Week 3: Dermatology management and examples

Question 1

describing lesions

Answer 1

non-pigment: SCAM

• size/shape
• colour
• associated secodnary change
• morphology/margin

pigmented: ABCDE

Question 2

management of atopic eczema

Answer 2

• Avoid exacerbating agents
• Topical therapies
  
  • Steroids for flare-ups
  • Topical immunomodulators (e.g. tacrolimus,) can be used a steroid sparing agent
  • Oral therapies- antihistamines for symptomatic relief
  • Flucloxacillin for bacterial infections
  • Antivirals for herpes
  • Phototherapy and immunosuppressants (oral prednisolone, azathioprine)

Question 3

management of acne vulgaris

Answer 3

• General measures (change food), treatment needs to be changed for at least 6 weeks
• Topical therapies (mild acne)
  
  • Benzoyl peroxide
  • Topical antibiotics
  • Topical retinoid)
  • Oral therapies (mod to sev)
    
    • Oral antibiotics e.g. doxy
    • Anti-androgens in women
  • Severe acne- oral retinoid

Question 4

management of psoriasis

Answer 4

• General measures: avoid precipitating factors
• Topical therapies (localised/mild)
  
  • Vitamin D analogues
  • Topical corticosteroids
  • Coal tar preparations, dithranol, topical retinoids, keratolytic and scalp presentations
  • Phototherapy (extensive disease) i.e. UVB and photochemotherapy I,e, psoralen+UVA
  • Oral therapies (for extensive and severe psoriasis or psoriasis with systemic involvement
    
    • Methotrexate
    • Retinoids
    • Ciclosporin
    • Mycophenolate mofetil
    • Fumaric acid esters
    • Biological agents (e.g. infliximab)

Question 5

management of emergency dermatology

Answer 5

• Antihistamines for urticaria
• Corticosteroids for severe acute urticaria and angioedema
• Adrenaline, corticosteroids and antihistamines for anaphylaxis
• Urticaria is normally uncomplicated

Question 6

management of cellulitis

Answer 6

flucloxacillin, supportive care

Question 7

management of necrotising fascitis

Answer 7

IV abx and surgical debridement

Question 8

management of superficial fungal infection

Answer 8

• Treat underlying factors e.g. underlying immunosuppressive conditions
• Topical antifungal (terbinafine cream)
• Oral antifungal (e.g. itraconazole) for severe, widespread or nail infection
• Avoid topical steroids

Question 9

management of basal cell carcinoma

Answer 9

• Surgical excision- allows histological examination and margins
• Mohs micrographic surgery for high risk, recurrent tumours
• Radiotherapy when surgery not appropriate
• Other e.g. cryotherapy, curettage and cautery and topical treatment (imiquimod) when small and low-risk lesion

Question 10

management of squamous cell carcinoma

Answer 10

• Surgical excision
• Mohs micrographic surgery
• Radiotherapy for large, non-respectable tumours

Question 11

management of malignant melanoma

Answer 11

• Surgical excision
• Radiotherapy
• Chemotherapy for metastatic disease

Question 12

emollient indication

Answer 12

• to rehydrate skin and re-establish surface lipid layer
• useful for dry, scaling conditions .e.g eczema and psoriasis

Question 13

name some steroids in order of their potentcy

Answer 13

mildy potent -→ very potent

Topical

• hydrocortisone
• clobetasone butyrate
• betamethasone valerate (betnovate)
• clobestasol proprionate (dermovate)

Oral

• prednisolone

Question 14

steroid indication

Answer 14

anti-inflammatory and proliferative

• useful for allergic and immune reactions, inflammatory skin conditions, vasculitis

Question 15

oral acyclovir indication

Answer 15

herpes simples and herpes zoster virus

Question 16

oral antihistamiens can be classified into

Answer 16

non-sedative- cetirizine and loratadine

sedative- chlorpheniramine and hydroxyzine

Question 17

indication of antihistamines

Answer 17

block histamine receptors producing an anti-pruritic effect

• type 1 hypersensitivity reactions and eczema
• can have anticholinergic effect e.g. dry mouth, blurred vision, urinary retention and constipation*

Question 18

name some topical antibiotics

Answer 18

fusidic acid

mupirocin

neomycin

Question 19

name some oral antibiotics for skin infecttions

Answer 19

penicillin e.g. fluclox, cephalosporins, gentamicin, macrolide, nitrofurantoin, tetracyclines, vancomycin, metronidazole, quinolone, trimethoprim

Question 20

indication of antibiotics

Answer 20

useful for skin infections and acne

Question 21

name an oral retinoid

Answer 21

isotretinoin -Roaccutane

Question 22

indication for oral retinoids

Answer 22

acne, psoriasis, disorders of keratinisation

Question 23

topical antiseptics for prevention of skin infection

Answer 23

chlorhexidine

Question 24

diagnose

Answer 24

contact dermatitis

• Bilateral erythematous scaly patches situated on the hips
• Borders are poorly defined
• Itchy
• Caused by copper studs allergic contact dermatitis

Question 25

diagnose

Answer 25

* **Inflammatory reaction to a scratch** * Bilateral, diffuse erythematous papules (some individual nad some in a linear pattern) * Small plaques over flexor surface of forearm * Smooth and shiny surface * Very itchy

Question 26

diagnose

Answer 26

* Multiple individual and coalescing erythematous plaques with **targetoid** appearance

Question 27

diagnose

Answer 27

* Multiple individual and coalescing erythematous plaques with targetoid appearance * Examine joints- psoriatic arthiritis

Question 28

describe

Answer 28

* Multiple vesicles and pustules * cold sore

Question 29

describe

Answer 29

* Bullae and erosions

Question 30

diagnose

Answer 30

erythema nodosum by **tender, red bumps**, usually found symmetrically on the shins. causes * infection * disease * drug

Question 31

diagnose

Answer 31

Malignant melanoma A not symmetrical B irregular C irregular D **\>8mm** E

Question 32

diagnose

Answer 32

* Multiple well demarcated patches of alopecia effecting the scalp * Affected area shows normal skin without erythema or scales

Question 33

diagnose

Answer 33

* Inflammation round the outer ring * excoriations Flat erythematous and annular

Question 34

diagnose

Answer 34

contact dermatitis * crusting and scaling of the hands * emollient

Question 35

diagnose

Answer 35

acne vulgaris * raised lesion, closed comedones, white head * doxy, rocatotane, UV

Question 36

diagnose

Answer 36

**Plaque psoriasis** * raised inflammatory erythematous patches on the extensors of the elbow with ***silvery scaling***

Question 37

diagnose

Answer 37

fungal skin infection * well demarcated, inflammatory erythematous sore under the breast

Question 38

diagnose

Answer 38

Cambell de morgan spot * **red and raised uniform border**

Question 39

diagnose

Answer 39

squamous cell carcinoma * asymmetrical irregularly raised and no clear margins * non-uniform colour * light red nodule with rough surface * can resemble warts * grow slowly * sometimes with **central ulceration**

Question 40

diagnose

Answer 40

basal cell carcinoma A **shiny, skin-colored bump that's translucent**, meaning you can see a bit through the surface. The bump can look pearly white or pink on white skin. On brown and Black skin, the bump often looks brown or glossy black. Tiny blood vessels might be visible, though they may be difficult to see on brown and Black skin.

Question 41

diagnose

Answer 41

ulcerated basal cell carcinoma

Question 42

diagnose

Answer 42

acne vulgaris * open comedones- black heads

Question 43

diagnose

Answer 43

Eczema * excoriations in flexor area

Question 44

diagnose

Answer 44

**allergic reaction to henna- inflammatory erythema**