All pictures together for ID Flashcards
What disease is this
Cellulitis
Caused by Group A strep
Treat with Diclox 500mg (bacterial) PO
Systemic symptoms
What disease is this
Erysipelas
Caused by Strep A pyrogens
Treat with Amoxicillin 300mg PO
IF Staph, treat with azithro or IV abx
Systemic symptoms
What disease is this
Impetigo- Bullous- honey colored crust
weakness, fever, diarrhea in young kids. Warm temperatures cause it
Treat with Mupirocin (Ointment)
Bullous caused by strep
What disease is this
Impetigo- non bullous- Honey colored crust, caused by staph
Treat with Muprocin
What disease is this
Follliculitis
Staph aureus most common cause from shaving, etc
Pseudomonas aerginosa (hot tub folliculitis) common
TENDER and ITCHY, NO systemic Sx
Treatment:
Treat with Mupirocin (IF staph), if Pseudomonas, treat with Ciprofloxacin PO
What disease is this
Condyloma acuminatum
HPV- genital warts
100 types of HPV
Diagnosis: Viral culture to confirm and PCR
Treat with Topical imiquimod or Liquid nitrogen therapy
What disease is this
HSV type 1
Single or grouped vesicular lesions
Labs: Cell culture, tzanck smear, antibody detection, PCR
Treatment: Acyclovir, Valcyclovir (IV acyclovir needed for encephalitis)
What disease is this
HSV type 2
Papules>vesicles> pustules, may have fever, headache, malaise
Fluid filled vesicles, shallow
Diagnosis:
Cell culture, Tzanck smear, antibody detection, PCR
Treatment: Acyclovir, valcyclovir (IV acyclovir if encephalitis)
What disease is this
Molluscum contagiosum
Asymptomatic, firm, umbilicated, pearly papules
painful
MolluscUM=UMbillicated
Diagnosis:
Viral culture
Histologic culture shows Henderson-paterson bodies
Treatment:
Self resolving in 6-9 months, curettage to remove infectious central core
Topical cantharidin
What disease is this
Varicella-zoster (Chickenpox)
Caused by stress, radiation, contact, infection
VERY sick, widespread vesicles, cough
Diagnosis: Viral culture, PCR, Tzanck smear
Treatment: Acyclovir PO, Valacyclovir
Gabapentin for pain
What disease is this
Vericella Zoster (Shingles)
Can be dormant in spine for years after chickenpox infection
VERY painful, acute pain along dermatome, Hutchison’s Sign: Vesicle tip of side of nose (Trigeminal nerve- EMERGENCY)
Ramsay Hunt- Facial nerve palsey
Diagnosis: Viral Culture, PCR, Tzanck smear
Treatment:
Acyclovir, Valacyclovir, Gabapentin for Pain
NO oral steroids Work
What disease is this
Viral Exanthem, 5th disease (Erythema infectiosum)
Red facial rash with lacy, pink, macular rash on torso and extremities
Usually young kids, caused by PARVOVIRUS 19
Spread by Respiratory transmission
Clinical presentation:
Can cause Aplastic crisis, Arthritis in adults
LABS:
Clinical findings, IgM antibodies for Parvovirus, CBC, Culture
Treatment:
Antipyretics, analgesics, hydration
What disease is this
Coxsackievirus A16 infection (Hand foot and mouth disease)
Painful oral ulcers, low grade fever, grey-red vesicles, Erosion, 1 week recovery
Labs:
Clinical diagnosis, Viral culture for IgA (Coxsackievirus) CBC
Treatment:
Magic Mouthwash, hydration
What disease is this
Measles
Koplik’s Spots(FIRST before rash)- Grey-White papules on buccal mucosae
3 C’s: Cough, Coryza, Conjunctavitis
Erythmatous rash that goes from head to toes
Diagnosis:
PCR, Measle’s Virus IgM antibodies, CBC
Treatment: Vitamin A, Magic Mouthwash, Hydration
What disease is this
Tinea Capitis (fungus)
Trichophyton tonsurans causes 90% of cases
Spread from person to person
Ranges from mild puritis to Kerions, alopecia, scales, posterior cervical lymphadenopathy
Diagnosis:
KOH, Wood’s Lamp (can be -), Lab Culture
Treatment: Griseofulvin PO for 4-6 weeks.
CMP for Liver Fx before giving Antifungals
Ketoconazole shampoo
What disease is this
Tinea Corporis (ringworm)
Infection of trunk and limbs
Trichophyton rubrum
Bulls eye center, red scaly papule, annular plaque, demarcated border
Diagnosis: KOH exam (Branched septate hyphae, spores)
Cultures from border of lesion
DTM cultures- 2 weeks
Skin Biopsy (PAS- periodic acid schiff- hyphae in skin)
Treatment:
Terbinafine, miconazole
Oral antifungals
What disease is this
Tinea Cruris
Jock Itch
Annular, hyperpigmented patches or plaques, sharpley demarcated, raised border
Diagnosis: Fungal cultures
Treatment: Topical antifungals (first-line), Avoid Tight-fitting clothing
What disease is this
Tinea Pedis
Interdigital toe web infections
Superficial fungal infection
Itching and scaling of feet, moccasin style pattern
Diagnosis:
KOH (branched septate hyphae, segmented hyphae)
DTM( Fungal fulture)
PAS (Hyphae)
Biopsy (confirm Dx)
Treatment: Terbinafine (topical)
What disease is this
Tinea Unguium (onychomycosis) (yeast infection)
Candida albicans
Most commonly on big toe
Diagnosis: KOH
Cultures
Biopsy
Treatment: Fluconazole
What disease is this
Tinea Versicolor
Yeast infection
Surfer’s spots
Spaghetti and meatballs
White scaley powder on skin
Diagnosis:
Wood lamp- Green-yellow flourescence
KOH shows spaghetti and meatballs
Cultures
Treatment:
Ketoconazole lotion, or pigmentation resolves with sun exposure
What Disease is this
Candidiasis
Yeast infection
Diaper rash, budding leash, satellite lesions
Angular cheilitis
Plaques with scalling, purietic
Diagnosis:
KOH shows budding yeast
Traetment: Nystatin, ketoconazole
What Disease is this
Candidiasis
Yeast infection
Diaper rash, budding leash, satellite lesions
Angular cheilitis
Plaques with scalling, purietic
Diagnosis:
KOH shows budding yeast
Traetment: Nystatin, ketoconazole
What Disease is this
Photosensitivity reaction
Exogenous photodermatoses- reaction by photosensitizer
Can be drug induced (NSAIDS, hydrochlorathiazide, antifungals)
LABS:
CBC, ANA (if its autoimmune), Urine test for polyphyrins
Treatment: Sun protection, treat underlying disorder
What Disease is this
Acne Vulgaris
Papules and pustules, comedones on forehead
Diagnosis: History and clinical findings
Treatment:
Benzoyl peroxide, retanoids- Trentanoin
What Disease is this
Acne Vulgaris
Moderate with comedones, papules and pustules
Treatment:
Benzoyl peroxide, doxycycline, YAZ (estrogen and peresterone)
What Disease is this
Acne Vulgaris
Severe (Nodular and cystic acne)
Treatment:
Oral contraceptives (YAZ), Isotrentin (For severe)
What Disease is this
Rosacea
Chronic inflammatory disorder
Vasomotor instability
Triggers: Alcohol, hot or cold weather, hot drinks, hot baths, sun exposure
Treatment:
Avoid Triggers
Topical Antibiotics
Oral antibiotics (tetracycline if BAD)
What Disease is this
Phymatous roscea
Rhinophyma with nodules
Treatment: Oral antibiotics (tetracycline)
Topical antibiotics (Clindamycin)
What Disease is this
erythematotelangiectatic rosacea
Chronic inflammatory disorder
Vasomotor instability
Triggers: Alcohol, hot or cold weather, hot drinks, hot baths, sun exposure
Treatment:
Avoid Triggers
Topical Antibiotics
Oral antibiotics (tetracycline if BAD)
What Disease is this?
Perioral Dermatitis
Not on lips
Rash and acne like
Diagnosis: history and clinical findings, skin biopsy in atypical cases
Treatment:
Topical calcineurin inhibitors, Cyclosporin gel
Give Doxycycline daily for 6 weeks orally
What Disease is this?
Hidradenitis suppurativa
Chronic inflammatory skin condiiton from hair follicle obstruction
Tombstone and rope like scarring
Diagnosis: Recurrent abscesses and lesions, typical distribution and presence, Diffuse connections
Treatment:
Weight loss, topical medications, loose fitting clothing, Retinoids
What Disease is this?
Dishydrotic eczema
Recurrent puritic rash on hands and palms
Triggers: Sweating, emotional stress, humid weather
Sudden onset of the development of puritic vesicles
Labs:
KOH
Patch testing to ensure no allergy
Treatment: Wet dressings (Burrow solution) to dry dressings
Alternate steroids (medium-High with wet dressings)
Resolves on own, but leaves BROWN spots
What Disease is this?
Atopic Dermatitis
Pruretic inflammation of dermis via epidermal barrier
Dry skin, plaques
ATOPIC triad:
Allergy, Atopic Dermatitis, Allergic Rhinitis
Diagnosis:
IgE increased
Swab and culture
CBC
Treatment:
Avoid triggers
Diphenhydramine
Aquaphor
Topical Steroids
Dicloxacillin (oral)
What Disease is this?
Contact Dermatitis
Scales, plaques, Exposure to irratant
Burning and itching after exposure
Linear lesions
Labs:
CBC, Culture/Swab, Scraping to rule out anything else
Treatment:
Remove Irratant
Topical Steroids
Cool compresses/oatmeal baths
Oral staroids if SEVERE
What Disease is this
Seborrheic keratosis
Common, Benigh, epidermal lesions
Around 50 years of age
Labs:
Shave or punch biopsy
Treatment:
Cryosurgery
Cautery and curettage
Sign of Leser-Trelat is associated with what disorder
internal malignancy
Sudden apperance of SKs
What is this
Dysplastic nevi
What is this
Spitz Nevi
What is this
Lipoma
Very common, non cancerous tumor made of fat cells
Slow growing, symptomless
What is this
Lipomas and epithelial inclusion cysts
What is this
Pilinodal disease
What is this
Cherry angioma
What is this
Spider Angioma
What is this
Actinic keratosis
Diagnosis:
Based on clinical findings and biopsy results
Treatment:
Follow up with skin exam (complete skin exam)
Single lesions- treated with cryotherapy
Multiple lesions- Treated with 5-flouracil to decrease lesions, imiquimod
What disease is this
Squamous cell carcinoma
Diagnosis:
Excisional or Punch biopsy
Treatment:
Surgical Excision, MOHS surgery
What disease is this
Squamous cell carcinoma
Diagnosis:
Excisional or Punch biopsy
Treatment:
Surgical Excision, MOHS surgery
What disease is this
Keratoacanthoma
What is this
Melanoma
Diagnosis:
Excisional biopsy
Treatment:
Excision of the lesion with margins
MOHS surgery
Keytruda (immunotherapy)
What is this
Melanoma
How do you measure thickness of the tumor
Breslow score
What is this
Kaposi’s sarcoma
Associated with HIV
Diagnosis:
Biopsy: angiogenesis, inflammation, and proliferation (whorls of spindle-shaped cells with leukocytic infiltration and neovascularization), and immunohistologic staining.
Treatment:
HIV-associated KS: antiretroviral therapy.
Intralesional chemo (vinblastine)
Extensive disease: radiation
If biopsy is +, must get HIV test.
Radiation therapy, excision, cryotherapy, laser ablation, intralesional, topical therapy, chemotherapy.
What is this
Mycosis Fungioides
Also called cutaneous T cell Lymphoma
Localized or generalized erythematous scaly patches or plaques, on trunk
Severe pruritus w/ follicular involvement and hair loss
Local or diffuse lymph node enlargement
Plaques >5cm
Diagnostics:
Skin biopsy
CBC w Sezary count
Treatment: Stage 1-2: Radiation
Topical chemotherapy
What is this disease, and describe diagnosis/treatment
Nummular eczema/dermatitis
Diagnosis: History and clinical
Biopsy/culture to rule out
KOH to rule out fungus
Treatment:
Hydrated petrolium/aquaphor, topical steroids
What is this disease, and describe diagnosis/treatment
Lichen Simplex chronicus
Skin thickening from chronic skin scratching
Thick and scaly, well demarcated
Dx:
KOH, History and clinical, culture to rule out something else
Treatment:
Stop rubbing and scratching,
occlusive dressings at night over high potency topical steroids or low potency on face
What is this disease, and describe diagnosis/treatment
Stasis dermatitis
Edema and hyperpigmentation
Labs: History and clinical findings, Viral to rule out other cause, KOH to rule out fungus
Treatment
Elevation and compression, Cool water dressings for inflammation, oral antihistamines for puritis
What is this disease, and describe diagnosis/treatment
Seborrheic dermatitis
Inflammatory papulosquamous disease
Sebaceous glands make hypersensativity reaction
Pink, red patches with areas with sebaceous glands (or scalp itching, dandruff)
Cradle cap Yellow, greasy adherance scales
Treatment:
Dandruff shampoos (selenium sulfide or zinc pyrithione)
1% hydrocortisone decreases itching and redness
Topical antifungals (ketoconazole)– mild to moderate
What is this disease, and describe diagnosis/treatment
Alopecia areata
Nonscarring immune mediated hair loss
Diagnosis:
Clinical diagnosis, biopsy can be performed when diagnosis is uncertain.
Punch biopsy- definitive, peritubular lymphocytic inflammatory infiltraties sourrounding follicles
Treatment:
Intralesional corticosteroids (topical corticosteroids)
JAK inhibitors (Bactrin)
What is this disease, and describe diagnosis/treatment
Onchomycosis
Labs:
KOH and fungal culture
PCR
PAS (periodic acid schiff test)
Check LFTs before perscribing antifungals
Treatment: Management if KOH or PAS are positive
Systemic antifungals- oral terbinafine, fluconazole
What is this disease, and describe diagnosis/treatment
Paronychia
Acute infection of the nail folds
Staph infection
Labs:
Bacterial culture to determine cause
CBC to make sure not systemic
Treatment:
Warm water with antiseptic soaks, Bactrin and mupirocin
Moderate: Oral abx
MRSA risk: TMP-SMX
I&D for treatment if severe
What is this disease, and describe diagnosis/treatment
SLE- can look like anything (Butterfly rash, maculopapular, annular polycyclic lesions, ring-shaped)
Labs:
DIF- positive for lupus
CBC, ANA (autoimmune antibody)
CRP
RFTs
Treatment:
Topical steroid
Antimalarials (Hydrochloroquine, methotrexate
Refer to rheum
What is this disease, and describe diagnosis/treatment
Dermatomyositis,
Autoimmune, attacks skin, muscles, joints, lungs
Photodistributed on face
Sholder weakness, joint weakness, systemic symptoms of muscle weakness
Labs:
CBC, CMP, Skin biopsy (Shows increased mucosin), muscle biopsy
Possible malignancy before or after diagnosis
PSA, PAP to rule out malignancy
Treatment:
Systemic steroids, Methotrexate, JAK inhibitors, IvIG
Refer to rheum
What is this disease, and describe diagnosis/treatment
Vasculitis-
Caused by medication, infection, environment, malignancy. Elderly women
May Itch or burn, or have no symptoms
Jaw Claudication, vision changes
LABS:
CMP, CBC, UA (blood)
DIF skin biopsy
Treatment: Resolves over 1 week with RICE and NSAIDS, dapsone
What is this disease, and describe diagnosis/treatment
Acanthosis Nigricans
Linked to insulin resistance (obesity, PCOS, diabetes)
Brown, velvety patches and plaques on axilla, groin, back of neck
Puritis common
LABS: Biopsy, Fasting glucose, HgA1C
Treatment:
Manage underlying disease Retinoids (trentonin)
What is this disease, and describe diagnosis/treatment
Xanthelasma
caused by high cholesterol, age, bad diet, Yellow deposits around eyes
LABS:
Increased cholestorol
Treamtent: Lipid control, cosmetic removal, recurrence is common
What is this disease, and describe diagnosis/treatment
Dermatitis herpitiformis
Autoimmune (gluten sensitive, celiac)
Intense puritis papules, vesicles, on extensor surfaces
LABS: Blood test, biopsy
Treatment: Stop gluten ingestion
A patient has Spider angiomas, talengiectasia on palms, Terry’s nails, and porphyria. What condition is this likely to be?
Liver disease and the associated symptoms
What dermatologic symptoms are associated with liver disease
Terry’s nails, porphyria (sores on hands), spider angiomas and telangiectasia on palms
What dermatologic symptoms are associated with lung disease
Sarcoidosis (granulomatous disease)
Lupus pernio (large blue/red and dusky purple nodules, plaque-like lesions on nose, cheeks, ears, fingers, toes. Purple-red or borwn plaques, or circular lesions
Thickening of old scars (sarcoidosis)
Erythema nodosum (Bumps on shins, plaques of red-purple or brown, thickened, circular skin lesions)
LABS:
Biopsy shows granuloma on organs and lungs
Treatment: Biopsy of skin, corticosteroids, Methotrexate, tetracycline
What is this disease, and describe diagnosis/treatment
Lung disease/ granulomatous disease
Also has erythema nordosum
Etiology: 20-40, black women and men, maculopapular eruptions, subcutaneous nodules, sarcoid plaques and papules
LABS:
Biopsy shows granuloma on organs and lungs
Treatment: Tetracycline, NSAIDS, self limited
NO DOSE
No cause
Oral contraceptives/ Pregnancy
Drugs (Sulfa, NSAIDs)
Other infections (strep, TB, histoplasmosis)
Sarcoidosis
Enteropathies (IBD– Crohns’s, Ulcerative colitis)
^ or NODOSUM
What is this disease, and describe diagnosis/treatment
RMSF (Rocky moutnain spotted fever)
Tick borne (Rickettsia rickettsii (attached for 24 hours)
Spring/Summer, North/South America
Rash: Ankles, limbs, and trunk rash, Start as macules, then become papules, petechiae, and ecchymotic
Labs: Antibody test (Serology)
Indirect flourescence
Ab test 10-14 days after
Treatment: Doxycycline, Chloramphenicol
What is this disease, and describe diagnosis/treatment
Chancroid
STI
Caused by Haemophilius ducreyi
PAINFUL
LABS:
Swab for everything (syphillis)
PCR test
Treatment:
Azithromycin, cipro
What is this disease, and describe diagnosis/treatment
Lyme disease
Deer tick (Borrelia burgdorfi)
Fever, Malaise, aches
Erythema migrans skin lesion
Targetoid lesion (LARGE, takes up all of trunk)
Labs: Antibody test (Serology)
Indirect flourescence
Ab test 10-14 days after
Treatment:
Doxycycline, chloramphenicol
What is this disease, and describe diagnosis/treatment
Chancre lesion
Caused by syphilis infection
PAINLESS
BUT comes back over time (1-10 years) and causes damage to brain, nerves, eyes, heart
Labs:
PCR test
Treatment:
Benzathine penicillin G
What is this disease, and describe diagnosis/treatment
Granuloma Inguinale caused by Klebsiella granulomatis
STI
PAINLESS
Bad smelling
LABS: Examine fluid from sore
STI swab
Viral culture
Treatment:
Oral antibiotics 3 weeks or more, TMP-SMX, Azithromycin, IM or IV abx
What is this disease, and describe diagnosis/treatment
Lymphogranuloma venerum
STI caused by chlamydia trachomatis
Symptoms begin 3 days after infection
SYSTEMIC symptoms ( fever, lymph nodes swollen, skin broken down, forms sinus tract)
LABS: Blood test
NAATS (nucleic acid amplicication) from sores
Treatment
ABX 3 weeks, Doxycycline, Erythromycin, Tetracycline
What is this disease, and describe diagnosis/treatment
Psoriasis
Inflammatory papulosquamous disease
Abnormal T cells that are joined in skin, nails, joints, can be above ears or near hair
Silvery-white plaques that bleed when removed (Auspitz sign)
Nail pitting (90%)
Strep bacteria associated with guttate psoriasis
30% of psoriasis patients develop psoriatic arthritis
Labs: History and clinical findings, Punch biopsy if warrented to show acanthosis ( thickening of skin)
Treatment: Topical (TAR)
Phototherapy (UVB light)
Systemic: Methotrexate, cyclosporin steroids over thick plaques with occlusion
What phenomenon is this
Koebner phenomenon
Injury or irritation to skin induces psoriasis
What is this disease, and describe diagnosis/treatment
Lichen sclerosis
Acute or chronic inflammatory mucocutaneous, papulosquamous dermatitis (skin, nails, mucous membranes)
Biopsy shows atrophic, hypopigmented skin that is thinned
White patches, fine cigarette paper
Labs: Biopsy (shows hypopigmented skin that is thinned)
Treatment: High potency steroids (Clobestasol)
Increases chance of SCC
Can be mistaken for abuse in children because of itching
What is this disease, and describe diagnosis/treatment
Purigo nodularis
Puritic chronic dermatitis (result of scratch-itch cycle)
LABS:
Biopsy- shows increased nerve fibers in dermis, neural hyperplasia
Treatment:
High potency steroids with occlusion
Azathioprine, Gabapentin for pain
What is this disease, and describe diagnosis/treatment
Purigo nodularis
Puritic chronic dermatitis (result of scratch-itch cycle)
LABS:
Biopsy- shows increased nerve fibers in dermis, neural hyperplasia
Treatment:
High potency steroids with occlusion
Azathioprine, Gabapentin for pain
What is this disease, and describe diagnosis/treatment
Purigo nodularis
Puritic chronic dermatitis (result of scratch-itch cycle)
LABS:
Biopsy- shows increased nerve fibers in dermis, neural hyperplasia
Treatment:
High potency steroids with occlusion
Azathioprine, Gabapentin for pain
What is this disease, and describe diagnosis/treatment
Pityriasis rosea
Pink, oval plaques, with scales
Onset related to URI within 1 month
Herald patch- FIRST- Largest- Appears first on trunk, christmas tree pattern
LABS:
History and clinical findings, rule out syphillis
Treatment: Self-limited, Topical steroids if purietic
What is this disease, and describe diagnosis/treatment
Lichen Planus
Inflammatory papular squamous disorder
Middle age adults
ITCHY lesions, planar, purple, plaques, Wikhams striae (white lines with magnificatoin)
Treatment: Antihistamines for itching, Topical steroids
Systemic retinoids (spironalactone)
What is this disease, and describe diagnosis/treatment
Urticaria (HIVES)
Allergy to drugs (penicillin, ASA, radiographic dye), Foods
Anaphylaxis in minutes (IgE)
Swelling of lips, trouble breathing
LABS:CBC- High eosinophils
RAST testing
Treatment: Antihistamines, H1 blockers (loratidine), H2 blockers (ranitidine)
Steroids (oral)
What is this
Angioedema
What is this
Angioedema
What is this disease, and describe diagnosis/treatment
Vitiligo
Autosomal recessive
Type A- symmetric pattern
Type B- Segmental (one area of the body)
LABS:
Wood’s lamp (hypopigmentation, bright blue/white light)
Biopsy: Abscence of melanocytes and pigment
Check TSH, CBC, CMP
Treatment:
Mild to low potency topical steroids
Calcineurin inhibitors (tacrolimus)
What is this disease, and describe diagnosis/treatment
Post inflammatory hyperpigmentation
Acne can cause it after inflammation or lazer treatments
Risk factor: darker skin types, areas resolving erythema multiforme
Treatment:
SPF, Hydroquinone (bleaching agent)
Azelaic acid
What is this disease, and describe diagnosis/treatment
Brown pigmentation on face, macular, brown, hyperpigmentation caused by sun exposure, oral contraceptives, pregnancy
Treatment: Fades after pregnancy, hydroquinone or azelaic acid (skin lighteners)
What is this
Merkel Cell carcinoma
Diagnosis:
Excisional biopsy
Treatment:
Surgery
Lymph node drainage
Excision of leson and sourrounding lymph nodes
Spreads VERY quickly, so biopsy LNs
What is this
Mycosis Fungoides (T cell lymphoma)
Diagnosis: Skin biopsy, CBC shows eosinophilia and malignant T cells
Treatment: UV radiation, chemotherapy (topical)
What disease is this
Drug eruption
Single or multiple round, demarcated, red plaques with GREY center
Itches and burns
Systemic fever and rash, hives
Diagnosis:
Ask about history/drugs currently on
Usually spares face
Treatment:
Stop medications, antihistamines, cooling lotions
What is this disease
Urticaria
**Wheeles
SUPER itchy
ASA, PCN, BP meds, Radiographic dye causes
Type 1 Reaction– Anaphylaxis (IgE mediated)
Diagnosis:
CBC- high eosinophils
RAST testing
Treatment: Antihistamines, cooling lotions
What disease is this
Seborrheic Keratoses
Diagnosis:
Sign of lesser trelalt- apperance of many of them at the same time
Biopsy if ANY question about melanoma
Treatment:
Benign, no treatment needed. But, cryotherapy if desired for visual apperance
What Disorder is this
Vitiligo
Diagnosis: Wood’s lamp (depigmented, bright white and blue apperance)
Biopsy: absence of melanocytes
Treatment:
Low potency topical corticosteroids
Tacrolimus (calcineurin)
What disease is this?
Linchen Planus
6 P’s
Planus
Puiruitic
Planar
Plaques
Purple
Polygonal
Diagnosis: history and clinical findings (ideopathic, inflammatory condition)
Treatment: Antihistamines for itching, steroids for local disease
What disease is this? Diagnosis and treatment?
Erythroderma/ Exfoliation
Inflammatory disease
30% idiopathic
>90% of body erythema
Can occur because of psoriasis
Males>females
Diagnosis:
DIF/Biopsy- autoimmune
CBC
Treatment:
LIFE THREATENING
Maintain fluid and temperature, wet to dry dressing, antibiotics, treat underlying disease, antihistamines
IVs if loss of fluids
Keep warm (loss of body temp due to widespread erythema)
What is this? Diagnosis? Treatment?
DRESS syndrome
Clinical triad:
High fever, extensive skin rash, organ involvement
Develops over many days and weeks
Have Fever
Mibiliform rash
Erythroderma or exfoliative
Facial swelling
Diagnosis:
CBC, LFTs
WBC, LFTs, Fever, Skin rash
Lymphatenopathy usually
Eosinophilia
Hepatomegaly (FEEL LIVER ON PE)
Treatment: Stop medication, supportive care, corticosteroids, antibiotics. IvIG
8% mortality rate
What is this? Diagnosis Labs? Treatment?
Erythema Multiforme
Target lesions
HSV
Commonly caused by URI, mycoplasma pneumona
Dusty center of lesion
Diagnosis:
Biopsy or direct IF studies
Negative Niklosky’s sign (no epidermal detatchment)
Often febrile
Palms, soles, arms, legs
Treatment:
Remove offending drugs
Topical steroids, oral antihistamines, analgesics, skin care
What disease is this?
Erythema Multiforme
TARGETOID on palms and soles
HSV causes it
What is the most common reaction in a patient who has HSV?
Erythema multiforme
If you suspect a patient has erythema multiforme that is caused by Herpes, what test do you run to see if they have had it recently?
Run a Titer test for HSV
What disease is this? What labs do you order? Treatment?
SJS/TEN
Also in mouth and mucosae surfaces
Diagnosis:
Blood culture and blister
Biopsy (shows full tissue necrosis)
CBC, CMP
Treatment:
Supportive therapy, airway management
Treat like severe burns (pain control, withdrawal medications, electrolytes)
What disease is this? What labs diagnose it?
Treatment?
SJS/TEN
Also in mouth and mucosae surfaces
Diagnosis:
Blood culture and blister
Biopsy (shows full tissue necrosis)
CBC, CMP
Treatment:
Supportive therapy, airway management
Treat like severe burns (pain control, withdrawal medications, electrolytes)
Erythroderma is caused by which diseases
HIV, Eczema, Psoriasis
The most common virus that causes erythema multiforme is
HSV
Most common cause of SJS in kids
Infection
Lesions in SJS and EM are described as
Targetoid
What disease is this? What labs do you order to diagnose it? Treatment?
Bullous pemphigoid
ITCHY, TENSE Blisters
Caused by sulfa drugs, penacillin, or IgG caused
Erythema or purietic papules that form plaques, on skin folds and flexural areas
Plaques turn dark red after 1-3 weeks, vesicles and bullae appear rapidly
Bullae are tense and rupture in around 1 week
Labs:
DIF+, IIF+, Skin biopsy shows subepidermal bullae with infiltration of eosinophils
Treatment:
Oral/topical steroids, immunosuppressive drugs, minocycline
Itchy tense blisters vs flaccid, painful blisters
Itchy and tense= bullous pemphigoid
Flaccid and Painful= pemphigus vulgaris
What disease is this? What labs do you order to diagnose it? Treatment?
Pemphigus vulgaris
IgG autoimmune disorder
Flaccid, easily ruptured, erosions, mucosal involvement, head, upper trunk, +Niolsky’s sign
Armpits are involved
Diagnosis:
Skin biopsy shows Intraepidermal bulla
+DIF, +IIF
Treatment:
Eroded areas covered with petrolatum and dressings
Fatal if untreated– send to burn unit or ICU
Rituximab to treat, IVIG
What is the deepest skin structure involved in a superficial burn
Epidermis
first degree burn
What is the deepest skin structure involved in a superficial partial thickness
upper dermis
2nd degree
What is the deepest skin structure involved in a deep partial thickness burn
lower dermis
2nd degree
What is the deepest skin structure involved in a full thickness burn
3rd degree
subcutaneous structures
What classification of burn is this
first degree, superficial, epidermis involvement
What classification of burn is this
Epidermis and superficial dermis
Blistered
Very painful
Minimal scarring
What classification of burn is this
Deep partial thickness burn
Epidermis and deep dermis
Blistered dermis is pale or white
Scarring
No pain, 3 weeks -2 months to heal
May need surgery or graft
What classification of burn is this
Partial/full thickness
Treat with sterile, clean gauze, pain control (opioids), burn center for sure
What procedure is done in full thickness burns to increase blood flow
escherotomy (cut skin so it doesn’t restrict blood flow)
Most common causes of chemical burns
Cement
Concrete
Lime-fertilizer
TAR (roofing and asphalt)
Brush off dry chemicals
Irrigate with water
use proper PE