Derm Flashcards
Different techniques/equipment for skin exam
Wood lamp: looking for bacterial
Patch testing: allergic rxn
Diascopy: no blanching = viral
Punch bx and simple excision
Dry skin tips:
do not shower for longer than 15 min
soak hands in lukewarm water for 10-15min before putting on topical steroid
do not bathe more than once a day
use mild soap (dove)
Pt presents with weepy lesions on trunk and extensor surfaces of body.
Nummular eczema
Tx: CS - triamcinolone and abx
Pt presents with a rash that itches on the flexor surfaces.
Parents have the same symptoms.
Upon examination:
Complication:
Atopic dermatitis eczema
Upon examination: there are ill defined borders, pruritus, dry skin, papules, and lichenification
Complication: secondary infection for (1) bacterial - imetigo (2) yeast - candidia (3) viral - molluscum contagiosum
Tx: Triamcinolone and abx
Pt presents with vesicles on the arm after hiking.
Chronic?
Allergic contact dermitits
chronic - scaling
Tx: CS, derm patch, hx taking is very crucial
Pt presents with scaling under the breasts.
Irritant contact dermitits
Tx: CS, history taking is very important
Pt presents with very dry skin and lines are prominent.
Lichen Simplex Chornicus
End stage dx
Tx: aggressively with glucosteroids
Pt is a young female with erythermous rash around mouth. She says it goes away, comes back, and goes away.
Upon examination: NO pastules/cysts.
Periorbital dermatits
Tx: metrondiazole gel
systemically use doxycyline and tetracylcine but that is only relieving antiinflammation not the bacteria
Pt presents with dandruff and scaling on scalp.
Upon examination, hair is very greasy and scaling comes off when pulled.
Seborreic dermatitis
Tx: antifungal - azole
adult: selenium sulfide and CS
babies: oil and baby shampoo
Pt has CHF and is concerned about the ant lateral lesions on her legs. She is also a cook and has given birth to her 4th child.
Statis dermatits
affects lower extremities and DVT pts (be worried about vein circulation)
early stages: ant lateral is fleshy
later stages: brown edemas and lichenification
Tx: treat the rash with emollients (CS), leg elevation, stockings, and avoid trauma
Pt has vesicles on her hands and scales on her feet. She lives in Az.
Upon examination:
Dyshidorsis (pompholyx)
atopy background and triggered by emotional stress and weather.
2 stages - 1) vesicles (palms and feet) 2) fissure (dry and itchy)
Upon examination: always inspect both hands and feet
Tx: CS
if secondary infxn occurs - use oral abx
Pt has been taking amoxcillin and started noticing red spots.
Morbilliform
NOT drug rxn - IgM mediated
looks like measles
Tx: stop drug and use topical CS and oral antihistamines
Pt takes a drug and rxn occurs as the same place all the time.
Fixed Drug Rxn
Tx: stop medication
erorded: abx
nonerosion: topical CS
Signs of when to stop medication:
blisters, ulcers, utricaria, facial edema, purapura, fever, lympadenopathy, mucosal invovlement
Spectrum of drug rxn (draw)
Inpatient: morbillform (IgM) - Fixed Drug rxn - Urticaria (IgE, I) - Erythema Multiforme Minor (cell, IV)
Outpatient: Erythema Multiforme Major (cell, IV) - Angioedema (IgE, I) - Anaphylaxis (IgE, I), SJS and TENS (cell, IV)
Pt presents with papulosquamous rash on her wrist.
Upon examination, there is wickham striae on her tongue.
affects:
Lichen planus
Affects: wrists, shins, lower back, and genitalia/gold and mercury
Tx: healing takes a long time but topical glucoCS +/- occulsion patching
systemic: oral glucoCS - derm referral
Pt comes in with Herold patches on the back.
Upon examination, the patches are clustered in christmas tree formation on the back.
Pityriasis Rosea
d/t viral - once you get it, you don’t get it again
Tx: supportive; CS and oral antihistamines for pruritics
Pt comes in with a white scaly lesion on elbow. She was playing football when she skinned her leg on the gravel ground. *
Upon examination, the scales do not come off and bleeds.* Plaques are well defined and on both elbows.
Plaque Psoriasis
d/t autoimmune - could affect joints and nails
DO NOT GIVE ORAL STEROIDS –> CAN FLARE PSORIASIS AND LEAD TO PUSTULES
d/t T cells playing a role - keratinzed skin life is shortened causing the plaques to look thick
*Koebner phenomenon: d/t trauma
*Ausptiz sign: picking up the scale and bleeding spots occur
Tx: topical steroids w/ occulsive dressing (oral steroids - derm referral)
Pt has red spots under armpits and breasts.
Inverse/Flexural psoriasis
Pt has strep and noticed rain drop lesions on arms
Guttate Psoriasis
d/t strep
Pt presents with bright red spots on back w/ fever and chills
Erythroderma psoriasis
Hospitalized immediately
Pt presents with nails rash, felt pain before noticing the rash.
Arthritis Psoriasis
Pt is 85 yo and noticed blisters on armpit and thighs.
Upon examination, the blisters do not have a red base.
Bullous pemphigoid
Tx: oral steroids (prednisone)
Pt is 20yo female with acne. She finds them on her face, neck, upper trunk, and upper arms. Her parents have them as well.
Upon examination there are white and blackheads.
Acne Vulgaris
Factors: incr androgens, P acnes (bacteria), plugging of hair follicle
May get papules (debris and bacteria)
White heads: closed comedones
Black heads: open comedones
Tx:
Mild comedonal: topical retinoid
Mild paulo-pustular: topical abx (erythomycin and clindamycin) and topical benzyol peroxide
Mod paulo-pustular: oral abx w/ retinoid and benzyol peroxide
Severe nodular and scarring keloids: derm referral
