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Derm Flashcards

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Dermatology Board Prep flashcards
0
Q

Elidel

A

Immunomodulator - corticosteriod sparing topical cream used to treat Atopic Dermatitis;
mechanism: inhibits T-cell activation

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1
Q

Characteristics of Nummular Eczema:

A

coin shaped plaques (1-5 cm) of grouped papulovesicles on an erythematous base

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2
Q

Pramoxine

A

(Eczemin) - topical anesthetic to reduce pain and itching

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3
Q

What is the time frame of exposure to Rhus genus and eruption of lesions?

A 
Initial = 12-72 hrs 
Re-exposure = minutes
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4
Q

What is Burow’s Solution?

A

Aluminum Acetate topical used in treatment of Contact Dermatitis
Decreases inflammation and secretions; vasoconstricts

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5
Q

Pathophysiology of Psoriasis

A

Hyperproliferation of the epidermis d/t a shortened cell cycle from 311 –> 36 hrs caused by immune reaction
Epidermal cell increased cohesiveness –> thick/scaly plaques

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6
Q

Characteristics of Psoriasis

A

Sharply marginated salmon pink papules/plaques w/silver scales

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7
Q

Common cause of Eruptive/Guttate Psoriasis:

A

often follows strep. pharyngitis d/t T cell activation by the strep. antigens
scattered and discrete salmon pink papules

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8
Q

Clinical Manifestations of Pustular Psoriasis:

A

sterile yellow deep seated pustules that evolve into dusky red macules and crusts (palms/soles)
may be disseminated (life threatening)

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9
Q

What is the number one Rx for psoriasis treatment?

A

Calcipotriene/(Dovonex) - vit D derivative that affects keratinocyte proliferation and immune modulation
usually used w/a steroid until psoriasis clears

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10
Q

Tachyphylaxis

A

rapidly decreasing response to a drug which decreases its effectiveness

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11
Q

What are the treatments of psoriasis?

A
  1. Topicals (first line and for limited disease)
    - moisturizers & keratolytics, coal tar, anthralin, steroids, calcipotriene, tazarotene
  2. Phototherapy
    - sun bathing, UVB (broadband, narrowband, XTRAC laser), Psoralens + UVA
  3. Systemic therapy
    - methotrexate , cyclosporine, oral retinoids, biologics
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12
Q

Common Ddx of Guttate Psoriasis:

A

Candidiasis, Syphillus, Pityriasis Rosea

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13
Q

Herald Patch

A

primary lesion of Pityriasis Rosea which usually occurs on the trunk that precedes the rash by 1-2 weeks
salmon red oval 2-5 cm plaque with finely scaled periphery

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14
Q

Which skin disease is associated with the characteristic christmas tree pattern?

A

Pityriasis Rosea - dull pink scattered and discrete oval lesions found mainly on trunk with fine scale or collarette/rim

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15
Q

T/F: Actinic Keratosis is a malignant lesion?

A

False - precancerous lesion of sun-exposed areas that manifest as a hyperkeratotic rough scale that feels like sand-paper; should be biopsied to rule out SCC

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16
Q

5-FU

A

5-Fluorouracil topical medication used to treat Actinic Keratosis
Mechanism: inhibits DNA/RNA synthesis

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17
Q

60% of SCC arise from a lesion clinically diagnosed as _________ in the previous year?

A

Actinic Keratosis

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18
Q

Presentation of Paget’s Disease

A
  • erythema on one nipple –> drains serious fluid, crusts
  • eczematous appearing lesion –> spreads to surrounding skin
  • indurated plaque w/sharp margins
  • ulceration
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19
Q

Types of Urticaria/Angioedema

A

Urticaria
- acute: 30 days
Angioedema
- hereditary: dominant
Physical Urticaria
- dermographism: direct pressure to skin causes “trauma” and get over exaggeration of mast cells/histamine
- pressure urticaria: prolonged pressure causes painful pruritic lesions (buttocks, soles)
- solar/heat/cold urticaria: caused by ice, irradiation, warm water and is self limiting
- cholinergic: intense pruritic wheals in response to sweating, exercise, or emotion caused by a neural reflex and ACh release

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20
Q

What are the 3 causes of mast cell degeneration?

A

direct stimulation
Hypersensitivity IgE mediated
Complement mediated

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21
Q

What is the common etiology of exfoliative dermatitis?

A

reaction to a medication (16-42%)

often impossible to identify cause at diagnosis

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22
Q

Dermatitis Medicamentosa definition:

A

a generally abrupt onset of widespread, systemic erythematous eruption w/various clinical manifestations

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23
Q

Intertrigo definition:

A

presence of friction/heat/moisture in areas where two opposing skin surfaces contact each other creating eroded patch of epidermis –> susceptibility to secondary infections

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24
Q

Cushing’s striae vs. Wt. Change striae

A

Cushing’s: characterized by a central obesity w/thin extremities

  • dark pink/purple prominent striae d/t fat redistribution
  • areas: abdomen flanks, arms, thighs

Wt. Change: striae d/t rapid growth

  • lighter pink/less purple, may be red & silver striae
  • areas: hips, buttocks, abdomen, breasts
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25
Q

(8) Predisposing factors to decubitous ulcers:

A
  • Immobility
  • Elderly
  • Vasc. disease: common in diabetics
  • Altered mental status
  • Incontinence: moisture leads to skin breakdown
  • Malnourishment
  • Diminished sensation: unaware of discomfort (Diabetics/Alcoholics)
  • Poor nursing care
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26
Q

Decubitous ulcer staging

A
  • unable to stage ulcer until eschar is removed
    (I) non-blanching erythema
    (II) superficial or partial thickness necrosis (epidermis &/or dermis)
    (III) full thickness necrosis down to fascia, but not through it yet
    (IV) full thickness ulceration w/extensive damage and necrosis to muscle/bone/supporting structures
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27
Q

What is the first sign of a decubitous ulcer?

A

erythema w/blanching pressure d/t trauma that is caused by compression

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28
Q

T/F: Stage III & IV decubitous ulcers may be treated w/topical antibiotics or steriods?

A

False: must be treated with surgical management to remove necrotic tissue/bony prominences, and possible use of flaps or skin grafts for treatment

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29
Q

Syphilis stages:

A

Primary:
chancre development at site of inoculation (heals spont. 1-3 months)

Secondary:
fever and widespread rash involving genitals, soles, palms, face that is initially pink and macular –> brown and papular (resembles pityriasis rosea/psoriasis)
condyloma lata occur
syphilitic anetoderma occurs
mucous membrane rashes of eroded off white oval patches
patches of erythrema/scaling/alopecia on scalp common

Tertiary:
Hallmark is Gumma lesions
yellow slough based ulcers

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30
Q

Condyloma lata

A

flat topped, moist pink-tan papules/nodules found in intertriginous areas, perineum, and perianal areas, exuding with treponemes
occur during secondary syphilis stage infection

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31
Q

Gumma

A

asymmetric brownish red papules/nodules arranged annularly
may be sparse or singular lesions that are smooth or scaly –> ulcerate
hallmark of tertiary syphilis

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32
Q

(5) Epidermal Layers, components & functions:

A
  1. Stratum corneum: tightly packed dead squamous cells that contain keratin for water-proofing
  2. Stratum lucidum: cell nuclei have disappeared; espec. thick on palms/soles
  3. Stratum granulosum: keratin begins to form
  4. Stratum spinosum: tends to be approx. 5 cells thick; composed of desmosomes responsible for cell-to-cell adhesion & communication w/immune system
  5. Stratum basale: made up of keratinocytes & melanocytes in a single layer
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33
Q

Main functions of the skin layers:

A

Epidermis - water-proofing
Dermis - contains vessels to provide nutrition to epidermis
Hypodermis - subcutaneous fat layer which provides cushion, heat, shock absorption

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34
Q

Dermal contents:

A
  • connective tissue
  • sebaceous glands
  • vessels
  • sensory nerve fibers (pain/touch/temp regulation)
  • autonomic motor nerves
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35
Q

Hypodermal contents:

A
  • loose connective tissue w/fat cells
  • sweat glands
  • deeper hair follicles
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36
Q

What is the function of sebaceous glands?

A

stimulated by androgens beginning at puberty glands secrete lipid rich sebum to lubricate skin/hair
bacteriostatic & fungostatic properties
none located on palms/soles

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37
Q

Where does sebum come from?

A

cell breakdown products

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38
Q

(4) normal skin colors:

A
  1. bright red (oxyHgb)
  2. yellow/orange (carotene)
  3. blue/dark blue (deoxyHgb)
  4. brown/tan (melanin)
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39
Q

(5) Abnormal skin colors:

A
  1. palor
  2. cyanosis
  3. erythema
  4. jaundice/scleral icterus
  5. ashen/dusky/gray
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40
Q

Hair lifecycles:

A
  1. anagen: growth (80-90% of hairs in this stage)
  2. catagen: atrophy - root separating from papilla
  3. telogen: rest - thick bulbed root (higher % in brow/armpit/pubic)
  4. shed
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41
Q

Nail composition & anatomy:

A

invaginated epidermal cells converted into hard plates of keratin

  • nail bed: very vascular
  • lunula: white crest/site of growth
  • eponychium: cuticle
  • paranychium: tissue surrounding nail
  • hyponychium
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42
Q

What are the 2 most important questions to ask about pigmented moles?

A
  • How long have you had this mole?

- Any changes?

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43
Q

Primary vs. Secondary skin lesions:

A

Primary: occur as initial spontaneous manifestation of underlying pathologic process

Secondary: lesions that result from later evolution or external trauma to a primary lesion; may occur d/t treatment

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44
Q

Side effects of steroids:

A
  • local: telagiectasias, purpura, atrophy, striae
  • rebound rosacea & perioral dermatitis
  • HPA axis suppression (rare)
  • glaucoma/cataracts
  • infections
  • allergic rxns (usually d/t other ingredients in med besides steriod)
  • hypopigmentation
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45
Q

What is the most sensitizing topical antibiotic?

A

Neomycin - causes contact dermatitis

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46
Q

(7) Common skin changes during pregnancy:

A
  • spider nevi
  • palmer erythema (normal)
  • increased pigmentation (areola/genitals/linea alba/nigra/chloasma)
  • increased hair growth (head/belly)
  • striae
  • nevi enlargement
  • increased skin infections (yeast/abnormal pap HPV breakout/herpes)
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47
Q

Natural Nevi progression:

A
  • begins as junctional nevus at dermal/epidermal junction above basement membrane as flat, small, & brown macule
  • grows in size over 2+ decades and becomes compound nevus where it invades dermis presenting as a raised & warty papule
  • in 7-8th decades the nevus undergoes fibrosis and loses pigmentation and is found primarily in the dermis to become a dermal nevus
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48
Q

Indications for mole removal:

A

suspected melanoma
undergoing change
patient at increased risk of melanoma and lesion in area unable to be monitored

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49
Q

Blue nevi are most commonly found in which ethnicity?

A

Common in those of asian descent

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50
Q

Which other skin lesion looks similar to blue nevus?

A

nodular melanoma - if newly appeared lesion of blue nevi –> excise to rule out melanoma

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51
Q

Pathophys of Halo Nevus?

A

caused by autoantibodies toward melanocyte cytoplasmic antigens

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52
Q

Vitiligo has an increased incidence w/which skin lesion?

A

halo nevus

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53
Q

Which pigmented lesion has an increased risk of developing melanoma, espec. early in life?

A

Congenital nevi - common conversion to malignant melanoma even in first 3-5 yrs of life; removal indicated if possible

  • males = trunk
  • females = leg
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54
Q

Freckles vs. Lentigines

A

Freckles: flat brown spots common in kids

  • d/t increased melanin production
  • do NOT have increased melanocytic proliferation
  • prominent in summer and fade in winter, but not a permanent lesion
  • first indicator of sun damage

Lentigines: flat brown spots (tan –> dark brown) typically found in older age groups

  • d/t increased melanin production
  • increased number of melanocytes
  • found only on sun exposed areas
  • permanent lesion because considered a later complication of solar damage
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55
Q

Seborrheic Keratosis

A

begin as light tan macule –> darker pigmented plaque –> warty greasy papule
appears “stuck on”
common to patients with oily or acne seborrhea type skin
Tx not necessary - usually only for cosmetic reasons

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56
Q

Koebner Phenomenon

A

the appearance of lesions in an area of trauma

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57
Q

Vitiligo

A

hypopigmentation disorder of chalk white macules w/borders that appear to “flow” into normal skin d/t completely absent melanocytes in affected areas
etiology - unknown/genetic/autoimmune

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58
Q

Vitiligo managment/treatment

A
  • determine etiology –> complete ROS & screenings
  • sunscreen d/t increased risk of sun damage
  • cosmetic makeup
  • repigmentation: topical corticosteriods, topical &/or systemic photochemotherapy
  • minigrafting: may cause Koebner
  • depigmentation: skin bleaching to permanent chalky white
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59
Q

What is the most common form of secondary hyperpigmentation?

A

Post-inflammatory hyperpigmentation - often occurs in darker skinned individuals usually over areas of previous inflammation/scarring

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60
Q

Which hyperpigmentation skin condition is also known as the “mask of pregnancy?”

A

Melasma/Chloasma - irregular hyperpigmentation of the skin located over sides of face/forehead/sides of neck
Related to pregnancy and OCP use
Increased d/t sun exposure d/t increase in melanin production

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61
Q

Treatment/Prognosis of Melasma

A

May or may not fade after delivery of cessation of OCPs
Can recur w/subsequent pregnancies
Treatment: decrease sun exposure & use opaque sun block

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62
Q

Common associated etiologies/diseases of Acanthosis Nigricans:

A
  • Hereditary
  • Endocrine disorders
  • Obesity
  • Drug-induced
  • Cancer
  • Need to treat underlying cause
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63
Q

Acanthosis Nigricans presentation

A

slowly progressing dark, thick, velvety skin in body folds/creases

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64
Q

Drug of choice used to treat erythema migrans

A

Doxycycline 100mg BID x10 days - only effective at onset of infection

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65
Q

Deep seated subcutaneous lesions found bilaterally on the pre-tibial surfaces are assoc. w/which skin condition?

A

Erythema Nodosum

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66
Q

What is the cause of Erythema Nodosum?

A

Idiopathic 40% - many etiologies

Occurs through acute inflammatory rxns caused by immune response

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67
Q

Panniculitis

A

inflammation of the pannus (subcutaneous fat)

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68
Q

Which skin pathology is listed as one of the Major Jones criteria?

A

Erythema Marginatum

can help in diagnosing Rheumatic Fever

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69
Q

T/F: Erythema Migrans presents as rapidly enlarging annular or crescent shaped macules

A

False - this presentation is known as Erythema Marginatum

Erythema Migrans is assoc. w/gradually expanding erythema around a lesion having distinct borders w/a partial central clearing immediately around the lesion (bullseye)

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70
Q

Presentation & clinical manifestations of Erythema Multiforme

A

Rxn pattern of the dermis w/secondary epidermal changes exhibiting target shaped papules and vesiculobullous lesions
Minor: no bullae or mucous membrane involvement
Intermediate: vesiculobullous lesions w/mucous membrane involved
Major: Steven Johnson Syndrome
Max: Toxic Epidermal Necrolysis

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71
Q

Target lesions are characteristic of which skin disease?

A

Erythema Multiforme - these lesions also called Iris lesions; have 3 concentric zones of color change & are commonly found on hands/feet

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72
Q

Common cause of recurrent Erythema Multiforme

A

HSV

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73
Q

What syndrome is the most severe form of Erythema Multiforme & how is it described?

A

SJS - Steven Johnson Syndrome

widespread blistering and ulceration of the skin and mucous membranes causing epidermal detachment (<10%)

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74
Q

Common etiology of SJS?

A

50% d/t drug exposure

re-exposure to offending agent/drug may cause more severe episode

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75
Q

Condition known as the maximal form of SJS:

A

TEN - Toxic Epidermal Necrolysis
widespread acutely tender skin w/flaccid bullae causing skin sheeting and red/raw denuded areas of >30% epidermal detachment
High fevers and mortality rate of approx. 30%

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76
Q

What are the 4 P’s that describe Lichen Planus?

A

Purple
Polygonal
Pruritic
Papules

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77
Q

Which condition includes a clinical manifestation w/Wickham’s striae?

A

Lichen Planus - flat topped purple papules with white lines persisting for months –> years
found on mucous membranes and areas of trauma (Koebner)

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78
Q

A figure 8 appearance is often described in which skin disease?

A

Lichen Sclerosus - common white lesion of the vulva that may become dysfiguring if not treated

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79
Q

Pemphigus vs. Bullous Pemphigoid

A

Pemphigus: rare & serious autoimmune disease

  • flaccid bullae on apparently normal skin (early)
  • painful erosion of skin & mucous membranes follow d/t epidermal dislodging
  • Secondary lesions: crusting and bacterial infection
  • Untreated can be fatal

Bullous Pemphigoid: autoimmune disorder common to the elderly

  • spontaneous chronic bullous eruption of tense blisters
  • blisters have erythematous base
  • usually begins in inner thighs
  • Secondary lesions d/t rupture causing erosion –> scabbing
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80
Q

Cause of Pemphigus disorder

A

IgG antibody against antigens found on the surface of keratinocytes
causes loss of normal cell-to-cell cohesion –> flaccid bullae

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81
Q

Nicholsky’s Sign

A

Extension of lesion onto adjacent normal tissue d/t light pressure on bulla causing a dislodging of the epidermis and ulceration

Seen in Pemphigus

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82
Q

What is the most common cutaneous cyst?

A

Sebaceous cyst - smooth, mobile dome-shaped lump w/a central punctum composed of a wall of true epidermis enclosed w/in the dermis that becomes filled w/keratin and lipids

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83
Q

Epidermal Inclusion Cyst

A

secondary occurrence to traumatic implantation of the epidermis into the dermis appearing as a nodule w/out a central punctum

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2
3
4
5
Perfectly
84
Q

Dimple sign

A

compression of the lateral edges of the dermal nodule causes dimpling
Assoc. w/dermatofibroma

85
Q

T/F: Pyogenic granulomas blanch under pressure from glass sides

A

True - pyogenic granulomas are vascular malformations resulting from uncontrolled production of granulation tissue during healing that causes solitary rapidly growing dark-red papules

86
Q

Which type of growth do malignant melanomas undergo?

A

radial/horizontal growth spread across epidermis and vertical growth down into the dermis

87
Q

What are the 3 precursor lesions of malignant melanoma?

A

Lentigo Maligna
Congenital Melanocytic Nevi
Clark’s (dysplastic) Melanocytic Nevi

88
Q

Which lesion is often described as a “stain on sun exposed skin with striking variations of brown or black pigmentation?”

A

Lentigo Maligna - precursor to Lentigo Maligna Melanoma

89
Q

Common precursor to Superficial Spreading Melanoma

A

Clark’s Dysplastic Melanocytic Nevi

90
Q

(4) Types of Melanoma

A

Superficial Spreading Melanoma (most common form)
Nodular Melanoma
Lentigo Maligna Melanoma
Acral Lentiginous Melanoma

91
Q

Which type of UV radiation plays a role in malignant melanoma?

A

UVB

92
Q

Superficial Spreading Melanoma

A
  • 70% of all melanomas
  • characterized by a prolonged radial growth phase up to 10 yrs
  • begins as irregularly bordered flat pigmented patch that eventually becomes palpable
  • various shades of brown/black &/or foci of red/blue/purple
  • vertical growth indicated by nodule formation, bleeding, or ulceration
93
Q

What is the second most common form of Malignant Melanoma?

A

Nodular Melanoma - 15% of melanomas

similar appearance to Blue nevus

94
Q

What type of growth phase primarily occurs in nodular melanoma?

A

Immediate vertical growth over period of 4 months - 2 yrs w/out the presence of radial growth
lesion begins as papule and gradually becomes nodular w/bleeding & ulceration

95
Q

Which form of melanoma is commonly found in middle age males of Japanese decent?

A

Nodular Melanoma

96
Q

Which type of melanoma is commonly found in the elderly and presents as a variably colored flat stain-like macule?

A

Lentigo Maligna Melanoma - occurs on sun-exposed areas
Variable color brown/black with flecks of irregular pigmentation
Focal papular/nodular lesions arise eventually

97
Q

Which of the melanomas is highly metastatic and is commonly found on the tips of fingers & toes?

A

Acral Lentiginous Melanoma: flat black-brown macule which undergoes invasion quite early
may also be found under the nail bed & on soles/palms

98
Q

What is the number one prognostic factor regarding malignant melanoma?

A

thickness/depth of invasion

Clark’s levels & Breslow used to measure grade

99
Q

What is the most common viral infection of the skin?

A

HPV

100
Q

Condyloma Acuminata

A

Urogenital warts - cauliflower-like growths on the mucous membranes of the penis/vulva/perianal region
may spread to face/mouth

101
Q

What are the (4) clinical manifestations of Verrucae?

A 
Common warts (verruca vulgaris) 
Urogenital warts (condyloma acuminata)
Plantar warts ( verruca plantaris) 
Flat warts (verruca plana)
102
Q

Which type of wart is commonly found in clusters on the face, but also on the backs of hands, and shins?

A

Verruca plana - flat warts

flesh colored and commonly appear in areas of trauma (keobner)

103
Q

Why is the treatment of plantar warts so difficult?

A

If treatment is too aggressive, may cause a scar that is actually worse than the wart itself, which causes pain when walking.

104
Q

What common skin manifestation is often confused with a plantar wart?

A

Callous &/or corn

105
Q

Define callous

A

localized hyerpkeratosis of the skin induced by repeated trauma

106
Q

Signs & Symptoms of a Corn

A

localized, tender, thickened area of skin
central core over bony prominence
usually d/t to poorly fitting shoes or deformed feet

107
Q

T/F: If peeling skin back on the surface of a corn, bleeding will occur?

A

False - corns do not bleed because no vessels are present w/in the lesion since it is composed of a hyperkeratosis of the epidermis

108
Q

What is the etiology of Molluscum Contagiosum?

A

Pox virus - passed by direct skin-to-skin transmission or through fomites

109
Q

Molluscum Contagiosum

A

Flesh colored shiny umbilicated pearly pink papules - may be filled w/puss –> important not to pop because will spread virus
May be found in young children or in the pubic area/genitalia of sexually active persons
Usually spontaneously regress w/out recurrence

110
Q

What is the most common type of cancer?

A

Basal Cell Carcinoma - accounts of 75% of all cancers

111
Q

What are the danger areas of BCC?

A

around the eyes
nasolabial folds
posterior auricular sulcus

112
Q

Which type of carcinoma is known to metastasize easily?

A

Squamous Cell Carcinoma - exhibits horizontal & vertical growth & has increased mets in mucous membrane areas d/t lymph spreading

113
Q

___________ is commonly referred to as a scab that won’t heal?

A

BCC - locally destructive malignant cutaneous tumor of basal cells that ulcerates early on and then crusts up –> slightly resolves –> lesion returns with elevated border and a scab that does not resolve

114
Q

What are the (4) types of BCC?

A
  1. Noduloulcerative - small & waxy nodule w/central depression –> ulceration, pearly border, & telangiectasias
  2. Pigmented - brown or black pigmented nodule w/pearly border & central ulceration
  3. Superficial - erythematous scaly macule/patch w/an elevated pearly border often found in multiples on the trunk, not assoc. w/sun exposure
  4. Fibrosing - white scarred plaque w/poorly defined border usually found on face
115
Q

Which type of treatment for BCC is the preferred for elderly patients?

A

curettage & cautery of small papular lesions < 1 cm

116
Q

What is the prognosis for BCCs?

A

Usually excellent d/t its rare metastasis, but can become very locally destructive if not removed

117
Q

What is the most common skin cancer in darkly pigmented individuals & smokers?

A

Squamous Cell Carcinoma

118
Q

Squamous Cell Carcinoma

A

2nd most common cancer in lighter pigmented individuals
Malignant tumor from keratinocytes that presents as a firm & raised skin color –> red/brown nodule on damaged skin w/central ulceration on sun exposed areas & mucous membranes

119
Q

(4) Risk factors of SCC

A

HPV
UV radiation
skin phototypes I & II
Actinic Horn

120
Q

Which skin lesion is thought to be a variant of squamous cell carcinoma?

A

Keratoacanthoma - a rapidly growing low grade tumor found on sun exposed areas that resembles SCC histologically

121
Q

Keratoacanthoma signs & symptoms

A

quickly forming (w/in weeks) 1.5-2 cm erythematous dome-shaped nodule w/central keratin crater/plug, raised rolled borders, and overlying telangiectasias

122
Q

Pathophys of Acne Vulgaris

A
  1. Follicular thickening:
    - hyperkeratosis & thickening of hair follicle
    - sebaceous duct blockage –> comedome
    - follicle rupture into dermis –> inflammatory rxn
    - papules/pustules/nodules/cyst formation
  2. Sebum Production:
    - stimulated by androgens
    - formed by glandular cell breakdown products
    - P. acnes produces lipase (Tris –> FFAs)
123
Q

T/F: Free Fatty Acids may cause a sterile inflammatory response that leads to acne vulgaris?

A

True - injection of FFAs into the skin cause a sterile irritation & comedome formation = NOT a bacterial infection

124
Q

Oxidation of which substance causes black heads?

A

Tyrosine –> Melanin

125
Q

What is the best topical comedolytic medication?

A

Retin-A: disrupts comedomes d/t its keratolytic properties by increasing basal cell mitosis & epithelial turnover
- Will cause redness/irritation so PM application & sun avoidance is recommended

126
Q

Azelex

A

Azelaic acid - antibacterial topical used in treatment of acne vulgaris to declog pores & decrease mild secondary post-inflammatory hyperpigmentation

127
Q

Systemic Treatments of Acne Vulgaris:

A 
Tetracycline: 250 mg QID or 500 mg BID 
Erythromycin: but causes GI issues
Minocycline: 50 -100 mg BID 
Doxycycline: 100 mg BID
Estrogens/OCPs 
Accutane (Isotretinoin)
128
Q

Accutane function/uses/benefits

A

Inhibits sebaceous gland function & keratinization
Attacks ALL pathogenic factors in acne
Highly effective in preventing scarring & in tx of antibx resistant acne
Used ONLY for resistant scarring nodulocytic acne & antibx resistant
Continues to work after cessation of 15-20 wk therapy

129
Q

Accutane side effects

A

Very teratogenic (category X) - adequate contraception during tx –> 3 mons after; must test for pregnancy before initiation and monthly
hepatotoxic
causes extremely dry skin (lips)
risks of depression & suicidal ideation

130
Q

Rosacea Progression

A

easy flushing on central face –> persisting erythema –> telangiectasias –> papules & pustules –> persistent deep erythema, dense telangiectasias, papules & pustules –> Rhinophyma

131
Q

Rhinophyma

A

exuberant overgrowth of soft tissue secondary to sebaceous gland hyperplasia & fibrosis

132
Q

T/F: comedome presence occurs during later stages of rosacea?

A

False: comedomes are NOT present in any stage of rosacea

133
Q

Oracea

A

40 mg controlled release doxycycline below the level for antibiotic threshold
inhibits nitric oxide reactivity to aid in reduction of inflammation & may be used to treat rosacea

134
Q

Miliaria is caused by the blockage of _________?

A

Blockage of eccrine ducts d/t to excess sweating causes gland hypertrophy –> rupture –> inflammation/erythema/edema

135
Q

Crystalline & Rubra are the 2 types of which skin disorder?

A

Miliaria (prickly heat)
Crystalline - thin-walled clear vesicles
Rubra - erythematous tender/pruritic papules (occurs d/t rupture)

136
Q

Perioral Dermatitis presentation

A

Pruritic or burning erythematous or skin colored papules/pustules around the mouth/nose/eyes, which may scale or become superinfected

137
Q

Common association/cause of Perioral Dermatitis?

A

steriod use - D/C of steroids will clear up skin lesions after rebound worsening effect that occurs immediately after

138
Q

Hidradenitis Suppurativa is a chronic inflammatory disorder of which glands?

A

Apocrine glands become blocked d/t hyperkeratinization of the hair follicle –> which causes dilation the follicle and duct –> bacterial growth occurs in duct
Common in axilla/anogenital region/buttocks/scalp

139
Q

Clinical lesions of Hidradenitis Suppurativa

A
  • tender, erythematous inflammatory nodules/abscesses
  • open comedomes: double comedomes highly characteristic
  • sinus tracts
  • scarring
140
Q

What are the 8 HSV viruses?

A 
HSV1 - assoc. w/cold sores; now being found in genital regions
HSV2 - genital herpes; now being found in mouth mucous membranes
HSV3 - VZV/Shingles
HSV4 - Epstein Barr Virus 
HSV5 - Cytomegalovirus 
HSV6 - Roseola (children)
HSV7 - Pityriasis Rosea 
HSV8 - Kaposi's sarcoma
141
Q

Primary episode of HSV infection

A
  • incubation: 2-12 days following exposure
  • begins w/area of erythema –> papules and grouped vesicles –> erode/crust
  • pain, fever, regional lymphadenopathy usually common
142
Q

Common causes of recurrent HSV episodes

A 
stress
trauma 
sunlight
fever
menses
pregnancy

Often beginning with prodrome of tingling/discomfort in area before vesicular breakout
Recurrent episodes not as long in duration compared to primary episode - about a week

143
Q

2 assoc. symptoms of a genital HSV infection

A

dysuria & urinary retention (usually more common in women)

144
Q

Neonatal HSV Infection

A
  • very rare & serious disorder (HSV1 more problematic)
  • vesicular lesions develop commonly on scalp or buttocks & may become bullous/denuded/pustular
  • Systemic symptoms: fever/poor feeding/irritability/lethargy/vomiting
  • 70% develop disseminated or CNS infections: grand mal seizures –> coma –> death
  • 50% fatality
  • Survivors have subsequent neurologic problems
145
Q

What is a primary infection of HSV that occurs on a finger & in what particular type of profession is this common?

A

Herpetic Whitlow - often seen in medical &/or dental workers

146
Q

Keratoconjunctivitis is caused by?

A

HSV infection of the eye causing purulent conjunctivitis w/corneal ulceration which can lead to blindness

147
Q

Which pathology manifests as: grouped vesicles on erythematous tender base unilaterally along a dermatome?

A

Herpes Zoster/Shingles/HSV3 - VZV reactivation

148
Q

Common medications for Post-Herpetic Neuralgia treatment:

A
  • narcotic analgesics
  • antivirals: Valtrex/Famvir/Zovirax
  • oral corticosteriods: 1mg/kg QD x1 wk –> taper over 3wks
  • Elavil: 25 mg PO TID (tri-cyclic anti-depressant)
  • Zostavax
149
Q

Hutchinson’s Rule

A
  • lesions present on tip/side of nose assoc. w/Herpes Zoster

- indicates involvement of ophthalmic branch of trigeminal nerve –> possible Herpes Zoster Ophthalmicus

150
Q

Facial nerve involvement of Herpes Zoster infection is known as ____________ & presents as?

A

Ramsay Hunt Syndrome: lesions on external ear, ear canal, neck, or jaw; assoc. ear pain; may cause facial paralysis

151
Q

Dyshidrotic Eczema

A
  • Inflammatory rxn occurring on palms/soles w/a sudden onset of many deep seated pruritic, clear, tapioca like vesicles which may rupture causing secondary lesions
  • Tx is very frustrating d/t recurrent attacks & possible secondary infection
  • high potency corticosteroid ointments x2 wks necessary
152
Q

Clinical lesions of Atopic Dermatitis:

A
  • Acute: poorly defined erythematous patches/plaques w/possible scale
  • Chronic: secondary lesions (lichenification/fissures/alopecia)
  • Infantile: skin erythema, tiny vesicles w/scaling, exudates, crusts, fissures
  • Found on flexor surfaces and many other areas in adults
  • Found on the scalp, arms, legs (general) in infants
153
Q

What is the single most important etiology of Atopic Dermatitis?

A

Heredity - hx of atopy (asthma, allergies, atopic dermatitis)
most affected between infancy –> age 12 y/o

154
Q

Who might be predisposed to Lichen Simplex Chronicus?

A

Patients w/family hx & other atopic conditions

155
Q

What is the predominant symptom of Lichen Simplex Chronicus?

A

Pruritus - ankles, ant. tibial and nuchal regions, inner thighs, lateral neck, extensor surfaces, anogenital (PM)

156
Q

What is the etiology of Impetigo?

A

staph. aureus & strep. pyogenes

157
Q

What are the (3) clinical manifestations of Impetigo?

A
  • Impetigo Contagiosa: non-bullous erythematous sores which ooze & form honey colored crusts
  • Bullous: painless fluid filled bullae rupture –> scab –> crust
  • Ecthyma: more serious, penetrates into dermis –> ulcerates –> crusts
158
Q

Complications of Impetigo:

A
  • pigmentation changes
  • cellulitis
  • MRSA
  • Poststreptococcal Glomerulonephritis
  • Staphylococcal Scalded Skin Syndrome (newborns & infants <2 yrs)
159
Q

(5) Specific etiologies of Cellulitis

A

Streptococcus & Staph. aureus infection of the dermis & subcutaneous tissue (most commonly)

  • S. aureus: focal infection most common in injection drug users; causes toxin syndromes
  • Group A Strep: high morbidity & mortality –> Nec. Fasciitis
  • Pneumococcus: immunocompromised
  • Erysipeloid: common in game/poultry/fish handlers on hand/finger
  • Pasteurella multocida: cat bites
160
Q

(2) Cellulitis complications

A

sepsis & necrotizing fasciitis

161
Q

Erysipelas vs. Erysipeloid

A

Erysipelas: distinct superficial cellulitis caused by Beta Hemolytic Strep

  • sharply demarcated
  • erythematous, hot & painful
  • glistening

Erysipeloid: specific cause of cellulitis

  • hunters/fisherman
  • sharply defined plaque & irregular raised border at inoculation site (hand/finger)
  • enlarges peripherally w/central fading
  • painful, tender, warm
162
Q

Tinea Capitus

A
  • Clinically manifests w/in 3 wks
  • Non-inflammatory type:
  • -> Black dot - irregular patches of hair loss w/broken off hairs
  • -> Gray patch - well marginated areas of hair loss, scaling, numerous broken hairs, secondary coating of hair shaft by spores
  • Inflammatory type: mild - intense erythema, kerion development when severe
163
Q

T/F: Tinea Corporis infection may spread to over the entire body except for the scalp.

A

False: dermatophyte infection does not include the scalp, hands, feet, or groin

164
Q

Tinea Corporis presentation

A

annular, scaly, erythematous patches w/ peripheral enlargement & central clearing

165
Q

Tinea Cruris clincal presentation

A

(Jock itch) - symmetric, slowly enlarging annular erythematous lesion w/peripheral scale usually involving the upper inner thigh & groin; may spread to perianal & perineal areas except scrotum

166
Q

Tinea Manuum

A

dermatophyte infection of the hand commonly on the palmer surface w/accentuation of flexural creases

167
Q

Which two fungal infections often occur at the same time & manifest in one hand & both feet?

A

Tinea Manuum & Tinea Pedis

168
Q

What is the most common fungal disease?

A

Tinea Pedis - approx. 70% of population experiences it at some point

169
Q

Tinea Pedis presentation

A
  • hyperkeratotic scaling lesion along sides of feet & sole
  • fissures between toes
  • often assoc. w/onychomycosis
  • malodorous
170
Q

Staph. aureus related toxin syndromes:

A

Toxic Shock Syndrome

Staphylococcus Scalded Skin Syndrome

171
Q

Tinea Unguium

A

(Onychomycosis) - begins as brownish discoloration at nail edge that becomes thickened & deformed –> separation & deterioration

172
Q

Dermatophytid - ID Reaction

A

appearance of minute sterile papules/vesicles d/t an allergic response caused by a dermatophyte infection elsewhere on body. Tx w/med-high steroids x2 wks

173
Q

Tinea Versicolor

A

fungal infection common in area of active sebaceous glands well demarcated hypo/hyperpigmented scaling macules/patches

174
Q

Clinical manifestation of mucocutaneous candidiasis (5):

A
  1. Intertriginous areas: primary pustule –> erythematous macerated patches w/sharp scaling border & satellite lesions
  2. Vulvovaginitis: beefy red vaginal mucosa w/thick creamy discharge; pruritus, soreness
  3. Interdigital Candiasis: eroded white macerated tissue & fissures between digits (housekeepers/launderers/barbers)
  4. Chronic Paronychia: inflamed nail fold containing pus; absent cuticle; irregular edges of the nail
  5. Thrush: mouth & tongue covered w/white movable curdy plaques that bleed
175
Q

Predisposing factors of Thrush/Candidiasis (4):

A

obesity
humidity
antibx use
hyperglycemia

176
Q

Ketoconazole

A

systemic antifungal medication used to treat both candida & dermatophyte infections

177
Q

Pathophys of Scabies

A

Mite infestation of the skin caused by burrowing into the stratum corneum & deposition of eggs by the female mite
1-2 months later: acquired sensitivity infection to the mite or fecal pellets –> intense pruritus & crusted papules

178
Q

Scabies presentation

A
  • widespread pruritic crusted papules –> excoriations
  • burrows: 5-20 mm S-shaped ridges or black dotted lines
  • adults: common in genital region
  • children: palms, soles, head, neck, face
179
Q

How to diagnose scabies?

A

Wet mount using mineral oil to identify mites

180
Q

Permethrin

A

anti-scabicidal

181
Q

Kerion

A

erythematous boggy scale developed secondary to Tinea Capitus infection

182
Q

What is the common name for Pediculosis Capitus?

A

Head lice infestation

183
Q

Pediculosis Pubis

A

Crabs - pubic lice exclusive to humans found on any hairy region
Manifestations - papular urticaria @ feeding sites, lichenification/excoriation, maculae cerulean

184
Q

Maculae Cerulean

A

slate-bluish gray non-blanching macules 0.5-1 cm diameter assoc. w/pubic lice/crabs

185
Q

Pediculosis Corporis

A
  • body louse that lives in the seams of clothing/bedding & visits human to feed
  • erythematous papules, macules, papular urticaria –> secondary lesions
186
Q

Trench fever and epidemic typhus are assoc. w/which infestation of the skin?

A

Pediculosis Corporis

187
Q

Brown Recluse bite signs/symptoms & treatment:

A
  • mild burning/stinging
  • redness/swelling around 2 small bite marks
  • increasing pain 2-8 hrs
  • formation of dusky red/blue blood blister –> rupture
  • deep enlarging ulcer
  • systemic symptoms: N/V, fever, body aches, malaise
  • Tx: Antivenom, Dapsone, Wound care
188
Q

Black Widow bite signs/symptoms & treatment:

A
  • pain/stinging
  • slight swelling around 1-2 bite
  • dull numbing pain from bite to abdomen & back w/in 1 hr
  • severe cramping/rigidity in abdomen
  • systemic symptoms plus: arthralgias, dizziness, tremor, sweating, facial swelling, dyspnea
  • Tx: antivenom, calcium gluconate
189
Q

Effluvium

A

loss of hair

190
Q

Alopecia definition

A

condition resulting from effluvium

191
Q

(2) types of Alopecia & Etiology

A
  • Cicatricial: scarring, tissue destruction & inflammation
  • Noncictricial: non-scarring & no tissue destruction; may be diffuse or patchy

Etiology: loss of hair secondary to damage/destruction of follicle

192
Q

Telogen Effluvium

A
  • transient increased loss of normal resting hair follicles
  • have increased daily hair loss & thinning
  • d/t factors affecting the follicle (pregnancy, surgery, injury, wt. loss, fever)
  • precipitating even precedes loss by 6-16 wks
  • Prognosis: complete regrowth 4-6 months
193
Q

Anagen Effluvium

A
  • diffuse loss of hair growth involving entire scalp w/rapid onset
  • rapid growth arrest/damage to anagen hairs that skip catagen & telogen –> then shed
  • Causes: chemo, intoxication, drugs
194
Q

Which type of hair loss occurs d/t pregnancy?

A

Telogen effluvium

195
Q

Trichotillomania

A
  • habit-like self induced hair loss common in children & adults w/emotional disturbances
  • affected side = dominant hand
196
Q

Traction Alopecia

A
  • localized hair loss secondary to trauma
  • patchy distribution w/out scalp abnormality
  • maybe d/t styling &/or rubbing/traction
  • may be permanent
197
Q

Alopecia Areata

A
  • localized loss of hair in round/oval areas w/out inflammation
  • possible autoimmune process, but not sign of any multisystem disease
  • scattered - confluent distribution of loss in scalp/brows/lashes/pubic area/beard
  • Exclamation point hairs
  • no cures
198
Q

Onycholysis

A

separation of nail from nail bed (at hyponychium) often d/t trauma

199
Q

Beau’s Lines

A

horizontal depression/trough across nail plate of ALL nails d/t interrupted growth
noticed approx. 3 months after precipitating cause

200
Q

Exclamation Point hairs are diagnostic of what condition?

A

Alopecia Areata

201
Q

Loss of Lovibond’s Angle is seen in which disorder?

A

Clubbing

202
Q

Koilonychia

A

Spoon nails - concave nail plate d/t thinning & softening

Etiology - congenital, illness, physical or chemical trauma

203
Q

Iron deficiency anemia & Raynaud’s phenomenon are assoc. w/what nail disorder?

A

Koilonychia

204
Q

Etiologies of Pitted Nails (3)

A

psoriasis
alopecia areata
parakeratosis

Shortened cell cycle causes faster proliferation & nucleus retention –> then nucleus falls out

205
Q

Habit Tic deformity

A

longitudinal depressions in nails d/t repeated scratching/picking

206
Q

Leukonychia

A

White spots on nails thought to be caused by trauma

207
Q

(3) Etiologies of Splinter Hemorrhages

A

trauma
bacterial endocarditis
SLE

208
Q

Lamellar Nail Dystrophy

A

Splitting of the nail into layers caused by repeated wetting/drying out of nails

209
Q

Paronychia

A
  • infection of skin around nail presenting w/signs of erythema, tenderness, purulent exudate, nail changes/detachment
  • acute: bacterial d/t injury
  • chronic: candida, fungus, or bacteria d/t constant moisture
210
Q

Hutchinson’s Sign

A

pigmentation of the nail fold/around nail assoc. w/malignant melanoma
- often confused w/hematoma

Derm (1 decks)

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