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Drug of Choice Cheatsheet — Dermatology Focus (MRCP Part 1)

TL;DR

This clinician-written guide summarises the drug of choice decisions most frequently tested in dermatology for MRCP Part 1. It focuses on first-line therapy, escalation rules, and common traps, with a short MCQ and a practical revision checklist. Use this alongside structured revision from the MRCP Part 1 hub and question practice to lock in marks.


Why dermatology drug choice matters in MRCP Part 1

Dermatology contributes a small but highly predictable share of Part 1 questions. Candidates often identify the diagnosis correctly but lose marks by choosing an inappropriate treatment: the wrong potency of steroid, unnecessary antibiotics, or escalation too early. The exam tests safe, guideline-based UK practice, aligned with NICE and British Association of Dermatologists (BAD) guidance.

If you are building a systematised revision plan, start with the MRCP Part 1 overview (https://www.crackmedicine.com/mrcp-part-1/) and then reinforce decisions with targeted MCQs from the question bank (https://www.crackmedicine.com/qbank/).


Scope: what the exam actually tests

You are unlikely to be asked niche dermatology. Instead, expect:

  • Common inflammatory dermatoses (eczema, psoriasis, acne)

  • Skin infections (impetigo, cellulitis, dermatophytes, scabies)

  • Drug reactions and emergencies (SJS/TEN)

  • Autoimmune blistering disease (bullous pemphigoid)

The emphasis is on first-line treatment, one step of escalation, and contraindications (pregnancy, age, immunosuppression).


High-yield drug of choice list (memorise these)

  1. Atopic eczema (moderate flare)First line: Emollients + topical corticosteroid (potency according to site and severity).Key rule: Face and flexures → mild potency only.

  2. Psoriasis (chronic plaque)First line: Vitamin D analogue ± potent topical steroid. Next step: Phototherapy or systemic therapy for extensive disease.

  3. Acne vulgaris (moderate inflammatory)First line: Topical retinoid + benzoyl peroxide. Avoid: Oral or topical antibiotics as monotherapy.

  4. Rosacea (papulopustular)First line: Topical metronidazole or ivermectin. Trap: Do not use topical steroids.

  5. Impetigo (localised)First line: Topical fusidic acid (short course).Widespread/systemic: Oral flucloxacillin if appropriate.

  6. Cellulitis (non-purulent)First line: Oral flucloxacillin. Escalate: IV therapy if systemic features.

  7. Tinea corporis or cruris First line: Topical terbinafine. Oral therapy: Only if extensive or refractory.

  8. Scabies First line: Permethrin 5% cream, repeat after 7 days.Exam rule: Treat all close contacts simultaneously.

  9. Bullous pemphigoid First line: High-potency topical corticosteroids, even in extensive disease.

  10. Stevens–Johnson syndrome / TEN Immediate management: Stop the offending drug + supportive care in HDU/burns unit. Trap: No routine antibiotics.

  11. Chronic spontaneous urticaria First line: Non-sedating H1 antihistamine, up-titrate dose if needed.

  12. Herpes zoster (within 72 hours)First line: Oral aciclovir. IV therapy: Immunocompromised or severe disease.

MRCP Part 1 candidate revising dermatology drug of choice notes at a study desk

Five most tested subtopics (with examiner intent)

  1. Eczema vs psoriasis – steroid potency and vitamin D use distinguish them.

  2. Acne treatment ladders – combination topical therapy before systemic agents.

  3. Fungal infections – topical first; avoid unnecessary oral antifungals.

  4. Blistering disease – topical steroids are first-line in bullous pemphigoid.

  5. Drug reactions – SJS/TEN equals supportive care, not pharmacological escalation.

Quick reference table

Condition

Drug of choice

Key exam point

Atopic eczema

Topical corticosteroid

Potency depends on site

Psoriasis

Vit D analogue ± steroid

Chronic disease pathway

Acne (moderate)

Retinoid + BPO

No antibiotic monotherapy

Impetigo

Topical fusidic acid

Short duration

Scabies

Permethrin 5%

Treat contacts

Bullous pemphigoid

Potent topical steroid

Elderly patients

Mini-case (MCQ)

Question A 74-year-old man presents with tense blisters on erythematous skin, intense pruritus, and no mucosal involvement. Skin biopsy confirms bullous pemphigoid. What is the most appropriate initial treatment?

A. Oral azathioprineB. High-potency topical corticosteroidsC. Oral aciclovirD. MethotrexateE. Dapsone

Correct answer: B

Explanation: Bullous pemphigoid is usually managed initially with potent topical steroids, even in widespread disease. Systemic immunosuppressants are reserved for refractory cases or when topical treatment is impractical.


Common pitfalls (exam favourites)

  • Using potent topical steroids on the face

  • Prescribing antibiotics for SJS/TEN

  • Forgetting to treat scabies contacts

  • Escalating to oral antifungals unnecessarily

  • Confusing eczema and psoriasis treatment pathways


Practical study-tip checklist


FAQs

Is dermatology high yield in MRCP Part 1?

Yes. Although fewer questions, they are predictable and heavily guideline-based.

Do I need to memorise doses?

Rarely. The exam focuses on correct drug choice, not dosing minutiae.

Are combination steroid–antifungal creams safe?

Generally avoid unless specifically indicated; they are a common exam trap.

What resources should I trust?

MRCP(UK) sample questions, NICE CKS, and BAD guidelines are the safest sources.


Ready to start?

Consolidate this cheatsheet within your broader revision using the MRCP Part 1 hub (https://www.crackmedicine.com/mrcp-part-1/). Pair it with question-based learning and mocks to ensure fast, error-free recall on exam day.


Sources

 
 
 

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