Dermatology

Question 1

What is the first line treatment of psoriasis?

Answer 1

Emollient (reduce scale and itch)

Potent topical corticosteroid + topical vitamin D applied at different times

Question 2

What is the second line treatment of psoriasis?

Answer 2

Emollient (reduce scale and itch)

Stop topical corticosteroid and just apply topical vitamin D twice daily

Question 3

What is the third line treatment of psoriasis?

Answer 3

Emollient (reduce scale and itch)

Stop topical vitamin D and apply a potent topical corticosteroid twice a day

Question 4

When would coal tar preparations typically be used for psoriasis?

Answer 4

In patients with scalp psoriasis

Question 5

What are the two secondary care management options for psoriasis?

Answer 5

Phototherapy

Systemic therapy
(methotrexate or ciclosporin)

Question 6

When would UVB phototherapy be used in psoriasis patients?

Answer 6

Mainly guttate psoriasis

Also used for classic and plaque psoriasis

Question 7

What are the treatment options for seborrhoeic keratosis?

Answer 7

Cryotherapy

Curettage

Question 8

Give advantages of topical emollients?

Answer 8

Direct application

Reduced systemic effects

Question 9

Give disadvantages of topical emollients?

Answer 9

Time consuming

Messy to use, inconvenient

Correct dosing is difficult

Question 10

What are the types of topical emollients in dermatology?

Answer 10

Gels
Creams
Ointments
Pastes
Lotions
Foam

Question 11

What type of emollients have a fire risk associated with them?

Answer 11

Paraffin-based emollients

Question 12

Give some emollient application tips?

Answer 12

Apply after bathing
Apply in direction of hair growth
Be aware of slippery surfaces
Use a spatula to remove from tubs

Question 13

What are the three key actions of topical corticosteroids?

Answer 13

Vasoconstrictive

Anti-inflammatory

Antiproliferative properties

Question 14

What are topical corticosteroids used for in dermatology?

Answer 14

Eczema and psoriasis

Keloid scars
Non-infective inflammatory dermatoses (lichen planus etc)

Question 15

What can occur as a result of strong steroids / sudden steroid halting?

Answer 15

Rebound flare of disease

Note* mostly seen in psoriasis

Question 16

What is the fingertip rule?

Answer 16

One fingertip unit of topical steroid should cover the front and back of the hand

Usually 1-2g

Question 17

List some side effects of topical steroids?

Answer 17

Rebound flare of disease

Thinning of the skin
Purpura
Stretch marks
Steroid rosacea
Perioral dermatitis
Fixed telangiectasia
Tachyphylaxis
Systemic absorption

Question 18

When are antiseptics used in dermatology?

Answer 18

Recurrent infection
Skin cleansing
Wound irrigation

Question 19

What are antibiotics used to treat in dermatology?

Answer 19

Acne and rosacea

Skin infection

Infected eczematous process

Question 20

What are antivirals used to treat in dermatology?

Answer 20

Herpes simplex

Eczema herpeticum

Herpes Zoster

Question 21

What are topical antifungals used to treat in dermatology?

Answer 21

Candida

Dermatophytes

Pityriasis versicolor

Question 22

Name some antipruritics?

Answer 22

Menthol
Capsaicin
Crotamiton
Camphor / phenol

Question 23

What are keratolytics and what are they used to treat?

Answer 23

Drugs used to soften keratin

Viral warts, hyperkeratotic eczema & psoriasis, corns, calluses etc.

Question 24

When area cytotoxic & antineoplastic therapies used in dermatology?

Answer 24

Solar damage
Bowen’s disease
Superficial basal call carcinoma

Question 25

Give examples of cytotoxic & antineoplastic therapies?

Answer 25

Fluorouracil Imiquimod

Question 26

Give some side effects of topical therapies?

Answer 26

Burning and irritation Contact allergic dermatitis Local toxicity Systemic toxicity

Question 27

What are some systemic effects of topical therapies?

Answer 27

Salicylism Hypercalcaemia / hypercalciuria Suppression of pituitary - Cushingoid features

Question 28

What is used to treat actinic keratosis?

Answer 28

5-flurouracil cream

Question 29

What is used to treat bullous pemphigoid?

Answer 29

Highly potent topical steroids

Question 30

How is pemphigus vulgaris managed?

Answer 30

Local - topical steroids + topical anaesthetics Systemic - high dose oral steroids + immunosuppression +/- rituximab

Question 31

How is dermatitis herpetiformis managed?

Answer 31

Gluten free diet Dapsone

Question 32

What is used first line in the treatment of acne?

Answer 32

Benzoyl peroxide +/- topical antibiotic

Question 33

What is given by a dermatologist for severe acne?

Answer 33

Systemic antibiotic therapy Oral isotretinoin

Question 34

What systemic treatment is given to children under 12 with acne?

Answer 34

Erythromycin or clarithromycin twice daily

Question 35

What systemic treatment is given to patients over 12 with acne?

Answer 35

Lymecycline or doxycycline once a day OR Erythromycin / clarithromycin twice a day

Question 36

How is rosacea managed?

Answer 36

Avoiding triggers Topical metronidazole Topical therapies + antibiotics Isotretinoin Laser therapy

Question 37

How is mild eczema managed?

Answer 37

Avoiding irritants Emollients 1% hydrocortisone cream - mild topical steroid

Question 38

How is moderate eczema managed?

Answer 38

Avoiding triggers Emollients Betamethasone valerate Clobetasone butyrate

Question 39

How is severe eczema managed?

Answer 39

Avoid triggers Emollients Betamethasone valerate 0.1% Clobetasone butyrate

Question 40

How is impetigo managed?

Answer 40

Topical fusidic acid Oral flucloxacillin / clarithromycin

Question 41

How is lichen planus managed?

Answer 41

Topical steroids Antihistamines