BRS Dermatology Flashcards
examples of keratolytics (for thickened skin)
salicyclic acid
urea
alph-hydroxy acids
retinoic acid
ointment vs. cream vs. lotion
- ointment- little or no water, maximal water retaining properties –> useful for very dry skin
- cream- 20-50% water –> useful for skin of average dryness
- lotion- more water than creams –> useful for minimally dry skin or for large surface areas
when should you worry about topical steroids having systemic effects
when very potent topical steroids are used on damaged or thin skin for longer than 2 weeks
-adrenal suppression, depressed growth, cataracts, glaucoma, cushing syndrome
what is tacrolimus ointment used for
atopic dermatitis
one to five percent sulfur is used for _____
acne
tar is used for _____ and ______
eczema and psoriasis
2 types of contact dermatitis
allergic contact dermatitis
primary irritant contact dermatitis
etiology of allergic contact dermatitis
- direct T cell mediated response to an exogenous applied allergen
- requires sensitization and then rechallenge, not dose dependent
- poison ivy, oak, or sumac; nickel containing jewelry and belt buckes; topical lotions and cream; perfumes and soaps
what does allergic contact dermatitis look like
how to tx it
erythematous papules and vesicles in the area of contact
tx with topical steroids
etiology of primary irritant contact dermatitis
what’s the most common type
- caustic substance irritates the skin
- no sensitization needed, dose dependent
- most common type is diaper dermatitis +/- Candida albicans secondary infection
what does diaper dermatitis look like
- erythema with papules on the upper thighs, buttocks, and GU area without involvement of the inguinal creases
- if inguinal creases are involved, there is more confluent erythema, and satellite lesions are present –> suspect candidal superinfection
how to tx diaper dermatitis
skin moisturizers
barrier creams and ointments (ex. zinc oxide)
frequent diaper changes
low potency steroids for severe inflammation
if there’s candidal infection, give nystatin or clotrimazole
eruption of red scales and crusts in ares with high numbers of sebaceous glands like the scalp, face, chest, and groin; skin lesions may be greasy
-what is this, what demographic
seborrheic dermatitis
-infants and teens
infants with seborrheic dermatitis on the head is called _______
cradle cap/seborrheic capitis
how to tx seborrheic dermatitis
- low potency topical steroids
- sulfur, zinc, or salicyclic acid based shampoos –> light scrubbing to remove crusts
- topical antifungal to eradicate pityrosporium ovale (potential causative agent)
what age group do you see pityriasis rosea in
late childhood and teens
papulosquamous disorder that begins with a solitary large scaly erythematous lesion (herald patch) –> 1-2 weeks after, oval erythematous macules and papules erupt from chin to mid-thigh following skin lines in a christmas tree distribution
pityriasis rosea
how to tx pityriasis rosea
topical or stystemic antihistamines
exposure to UV light may help
scaling papules and plaques often on the scalp (non-greasy w/o hair loss), ears, elbows, knees, lumbosacral area, and groin; some lesions with silvery scale
psoriasis
in childhood onset psoriasis, what is the cause
often genetic with AD inheritance
psoriasis may exhibit koebner phenomenon, which is _____
new lesions develop at sites of skin trauma
nail involvement in psoriasis is _____
examples are ______
common
pits, distal thickening, lifting of the nail bed, nail destruction
how to tx psoriasis
- moderate or high potency steroids
- UV light therapy
- analogs of vitamin D
- 3% salicylic acid in mineral oil for scalp
- retinoids
- anthralin (down regulates EGF)
etiology of miliaria rubra
heat rash
-disrupted sweat ducts (caused by occlusion or friction) –> sweat released onto skin –> inflammatory response
small erythematous pruritic papules or vesicles occur in areas of occlusion or in areas that have been rubbed (inguinal region, axilla, chest, neck)
miliaria rubra
how to tx miliaria rubra/heat rash
avoid occlusive clothing
no meds needed
urticaria but then fever, arhtralgias, adenopathy, evidence of organ injury
-caused by meds like cephalosporins
serum sickness
______ is a severe reaction to drugs that cause widespread epidermal necrosis
> 30% skin loss
severe mucous membrane involvement
Nikolsky sign with high mortality (10-30%)
toxic epidermal necrolysis (TEN)
erythema multiforme is a hypersensitivity reaction to many different stimuli…what are the 3 major types?
what is the classic skin lesion in all cases?
erythema multiforme major
erythema multiforme minor
Stevens-Johnson syndrome
classic skin lesion is a target lesion: a fixed, dull red, oval macule with a dusky center that may contain a papule or vesicle
Stevens-Johnson syndrome
- major cause
- skin findings
- mucous membrane findings
- systemic findings
- management
- prognosis
- drugs
- widespread atypical, asymmetric target lesion, blisters, and necrosis
- at least 2 mucosal surfaces (often mouth and eyes)
- prodrome of high fever, cough, malaise, HA, arthralgias
- supportive care, stop drug, ophtho consult, +/- steroids/IVIG/burn unit
- high morbidity and mortality (5%)
erythema multiforme major
- major cause
- skin findings
- mucous membrane findings
- systemic findings
- management
- prognosis
- mycoplasma pneumoniae; drugs
- typical symmetric target lesions; acral and truncal distribution
- at least 2 mucosal surfaces (often mouth and eyes)
- prodrome of low grade fever, arthralgias, myalgias
- supportive care; erythromycin or azithromycin if M pneumoniae; stop the offending drug
- good prognosis
erythema multiforme minor
- major cause
- skin findings
- mucous membrane findings
- systemic findings
- management
- prognosis
- HSV
- symmetric target lesions; acral distribution
- occurs in 25%; only one surface (often mouth)
- prodrome of low grade fever, arthralgia, myalgias
- supportive care; acyclovir may present recurrence
- good prognosis; possible recurrence
tinea capitis is a fungal infection of _____
MC organisms
- hair
- 95% Trichophyton tonsurans, 5% Microsporum canis
- patchy hair loss in which hairs break off at the scalp (black dot ringworm) or in which broken hairs are thickened and white
- scales and pustules
- kerion- large red boggy nodule
- occipital and posterior cerval LAD
tinea capitis
how to dx tinea capitis
microscopic evaluation of hairs with 10% KOH
fungal cx
hairs fluoresce under woods light if it’s M. canis
how to tx tinea capitis
systemic oral antifungal (ex. griseofulvin)
topical 2.5% or 5% selenium sulfide shampoo to reduce infectivity
tinea corporis tinea pedis tinea cruris tinea unguium (onychomycosis) *where is the infection?
body
foot
groin
nails
oval or circular scaly, erythematous patches with partial central clearing
tinea corporis (ringworm)
post pubertal teens with scaling and erythema between the toes or on the plantar aspects of the foot
tinea pedis (athlete’s foot)
scales and erythema in the groin and inguinal creases
tinea cruris
how to dx and tx tinea corporis, tinea pedis, and tinea cruris
dx on H&P
can do KOH exam of skin scrapings
-tx with topical antifungal meds (clotrimazole, terbinafine, ketoconazole)
how to tx tinea unguium (onychomycosis)
- topical tx is challenging and unsuccessful most of the time
- systemic meds like griseofulvin, terbinafine, and ketoconazole can be tried
-fine scaly oval macules on the trunk, proximal arms, and face
-macules may be hypo or hyperpigmented and become more prominent with sun exposure
what is this and what is it caused by
tinea versicolor common in teens
caused by yeast pityrosporum orbiculare
how to dx and tx tinea versicolor
KOH exam- spaghetti and meatballs, yellow/orange under woods lamp
tx with overnight application of 2.5% selenium sulfide weekly for 3-4 weeks, ketoconazole shampoo or cream, or systemic antifungals
define exanthem and enanthem
exanthem- skin rash asso with a viral infection
enanthem- involvement of the oral mucosa
erythema infectiosum (fifth disease) is associated with ______ infection, which may also cause these things
parvovirus B19
aplastic crisis, prolonged anemia, fetal hydrops or miscarriage in pregnant women
URI –> slapped cheek appearance 1-2 weeks later –> lacy, reticular rash on the trunk and extremities for 3-5 days after the facial rash
what is it and how to tx
most common demographic
fifth disease/parvovirus B19 infection
supportive tx
school age children
pts with slapped cheek rash are still contagious with parvovirus B19
F
they are no longer contagious when the facial rash appears
_______ is caused by HHV 6 and 7 in children younger than 2 years
what are the clinical features and what is the tx
roseola infantum (exanthem subitum)
- 3-5 days of high fever –> pink papular eruption that looks flat and confluent on the trunk that generally fades in 24-48 hours
- tx is supportive
gianotti-crosti (papular acrodermatitis) occurs in kids ______ of age and is associated with ______ infection
- what does it look like
- how do you tx it
- younger than 3 years
- hepatitis B (EBV, CMV, and coxsackievirus)
- red or flesh colored flat topped papules in the acral areas (extremities, buttocks, cheeks)
- treatment is supportive
intensely pruritic erythematous macules that develop central vesicles within 1-2 days; “dew drop on a rose petal”/vesicle on a red background; fever
what is this and how to tx it
varicella (chickenpox)
- tx with antipyretics, antibacterial soaps to prevent bacterial infxn, antihistamines, etc
- acyclovir IV for varicella pneumonia and encephalitis, oral for high risk for complications, topically in eyes for those with ophthalmic involvement
two types of HSV infection
neonatal infection- acquired through birth canal; 2/3 HSV2, 1/3 HSV1
gingivostomatitis- HSV1
characteristic lesions are grouped vesicles on an erythematous base
- young infants with grouped vesicles and ulcers on the lips, corners of mouth, tongue, drooling, fever
- first week of life… may only have a few vesicles in one spot but may also have serious signs of meningoencephalitis, hepatitis, sepsis, shock
- HSV1 infection of the thumb or fingers
- HSV gingivostomatitis
- neonatal HSV
- herpetic whitlow
HSV resides in the ______ after initial infection
DRG
how to dx HSV infection
Tzanck preparation
direct fluorescent antibody testing
viral cx
PCR
how to tx HSV infection
- neonatal
- cutaneous and oral
- neonatal- this is a medical emergency!! immediate hospitalization and tx with IV acyclovir
- cutaneous and oral- oral acyclovir
vesicles, papules, pustules on the palms, soles, or fingertips and shallow ulcers on the soft palate/tongue
what is it, what’s the etiology, what’s the tx
hand foot mouth disease caused by coxsackievirus type A16
if it’s only oral lesions, it’s called herpangina
tx is supportive
irregularly shaped, discrete flesh colored papules that may be smooth or rough
what is it and what is it caused by
how to tx
warts caused by HPV
if multiple external warts in the genital area –> condylomata acuminata
most resolve in 1-2 years… tx with liquid nitrogen, salicylic acid, etc
flesh colored papules with central umbilication
- what is it called
- what’s it caused by
- if extensive, think ______
- tx?
- molluscum contagiosum
- poxvirus
- HIV
- tx is observation with expected resolution; can do curettage or liquid nitrogen, etc
____ causes head and body lice
____ causes pubic lice
how to tx?
pediculum humanus
phthirus pubis
- head lice: 1% permethrin shampoo and comb
- body and pubic lice: 12 hour application of 1% gamma-benzene hexachloride lotion
severe itching, S shaped burrows, pruritic papules or vesicles in dorsum of hands, groin, axilla, interdigital spaces
- what is it
- what is it caused by
- how to dx
- how to tx
- scabies
- sarcoptes scabiei
- microscopic examination of a scraping demonstrates mite, egg, mite feces, etc
- tx with overnight application of 5% permethrin lotion or 1% lindane (teens and adults only), wash everything, tx family members
hypopigmented, dry, scaly patches- most commonly on the cheeks
what is it and how to tx
pityriasis alba
- related to atopic dermatitis
- tx with moisturizers and mild steroids
complete loss of skin pigment in patchy areas 2/2 melanocyte destruction
vitiligo
no effective tx
genetic defect in melanin synthesis
white skin and hair, blue eyes, photophobia, nystagmus
oculocutaneous albinism
no tx
ash leaf spots (hypopigmented macules under woods light)
adenoma sebaceum (angiofibromas on nose or face)
shagreen patch (thickened orange peel appearance)
infantile spasms
#1 cause of neonatal cardiac tumors
tuberous sclerosis
cafe au lait spots
axillary or inguinal freckling
optic glioma
lisch nodules (iris hamartoma)
NF-1
congenital vs. acquired nevi
which is at higher risk of malignancy
giant nevi (a type of congenital nevus)
autoimmune lymphocyte mediated injury to the hair follicles
- complete hair loss occurs in one to three sharply demarcated scalp areas w/o any scalp inflammation
- nail pitting can occur
what is this called, what are some subtypes, how to tx
- alopecia areata
- subtypes include alopecia totalis (loss of all scalp) and alopecia universalis (loss of all body and scalp hair)
- tx with topical or injected steroids and topical minoxidil to speed up the process… regardless, hair will regrow spontaneously within 1 year
traction alopecia
hair loss 2/2 constant traction or friction (tight hair braids, vigorous scalp massage, etc)
telogen effluvium the second most common type of alopecia (after male pattern baldness) and is 2/2 ________
acutely stressful event that converts hairs from growing phase (anagen) to final resting phase (telogen)
- causes generalized excessive hair loss
- spontaneous regrowth occurs
acne is associated with this bacteria
P acnes
open comedones (blackheads) and closed comedones (whiteheads) are associated with \_\_\_\_\_\_\_ erythematous papules, pustures, nodules, cysts are associated with \_\_\_\_\_\_
noninflammatory acne
inflammatory acne
*most ppl have both
how to tx acne
- noninflammatory and mild inflammatory: topical benzoyl peroxide, tretinoin, salicylic acid
- inflammatory: antibiotics (oral or topical) and benzoyl peroxide
- really intense tx that can cause teratogenic effects: systemic isotretinoin (accutane)
