Derm Flashcards
tx acne vulgaris
mild: benzoyl peroxide topical/wash first line, benzoyl peroxide + abx (topical clinda/erythro) 2nd line
moderate: systemic abx (PO doxy/mino) 1st line, topical retinoids (adapalene, trentinoin) 2nd line
severe: systemic retinoids (PO isotrentinoin/accutane)
hormonal: OCP or spironolactone
Isotrentinoin monitor
need pregnancy test done
acne rosacea tx
topical metronidazole
brimonidine: for itchy dry eyes
resistant/ocular: PO tetracycline, retinoids
folliculitis MCC
S. aureus
Folliculitis from hot tub MCC
pseudomonas
tx folliculitis
topical mupirocin 1st line
benzoyl peroxide
2nd line: PO clindamycin, bactrim, keflex
erythema multiforme hypersensitivity reaction
type IV
erythema multiforme MCC
herpes simplex virus (HSV1)
erythema multiforme rx causes
beta lactams, sulfonamides, phenytoin, phenobarbital
erythema multiforme tx
minor: supportive
PO acyclovir for HSV
major: PO prednisone, mucous membranes involved
SJS/TEN med causes
allopurinol
abx (sulfa, bactrim), tetracyclines, penicillin
anticonvulsants (carbamazepine, lamotrigine, phenytoin)
NSAIDS
sulfasalazine
SJS vs TEN
SJS <10%
SJS/TEN: 10-30%
TEN: >30%
SJS/TEN tx
dermatologic emergency
initial: D/C Rx. admit to ICU/burn unit
supportive care
alopecia sx
localized, round, no inflammation or scarring
exclamation mark hairs
alopecia tx
resolves in 6mo
refer to derm if large area
potent topical CS
androgenic alopecia tx
minoxidil (smaller area and recent onset)
oral finasteride
finasteride AE
decreased libido
sexual or ejaculatory dysfunction
onychomycosis MC type
distal sublingual (DSO) due to T. rubrum
onychomycosis tx
terbinafine
2nd line: itraconazole
terbinafine AE
hepatotoxic, monitor LFT
itraconazole monitor
check LFT
paronychia tx
w/ abscess: culture and I&D, PO bactrim or clindamycin
w/o abscess: topical abx
severe: empiric PO abs
nail biter: augmentin, tx for eikenella
brown recluse bite sx
red, white, and blue sign
brown recluse bite tx
rest, ice, elevation
tetanus
supportive
black widow bite sx
local papule w/ halo
neuro/msk sx (diaphoresis, abd pain, muscle fasciculations)
black widow bite tx
initial: wound care, tetanus
opioids and benzos
antivenin in severe cases
scorpion sting can cause
pancreatitis
scorpion sting sx
increased oral secretions
blurred vision, tongue fasciculations
nystagmus, chorea, hyperthermia
scorpion sting tx
antivenom needed
analgesics, IV benzos, tetanus
intubate if respiratory compromise
snake bite sx
bleeding (coagulopathy)
local edema, neuromuscular blockage
cardiac failure due to hypotension and acidosis
rattlesnake identification
triangular head with elliptical pupils and nostril pits
coral stake identification
ren on yellow stripes w/ black in between
rattlesnake bite sx
local pain, swelling, paresthesia
oozing blood, coagulopathy
coral snake bite sx
muscle paralysis
rattlesnake bite tx
antivenom
observe for 8hrs
dopamine for shock
coral snake bite tx
antivenin needed
observe 8h
dopamine for shock
erythema infectiosum etiology
5th disease
Parvovirus B19
erythema infectiosum sx
children 4-10yo
low fever, coryza
slapped cheek
lace like reticular eruption on trunk and extremities
erythema infectiosum test
clinical
specific IgM ab to confirm
erythema infectiosum tx
supportive
resolves 5-10d
erythema infectiosum complications
aplastic crisis (sickle cell)
hand foot and mouth dz etiology
coxsackie virus type A
hand foot and mouth dz sx
children
mild F, sore throat, joint pain
painful oral lesions, palms and soles, grey yellow vesicles palms and soles
vesicular lesions w/ erythematous halos
herpangina sx
sudden fever
stomatitisL small vesicles on soft palate, uvula, and tonsils
hand foot and mouth tx
supportive
resolves in 10d
hand foot and mouth complications
myocarditis
CNS dz
rubeola sx
measles, unvaccinated children
F, conjunctivitis, cough, coryza
begin on face, spread down
koplik spots (grains of salt on wet background)
rubeola test
clinical, confirm w/ serology and report to local/state departments
anti measles IgM and IgG
rubeola tx
self limited
supportive
vitamin A
necrotizing fasciitis etiology
GABHS
fournier’s gangrene
necrotizing fasciitis of the penis/scrotum
pts w/ DM, impaired immunity, or trauma
fournier’s gangrene sx
pain out of proportion, erythema
blue, hemorrhagic bullae –> gangrene –> septic shock
fournier’s gangrene tx
surgical debridement
broad spectrum abx (zosyn, imipenim)
cellulitis etiology
GABHS (s. pyogenes)
cellulitis tx
non purulent outpt: PO cephalexin MRSA (IVDU): PO clindamycin purulent/systemic infx: IV clindamycin, culture fluctuant: I&D, tx both MRSA and GAS Bites: augmentin
erysipelas etiology
GAS (S. pyogenes)
erysipelas vs cellulitis
Cellulitis: not sharply demarcated
erysipelas: well defined margins
erysipelas tx
limb elevation
mild: PCN/amoxicillin or cephalosporin
IV: cefazolin or ceftriaxone
erysipeloid
puncture wound from raw fish, shellfish, raw meat, poultry
edema, purplish erythema w/ sharp irregular margins extending peripherally but clearing centrally
tx w/ pen G or V, cephalosporin, or clindamycin
impetigo etiology
S. aureus or GAS
impetigo tx
topical mupirocin
PO cephalexin/dicloxacillin
another name for staphylococcal scalded syndrome
Ritter disease
staphlococcal scalded skin syndrome
S. aureus neonate/children flaccid blisters in areas of mechanical stress MSSA: IV nafcillin MRSA: IV vanco
candida intertrigo sx
candida diaper dermatitis in children
beefy red plaques
peripheral scaling
satellite lesions
candida intertrigo test
clinical
KOH prep initial
fungal culture definitive
candidal intertrigo tx
nystatin, clotrimazole, or ketoconazole 1st line
severe: PO fluconazole, itraconazole
diaper dermatitis: zinc oxide, nystatin cream
tinea capitis sx
school kids, pruritic scalp w/ patchy hair loss
kerion: inflammatory plaque w/ drainage and crusting. raised boggy lesion w/ purulent nodules
tinea capitis test
clinical
KOH/ woods lamp
culture definitive
tinia capitis tx
conservative, ketoconazole or selenium sulfide shampoo
PO antifungals 1st line= griseofulvin PO (child), terbinafine
tinea corporis MCC
trichophyton rubrum
tinea corporis sx
scaly patch in oval/annual shape w/ central clearing
tinea corporis test
KOH
microscopy and culture definitive
tinea corporis tx
topical antifungals 1st line: clotrimazole or miconazole
allylamines 2nd line: terbinafine
failure of topicals: PO itraconazole or PO terbinafine
tinea pedis tx
topical clotrimazole and miconazole 1st line
topical terbinafine if <12yo
PO terbinafine or itraconazole 2nd line
tinea versiolor association
seborrheic dermatitis
tinia versicolor etiology
malassezia
tinta versicolor sx
hypo/hyperpigmented macules/patches of trunk, neck, and face
lesions w/ fine scaling
tinea versicolor test
KOH: spaghetti and meatballs
woods lamp: yellow/green scales
tinea versicolor tx
1st line: shampoo (selenium sulfide, ketoconazole)
2nd line: PO antifungals (fluconazole, itraconazole)
amphotericin B AE
nephrotoxic cardiotoxic (QT prolongation, arrhythmia, electrolyte imbalance)
ketoconazole AE
avoid in pregnancy and breastfeeding
CI in arrhythmias
D/C PPI (for absorption)
ciclopirox AE
facial edema
V tach in shampoo form
skin irritation/pruritus
terbinafine AE
hepatotoxic
CI in SLE, children <4yo, and breastfeeding
check and monitor LFT
griseofulvin AE
hepatotoxic
CI in pregnancy and breastfeeding
SJS
lice caused by
pediculosis capitis
lice tx
was everything in hot water
topical pediculicide: permethrin cream
PO ivermectin if topical fails
scabies cause
sarcoptes sabiei (mite)
scabies sx
burrows, linear markings on wrist, elbow, and webs of fingers
scabies tx
topical permethrin
ivermectin if immunocomp
lindane AE
neurotoxic
seizures
teratogenic
condyloma acuminatum caused by
HPV 6 and 11
condyloma acuminatum transmission
sexual contact (adults)
if in children, investigate abuse
immunocomp
condyloma acuminatum tx
1st: TCA, todophyllin, imiquimod
operative
HSV sx
vesicles on erythematous base
bright red rim
HSV test
tzank smear
confirm w/ PCR
HSV tx
acyclovir
1st time/conservative: cool compress, lubricants, topical/PO analgesics
herpes zoster tx
famciclovir
postherpetic neuralgia: gabapentin
shingle vaccine
one time dose >50yo regardless of chickenpox hx
molluscum contagiosa etiology
poxvirus
molluscum contagiosa sx
flesh colored pearly white dome shaped papules w/ central umbilication
BOTE: tenderness, crusting, erythema, inflammatory halo
molluscum contagiosum tx
self limited, resolve in 6-9mo
chickenpox caused by
HHV3
chickenpox sx
teardrop vesicles
chickenpox tx
supportive
immunocomp: acyclovir
chickenpox complications
secondary infx
reyes syndrome (ASA=CI)
encephalitis
verrucae etiology
HPV 1, 3, 10
verrucae tx
salicylic acid or cryotherapy 1st line
actinic keratosis has potential of turning into
SCC
actinic keratosis sx
sun exposure
rough gritty scale
sandpaper
easier to feel than see
actinic keratosis tests
clinical
skin bx: doesn’t bleed w/ excoriation
actinic keratosis tx
annual f/u w/ derm
liquid nitrogen/cryo if single lesion
topical 5FU, imiquimod if multiple
seborrheic keratosis sx
wart like, velvet or verrucous
waxy greasy
stuck on appearance
seborrheic keratosis tx
N/A
curettage or cryotherapy for cosmetic
BCC of skin sx
translucent pearly white or shiny pink papule/nodule
telangiectasia
raised/rolled boarder
BCC of skin dx
dermoscopy initial
definitive: skin bx
BCC skin tx
nonfacial, small, superficial: electrodesiccation and curettage
danger sites: mohs
nonsurgical: imiquimod, 5FU cream
f/u Q 6-12mo for 2yrs
kaposki sarcoma etiology
HHV8
HIV/AIDS
CD4 <100
kaposki sarcoma sx
red/purple painless lesion
oral lesions start on feet, leg, hands
slowly spread centripetally
kaposki sarcoma tx
antiviral
HAART therapy
melanoma criteria
Asymmetric Border irregularity Color change Diameter >6mm Evolution over time
most important prognosis factor for mets of melanoma
thickness
SCC skin sx
sun exposed, HPV, actinic keratosis hx
friable, raised elevated thickened nodule
SCC skin tests
1st line and definitive: skin bx
SCC skin tx
surgical excision TOC
mohs
perioral dermatitis tx
topical metronidazole or erythromycin
oral tetracyclines
avoid topical CS
contact dermatitis tx
topical steroids
poison ivy tx
PO prednisone
drug eruption causes
bactrim, tetracyclines, PCN, NSAIDS, allopurinol
drug eruption tx
D/c med
diphenhydramine
topical steroids
reassurance
DRESS (drug reaction w/ eosinophilia and systemic systems) causes
anticonvulsants: phenytoin, carbamazepine
allopurinol
sulfonamides (sulfasalazine)
abx: minocycline, vancomycin
DRESS sx
systemic sx and internal organ involvement w/ drug eruption
2-8wks after drug exposure
morbilliform rash, F, LAD, eosinophilia >700
liver, kidney, lung
atopic triad
eczema
allergic rhinitis
asthma
nummular eczema sx
coin shaped
dorsum of hands, feet, and extensor surfaces
lichen Planus sx
6Ps: papule, purple, polygonal, planar, pruritic, plateau
whickham striae
lichen Planus tx
first line: high dose topical steroids w/ occlusion (betamethasone)
2nd line: PO prednisone, phototherapy, PO retinoids
lichen simplex chronicus
neurodermatitis
skin thickening in patients w/ eczema secondary to scratching
pityriasis rosea etiology
HHV7
pityriasis rosea sx
stage 1: URI sx
stage 2: herald patch, salmon colored
eruption: Christmas tree distribution, longer lines
stage 3: resolution 4-12w w/o scarring
pityriasis rosea test
clinical
skin bx w/ KOH -
pityriasis rosea tx
self limited
mild: topical emollients and PO antihistamines
severe: topical steroid creams, UVB phototherapy
koebners sign
lesions appear at site of mechanical or thermal trauma
auspitz sign
small pinpoint bleeding when scraped off
psoriasis
psoriasis tx
moisturizers + topical steroids, first line (triamcinolone or clabetasol)
moderate: topical RX and systemic (MTX)
severe: topical + systemic TX, phototherapy, biologics
seborrheic dermatitis tx
initial: emollients/shampoos/topical steroids
anti dandruff shampoo: topical keoconazole, selenium sulfide
flares: topical CS (desonide)
severe: PO ketoconazole or steroids
melasma tx
daily sunscreen
triple topical therapy: hydroquinone, trentinoin, CS
laser, chemical peels
vitiligo associated w/
vitamin D deficiency
thyroid
alopecia
vitiligo tx
potent topical CS
topical tacrolimus/pimecrolimus ointment
cyanide poisoning tx
amyl nitrate
IV sodium nitrate or thiosulfate
MC complication pressure ulcers
osteomyelitis
stasis dermatitis sx
itchy pruritic red scaly plaques, yellow brown pigmentation
venous ulcers (medial malleolus)
inverted champagne bottle legs
stasis dermatitis test
doppler US
stasis dermatitis tx
elevation, compression stockings
high potency topical CS
avoid topical Abx
bullous pemphigoid tx
prednisone
mild/stable/local: topical CS or tacrolimus
pemphigus vulgaris tx
PO steroids 1st line
pemphigus vulgaris associated with
Rx: PCN, captopril, cephalosporin
thymoma
myasthenia gravis
lupus
acanthosis nigricans malignancy
MC gastric CA
lung/GU/lymphoma
acanthosis nigricans malignant sx
palms, oral mucosa, periocular, vermillion border
mamillary
stripe hands
hidradenitis suppurativa tx
mild: topical abs (clindamycin) + intralesional tramcinolone
mod/maintenance: PO abx (minocycline, doxy, augmentin, clindamycin)
severe: immunosuppressants (adalimumab, cyclosporine)
surgery
photosensitivity reaction caused by
abx: tetracyclines (doxy), sulfonamides, FQ
antipsychotics: chlorpromazine
diuretics: furosemide, HCTZ
amiodarone, promethazine
pyogenic granuloma
aka lobular capillary hemangioma
children/young adult after trauma
solitary glistening friable red (raspberry like) nodule or papule
excision, topical imiquimod, injectable sclerosis agents
pyoderma gangrenosum
associated w/ IBD
ulcerative skin lesion 2ndry to immune dysregulation
painful necrosis ulcer w/ irregular purple undermined borders and purulent base
tx w/ topical CS high potency or tacrolimus
miliaria
blocked eccrine sweat glands
milia tx
N/A
resolves 1st month of life
child with >6 cafe au lait macules
possible neurofibromatosis type I
port wine stains
pink red sharply demarcated macules or papules
darken to purple and may develop thickened surface
pulse dye laser treatment
surge weber syndrome
triad: facial port wine stain, leptomeningeal angiomatosis, ocular involvement (glaucoma)
can develop hemiparesis contralateral to facial lesion
seizures
intracranial calcification and learning disabilities
Mongolian spots
blue or slate gray pigmented macular lesions
common in presacral/sacral-gluteal area, indefinite borders
usually fade over first few years (before 10yo)
nevus simplex
stork bite
surface capillary dilation on nape of neck , eyelid, forehead
observation: resolve by 2yo and dont darken over time
laser therapy to reduce appearance
