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A2 ME3031 DERM > W6: Acne & Rosacea, Acute & Emergency, Eczema, Psoriasis > Flashcards

W6: Acne & Rosacea, Acute & Emergency, Eczema, Psoriasis Flashcards

1
Q

Describe the epidemiology, pathophysiology & common presentations of acneiform eruptions

A

(1) PAPULOPUSTURAL ACNE: inflamm.

*ACNE FULMINANS: sidden + eruption, systemic joints
=>isotretinoin+prednisolone

  • NODULAR CYSTIC ACNE: pain++, large nodular
  • COMEDOMAL ACNE

*ACNE KELOIDALIS NUCHAE: skinV-VI, 2º inflamm bacterial infection = chronic folliculitis
=> topical steroid + abx wash

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2
Q

Acne Vulgaris Management

A

TOPICAL:
=> benzoyl peroxide !bleaches
=> clindomycin, erythromycin (under 12)
=> Retinoids

combos: 
DUAC (BPO+clindamycin)
TRECLIN (tretinoin + clindamicin)
EPIDUO GEL (BPO + Adapalene)
!DRY SKIN

systemic:
=> TETRACYCLINES; ERYTHROMYCIN; TRIMETHOPRIN
=> Anti-Androgens + Contraceptive pill
=> Isoretinoin (resistant only) !teratogenic
=> UVB
=> Dapsone

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3
Q

Acne Rosacea

A

ace of clubs, chronic, PSU inflamm, flushing, fair skin

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4
Q

Describe clinical features of acne vulgaris and rosacea

A

(1) ERYTHEMA-TELANGIECTATIC

PHYMATOUS: nose, M>F
=> ablative tx

PAPULO-PUSTULAR: rosacea+acne; nil comedomes

OCULAR

=> RETRONIDAZOLE
=> Azeleic Acid
=> Ivermectin
=> Brimonidine

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5
Q

Principles of Acute Skin Failure

A

Sepsis, hypo/hyper thermia, fluid loss d/t peripheral vasodilation

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6
Q

Acute (and chronic) urticaria

A

itching; oedema

ACUTE URTICARIA: viral, idiopathic, IgE-med.
(1) AuImm = systemic

=> antihistamine
=> oral steroid

CHRONIC URTICARIA
=> antihistamine
=> antileukotriene: tranexamic acid
=> Imm Mod: Omalizumab

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7
Q

Stevens-Johnson syndrome / toxic epidermal necrolysis spectrum

A

often 2º to drugs w/ delayed onset, imm suppr Hx, prodromal flu>rashdev

systemic symptoms, papules, haemorrhagic, epitheliual detachment
+oral involvement
+ocular involvement

> scarring, blindness, nail+hair loss, joints

=> steroids
=> nutrition
=>Ig
=> anti-TNF
=> Abx
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8
Q

blistering eruption

A

PEMPHIGUS - superfiicial splitting, Ab atttack of desmosomes, NIKOLSKY+, younger,
=> imm supp.

PEMPHIGOID - elderly, basal epidermal junction
=> imm supp

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9
Q

Erythroderma

A

ERYTHEMA MULTIFORME: HJV, mycoplasma, hypersens as a result of infection

  • target lesions
  • self-resolve, distal->proximal dev.

UNSTABLE PSORIASIS: systemic, 90% of body red, ?strept throat, new drugs?

=>emolients
=> underlying trigger?
=> monitor fluids, nutrition, humidity
=>topical corticost.

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10
Q

Eczema with secondary infection (including eczema herpeticum)

A

ECZEMA HERPETICUM: children systemic = monomorphic blisters punched out erosions, pain++ nil itch

=> aciclovir
=> emolient
=>abx

+cellulitis/impetigo

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11
Q

Staphylococcal scalded skin syndrome

A

superficial peeling, macular rash, children + imm compr. adults,

  • d/t toxin produ. stimulate response at flexural site
  • biopsy, blood culture

=> IV Abx

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12
Q

Principles of managing dermatological emergencies

A

Treat underlying cause: drug? infection?

Monitor barrier: emollient? corticosteroids? humidity + temp? nutrients? hydration?

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13
Q

Describe the classification of dermatitis

A

inflamm nature @ flexurals; itchy skin condition in the last 12mos.
evinronmental vs FILAGGRIN GENE

ATOPIC DERM.
erythema, scale, papules, vesicles, leakage > fissuring+exudate !infection

CONTACT DERM.

  • allergy: Type IV hypersens, delayed
  • irritant

SEBORRHOEIC DERM.
-hair sites, self resolve
*malassezia yeast, scaly epidermis - dandruff
*sebaceous gland: red scaling | severe - HIV?
=> anti yeast

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14
Q

Internal Eczema

A

discoid: circular plaques, middle aged, trauma
vesicular: palm, sole itchy, acute
asteatotic: dry skin elderly, hot climate

venous

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15
Q

Topical and systemic management of atopic derm.

A

topical steroids, emolient, antihistamines, calcineurin inhib.

systemic:
- UV Tx
- imm suppr (azathiprine)
- biologics

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16
Q

Describe the clinical presentations of psoriasis including associated nail and joint involvement.

A

chronic imm-med = sharply demarcated plaques w/micaceous scale.

  • widely disseminated papules + plaques
  • ONYCHOLYSIS = splitting form nail bed + ptting and oil spots
  • Koebner phenomenon (lesions @ trauma)
  • Scalp
  • Joint Psoriasis
17
Q

Flexural/Inverse Psoriasis

A

Infective trigger, less scales

18
Q

Palmo-Plantar Psoriasis

A

RF: smoking

Thick scaly plaque, inflamm bone.

19
Q

Guttate Psoriasis

A

Younger. Infective trigger

Pink papules w/ fine scale. Self resolve or prog. to chronic.

20
Q

Chronic Plaque Psoriasis

A

Symmetric. Scaly.Extensor surface. Spreads

21
Q

Pustular Psoriasis

A

Pregnancy: taper steroids, hypocalcaemia, infection

Sterile pustules. Red tender.

22
Q

Erythodermic Psoriasis

A

RED MAN SYNDROME: temp. dysreg. + oedema
=> fluid balance
=> thick ointment

23
Q

Psoriasis Mgmt

A 
(1)
=> emolients
=> vit D3 analogues
=> coal tar cream
=> topical steroid
=> salicylic acid
(2)
=> crude coal tar
=> UVB
=> Dithranol
=> Oral retinoids
=> Imm Suppr.
24
Q

Non Melanoma Skin Ca

A

Basal: slow, local, rare mets.

  • nodular: rolled edge
  • superficial
  • pigmented
  • morphoeic BCC: scarred

Squamous Cell Carcinoma: ↑mets risk, faster, well-differentiated
- Keratocanthoma: hair follicle eruption

=>Excision +/-RT
+Follow up
=> MOH Sx (excise around border allows mapping)
=> VISMODEGIB: inhibits hedgehog pathway signalling = shrinks

25
Q

Melanoma Skin Ca (RF and Red Flags)

A

RF: UV, genetic, burn, fair skin, familial melanoma

ABCDE 🚩multi-colour, 7mm+, evolved

26
Q

Describe the characteristics of pre-malignant and malignant tumours

A

contained by epidermal border

MELANOMA IN-SITU: lentigo maligna
=>excision

actinic keratoses: progresses to epidermal SCC,
*scaly areas. chronic scabbing.
=>DICLOFENAC GEL

BOWENS DISEASE: irregular scaly erythemations. intraepiderma SCC.

=> Cyrotx.
=> curretage
=> Photo Rx
=> IMIQUIMOD: imm mod. stimulate cytokine.

27
Q

Principles of treatment of patients with skin cancer

A

Melanoma
=> sx excision + surveillance
+ immunotherapy: BRAF MUT. TARGETTING.

Cutaneous Lymphoma:
=> topicals
=> PUVA (sens to UV)
=> UVB
=> RT
=> Interferon
28
Q

Cutaneous Lymphoma

A

cut. t lymphoma: MYCOSIS FUNGOIDES commonest. LT plaque can dev into tumour and into mets.
* commonly 2º to breast, colon, lung*

SEZARY SYNDROME: red man.
=>extracorporeal photophoresis

29
Q

Viral warts

A

hpv

=>induce imm response via cryotx. or wart paints
=> curettage (severe)

30
Q

Epidermoid and pilar cysts

A

epidermoid/sebaceous - commonest

source of 2º infection d/t rupture

=>excision
=> Abx, steroid, drainage

31
Q

Seborrhoeic keratoses

A

Leser–Trélat sign: GI adenocar. / paraneoplastic

warty growths, multiple, +/- cherry angiomas
=>cryotx.
=> curettage

32
Q

Dermatofibroma

A

dimple sign, pale centre+pigmented rim.

  • asympt.
  • malignancy
33
Q

Lipoma

A

common, asympt.

  • angiolipoma
  • liposarcoma

difficult to excise

34
Q

Common vascular lesions

A

angioma: liver disease spider naevi cherry angio and venous lakes

pyogenic granuloma: rapid, bleeds, trauma sites
*hand and face, 5% pregnancy
=> currette
=>cautery

A2 ME3031 DERM (4 decks)

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