Rashes

Question 1

how long should patients with mild/moderate acne be treated before a review?

Answer 1

three months

Question 2

what is the topical treatment for mild/moderate acne?

Answer 2

benzoyl peroxide
retinoids
topical antibiotic

Question 3

what are three topical retinoids?

Answer 3

adapalene
isotretinoin
tretinoin

Question 4

if patients under 12 have a poor response to topical treatment for mild/moderate acne what should be given?

Answer 4

erythromycin or clarithromycin

Question 5

if patients over 12 have a poor response to topical treatment for mild/moderate acne what should be given?

Answer 5

doxycycline

erythromycin or clarithromycin

Question 6

what medication could be considered in females with acne?

Answer 6

anti androgens

Question 7

what management should be started for severe cystic acne with scarring?

Answer 7

systemic antibiotics

refer for systemic isotretinoin

Question 8

how does discoid eczema appear on the skin?

Answer 8

in circular or oval patches

Question 9

what is the most common site affected by contact eczema?

Answer 9

hand

Question 10

what body part is associated with varicose eczema?

Answer 10

lower legs

Question 11

what is varicose eczema associated with?

Answer 11

venous insufficiency

Question 12

what body parts are affected by seborrheic dermatitis?

Answer 12

nose
eyebrows
ears
scalp

Question 13

how does dyshidrotic eczema present?

Answer 13

tiny blisters on the hands and feet

very itchy

Question 14

what are the general measures for managing dermatitis?

Answer 14

remove triggers
loose, cotton clothes
emollients

Question 15

what is given for mild dermatitis?

Answer 15

mild topical steroids

Question 16

what is given for moderate dermatitis?

Answer 16

moderate topical steroids

Question 17

what is given for severe dermatitis?

Answer 17

a potent topical steroid

Question 18

what options are available for managing dermatitis in secondary care?

Answer 18

phototherapy
systemic immunosuppressants
biological agents

Question 19

how does psoriasis present?

Answer 19

symmetrical red scaly plaques that are well defined

Question 20

what are some common sites for psoriasis?

Answer 20

scalp
elbows
knees

Question 21

what is Auspitz sign?

Answer 21

bleeding when surface scale is removed

seen in psoriasis

Question 22

what is the koebner phenomenon?

Answer 22

when psoriasis develops in areas of skin trauma

Question 23

what five topical therapies for psoriasis are used?

Answer 23

vitamin D analogues 
coal tar 
dithranol 
steroid ointments 
emollients

Question 24

what are two types of vitamin D analogues used in psoriasis?

Answer 24

calcipotriol (dovonex)

calcitriol

Question 25

when is dithranol used in psoriasis?

Answer 25

localised plaques

Question 26

what is a whitehead?

Answer 26

a closed comedone

Question 27

what is a blackhead?

Answer 27

an open comedone

Question 28

what is acne vulgaris?

Answer 28

chronic inflammatory disease of the pilosebaceous gland

Question 29

what sites are commonly affected by acne?

Answer 29

face | upper back chest

Question 30

what classifies mild acne?

Answer 30

scattered papules and pustules | comedones

Question 31

what classifies moderate acne?

Answer 31

numerous papules and pustules | mild atrophic scarring

Question 32

what classifies severe acne?

Answer 32

cysts nodules significant scarring

Question 33

where does rosacea affect?

Answer 33

nose chin cheeks forehead

Question 34

what lesions are present in rosacea?

Answer 34

papules pustules erythema

Question 35

what can exacerbate rosacea?

Answer 35

temperature changes alcohol spicy foods

Question 36

what is rhinophyma and what skin condition is that associated with?

Answer 36

an enlarged misshapen nose rosacea

Question 37

what effects can rosacea have on the eyes?

Answer 37

conjunctivitis | gritty eyes

Question 38

what are possible psychiatric complications of acne?

Answer 38

depression | anxiety

Question 39

what is the timescale for management of mild to moderate acne in primary care?

Answer 39

topical treatment for 3/12 then review if poor response after three months, consider systemic treatment

Question 40

what is involved in the initial treatment for mild to moderate acne?

Answer 40

topical benzoyl peroxide topical retinoids topical antibiotics

Question 41

name three retinoids

Answer 41

adapalene isotretinoin tretinoin

Question 42

what systemic treatment can be considered after topical treatment for acne fails in patients under 12 in primary care?

Answer 42

erythromycin or clarithryomycin BD

Question 43

what systemic treatment can be considered after topical treatment for acne fails in patients over 12 in primary care?

Answer 43

lymecycline 400mg OD doxycycline 100mg OD erythromycin/clarithromycin 500ng BD

Question 44

what is the initial management for severe cystic acne with scarring?

Answer 44

systemic antibiotic therapy | refer for consideration of systemic isotretinoin

Question 45

describe the appearance of discoid eczema

Answer 45

occurs in circular or oval patches

Question 46

when does contact eczema occur?

Answer 46

when the body comes into contact with a specific substance often affects the hands

Question 47

what part of the body is affected by varicose eczema?

Answer 47

the lower legs

Question 48

what is varicose eczema associated with?

Answer 48

venous insufficiency

Question 49

what parts of the body are affected by seborrheic eczema?

Answer 49

nose eyebrows ears scalp

Question 50

how does dyshidrotic eczema present?

Answer 50

tiny blisters on the hands and feet | very itchy

Question 51

what conditions make having eczema more likely?

Answer 51

allergies asthma hayfever

Question 52

what are the general conservative management options for eczema?

Answer 52

remove triggers wear loose cotton clothing emollient use

Question 53

what is the management for mild eczema?

Answer 53

mild topical steroid

Question 54

what is the management for moderate eczema and name examples?

Answer 54

moderate topical steroid e.g. betamethasone valerate 0.25% or clobetasone butyrate 0.05%

Question 55

what is the management for moderate eczema on the face?

Answer 55

mild steroid on the face - can increase in potency if needed to moderate

Question 56

what is the management for severe eczema and state an example?

Answer 56

potent topical steroid on inflamed areas e.g. betamethasone valerate 0.1%

Question 57

when should adults with eczema be referred to secondary care?

Answer 57

``` failure to respond to moderate steroids sleep problems recurrent infection erythrodermic eczema contact allergy ```

Question 58

when should children with eczema be referred to secondary care?

Answer 58

uncontrolled despite maintenance + flare treatment psychological or social difficulties diagnosis uncertain

Question 59

what options are available for management of eczema in secondary care?

Answer 59

phototherapy systemic immunosuppressants biological agents

Question 60

how does guttate psoriasis present?

Answer 60

post strep infection | widespread small plaques

Question 61

what is another name for chronic plaque psoriasis?

Answer 61

psoriasis vulgaris

Question 62

what are unstable psoriasis plaques and what can trigger this?

Answer 62

rapid extension fo new or existing plaques stress, infection, drugs, withdrawal

Question 63

what is the koebner phenomenon?

Answer 63

presence of new psoriatic plaques at the site of skin injury

Question 64

describe flexural psoriasis

Answer 64

affects body folds and genitals | smooth, well defined

Question 65

what microbe colonises flexural psoriasis?

Answer 65

candida

Question 66

what is sebopsoriasis?

Answer 66

the overlap of seborrheic dermatitis and psoriasis affects the scalp, face, ears and chest

Question 67

what microbe colonises sebopsoriasis?

Answer 67

malassezia

Question 68

what is auspitz sign in psoriasis?

Answer 68

bleeding when surface scale removed

Question 69

what causes psoriasis?

Answer 69

multifactorial - genetic and environmental inputs

Question 70

what sites are commonly involved in chronic plaque psoriasis?

Answer 70

``` extensors (elbow, knee) scalp sacrum hands feet trunk nails ```

Question 71

describe the plaques in chronic plaque psoriasis

Answer 71

symmetrical well demarcated scaly erythematous

Question 72

name some nail signs seen in psoriasis

Answer 72

onycholysis nail pitting dystrophy subungual hyperkeratosis

Question 73

what biomarkers are raised in psoriasis?

Answer 73

those of systemic inflammation

Question 74

name some comorbidities associated with psoriasis

Answer 74

``` psoriatic athritis metabolic syndrome crohn's cancer depression uveitis ```

Question 75

how can severe psoriasis reduce life expectancy?

Answer 75

increased CVD risk reduces expectancy by 4 years

Question 76

can psoriasis be cured?

Answer 76

no - important to ensure that the patient knows this and to set realistic goals

Question 77

describe mild acne

Answer 77

scattered papules and pustules | comedones

Question 78

describe moderate acne

Answer 78

numerous papules pustules mild atrophic scarring

Question 79

describe severe acne

Answer 79

cysts nodules significant scarring

Question 80

what parts of the body are affected by rosacea?

Answer 80

nose chin cheeks forehead

Question 81

what lesions are seen in rosacea?

Answer 81

papules pustules erythema no comedones seen

Question 82

what can exacerbate facial flushing in rosacea?

Answer 82

changes in temperature alcohol spicy foods

Question 83

what change can affect the nose in rosacea?

Answer 83

rhinophyma - an enlarged, unshapely nose

Question 84

what topical therapies can be given for rosacea?

Answer 84

metronidazole | ivermectin

Question 85

what oral therapies can be given for rosacea?

Answer 85

long term oral tetracycline low dose isotretinoin in severe disease

Question 86

what can be used to treat telangiectasia in rosacea?

Answer 86

vascular laser

Question 87

what can be done to manage rhinophyma in rosacea?

Answer 87

surgery | laser shaving

Question 88

what characterises lichenoid eruptions?

Answer 88

damage and infiltration between the epidermis and the dermis

Question 89

name the two most common types of lichenoid eruptions

Answer 89

lichen planus | lichenoid drug eruption

Question 90

what is the pathology behind lichen planus?

Answer 90

T cell mediated inflammation targeting a protein in the skin + mucosal keratinocytes

Question 91

describe the lesions seen in lichen planus

Answer 91

pink/purple flat topped shiny papules wickham's striae - white lacey pattern on the surface itchy

Question 92

what body parts are usually affected by lichen planus?

Answer 92

volar wrists/forearms shins ankles

Question 93

how long does lichen planus usually last?

Answer 93

12-18 months

Question 94

how is lichen planus managed?

Answer 94

emollients topical steroids (oral if extenisve) UVB phototherapy if severe