Dermatology by Dr Cintia

Question 1

Precancerous skin lesions

Question 2

Melanoma INVESTIGATION BEST

Answer 2

Surveillance:
- First 2 years: e/3m
- Next 2 years: e/6m
- After: e/1y
- 1st Deg Rel: Skin check
e/1y

For the patient with a history of melanoma:

• First 2 years: Examination every 3 months (e/3m)
• Next 2 years: Examination every 6 months (e/6m)
• After 4 years: Examination every year (e/1y)

For first-degree relatives (due to increased risk):

• Skin check: Examination every year (e/1y)

These surveillance intervals help in early detection of recurrence or new melanomas, optimizing patient outcomes through timely intervention.

Question 3

Melanoma TREATMENT

Answer 3

Excision margin:
- In situ: 0.5cm
- <1mm: 1cm
- 1-4mm: 1-2cm
>4mm: 2cm
If eye: Refer to plastic surgery

Question 4

NODULAR MELANOMA

Question 5

ACRAL LENTIGINOUS MELANOMA

Question 6

LENTIGO MELANOMA

Question 7

DESMOPLASTIC MELANOMA

Question 8

Squamous Cell
Carcinoma TREATMENT

Answer 8

Surgery with 3-5mm margin

Question 9

BOWEN DISEASE BEST INVESTIGATION

Answer 9

Shave or Punch Biopsy

Question 10

BOWEN DISEASE TREATMENT

Answer 10

Fluorouracil, Imiquimod

Question 11

KERATOACANTHOMA

Question 12

Basal Cell Carcinoma BEST INVESTIGATION

Answer 12

Biopsy

Question 13

Basal Cell Carcinoma TREATMENT

Answer 13

Mohs Surgery with 3-4mm excision

Question 14

Gas gangrene (Clostridial myonecrosis)

Answer 14

Gas gangrene, also known as Clostridial myonecrosis, is a severe and potentially life-threatening bacterial infection that affects muscle tissue. It is most commonly caused by bacteria from the Clostridium family, particularly Clostridium perfringens.

1. Cause:
   
   • Clostridium Bacteria: These bacteria are anaerobic, meaning they thrive in environments with little or no oxygen. They are often found in soil, dust, and the intestines of humans and animals.
   • Infection Trigger: Gas gangrene typically occurs after a traumatic injury or surgery, where the bacteria can enter a wound. Once inside the body, they multiply rapidly and produce toxins that destroy tissue.
2. Symptoms:
   
   • Severe Pain: The pain at the site of infection is often out of proportion to the injury.
   • Swelling and Discoloration: The affected area becomes swollen, pale, and may turn a purplish or black color as the tissue dies.
   • Gas Production: The bacteria produce gas as they multiply, which can cause a crackling sensation under the skin when touched (crepitus).
   • Foul-Smelling Discharge: The wound may ooze a thin, foul-smelling fluid.
   • Rapid Progression: The infection spreads quickly, leading to shock, organ failure, and, if untreated, death.
3. Diagnosis:
   
   • Clinical Examination: The appearance of the wound, the presence of gas in tissues (seen on imaging like X-rays), and the rapid progression of symptoms are key indicators.
   • Laboratory Tests: Blood tests, cultures, and analysis of the wound tissue can confirm the presence of Clostridium bacteria.
4. Treatment:
   
   • Emergency Surgery (Debridement): Immediate removal of dead tissue (debridement) is critical to stop the spread of the infection.
   • Antibiotics: High-dose intravenous antibiotics, typically penicillin and clindamycin, are administered to fight the bacteria.
   • Hyperbaric Oxygen Therapy: This treatment involves breathing pure oxygen in a pressurized room. It increases oxygen in the blood, which helps kill the anaerobic bacteria.
   • Amputation: In severe cases, if the infection has spread extensively, amputation of the affected limb may be necessary to save the patient’s life.
5. Prognosis:
   
   • High Mortality Rate: Gas gangrene has a high mortality rate, especially if not treated promptly. Quick medical intervention is essential for survival.

Gas gangrene (Clostridial myonecrosis) is a rapidly progressing and deadly infection caused by Clostridium bacteria, often following a wound or injury. It is characterized by severe pain, swelling, gas production in tissues, and rapid tissue death. Immediate surgical removal of dead tissue, aggressive antibiotic therapy, and sometimes hyperbaric oxygen therapy are crucial for treatment. Without prompt intervention, the infection can lead to death.

Question 15

Shingles

Question 16

Molluscus contagiosum TREATMENT

Answer 16

No tx needed.
Resolvesin 3-6m
No school exclusion necessary
Avoid sharing towels/baths

Question 17

Impetigo TREATMENT

Answer 17

1. Topical mupirocin 2% OR
2. cefalexin if widespread or large areas.

Question 18

Staphylococcal scalded skin syndrome

Question 19

Dermatophyte infections

Question 20

Tinea CLINICAL FEATURES

Answer 20

Ringworm

Question 21

Tinea TREATMENT

Answer 21

1. Oral Griseofulvin/Terbinafine

Question 22

Scabies CLINICAL FEATURES

Answer 22

Common in nursing homes

Question 23

Scabies TREATMENT

Answer 23

1.Permethrin.

Question 24

Lice

Question 25

Cutaneous larva migran

Question 26

PAPULAR URTICARIA

Question 27

CERCARIAL DERMATITIS Erythrasma

Question 28

Dermatitis CLINICAL FEATURES

Answer 28

Itchy, rash

Question 29

Dermatitis TREATMENT

Answer 29

1. Topical steroids & Moisturiser

Question 30

Dermatitis Herpetiformes CLINICAL FEATURES

Answer 30

Assoc w/ Celiac Dx in elbows, knees, lumbosacral area

Question 31

Dermatitis Herpetiformes BEST INVESTIGATION

Answer 31

Skin biopsy

Question 32

Dermatitis Herpetiformes TREATMENT

Answer 32

1.  Dapsone. 2.  Gluten free diet

Question 33

Atopic Dermatitis CLINICAL FEATURES

Answer 33

Kids in face, cubital, popliteal

Question 34

Atopic Dermatitis TREATMENT

Answer 34

1.  Topical Steroids & Moisturiser 2.  Severe: Immunosuppressants - Infected: Swab then mupirocin/Dicloxacillin

Question 35

Contact Dermatitis

Question 36

Seborrheic Dermatitis CLINICAL FEATURES

Answer 36

Dandruff

Question 37

Seborrheic Dermatitis

Answer 37

1.  Dandruff Shampoo 2.  Ketoconazole

Question 38

Stasis Dermatitis

Question 39

Discoid Dermatitis

Question 40

ASTEATOTIC DERMATITIS

Question 41

GENITAL DERMATITIS

Question 42

Wound treatment

Question 43

Wound Healing

Question 44

SUNBURN

Question 45

Solar keratose

Question 46

SEBORRHOEIC KERATOSES

Question 47

LENTIGINES

Question 48

MELANOCYTIC NAEVI DYSPLASTIC

Question 49

NAEVI TREATMENT

Answer 49

Surgery with 2mm margin

Question 50

Acneiform Eruptions

Question 51

Acne vulgaris

Question 52

Rosacea

Question 53

Lichen planus

Question 54

Pityriasis rosea

Question 55

Psoriasis CLINICAL FEATURES

Answer 55

Cause: Autoimmune, lithium, ACE inhs

Question 56

Psoriasis TREATMENT

Answer 56

1.  Tar 2.  Steroids 3.  Calcipotriol The RACGP guidelines for treating psoriasis typically include the following steps: 1. **Topical Treatments**: - **Corticosteroids**: Applied directly to the skin to reduce inflammation and slow down the rapid skin cell turnover. - **Vitamin D analogues**: Such as calcipotriol, which help to slow down skin cell growth. - **Coal tar and dithranol**: Help reduce scaling, inflammation, and slow skin cell growth. - **Moisturizers**: Keep the skin hydrated and reduce itching and scaling. 2. **Phototherapy**: - **UVB Therapy**: Exposure to ultraviolet B light can help slow the growth of affected skin cells. - **PUVA Therapy**: Combining a drug called psoralen with UVA light to improve skin symptoms. 3. **Systemic Treatments** (for moderate to severe cases): - **Methotrexate**: Reduces skin cell production and suppresses the immune system. - **Ciclosporin**: An immunosuppressant that reduces the immune response. - **Acitretin**: An oral retinoid that helps normalize skin cell growth. - **Biologics**: Target specific parts of the immune system. Examples include TNF inhibitors (etanercept, infliximab) and IL-17 inhibitors (secukinumab). 4. **Lifestyle and Supportive Measures**: - **Weight management**: Maintaining a healthy weight can improve treatment outcomes. - **Smoking cessation**: Smoking can worsen psoriasis. - **Stress management**: Stress can trigger or worsen psoriasis. - **Patient education and support**: Understanding the condition and having access to support groups can be beneficial. 5. **Regular Monitoring and Follow-Up**: - **Regular check-ups** to monitor the effectiveness of the treatment and make adjustments as needed. - **Screening for associated conditions** such as psoriatic arthritis, cardiovascular disease, and mental health issues. Always consider patient-specific factors when selecting and adjusting treatments.

Question 57

FLUSHING-BLUSHING

Question 58

Autoimmune blistering diseases

Question 59

Porphyrias

Question 60

Ichthyosis

Question 61

Vitiligo

Question 62

Neurocutaneous syndromes

Question 63

Pityriasis alba

Question 64

ALERGIC REACTIONS MULTI-SYSTEMIC CLINICAL FEATURES

Answer 64

ACUTE ANAPHTLAXIS - ANAPHYLACTIC REACTION

Question 65

ALERGIC REACTIONS LOCALISED CLINICAL FEATURES

Answer 65

ANGIOEDEMA - URTICARIA

Question 66

exanthematic

Answer 66

DRAFT: morbilliform; most common

Question 67

urticarial phototoxic eruption lichenoid

Question 68

cutaneous vasculitis fixed drug eruption

Question 69

Stevens-Johnson syndrome toxic

Question 70

epidermal necrolysis (TEN)

Question 71

drug rash with eosinophilia and systemic symptoms (DRESS) acute

Question 72

generalised exanthematous pustulosis (AGEP)

Question 73

Androgenetic Alopecia TREATMENT

Answer 73

1.  Topical steroids for 12w 2.  Intradermal Steroid (Triamcinolone) 3.  Minoxidil

Question 74

Hirsutism CLINICAL FEATURES

Answer 74

Cause: Valproate, phenytoin, minoxidil, steroids, danazol

Question 75

Hirsutism TREATMENT

Answer 75

1.  Shave 2.  Laser 3.  Spironolactone

Question 76

NAILS DISORDERS

Question 77

ONYCHOMYCOSIS

Question 78

INGROWN TOENAILS

Question 79

PARONYCHIA

Question 80

ONYCHOLYSIS

Question 81

Brittle nails

Question 82

Koilonychia

Question 83

Aphthous stomatitis

Question 84

Photodermatoses

Question 85

Erythema nodosum

Question 86

Erythema multiforme

Question 87

Erysipelas CLINICAL FEATURES

Answer 87

Upper dermis and lymphatics, non-purulent

Question 88

Cellulitis CLINICAL FEATURES

Answer 88

Deeper dermis, SC fat, purulent/non purulent

Question 89

Cellulitis TREATMENT

Answer 89

IV Flucloxacillin

Question 90

Hemangiomas TREATMENT

Answer 90

-    If in eyes, nose, ears, trachea->Laser Qx or refer -    Other parts: Observe/Reassure (self-resolve by 7yo. -    Propranolol can be used

Question 91

Acne CLINICAL FEATURES

Answer 91

-  Non-inflamm: Comedones -  Inflamm: Pustules/Papules -  Severe: Scarring

Question 92

Acne TREATMENT

Answer 92

-    Mild: Benzoyl peroxide + Topical retinoin -    Mod: Non inflamm (Benzoyl peroxide + Retinoin. Inflamm (Benzoyl peroxide+Doxicycline, if pregnant Erythromycin) -    Severe: Isoretinoin (Oral). In females add OCPs

Question 93

Allergies CLINICAL FEATURES

Answer 93

Just local symptoms

Question 94

Allergies TREATMENT

Answer 94

1.  Strop triggers 2.  Emollients 3.  Oral promethazine 4.  Steroids

Question 95

Anaphylaxis CLINICAL FEATURES

Answer 95

Respiratory problems

Question 96

Anaphylaxis TREATMENT

Answer 96

1. Adrenaline IM: (All 1:1000) -  <6m: 0.10 mg -  6m-6y: 0.15mg -  6-12y: 0.3mg -  >12y: 0.5mg

Question 97

Vitamin D deficiency CLINICAL FEATURES

Answer 97

Children: Rickets (Bowlegs, rachitic rosary, soft skull). Adults: HypoCa (Tetany, prox myopathy, frontal bossing)

Question 98

DERMATOLOGY CLINICAL FEATURES

Answer 98

Night blindness, scaly skin, bitot spots (foamy appearance on conjunctiva), corneal degeneration

Question 99

Vitamin B3 deficiency CLINICAL FEATURES

Answer 99

3 Ds (Dermatitis, Diarrhoea, Dementia).

Question 100

Vitamin B3 deficiency TREATMENT

Answer 100

Resolves in 3-6m No school exclusion necessary Avoid sharing towels/baths

Question 101

Alopecia - SCARRING

Question 102

Alopecia - TELOGEN EFFLUVIUM ANAGEN EFFLUVIUM

Question 103

Alopecia - TRICHOTILLOMANIA HIRSUTIES-