derm 2 Flashcards
Other term for pityriasis versicolor + etiology
- Tinea versicolor
2. Superficial fungal infection
treatment of pityriasis versicolor
Antiseborrheic shampoos or lotions (selenium sulfide or ketoconazole)
Treatment of epidermal inclusion cyst/sebaceous cyst
Excision, not I&D (need to remove epithelial lining)
Treatment of dermatitis herpetiformis
Dapsone to induce remission + gluten free diet for long term control
Dermatitis herpetiformis clinical features
small tense papules + Vesicular + extremely pruritic, so excoriations on elbows, knees, buttocks
Dermatitis herpetiformis diagnosis
skin biopsy (IgA deposition)
Dermatophyte infection clinical features
annular scaly patch (don’t necessarily have to have central clearing)
Treatment of tinea pedis
Topical Azole or terbinafine cream BID for 2-4 weeks (avoid oral azoles)
Differential for lower extremity ulcers
PAD, DM2, *venous stasis ulcers
Treatment of venous stasis ulcer
Compression therapy
Location + clinical features of venous stasis ulcers
- Distal lower leg (particularly medial aspect of the ankle)
- Irregular border + surrounding hyperpigmentation + thickened surrounding skin and subcutaneous tissues + surrounding varicose veins and edema
- Result from minor trauma, medical procedure, or acute stasis dermatitis flare
Porphyria cutanea tarda clinical features
Skin fragility + small, easily ruptured vesicles in sun-exposed areas, which then rupture, forming erosions, dyspigmentation, scarring. mainly hands
Common initial site of involvement with pemphigus vulgaris
Oral mucosa
What to evaluate patients with seborrheic dermatitis for?
HIV (not hyperlipidemia) (extremely common among patients with HIV)
Cause of Xanthoma?
secondary to dyslipidemia, different subtypes associaed with hypercholesterolemia and hypertriglyceridemia
Eruptive xanthomas clinical features
Rapid onset of numerous yellow papules with surrounding erythema + extensor surfaces of extremities and buttocks
Eruptive xanthoma association
hypertriglyceridemia
Tuberous xanthoma association
familial hypercholesterolemia
Tuberous xanthoma vs. eruptive xanthoma
Tuberous are larger (up to 3 cm)
Management of actinic keratosis that recurrs after cryotherapy
Biopsy (may be a basal or SCC), never proceed directly to wide local excision for BCC or SCC
Other skin manifestation of amyloidosis
- yellow waxy papules and plaques around eyes (look like xanthomas)
Treatment of pruritic urticarial papules and plaques of pregnancy (PUPPP)
Topical steroids (topical steroids are safe in pregnancy)
AK management vs basal cell
- basal cell = wide local excision
- AK = cryotherapy and surgical procedures, are the primary approach for isolated lesions [3]. Field-directed therapies, such as topical fluorouracil, imiquimod, and PDT, are particularly useful for treating areas with multiple AKs.
Pemphigus vulgaris diagnosis
- punch biopsy with immunofluorescent staining
Miliaria presentation
- lesions ranging from small, thin-walled vesicles (miliaria crystallina) to erythematous papules and pustules (militia rubra)
- flesh colored papules and or pustules (miliaria profunda)
keratosis pilaris cause + clinical features
- retained keratin from plugged hair follicles
- pruritic or pustular lesions in upper arms (most common), face, trunk, and lower extremities
- worse in cold and dry climates
folliculitis presentation
- erythematous, pustular eruption
- lesions can be asymptomatic or cause significant pruritus and pain
treatment of miliaria
sweat reduction with cool baths, compresses, or light and loose clothing
Presentation of poorly differentiated SCC
IF poorly differentiated – fleshy, soft, granulomatous papules and nodules
- can ulcerate, bleed, become necrotic, or cause pain and pruritus
pyogenic granuloma presentation
- small red papule that grows rapidly over weeks to months + friable and can bleed with minor trauma
When you can discontinue cervical cancer screening
- prior adequate screening + no significant RF’s for cervical cancer (immunosuprresion, multiple sexual partners, tobacco use or STI hx, history of HSIL)
larva migrans clinical features
- serpigenous red or brown lesion (due to larva migration) + pruritic + commonly from sand and soil in Caribbean, Africa, Southeast Asia
- hookworm infection
larva migrans treatment
Ivermectin
cutaneous leishmaniasis presentation
- red papule that forms an ulcer with granulomatous tissue at the base with raised margins
swimmers itch presentation
- pruritic maculopapular rash within hours of exposure to contaminated water + rash limited to areas exposed to water
- caused by schistosome
Sweet syndrome presentation
- abrupt onset of painful erythematous lesions (papules, plaques, or nodules) + *febrile
- think rash + fever (without evidence of infection or failed antibiotics) = sweet
- often preceding infection
Treatment and management of sweet syndrome
- Dramatic response to topical (mild sweet syndrome) or systemic steroids
- Age appropriate cancer screening
lichen planus treatment
topical high-potency steroids
associations of lichen planus
hep C
lichen planus diagnosis
- mainly clinical (if uncertain punch biopsy)
other patients with greater than 5mm PPD induration who need treatment
- nodular or fibrotic changes on CXR (consistent with previously healed TB)
Next step after positive PPD
CXR to rule out active infection
SJS and TEN presentation
- acute flu-like syndrome
- rapid onset macules, vesicles
- necrosis and sloughing of epidermis
- mucosal involvement
Drugs that can cause SJS and TEN
- allopurinol
- abx (sulfonamides) (bactrim)
- anticonvulsants (carbamazepine, lamotrigine, phenytoin)
- NSAIDs
- sulfasalazine
Other triggers for SJS and TEN
- mycoplasma
- vaccination
- GVHD
SCC clinical features
tender, bleeding, or ulcerated papules, plaques, or nodules = sun-exposed areas or areas of chronic inflammation
Association of porphyria cutanea tarda
- hep c
diagnosis of porphyria cutanea tarda
- high serum/urine uroporphyrin level
Treatment of porphyria cutanea tarda
- phlebotomy (it is a disorder of heme synthesis)
- treat HCV if present
Lab features of porphyria cutanea tarda
mildly elevated liver enzymes + iron overload
Pityriasis rosea clinical features
- salmon-colored plaques involving trunk, neck, and proximal limbs
- begins with single large lesion (herald Patch)
Pityriasis rosea treatment
- reassurance (self limited)
Guttate psoriasis clinical features + vs. pityriasis
- scaly plaques + following streptococcal infection
* no herald patch (vs. pityriasis)
Treatment of seborrheic dermatitis
- antifungals + steroids
guttate psoriasis clinical features
Psoriasis + following streptococcal infection
nummular eczema clinical features
round papules and plaques + highly pruritic
treatment of guttate psoriasis
phototherapy
solar purpura clinical features
elderly patient + easy bruising limited to forearms and hands
Behcet clinical features
- recurrent genital + oral ulcers *ulcers lead to scarring + ocular lesions + acne + pathergy + asymmetric arthritis + renal disease + GI (nausea, abdominal pain)
- may have limited ulcer disease
- commonly misdiagnosed has having genital herpes
- may not state person is from endemic area
oral leukoplakia clinical features
- white patches or plaques over the oral mucosa
- can’t be scraped off
- patient with smoking and drinking history
appearance of oral SCC
- nodular, erosive, ulcerative lesions with surrounding erythema or induration
Treatment of aphthous ulcers (aphthous stomatitis)
topical steroids
necrobiosis lipoidica diabeticorum clinical features
- asymptomatic, annular yellowish plaques on the shins in a diabetic patient
- granulomatous
necrobiosis lipoidica diabeticorum treatment
- high potency steroids or intralesional steroids
Treatment of tinea versicolor
topical therapy (ketoconazole, terbinafine, selenium sulfide)
AK presentation
rough, scaly, erythematous macules or papules
Indications for biopsies of AKs
- unclear dx
- large (greater than 1 cm)
- indurated, ulcerated, tender, or rapidly growing
- not responding to therapy
treatment of viral conjunctivitis
- warm or cold compresses
treatment of bacterial conjunctivitis
- erythromycin or azithromycin drops
- polymyxin-trimethoprim drops
- if contact lens: quinolone drops
Treatment of crusted scabies
- oral ivermectin
Initial treatment of psoriasis
- high potency topical steroids (safe to use on extensor surfaces because won’t induce significant skin atrophy)
- topical vitamin D derivatives
treatment of severe plaque psoriasis
- phototherapy
- systemic therapy
treatment of facial and intertriginous psoriasis
- topical tacrolimus
- low-potency steroids
high potency steroids
betamethasone
clobetasol
venous lakes clinical features
- gray-blue-purple nodules on lips and ears of old people that disappear when compressed
management of chronic venous stasis ulcers
- aspirin (accelerates ulcer healing) + compression
Association of skin tags
- insulin resistance, dm2
- pregnancy
Association of recurrent herpes zoster
HIV
Management of keratoacanthoma
- biopsy (difficult to distinguish KA from SCC)
Basal cell carcinoma clinical features
- slow growing
- pearly, rolled border
- overlying telangiectasia
dermatitis herpetiformis presentation
- pruritic
- papules, vesicles and bullae
- extensor surfaces of elbows, knees, back, and buttocks
- see photo online