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Flashcards in Rashes in Creases Deck (31)
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1

What is a good algorithm for symmetrical rashes in creases?

2

What is a good algorithm for asymmetrical rashes in creases?

3

What is a good algorithm for flexural rashes in that are pigmented or skin coloured?

4

Why must one be careful when using steroids on flexural sites?

They have a natural occlusive effect making the steroid more potent.

5

What is thought to be the cause for seborrheic eczema/dermatitis?

Malassezia furfur

6

What is the treatment for Scalp Seborrheic Eczema/Dermatitis?

  • Overnight application of olive oil
  • Low potency topical steroids - apply for a few hours for thicker crusts. (SEBCO ointment)
  • Ketoconazole shampoo (leave on for 5 minutes)
    • Initiation: 2-3 times weekly until clear
    • Maintenance: Once every 2 weeks.
  • FOR ITCH: steroid mouse, gel or lotion 2-3 times per week at night for 2-4 weeks. (e.g. Betnovate)

7

What is the treatment for Adult Seborrheic Dermatitis/Eczema on the skin?

  1. Ketoconazole shampoo as a bodywash.
    • Leave on for 5 minutes. Use 3 times weekly for 2 weeks and then as required.
  2. Topical Anti-fungals- Miconazole, Clotrimazole, Ketoconazole.
  3. ITCH
    • Mild to moderate potency steroids - Eumovate
    • Comabined steroid/Antifungal - Daktacort/Resolve Plus.
  4. Calcineurin inhibitors - Pimecrolimus or Tacrolimus for flares and resistant cases.

8

Is the treatment for Seborrheic Dermatits/Eczema curative or to control?

To Control

It is not curable.

9

What is the treatment for Recalcitract Seborrheic Eczema/Dermatitis?

 

What should you also investigate for?

Oral Itraconazole 200mg Once daily for 7 days

Consider Ix for HIV

10

What is the treatment for infantile seorrheic eczema?

  • Emollients
  • Mild topical corticosteroids
  • Steroid+ Antifungals can be used - rarely needed.

11

What is this?

Infantile Eczema

(Lack of satellite lesions & the fact that it flows together makes it more likely to be eczema)

12

If a case of infantile eczema or tinea doesn't clear, what should you consider as a differential diagnosis?

Langerhan's Cell Histiocytosis

  • Accumulation of abnormal histiocytes in the skin and reticuloendothelial system.
  • Yellow brown papules.
  • Scalp often affected.
  • Often have bone pains/bone lumps.

13

What is this?

Contact dermatitis

14

What is this?

Flexural psoriasis

15

What are 3 causes of intertrigo?

  1. Red skin from 2 moist surfaces rubbing together
  2. Cutaneous candidiasis
  3. Seborrhoeic eczema

16

What is the treatment of flexural psoriasis?

Generally resistant

  • Hygeine measures
  • Vitamin D Analogues - test patch first as it might irritate.
  • Combined topical steroids/antifungal
  • Calcineurin Inhibitors

17

What is the cause of erythrasma?

Corynebacterium Minutissimum

18

What colour does Erythrasma (Corynebacterium) go under a wood's light?

Orange

19

What is the treatment for Erythrasma?

  • Antibacterial washes
  • Topicals - clindamycin & Fusidic acid.
  • Resistant - oral erythromycin or doxycycline.

20

What is this?

Tinea Cruris

(Raised erythematous scaly border)

Satellite lesions are NOT seen unlike in Candidiasis.

21

What is this?

Candida infection 

(Satelite lesions in candida infection)

22

What is the treatment for candida infection?

  • General hygiene and keep dry.
  • Clotrimazole cream
  • For severe cases oral itraconazole may be required.

23

What is the treatment for tinea cruris?

  • Keep dry
  • Clotrimazole cream twice daily for 2-3 weeks.
  • Oral terbinafine can also be used for 2-3 weeks if needed.

24

What is the treatment for acanthosis nigricans?

  • Topical retinoid - Tazarotene gel
  • Pigmanorm - Hydroquionone + RetinA + Hydrocortisone.

The above will not get rid of it but can help lighten the pigmentation.

25

What is this rare genetic disease of blisters in teh groin?

Hailey-Hailey Disease

  • Erythematous plaques and flaccid blisters on the neck and intertrigenous areas.
  • Diagnosis - skin biopsy with Direct IMF.
    • H&E histology is very similar to pemphigus vulgaris or Darius Disease.
    • IMF is usually negative.
  • Treatment:
    • Topical antibacterials and antifungal agents.
    • Mild/moderate strength topical steroids are the mainstay of treatment.
    • CO2 Laser.
    • Topical Metronidazole is good for malodorous cases.

26

Hidradenitis Suppuritiva is a disease of what?

Of the apocrine sweat glands.

27

HS is more common in which gender?

Women

28

What is the staging system for HS?

The Hurley Staging System

  • Hurley I: abscess formation (single or multiple) w/o sinus tracts 
  • Hurley II: one or more widely separated recurrent abscesses with tract formation and scars
  • Hurley III: multiple interconnected tracts and abscesses throughout an entire area

29

What is the treatment for HS?

  1. Conservative  - weight reduction, smoking cessation.
  2. Mild Disease -
    • Clindamycin BD Topical
    • Chlorhexidine washes.
  3. Moderate Disease
    • 1st line - Erythromycin/Doxycycline or Lymecycline
    • 2nd line - Rifampicin and Clindamycin
    • Use for 3-6 months. Monitor LFTs with Rifampicin. Don't use rifampicine alone.
  4. Adjuncts
    • Yasmin - antiandrogen.
    • Systemic retinoids.
    • Botox
  5. Severe Disease
    • Immunosuppression - ciclosporin, Adalimumab.
    • Surgery

30

What is the treatment for axillary hyperhydrosis?

  • Antiperspirant - topical 20% aluminium chloride hexahydrate (Driclor).
  • Topical antichlorinergics - topical glycopyrrolate.
  • Oral therapies
    • Oxybutnin 10mg at night.
    • Propantheline 15-90mg daily.
  • Botulinum Toxin A - 15-20 injections to the axillae.
  • Iontophoresis - electrical current. Machines can be bought.
  • Surgical removal of the sweat glands.