SKIN

Question 1

Acne

Answer 1

Disorder of the pilosebaceous follicles found in the face and upper trunk.
RF: boys, teenagers, PCOS, Premenstrual

CF: greasy skin

Management: Benzyl peroxide, teopical retinoids, Systemic Rx, Doxycycline, Oral contraceptive, Oral isotretinoin (hospital use only)

Refer to dematologist if risk of scarring despite treatment in primary care
Endocrine input if ? PCOS

Question 2

Eczema

CF

Management:

If bacterial infection –>

Answer 2

Chronic, relapsing, inflammatory
- itchy red rash that favours the skin creases
- 20% children
Cause: Irritants, skin infections, allergies, stress

CF: Itchy skin Atopy, general dry skin, scaling and cracking of skin
Infants: involves face, scalp and extensor surfaces of limbs

Bacterial infetion = crusting, weeping

Eczema herpeticum: blisters and possible fever

Management: Emoillients, keep nails short, Topical steroids- betnovate –> Dermovate
Bacterial infection: 14 day course oral fluclox
Phototherapy and bandaging or systemic immunosupressant

Question 3

Psoriasis

Syx and associated changes

Management:

Answer 3

• Chronic inflammatory + strong family history

Triggers: smoking, stress, alcohol, obesity

CF: Symmetrical well defined red plaques with silvery scale on extensor aspects of elbows, knees, scalp and sacrum
Nail changes in 50% - pitting and oncholsis
Associated with arthritis

Management: Vit D analogue CALCIPOTRIL + BETHAMETHASONE
Tar
Tacalcitol

Severe: Methotrexate, Biologics or phototherapy

Question 4

Warts

Answer 4

Common benign, hyperkeratotic skin lesions associated with ageing

Refer if suspect malignancy

Tx:• Reassurance: most often, no treatment is required.
Remove where there is cosmetic dislike, repeated irritation or chafing from clothes, or diagnostic uncertainty.

Question 5

Basal Cell Carcinoma

speed it grows at?

Look like??

Answer 5

• Slow-growing, locally invasive malignant epidermal skin tumours
  Metastasis is rare
  Caucasions

CF: 80% head and neck
Pearly RAISED edges with telangiectasia, Rodent ulcer

IVX: Excision margin of 4MM around tumour
or Topical Imiquimo for primary small superficial BCC

Reduce sun exposure

Question 6

Squamous Cell carcinoma

CF:

Answer 6

-• Malignant tumour that arises from the keratinising cells
CAN METASTASISE

Cause: UV light

CF: Crusted tumour, non healing ulcer, Slow growing reddish skin plaque

IVX: skin biopsy and CT scan to see bone or soft tissue spread

Management: 2 week urgent GP referral
Complete Excision

Question 7

Melanoma

pigmented cells cancer

Answer 7

When cancer has grown through dermis –> invasive
More comon in women
Cause: sun exposure

CF: ABCDE
Diamter above 7mm

IVX: Full thickness excisional biopsy and look in Dematascope

Management: wide local excision and therapeutic lymph node dissection
Adjuvent Radiotherapy

Question 8

Leg Ulcers

Answer 8

• Loss of skin below knee taking over 2 weeks to heal
  Cause: Venous, arterial or both

VENOUS
RF: varicose veins, previous DVT, phlebitis in affected leg

CF: Large and shallow, varciose veins, mild pain relieved on elevation

ARTERIAL

RF: CHD, history of stroke, DM

CF: More distal, smaller well defined ulcers, noctural pain relieved when dangling legs

Question 9

Vascular lesions of the skin

AKA pyogenic granulomata or lobar capillary haemangioma

Answer 9

Reactive inflammatory mass of blood vessels in the skin

Syx: Solitary red, purple or yellow papule or nodule arising from normal skin.
Size varies from a few millimetres in diameter to several centimetres
Rapid eruption and growth over a few weeks

Management: Curettage and cautery or Shave excision