Derm Flashcards
Condyloma acuminata
are soft, fleshy warts that are caused by the HPV. Cervical dysplasia and carcinoma in situ are likely caused by types 16, 18, 31, 33, and 34
erythematous, scaly, nontender nodule on his left lower lip. There are no surrounding telangiectasias. The nodule is firm, ill-defined, and fixed to the underlying tissue
Squamous cell carcinoma
If you push on a Hemangiomata if will?
blanch under pressure
___________ are precursors to squamous cell carcinoma
Actinic keratoses (AK)
difference between tinea capitis and alopecia areata
alopecia areata has round sharply demarcated patches of hair loss. Tinea Capitis is scaly and painful, less demarcated.
Secondary syphilis hair findings
moth eaten
What type of ulcer is associated with DM?
Neurotropic
Name the rule of 9s for burn victims
9(neck/head)9(upper anterior torso)9(lower posterior torso)9(lower anterior torso)9(upper anterior torso)9(each arm)9(anterior leg) 9(posterior leg) 1(genital)
bites from what spider can cause bites can lead to necrosis of the skin, destruction of red blood cells, blood clot formation, acute renal failure, coma, and death.
Brown recluse
2 most common bugs of cellulitis
strep A and staph A
Neonates: cellulitis most common bug
Group B Strep
US finding of cellulitis
cobblestone
Erysipelas
Superficial bacterial skin infection that involves lymphatics
● Classically on face, common on leg
most common bug of Erysipelas
strep progenies, treat for strep. raise border
Impetigo bugs
Staph aureus predominantly, also strep pyogenes
tx Impetigo
Mupirocin ointment
● Avoid scratching (can self inoculate)
● Oral abx: for more severe cases (dicloxacillin, cephalexin (MSSA), TMP/SMX, clindamycin (MRSA)
tx of acne
Tx: topical retinoids, benzoyl peroxide, oral abx (tetracyclines), OCPs (decreased
androgen levels), oral isotretinoin (teratogenic).
When on isotretinoin, MUST be on
OCPs simultaneously due to potential teratogenic effects.
tx for rosacea
Tx: avoid triggers (hot beverages, Ethanol, sunlight)
○ Hydrocortisone topical
○ Metronidazole topical
which one is worse and has oral lesions? Bullous pemphigoid or Pemphigus vulgarism
Pemphigus vulgarismtx
low down on Bullous pemphigoid
● Low mortality (“not so bad”) ● Elderly ● Negative Nikolsky sign ● Tense bullae ● Rarely oral lesions ● Treatment: stop offending drug, topical/oral steroids
name 3 disorder with positive Nikolsky sign
Pemphigus vulgaris, SSSS, Toxic epidermal necrolysis
tx of Pemphigus vulgaris
Treatment: treatment similar to burns, systemic steroids, immunomodulators
● High mortality (“bad”) ● Younger ● Positive Nikolsky sign ● Flaccid bullae ● Oral lesions ●
of Pemphigus vulgaris
Desquamation (AKA: skin sloughing) 3 disorders
Erythema multiforme “minor, Stevens-Johnson syndrome,
Toxic epidermal necrolysis.
Target lesions, Palms and soles, then moves centrally
● Causes: Herpes simplex and Mycoplasma pneumonia
ONLY ON SKIN
Erythema multiforme “minor
tx of Erythema multiforme “minor
acyclovir,
Severe immune-complex mediated hypersensitivity
● MUCOUS membranes
● Systemic symptoms
●
Stevens-Johnson syndrome
causes of Stevens-Johnson syndrome
o Antibiotics (PCN, Sulpha)
o Antiepileptics
o NSAIDs
Tx of steven johnson syndrome
● Treatment: remove cause, treat similar to burns
● Severe form of Stevens-Johnson syndrome
● Histology: dermal-epidermal cleavage
● >30% body surface area ( larger involvement than Steven john sons syndrome)
dermal cleavage (external vs.. internal layers of the skin
Toxic epidermal necrolysis
● Treatment of toxic epidermal necrolysis
Burns ICU, supportive, IV immunoglobulin
steven johnson of the eye
can go blind must see ophthalmologist (acute care)
Lichen simplex chronicus
Firm, thick plaques
● Secondary to pruritis
● Lichenification
● Treatment: topical steroids
Pityriasis rosea is from what herpes family
Human herpesvirus 7
Symptom progression: 1-Viral prodrome, 2-Herald patch, 3-“Christmas Tree”
● Round, oval salmon-colored maculopapular rash
Pityriasis rosea
raised scaly rashes: Papulosquamous diseases
Psoriasis, Pityriasis rosea, Psoriatic arthritis,Lichen planus,
Fixed drug eruption, Dermatophyte (fungal) infection & secondary syphilis
Distal IP polyarthritis ● Pitting of finger nails ● Pathology: HLA B27 positive (iritis, sacroiliitis, inflammatory bowel disease) ● Treatment: o systemic steroids
Psoriatic arthritis
Pruritic o Planar o Purple o Polygonal o Papules (“violaceous papules”)
Lichen planus (this is immune related) Wrist, ankles, legs and MOUTH (white linear line inside cheek)
Actinic keratosis or Seborrheic keratosis can cause CA?
ACTINIC KERATOSIS
horrible DIP joints and skin issues (pencil cup)
psoratic arthritis (give strong immunosuppressant drugs)
Seborrheic keratosis describe
flat warty brown
androgenic alopecia
male patterned baldness
Paronychia tx
I & D
treatment for lice
Primarily topical o Permethrin (Elimite®, Nix®) o Pyrethroids (A200®, RID®) o Malathion (Ovide®) o Lindane (Kwell®) ⇒ too toxic ⇒ seizure ● Oral Ivermectin - for severe cases
dx scabies
Light microscopy of skin scrapings
● CBC
tx for bed bugs
Treatment is supportive
○ Antipyretics, antibiotics if infection
● Eradication with insecticides
● New mattresses, etc
Africanized Bees
● “Killer” bees may result in?
May result in:
○ Hemolysis
○ Rhabdomyolysis
○ Acute renal failure
localized, Most common, Death rare because usually, pearly, rolled edges
BCC
Exanthems think
viral or drug rash
Primarily head, neck, and oral
● Actinic keratosis is a precancerous lesion that can precede this
● Clinically: scaling, crusting, telangiectasia, raised nodule or shallow ulcer, firm, slow
growing, may bleed
SCC
A: B: C: D: how many mm E: of skin cancer
asymmetry (irregular) borders (variation in) coloration diameter >6mm evolution in lesions
Connective tissue tumor, predominantly in HIV and immunosuppressed
● HHV-8 causative
● Usually cutaneous but also in other organs
● Clinically: on skin it is purple-red-blue papules, painless, non-pruritic
Kaposi sarcoma
Common viral disease of the skin
● Poxvirus
● Discrete, flesh colored, waxy, dome shaped umbilicated papules
Molluscum contagiosum
Molluscum contagiosum tx
self limiting
Verrucae (bad HPV numbers)
warts 16,18
Vitiligo
Associated with autoimmune endocrine disease destruction of melanocytes
what are worse Alkali or acid burns
Alkali more severe than acid
urticara is _____ mediated by
IgE
stage I-IV pressure ulcers
Stage I: non-blanching erythema
Stage II: necrosis, superficial, partial thickness
Stage III: deep necrosis, crater ulcer with full thickness skin loss
Stage IV: FULL thickness
chloasma / Melasma
sun damage
Hidradenitis suppurativa
Disease of apocrine sweat glands
Tinea Versicolor / Pityriasis versicolor bug
Malassezia furfur
Tinea Versicolor tx
selenium sulfide shampoo
Dermatophyte tx
Itraconazole – careful with liver dz
o Terbinafine
Which of the following is the most common complication associated with Herpes Zoster infection?
Post-herpetic neuralgia
Where is Atopic Dermatitis usually found in infants and young children?
Antecubital and popliteal fossa
A 7 year old girl is brought to your clinic because for the last 5 days she has had a slight fever, sore throat, and abdominal pain. This morning, however, she developed a rash on her cheeks. Physical exam shows a brightly erythematous rash across both cheeks, and a lacy rash on both arms. Given this patient’s most likely diagnosis, what is the causative organisms?
This patient most likely has Erythema infectiosum, for which the most common causative agent is Parvovirus B19.
A 23 year old female with history of anxiety and depression presents to your office because of an itchy rash on her abdomen that she has had for years some evidence of excoriation, but no telangiectasias, or signs of infection. Which of the following is the most likely diagnosis
Lichenified plaques due to chronic scratching, especially in someone with a nervous habit (due to anxiety) leads to lichen simplex chronicus.
what is hydoxyzine
Hydroxyzine or another H1 receptor blocking agent is the treatment of choice in Urticaria. Other agents may be added if the patient is still having symptoms (corticosteroids, H2 receptor blockers, doxepin, etc)
What is the different between diagnosis of Hansen’s disease instead of vitiligo?
The loss of sensation at the areas of depigmentation should increase your suspicion of leprosy (Hansen’s disease).
What is the most common location affected by erysipelas?
the legs
A 63 year old man presents complaining of discoloration and scaling on the top of his head. Physical exam reveals a bald male with various erythematous papules and scaly plaques covering the majority of the scalp. Lesions are rough to palpation. Which of the following is the treatment of choice in this condition?
Topical 5-Fluorouracil cream would be the treatment of choice in this patient with Actinic Keratosis. Since his lesions are widespread over the scalp, cryotherapy or excision are unreasonable treatment options at this time.
What is the most common location affected by erysipelas?
legs
what is potassium hydroxide preparation?
KOH prep
