Extra Derm

Question 1

What is a pyogenic granuloma?

Answer 1

overgrowth of blood vessels, red nodules, usually follows trauma

Question 2

What is a keratoacanthoma?

Answer 2

common rapidly growing locally destructive skin tumour, can regress spontaneously with scarring or grow to be virtually indistinguishable from a SCC

Question 3

Where are keloid scars most common?

Answer 3

the sternum

Question 4

What is a keloid scar?

Answer 4

tumour like lesions that arise from the connective tissue of a scar and extend beyond the dimensions of the original wounds more common in areas of high skin tension eg. sternum

Question 5

Treatment of keloid scar?

Answer 5

can be treated with intralesional steroids

Question 6

What area tends to be more affected in vitligo?

Answer 6

peripheries

Question 7

Presentation of scabies?

Answer 7

itch worse at night
characteristic irregular tracks in between digits of hands
nodules
neck and face tend to spared

Question 8

Hirsutism vs hypertrichosis?

Answer 8

Hirsutism - hair growth in a male pattern
Trichosis - excess hairgrowth in any pattern

Question 9

Risk of cryotherapy in darker skins?

Answer 9

can cause hypopigmentation

Question 10

What is the oil drop sign?

Answer 10

it is indicative of nail psoriasis (doesnt occur in fungal infection)
it is an area of discolouration in the right fifth digit

Question 11

Differential for psoriatic nail disease?

Answer 11

fungal nail infection

Question 12

What is acanthosis nigrans? Links?

Answer 12

symmetrical brown, velvety plaques often found on neck, axilla and groin

predominantly linked to states of insulin resistance e.g. t2dm

Question 13

Is pregnancy a contraindication to retinoids?

Answer 13

yes both topical and oral

Question 14

AK vs Bowen disease?

Answer 14

Ak - varying forms of squamous dysplasia
bowens - squamous cell carcinoma in situ (some will say that bowen is only SCC on a sunexposed site some use it for all SCC)

Question 15

Management of AK?

Answer 15

Sun protection
emollients
vigilance for skin cancers
cryotherapy
5-fluoruracil cream (efudex)
imiquimob (aldara)
for mild can sometimes use diclofenac

Question 16

Explain what exclamation mark hairs are?

Answer 16

short fragile hair that is thinner at the base where it attaches to the body than the other end

occurs in alopecia areata

Question 17

Prognosis of alopecia areata?

Answer 17

hair will regrow in 50% of patients by 1 year and 80-90% eventually

Question 18

Give an example of a sedating antihistamine?

Answer 18

chlorphenamine

Question 19

Give an example of 3 non-sedating antihistamines? Normal doses?

Answer 19

fexofenadine (120mg once daily), loratidine (10mg once daily), cetirizine (10mg once daily)

Question 20

Features of a nodular BCC?

Answer 20

pearly nodule
telangiectasia
central ulceration
rolled edges
“rodent ulcer”

Question 21

What is auspitz sign?

Answer 21

if scale removed on psoriasis there is pinpoint bleeding

Question 22

What is erythema multiforme? What causes it?

Answer 22

this is a immune mediated, self limiting mucocutaneous condition
common precipitant is herpes simplex virus
other precipitants include: other viruses, medications and vaccinations

Question 23

Presentation of erythema multiforme?

Answer 23

widespread, itchy, erythematous rash with classic target lesions, can get oral mucosa features

Question 24

Management of erythema multiforme?

Answer 24

often not needed, can give symptom control e.g. antihistamine, local anaesthetic, steroid cream

Question 25

Causes of erythema nodosum?

Answer 25

pregnancy drugs - sulphonamides, cocp, penicillins infections - strep, tb, brucellosis malignancy - mainly leukaemias and lymphomas systemic conditions - behcets, sarcoidosis, IBD

Question 26

Presentation of fungal toenail infection?

Answer 26

presents similarly to psoriatic nails toenails more likely to be infected than fingernails

Question 27

Management of fungal nail infections?

Answer 27

do not need any treatment if patient is asymptomatic and not bothered by it if < 50% nail affected and < 2 nails can use topical treatments however most will need oral terbinafine (which can cause liver damage)

Question 28

Who is guttate psoriasis more common in?

Answer 28

more common in children and adolescents often strep throat 2-3 weeks before

Question 29

Prognosis and treatment of guttate psoriasis?

Answer 29

most resolve in 2-3 months use topical psoriasis treatments

Question 30

Guttate psoriasis vs pityriasis rosea presentation?

Answer 30

Guttate is classically following strep throat, pityriasis may be following URTI Guttate is tear drop scaly papules, pityriasis is herald patch 1-2 weeks later followed by lesions which are more oval and red with scale refined to the outer aspect of the lesions Guttate psoriasis can be on trunk and arms, pityriasis is classically a fir tree/ christmas tree distribution guttate psoriasis lasts 2-3 months, treat with psoriasis treatment. Pityriasis last about 6 weeks and is self resolving.

Question 31

Koebner phenomenon?

Answer 31

skin lesions seen at site of injury clasically in psoriasis but can occur in other skin conditions too e.g. lichen planus

Question 32

Presentation of lichen planus rash?

Answer 32

itchy, papular rash most common on the palms, soles, genitalia and flexor surfaces of the arms polygonal in shape with white lines (wickhams striae) koebner phenomenon mucosal involvement - white lace pattern on buccal mucosa

Question 33

Treatment of lichen planus?

Answer 33

potent steroids

Question 34

Presentation of pityriasis rosea?

Answer 34

majority no prodrome but potentially recent viral infection herald patch 1-2 weeks later, erythematous oval lesions with scale on outside fir tree/ christmas tree distribution

Question 35

Management of pityriasis rosea?

Answer 35

self limiting - 6 weeks help with symptoms: topical steroids and oral antihistamines to reduce itch

Question 36

What is seborrhoeic dermatitis?

Answer 36

chronic dermatitis - inflammatory reaction related to proliferation of normal skin inhabitant - fungus Malassezia Furfur (pityrosporium ovale)

Question 37

Presentation of seborrhoeic dermatitis?

Answer 37

eczematous lesions on sebum rich areas e.g. scalp, periorbital, auricular and nasolabial folds

Question 38

Management of seborrhoeic dermatitis?

Answer 38

scalp: OTC shampoos with zinc pyrithione e.g. head and shoulders, 2nd ketoconazole face and body: topical antifungals e.g. ketoconazole

Question 39

Explain what steven johnson syndrome and TENS is?

Answer 39

variants of same condition but SJS usually affects less of the skin disproportional immune response to a trigger, there is then sheet like mucosal and skin loss

Question 40

Triggers of SJS/ TENS?

Answer 40

Medications e.g. antiepileptics, NSAIDs, allopurinol, antibiotics infections: CMV, HSV, HIV, Mycoplasma pneumonia

Question 41

Presentation of SJS/ TENS?

Answer 41

prodrome of fever, sore throat, difficulty swallowing, sore red eyes, general aches and pains then get sheet like mucosal and skin loss medical emergency and can be fatal

Question 42

When should antivirals be used in shingles?

Answer 42

in the majority of patients within 72 hours

Question 43

Chronic plaque psoriasis guidelines?

Answer 43

NICE recommend a step-wise approach for chronic plaque psoriasis regular emollients may help to reduce scale loss and reduce pruritus first-line: NICE recommend: a potent corticosteroid applied once daily plus vitamin D analogue applied once daily should be applied separately, one in the morning and the other in the evening) for up to 4 weeks as initial treatment second-line: if no improvement after 8 weeks then offer: a vitamin D analogue twice daily third-line: if no improvement after 8-12 weeks then offer either: a potent corticosteroid applied twice daily for up to 4 weeks, or a coal tar preparation applied once or twice daily short-acting dithranol can also be used

Question 44

Scalp psoriasis guidelines?

Answer 44

NICE recommend the use of potent topical corticosteroids used once daily for 4 weeks if no improvement after 4 weeks then either use a different formulation of the potent corticosteroid (for example, a shampoo or mousse) and/or a topical agents to remove adherent scale (for example, agents containing salicylic acid, emollients and oils) before application of the potent corticosteroid

Question 45

What could SSSS be secondary to?

Answer 45

an initial impetigo

Question 46

Presentation of SSSS?

Answer 46

widespread erythematous rash with tense bullae, nikolsky sign positive, usually children < 6 years old, spares the oral mucosa

Question 47

Management of SSSS?

Answer 47

IV flucloxacillin and topic fusidic acid

Question 48

What malignancy are renal transplant patients at risk of?

Answer 48

skin cancers such as SCC

Question 49

Main advantage of antivirals in shingles?

Answer 49

reduces the risk of post herpetic neuralgia