Dermatology Mx

Question 1

Acne: Simple Measures (4)

Answer 1

Wash face 1-2x daily
don’t squeeze pimples
avoid excess makeup + remove before bed
wash hair regularly + avoid getting on face

Question 2

Mild comedonal acne

Answer 2

topical retinoid

Question 3

Mild papulo-pustular acne

Answer 3

topical retinoid or ABx + benzoyl peroxide

Question 4

Moderate papulo-pustular acne

Answer 4

topical retinoid + oral Abx
(doxycycline, mioncycline, trimethoprim)
consider OCP with cyproterone acetate (Diane) + topical Abx/retinoid + benzoyl peroxide in females

Question 5

severe nodulocyctic acne

Answer 5

Refer to dermatologist for isotretinoid/roacutane

Question 6

Acne on back or chest

Answer 6

Oral Abx

Question 7

Acne DDx

Answer 7

folliculitis
perioral dermatitis
rosacea

Question 8

Eczema: simple measures (3)

Answer 8

Avoid dryness, overheating, irritation
Use moisturisers
Treat infection aggressively

Question 9

Eczema - pharmacological

Answer 9

topical steroids in ointment, increase strength if flare/infection
oral ABx if infected

Question 10

Eczema DDx

Answer 10

Seborrhoeic dermatitis
Irritant/allergic contact dermatitis
Scabies
Psoriasis

Question 11

Erythema Multiforme Mx

Answer 11

supportive - fluid and salt replacement, pain relief, Mx body temp
remove triggers
immediate referral if ?SJS or TEN
no accepted systemic therapy

Question 12

Erythema Multiforme DDx

Answer 12

Allergic contact dermatitis
Molluscum contagiosum
Lyme disease

Question 13

Lichen Planus

Answer 13

++potent topical steroid ± occlusive dressing, 2x daily

or PO pred 25-50mg once daily for 4-6wks, then taper for 1-2wks

Question 14

Lichen Planus DDx

Answer 14

psoriasis

chronic graft-vs-host disease

Question 15

Perioral Dermatitis Mx

Answer 15

discontinue all face creams
wash face w/ warm water alone when rash is present; use non-soap cleanser once cleared
ABx: topical erythromycin or metronidazole gel (mild cases), or PO tetracycline for 6-12wks (severe cases), or isotreinoin (nonresponsive cases)

Question 16

Perioral Dermatitis DDx

Answer 16

Acne
Seborrhoeic Dermatitis
Rosacea

Question 17

Pityriasis Rosacea Mx

Answer 17

aim: fix itch, wait for spontaneous resolution
moderately potent topical steroid 1-2x daily
can use phototherapy if required

Question 18

Pityriasis rosacea DDx

Answer 18

Guttate psoriasis
Secondary syphilis
Tinea corporis
Drug reaction
Tinea versicolor

Question 19

Psoriasis Mx

Answer 19

stress control: exercise, quit smoking, reduce EtOH, lose weight
moisturisers+++, short-term potent topical steroids, long-term topical calcipotriol (may need to rotate treatments)
can go to systemics if severe, but will need referral (methotrexate, acitretin, cyclosporin, biologicals)

Question 20

Psoriasis DDx

Answer 20

SLE
Pityriasis rosea
Seborrhoeic dermatitis
Solar keratosis
Eczema
Lichen Planus

Question 21

Rosacea Mx

Answer 21

Topical metronidazole gel + oral doxycycline for 3-6 months, then maintenance dose
avoid exacerbating factors/triggers - spicy food, hot drinks, alcohol
daily sunscreen
avoid cosmetics/skin-care products

Question 22

Rosacea DDx

Answer 22

Seborrhoeic dermatitis
contact dermatitis
SLE
dermatomyositis
Polycythemia vera
Sarcoidosis
Acne

Question 23

Seborrhoeic Dermatitis Mx

Answer 23

SCALP
Mild: daily use of regular shampoo
If ineffective/severe: daily wash with antifungal shampoo
If required: add topical treatment to damp scalp each night for 7 nights, washing off in am with antifungal shampoo (betamethasone 0.05%)

ELSEWHERE
low-irritant skin cleanser
hydrocortisone 1% + clotrimazole 1% topically 1-2x daily

MAINTENANCE
emollient most days + treat flares
(severe flare needs ketoconazole 200mg PO once daily for up to 10d)

Question 24

Seborrhoeic Dermatitis DDx

Answer 24

psoriasis
SLE
tinea capitis
rosacea
eczema
impetigo
contact dermatitis
acne
lichen planus

Question 25

Impetigo Mx

Answer 25

mild/localised: soap and water 8hrly, then mupirocin 2% to any crusted areas 8H for 7d widespread/recurrent: fluclox 500mg PO 6H for 10d

Question 26

Impetigo DDx

Answer 26

Herpes varicella candida discoid eczema

Question 27

Tinea Mx

Answer 27

localised: terbinafine 1% once daily for a week (topical) otherwise: terbinafine 250mg PO once daily or fluconazole 150mg PO once daily

Question 28

Tinea DDx

Answer 28

Psoriasis Seborrheic dermatitis acne contact dermatitis

Question 29

Herpes simplex Mx

Answer 29

Minor: acyclovir topically every 4h (while awake) for 4d @ first sign of recurrence Severe primary: aciclovir 400mg PO 5x daily for 7d severe episodic: famciclovir 1500mg PO 12H for 1d (within 48h of outbreak) suppressive: valaciclovir 500mg PO once daily for up to 6 months

Question 30

Herpes Simplex DDx

Answer 30

``` contact dermatitis Behcet's Crohn's Scabies SCC Perioral shingles ```

Question 31

Scabies Mx

Answer 31

permethrin 5% topically to dry skin from the neck down, leave on for ≥8hrs (overnight is good), increasing to 24hrs if failure; repeat 1 week later. Wash or subject to heat from iron/clothes dryer, or store for one week: clothes, towels, bedding CONTACT TRACE - treat family and close contacts at same time. Can use steroid or emollient for itching.

Question 32

Scabies DDx

Answer 32

Impetigo Folliculitis Allergic contact dermatitis Flea bites

Question 33

Lice Mx

Answer 33

Maldison 1% topically for 6h, or permethrin 1% topically for ≥20min; repeat 7-10d later Wet hair + conditioner + fine comb after each treatment to check for absence of lice If present, they're resistant - use another product, or PO trimethoprim + sulfamethoxazole 12Hrly for 3d, repeating again after 10d

Question 34

Varicella zoster (chicken pox)

Answer 34

pregnant women, or immunocompromised: acyclovir PO for 7-14d within 72hrs of rash onset if severe in adults, may need IV antivirals

Question 35

Measles, Rubella, Chickenpox DDx

Answer 35

``` Scarlet Fever Smallpox Shingles EBV TEN Drug reaction Measles Rubella Chickenpox ```