Derm Flashcards
Shave biopsy or full thickness biopsy for melanoma
Full thickness
Is shave biopsy okay for BCC
Yes
Type of surgery for BCC
MOHs micrographic surgery
Recurrence rate of BCC
Less than 5%
Describe MOHs microscopic surgery
Removing skin cancer under a dissecting microscope with immediate frozen section; loss of only smallest amount of normal tissue;
No need to remove a wide margin
Mohs surgery is best for what location
DELICATE areas— eyelid or ear
2 other places you find kaposis sarcoma
GI
LUNG
AIDS from injecting drugs or sexual contact more likely to give kaposis sarcoma
SEXUAL CONTACT
Treatment of kaposis sarcoma
HAART (no need to do surgery)
- intra lesions vincristine or IFN
- liposomal doxorubicin= last resort
Age of atopic dermatitis
Before 30yo
Lichenified
Thickened skin from scratching
Scaly rough areas of thickened skin
Eczema
What is common with eczema
Secondary infection with S aureus
Do food allergies exacerbate atopic dermatitis
NOOOO
Tx of eczema skin care
- Stay moisturized – lotion and humidifier
- Avoid bathing, soaps and washcloths
- Cotton> wool
Medical tx eczema
- Topical steroids
- Tacrolimus or pimecrolimus– helps them GET OFF steroids
- Antihistamines
- Antibiotics
- UVB – severe recalcitrant disease
Use of tacrolimus or pimecrolimus in eczema
Helping them GET OFF steroids
Severe eczema which anti-histamine
DOXEPINE
Mild eczema antihistamines
NON- sedating
Cetirizine, fexofenadine, loratadine
Which antibiotics when impetigo in eczema
Cephalexin
Mupirocin
Retapamulin
Risk of tacrolimus and pimecrolimus giving lymphoma
LOW RISK
Tx of psoriasis local disease
- topical steroids
- vit A and D
- coal tar
- tacrolimus and pimecrolimus
Tacrolimus and pimecrolimus use in psoriasis
FACE and PENIS since less potentially deforming
How do steroids cause skin atrophy
Inhibit collagen formation and growth
Try and convert all amino acids into glucose for gluconeogenesis
Worst prognostic factor skin cancer
Growing lesions
Tx of extensive psoriasis
- UV light
- Anti-TND
- MTX
Seborrheic dermatitis= dandruff
Hypersensitivity to dermal infection
Seborrheic = same as….
benign
Dandruff more common in patients with
AIDS
Parkinson’s disease
What drug associated with pemphigus vulgaris
ACE inhibitors
Most accurate diagnosis of pemphigus vulgaris
BIOPSY– Abs on immunofluorescent
No tx of pemphigus vulgaris
DEATH
Weaning pemphigus vulgaris patients off steroids with….
Azathioprine or mycophenolate
Initial tx of bullous pemphigoid
Prednisone
Tx of mild bullous pemphigoid
Erythromycin
DAPSONE
Nicotinamide (not niacin)
Porphyria cutanea tarda associated with
HepC
Iron overload
Estrogen use
Most accurate diagnostic test in PCT
Increased uroporphyrins in a 24hr urine collection
Where does PCT present?
Backs of the hands and face
What is Porphyria Cutanea Tarda
Hypersensitivity of skin to abnormal porphyrins when they are exposed to light
Number 1 tx of mild impetigo
MUPIROCIN
Community acquired MRSA impetigo tx
Doxy
CLINDAMYCIN
TMP-SMX
Cause of eryysipelas
Strep> staph
Mild skin infections = ORAL
Dicloxacillin, cephalexin, cefadroxyl
Penicillin allergy: erythromycin, clarithromycin
MRSA: doxycycline, clindamycin, TMPSMX
Severe skin infections–IV
Oxacillin, nafcillin, cefazolin
Penicillin allergic: clindamycin, vancomycin
MRSA: vancomycin, linezolid, daptomycin, tigecycline, ceftaroline
Antistaph penicillins
Ox, clox, diclox, naf
Only cephalosporin that covers MRSA
Ceftaroline
Penicillin allergy= rash and skin infection use…
Cephalosporins
Penicillin allergy= mild anaphylaxis with skin infection use…
Macrolides
Clindamycin
Doxycycline
TMPSMX
Penicillin allergy= severe anaphylaxis with skin infection use…
Vancomycin
Linezolid
Broad spectrum agents that cover staph but are not specific for skin infections– NO need to add anything for skin infection if already on them
Second gen cephalosporins
Beta lactam/ beta lactamase combos
Carbapenems
Most accurate test for tinea
Fungal culture
Best initial tx of tinea
Topical fungal if no hair or nail involvement
Best initial tx for hair or nail tinea
TERBINAFINE
Best initial test for tinea
KOH
Diagnosis of most cases of tinea Cruris
NO specific diagnostic test– aided by KOH
Which specific type of ketoconazole causes Gynaecomastia
ORAL ketoconazole
Efficacy of griseofulvin
LESSSSSSSSS than TERBINAFINE or intraconazlle
Drugs that causes hypersensitivity reactions are the same that cause hemolysis, interstitial nephritis and often drug induced thrombocytopenia (except heparin)
Penicillins Sulfa drugs Allopurinol Phenytoin Lamotrigine NSAIDs
Spectrum of skin drug reactions
TEN> SJS> erythema multiforme> morbilliform rash
Tx morbilliform rash
No specific tx
Tx erythema multiforme
Prednisone
Tx of SJS
Steroids are NOT NOT beneficial
Use IV IMMUNOGLOBULINS
Do steroids help in TEN
NOOOOOOOO,
Tx= IV IMMUNOGLOBULINS
Do antibiotics reverse SSS and TSS
Nooooooo, the just kill the staph producing the toxin
Tx mild acne
Benzoyl peroxide
Mild acne– if benzoyl peroxide is ineffective
Clindamycin or erythromycin
Tx moderate acne
Topical vit A
Topical vitamin A
Tretinoin
Adapalene
Tazarotene
Moderate acne– if the topical vitamin A is ineffective,
Oral antibiotics
- minocycline
- doxycycline
Severe acne tx
Oral vitamin A– isoretinoin
Isoretinoin
Teratogenic
Hyperlipidaemia