Dermatology

Front 1

Acne

1. Pathogenesis

2. Describe the different classifications

Back 1

1. Increased sensitivity of pilosebaceous unit to circulating androgens -> follicular plugs of sebum and keratin

2. Noninflammatory – open and closed comedones

Inflammatory – pustules, red papules, nodules and cysts

Resolving – macules or scars

Front 2

How is acne treated?

Back 2

1.Mild

Benzoyl peroxide 5 % creams or gels (bleaches fabrics)

- If poor response and mainly commedonal add topical retinoid) (eg tretinoincream, adapalene)

- If inflammatory papules and pustules as well ascomedones, add topical antibiotic (benzoyl peroxide + clindamycingel)

2.Moderate to severe acne

Oral therapy should be started with either topical retinoid or topical combination

a) Oral antibiotics

- Doxycycline 50 – 100mg OD for 6 weeks

b) COPC – takes approx 3 months to work, so give 6month trial

c) Spironolactone 25 - 100mg OD

3.Severe, cystic or scarring acne

Oral isotrenitoin

Front 3

ETG flowchart

Back 3

Front 4

What is:

- a macule

- a patch

- a papule

- maculopapular

- a nodule

- a plaque

Back 4

Macule: Circumscribed area of altered skin colour < 1cm diameter

Patch: Circumscribed area of altered skin colour > 1cm diameter

Papule: palpable mass on skin surface <0.5cm

Maulopapulae: a raised and discoloured circumscribed lesion

Nodule: palpable mass on skin surface >0.5cm

Plaque: flat topped palpable mass >1cm diameter

Front 5

What is a:

- wheal

- angioedema

- vesicle

- bulla

- pustule

- abscess

- furuncle

- carbuncle

Back 5

Wheal: a pale, compressible area of dermal oedema

Angioedema: a diffuse area of oedema extending into subcutaneous tissue

Vesicle: fluid filled blister < 0.5cm diameter Bulla: vesicle >0.5cm diameter

Pustule: visible collection of pus in skin <1cm Abscess: localised collection of pus in a cavity >1cm

Furuncle: a purulent infected hair follicle. Includes folliculitis (small funruncles) and boils (larger furuncles)

Carbuncle: A cluster of boils discharging through several openings

Front 6

What is

- purpura

- Petechiae

- ecchymosis

- haematoma

- telengectasiae

- comedo (blackhead, whitehead)

Back 6

Purpura: bleeding into skin

Petechiae: purpuric lesions 2mm or less in diameter

Ecchymosis: Larger purpuric lesions Haematoma: swelling from any gross bleeding Telengectasiae: visible dilatation of small cutaneous blood vessels

Comedo: a plug of keratin and sebum in a dilated pilosebaceous gland

- Blackead: open comedo

- Whitehead: closed comedo

Front 7

Due to intolerance to the gliadin fraction of gluten (90% also have enteropathy).

Symmetrically distributed extremely itchy papules and vesicles on normal or reddened skin, which often appear in groups. Blisters are often eroded and crusted due to immediate scratching.

Back 7

Ans: dermatitis herpetiformis

Diagnosis requires biopsy.

Front 8

autoimmune disease in which inflammatory cells attack an unknown protein within skin and mucosal keratinocytes

shiny, flat topped firm papules most often found on wrist, lower back and ankles. Can also be found in oral cavity, vulva and penis.

Back 8

Ans: lichen planus

Longstanding erosive forms can rarely evolve into SCC. Biopsy is often recommended to confirm diagnosis. Treatment is not always necessary. Options include topical steroids, topical retinoids and intralesional steroid injection.

Front 9

A boggy lump, usually on the scalp, secondary to drammatic immune response to a fungal infection.

Back 9

Ans: kerion

Rx: oral antifungals +/- PO Abs if infected

Front 10

A common yeast infection of the skin

Back 10

Ans: Pityriasis versicolour

Rx: topical antifungals, oral fluconazole if ineffective

Front 11

Psoriasis:

1. what is it?

2. where is it found?

3. What is the treatment?

4. What are the associated health disorders?

Back 11

1. an inflammatory and hyperplastic condition of theskin, characterised by erythema and scale.

2. Commonsites - elbows, knees, sacrum and scalp. Can also affect trunk and limbs, palms and soles,nails, flexures (including genitals) and face.

3a) avoid triggers - stress, sunburn, medication etc

b) GP level rx: Tar, steroids, calcipitriol (combos eg ar/steroids, calcipitriol/steroids)

c) more complex: methotrexate, UV therapy, cyclosporin, biologic therapy etc

d) IBD, inflammatory arthritis, uveitis, cardiovascular disease/metabolic syndrome

Front 12

What am I?

Back 12

Typical plaque psoriasis?

Front 13

Numeours droplet shaped lesions, often a response to Group A strep infection

Back 13

Guttate psoriasis. Common on trunk and proximal limbs. Often responds well to milder corticosteroids.

Front 14

Psoriasis treatment: an overview of primary care management

Back 14

Topicalcorticosteroids (anti-inflammatoryand antimitotic).

Tars (anti-inflammatoryand antipruritic)

- eg LPC 6% + salicylic acid 3%, icthammol

- often used mane with corticosteroids nocte

- often need to be made at compounding pharmacy

Calcipotriol (regulatesproliferation and differentiation of keratinocytes)

Usually always combined with topical corticosteroid therapy

Front 15

Dermatitis Treatment

Back 15

1. Treat dry skin - emollients, oil in baths etc

2. Decrease irritants - avoid soaps, wool, overheating etc

3. Corticosteroids applied liberally OD until skin is clear

Mild/face/axilla/groin:

Hydrocortisone 1% for one week

If fails try methylprdnisolone aceponate 0.1% (Advantan)

Mod/Trunk/Limbs:

Triamcinolone acetonide (Aristocort) 0.02% ointment OD

Severe or in flexures:

methylprdnisolone aceponate 0.1% OD (Advantan)

mometasonefuorate (elocon) 0.1% OD

FINGERS, LICHENIFIED WRISTS OR ANKLES, FEET

Betamethasone diproprionate (diprosone) 0.05%

Batamethasone valerate (betnovate) 0.1%Mometasone fuorate 0.1% (elocon)

Front 16

What Am I? A Common, relapsing form of eczema mainly affecting scalp and face

Back 16

Seborrhoiec dermatitis

Treatment: topical antifungal + topical corticosteroid

Front 17

What am I? A form of eczema affected hands and fingers characterised by vesicles

Back 17

Ans: Pompholyx Eczema. Avoid irritants and use strong steroids to treat.

Front 18

What am I?

Back 18

Discoid eczema

Front 19

What am I?

Back 19

Tinea - a skin infection with a ringworm fungus. Defined by definite edge and central clearing

Rx - initially topical terbinafine