Epidermal cyst
  • Soft fibroma
  • Keloid
  • Chondroma
  • Dilated pore of Winer
24
Guttate psoriasis Rx options (3)
* Same as for psoriasis of trunk & limbs* - LPC6% + salicylic acid3% BD for 1 month - Methylpred 0.1% (Advantan)/mometasone 0.1% daily for 2-6 weeks - Calcipotriol + betamethasone foam 50+500, daily for 6 weeks
25
Urticaria triggers (7)
- Allergy (occurs w/ exercise, w/ assoc. abdo pain/SOB, within 1-2 hrs of meal) - infections - Meds - e.g penicillins - Contact allergy to plants/animals - Foods - Bites and stings - Physical (cold, pressure)
26
Scabies Rx - Adults/kids \>5 y.o - Crusted scabies
1. Permethrin 5% from neck down, nails w/ nialbursh, leave on for 8 hours, repeat in 7 days 1. Oral ivermectin 200mcg/kg stat, repeat in 7 days 2. Benzyl benzoate 25% topical from neck down, repeat 7 days --Treat all household contacts --Hot wash clothes/bedsheets (apply creams to face and scalp if central/northern Aust, infants/elderly) Crusted - refer ID/hospital
27
Biopsy margins for: - Suspected melanoma - Lentigo maligna - SCC/BCC
- excisional biopsy w/ 2mm margin - shave excision of entire lesion if possible - SCC/BCC - excisional biopsy with 3-5mm margins
28
Folliculitis Rx -Spa bath folliculitis - causative agent & Rx
- Warm compress, mupirocin 2% ointment BD for 5/7 - Pseudomonas aeruginosa, cease contact w/ water supply/irritant
29
Erythrasma risk factors (7)
Warm climate Excessive sweating Diabetes Obesity Poor hygiene Advanced age/immunocompromise Skin of colour *Normal commensal bacterium, cornyebacterium*
30
Erythramsa Rx (2)
1. Fusidate sodium 2% ointment, BD for 14 days 2. Clarithromycin 1g oral stat dose
31
Pityriasis versicolour - causative organism, Rx options (4)
Malassezia yeast * Econazole 1% overnight for 3 nights * Ketoconazole 2% shampoo top, daily for 3-5 mins & wash off, for 5 days * Miconazole 2% shampoo top, daily for 10 mins & wash off, for 10 days * Selenium sulfide 2.5% shampoo, daily for 10mins/overnight for 7-10 days Unresponsive = fluconazole 400mg stat dose
32
Common warts Rx (2) Plane warts Rx (1)
- Salicylic acid up to 40% w/v, daily until cleared - Cryotherapy - three freeze-thaw cycles of 10-20 secs every 2-4 weeks Typically resolve spontaneously 6-12 mths -Topical retinoid
33
Imiquimod/fluorouracil doses for SCC
Imiquimod 5% cream nocte up to 5 nights per week for up to 6 weeks Fluorouracil 5% cream once or twice daily, 2-4 wweeks
34
Referral thickness for melanoma to MDT Definitive management (margins)
* Refer _all \>1mm thickness/uncertainty in histopath dx_ to multidisciplinary melanoma team * Definitive Rx of in situ melanoma = **wide local excision with 5-10mm margin** * Invasive = margins of _10-20mm_ * + **sentinel lymph node biopsy** if thickness \>1mm
35
Follow-up advice aspects post-melanoma treatment (3)
* Peak risk period is within _first 3 years_ * Educate on self-skin examinations * 3 monthly skin check if stage 3, 12-monthly skin check if stage 1
36
Onycomychosis DDx (7)
* Nail psoriasis * Lichen planus * Yellow nail syndrome * Traumatic onychodystrophy * Alopecia areata * Age-related nail dystrophies * Subungal melanoma/SCC
37
BCC low risk management options (other than biopsy/excision) (4) -High risk management options (2)
* Other management options _only if_ **superficial** and **low risk area** * Imiquimod 5% 6 weeks * Curettage and cautery * Photodynamic therapy * Cryotherapy * High risk Rx * Referral to _specialist_ * RTx or Moh's surgery
38
Follow-up intervals post-SCC treatment
-Every 3-6 months after excision for first 2 years Then 6-12 monthly *(Recurrence is common in first 2 years)*
38
Follow-up intervals post-SCC treatment
-Every 3-6 months after excision for first 2 years Then 6-12 monthly *(Recurrence is common in first 2 years)*
39
Oral leukoplakia DDx (6)
- Candidiasis - Lichen planus - Nicotine stomatitis - Habitual cheek/lip biting - Frictional keratosis - SLE
40
Psoriasis RFs/flares (7)
Drugs (b-blockers, ACEIs, NSAIDs) Infections (strep/HIV) Skin trauma Stress Alcohol Sunburn Hormonal factors (pregnancy)
41
Mild recurrence of oral mucocutaneous herpes - immunocompetent pt Rx options (2)
Episodic therapy 1. aciclovir 5% cream topically, 5 times daily for 5 days 1. Famciclovir 1500mg oral stat
42
infrequent, severe recurrence of oral mcuocutaneous herpes - immunocompetent Rx options (3)
1. Famciclovir 1500mg stat dose 1. valaciclovir 2g oral BD for 1 day 2. Aciclovir 200mg, 5 times daily for 5 days
43
Erythema nodosum treatment
Bed rest NSAIDs Elevation/compression Pred 25mg daily 2/52 then taper, if severe
44
Wound or ulcer history questions (6)
- Smoking status - Tetanus immunisation - Immunosuppressant conditions/meds - Compliance w/ treatment (e.g diabetes) - Symptoms of infection (e.g fever) - Presence of PVD/arterial disease

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