FACIAL RASHES

Question 1

Define:
macule
papule
nodule

Answer 1

macule- textural/colour change
papule- small solid elevation <5mm diameter
nodule- small solid elevation >5mm diameter

Question 2

What oral conditions have facial/skin manifestations

Answer 2

• HSV
• Varicella zoster virus
• KSHV
• Erythema multiforme
• Pemphigus vulgaris
• MMP
• chronic hyperplasia candidosis- angular chelitis

Question 3

Herpes simplex virus (what is it + tx)

Answer 3

• fluid filled blisters that burst forming painful ulceration
• lip involvement + skin manifestations
• primar herpatic gingivostomatitis

Treatment:

• ACYCLOVIR SUSPENSION 200mg in 5ml of water 5 times a day for 5 days
• keep patient hydrated (this could be a reason for hospital admission)
• CHX mouthwash to prevent secondary bacterial infection
• analgesics eg. lidocaine/difflam or paracetamol/ibuprofen
• prevent close contact

Question 4

Varicella zoster virus what is it

Answer 4

• initially as a kid= chicken pox and adult= reactivates as shingles
• underlying malignancy/immunocompromised pt (HIV)
• singles= effects a single dermatome (trunk)
• preference of Cranial nerve 5 and 7

Question 5

oral symptoms of herpes zoster

Answer 5

• unilateral vesicles

- burst leaving painful herpetic ulcers

Question 6

What divisions of the trigeminal nerve (5) are effected in varicella zoster virus (herpes zoster)

Answer 6

V1 opthamlic and V2 maxillary
V1= opthalmic herpes zoster ->corneal scarring ->loss of vision
V2= gingival/tooth pain and can be misdiagnosed as pulpitis
systemic associations:
Lymphadenopathy
pyrexia
malaise

Question 7

Herpes zoster effecting the 7th cranial nerve is called?

Answer 7

Ramsay Hunt syndrome

• LMN facial paralysis
• External auditory meatus vesicles
• deafness
• altered taste

Question 8

What is Karposi sarcoma

Answer 8

• malignant tumor of endothelial cells
• abnormal vascule proliferation = purple colour
• caused by HHV8 (endotheliotropic and angiogenic properties)
• associated with HIV/AIDS
• low CD4+ levels (normal= 500-1500)

Question 9

Kaposi sarcoma clinical features

Answer 9

• often on the palate
• purple/red papules/macules/nodules
• associated with HIV/AIDS
• lymph, GIT, oral, cutaneous
• low CD4+ (normal 500-1500)

Question 10

How to treat KSHV

Answer 10

• cART
• follow up to check CD4+
• Kaposi sarcoma= surgical excision/cryotherapy/radiothrapy/chemotherapy

Question 11

What is rosacea

Answer 11

chronic inflammatory facial dermatosis= pustules+erythema+telangiectasia + congested conjunctiva/conjunctivitis/blepharitis/keratitis (corneal scarring)/rhinophyma
-common in fair skin+ blue eyes
EXACERBATED BY= TOPICAL CORTICOSTEROIDS+SUN

Question 12

Management of rosacea

Answer 12

NO CORTICOSTEROIDS AS THIS EXACERBATES IT
topical metronidazole gel 2 times a day
tetracycline for 2-3 months (causes oral pigmentation)
rhinoplasty for rhinophyma

Question 13

Seborrheic dermatitis

Answer 13

chronic inflammation scaly itchy erythematous eruption
scalp+face (effects sebaceous glands)
flexural surfaces have a secondary infection of c.albicans
pityrosporum ovale

Question 14

seborrhoeic dermatitis scalp and facial presentations

Answer 14

• dandruff
• itchy scaly erythematous eruption
• blepharitis
• side of nose scalp marign ears eyebrows eyes- blepharitis

Question 15

Management of seborrheoic dermatitis

Answer 15

scalp- medicated shampoo

facial- imidazole+hydrocortisone cream

Question 16

perioral dermatitis

Answer 16

• nares, nasolabial folds and lip commisieurs
• red papules and pustules
• clear zone at vermillion border
• EXACERBATED WITH CORTICOSTEROIDS LIKE ROSACEA

Question 17

Treatment of perioral dermatitis

Answer 17

stop topical corticosteroids

tetracyclines for 8-12 weeks

Question 18

Topical corticosteroid side effects

Answer 18

• perioral dermatitis

- rosacea

Question 19

eczematous chelitis 2 groups

Answer 19

ENDOGENOUS- atopic eczema

EXOGENOUS- eg. lip licking

Question 20

What causes alopecia

Answer 20

• DLE
• Lichen planos -planopilaris
• MMP