Which one of the following antibiotics is most associated with the development of Stevens-Johnson syndrome?
Correct Answer A: Stevens-Johnson syndrome severe form of erythema multiforme associated with mucosal involvement and systemic symptoms.
Stevens-Johnson syndrome Features:
Causes:
Stevens–Johnson syndrome/toxic epidermal necrolysis (SJS/TEN). Atypical targets. There are multiple discrete red macules – each has a darker centre and a slightly paler outer ring.
Stevens–Johnson syndrome/toxic epidermal necrolysis (SJS/TEN). Purpuric macules. The dusky, purpuric lesions on this patient’s skin are coalescing and blistering.
Stevens–Johnson syndrome/toxic epidermal necrolysis (SJS/TEN). Palm involvement. Multiple circular lesions are present on the palms blistering is occurring.
Stevens–Johnson syndrome/toxic epidermal necrolysis (SJS/TEN). Plantar involvement. Multiple circular lesions are present on the soles blistering is occurring.
Ocular disease in Stevens–Johnson syndrome (SJS). Acute conjunctivitis with mucus discharge occurring concurrently with erythema multiforme-like skin lesions.
Haemorrhagic crusting of the lips in Stevens–Johnson syndrome.
A 33-year-old man presents complaining of an itchy scalp and dandruff. On examination he is noted to have eczema on his scalp, behind his ears and around his nose. He has tried 'Head and Shoulders' and 'Neutrogen Tgel' but with poor results.
Which one of the following is the most appropriate treatment for his scalp?
Correct Answer E: Seborrhoeic dermatitis in adults is a chronic dermatitis thought to be caused by an inflammatory reaction related to a proliferation of a normal skin inhabitant, a fungus called Malassezia furfur (formerly known as Pityrosporum ovale). It is common, affecting around 2% of the general population.
Seborrhoeic dermatitis in adults Features:
Associated conditions include:
Scalp disease management:
Face and body management:
A 34-year-old patient who is known to have psoriasis presents with erythematous skin in the groin and genital area. He also has erythematous skin in the axilla. In the past he has expressed a dislike of messy or cumbersome creams.
What is the most appropriate treatment?
Correct Answer A: Flexural psoriasis - topical steroid.
This patient has flexural psoriasis which responds well to topical steroids. Topical calcipotriol is usually irritant in flexures. Mild tar preparations are an option but may be messy and cumbersome.
Psoriasis: management:
SIGN released guidelines in 2010 on the management of psoriasis and psoriatic arthropathy. Please see the link for more details.
Chronic plaque psoriasis:
Steroids in psoriasis:
Scalp psoriasis:
Secondary care management:
Phototherapy:
Systemic therapy:
Mechanism of action of commonly used drugs:
Which one of the following statements regarding vitiligo is true?
Correct Answer C: This is known as the Koebner phenomenon.
Vitiligo is an autoimmune condition which results in the loss of melanocytes and consequent depigmentation of the skin. It is thought to affect around 1% of the population and symptoms typically develop by the age of 20-30 years.
Vitiligo Features:
Associated conditions:
Management:
A 50-year-old man presents with shiny, flat-topped papules on the palmar aspect of the wrists. He is mainly bothered by the troublesome and persistent itching. A diagnosis of lichen planus is suspected.
Correct Answer E: Lichen planus is a skin disorder of unknown aetiology, most probably being immune mediated.
Lichen planus Features:
Lichenoid drug eruptions - causes:
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