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Dermatology Flashcards

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1
Q

What is (acne) rosacea?

A

A common, chronic skin condition causing flushing of the forehead, nose, cheeks and chin - flushing can be transient, recurrent or persistent

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2
Q

When does rosacea typically present?

A

Age 30-60

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3
Q

In who is rosacea more common?

A

1) Those with pale skin
2) Affects females more commonly than males (although can affect males more severely)

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4
Q

How does rosacea present?

A

With a red rash over the central face

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5
Q

Describe the rash in rosacea

A

1) Consists of papules and pustules on an erythematous background
2) Often with telangiectasia (dilated, superficial, small blood vessels)

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6
Q

What is rosacea exacerbated by?

A

Factors that cause facial flushing e.g:
1) Sun exposure
2) Hot weather
3) Warm baths
4) Stress
5) Spicy foods

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7
Q

What causes rosacea?

A

Not fully understood - thought to involve genetics, immune, vascular and environmental factors

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8
Q

What are general measures to manage rosacea (not treat)?

A

1) Camouflage creams
2) Sun protection
3) Avoiding factors causing facial flushing

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9
Q

How do you treat rosacea?

A

Topical treatments
1) Brimonidine (first line according to NICE)
2) Azelaic acid
3) Ivermectin
Topical antibiotics
4) Metronidazole
5) Oral antibiotics can also be used if symptoms are more severe
6) Adjunct - emollient can be used as soap substitute to help improve symptoms if the skin is dry
7) Adjunct - laser therapy an be used to manage persistent telangiectasia

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10
Q

What are complications of untreated rosacea?

A

1) Rhinophyma - skin thickening, enlargement and disfiguration of the nose
2) Ocular involvement e.g. blepharitis, conjunctivitis or keratitis

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11
Q

What is acne vulgaris?

A

Inflammatory disease of the pilosebaceous follicle common in adolescents

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12
Q

How does acne vulgaris present?

A

1) Presents with comedones, papules and pustules on a background of greasy skin
2) Most often seen on the face, chest and upper back

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13
Q

What is steroid rosacea?

A

Can appear similarly to rosacea however follows use or withdrawal of strong topical corticosteroids

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14
Q

What is seborrhoeic dermatitis caused by?

A

Proliferation of Malassezia furfur, a yeast found normally on the skin

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15
Q

How does seborrhoeic dermatitis present?

A

Erythematous, greasy, scaly patches on the scalp, nasolabial folds and posterior auricular skin

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16
Q

What is contact dermatitis?

A

A type of eczema caused by exposure to an irritant or an allergen on the skin e.g. metals, make up or hair dye

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17
Q

How does contact dermatitis present?

A

Dry, painful, pruritic rash often with blistering and fissuring on the skin, most commonly on the hands

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18
Q

What is another name for tinea corpis?

A

Ringworm (fungal infection)

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19
Q

What does ringworm cause?

A

Rash e.g. face and skin around ears - painless and does not blister

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20
Q

How does impetigo present?

A

Blister-like lesions with gold coloured crust, often affects the face

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21
Q

What is Ramsay Hunt syndrome?

A

Shingles affected the nerve supplying the outer ear

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22
Q

Which patients are more susceptible to Ramsay Hunt syndrome?

A

Immunosuppressed e.g. on methotrexate

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23
Q

How does Ramsay Hunt syndrome present?

A

1) Very painful ear, pain worsening
2) Feeling generally unwell for a few weeks
3) Muffled hearing but no discharge
4) Erythematous ear and ear drum (not bulging) with blister-like lesions surrounding the outside of the ear
5) Ipsilateral facial palsy after ear/skin symptom onset

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24
Q

How does plaque psoriasis present?

A

Red scaly plaques on extensor surfaces, sacrum and scalp

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25
What is cellulitis?
Bacterial soft tissue infection of the dermis and subcutaneous tissue
26
What are risk factors for cellulitis?
1) Advancing age 2) Immunocompromised e.g. diabetic 3) Predisposing skin condition e.g. ulcers, pressure sores, trauma, lymphoedema
27
What pathogens generally cause cellulitis?
Streptococcus or staphylococcus bacteria
28
What are the clinical features of cellulitis?
1) Erythema 2) Calor (heat) 3) Swelling 4) Pain 5) Poorly demarcated margins 6) Systemic upset - fever, malaise 7) Lymphadenopathy 8) Often evidence of breach of skin barrier e.g. trauma, ulcer etc
29
What investigations do you do for cellulitis?
1) Blood tests - culture 2) Skin swab - culture
30
How do you treat cellulitis?
1) Oral or IV abx - depending on severity 2) Mark the area of erythema to aid in detection of rapidly spreading cellulitis 3) Elevate if possible 4) Wound debridement may be necessary
31
What is dermatitis herpetiformis?
1) Autoimmune skin disorder that usually presents with vesicular lesions on extensor surfaces e.g. elbows, knees and buttocks 2) Associated with coeliac disease
32
Which patients are more susceptible to molluscum contagiosum?
Children and adolescents
33
What causes molluscum contagiosum?
Skin to skin contact of molluscum contagiosum virus (MCV)
34
How does molluscum contagiosum present?
1) Small, smooth, pearly/flesh coloured papules with a central area of umbilication - lesions are round and raised with a small depression in the centre (not itchy or painful but can be inflamed) 2) Can occur anywhere on the body (face, neck, trunk, arms, legs), but commonly occur on the genitals 3) In immunocompromised patients e.g. HIV, lesions can be found to be extra-genital, esp. on the face
35
How do you diagnose molluscum contagiosum?
Visual inspection
36
How is molluscum contagiosum managed?
1) All patients presenting with genital molluscum should be offered a full STI screen 2) It is usual for the infection to clear spontaneously after 3 months 3) If the patient is caused distress due to cosmetic reasons, they may be offered cryotherapy to remove the lesions
37
How does herpes zoster (shingles) present?
Thin rash along a dermatome e.g. trunk - occurs in up to ⅓ of patients with VZV, not often serious and would not commonly occur in childhood
38
Which pathogen causes shingles?
VZV
39
What is shingles?
VZV reactivation
40
Where does VZV lie dormant?
In the dorsal root ganglion
41
What are risk factors for shingles?
1) Elderly 2) Immunosuppression
42
How does shingles present?
1) Erythematous papular rash in dermatomal distribution 2) This rash develops into a vesicular rash which then crusts over and heals 3) Systemic symptoms = fever, headache, malaise 4) Herpes zoster ophthalmicus
43
How does herpes zoster ophthalmicus present?
1) Painful red eye 2) Keratitis 3) Vision loss 4) Systemic symptoms = fever, headache, malaise 5) Typical erythematous vesicular rash in the region of the ophthalmic branch of the trigeminal nerve (V1)
44
Where is a typical location for herpes zoster to present?
Ophthalmic branch of the trigeminal nerve - causes herpes zoster ophthalmicus
45
What is Hutchinson's sign?
A lesion on the tip/side of the nose which is a strong predictor of ocular involvement in herpes zoster
46
What are potential complications of shingles?
1) Secondary bacterial infections (lesions) 2) Corneal ulcers/scarring/blindness 3) Post-herpetic neuralgia
47
How do you diagnose shingles?
Clinical - history + examination
48
How do you manage herpes zoster?
1) Antivirals e.g. valaciclovir PO 1g TDS for 7 days if eye involvement or immunocompromised 2) IV antivirals if severe disease 3) Avoid contact with vulnerable people until the lesions are fully crusted over
49
Who is the one-off shingles vaccine advised for?
Adults in their 70s
50
What is cellulitis?
Bacterial soft tissue of the dermis and subcutaneous tissues
51
What are the risk factors for cellulitis?
1) Advancing age 2) Diabetes (bc of immunocompromise) 3) Predisposing skin condition e.g. breaks in the skin barrier, ulcers, pressure sores, trauma, lymphoedema
52
What are the infectious agents in cellulitis?
Streptococcus and staphylococcus - Staph aureus and strep pyogenes (group A strep)
53
How does cellulitis present?
1) Inflammation - erythema, heat, pain, swelling, loss of function 2) Poorly demarcated margins 3) Systemic upset - fever, malaise 4) Lymphadenopathy 5) Evidence of skin barrier breach/breakdown
54
How do you diagnose cellulitis?
1) Blood culture 2) Skin swab culture
55
How do you manage cellulitis?
1) Mark area of erythema - to help identify rapidly spreading cellulitis 2) PO/IV abx e.g. oral cephalosporins e.g. PO cefalexin in uncomplicated cellulitis 3) Elevate 4) Wound debridement
56
What is necrotising fasciitis?
Rare life-threatening condition with high mortality - affects subcutaneous soft tissues and spreads along the fascial planes (NOT the underlying muscle)
57
How many types of necrotising fasciitis are there and which are the two most common?
4 - type 1 and 2
58
What is type 1 necrotising fasciitis?
Polymicrobial infection with anaerobes
59
What is type 2 necrotising fasciitis?
Monomicrobial infection with group A strep
60
What are risk factors for necrotising fasciitis?
Cutaneous portal of entry for bacteria - trauma, surgery
61
How does necrotising fasciitis present?
1) Rapidly spreading cellulitis 2) Systemically very unwell - pyrexial, tachycardia, tachypnoea, hypotension (septic) 3) Affected regions will be blistering, erythematous and oedematous 4) Severe pain 5) Grey skin with overlying crepitus
62
How do you confirm diagnosis of necrotising fasciitis?
CT or MRI - should NOT delay surgery
63
How do you manage necrotising fasciitis?
1) Haemodynamic support 2) Urgent debridement surgery 3) Broad-spectrum abx e.g. Piptaz, meropenem
64
How does eczema herpeticum present?
1) Clusters of itchy, painful monomorphic blisters on the face/neck 2) Old blisters crust over and form sores (erosions/punched out lesions)
65
What is the cause of eczema herpeticum?
HSV1 or HSV2 disseminated viral infection
66
What condition predisposes you to eczema herpeticum?
Eczema (paediatric)
67
What is a complication of eczema herpeticum?
Secondary bacterial infection (impetigo or cellulitis)
68
How do you diagnose eczema herpeticum?
1) Clinical diagnosis 2) Viral culture 3) Direct fluorescent Ab stain 4) PCR 5) Tzank smear - epithelial multinucleated giant cells, acantholysis (cell separation) 6) Bacterial swabs
69
How do you treat eczema herpeticum?
1) Aciclovir PO 400-800mg 5 times daily for 10-14 days 2) Valaciclovir 1g BD for 10-14 days
70
How is impetigo diagnosed?
Clinical diagnosis

Stage 3 (61 decks)

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