1.
2.
3.
4.
5.
6.
Which of the following are mild to moderately potent topical steroids?
a)
Hydrocortisone 1%
b)
Betnovate (betamethasone butyrate 0.1%)
c)
Flucinalone
d)
Locoid (Hydrocortisone butyrate 0.1%)
e)
Diprosalic (Betamethasone dipropionate 0.1%)
Which of the following is true?
a)
Discoid lupus is usually associated with SLE
b)
Dermatomyositis is associated with a violaceous heliotrope rash
on the eyelids, elbows and knuckles.
c)
Neurofibromatosis is characterized by adenoma sebaceum,
ash leaf macules and shagreen patches
d)
Pretibial myxoedema is seen in Graves disease
e)
Granuloma annulare is commonly associated with
Diabetes mellitus
Which of the following statements are true?
a)
A nodule is a raised lesion >0.5 cm in diameter
b)
Dermatitis is characteristically scaly
c)
A macule in a raised lesion <1cm in diameter
d)
A golden yellow crust on the skin is suggestive of
Streptococcus pyogenes infection
e)
Violaceous lesions are suggestive of connective tissue disease
The following statements are correct:
a)
A bulla is a collection of fluid under the skin
b)
Weals are pathognognomic of dermatitis
c)
Small pus-filled blisters are called vesicles
d)
A rash lasting less than 24 hours is virtually
diagnostic of urticaria
e)
A plaque is a raised lesion with a flat surface
T
F
T
F
F
F
T
F
T
F
T
F
F
T
T
T
F
F
T
T
In relation to systemic malignancy, the following statements are correct:
a)
Pruritis is a cutaneous marker
b)
Bullous pemphigoid is a cutaneous marker
c)
Dermatomyositis is a cutaneous marker
d)
Acanthosis nigricans is a cutaneous marker
e)
Alopecia areata is a cutaneous marker
T
F
T
T
F
Patch testing is useful in following circumstances:
a)
diagnosing allergic contact dermatitis
b)
diagnosing food allergy
c)
diagnosing latex allergy (Type 1 hypersensitivity)
d)
diagnosing atopic dermatitis
e)
investigation of occupational dermatitis
T
F
F
F
T
7.
8.
9.
10.
11.
12.
The following are types of endogenous dermatitis:
a)
atopic dermatitis
b)
seborrheic dermatitis
c)
irritant contact dermatitis
d)
nummular (discoid) dermatitis
e)
allergic contact dermatitis
T
T
F
T
F
In relation to acne, the following statements are true:
a)
most patients have increased circulating androgen levels
b)
most patients have increased sebum production
c)
narrowing of the sebaceous gland duct is an important factor
d)
S.aureus is the main bacterium seen
e)
Penicillin is the first line treatment of choice
F
T
F
F
F
The following statements are correct:
a)
Rosacea is commoner in women than men
b)
Rosacea can be treated with topical steroids
c)
Rosacea is associated with tinnitus
d)
Rosacea is associated with conjunctivitis
e)
Rosacea is commonly treated with oral oxytetracycline
T
F
F
T
T
In relation to syphilis, the following statements are correct:
a)
the primary chancre is usually painful ulcer of genitalia
b)
the interval between the primary chancre and the eruption
of secondary syphilis is usually 6-12 months
c)
the disease may be transmitted by shared needles
d)
a rash on the palms and soles is characteristic
of secondary syphilis
e)
alopecia is a recognized feature
The following statements are correct:
a)
Grouped vesicles on an erythematous base are suggestive
of herpes simplex infection.
b)
Post herpetic neuralgia can follow untreated herpes simplex
c)
Eczema herpeticum often requires treatment with IV Aciclovir
d)
Herpes zoster is not contagious
e)
Herpes simplex infection is a common trigger
for erythema multiforme
The following statements are correct:
a)
Candida albicans infection can cause paronychia
b)
Candida albicans infection of the scalp can result
in kerion formation
c)
Candida albicans is frequently found in babies with nappy rash
d)
Tinea pedis is commonly caused by Trichophyton rubrum
e)
Tinea pedis is usually treated with oral antifungals
F
F
F
T
T
F
F
T
T
T
T
F
T
T
F
13.
14.
15.
16.
17.
18.
The following are appropriate treatments for acne vulgaris:
a)
Oxytetracycline
b)
Dietary advice
c)
Rifampicin
d)
Iso-t-retinoin
e)
Minocycline
T
F
F
T
T
The following statements are correct:
a)
onychomycosis describes fungal infection of the nails
b)
3% of the population has a fungal nail infection
c)
fungal nail infections respond well to topical antifungals
d)
Trichophyton tonsurans causes tinea capitis
e)
Tinea capitis can cause scarring alopecia
T
T
F
T
T
The following associations are correct:
a)
Gianotti crosti syndrome and hepatitis
b)
Kawasaki disease and coronary artery aneurysms
c)
Chicken pox and pneumonitis
d)
Guttate psoriasis and staphylococcal infection
e)
Leishmaniasis and sand fly
T
T
T
F
T
The following are true of psoriasis:
a)
Affects 10% of population
b)
Peak age of onset is first decade
c)
Frequently involves palm
d)
May follow episode of sort throat
e)
Demonstrates dominant inheritance pattern
F
F
F
T
F
The Koebner (isomorphic) phenomenon is observed in the following:
a)
Psoriasis
b)
Plane warts
c)
Dermatitis herpetiformis
d)
Lichen planus
e)
Herpes simplex infection
T
T
F
T
F
The following might be considered as first line treatment options
in an 18 year old female with generalized psoriasis:
a)
dithranol ointment
b)
oral tetracycline
c)
Vitamin D analogues
d)
Oral steroids
e)
Oral retinoids
T
F
T
F
F
19.
20.
21.
22.
23.
24.
Psoriasis may be aggravated by:
a)
Lithium
b)
Sunlight
c)
Stress
d)
Dithranol ointment
e)
Oral tetracycline
T
T
T
T
F
Actinic keratoses:
a)
are common on the ears of females
b)
common on the palms
c)
some 20% will progress to SCC
d)
responds well to liquid nitrogen therapy
e)
are common on the shins of females
F
F
F
T
T
Basal cell carcinomas
a)
frequently metastasize
b)
may be pigmented
c)
usually presents as a scaling patch
d)
best treated with liquid nitrogen
e)
may present on the legs
F
T
F
F
T
Squamous cell carcinomas
a)
readily metastasize
b)
commonly occur on legs
c)
may develop following PUVA therapy
d)
early lesions are typically cystic in appearance
e)
are less common in transplant patients
T
T
T
F
F
Photosensitivity is seen in the following
a)
Paracetamol
b)
thiazide diuretics
c)
oral erythromycin
d)
NSAIDs
e)
psoralen ingestion
F
T
F
F
T
Erythema multiforme may be precipitated by
a)
herpes simplex infection
b)
radiotherapy
c)
mycoplasma infection
d)
PUVA therapy
T
T
T
F
1.
Which of the following are mild to moderately potent topical steroids?
a)
Hydrocortisone 1%
b)
Betnovate (betamethasone butyrate 0.1%)
c)
Flucinalone
d)
Locoid (Hydrocortisone butyrate 0.1%)
e)
Diprosalic (Betamethasone dipropionate 0.1%)
2.
Which of the following is true?
a)
Discoid lupus is usually associated with SLE
b)
Dermatomyositis is associated with a violaceous heliotrope rash
on the eyelids, elbows and knuckles.
d)
Neurofibromatosis is characterized by adenoma sebaceum,
ash leaf macules and shagreen patches
d)
Pretibial myxoedema is seen in Graves disease
e)
Granuloma annulare is commonly associated with
Diabetes mellitus
3.
Which of the following statements are true?
a)
A nodule is a raised lesion >0.5 cm in diameter
b)
Dermatitis is characteristically scaly
c)
A macule in a raised lesion <1cm in diameter
d)
A golden yellow crust on the skin is suggestive of
Streptococcus pyogenes infection
e)
Violaceous lesions are suggestive of connective tissue disease
4.
The following statements are correct:
a)
A bulla is a collection of fluid under the skin
b)
Weals are pathognognomic of dermatitis
c)
Small pus-filled blisters are called vesicles
d)
A rash lasting less than 24 hours is virtually
diagnostic of urticaria
e)
A plaque is a raised lesion with a flat surface
5.
In relation to systemic malignancy, the following statements are correct:
a)
Pruritis is a cutaneous marker
b)
Bullous pemphigoid is a cutaneous marker
c)
Dermatomyositis is a cutaneous marker
d)
Acanthosis nigricans is a cutaneous marker
e)
Alopecia areata is a cutaneous marker
6.
Patch testing is useful in following circumstances:
a)
diagnosing allergic contact dermatitis
b)
diagnosing food allergy
c)
diagnosing latex allergy (Type 1 hypersensitivity)
d)
diagnosing atopic dermatitis
e)
investigation of occupational dermatitis
7.
The following are types of endogenous dermatitis:
a)
atopic dermatitis
b)
seborrheic dermatitis
c)
irritant contact dermatitis
d)
nummular (discoid) dermatitis
e)
allergic contact dermatitis
8.
In relation to acne, the following statements are true:
a)
most patients have increased circulating androgen levels
b)
most patients have increased sebum production
c)
narrowing of the sebaceous gland duct is an important factor
d)
S.aureus is the main bacterium seen
e)
Penicillin is the first line treatment of choice
9.
The following statements are correct:
a)
Rosacea is commoner in women than men
b)
Rosacea can be treated with topical steroids
c)
Rosacea is associated with tinnitus
d)
Rosacea is associated with conjunctivitis
e)
Rosacea is commonly treated with oral oxytetracycline
10. In relation to syphilis, the following statements are correct:
a)
the primary chancre is usually painful ulcer of genitalia
b)
the interval between the primary chancre and the eruption
of secondary syphilis is usually 6-12 months
c)
the disease may be transmitted by shared needles
d)
a rash on the palms and soles is characteristic of secondary syphilis
e)
alopecia is a recognized feature
11. The following statements are correct:
a)
Grouped vesicles on an erythematous base are suggestive
of herpes simplex infection.
b)
Post herpetic neuralgia can follow untreated herpes simplex
c)
Eczema herpeticum often requires treatment with IV Aciclovir
d)
Herpes zoster is not contagious
e)
Herpes simplex infection is a common trigger
for erythema multiforme
12.
The following statements are correct:
a)
Candida albicans infection can cause paronychia
b)
Candida albicans infection of the scalp can result
in kerion formation
c)
Candida albicans is frequently found in babies with nappy rash
d)
Tinea pedis is commonly caused by Trichophyton rubrum
e)
Tinea pedis is usually treated with oral antifungals
13.
The following are appropriate treatments for acne vulgaris:
a)
Oxytetracycline
b)
Dietary advice
c)
Rifampicin
d)
Iso-t-retinoin
e)
Minocycline
14.
The following statements are correct:
a)
onychomycosis describes fungal infection of the nails
b)
3% of the population has a fungal nail infection
c)
fungal nail infections respond well to topical antifungals
d)
Trichophyton tonsurans causes tinea capitis
e)
Tinea capitis can cause scarring alopecia
15.
The following associations are correct:
a)
Gianotti crosti syndrome and hepatitis
b)
Kawasaki disease and coronary artery aneurysms
c)
Chicken pox and pneumonitis
d)
Guttate psoriasis and staphylococcal infection
e)
Leishmaniasis and sand fly
16.
The following are true of psoriasis:
a)
Affects 10% of population
b)
Peak age of onset is first decade
c)
Frequently involves palm
d)
May follow episode of sort throat
e)
Demonstrates dominant inheritance pattern
17.
The Koebner (isomorphic) phenomenon is observed in the following:
a) Psoriasis
b) Plane warts
c) Dermatitis herpetiformis
d) Lichen planus
e) Herpes simplex infection
18.
The following might be considered as first line treatment options
in an 18 year old female with generalized psoriasis:
a) dithranol ointment
b) oral tetracycline
c) Vitamin D analogues
d) Oral steroids
e) Oral retinoids
19.
Psoriasis may be aggravated by:
a) Lithium
b) Sunlight
c) Stress
d) Dithranol ointment
e) Oral tetracycline
20.
Actinic keratoses:
a) are common on the ears of females
b) common on the palms
c) some 20% will progress to SCC
d) responds well to liquid nitrogen therapy
e) are common on the shins of females
21.
Basal cell carcinomas
a) frequently metastasize
b) may be pigmented
c) usually presents as a scaling patch
d) best treated with liquid nitrogen
e) may present on the legs
22.
Squamous cell carcinomas
a) readily metastasize
b) commonly occur on legs
c) may develop following PUVA therapy
d) early lesions are typically cystic in appearance
e) are less common in transplant patients
23.
Photosensitivity is seen in the following
a) Paracetamol
b) thiazide diuretics
c) oral erythromycin
d) NSAIDs
e) psoralen ingestion
24.
Erythema multiforme may be precipitated by
a) herpes simplex infection
b) radiotherapy
c) mycoplasma infection
d) PUVA therapy
1.
Topical steroids are classified by potency into four groups:
Group
Classification
Examples
.
1
Very potent
Betamethasone dipropionate, Clobetasol
2
Potent
Fluticasone, Betamethasone valerate,
Hydrocortisone butyrate, methylprednisone
3
Moderately potent
Clobetasone/Flucinalone/Triamcinolone
4.
Mildly potent
Hydrocortisone (0.5-1.0%)
Topical steroids can be combined to use in ointments (for dry skin) or creams
(for weeping or wet skin). They have therapeutic use in both eczema and
psoriasis.
Side effects: - epidermal atrophy (thinning)
- telangiectasia (blood vessels)
- striae (stretch marks)
- premature aging due to collagen loss
- exacerbation of skin infection
2.
a)
b)
Lupus erythematosus is an autoimmune disorder which occurs in two main
forms-SLE (systemic lupus erythematosus), which affects both the skin
and internal organs, and discoid lupus erythematosus (DLE), in which the
skin alone is affected. A small proportion of people suffering from DLE
may subsequently develop SLE. A third variant, SCLE (subacute
cutaneous lupus erythematosus) is characterized by distinctive skin lesions
which MAY be associated with systemic features.
Dermatomyositis is an autoimmune inflammatory disease of skin and
muscle which may occur in childhood or adult life. There are no
differences in the manifestations of the disease of these two age groups,
although only the adult variant may be associated with systemic
malignancy (and may not) and the childhood variant shows vasculitis and
calcinosis, which are NOT seen in the adult variant.
SKIN changes:
- violaceous (violet color) erythema on face and anterior neck.
This is known as “heliotrope erythema”
- periorbital edema
- erythema to dorsa of hands, dorsa of fingers, over knees and
elbows
- erythematous papules on knuckles
- CHILDHOOD variant has vasculitis whichskin ulceration in
axillae and groins
MUSCLE changes:
- anywhere from no muscle disease to profound muscle
weakness can be found.
- proximal, symmetrical weakness and wasting.
- Arthralgia, pulmonary fibrosis may be present
c)
There are two forms of neurofibromatosis, NFT-1 (chromosome
17) and NFT-2 (chromosome 22) both autosomal dominantly inherited
syndromes with cutaneous manifestations.
NFT-1 multiple café-au-lait spots, axillary freckling, Lisch nodules (iris
hamartomas), neurofibromas
NFT-2 cataracts, bilateral acoustic neuromas and CNS tumors
Tuberous sclerosis is a dominantly inherited disorder, but many cases are
sporadic and represent new mutations. There are hamartomatous
malformations in skin and internal organs. The condition contains
cutaneous and non-cutaneous lesions:
Cutaneous:
- numerous pink papules on face (aka adenoma sebaceum)
which are angiofibromas (CT and small blood vessels)
- CT naevus on back (aka shagreen patch)
- Periungual fibromas
- Hypopigmented macules (aka ash-leaf macules)
Ash leaf macules present at birth usually, but the other lesions (adenoma
sebaceum and shagreen patch) present about age 5-6.
Non-cutaneous: mental retardation, epilepsy, hamartomas (pulmonary,
renal) and cardiac rhabdomyomas.
d)
Graves disease is a form of hyperthyroidism, whose cutaneous
signs may include:
- excessive sweating
- palmar erythema
- diffuse alopecia
- nails clubbing and onycholysis
- pretibial myxoedema (subcutaneous deposition of excessive
amounts of mucopolysaccharide leading to erythema and
thickening over shins and dorsa of foot.
- Pruritis (seen in hypothyroidism and hyperthyroidism)
HyPOthyroidism leads to:
- dry thick skin due to subcutaneous mucin deposition
(myxoedema)
- yellowish skin due to carotene deposition
- periorbital edema
- thin hair
- loss of outer part of eyebrow
e)
3.
There is NO significant association between classical Granuloma annulare
and diabetes, but in a much RARER generalized form of granuloma
annulare there IS an association with diabetes. Typically, lesions are firm
skin-colored papules arranged in rings, occurring on the dorsa of hands
and feet. CUTANEOUS manifestations of diabetes mellitus include:
- cutaneous infections
- neuropathic ulcers
- necrobiosis lipoidica diabeticorum (erythematous yellowish
brown, atrophic, typically on shins. May ulcerate).
- Diabetic dermopathy (small brown scar like lesions on shins,
thought to be associated with diabetic microangoipathy)
- Diabetic bullae (uncommon)
- Xanthomas (due to hyperlipidemia)
- Acanthosis nigricans (associated with insulin resistance)
- Lipoatrophy
Characteristics of dermatological lesions can be summarized as:
Macule:
circumscribed FLAT area of skin discoloration
Papule:
circumscribed ELEVATION of skin LESS than 0.5 cm in
diameter.
Nodule:
circumscribed ELEVATION of skin MORE than 0.5 cm in
diameter
Plaque:
circumscribed, disc-shaped, elevated area of skin:
Small LESS than 2 cm diameter
Large MORE than 2 cm diameter
Vesicle:
small visible collection of fluid (less than 0.5 cm diameter)
Bulla:
large visible collection of fluid (more than 0.5 cm diameter)
Pustule:
Visible accumulation of pus
Ulcer:
loss of epidermis, often with loss of underlying dermis and
subcutis as well
Weal:
Circumscribed elevated area of cutaneous edema
Dermatitis is not characteristically scaly-it’s characteristically itchy
Typically scaly is psoriasis
Golden yellow crust on the skin refers to impetigo. Impetigo is a highly infectious
skin disease in children, which presents as weeping, exudative areas with a honeycolored crust on the surface. It’s spread by direct contact. Group A -Strep (aka
Strep.pyogenes) and Staph Aureus are the causative agents.
Violaceous lesions are found in dermatomyositis. Since dermatomyositis is a
autoimmune connective tissue disorder causing erythematous regions on elbows,
knees, knuckles, face and neck, this statement is true.
4.
Bulla is a large visible collection of fluid more than 0.5 cm in diameter, while
vesicle is a small visible collection of fluid less than 0.5 cm in diameter.
Weals are pathognomic of urticaria
Small pus-filled blisters are called pustules
Urticaria is the clinical term for disorders characterized by formation of “weals.”
(swellings of skin which disappear leaving no visible sign). The main pathological
change is dermal edema due to vascular dilatation, often in response to histamine
released by mast cells. The skin itches and stings-weals develop and lesions
become extensive and appear in many sites at once- “always clear spontaneously
within a few hours.
A plaque is a raised flat lesion.
5.
Malignant tumors may metastasize to the skin, and tumors of the kidneys, ovaries,
gastrointestinal system, breast and bronchus are most likely to do so.
Scalp metastases may produce areas of alopecia (alopecia neoplastica)
Alopecia areata is an autoimmune form of alopecia and is NOT associated with
neoplasm
Lymphatic extension to skin can produce erythematous induration called
carcinoma erysipeloides.
Metastases of ovarian and git can spread via ligamentum teres and present as an
umbilical nodule (Sister Joseph’s nodule).
Cutaneous signs of underlying malignancy include:
- dermatomyositis
- acanthosis nigricans (esp. GIT adenocarcinoma)
- generalized pruritis
- thrombophlebitis migrans (esp. pancreas Ca)
- acquired ichthyosis (“fish scale skin”: keratinization disorder
causing extremely dry scaly skin) (esp. lymphoma)
- pyoderma gangrenosum (esp. myeloma and leukemia)
- necrolytic migratory erythema (esp. pancreatic glucagonoma)
- flushing (esp. carcinoid syndrome)
- hypertrichosis lanuginosa (sudden growth of profuse vellus
hair over the face and body)
6.
Patch testing is based on the delayed type (Type 4) hypersensitivity, mediated by
macrophages and T-cells. It is useful in allergic drug reactions and eczema
(dermatitis). Since occupational dermatitis may include a contact allergic
component, patch testing may be useful. Since patch testing is to evaluate type
four hypersensitivity, latex allergy (type 1) is not effectively evaluated using
patch testing. Likewise, atopic dermatitis and food allergies are type 1, IgE
mediated hypersensitivity and thus patch testing is not useful for their diagnosis.
7.
The principal symptom of eczema is itching. Erythema, edema, papules, vesicles
and exudation are common. Chronic forms may show lichenification. Eczema is
classified into exogenous and endogenous groups, with the following included in
each:
Exogenous:
Endogenous: -
-
-
8.
primary irritant contact dermatitis
allergic contact dermatitis
atopic eczema (IgE mediated, associated with atopic asthma
and allergic rhinitis)
seborrheic dermatitis (involved Mallasezia yeasts, most
commonly on scalp, face, flexures and upper back; no cure
but steroid lotions, ketoconazole shampoo and
combinations of steroid/imidazole may be useful)
discoid eczema (scattered and well-demarcated
exuding/crusting eczema of unknown cause)
varicose eczema (chronic venous HTNeczematous changes
on legs which spreads to forearms. Treatment=topical
steroid)
palmoplantar eczema (long term topical steroids treat)
asteatotic eczema (“eczema craquele” (paving pattern over legs
usually, secondary to aging effect on decreasing lipid
content of stratum corneum)
Acne is seen on face, neck (posterior mostly), upper back, anterior chest,
shoulders and ears. Severe acne may extend to the arms. The skin appears greasy
due to increased production of sebum. Lesions include comedones (whiteheads
and blackheads), papules, pustules, nodules, scars and cysts.
Pathogenesis:
a.
Androgens stimulate increased sebum production
b.
Hair follicles in sebaceous gland block (not narrow)
with hyperkeratinization
c.
The closed comedo results
d.
Within the follicle, obligate anaerobe (Propionibacterium
acnes) proliferates.
e.
Propionibacterium acnes acts on sebum, releasing
inflammatory chemicals
f.
Inflammatory chemicals leak into the dermis
g.
Treatments:
9.
Body mounts an acute inflammatory response, leaving a
pustule, papule or nodule.
Topical:
- Benzoyl peroxide (reduces comedones)
- Retinoids
- Sulfur and astringents
- Topical antiseptics, antibiotics and combination products
Systemic:
- Antibiotics (Tetracyclines and erythromycins)
- Steroids
- Iso-t-retinoin (Vitamin A derivative-may affect LFTs)
- Cyproterone acetate (only in women-acts as anti-androgen)
Rosacea is a common inflammatory rash affecting the face. Onset is middle age
and it’s commoner in women. Cause is unknown. Clinically, it causes flushing,
papules, pustules affecting nose, forehead and cheeks. There are NO comedones,
but there MAY be telangiectasia, blepharitis, conjunctivitis. In men, keratitis and
sebaceous gland hypertrophy of the nose causes rhynophyma.
Treatment
-
topical metronidazole
oral tetracyclines
oral iso-t-retinoin (in resistant cases)
**steroids must be AVOIDED as they exacerbate or trigger this condition**
10.
Syphilis is a chronic systemic disease, acquired or congenital. The causative
organism, Treponema pallidum, is acquired by close sexual contact or
transplacentally. The disease is split into primary, secondary and tertiary stages
Exposure to pathogen
10-90 days passes
Primary:
- papule develops at site of inoculation
- papule ulcerates to form painless firm chancre
- painless lymphadenopathy
30-70 days pass
Secondary:
-
General: fever, sore throat, malaise and arthralgia.
Generalized lymphadenopathy is common (50%)
- Skin:
Maculopapular NONitchy rash
Condyloma lata (warty, plaque-like lesions in perianal area
and other moist sites
Ulcerated mucosal surfaces
Latency period may occur (may last 2 years)
Tertiary:
-
11.
Gummas (granulomatous ulcerating lesion) found in skull,
clavicle, tibia, fibula and viscera`
Cardiovascular and neurosyphilis can occur
Alopecia can occur
The herpes viruses have several subtypes, each of which has a unique clinical
presentation:
Herpes simplex:
- includes: HSV-1 cold sores on lips and face
HSV-2 genital herpes
While the trends above are generally true, there is
NOT a rigid territorial demarcation and lesions
anywhere may be caused by either antigenic type
- Contact with HSV-1 is usually contracted in early childhood.
Developing lesions are most often mild. RARELY, a severe
gingivostomatitis develops with painful erosions on buccal
mucosa and lips. Genital herpes results from sexual
transmission of HSV-2 or orogenital transmission of HSV-1.
Physical contact in sport can also cause HSV transmission.
- HSV settles in sensory ganglia and is triggered by
immunocompromise, etc.
- Recurrent HSV can trigger erythema multiforme (target
lesions). Prophylactic oral acyclovir is of great benefit in these
cases.
Eczema herpeticum: widespread herpes simplex infection
occurring in atopic eczema  lymphadenopathy in head and neck
If extensive, admit and give IV Aciclovir.
Herpes zoster (shingles):
Chicken pox and shingles are both caused by the VZV (varicella zoster
virus). Following chicken pox, virus remains dormant in dorsal root ganglia until
something restimulates it, causing shingles in the distribution of a dermatome,
most often in abdomen or thorax. “grouped vesicles on an erythematous base”
Immunocompromise may result in multiple dermatomes being affected.
Postherpetic neuralgia is the persistence of pain after the lesions have healed,
associated with herpes zoster.
12.
Candida infection: Candidiasis is a term applied to infections of the skin and
mucous membranes by yeast of genus Candida. The yeast Candida albicans is
commonest and is normally commensal in gastrointestinal tract. In pathogenic
forms, budding and mycelial forms are usually present. When situations favor its
multiplication (topical and systemic steroids, immunosuppression, broadspectrum
antibiotics, diabetes, etc), it can cause:
-
buccal mucosal candidiasis (oral thrush)
angular cheilitis (inflammatory process at corners of mouth)
paronychia (thickened erythematous nail fold+loss of cuticle)
balanitis and vulvovaginitis: creamy vaginal discharge and itchy
vulval erythema.
- diaper rash
Generally, lozenge or topical nystatin or imidazoles are helpful in treatment.
Kerion is a nodular, boggy, exudative, circumscribed lesion covered in pustules,
occurring usually in association with tinea barbae and tinea capitis, but
occasionally by other fungi. It is more common in those of African origin and is
often accompanied by severe alopecia.
Dermatophyte infections:
- referred to as “ringworm of the”, followed by “feet,” “groin,”
“scalp,” etc, or can also be referred to as “tinea” followed
by “pedis” (foot), “cruris” (groin),”capitis” (head),
“manuum” (hand), “unguium” (toenail), etc.
- belong to one of three genus (Microsporum, Trichophyton,
Epidermophyton).
- Tinea unguium causes thick, discolored brittle nails
(onychomycosis)
- All dermatophytes secrete keratinase, which digests keratin,
thus forming scaling of skin, loss of hair and crumbling of
nails.
Treatment for:
- small areas of skin for tinea pedis/ corporis/ cruris/
manuum:
topical antifungals (Imidazoles/Terbinafine)
- extensive areas: oral griseofulvin, terbinafine, itraconazole
- Tinea Capitis: MUST use oral griseofulvin. Terbinafine and
Imidazoles are less effective against tinea capitis, probably
because Trichophyton rubrum isn’t associated, instead it’s
Trichophyton tonsurans or Microsporum that are implicated.
- Tinea unguium: nail infections are not responsive to topical
treatments and long-term oral therapy is needed with oral
terbinafine for 6 weeks in fingernails and 12 weeks in toenail
infections. Contraindications to terbinafine should use oral
itraconazole pulse therapy.
13.
See question 8:
There is no evidence that changing diet alters acne vulgaris. Current treatments
include:
TOPICAL
- benzoyl peroxide
- retinoids and retinoid-like agents
- sulfur and astringents (make skin flaky and unblock hair
follicles)
- topical antiseptics, antibiotics (tetracyclines, erythromycin and
clindamycin) or combinations
SYSTEMIC
- antibiotics (tetracyclines, erythromycin, clindamycin)
- cyproteron acetate (anti-androgen, use only in women)
- iso-t-retinoin (Vitamin A derivative)
- steroids (esp. in acne fulminans)
14.
Onychomycosis is another term for tinea unguium (ringworm of the nail).
Since ringworms are in fact fungi, onychomycosis is in fact a fungal nail
infection.
The population prevalence of fungal nail infections (tinea unguium) is between 2
and 8%, according to the Australian Association of dermatology (online)
Fungal nail infections do not respond well to topical treatments, unless the nail is
thin and the infection is minimal (usually fungal infections make the nail thick,
however, rendering the topical treatments useless). Effective treatment of tinea
unguium requires 6 weeks (fingernail) or 12 weeks (toe-nail) oral terbinafine or
oral pulse itraconazole.
Tinea capitis
Tinea barbae
Tinea corporis
Tinea cruris
Tinea pedis
Tinea manuum
Tinea unguium
Trichophyton tonsurans
Microsporum andouinii
Microsporum canis
Trichophyton verrucosum
Trichophyton rubrum
Microsporum canis
Trichophyton tonsurans
Trichophyton verrucosum
Trichophyton rubrum
Epidermophyton floccosum
Trichophyton rubrum
Trichophyton mentagrophytes var interdigitaale
Trichophyton rubrum
Trichophyton mentagrophytes
Trichophyton rubrum
Trichophyton mentagrophytes var mentagrophyte
Tinea capitis can cause alopecia of a non-scarring variety (on its own). However,
tinea capitis is associated with kerion formation, and kerion can cause scarring
alopecia.
15. Gianotti crosti syndrome (aka infantile acrodermatitis, popular acrodermatitis of
childhood): a generally benign and self-limited disease of young children,
characterized by nonpruritic, red, flat topped firm papules forming symmetrical
eruption on face, buttocks and limbs (INCLUDES palms and soles!). Associated
with malaise, low grade fever. Cause is viral infection, often Hepatitis B.
Kawasaki disease: syndrome of unknown cause, usually affecting young children,
associated with vasculitis of large coronary vessels, causing cervical
lymphadenopathy, and maculoerythematous skin eruption. Skin becomes
indurated and edematous. Aneurysms of coronary vessels is common and thus
echocardiography must be performed after resolution of symptoms
Varicella Zoster virus (VZV) causes chicken pox and shingles. Chicken pox most
commonly, after a 2 week incubation period, causes fever, headache and rash. The
rash starts on the face and trunk and spreads to cover the whole body, including
mucus membranes. In immunocompromised, pneumonia (inflammation of lungs
with consolidation) and encephalitis may occur. Pneumonitis (inflammation of
lungs) thus also occurs.
Guttate psoriasis often develops suddenly, and may follow an infection, especially
“strep throat.” It’s a common way for psoriasis to present in young adults. “Gutta”
means “drop,” as most lesions are about 1cm in diameter and paler in color than
established plaque psoriasis. The main differential for guttate psoriasis is
pityriasis rosea. These can be distinguished as below:
Guttate psoriasis
Pityriasis rosea
- parakeratotic scale
- “herald patch” of large red oval scaly
- round lesion
- oval lesion
Leishmania is zoonotic, carried by rodents,dogs and foxes, transmitted to humans
by the bite of the sandfly. Following transmission, the leishmania invades
phagocytic cells and multiplies within the phagocytic cells in the lymph nodes,
spleen, liver and bone marrow (reticuloendothelial system). Leishmaniasis can
form three different clinical pictures depending on the T-cell response of the host.
Cutaneous leishmaniasis:
A skin ulcer develops at the site of the sandfly bite, heals within a year if
host responses are intact (simple cutaneous leishmaniasis). If immune system is
deficient, nodular skin lesion arises without ulceration. Numerous nodular lesions
are found across the body, especially around the nose (diffuse cutaneous
leishmaniasis).
Mucocutaneous leishmaniasis:
Dermal ulcer at site of sandfly bite is followed by erosion of nasal septum,
soft palate, and lips.
Visceral leishmaniasis:
Sandfly transmits leishmania who months later complains of abdominal
discomfort and distension, low-grade fevers and weight loss. Invasion of the
reticuloendothelial cells cause hepatomegaly and MASSIVE splenomegaly.
16.
Psoriasis affects up to 2% of the population of Western countries. Psoriasis
generally doesn’t present until youth or early adulthood.
While one psoriasis variant is palmo-plantar pustulosis (erythematous patches
with pustules on palms and plantar surfaces, that turn brown and scaly then peel
off), most cases of psoriasis do NOT involve the palm.
Guttate psoriasis commonly presents after “strep throat” particularly in young
adults.
Although a family history is common, there is no clear cut inheritance pattern and
the “genetic” explanation may not be readily understood by patients.
17.
The Koebner phenomenon (aka “isomorphic” phenomenon) is a cutaneous
response of lesions on uninvolved skin typical of skin disease at sites of trauma,
scars or points of pressure. It is seen in psoriasis (general plaque psoriasis), lichen
planus, infectious eczematous dermatitis and plane warts (HPV virus is inoculated
into scratches and abrasions).
Dermatitis herpetiformis, aka linear IgA disease, is associated with celiac disease,
and most often presents with erythematous papules and vesicles on elbows,
knees, shins, shoulders and scalp. The itch may result in excoriations, secondary
eczematization and lichenification.
18.
Dithranol is a first choice, but patient lifestyle or side-effects may make it
impractical. If so, vitaminD analogues or topical steroids (with or without
tar/salicylic acid) are often used. UV may help. Extensive lesions or poor
response lead to PUVA, retinoid (2nd line) or cytotoxic drug use. Under no
circumstances should oral steroids be used.
19.
Drugs that can aggravate psoriasis include lithium, chloroquine and
hydroxychloroquine, beta-blockers, NSAIDs and ACE inhibitors.
While difficult to quantify, it is generally agreed that stress can aggravate
psoriasis.
Sun can exacerbate psoriasis in some patients, even though UV is more often
helpful in psoriasis.
Dithranol is a first choice in plaque psoriasis and works by an unknown
mechanism. It is often so effective that the plaque disappears completely.
However, it can exacerbate psoriasis in some patients, especially when applied to
previously non-affected skin.
20.
Actinic or solar keratoses are areas of dysplastic squamous epithelium without
invasion, but they DO have low-grade malignant potential and their presence
indicates unstable epithelium.
Red scaly patches wax and wane with time.
Common sites:light exposed areas (face, forearms, dorsa of hands, lower legs,
bald scalp).
Treatment:
For small numbers of lesions, use cryotherapy.
For large areas of face and scalp affected, use topical antimitotic
agent 5-fluorouracil.
In elderly, may be best to do nothing
(old bastards croak before actinic keratosesSCC)
It is estimated (by www.skincancer.org/ak/index.ahp) that 2-5% of all actinic
keratoses progress to SCC, but this usually takes a very long time.
21.
Basal cell carcinomas are the commonest malignant skin tumor and are also
known as “rodent ulcers.”
Clinically:
- rolled edge (spreads outward leaving central depression)
- pearly skin+ telangiectasias ( contact bleeding).
- metastases are extremely rare but local invasion is extensive
and destructive (can spread along bone into skull)
- affects predominantly the face, but can be anywhere on sunexposed areas (esp. scalp, behind ear, on trunk)
- can be pigmented, superficial, or morphemic (ivory waxy) as
well.
Treatment depends on type:
- SUPERFICIAL curettage, cryotherapy or photodynamic
therapy
- Morphoeic or other excision, biopsy and radiotherapy
22.
SCCs are locally invasive and metastasize to regional lymph nodes and beyond.
UV radiation is an important cause as is smoking (lip and mouth SCC) and HPV
(genital SCC).
Clinically keratotic lump OR
Polypoid mass OR
Cutaneous ulcer.
SCC may be surrounded by actinic keratoses.
Sites:
lips, mouth, genitals, sun-exposed areas (legs)
Treatment surgical removal and radiotherapy
23.
Photosensitive reactions have been reported for several drugs. Clinically, patients
complain that sun exposure is followed by a burning sensation (not on urination),
followed by erythema, swelling and eczematous changes on light-exposed areas.
Common causes include:
phenothiazines
chlorpromazine, thioridazine,
fluphenazine, prochlorperazine
sulfonamides
sulphamethoxazole, trimethoprim
tetracyclines
tetracycline, oxytetracycline, minocycline
thiazides
bendroflumethiazide, indapamide, xipamide
One of the macrolides (Azithromycin) has reported to have a risk of
photosensitivity, none of the other macrolides (erythromycin, clarithromycin,
telithromycin) has had such reports.
Of course, psoralen is also photosensitive and it is this benefit that allows it to be
used in PUVA therapy in psoriasis and eczema (less commonly, but may be
useful in atopic eczema)
24.
.
Erythema multiforme involves a classic lesion of “target” lesion- round or oval
area of erythema with dusky purple center.
Lesions:
- appear suddenly and enlarge over few days then fade
- repeated episodes usually triggered by herpes simplex.
Clinically:
- extensor surfaces including palms and soles
Pathology
- vasculitis (the extent of the damage relates to seriousness of
vascular damage)
Treatment
- self-limiting, thus no treatment is usually required
Known triggers include:
- viruses (EBV, HSV, Hepatitis, mumps)
- mycoplasma infection
- radiotherapy
- carcinomas and lymphomas
- CT diseases (SLE and polyarteritis nodosa)
- Wegener’s granulomatosis
- drugs (sulphonamides and anticonvulsants)