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SPRING16 757 PC Adults > Derm > Flashcards

Derm Flashcards

Exam: acne treatment, facial rashes, psoriasis vs eczema vs tinea vs contact dermatitis, skin malignancies assoc w/metastatic ca, actinic keratosis, erythema migrans description, trichotillomania

1
Q

Exam: acne treatment, facial rashes, psoriasis vs eczema vs tinea vs contact dermatitis, skin malignancies assoc w/metastatic ca, actinic keratosis, erythema migrans description, trichotillomania

What is scabies?

A

Scabies (“the itch”) is an infestation of the skin by the mite Sarcoptes scabiei that results in an intensely pruritic eruption with a characteristic distribution pattern.

-UpToDate

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2
Q

Exam: acne treatment, facial rashes, psoriasis vs eczema vs tinea vs contact dermatitis, skin malignancies assoc w/metastatic ca, actinic keratosis, erythema migrans description, trichotillomania

How is scabies typically distributed?

A

usually sides and webs of the fingers, flexor aspects of the wrists, extensor aspects of the elbows, anterior and posterior axillary folds, the skin immediately adjacent to the nipples (especially in women), the periumbilical areas, waist, male genitalia (scrotum, penile shaft, and glans), the extensor surface of the knees, the lower half of the buttocks and adjacent thighs, and the lateral and posterior aspects of the feet.

The back is relatively free of involvement, and the head is spared except in very young children. Rarely, may be localized to a single area

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3
Q

Exam: acne treatment, facial rashes, psoriasis vs eczema vs tinea vs contact dermatitis, skin malignancies assoc w/metastatic ca, actinic keratosis, erythema migrans description, trichotillomania

Clinical characteristics of scabies

A
  • **itching. often severe and usually worse at night.
  • small, erythematous, nondescript papule, often excoriated and tipped with hemorrhagic crusts (not dramatic lesion and not always easy to see.
  • Burrow is pathognomonic. thin, grayish, reddish, or brownish line that is 2 to 15 mm long. (Often absent or obscured by excoriation or secondary infection)
  • Miniature wheals, vesicles, pustules, and rarely bullae may also be present.
  • Magnify the lesion – will see burrow, seripigenous lesion, can use india ink dye test (usually in derm)
  • Crusted - suggests immunodeficiency (look for RFs for HIV)
  • Can be nodular
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4
Q

Exam: acne treatment, facial rashes, psoriasis vs eczema vs tinea vs contact dermatitis, skin malignancies assoc w/metastatic ca, actinic keratosis, erythema migrans description, trichotillomania

Why does scabies itch?

A
  • delayed type-IV hypersensitivity reaction to the mite, mite feces, and mite eggs
  • three to six weeks after primary infestation
  • UNLESS previously infested with scabies: one to three days after reinfestation, presumably because of prior sensitization of the patient’s immune system
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5
Q

Exam: acne treatment, facial rashes, psoriasis vs eczema vs tinea vs contact dermatitis, skin malignancies assoc w/metastatic ca, actinic keratosis, erythema migrans description, trichotillomania

Treatment for scabies

A

Ivermectin oral or Permethrin topical

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6
Q

Exam: acne treatment, facial rashes, psoriasis vs eczema vs tinea vs contact dermatitis, skin malignancies assoc w/metastatic ca, actinic keratosis, erythema migrans description, trichotillomania

What is post scabetic dermatitis?

A

No longer infected but still having immune response to scabies. Will go away as skin sheds.

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7
Q

Exam: acne treatment, facial rashes, psoriasis vs eczema vs tinea vs contact dermatitis, skin malignancies assoc w/metastatic ca, actinic keratosis, erythema migrans description, trichotillomania

Treatment of postscabetic dermatitis

A

Comfort care

Atarax, topical steroids or other anti-itch creams

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8
Q

Exam: acne treatment, facial rashes, psoriasis vs eczema vs tinea vs contact dermatitis, skin malignancies assoc w/metastatic ca, actinic keratosis, erythema migrans description, trichotillomania

How crazy do patients have to get about washing/bagging all their linens/clothes/etc?

A

mites survive only 2-3 days away from human skin

clothing and linens used within the preceding few days should be washed in hot water and dried in a hot dryer or bagged for several days.

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9
Q

Exam: acne treatment, facial rashes, psoriasis vs eczema vs tinea vs contact dermatitis, skin malignancies assoc w/metastatic ca, actinic keratosis, erythema migrans description, trichotillomania

Clinical characteristics of bed bugs

A
  • face, neck, hands, and arms
  • may be noticed upon awakening or one to several days after the bites
  • small punctum without a surrounding reaction. May have only asymptomatic purpuric macules.
  • Lines of 3: not always linear
  • usually pruritic
  • History of travel, new furniture
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10
Q

Exam: acne treatment, facial rashes, psoriasis vs eczema vs tinea vs contact dermatitis, skin malignancies assoc w/metastatic ca, actinic keratosis, erythema migrans description, trichotillomania

Treatment for bed bugs

A
  • get rid of stuff, fumigate
  • hard to get rid off.
  • Symptomatically – topical steroids, atarax, orals steroids if very severe
  • Psychological support
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11
Q

Exam: acne treatment, facial rashes, psoriasis vs eczema vs tinea vs contact dermatitis, skin malignancies assoc w/metastatic ca, actinic keratosis, erythema migrans description, trichotillomania

What is Morgellons Syndrome?

A
  • aka Delusional parasitosis
  • fixed, false belief (delusion) that they are infected by “bugs”: parasites, worms, bacteria, mites, or other living organisms
  • technically, Morgellons is a lay term for DP + beliefs of inanimate objects in the lesion as well (such as colored strings or fibers)
    • named and described in 1674 by Sir Thomas Browne. The term “Morgellons disease” has been adopted by an active community of patients and family members on the internet who believe that this unexplained dermopathy is a poorly diagnosed infectious disease and dispute an underlying psychological basis.
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12
Q

Exam: acne treatment, facial rashes, psoriasis vs eczema vs tinea vs contact dermatitis, skin malignancies assoc w/metastatic ca, actinic keratosis, erythema migrans description, trichotillomania

Treatment for delusional parasitosis

A
  • —Atarax, anti-itch creams, anti-psychotics
  • A lot of tx is about gaining trust. Tell them sx real, we don’t know what’s causing, but can manage sx.
  • May eventually find a cause for what these people are experiencing, but for now considered delusional do
  • Oatmeal baths can also help.
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13
Q

Exam: acne treatment, facial rashes, psoriasis vs eczema vs tinea vs contact dermatitis, skin malignancies assoc w/metastatic ca, actinic keratosis, erythema migrans description, trichotillomania

What is urticaria?

A
  • AKA Hives
  • -A skin rash that results from the release of histamine.
  • -Can be acute (
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14
Q

Exam: acne treatment, facial rashes, psoriasis vs eczema vs tinea vs contact dermatitis, skin malignancies assoc w/metastatic ca, actinic keratosis, erythema migrans description, trichotillomania

Causes of urticaria

A
  • Food allergy
  • *Drug induced: especially sulfa, PCN
  • *Parasites
  • *Poison ivy, poison sumac
  • *Dermatographic
  • *Stress or cholinergic
  • *Cold or heat induced
  • *Solar
  • *Exercise
  • *Water
  • *Autoimmune thyroiditis
  • *Infections- especially strep and viral (if fever, consider)
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15
Q

Exam: acne treatment, facial rashes, psoriasis vs eczema vs tinea vs contact dermatitis, skin malignancies assoc w/metastatic ca, actinic keratosis, erythema migrans description, trichotillomania

Work up for urticaria

A

Allergy panels (Immunocap), TSH, Free T4, Anti-thyroid peroxidase antibodies, thyroglobulin level, Histamine release, CBC, step test (if applicable), blood screening for viral infections (if applicable), testing for parasites (if applicable)

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16
Q

Exam: acne treatment, facial rashes, psoriasis vs eczema vs tinea vs contact dermatitis, skin malignancies assoc w/metastatic ca, actinic keratosis, erythema migrans description, trichotillomania

Treatment for urticaria

A
  • Avoid the cause if possible.
  • Treat underlying infection if applicable.
  • Medrol dose pak (if infrequent or acute).
  • Anti-histamines.
  • Doxepin (good anti-itch cream usually covered by insurance)
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17
Q

Exam: acne treatment, facial rashes, psoriasis vs eczema vs tinea vs contact dermatitis, skin malignancies assoc w/metastatic ca, actinic keratosis, erythema migrans description, trichotillomania

What are Tinea corporis, pedis, cruris, capitus?

A

—Fungal infection of the skin (dermatophytes)

  • Corporis: body
  • Pedis: feet
  • Cruris: groin and adjacent skin
  • Capitus: scalp
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18
Q

Exam: acne treatment, facial rashes, psoriasis vs eczema vs tinea vs contact dermatitis, skin malignancies assoc w/metastatic ca, actinic keratosis, erythema migrans description, trichotillomania

How do the tineas present?

A
  • —hyperpigmented plaques, Annular patches, crust.
  • Pruritic.
  • Feet: most commonly presents in the toe web as erosions. Can present as blisters as well (atypical).
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19
Q

Exam: acne treatment, facial rashes, psoriasis vs eczema vs tinea vs contact dermatitis, skin malignancies assoc w/metastatic ca, actinic keratosis, erythema migrans description, trichotillomania

Treatment for tineas

A
  • —Topical antifungal. If hair follicle involvement will need oral.
  • Oral ketoconazole BBW now 2/2 adverse effects – only for severe life threatening infections in bloodstream
  • **If initially treated w/a steroid, develop odd lesions – tinea incognito - makes more difficult to Dx. Diminished erythema and scale, loss of a well-defined border, exacerbation of disease, or a deep-seated folliculitis (Majocchi’s granuloma)
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20
Q

Exam: acne treatment, facial rashes, psoriasis vs eczema vs tinea vs contact dermatitis, skin malignancies assoc w/metastatic ca, actinic keratosis, erythema migrans description, trichotillomania

What is Dishydrotic eczema?

***exam

A

Type of eczema characterized but vesicular or papular eruptions on the palms and soles. Triggers can include hot water, nickel, allergens.

Lean towards this if, eg. Washing dishes a lot

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21
Q

Exam: acne treatment, facial rashes, psoriasis vs eczema vs tinea vs contact dermatitis, skin malignancies assoc w/metastatic ca, actinic keratosis, erythema migrans description, trichotillomania

Treatment for dishydrotic eczema

A

Topical corticosteroids. Avoidance of triggers.

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22
Q

Exam: acne treatment, facial rashes, psoriasis vs eczema vs tinea vs contact dermatitis, skin malignancies assoc w/metastatic ca, actinic keratosis, erythema migrans description, trichotillomania

What is Lichen simplex chronicus?

A
  • —A skin disorder characterized by scaling and skin thinning resulting from repetitive scratching
  • —Creates a scratch-itch cycle
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23
Q

Exam: acne treatment, facial rashes, psoriasis vs eczema vs tinea vs contact dermatitis, skin malignancies assoc w/metastatic ca, actinic keratosis, erythema migrans description, trichotillomania

Treatment of lichen simplex chronicus

A

—Anti-itch medication, topical steroids, emollients and lotions, behavior modification

Hydrocolloid dressing on small area so that cannot scratch

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24
Q

Exam: acne treatment, facial rashes, psoriasis vs eczema vs tinea vs contact dermatitis, skin malignancies assoc w/metastatic ca, actinic keratosis, erythema migrans description, trichotillomania

What is psoriasis?

***exam

A

autoimmune disorder resulting in excessive growth of the skin.

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25
Q

Exam: acne treatment, facial rashes, psoriasis vs eczema vs tinea vs contact dermatitis, skin malignancies assoc w/metastatic ca, actinic keratosis, erythema migrans description, trichotillomania

How does psoriasis present?

***exam

A
  • Classically presents as a salmon colored plaque with scale on extensor surfaces, umbilicus, groin and scalp
  • can also present as pustules and vesicles.
  • Nails will have pitting.
  • May develop arthritis as well, which is called psoriatic arthritis.
  • Psoriasis severity index can be used to evaluate.
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26
Q

Exam: acne treatment, facial rashes, psoriasis vs eczema vs tinea vs contact dermatitis, skin malignancies assoc w/metastatic ca, actinic keratosis, erythema migrans description, trichotillomania

Risks associated with psoriasis

A

Associated with arthritis, increased cardiovascular risk, risk of inflammatory bowel, ankylosis spondylitis, SCC and lymphoma.

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27
Q

Exam: acne treatment, facial rashes, psoriasis vs eczema vs tinea vs contact dermatitis, skin malignancies assoc w/metastatic ca, actinic keratosis, erythema migrans description, trichotillomania

Treatment of psoriasis

A
  • Topical corticosteroids, dovonex, protopic.
  • If extensive- biologics like Remicaid and Humira;
  • Methotrexate: particularly in psoriatic arthritis (watch out for fibrosis in lungs, liver problems)
  • phototherapy.
  • No tattoos, trauma may cause outbreak (Koebner phenomenon).
  • No treatment with oral corticosteroids (initially helpful, but comes back worse)
  • Supportive: beach - salt water and sun, but avoid sunburns
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28
Q

Exam: acne treatment, facial rashes, psoriasis vs eczema vs tinea vs contact dermatitis, skin malignancies assoc w/metastatic ca, actinic keratosis, erythema migrans description, trichotillomania

Lichen sclerosis: cause

A

unknown- some research indicates that may be associated with thyroid disease.

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29
Q

Exam: acne treatment, facial rashes, psoriasis vs eczema vs tinea vs contact dermatitis, skin malignancies assoc w/metastatic ca, actinic keratosis, erythema migrans description, trichotillomania

Lichen sclerosis men vs women

A

women more than men (10:1)

Occurs more frequently around and after menopause

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30
Q

Exam: acne treatment, facial rashes, psoriasis vs eczema vs tinea vs contact dermatitis, skin malignancies assoc w/metastatic ca, actinic keratosis, erythema migrans description, trichotillomania

Clinical presentation of lichen sclerosis

A
  • Usually genitalia and anus, can be located on the upper thigh
  • -Ivory white raised plaques, may have itching, may cause genitalia to shrink- which can cause pain during intercourse/urination/defecation
  • -In men, may develop into phimosis
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31
Q

Exam: acne treatment, facial rashes, psoriasis vs eczema vs tinea vs contact dermatitis, skin malignancies assoc w/metastatic ca, actinic keratosis, erythema migrans description, trichotillomania

lichen sclerosis: treatment

A

High potency topical steroids (Clobetasol)

educate pt to watch out for yeast infections

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32
Q

Exam: acne treatment, facial rashes, psoriasis vs eczema vs tinea vs contact dermatitis, skin malignancies assoc w/metastatic ca, actinic keratosis, erythema migrans description, trichotillomania

What is intertrigo?

A

—Yeast infection in skin folds caused by excess moisture

—More common in obesity, diabetes, and with advanced age

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33
Q

Exam: acne treatment, facial rashes, psoriasis vs eczema vs tinea vs contact dermatitis, skin malignancies assoc w/metastatic ca, actinic keratosis, erythema migrans description, trichotillomania

Appearance of intertrigo

A

—Skin is red, denuded, tended may have satellite lesions and an odor.

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34
Q

Exam: acne treatment, facial rashes, psoriasis vs eczema vs tinea vs contact dermatitis, skin malignancies assoc w/metastatic ca, actinic keratosis, erythema migrans description, trichotillomania

Treatment for intertrigo

A

—Avoidance of moisture. Antifungals.

Nystatin powder, Desitin cream (zinc oxide)

Interdry-ag is a textile with silver component but is very expensive

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35
Q

Exam: acne treatment, facial rashes, psoriasis vs eczema vs tinea vs contact dermatitis, skin malignancies assoc w/metastatic ca, actinic keratosis, erythema migrans description, trichotillomania

Clinical characteristics of lichen planus

A
  • —Itchy violaceous rash.
  • Oral lesions common: tends to be lacy, white, side of mouth
  • May cause nail and hair loss.
  • —Cause is unknown.
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36
Q

Exam: acne treatment, facial rashes, psoriasis vs eczema vs tinea vs contact dermatitis, skin malignancies assoc w/metastatic ca, actinic keratosis, erythema migrans description, trichotillomania

5 Ps of Lichen Planus

A
  • —pruritic,
  • —planar
  • —purple
  • polygonal
  • papules and plaques

are additionally well-defined

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37
Q

Exam: acne treatment, facial rashes, psoriasis vs eczema vs tinea vs contact dermatitis, skin malignancies assoc w/metastatic ca, actinic keratosis, erythema migrans description, trichotillomania

Treatment for lichen planus

A
  • —Oral and topical steroids
  • —Protopic or Elidel
  • —Phototherapy
  • —Oral retinoids

tends to be difficult to treat

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38
Q

Exam: acne treatment, facial rashes, psoriasis vs eczema vs tinea vs contact dermatitis, skin malignancies assoc w/metastatic ca, actinic keratosis, erythema migrans description, trichotillomania

What is Seborrheic dermatitis?

A

—inflammatory skin condition caused by a combination of a pathological over production of sebum combined with fungal overgrow.

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39
Q

Exam: acne treatment, facial rashes, psoriasis vs eczema vs tinea vs contact dermatitis, skin malignancies assoc w/metastatic ca, actinic keratosis, erythema migrans description, trichotillomania

What to consider if seborrheic dermatitis is severe new onset in adult?

A

work up for immune disorder such as HIV.

Also associated with Parkinson’s and MS.

Parkinson’s - likely 2/2 lack of facial muscle mvmt - overgrowth

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40
Q

Exam: acne treatment, facial rashes, psoriasis vs eczema vs tinea vs contact dermatitis, skin malignancies assoc w/metastatic ca, actinic keratosis, erythema migrans description, trichotillomania

Treatment for seborrheic dermatitis

A

—Topical antifungals. Topical steroids. Protopic.

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41
Q

Exam: acne treatment, facial rashes, psoriasis vs eczema vs tinea vs contact dermatitis, skin malignancies assoc w/metastatic ca, actinic keratosis, erythema migrans description, trichotillomania

What is Atopic dermatitis?

***exam

A

—Inflammatory skin disorder associated associated with other atopic diseases such as allergy and asthma

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42
Q

Exam: acne treatment, facial rashes, psoriasis vs eczema vs tinea vs contact dermatitis, skin malignancies assoc w/metastatic ca, actinic keratosis, erythema migrans description, trichotillomania

Clinical characteristics of atopic dermatitis?

***exam

A
  • —Lichenification, papules, crust on flexor surfaces and cheeks common.
  • —Onset is typically in childhood usually improves with age
  • *if new onset n adult think of cancer
  • *if only one area: consider fungal
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43
Q

Exam: acne treatment, facial rashes, psoriasis vs eczema vs tinea vs contact dermatitis, skin malignancies assoc w/metastatic ca, actinic keratosis, erythema migrans description, trichotillomania

Differences in atopic dermatitis kids vs adults

***exam

A
  • 0-2yo: pruritic, red, scaly, and crusted lesions on the extensor surfaces and cheeks or scalp, sparing diaper area
  • 2-16yo: less exudation and often demonstrates lichenified plaques in a flexural distribution, especially of the antecubital and popliteal fossae, volar aspect of the wrists, ankles, and neck (“dirty neck”)
  • Adults: considerably more localized and lichenified. Skin flexures. Face, neck, and hands less frequently affected.
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44
Q

Exam: acne treatment, facial rashes, psoriasis vs eczema vs tinea vs contact dermatitis, skin malignancies assoc w/metastatic ca, actinic keratosis, erythema migrans description, trichotillomania

Treatment atopic dermatitis

A

—Topical steroids. Protopic/Elidel. Emollients/ lotions. Avoidance of triggers. Treatment of allergens.

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45
Q

Exam: acne treatment, facial rashes, psoriasis vs eczema vs tinea vs contact dermatitis, skin malignancies assoc w/metastatic ca, actinic keratosis, erythema migrans description, trichotillomania

Clinical characteristics of tinea versicolor?

***exam

A
  • —Caused by Malassezia yeast.
  • —Hyper or hypopigmented patches and plaques over sebaceous areas (Hypo more in darker skin, hyper/erythematous in lighter)
  • —Tends to relapse in hotter months or if sweating more
  • —Will relapse: natural yeast on body
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46
Q

Exam: acne treatment, facial rashes, psoriasis vs eczema vs tinea vs contact dermatitis, skin malignancies assoc w/metastatic ca, actinic keratosis, erythema migrans description, trichotillomania

Treatment for tinea versicolor

A

—Cotton t-shirts. Topical antifungals. Topical steroids. Oral antifungals. Ketoconazole or selsen shampoos.

can help with the skin coloring but can make worse

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47
Q

Exam: acne treatment, facial rashes, psoriasis vs eczema vs tinea vs contact dermatitis, skin malignancies assoc w/metastatic ca, actinic keratosis, erythema migrans description, trichotillomania

What is pityriasis rosea?

A
  • —A viral exanthem- exact virus unknown. Suspected HHV-7.
  • —Typically seen in young adults.
48
Q

Exam: acne treatment, facial rashes, psoriasis vs eczema vs tinea vs contact dermatitis, skin malignancies assoc w/metastatic ca, actinic keratosis, erythema migrans description, trichotillomania

Clinical characteristics of pityriasis rosea

A
  • —Starts as a large patch on the trunk called a herald patch with collarette scale then smaller patches and plaques appear on the trunk and out to the extremities .
  • Usually takes on a Christmas tree pattern.
  • Pruritic (often)
49
Q

Exam: acne treatment, facial rashes, psoriasis vs eczema vs tinea vs contact dermatitis, skin malignancies assoc w/metastatic ca, actinic keratosis, erythema migrans description, trichotillomania

Treatment of pityriasis rosea

A

—supportive. Will resolve in several months

50
Q
A

Cutaneous horn

Hyperkeratotic skin lesions that take a conical shape. Caused by DNA damage from sunlight, radiation, HPV.

51
Q

Exam: acne treatment, facial rashes, psoriasis vs eczema vs tinea vs contact dermatitis, skin malignancies assoc w/metastatic ca, actinic keratosis, erythema migrans description, trichotillomania

Significance of cutaneous horn

A
  • Often benign but can be a premalignant lesion or develop squamous cell carcinoma.
    • -20% of cases have squamous cell carcinoma
    • -when present on the penis up to 37% of cases have squamous cell carcinoma
52
Q

Exam: acne treatment, facial rashes, psoriasis vs eczema vs tinea vs contact dermatitis, skin malignancies assoc w/metastatic ca, actinic keratosis, erythema migrans description, trichotillomania

Treatment of cutaneous horn

A

Referral to derm - biopsy. If SCC in situ will remove and put stitches in, no further tx needed

may remove for cosmetic reasons/size

53
Q

Exam: acne treatment, facial rashes, psoriasis vs eczema vs tinea vs contact dermatitis, skin malignancies assoc w/metastatic ca, actinic keratosis, erythema migrans description, trichotillomania

What is actinic keratosis?

Clinical characteristics/progression

***exam

A

Pre-malignant condition characterized by scaly or crusty patches of skin over sun exposed areas. Start as flat scaly areas and progress to wart-like areas. Range between 2-6 mm in size. Caused by sun exposure.

54
Q

Exam: acne treatment, facial rashes, psoriasis vs eczema vs tinea vs contact dermatitis, skin malignancies assoc w/metastatic ca, actinic keratosis, erythema migrans description, trichotillomania

Treatment of actinic keratosis

A

Imiquimod, 5-FU, cryofreezing, topical diclofenac.

May need to biopsy to distinguish from SCC

55
Q

Exam: acne treatment, facial rashes, psoriasis vs eczema vs tinea vs contact dermatitis, skin malignancies assoc w/metastatic ca, actinic keratosis, erythema migrans description, trichotillomania

What is solar lentigo?

A

—Aka liver or age spot

—Hyperpigmentation from age and sun exposure

56
Q

Exam: acne treatment, facial rashes, psoriasis vs eczema vs tinea vs contact dermatitis, skin malignancies assoc w/metastatic ca, actinic keratosis, erythema migrans description, trichotillomania

Treatment for solar lentigo

A

—Treatment includes cryofreezing, hydroquinone, topical retinoids (all cosmetic)

Hydroquinone – works on area around lesion as well – may end up with lighter area around

57
Q

Exam: acne treatment, facial rashes, psoriasis vs eczema vs tinea vs contact dermatitis, skin malignancies assoc w/metastatic ca, actinic keratosis, erythema migrans description, trichotillomania

What is seborrheic keratosis?

Clinical characteristics/cause

A
  • —Noncancerous benign skin growth. More common in elderly. But still occur in the young
  • —No association with sun exposure
  • —Hyperpigmented papules with a warty and “stuck on” appearance.
  • —Cause is genetic.
58
Q

Exam: acne treatment, facial rashes, psoriasis vs eczema vs tinea vs contact dermatitis, skin malignancies assoc w/metastatic ca, actinic keratosis, erythema migrans description, trichotillomania

Treatment for seborrheic keratosis

A

—Treatment is cosmetic: excision, cryofreezing

59
Q

Exam: acne treatment, facial rashes, psoriasis vs eczema vs tinea vs contact dermatitis, skin malignancies assoc w/metastatic ca, actinic keratosis, erythema migrans description, trichotillomania

What is basal cell carcinoma?

clinical characteristics

***exam

A
  • —Skin cancer affecting the basal layer of the epidermis
  • —Classic is a pearly nodule with pedunculated center and telangectasia running through
60
Q

Exam: acne treatment, facial rashes, psoriasis vs eczema vs tinea vs contact dermatitis, skin malignancies assoc w/metastatic ca, actinic keratosis, erythema migrans description, trichotillomania

Treatment for basal cell carcinoma

A

—Moh’s surgery, excisional surgery, chemotherapy, radiation

  • Can cause serious problems, e.g., need for prosthetic replacement of part of face – treatment highly recommended*
  • Mohs surgery is a precise surgical technique used to treat skin cancer. During Mohs surgery, thin layers of cancer-containing skin are progressively removed and examined until only cancer-free tissue remains*
61
Q

Exam: acne treatment, facial rashes, psoriasis vs eczema vs tinea vs contact dermatitis, skin malignancies assoc w/metastatic ca, actinic keratosis, erythema migrans description, trichotillomania

What is squamous cell carcinoma?

clinical characteristics

***exam

A

—A skin cancer of the squamous cell of the epithelium.

Can have a variety of presentations:

  • —Common presentations: Firm red nodule, flat lesion with a scaly crust, a new ulceration in a scar or ulcer, rapidly expanding mole or keratotic lesion, change in mole color- especially varigation
  • —Non-healing ulcer without other probable cause (Marjolin’s ulcer)
  • —Bleeding or expanding lesion on the lip or mouth
62
Q

Exam: acne treatment, facial rashes, psoriasis vs eczema vs tinea vs contact dermatitis, skin malignancies assoc w/metastatic ca, actinic keratosis, erythema migrans description, trichotillomania

What is melanoma? Clinical characteristics

***exam

A
  • —Malignant cancer of the melanocytes
  • —Spreads rapidly
  • —Presents as a change in size, shape and color to an existing mole or new “lump” on the skin if nodular
  • —Use the ABCDE rule with E being evolving when evaluating moles
  • —Also can use the ugly duckling rule
  • Common in young adults too!
63
Q

Exam: acne treatment, facial rashes, psoriasis vs eczema vs tinea vs contact dermatitis, skin malignancies assoc w/metastatic ca, actinic keratosis, erythema migrans description, trichotillomania

Treatment for melanoma

***exam

A

—Refer promptly for excisional biopsy when suspected

refer if notice new mail under nailbed

64
Q

Exam: acne treatment, facial rashes, psoriasis vs eczema vs tinea vs contact dermatitis, skin malignancies assoc w/metastatic ca, actinic keratosis, erythema migrans description, trichotillomania

What is cutaneous lymphoma

***exam

A

Skin manifestation of lymphoma (cancer of the B and T lymphocytes)

-T- cell lymphoma may have the appears of atopic dermatitis without the distribution pattern, atopic history, or history of dermatitis in childhood. May also appear to be fungal disease.

65
Q

Exam: acne treatment, facial rashes, psoriasis vs eczema vs tinea vs contact dermatitis, skin malignancies assoc w/metastatic ca, actinic keratosis, erythema migrans description, trichotillomania

MGMT of suspected cuteneous lymphoma

A
  • Patients who do not respond to topical steroids, Elidel/Protopic should be referred to a dermatologist unless it is suspected that tinea was misdiagnosed.
  • -B-cell lymphoma may present as a tumor
  • -Treatment: Chemotherapy as directed by oncology
  • Reasonable to refer to derm immediately
66
Q

Exam: acne treatment, facial rashes, psoriasis vs eczema vs tinea vs contact dermatitis, skin malignancies assoc w/metastatic ca, actinic keratosis, erythema migrans description, trichotillomania

What is Keratoacanthoma?

A
  • —Pre-cancerous nodule, typically occurring on the leg (however some consider it to be a low grade SCC). 6% will become SCC if untreated. Primarily in elderly
  • —Domed shaped nodule with scale on top- grows rapidly.
  • Differentials include SCC and BCC
67
Q

Exam: acne treatment, facial rashes, psoriasis vs eczema vs tinea vs contact dermatitis, skin malignancies assoc w/metastatic ca, actinic keratosis, erythema migrans description, trichotillomania

Prognosis/mgmt of keratoacanthoma

A
  • —Many will regress on their own in 2 years
  • —Refer to dermatologist for treatment or to general surgeon for excision and biopsy if derm unavailable.
68
Q

Exam: acne treatment, facial rashes, psoriasis vs eczema vs tinea vs contact dermatitis, skin malignancies assoc w/metastatic ca, actinic keratosis, erythema migrans description, trichotillomania

What are fungating wounds?

A
  • Advanced breast, head and neck cancers, also labial cancers
  • Odorous, painful, highly exudative, bleed often
69
Q

Exam: acne treatment, facial rashes, psoriasis vs eczema vs tinea vs contact dermatitis, skin malignancies assoc w/metastatic ca, actinic keratosis, erythema migrans description, trichotillomania

mgmt of fungating wounds

A

usually advanced- palliative wound care. Target symptoms:

  • Odor: metrogel, ostomy bag over wound (open occasionally to let out gas)
  • Wound vac contraindicated in cancerous wounds
  • Bleeding: calcium algenate, silver nitrate to cauterize
  • Pain: typically opiate mgmt, lidocaine gel before irrigating
70
Q

Exam: acne treatment, facial rashes, psoriasis vs eczema vs tinea vs contact dermatitis, skin malignancies assoc w/metastatic ca, actinic keratosis, erythema migrans description, trichotillomania

What is a Nevus sebaceous?

A

-Congenital hairless plaque that starts off as smooth at birth. When the individual reaches puberty, the lesion increases in size and takes on a warty appearance. Found on scalp and face.

71
Q

Exam: acne treatment, facial rashes, psoriasis vs eczema vs tinea vs contact dermatitis, skin malignancies assoc w/metastatic ca, actinic keratosis, erythema migrans description, trichotillomania

Treatment for nevus sebaceous

A

Can be excised for cosmetic reasons. Controversial if it is associated with skin cancer (bcc and sebaceous carcinoma).

insurance will cover removal

72
Q

Exam: acne treatment, facial rashes, psoriasis vs eczema vs tinea vs contact dermatitis, skin malignancies assoc w/metastatic ca, actinic keratosis, erythema migrans description, trichotillomania

What is impetigo?

clinical characteristics

A
  • —Superficial staph (usually- rarely can be strep) infection involving the epidermis. Highly contagious. Can occur as a suprainfection from herpes or other lesions.
  • —Can start as vesicles. General appears as honey colored crusted scabs on the face, arms or legs.
73
Q

Exam: acne treatment, facial rashes, psoriasis vs eczema vs tinea vs contact dermatitis, skin malignancies assoc w/metastatic ca, actinic keratosis, erythema migrans description, trichotillomania

Treatment for impetigo

A
  • — Bactroban; if severe: oral antibiotic.
  • Topical before oral (e.g., keflex if not suspecting mrsa) but to avoid antibiotic resistance, prefer bactroban
  • In kids – probably safe to use keflex, in adults, more likely doxy or bactrim, but could start w/keflex
74
Q

Exam: acne treatment, facial rashes, psoriasis vs eczema vs tinea vs contact dermatitis, skin malignancies assoc w/metastatic ca, actinic keratosis, erythema migrans description, trichotillomania

Clinical characteristics of contact dermatitis?

***exam

A

—Inflammatory skin condition due to contact with a substance. May be irritant, allergic or photocontact.

—Lesions may be in the shape of the item in contact with the skin. May be erythematous, blisters, papules, wheals or plaques. Frequently pruritic.

75
Q

Exam: acne treatment, facial rashes, psoriasis vs eczema vs tinea vs contact dermatitis, skin malignancies assoc w/metastatic ca, actinic keratosis, erythema migrans description, trichotillomania

Common sources of allergic and irritant contact dermatitis

***exam

A

—Allergic: Commonly, poison ivy, nickel allergy, gold, balsam of peru.

—Irritant: Commonly acetone, alcohol, alkalies, ingredients in cosmetics.

76
Q

Exam: acne treatment, facial rashes, psoriasis vs eczema vs tinea vs contact dermatitis, skin malignancies assoc w/metastatic ca, actinic keratosis, erythema migrans description, trichotillomania

Treatment for contact dermatitis

***exam

A

Treatment: avoidance of offending agent. Topical steroids. Anti-histamines. Barrier creams

  • Barrier cream – e.g., if buttons on jeans are nickel and they still want to wear it.*
  • Oral vs topical steroid – if >10% of body can do oral*
77
Q

Exam: acne treatment, facial rashes, psoriasis vs eczema vs tinea vs contact dermatitis, skin malignancies assoc w/metastatic ca, actinic keratosis, erythema migrans description, trichotillomania

What is acne rosacea?

Clinical characteristics

***exam

A
  • —Chronic inflammatory condition involving facial erythema, telangectasias, nodules, and pimples
  • —May develop nodules or alterations to the shape of the nose over time (rhinophyma- example is Churchill)
  • —Many triggers
  • —May co-exist with seborrheic dermatitis and acne vulgaris
78
Q

Exam: acne treatment, facial rashes, psoriasis vs eczema vs tinea vs contact dermatitis, skin malignancies assoc w/metastatic ca, actinic keratosis, erythema migrans description, trichotillomania

how do distinguish acne rosacea from malar rash

***exam

A

A malar rash spares the nasolabial folds…

79
Q

Exam: acne treatment, facial rashes, psoriasis vs eczema vs tinea vs contact dermatitis, skin malignancies assoc w/metastatic ca, actinic keratosis, erythema migrans description, trichotillomania

Treatment of acne rosacea

***exam

A

—Metrogel, tetracycline abx, Azeleic acid, laser treatments, avoidance of triggers

  • New creams: alpha 2 antagonist – receptors in small blood cells of face constrict.
  • Oral tetracyclines: anti-inflammatory effect not antibacterial so they can take with food. Permanent tx unless woman of childbearing age
  • Can expect 15% reduction in erythema
80
Q

Exam: acne treatment, facial rashes, psoriasis vs eczema vs tinea vs contact dermatitis, skin malignancies assoc w/metastatic ca, actinic keratosis, erythema migrans description, trichotillomania

What is herpes zoster?

Clinical characteristics

A
  • —Viral disease characterized by a painful skin rash that follows a dermatome.
  • Starts as blood filled vescles that open and become scabs or crust.
  • This can frequently be mistaken for lumbago or a kidney stone prior to the emergence of the lesion if located on the low back.
  • —The virus lays dormant in nerves and will come out opportunistically when the immune system is down.
81
Q

Exam: acne treatment, facial rashes, psoriasis vs eczema vs tinea vs contact dermatitis, skin malignancies assoc w/metastatic ca, actinic keratosis, erythema migrans description, trichotillomania

Risks associated with herpes zoster

A
  • —May develop impetigo suprainfection. May have prodromal pain over the dermatome and post-herpetic neuralgia which can be permanent.
  • eye involved = herpes zoster ophthalmicus. Called Ramsay Hunt Syndrome.
  • May cause Bells Palsy if facial involvement.
82
Q

Exam: acne treatment, facial rashes, psoriasis vs eczema vs tinea vs contact dermatitis, skin malignancies assoc w/metastatic ca, actinic keratosis, erythema migrans description, trichotillomania

Preventing herpes zoster

A

—Vaccine is available for older adults to re-boost their immune system. Recommended now for age 50 and older. (40% of adults who get the vaccine may get shingles still though). Vaccination rates are low currently.

83
Q

Exam: acne treatment, facial rashes, psoriasis vs eczema vs tinea vs contact dermatitis, skin malignancies assoc w/metastatic ca, actinic keratosis, erythema migrans description, trichotillomania

Treatment for herpes zoster

A
  • —Oral Valtrex, Famvir, or acyclovir (watch kidney funtion w/acyclovir!)
  • One study suggests that oral acyclovir in combination with oral prednisone improves outcomes in patients over the age of 50. Analgesics.
  • Lidoderm patches as needed.
  • Bacitracin or bactroban topical as needed.
  • Lyrica, Tricyclics, or Neurontin as needed for post-herpetic neuralgia.
  • Immediate referal to eye doctor or ENT if eardrum or eye involvement.
84
Q

Exam: acne treatment, facial rashes, psoriasis vs eczema vs tinea vs contact dermatitis, skin malignancies assoc w/metastatic ca, actinic keratosis, erythema migrans description, trichotillomania

Degrees of burns

A
  • Superficial burn (1st degree)
  • Partial thickness burn (second degree)
  • Deep partial thickness burn (second degree burn)
  • Full thickness burn (3rd and 4th degree):
85
Q

Exam: acne treatment, facial rashes, psoriasis vs eczema vs tinea vs contact dermatitis, skin malignancies assoc w/metastatic ca, actinic keratosis, erythema migrans description, trichotillomania

When to send to ED for a burn

A

hemodynamically unstable,inhalation of smoke, infected

86
Q

Exam: acne treatment, facial rashes, psoriasis vs eczema vs tinea vs contact dermatitis, skin malignancies assoc w/metastatic ca, actinic keratosis, erythema migrans description, trichotillomania

When to refer to a burn center

A

over joint, face, groin, circumferential

87
Q

Exam: acne treatment, facial rashes, psoriasis vs eczema vs tinea vs contact dermatitis, skin malignancies assoc w/metastatic ca, actinic keratosis, erythema migrans description, trichotillomania

Common treatments for burns

A

Silvadene, Sulfamylon, Acticoat, Aquacel Ag, grafting, debridement, Santyl, MediHoney, hydrogels, xeroform, silver nitrate, acetic acid and bacitracin

88
Q

Exam: acne treatment, facial rashes, psoriasis vs eczema vs tinea vs contact dermatitis, skin malignancies assoc w/metastatic ca, actinic keratosis, erythema migrans description, trichotillomania

MGMT considerations for severe burns / electrical burns

A

Will need continued PT/OT to prevent contractures, will need compression wear (made Jobst- custom fitting needed) to decrease likelihood of hypertrophic scars. Individuals with electrical burns will need annual eye exams.

89
Q

Exam: acne treatment, facial rashes, psoriasis vs eczema vs tinea vs contact dermatitis, skin malignancies assoc w/metastatic ca, actinic keratosis, erythema migrans description, trichotillomania

Clinical characteristics of cellulitis

cause

A
  • —Local or diffuse infection of the dermal and/ or subcutaneous layer.
  • —Caused when bacteria enter through cracks in the skin. Most commonly caused by staph or strep A
90
Q

Exam: acne treatment, facial rashes, psoriasis vs eczema vs tinea vs contact dermatitis, skin malignancies assoc w/metastatic ca, actinic keratosis, erythema migrans description, trichotillomania

Treatment for cellulitis

A
  • —oral antibiotics if outpatient.
  • IV antibiotics inpatient.
  • Elevate legs. Moist heat.
  • If worsens outpatient, patient is extremely immunocompromised, large area of involvement, major temp, s/s of SIRS or necrotizing faciitis–> ER.
91
Q

Exam: acne treatment, facial rashes, psoriasis vs eczema vs tinea vs contact dermatitis, skin malignancies assoc w/metastatic ca, actinic keratosis, erythema migrans description, trichotillomania

What is Erysipelas?

Clinical characteristics

A
  • —A skin infection of the upper dermis caused by strep.
  • —Characterized by high fevers, chills, shaking, HA and malaise in the first 48 hours.
  • —Skin lesion is erythematous plaque that enlarges rapidly and has a sharply demarcated raised edge. It appears as a red, swollen, warm, hardened and painful rash with a peau d’orange appearance.
92
Q

Exam: acne treatment, facial rashes, psoriasis vs eczema vs tinea vs contact dermatitis, skin malignancies assoc w/metastatic ca, actinic keratosis, erythema migrans description, trichotillomania

Treatment for erysipelas

A

—PCN, clindamycin, erythromycin oral or IV.

93
Q

Exam: acne treatment, facial rashes, psoriasis vs eczema vs tinea vs contact dermatitis, skin malignancies assoc w/metastatic ca, actinic keratosis, erythema migrans description, trichotillomania

What is an abscess?

Clinical characteristics

A
  • —A collection of pus that accumulates in a cavity or cyst. Infectious process.
  • —Start as firm, red indurated area with warm with will progress to a flunctuant area that may open and drain. Typically will increase in size if untreated. If untreated can cause gangrene and necrosis.
  • —Typically caused by staph, if recurrent suspect MRSA. Take cultures to identify offending pathogen.
94
Q

Exam: acne treatment, facial rashes, psoriasis vs eczema vs tinea vs contact dermatitis, skin malignancies assoc w/metastatic ca, actinic keratosis, erythema migrans description, trichotillomania

Treatment of an abscess

A
  • —Treatment can consist of I&D alone. Will be packed after. Follow up should be planned for 2-3 days later.
  • Large abscess that are difficult to anesthesize should be referred to general surgery.
  • Deep abscesses that may extend to bone or organs should be sent to the ED.
  • —Initial antibiotics are only necessary in immunocompromised patients, MRSA colonized patients, elderly or with surrounding cellulitis.
  • To prevent recurrent: Hibiclens washes to decolonize MRSA, bactroban nasal
95
Q

Exam: acne treatment, facial rashes, psoriasis vs eczema vs tinea vs contact dermatitis, skin malignancies assoc w/metastatic ca, actinic keratosis, erythema migrans description, trichotillomania

What is hidradenitis suppurativa?

Clinical characteristics

A
  • —Disease of the apocrine glands resulting in the formation of large, sometimes painful, cysts or abscesses
  • —Distributed in axilla, groin, chest, breasts, inner thighs and buttocks
96
Q

Exam: acne treatment, facial rashes, psoriasis vs eczema vs tinea vs contact dermatitis, skin malignancies assoc w/metastatic ca, actinic keratosis, erythema migrans description, trichotillomania

Conditions/gender associated with hidradenitis suppurativa

A
  • —Associated with PCOS, hyperinsulinemia, obesity, genetic predispositions
  • —More common in females
97
Q

Exam: acne treatment, facial rashes, psoriasis vs eczema vs tinea vs contact dermatitis, skin malignancies assoc w/metastatic ca, actinic keratosis, erythema migrans description, trichotillomania

Treatment of hidradenitis suppurativa

A

Humira, Weight loss, work up for PCOS/ diabetes and treat, I&D of lesions, Doxycycline, corticosteroid injections, Hibiclens washes, split thickness grafts, spironolactone, metformin, exogenous extrogen

98
Q

Exam: acne treatment, facial rashes, psoriasis vs eczema vs tinea vs contact dermatitis, skin malignancies assoc w/metastatic ca, actinic keratosis, erythema migrans description, trichotillomania

What is erythema nodosum

clinical characteristics

A
  • —An inflammation of the fat cells.
  • —Tender red nodules on the skin- typically the lower extremities.
  • Typically resolves in 3-6 weeks.
99
Q

Exam: acne treatment, facial rashes, psoriasis vs eczema vs tinea vs contact dermatitis, skin malignancies assoc w/metastatic ca, actinic keratosis, erythema migrans description, trichotillomania

Causes of erythema nodosum

A
  • —30-50% idiopathic
  • —Hepatitis C
  • —TB
  • —Strep infection (anywhere on the body- not of the skin)
  • —Sarcoidosis
  • —Behcet’s disease
  • —Other autoimmune diseases
100
Q

Exam: acne treatment, facial rashes, psoriasis vs eczema vs tinea vs contact dermatitis, skin malignancies assoc w/metastatic ca, actinic keratosis, erythema migrans description, trichotillomania

Work up and treatment for erythema nodosum

A
  • —ESR
  • —Antistreptolysin O
  • —UA
  • —Throat culture
  • —CXR
  • —ANCA
  • —PPD or TB gold
  • —RF
  • —ANA
  • —Treatment: treat underlying cause. Supportive therapy
101
Q

Exam: acne treatment, facial rashes, psoriasis vs eczema vs tinea vs contact dermatitis, skin malignancies assoc w/metastatic ca, actinic keratosis, erythema migrans description, trichotillomania

What is Alopecia areata?

A

-Autoimmune disorder causing round patches of hairloss.

102
Q

Exam: acne treatment, facial rashes, psoriasis vs eczema vs tinea vs contact dermatitis, skin malignancies assoc w/metastatic ca, actinic keratosis, erythema migrans description, trichotillomania

Treatment for alopecia areata

A

Topical and injectable corticosteroids, minoxidil, UV light therapy, use of wigs.

103
Q

Exam: acne treatment, facial rashes, psoriasis vs eczema vs tinea vs contact dermatitis, skin malignancies assoc w/metastatic ca, actinic keratosis, erythema migrans description, trichotillomania

What is Telogen effluvium

causes

A
  • —Hair loss result from the hair follicle entering the telogen phase early
  • —Cause is usually a physiologic or psychologic stress to the body
    • viral infections, pregnancy, extreme dieting, malnutrition, chronic illness, hypothyroidism, anemia, depression, anxiety, fever or anemia.
104
Q

Exam: acne treatment, facial rashes, psoriasis vs eczema vs tinea vs contact dermatitis, skin malignancies assoc w/metastatic ca, actinic keratosis, erythema migrans description, trichotillomania

Treatment of telogen effluvium

A

—treat the underlying cause. Can also use minoxidil.

105
Q

Exam: acne treatment, facial rashes, psoriasis vs eczema vs tinea vs contact dermatitis, skin malignancies assoc w/metastatic ca, actinic keratosis, erythema migrans description, trichotillomania

What is Androgenic/ androgenetic hair loss?

A
  • —AKA male pattern baldness
  • —Occurs in men and women
  • —Hair loss begins at temples and also at the crown of the head
106
Q

Exam: acne treatment, facial rashes, psoriasis vs eczema vs tinea vs contact dermatitis, skin malignancies assoc w/metastatic ca, actinic keratosis, erythema migrans description, trichotillomania

Treatment for androgenic/androgenetic hair loss

males and females

A
  • —Treatment in males includes: minoxidil, finasteride, dusateride and hair transplant.
  • —Treatment for women: work up for PCOS, minoxidil, spironolactone, exogenous estrogen.
107
Q

Exam: acne treatment, facial rashes, psoriasis vs eczema vs tinea vs contact dermatitis, skin malignancies assoc w/metastatic ca, actinic keratosis, erythema migrans description, trichotillomania

What is Trichotillomania?

***exam

A

—Disorder characterized by a compulsive urge to pull out one’s own hair. Usually rooted in an anxiety disorder.

—Usually starts before the age of 17

108
Q

Exam: acne treatment, facial rashes, psoriasis vs eczema vs tinea vs contact dermatitis, skin malignancies assoc w/metastatic ca, actinic keratosis, erythema migrans description, trichotillomania

Treatment for trichotillomania

***exam

A

—Treatment includes SSRIs, benzodiazepines, behavior modification therapy

109
Q

Exam: acne treatment, facial rashes, psoriasis vs eczema vs tinea vs contact dermatitis, skin malignancies assoc w/metastatic ca, actinic keratosis, erythema migrans description, trichotillomania

What is Scarring alopecia?

A
  • —Hair loss that occurs when the follicle is destroyed and replaced by collagen (scar).
  • —May be primary (lymphocytic or neutrophilic) or secondary.
  • —Secondary cause: traction alopecia, lupus, scleroderma
110
Q

Exam: acne treatment, facial rashes, psoriasis vs eczema vs tinea vs contact dermatitis, skin malignancies assoc w/metastatic ca, actinic keratosis, erythema migrans description, trichotillomania

Diagnostic work up for scarring alopecia

A

—history, physical, biopsy, RF, ANA, ESR.

111
Q

Exam: acne treatment, facial rashes, psoriasis vs eczema vs tinea vs contact dermatitis, skin malignancies assoc w/metastatic ca, actinic keratosis, erythema migrans description, trichotillomania

Treatment of scarring alopecia

A

—Treatment (depends on subtype):

  • —Seconday
    • —Treat the cause
  • —Primary (refer to derm)
    • —Topical steroids (lymphocytic)
    • —Elidel/Protopic (Lymphocytic)
    • —Cellcept (Lymphocytic)
    • —Plaquenil (Lymphocytic)
    • —Doxycycline (lymphocytic or neutrophilic)
    • —Antibiotics (neutrophilic)
    • —Retinoids (neutrophilic)
112
Q

Exam: acne treatment, facial rashes, psoriasis vs eczema vs tinea vs contact dermatitis, skin malignancies assoc w/metastatic ca, actinic keratosis, erythema migrans description, trichotillomania

What is Dissecting cellulitis of the scalp?

Who does it affect?

A
  • A type of primary neutrophilic scarring alopecia. Chronic perifollicular pustules, nodules, cysts on the scalp than result in scaring and alopecia
  • areas of fluctuance, pustules, and nodules on the scalp. Depending on how long they have had it, you may see scars and alopecia.
  • -Primarily affects men of African descent in the 2nd-4th decades of life
  • -Cause not clearly known
113
Q

Exam: acne treatment, facial rashes, psoriasis vs eczema vs tinea vs contact dermatitis, skin malignancies assoc w/metastatic ca, actinic keratosis, erythema migrans description, trichotillomania

Work up and treatment of dissecting cellulitis of the scalp

A
  • Work up: Take culture if open lesion present
  • -Treatment includes: Oral retinoids (Accutane), tetracycline antibiotics, infliximab, surgical excision
114
Q

Exam: acne treatment, facial rashes, psoriasis vs eczema vs tinea vs contact dermatitis, skin malignancies assoc w/metastatic ca, actinic keratosis, erythema migrans description, trichotillomania

What is traction alopecia?

A
  • A type of secondary scarring alopecia caused by pulling forces or traction.
  • Key is history- ask about recent hairstyles.
  • Common culprits: ponytails, braids, barrettes, hair weaves
115
Q

Exam: acne treatment, facial rashes, psoriasis vs eczema vs tinea vs contact dermatitis, skin malignancies assoc w/metastatic ca, actinic keratosis, erythema migrans description, trichotillomania

Treatment of traction alopecia

A

Stop the cause (ie change the hairstyle). Hair transplant for permanent loss.

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