derm Flashcards
tx acne vulgaris
tretinoin
benzoyl peroxide
azelaic acid
salicylic acid
erythromycin or clindamycin (topical)
doxycycline or sulfamethoxazole (oral)
isotretinoin 20 weeks if severe and unresponsive to others ^^
tx treatment resistant acne (before isotretinoin)
spironolactone
combo oral BC
what acne meds are C/I in pregnancy
tretinoin
isotretinoin
doxy
MC premalignant skin condition
actinic keratosis (may progress to squamous cell CA)
what should you do when you see actinic keratosis
punch or shave biopsy
alopecia areata is thought to be due to
underlying autoimmune disease
PE alopecia areata
smooth, non scarring hair loss w patches of smaller hairs termed exclamation hairs
tx alopecia areata
intralesional corticosteroids
MC type of skin cancer in US
basal cell CA
sx basal cell CA
small, raised papule that are pink, white or flesh colored; translucent, waxy, or pearly quality with raised “rolled” borders and central depression and/or ulceration with overlying telangiectatic surface vessels
bleeds easily
dx basal cell CA
punch or shave biopsy
what topical can you use for basal cell CA
Imiquinod
sx bullous pemphigoid
pruritus w eczematous or urticarial plaques followed by multiple tense large bullae (1-3 cm) that don’t rupture easily
PE bullous pemphigoid
negative Nikolsky - no epidermal detachment
dx bullous pemphigoid
skin biopsy w direct immunofluorescence - linear C3 and IgG along the dermal epidermal junction sub epidermal blisters, and eosinophilia
MC cause cellulitis
Group A strep (MC)
staph aureus
RF cellulitis
skin inflammation (abrasion)
lowered immunity
skin infection (tinea, rash)
edema
obesity
recent surgery or trauma or animal bites
sx cellulitis
localized macular erythema (flat margins not sharply demarcated)
swelling
warmth
tenderness
Tx cellulitis
Nafcillin, cefazolin, clindamycin, dicloxacillin, cephalexin, doxycycline, and trimethoprim-sulfamethoxazole
MC cause condyloma acuminata
HSV 6 and 11
tx condyloma acuminata
resolution w/in 18 mos
Imiquimod or Pdophyllotoxin or Sinecatechins
cryotherapy, trichloroacetic acid, surgical removal
atopic dermatitis is also called
eczema
eczema/atopic dermatitis sx
pruritus is hallmark and required for dx
erythematous, ill-defined blisters, papule, or plaques w oozing
lesions dry and crus over and scale
MC ON FLEXOR SURFACES
tx eczema/atopic dermatitis
topical corticosteroids
skin hydration
pathophysiology seborrheic dermatitis
increased sebaceous gland activity + hypersensitivity to malassezia furfur
seborrheic dermatitis is associated w what neurologic dz
parkinson dz
HIV
sx seborrheic dermatitis
erythematous plaques or patches covered w fine white-yellow greasy scales
common in areas w high sebaceous gland secretion (scalp - dandruff), eyelids, beard, mustache, nasolabial folds, chest, groin
tx seborrheic dermatitis
anti fungal shampoo
low potency topical corticosteroids, topical anti fungal agents for face
oral anti fungal if resistant
sx dyshidrotic eczema
sudden onset of pruritic “tapioca-like” small tense vesicles on the soles, palms, fingers (lateral aspect of digits)
tx dyshidrotic eczema
Topical corticosteroids
MC cause erysipelas
Group A strep (S. pyogenes)
sx erysipelas
intensely erythematous, raised area with sharply demarcated borders
MC involves lower extremities and face
often associated w systemic manifestations
MC cause erythema multiforme
herpes simplex virus (MC)
mycoplasma spp (esp in kids)
meds that can cause erythema multiforme
sulfa drugs
beta-lactams
phenytoin
phenobarbital
erysipelas
a variant of cellulitis (more superficial infxn)
sx erythema multiforme
target lesions hallmark finding - a dusky, central area or blister, a dark red inflammatory zone surrounded by a pale ring of edema, and an erythematous halo on the extreme periphery of the lesion
negative nikolsky sign
sx erythema multiforme
target lesions hallmark finding - a dusky, central area or blister, a dark red inflammatory zone surrounded by a pale ring of edema, and an erythematous halo on the extreme periphery of the lesion
negative nikolsky sign
minor - no mucosal membrane involvement
major - mucosal membrane involvement
tx erythema multiforme
supportive
remove offending drugs
topical steroids, antihistamines, analgesics, skin care etc
prophylactic acyclovir if recurring
erythema infectiosum is also called
fifth disease
erythema infectiosum is caused by
parvovirus B19
sx erythema infectiosum
erythematous malar rash “slapped cheek: and circumoral pallor
lacy, reticular maculopapular rash on extremities
may have arthropathy or arthralgias
associated w fetal loss
tx erythema infectiosum
supportive
cause of rubeola
measles virus
sx rubeola
high fever + cough, coryza, conjunctivitis
kopek spots - small 1-3 mm pale white or blue papule w an erythematous base on the buccal mucosa
morbilliform maculopapular brick-red rash beginning at the hairline
cause of hand, foot, mouth dz
coxsackie virus (esp type A)
sx hand, foot, mouth dz
oral - erythematous macula’s that become painful oral vesicles surrounded by a thing halo of erythema
exanthema - grayish-yellowish vesicular, macular, or maculopapular nonpruritic contender skin lesions on distal extremities (includes palms and soles)
roseola infantum is caused by
HHV 6
sx roseola infantum
abrupt onset high fever
rose-pink macular or maculopapular, BLANCHABLE, rash beginngin on the TRUNK AND NECK before spreading to face
nagayama spots - erythematous papule, macules, or ulcers on the soft palate and uvula
cause of rubella / German measles
rubella virus
sx rubella
low grade fever
posterior cerical and posterior auricular lymphadenopathy most prominent
pink or light red non confluent maculopapular rash that last 3 days
forchheimer spots - small red macules or petechiae on the soft palate
arthralgia and arthritis
MC cause folliculitis
staph aureus
sx folliculitis
peri follicular papule and/or pustules w surrounding erythema on hair bearing skin
tx folliculitis
topical mupirocin
hidradenitis suppurativa
painful, chronic inflammatory suppurative condition involving skin and subq tissue
chronic follicular hair follicle obstruction
sx hidradenitis suppurativa
recurrent, painful, and inflamed nodules
fibrotic hypertrophic scars
intertriginous skin MC - axillae
tx hidradenitis suppurativa
topical clindamycin
MC cause impetigo
staph aureus
tx impetigo
topical mupirocin
MC cause kaposi sarcoma
HHV 8
seen in immunosuppressed (like HIV)
sx kaposi sarcoma
painless
nonpruritic
macular, papular, nodules, plaque-like brown, pink, red or violaceous lesions
tx kaposi sarcoma
antiretroviral if associated w HIV
lice is termed
pediculosis
tx pediculosis
permethrin
lichen planus is associated w
hepatitis C
sx lichen planus
purple (violaceous)
polygonal
planar
pruritic
papules or plaques w fine scales
Wickham’s striae - fine gray-white lines on the skin lesions or on the oral mucosa
Koebner’s phenomena - new lesions at sites of trauma (also seen in psoriasis)
erysipelas
a variant of cellulitis (more superficial infxn)
tx lichen planus
topical corticosteroids
lichen simplex chronics (neurodermatitis)
skin thickening in pts w atopic dermatitis secondary to repetitive rubbing and scratching
sx lichen simplex chronicus
scaly, well-demarcated, rough hyperkeratotic (lichenified) plaques w exaggerated skin lines
tx lichen simplex chronicus
avoid scratching
topical corticosteroids
sx lipoma
soft, painless subcutaneous nodules that are easily mobile
no tx needed!!!
MC cause of skin cancer related death
melanoma
high malignant potential
MC type of melanoma
superficial spreading
all types of melanoma
superficial spreading
nodular
lentigo maligna
aural lentiginous
desmoplastic
superficial spreading melanoma
MC
arises de novo or from pre-existing nevus
MC on trunk in men and legs in women
nodular melanoma
associated w rapid vertical growth phase
lentigo maligna melanoma
arises in chronically sun-damaged or sun-exposed areas of skin in older individuals such as face
begins as tan or brown macule that darkens
aural lentiginous melanoma
MC in darker-pigmented individuals
palms, soles, nail beds, areas without sun exposure
erysipelas
a variant of cellulitis (more superficial infxn)
most aggressive type of melanoma
desk-plastic
what is discouraged for melanoma
shave biopsy
dx and tx melanoma
dx - complete biopsy
tx - complete local wide surgical excision
melasma is also called
chloasma
RF melasma
increased estrogen exposure (OCP, pregnancy, women)
sunlight exposure
sx melasma
mask-like hypertmelanotic symmetrical macules esp on face and neck
dx melasma
clinical
wood lamp to deter pattern of pigment deposition
tx melasma
sun protection
hydroquinone 4%
if combo - fluocinolone acetonide + hydroquinone + tretinoin
erysipelas
a variant of cellulitis (more superficial infxn)
causes of onchomycosis
dermatophytes - trichophyton and epidermophyton (T rubrum MC)
sx onchomycosis
nail that is opaque, thickened, discolored and/or cracked
dx onchomycosis
50% of dystrophic nails are due to fungal infxn
confirmation with rapid test (KOH wet mount prep, histopathologic exam with a PAS strain, or PCR + fungal culture)
periodic acid-schiff test - performed on nail plate clippings
tx onchomycosis
systemic antifungals
oral terbinafine first line
caution for hepatotoxicity and drug-drug interactions
paronychia
infection of lateral and proximal nail folds including the tissue that borders the root and sides of the nail for < 6 weeks
MC cause paronychia
staph aureus
sx paronychia
rapid onset of painful erythema and swelling to the proximal and or lateral nail folds
tx paronychia without fluctuance
triple antibiotic ointment or topical mupirocin
warm compress, warm water, antiseptic soap (chlorhexidine, povidone-iodine)
OTC analgesics
tx paronychia w fluctuance or immunocompromised
oral dicloxacillin or cephalexin
I & D
paronychia can progress to
felon (closed space infection of fingertip pulp space)
tx pityriasis rosea
topical corticosteroids
sx psoriasis
plaque - MC type; raised, well-demarcated, pink-red plaques or papules w thick silvery white scales. MC on EXTENSOR surfaces.
Auspitz sign - punctate bleeding w removal of plaque or scale
Koebner’s phenomena - new lesions at sites of trauma (seen in lichen planus, eczema, vitiligo)
nail involvement - pitting. yellow-brown discoloration under the nail (oil spot) pathognomonic
guttate psoriasis often appears after
strep pharyngitis
tx psoriasis
topical corticosteroids
SJS versus TEN
sis < 10%
TEN > 30%
scabies is due to
sarcoptes scabiei
sx scabies
intense pruritus esp at night
tx scabies
permethrin
MC benign epidermal skin tumor
seborrheic keratosis
sx seborrheic keratosis
well-demarcated round or oval velvety warty lesions w a greasy or stuck on appearance
premalignant potential w seborrheic keratosis
none
which spider bite forms bullae
brown recluse
dx all tinea infections
KOH prep
tx tinea capitis
oral griseofulvin
oral terbinafine
tx tinea pedis, cruris, corporis, intertrigo
topical antifungals
tinea versicolor cause
malassezia furfur
erysipelas
a variant of cellulitis (more superficial infxn)
verrucous papule is also known as
a wart
tx warts
liquid nitrogen cryotherapy
salicylic acid plaster w paring
tx vitiligo
topical corticosteroids
