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Rapid Reference - Dermatology > Trunk > Flashcards

Trunk Flashcards

1
Q

What is psoriasis

A

A chronic, non-infectious inflammatory dermatosis characterised by well-demarcated erythematous plaques topped by silvery scales

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2
Q

What are some triggers of psoriasis

A 
Environmental factors 
Infection 
stress
trauma 
drugs (b blockers and lithium)
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3
Q

Where are the common sites for psoriasis to occur

A

Elbows, knees, trunk, scalp margin or sacrum

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4
Q

Describe the clinical features of psoriasis

A 
plaques 
2-severalcm diameter
red
covered by waxy white scales 
sometimes itch
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5
Q

What sort of nail involvement is seen in psoriasis

A

Thimble pitting
onycholysis
oily or salmon pink discolouration of the nail bed
subungual hyperkeratosis

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6
Q

What are the first line treatments for psoriasis

A

Topical therapy:

Vitamin D analogues (calcipotriol and tacalcitol)

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7
Q

What are the benefits of using Vitamin D topical analogues

A

They do not smell or stain,

easy to apply and do not have the risk of skin atrophy seen with topical steroids

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8
Q

What are some advantages of topical corticosteroids

A

clean
non-irritant
easy to use

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9
Q

What are topical steroids the treatment of choice for

A

face
genitalia
flexures
stubborn plaques on hands, feet and scalp

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10
Q

What are some moderately potent steroids

A

Clobetasone (eumovate)

betamethasone (Betnovate RD)

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11
Q

What is the name of a coal tar cream

A

Alphosyl

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12
Q

What are the disadvantages of coal tar

A

They are messy and smelly and patients don’t like them

Stain skin, hair, linen and clothes

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13
Q

When are keratolytics and scalp preparations used

A

thick plaques and scalp psoriasis

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14
Q

Give some examples of systemic therapies for psoriasis

A 
Ohototherapy 
Methotrexate 
Retinoids 
Ciclospororin 
Biologicals
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15
Q

How often and for how long is phototherapy used

A

3 times a week for a 6 week course

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16
Q

What are retinoids effective in

A

thinning hyperkeratotic plaques

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17
Q

What is a common side effect of retinoids

A

Cracked lips

Teratogenic

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18
Q

What are side effects of cyclosporin (Neoral)

A

Hypertension and nephrotoxicity

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19
Q

What are some examples of biologicals

A

efalizumab (Raptiva)

infliximab (Remicade)

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20
Q

How do biologics work in psoriasis

A

They block inflammatory receptors involved in psoriasis

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21
Q

What is pityriasis rose

A

An acute, self -limiting disorder often affecting adolescents and young adults

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22
Q

What is characteristic of pityriasis rose

A

Scaly oval papules and plaques mainly on the trunk

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23
Q

Why does pityriasis rosea occur

A

In response to a viral infection

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24
Q

What is the general eruption usually preceded by in Pityriasis rosea

A

a herald patch (2-5cm diameter)

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25
Q

Describe the appearance of individual plaques in pityriasis rose

A

Oval, pink with a delicate peripheral collateral of scale

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26
Q

Where on the body is pityriasis rosea found

A

Usually parallel to the lines of the ribs, radiating away from the spine

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27
Q

How long does it take for the condition to clear

A

1-2 months

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28
Q

Is pityriasis rosea

A

Yes - mild to moderate (can give steroids)

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29
Q

What is tinea (pityriasis) versicolor

A

chronic fungal infection characterised by pigment changes

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30
Q

What is the causative organism in tinea (pityriasis) versicolor

A

Pityrosporum orbiculare (yeast)

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31
Q

Who is affected by tinea versicolor

A

young adults often in more tropical countries

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32
Q

What are the clinical features of tinea versicolor in an untanned white Caucasian

A

brown or pinkish oval or round superficially scaly patches

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33
Q

What are the clinical features of tinea versicolor in a tanned or racially pigmented skin

A

hypopigmentation

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34
Q

What is the treatment for tinea versicolor

A

TOpical application of clotrimazole (Canesten) or miconazole (daktarin) cream twwice daily

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35
Q

How common is recurrence of tinea versicolor

A

Very common

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36
Q

What is viral exanthema

A

An eruption associated with the general features of a viral illness

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37
Q

Who is viral exanthema most commonly seen in

A

children or adolescents

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38
Q

Describe the appearance of viral exanthema

A

erythematous
macules and papules
blotchy appearance

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39
Q

What are some associated general features of viral exanthema

A

Arthralgia
malaise
sore throat

40
Q

What is viral exanthema sometimes confused with

A

a drug eruption

41
Q

Describe the appearance of Measles

A

Kiplik’s spots of white papules on the buccal muscosa

erythematous macules on the face, trunk and limbs

42
Q

Describe the appearance of Rubella

A

discrete red merciless on face then trunk. Cervical lymphadenopathy

43
Q

Describe the appearance of hand, foot and mouth disease

A

red edged vesicles appear on the hands and feet with mouth ulcers and mild fever. They fade in 7 days

44
Q

What is the treatment for most viral exanthema

A

Emollient (E45) or a cooling agent (calamine lotion)

45
Q

Describe the appearance of chickenpox

A

24 hour prodrome followed by crops of papulovesicles centred o the trunk that become crusted with lesions at different stages at the same time

46
Q

All drug eruptions are allergic in origin. True or False

A

False

47
Q

What is the commonest drug eruption

A

toxic erythema

48
Q

How does toxic erythema present

A

morbilliform (measles like)
urticarial
resemble erythema multiforme
sometimes fever followed by peeling of the skin

49
Q

What are some drugs that commonly cause drug eruptions

A

Amoxicillin
PPI
carbamazepine

50
Q

How long does it take for a rash from a drug eruption to clear

A

1-2 weeks after stopping the drug

51
Q

What is the name of the drug eruption that appears with round red or purplish plaques that recur at the same site each time

A

Fixed drug eruption

52
Q

What drugs are responsible for fixed drug eruption

A

NSAIDs
phenolphthalein
quinine

53
Q

What is a serious and life-threatening drug eruption

A

Toxic epidermal necrolysis (TEN)

54
Q

Describe the appearance of a TEN

A

red
swollen
separates as in a scald

55
Q

What is the treatment for a drug eruption

A

Withdraw the drug

Simple emollients or topical steroids to help ease itch or scaling

56
Q

What is meant by generalised pruritus

A

Itch with no primary rash

57
Q

What are some blood disorders that can cause generalised pruritus

A 
Polycythaemia or iron deficiency 
liver disease (cholestasis)
58
Q

What are some other causes of generalised pruritus

A

Malignancy - Hodgins disease
neurological disorders
renal failure
thyroid dysfunction

59
Q

What is the treatment for generalised pruritus

A

Underlying disorder

Sedative antihistamines or antipruritic for symptomatic relief

60
Q

What is pemphigoid

A

Autoimmune condition in which cicrulating IgG autoantibodies locate to an antigen at the derma-epidermal junction and induce inflammation that leads to sub epidermal bulla formation

61
Q

Who is most commonly affected by pemphigoid

A

Elderly

62
Q

Describe the appearance of pemphigoid

A

Tnese large blisters arise on red and normal-looking skin often of the limbs, trunk and flexures

63
Q

What is the treatment for pemphigoid

A

Oral prednisolone (starting at 20-40mg/day and reducing to 10mg asap)

64
Q

How should a patient presenting with blistering eruptions be managed

A

dermatological emergency - urgent referral

65
Q

What is herpes zoster

A

an acute , self limiting, vesicular eruption that occurs in a dermatomal distribution and mostly afflicts the elderly

66
Q

What causes shingles

A

A recrudescence of Varicella zoster virus which lis dormant in the dorsal root ganglion following childhood chickenpox

67
Q

What are the clinical features of herpes zoster

A

pain, tenderness or paraesthesia often precede the onset of redness and vesicles in a dermatome by 3-5 days.
Vesicles become pustular then crusts form, which fall off in 2-3 weeks leaving scars

68
Q

What dermatomes are most commonly involved in shingles

A

Thoracic dermatomes

Trigeminal in elderly

69
Q

What occurs in a third of over 60s with shingles

A

Post-herpetic neuralgia

70
Q

What is the treatment for mild shingles

A

Rest
analgesia
calamine lotion (dry vesicles)
topical antibiotic (Fucidin)

71
Q

What is the treatment for severe shingles

A

Oral aciclovir or famciclovir for 7 days

72
Q

What is the treatment for Post-herpetic neuralgia

A

Topical capsaicin
routine analgesics
amitriptyline

73
Q

What is the clinical appearance of a candidate infection (thrush)

A

Adherent white plaques with a discharge

74
Q

Who is napkin dermatitis seen in

A

children under 1 year

75
Q

What causes napkin dermatitis

A

irritant eczema due to contact with urine and faeces, characterised by glazed erythema

76
Q

What is characteristic of Lichen sclerosis

A

white patches on the vulva or penis

77
Q

What is helpful in treating napkin dermatitis

A

disposable super-absorbent nappies to dry and keep the area dry

78
Q

What is melanocytic naevi

A

Moles

79
Q

What are melanocytic naevi composed of

A

naevus cells derived from melanocytes during embryonic development

80
Q

Where are moles located

A

in the dermis or the demo-epidermal junction

81
Q

What might provoke new naevi

A

sun exposure or pregnancy

82
Q

What are some reasons for excising naevi

A 
Concern about malignancy (increase in size or colour)
Cosmetic reasons (usually on face or neck) 
Repeated inflammation (bacterial infection often in hairy facial naevi) 
Recurrent trauma (naevi on back catch on bra strap)
83
Q

What is a seborrhoeic keratosis

A

Basal cell papilloma

84
Q

Describe the clinical features of a seborrhoeic keratosis

A

usually pigmented, benign tumours comprising a proliferation of keratinocytes
Round or oval
Stuck on appearance
Keratin plugs and well defined edges
small papule at first, often lightly pigmented or yellow
become darkly pigmented warty nodules 1-6cm in diameter

85
Q

What is the treatment for seborrhoeic keratosis

A

Liquid nitrogen cryosurgery

thicker ones are usually best removed by curettage or shave bios

86
Q

What is a skin tag

A

common pedunculate benign fibroepithelial polyp

87
Q

Where are common sites of skin takes

A

neck
axillae
groin
eyelids

88
Q

In what populations are skin tags commonly seen

A

elderly
middle aged
obese

89
Q

What is the treatment for skin tags

A

Removal by snipping the stalk with scissors or cutting through it with a hyfrecator
cryosurgery

90
Q

What is molluscum contagiosum

A

discrete pearly-pink umbilicate papule

91
Q

What causes molluscum contagiosum

A

DNA poxvirus

92
Q

What are the clinical features of molluscum contagiosum

A

Dome-shaped papulsed with a puncture
Commonest on the trunk, face and neck
if squeezed a cheesy material is expressed

93
Q

How are molluscum contagiosum spread

A

contact - including sexual transmission or towels

94
Q

What is the treatment for molluscs contagious

A

Not always necessary

Removal by expressing contents with forceps, curettage or cryosrugery

95
Q

What might many mollusca be an indication of

A

underlying immunosuppression (HIV)

Rapid Reference - Dermatology (4 decks)

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