Derm 2 Flashcards
Greasy, “stuck-on” appearance
Average diameter is 1 cm
Flesh-colored, tan, brown, or black
Appear on the face, neck, scalp, back, upper chest and less frequently on the arms, legs and lower trunk
Seborrheic Keratosis (SK)
tx for seborrheic keratosis
Scissor biopsy, electrosurgery, liquid nitrogen, surgical excision
Often reoccur
Typically multiple pre-malignant lesions on sun-exposed areas.
Itching, burning or dry skin
looks rough and feels rough
actinic keratosis
first line tx for actinic keratosis
surgical- liquid nitrogen
other topical tx for actinic keratosis
fluorouracil (FU)
imiquimod
diclofenac
how do you dx actinic keartosis
touch it- will feel rough
does actinic keratosis occur on non-sun exposed skin?
No
how long can lice be asymptomatic for?
30 day (inducbation)
Tx for lice
Permethrin, malathion, lindane, benzyl alcohol
wash all bedding and clothing in hot water
remove nit s
should close contacts with lice be treated
Yes
inflammatory, erythematous pruritc papules. Most common in finger webs, flexor surfaces of wrists, elbows, axillae, buttocks. Burrows, worse at night.
Scabies
tx for scabies
Permethrin is most effective topical treatment
Treat all close contacts
if someone comes in with a “spider bite” but didn’t witness the bit bite what should you consider?
MRSA
Local- : pain that is sharp or burning, onset within minutes of the bite, typically resolving within minutes to hours. onset within 20 – 30 minutes, painful cramps or spasms, arm bite may lead to chest tightness or dyspnea. : tetanic contractions of the limbs, spasms, rigidity
Black widow spider bite
tx for black widow spider bite
Pre-hospital – immobilize the wound site
Supportive care, tetanus immunization prn
Venom extracting apparatus – must be used within 10 minutes of the bite
Local: often asymptomatic, pain that is stinging or burning, onset 1 – 24 hours after the bite
Systemic: fever, chills, malaise, nausea, vomiting
brown recluse spider
tx for brown recluse spider
Pre-hospital – immobilize the wound site, cool compresses
Supportive care, tetanus immunization prn
Venom extracting apparatus – must be used within 10 minutes of the bite
tests for brown recluse
venom can be detected in wound (not widely used)
UA for systemic hemolysis
what can happen with a brown recluse spider
tissue necrosis around bite
Pink papule/plaque, crusting, Rolled periphery, telangectasias, head/face/neck, atrophic center
basal cell carcinoma
tests for BCC
shave bx or punch bx to assess depth
most common skin cancer
BCC
tx for BCC
topical- 5-flurouracil, imiquimod
radiation, phototherapy
surgical excision is preferred
what is a melanoma that occurs on a nail?
ACRAL
does melanoma have to do with sun exposure?
No, there is some genetic predisposition
Tx for melanoma
surgical management
margins you need to get if melanoma is >1 mm thick
1 cm
margins needed if lesion is 1-2 mm thick
1-2 cm
Sun-exposed sites of elderly, fair-skinned individuals.
Majority of lesions arise from actinic keratoses but some arise de novo, also from old burn scar or from sites previously exposed to ionizing radiation, or preexisting human papilloma virus infection
Squamous cell carcinoma
where does SCC commonly metastasize to?
Lung
when is a SCC most apt to metastasize
when on the lip
tx for SCC
Total excision, electrocautery, or Mohs
loss of hair on the entire scalp
alopecia totalis
hair loss of all body hair
alopecia universalis
tests for alopecia
TSH CBC (anemia) CMp (electrolytes) testosterone iron ferritin zinc RPR (syphillis) prolactin (pituitary) ANA (autoimmune disorders) KOH (tinea vs. alopecia)
test where you pull on the hair and depending on the number of hair that pall out can determine alopecia vs. androgen problem
light hair pull test
tx for alopecia areata
intralesional steroids (painful) oral corticosteroids
Patchy, non-scarring hair loss
Alopecia Areata
Hair loss along with miniaturization of hair follicles
Men: frontal recession, then vertex affected; over time, only has lateral and occipital hair
Women: Thinning across the crown with frontal hair initially in place but later may be lost
Androgenetic alopecia
tx for androgenetic alopecia
Topical minoxidil or finasteride
Chronic fungal infection of the finger- or toenails. Subungual hyperkeratosis, subungual paronychia, onycholysis, nail dystrophy, discoloration (yellow-brown)
Onycomycosis
test for onycomycosis
KOH prep or culture
tx for Onycomycosis
Oral antifungals are first line, but some severe systemic side effects and drug reactions
Cicloporox 8% nail lacquer
Nail debridement
Swelling and erythema of the nail bed or surrounding tissues. Acute or chronic infection or eczematous inflammation of the skin folds surrounding the finger- or toenails
Paronychia
if there is a Green changes in nail it is typically what?
Pseudomonas
tx for paronychia
tetanus is indicated
abx, antifungals
I and D
Soft, skin-colored, fleshy warts that are caused by human papillomavirus (HPV)
Warts appear singly or in groups, on the vagina, cervix, around the external genitalia and rectum, and in the urethra and anus
Condyloma acuminatum
tests where Subclinical lesions can be visualized by wrapping the penis with gauze soaked with 5% acetic acid for 5 minutes. Using a 10× hand lens or colposcope, warts appear as tiny white papules.
acetowhitening test
tx for condyloma acuminatum
cryosurgery
imiquimod, podophyllin TCA acid
usually painful vesicles that often occur in clusters on skin, cornea, or mucous membranes
May occur as encephalitis, pneumonia, or disseminated infection, and/or skin lesions including but not limited to oral and genital sites
herpes simplex
tests for herpes simplex
STI screening
Tzanck smear
HSV culture
tx for herpes simplex
antiviral (acyclovir)
Dome-shaped papules with central umbilication
Common, benign, viral skin infection
Highly contagious with autoinoculation, skin-to-skin contact, sexual contact, shared clothing, towels, bathing water
Molluscum contagiosum
Tx for molluscum contagiosum
Topical (harsh meds like cantharidin), podophyllin, cryosurgery
how long can it take for molluscum contagiosum to go away
3 months
who have hve molluscum contagiosum occur all over their body w/ hundres of lesions
those with HIV/ AIDS
Raised, flesh-colored lesions, no central umbilication
verrucae
what are common warts
verruca vulgaris
what are plantar warts
verruca plantaris
what are veneral warts
condyloma acuminatum
Rough-surfaced, hyperkeratotic, papillomatous, raised, skin-colored to tan papules 5–10 mm in diameter; most frequently seen on hands, knees, and elbows; usually asymptomatic
verrucae
tx for verrucae
Most warts regress spontaneously
OTC topicals, Rx topicals, cryotherapy
what should you do before freezing warts off
take off the top layers of the wart off first
Generally a unilateral, painful, vesicular eruption within a dermatome
varicella zoster
tx for varicella zoster
Oral antivirals within 72 hours of onset of symptoms
Analgesics (NSAIDs, acetaminophen, opioids)
Gabapentin is commonly prescribed for pain (adverse reactions)
pain associated along same area are varicella zoster
poster herpatic neurlagia
Diffuse non-purulent infection of the skin and sub-Q tissues
Initially epidermis and dermis, but can spread to deeper fascia. Localized pain and tenderness, erythema
Fever, chills, malaise, regional lymphadenopathy
Itching, burning, irritability
cellulitis
tests for cellulitis
Culture aspirates from point of maximum inflammation
Blood cultures
Plain radiographs show bubbles in soft tissues
tx for cellulitis
Empiric therapy or mild cellulitis: oral dicloxacillin, cephalexin, clindamycin or IV cefazolin, oxacillin, or nafcillin
may want to culture area
Presentation results from the destruction of blood vessel walls, with subsequent aneurysm, bleeding, thrombosis, or ischemia in the various vascular beds
Constitutional: malaise, fatigue, anorexia, sweats, and weight loss
Skin: palpable purpura, livedo reticularis, nodules, ulcers, gangrene, nail bed capillary changes
Vasculitis
tests for vasculitis
Necessary to rule out multiple etiologies, so lots and lots of tests
most common cause of vasculitis
adverse drug rxns
tx for vasculitis
glucocorticoids then stronger immunosuppressive meds
remove offending agent if drug related
Sharply demarcated, erythema, swelling, shiny
Erysipelas
what bacteria causes erysipelas most commonly
S. pyogenes
hx associated w/ erysipelas
Prodromal symptoms may occur in the first 48 hours that include chills, malaise, headache, fever, vomiting, and anorexia
tx for mild erysipelas
penicillin V
tx for moderate to severe erysipelas
cefazolin
if MRSA is suspected how do you tx erysipelas
vanco
Small, flaccid bullae, honey-colored crusts
impetigo
most common cause of impetigo
staph aureus
tx for impetigo
topical abx
what should you not rx for impetigo due to huge resistance
penicillin and macrolide therapy
Painful erythematous papules/nodules (1–5 cm) with central pustulation
Located in hirsute sites of body, especially areas prone to friction or minor trauma (e.g., underneath belt, anterior thighs, back of neck, buttocks)
Tender red perifollicular swelling, terminating in discharge of pus and necrotic plug; pus usually drains spontaneously
Furnucle/ carbuncle/ abscess
tx for furnucle/ carbuncle/ abscess
drain
oral abx
use swab to get out inoculations
used those aimed at MRSA if suspected
Dark, thick, velvety skin in body folds and creases
often hx of Obesity, endocrine disorders, namely diabetes
Acanthosis Nigricans
Burn- Erythema of involved tissue, skin blanches with pressure, skin may be tender
first degree burn
Burn- Skin is red and blistered, skin is very tender
second degree burn
Burned skin is tough and leathery, skin is not tender
3rd degree burn
how much is each upper extremity percentage
9% adult and child
how much is each lower extremity rule of 9s
adult 18% child 14%
anterior trunk percentage
18% adult and child
posterior trunk percetnage
18% adult and child
head and neck percentage
9% adult 18% child
genitals percentage
1%
stage of pressure ulcer with Nonblanching erythema, warmth, induration
Stage 1 pressure ulcer
stage of pressure ulcer with that may include dermis; appears as abrasion, blister, or superficial ulcer
Stage II pressure ulcer
stage of pressure ulcer that Extends through subcutaneous tissues but not fascia; may appear necrotic with changes in pigmentation
stage III pressure ulcer
Ulcers extend beyond deep fascia into muscle or bone, decayed area may be larger than visibly apparent wound, osteomyelitis or sepsis may be present, and granulation tissue and epithelialization may be present at wound margins.
stage IV pressure ulcer
will pressure ulcers heal without proper nutrition
No, need higher protein diet
tx for pressure ulcers
antibiotics for cellulitis or osteomyelitis, silver dressings, triple antibiotic ointment can be tried for 2 weeks to treat bacterial overgrowth
Second Line – zinc and vitamin C if dietary deficiency
Cyst-like abscesses in gland-bearing skin, boils. often happens in obese, smoking, females. Tender nodules (dome-shaped) 0.5–3 cm in size are present:
Large lesions often are fluctuant
Hidrandenitis suppurativa
is there a staging system with hidradenitis suppurativa?
Yes- used to guide tx
first line tx for hidradenitis suppurativa
I & D
oral antibiotics
mobile mass
Most common soft tissue tumors
Mostly are subcutaneous and composed of normal adipose tissue
Slow growing, often asymptomatic, and usually diagnosed by palpation
Lipoma
tx for lipoma
observatin
sx removal if questionable
Common skin condition in which brown patches appear on the skin often affects the face
Typically young women who are pregnant or taking any form of hormone-based birth control
Melasma
fast growing lipoma with a large diameter may indicate what?
liposarcoma
Raised, red lesions with central clearing and swelling. blanching; associated with itching or burning. often will have generalized edema/ swelling of skin
Urticaria
From sunlight exposure, usually UV; onset in minutes; subsides within 2 hours
solar urticaria
Linear, itchy, red wheal and flare from scratching or rubbing the skin
Dermatographism
hives from : From exposure to cold; usually idiopathic
cold urticaria
hives from From strong vibrating mechanical forces, very rare
vibratory urticaria/ angioedema
Owing to brief increase of core body temperature; small pin-sized (5- to 10-mm) wheals surrounded by an erythema but also can have larger wheals; from physical exercise, stress, and hot showers
Cholinergic urticaria
Caused by stress; extremely rare; has pinpoint-sized red wheals with a white halo
Adrenergic urticaria:
Wheals at sites where chemical substances contact the skin
contact urticaria
Small wheals after contact with water at any temperature; rare
Aquagenic urticaria
A leukocytoclastic vasculitis looking like urticaria and tending to last > 24 h; more painful than pruritic; may be palpable and purpuric; usually caused by a collagen-vascular disease
Urticarial vasculitis
Acquired, slowly progressive, depigmenting condition of the skin due to the disappearance of previously active melanocytes
vitiligo
what is repigmentation tx for vitiligo
corticosteroids, calcineurin inhibitors, phototherapy (narrow-band ultraviolet B (NB-UVB) or broadband ultraviolet B (BB-UVB), and surgery
what is depigmentation tx
For vitiligo affecting more than 50% of the face or body and recalcitrant to therapy. Topical agents include monobenzyl ether of hydroquinone 20% and methoxy-phenol
