Derm 2 Flashcards
Which benign skin lesion?
- Superficial epidermal growth
- Stuck on quality
- Appear >40y/o
- All body surfaces (NOT palms/soles)
- Usually papules/plaques- can be macular
- Velvety–> verrucous (wart like)
Seborrhic Keratosis
What do you see on microscopy for seborrhic keratosis?
keratin pseudocysts
How do you tx Seborrhic Keratosis? (4 options)
currettage, cryotherapy, electrodessication or shave removal
Which benign skin lesion?
- Variant of a seborrhic keratosis
- Multiple, small, hyperpigmented, sessile to filliform, smooth-surfaced papules
- Common in dark skin- cheeks and temples
Dermatosis Papulosa nigra
How do you treat Dermatosis Papulosa nigra? What do you NOT treat with?
- Tx w/ very light electrodessication
- NO LIQUID NITROGEN- could cause pigmentation changes
Which benign skin lesion?
- Variant of Seborrhic keratosis
- small white gray SKs on dorsal feet/ankles
- older, light-skinned individuals
Stucco keratoses
How do you tx stucco keratoses? (4 options)
- Cryotherapy
- Curettage
- Electrodessication
- OTC ammonium lactate lotion/cream
Which benign lesion?
- Often pedunculated, fleshy papules
- Eyelids, neck, axillae, groin
- Asymptomatic
- Risk factors- genetics, obesity, friction, pregnancy
- Can be marker of insulin resistance
Acrochordons (skin tags)
What is the treatment for Acrochordons?
Elective removal:
- Snipping
- Liquid nitrogen
- Electrodessication
- Can fall off on own
Which benign lesion?
- Round to oval, red, dome shaped papule
- Arises in 40s
-
increases in # over time
*
Cherry angioma
Which benign lesion?
- Extremities
- Firm, hyperpigmented dome shaped papule
- “dimple sign”–> dimples if pinched
- Asymptomatic, doesn’t require tx
Dermatofibroma
Which benign skin lesion is due to sun damage?
Solar lentigines
How do you prevent and treat solar lentigines?
- prevention- sun protection
- No tx required, but can do cosmetic tx- bleaching creams, liquid nitrogen, chemical peels, lasers
Which benign skin lesion?
- Sebaceous gland enlargement
- Yellow
- Umbilicated
- Removal is cosmetic
- Biopsy/referral may be necessary
Sebaceous hyperplasia
Which benign skin lesion
- African American + skin lesion
- Overgrowth of scar tissue
- Difficult to tx (intralesional corticosteroid injection)- high recurrence rate
Keloids
What is the mainstay tx for keloids?
- Intralesional corticosteroid injection
- Difficult to tx and has a high recurrence rate
Which benign lesion?
- Tiny epidermoid cysts
- 1-2mm white to yellow subepidermal papules
- Fixed and persistent
- All ages
- Cheeks, eyelids, forehead, genitals
- Spontaneous or secondary from trauma/skin dz/rx
Milium
How do you tx a Milium?
- Easily extracted w/o scarring
- Nick surface w/ 11 blade or 18 gauge needle, express entire cyst lining and contents
What causes Verucca Vulgaris?
HPV
(this is a wart)
Which type of wart?
- Flat
- Skin colored or pink
- Smooth-surfaced, slightly elevated, flat topped papule
- Dorsal hands, arms, face
Verrucae Planae
Which type of wart?
- Thick, endophytic papules (depressed into skin of sole)
- Can accumulate a thick callus over and around wart
- Plantar warts may be painful when walking
Palmoplantar Verruca
What is a mosaic wart?
Plantar warts coalescing into large plaques
Which type of warts?
- External genitalia, perineum, perianal, inguinal fold
- NOT hard or hyperkeratotic
- Sessile (broad based) papules
- On physical exam- papillomatous exophytic papules and plaques
Papillomatous, sessile papules (genital warts)
Which HPV type causes Verruca vulgaris (common warts)?
HPV 2, 4
Which type of HPV causes Verrucae plana (flat warts)?
HPV 3, 10
Which types of HPV causes palmoplantar warts?
HPV 1
Which Types of HPV causes Condylomata acuminata (external genital warts)?
HPV 6, 11, 16, 18, etc
What is the initial tx plan for a pt with warts?
- Observation: >75% chance of spont. resolution at 2 yrs
- Multiple txs almost always needed (laser, acids, cryotherapy)
- start with: Cryotherapy and salicylic acid
How do you tx genital warts?
- Imiquimod
- Surgical methods- laser, electrocautery, scissor or shave debulking
*most favored at top, least favored at bottom*
How do you tx a patient with a few warts on the hands and feet?
- Salicylic acid
- Adhesive tape
- Cryotherapy
- laser
*most favored at top, least favored at bottom*
How do you tx a patient with a MANY warts on the hands and feet?
- Salicylic acid
- Cryotherapy
- Squaric acid or DCNB
- laser
*most favored at top, least favored at bottom*
How do you tx a patient with a few warts on the face?
- Cryotherapy
- Shave (surgical removal)
*most favored at top, least favored at bottom*
How do you tx a patient with a MANY warts on the face?
- Cryotherapy
- Tretinoin cream
*most favored at top, least favored at bottom*
How do you tx a patient with a few warts at other sites than the hands, feet or face?
- Cryotherapy
- salicylic acid
*most favored at top, least favored at bottom*
How do you tx a patient with a MANY warts at other sites than the hands, feet or face?
- Imiquimod
- Tretinoin cream
- Squaric acid or DCNB
*most favored at top, least favored at bottom*
What should you consider in tx of warts in kids?
Consider observation
When should you use cryogenic therapy?
- Benign lesions (warts, seborrheic keratoses)
- Premalignant lesions (actinic keratoses)
What vaccine can be given to prevent warts?
- HPV vaccine to prevent genital warts
- Gardasil and Cervarix
- ***FOR PREVENTION of genital warts and genital cancers not treatment–> not for common warts***
What age is the Gardasil vaccine approved for (prevention of HPV)? Cervarix?
- Gardasil- Females and males 9-26y/o
- Cervarix- Females 10-25y/o
What are open comedones also known as? Closed comedones?
- Open= blackheads
- Closed= whiteheads
What are the 5 tx options for acne vulgaris?
- Topical retinoids (tretinoin)
- Benzoyl peroxide
- Topical antibiotics (Erythromycin 2% or Clindamycin 1%)
- Oral abx (for moderate-severe inflammatory acne, often combined w/ BP)
- Oral Isotreitinoin (Accutane- for severe nodulocystic acne failing other tx)
T/F: Isotreitinoin (Accutane) is contraindicated in pregnancy
TRUE
Females must be on 2 forms of contraception during and 1 month after, iPLEDGE)
What do you do if a patient has no response to acne therapy after 3 months?
Increase dose, change tx or refer to derm
What are the 4 SEs of oral Isotreitnoin (Accutane)?
- Dry skin
- Chelitis
- Elevated liver enzymes
- Hypertriglyceridemia
How do you tx severe acne?
- Can require combo of oral abx, topical retinoids, benzoyl peroxide, +/- topical abx
- Refer to derm for tx w/ isotretinoin (Accutane) if acne failing other therapies
- Consider hormonal therapy in pubertal females
What is initial tx of mild acne?
- topical retinoid or benzoyl peroxide
- alternative- topical retinoid and BP +/- topical abx
How do you tx moderate acne?
(moderate= comedones w/ marked number of inflammatory lesions)
- Initial: Topical retinoid and benzoyl peroxide +/- topical abx
- if inadequate response- consider oral abx, derm referral and hormonal therapy for females
What is the initial tx for severe acne (extensive inflammatory lesions w/ diffuse scarring)? What do you do if there is inadequate response to initial tx?
- Initial: Oral abx + topical retinoid + Benzoyl peroxide +/- topical abx
- Inadequate response: Consider oral isotretinoin, derm referral, hormonal therapy for females
- How long does it take before a patient sees the effects of acne treatment?
- How long should a therapy be continued before a tx response can be accurately evaluated?
- 2-3 months before see a response
- Therapy should be continued for at least 8 weeks before a tx response can be accurately evaluated
How is Acne Rosacea different than acne vulgaris?
Acne Rosacea has:
- absence of comedones
- Presents w/ easy flushing, erythema, telangietasias
- Triggers= alcohol, sun, heat, spicy food, emotional stress
- Not related to hormones
- Treated topically and orally
When do you refer a patient with acne to derm?
Pt w/ difficult to control acne or the presence of scarring
When is oral abx contraindicated in the tx of acne (eg: Minocycline, Doxycycine)?
- Pregnancy
- pt <8y/o (damages tooth enamel and bones)
T/F: Tetracyclines interfere with birth control pills
FALSE
What are the common adverse effects of oral abx used to tx acne (eg: minocycline, doxycycline, etc)?
- GI upset
- photosensitivity
- Minocycline- vertigo, dizziness, hyperpigmentation
