Dermatology

Question 1

What is the most common type of exzema?

Answer 1

Atopic excema

Question 2

What is atopy?

Answer 2

overactive immune response to environmental stimuli

Question 3

What is the atopic march?

Answer 3

tendency to 3 commonly linked conditions:

ECZEMA, ASTHMA and HAYFEVER

Question 4

Atopic exzema is caused by an abnormality in the expression of which protein?

Answer 4

Abnormality in filaggrin expression.

Question 5

Distribution of atopic exzema

Answer 5

• Infancy
  
  • Typically starts on the face/neck (cheeks common), can spread more generally
• Older children
  
  • Flexural pattern predominates (antecubital fossae, popliteal fossae, wrists, hands, ankles)

Question 6

Childhood exzema flares can be associated with:

Answer 6

• Infections/viral illness
• Environment: central heating, cold air
• Pets: if sensitised/allergic
• Teething
• Stress

Question 7

What type of exzema is this?

Which parts of the body does it affect?

What age group does it affect?

Treatment

Answer 7

• Seborrheoic dermatitis
• Mainly scalp and face
• Often babies under 3 months, usually resolves by 12 months
• Emollients, antifungal creams, antifungal shampoos, mild topical steroids

Question 8

What type of exzema is this?

Answer 8

• Discoid exzema
• Scattered annular/circular patches of itchy eczema
• Can occur in this pattern as part of atopic eczema or in isolation

Question 9

What type of exzema is this?

Which body part is it found on?

Characteristics

Answer 9

• Pomphylx eczema
• Hand and foot exzema
• Characterised by vesicles; can be intensly itchy

Question 10

What are the two types of exogenous exzema?

Answer 10

• Allergic eczema
  
  • sensitised to allergen
  • Type IV hypersensitivity - patch testing helpful
• Irritant eczema
  
  • repeated contact; water and soaps, touching irritant foods; citrus, tomatoes, chemical irritants

Question 11

Symptoms of immediate reactions from food allergy

Answer 11

• lip swelling
• facial redness/itching
• anaphylactoid symptoms

(Type 1 reaction)

Question 12

Symptoms of late reactions to food allergy

Answer 12

• worsening of eczema 24/48 hours after ingestion
• GI problems
• Failure to thrive
• Severe eczema unresponsive to treatment
• Severe generalised itching - even when the skin appears clear

(Type 4 hypersensitivity)

Question 13

Tests for immediate reaction food allergies

Answer 13

• Blood test for specific IgE antibodies (RAST)
• Skin prick testing

Question 14

What are some of the causes of immediate reaction allergies

Answer 14

• Commonest: milk, soy, peanuts, eggs
• Airborne allergens - house dust mite, pet dander, pollens

Question 15

How would you confrim the allergy for late reaction food allergies?

Answer 15

• Dietary restrictions/eliminations 6-8 weeks
• Eliminate one food at a time

Question 16

Exzema treatment

Answer 16

• Emollients
• Topical steroids
• Calcineurin inhibitors (e.g protopic – steroid sparing topical agents)
• UVB light therapy
• Immunosuppressive medication

Question 17

Side effects of prolonged use of topical steroids

Answer 17

Skin thinning

Question 18

How are creams measured?

Answer 18

Finger tip unit

Question 19

What type of skin infection is this?

How does transmission take place?

Describe the lesions

How long does it take to clear?

Management

Answer 19

• Molluscum contagiosum
• Transmission to close direct contacts
• Pearly papules, umbilicated centre
• Can take up to 24 months to clear
• Reassurance + 5% Potassium Hydroxide

Question 20

What is this skin infection?

Which bacteria is this superficial skin infection caused by?

Describe the skin

Treatment

Answer 20

• Impetigo
• Staph aureus
• Pustules and honey-coloured crusted erosions
• Topical antibacterial (fucidin); Oral antibiotic (flucloxacillin)

Question 21

What is this skin condition?

What is it caused by?

How is it transmitted?

Treatment

Answer 21

• Viral warts
• Human papiloma virus
• Transmitted by direct skin contact
• Topical treatments such as salicylic acid and paring; Cryotherapy

Question 22

What does this picture show?

What is the most common cause for this in children?

Answer 22

Chicken pox

Question 23

What are the symptoms of varicella zoster?

Answer 23

• Red papules (small bumps) progressing to vesicles (blisters) often start on the trunk
• Itchy
• Associated with viral symptoms

Question 24

When is varicella zoster contageous?

Answer 24

Contagious 1-2 days before rash appears and until lesions have crusted.

Question 25

What is this picture showing? Describe the lesions What areas does this occur? How long does it take to resolve?

Answer 25

* **Erythema Nodosum** * Painful, erythematous subcutaneous nodules * Over Shins; sometimes other sites * Slow resolution - like bruise, 6-8 weeks

Question 26

Causes of erythema nodosum

Answer 26

* Infections - Streptococcus, Upper respiratory tract * Inflammatory bowel disease * Sarcoidosis * Drugs - OCP, Sulphonamides, Penicillin * Mycobacterial infections * Idiopathic

Question 27

What does this picture show? What can cause this? Treatment

Answer 27

* Wheals / hives * Viral infection; bacterial infection; food or drug allergy; NSAIDS, opiates; vaccinations * Antihistamines 3x daily