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GP - Derm Flashcards

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1
Q

What are the clinical features of eczema?

A
  • Itchy, erythematous rash exacerbated by repeated scratching
  • Infants = face/trunk
  • Young children = extensor surfaces
  • Older children = flexor surfaces/creases of face and neck
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2
Q

Describe the pathophysiology of eczema

A
  • Defects in the normal continuity of the skin barrier
  • Provides entrance for irritants/microbes/allergens
  • Inflammation in skin
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3
Q

What is the management for eczema?

A

Create artificial barrier using emollients
- Thin = creams (E45/diprobase/cetraben/epaderm)
- Thick/greasy = ointments (hydromol/diprobase/cetraben/epaderm)

  • Avoid hot baths/scratching/certain soaps
  • Topical steroids (flares)
  • Wet wraps (flares)
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4
Q

What steroids are used for eczema?

A

Mild = hydrocortisone

Moderate = betamethasone/clobetasone

Potent = fluticasone propionate/betamethasone valerate

Very potent = clobetasol propionate

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5
Q

What are risk factors for psoriasis?

A
  • Genetics = HLA-B13/HLA-B17/HLA-Cw6
  • Environment (skin/trauma/stress)
  • Improves in sunlight
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6
Q

What are the clinical features of psoriasis?

A

-Red/scaly patches on skin
- Pitting/onycholysis
- Arthritis

  • Plaque psoriasis = most common = well-demarcated red scaly patches affecting extensor surfaces/sacrum/scalp
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7
Q

What are the subtypes of psoriasis?

A
  • Plaque psoriasis (most common - typical presentation)
  • Flexural psoriasis (skin is smooth)
  • Guttate psoriasis (transient rash triggered by strep infection –> teardrop lesions)
  • Pustular psoriasis (palms/soles)
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8
Q

What are exacerbating factors for psoriasis?

A
  • Trauma
  • Alcohol
  • Drugs (beta blockers/lithium/antimalarials/NSAIDs/ACEis/infliximab)
  • Withdrawal of systemic steroids
  • Strep infection (may trigger guttate psoriasis)
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9
Q

What is the management for psoriasis?

A
  • Regular emollients
  • Potent corticosteroid + vitamin D analogue
  • Coal tar preparation
  • Short acting dithranol
  • Phototherapy
  • Systemic therapy e.g. methotrexate
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10
Q

What are complications of psoriasis?

A
  • Psoriatic arthropathy
  • Increased risk of metabolic syndrome
  • Increased risk of CVD/VTE
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11
Q

What is Koebner phenomenon?

A

Psoriasis develops in areas of trauma or friction

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12
Q

What is intertrigo?

A

Rash in flexures e.g. behind ears/folds of neck/under arms/finger webs due to skin-to-skin friction intensified by heat and moisture

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13
Q

What are risk factors for intertrigo?

A
  • Obesity
  • Hyperhidrosis
  • Age
  • Diabetes
  • Smoking
  • Alcohol
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14
Q

What are the clinical features of intertrigo?

A
  • Inflamed/reddened/uncomfortable skin
  • Moist/macerated skin leading to fissuring and peeling
  • Foul odour (if secondary bacterial infection e.g. pseudomonas)
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15
Q

What are some infections that can cause intertrigo?

A
  • Thrush (candida albicans)
  • Tinea cruris/athlete’s foot
  • Impetigo (staph aureus/strep pyogenes)
  • Boils (staph aureus)
  • Folliculitis (staph aureus)
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16
Q

What are the investigations for intertrigo?

A
  • Swab for culture/microscopy (bacterial/fungal)
  • Skin biopsy for histopathology
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17
Q

What is the management for intertrigo?

A
  • Treat underlying cause
  • Zinc oxide paste
  • Physical exertion followed by bathing/completely drying skin flexures
  • Antiperspirant cream/powder
  • Topical abx/antifungals
  • Low potency steroid creams
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18
Q

What is tinea and give some examples?

A

Dermatophyte fungal infections
- Tinea capitis - scalp (scalp ringworm)
- Tinea corporis - trunk/legs/arms (ringworm)
- Tinea pedis - feet (athlete’s foot)
- Tinea cruris - groin

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19
Q

What are the features of tinea?

A
  • Scarring alopecia (tinea capitis)
  • Well-defined erythematous lesions with pustules/papules
  • Itchy/peeling skin
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20
Q

What is the management for tinea?

A
  • Anti-fungal creams (clotrimazole)
  • Anti-fungal shampoos (ketoconazole)
  • Anti-fungal oral medications (fluconazole)
  • Topical steroid
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21
Q

What is pityriasis versicolor and what causes it?

A
  • Common yeast infection of the skin
  • Yeast = malassezia
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22
Q

Describe the epidemiology of pityriasis versicolor

A
  • More common in men
  • More common in hot/humid climates (people that perspire heavily)
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23
Q

What are the clinical features of pityriasis versicolor?

A
  • Flaky discoloured patches on the trunk/neck/arms
  • Usually asx but may be itchy
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24
Q

What is the management for pityriasis versicolor?

A
  • Topical antifungals (selenium sulfide shampoo; topical econazole/ketoconazole cream/shampoo; terbinafine gel)
  • Oral antifungals (itraconazole/fluconazole)
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25
What are some inducible features of urticaria?
- Cold urticaria - Cholinergic urticaria - Contact urticaria - Sun urticaria - Heat urticaria
26
What is the management for urticaria?
- Non-sedating antihistamine e.g. cetirizine/loratadine - Sedating antihistamine e.g. chlorphenamine - Prednisolone (severe/resistant episodes) - Avoidance of trigger factors
27
What is the cause of chickenpox and how is it spread?
- Varicella zoster virus - Shingles = reactivation of dormant virus in dorsal root ganglion - Respiratory droplets
28
What are the clinical features of chickenpox?
- Fever initially - Itchy rash that starts on head/trunk = macular --> papular --> vesicular
29
What is the management for chickenpox?
- Calamine lotion - School exclusion until all lesions are dry and have crusted over - Varicella zoster immunoglobulin (VZIG) if immunocompromised/newborns
30
What are complications of chickenpox?
- Secondary bacterial infection (cellulitis/group A strep/necrotising fasciitis) --> DO NOT GIVE NSAIDS - Pneumonia - Encephalitis
31
Describe the typical features of measles
- Fever - Coryzal sx - Conjunctivitis - Koplik spots (blue/white spots in cheek) - Rash starts behind ears and spreads
32
What is the management for measles?
- Supportive - Consider admission in immunosuppressed/pregnant patients - Notify public health - MMR vaccine (1 year and 3 years)
33
What are the complications of measles?
- Otitis media - Pneumonia - Encephalitis - Febrile convulsions
34
What is molluscum contagiosum and who is it most common in?
- Skin infection caused by molluscum contagiosum virus (MCV) - Children (often with atopic eczema) around 1-4 years
35
What are the clinical features of molluscum contagiosum?
- Pink/white papules with central umbilication/dimple - Lesions appear in clusters on the body (NOT palms/soles)
36
What is the management for molluscum contagiosum?
- Self-limiting - Spontaneous resolution within 18 months - Avoid sharing towels/clothing/baths as lesions are contagious - Don't scratch Treatment (not usually recommended - only if troublesome): - Squeezing/piercing lesions following a bath - Cryotherapy - Topical corticosteroid/abx if eczema/inflammation around lesions
37
What are the features of herpes simplex virus?
- Gingivostomatitis (blisters on lips/canker sores in mouth) - Cold sores - Painful genital ulceration
38
What is the management for herpes simplex virus?
- Oral/topical aciclovir - Chlorhexidine mouthwash
39
What is the guidance for pregnant patients with herpes simplex virus?
- Elective c-section at term if primary attack occurs >28 weeks - Recurrent herpes = suppressive therapy to reduce risk of transmission
40
What is shingles?
Herpes zoster infection caused by reactivation of varicella zoster virus - virus lies dormant following primary infection (chickenpox) in dorsal root/cranial nerve ganglia
41
What are the risk factors for shingles?
- Increasing age - HIV - Immunosuppression
42
What are the clinical features of shingles?
- T1-L2 dermatomes most affected - Prodromal period = burning pain/fever/headache/lethargy - Erythematous, macular rash --> becomes vesicular
43
What is the management for shingles?
- Analgesia - Infectious until vesicles have crusted over - Antivirals within 72 hours (aciclovir/famciclovir/valaciclovir)
44
What are the complications of shingles?
- Post-herpetic neuralgia (most common) - Herpes zoster ophthalmicus - Herpes zoster oticus (Ramsay Hunt syndrome)
45
What are the clinical features of pityriasis rosea?
- May have recent viral infection sx - Herald patch (usually on trunk) - Erythematous, oval, scaly patches (fir tree appearance)
46
What is the management for pityriasis rosea?
Self-limiting = usually disappears after 6-12 weeks
47
What is impetigo and what is it caused by?
- Superficial bacterial skin infection - Usually staph aureus or strep pyogenes - Common in children (especially in warm weather)
48
What are the clinical features of impetigo?
- Golden, crusted skin lesions typically found around mouth/face/flexures/limbs - Very contagious
49
What is the management for impetigo?
- Hydrogen peroxide 1% cream (first line) - Exclusion from school until lesions are crusted/healed or 48 hours after commencing abx treatment - Topical abx = fusidic acid/mupirocin - Extensive disease = oral flucloxacillin/erythromycin
50
What is cellulitis and what is it caused by?
- Bacterial infection affecting dermis and deeper subcutaneous tissues - Strep pyogenes (most common) or staph aureus
51
What are the clinical features of cellulitis?
- Unilateral - Usually on shins - Erythema - Blisters/bullae (more severe) - Swelling - Systemic sx = fever/malaise/nausea
52
What criteria is used for cellulitis?
Eron classification: - Class I = no signs of systemic toxicity - Class II = systemically unwell or has a comorbidity which may complicate/delay resolution of infection - Class III = significant systemic upset e.g. acute confusion/tachycardia/tachypnoea/etc. that may interfere with response to treatment - Class IV = sepsis syndrome/severe life threatening infection e.g. necrotising fasciitis
53
What is the management for mild/moderate cellulitis?
Oral abx = flucloxacillin (first line)/clarithromycin/erythromycin (pregnancy)/doxycycline
54
What is the admissions criteria for cellulitis?
- Eron class III or IV - Severe/rapidly deteriorating cellulitis - <1 year or frail - Immunocompromised - Has significant lymphoedema - Has facial cellulitis/periorbital cellulitis
55
What is the management for severe cellulitis?
- Admit - Oral/IV co-amoxiclav/clindamycin/cefuroxime/ceftriaxone
56
What are the clinical features of acne rosacea?
- Typically affects nose/cheeks/foreheads - Flushing - Telangiectasia --> persistent erythema with papules/pustules - Rhinophyma - Blepharitis - Exacerbated by sunlight
57
What is the management for acne rosacea?
- High factor suncream - Topical brimonidine (flushing - alpha-adrenergic agonist) - Topical ivermectin/metronidazole/azelaic acid (mild-moderate papules/pustules) - Topical ivermectin + oral doxycycline (moderate-severe papules/pustules)
58
Describe the pathophysiology of acne vulgaris
Chronic inflammation/blockage of pilosebaceous units, increased sebum production and trapping of keratin
59
What are the clinical features of acne vulgaris?
- Comedones (whitehead/blackhead) - Papules/pustules - Nodules/cysts - Ice-pick scars/hypertrophic scars
60
What is the management for mild to moderate acne vulgaris?
- Topical benzoyl peroxide - Topical retinoid (adapalene/tretinoin) - Topical abx (clindamycin)
61
What is the management for moderate to severe acne vulgaris?
- Topical benzoyl peroxide - Topical retinoid (adapalene/tretinoin) - Topical abx (clindamycin) - Oral abx (lymecycline/doxycycline) - Topical azelaic acid - COCP (co-cyprindiol - Dianette) - Oral retinoid (isotretinoin = roaccutane) - specialists only
62
What are the side effects of roaccutane (isotretinoin)?
- Highly teratogenic - Dry skin/lips - Photosensitivity of skin - Depression/anxiety/aggression/suicidal ideation - Stevens-Johnson syndrome and toxic epidermal necrolysis
63
What are head lice caused by?
Parasitic insect - Pediculus capitis
64
What are the clinical features of head lice?
Itching/scratching on scalp 2-3 weeks after infection
65
What is the management for head lice?
- Malathion - Wet combing - Dimeticone - Isopropyl myristate - Cyclomethicone
66
What is scabies caused by?
Sarcoptes scabiei
67
What are the clinical features of scabies?
- Widespread pruritus - Linear burrows on side of fingers/interdigital webs/flexor aspects of wrist/face/scalp - Excoriation/infection (due to scratching)
68
What is the management for scabies?
- Permethrin 5% (first line) - Malathion 0.5% - Treat all household/close physical contacts even if asx - Avoid close physical contact with others until treatment complete
69
What is crusted scabies?
- a.k.a Norwegian scabies - Seen in patients with suppressed immunity (especially HIV) - Management = ivermectin + isolation
70
What is exanthem?
Widespread rash usually accompanied by systemic sx e.g. fever/malaise/headache usually caused by a virus
71
What are common causes of exanthems?
Viral infections: - Chickenpox (varicella) - Measles (morbillivirus) - Rubella (rubella virus) - Roseola herpes virus 6B - Erythema infectiosum (parvovirus B19)
72
What is the management for exanthems?
- Supportive management - Paracetamol - Emollients
73
What chronic conditions may cause pruritus?
- Liver disease - Renal disease - Anaemia - Diabetes - Hyper/hypothyroidism - Cancer
74
What are the most common types of malignant melanoma?
- Superficial spreading (most common) - Nodular (most aggressive) - Lentigo maligna - Acral lentiginous
75
What are the risk factors for melanomas?
- Immunosuppression - Numerous moles - Family history - Exposure/overexposure to UV light
76
What are the classic appearances of melanomas?
ABCDE: - Asymmetry - Border irregularities - Colour variation - Diameter >7mm - Enlargement Nodule = EFG - Elevated - Firm to touch - Growing
77
What are the clinical features of melanomas?
- New/changed skin lesion (colour/shape/size/ulcerations/pruritus/bleeding) - Nausea/vomiting/loss of appetitie/fatigue
78
What is the investigation and management for malignant melanomas?
Investigation = sentinel node biopsy Management = excision biopsy
79
What are the complications of melanomas?
Metastasis to lymph nodes/skin/subcutaneous tissue/lungs/liver/brain
80
What is the most common type of skin cancer?
Basal cell carcinoma
81
What are the main causes of basal cell carcinoma?
- UV radiation - Gorlin syndrome (mutation of PTCH1 gene)
82
What are the most common types of basal cell carcninoma?
- Nodular (most common) - Infiltrative - Micronodular - Morpheaform - Superficial
83
What are the classic appearances of basal cell carcinomas?
- Nodular = white circular cystic pigmented nodule - White/yellow lesion - May be waxy - Erythematous plaque
84
What are the clinical features of basal cell carcinomas?
- Sun-exposed areas e.g. face/neck/scalp - Newly discovered lesion - Doesn't heal within 4 weeks - Dimpled at midpoint - Grows slowly - May bleed - Painless/may itch - Telangiectasia - Ulcerated
85
What is the investigation for basal cell carcinomas?
Biopsy and histology = basal cells form clusters (islands) with peripheral palisading nuclei
86
What is the management for basal cell carcinomas?
- Topical 5-fluorouracil/imiquimod - Srugical excision - Curettage - Cryotherapy - Radiotherapy RARELY METASTASISES
87
What are the risk factors for squamous cell carcinomas?
- Overexposure to UV light - Actinic keratoses/Bowen's disease - Immunosuppression - Smoking - Long-standing leg ulcers
88
What are the clinical features of squamous cell carcinomas?
- Sun exposed sites e.g. head/neck/arms - Rapidly expanding, painless, ulcerate nodules - May have cauliflower-like appearance - Bleeding
89
What are the investigations for squamous cell carcinomas?
- Biopsy - CT - MRI
90
What is the management for squamous cell carcinomas?
- Surgical excision - Topical immunomodulators (e.g. tacrolimus) - Chemotherapy/radiotherapy
91
What are the complications of squamous cell carcinomas?
Metastasis
92
What are the risk factors for venous ulcers?
Most common type of leg ulcer - Previous DVT - Reduced mobility e.g. OA/leg injury/obesity/paralysis - Varicose veins - Leg surgery
93
What are the clinical features of venous ulcers?
- Typically seen above medial malleolus - Pain/itching/swelling in affected leg - Discoloured/hardened skin around ulcer - Offensive discharge
94
What is the investigation for venous ulcers?
ABPI in non-healing ulcers: - Assess for poor arterial flow which could impair healing - Normal = 0.9-1.2
95
What is the management for venous ulcers?
- Compression bandaging (4 layer) - Oral pentoxifylline (peripheral vasodilator) - Abx if infected
96
What is a port-wine stain?
- Capillary malformation seen at birth - Flat and dark red/purple - Usually requires no treatment
97
What is the most common type of contact dermatitis?
Irritant contact dermatitis - non-allergic reaction due to weak acids/alkalis e.g. detergents
98
What is the most common cause of cutaneous warts?
Viral - HPV
99
What are common causes of folliculitis?
- Infection e.g. staph aureus/candida albicans/herpes zoster - Occlusions e.g. paraffin-based ointments - Irritation - Skin diseases - Overuse of topical steroids
100

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