32- derm

Question 1

Seborrheic dermatitis presentation

Answer 1

common skin condition in infants scalp

if older- caused by malassezia

erythematous plaques with fine to thick, greasy yellow scale

Question 2

Seborrheic dermatitis treatment

Answer 2

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.

Question 3

Hidradenitis suppurativa

Answer 3

Pustular lesions caused by occlusion of the apocrine follicular units (instead of the pilosebaceous units).

in women- axilla, groin
in men- perineal, perianal

Question 4

treat roseacea with

Answer 4

topic metronidazole

Question 5

Perioral dermatitis

Answer 5

A variant of rosacea also commonly seen in adolescents, and treated the same way.

erythema, scaling, and papules or pustules, but no comedones.

Question 6

Acne vulgaris causes

Answer 6

Keratinous material and excess sebum (due to androgenic influence) plug the pilosebaceous gland.

Increased sebum provides a growth medium for superinfection with Propioniobacterium acnes.

Question 7

acne triggers

Answer 7

• make up
• overzealous cleanliness
• manipulation (pokin)
• occlusion (sports gear)
• high glycemic diets–insulin res.–> androgens

Question 8

acne treatments

Answer 8

1. benzoyl peroxide
2. Retinoids- tretinoin, adapalene
3. topic erythromycin, clindamycin
4. OCPs, oral antibiotics
5. oral isotretinoin- side effects!

Question 9

oral isotretinoin- side effects!

Answer 9

depression
hypertriglycerides
hepatitis
decreased night vision
photosensitivity
*teratogen

Question 10

retinoids consideration

Answer 10

• apply at night because cause sunburn
• inactivated by benzoyl peroxide
• apply to dry skin only
• will make acne look transiently worse

Question 11

nickel allergy what type of hypersensitivity

Answer 11

Type 4- takes 24-72 hours to manifest after exposure

Question 12

treatment for nickel allergy

Answer 12

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

Question 13

treating impetigo

Answer 13

mupirocin

watch for abscess if MRSA

Question 14

Toxicodendron Exposure

Answer 14

allergy to urushiol, present in plant

topical steroids and antihistamines

Question 15

lice treatment

Answer 15

• permetherin lotion OTC- 1st line
• benzoyl alcohol for >6 mo
• malathion 0.5% for >2 yo

Question 16

scabies presentation

Answer 16

mites burrows, itchy most at night
Wrists, elbows, fingers, and toes

secondary infections- impetigo, cellulitis

Question 17

scabies dx

Answer 17

scrape lesion laterally and look under light microscope

Question 18

scabies tx

Answer 18

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

Question 19

ringworm appearance

Answer 19

annular, well-circumscribed, scaly plaque with a raised border and a center that is brown or hypopigmented.

Question 20

ringworm dx

Answer 20

clinically, but a KOH wet-mount examination of skin scrapings can confirm

Question 21

treatment of choice for tinea capitis

Answer 21

griseofulvin

Question 22

Pityriasis rosea

Answer 22

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.

Question 23

OTC treatment of warts

Answer 23

Salicyclic acid - apply daily, works slowly

Question 24

causes of diaper rash and their treatments

Answer 24

• irritant dermatitis- keep clean with zinc oxide
• candida- use nystatin
• group A strep- oral antibiotics

uncommon causes:

• zinc def
• langerhans cell histiocytosis

Question 25

potential side effects of topical steroids

Answer 25

Skin atrophy
Telangiectasias
Hypopigmentation
Suppression of the hypothalamic-pituitary axis

Question 26

treatment for irritant dermatitis diaper rash

Answer 26

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.

Question 27

treatment for candida diaper rash

Answer 27

nystatin

Question 28

treatment for bacterial diaper rash

Answer 28

oral abx

Question 29

differential of ringworm

Answer 29

Nummular eczema
Psoriasis
Pityriasis alba
Pityriasis rosea

Question 30

Nummular eczema

Answer 30

Consists of coin-shaped lesions commonly on the legs and buttocks. Has an annular configuration and scaly appearance like tinea.

Question 31

steroid potencies- 4 groups

Answer 31

Mild-hydrocortisone acetate, 1% (OTC)

Intermediate- triamcinolone acetonide, 0.1%

Potent- betamethasonedipropionate, 0.05%

Super Potent-clobetasol propionate, 0.05%