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YR6 Rotations > Medicine - Dermatology > Flashcards

Medicine - Dermatology Flashcards

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1
Q

How can you differentiate between SJS and TEN?

A 
SJS = up to 10% skin involvement
TEN = \>30% skin involvement
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2
Q

What is Nikolsky’s sign?

A

Epidermis separates with mild lateral pressure - secondary to adverse drug reaction

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3
Q

How should SJS or TEN be managed?

A

Stop the cause
Transfer to ITU
IV Ig
Immunosuppression (eg ciclosporin and cyclophosphamide)

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4
Q

Which drugs are most likely to cause SJS?

A

Never Press Skin As It Can Peel
NSAIDs
Phenytoin
Sulphonamides
Allopurinol
IV Ig
Carbemazapine
Penicillins

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5
Q

What is erythroderma?

A

Any rash involving >95% of the body

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6
Q

Recall 3 possible complications of erythroderma

A

Dehydration
High output heart failure
Infection

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7
Q

What is the cause of adult seborrhoeic dermatitis?

A

Fungus called malassezia furfur

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8
Q

What 2 skin conditions can be caused by malassezia furfur?

A

Seborrhoeic dermatitis
Pityriasis versicolor

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9
Q

What are the 1st and 2nd line options for treating scalp seborrhoeic dermatitis?

A

1st line = zinc pyrithione (‘head and shoulders’)
2nd line = ketoconazole

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10
Q

Which pathogen is the most common cause of impetigo?

A

Staphylococcus aureus

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11
Q

What are the 3 classes of impetigo and their respective management?

A

Localised, non-bullous: topical H2O2 1% cream / topical fusidic acid

Widespread, non-bullous: oral flucloxacillin or topical fusidic acid

Widespread, bullous: oral flucloxacillin

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12
Q

How long should children with impetigo be excluded from school?

A

Until lesions crusted over or 48 hours after antibiotics started

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13
Q

Describe the pathophysiology of acne

A

Obstruction of pilosebaceous follicle with keratin plugs which result in comedones, inflammation + pustules

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14
Q

Epidemiology of acne

A

Affects 80-90% Teenagers

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15
Q

What are the lay terms for open and closed comedones?

A

Open = blackheads
Closed = whiteheads

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16
Q

5 features of acne

A

Comedones
Inflammatory lesions: papules + pustules / nodules + cysts
Scarring
Pigmentation
Seborrhoea (oily skin)

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17
Q

What to enquire about in acne history? (8)

A

Duration, type + distribution
Previous Tx
Exacerbating factors: menstruation, cosmetics
Systemic features: fever, myalgia
Psychological impact
FH: acne, PCOS
DH: steroids, lithium
Hyperandrogenism: irregular periods, hirsutism

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18
Q

Recall 3 conservative recommendations for acne

A

Avoid over-cleaning face: BD with gentle soap is okay
Avoid oil-based cosmetics
Avoid picking + squeezing (scarring)

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19
Q

How long should each acne medication be tried for to give it chance to work?

A

8 weeks

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20
Q

Describe treatment for mild to moderate acne

A

12w course topical combination therapy
Adapalene + Benzoyl peroxide TOP
or
Tretinoin + Clindamycin TOP
or
Benzoyl peroxide + Clindamycin TOP
or
Benzoyl peroxide TOP monotherapy

Adapalene + Tretinoin = Retinoids

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21
Q

Describe treatment for moderate- severe acne

A

12w course:
Adapalene + Benzoyl peroxide TOP
or
Tretinoin + Clindamycin TOP
or
Adapalene + Benzoyl peroxide TOP + Lymecycline/ Doxycycline PO
or
Azelaic acid TOP + Lymecycline/ Doxycycline PO

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22
Q

In which patients should tetracyclines be avoided? What can be used instead?

A

Pregnant, breastfeeding + <12y

Erythromycin

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23
Q

What should always be prescribed with antibiotics (TOP + PO) for acne? Why?

A

Retinoid or Benzoyl peroxide TOP to reduce risk of abx resistance developing

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24
Q

Give an alternative to oral antibiotics for acne in females. How should these be used?

A

COCP
Used in combination with TOP agents

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25
What form of acne requires urgent same day referral to the on-call dermatologists? What is this? Give 3 signs of this
Acne fulminans Sudden severe inflammatory reaction that precipitates deep ulceration + erosions Fever Arthralgia Myalgia
26
5 indications for referral for acne
Mild-mod not responded to 2 completed courses Mod-severe not responded to Tx inc. an Abx Scarring Persistent pigmentation Acne contributing to psychological distress/ MH disorder
27
What can be prescribed by specialists for acne?
Isotretinoin (PO) (aka roaccutane = synthetic vitamin A)
28
Once acne has cleared, how should this be maintained?
Topical retonoids and azelaic acid
29
What pregnancy prevention plan should be in place for Roaccutane?
1 highly effective e.g. IUD/ Implant or 2 user dependent forms e.g. OCP + Condoms
30
Recall 7 side effects of Roaccutane
Dry skin, eyes, lips, mouth Teratogenicity Low mood Raised triglycerides Hair-thinning Intracranial HTN Photosensitivity
31
What is the progression of symptoms of rosacea?
``` 1st = flushing 2nd = symmetrical facial rash with telangiectasia 3rd = persistent pustulopapular erythema ```
32
How should rosacea be managed?
``` Mild-moderate = topical metronidazole Severe = oral tetracycline ```
33
What is the aetiology of hidradenitis supparativa?
Chronic inflammatory occlusion of folliculopilosebaceous units that obstructs the apocrine glands and prevents keratinocytes from properly shedding the follicular epithelium
34
In lay terms, what is hidradenitis supparativa?
Abscesses that form near hair follicles in places where we tend to sweat more
35
What are the 2 biggest risk factors for hidradenitis supparativa?
Smoking and obesity
36
Rarely, what inflammatory disease is associated with hidradenitis supparativa?
Crohn's
37
How can hidradenitis supparativa be managed?
Conservative: weight loss, stop smoking, hygeine Acutely: steroids PO, flucloxacillin, I&D Chronically: topical clindamycin
38
What pathogen causes pityriasis versicolor?
Malassezia furfur
39
How does pityriasis versicolor appear?
Hypopigmented patches on trunk Mild pruritis
40
How is pityriasis versicolor managed?
Topical ketoconazole
41
How does vitiligo appear?
Well demarctaed, depigmented skin patches usually affecting the peripheries
42
Recall some associations of vitiligo (don't need to know in detail)
T1DM, Addison's, autoimmune thyroid, pernicious anaemia, alopecia areata
43
How can vitiligo be managed?
``` Sunblock Topical corticosteroids (reverses changes if applied early) ```
44
What pathogen causes pityriasis rosea?
HHV-7
45
Describe the presentation of pityriasis rosea
Recent viral infection --\> herald patch Then erythematous, oval scaly patches
46
How should pityriasis rosea be managed?
It is self-limiting (6-12w) so no need
47
Broadly describe the 4 types of psoriasis
Plaque - most common, is well-demarcated red and scaly - affects scalp, back, extensors Guttate - following a strep infection, "tear drop" lesions Pustular - affects palms and soles Flexural - skin is smooth
48
Recall some factors that exacerbate psoriasis
Trauma EtOH Certain drugs
49
Which drugs can exacerbate psoriasis?
INFLAME Infliximab NSAIDs For HTN (beta blockers) Lithium ACE inhibitors Malarial drugs EtOH
50
How should chronic plaque psoriasis be managed in primary care? (give 1st, 2nd and 3rd line)
1st line: 4w trial of OM potent corticosteroid and ON vitamin D analogue 2nd line: after 8w (so 4w break): OM potent corticosteroid and BD vitamin D analogue 3rd line: 4w trial of BD potent corticosteroid OR coal tar Use emollients as an adjunct
51
What is the maximum duration of use of topical potent and very potent steroids before a break is needed?
Potent = 8w Very potent = 4w
52
How can chronic plaque psoriasis be managed in secondary care?
``` Phototherapy/photochemotherapy Systemic immunosuppression (eg infliximab, etanercept, ustekinumab) ```
53
Describe the distribution of eczema in infants vs children vs young adults
Infants: face and trunk Child: extensors Young adult: flexures
54
Describe the different severities of eczema in terms of physical symptoms
Mild: infrequent itching, some areas of dry skin and a little redness Moderate: frequent itching, lots of redness and some excoriation Severe: widespread dryness, incessant itching, redness, excoriation, thickening, cracking, alteration of pigmentation
55
How should eczema be investigated?
Consider food allergy and contact dermatitis Skin prick tests Patch tests
56
How long should flares of eczema be treated for?
Treat ASAP and for 48 hours after resolution of symptoms
57
Recall the management of mild, moderate and severe eczema
Mild: emollients, mild potency topical corticosteroids Moderate: emollients, moderate potency topical corticosteroids, topical calcineurin inhibitors and bandages Severe: emollients, potent topical corticosteroids, topical calcineurin inhibitors, bandages and phototherapy
58
How should infected eczema (not herpeticum) be managed?
Skin swab and culture Flucloxacillin PO
59
How should eczema herpeticum be managed?
Oral aciclovir If around eyes, same day referral to ophthalmologist Looks similar to impetigo so ALSO treat for that with oral aciclovir
60
How should topical emollients and steroids be applied
Emollients applied liberally Wait 30 mins then apply steroids
61
Recall 2 examples of topical calcineurin inhibitors that can be used to manage eczema
Mild-moderate - pimecrolimus Moderate - severe - tacrolimus
62
Recall some points for PACES counselling for eczema
Explain diagosis (dry, itchy skin) Explain epidemiology (very common, many grow out of it) Explain management Encourage frequent, liberal use of emollients and use of emollients as a soap substitute Advise avoidance of triggers Avoid scratching if poss (eg mittens for infants) Safety ned about signs of infection Info: itchysneezywheezy.co.uk shows how to apply emollients
63
What type of pathogen causes tinea?
Dermatophyte fungi
64
What pathogen causes tinea?
Trichophytum rubrum
65
How should scabies be managed?
Permethrin - full body treatment that you wash off after 8-12 hours - treat all household/close contacts
66
How should headlice be managed?
Malathion
67
How should tinea be managed?
Mild --\> topical antifungals (terbinafine) Mod--\> hydrocortisone 1% Severe--\> oral antifungals (eg terbinafine) If tinea capitis --\> oral antifungal
68
How long should children with tinea be excluded from school?
No need
69
Recall 2 risk factors for shingles
Increasing age Immunosuppression
70
Describe the symptoms of shingles
Prodromal burning pain over the affected dermatome for 2-3 days +/- fever, headache, lethargy Rash begins erythematous, macular --\> vesicular
71
For how long is shingles infectious?
Until vesicles have crusted over (about 5-7 days)
72
How should shingles be managed?
PO aciclovir if \<72 hours from symptom onset and \>50y/in lots of pain/ immunocompromised Analgesia: paracetamol/ NSAIDs --\>amitriptyline Emergency referral if serious complications suspected
73
Recall 3 possible complications of shingles
Post-herpetic neuralgia Herpes zoster ophthalmicus (affects ocular division of CNV) Herpes zoster oticus (Ramsay Hunt syndrome)
74
What are the 2 pre-malignant conditions for squamous cell carcinoma known as?
Actinic keratoses and keratocanthomas
75
Where do actinic keratoses appear?
sun-exposed areas
76
How can actinic keratoses be managed medically?
Fluorouracil + topical hydrocortisone Topical diclofenac/imiquimod
77
What are some surgical options for managing actinic keratoses?
Cryotherapy Curettage and cautery
78
What is a keratocanthoma?
Pre-malignant skin condition (for SCC) with rapid growth (around 1 week)
79
How should keratocanthomas be managed?
Excision
80
What is the causative organism in fungal nail infections 90% of the time?
Trichophytum rubrum (dermatophyte)
81
How can fungal nail infections be investigated?
Nail clipping MC&S
82
How should fungal nail infections be managed?
Must first confirm infection by MC&S in order to commence treatment - Can do nothing (if pt not bothered) - Can do PO terbinafine (2nd line itraconazole) - finger = 6w-3m - toe = 3-6m - If candida infection --\> topical antifungals
83
How does lichen planus appear?
Rash is: Purple Pruritic Papular Polyglonal Also can get thin, white lines in the mouth
84
Where does lichen planus tend to affect?
Flexor surfaces
85
Recall some causes of lichen planus
Gold Thiazides Quinine
86
How should lichen planus be managed?
Topical steroids
87
How does lichen sclerosus appear?
Itchy white spots typically on the vulva of elderly womenn
88
How should lichen sclerosus be managed?
1st: clobetasol proprionate ointment 2nd: tacrolimus and biopsy
89
Which 2 pathogens are most likely to cause cellulitis?
Strep pyogenes Staph aureus
90
What classification system is used for cellulitis?
Eron classification
91
How should cellulitis be managed?
Mild/mod: flucloxacillin Severe: co-amox
92
Describe the 4 severities of cellulitis under the Eron classification
I - no signs of systemic toxicity, person has no uncontrolled comorbidities II - systemically unwell OR systemically well with an uncontrolled comorbidity III - significant systemic upset such as acute confusion, tachycardia/tachypnoea, hypotension, unstable comorbidity IV - sepsis/ necrotising fasciitis
93
What is the cause of erysipelas?
Strep pyogenes
94
How should erysipelas be managed?
PO flucloxacillin
95
What is the cause of erythrasma?
corynebacterium minitissimu
96
How can erythrasma be investigated?
Wood's slit lamp --\> coral-red fluorescence
97
How should erythrasma be managed
Topical miconazole
98
Recall some causes of pyoderma gangrenosum
IBD Connective tissue disorders Myeloproliferative disorders
99
Describe the classical natural history of pyoderma gangrenosum
Small red papule --\> later deep, red, necrotic ulcers with a violaceous border
100
How should pyoderma gangrenosum be managed?
PO steroids
101
In what patient population is necrobiosus lipoidica diabeticorum seen and how does it appear?
Diabetics Shiny, painless area of yellow/red skin on shins
102
What are antibodies directed against in bullous pemphigoid?
Basement membrane (dermo-epidermal junction)
103
How can bullous pemphigoid be managed?
Oral corticosteroids
104
How can bullous pemphigoid and pemphigus vulgaris be differentiated?
Bullous pemphigoid = tense blisters with no oral involvement Pemphigus vulgaris = flaccid blisters with oral involvement
105
What are antibodies directed against in pemphigus vulgaris?
Desmosomes
106
What is this? (Source: Derm Net NZ)
Guttate psoriasis
107
What is this? (source: Derm Net NZ)
Pityriasis versicolor
108
What is this? (source: Derm net NZ)
Impetigo
109
What is this? (source NHS)
Hidradenitis supparativa
110
What is this? (source: Derm Net NZ)
Vitiligo
111
What is this? (source: Derm Net NZ)
Pityriasis rosea
112
What is this? (source: NHS)
Plaque psoriasis
113
What is this?
Guttate psoriasis
114
What is this? (Source: Derm Net NZ)
Pustular psoriasis
115
What is this? (Source: Derm Net NZ)
Flexural psoriasis
116
What is this? (Source: Derm Net NZ)
Tinea corporis
117
What is this? (Source: Derm Net NZ)
Scabies
118
What is this? (Source: Derm Net NZ)
Actinic keratosis
119
What is this? (Source: Derm Net NZ)
Keratocanthoma
120
What is this? (Source: Derm Net NZ)
Lichen planus
121
What is this? (Source: Derm Net NZ)
Erysipelas
122
What is this? (Source: Derm Net NZ)
Erysipelas
123
What is the recommended margin for excision of a malignant melanoma?
When the breslow thickness is known = 2mm
124
Recall 3 causes of Koebner's phenomena
Vitiligo Psoriasis Lichen planus
125
Which type of skin lesion commonly appears in response to traume eg an insect bite?
Dermatofibroma

YR6 Rotations (22 decks)

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