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Dermatology > Rash Clinical Cases > Flashcards

Rash Clinical Cases Flashcards

1
Q

what else can psoriasis affect as well as the skin?

A

nails - pitting, oncholysis, dystrophy, subungal hyperkeratosis
joints

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2
Q

what causes psoriasis?

A

multifactorial

genetic predisposition and environmental trigger - stress, drugs, infection

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3
Q

what is the most common form of psoriasis?

A

chronic plaque psoriasis (psoriasis vulgaris)

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4
Q

what is the koebner phenomenon?

A

psoriasis develops in scar, wound or area of trauma

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5
Q

what is auspitz sign?

A

removal of surface scale reveals tiny bleeding points due to capillaries in extended dermal papillae

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6
Q

give 3 other types of psoriasis?

A

guttate (after throat infection)
palmoplantar pustular (hands and feet)
erythrodermic/ pustular (drug induced)

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7
Q

how are inflammatory markers affected by psoriasis?

A

raised

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8
Q

does psoriasis affect life expectancy?

A

yes, by about 4 years due to increased cardiovascular risk

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9
Q

what are some comorbidities with psoriasis?

A 
arthritis
metabolic syndrome
crohns
cancer
depression
uveitis
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10
Q

what are 5 topical therapies for psoriasis?

A 
Vit D analogues
- calcipotriol
- calcitriol
coal tar
dithranol
steroid ointment (used in conjunction with other treatments)
emollients (essential)
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11
Q

what non-topical treatments are used for psoriasis?

A

UVB and PUVA
Immunosuppression (methotrexate)
immune modulation

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12
Q

first line for acne?

A 
topicals:
- benzoyl peroxide
- Vit A derivatives (retinoids)
- antibiotics
Systemic:
- antibiotics (doxy)
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13
Q

second line for acne?

A

oral isotretinoin (systemic retinoid)

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14
Q

what happens with isotretinoin treatment?

A

causes initial flare 2-3 weeks in then improves over 16 weeks

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15
Q

pathogenesis of acne?

A

increases sebum production, pore occlusion, dermal inflammation, bacterial colonisation of duct

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16
Q

how is acne vulgaris distributed?

A

related to sites with most sebaceous units (face, upper back, anterior chest)

17
Q

describe acne vulgaris morphology?

A

comedones (whiteheads/blackheads)
pustules/papules
cysts
erythema

18
Q

what types of scarring can occur in acne?

A

atrophic, ice pick, texture change, hypertrophic

19
Q

what are the 3 grades of acne?

A

mild (scattered)
moderate (numerous with mild scarring)
severe (cysts, nodules and significant scarring)

20
Q

how long does it take to see the effect of oral antibiotics in acne?

A

up to 6 months

21
Q

what are the features of rosacea?

A

papules, pustules and erythema with no comedones
prominent facial flushing aggrevated by temp change, alcohol, spicy foods, UV
rhinophyma
conjunctivitis

22
Q

what is the cause of rosacea?

A

unknown but could be to do with the larger amount of demodex mite found in people with rosacea
can run in families

23
Q

how is rosacea managed?

A 
topical:
- metronidazole, ivermectin
oral:
- oral tetracycline (long term)
- isotretinoin if severe
vascular laser
surgery for nose
24
Q

what can lichen planus do to the nails?

A

ridges

25
Q

what drugs can cause a lichenoid drug eruption?

A

ACE inhibitors

statins

26
Q

where and who does lichen planus often affect?

A

middle aged

volar wrists/forearms, shins and ankles

27
Q

what is wickhams striae?

A

fine lace like pattern on surface of buccal mucosa

28
Q

how long does lichen planus last?

A

12-18 months

29
Q

how is lichen planus treated?

A

symptomatically
topical steroids
oral steroids if severe

30
Q

what can happen in untreated lichen planus?

A

hyperpigmentation

hypertrophic scars

31
Q

what is nikolsky’s sign?

A

when the top layers of the skin slip away when slightly rubbed
indicates pemphigus

32
Q

who is bullous pemphigoid common in?

A

elderly

33
Q

what are the features of bullous pemphigoid?

A

large tense, non-scarring bullae on normal skin with erythema which can burst to leave erosions
itchy plaques and papules may also be present early on

34
Q

what are the features of pemphigus vulgaris?

A

flaccid, thin roofed vesicles/bullae on scalp, face, axillae, groin
can rupture to leave erosions
nikolsky sign positive

35
Q

what is the prognosis for pemphigus vulgaris?

A

self-limiting
can last months to years but most get remission in a few months with treatment
high mortality if untreated

36
Q

how is pemphigus/pemphigoid investigated?

A

skin biopsy with immunofluoroscence

37
Q

how is pemphigus and pemphigoid treated?

A

systemic steroids
immunosuppressants
topicals - emollients, steroids, antiseptics
tetracycline in pemphygoid

Dermatology (38 decks)

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