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AGPCNP Board Prep > Ch6: Dermatology > Flashcards

Ch6: Dermatology Flashcards

1
Q

keratosis pilaris is a variation of ______

A

eczema

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2
Q

acneiform lesions in someone of age 30-60yo, think…..

A

acne rosacea

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3
Q

what is a primary lesion

A

result from a disease process

has not been altered by outside manipulation, treatment, or the natural course of the disease (e.g., vesicle)

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4
Q

what is a secondary lesion

A

lesion that is altered by outside manipulation, treatment, or the natural course of the disease e.g., crust

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5
Q

what is a “vesicle”

A

fluid-filled lesion that is <1cm in diameter

think varicella (chickenpox), herpes zoster (shingles), HSV1 and 2

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6
Q

what is “crust”

A

raised lesion caused by dried serum and blood remnants that develops when a vesicle ruptures

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7
Q

single, uniformly brown-colored, slightly raised, irregularly-shaped with defined borders, 6mm in diameter

A

papule

must be RAISED

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8
Q

single, flat non-palpable area of skin discoloration, irregularly-shaped, and 0.5cm in diameter

A

macule

must be FLAT

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9
Q

single, firm, smooth, raised, dome-shaped fluid-filled flesh-colored encapsulated lesion of 1.5cm with liquid seeping out sometimes

A

cyst

A BALL OF FLUID

cysts are not transformative, they do not evolve into a malignancy, almost ALWAYS benign and self-limiting

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10
Q

raised, irregularly-shaped lesions with defined-borders, different color than surrounding skin, patches of >2cm in diameter located over the knees which bleeds a little when picked

A

plaque

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11
Q

(2) most common sites for psoriasis

A

tips of the elbows, front of knees

may be anywhere on the body, including the scalp, when widespread but tends to spare the face

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12
Q

flat, non-blanchable confluent purple-colored irregularly-shaped lesions on the skin ranging in size from 2-20mm

A

purpura

NON-BLANCHABLE is key (vs. vascular lesions will blanch)

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13
Q

purpura are [blanchable vs. non-blanchable]

A

non-blanchable

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14
Q

clustered, smooth, slightly-raised, circumscribed, pruritic skin-colored lesions of various sizes up to 2cm surrounded by area of erythema which began all over after starting an antibiotic

A

wheal

e.g., hives = urticaria

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15
Q

hives are an example of this skin lesion

A

wheal (urticaria)

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16
Q

umbilicated, waxy-looking lesions, suspect….

A

molloscum contagiosum

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17
Q

presentation of varicella (chickenpox)

A

presents with primary and secondary lesions including vesicles and crusts that are scattered over the entire body. usually in children or young adults. mild-moderately systemically ill with a fever, myalgias, significant pruritis.

typical for the vesicular lesions to start on the trunk and spread to the limbs 2-3 days latter.

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18
Q

presentation of herpes zoster (shingles)

A

presents with primary and secondary lesions including vesicles and crusts usually unilateral in a dermatomal pattern. usually in an adult >50yo but possible at any age if they have a history of varicella. they may be miserable with pain, some itch, but usually do not have a fever.

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19
Q

which can be treated with oral antiviral therapy: varicella or herpes zoster?

A

both!

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20
Q

priority complications of varicella (chickenpox)

A

bacterial superinfection of the lesions

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21
Q

priority complications of herpes zoster (shingles)

A

post-herpetic neuralgia, ophthalmic involvement, superimposed bacterial infection

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22
Q

treatment for varicella (chickenpox)

A
  • antiviral medications such as oral acyclovir in early illness (start within 24-48 hours of skin eruption), particularly in higher risk groups (children with underlying health conditions, most adults)
  • antivirals help minimize the duration and severity of the illness
  • AVOID ASPIRIN THERAPY AND NSAIDs d/t risk for Reye’s syndrome and necrotizing fasciitis
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23
Q

priority medications to avoid with varicella (chickenpox) (2)

A
  • NSAIDs d/t risk for necrotizing fasciitis

- Aspirin d/t risk for Reye’s syndrome

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24
Q

treatment for herpes zoster (shingles)

A
  • high dose antiviral medication in early illness (within 72 hours) can help minimize duration and severity
  • provide analgesia (??_
  • itch can be treated systemically (??) and with local ice pack, calamine lotion, and avoiding the clothes rubbing on the lesions
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25
Q

efficacy of the varicella vaccine

A

80% with first dose
99% with second dose

lifetime immunity

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26
Q

what is “clustered” pattern

A

occurring in a group without pattern, such as lesions in HSV1 (clustered vesicles)

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27
Q

what is “linear” pattern

A

in a line, streaks

typically with phytodermatitis by exposure to plant oil

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28
Q

HSV1 tends to be where…..

A

above the waist

but can also be below

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29
Q

HSV 2 tends to be where….

A

below the waist

does not tend to go above the waist

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30
Q

what is “scattered” pattern

A

generalized over the entire body without a specific pattern or distribution such as seen in viral exanthems (e.g., rubella - German measles)

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31
Q

what is “confluent” or “coalescent” pattern

A

multiple lesions blending together, such as in psoriasis

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32
Q

what is a viral examthem

A

a rash that goes along with a viral infection (non-specific)

common in children (benign, self-limiting), very uncommon in adults

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33
Q

what is “annular” pattern

A

in a ring,

e.g., bull’s eye characteristic of Lyme, or ring seen in tinea

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34
Q

what is “nummular” pattern

A

coin-shaped

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35
Q

scaling, flesh-colored lesions in a cluster ranging in size from 3-10mm on the dorsal aspect of the hand, present for a number of months without patient complaint in a 60yo m.

you suspect….

A

actinic keratoses (pre-cancer) - clinical dx

often on sun-exposed skin

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36
Q

well-demarcated round-to-oval erythematous coin-shaped plaques approximately 10mm in diameter over the anterior aspects of the lower legs described as intermittently itchy present for a number of months.

you suspect…

A

nummular eczema - clinical dx

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37
Q

patient notes loss of pigment in patches of skin present for weeks-months

you suspect…

A

vitiligo - clinical dx, auto-immune

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38
Q

pt presents with a painless, ulcerated lesion approx 1.5cm in diameter over the sternum presents for a number of weeks

you suspect….

A

squamous cell carcinoma – needs a biopsy

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39
Q

since vitiligo is auto-immune, it is often associated with….. (3)

A

other autoimmune conditions

  • thyroid dz
  • t1dm
  • rheumatoid arthritis
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40
Q

classic presentation of actinic keratosis

A

on skin surface (looks like someone loosely glued a cornflake onto the skin)

red or brown, scaly, often tender but usually minimally symptomatic

occasionally flesh-colored, more easily felt but running a finger over the affected area than seen

they can remain unchanged, spontaneously resolve, or progress to SCC

clinical dx, biopsy is usually not required

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41
Q

how common is it for actinic keratoses to progress into SCC

A

1 in 100

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42
Q

treatment options for actinic keratosis

A
  • topical 5-flourouracil cream (5FU)
  • topical imiquimod cream 5%
  • topical diclofenac gel (NSAID)
  • photodynamic therapy with topical delta-aminolevulinic acid (derm specialty office only)
  • cryosurgery with liquid nitrogen (generalist NP can do)
  • medical-grade laser resurfacing or chemical peel (derm specialty office)
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43
Q

which is more common? basal vs. squamous cell carcinoma

A

basal cell carcinoma

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44
Q

common presentation of basal cell carcinoma

A

papule, nodule

with or without central erosion

pearly or waxy appearance usually with relatively distinct borders and with or without telangiectasia

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45
Q

which has a greater risk of metastasis? basal vs. squamous cell carcinoma

A

basal cell carcinomas have virtually no metastatic risk

metastatic risk is greater with SCC, at 3-7%

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46
Q

highest risk for SCC skin cancer metastasizing when they are located where? (3)

A
  • lip
  • oral cavity
  • genitals
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47
Q

risk for squamous cell carcinoma of skin becoming metastatic

A

3-7%

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48
Q

ABCDE is for what type of skin cancer?

A

malignant melanoma

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49
Q

ABCDE of malignant melanoma

A 
Asymmetric
Borders (irregular)
Color (not uniform)
Diameter (usually >6mm)
Evolving (new, changing)
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50
Q

malignant melanomas are most commonly greater than ____mm

A

> 6mm

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51
Q

most melanomas evolve from [new vs. existing] moles

A

new

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52
Q

most common place for malignant melanomas in darker skin folks (3)

A
  • soles of feet
  • palms of hands
  • nailbeds
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53
Q

sensitivity and specificity of ABCDE when 2 or more features are present

A

100% sensitive, 98% specific

refer for excisional biopsy

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54
Q

treatment for psoriasis vulgars

A

medium-potency topical corticosteroids

if limited, a couple times a day until under control and then try 3x per week

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55
Q

treatment for scabies

A

permethrin lotion

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56
Q

treatment for verruca vulgaris (common warts)

A

imiquimod cream (Aldara)

an immune modulator that causes the body to mount an immunologic reaction to keep HPV in check

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57
Q

what causes warts?

A

HPV (many types)

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58
Q

treatment for tinea pedis (athlete’s foot)

A

topical ketoconazole

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59
Q

treatment for acne rosacea

A

topical metronidazole (MetroGel)

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60
Q

common derm condition that presents in folks of the elbow (antecubital fossa) and behind the knees (popliteal space)

A

eczema (atopic dermatitis)

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61
Q

common locations for scabies to present (4)

A
  • webs of fingers
  • under the breasts
  • under the arms (upper arm)
  • waistband area on the trunk

warm places

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62
Q

derm condition characterized by a preceding herald patch on the trunk followed by the development of scattered lesions in a christmas-tree pattern

generally pt is not bothered by the rash, no other symptoms

A

pityriasis rosea

we dont know what causes it for sure and tends to be mild and self-limiting

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63
Q

hyperpigmented plaques with a velvet-like appearance on the nape of the neck and axillary region

A

acanthosis nigricans

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64
Q

most common locations for acanthosis nigricans

A
  • neck
  • axilla
  • groin folks
  • elbows
  • knuckles

tends to spare the plantar surface of the feet

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65
Q

cutaneous manifestation of insulin resistance

A

acanthosis nigricans

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66
Q

another skin finding commonly presenting with acanthosis nigricans

A

multiple skin tags

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67
Q

can acanthosis nigricans ever go away?

A

yes, it can regress, may not go away completely but can get much much lighter with weight loss and dietary changes with reduction in insulin resistance

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68
Q

plant phytodermatitis covering >20% total BSA, consider prescribing the following:

A
    • systemic corticosteroids **

- oral anthistamine

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69
Q

once >___% of BSA is affected by a plant dermatitis, do a systemic corticosteroid

A

> 20%

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70
Q

reasons to consider prescription for SYSTEMIC corticosteroids in someone with a plant phytodermatitis

A
  • > 20% BSA is affected
  • severe rash (e.g., large number of blisters)
  • rash impacts the face, genitals, or hands
  • rash impacts the ability to work
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71
Q

duodenal ulcers are caused by…..

A

h pylori

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72
Q

gastric ulcers and gastritis can be caused by…..

A

systemic corticosteroids

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73
Q

pharm topical treatment for plant dermatoses

A
  • optimal for localized acute contact dermatitis
  • mid or high potency topical corticosteroids (e.g., triamcinolone or clobetasol)
  • use lower potency (e.g., desonide) for thinner skin areas (e.g., flexural surfaces, eyelids, face, ano-genital)
  • ointment is preferred over cream because medication contacts skin longer
  • risk for skin atrophy with protracted use (2-3 weeks or more) with higher potency topical steroids
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74
Q

systemic pharm treatments for plant dermatoses

A
  • prednisone 0.5-1mg/kg/day PO x5-7 days
  • will usually provide relief within 12-24 hours
  • should be followed by an additional 5-7 of 50% of dose to minimize risk of recurrence (total course = 10-14 days)
  • do not need an additional taper when systemic steroids are used only short-term (<14 days)
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75
Q

you do not need an oral steroid taper when it is used for less than ____ days

A

<14 days

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76
Q

other non-pharm and OTC options for plant dermatoses beyond topical or systemic steroids

A
  • cool compress
  • calamine lotion
  • colloidal oatmeal baths
    (dry and soothe oozing lesions)
  • OTC analgesics to relieve pain
  • oral anthistamines for pruritis
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77
Q

what is “bullae”

A

big blisters - aka, big vesicles

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78
Q

clinical presentation of non-bullous impetigo

A

erythematous macules (flat) that rapidly evolves into a vesicle or pustule, then ruptures, and when the contents dry leaves a honey-colored crusted exudate

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79
Q

(2) most likely causative agents of non-bullous impetigo

A
  • staph aureus

- strep pyogenes (GAS)

80
Q

treatment for nonbullous impetigo

A
  • often can be treated with topical antimicrobials such as muciprocin (Bactroban)
  • systemic antibiotics when extensive lesions or if topical tx fails (penicillin VK, cephalexin, dicloxacillin, clindamycin)
81
Q

clinical presentation of bullous impetigo

A

most common in children

bulla contain clear, yellow fluid that turns cloudy, dark yellow.

the bulla rupture easily, within 1-3 days, leaving a rim of scale around red, moist base followed by a brown-lacquered or scalded-skin appearance

82
Q

treatment for bullous impetigo

A

usually requires PO systemic antibiotics due to extensive distribution

83
Q

which impetigo is most likely limited to only one area of the body vs. generalized all over body

A

nonbullous impetigo = localized

bullous impetigo = generalized

84
Q

clinical presentation of cellulitis

A

infection of the dermis and subcutaneous fat usually including heat, redness, and discomfort in the region

85
Q

cellulitis is almost always caused by…..

A

strep pyogenes (GAS)

86
Q

most common causative pathogens for cellulitis (3)

A
  • strep pyogenes (GAS)
  • staph aureus (MSSA; methicillin-susceptible)
  • MRSA
87
Q

clinical presentation of cutaneous abscess

A

skin infection involving a hair follicle and the surrounding tissue, usually presenting with heat, redness, and discomfort in the region

88
Q

most common causative organism for cutaneous abscess (1)

A

staph aureus (MSSA or MRSA)

89
Q

(4) PO antibiotics used to treat mild impetigo

A
  • cephalexin (Keflex) ** first choice **
  • penicillin VK
  • dicloxacillin
  • clindamycin
  • PO penicillin VK –> only drawback is will not work against beta-lactamase producing strains
  • PO cephalexin (Keflex) –> this is cheap, easy on the stomach, BID dosing, and works well against beta-lactamase producing organisms so BEST CHOICE
  • PO dicloxacillin –> works well but is 4x per day dosing, not preferred
  • PO clindamycin –> risk factor for C. diff, not preferred
90
Q

antibiotic most commonly associated with C. Diff in the community

A

clindamycin

91
Q

topical antibiotic of choice for mild impetigo

A

mupirocin (Bactroban)

92
Q

mild abscess treatment

A
  • I&D

- warm compress

93
Q

moderate abscess treatment

A
  • I&D with culture & sensitivity
  • empiric antibiotics with TMP/SMX (Bactrim) or doxycycline … both of which will cover MRSA
  • tx further refined by culture & sensitivity results
94
Q

(2) first line antibiotic therapies for moderate abscess

A
  • TMP-SMX (Bactrim)

- doxycycline

95
Q

If culture & sensitivity of an abscess returns MRSA, what antibiotics are your best options? (2)

A
  • TMP/SMX PO

- doxycycline PO

96
Q

If culture & sensitivity of an abscess returns MSSA, what antibiotics are your best options? (2)

A
  • dicloxacillin PO
  • cephalexin (Keflex) PO

doxy and bactrim (TMP-SMX) do well with MRSA but they don’t have great coverage of MSSA

97
Q

most common reason in the USA for a new-onset ulcerating skin lesion

A

MRSA infection

98
Q

presentation of a brown recluse spider bite

A

“red white and blue” sign

blue=central lesion where bit occurred
red = red ring
white = blanched area between red ring and blue interior

central blistering with surrounding gray-to-purple discoloration at bite site surrounded by a ring of blanched skin surrounded by a larger area of redness

99
Q

treatment for brown recluse spider bite

A
  • ice at the time of event to keep venom from spreading
  • local debridement
  • elevation and loose immobilization
  • dapsone (antibiotic) is often used with little evidence of its being helpful
100
Q

where does brown recluse spider like to hide

A

footwear, boxes, hidden things

101
Q

where is the most common place to get a brown recluse spider bite

A

hand, foot

102
Q

what will a second degree (partial thickness) burn present as

A

red, moist with peeling borders and scattered bulla
may be swollen and painful

caused by scalds, flash burns, flame

103
Q

what will a first degree (superficial) burn present as

A

reddened skin, easily blanched with gentle pressure
burn site is red, painful and dry with no blisters

caused by sunburn, scald, flash flame

104
Q

first degree burns affect the…..

A

epidermis only (outer layer) - superficial

105
Q

second degree burns affect the….

A

epidermis and dermis (partial thickness)

106
Q

third degree burns affect the…..

A

epidermis, dermis, and hypodermis/underlying fat (full thickness)

107
Q

equivalent to 1% of BSA

A

size of the palmar surface of the hand

108
Q

what will a third degree (full thickness) burn present as

A

can appear white or charred

caused by flame, hot surface, hot liquids, chemical, or electric

109
Q

treatment recommendations for a first degree (superficial) burn

A

cool compresses
lotion or ointment
acetaminophen or ibuprofen

110
Q

treatment recommendations for a third degree (full thickness) burn

A

referral to burn specialty care

111
Q

% of burns treatment that can be managed in the outpatient setting

A

95%! most are superficial, partial-thickness burns involving limited BSA

112
Q

Treatment recommendations for second degree (partial thickness) burns

A
  • pain control with acetaminophen or NSAIDs
  • run under cool water for 15-20 minutes
  • clean the wound with sterile water
  • eave the blisters intact if possible; otherwise, debride large blisters with thin walls that will prevent movement of a joint or that are likely to rupture
  • use topical agents and dressings to keep the area MOIST
  • ensure adequate hydration for wound healing
  • topical antibiotics such as bacitracin, mafenide acetate (Sulfamylon), mupirocin (Bactroban), silver sulfadiazine (Silvadene)
113
Q

topical antimicrobial therapies for second-degree burns (4)

A
  • bacitracin
  • mafenide acetate (Sulfamylon)
  • mupirocin (Bactroban)
  • silver sulfadiazine (Silvadene)
114
Q

when to refer a burn to a burn center

A
  • pts with preexisting medical conditions that could complicate management or prolong recovery
  • partial and full-thickness burns that affect the face, hands, feet, genitals, perineum, or major joints
  • chemical burns
  • electrical burns including lightning injury
  • inhalational injury
  • partial-thickness burns of >10% BSA
  • third degree burns in any age group
115
Q

% BSA: head and neck

A

9%

116
Q

% BSA: upper limbs (front and back)

A

9% each

117
Q

% BSA: trunk (front and back)

A

36%

118
Q

% BSA: genitalia

A

1%

119
Q

% BSA: palmar aspect of hand

A

1%

120
Q

% BSA: lower limbs (front and back)

A

18% each

121
Q

Sun safety information for adults

A
  • covering up is the best first defense = hat with a brim or bill, sunglasses that block 99-100% of UV rays, cotton clothing with a tight weave
  • stay in the shade when possible and limit sun exposure during peak intensity hours (10am-4pm)
  • on all days (even cloudy), wear a sunscreen with SPF at least 15 that protects against UVA and UVB
  • apply enough sunscreen = 30mL (1oz) per sitting
  • reapply sunscreen Q2 hours or after swimming or sweating
  • use extra caution near reflective surfaces that can cause sunburn more quickly including water, sand, and snow
122
Q

words for PRIMARY lesions

A
  • macule, patch
  • papule, nodule, mass
  • plaque
  • wheal (urticaria, hives)
  • vesicle, bulla
  • cyst
  • pustule
123
Q

words for SECONDARY lesions

A
  • scale
  • crust
  • erosion
  • ulcer
  • fissure
  • scar
  • lichenification
124
Q

words for the SHAPE of skin lesions

A
  • annular (round)
  • iris or targetoid (concentric, bulls eye)
  • gyrate (curved)
  • linear (line)
  • nummular (coin-shaped)
  • polymorphous
  • punctate (tiny)
  • serpinginous (snake like)
125
Q

words for the LOCATION/DISTRIBUTION of skin lesions

A
  • solitary
  • satellite
  • grouped
  • confluent
  • diffuse
  • discrete
  • generalized
  • localized
  • symmetrical
  • zosteriform
126
Q

what is a MACULE

A

1cm or less
flat
non-palpable

127
Q

what is a PATCH

A

> 1cm
flat
non-palpable

128
Q

what is a PAPULE

A

1cm or less
raised
round-topped

129
Q

what is a NODULE

A

> 1cm
raised
round-topped

130
Q

medical term for a mole

A

benign nevus (pl. nevi)

collection of melanocyte cells

131
Q

what is a MASS

A

raised lesion >3cm

bigger than a papule or nodule

132
Q

what is a PLAQUE

A

> 1cm
raised
flat-topped

133
Q

what does a seborrheic keratosis present as

A

elevated, flat topped “stuck-on” plaque, brownish-tan, older folks

134
Q

what is a WHEAL

A 
edematous plaque
peripheral redness
transient (<24h)
probably pruritic
aka "hive"
135
Q

what are hives (wheals) caused by

A

transient, d/t allergic rxn in the skin (histamines) –> cause the vessels to be leaky

goes away in 24h

136
Q

what is a VESICLE

A

1cm or less
raised
contains clear, serous, or serosanguinous fluid

137
Q

what is a BULLA

A

> 1cm
raised
contains clear, serous, or serosanguinous fluid

aka blister

138
Q

what is a PUSTULE

A

1cm or less
raised
vesicle that contains pus

139
Q

what is a CYST

A 
any size
raised/elevated
thick-walled/subcutaneous
contains liquid or semisolid material
encapsulated
140
Q

most common type of cyst

A

epidermal (inclusion) cyst

141
Q

what is a FURUNCLE

A

> 1cm
deep
contains pus/purulent exudate

aka boil or abscess

142
Q

what is SCALE

A

dried fragments of dead epidermal cells, major component of household dust

usually white

e.g., white flakes of skin on top of a primary lesion

DANDRUFF

143
Q

what is CRUST

A

dried sebum, blood, or pus

aka “scab”

144
Q

what is an EROSION

A

loss of SUPERFICIAL layers of the epidermis

smooth, moist, erythematous

145
Q

what is an ULCER

A

loss of the entire epidermis and all or part of the dermis

146
Q

what is a FISSURE

A

a linear ulcer, sharply defined

147
Q

what is LICHENIFICATION

A

thickened epidermis, increased skin lines, results from scratching

148
Q

what is EXCORIATION

A

linear abrasions of the epidermis, results from scratching

149
Q

NON-BLANCHING lesions (3)

A

petechiae
purpura/ecchymosis
hematoma

150
Q

BLANCHING lesion

A

vascular lesions = telangiectasia

151
Q

are telangiectasias blanchable?

A

yes

152
Q

are purpura/hematomas blanchable?

A

no

153
Q

what is PETECHIAE

A

non-blanching
reddish brown
macule (flat, small)

154
Q

what is PURPURA/ECCHYMOSIS

A

non-blanching
reddish brown
patch (flat, larger)

155
Q

what is HEMATOMA

A

deep collection of blood
non-blanching
usually as a result of blunt trauma

156
Q

most common cause of telangiectasias

A

sun damage

157
Q

When taking a pt’s blood pressure, you see a shower of petechiae to the lower arm after placing the tourniquette. you suspect….

A

scurvy, vitamin C deficiency

158
Q

satellite lesion distribution, most commonly from what kind of infection?

A

yeast (candida)

e.g., under the breasts, in armpits, in skin folds

159
Q

what is ZOSTERIFORM

A

skin lesions arranged in a dermatomal pattern

160
Q

If a mole does not change at all over the course of ______, it is very unlikely to turn into a melanoma

A

6-12 months

161
Q

what is a telangiectasia?

A

a blanching dilated capillary

162
Q

treatment for seborrheic keratosis

A

benign, treatment is not necessary

if irritating, can use cryotherapy (liquid nitrogen)

163
Q

most common causative agent of acne vulgaris

A

p. acnes (propionibacterium acnes)

164
Q

(2) topical antibiotic options for treatment of acne vulgaris

A
  • topical clindamycin

- topical erythromycin

165
Q

(4) oral antibiotic options for the treatment of acne vulgaris

A
  • doxycycline 100mg PO QD-BID
  • minocycline 100mg PO QD
  • erythromycin 500mg PO BID-TID
  • TMP-SMX (Bactrim) 800/160mg 1 tablet BID
166
Q

classes of medications for treatment of acne vulgaris (from mild to severe)

A
  • topical benzoyl peroxide cream or gel
  • topical retinoids (tretinoin, adapalene)
  • topical antibiotics (clindamycin, erythromycin)
  • OCPs (low progesterone or drospirenone progesterone)
  • oral antibiotics (doxycycline, minocycline, erythromycin, TMP-SMX)
  • oral spironolactone (anti-androgen, uncommon)
  • isotretinoin (Accutane) – only for severe, nodulocystic acne
167
Q

medication options for the treatment of acne rosacea

A
  • topical metronidazole cream or gel BID (Metrogel)
  • azelaic acid
  • ivermectin
  • sulfur products
  • oral antibiotics if severe including doxycycline, minocycline, or erythromycin
168
Q

dx: a chronic eruption of scaly plaques on the EXTENSOR surfaces that may involve the scalp and nails. well-defined plaque with thick silvery scale with associated pitting of the nails

A

psoriasis

169
Q

psoriasis tends to affect [flexor vs. extensor] surfaces

A

extensor

170
Q

eczema tends to affect [flexor vs. extensor] surfaces

A

flexor

171
Q

what causes psoriasis?

A

largely unknown – possible genetic, environmental, and physical factors?

immune dysregulation drives condition (auto-immune)

172
Q

medication options for the treatment of psoriasis

A
  • topical steroid creams and ointments
  • topical calcipotriene cream or ointment
  • topical tazarotene (retinoid) gel
  • topical tar-containing ointments
  • phototherapy (UVB & PUVA)
  • oral methotrexate, acetretin (retinoid) or cyclosporine (immune modulator)
  • injectable biologic response modifiers (etanercept, infliximab, adalimumab, etc.)
173
Q

Class I-VII topical steroid potencies – which is the strongest vs. weakest?

A

class I&II are the strongest, NEVER use on face or skin folds

Class VII is the weakest, safe for skin folds and face

174
Q

Topical steroid options from least to most potent: TRIAMCINOLONE

A

(more gentle)
Class VI
- triamcinolone acetonide 0.025% cream

Class V
- triamcinolone acetonide 0.025% ointment

Class III
- triamcinolone acetonide 0.1% ointment
(more potent)

175
Q

Topical steroid options from least to most potent: BETAMETHASONE

A

(more gentle)
Class V
- betamethasone valerate 0.1% cream

Class I
- betamethasone diproprionate 0.05% ointment
(MOST potent of all)

176
Q

Topical steroid options from least to most potent: CLOBETASOL

A

Class I
- clobetasol propionate 0.05% ointment or cream
(MOST potent of all)

177
Q

Topical steroid options from least to most potent: HYDROCORTISONE

A

(MOST gentle of all)
Class VII
- hydrocortisone 0.5%, 1%, and 2.5% ointment and cream

Class IV
- hydrocortisone valerate 0.2% ointment
(more potent)

178
Q

can retinoid skin products (topical or oral) be used in pregnancy?

A

NO!

179
Q

choosing a topical steroid for limited plaque psoriasis treatment

A
  • class I or II (most potent) for short term (14 days) control
  • class III-IV for daily maintenance therapy
180
Q

medication treatment for mild-moderate eczema (atopic dermatitis)

A
  • good skin care (mild cleanser, lukewarm showers, fragrance free lotions)
  • topical steroids for flares ONLY (class I or II for severe flares for 14 days; class IV-VII for mild flares)
  • consider topical antibiotics if the lesions are crusted (bacitracin/polymyxin, avoid neomycin)
  • consider oral antibiotics if widespread or grossly infected (cephalexin [Keflex] or erythromycin)
  • consider biologic response modifiers (tacrolimus, pimecrolimus) topically for refractory disease (expensive!)
181
Q

therapy options for severe or widespread eczema

A
  • dermatology referral!

anticipatory guidance for they can expect options to include: oral or IM steroids, phototherapy, oral methotrexate

182
Q

what causes urticaria

A

local histamine release in the skin

Type I hypersensitivity reaction mediated by IgE mast cell degranulation which causes the release of histamine and other chemical mediators&raquo_space; leading to increased capillary permeability and tissue edema

183
Q

medication therapy for urticaria

A
  • identify the allergen and avoid (drugs, pollen, chemicals, food, bacteria, preservatives, malignancy)
  • oral antihistamines, e.g., loratidine (Claritin) 10mg QD, cetirizine 10mg QD, fexofenadine 180mg QD, hydroxyzine 10-20mg Q6-8 hrs
  • AVOID systemic steroids
184
Q

topical antifungal cream options for the treatment of fungal skin infections (dermatophyte fungi)

A
  • miconazole 2% BID
  • clotrimazole 1% BID
  • econazole 1% QD-BID
  • ketoconazole 2% QD-BID
  • terbinafine 1% QD-BID
185
Q

topical nystatin and fungal infections?

A

only works against candida species

has NO effect on dermatophyte fungi

186
Q

are combination topical antifungals-steroids a good idea for fungal skin infections?

A

NO - avoid!

topical steroids cause localized immunosuppression which promotes fungal growth

can cause permanent skin atrophy due to the strong topical steroid

187
Q

priority risks/side effects of oral antifungals

A
  • photosensitivity
  • GI upset
  • elevated liver enzymes
188
Q

most common causative agent of tinea corporis (fungal infection on the body)

A

trichophyton rubrum

189
Q

most common causative agent of tinea capitis (fungal infection of the hair)

A

trichophyton tonsurans

190
Q

most common causative agent of tinea unguium (fungal infection of the nails)

A

trichophyton rubrum

191
Q

topical antifungals are ineffective against which types of tinea infection (fungal infection) (2)

A
  • tinea capitis (hair)

- tinea unguium (nails)

192
Q

treatment options for tinea capitis

A
  • topical agents are ineffective
  • oral griseofulvin suspension 15-20mg/kg/day x8 weeks
  • terbinafine 250mg QD x2-8 weeks
  • selenium sulfide 2.5% shampoo daily to reduce infectivity
193
Q

treatment options for tinea unguium

A
  • topical agents are ineffective
  • terbinafine 250mg QD x6 weeks (fingers) or 12 weeks (toes)
  • itraconazole pulse therapy 400mg QD x 7 days Q4 weeks x2 pulses (fingers) or 3 pulses (toes)
194
Q

treatment options for scabies

A
  • permethrin 5% cream (Elimite)… apply to all skin sparing the face for 8-12 hours as a single application
  • topical steroids class III-IV for itching
  • oral antihistamines for itching

may take 3-4 weeks for itching to resolve completely

195
Q

treatment options for herpes simplex labialis (cold sore)

A
  • no treatment is necessary
  • topical acyclovir is not very effective
  • can consider topical bacitracin/polymyxin ointment to prevent a bacterial superinfection
196
Q

treatment options for herpes genitalis

A
  • oral acyclovir 400mg TID x5 days (recurrent infection) - 7 days (primary infection)
  • can consider topical bacitracin/polymyxin ointment to prevent bacterial superinfection
197
Q

what topical ointment has excellent action against staph and strep, the most common skin pathogens

A

mupirocin (Bactroban)

AGPCNP Board Prep (21 decks)

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