32- derm Flashcards
Seborrheic dermatitis presentation
common skin condition in infants scalp
if older- caused by malassezia
erythematous plaques with fine to thick, greasy yellow scale
Seborrheic dermatitis treatment
Baby oil and a small brush to remove the scales
Frequent (i.e., daily) shampoong with a gentle baby shampoo, or-for more persistent cases-use of a prescription shampoo containing ketoconazole, an anti-fungal agent, or pyrithione zinc. Care must be taken not to get the shampoo in the infant’s eyes.
A low-potency topical steroid cream (e.g., hydrocortisone). In older children and adults, ketoconazole cream may be used.
Hidradenitis suppurativa
Pustular lesions caused by occlusion of the apocrine follicular units (instead of the pilosebaceous units).
in women- axilla, groin
in men- perineal, perianal
treat roseacea with
topic metronidazole
Perioral dermatitis
A variant of rosacea also commonly seen in adolescents, and treated the same way.
erythema, scaling, and papules or pustules, but no comedones.
Acne vulgaris causes
Keratinous material and excess sebum (due to androgenic influence) plug the pilosebaceous gland.
Increased sebum provides a growth medium for superinfection with Propioniobacterium acnes.
acne triggers
- make up
- overzealous cleanliness
- manipulation (pokin)
- occlusion (sports gear)
- high glycemic diets–insulin res.–> androgens
acne treatments
- benzoyl peroxide
- Retinoids- tretinoin, adapalene
- topic erythromycin, clindamycin
- OCPs, oral antibiotics
- oral isotretinoin- side effects!
oral isotretinoin- side effects!
depression hypertriglycerides hepatitis decreased night vision photosensitivity *teratogen
retinoids consideration
- apply at night because cause sunburn
- inactivated by benzoyl peroxide
- apply to dry skin only
- will make acne look transiently worse
nickel allergy what type of hypersensitivity
Type 4- takes 24-72 hours to manifest after exposure
treatment for nickel allergy
resolves within days-weeks
vaseline or lotion (eucerin)
steroid ointment for 2 weeks
avoid- jewlery thats not stainless steel or 24k gold, watches, glasses, metal studs in furniture
treating impetigo
mupirocin
watch for abscess if MRSA
Toxicodendron Exposure
allergy to urushiol, present in plant
topical steroids and antihistamines
lice treatment
- permetherin lotion OTC- 1st line
- benzoyl alcohol for >6 mo
- malathion 0.5% for >2 yo
scabies presentation
mites burrows, itchy most at night
Wrists, elbows, fingers, and toes
secondary infections- impetigo, cellulitis
scabies dx
scrape lesion laterally and look under light microscope
scabies tx
two applications of permethrin 5% cream, one week apart, for all affected household members.
applied at night before bed and washed off in the morning, or after around 8-12 hours.
Adults - from the neck down.
Infants- the entire body should be covered from the hairline down
After bathing, wash all bed linens and clothing worn during treatment.
Itching may persist for a few weeks
ringworm appearance
annular, well-circumscribed, scaly plaque with a raised border and a center that is brown or hypopigmented.
ringworm dx
clinically, but a KOH wet-mount examination of skin scrapings can confirm
treatment of choice for tinea capitis
griseofulvin
Pityriasis rosea
scaly papules and plaques in the hallmark “christmas tree” distribution on the back and trunk, following the lines of skin cleavage.
Lesions may also be found on the upper thighs and in the groin area.
The initial lesion, called the “herald patch,” is usually the largest scaly plaque with a raised border and can easily be confused with tinea corporis.
OTC treatment of warts
Salicyclic acid - apply daily, works slowly
causes of diaper rash and their treatments
- irritant dermatitis- keep clean with zinc oxide
- candida- use nystatin
- group A strep- oral antibiotics
uncommon causes:
- zinc def
- langerhans cell histiocytosis
potential side effects of topical steroids
Skin atrophy
Telangiectasias
Hypopigmentation
Suppression of the hypothalamic-pituitary axis
treatment for irritant dermatitis diaper rash
zinc oxide-containing creams or ointments.
The barrier provided by the zinc oxide helps limit contact of urine and feces with the skin allows the rash underneath to heal.
treatment for candida diaper rash
nystatin
treatment for bacterial diaper rash
oral abx
differential of ringworm
Nummular eczema
Psoriasis
Pityriasis alba
Pityriasis rosea
Nummular eczema
Consists of coin-shaped lesions commonly on the legs and buttocks. Has an annular configuration and scaly appearance like tinea.
steroid potencies- 4 groups
Mild-hydrocortisone acetate, 1% (OTC)
Intermediate- triamcinolone acetonide, 0.1%
Potent- betamethasonedipropionate, 0.05%
Super Potent-clobetasol propionate, 0.05%
