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Flashcards in Dermatology Deck (22)
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1

What's that?

Pityriasis versicolour 

aka Tinea Versicolour 

keyword: hypopigmented patches

  • it's a superficial fungal infection 
  • caused by Malassezia furfur 

 

May look similarly to vitiligo, but vitiligo would have more symmetrical pattern

2

Features of Pityriasis Versicolour

  • most commonly affects the trunk
  • patches may be hyperpigmented, pink or brown (since the name versicolour)
  • maybe more noticeable following a suntan
  • scale is common 
  • mild pruritis 

3

Management of Pityriasis Versicolour

  • topical antifungal → ketoconazole shampoo (for large areas) 

 

If failure to respond to topical treatment → consider another diagnosis (e.g. send scrapings to confirm Dx)

  • oral itraconazole

4

What's that? 

Acne rosacea

 

chronic skin condition, idiopathic

5

Features of acne rosacea 

  • typically affects nose, cheeks and forehead
  • flushing is often the first symptom
  • telangiectasia are common
  • later develops into persistent erythema with papules and pustules
  • rhinophyma
  • ocular involvement: blepharitis
  • sunlight may exacerbate symptoms

6

Management of acne rosacea 

 

  • topical metronidazole may be used for mild symptoms 
  • more severe disease is treated with systemic antibiotics e.g. Oxytetracycline
  • recommend daily application of a high-factor sunscreen
  • camouflage creams may help conceal redness
  • laser therapy may be appropriate for patients with prominent telangiectasia

7

8

What's that? 

Pemphigus vulgaris 

  • an autoimmune disease 
  • antibodies directed against desmosomes 
  • present in younger people 
  • flaccid, easily ruptured vesicles, bullae and mucosal ulceration 

 

Management: steroids, immunosupressants 

9

Characteristics of the appearance of Pemphigus Vulgaris

  • flaccid vessels, mucosal ulceration, bullae, vesicles that rupture easily

 

10

Potency of topical steroids

11

How much topical steroid to apply?

Finger tip rule

  • 1 finger tip unit (FTU) = 0.5 g ⇒ sufficient to treat a skin area about twice that of the flat of an adult hand

12

What's that?

Erythema multiforme

  • a hypersensitivity reaction which is most commonly triggered by infections

 

  • it may be divided into minor and major forms

13

Features of erythema multiforme

  • target lesions
  • initially seen on the back of the hands / feet before spreading to the torso
  • upper limbs are more commonly affected than the lower limbs
  • pruritus is occasionally seen and is usually mild

14

Causes of erythema multiforme

  • viruses: herpes simplex virus (the most common cause)
  • idiopathic
  • bacteria: Mycoplasma, Streptococcus
  • drugs: penicillin, sulphonamides, carbamazepine, allopurinol, NSAIDs, oral contraceptive pill, nevirapine
  • connective tissue disease e.g. Systemic lupus erythematosus
  • sarcoidosis
  • malignancy

15

Management of erythema multiforme

  • Mild disease (no systemic features) → treat at home with topical corticosteroid and oral antihistamine 

 

  • Severe disease with systemic features → systemic steroid (e.g. oral prednisolone) +/- admit to hospital

 

  • if ocular involvement → refer to an ophthalmologist as emergency 

16

Describe the rash 

give a diagnosis

management

Maculopapular rash 

Diagnosis: Measles 

 

Features of Measles: 

  • prodrome: irritable, conjunctivitis, fever
  • Koplik spots (before rash): white spots ('grain of salt') on buccal mucosa
  • rash: starts behind ears then to whole body, discrete maculopapular rash becoming blotchy & confluent

 

Management

  • mainly supportive
  • admission may be considered in immunosuppressed or pregnant patients
  • notifiable disease → inform public health

17

Management of contacts in Measles 

  • if a child not immunized against measles comes into contact with measles then MMR should be offered (vaccine-induced measles antibody develops more rapidly than that following natural infection)

 

  • this should be given within 72 hours

18

Possible complications of Measles

  • otitis media: the most common complication
  • pneumonia: the most common cause of death
  • encephalitis: typically occurs 1-2 weeks following the onset of the illness)
  • subacute sclerosing panencephalitis: very rare, may present 5-10 years following the illness
  • febrile convulsions
  • keratoconjunctivitis, corneal ulceration
  • diarrhoea
  • increased incidence of appendicitis
  • myocarditis

19

What's that? 

Hx: GP has given then antibiotics and they developed rash 

Description: Maculopapular rash 

Diagnosis: Infectious Mononucleosis (glandular fever) 

20

What's that? 

Management 

Management

mite Sarcoptes scabiei

  • permethrin 5% is first-line
  • malathion 0.5% is second-line
  • give appropriate guidance on use (see below)
  • pruritus persists for up to 4-6 weeks post eradication


Patient guidance on treatment:

  • avoid close physical contact with others until treatment is complete
  • all household and close physical contacts should be treated at the same time, even if asymptomatic
  • launder, iron or tumble dry clothing, bedding, towels, etc., on the first day of treatment to kill off mites

21

Describe rash 

Diagnosis 

Description: well-defined annular, erythematous lesions with pustules and papules

Diagnosis: Tinea corporis (ringworm) 

Management: topical/oral fluconazole

*oral only if topical therapy failed 

22

Diagnosis 

Management 

Tinea Captis (scalp dermatophyte) 

 

Management

  • oral antifungals: terbinafine
  • topical ketoconazole shampoo should be given for the first two weeks to reduce transmission