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GP Matrix > Dermatology > Flashcards

Dermatology Flashcards

1
Q

What is the name of flat pigmented lesions?

A

Macule (<0.5cm), Patch (>0.5cm)

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2
Q

What is the name of raised pigmented lesions?

A

Papule (<0.5cm), nodule (>0.5cm)

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3
Q

What are pertinent predisposing factors for atopic dermatitis?

A

Atopy
IgE and TH2 dysregulation
Filaggrin LOF
Defensin deficiency

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4
Q

What are the clinical features of atopic dermatitis?

A

Patchy erythematous, poorly defined, scaly, itch, rash.

Dry skin with excoriations

Lichenification

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5
Q

What is the typical distribution for atopic dermatitis in babies?

A

Face, then elbows and knees (from crawling)

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6
Q

What is the typical distribution for atopic dermatitis in Early childhood?

A

Elbow and knee flexures

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7
Q

What is the typical distribution for atopic dermatitis in Adults?

A

More localised
Mostly hands and face
Flexural

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8
Q

What is the non-pharmacological management of atopic dermatitis?

A 
Avoid triggers (wool and synthetic, soap and hot bath, hot/cold/dry weather, sand)
Use emollients (sorbolene and 50/50 parafin)
Wet wraps if bad
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9
Q

What is the pharmacological treatment for atopic dermatitis?

A

Appropriate strength steroid for skin site and severity:
Mild –> face, genitals, flexures

Moderate –> trunk, limbs

Potent –> palms, soles, elbows, knees

Very potent –> nodules and lichenification

Topical calineurin inhibitor for sensitive areas

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10
Q

for atopic dermatitis, where are MILD corticosteroids used?

A

Face
Genitals
Flexures

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11
Q

for atopic dermatitis, where are MODERATE corticosteroids used?

A

Trunk

Limbs

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12
Q

for atopic dermatitis, where are POTENT corticosteroids used?

A

Palms
Soles
Elbows
Knees

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13
Q

for atopic dermatitis, where are VERY POTENT corticosteroids used?

A

Nodules

Lichenification

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14
Q

What is the typical management plan for infection in atopic dermatitis?

A

Swab for MCS
Topical mupirocin 2%
Dilute chlorine baths

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15
Q

What are the clinical features of seborrheic dermatitis in INFANTS?

A

Starts in first few weeks of life
Erythematous, well defined rash with greasy scales
Localised to the scalp, face, neck, axillae, and nappy area

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16
Q

What is the management of seborrheic dermatitis in INFANTS?

A 
Gentle bathing in warm water
Emollients
Weak topical steroids
Antibiotics (MCS, or mupirocin)
Antifungals if needed
2% salicylic acid aqueous cream if on scalp
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17
Q

What are the clinical features of seborrheic dermatitis in ADULTS?

A

Chronic, fluctuating condition
Emotional and physical stress trigger
Erythematous, flaky, greasy scales on the medial cheek, nose, and nasolabial folds
Scales and mild itching of the scalp, ears, and medial eyebrows
Groin and axillae involvement

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18
Q

What is the management of seborrheic dermatitis in ADULTS?

A

Anti-dandruff shampoo (ketakonazole, sulfide, miconazole) to control Malessezia on scalp

Topical steroids, topical antifungals, or weak tar creams for non-scalp

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19
Q

What is the pathogenesis of seborrheic dermatitis?

A

Malassezia overgrowth

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20
Q

What is the clinical presentation of Nummular eczema?

A 
Any age
Physical or emotional stress
Very itchy round or oval lesions with well defined edges
Rapid lichenification
Bacterial superinfection
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21
Q

How is nummular eczema differentiated from psoriasis and tinea?

A

Psoriasis:
Less itchy
Adherent silvery scale
Usually localised to knees and elbows

Tinea:
Central clearing
Red scaly edge

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22
Q

What is the management for Nummular eczema?

A

Potent topical steroids
Very potent or intralesional for lichenified lesions
Wet wraps
Antibiotics for superinfection

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23
Q

What are the clinical features of stasis dermatitis?

A 
Below the knees
Haemosiderin staining
Firm oedema
Varicose veins
Venous ulcers
Erythema
Weeping
Crusting
Cellulitis
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24
Q

What is the management of stasis dermatitis?

A

For dryness:
Avoid soap, apply greasy moisturiser, and limit bath length and temperature

For Inflammation:
Weak to moderate topical corticosteroids

For acute exacerbations:
Short duration potent topical corticosteroids
Wet wraps
Antibiotics

For venous insufficiency:
Compression bandages and stockings
Foot elevation at night

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25
Q

What is the age of onset for psoriasis?

A

Bimodal - 15-25 and 50-60

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26
Q

What are the clinical features of psoriasis?

A

Symmetrically distributed, well defined red plaques with silvery scales primarily on the extensor surface

Non-itchy to mildly itchy

Auspitz sign - Small bleeding points after plaque is removed

Nail changes - Pitting, ridging, onycholysis, hyperkeratosis

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27
Q

How is psoriasis severity measured?

A

Psoriasis area and severity index

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28
Q

What are the nail changes associated with psoriasis?

A

Pitting
Ridging
Onycholysis
Hyperkeratosis

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29
Q

What are the common variants of psoriasis?

A 
Scalp
Guttate
Palmoplantar pustular
Chronic plaque
Inverse
Erythrodermic
30
Q

What is scalp psoriasis?

A

Diffuse or well circumscribed plaques on the scalp

31
Q

What is guttate psoriasis?

A

Acute onset widespread plaques 2-3 weeks following a strep infection. Self resolves

32
Q

What is palmoplantar pustular psoriasis?

A

Associated with steroid discontinuation

Scaling, redness, and pustules on the palms and soles of feet

33
Q

What is chronic plaque psoriasis?

A

Classical psoriasis

34
Q

What is inverse psoriasis?

A

Located on the flexural surfaces
Sharply defined patches
No to little scaling

35
Q

What is erythrodermic psoriasis?

A

Rare - but dermatological emergency

Red inflamed areas which can involve the whole skin

History of psoriasis

Can cause systemic illness

Requires oral therapy

36
Q

What is the pathogenesis of psoriasis?

A

No completely known, but probably involves the immune system.

T-cell, IL`B, TNFa, IL17A

37
Q

What medications can trigger psoriasis?

A

Beta blockers, hydroxychloroquine, lithium, NSAIDS, Corticosteroid withdrawal

38
Q

What are the histopathological features of psoriasis?

A 
Elongated rete edges
Thinning of the stratum granulosum
Parakeratosis
Dilated capillaries in the dermal papillae
Micro abscesses in the epidermis
39
Q

What are the investigations for psoriasis?

A

Biopsy - not always needed

FBC, UEC+CrCL, LFT, BHCG

Streo tests (throat swab, serum ASOT titre) for guttate

40
Q

What is the management for psoriasis?

A

Stress and SNAPW

Screen for infection

Salicylic acid, baths, and increased sun

If mild or localised –> topical therapy

If moderate or extensive –> Phototherapy

If severe or treatment resistant –> systemic treatment

Expectation setting –> 6 weeks for results

Refer to derm if phototherapy is needed

Go to hospital if erythrodermic psoriasis

41
Q

What are the 5 topical treatments for psoriasis?

A

Corticosteroids - Anti-inflammatory
Intermittent pulsed use

Tar-(LPC) - Anti-inflammatory + antiproliferative
Works well, but very slow

Calcipotriol - antiproliferative + anti keratinocyte
Needs high dosage, slow to work, good for maintenance. Combined with corticosteroid cream in acute

Dithranol - Antiproliferative
Fastest acting. Can have concentration or application time dosage. Can’t use on face or flexures

Tazarotene - Retinoid
Hyperkeratotic plaques, very irritating

42
Q

Describe phototherapy for psoriasis?

A

Narrow band UVB therapy at wavelength 311nm

2-3 times per week

Inhibits immune and inflammatory pathways in the skin

43
Q

What are the four systemic therapies for psoriasis?

A

Methotrexate + folic acid

Acitretin - Highly teratogenic need to wait two years after cessation for pregnancy

Cyclosporin - Quick rebound of symptoms after cessation. Not long term

Biological therapy
PASI>15 and significant involvement of the face, hands, and feet
Failed other non-topical therapies

44
Q

What is the management of acne (for osces)

A
  1. Assess impact and desire for treatment
  2. Assessment of severity
  3. Modification of excacerbating lifestyle factors
  4. Investigations (hormonal, PCOS)
  5. Topical treatment
  6. antibiotics
  7. Derm referral
  8. Hormonal treatment
  9. Isotretinoin
45
Q

What is the pharmacological management for mild comedonal acne?

A

Topical retinoid (Adapalene, Tretinoin, Isotretinoin, Tazarotene) alone

46
Q

What is the pharmacological management for mild papulopustular acne?

A

Topical retinoid with either a topical antiseptic (benzoyl peroxide)
OR
Topical antibiotics (clindamycin, erythromycin) and a salicylic acid cleansing agent.

47
Q

What is the pharmacological management of moderate acne, or non-responsive mild acne?

A

Topical retinoid (Adapalene, Tretinoin, Isotretinoin, Tazarotene)
AND
Oral antibiotics (tetracyclines, erythromycin),
OR
Anti androgenic (OCP, spironolactone, cyproterone acetate) in females.

48
Q

What is the pharmacological management of severe acne

A

Oral isotretinoin – must be prescribed by a dermatologist.

49
Q

What is pityriasis rosea?

A

Post-viral rash associated with HHV6/7

Mainly affects teenagers and young adults

50
Q

What are the clinical features ff Pityriasis rosea?

A

Herald patch, followed by development of smaller oval red patches

Mostly on the back and chest

Lasts 6-12 weeks

51
Q

What is the treatment of Pityriasis rosea?

A

Conservative, lotions, bathing etc

Topical steroids for itch

7-day course of acyclovir can reduce length, but it is not routinely recommended

52
Q

What is Rosacea and how does it present?

A

A chronic rash affecting the central face, associated with flushing, telagiectasia and pustules.

Some patients also get Rhinophyma or Morbihan disease (facial lymph obstruction)

53
Q

What are some differentials for Rosacea?

A

SLE, Acne, Menopause, Seborrheic dermatitis

54
Q

What is the management for Rosacea?

A

Conservative therapy (mild soap and oil free sunscreen)

Topical:
Twice per day until rash improves, then once per day for 6-12 weeks
-Metronidazole cream
-Clindamycin lotion or cream
-Erythromycin gel
-Azelaic acid gel
55
Q

What are the types of inducible urticaria?

A 
Cold urticaria
Symptomatic dermographism
Cholinergic urticaria
Delayed pressure urticaria
Contact urticaria
Solar urticaria
Heat urticaria
Vibratory urticaria
Vibratory angioedema
Aquagenic urticaria
56
Q

What are the clinical features of urticaria?

A

Wheals

Angioedema (+++eyelids, perioral)

57
Q

What are the investigations for Urticaria?

A

Skin prick
Radioallergeosorben tests (RAST)
CAP fluoroimmunoassay

58
Q

What is the management for urticaria?

A
  1. Less sedating antihistamine (Cetirizine, desloratadine, fexofenadine, levocetirizine, loratadine)
  2. Sedating antihistamine at night (Cyproheptadine, dexchlorpheniramine, pheniramine, promethazine, alimemazine)
  3. Ranitidine at night
  4. Doxepin at night
59
Q

What are the three main presentations of impetigo?

A
  1. Crusted or non-bullous impetigo
    Most common
    Golden yellow crust with erosions. Itchy but not painful. Sometimes pustular
    Staph (most common), or strep (more common in Indigenous populations). Can be both
    Satellite lesions
  2. Bullous impetigo
    Rapidly eroding blisters
    Brown crust
    Always staph
  3. Ulcerative impetigo
    Ulcers
    Always strep
60
Q

What are some complications of strep impetigo?

A

Post-strep glomerulonephritis

Deep ulceration

61
Q

What are the relevant investigations for impetigo?

A

Swab (MCS)

Nasal or perineal swab for chronic strep carrier

62
Q

What is the treatment for impetigo?

A

Localised and non-severe:
Mupirocin 2%

Widespread / severe:
Dicloxacillin or flucloxacillin (Cephalexin –> Trimethoprim+Sulfa if allergic)

Decolonisation
Mupirocin 2% nasal

School exclusion until crusts are dry

63
Q

What is the difference between cellulitis and weysipelas?

A

Cellulitis is an infection of the dermis and subcutaneous tissue

Erysipelas is a superficial form of cellulitis which effects the dermis only. (more defined edges)

64
Q

What are the common causes of cellulitis?

A

Group A strep
Staph Aureus - near wound
Strep pyogenes - periorbital

65
Q

Outline the pharmacological treatment for cellulitis in the ABSENCE OF SYSTEMIC SYMPTOMS

A

-strep (non-purulent): Phenoxymethylpenicillin or procain benzylpenicillin

-Staph (purulent, or penetrating trauma):
Docloxacillin or flucloxacillin

-If allergic, cephalexin, clindamycin, or Trimethoprim+sulfamethoxazole

66
Q

Outline the pharmacological treatment for cellulitis in the PRESENCE OF SYSTEMIC SYMPTOMS

A

-Strep (non-purulent): Benzylpenicillin

-Staph (purulent, penetrating trauma):
Flucloxacillin

  • If allergic:
    Cefazolin or Vacomycin
67
Q

Outline the pharmacological treatment for PRESEPTAL cellulitis

A

Flucloxacillin or dicloxacillin

If allergic:
Cefalexin, clindamycin, or augmentin

68
Q

Outline the pharmacological treatment for POSTSEPTAL cellulitis

A

Cefotaxime
Ceftriaxone + Flucloxacillin

If allergic:
Vancomycin + Ceftriaxone or ciprofloxacin

69
Q

Outline the pharmacological management for cellulitis with MRSA

A

Trimethoprim + sulfamethoxazole

Clindamycin

Vancomycin

70
Q

What is the panton-valentine leucocidin (PVL) gene

A

Virulence gene in some CA-MRSA strains which leads to more significant infections like necrotising pneumonia and necrotising fasciitis

71
Q

What is paronychia?

A

Infection of the paronychium (area surrounding the nail bed)

72
Q

What is the management of paronychia?

A

Drainage with sterile needle

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