Adult - Derm Flashcards
What is the most common of all skin disorders?
acne
Which acne symptoms are red flags that indicate the need for referral?
- scarring
- cyst formation
First line (non-pharmocologic) treatment for acne
wash several times daily with mild soap
use oil-free products
What is the order of pharmacologic treatment in acne?
- comedolytics
- topical combination agents: comedolytic + ABT
- topical antibiotics
- oral antibiotics
- oral contraceptives
First line pharmacologic treatment for acne
comedolytics:
benzoyl peroxide - bacteriocidal
trentoin (Retin-A)
What is a potential side effect of retin-a (tretinoin)?
Increased sensitivity to sunlight
What is the second pharmacologic step in acne treatment?
combination agents:
benzoyl peroxide + erythromycin = Benzamycin
benzoyl peroxide + clindamycin = Benzaclin
What is the third pharmacologic step of acne management?
topical antibiotics:
clindamycin
What is the** fourth** pharmacologic step of acne management?
Oral antibiotics:
tetracycline
why is tetracycline contraindicated in pregnancy and children under 9 years?
due to staining of teeth
What is the** fifth** pharmacologic step of acne management?
oral contraceptives:
combination products are most effective
ortho tri-cyclen or estrostep
What is a derm-related side effect of oral contraceptive therapy?
melasma - brown splotches on the skin
as opposed to the “mask of pregnancy” which is known as:
chloasma
What are two additional therapies that could be used for acne treatment, though not in primary care?
dermabrasion
intralesional injections of the steroid triamcinolone
Which two pathogens are the “major players” in skin infections in the community?
staph aureus
strep (usually Group A)
Inflammation of the hair follicle -
term and pathogen
folliculitis
staph
Localized infection originating from the hair follicle but now more involved -
term and pathogen
furuncle
“boil”
staph
What does a CA-MRSA furuncle look like?
A spider bite
A red, swollen, and painful cluster of boils that are connected to each other under the skin -
term and pathogen
carbuncle
staph
What are the common causes of cellulitis in the community?
- Strep pyogenes (Group A) - usual cause
- Staph aureus - less common
What are the common causes of cellulits in the inpatient population?
Gram NEGATIVE organisms -
E. coli
Klebsiella
Psuedomonas
Enterobacter
less frequently - Gram POSITIVE organisms
MRSA? CA-MRSA?
In the outpatient, what 3 drugs can be used to treat CA-MRSA cellulitis?
- Bactrim (TMP/SMZ)
- Doxyclycline / minocyline
- Clindamycin
Which of these also covers Group A strep?
Clindamycin
What additional drug class must be aded to Bactrim or Doxycyline / Minocycline in order to provide Group A strep coverage?
a beta lactam
What are some examples of the beta lactams?
penicillin
amoxicillin
1st generation cephalosporin (Keflex)
What cellulitis-treating antibiotic provides coverage for both staph and strep?
Clindamycin
An acute infection of the upper dermis and superficial lymphatics; more superficial than cellulitis, typically more raised and demarcated
“look’s like big sunburn”
- condition and pathogen
Erysipelas
Strep
Known for insidious or rapid progression?
rapid
Infection and abcess formation,
typically in the axilla or groin -
condition and pathogen
Hidradenitis suppurativa
staph
Characterized by honey colored crusts on an erythematous base -
condition and pathogen
Impetigo
staph
Infection of the skin around the finger or toe nail -
term and pathogen
paronychia
staph
Collection of blood between the fingernail and nail bed -
term and management
subungual hematoma
trephination - drilling a hole through the nail
to relieve the pressure
candida **balanitis - **
location?
candida of the penile head
candida intertrigo -
location?
candida in warm, moist folds of skin
For most candida, what is management?
topical antifungals first
oral antifungals only if topicals unsuccessful
Four examples of antifungals?
miconazole
clotrimazole
fluconazole
griseofulvin
What are two fungal infections which are treated with selenium shampoo?
tinea capitus
tinea versicolor
Another name for herpes zoster is:
shingles
Pharm options for herpes zoster have what suffix?
-cyclovir
What is a red flag in herpes zoster?
eye or face involvement -
** refer right away**
What medications can be used for post-herpetic neuralgia?
gabapentin (Neurontin)
pregabalin (Lyrica)
What are two significant side effects of gabapentin and pregabalin?
excessive sleep
significant weight gain
What vaccine can be used to prevent or mitigate herpes zoster?
approved starting at what age?
zostavax
age 50
What are pre-malignant, small, rough patches on sun-exposed parts of the body?
actinic keratosis
What type of skin cancer arises from actinic keratosis?
squamous cell carcinoma
How is actinic keratoses treated?
liquid nitrogen
What lesions are the precursors to squamous cell carcinoma?
actinic keratosis
How long does it take for squamous cell carcinoma to develop from an AK?
over a few months
Description of squamous cell carcinoma
firm, irregular papule or nodule
with keratictic, scaly bleeding
(yum)
Treatment for squamous cell carcinoma
refer for:
biopsy
Mohs excision
Benign, beige to black plaque, with a “stuck-on” appearance.
seborrheic keratosis
Treatment in seborrheic keratoses
liquid nitrogen
or
none
What is the most common type of skin cancer?
basal cell carcinoma
Waxy, pearly, shiny lesion with central depression or rolled edge, and possibly with telangiectatic vessels.
basal cell carcinoma
What is the treatment for basal cell carcinoma?
shave or punch biopsy and surgical excision
Which skin cancer has the highest mortality rate?
melanoma
What are the ABCs to remember with melanoma?
A - asymmetry
B - border irrecularity
C - color variation
D - diameter > 6 mm
E - elevation
E - enlargement
What is an important detail to teach patients about applying steriods to their atopic dermatitis?
it is most effective when rubbed in very well
What might be the underlying cause of an explosive onset derm disorder that an adult has never previously had?
HIV infection
What is the only derm disorder for which tar shampoo is recommended?
psoriasis
Yellow plaques as a result of fat build up under skin; often near inner canthus.
Xanthelasma
what is underlying cause?
hyperlipidemia
What is the hallmark rash of Lyme disease?
erythema migrans
What is the initial test for Lyme disease?
confirmatory?
ELISA
Western blot
(same as HIV)
What antibiotics are used for Lyme disease?
Doxycyline
Amoxicillin
What is the typical rash in Rocky Mountain Spotted fever?
maculo-papular
petechial
What is the testing for Rocky Mountain Spotted fever?
PCR (like infant HIV test)
What is the treatment for Rocky Mountain Spotted Fever?
Doxycycline
Hallmark distribution of smallpox lesions -
first lesions on face, palate, oral mucosa
spread from there
on any one part of the body, all lesions are at the same stage
What is the causative agent of anthrax?
bacteria, though often referred to as “spores”
Is there a vaccine for anthrax?
yes
What are the two types of anthrax infections?
cutaneous
inhalation
What is the progression of the cutaneous form of anthrax?
pruritic papule
ulcer surrounded by vesicles
black necrotic eschar with edema
eschar falls off leaving scar
What is used to treat anthrax?
PCN
ciprofloxacin (Cipro)
doxycyline
Treatment options for genital warts:
- podophyllin resin
- podofilox (Condylox)
- cryosurgery
- TCA - trichloroacetic acid
- BCA - bichloracetic acid
