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DERM > COMMON SKIN DISORDERS & INFECTIONS > Flashcards

COMMON SKIN DISORDERS & INFECTIONS Flashcards

1
Q
  • inflammation of pilosebaceous units of certain body parts
A

acne vulgaris

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2
Q

sebaceous glands - help hydrate the skin - also aid in __________________

A

thermoregulation

allows sweat to stick to us instead of rolling off - to help us cool down when too hot

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3
Q

acne occurs more often in ___________ during adolescence

A

males

o Age of onset = boys/girls going through puberty (starts around 12)
o Occurs more in males than females during adolescence
o Adult acne more prevalent in women
o acne should start “burning out” by late 20’s into 30’s

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4
Q

4 factors involved in the pathogenesis of acne

A

follicular hyperkeratinization
increased sebum production
Propionibacterium acnes within the follicle
inflammation

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5
Q

bacteria that causes acne

A

Propionibacterium acnes

normal bacteria on our skin, but with excess sebum –> plugged up follicle with bacteria –> acne

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6
Q

___________ are what kick off the sebaceous glands -> increased sebum production

A

androgens (DHEA)

precursor to testosterone

DHEA = what increases sebum production

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7
Q

___________ in the sebum is what bacteria thrives on

A

triglycerides

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8
Q

PATHOGENESIS OF ACNE

A

Androgens cause increased sebum production & abnormal follicular desquamation
o seborrhea
o follicular desquamation

  • which lead to altered follicular milieu –>

Propionibacterium acnes colonization & proliferation –> inflammation

hormones & p. acnes bacteria present

1) accumulation of dead skin cells filled with keratin & sebum from sebaceous gland
2) bacteria colonizes and eats excess sebum; chemicals released into bloodstream
3) bacteria proliferation / WBCs accumulate
4) marked inflammation & scarring

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9
Q

clinical presentation & skin lesions of acne

A

CLINICAL PRESENTATION
lesions on the skin - inflammation
pain

SKIN LESIONS INCLUDE

  • comedones (open / closed)
  • papules & papulopustules
  • nodules
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10
Q

open comedone = _____________

closed comedone = __________

A 
open = blackhead
closed = whitehead
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11
Q

diagnosis of acne

A
  • clinical
- for female patients who have dysmenorrhea or hirsutism
o free / total testosterone
o DHEA - S
o FSH
o LH
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12
Q

diagnosis of acne for female patients who have dysmenorrhea or hirsutism

A

o free / total testosterone
o DHEA - S
o FSH
o LH

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13
Q

1st line treatment for acne

A

retinoids

Adapalene (Differin): best tolerated –OTC now
Tretinoin (Retin-A)
Tazarotene (Tazorac)

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14
Q

2nd line treatment for acne

A

topical antibiotics

clindamycin
erythromycin

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15
Q

treatment for acne

A

OTC
benzoyl peroxide
salicylic acid

1st line = Topical retinoids: Adapalene (Differin) = best tolerated; Tretinoin (Retin-A), Tazarotene (Tazorac)

2nd line = topical antibiotics: Clindamycin, Erythromycin
- for moderate to severe acne = Doxycycline or Minocycline (Minocin)

For severe acne and/or treatment failure = Isotretinoin (accutane) - must go through IPLEDGE

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16
Q

After individual treatment goals have been met, oral antibiotics can be discontinued and replaced with ________________

A

topical retinoids for maintenance therapy

retinoids help to ALTER THE PILOSEBACEOUS GLANDS

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17
Q

The use of isotretinoin has been suggested to worsen _________ and increase the risk of ________

A

depression

suicide

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18
Q

Laboratory monitoring during isotretinoin therapy includes:

A

CBC
Lipids
LFTs

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19
Q
  • increased reactivity of capillaries to heat

Chronic acneiform disorder of facial pilosebaceous units

A

rosacea

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20
Q

rosacea onset:

predominantly affects

A
  • onset: 30-50 years old

- predominantly affects females

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21
Q

exacerbating rosacea factors

A 
hot liquids
spicy foods
alcohol
exposure to sun & heat
exercise
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22
Q

clinical presentation of rosacea

A
  • redness to cheeks, nose and chin
  • burning or stinging with episodes
  • skin dryness, edema
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23
Q

4 subtypes of rosacea

A

erythematotelangiectatic rosacea
papulopustular rosacea
phymatous rosacea (large nose)
ocular rosacea

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24
Q

1st line therapy for mild to moderate patient with rosacea

A

topical antibiotics

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25
Q

rosacea treatment

A
  • minimize precipitating factors
  • TOPICAL ANTIBIOTICS = 1st line therapy for mild to moderate patient

use gel or creams

Azelaic acid
Metronidazole - most common
Erythromycin
Clindamycin
Brimonidine = best for facial flushing / persistent redness
Topical Ivermectin cream = for ppl who get rosacea due to being immunologically sensitive to mites

SYSTEMIC ANTIBIOTICS = for mod/severe rosacea
⦁ Tetracycline
⦁ Doxycycline / Minocycline
⦁ Erythromycin

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26
Q

most common treatment for rosacea

A

metronidazole (cream or gel)

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27
Q

other treatment considerations for rosacea

A

⦁ laser tx - can be helpful for telangiectasias
⦁ pulsed light therapy for facial erythema
⦁ cleansers
⦁ photodynamic therapy

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28
Q

complications of rosacea

A

⦁ eye involvement
⦁ gram negative folliculitis
⦁ permanent telangiectasias
⦁ rhinophyma

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29
Q

MOST COMMON PATHOGEN FOR FOLLICULITIS

A

STAPH AUREUS

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30
Q

“hot tub” folliculitis caused by

A

pseudomonas

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31
Q

folliculitis symptoms

A

⦁ looks like red pimples with hair in the center
⦁ may itch or burn
⦁ “hot tub” folliculitis appears about 72hrs after

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32
Q

recurrent folliculitis is associated with nasal carriage of

A

staph

try mupirocin in nares

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33
Q

Antibiotic therapy, corticosteroid therapy, and immunosuppression may predispose a patient to

A

candida folliculitis

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34
Q
  • “razor bumps”
A

pseudofolliculitis

  • very common in african americans
  • occurs when free ends of tightly coiled hairs re-enter skin and cause foreign body inflammatory response
  • firm papules with embedded hair
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35
Q

extrafollicular vs intrafollicular penetration

A

⦁ extrafollicular penetration = curly hair coming out and coming back into the hair = more common

⦁ intrafollicular penetration = hair grows out of a different spot - out of the follicle

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36
Q

1st line treatment for pseudofolliculitis

A

stop shaving

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37
Q

treatment for pseudofolliculitis

A

⦁ Most effective and safe is stop shaving (first line)
⦁ Laser hair removal
⦁ Adjunctive medical therapy
- Topical retinoids (Tretinoin)
- Low potency topical corticosteroids (treat only for 3-4 weeks)
- Topical antimicrobials (benzoyl peroxide 5% or clindamycin 1%)

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38
Q

boils or skin abscesses

A

furuncles

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39
Q

furuncles = boils or skin abscesses caused by _______ infection of hair follicle

A

STAPH

40
Q

cluster of furuncles

A

carbuncles

41
Q

common areas of furuncles / carbuncles

A 
⦁	buttocks
⦁	axillae
⦁	neck
⦁	face
⦁	waist
42
Q

furuncle / carbuncle treatment

A

< 5 cm

  • hot compresses to enhance drainage
  • fluctuant lesions = I&D (may have to pack wound)

> 5cm = systemic antibiotics of constitutional symptoms or concomitant cellulitis

  • Bactrim
  • Clinda + Keflex
43
Q

impetigo most common pathogens

A

strep or staph

44
Q

impetigo tx

A

mupirocin (Bactroban)

45
Q

IMPETIGO

A
  • red lesions that can break open/ooze –> develop YELLOW-BROWN CRUST = HONEY COLORED
  • sores = usually appear around mouth & nose
  • can spread to others through close contact or by sharing items like towels and toys
  • scratching can also spread it to other parts of the body
46
Q

MOLES

A
  • well defined borders
  • uniform in color
  • usually brown or black
  • can be anywhere on the body, alone or in groups
  • generally appear before age 20

Some moles change slowly over the years: become raised, develop hair, change color, etc.
- Most are non-cancerous, but some moles have a higher risk of becoming cancerous

Biopsy the mole if does not meet ABCDE criteria, or if mole becomes itchy, bleeds or ulcerates

Treatment = remove with shave biopsy or excision

47
Q

1st line treatment for SLs

A

cryotherapy

48
Q

solar lentigo treatment

A

⦁ cryotherapy = 1st line
⦁ laser treatments
⦁ tretinoin cream or hydroquinone cream (lightens)
⦁ modified Kligman (fluocinolone / hydroquinone / tretinoin)
⦁ bleaching solutions / chemical peels

49
Q

appearance of SKs

A

Well-circumscribed gray-brown-to-black plaques with a “stuck-on” appearance

Warty

often scaly

hyperpigmented lesion

50
Q

SK treatment

A
  • don’t require treatment unless causing discomfort or for cosmetic reasons
    ⦁ cryotherapy
    ⦁ curettage & cautery
    ⦁ laser surgery
    ⦁ shave biopsy
    ⦁ send any suspicious looking lesions for pathology
51
Q

AKs

A
  • Rough, dry, scaly patch or growth that forms on the skin
  • Extremely common, occurs in sun exposed areas
  • More common in fair-skinned individuals
SYMPTOMS
⦁	Rough feeling patch on skin
⦁	Rough patch that feels painful when rubbed
⦁	Itching or burning
⦁	Lips feel constantly dry
52
Q

causes of AKs

A

sun exposure

tanning beds

53
Q

AK treatment

A

o nonhypertrophic = LN2
o Hypertrophic = surgical curettage (send these to pathology)
o multiple AKs = Efudex or Imiquimod (aldara)

54
Q

triggers for melasma

A

⦁ Sun exposure
⦁ Change in hormones
⦁ Cosmetics

55
Q

MELASMA

A
  • Tan or brown patches on the cheeks, nose, forehead, and chin.
  • Melasma occurs in half of all women during pregnancy.
  • Usually called “pregnancy mask,” men can also develop it.
  • More often in women and people with darker skin
56
Q

diagnosis of melasma

A
  • clinical

- biopsy

57
Q

1st line melasma treatment

A

hydroquinone

58
Q

melasma treatment

A

⦁ Will usually go away on own
⦁ Hydroquinone (first line)
⦁ Tretinoin and corticosteroids (second line)

59
Q

2nd line melasma treatment

A

tretinoin & corticosteroids

60
Q

superficial fungal infection caused by DERMATOPHYTES - most commonly the TRICHOPHYTON TYPE

A

TINEA

61
Q

TINEA = superficial fungal infection caused by ___________- most commonly the ________TYPE

A

DERMATOPHYTES

TRICHOPHYTON

62
Q

TINEA TYPES

A 
Capitis 
Corporis 
Pedis 
Cruris
Versicolor
63
Q

Gradual appearance of round patches of dry scale, alopecia, or both on scalp

A

tinea capitis

64
Q

tinea capitis diagnosis

A
  • clinical
  • wet mount - KOH
  • woods lamp
65
Q

tinea capitis treatment

A
  • griseofulvin (kids)
  • terbinafine (adults)
  • selenium sulfide shampoo
66
Q

cause of tinea corporis

A

trichophyton rubrum

67
Q

tinea corporis

A

“ringworm”

Dermatophytosis that causes pink-to-red O-shaped patches and plaques.
Crusty ring with central clearing.

68
Q

tinea corporis treatment

A
  • clotrimazole
  • miconazole
  • ketoconazole

for extensive or resistant lesions = Oral Itraconazole or Terbinafine

69
Q

most common dermatophytosis

A

tinea pedis

70
Q

4 forms of tinea pedis

A

Chronic hyperkeratotic = most common
Chronic intertriginous
Acute ulcerative
Vesiculobullous

71
Q

treatment for tinea pedis

A

⦁ topical / oral antifungals - Itraconazole (sporanox)

  • moisture reduction & drying agents
    ⦁ miconazole powder
    ⦁ burrow solution soaks - aluminum acetate - dries it out
72
Q

risk factors for tinea cruris

A

⦁ Warm weather
⦁ Wet restrictive clothing
⦁ Obesity

73
Q

tinea cruris & treatment

A

Lesions are pruritic ringed lesions that extend from crural fold over adjacent upper thigh

Treatment
⦁ Clotrimazole
⦁ Ketoconazole

74
Q

Skin infection from Malassezia furfur

Manifest as multiple asymptomatic scaly patches varying in color

A

tinea versicolor

75
Q

tinea versicolor is due to the overgrowth of the yeast _______________

A

Malassezia furfur

76
Q

risk factors for tinea versicolor

A

Heat & humidity
Pregnancy
Diabetes
undernutrition

77
Q

fifth’s disease caused by

A

parvovirus

“slapped cheek” disease

78
Q

fifth’s disease rash

A

Bright red raised rash on the face, then arms, legs and trunk

Flu-like symptoms

Rash usually goes away within 2 weeks, fades from the center outward causing a blotchy or “lacy” look

79
Q

5ths disease treatment

A

NSAIDS for symptomatic relief

80
Q

5ths disease complications

A

pregnancy: Can cause the baby to develop severe anemia and miscarriage or stillbirth

81
Q

hand-foot-mouth disease caused by

A

Coxsackie virus A16

82
Q

hand-foot-mouth disease

A

This common, contagious childhood illness starts with a
⦁ Fever
⦁ Painful mouth sores
⦁ Non-pruritic rash with blisters on hands, feet, and sometimes buttocks and legs that follow

It spreads through coughing, sneezing, so wash hands often when dealing with coxsackie.

83
Q

treatment for hand/foot/mouth

A

Home treatment includes ibuprofen or acetaminophen (do not give aspirin to children) and fluids. It will typically resolve in 7-10 days

84
Q

SCARLATINA CAUSED BY

A

GROUP A STREP (like erysipelas)

85
Q

strawberry tongue

A

scarlatina

86
Q

scarlatina rash

A 
fine, red, and rough-textured
appears 12–48 hours after the fever
generally starts on the chest, armpits, and behind the ears
spares the face 
Swollen red tongue (strawberry tongue)
87
Q

if scarletina is left untreated, may develop into

A

⦁ rheumatic fever
⦁ glomerulonephritis
⦁ meningitis
⦁ pneumonia

88
Q

treatment for scarletina

A

1st line = PCN

2nd line = 1st gen cephalosporin

89
Q

ROSEOLA SYMPTOMS

A

⦁ respiratory illness, followed by a HIGH FEVER x 3-5 days (which can trigger seizures)
⦁ fever abruptly ends, and is followed by a rash on the trunk which then spreads to extremities

this rash blanches!

90
Q

cause of roseola

A

HH6

91
Q

roseola treatment

A

supportive

92
Q

HEAT RASH (MILIARIA)

A
  • occurs as a result of blocked sweat ducts
  • looks like small red or pink pimples

TX = benign & does NOT require treatment

often caused when parents dress babies too warmly, but can happen to any infant in very hot weather. A baby should be dressed as lightly as an adult who is resting

93
Q

miliaria treatment

A 
benign &amp; does NOT require treatment
⦁	Keep skin cool and dry
⦁	Cool down
⦁	Dry off
⦁	Reduce friction
⦁	Treat fever
94
Q

heat rash more likely to occur in which locations

A 
⦁	Neck
⦁	Groin
⦁	Underneath the breasts
⦁	In creases of elbows
⦁	Armpits
95
Q

small flap of flesh-colored or slightly darker tissue that hangs off the skin by a connecting stalk

A

skin tag

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