Derm Flashcards

Question

How does psoriasis present?

Answer 1

* 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.

Answer 2

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

Answer 3

* **Topical corticosteroids, dovonex, protopic.** * * If extensive- biologics like **Remicaid** and **Humira** * **Methotrexate**: particularly in psoriatic arthritis * can cause fibrosis in lungs, issues with liver * 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 -If COPD/asthma is risk benefit analysis bc psoriasis is worse at the end w ICS

Answer 4

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

Answer 5

women more than men (10:1) Occurs more frequently around and after menopause

Answer 6

* 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 * -Can be a plaque. - Can be pain/itching. - Uncircumsized male can get phimosis. * In men, may develop into phimosis (tight foreskin can't be pulled back over the head of the penis)

Answer 7

High potency topical steroids (Clobetasol) educate pt to watch out for yeast infections

Answer 8

Yeast infection in skin folds caused by excess moisture More common in obesity, diabetes, and with advanced age Yeast infection to the skin -Yeast in skin + excess moisture + diabetes (high glucose w issues of immune) – yeast overgrowth = infection

Answer 9

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

Answer 10

Avoidance of moisture. Antifungals. Nystatin powder, Desitin cream (zinc oxide) Interdry-ag is a textile with silver component but is very expensive * -Textile – interdry Ag – keeps skin dry with silver component but expensive . - Tx: lotrimin (anti fungal) Lotrisone, Nystatin. - Very severe and topical not working – go with oral nystatin

Answer 11

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

Answer 12

\* pruritic \* planar \* purple \* polygonal \* papules and plaques are additionally well-defined

Answer 13

\* Oral and topical steroids \* Protopic or Elidel \* Phototherapy \* Oral retinoids tends to be difficult to treat

Answer 14

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

Answer 15

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

Answer 16

Topical antifungals. Topical steroids. Protopic.

Answer 17

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

Answer 18

* Lichenification (hardened), 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

Answer 19

* **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 (palm/sole) aspect of the wrists, ankles, and neck ("dirty neck") * **Adults**: considerably more localized and lichenified. Skin flexures. Face, neck, and hands less frequently affected.

Answer 20

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

Answer 21

* 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

Answer 22

Cotton t-shirts. Topical antifungals. Topical steroids. Oral antifungals. Ketoconazole or selsen shampoos. can help with the skin coloring but can make worse Prevention: dose of conazole per month, steroid cna help get rid of pigmentation

Answer 23

* A viral exanthem- exact virus unknown. Suspected HHV-7 (human herpes virus -7). * Typically seen in young adults.

Answer 24

* 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)

Answer 25

supportive. Will resolve in several months

Answer 26

* Cause: hyperkeratoic skin lesion = conical shape * Caused by DNA damage from sunlight, radiation, HPV * Benign but premalignant 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

Answer 27

Referral to derm - biopsy. If SCC in situ will remove and put stitches in, no further tx needed may remove for cosmetic reasons/size

Answer 28

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.

Answer 29

Imiquimod, 5-FU, cryofreezing (Common in derm), topical diclofenac (NSAID). May need to biopsy to distinguish from SCC Side note: diclofenac NSAID used for migraines, OA, or RA

Answer 30

Aka liver or age spot Hyperpigmentation from age and sun exposure

Answer 31

Treatment includes cryofreezing, hydroquinone, topical retinoids (all cosmetic) ## Footnote *Hydroquinone – works on area around lesion as well – may end up with lighter area around*

Answer 32

* 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.

Answer 33

Treatment is cosmetic: excision, cryofreezing

Answer 34

* Skin cancer affecting the basal layer of the epidermis * Classic is a pearly nodule with pedunculated center and telangectasia running through -- indented in the middle and can ulcer over time Note: telangectasia = dilation of the capillaries, which causes them to appear as small red or purple clusters, often spidery in appearance, on the skin or the surface of an organ.

Answer 35

Moh’s surgery, excisional surgery, chemotherapy(less), radiation (more) ## Footnote * Can cause serious problems, ex.) 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*

Answer 36

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 ANY AREA LIP – BLEEDING EXPENDING - doesn’t look like sore = painless ulcer w middle age older = SCC!

Answer 37

* 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! This is the most dangerous skin cancer = Malignant!!! - greater than 6 mm, and can be under the nail!

Answer 38

Refer promptly for excisional biopsy when suspected refer if notice new mail under nailbed

Answer 39

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.

Answer 40

* 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 B cell – tumor T cell – looks like atopical dermatitis ----- new in adult bc adults normally don’t get atopical derm and get area that is not topical like shin, leg , top of head - Start in derm. - Had lesion not responding, that would send derm to rule out T cell lymphoma

Answer 41

* 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

Answer 42

* Many will resolve on their own in 2 years * Refer to dermatologist for treatment or to general surgeon for excision and biopsy if derm unavailable.

Answer 43

\* Advanced breast, head and neck cancers, also labial cancers \* Odorous, painful, highly exudative, bleed often pallative care!

Answer 44

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

Answer 45

-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. Mostly in teenager - Skin colored, at puberty, get warty looking - Controversial whether it will become bcc. - Up to them if they want it removed for cosmetic reasons or prophylactic

Answer 46

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

Answer 47

* 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.

Answer 48

* **Bactroban cream**; 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

Answer 49

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.

Answer 50

Allergic: Commonly, poison ivy, nickel allergy, gold, balsam of peru. Irritant: Commonly acetone, alcohol, alkalies, ingredients in cosmetics.

Answer 51

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* More than 10% - taper of oral w poision ivy Exzema – no oral steroid bc there is cycle w long term use steroids Psorasis – never steroids

Answer 52

* 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

Answer 53

A malar rash spares the nasolabial folds...

Answer 54

**Metrogel**, **tetracycline** abx, **Azeleic** acid, laser treatments, avoidance of triggers * New creams: alpha 2 antagonist – receptors in small blood cells of face constrict. Less than 10% have rebound erythema at end of 12 hour. **Topical ivermectin** - parasite overgrown in patients with rosacea. * **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

Answer 55

* Viral disease = painful skin rash that follows a dermatome. * Starts as blood filled vescles that open and become scabs or crust. * Commonly 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. ex.) tounge, eye, ears, back

Answer 56

* 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. * Trigeminal nerve = oph referral ASAP bc eye * ear = ENT right away bc permanent hearing loss

Answer 57

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.

Answer 58

* **Oral Valtrex, Famvir, or acyclovir** (watch kidney funtion w/acyclovir!) * oral acyclovir in combination with prednisone improves outcomes in 50 +. * Lidoderm patches as needed. Bacitracin or bactroban topical as needed. * **Lyrica, Tricyclics, or Neurontin** as needed for post-herpetic neuralgia. * Immediate referal to eye or ENT if eardrum or eye involvement. - Acycolvir – watch kidney function - HIV – anti retro viral – will get shingles bc immune reconstitution syndrome - Call ID or possibly hospitalized - Check for rash w kidney stone

Answer 59

* Superficial burn (1st degree) * Partial thickness burn (second degree) * Deep partial thickness burn (second degree burn) * Full thickness burn (3rd and 4th degree)

Answer 60

hemodynamically unstable, inhalation of smoke, infected

Answer 61

over joint, face, groin, circumferential

Answer 62

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

Answer 63

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.

Answer 64

\* 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**

Answer 65

* 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 (systemic inflammatory response syndrome) or necrotizing faciitis * --\> ER.

Answer 66

* 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.

Answer 67

PCN, clindamycin, erythromycin oral or IV.

Answer 68

* 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. * Increase in size if untreated. If untreated can cause gangrene and necrosis. * Typically caused by staph, if recurrent suspect MRSA.

Answer 69

* 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

Answer 70

* Disease of the apocrine glands resulting in the formation of large, sometimes painful, cysts or abscesses * In axilla, groin, chest, breasts, inner thighs and buttocks

Answer 71

\* Associated with PCOS, hyperinsulinemia, obesity, genetic predispositions More common in females

Answer 72

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

Answer 73

\* An inflammation of the fat cells. \* Tender red nodules on the skin- typically the lower extremities. \* Resolves in 3-6 weeks.

Answer 74

* 30-50% idiopathic * Hepatitis C * TB * Strep infection (anywhere on the body- not of the skin) * Sarcoidosis ( growth of tiny collections of inflammatory cells (granulomas) in different parts of your body — most commonly the lungs) * Behcet’s disease (inflammation in blood vessels) * Other autoimmune diseases

Answer 75

* ESR \* * Antistreptolysin O - determine whether a recent strep inf w/ group A Strep * **UA \* Throat culture \* CXR** * **ANCA** - antineutrophil cytoplasmic antibodies (check autoimmune dz) * PPD or TB gold * **RF** - rheumatoid factor (RF) test is primarily used to help diagnose rheumatoid arthritis * ANA * **_Treatment_**: treat underlying cause. Supportive therapy

Answer 76

-Autoimmune disorder causing round patches of hairloss.

Answer 77

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

Answer 78

* Hair loss result from the hair follicle entering the telogen phase early * Cause = physiologic or psychologic stress to the body * viral infections, pregnancy, extreme dieting, malnutrition, chronic illness, hypothyroidism, depression, anxiety, fever or anemia.

Answer 79

treat the underlying cause. Can also use minoxidil.

Answer 80

\* AKA male pattern baldness \* Occurs in men and women \* Hair loss begins at temples and also at the crown of the head

Answer 81

\* Treatment in **males**: minoxidil, finasteride, dusateride and hair transplant. \* Treatment for **women**: work up for PCOS, minoxidil, spironolactone, exogenous estrogen.

Answer 82

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

Answer 83

Treatment includes SSRIs, benzodiazepines, behavior modification therapy

Answer 84

\* 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 scleroderma = (systemic sclerosis, is a chronic connective tissue dz,autoimmune rheumatic = hardening/tightening of skin)

Answer 85

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

Answer 86

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)

Answer 87

* 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. * Men of African descent in the 2nd-4th decades of life 20s-40s * Cause not clearly known

Answer 88

\* Work up: Take culture if open lesion present Treatment includes: Oral retinoids (Accutane), tetracycline antibiotics, infliximab, surgical excision

Answer 89

\* 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

Answer 90

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

Answer 91

Hyperkaratotic skin lesions that take conical shape. Caused by DNA Damange from sunlight, radiation, HPV.

Answer 92

Treatment: Excision, Moh’s surgery, electrosurgery, cryosurgery, radiation, 5-FU (Efudex), Imiquimod (Aldara).