Computer generated transcript

Warning!
The following transcript was generated automatically from the content and has not been checked or corrected manually.

EVERYTHING YOU NEED TO KNOW ABOUT SKIN RASHES Priya Potamsetty and Shrey Parmar Here’s what we do: ■ Weekly tutorials open to all! ■ Focussed on core presentations and teaching diagnostic technique If you’re new here… ■ Bstudentsl students, for medical ■ Reviewed by doctors to ensure W elcome to accuracy T eaching ■ We’ll keep you updated about our Things! upcoming events via email and groupchats! T erminology Skin Disease Texture Image <10MM, flat lesion, not palpable T erminology Skin Disease Texture Image MACULE <10MM, flat lesion, not palpable T erminology Skin Disease Texture Image >10MM, flat lesion, not palpable T erminology Skin Disease Texture Image PATCH >10MM, flat lesion, not palpable T erminology Skin Disease Texture Image <10mm, distinct raised lesion T erminology Skin Disease Texture Image PAPULE <10mm, distinct raised lesion T erminology Skin Disease Texture Image >10mm, elevated, solid lesion, well circumscribed T erminology Skin Disease Texture Image >10mm, elevated, solid lesion, well PLAQUE circumscribed T erminology Skin Disease Texture Image <10mm, inflamed, pus-filled lesion T erminology Skin Disease Texture Image PUSTULE <10mm, inflamed, pus-filled lesionAcneSBA 1 A 14 year old boy presents to GP complaining about recent skin changes. On examination, he has diffuse papules, pustules and comedones of the face. This is affecting his self-esteem and he is keen to start treatment. What isthe most appropriate initial management? a. Topical benzoyl peroxide b. Oral retinoid c. Advise strict skin hygiene routine d. Topical adapalene and benzoyl peroxide e. Oral doxycycline and topical clindamycinSBA 1 A 14 year old boy presents to GP complaining about recent skin changes. On examination, he has diffuse papules, pustules and comedones of the face. This is affecting his self-esteem and he is keen to start treatment. What isthe most appropriate initial management? a. Topical benzoyl peroxide b. Oral retinoid c. Advise strict skin hygiene routine d. Topical adapalene and benzoyl peroxide e. Oral doxycycline and topical clindamycinSBA 1 - 1st line treatment of moderate acne A 14 year old boy presents to GP complaining about recent skin changes. On examination, he has diffuse papules, pustules and comedones of the face. This is affecting his self-esteem and he is keen to start treatment. What is the most appropriate initial management? a. Topical benzoyl peroxide b. Oral retinoid c. Advise strict skin hygiene routine d. Topical adapalene and benzoyl peroxide (or tretinoin+clindamycin or benzoyl peroxide + clindamycin) e. Oral doxycycline and topical clindamycinSBA 1 - 1st line treatment of moderate acne A 14 year old boy presents to GP complaining about recent skin changes. On examination, he has diffuse papules, pustules and comedones of the face. This is affecting his self-esteem and he is keen to start treatment. What is the most appropriate initial management? a. Topical benzoyl peroxide b. Oral retinoid -severe acne - 3rd line treatment c. Advise strict skin hygiene routine d. Topical adapalene and benzoyl peroxide (or tretinoin+clindamycin or benzoyl peroxide + clindamycin) e. Oral doxycycline and topical clindamycinSBA 1 - 1st line treatment of moderate acne A 14 year old boy presents to GP complaining about recent skin changes. On examination, he has diffuse papules, pustules and comedones of the face. This is affecting his self-esteem and he is keen to start treatment. What is the most appropriate initial management? a. Topical benzoyl peroxide - should combination treatment as moderate acne b. Oral retinoid -severe acne - 3rd line treatment c. Advise strict skin hygiene routine d. Topical adapalene and benzoyl peroxide (or tretinoin+clindamycin or benzoyl peroxide + clindamycin) e. Oral doxycycline and topical clindamycinSBA 1 - 1st line treatment of moderate acne A 14 year old boy presents to GP complaining about recent skin changes. On examination, he has diffuse papules, pustules and comedones of the face. This is affecting his self-esteem and he is keen to start treatment. What is the most appropriate initial management? a. Topical benzoyl peroxide - should combination treatment as moderate acne b. Oral retinoid - severe acne - 3rd line treatment c. Advise strict skin hygiene routine d. Topical adapalene and benzoyl peroxide (or tretinoin+clindamycin or benzoyl peroxide + clindamycin) e. Oral doxycycline and topical clindamycin - don’t combine oral and topical AbxSBA 1 - 1st line treatment of moderate acne A 14 year old boy presents to GP complaining about recent skin changes. On examination, he has diffuse papules, pustules and comedones of the face. This is affecting his self-esteem and he is keen to start treatment. What is the most appropriate initial management? a. Topical benzoyl peroxide - should combination treatment as moderate acne b. Oral retinoid - severe acne - 3rd line treatment c. Advise strict skin hygiene routine d. Topical adapalene and benzoyl peroxide (or tretinoin+clindamycin or benzoyl peroxide + clindamycin) e. Oral doxycycline and topical clindamycin - don’t combine oral and topical Abx Lifestyle/skincare: - Avoid over-cleaning - Use non-alkaline synthetic detergent x2 daily - Avoid oil-based comedogenic skin care products, and remove all products at the end of the day - Eat a balanced, healthy dietPathogenesis of acne vulgaris 1. Pilosebaceous follicle hyperkeratinisation (clogging of the follicle) 2. ↑ sebum production 3. Propionbacterium acnes ( now known as cutibacterium )cnes proliferation within follicle 4. InflammationAcne vulgaris severity Severe acne: widespread papules, pustules and nodules Mild acne: mostly or cysts, often with scarring non-inflamed lesions (comedones) Moderate acne: more widespread with more papules and pustules Management Conservative Medical (GP) Dermatologist Minimise stress/triggers See below Oral isotretinoin Don’t overwash Mild-moderate acne: Can start with single treatments then: Mixed combination of a topical cream for 12 weeks: Retinoids are ■ Topical adapalene + topical benzoyl peroxide teratogenic! ■ Topical tretinoin + topical clindamycin Ensure not pregnant, ■ Topical benzoyl peroxide + topical clindamycin contraception If this doesn’t work - for moderate-severe acne: ■ Topical adapalene + topical benzoyl peroxide WITH oral lymecycline OR oral doxycycline ■ Topical azelaic acid x2 daily WITH oral lymecycline OR oral doxycyclineA quick review of ABx Clindamycin is what family of Abx?A quick review of ABx Clindamycin is what family of Abx? ■ MacrolideA quick review of ABx Clindamycin is what family of Abx? ■ Macrolide Big macrolide side effects?A quick review of ABx Clindamycin is what family of Abx? ■ Macrolide Big macrolide side effects? ■ Long QT ■ P450 inhibitors ■ GI disturbancesA quick review of ABx Doxycycline is what family of Abx?A quick review of ABx Doxycycline is what family of Abx? ■ TetracyclineA quick review of ABx Doxycycline is what family of Abx? ■ Tetracycline Big tetracycline side effects?A quick review of ABx Doxycycline is what family of Abx? ■ Tetracycline Big tetracycline side effects? ■ Don’t give in pregnancy ■ GI disturbances maternal hepatotoxicityh discolouration in baby, risk of ■ PhotosensitivitySBA 2 A 14 year old boy presents to GP complaining about recent skin changes. On his face, he has several papules, pustules and comedones. What organism is thought to have a role in this condition? A. Staphylococcus aureus B. Demodex folliculorum C. Cutibacterium acnes D. Propionebacterium acnes E. Malassezia furfurSBA 2 A 14 year old boy presents to GP complaining about recent skin changes. On his face, he has several papules, pustules and comedones. What organism is thought to have a role in this condition? A. Staphylococcus aureus B. Demodex folliculorum C. Cutibacterium acnes D. Propionebacterium acnes E. Malassezia furfurSBA 2 A 14 year old boy presents to GP complaining about recent skin changes. On his face, he has several papules, pustules and comedones. What organism is thought to have a role in this condition? A. Staphylococcus aureus - impetigo B. Demodex folliculorum C. Cutibacterium acnes D. Propionebacterium acnes E. Malassezia furfurSBA 2 A 14 year old boy presents to GP complaining about recent skin changes. On his face, he has several papules, pustules and comedones. What organism is thought to have a role in this condition? A. Staphylococcus aureus - impetigo B. Demodex folliculorum - rosacea C. Cutibacterium acnes D. Propionebacterium acnes E. Malassezia furfurSBA 2 A 14 year old boy presents to GP complaining about recent skin changes. On his face, he has several papules, pustules and comedones. What organism is thought to have a role in this condition? A. Staphylococcus aureus - impetigo B. Demodex folliculorum - rosacea C. Cutibacterium acnes D. Propionebacterium acnes E. Malassezia furfur - seborrheic dermatitis, pityriasis versicolorSBA 2 A 14 year old boy presents to GP complaining about recent skin changes. On his face, he has several papules, pustules and comedones. What organism is thought to have a role in this condition? A. Staphylococcus aureus - impetigo B. Demodex folliculorum - rosacea C. Cutibacterium acnes Propionibacterium is now known as Cutibacterium D. Propionebacterium acnes E. Malassezia furfur - seborrheic dermatitis, pityriasis versicolorSBA 3 An 18 year old woman comes to GP complaining of acne, weight gain, and facial hair growth. She uses topical benzoyl peroxide which offers some, but not complete, improvement of her acne. Which is the most appropriate treatment to offer her? a. Dianette b. Mirena coil c. Oral doxycycline d. Oral retinoid e. Progesterone-only pillSBA 3 - Anti-androgen medication in females An 18 year old woman comes to GP complaining ofacne, weight gain, and facial hair growth. She uses topical benzoyl peroxide which offers some, but not complete, improvement of her acne. Which is the most appropriate treatment to offer her? a. Dianette - this is a COCP - she has PCOS which makes this a great option b. Mirena coil c. Oral doxycycline d. Oral retinoid e. Progesterone-only pill SBA 3 - Anti-androgen medication in females An 18 year old woman comes to GP complaining ofacne, weight gain, and facial hair growth. She uses topical benzoyl peroxide which offers some, but not complete, improvement of her acne. Which is the most appropriate treatment to offer her? a. Dianette - this is a COCP - she has PCOS which makes this a great option b. Mirena coil c. Oral doxycycline d. Oral retinoid e. Progesterone-only pill *Brand names are rarely used in SBAs but Dianette is a good one to know! COCP is a good option for young women with acne even without PCOS.SBA 4 A 24-year old pregnant women presents to GP. A picture of her face is shown below. What is the most appropriate initial treatment? A. Topical benzoyl peroxide B. Dianette C. Oral doxycycline D. Oral isotretinoin E. Topical retinoidSBA 4 - drugs to avoid in pregnancy A 24-year old pregnant women presents to GP. A picture of her face is shown below. What is the most appropriate initial treatment? A. Topical benzoyl peroxide B. Dianette C. Oral doxycycline D. Oral isotretinoin E. Topical retinoidSBA 4 - drugs to avoid in pregnancy A 24-year old pregnant women presents to GP. A picture of her face is shown below. What is the most appropriate initial treatment? A. Topical benzoyl peroxide B. Dianette - not during pregnancy C. Oral doxycycline D. Oral isotretinoin E. Topical retinoidSBA 4 - drugs to avoid in pregnancy A 24-year old pregnant women presents to GP. A picture of her face is shown below. What is the most appropriate initial treatment? A. Topical benzoyl peroxide B. Dianette - not during pregnancy C. Oral doxycycline - Highly teratogenic - definitely not during pregnancy D. Oral isotretinoin E. Topical retinoid - likely not as teratogenic as oral but likely not worth the riskSBA 4 - drugs to avoid in pregnancy A 24-year old pregnant women presents to GP. A picture of her face is shown below. What is the most appropriate initial treatment? A. Topical benzoyl peroxide B. Dianette - not during pregnancy C. Oral doxycycline - Highly teratogenic - defintiely not during pregnancy D. Oral isotretinoin E. Topical retinoid - likely not as teratogenic as oral but likely not worth the risk *Erythromycin can be used during pregnancy if oral antibiotic is indicatedSBA 5 A 21 year old man presents to GP; his face is shown below. He currently takes oral tetracycline, topical isotretinoin and topical benzoyl peroxide. What is the best next step in this management of this patient? a. Oral isotretinoin b. Laser therapy c. Refer to dietician with follow up in 4 weeks d. Reassure and discharge e. Refer to dermatologySBA 5 A 21 year old man presents to GP; his face is shown below. He currently takes oral tetracycline, topical isotretinoin and topical benzoyl peroxide. What is the best next step in this management of this patient? a. Oral isotretinoin b. Laser therapy c. Refer to dietician with follow up in 4 weeks d. Reassure and discharge e. Refer to dermatology - with a view to start oral retinoidSBA 5 A 21 year old man presents to GP; his face is shown below. He currently takes oral tetracycline, topical isotretinoin and topical benzoyl peroxide. What is the best next step in this management of this patient? a. Oral isotretinoin - correct treatment but dermatology must start it, not the GP b. Laser therapy c. Refer to dietician with follow up in 4 weeks d. Reassure and discharge e. Refer to dermatology - with a view to start oral retinoidSBA 5 A 21 year old man presents to GP; his face is shown below. He currently takes oral tetracycline, topical isotretinoin and topical benzoyl peroxide. What is the best next step in this management of this patient? a. Oral isotretinoin - correct treatment but dermatology must start it, not the GP b. Laser therapy - not a tx for acne c. Refer to dietician with follow up in 4 weeks d. Reassure and discharge - maybe if it were mild e. Refer to dermatology - with a view to start oral retinoid *The stem of the question said management, not treatment! Be aware of this!SBA 5 A 21 year old man presents to GP; his face is shown below. He currently takes oral tetracycline, topical isotretinoin and topical benzoyl peroxide. What is the best next step in this management of this patient? a. Oral isotretinoin - correct treatment but dermatology must start it, not the GP b. Laser therapy - not a tx for acne c. Refer to dietician with follow up in 4 weeks d. Reassure and discharge - maybe if it were mild e. Refer to dermatology - with a view to start oral retinoid Oral isotretinoin side effects: ● Liver derangement (monitor LFTs) ● Teratogenic (avoid in pregnancy) ● ?Depression (screen with PHQ9) ● Others: dry lips, headache, photosensitivity, myalgiaSBA 6 What is the likeliest cause of the presentation shown below? a. Acne vulgaris b. Lupus pernio c. Rosacea d. Neurofibromatosis 1 e. IdiopathicSBA 6 - Rosacea What is the likeliest cause of the presentation shown below? a. Acne vulgaris b. Lupus pernio c. Rosacea - a.k.a. Acne rosacea d. Neurofibromatosis 1 e. Idiopathic Rhinophyma - ‘nose swelling’Rosacea ■ Circular distribution around nose ■ Looks like acute lupus but does not spare folds and maybe pustular (is also way more common) ■ Looks like acne but no comedones and also later in life ■ Complications: rhinophyma and posterior blepharitisRosacea ■ Circular distribution around nose ■ Looks like acute lupus but does not spare folds and maybe pustular (is also way more common) ■ Looks like acne but no comedones and also later in life ■ Complications: rhinophyma and posterior blepharitis WEATHER/SUNLIGHTS SPICY FOOD R LIFESTYLE G I T STEROIDS DRUGS VASODILATORSSBA 7 A 37 year old woman presents to GP complaining that she has developed ‘red bumpy skin’ on her face which is worse when she is out in the sun. On examination, she has papules and pustules with a small amount of telangiectasia. What is the most appropriate initial treatment? A. Topical brimonidine gel B. Topical metronidazole C. Topical retinoid D. Topical ivermectin E. Topical steroidSBA 7 - 1st line treatment of rosacea A 37 year old woman presents to GP complaining that she has developed ‘red bumpy skin’ on her face which is worse when she is out in the sun. On examination, she has papules and pustules with a small amount of telangiectasia. What is the most appropriate initial treatment? A. Topical brimonidine gel B. Topical metronidazole C. Topical retinoid D. Topical ivermectin E. Topical steroidSBA 7 - 1st line treatment of rosacea A 37 year old woman presents to GP complaining that she has developed ‘red bumpy skin’ on her face which is worse when she is out in the sun. On examination, she has papules and pustules with a small amount of telangiectasia. What is the most appropriate initial treatment? A. Topical brimonidine gel - used in rosacea for those who have predominant erythema/flushing B. Topical metronidazole C. Topical retinoid D. Topical ivermectin E. Topical steroidSBA 7 - 1st line treatment of rosacea A 37 year old woman presents to GP complaining that she has developed ‘red bumpy skin’ on her face which is worse when she is out in the sun. On examination, she has papules and pustules with a small amount of telangiectasia. What is the most appropriate initial treatment? A. Topical brimonidine gel - used in rosacea for those who have predominant erythema/flushing B. Topical metronidazole C. Topical retinoid - used in acne vulgaris D. Topical ivermectin E. Topical steroidSBA 7 - 1st line treatment of rosacea A 37 year old woman presents to GP complaining that she has developed ‘red bumpy skin’ on her face which is worse when she is out in the sun. On examination, she has papules and pustules with a small amount of telangiectasia. What is the most appropriate initial treatment? A. Topical brimonidine gel - used in rosacea for those who have predominant erythema/flushing B. Topical metronidazole C. Topical retinoid - used in acne vulgaris D. Topical ivermectin E. Topical steroid - never! - you would get initial improvement then subsequent worsening.SBA 7 - 1st line treatment of rosacea A 37 year old woman presents to GP complaining that she has developed ‘red bumpy skin’ on her face which is worse when she is out in the sun. On examination, she has papules and pustules with a small amount of telangiectasia. What is the most appropriate initial treatment? A. Topical brimonidine gel - used in rosacea for those who have predominant erythema/flushing B. Topical metronidazole - alternative to ivermectin C. Topical retinoid - used in acne vulgaris D. Topical ivermectin E. Topical steroid - never! - you would get initial improvement then subsequent worsening.EczemaPathophysiology of Eczema ■ Genetic predisposition to having defects in skin barrier ■ Environmental triggers e.g. chemicals/detergents ■ IgE mediated type 1 hypersensitivity, IL17 & IL22 ■ Therefore important to keep moisturised to maintain skin barrierSBA 8 A woman brings her 1 year old son to GP. She says that he has dry, red skin which is most obvious at the elbows. She has been diligently applying moisturising cream to the affected areas but would like something stronger. Which is the most appropriate treatment to advise? A. Emollient gel B. Topical clobetasol C. Topical hydrocortisone 5% D. Topical hydrocortisone 1% E. Topical diphenhydramineSBA 8 - treatment for mild atopic eczema A woman brings her 1 year old son to GP. She says that he has dry, red skin which is most obvious at the elbows. She has been diligently applying moisturising cream to the affected areas but would like something stronger. Which is the most appropriate treatment to advise? A. Emollient gel B. Topical clobetasol C. Topical hydrocortisone 5% D. Topical hydrocortisone 1% E. Topical diphenhydramineSBA 8 - treatment for mild atopic eczema A woman brings her 1 year old son to GP. She says that he has dry, red skin which is most obvious at the elbows. She has been diligently applying moisturising cream to the affected areas but would like something stronger. Which is the most appropriate treatment to advise? A. Emollient gel - a.k.a moisturising gel B. Topical clobetasol C. Topical hydrocortisone 5% D. Topical hydrocortisone 1% E. Topical diphenhydramineSBA 8 - treatment for mild atopic eczema A woman brings her 1 year old son to GP. She says that he has dry, red skin which is most obvious at the elbows. She has been diligently applying moisturising cream to the affected areas but would like something stronger. Which is the most appropriate treatment to advise? A. Emollient gel - a.k.a moisturising gel B. Topical clobetasol - too strong C. Topical hydrocortisone 5% D. Topical hydrocortisone 1% E. Topical diphenhydramineSBA 8 - treatment for mild atopic eczema A woman brings her 1 year old son to GP. She says that he has dry, red skin which is most obvious at the elbows. She has been diligently applying moisturising cream to the affected areas but would like something stronger. Which is the most appropriate treatment to advise? A. Emollient gel - a.k.a moisturising gel B. Topical clobetasol - too strong C. Topical hydrocortisone 5% D. Topical hydrocortisone 1% E. Topical diphenhydramine - antihistamine - can be useful is there is itch/urticariaSBA 8 - treatment for mild atopic eczema A woman brings her 1 year old son to GP. She says that he has dry, red skin which is most obvious at the elbows. She has been diligently applying moisturising cream to the affected areas but would like something stronger. Which is the most appropriate treatment to advise? A. Emollient gel - a.k.a moisturising gel B. Topical clobetasol - too strong C. Topical hydrocortisone 5% - too strong D. Topical hydrocortisone 1% E. Topical diphenhydramine - antihistamine - can be useful is there is itch/urticariaEczema - a.k.a atopic dermatitis Inflammatory skin condition characterised by severe itching, redness, rashes - can be really painful and cause changes in skin colour. Features in history: Atopy Distribution: ● Flexors in adults ● Extensors in kids Conservative Topical UV Systemic Biologics Steroids Phototherapy Traditional Emollients after Will discuss in a bit Dupilumab - sc every shower Review after 2 injection Avoid triggers weeks 30 mins after emollients Steroid potencies Potency Generic Name Brand Name Mild Hydrocortisone Hydrocortisone Moderate Clobetasone Eumovate Potent Betamethasone Betnovate Very Potent Clobetasol Dermovate ‘This aide-memoire… Helps Every Budding Dermatologist Learn steroid potencies’SBA 9 You are the FY1 on ward and a student nurse approaches you saying that her hands feel itchy and tight. She denies repeated hand washing this morning as she has been diligently wearing PPE. What is the most likely diagnosis? A. Atopic dermatitis B. Irritant contact dermatitis C. Allergic contact dermatitis D. Seborrhoeic dermatitis E. Nummular dermatitisSBA 9 - allergic presentation You are the FY1 on ward and a student nurse approaches you saying that her hands feel itchy and tight. She denies repeated hand washing this morning as she has been diligently wearing PPE. What is the most likely diagnosis? A. Atopic dermatitis B. Irritant contact dermatitis C. Allergic contact dermatitis - probably from latex-containing gloves D. Seborrhoeic dermatitis E. Nummular dermatitisSBA 9 - allergic presentation You are the FY1 on ward and a student nurse approaches you saying that her hands feel itchy and tight. She denies repeated hand washing this morning as she has been diligently wearing PPE. What is the most likely diagnosis? A. Atopic dermatitis B. Irritant contact dermatitis C. Allergic contact dermatitis - probably from latex-containing gloves D. Seborrhoeic dermatitis E. Nummular dermatitis Investigations involve patch testing!SBA 10 You are the FY1 on the COOP ward round. The team come to Mr Smith, a 76year old male with suspected delirium secondary to UTI on a background of Parkinson’s disease. Although his delirium and UTI are improving, Mr Smith complains about intensely itchy scalp. What is the most likely diagnosis? A. Psoriasis B. Atopic dermatitis C. Scabies D. Seborrhoeic Dermatitis E. Tinea CapitisSBA 10 - Seborrhoeic dermatitis You are the FY1 on the COOP ward round. The team come to Mr Smith, a 76year old male with suspected delirium secondary to UTI on a background of Parkinson’s disease. Although his delirium and UTI are improving, Mr Smith complains about intensely itchy scalp. What is the most likely diagnosis? A. Psoriasis B. Atopic dermatitis C. Scabies D. Seborrhoeic Dermatitis - greasy eczema E. Tinea Capitis SBA 10 - Seborrhoeic dermatitis You are the FY1 on the COOP ward round. The team come to Mr Smith, a 76year old male with suspected delirium secondary to UTI on a background of Parkinson’s disease. Although his delirium and UTI are improving, Mr Smith complains about intensely itchy scalp. What is the most likely diagnosis? A. Psoriasis B. Atopic dermatitis C. Scabies D. Seborrhoeic Dermatitis - greasy eczema E. Tinea Capitis In infants - ‘cradle cap’ In the elderly - occurs on a background of immunosuppression or, neuro/psych conditions (Parkinson’s, depression, tardive dyskinesia…)Seborrhoeic Dermatitis Caused by Malassezia furfur - a fungus Treated with ketaconazole - an anti-fungal Not with steroids like the other types of dermatitisSeborrhoeic Dermatitis A young person presenting with Seborrhoeic Dermatitis - what should we test them for?Seborrhoeic Dermatitis A young person presenting with Seborrhoeic Dermatitis - what should we test them for? HIVSBA 11 You are in the GP practice seeing a patient you saw last week. It is a 1 year old boy with eczema who you saw last week and gave hydrocortisone 1%. Today, he has been brought in by his mum has he has a new rash on his face, and seems to be in severe pain and refusing to eat. On examination, the boy’s face is very red with a large vesicular rash. What is the most appropriate management? A. Refer urgently to paediatric A&E B. Increase topical therapy to hydrocortisone 5% C. Oral acyclovir D. Oral hydrocortisone E. Oral flucloxacillin SBA 11 - eczema herpeticum You are in the GP practice seeing a patient you saw last week. It is a 1 year old boy with eczema who you saw last week and gave hydrocortisone 1%. Today, he has been brought in by his mum has he has a new rash on his face, and seems to be in severe pain and refusing to eat. On examination, the boy’s face is very red with a large vesicular rash. What is the most appropriate management? A. Refer urgently to paediatric A&E B. Increase topical therapy to hydrocortisone 5% C. Oral acyclovir D. Oral hydrocortisone E. Oral flucloxacillin *Management is IV Aciclovir - it’s an emergency as high mortality riskPsoriasisPathophysiology of Psoriasis ■ Multifactorial & not fully understood ■ Inflammation and immune changes to skin ■ Triggers include trauma (Koebner’s phenomenon), drugs, strep throat etc. ■ T cell mediated- not a hypersensitivity ■ Keratinocyte deposition ■ Various manifestations in skin & extradermal complications, e.g. psoriatic arthritisSBA 12 A 42 year old man comes to GP complaining of red, itchy skin. On examination, multiple red, scaly, raised, well-demarcated regions are visible on trunk.What is the most likely diagnosis? A. Plaque psoriasis B. Flexural psoriasis C. Guttate psoriasis D. Pustular psoriasis E. Generalised psoriasisSBA 12 - plaque psoriasis A 42 year old man comes to GP complaining of red, itchy skin. Onexamination, multiple red, scaly, raised, well-demarcated regionsof skin are visible on trunk. What is the most likely diagnosis? A. Plaque psoriasis - typical form B. Flexural psoriasis C. Guttate psoriasis D. Pustular psoriasis E. Generalised psoriasisSBA 13 An 18 year old man comes to GP complaining of an outbreak of dry, scaly patches of skin. He has no medical hx other than a sore throat last week. What is the most likely diagnosis? A. Plaque psoriasis B. Flexural psoriasis C. Guttate psoriasis D. Pustular psoriasis E. Generalised psoriasisSBA 13 An 18 year old man comes to GP complaining of an outbreak ofdry, scaly patches of skin. He has no medical hx other than a sore throat last week. What is the most likely diagnosis? A. Plaque psoriasis B. Flexural psoriasis C. Guttate psoriasis - follows strep throat D. Pustular psoriasis E. Generalised psoriasis SBA 13 An 18 year old man comes to GP complaining of an outbreak ofdry, scaly patches of skin. He has no medical hx other than a sore throat last week. What is the most likely diagnosis? A. Plaque psoriasis B. Flexural psoriasis C. Guttate psoriasis - follows strep throat D. Pustular psoriasis E. Generalised psoriasis Guttate Psoriasis: ● Post-strep/URTI ● Teardrops, scaly rash ● Clears spontaneouslySBA 14 One of your patients, a 50 year old man, has ischaemic heart disease and psoriasis. Three weeks ago, his medications were changed. Over the past two weeks, he has significant worsening of his psoriasis. What is the likely causative drug? A. Amlodipine B. Atenolol C. Simvastatin D. Clopidogrel E. GTNSBA 14 - drugs which trigger psoriasis One of your patients, a 50 year old man, has ischaemic heart disease and psoriasis. Three weeks ago, his medications were changed. Over the past two weeks, he has significant worsening of his psoriasis. What is the likely causative drug? A. Amlodipine Common drugs that flare psoriasis: Psoriasis causes white (blanc or blanq) plaques: B. Atenolol ● Beta blockers C. Simvastatin ● Lithium D. Clopidogrel E. GTN ● Alcohol/ACEi ● NSAIDs ● Quines (antimalarials)SBA 15 A 42 year old man comes to GP complaining of red, itchy skin. O/E, multiple red, scaly, raised, well-demarcated regions are visible on his trunk. What is the most appropriate initial treatment? A. Topical Vitamin D B. Oral Vitamin D C. Topical betamethasone D. Oral betamethasone E. Topical Vitamin D + betamethasoneSBA 15 - Psoriasis 1st line tx (topical) A 42 year old man comes to GP complaining of red, itchy skin. O/E, multiple red, scaly, raised, well-demarcated regions are visible on his trunk. What is the most appropriate initial treatment? A. Topical Vitamin D B. Oral Vitamin D C. Topical betamethasone D. Oral betamethasone E. Topical Vitamin D + betamethasone *These are applied at different times of the the day (one in the morning, one night) otherwise they disrupt each other’s absorption.SBA 16 A 42 year old man with psoriasis has been fully compliant with his treatment and has found good relief from eight weeks of daily topical Betnovate. How long should he wait, if at all, before another course of topical steroid? A. He doesn’t need to wait B. 2 weeks C. 4 weeks D. 6 weeks E. 8 weeksSBA 16 - steroid treatment breaks A 42 year old man with psoriasis has been fully compliant with his treatment and has found good relief from eight weeks of daily topical Betnovate. How long should he wait, if at all, before another course of topical steroid? A. He doesn’t need to wait Betnovate is potent B. 2 weeks C. 4 weeks D. 6 weeks E. 8 weeksSBA 17 Another of your patients had an eight week course of topical therapy but saw no improvement in their psoriasis. What is the best additional treatment for this patient? A. Oral betamethasone B. Infliximab C. Methotrexate D. Ciclosporin E. UVB therapySBA 17 - step up from topical to phototherapy Another of your patients had an eight week course of topical therapy but saw no improvement in their psoriasis. What is the best additional treatment for this patient? A. Oral betamethasone B. Infliximab C. Methotrexate D. Ciclosporin E. UVB therapy - if topical fails, step up to phototherapy UVB phototherapy Or PUVA phototherapy - UVA + oral PsoralenSBA 18 The poor patient is on maximum topical therapy and phototherapy to no avail. What next? A. Cyclophosphamide B. Methotrexate C. Ciclosporin D. Acitretin E. TacrolimusSBA 18 - step up from phototherapy to systemic The poor patient is on maximum topical therapy and phototherapy to no avail. What next? A. Cyclophosphamide B. Methotrexate C. Ciclosporin All used for systemic therapy, but methotrexate D. Acitretin is the go-to in most instances E. TacrolimusSBA 19 A 50 year old man was referred urgently to dermatology outpatients. Despite maximum topical therapy and phototherapy, he has plaque psoriasis affecting almost his entire body, and he complains of arthritis which is limiting his mobility. His daughter is getting married in two weeks and he asks whether there is anything that will help his condition. What is the most appropriate treatment to advise? A. Cyclophosphamide B. Methotrexate C. Cyclosporin D. Acitretin E. TacrolimusSBA 19 - rapid improvement with cyclosporin A 50 year old man was referred urgently to dermatology outpatients. Despite maximum topical therapy and phototherapy, he has plaque psoriasis affecting almost his entire body, and he complains of arthritis which is limiting his mobility. His daughter is getting married in two weeks and he asks whether there is anything that will help his condition. What is the most appropriate treatment to advise? A. Cyclophosphamide B. Methotrexate C. Cyclosporin - can produce rapid improvement D. Acritretin E. Tacrolimus THANKS FOR WATCHING! Please fill out the feedback form on Medall and see you next week!