Dermatology

Question 1

What is the primary care management of acne vulgaris?

Answer 1

Topical benzoyl peroxide
Topical retinoid
Topical abx eg. clincamycin
Oral abx eg. lymecycline
COCP in females - co cyprindiol most effective but high risk VTE, only 1 yr

Question 2

What is the secondary care management of acne vulgaris?

Answer 2

Oral retinoid eg. isotretinoin as last line

Question 3

What are the SE of isotretinoin?

Answer 3

Dry skin and lips
Photosensitivity
Depression, anxiety, suicidal ideation
Stevens Johnson syndrome and toxic epidermal necrolysis

Question 4

What is the maintenance of eczema?

Answer 4

Emollients as often as possible
Soap substitutes
Avoid triggers

Question 5

What is used in treating flares of eczema?

Answer 5

Thicker emollients
Topical steroids
Wet wraps and garments
IV abx or oral steroids if severe

Question 6

What are some secondary care options for managing eczema?

Answer 6

Topical tacrolimus
Phototherapy
Systemic immunosuppressants - oral steroids, methotrexate, azathioprine

Question 7

What are the stages of emollient?

Answer 7

Thin - lotion
Middle - cream eg. E45, aveeno, cetraben, epaderm
Thick - emollient eg. epaderm ointment, hydromol ointment

Question 8

What is the steroid ladder?

Answer 8

Mild - hydrocortisone - 0.5, 1 and 2%
Mod - eumovate - clobetasone 0.05%
Potent - betnovate - betamethasone 0.1%
V potent - dermovate - clobetasol

Question 9

Bacterial infection in eczema

Answer 9

Common due to skins protective barrier is broken down, most commonly S.aureus
Treat - oral fluclox

Question 10

What is eczema herpeticum?

Answer 10

Viral skin infection caused by HSV or VZV, normally in atopic aczema due to close contact w some w cold sore or having a cold sore

Question 11

What is the presentation of eczema herpeticum?

Answer 11

Widespread painful vesicular rash, erythematous and burst vesicles = ulcer
Systemic sx - fever, lethargy, irritability, reduced oral intake, lymphadenopathy

Question 12

What is the management of eczema herpeticum?

Answer 12

• Viral swabs or vesicles confirm dianosis
• Aciclovir, oral if mild, IV if severe

Question 13

What are the complications of eczema herpeticum?

Answer 13

Life threatening if immunocompromised or not treated well
Can also have bacterial superinfection on top

Question 14

What are the different types of ringworm?

Answer 14

Tinea capitits - head
Tinea pedis - atheletes foot
Tinea cruris - groin
Tinea corporis - body
Onychomysosis - fungal nail infection

Question 15

What does ringworm look like?

Answer 15

Itchy erythematous, scaly, well demarcated rash in rings or circles that spread outwards w well demarcated edge - red on outside clear in middle.
Capitis - hair loss
Onychomycosis - thickened, discoloured, deformed nails

Question 16

What is the management of tinea?

Answer 16

Anti fungal cream - clotrimazole and miconazole
Anti fungal shampoo - ketoconazole
Oral anti fungals - fluconazole
Nail infection - amorolfine nail lacquer for 6-12 m or oral terbinafine
Topical steroid for itch

Question 17

What is impetigo?

Answer 17

Superficial bacterial skin infection caused by S.aureus when bacteria gets into skin.
- Non bullous - golden crust
- Bullous - fluid filled vesicles which burst = golden crust

Question 18

What is the management of non bullous impetigo?

Answer 18

Topical fusidic acid
Oral fluclox if wide spread or severe
Contagious !!! So stay off school until healed or on abx for 48 hours

Question 19

What is the management of bullous impetigo?

Answer 19

More common in <2 years and get systemic sx
Fluclox oral or IV
Isolation

Question 20

What are the complications of impetigo?

Answer 20

Cellulitis
Sepsis
Scarring
Post strep GN
Staph scaled skin syndrome
Scarlet fever

Question 21

What causes hand foot and mouth disease and what does it look like?

Answer 21

Coxscakie A virus
1. URTI sx
2. Oral ulcers
3. Blistering red spots across body, esp hand foot and mouth

Question 22

What is the management for hand foot and mouth disease?

Answer 22

Supportive management
Highly contagious - avoid towels and bedding, no school etc

Question 23

What are some complications of hand foot and mouth disease?

Answer 23

Dehydration
Bacterial superinfection
Encephalitis

Question 24

What is the management of headlice?

Answer 24

Dimeticone lotion can be put on hair for 8 hours then washed off, then again 7 days later
Bug Buster kit - fine combing out lice out

Question 25

What does a scabies rash look like?

Answer 25

Itchy!!!! small red spots and burrow marks, normally between finger webs but can spread to whole body

Question 26

What is the management of scabies?

Answer 26

- Permethrin cream over whole body for 8-12 hours and then wash off, then repeat again 7 days later - Oral ivermectin single dose if difficult to treat - Treat all household and close contacts - Wash linens - Itching can continue for 4 weeks - antihistamines

Question 27

What is crusted scabies?

Answer 27

Serious scabies infestation in immunocompromised pt - v contagious. Not as itchy as little immune response. Scaly plaques of skin. Oral ivermectin and isolation

Question 28

What are the RF of nappy rash?

Answer 28

Delayed changing of nappies Irritant soap or rough cleaning Bad nappies Diarrhoea Oral abx = candida

Question 29

Nappy rash vs candida infection

Answer 29

Candida - rash into skin folds, larger red macules w demarcated border, rash spreads outwards, satellite lesions

Question 30

What is the management of nappy rash?

Answer 30

- Better nappies and better nappy changing - Gentle products for cleaning and then dry the area before replacing the nappy - As much time as possible no nappy Candida - antifungals

Question 31

What is infantile seborrhoeic dermatitis? How do you treat?

Answer 31

Cradle cap - crusted flaky scalp that is self limiting. Treat - gentle brushing of scalp w baby oil and then wash, vaseline at night. Then clotrimazole or miconazole for up to 4w

Question 32

What are the CF of molluscum contagiosum?

Answer 32

- Viral cause - Small flesh coloured papules w central dimple - Resolve themselves w/o any treatment but may take 18m, immunocompromised = specialist

Question 33

Stevens Johnson syndrome vs toxic epidermal necrolysis

Answer 33

SJS - <10% body affected, TEN - >10% of body affected

Question 34

What are the causes of SJS?

Answer 34

Meds - anti epileptics, abx, allopurinol, NSAIDs Infections - herpes simplex, mycoplasma pneumonia, CMV, HIV

Question 35

What are the CF of SJS?

Answer 35

- Non specific sx first = fever, cough, sore throat, mouth, eyes and ithcy skin - Purple red rash that spreads across skin - Skin begins to blister and then break away = raw tissue - Pain, erythema and blistering of the lips of mucous membranes - Eyes = ulcered and inflam

Question 36

What is the management of SJS?

Answer 36

Medical emergency: - Admit - Supportive - Steroids - Immunoglobulins and immunosuppressants

Question 37

What are the complications of SJS?

Answer 37

- Cellulitis and sepsis - bacteria get in through the broken skin - Permanent skin damage - scarring - visual complications if eye involved