Hoon Eats Big Donuts Hydrocortisone Eumovate Betnovate Dermovate

Dermatology Flashcards by Richard Wu

Tx of acute flare of eczema

Emollients

+ Topical corticosteroids

+/- Antihistamine

Antibiotics (topical or oral)

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Steroid ladder

Hoon Eats Big Donuts

Hydrocortisone
Eumovate
Betnovate
Dermovate

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Tx of chronic eczema

(1) Emollients + Topical corticosteroids

+/- Topical calcineurin inhibitor (Tacrolimus)

+/- Topical NSAID (crisaborole)

(2) UV light therapy +/- Topical coal tar
(3) Systemic immunosupressant (Ciclosporin, Methotrexate)

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Ix for contact dermatitis

Patch testing

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Scaly eruption on scalp

Red

Itchy

White flakes

+/- Bleeding

Diagnosis? Treatment?

Seborrhoeic dermatitis

(In infants ==> Cradle cap)

(In adults ==> Dandruff)

(1) Emollient

+/- Topical shampoo (contains ketoconazole, selenium sulphide..etc)

(2) Topical corticosteroids
(3) Oral antifungals

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Psoriatic nail changes

POSH

Pitting

Onycholysis

Subungual hyperkeratosis

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Salmon pink, silvery scales

On extensor surfaces

Auspitz sign (removal of scales –> bleeding)

Diagnosis?

Plaque psoriasis

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Preceding strep throat infection

Tear drop scaly, papule

Diagnosis?

Guttate psoriasis

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Conjunctivitis

Urthritis

Arthritis

Hyperkeratotic plaques on soles of feet

Diagnosis?

Keraderma blenorrhagicum

(Reactive arthritis)

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Dry, red skin all over body

Fine scales

Recent drug or infection

Diagnosis?

Erythrodermic psoriasis

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Tx of Psoriasis

PECS DDD (Topical Steroids + Vitamin D for acute flare)

Phototherapy

Emollients

Coal tar

Topical steroids (hydrocortisone, eumovate, betnovate, dermovate)

Topical Vitamin D

Dithranol (inhibits DNA synthesis)

DMARDs (Methotrexate, Ciclosporin)

Biologics - infliximab (anti-TNFa)

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Types of Psoriatic arthritis

MASAP

Monoarthritis of DIPJ (similar to OA)
Asymmetrical polyarthritis - most common type
Symmetrical polyarthrtitis (simmilar to RhA)
Arthritis mutilans - destructive
Psoriatic spondylitis (similar to Ank Spond)

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Pearly papule

Nodule

Rolled borders

Telangiectasia

Ulcerated centre

Diagnosis?

Basal cell carcinoma

(Nodular BCC is the most common type)

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Ix and Tx for BCC

Ix: Skin biopsy

Tx: Moh’s surgery

+/- Curettage

+/- Cryotherapy

+/- Radiotherapy

Rarely metastasise (<1%)

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Progression to SCC

Actinic keratosis –> Bowen’s disease –> SCC

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Growing tumour

Bleeding

Itchy

Keratin horn

Ulcerated

Diagnosis?

Squamous cell carcinoma

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Types of SCC

Keratoacanthoma = keratin filled centre, rarely mets

Verrucous carcinoma = verrucous nodule, rarely mets

Marjolin’s ulcer = agressive ulcerating SCC, 40% mets

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Tx of SCC

Surgical excision or Moh’s surgery

+/- Radiotherapy

+/- Chemotherapy

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Itchy, red macule

Overlying crust

On sun-exposed area

Diagnosis? Treatment?

Study These Flashcards

Actinic keratosis

May progress to SCC

Medical ==> Topical creams

Diclofenac gel (3%)
5-Fluorouracil cream (5%)
Imiquimoid cream (5%)

Surgical

Surgical excision and curettage
Cryotherapy

Itchy, red macule

Overlying crust

Sun-exposed limb

Biopsy shows full-thickness dysplasia

(i.e. carcinoma in situ)

Diagnosis? Treatment?

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Bowen’s disease (= SCC in situ)

Tx same as for Actinic keratosis

Medical ==> Topical creams

Diclofenac gel (3%)
5-Fluorouracil cream (5%)
Imiquimoid cream (5%)

Surgical

Surgical excision and curettage
Cryotherapy

Types of Melanoma

Study These Flashcards

Superficial spreading MM - most common

Nodular MM - most aggressive, lump

Lentigo maligna - usually on face

Acral - usually on palms and soles and nails

Sx of Melanoma

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ABCDE + FLAWS

Asymmetry

Borders (irregular)

Colours (multiple)

Diameter > 6mm

Evolving

Staging of melanoma

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Breslow thickness

(depth –> affects excision margins)

Define Keratoacanthoma

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benign epithelial tumour.

well differentiated SCC that arise from the hair follicle

volcano or crater

centrally-filled with keratin

Define Dermatofibroma

Solitary dermal nodules Free moving, firm Dimple forms when pinched

**"Stuck on appearance"** **Flat or Raised lesion** **Variable colour (flesh to light brown)** Diagnosis? Treatment?

**Seborrhoeic keratoses** Treatment: None required or Excision

**Round soft cutaneous mass** **Mobile** **Superficial** **Painless** Diagnosis? Treatment?

**Lipoma** _Treatment_: Observation (low malignant potential) or Excision

Types of Erythema multiforme

**Minor EM** = no mucosal involvement AND \< 10% body surface area affected **Major EM** = mucosal involvement AND \< 10% body surface area affected

Causes of EM

**Infection** (**HSV-1**) = most common **Drugs** (SNAP = sulphonamides, NSAIDs, allopurinolol, penicillin)

Characteristic finding in Erythema multiforme? Treatment?

**Target lesions** (3 zones) ## Footnote Treatment: Observation +/- Emollient +/- Corticosteroids

# Define **Erythema multiforme** **Steven-Johnson syndrome** **Toxic epidermal necrolysis**

**Erythema multiforme** = 1 mucosa surface + \< 10% BSA **SJS** = 2 mucosa surfaces + \< 10% BSA **SJS-TEN** = 10-30% BSA **TEN** = \> 30% BSA BSA = body surface area

Causes of SJS / TENS

**Drugs** (**AEDs** = most common, Antibiotics) Infection (mycoplasma pneumonia - rare)

Pathogenesis and Tx of SJS/TENS

Drug hypersensitivity reaction Separation of skin at epidermal-dermal junction (Nikolsky sign +ve) Treatment * **Stop causative drug** * **IV Fluids** * **IVIG**

Causes of erythema nodosum

Infection * **TB** * Streptococcal infection Inflammation * **IBD** * **Sarcoidosis** * Behcet's disease Malignancy * Lymphoma Drugs (COCP, Aspirin, Sulphonamides)

Tx of Acne

(1) **Gentle facial cleanser** (1) Single topical therapy * BAR * Topical **Benzoyl peroxide** * _or_ Topical **ABx** * _or_ Topical **retinoid** (2) Dual topical therapy (3) **Oral Antibiotoics** (Doxycycline) (4) **Oral retinoid** (**isotretinoin** / Roaccutane)

Itchy, erythematous papules and vesicles On elbows, buttocks and lower back Gluten-free diet

Dermatitis herptiformis

**Single salmon pink plaque appears first (Herald patch)** Then, **Christmas tree distribution** Diagnosis? Treatment?

**Pityriasis rosea** HHV6/7 infection Tx: Observation (self-limiting) +/- Anti-virals N.B. DDx from Psoriasis (which would be silvery)

Bullous pemphigoi**_d_**

Autoimmune disorder against basement membrane --\> affects dermoepidermal junction Tense bullae - found **_D_**eep (bullous pemphigoi**_D_**)

PemphiguS valgaris

Autoimmune IgG against desmosomes --\> acantholysis Acantholysis/Separation between layers of epidermis Flaccid blisters with red surface underneath Bullae are **_S_**uperficial (pemphigu**_S_** valgaris) Nikol**_s_**ky's sign +ve (pressure causes separation between epidermis and dermis)

Pemphigus foliaceus

Autoimmune IgG against desmosomes in upper epidermis --\> acantholysis Very thin bullae, no intact bullae

Criteria for hereditary haemorrhagic telangiectasia inheritance?

Requires 3 out of 4 **Epistaxis** (nosebleeds) **Teleangiectasia** (lips, mouth, fingers) **Visercal AV-malformations** **FHx** Autosomal dominant

Scarring alopecia Kerion (boggy mass) Green fluoresence under Wood's lamp

Tinea capitis

Circular, red lesion Well defined border

Tinea corporis / Ringworm

Itchy, peeling skin between toes

Tinea pedis / Athletes foot

**Itchy, hypopigmented patches** **Mainly on trunk** **Yellow-green fluoresence on Wood lamp** Diagnosis? Cause?

**Pityriasis versicolour** Caused by ***Malassezia furfur*** *T: Topical anti-fungal*

Dermatology Flashcards

(45 cards)