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Dermatology > Common skin disorders > Flashcards

Common skin disorders Flashcards

1
Q

What is acne vulgaris? What does it manifest as?

A
  • inflammation of pilosebaceous units of certain body parts
  • occur most frequently in adolescence
  • manifests as comedones, papulopustules, or nodules plus cyst
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2
Q

Epidemiology and pathogenesis of acne vulgaris?

A 
- age of onset:
10-17 females
14-19 males
more in males than females
- pathogenesis:
disease of pilosebaceous follicles
4 factors involved:
-follicular hyperkeratinization
-increased sebum production
- propionibacterium acnes w/in the follicle
- inflammation
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3
Q

Clinical presentation of acne vulgaris?

A
  • lesions on the skin
  • pain in lesions
  • skin lesions include:
    comedones
    papules and papulopustules
    nodules
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4
Q

What are the acne grades?

A
  • grade 1: minimal blackheads and a few papules
  • grade 2: 10 or more, blackheads, papules, and pustules, redness and inflammation
  • grade 3: 15-20+, blackheads, papules, and pustules, redness and inflammation
  • grade 4: severe case, extreme amt of pustules, extreme edema
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5
Q

What makes up the inflammatory lesions? The noninflammatory lesions?

A
  • inflammatory: papules/pustules

- noninflammatory: closed and open comedones

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6
Q

Dx for acne vulgaris?

A
  • clinical one

- female pts with dysmenorrhea or hirsutism: total/free testosterone, DHEA-S, LH, FSH

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7
Q

1st line Tx of acne vulgaris?

A 
- OTC: benzoyl peroxide
salicylic acid
- topical retinoids (first line): 
Adapalene (differin): best tolerated
tretinoin (retin-A)
Tazarotene (Tazorac)
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8
Q

2nd line tx of acne vulgaris?

A
  • topical abx: clindamycin, erythromycin (1st choice)
  • oral therapies:
    doxy and minocycline (Minocin)
  • oral isotretinoin (Accutane) - for severe tx failure, must register in iPLEDGE program b/f using (have to monitor CBC, lipids, and LFTs) - teratogenic
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9
Q

What is Rosacea? Epidemiology?

A
  • chronic acneform disorder of facial poilosebaceous units
  • increased reactivity of capillaries to heat
  • epidemiology:
    onset at 30-50yo
    females predominantly
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10
Q

Exacerbating factors of rosacea?

A
  • hot liquids
  • spicy foods
  • alcohol
  • exposure to sun and heat
  • cold
  • exercise
  • menopausal flushing
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11
Q

Clinical presentation of rosacea?

A
  • redness to the cheeks, nose and chin

- burning or stinging with episodes

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12
Q

4 subtypes of rosacea?

A
  • erythematotelangiectatic: flushing, redness, stinging
  • papulopustular rosacea: redness/bumps, resemble acne
  • phymatous rosacea: skin thickening/bumpy
  • ocular rosacea: skin is irritated around the eye, swollen
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13
Q

Tx of Rosacea?

A
  • minimize precip. factors
  • topical abx are first line therapy for mild to moderate pt (typically w/o papules or pustules)
  • Azelaic acid (gel or cream) apply BID
  • 1st line: metronidazole (apply daily - cream or gel)
  • erythromycin (cream) - apply thin layer BID
  • clindamycin (gel or soln apply bid)
  • brimonidine (gel) applied once a day
  • systemic abx for moderate to severe sxs (papules, pustules, or ocular involvement) - tetracycline, doxy/minocycline, erythromycin
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14
Q

Other non pharm tx for Rosacea?

A
  • laser tx can be helpful in telangiectasias
  • pulsed light therapy can be helpful for facial erythema
  • cleansers
  • photodynamic therapy (put on photosensitizing gel)
  • avoid harsh soaps, lotions - astringents
  • use sunscreen
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15
Q

Complications of Rosacea?

A
  • eye involvement
  • gram neg. folliculitis
  • permanent telangiectasias
  • rhinophyma
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16
Q

What is rhinophyma?

A
  • soft tissue hypertrophy of the nose related to vasodilation
  • if it gets severe - surgical resection of the tissue
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17
Q

What is folliculitis? MC pathogen? What else is it caused by?

A
  • infection of the hair follicles
  • MC pathogen: staph aureus
  • Hot tub folliculilits caused by pseudomonas
  • can be caused by yeast, but this is the exception to the rule (immunocompromised)
  • causes: irritation from shaving, clothes, enviro - oil, tar
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18
Q

Sxs of folliculitis?

A
  • looks like red pimples with a hair in the center
  • may itch or burn
  • “hot tub” folliculitis appears about 72 hrs after - may also have fever, upset stomach
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19
Q

Tx of folliculitis?

A
  • warm compresses 3x a day
  • shaving should be avoided in involved areas
  • topical abx such as Mupirocin (bactroban)
  • recent research shows systemic abx to be of no benefit
  • usually resolves spontaneously
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20
Q

What is recurrent folliculitis assoc with? Tx?

A
  • assoc with nasal carriage of S. Aureus (bactroban (Mupirocin) used on anterior nares bid for 2-5 days once monthly decreases frequency)
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21
Q

What may predispose a pt to candida folliculitis?

A
  • abx therapy, corticosteroid therapy, and immunosuppression may predispose a pt to candida folliculitis
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22
Q

What is pseudobarbae folliculitis?

A
  • aka razor bumps
  • very common in African Americans
  • occurs when free ends of tightly coiled hairs reenter skin and cause a fb inflammatory response
  • firm papules with embedded hair
  • dx is made based on clinical appearance
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23
Q

Tx of pseudobarbae folliculitis?

A
  • most effective and safe tx: stop shaving (first line)
  • warm compress
  • laser hair removal
  • adjunctive medical therapy:
    topical retinoids (tretinoin)
    low potency steroids (tx only for 3-4 wks)
    topical antimicrobials: benzoyl peroxide 5% or clindamycin 1%
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24
Q

What are furuncles and carbuncles?

A
  • furuncles (boils): skin abscesses caused by staph infection of a hair follicle
  • carbuncles: cluster of furuncles. They may progress from an erythematous lesion to a fluctuant lesion after 4 days
    lesion may rupture spontaneously (pus and necrotic tissue are extruded)
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25
Q

Common areas for furuncles and carbuncles? Predisposing factors?

A
  • butt, axillae, neck, face, waist

- predisposing factors: diabetes, malnutrition, obesity, hematologic disorders, living in hot/humid climate, acne

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26
Q

Tx of furuncles/carbuncles if less than 5 cm? Larger than 5 cm?

A
  1. hot compresses to enhance drainage
  2. fluctuant lesions benefit from I&D
    - packing of the wound may be necessary
    - system abx if constitutional sxs (fever and sx) or concomitant cellulitis bigger than 5 cm:
    - use bactrim 1-2 tabs BIDx 10 days (covers MRSA)
    - clindamycin and cephalexin (keflex) very effective against most staph and strep
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27
Q

What is impetigo? Main tx?

A
  • contagious infection: usually staph or strep bacteria
  • red lesions that can break open, ooze
  • develop a yellow brown (honey colored) crust
  • sores usually develop around mouth and nose, it can spread to others through close contact or by sharing items - towels or toys, scratching can also spread it to other parts of the body
  • topical bactroban is main tx (in severe cases - use oral abx - clindamycin, dicloxicillin)
28
Q

Normal characteristics of moles? Changes over time?

A
  • well defined borders
  • uniform in color
  • usually brown or black, moles can be anywhere on body, alone or in groups, and generally appear b/f 20
  • some moles change slowly over time: become raised, develop hair, and or changing color, whole most are non-cancerous - some may have higher risk of becoming cancerous
29
Q

Dx of moles - ABCDE? Tx?

A 
- bx
ABCDE: 
asymmetry
borders
color
diameter
evolution
- if mole becomes itchy, bleeds or ulcerates - worried
- tx: removed with shaving or excision
30
Q

What is solar lentigo?

A
  • flat, brown areas of skin that can be up to 1 inch in diameter. They are benign and painless
  • From sun exposure: areas that get a lot of sun, such as face, hands and arms
31
Q

Tx of solar lentigo?

A
  • cryotherapy: first line
  • tretinoin cream or hydroquinone cream (lighten)
  • triple combo cream:
    fluocinolone acetonide 0.01%
    hydroquinone 4%
    tretinoin 0.05%
  • bleaching solns and chemical peels
  • usually this is done for cosmetic reasons
32
Q

What is seborrheic keratosis? When does it appear?

A
  • common, multiple, benign skin lesion commonly found on the torso
  • a person may have an isolated lesion or hundreds of lesions
  • usually appear in 40s-50s: uncommon in people under 30
33
Q

Presentation of seborrheic keratosis?

A
  • well-circumscribed gray-brown-to-black plaques with a stuck on appearance
  • warty
  • often scaly
  • hyperpigmented lesion
34
Q

Tx of seborrheic keratosis?

A
  • doesn’t reqr tx unless causing discomfort or for cosmetic reasons
  • tx:
    crytherapy
    curettage and cautery
    laser surgery
    shave bx
    send any suspicous looking lesions for pathology
35
Q

What is actinic keratosis? Sxs?

A
  • rough, dry, scaly patch or growth that forms on skin
  • extremely common, occurs in sun exposed areas
  • more common in fair-skinned individuals
    sxs:
    -rough feeling patch
    -rough patch - painful when rubbed
    -itching or burning
  • lips feel constantly dry
36
Q

Causes of actinic keratosis? What can these progress to?

A
  • sun exposure
  • tanning beds
  • 10% of AKs turn into cancer
  • 60% of squamous cell carcinomas arise from AKs
37
Q

Prevention of AKs?

A
  • no sun exposure
  • using sunscreens reduces development of AKs:
    spf 15 or higher qd
    extended outdoor activity 30spf or higher
38
Q

Tx of actinic keratosis?

A
  • nonhypertrophic AKs: liquid nitrogen crytherapy (MC used)
  • hypertrophic AKs: surgical curettage (send to path)
  • multiple AKs: 5-FU (efudex) or imiquimod (Aldara)
39
Q

What is melasma? Triggers?

A
  • AKA pregnancy mask
  • tan or brown patches on cheeks, nose, forehead, and chin - occurs in half of all women during pregnancy (on birth control), men can develop this too
  • more often in women and people of darker skin
  • triggers:
    sun exposure
    change in hormones
    cosmetics
40
Q

Dx and tx of melasma?

A
  • dx: clinical, bx
  • tx:
    usually goes away on own
    hydroquinone (first line)
    tretinoin and top. steroids (lighten up melanocytes)
41
Q

What is the cause of tinea? Various forms?

A
  • aka Ringworm
  • it is a dermatophytosis that is superficial fungal infection caused by dermatophytes, MC Tricophyton rubrum
  • forms named after location:
    capitis
    corporis
    pedis
    cruris
    versicolor
42
Q

Dx and Tx of Tinea Capitis?

A
  • gradual appearance of round patches of dry scale, alopecia, or both
  • dx: clinical, wet mount, woods lamp
  • tx:
    oral antifungals: griseofulvin (kids), terbinafine (adults)
    selenium sulfide shampoo
43
Q

Presentation of Tinea Corporis? Tx?

A
  • dermatophytosis that causes pink to red O shaped patches and plaques
  • causes: T. rubrum
  • tx:
    mild to mod: imidazole bid
    extensive or resistant: oral itraconazole 200 mg q/day 2-3 wks
44
Q

MC form of dermatophytosis? 4 clinical forms?

A
  • Tinea Pedis (athlete’s foot)
  • chronic hyperkeratotic: patchy, fine scaling
  • chronic intertriginous: subdigital, scaling, erosion
  • acute ulcerative: plantar surface - macerated
  • vesiculobullous: vesicles or blisters develop on soles
45
Q

Tx of Tinea Pedis?

A
  • topical and oral antifungals: oral - itraconazole 200 mg
  • moisture reduction and drying agents: miconazole powder, burrow soln soaks
  • pt education: dry off feet thoroughly - wear open toed shoes, change socks throughout the day
46
Q

RFs of tinea cruris? Characteristics? Tx?

A

RFs: warm weather, wet restrictive clothing, obesity
- lesions are pruritic and ringed that extend from crural fold over adjacent upper thigh
- tx:
topical antifungal (cream, lotion, gel) - clotrimazole, ketoconazole

47
Q

What is Tinea Versicolor? RFs?

A
  • skin infection from Malassezia furor
  • manifest as multiple asx scaly patches varying in color
  • RFs:
    heat and humidity
    pregnancy
    diabetes
    undernutrition
48
Q

Presentation and dx of Tinea Versicolor?

A
  • presentation:
    usually asx, appearance of mult. tan, brown, salmon, pink or white scaling patches
  • dx:
    KOH wet mount - see hyphae and budding cells (spaghetti and meatballs)
    woods lamp
49
Q

Tx of Tinea versicolor?

A
  • topical antifungal: slenium sulfide shampoo, ketoconazole

- oral antifungals: ketoconazole, fluconazole

50
Q

S/Sxs of TV?

A
  • pruritus
  • annular, scaly plaques with raised erythematous edges
  • central clearing
51
Q

Labs for TV?

A
  • KOH will show hyphae
  • woods lamp: brilliant silver-blue fluorescence of infected hair
  • cultures (on sabouraud’s medium)
52
Q

Fifth disease:
cause
affects what pop
spread?

A
  • Human parvovirus B19
  • also called slapped cheek disease
  • medical name is erythema infectiosum
  • kids 5-7yo
  • spread by contact with saliva or mucus
53
Q

Presentation of Fifth’s disease?

A
  • bright red raised rash on face, then arms, legs and trunk
  • slapped cheek appearance
  • flu-like sxs
  • rash usually goes away within 2 wks, fades from center outward causing a blotchy or lacy look
54
Q

Tx and complications of Fifth’s disease?

A
  • tx: NSAIDs for sx relief
  • compications:
    prego ladies - can cause baby to develop severe anemia and miscarriage or stillbirth
55
Q

Hand-Foot-Mouth disease -
cause
presentation
spread?

A
  • Coxsackie virus A16
  • common, contagious kid illness presents with:
    1. fever
    2. painful mouth sores
    3. non-pruritic rash with blisters on hands, feet, and sometimes butt and legs that follow
  • spreads through coughing, sneezing, so WASH HANDS
56
Q

Tx of Hand-foot-mouth disease?

A
  • home tx:
    ibuprofen or acetaminophen (DONT give ASA to kids)
    fluids
  • this will typically resolve in 7-10 days
57
Q 
Scarlet fever (Scarlatina):
cause
characteristics?
A 
- caused by group A strep
 characteristic rash:
- fine, red, rough textured
- appears 12-48 hrs after fever
- generally starts on the chest, armpits, and behind the ears
- spares the face
- swollen red tongue (strawberry tongue)
- rash can last for more than a week
58
Q

Tx of scarlet fever? What happens if left untx?

A
  • may progress to rheumatic fever, glomerulonephritis, meningitis, pneumonia
    tx:
    1st line: PCN
    2nd: 1st gen cephalosporin
  • if allergic to PCN: clindamycin or erythromycin
59
Q

What is Roseola? Characteristics? Tx?

A
  • mild, contagious illness - MC in kids 6 mo-3 yo, rare after 4
  • sxs: respiratory illness, followed by fever (103-105 - this can trigger seizures) for 3-5 days
  • fever abruptly ends and followed by rash of small, pink, flat or slightly raised bumps on trunk then the extremities
  • tx: supportive
60
Q

Presentation of a heat rash (Miliaria)? Most likely to appear where?

A
  • result of blocked sweat ducts
  • looks like small red or pink pimples
  • benign and doesn’t reqr tx
  • appears all over infant’s head, neck, shoulders: rash often caused when parents dress babies too warmly , or just in hot weather - baby should be dressed as lightly as adult
  • most likely to appear:
    neck, groin, under breasts, elbow creases, armpits
61
Q

Tx of heat rash?

A 
- keep skin cool and dry:
cool down
dry off
reduce friction
tx fever
62
Q

What are skin tags? Tx?

A
  • small flap of flesh colored or darker tissue that hangs off of skin by connecting stalk
  • neck, chest, back, armpits, under breasts, or in groin
  • most often in women and elderly
  • usually benign
  • tx: easily removed by cutting or cryotherapy
63
Q

Presentation of corns and callouses?

A
  • caused by friction and pressure on the skin overlying bony prominences which leads to hyperemia, hypertrophy of dermal papillae, and proliferation of keratin
  • corns often have central hard core that is painful if lesion is pressed - ill fitting shoes common cause
  • calluses don;t have core
  • These are often confused with plantar warts
64
Q

Prevention of corns and callouses?

A
  • eliminate friction and pressure through:

- having shoes that fit correctly and distribute pressure evenly, softer shoe materials

65
Q

Tx of corns and callouses?

A
  • paring down of hyperkeratotic lesions with scalpel blade
  • keratolytic agents can be used intermittently (saliccylic acid often used)
  • pumice stone
  • pts with refractory lesions and or underlying orthopedic disease as the cause should be referred to podiatrist or orthopedist

Dermatology (12 decks)

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