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Dermatology Flashcards

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1
Q

Erythema Nodosum causes

A

symmetrical, erythematous, tender, nodules which heal without scarring

Causes:
streptococcal infections, sarcoidosis, inflammatory bowel disease and drugs (penicillins, sulphonamides, oral contraceptive pill)

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2
Q

Pretibial myxodema

A

symmetrical, erythematous lesions seen in Graves’ disease
shiny, orange peel skin

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3
Q

Pyoderma Gangrenosum

A

initially small red papule - later deep, red, necrotic ulcers with a violaceous border

idiopathic in 50%, may also be seen in inflammatory bowel disease, connective tissue disorders and myeloproliferative disorders

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4
Q

Necrobiosis lipoidica diabeticorum

A

shiny, painless areas of yellow/red skin typically on the shin of diabetics
often associated with telangiectasia

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5
Q

Chronic plaque psoriasis Mx

A

regular emolients
1st - potent corticosteroid plus Vit D analogue once daily
2nd - Vit D analogue twice daily
3rd - Potent corticosteroid twice daily
OR - coal tar preparation

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6
Q

Seborrheic Dermatitis Fx

A

An itchy rash affecting the face and scalp distribution

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7
Q

Seborrheic Dermatitis associations (2)

A

HIV
Parkinsons

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8
Q

Perioral dermatitis Mx

A

PO/ Top Antibiotics

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9
Q

Perioral dermatitis Fx

A

more common in women
acne-like rash, with persistent redness, papules and occasional pustules affecting the area around the mouth and nose

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10
Q

Dermatophyte nail infections Mx

A

PO Terbinafine 12 weeks

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11
Q

Fungal nail infections Mx

A

Take nail sample to confirm before treatment

Limited disease - Top Amorolfine 5%
Extensive disease eg Dermatophyte - PO Terbinafine
More extensive eg Candida - PO Itraconazole

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12
Q

Acne Rosacea Fx

A

chronic skin condition which causes persistent facial flushing, erythema, telangiectasia, pustules, papules and rhinophyma

Associated with blepharitis, keratitis, conjunctivitis

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13
Q

Scalp psoriasis Mx

A

1st - topical potent corticosteroid

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14
Q

Lichen planus association

A

Wickham’s striae

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15
Q

Chondrodermatitis nodularis helicis Fx

A

Benign painful nodule on cartilage of ear

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16
Q

Causes of scarring alopecia (5)

A

trauma, burns
radiotherapy
lichen planus
discoid lupus
tinea capitis*

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17
Q

Causes of non scarring alopecia (7)

A

male-pattern baldness
drugs: cytotoxic drugs, carbimazole, heparin, oral contraceptive pill, colchicine
nutritional: iron and zinc deficiency
autoimmune: alopecia areata
telogen effluvium
hair loss following stressful period e.g. surgery
trichotillomania

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18
Q

Pyoderma gangrenosum Fx Mx

A

Painful skin ulceration - common on legs

Cx - idiopathic, autoimmune disease (RA, SLE, IBD)

Mx - steroid, immune suppression

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19
Q

Seborrhoeic dermatitis Fx

A

An itchy, scaly, greasy rash distributed across the face, scalp, upper back, chest and skin flexures

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20
Q

Sebhorroeic Dermatitis Mx

A

Ketoconazole shampoo (scalp)/ topical (body)

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21
Q

Dermatitis herpetiformis Fx

A

Chronic, itchy - grouped erythematous papules, vesicles and bulla
associated with coeliac disease

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22
Q

Contact dermatitis Ix

A

Patch test

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23
Q

Guttate Psoriasis Mx

A

1 - resolve within 3 months
2 - if >10% coverage or has psychological impact -for Urgent Dermatology for UVB phototherapy

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24
Q

Guttate Psoriasis Fx

A

Can be precipitated by strep infection (eg pharyngitis)
Tear drop papules
acute onset

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25
Discoid Eczema Fx
Coin shape, extremely itchy, on peripheries
26
Topical steroid ladder Mild Mod Potent very potent
Mild - Hydrocortisone Mod - Betamethasone 0.025% (Betnovate RD) - Clobetasone 0.05% (Eumovate) Pot - Fluticasone 0.05% - Betamethasone 0.1% (Betnovate) V Potent - Clobetasol 0.05% (Dermovate)
27
Hidradenitis suppurativa Mx
topical/ oral abx (eg clindamycin/ doxycycline)
28
Facial, flexural, genital psoriasis Mx
Topical Mild to mod steroid only
29
Actinic keratosis Mx
Topical flurouracil cream
30
Keloid scar Mx
refer for intralesional steroid eg Triamcinolone
31
sebhorriec dermatitis associated features
otitis externa blepharitis
32
Pityriasis vesicolour Mx
Ketoconazole 2% shampoo
33
Impetigo Mx
1st - top hydrogen peroxide 1% 2nd - top Fusidic acid 3rd - top Mupirocin
34
Tinea capitis Mx
Oral terbinafine with topical ketoconazole shampoo for the first 2 weeks
35
Psoriasis exacerbating factors
Trauma Alcohol B Blockers Lithium Antimalarial - chloroquine NSAID ACEi withdrawal of systemic steroids
36
necrobiosis lipoidica diabeticorum
Diabetes, waxy yellow shin lesions
37
Perioral dermatitis exacerbated by
topical steroids
38
Dermatitis artefacta Fx
Linear, well-demarcated skin lesions that appear suddenly, with 'la belle indifference' - self inflicted (usually psychological problem) - eg stress, self harm a psychocutaneous disorder in which the patients consciously create lesions in skin, hair, nail, or mucosae to satisfy a psychological need, attract attention, or evade responsibility.
39
Lichen planus Mx
Potent topical steroid
40
Pompholyx Fx
AKA dyshidrotic eczema intensely itchy vesicles on the palms and soles
41
Erythema Multiforme causes
viruses: herpes simplex virus (the most common cause), Orf* idiopathic bacteria: Mycoplasma, Streptococcus drugs: penicillin, sulphonamides, carbamazepine, allopurinol, NSAIDs, oral contraceptive pill, nevirapine connective tissue disease e.g. Systemic lupus erythematosus sarcoidosis malignancy
42
Acanthosis nigrans associated conditions
type 2 diabetes mellitus gastrointestinal cancer obesity polycystic ovarian syndrome acromegaly Cushing's disease hypothyroidism familial Prader-Willi syndrome drugs combined oral contraceptive pill nicotinic acid
43
Fungal nail infection Mx
Send nail clippings for lab analysis prior to treatment If asymptomatic - no treatment limited disease <50% - Topical Amorolfine 5% extensive disease - Oral Terbinafine (dermatophyte) very extensive disease - oral Itraconazole (candida)
44
bullous pemphigoid Mx
Refer dermatology oral corticosteroids
45
Bowens disease (intra-epidermal SCC) Mx
Top 5-fluorouracil
46
Pemphigus vulgaris Fx
Autoimmune blistering oral lesions initially then skin lesions
47
Guttate psoriasis Fx
Acute onset of tear-drop scaly papules on trunk and limbs triggered by preceding Strep - eg tonsilitis
48
Roseaca Fx
nose, cheeks, forehead flushing, telangiectasia leads to pustules and papules Blepharitis
49
Roseaca Mx
Mild - Brimonidine PRN Mod topical ivermectin + oral doxycycline Mod 2nd line topical metronidazole/ Top azelaic acid
50
Severe systemic psoriasis Mx
Methotrexate and ciclosporin
51
Coeliac disease is associated with what skin condition
Dermatitis herpetiformis
52
Acne Vulgaris Mx
1st - top combination (mild to mod) - benzoyl peroxide/ clindamycin/ retinoin (Combination of two - rarely use monotherapy) 2nd - Top + PO Abx (mod to sev) - topical retinoid/ benzoyl + PO lymecycline/ doxycyline (erythromycin if pregnancy) Consider COCP in addition for severe acne in young women
53
Perioral dermatitis Mx
oral lymecycline
54
Psoriasis nail changes (4)
pitting onycholysis subungal hyperkeratosis loss of nail
55
Notalgia paraesthetica Fx
chronic itch on medial border of scapula
56
Lichen planus Fx
pink/ purple plaque - shiny, flat, firm - on flexor surfaces crossed with fine white lines (Wickham striae) range from non to extreme itch associated with mucous membrane involvement
57
Depth of Burns Superficial epidermal Superficial dermal Deep derma Full Thick
Superficial epidermal - Red and painful, dry, no blisters Partial thickness (superficial dermal) - Pale pink, painful, blistered. Slow capillary refill Partial thickness (deep dermal) - Typically white but may have patches of non-blanching erythema. Reduced sensation, painful to deep pressure Full thickness - White ('waxy')/brown ('leathery')/black in colour, no blisters, no pain
58
Erythema nodosum Fx
symmetrical, tender erythematous nodules heal without scarring associated: strep, sarcoid, IBD, COCP, penicillin
59
Pretibial myxoedema Fx
symmetrical shiny orange peel associated: Graves
60
Pyoderma gangrenosum Fx
initially small red papule -> deep, red, necrotic ulcer associated: idiopathic, IBD,
61
Necrobiosis lipoidica diabeticorum
shiny painless yellow/red skin in diabetics
62
Porphyria cutanea tarda Fx
photosensitive rash with blistering and skin fragility on the face and dorsal aspect of hands
63
Isoretinoin SE
dry skin teratogenic low mood Intracranial hypertension (thus should not be combined with tetracyclines) photosensitivity raised lipids
64
Pityriasis versicolor cause
Malassezia furfur
65
Oral lichen planus Mx
Benzydamine mouth wash
66
Hidrandenitits suppravita Mx
Long term top/ po lymecycline
67
Molluscum contagiosum cause
Poxvirus
68
Hyperhydrosis (excessive sweating) Mx
Top Aluminium Chloride
69
Facial hirsutism Mx
1st - Top Eflornithine 2nd - Co-cyprindol
70
Seborrheic dermatitis cause
malassizia furfur
71
Blisters/bullae differentials (2)
Blisters/bullae no mucosal involvement: bullous pemphigoid mucosal involvement: pemphigus vulgaris
72
Potency of steroid creams
- Mild Hydrocortisone 0.5-2.5% - Moderate Betamethasone valerate 0.025% (Betnovate RD) Clobetasone butyrate 0.05% (Eumovate) - Potent Fluticasone propionate 0.05% (Cutivate) Betamethasone valerate 0.1% (Betnovate) - Very Potent Clobetasol propionate 0.05% (Dermovate)
73
Erythema Multiforme Fx
Target lesions back of hands/ feet, spread to torso Upper limbs > lower limbs Mild pruritis
74
Erythema multiforme causes
Virus - herpes simplex (most common) Idiopathic Bacteria - Mycoplasma, streptococcus Drugs - penicillin, sulphonamides, carbemazepine, allopurinol, NSAIDs, COCP SLE Sarcoid Malignancy
75
Erythema Nodosum Fx
Tender, erythematous, nodular lesions usually shins, but elsewhere also (forearms, thighs) self resolves with 6 weeks lesions heal WITHOUT scarring
76
Erythema nodosum causes
Infection - streptococci, Tb, brucellosis Systemic - sarcoid, IBD, Behcets Malignancy/ lymphoma Drugs - penicillin, sulphonamides, COCP Pregnancy
77
Chronic plaque Psoriasis Mx
Regular emollients 1st - Potent corticosteroid plus vitamin D analogue applied separately, one in morning one in evening 2nd - Vitamin D analogue BD only 3rd - Potent corticosteroid BD only OR coal tar preparation BD 4th - refer to Derm - phototherapy, biologics, immunotherapy Short acting dithranol can also be used
78
Scalp psoriasis Mx
1st - Potent topical corticosteroid 4 weeks 2nd - alternative topical corticosteroid
79
Face, Flexural, genital psoriasis Mx
Mild to Mod topical corticosteroid - Max 2 weeks per month
80
(Acne) Rosacea Mx
1st - Top Brimodine/ PO Metronidazole? 2nd - Top Ivermectin (Mild to mod) 3rd - Top Ivermectin + PO Doxycycline (Mod to Sev - have pustules)
81
Isoretinoin SE (7)
Teratogenic dry skin, lips, mouth low mood nose bleeds (epistaxis) intracranial hypertension photosensitivity hyperlipidaemia
82
Psoriasis exacerbating factors (9)
trauma alcohol B blockers Lithium antimalarials NSAIDs ACEi infliximab withdrawal of systemic steroids
83
Steven Johnson syndrome causes (6)
penicillin sulphonamides (eg sulfasalazine) anti epileptics - lamotrigine, carbamazepine, phenytoin allopurinol NSAIDs COCP
84
Fungal nail infections Mx
asymptomatic- no treatment IF CONFIRMED (take sample before treatment) dermatophyte or candida: 1st - Top Amorolifine 2nd - PO Terbinafine (Dermatophyte) 3rd - PO Itraconazole (Candida)
85
Lichen planus Fx
itchy purple, papular flexor surfaces, palms Covered with a "white lace"
86
Differentiating Shin lesions Erythema Nodosum Pretibial myxoedema pyoderma gangrenosum necrobiosis lipoidica diabeticorum
EN - Symmetrical, Tender nodules, heal without scarring PM - symmetrical, shiny, orange peel PG - small red papule -> deep red necrotic ulcer
87
Guttate psoriasis Fx
Children/ adolescents tear drop papules on trunk after sore throat (strep throat)
88
Skin disease related to Coeliac disease
Dermatitis herpetiformis - itchy vesicles on buttocks and elbows
89
Skin conditions in pregnancy Polymorphic eruption Pemphigoid gestationis
Polymorphic eruption - Last trimester, striae, itchy Pemphigoid gestationis - blistering, peri-umbilical, 2nd/ 3rd trimester
90
Tinea capitis Fx
scarring alopecia in children Kerion - boggy, pustular, raised lesion on scalp
91
Juvenile Spring Eruption Fx
Itchy rash on tops of ears, worse in sun classically boys aged 5-14 years in the spring (Sun)
92
Actinic keratosis Fx
AKA Solar keratosis Small crusty/ scaly lesions sun exposed areas - top of head, ears
93
Actinic Keratosis Mx
1st - Fluorouracil cream for 2-3 weeks - can lead to soreness and redness of skin Can use hydrocortisone after 2-3 weeks to help with inflammation 2nd - Top Diclofenac
94
Porphyria Cutanea Tarda Fx
Photosensitivity, blistering and skin fragility - on face, dorsum of hands
95
Tinea pedis (athletes foot) Mx
Top Miconazole
96
Causes of spider naevi (3)
liver disease pregnancy COCP
97
Alopecia Areata Mx
Watch and wait - self resolve within 1 year If psychological stress, >50% hair loss - Dermatology refer and Topical High potency steroid
98
Impetigo School exclusion time
2 days after treatment starts or once all lesions have crusted over
99
Melanoma prognosis scoring system
Breslow thickness
100
weighted 7 point check list for skin lesions
weighted seven-point checklist includes: Major features (two points each): Change in size Irregular shape Irregular colour Minor features (one point each): Inflammation Altered sensation Largest diameter 7 mm or more Oozing of lesion >3 = dermatology refer
101
Recurrent oral ulcers of no known cause (extensively investigated with no cause) Mx
All - Simple/ Antiseptic mouthwash 1st - Topical corticosteroids 2nd - Topical anaesthetics, topical analgesics/anti-inflammatory agents, antibiotic rinses and oral vitamin B12 3rd - Systemic steroids and low threshold for referral for specialist input

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