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Senoir 21-2 > Cutaneous Systemic Dz > Flashcards

Cutaneous Systemic Dz Flashcards

1
Q

Oval, violaceous patch that expands slowly

Proceeds to a red advancing border with yellow brown central area

Soon ulcerates and has a woody duration

Associated with DM and on the anterior Tib/fib

A

Necrobiosis lipoidica

Tx: Topical & Intralesional steroids
—Stops inflammation, but promotes atrophy

Systemic oral steroids
3-5 week course may stop the disease (existing lesions will remain)

Pentoxifylline 400mg tid
—Shown significant results in 1 month

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2
Q

A pt presents with a RING of small red flesh colored papules

That start out flesh colored and turn to red

MC to the lateral dorsal side of the hands and feet

Think?

A

Grannuloma Annulare

Strong association with HIV, DM

No treatment necessary, cosmetically can use topical steroids and occlusion

If Disseminated; PUVA + Dapsone

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3
Q

A pt presents with Velvety hyperpigmented plaques

Think

A

Acanthosis Nigrans

MC 2/2 obesity and in the axilla

Any pt with DM or Cushings

Treat underlying cause

+ ammonium lactate to soften
Or tretinoin cream to thicken

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4
Q

What is the most common manifestation of xanthomas

A

Xanthalsma

Lipid deposits around the eyes

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5
Q

A pt presents with 1-4 mm yellow deposites with a red halo
On the extensior surfaces
(Arms, leg, back)

Think

A

Eruptive xanthomas

Sign of high triGs

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6
Q

A pt presents with slow evolving paupules/ tumors
(lipid deposits) MC to the knees, elbows, extensors, AND palms That are painless

Think

A

Tuberous Xanthomas

Sign of high TriGs and/or Billiary cirrhosis

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7
Q

A pt presents with smooth deep deposits/ lesions that are attached to tendons
MC to the Achilles

Think

A

Tendonous xanthomas

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8
Q

What is the treatment for any xanthomas

A

Treat underlying lipidemia

Cosmetically: trichloroacetic acid

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9
Q

This is a VASCULAR cancer, 2/2 HPV 8

MC in older men, on the hands feet and LE
And is the most common tumor in AIDS pts
“Raised, oval, elongated, RUST colored infiltrates: that DECRESAED with pressure and then return to size. Progress to ulcers

A

Kaposi’s Sarcosis

The decrease with pressure helps DDx this from lichen planus

If on the Trunk suspect AIDS

Dx with Bx
(Blood vessel w neoplastic epithelium)

Tx with nitrogen creo or excision
Or intralsional chemo
(Vinblastine)

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10
Q

What is Vinblastine

A

Intralesional chemo treatment for Kaposi’s sarcoma

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11
Q

Pt presents with moist, warm, smooth skin, with hyperhydrosis
(Sweating), thin hair, with a bronze tint to the skin, clubbing of the fingers and nails, with concave nails, and an ORANGE PEEL appearance on the pretibial surfaces

Think

A

Hyperthyroioism

Think orange peel look is called pretibial myxedema

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12
Q

A pt presents with swollen, cool, waxy, pale dry skin with increased wrinkles,
Eyelid puffiness, with a YELLOWING tint to the skin
(Carotemia), + alopecia of the lateral eyebrows
+vitiligo

Think

A

Hypothyroidism

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13
Q

A pt presents with immune mediated hyper keratosis
+koebner phenomomen

Is a red flat papule that coalesces into oval plaques
“Thick adherent silvery scales”

+auspitz sign

MC to the extensor surfaces
+pitting/ oil spots on the nails

Think

A

Psoriasis
(Chronic plaque psoriasis)

Tends to worsen with stress and triggers

Tx with a group I/II topical steroid
(Avoid tachyphylaxis with steroid holiday)

+/- salicylic acid to remove scales

Topical D3 analogs/ Topical V. D3

Steroids plus D3 is the best combination

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14
Q

What is the treatment for psoriasis of the scalp

A

Karatinolytics to the scalp with foams or gels

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15
Q

If psoriasis covers more that 5 % of the body what is the treatment approach

A

Biologics: methotrexate, cyclosporine

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16
Q

A pt presents with a recent viral URI and two weeks later has psoriasis like lesions, with sudden scaling papules on the trunk/ extremities
That SPARES the Palmer and soles

“Tear drop” scattered or diffuse pattern that are RED and tiny with a thick white scale

Think

A

Guttate Psoriasis

Tx with throat culture
UVB 1st line tx and emollients

17
Q

A pt presents with deep creamy yellow pustules mc tot he middle of the palm or foot that turn into dry crusts and DO NOT RUPUTRE

Think

A

Pustular psoriasis

Tx with Group I steroid
(Clobetasol)
+occlusion and PUVA

DO NOT GIVE PO STEROIDS

Encourage smoking cessation

18
Q

What is the general variant of pustular psoriasis

A

Lakes of pus that can be fatal

19
Q

A pt presetns with scales that are macerated and dispersed in the flexural or intertriginous areas that are smooth rep plaques

Thin k

A

Psoriasis inversis

DDX with candida

20
Q

A pt presents with fine white or yellow greasy flakes, +/- inflamed base, pruritus and red papules

2.2 increased sebum production
Around hormonal periods
Or dry winters

On the scalp/ margins, eyebrows, or Nasolabial folds

Think

A

Seborrheric dermatitis

Treat with frequent wasting with antiseborrheic shampoos

Ketoconazole
( shampoo or cream)
or selenium sulfide

Can use baby shampoo on eye lids

Topical steroids to reduce inflammation
-use weak steroids and avoid overuse

21
Q

When would you use oral anti fungals for seborrheic dermatitis

A

If moderate to severe

Itraconazole 200mg/day x 1 week, then 200mg once every 2 weeks until remission

22
Q

Pattern of distribution for Seborrheic dermatitis in an infant

A

Vertex of the scalp

“Cradle Cap”

23
Q

Severe seborrheic dermatitis is one of the most common cutaneous manifestations of….

A

AIDS pts

24
Q

A pt presents with a salamon colored Harald patch in an Xmas tree distribution,
+fine wrinkled tissue like scales
Very pruritic

Pt thinks they have wringworm

Think

A

Pityriasis Rosea

Treat with reassurance as most do not require treatment

GrouP V (weak) steroids and Anithistamines as necessary for itch

Natural sunlight

If severe: Predinsone, UVB x 22 weeks

Or Oral acyclovir for 1 week

CONSIDER SYPHILLIS INFECTION

25
Q

What are the 5 ps of lichen planus

A 
5 “P’s”
Pruritic
Planar (flat topped)
Polygonal
Purple
Papules/plaques
(Persistent – 6th “P”)

Senoir 21-2 (77 decks)

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