Derm Flashcards

1
Q

Malignant Melanoma

A

Irregular pigmented lesion >6mm in size. ABCDE. Most common site is back (M) and leg (F). Tumor thickness is prognostic. Hx of changing mole is number 1 reason for biopsy. Excision biopsy is Tx/diagnostic.

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2
Q

Atopic dermatitis

A

Rough, red plaques w/o, thickening (though it will toughen) or sharp margins of psoriasis. ++pruritis (more than seborrheic dermatitis).
Most common loc: Face, neck, upper trunk, elbows/knees
Typically begins in childhood.

Tx: Avoid irritants, reduce soap, use emolients (moisturizer) after shower, topical corticosteroids (strength depends on chronicity, location).

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3
Q

Lichen simplex chronicus

A

Chronic itching and scratching, most often on neck, ankles, wrist, perineum. Causes thickened excoriated skin with exaggerated skin lines.
Tx: high-potency topical corticosteroid

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4
Q

Psoriasis

A

Silvery scales on bright red, sharply demarcated plaques + nail pitting/onycholysis. Cause unknown- partially genetic. Worse in winter (vs summer).
NOT pruritic
Auspitz’s sign: removing scale causes pinpoint bleeds.

Tx: phototherapy for small plaques (

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5
Q

Pityriasis Rosea

A

Benign- many fawn-colored plaques + scaly eruptions following cleavage lines of trunk (xmas tree pattern). Often preceded by 2 weeks by large HERALD patch. Young>Old; F>M; spring+fall>other months.
Tx is symptomatic UVB, topical corticosteroids or oral antihistamines.

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6
Q

Seborrheic dermatitis

A

Dry scales w/ underlying erythema located on scalp, central face, presternal, interscapular folds, skin creases (NL folds), eyebrows, behind ears. Causes dandruff.
DOES NOT CAUSE PRURITIS

Tx: scalp: selenium sulfide or ketoconazole shampoo.
Face; topical ketoconazole or steroid if severe.
Creases: clotrimazole + steroid

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7
Q

How do you treat tinea? What is important to remember about tinea pedis?

A

Topical anti-fungals. If refractory or difficult to treat topically, Griseofulvin can be used. For tinea versicolor ketoconazole PO can be used (or fluconazole).

Interdigital tinea pedis is the most likely cause of cellulitis in the healthy

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8
Q

Actinic keratosis

A

Premalignant lesion related to sun exposure. Small (0.2-0.6 cm), pink, rough, TENDER, macule or papule. Rarely progresses.

Tx: biopsy to r/o SCC if lesion is indurated, tender, or bleeds spontaneously.

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9
Q

Intertrigo

A

Caused by macerating effect of heat, moisture, friction. Most likely in obese patient in humid climate. Body folds develop fissures, erythema, sodden epidermis. May be complicated by candidiasis.
Tx: hygiene, keep dry. Hydrocortisone plus imidazole(anti-fungal) or nystatin

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10
Q

Imitizole

A

class of topical anti-fungals.

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11
Q

Pompholyx; Vestibulobullous hand eczema

A

Small, clear vesicles stud skin at sides of fingers and on palms or soles (tapioca-like). Pruritis. Vesicles dry and area becomes scaly and fissured.
Appears in 3rd decade in pts with Hx of atopic background

Tx: Topical corticosteroids.

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12
Q

Impetigo

A

Superficial blisters filled with purulent material that rupture easily, w/ honey-colored crusts.
Etiology is staph or strep.
Tx: Soaks, scrubbing. Topical Abx (bacitracin, mupirocin) if small area, otherwise give systematic ABx (Cephalexin or Doxycycline). If MRSA is suspected, treat with Clindamycin, doxy, or TMP-SMZ.

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13
Q

Contact dermatitis

A

erythema and edema with pruritis followed by vesicles or bullae (allergic contact dermatitis). Later, weeping, crusting, or sec. infection.
Irritant is more common than allergic.

Tx: Acute, weeping: Wet dressings (30-60 mins several times/day); high-potency topical corticosteroid. Sub-acute- mid-potency corticosteroid. Chronic (lichenified)- high-super potency topical steroid .

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14
Q

Acne vulgaris: Comedonal

A

MOre mild form of acne made up of open and closed comedones.

Tx: Topical retionoid (tretinoin) is very effective. Wait 20 mins after washing to apply. Benzoyl peroxide and antibiotics if refractory.

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15
Q

Acne vulgaris: Papular or cystic Inflammatory acne

A

Tx depends on severity:
Mild: Benzoyl peroxide + topical erythromycin or clindamycin.
Moderate: Tetracycline or doxycycline or minocycline PO
(Erythromycin in preg)
Severe: Isotretinoin (oral retinoid- teratogenic) - make sure they have no bowel or bladder problems, depression.

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16
Q

Rosacea

A

A chronic erythema of face, forehead and cheeks, that SPARES PERIORBITAL area. Starts in middle age. Erythema and flushing, papules, pustules with Telangiectasia. Nose becomes bulbous.

Tx: Avoid EtOH, hot beverages, suck on ice cube. Topical metronidazole, oral tetracycline. Isotretinoin if refractory.

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17
Q

Folliculitis

A

Tx: Anhydrous ethyl EtOH containing aluminum chloride aplied 3-7x weekly for chronic, recurrant type.
**Pseudomonas folliculitis will clear spontaneously in healthy pts. All others treat with oral ABx based on susceptibility.

18
Q

Miliaria

A

heat rash- on trunk and intertriginous areas. Hot moist environment is most frequent cause. Burning and itching with small, superficial, red, thin-walled disecrete vesicles, papules, or pustules.

Tx: tramcinolone acetide OR mid-potency corticosteroid.

19
Q

Candidiasis Tx

A
Nails and paronychia- clotrimazole solution
Skin- nystatin or clitrimazole cream
Mucous membranes/vulva- Oral fluconazole
Balanitis- topical nystatin
Mastitis- Oral fluconazole
20
Q

Urticaria & angioedema

A

Eruptions of wheals w/ intense itching- typically an IgE mediated immune reaction, insect bite. Can occur before blisters in contact dermatitis. Often caused by med allergies.

Tx: H1 antihistamines (hydroxyzine). In refractory, use 2nd gen antihistamines at 4x dose given for allergic rhinitis.

21
Q

Erythema multiforme minor

A

Minor- most common cause is herpes- On extensor surfaces, palms, soles, mucous membranes.
Target lesions with clear centers and concentric erythematous rings.
Tx: Acyclovir if caused by herpes.

22
Q

Erythema multiform major

A

See SJS and TEN

23
Q

Stevens Johnson Syndrome and Toxic Epidermal Necrolysis

A

Erythema multiforme- drug induced. TEN is when >30% TBSA is involved.
Culprits are usually: sulfas, anticonvulsants, allopurinol, NSAIDs.

Purpuritic target-like lesions with two zones of colorg cange and a center blister, or nondescript red/purpuric macules.

Tx: Immediate cessation of offending med, nutritional and fluid support and high vigilence for infection. Burn unit if TEN. Manage lesions like 2nd degree burn.

24
Q

Erysipelas

A

Superficial form of cellulitis that classically occurs on cheeks (bilat), caused by beta-hemolytic strep. Accompanied by pain, malaise, fever. Sharply-defined, raised border. Glistening, smooth, hot plaque. Dx- biopsy is diagnostic.

Tx: IV penicillin. If allergic or prefer PO- give 1st gen cephalosporin or clindamycin.

25
Q

Cellulitis

A

Edematous, expanding, erythematous, warm plaque. Lower leg is most common site. Pain, fever, chills.
Dx: Skin biopsy. R/o necrotizing faciitis (bullae, crepitus); DVT

Tx: IV abx (cover staph, strep). Clindamycin, vanc, or TMP-SMZ+beta lacatam if MRSA is suspected. Hospitalize if hypotension, elevated serum Cr, low bicarb elevated WBC with left shift, CRP.

26
Q

molluscum contagiosum

A

Single or multiple dome-shaped waxy papules (start firm, solid, then whitish, suppurative). Caused by a posxvirus, comon in immunocompomised.

Tx. is curretage or liquid nitrogen.

27
Q

Basal cell carcinoma

A

Sun exposure is RF: Pearly/translucent papule, erythematous patch >6mm; or non-healing ulcer with telangiectasis.
Hist: composed of islands and strands of invasive neoplastic cells.
Tx: resection (rarely mets). MOre than half recur, so check skin yearly.

28
Q

Squamous cell carcinoma

A

Nonhealing ulcer or warty nodule- skin damage; often crusting, small, red, scaly and ROUGH (like actinic keratosis)- Truly malignant lesion.

Immunosuppressed and fair skinned are at highest risk.

Tx: surgical removal, F/u every 3 months with careful examination of lymph nodes for 1 yr, then every 6 mo. Always palpate lips.

29
Q

Lichen planus

A

Pruritic, violaceous, flat-topped papules wiht fine white streaks and symmetric distribution on extensor surfaces of writsts, penis, lips, mucous membranes.

Tx: High strength topical steroids OR systemic steroids.

30
Q

Kaposi sarcoma

A

Occurs in immunocompromised. Always accompanied by HHV-8 infection.
Red or purple plaques or nodules on cutaneous or mucosal surfaces are characteristic. May have marked edema. Commonly involves GI tract, so may screen+ for fecal occult blood.

Tx: If elderly- palliative (+ intralesional chemo, radiation)
Iatrogenic- discontinue immunosuppression
AIDS: ART- immune reconstitution. Cryotherapy for ugly lesions. Radiation for space occupying lesions.

If >10 lesions/month, pain/edema or symptomatic visceral disease Tx is Liposomal doxorubicin.

31
Q

Anogenital pruritis

A

Itching due to intertrigo, psoriasis, lichen simplex, or seborrheic/contact dermatitis.

Tx: good hygiene, wet wipes (not baby wipes), treat constipation. Can treat with pramoxine cream.

32
Q

Scabies

A

Contagious arthropod caused skin rash. MOst common in kids, in fingers, interwebs, wrists, scrotum, elbows, feet, ankles…..
Sx is severe pruritis worse at night with linear burrows, vesicles, and pustules

Dx is microscopic demonstration of organism, ova, or feces- scrape lesion.

Tx: pts and all close contacts w/ Permethrin (topical) (+ivermectin if immunocompromised). Antihistamines help with itching.

33
Q

Pediculosis

A

Body lice infesting skin of scalp, trunk, pubic areas. Sx is pruritis with excoriation. Occasionally light-blue macules.

Dx: Nits on hair shafts, lice on skin/clothes. Fluoresce pearly under wood lamp.
Tx is Permethrin. Dispose of infested clothing.

34
Q

Furuncle & carbuncle

A

Severe form of folliculitis causing abcess. Carbuncle is multiple follicle involvement. Tx: Incision and drainage. Antibiotics can be given (Sodium dicloxacillin or double strength bactrim if MRSA suspected).

35
Q

Erythema nodosum

A

painful red nodules without ulceration on anterior legs. Slow regression over weeks to resemble contusion. Women 10x>men. May be associated with infection, IBD, or drugs.

Tx: NSAIDs, Systemic therapy against cause.

36
Q

Epidermal inclusion cyst

A

Firm dermal papule or nodule with overlying black comedone and expressible foul-cheesy material. May become red and drain, but is sterile. Secondary to traumatic implantation of epidermis into dermis at site of follicle.

Tx: Excision and removal of cyst if symptomatic.

37
Q

Photodermatitis

A

Painful, pruritic erythema, edema, vesiculation in response to UV light exposure. Inner upper eyelids spared, as is under chin. Can be in people who just burn easily or true allergy to UV light.

Avoid sunlight, use sunscreen, discontinue offending meds.

38
Q

Leg ulcer secondary to venous insufficiency- classification and Tx

A

Skin edema, followed by dermatitis (pruritic), sclerosis, and ulceration.
S1- skin intact, non-blanching erythema
S2- partial thickness skin loss
S3- full-thickness skin loss, extends into subQ but not through fascia
S4- same as S3 but extends into muscle, bone, joints, tendons

Prevention is most important- compression stockings

Tx: metronidazole ointmant, occlusive hydroactive dressing, then Unna zinc paste boot. If DM, apply becaplermin too.

Oral pentoxifylline may help healing.

39
Q

When should burns be treated in burn unit?

A

Any 3rd degree (full-thickness) burn, all children, any burn with concommittent trauma, burns of face, hands, feet, genitals, perineum, joints. Refer partial thickness burns covering > 10% TBSA

40
Q

Rule of 9s

A

9% TBSA for head (4.5 for each side); Each arm is 9% (4.5 for each side); Trunk is 18%x2 (18 for each side); each Leg is 9%x2 (9 for each side); perineum is 1%.

41
Q

Drug eruption- common culprits

A

Can have pulm, renal, hematologic componants as well. Not always allergy. Often due to Betal lactam antibiotics, ASA, NSAIDs & sulfas.

42
Q

Seborrheic keratoses

A

AKA senile warts- benign elevated plaques w/ velvety/warty surface and stuck-on appearance. V. Common in elderly. Not associated with sun exposure. Face and trunk are common sites. Tx not necessary.