Dermatology Flashcards
(146 cards)
1
Q
Treatment of solar keratosis?
A
Fluorouracil cream and topical hydrocortisone
Imiquimod
Cyrotherapy/shave/curettage/excision
2
Q
What are the two most common types of malignant melanoma?
A
Superficial spreading
Nodular
3
Q
What is the first step in treatment for acne?
1st line =
2nd line =
A
First line = topical retinoid +/- benzoyl peroxide
Second line = azelaic acid
4
Q
What is the second step in treatment for acne?
A
Either topical retinoid + benzoyl peroxide
Or antibiotic + benzoyl peroxide
5
Q
3rd step in acne treatment?
A
Systemic antibiotics + benzoyl peroxide
6
Q
What kind of antibiotics are used in acne treatment?
A
Tetracyclines e.g. erythromycin
7
Q
What is an alternative treatment for moderate-severe acne in women?
A
The combined pill Dianette
8
Q
What treatment is likely to be given for severe acne in secondary care?
A
Oral isotretinoin
Or high dose Abx e.g. lymecycline, trimethoprim
Rarely short courses of oral corticosteroids
9
Q
Allergic contact dermatitis is a type ? hypersensitivity reaction?
A
IV - delayed T cell mediated reaction
10
Q
3 features of ACD rash?
A
- pruritic
- erthematous, scaly rash
- develops with contact, after delay of hours- days
11
Q
How is ACD diagnosed?
A
Skin patch testing
12
Q
Acute management of acute contact dermatitis?
A
Avoid stimulus
Liberal emmolients, topical corticosteroids
Identify and treat any secondary infection
13
Q
Second line treatments for acute contact dermatitis after topical corticosteroids?
A
Phototherapy, immunosuppressants (cyclosporin, methotrexate)
14
Q
When would you notify the Health and Safety Executive about contact dermatitis?
A
When it is occupational
15
Q
Up to 80% of contact dermatitis is …?
A
Irritant contact dermatitis
16
Q
T/F - ICD doesn’t require sensitisation to a stimulus to cause inflammation, whereas ACD does?
A
True
17
Q
ICD typically presents within …. hours after exposure to an irritant?
A
48 hours
18
Q
What feature of an erythematous scaly rash on the hands might point towards ICD?
A
Stinging/burning
Webspace involvement
19
Q
A 4 year old come to the GP with their mother, with an itchy dry rash in the elbow crease, with scratch marks.
What is the most likely diagnosis?
What type of cell drives this disease?
A
Atopic dermatitis
T helper 2 cells
20
Q
What complication of eczema are the following:
a) weeping, crusted lesions
b) painful, monomorphic vesicles in clusters
A
a) secondary bacterial infection
b) eczema herpeticum
21
Q
Outline the long-term management of standard eczema
A
- Education, avoid triggers
- Emollients
- Topical low potency steroids for inflamed skin
22
Q
What is the treatment for infrequent eczema flare-ups?
A
Stronger topical steroid
Consider sedating antihistamine if sleep disturbed
23
Q
Treatment for refractory eczema?
A
Phototherapy
Oral immunosuppressants (methotrexate, azathioprine)
Wet wraps
24
Q
Treatment for eczema herpeticum?
A
Systemic acyclovir
25
A patient presents with pruritic round and oval plaques with some crusting, on her arms and legs. What type of eczema is this?
Discoid/nummular eczema
26
A 45 year old man presents with an erythematous scaly rash affecting the nasolabial folds and bears. He complains of having 'dandruff' coming from his beard and moustache, as well as his normal dandruff from his head. He has a PMH of HIV, for which he is on ARTs and viral load is undetectable.
What is the likely diagnosis?
What 2 conditions is this more common in?
What are the first line treatment options?
Seborrhoeic dermatitis
HIV and Parkinsons Disease
Ketoconazole 2% shampoo, selenium sulphide shampo or anti-dandruff shampoo (coal tar or salicyclic)
For the face --> imidazole
27
In infants, what is the term used to describe seborrhoeic dermatitis on the scalp?
How is it treated?
Cradle cap
Wash scalp with baby shampoo and brush scalp with soft brush. Second line treatment= imidazole topical
28
What type of eczema is associated with chronic venous insufficiency?
The erythematous rash affects what region of the body?
Venous eczema
The gaiter regions
29
What examination is it important to perform in venous eczema?
Peripheral vascular examination, especially palpating perdal pulses
30
What do you need to measure before recommending compression stockings?
Ankle-brachial index to exclude arterial insufficiency
31
What investigation confirms the diagnosis of venous insufficiency
Venous duplex ultrasound
32
Give 3 pieces of advise to give to someone with venous eczema?
- Elevate the legs when sitting
- Regular application of emollients
- Use of compression stockings
33
What is the common exacerbating factor for psoriasis?
Stress
34
What is the Koebner phenomenon?
| Other than psoriasis, when is it seen?
Psoriasis lesions occur at sites of skin trauma (including sunburn!)
Lichen planus
35
Which 4 drug types may cause psoriasis?
beta blockers, lithium, NSAIDs, antimalarials
36
Which type of psoriasis is characterised by well-demarcated erythematous plaques covered in silvery white scales, commonly over extensor surfaces (also scalp, retroauricular, perianal, periumbilical?
Chronic plaque psoriasis
37
Scaly, raindrop shaped plaques on the trunk, commonly following streptococcal URTI occurs in what type of psoriasis?
Guttate psoriasis
38
Name 3 associated nail changes in psoriasis?
- Pitting
- Thickening of nail plate
- Ridging
- Onycholysis
- Subungal hyperkeratosis
- Oil spots
39
What scoring system is used to quantify psoriasis disease severity?
What questionnaire could be used to assess impact on the patient?
Psoriasis Area and Severity Index
Dematology Life Quality Index
40
Outline the stepwise treatment for psoriasis, including 1st, 2nd, 3rd line.
- Lifestyle advice e.g. avoid triggers
- Application of emollients
- Combo potent topical steroid and calcipotriol
- 2nd line = phototherapy, cyclosporin, methotrexate, acitretin
- 3rd line = biologics e.g. etanercept, infliximab, adalimumab
41
What type of phototherapy is used for psoriasis?
Narrow band UVB
42
A 24 year old female presents to her GP with an oval rash across her trunk and limbs, with mild pruritis. When asked, she mentions that several days ago she noticed a salmon-coloured patch.
What is the condition?
What is the name of the pattern seen with this rash?
What is the management?
Pityriasis rosea
Christmas tree pattern
Reassure patient rash usually settles without treatment, within 2-3 months. Symptomatic relief for itch.
43
Lichen planus is associated with:
a) Hep A
b) Hep B
c) Hep C
d) Hep D
e) Hep E
Hep C
44
What condition presents with pruritic flat-topped papules and plaques covered by Wickham striae?
Which body parts are most affected?
Lichen planus
Ventral wrists, forearms, ankles, legs, oral cavity, genitalia
45
What is the first line treatment of lichen planus?
Second line?
3rd line?
Potent/very potent topical steroids
Intralesional/systemic steroids
Phototherapy, cyclosporin, acitretin
46
What treatment can be used to manage oral lichen planus?
Steroid inhaler
47
A patient on the ward develops a smooth, non-scaly plaques surrounded by erythema, following abdominal examination by the junior doctor.
What is this likely to be and what caused it in this case?
Urticaria
| Triggered probably by contact with latex in gloves during abdo examination
48
What is first-line therapy for urticaria?
Non-sedating antihistamine
49
What may be given in severe acute urticaria?
Short course of oral corticosteroids
50
Patients with possible urticarial vasculitis require which two investigations?
- Skin biopsy
| - vasculitic screen
51
What are the 4 main pathogenic features of acne vulgaris?
1. Follicular kyperkeratinisation
2. Propionibacterium acnes colonisation
3. Increased sebum production
4. Inflammatory process involving innate and acquired immunity
52
Give 3 side effects of oral isotretinoin?
Dry skin/mucous membranes, teratogenicity, photosensitivity, vision changes, mood changes, deranged LFT, elevated triglyceride and cholesterol level, benign intracranial hypertension, acne flare
53
A patient comes to the GP complaining of recurring episodes of facial flushing, and redness and papulopustular lesions affecting the central face. On examination there are also telangiectasia in the central face, with sparing of periocular skin.
What is the likely diagnosis?
Give 3 aggravating factors.
Rosacea
Sunlight, caffeine, alcohol, spicy food, exercise, topical steroids, drugs that cause vasodilatation
54
Do you get comedones in rosacea?
No, unlike in acne vulgaris
55
What is rhinophyma?
Thickened, enlarged skin with irregular nodular surface affecting the nose
56
What is first line therapy for papulopustular lesions in rosacea?
Second line?
Topical metronidazole or azelaic acid
Oral antibiotics (tetracycline, erythromycin)
57
Treatment for facial flushing in rosacea?
Treatment for erythrotelangiectatic symptoms?
Ocular symptoms e.g. gritty eyes, blepharitis?
Non-selective beta blocker or clonidine
Topical brimonidine and laser therapy
Lid hygiene and artificial tears
58
Rhinophyma responds to ?
CO2 laser ablation
59
What condition is characterised by monomorphic papules and pustules involving perioral area with relative sparing of vermillion border
Perioral dematitis
60
What treatment commonly precedes perioral dermatitis?
Topical corticosteroid use on face
61
How is perioral dermatitis managed?
Stop any topical steroids use on face
Condition may initially worsen
Topical Abx (clindamycin, erythromycin), or oral erythromycin if severe
62
Which type of skin cancer presents as a pearly nodule with telangiectasia on the head/neck region, which ulcerates with time to result in a rolled edge?
Nodular basal cell carcinoma
63
Which type of skin cancer presents as a slow-growing erythematous patch/plaque that is usually found on the trunk.
Superficial basal cell carcinoma
64
T/F - BCC rarely metastasises
True
65
Give 3 important RFs for BCC.
Age, UV exposure, skin types I and II, male, smoking, immunosuppression.
66
What is the treatment for most BCCs?
Surgical excision with histological assessment of the margin
| Radiotherapy
67
What is the target excision margin for nodular BCC?
3mm
68
What are some other management options for low risk BCCs?
Curettage and cautery, cryosurgery, phototherapy
69
What topical treatment may be used to treat superficial BCC?
Imiquimod
70
Which type of skin cancer presents as an indurated keratinising/crusting plaque or nodule at sun-exposed sites?
What symptoms are typically associated with this type of skin cancer?
Squamous cell carcinoma
Pain, discomfort, bleeding, ulcerating, sensory changes
71
What are the two precursor forms of SCC?
Actinic keratosis and Bowen disease (SCC in situ)
72
Give 4 risk factors for SCC.
Skin phototype
Chronic UV radiation
Smoking
Immunosuppression - most common type after transplant e.g. renal transplant patients
Chronic inflammation
Genetic skin conditions e.g. xeroderma pigmentosum
73
What is the management of SCC
Surgical excision with margin 4-6mm
74
What if SCC Is unresectable, what is the management?
Radiotherapy
75
What is the management of AK and Bowens disease?
Cryotherapy, topical chemo (Fluorouracil, imiquimod), or photodynamic therapy
76
What treatment is indicated for high risk BCC and SCC?
Mohs surgery
77
Name the 3 types of melanoma that are predominantly radial growing/
What rules define how they grow/appear?
Superficial spreading, acral lentiginous melanoma, lentigo maligna melanoma
ABCDE rule e.g. Asymmetry, irregular border, multi-coloured, diameter >0.6cm, evolution
78
What type of melanoma is predominantly vertical growing?
| What 'rules' define it's growth/appearance?
Nodular melanoma.
EFG = elevation, firm, growing
Presents as a hyperpigmented/blue/black/amelanotic firm papule, nodule or plaque
79
Which melanoma is the most common subtype, and typically begins as a hyperpigmented patch/plaque growing radially?
Superficial spreading
80
What is the gold standard investigation for melanoma?
Excisional biopsy with 2mm margin
81
Give 4 prognostic factors for melanoma that would be included in the pathology report of a biopsy.
- Breslow thickness
- Clark level
- lymphatic/vascular invasion
- ulceration
- mitotic count
- perineural infiltration
82
How is melanoma staged and what are the stages?
```
TNM staging
1 = Breslow thickness <1mm or 1.01-2mm w/o ulceration
2 = BT >2mm or 1.01-2mm with ulceration
3 = lymphnode involvement
4 = organ metastasis
```
83
What further investigations would a patient with 3b or 3c melanoma need?
What blood test should be measured in a pt with stage 4 melanoma?
CT CAP
LH
84
Outline the management of melanoma.
Surgical excision with margins depending on BT (at least 5mm)
+/- lymphnode clearance
+/- chemo/radio
Advised on sun protection!
85
A patient presents with a rapidly enlarging, painful ulcer with granulomatous bases and violaceous edges on his lower leg. He said it started at a pustule where he had knocked his shin on the coffee table.
Describe how you would investigate this patient
What is the likely diagnosis?
1- Skin biopsies sent for histopathology (rule out malignancy or infection)
2- FBC, CRP, U&Es, RF, cryoglobulins
Pyoderma gangrenosum
86
What is the management of pyoderma gangrenosum?
Pain management and wound care
Topical steroids or tacrolimus
Systemic corticosteroids +/- ciclosporin
Some cases may need skin grafting
87
A 25 year old woman presents to A&E with very tender red plaques on both shins.
What is the likely diagnosis?
Give 4 possible causes of this/
Erythema nodosum
Idiopathic, infection (strep, TB, URTI), drugs (penicillins, sulphonamides), AI (RA, sarcoidosis, IBD), pregnancy, OCP, Hodgkin's lymphoma
88
What is the management of erythema nodosum?
What is second line?
Treat underlying cause
Supportive e.g. bed rest, NSAIDs, compression bandages, elevation
Corticosteroids or oral tetracycline
89
What condition presents with acrally distributed targetoid lesions, which may be accompanied by oropharyngeal, genital, respiratory, or ocular mucosal erosions?
Erythema multiforme
90
What infection commonly precedes eryhema multiforme?
| What is the second commonest infectious cause of HSV?
HSV
| Mycoplasma pneumoniae
91
What drugs can cause drug induced erythema multiforme?
NSAIDs, sulphonamides, antiepileptics, antibiotics
92
What is the management of erythema multiforme?
Remove any inciting cause e.g. drugs. Treat mycoplasma infection
Muscosal involvement --> topical corticosteroids, anaesthetic/antiseptic mouthwash
Opthalmology referral for ocular involvement
93
What counts as recurrent erythema multiforme and how is it treated?
>6 eps per year
| 6 months of acyclovir
94
What is first line therapy for granuloma annulare?
Other options?
Potent/very potent topical steroids
Tacrolimus, oral isotretinoin, phototherapy, cryotherapy
95
What is the appearance of granuloma annulare?
Smooth annular plaques, asymptomatic, typically on dorsal aspect of hands and feet
96
What condition presents with demyelinated, well-demarcated patches?
What is it called if patches are distributed:
a) symmetrically, b) unsymmetrical
and which is more common?
Vitiligo
Non-segmental vs segmental.
Non-segmental vitiligo is more common
97
Name 4 conditions associated with vitiligo
T1DM, pernicious anaemia, autoimmune thyroiditis, alopecia, Addison's
98
What is first line therapy for vitiligo?
What are other options?
What advice would you give?
Topical steroids or calcineurin inhibitor
Phototherapy
Consider surgical treatments or depigmentation therapy
Advice = sun protection and possible camouflage products
99
A patient presents to A&E with painful erythema with blisters and erosions, that are rapidly confluencing and progressing to epidermal detachment.
What is this condition?
What drugs typically cause it?
What sign is positive on examination?
Toxic epidermal necrolysis/Steven-Johnson syndrome
Allopurinol, phenytoin, sulphonamides, penicillins, carbamazepine, NSAIDs
Nikolsky sign positive (epidermal separates with mild pressure)
100
Other than the epidermis, what area of the body is commonly affected by TEN/SJS?
Mucosal involvement e.g. eyes, lips, mouth, oesophagus, URT, genitalia
101
Give 3 investigations in suspected TEN/SJS?
Skin biopsy
Direct immunofluorescence
Blood tests e.g. FBC, U&E, CRP, LFTs
102
Outline the management of TEN
- Withhold culprit drug
- Supportive care, often on ITU e.g. fluids, electrolytes, wound care
- IVIg
- Opthalmology review if eye involvement
103
What is the difference between SJS and TEN, and their mortalities?
SJS involves <10% BSA and mortality is 1-5%
| TEN involves >30% BSA and mortality is 25-35%
104
What is the aetiology of pemphigus vulgaris?
| In what population is it more common>
AI disease caused by IgG auto-antibodies against Desmoglein 3
Ashkenazi Jews
105
Give 4 clinical features of pemphigus vulgaris
- Oropharyngeal mucosal involvement
- Blisters and erosions
- Nikolsky sign positive
- Painful flaccid blisters and erosions usually involving trunk and intertriginous areas
106
A biopsy is taken to diagnose pemphigus vulgaris. What two things are done to it and what will these each show?
Histology - shows acantholytic cells, and blisters
DIF - shows fishnet appearance with IgG depositis in epidermis
107
What is first line management of pemphigus vulgaris?
Second line options?
1mg/kg systemic steroids (plus wound care, emollients, antiseptic wash)
Steroid sparing agents e.g. azathioprine, cyclophosphamide, rituximab, IVIg
108
What condition typically affects the elderly, and causes itchy, tense blisters on the trunk and around the flexures which erode. It is uncommon to have mucosal involvement?
Bullous pemphigoid
109
What is the aetiology of bullous pemphigoid?
Auto-immune antibodies against hemidesmosomal proteins (BP180 and BP230)
110
What is the characteristic histological finding for diagnosis of bullous pemphigoid?
Linear deposition of IgG +/- C3 along basement membrane zone on DIF
111
Briefly outline the management of bullous pemphigoid.
- Referral to dermatology
- Very potent topical steroids/systemic steroids
- Immunosuppressants and Abx may also be used
112
A 45 year old man presents with an extremely itchy rash on his shoulders. O/E you find a symmetrical papulovesicular rash affecting the shoulders and extensors of the arms, which has been excoriated causing erosions and crusted papules.
What is the likely diagnosis?
What condition is this associated with?
Dermatitis herpetiformis
Coeliac disease
113
Give 5 investigations for dermatitis herpetiformis
IgA, anti-TTG, folate, iron studies, biopsy for histology and DIF
114
What is the characteristic finding of DH on DIF?
Granular IgA deposits along dermo-epidermal junction
115
Which haplotypes are associated with DH?
HLA DQ2 and DQ8
116
Give 3 aspects of management of DH
- Oral dapsone
- Refer to gastroenterologist for CD investigation
- Refer to dietician for advice on gluten-free diet
117
What are the 2 possible causative organisms of non-bullous impetigo?
What is the causative organism for bullous impetigo?
Staph aureus, strep pyogenes
Staph aureus
118
Give 3 RFs for impetigo
Pre-existing eczema, skin trauma, hot and humid climate, poor hygeine, crowding, dare care settings, DM
119
Describe appearance of impetigo
Maculopapular lesions that progress to painful erosions covered with honey-coloured crust
Found on face and extremities
120
2 pieces of information to give the patient
1) stay away from school or work until lesions are dry and scabbed over, or 48h after abx treatment
2) don't share towels/flannels
121
What is first line treatment for limited, localised disease (new guidance in 2020)?
Second line for limited disease?
Topical hydrogen peroxide 1% cream
New guidance to try to limit antibiotic resistance
Topical fusidic acid
122
Treatment for extensive impetigo?
Oral fluclox/erythromycin if penicillin allergic
123
What are the two most common organisms that cause cellulitis?
How is it diagnosed?
Strep pyogenes and staph aureus
Clinical diagnosis, doesn't necessarily need Ix unless systemically unwell
124
Give 3 RFs for cellulitis
Diabetes, trauma, insect bite, venous insufficiency, obesity, lymphoedema, ulcers, tinea pedis
125
Give 2 acute and 2 chronic complications of cellulitis
```
Acute = sepsis, subcut abscess, myositis, necrotising fasciitis
Chronic = lymphoedema, chronic ulcer, recurrence
```
126
What classification of cellulitis is used to determine management?
Outline the stages
Eron classification
1 = no signs of systemic illness and no comorbidities
2 = systemicall well or unwell, with a comorbidity
3 = significant systemic toxicity or unstable comorbidities
4 = sepsis or nec fasciitis
127
What is the first line antibiotic for cellulitis?
Flucloxacillin
Clarithromycin if penicillin allergic
128
Give 3 indications for admission and treatment of cellulitis with IV antibiotics
- Elon classification 3 or 4
- Severe or rapidly deteriorating cellulitis
- <1 yr or very frail
- Immunocompromised
- Significant lymphoedema
- Facial or periorbital cellulitis
129
What is the indicated treatment for cellulitis causing sepsis or necrotising fasciitis (Elon classification IV)?
IV benpen + ciprofloxacin + clindamycin.
130
What is first line therapy for viral warts?
| second line?
Salicylic acid with paring and occlusion
| Cryotherapy
131
A patient presents complaining of a rash on their body. O/E you can see an erythematous scaly plaque, which is annular with central clearing and an advancing scaly edge.
What is the most likely diagnosis?
Tinea corporis (a dermatophyte caused fungal infection)
132
What is the treatment for tinea capitis?
Ketoconazole shampoo and oral terbinafine
133
What is the treatment for onychomycosis?
Oral terbinafine or itraconazole (poor penetration with topical treatment
134
What is first line treatment for tinea corporis/pedis?
Topical terbinafine or imidazole
Second line = oral terbinafine
135
A superficial cutaneous fungal infection caused by Malassezia furfur = ?
Pityriasis versicolor
136
Features of pityriasis versicolor rash?
- Different colours e.g. hypopigmented, pink or brown
- Mostly affects trunk
- Scaly
- Pruritis
137
2 things to educate patients on about pityriasis versicolor?
- Not contagious
| - Skin discolouration may persist for several weeks following successful eradication
138
What is first line treatment for pityriasis versicolor?
Ketoconazole shampoo
| Imidazole antifungal cream if only small areas of skin invovled
139
What causes scabies?
Human parasite Sarcoptes scabiei
140
Give 3 population groups who are more likely to get scabies?
Young, elderly, immunocompromised or of a low SES
141
What causes the rash in scabies?
Pts develop a hypersensitivity reaction towards the mite/its byproducts
142
Describe the rash seen with scabies.
Linear burrows, and papular/papulovesicular rashes involving fingerwebs/wrists/elbows/armpits/genitals etc.
Intense pruritis
143
Is pruritis of scabies worse in the day or night?
Night
144
If diagnosis is uncertain, what investigation is used to diagnose scabies?
Skin scrapings
145
Outline the management of scabies
- Treat pt and all household members and close contact, with topical permethrin 5% cream (applied twice, one week apart)
- Machine wash >50 clothes, towels and bed linen on first day of application
- Avoid close contact with others until treated
- Topical crotamiton or topical hydrocortisone 1% for itch (or oral sedating antihistamine)
146
What is commonly used in the context of a scabies outbreak?
Oral ivermectin
