Other Dermatology Flashcards

(87 cards)

1
Q

Where can tinea rashes appear?

A

Capitis - scalp
Corporis - trunk, legs and arms
Pedis - feet

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2
Q

What organism causes tinea wapitis?

A

Trichophyton tonsurans

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3
Q

What organism causes tinea corporals?

A

Trichophyton rubrum

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4
Q

How does tinea capitis present?

A

Kerion forms if untreated:

- raised, pustular spongy mass

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5
Q

How does tinea corporis appear?

A

Well-defined annular erythematous lesions with pustules and papules

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6
Q

How does tinea pedis present?

A

Itchy peeling skin between toes

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7
Q

How is tinea capitis managed?

A

Oral antifungals - terbinafine

Topical ketoconazole shampoo

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8
Q

How is tinea corporis and pedis managed?

A

Topical terbinafine or imidazole

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9
Q

What complications are associated with tinea infections?

A

Secondary infections - impetigo and cellulitis

Hair loss in tinea capitis

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10
Q

Where can candidal infections appear?

A

Oral

Oesophageal

Skin

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11
Q

How does oral candida present?

A

Curd like white patches on tongue

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12
Q

What is oral candida associated with?

A

Smoking
Steroid inhaler
Dentures
Oral Abx use

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13
Q

How is oral candida managed?

A

Topical miconazole

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14
Q

How does oesophageal candida present?

A

Dysphagia

Retrosternal pain

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15
Q

What is oesophageal candida associated with?

A

Haematological malignancy

HIV

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16
Q

How is oesophageal candida managed?

A

Refer to secondary care - oral abx or IV fluconazole

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17
Q

How do skin candidal infections present?

A

Soreness and itching
Red moist skin area with ragged edges
Yellow white scale on surface

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18
Q

What is associated with candidal skin infections?

A

Obesity

Moist skin

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19
Q

How are candidal skin infections managed?

A

Topical Imidazole cream

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20
Q

What are the presentations of oral herpes simplex (HSV1)?

A
Cold sore (90% HSV1)
Gingivo stomatitis
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21
Q

Give examples of some imidazole antifungals

A

Clotrimazole
Ketoconazole
Miconazole

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22
Q

How do cold sores present?

A

Fever and Malaise prodrome
Itching/tingling precede lesion
Crusts of vesicles and rupture and crust over - on lips

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23
Q

How long do cold sores last?

A

10-14 days

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24
Q

How does gingivostomatitis present?

A

Fever and malaise prodrome
Sore mouth and throat

Crops of painful vesicles on an erythematous base that ruptures and ulcerates

Affect oral and pharyngeal mucosa

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25
What usually happens to herpes simplex following primary infection?
Sit dormant in trigeminal nerve ganglion
26
When is herpes simplex at its most contagious?
Time of vesicle rupture to point of scabbing over
27
How is herpes simplex managed?
Supportive - NSAID's and paracetamol Topical aciclovir - over the counter Advice
28
What advice is given regarding a herpes simplex infection?
No kissing Don't touch vesicles Avoid sharing lipstick Careful with contact lenses
29
What complications are associated with herpes simplex?
Dehydration - reduced oral intake Lip adhesions Herpetic Whitlow - common in thumb suckers Eye complications - herpetic keratitis
30
What is herpetic whitlow?
Painful blisters on fingers or thumb
31
What causes chicken pox?
Varicella zoster
32
How is chicken pox spread?
Direct contact Droplets - resp route Can be caught from someone with shingles
33
When is chicken pox infective?
4 days before rash 5 days after rash first appear or once vesicles have crusted
34
What is the incubation period for chicken pox?
10-21 days
35
What happens to varicella zoster following a chicken pox infection?
Persist in sensory nerve root ganglion Can be reactivated to cause shingles
36
How does chicken pox present?
Prodrome of nausea, myalgia and anorexia General malaise Initial fever - 38/39 degrees for upto 4 days Itchy rash - begin on head, trunk and proximal limb Macular --> papular --> vesicular --> crust
37
How is chicken pox managed?
Paracetamol - fever Calamine lotion or chlorphenamine - itch Advice - trim nails, stay hydrated and cool cotton clothes Exclude from school for 5 days since rash onset
38
What complications are associated with chicken pox?
Bacterial superinfection Neurological complications - Reyes Complications more common in adults - pneumonia and encephalitis
39
What risks to the mother are associated with chicken pox in pregnancy?
Pneumonia and other complications
40
What risks to the fetus are associated with chicken pox in pregnancy?
<28wks - fetal varicella syndome 1-4 wks before delivery - Varicella of newborn Rash 7 days before/after birth - Severe infection, can be fatal
41
How does fetal varicella syndrome present?
Skin scarring in dermatomal fashion Eye complications - cataracts Limb hypoplasia Learning difficulties
42
How is chicken pox in pregnancy managed?
If any doubt - check maternal blood for varicella antibodies Maternal VZIG (varicella zoster immunoglobulin) Oral aciclovir if presents within 24 hrs of rash
43
What is a wart?
Small rough growth caused by an infection of keratinocytes by certain strains of HPV A verruca is a wart on the sole of the foot
44
What are the types of wart?
Common Plane Filiform Plantar (verucca)
45
How do common warts appear?
Firm, rough, raised Cauliflower looking Knuckles, knees and fingers
46
How do plane warts appear?
Round, flat topped, yellow Back of hands
47
How do filiform warts appear?
Long and slender Face and neck
48
How do plantar warts appear?
Central dark dots Painful Palms and soles of feet
49
How are warts managed?
Cryotherapy or salicylic acid if requested by patient - painful/unsightly
50
What causes molluscum contagiousum?
MCV virus - molluscum contagiousum virus
51
How does molluscum contagiousum present?
``` Symptomless lesions Develop over few weeks Dome shaped, flesh coloured papules with central umbilication 3-5mm Seen in clusters Don't affect palms or soles ```
52
How is molluscum contagiousum managed?
Spontaneously resolve - usually take 18 months Avoid squeezing and scratching No school/swimming exclusion Itching - emollient and hydrocortisone Infected - fusidic acid
53
What is erythema nodosum?
Inflammation of subcutaneous fat
54
What are some causes of erythema nodosum?
``` NO - idiopathic D - drugs - penicillin/sulphonamides O - oral contraceptive/pregnancy S - Sarcoidosis/TB U - UC/Crohns/Behcet's disease M - microbiology - streptococcus, mycoplasma, EBV ```
55
How does erythema nodosum present?
Tender, erythematous nodular lesions Occur over shins but can occur elsewhere Lesions heal without scarring
56
How is Erythema nodosum managed?
Supportive management Usually resolve within 6 weeks
57
How do actinic keratoses present?
Small crusty/scaly lesions on sun exposed areas - e.g. temples of head Pink/red/brown Multiple lesions may be present
58
How are actinic keratosis managed?
Prevent further risk - sun avoidance/sun cream Fluorouracil cream - 2-3 week course Topical diclofenac - mild cases Topical imiquimod Cryotherapy Curettage and cautery
59
What issues can fluorouracil cream cause in management of actinic keratosis?
Skin may become red and inflamed Manage with hydrocortisone
60
What is Bowens disease?
Type of intraepidermal squamous cell carcinoma More common in elderly females 3% chance of developing invasive skin cancer
61
How does Bowen's disease present?
Red scaly patches Sun exposed areas - lower limbs
62
How is Bowen's disease managed?
topical 5-FU cream Imiquimod Cryotherapy and Excision Must be referred
63
Where do pressure sores typically develop?
Over bony prominences - sacrum or heel
64
What are some predisposing factors to pressure sores?
Malnourishment Incontinence Lack of mobility Pain - reduced mobility
65
How are pressure sores scored?
Grade 1 - 4
66
How would you screen for patients at risk of developing pressure sores?
Waterlow score Includes factors such as BMI, nutritional status, skin type, mobility and continence
67
How would a grade 1 pressure sore appear?
Non blanch able erythema of intact skin Skin discoloured Warmth, oedema, induration or hardness may be seen
68
How would a grade 2 pressure sore appear?
Partial thickness skin loss - epidermis and/or dermis Ulcer superficial and presents as abrasion or blister
69
How would a grade 3 pressure sore appear?
Full thickness skin loss - damage to/necrosis of subcutaneous tissue May extend down to underlying fascia
70
How would a grade 4 pressure sore appear?
Extensive destruction Tissue necrosis Damage to muscle, bone or supporting structures
71
How are pressure sores managed?
Moist environment - encourage healing Hydrocolloid dressing and hydrogels Avoid soap - dry out Infection - wound swabs shouldn't be routine. Systemic antibiotics if clinically necessary (e.g. surrounding cellulitis) Consider referral to tissue viability nurse Surgical debridement may be beneficial
72
What is eczema herpeticum?
Infective Rash that develops 5-12 days after HSV infection Commonly in children with atopic eczema but can occur in other skin breaks
73
How does eczema herpeticum present?
Unwell - fever and lymphadenopathy Blisters - blood stained Often around face and mouth Occur in clusters Painful +- itchy
74
How is eczema herpeticum managed?
Admit to hospital | Oral/IV aciclovir
75
What is toxic epidermal necrolysis?
Life threatening dermatological disorder characterised by widespread erythema, necrolysis and skin sloughing
76
What causes toxic epidermal necrolysis?
Mostly a reaction to drugs: - phenytoin - sulphonamides - allopurinol - penicillins - carbamazepine - NSAID's
77
How does toxic epidermal necrolysis present?
Prodrome of fever and URTI symptoms Involve mucous membranes initially 1 Ill defined erythematous macular/papular rash 2 Bullae form and join 3 skin slough
78
What is Nikolsky's sign?
When seemingly normal skin is rubbed in a patient with toxic epidermal necrolysis, the epidermis with separate away
79
How is toxic epidermal necrolysis managed?
Withdraw causative agent Transfer to ITU Supportive treatment - fluids, electrolytes, dressings and creams
80
What complications are associated with toxic epidermal necrolysis?
Dehydration and hypovolaemic shock Sepsis PE DIC Mortality of upto 55%
81
What ADR's are associated with topical corticosteroids?
Rare if mild/moderate preparation used ``` Thinning Bruising Stretch marks Folliculitis Pimples Loss of skin pigment Hair growth at site of application Burning or stinging common in first few days but usually resolve ```
82
What adverse effects are associated with methotrexate?
``` Mucositis Myelosuppression Pneumonitis Pulmonary fibrosis Liver fibrosis ```
83
What are the rules surrounding methotrexate use and pregnancy?
Women - avoid pregnancy for at least 6 months after treatment stopped Men - use effective contraception for at least 6 months after treatment stop
84
How should methotrexate be prescribed?
Weekly Folic acid 5mg once weekly co-prescribed - more than 24hrs after methotrexate dose Methotrexate Monday's Folate Fridays
85
How should patients on methotrexate be monitored?
FBC U&E LFT Before treatment Weekly until stabilised Every 2-3 months thereafter
86
What interactions with methotrexate should you be aware of?
Avoid trimethoprim/co-trimoxazole - increase risk of marrow aplasia High dose aspirin increase risk of methotrexate toxicity secondary to reduced excretion
87
Should a patient have a methotrexate toxicity, how should it be managed?
Folinic acid