Dermatology

Question 1

Describe general eczema features

Answer 1

Itchy, dry, erythematous in skin types 1 and 2

skin types 4,5 and 6 you can get areas of pigmentation

Question 2

What are patterns of eczema?

Answer 2

Atopic; flexures or can be diffuse, itchy, red

Seborrhoeic; face/scalp, scale associated

Discoid; annular/circular patches

Pomphylx; vesicles affecting palms/soles

Varicose; oedema/venous insufficiency

Contact allergic dermatitis

Contact irritant dermatitis

photoaggravated

Question 3

Describe atopic eczema

Answer 3

Commonest type

Overactive immune response to environmental stimuli

Atopic march; tendency to 3 commonly linked conditions - eczema, asthma and hayfever

Infancy; face/neck/cheeks

Older children; flexural pattern predominates

Abnormality in filaggrin expression (binds keratin filaments together)

Question 4

Describe seborrhoeic dermatitis

Answer 4

Mainly scalp and face

Often babies <3months, resolve by 12 months

Proliferation Malassezia in yeast form

Emollients, antifungal creams, antifungal shampoos, mild topical steroids

Question 5

Describe discoid eczema

Answer 5

Scattered annular/circular patches

Can occur in this pattern as part of atopic eczema or an isolation

Question 6

Describe pomphylx eczema

Answer 6

Hand and foot

Characterised by vesicles

intensely itchy

Question 7

Describe exogenous eczema

Answer 7

Allergic; type IV hypersensitivity (delayed onset), patch testing helpful

irritant; repeated contact, water and soaps, irritant foods etc

Question 8

Describe eczema treatment

Answer 8

Emollients
Topical steroids
Calcineurin inhibitors
UVB light therapy
Immunosuppresive medication

Question 9

What are some topical steroid options?

Answer 9

Very potent; dermovate
Potent; betnovate
Moderate; Eumovate
Mild; hydrocortisone

Question 10

Describe impetigo

Answer 10

Acute superficial bacterial skin infection

Pustules and honey-coloured crusted erosions

Staph aureus

Topical anitbacterial; fucidin (increasing resistance in community)
Oral antibiotic; flucloxacillin

Question 11

Describe molluscum contagiosum

Answer 11

Benign, self-limiting

Molluscipox virus

2wk-6month incubation

Pearly papules with umbilicated centre

Up to 24months to clear

Potassium hydroxide can speed up natural process

Question 12

Describe viral warts

Answer 12

Skin coloured

HPV infection

Sole foot; verruca

Direct skin contact

topical i.e. salicylic acid and paring

cryotherapy

90% resolve 24 months

Question 13

Describe viral exanthems

Answer 13

Associated w/viral illness
Common
Fever, malaise, headaches

Either reaction to toxin from organism, damage to skin by organism or immune response

Chicken pox, measles, rubella

Question 14

Describe chicken pox

Answer 14

VZV, highly contagious

Red papules (small bumps) progressing to vesicles often starting on trunk

Itchy

Associated viral symptoms

Incubation 10-21days

Contgious 1-2 days before rash appears and until lesions have crusted

Self-limiting

Question 15

Describe parovirus

Answer 15

Slappd cheek

Fifth disease

Incubation 7-10days

Viral symptoms

Erythematous rash cheeks initially then lace network rash (trunk and limbs)

6w to fully fade

Usually mild, self-limiting

Question 16

Describe hand foot and mouth disease

Answer 16

Eterovirus; usually coxsackie virus A16

Blisters hands, feet and mouth

Viral symptoms

Self limiting

Supportive treatment

Question 17

Describe eczema herpeticum

Answer 17

Unwell child

Hx of eczema

Monomorphic punched out lesions

Withhold steroids for 24hrs

Aciclovir oral or IV

Opthalmology review if near eye

Question 18

Describe eczema coxsackium

Answer 18

Associated viral symptoms

Hx eczema

Flared sites

Self limiting