Derm 1 Flashcards
most used form of treatment in dermatology.
Topicals
is an ointment good for a hairy person?
Not really, will stick to hair. Best to use a gel or solution.
typical location of eczema in an infant
face and cheeks
will have the chief complaint of itching. Common on flexor surfaces. Cyclical pattern of relapse and recurrence.
Atopic dermatitis
other atopic problems that go hand and hand with eczema
asthma
allergies
is there a diagnostic test for eczema?
No (but IgE can be elevated)
First line tx for atopic dermatitis
Frequent lubrication with thick emolient creams
Infants- 0.5-1.0% hydrocortisone BID to TID
Adults- higher potency topical steroids (triamcinolone 0.5%) BID to TID
Second line tx for atopic dermatitis
systemic steroids
plastic occlusive dressing w/ topicals
immunomodulators
Reaction to an external substance
Will have pruritus
Contact dermatitis
tx for contact dermatitis
Avoid the irritant
Lotion with zinc oxide, talc, menthol, phenol (i.e. Gold bond)
Topical corticosteroid
Oral antihistamine
2 types of contact dermatitis
Irritant dermatitis
allergic contact dermatitis
tests for contact dermatitis
Patch test (if severe or persistent)
Red maculopapular areas that are aside from the original site
Satellite lesions
Occurs under the covered area of a diaper.
Diaper dermatitis
causes of diaper dermatitis
Material the diaper is made of
recent diarrhea/ illness
are skin folds usually affected by diaper dermatitis?
usually spared, not affected until late
Satellite lesions with diaper dermatitis usually indicate what?
Candida
Tx for diaper dermatitis
Low potency steroid hydrocortisone
tx for diaper dermatitis + candida
antifungal (miconazole cream or powder)
Coin-shaped, vesicular, erythematous lesions with some crusting
Nummular eczema dermatitis
Tx for nummular eczema dermatitis
Avoid excessive use of soap but use supper-fatted soaps like Dove
lubricate skin immediately after bath or shower
Erythematous papules, small pustules with mild scaling at the area of the chin, upper lip, and nasolabial folds
Perioral dermatitis
difference between nummular eczema and tinea?
Tine is scaling
eczema is crusting
Tx for perioral dermatitis
tetracycline abx (typically doxycycline) don't use topical steroids (gets worse)
causes or perioral dermtiatis
toothpaste, face products
Macular, erythematous, greasy lesions on face or near scalp line.
Seborrheic dermatitis
tests for seborrheic dermatitis with treatment failure
biopsy
tx for seborrheic dermatitis
topical antifungals or corticosteroids
coal tar
selenium sulfide
Increased scaling, peripheral edema, erosions, crusts. Erythema, itching, scaling. On the lower extremities. long, insidious process . Typically medial.
Stasis dermatitis
Tests for stasis dermatitis
no specific testing
get dx of venous insufficiency (Duplex US)
First line Tx for stasis dermatitis
Abx for secondary infection Burrow's solution (aluminum acetate) wet dressing and cooling paste is ulcerated topical corticosteroids leg elevation
Second line tx for stasis dermatitis
Abx based on C&S
lubrication when dermatitis is quiescent
Recurring vesicular papules on the palms, soles, or interdigital areas that are typically not erythematous
Possibly associated with excessive sweating
Dyshidrotic eczema
Tx for mild dyshidrotic eczema
low potency topical steroids
Tx for moderate- severe dyshidortic eczema
Ultrahigh potency steroids with occlusive dressing
Tx for recurrent dyshidrotic eczema
Systemic steroids at onset of itching
Non pharm tx for dyhidrotic eczema
Don’t use hot water
avoid prolonged immersion in water
emollients
Chronic dermatitis that results from constant rubbing or scratching of the skin. Pruritus is out of proportion to appearance of the lesion
Lichen simplex chronicus
tx for lichen simplex chronicus
topical anti-pruritic agents
high potency topical steroids, transition to lower potency
can also use oral antihistamine for pruritis
what are 2 anti-pruritc agents used for lichen simplex chronicus?
doxepin, menthol preparations
what is papulosquamous?
Raised and scaly
Superficial fungal infections associated with scaling, erythema, or change in skin pigmentation
Dematophyte infections (tinea)
typically asymptomatic macules more commonly found in summer with periodic recurrences. Hypopigmented lesions
Tinea versicolor
Round to oval patches of alopecia with erythema
Seborrheic dermatitis-like pattern with minimal or no alopecia
Follicular pustules with crusting
Boggy, tender plaque with follicular pustules (kerion)
Diffusely dry scalp
tinea capitis
form of tinea capitis with Boggy, tender plaque with follicular pustules
kerion
tests for all tineas
Fungal culture
KOH prep
tx for tinea corporis/ cruris
topical azole antifungal, use for one week after resolution of symptoms; resort to oral meds if no resolution
tx for tinea capitis
oral griseofulvin, terbinafine, or itraconazole
tx for tinea pedis
antifungal cream BID until lesions have resolved for three days; resort to oral antifungals if no resolution
tx for tinea veriscolor
ketoconazole or selenium sulfide shampoo (Selsun Blue; dandruff shampoo); oral antifungals for non-responders
If you press on it and the color goes away then comes back what is it?
Blanchable
Adverse skin reaction response to administration of any medication
Drug eruptions
Most common type of drug eruptions
Urticarial
when can drug eruptions occurs
10-14 days after a patient starts a new medications
Small flat top, angular, red to violaceous, shiny, pruritic papules on the skin
“lot of P’s”
Lichen planus
Common locations of lichen planus
flexor surfaces of UE
extensor surfaces of LE
genitalia
mucous membranes
White, lacy pattern on the tongue
Lichen planus
if what is on top of the purple, patches of lichen plnaus.
white lacy pattern
Wickham striae
new lesions may be noted at sites of minor injuries such as scratches or burns
Koebner phenomenon
tx for lichen planus
superpotent topical steroids
soak and smear technique.
systemic steroids if no response
What is the soak and smear technique
soak in bath for 20 minutes
then immediately put steroids on
should be done at night
use ointment as solution
Self-limiting skin eruption with multiple papulosquamous lesions
initial sign is a herald patch
widespread rash begins 7-14 days later
Pityriasis rosea
tx for pityriasis rosea
Topical steroids or oral antihistamines for itching
Well-defined red papules coalescing to plaques; sharply demarcated silvery scales on red plaques
Psoriasis
Usually presents
Guttate psoriasis
True emergency: Severe form characterized by widespread erythema, scaling, pustule formation
Pustular psoraisis
First line Tx for psoriasis
emollient topical corticosteroids Vit D analgoues topical retinoids light therapy
Second line tx for psoriasis
topical immunosuppressants
salicylic acid
coal tar
what is Underlying pinpoints of bleeding following scraping of psorasis plaques
Auspitz sign
Generalized hypersensitivity reaction, usually to a drug, in which skin and mucous membrane lesions are an early manifestation
Stevens-Johnson syndrome
what usually causes stevens-johnson syndrome
a drug rxn
what do the lesions look like with SJS and TEN
targetoid
when is a targetoid rash considered TEN?
> 30% of body surface area
when targetoid lesions occupy 10–30% of body surface area what is it considered
overlap between SJS and TEN
do you managed SJS in clinic?
No, you should admit them
Tx for SJS
supportive care in hospital
where does a patient with TEN admitted to?
Burn unit
Acute and self-limiting hypersensitivity reaction
Previously thought to be on spectrum of SJS and TEN
Mostly triggered by infectious agents, especially HSV
Erythema multiforme
3 zones of target lesions with erythema multiforme
raised and cyanotic center, edematous light intermediate ring and bright erythematous border
what causes erythema multiforme?
HSV previous infection
Tx for erythema multiforme
Medication for any underlying process
Topical corticosteroids or oral antihistamines for symptomatic relief
Possible antivirals with comorbid viral infection
Epidermal detachment with light lateral pressure
seen with SJS
Nikolsky’s sign
Large, tense subepidermal blisters and urticarial plaques or bullae commonly occur in the flexural areas of the legs and arms, axillae, abdomen, and groin. Due to autoimmune process
Bullous Pemphigoid
what signs will be negative with bullous pemphigoid
Nikolsky
Asboe-Hansen
what is required for a dx of bullous pemphigoid
biopsy
first line tx for bullous pemphigoid
high potency topical corticosteroids
possible oral steroids
chronic inflammatory dermatosis notable for open/closed comedones and inflammmatory lesions, including papules, pustules, or nodules
Acne vulgaris
what is a Closed comedones
whitehead
wat is an open comedones
blackhead
when will you do testing with acne
female comes in with signs of androgenation
Chronic condition characterized by recurrent episodes of facial flushing, erythema (due to dilatation of small blood vessels in the face), papules, pustules, and telangiectasia (due to increased reactivity of capillaries) in a symmetrical, facial distribution
Rosacea
what differentiated rosacea from acne
lack of comedones
tx for rosacea
low dose oral tetracyclines
topical metronidazole, or other topical antibiotics
topical sulfur-containing compounds
what exacerbates rosacea?
Spicy foods
heat
alcohol
sun
Inflammation of the hair follicle caused by infection, irritation, or injury
Will have pustules at the base of hair follicle
Follicuiltis
cause of hot tub foliculitis
pseudomonas
Tx for folliculitis
systemic abx haven’t been found to be helpful
consult sanford guide