CLINICAL CARE OF THE SKIN, HAIR AND NAILS Flashcards
What is an inflammation of a hair follicle that can occur anywhere on the body where hair is found?
Folliculitis
Folliculitis is most frequently due to what bacteria?
S. aureus (+/- MRSA)
Strep species, pseudomonas also contribute
These are what kind of causes of folliculitis ?
- Dermatophytic
- Pityrosporum on upper chest and back
- Candida albicans
Fungal
What are viral causes of folliculitis ?
- HSV
2. Molluscum contagiosum
What are some parasitic causes of folliculitis?
- Demodex spp. Mites
2. Schistosomes
What are the non infectious causes of Folliculitis?
- PFB
2. Mechanical Folliculitis (Skinny Jeans Syndrome)
The following are all risk factors for what?
- Hair removal
- Other pruritic skin conditions: eczema, scabies
- Occlusive dressing or clothing
- Personal carrier or contact with MRSA
- DM
- Immunosuppression
- Use of hot tubs or saunas
- Chronic antibiotic use
- Tattoos
- Poor hygiene
Folliculitis
What is an abrupt onset of follicular erythematous papules or pustules, with pruritis and pain in hair areas; rash occurs on hair-bearing skin, especially the face (beard), proximal limbs, scalp, and pubis?
Folliculitis
What form of folliculitis appears as a widespread rash, mainly on the trunk and limbs?
Pseudomonal Folliculitis
What is the clinical hallmark of folliculitis ?
Hair emanating from the center of a pustule
True or False
The diagnosis for folliculitis is made clinically
True
What is the treatment of folliculitis?
- Antiseptic and supportive care is usually enough.
- Good hygiene practices
- Wash hands
- Wash towels, clothes, and linens frequently
- Good hair removal practices
- Use witch hazel, alcohol, or tend skin afterward
What is the treatment for Staphylococcal folliculitis?
- Mupirocin ointment applied TID for 10 days
- Cephalexin: 250-500 mg PO QID (7-10 days)
- Dicloxacillin: 250-500 mg PO QID (7-10 days)
Folliculitis
What is the treatment for MRSA?
- Bactrim DS: 1-2 tablets BID PO (5-10 days)
- Clindamycin: 300 mg PO TID (10 to 14 days)
- Doxycycline: 50-100 mg PO BID (5-10 days)
What is the treatment for Pseudomonas folliculitis?
- Ciprofloxacin: 500 to 750 mg PO BID for 7 to 14 days if lesions are
persistent - High-potency topical corticosteroids for inflammation
- Antihistamines (hydroxyzine, cetirizine) to control itching
What is the treatment for Fungal Folliculitis?
- Topical antifungals: ketoconazole 2% cream or shampoo or selenium
sulfide shampoo daily - Systemic antifungals for relapses fluconazole (100 to 200 mg/day for 3 weeks) or itraconazole (200 mg/day for 1 week) or griseofulvin (500 mg/day for 2 to 4 weeks)
What is the treatment for Parasitic folliculitis?
- 5% permethrin: Apply to affected area, leave on for 8 hours, and wash off.
What is the treatment for Herpetic Folliculitis?
- Valacyclovir: 500 mg PO TID for 5 to 10 days
2. Acyclovir: 200 mg PO 5 times daily for 5 to 10 days
What is the primary complication of folliculitis?
Recurrent folliculitis
What is a condition caused by ingrowing hairs, mostly in the beard area (neck area is typically most severe)?
Pseudofolliculitis Barbae
What condition affects people with curly hair or those with hair follicles oriented at an oblique angle to the skin surface, a sharp, shaved, tapered hair re-enters the skins as it grows from below the skin surface and induces a foreign body reaction, producing a micro-abscess?
Pseudofolliculitis Barbae
What condition presents with red papules or pustules that can be both painful and or pruritic, occurs in any area where the hair is shaved, scarring and hyper pigmentation may result from this condition?
Pseudofolliculitis barbae
Keloid formation is often a problem in what condition, especially in African-American people?
Pseudofolliculitis Barbae
PFB is found in ___% to ___% of blacks and __% to ___% of whites who shave
- 50%-75%
2. 3%- 5%
What is treatment approach 1 for PFB?
Medical treatment with grooming standard modifications
What is treatment approach 1 for PFB (mild to moderate)?
Medical treatment with Grooming modifications
The treatment of what consists of the combined use of: application of medicated creams to make hairs more shaveable, shaving with gentle equipment and shaving techniques to minimize the risk of irritation and hair re-entry into the skin?
Mild to Moderate PFB
What is treatment approach 2 for PFB (moderate to severe PFB)?
Laser hair reduction with grooming modification
True or False
Where available, laser hair reduction is the most reliable approach allowing a return to grooming standards. This is an appropriate treatment for moderate to severe cases of PFB or any case desiring permanent hair reduction.
True
Laser Treatment of PFB
A series of at least ____ treatments is usually needed, with ___ to ___ days between treatments. This procedure is usually available at military medical treatment facilities with a dermatology department.
- Three
2. 30-45 days
What are the complications of PFB?
Abscess formation and scarring
What is a contagious, superficial, intra-epidermal infection occurring prominently on the exposed areas of the face and extremities?
Impetigo
What form of Impetigo is the invasion of previously healthy skin?
Primary Impetigo (pyoderma)
What form of Impetigo is an invasion at sites of minor trauma (abrasions, insect bites, underlying eczema) and can be considered to be S. aureus Impetigo of hair follicles?
Secondary Impetigo (impetiginization)
True or False
Impetigo may present with S. Aureus alone or combined with Group A beta-hemolytic streptococci
True
What is known as a deeper, ulcerated impetigo infection often with lymphadenitis?
Ecthyma
What are the synonyms for Impetigo?
- Pyoderma
- Impetigo contagiosa
- Impetigo vulgaris
What is the most common form of impetigo, presenting with the formation of vesiculpustules that rupture, leading to crusting with a characteristic golden appearance; some local lymphadenopathy may occur?
Nonbullous impetigo
What is a staphylococcal impetigo that progresses from small to large flaccid bullae (newborns/young children) caused by epidermolytic toxin release; ruptured bullae leaving brown crust; less lymphadenopathy; trunk is most often affected in <30% of patients?
Bullae Impetigo
These are all risk factors associated with what condition?
- Warm humid environment
- Tropical or subtropical climate
- Summer or Fall season
- Minor trauma, insect bites, breaches in skin
- Poor hygiene, poverty, crowding, epidemics, wartime
- Familial spread
- Complications of pediculosis, scabies, chicken pox, eczema/atopic dermatitis
- Contact dermatitis
- Burns
- Contact sports
- Children in day care
- Carriage of Group A Strep and S. Aureus
Impetigo
What is a cutaneous pyoderma characterized by thickly crusted erosions or ulceration, usually a consequence of neglected impetigo and classically evolves in impetigo occluded by footwear and clothing?
Ecthyma
True or False
Impetigo Treatment
Treatment speeds healing, improves cosmetic appearance, and avoids spread of disease. Avoidance of infection spread is the key; hand washing is vital, especially for reducing spread in children.
True
What can be used to help prevent impetigo at the sites of minor skin trauma?
Mupirocin ointment TID
Impetigo Treatment
Remove crusts, clean with gentle washing ___ to ___ times daily, and clean with antibacterial soap, chlorhexidine, or Betadine
2-3 times daily
Impetigo treatment
What is the treatment for Vanilla Staph?
Nonbullous (minor spread, treat 7 days; widespread, treat 10 days); bullous (treat 10 days)
- Mupirocin (Bactroban) 2% topical ointment applied TID for 5 to 7 days (nonbullous only)
- Dicloxacillin: Adult 250 mg PO QID
Impetigo treatment
What is the treatment for MRSA?
- Clindamycin, tetracyclines, or trimethoprim-sulfamethoxazole. Oral
doses given for 7 days are usually sufficient. - Clindamycin 300 mg q6-8h
What is the disposition for a patient with Impetigo?
- Full duty or modified duty
2. Dependent on location, distribution, and extent
What is an acute bacterial infection of the dermis and subcutaneous (sc) tissue and is typically caused by bacterial penetration through a break in the skin?
Cellulitis
What infection of the skin presents with these 4 classic signs of inflammation?
- Erythema
- Edema
- Tenderness to palpation
- Elevated skin temperature surrounding area of infection
Cellulitis
What skin infection typically has unilateral lower-extremity involvement with systemic symptoms usually being absent, the most common portal of entry of this for the lower leg is the toe web intertrigo with fissuring ?
Cellulitis
True or False
Cellulitis typically occurs near surgical wounds and trauma sites
True
A patient presents with a wound to the lower left leg with itching and burning; he is running a fever and reports chills and malaise over the past 4 days. He has some localized pain and tenderness with erythema, induration, swelling and warmth to the site. Regional lymphadenopathy and purulent drainage is noted as well. What is the most likely diagnosis?
Cellulitis
The following is the treatment for what?
- Demarcate area w/ sharpie to measure progress once treatment is started
- Immobilize and elevate involved limb to reduce swelling
- Sterile saline dressing or cool aluminum acetate compresses for pain relief
- Compression stocking for edema
- Tylenol +/- NSAIDS for pain relief
- Tetanus if needed (especially if there is an open traumatic wound)
Cellulitis
What is the antimicrobial treatment for Non-purulent cellulitis?
(target treatment toward beta-hemolytic streptococci and MSSA)
- Cephalexin 500mg PO q6H
2. Dicloxacillin 500mg PO q6H
What is the antimicrobial treatment for Purulent cellulitis?
probable CA-MRSA
- Clindamycin 450mg PO
- Trimethoprim-sulfamethoxazole (TMP-SMX) 1 DS tab PO BID
- Doxycycline 100 mg PO BID
What is the antimicrobial treatment for cellulitis secondary to a human or animal bite?
Amoxicillin + clavulanic acid (Augmentin)
MEDADVICE needs to be considered when for cellulitis?
- Elevated WBC with marked left shift
- Failure to respond to oral antibiotics
- Severe infection, suspicion of deep or rapidly spreading infection, tissue necrosis, or severe pain
- Worsening symptoms that do not resolve/improve after 24 - 48 hrs of therapy
True or False
Cellulitis of the hands and face my require hospitalization
TRUE TRUE TRUE
What are rare and rapidly progressing infections involving any layer of the soft tissue including the skin, subcutaneous fat, fascia, and or muscle; associated with extensive tissue destruction, systemic toxicity, limb loss and are potentially fatal; and represents a MEDICAL EMERGENCY?
Necrotizing Soft Tissue Infections (NSTI)
These can all be risk factors for what tissue infection?
- Major penetrating trauma
- Minor laceration or blunt trauma (muscle strain, sprain, or contusion)
- Skin breach (varicella lesion, insect bite, injection drug use)
- Recent surgery
- Mucosal breach (hemorrhoids, rectal fissures, episiotomy)
- Immunosuppression
- Malignancy
- Obesity
- Alcoholism
Necrotizing Fasciitis
Where does necrotizing fasciitis most frequently occur?
extremities (predilection for the lower leg)
May mimic DVT
In what skin infection will you see and initial presentation of pain, erythema, edema, cellulitis and a high fever; pain is usually progressive, relentless, and severe and is often out of proportion to the severity of the physical findings?
Necrotizing Fasciitis
The skin exam for what may be unrevealing early on, or may be even confused with cellulitis or abscess; you may see blistering, crepitus, soft tissue edema, erythema, discoloration, necrosis, bullae, vesicles, or ulceration?
Necrotizing fasciitis
An MRI for a patient with Necrotizing fasciitis may show what?
Edema along the fascial plane
Cultures for necrotizing fasciitis may show what bacteria?
Group A strep and mixed aerobic and anaerobic bacteria
What is the cornerstone of treatment for necrotizing fasciitis ?
Prompt and wide surgical debridement
may require amputation
What should be administered once the diagnosis of Necrotizing soft tissue infections (NSTI) is suspected?
Broad spectrum antibiotics
Should cover gram positive, negative and anaerobic organisms
What is the main adjunctive therapy to surgery when a patient has Necrotizing fasciitis?
Antibiotics
What is the disposition for a patient with Necrotizing Fasciitis?
IMMEDIATE MEDEVAC
True or False
Necrotizing Fasciitis
Close contacts of patients and health care workers require chemoprophylaxis with antibiotics after being exposed
False
Do not require chemoprophylaxis (good to brief COC on)
What is a well-circumscribed, painful, inflammatory nodule at any site that contains hair follicles, may extend into the dermis and subcutaneous tissues?
Furuncle (aka Boil)
What is a collection of pus within the dermis and deeper skin tissues and manifests as a painful, tender, fluctuant, and erythematous nodules?
Typically no systemic symptoms
Skin abscess
What is a coalescence of several inflamed follicles into a single inflammatory mass with purulent drainage from multiple follicles?
Typically presents with systemic symptoms and fever
Carbuncle
The following is the etiology and pathophysiology of what?
- infection spreads away from the hair follicle into the surrounding dermis
- pathogen strain of S. aureus or CA-MRSA
Abscess
These are risk factors associated with what?
- Carriage of pathogenic Staphylococcus sp. in nares, skin, axilla, and perineum
- DM, malnutrition, alcoholism, obesity, atopic dermatitis
Abscess
The following is a description of what?
- Deep subcutaneous erythematous papules enlarge to deep seated nodules that can be stable or become fluctuant within several days
- Most commonly occurs on the back of the neck, upper back, and lateral thighs
- Tender perifollicular swelling, terminating in discharge of pus and necrotic plug
Carbuncle
True or False
With a carbuncle, malaise, chills, and fever may precede or occur during the height of inflammation
True
Carbuncle should be handled by ____ or _____ in all situations unless the patient is unable to be transferred
dermatology or general surgery
What systemic antibiotic therapy is used to cover MSSA with a patient with an Abscess?
- Dicloxacillin 250-500mg QID for 10 Days
- Cephalexin 250-500mg QID for 10 Days
- Amoxicillin and Clavulanate (Augmentin) 875 mg BID for 10 days
What systemic antibiotic therapy is used to cover MRSA with a patient with an Abscess?
- Doxycycline 100 mg BID
- Trimethoprim-Sulfamethoxazole DS BID
- Clindamycin 150-300 mg BID for 10 days
Abscess
What lab test is indicated if a patient has a fever or signs/symptoms of systemic disease?
CBC
What are the most common benign cutaneous cysts?
Epidermal Cysts
aka Epidermoid cysts, epidermal inclusion cysts, or improperly sebaceous cysts
What can occur anywhere on the body and the size ranges from a few millimeters to several centimeters in diameter, the wall of consists of normal stratified squamous epithelium derived from the follicular infundibulum?
Epidermal cysts
True or False
Cysts can be primary (de novo) or may arise of the implantation of the follicular epithelium in the dermis as a result of trauma or from a comedone
True
What is usually a firm or fluctuant flesh-to-yellow colored solitary nodule (0.5 to 5 cm) which often connects with the surface by keratin filled pores, grow slowly over time and may remain stable for months to years, and are commonly located in the face, neck, upper back, and chest; if due to trauma, on buttocks, palms or plantar side of the feet?
Stable epidermal cyst
True or False
Inflamed/Ruptured Epidermal Cyst
Inflamed epidermal cysts are warm, red and boggy and TTP; sterile purulent material and keratin debris often point toward and drain to the surface
True
What lesions often mimic and present very similarly to abscesses?
Inflamed/ruptured epidermal cysts
Do asymptomatic epidermal cysts require treatment?
Nope
True or False
Epidermal Cyst Disposition
Duty status is based on location, severity, and control of the infection. Wound should be checked throughout treatment to ensure symptoms improvement and adequate drainage/healing
True
What is the most common benign mesenchymal neoplasm in adults and are composed of mature white adipocytes?
Lipoma
What can occur on any part of the body and usually develop superficially in the subcutaneous tissue, may often occur on the neck, trunk, and on other extremities and is composed of fat cells?
Lipoma
True or False
Malignant transformation of a lipoma into a liposarcoma is common
False
Rare
What should be done for rapidly growing lipomas?
Biopsy
Treatment for lipomas is usually not required, but may be excised by Dermatology for what reasons?
- Cosmetic
- Pain
- Impedance of duties
True or False
Classic lipomas are entirely benign and recur only rarely
True
Intramuscular/intermuscular lipomas have a recurrence rate of up to what percentage?
20%
What is an acute inflammatory process, with or without abscess formation, that involves the proximal and lateral nail folds that has been present for less than 6 weeks?
Paronychia
What is most commonly caused by S. Aureus, Streptococcus pyogenes infection in the periungual tissue by minor mechanical or chemical traumas that disrupt the nail fold barrier?
Paronychia
What are some common factors contributing to paronychia?
- Manicuring
- Nail biting
- Thumb sucking
- Picking a hangnail
What is the most common infection of the hand, representing 35% of all hand infections in the United States?
Paronychia
What usually develops along the nail margin (proximal and lateral nail folds) manifesting over hours to days with pain, warmth, redness, and swelling?
Paronychia
What is the early treatment for paronychia?
Warm compresses and soaks
What is the disposition for a patient with paronychia?
LLD may be indicated based on occupation and treatment
What is an abscess of the distal phalanx fat pad, S aureus is the most common pathogen, patient usually presents with a painful and swollen distal pulp space?
Felon
What is a pyogenic infection of the distal pulp space, with pus collecting in the spaces formed by the vertical septa anchoring the pad to the distal phalanx?
Felon
nearly always follows minor finger injury
What condition is characterized by severe pain, exquisite tenderness, and tense swelling of the distal digit with erythema, may have a visible collection of pus or palpable fluctuance; underlying bone, joint or flexor tendons may become infected?
Felon
What is the treatment for a felon?
- Prompt incision with division of the fibrous septa to ensure adequate drainage
- Should be performed by Derm if available
- IDC should treat with antibiotics
a. MSSA- Dicloxacillin or Keflex
b. MRSA- Trimethoprim/sulfamethoxazole, clindamycin, or doxy - Rest and immobilization
- Elevation
What is the spectrum of cutaneous infections caused by Candida yeast?
Candidiasis
True or False
Candida acts as an opportunistic pathogen when allowed to overgrow and predisposing conditions permit
True
True or False
Yeast infects only the outer layers of the epithelium of the mucous membrane and skin (stratum corneum)
True
What are some synonyms for candidiasis?
- Monilia
- Thrush
- Yeast
- Intertrigo
These are all risk factors associated with what?
- Hormonal alteration of the skin microbiome
- Elimination of competing microorganisms
- Physical environmental changes
- Direct/indirect immunosuppression
Candidiasis and fungal infections
What occurs mostly in intertriginous areas such as the axillae, groin, digital web spaces, glans penis, and beneath the breasts; manifesting as pruritic, well-demarcated, erythematous patches of varying size and shape?
Candidiasis
The primary patches of what may have adjacent satellite papules and pustules; the contents of which dissect horizontally under the stratum corneum and then peel it away, resulting in a red, denuded, glistening surface with a long, cigarette paper-like, scaling and advancing border?
Candidiasis
True or False
Oral candidiasis is adults can be the first sign of HIV
True
What is the treatment for candidiasis?
- affected skin should be kept dry and exposed to air as much as possible
- Topical Azole class antifungals
- Allylamine class antifungals
a. Terbinafine (Lamisil)
What is the treatment for Vaginal candidiasis?
- First line (topical)
a. clotrimazole vaginal cream
b. miconazole nitrate vaginal cream - Second line (oral)
a. fluconazole (Diflucan)
What kind of fungal infection involves the crural fold and gluteal cleft?
Tinea Cruris
What kind of fungal infection involves the face, trunk, and/or extremities; often presents with ring shaped lesions, hence the misnomer ringworm?
Tinea Corporis
What kind of fungal infection involves the face, trunk, and/or extremities; often presents with ring shaped lesions, hence the misnomer ringworm?
Tinea Corporis
What kind of fungal infection involves the face, trunk, and/or extremities; often presents with ring shaped lesions, hence the misnomer ringworm?
Tinea Corporis
What fungal infection involves the scalp and hair; affected areas of the scalp can show characteristic black dots resulting from broken hairs?
Tinea Capitis
What is the cause of Tinea infections that can subsist on protein, namely keratin and can cause disease in keratin-rich structures such as skin, hair, and nails?
Dermatophytes
What are anthropophilic infections?
Infections acquired from personal contact
What form of tinea will present with scaling, round or oval pruritic plaques characterized by a sharply defined annular pattern with peripheral activity and central clearing (ring shaped lesions), the papules and occasionally the pustules/vesicles present at the border, and less commonly at the center?
Tinea Corporis
How long should treatment for Tinea Corporis be continued for after the resolution of the infection?
1 week
What oral medication can be used for Tinea Corporis?
Griseofulvin (ultra-microsize) 250 po mg QD x 2 weeks or
Fluconazole 150 mg once a week for 3-4 weeks.
What form is Tinea is well-marginated, erythematous, halfmoon-shaped plaques in crural folds that spread to the medial thighs, advancing border is well defined, often with fine scaling and sometimes vesicular eruptions; lesions are often bilateral and do not include scrotum/penis (unlike candida)?
Tinea Cruris
Can tinea cruris migrate to the perineum, perianal area, and gluteal cleft and onto the buttocks in chronic/progressive cases?
Yes
What is the first line treatment of tinea cruris?
Topical antifungal creams applied 2 times a day for 10 to 14 days
For refractory or wide spread tinea cruris infections what oral medication should be used?
Itraconazole 200 mg orally once a day or terbinafine 250 mg orally once a day for 3 to 6 weeks
What is a differential of tinea cruris that fluoresces red under a wood’s lamp?
Erythrasma
What is a superficial infection in the interdigital web and soles of the feet caused by dermatophytes?
Tinea Pedis
What is the most common dermatophyte infection encountered in clinical practice and is very contagious?
Tinea Pedis
What is often accompanied by tinea manuum, tinea unguium, and tinea cruris; more common in males than females?
Tinea Pedis
The following are treatments for what Tinea infection?
- Open-toed shoes when possible
- Shower shoes
- Dry between toes after showering
- Frequent sock changes
- Antifungal powders
Tinea Pedis
What form of tinea is caused by pityrosporum orbiculare, which is part of the normal skin flora?
Tinea Versicolor
What can predispose a patient to tinea versicolor?
Excessive heat and humidity
Very common, especially in tropical or semi-tropical regions
Prevalence can reach 50%
Is tinea versicolor a dermatophyte infection?
Nope
The following is the presentation for what infection?
- Velvety tan, pink or white macules that do not tan
- Color is uniform in each person but varies between people
- Fine scales that are not visible but are seen by scarping the lesion
- Central upper back, chest, and proximal arms
- Appearance is often the patients major concern
Tinea Versicolor
A wood’s lamp will show faint yellow-green fluorescence/pigment changes in what?
Tinea versicolor
What is the topical treatment for tinea versicolor?
- Selenium Sulfide 2.5% applied from neck to waist wash off after 5-15
minutes, repeat daily x 7 days. Repeat weekly x 1 month, then
monthly for maintenance. - Ketoconazole 2% shampoo chest and back, wash off after 5 minutes.
Repeat weekly.
What is the oral treatment for tinea versicolor?
Cure rates may be greater than 90%
- Ketoconazole 400 mg in a single dose with exercise to point of
sweating after ingestion. Single dose is not always effective. - Fluconazole 300 mg (2 capsules weekly x 2 weeks) has similar
efficacy.
Is oral terbinafine effective for tinea versicolor?
Noep
What is acquired through direct contact of the nail with dermatophytes, yeast or non-dermatophyte molds in the environment or through the spread of fungal infection from affected skin?
Onychomycosis
True or False
Onychomycosis most often occurs in adults and the elderly, not common in younger patients
True
What is the most common presentation of Onychomycosis?
Distal subungal Onychomycosis
Common clinical manifestations of what include nail discoloration, subungal hyperkeratosis, onycholysis, splitting of the nail plate and nail plate destruction?
Onychomycosis
Is confirmation of the Onychomycosis infection required prior to treatment due to the potential for liver toxicity of treatment with oral antifungals?
Yes, confirm with KOH and fungal culture
What is considered the gold standard therapy for Onychomycosis?
Oral antifungal therapy
What is a contagious parasitic infection of the skin caused by the mite Sarcoptes scabiei, var. hominis?
Scabies
A scabies rash will appear how many weeks after exposure?
2-6 weeks
Intense pruritis that worsens at night is a cardinal feature of what?
Scabies
A burrow is a linear, curved or S-shaped slightly elevated vesicle or papule up to 1-2mm wide and is the classic lesion of what?
Scabies
Where are the common sites for burrows with scabies?
- Finger webs
- Wrists
- Sides of hands and feet
- Penis
- Buttocks
- Scrotum
What test can you do to confirm the burrows from scabies?
Ink test
The treatment for scabies is two fold involving killing the mites and removing the infestation and controlling the dermatitis and pruritis, what medication should be used in the treatment?
Permethrin 5% or Lindane 1% applied to entire skin surface from the neck down, including under the fingernails and toenails an in the umbilicus, patient will have this on their skin for 12 hours, repeat regimen in 1 week
After treatment of scabies all clothes and bedding must be washed in hot water or put in a hot dryer at the time of application but can also be set aside wrapped in plastic bags for how long?
14 days
Lice feed or suck blood for how many hours?
3-6 hours
How long do lice live and how many eggs can the female lay per day?
- 1 month
2. 7-10 per day
Phthrius Pubis causes what that is typically sexually transmitted?
Pediculosis Pubis
Pediculus humanus var corporis causes what?
Pediculosis Corporis (body lice)
Pediculus humanus var capitis causes what?
Pediculosis Capitis (head lice)
True or False
Lice
Diagnosis is not usually difficult, but may require repeated examinations
True
What is the treatment for head lice?
- Permethrin rinse 1% (Nix); Permethrin 5% (Elimite); Lindane % (Kwell)
- Removing the nits is essential (nit combs)
What is an alternative therapy for removing head lice?
- Vaseline (Petrolatum) to the scalp overnight and covered with a
shower cap, smother the lice. - This treatment does not kill nits, so it should be repeated for 3-4
weeks.
What is a common, acute, self limited papulosquamous skin rash that is most commonly seen in individuals aged 10-35?
Pityriasis Rosea
Prodromal symptoms such as the following are reported in as much as 69% of patients with what?
- malaise
- mild fever
- fever
- headache
- sore throat
- cough
- mild URI
- GI symptoms
Pityriasis Rosea
Classic Pityriasis Rosea begins with a solitary herald patch that appears on the trunk or proximal limbs that precedes secondary eruption by __ to ___ days
7 to 14 days
The herald patch of what is a 2-5cm round or oval, sharply delimited, pink or salmon-colored lesion on the chest, neck, or back ?
Pityriasis Rosea
Within how many days will the secondary eruption lesions of PR appear, oval lesions similar in appearance to the herald patch, but smaller, appear in crops on the trunk and proximal areas of the extremities?
7-14 days
Lesions associated with what are distributed with long axes along cleavage (langer’s) lines and appear as the following:
- “christmas tree pattern” on back
- V-shaped pattern on the upper chest
- Mild-moderate pruritis is common
- rose or fawn color (not as evident in darker skin)
- generally resolve spontaneously within 45 days
Pityriasis rosea
What is used for the symptomatic treatment of Pityriasis Rosea?
- Non sedating antihistamines (centrizine, loratadine, fexofenadine)
- Sedating antihistamines if sleep is interrupted (Benadryl/Atarax)
- Topical corticosteroids
What is a contagious viral infection primarily with herpes simplex virus type 1 (HSV-1), and less often with herpes simplex virus type 2 (HSV-2), resulting in a rash of the skin and mucous membranes (usually lips)?
Herpes Labialis
Primary outbreaks of what manifest as herpetic gingivostomatitis, while recurrent episodes usually affect the vermillion borders of the lips or the mucosa of the hard palate?
Herpes simplex
True or False
HSV-1 can be transmitted via mucous membranes/secretions and open or
abraded skin by kissing and by sharing utensils or towels.
True
True or False
Herpes Simplex
Symptoms will resolve but the infection cannot be cured due to the
lifelong latency of the virus.
True
Primary infection of herpes simplex usually occurs in child hood (via nonsexual contact) and what percentage are usually infected by age 6?
33%
What percentage of adults reported to have experienced oral herpes and incidence of herpes simplex virus type 2 reported to be increasing due to increased oral-genital contact?
60-90%
True or False
Primary infection of Herpes simplex is defined as the initial exposure to the virus in a nonimmune person and is usually more severe and lasts longer than the recurrence
True
The recurrent infection of the herpes simplex virus is also known as what?
Herpes labialis
True or False
Recurrent infection is common with HSV-2
False
Recurrent infections are rare with HSV-2
What is the treatment for HSV-1 ?
- PT education
- Symptomatic treatment
a. analgesics
b. adequate hydration - Antivirals typically not needed because of self limited nature of the disease
When would oral antiviral therapy be indicated for patients with herpes simplex?
- Frequent outbreaks
2. Moderate to severe cases of primary infection in healthy persons
Herpes Simplex
What is a diffuse, pox-like eruption complicating atopic dermatitis; sudden appearance of lesions in typical atopic areas (upper trunk, neck, head); high fever, localized edema, and adenopathy?
Eczema Herpeticum
Herpes Simplex
What is a localized infection of an affected finger with intense itching and pain, followed by vesicles that may coalesce with swelling and erythema; mimics pyogenic paronychia; neuralgia and axillary adenopathy are possible and heals within 2-3 weeks?
Herpetic Whitlow
What is a clinical syndrome associated with reactivation of latent varicella zoster virus (VZV), typically occurs years after the primary VZV infection, and can occur at any age in persons previously infected with the varicella zoster virus (chickenpox) ?
Herpes Zoster (shingles)
What percentage of adults in the United States are seropositive for varicella?
Greater than or Equal to 95%
Herpes Zoster is most common in adults how old with age related immune decline?
Over 60
True or False
Approximately one-third of people with contract herpes zoster in their lifetime, there is an estimated 1 million cases each year in the US
True
Herpes Zoster
Characteristic prodrome may precede rash by __ to __ days; paresthesia with allodynia or hypesthesia described by Pt as a deep burning, throbbing, or stabbing sensation
1 to 5 days
What presents as a typically unilateral dermatomal rash without midline crossing that favors the thoracic, cranial (trigeminal), lumbar, and cervical dermatomes?
Herpes Zoster (shingles)
The rash associated with Herpes Zoster overlaps to adjacent dermatomes reported in what percentage of patients; involvement of noncontiguous dermatomes almost never occurs?
20%
What body rash begins with red macules and papules that progress to clear vesicles within 1-2 days, with new red vesicles forming 3-5 days, the vesicles evolve into pustules within 7 days; ulcerating and crusting of the pustules by day 14?
Lesions heal within 2-4 weeks
Herpes Zoster (shingles)
True or False
Herpes Zoster
The goal of treatment is to limit the extent/duration/severity of pain and rash in the primary dermatome and to prevent the disease elsewhere
True
If a patient with herpes zoster reports in less that 72 hours after the onset what should be done?
Antiviral therapy should be initiated
If a patient with Herpes Zoster reports over 72 hours after the onset what should be done?
- Antiviral therapy should be initiated if new lesions are still appearing at the time of presentation
- Minimal benefits of antivirals in patients with lesions that have already encrusted
What is the occurrence of pain for months or years in the same dermatomal distribution that was affected by Herpes Zoster ?
Postherpetic Neuralgia
True or False
Acute herpetic neuralgia refers to pain preceding or accompanying the eruption of a rash that persists up to 30 days from its onset
True
True or False
Subacute herpetic neuralgia refers to pain that persists beyond healing of the rash but which resolves within four months of onset
True
Postherpetic Neuralgia (PHN) refers to pain persisting beyond how many months from the initial onset of the rash?
Four months
Antivirals reduce the incidence of PHN by what percentage when given within 72 hours of rash onset?
50%
Herpes Zoster Opthalmicus involves the ophthalmic division of what nerve and presents with malaise, fever, headache, and periorbital burning/itching?
Trigeminal nerve
Approximately what percentage of patients with Herpes Zoster Opthalmicus experience direct ocular involvement if antiviral therapy is not used?
50%
Vesicles on the tip/side of the nose precedes the development of HZO is known as what sign?
Hutchinson’s Sign
The nasociliary branch of what nerve innervated both the cornea and the lateral dorsum of the nose as well as the tip of the nose?
Trigeminal nerve
What is the disposition for a patient with Herpes Zoster?
- LLD-based on location, presentation, symptoms, pain management and complications
- PTs with herpes zoster on the face should be referred to MO for further eval
Warts on the hands and or feet are caused by what?
HPV
What is a group of viruses belonging to the family Papillomaviridae ?
HPV
True or False
Infection with HPV occurs by direct skin contact, with maceration or sites of trauma predisposing patients to inoculation
True
What is the incubation period for HPV?
2-6 months
Cutaneous warts caused by HPV may manifest as what?
- Common warts (verruca vulgaris)
- Plantar wars (verruca plantaris)
- Plat (plane) warts (verruca plana)
- Genital Warts
What are the common sites for common warts (verruca vulgaris) ?
- Hands
- Periungal skin
- Elbows
- Knees
- Plantar surfaces
What warts are slightly elevated and flat topped, vary in size from 0.1-0.3 cm, may be few or numerous and often occur group or in a line as a result of spread from scratching?
Flat (plane) warts
What are the typical locations for Flat (plane) warts?
- Forehead
- Back of the hands
- Chin
- Neck
- Legs
What warts are caused by an HPV infection on the plantar foot?
Plantar warts
A cluster of many warts is called what?
Mosaic wart
What helps discriminate plantar warts from a callus or corn?
Black dots (thrombosed capillaries)
What are the treatment options for warts?
- PT education
a. may resolve on its own, discuss this with patient - Salicylic acid
a. terrible compliance - Cryotherapy
a. painful - Duct tape application
a. looks unprofessional
True or False
The terms “dermatitis” and “eczema” are frequently used interchangeably
True
True or False
“eczematous” also connotes some scaling, crusting, or serous oozing as opposed to mere erythema
True
What is an erythematous, pruiritic skin reaction caused by contact with exogenous agents?
Contact dermatitis
What is a non-immunologic reaction to substance or action producing direct damage to skin by chemical abrasion or physical irritation?
Irritant Contact Dermatitis
What are some causes of Irritant Contact Dermatitis?
- Chemical agents
- alcohol
- creams
- powders
- moisture
- friction
- temperature extremes
What form of dermatitis is due to a delayed immunologic response (type IV hypersensitivity) to a cutaneous or systemic exposure to an allergen to which the patient has been previously sensitized; usually has a latency period of 12-48 hours between exposure and the onset of dermatitis?
Allergic contact dermatitis
What are the most common causes of allergic contact dermatitis in the US?
- Poison ivy
- Poison sumac
- Poison oak
What is the most common cause of metal dermatitis and a common cause of allergic contact dermatitis?
Nickel
What form of dermatitis presents with erythema, dryness, painful cracking or fissuring and scaling with vesicles, may show juicy papules and/or vesicles on an erythematous patchy back ground with weeping and edema; hands are most often affected?
Irritant Dermatitis
What is the treatment for irritant dermatitis?
- Medium or high potency topical steroids
- Antihistamines
- Frequent application of a bland emollient to affected skin is essential
What form of dermatitis is characterized by vesicles, edema, redness, and extreme pruritis, distribution is first confined to the area of direct exposure, itching and swelling are the key component of the history with the itch predominating the burning sensation?
Allergic Contact Dermatitis
What are the most common sites for Allergic Contact Dermatitis?
- Hands
- Forearms
- Face
What is the treatment for Allergic Contact Dermatitis?
- Identification and avoidance of allergenic substances
- Topical treatment using topical corticosteroids
- Discontinue all moisturizers, lotions, and topical products
- Topical class I-II glucocorticoid preparations
- Pt education
What is a chronic, superficial, recurrent inflammatory rash affecting sebum rich, hairy regions of the body, especially the scalp, eyebrows, and face?
Seborrheic Dermatitis (dandruff)
What is the prevalence of Seborrheic Dermatitis (dandruff) ?
3-5%
What form of dermatitis has Intermittent active phases with burning, scaling, and itching, alternating with inactive periods; activity is increased in winter and early spring, with remissions commonly occurring in summer?
Seborrheic Dermatitis (Dandruff)
What form of dermatitis has the following presentations?
- Red, greasy, scaling rash in most locations consisting of patches and plaques with indistinct margins
- Red, smooth, glazed appearance in skin folds
- Mild pruritis
- Chronic waxing and waning course
- Bilateral and symmetrical
Seborrheic Dermatitis (Dandruff)
What is the treatment for Seborrheic Dermatitis (Dandruff)?
- Control symptoms
- can be treated with shampoos such as:
a. Zinc pyrithione (head and shoulders)
b. Selenium Sulfide (Selsun blue)
c. Ketoconazole (Nizoral)
d. Salicylic Acid (T/Sal)
e. Coal tar (T/gel)
What is a chronic, inflammatory disorder most commonly characterized by cutaneous erythematous plaques with silvery scales?
Psoriasis
What is a complex immune-mediated disorder associated with flares related to systemic, psychological, infectious, and environmental factors?
Psoriasis
What is the most common variant of of Psoriasis accounting for about 80% of cases?
Plaque (vulgaris)
What percentage of patients with psoriasis have a first degree relative with the disorder?
40%
What skin disorder presents with a well-demarcated salmon pink-to-red erythematous papules and plaques, silvery scales and the distribution favors the scalp, auricular conchal bowls, post auricular areas, extensor surface of the extremities, especially the knees and elbows, the umbilicus, lower back intergluteal cleft and nails?
Plaque Psoriasis
What are some nail findings you would see with Plaque Psoriasis?
- Pitting
- Oil spots
- Onycholysis
What is Auspitz sign?
Pinpoint bleeding with removal of a scale
New psoriatic lesions arising at sites of skin injury/trauma is known as what?
Koebner phenomenon
Genitals are affected in what percentage of patients with plaque psoriasis?
40%
What is the treatment for plaque psoriasis?
- Topical
a. medium potency corticosteroids daily - Systemic therapy
a. complicated and managed by derm - Phototherapy (light box therapy)
Where should patients with plaque psoriasis be referred to for further evaluation and definitive treatment?
Dermatology
What is a disorder of the pilosebaceous units that is notable for open/closed comedones, papules, pustules, and nodules?
Acne
The predominant age of acne is early to late puberty, and may persist in ___% to ___% of affected individuals into the 4th decade of life
20%-40%
What percentage of adolescents are affected by acne?
80%-95%
Open comedones are known as what?
Blackheads
Closed comedones are known as what?
White heads
What is the treatment for comedonal (non-inflammatory) acne?
Topical retinoid
What is the treatment for mild comedonal + papulopustular acne?
- Topical antimicrobial (BP alone or BP + topical antibiotic)
- Topical retinoid
OR - Topical antimicrobial
- Topical antibiotics (patients who cant tolerate retinoids)
What is the treatment for moderate papulopustular and mixed acne?
- Topical retinoid
- Oral antibiotic
- Topical benzoyl peroxide
What is the treatment for severe acne (nodulocystic acne)?
Oral isotretinoin monotherapy
Topical antibiotics for acne reduce the numbers of what in the sebaceous follicles?
C. acnes
What are the most common topical antibiotics used for the treatment of acne?
Erythromycin and Clindamycin
Should topical antibiotics alone be used for acne?
No, should not be used as monotherapy. Use with BP to decrease the occurrence of bacterial resistance
What is indicated for moderate to severe inflammatory acne and forms of inflammatory acne that are resistant to topical treatment?
Oral acne treatments
What are the most frequently used oral antibiotics for acne therapy?
- Doxy
- Minocycline
- Oral isotretinoin (accutane)
True or False
Isotretinoin is a teratogen with a very high risk for severe birth defects if taken during pregnancy in any amount, even for a short period of time.
TRUUUUUUUUUUEEEEE
True or False
Isotretinoin can only be prescribed by clinicians who participate in a special restricted distribution program (iPLEDGE).
Truuuee
What is known as an abscess, or sinus tract, in the upper part of the natal (gluteal) cleft?
Pilonidal Abscess
What does the word pilonidal mean?
Nest of hair
True or False
In asymptomatic pilonidal disease, there is no acute inflammation or infection
True
The following is the common clinical presentation of what?
Sudden onset of mild-to-severe pain in the intergluteal region while sitting or stretching the skin overlying the natal cleft +/- swelling with mucoid, purulent, and/or bloody drainage in the area.
Acute pilonidal abscess
What is the most common cause of an acute pilonidal abscess?
Staph
The clinical hallmark for what is a tender, swollen, and fluctuant nodule located along the superior gluteal fold?
Acute pilonidal abscess
Should patients with an asymptomatic pilonidal abscess be referred to surgery?
Probably not homie
How is an acute pilonidal abscess managed?
Prompt incision and drainage at the time of presentation
What is active hair growth, 80-85% of hairs are in this stage at a given time?
Anagen (growth) phase
What phase of hair growth is when hair growth stops due to the papilla detaching (removing blood supply), 1-3% of hairs are in this stage at a given time?
Catagen (transitional) phase
What phase hair development is when its in its resting phase for 1-4 months, up to 10-15% of hairs in the normal scalp, hair is no longer connected to anything but the follicle?
Telogen (resting)
What phase of hair development is in the late telogen phase, the follicle begins to grow again and the hair base breaks free from the root and it is shed, about 2 weeks, new hair shaft begins to emerge?
Exogen (shedding)
True or False
Alopecia = hair loss
True as fuck yall
____ may occur due to damage of hair cycling, inflammatory conditions that damage hair follicles, or inherited or acquired abnormalities in hair shafts
Hair loss
Alopecia is divided into what two forms?
Scarring and non-scarring
Present Follicular markings suggest what form of alopecia?
Non-scarring
Absent follicular markings suggest what form of alopecia?
Scarring
Non-scarring alopecia occurs due to something else IN the body such as?
- Systemic diseases
- endocrine disorders
- Vitamin deficiencies
- malnutrition
What is the most common form of male hair loss affecting 30-50% of men by age 50?
Androgenic alopecia (AKA male pattern baldness)
Androgenic alopecia (male pattern baldness)
Familial tendency, racial variation, and heredity account for __% of predisposition, with MAA genes being inherited from both parents
80%
What form of alopecia is believed to be an immunologic process, the patches are perfectly smooth and without scarring, involvement may extend to all of the scalp hair (alopecia totalis) or to all scalp and body hair (alopecia universalis)?
Alopecia Areata
What is know as temporary hair loss that usually happens after stress, a shock, or a traumatic event, usually occurs on the top of the scalp?
Telogen Effluvium
True or False
Cicitricial alopecia may occur following any type of trauma or inflammation that may scar hair follicles
True
What is an acute, delayed, and transient inflammatory response of the skin secondary to excessive exposure to Ultraviolet radiation (UVR)?
Sun burn
True or False
Sun burn
Depending on the frequency and exposure time, damage can be caused to melanocytes and keratinocytes
True
Sun burn
Erythema is usually first noted 3 to 5 hours following sunlight exposure, peaks at ___ to ___ hours, and in most cases subsides at ___hours
- 12-24 hours
2. 72 hours
Sun Burn
What is a rare, IgE mediated, photodermatosis characterized by pruritis, stinging, erythema, and wheal formation after exposure to sunlight?
Solar urticarial
What are some good prevention methods for sun burn?
- Sun avoidance
- Protective clothing (SPF 50+)
- Broad spectrum sunscreens (UVA & UVB w/ SPF 30+)
- Counsel patients
True or False
SPF measures the UV radiation required to produce sunburn on protected skin (with sunscreen) relative to UV radiation is required to produce sunburn on unprotected skin (no sunscreen).
True
What are some symptomatic treatments of sunburn?
- Cool compresses or soaks
- calamine lotion
- aloe vera
- NSAIDS
What is causesd by lateral pressure of poorly fitting shoes, by improper or excessive trimming of the lateral nail plate or by trauma?
Ingrown nail
What is the toe that is virtually the only toe involved in ingrown nails?
Great toe
What is the treatment for an ingrown nail?
- removal of the penetrated nail
2. curetting granulation tissue (treated w/ silver nitrate)
What is the most common of all injuries to the upper extremities; typically results from a direct blow to the fingernail or a squeezing type injury to the distal finger?
Subungual Hematoma
The bleeding associated with a subungual hematoma may cause what?
onycholysis (separation of the nail)
True or False
Subungual hematoma
Treatment consists of evacuation of the hematoma via trephination of the nail
True
What is the most common acquired benign epithelial tumor of the skin and is often mistaken for Melanoma?
Seborrheic Keratoses
What is the general age that Seborrheic Keratoses develops in?
After the age of 50
The following is the clinical presentation of what?
- Usually multiple lesions, can arise anywhere except the lips, palms and soles
- begin as circumscribed tan brown patches or thin plaques
- over time become more popular or verrucous with a greasy scale and a waxy stuck on appearance
Seborrheic Keratoses
True or False
Because seborrheic keratoses are benign and slow-growing lesions, treatment is generally not required. However, lesions that are symptomatic or that cause cosmetic concerns can be consulted to dermatology.
True
What are some treatments for Seborrheic Keratoses?
- Cryotherapy
- Curettage/shave excision
- Electrodessication
What results from the proliferation of atypical epidermal keratinocytes?
Actinic Keratosis (AKA solar keratosis)
What represents early lesions on a continuum with squamous cell carcinoma (SCC) and occasionally progresses to SCC?
Actinic Keratoses
Where does Actinic Keratoses usually occur?
Sun exposed areas
What are some risk factors for Actinic Keratoses?
- Extensive sun exposure
- Hx of sunburns
- Sunscreen use
- Fair skin
Actinic keratoses are commonly described as having what feeling and appearance?
“rough, sandpaper-like”, thicker and more yellow in color as it progresses
After referral to dermatology, what is the prescribed treatment for a patient with Actinic Keratoses?
- Topical 5-fluorouracil 5% cream (Efudex)
- Imiquimod 5% cream
- Electrodessication & curettage
- Application of liquid nitrogen (cryotherapy)
What is a malignant tumor arising from melanocytic cells and hence can occur anywhere these cells are found (anywhere on the body)?
Melanoma
What is the most fatal form of skin cancer?
Melanoma
The lesion associated with what will be the “ugly duckling”, and different than the other nevi on the body showing things such as:
- Asymmetrical
- Irregular borders
- Color changes
- Diameter >6mm
- Evolving
Melanoma
What is the treatment for melanoma that the IDC can perform?
- NOTHING! Outside the scope of practice for the IDC
- Refer all suspected lesions to MO and Biopsy
- Palpate regional lymph nodes and document findings
What phase of wound healing is days 0-5 and there is no gain in wound strength?
Phase 1: initial lag phase
What phase of wound healing is days 5-14 and there is a rapid increase in wound strength, at week two the wound has achieved only 7% of its final strength?
Phase 2: Fibroplasia phase
What phase of wound healing is about day 14 until the healing is complete, further connective tissue remodeling, and up to 80% of normal skin strength is achieved?
Phase 3: Final Maturation phase
What are some contraindications for wound repair?
- Wounds more than 12 hours old (>24hrs old on the face)
- Animal or human bite wounds
- Puncture wounds
What are the four principles that should be incorporated in the process of closing any wound?
- Control all bleeding before closure
- Eliminate “dead space”
- Accurately approximate tissue layers
- Approximate the wound with minimal skin tension
What sutuing technique should be as wide as it is deep, sutures with this technique need to be no closer than 2mm in a fine plastic closure, and this stitch is ideal in the scalp?
Simple interrupted sutures
True or False
Suturing techniques
The advantages of the simple running stich in sterile would under little or no tension are that it is quick and distributes tension evenly and provides excellent cosmetic results
True
What suturing technique is less desirable in traumatic laceration because of the increased risk for contamination?
Simple running stitch
What suturing technique promotes eversion of the skin edges, and it is useful when the natural tendency of loose skin is to create inversion of the wound margins, which is to be avoided, this suture is also appropriate when the skin is very thin and interrupted sutures have a tendency to pull through?
Vertical mattress sutures
What suturing technique is helpful in wounds under a moderate amount of tension, also promotes wound edge eversion, especially on the palms of the hands or soles of the feet and in patients who are poor candidates for deep sutures because of susceptibility to wound infections?
Horizontal mattress sutures
Skin staples provide a rapid and simple alternative to other methods of skin closure and wound repair; and are indicated for what?
- Wounds whose edges are easily approximated and not under undue tension
- Long, linear wound of the scalp
- proximal extremities of the torso where cosmesis is not a
When are skin staples contraindicated?
- facial or neck tissue
- areas where there is an inadequate subcutaneous base
- over small mobile joints or any other location where the staples may interfere with normal function
- wounds that are macerated/infected or over areas of large tissue loss
