Derm Flashcards
1
Q
cutaneous malignancies
A
all dermal malignancies occur more frequenstly in those iwth pale skin on more sun-exposed areas. diagnosis is by biopsy and the treatment is with surgical removal. no form of skin cancer has effective chemo
2
Q
skin cancer
A
more sun=more cancer
biopsy
remove
3
Q
Malignant Melanoma
overview
A
although melanoma occurs more frequently in sun-exposed areas, it is not exclusive to those areas. since there are many benign skin lesions, the main question is one of diagnosis.
4
Q
cutaneous malignancies
list
A
malignant melanoma
scc
bcc
kaposi sarcoma
actinic keratoses
seborrheic keratoses
5
Q
worse prognostic significance
A
growing lesions
6
Q
Malignant Melanoma is best disgnosed clinically by
A
ABCDE
asymmetry border irregularity color irregularitis diameter greater than 6 mm evolution
7
Q
the diagnosis for any suspicious lesion
A
is by biopsy taht includes the entire lesion if possible
8
Q
Benign lesions
A
round
even borders
color even spread
diamter constant
9
Q
malignant lesions
A
asymmetric
borders uneve
color uneven
diameter increases
10
Q
Malignant Melanoma
diagnostic test
A
full thickness biopsy is indispensible in diagnosis.do not do a shave biopsy
11
Q
Malignant Melanoma
treatment/ prognosis
A
surgical removal must include a significant removal of normal skin surrounding the lesion. interferon injection is helpful in widespread siease. melanoma has a strong tendency to metastasize to the brain
12
Q
Squamos Cell Cancer
A
besides sunligh, scc is geratly increased by organ tranplant secondar to the long-term use of immunosuppressive drugs. all forms of scc start out by looking like and ulcer htat does notheal or continues to grow
biopsy and remove
13
Q
Basal Cell Carcinoma
A
BCC is the omst common form of skin cancer. the question will describe a waxy lesion that is shiny like a pearl. unlike melanoma, wide margins are not necesary, shave biopsy is a fine way to make the diagnosis. recurrence rates are less than 5%. bcc is a good use of Mohs micrographic surgery
14
Q
Mohs Micrographic surgery
A
removal of skin cancer under a dissecting mocroscope with immediate frozen section is one of the most precise methods of treateing skin cancer. mohs allows removal of the skin cancer witht he loss of only the smallest amoutn of normal tissue. under microscopy, very thin slices of ksin are removed and examined by frozen section for cancer. you can stop resecting as soon as the margin is cancer-free. in other owrds, there is no need to remove a wide margin routinely.
15
Q
most is best for
A
delicate areas like the eyelid or ear
16
Q
Kaposi Sarcoma
A
in the past, kaposi, sarcoma was seen in older men of mediterranean origin. the omst common cause now is AIDS. it is from human herpes virus 8, which is oncogenic. the lesion is more reddish/purplish because it is more vascular than other forms of skin cancer. KS is also found in the GI tract and in the lung. only aids acquired thorugh secual cantact is associated with KS, aids from injection is rarely assocaited with KS
17
Q
bcc is very
A
slow to grow and is not hyperpigmented
18
Q
ks occurs in aids pts with cd4 count
A
<100
19
Q
KS
treatment
A
unlike other skin cancers, ks is not routinely treated with surgical removal
- treate the aids with antiretroviral and hte majority of ks will disappear as the cd4 count improves
- intralesional injections of vincristine or interferone are very successful
- if these fail, use choemtherapy with liposomal doxorubicin
20
Q
Actinic Keratoses
A
Premalignant lesions from high-intenstiy sun exposure in fari skinned people. tehy have a very samll risk of scc for each individual lesion. since many can occur in a single person the risk is sumculative and significant.
21
Q
Actinic Keratoses
treatment
A
they are slow to progress, butmust be removed with curettage, crytherapy, laser,or topical 5-flurouracil before they transform. the loal immunostimulatn imiquimod is also effectivve
22
Q
what is imiquimod used for
A
Actinic Keratoses
molluscum contagiosum
condyloma acuminatum
23
Q
Seborrheic Keratoses
A
these lesions are extrmely common in the elderly. they are hpyerpigmented lesions commonly referred to aliver spots. they give a stuck on appearance. although they may look like melanoma to some people , Seborrheic Keratoses have no premalignant potention they do not transfrom into melanoma.
24
Q
Seborrheic Keratoses
treatment
A
cryotherapy, surgery, or laser for cosmetic reasons
25
Atopic Dermatitis
common skin disorder associated with overactivity of mast cells and the immune system. look for a history of:
asthma
allergic rhinitis
family hx of atopic disorders
onset before age 5, very rare to start after age 30
26
Atopic Dermatitis
presentation
bc of premature and idiosyncratitic release of transmitters such as histamine, pruritus and scratching is the most common presentation. scratching leads to scaly rpugh areas of thisckened skin on the face, neck, and skin folds of the popliteal area behindthe knee
27
Atopic Dermatitis
itching
leads to scratching. scratching leads to more itching, superficial infections from staph are common bc microrganisms are driven under the epiermis by scratching. this, in turn, leads to more itching
28
skin that has thickened bc of scrathicn and drying is describes as
lichenified
29
do food allergies exacerbated Atopic Dermatitis
no
30
IgE levelsare elevatedin
atopic dermatitis
31
Atopic Dermatitis
treatment: skin care
stay moisturized: dry skin is more itchy. use a humidifier, especially in the winter. use skin moisturizers more frequently. less itching=less scratching=less itching
avoid bathing, soap, and washcloths. the skin in Atopic Dermatitis is hyperirritable. brushes, washclothes, hot water, and anythign rhat rubs on the skin, evn if minimal can make it worse
cotton is less irritating to skin than wool.
32
Atopic Dermatitis
topical corticosteroids
used in flares of disease. oral steroids are used only int eh most severe acute flares of disease
33
Atopic Dermatitis
tacrolimus and pimecrolimus
t cell inhibiting agents that provide longer-term control andhelp get the pt off steroids. they are used systemically in organ tranplant recipients to prevent organ rejection and keep ots off steroids. they are used topically or atopic dermatitis bc this disorder is a form of immune system hyperactivity.
34
Atopic Dermatitis
antihistamines
mild disease: nonsedating (cetirizine, fexofenadine, loratadine)
severe disease: hydrozyine, benadryl, doxepine
35
Atopic Dermatitis
antibiotics
cephalexin, mupirocin, retapamulin when impetigo occurs
36
Atopic Dermatitis
uv light
for severe recalcitrant disease
37
tacromlimus and pimecrolimus are rarely associated with
developing lymphoma
38
two derm disease with complex knowledge bases
eczema and psoriasis, everthing else is about 2 sentences long
39
Psoriasis
incredibly common with about 2 million people in the us have it
40
Psoriasis
presentation
characterized by silver, scaly plaques that are not itchy most of the time.less than 10% have arthritis. extensive disease is associated with depression
41
Psoriasis
treatment of local disease
1. topical high ptoency steroids: fluocinonide, triamcinolone, betamethasone, clobetasol
2. vit a and d ointment help get the pt off steroids. the vit d agent is calcipotriene. steroids cause skin atrophy
3. coal tar preaparation
4. pimcrolums and tacrolimus are used on more delicate areas such as the face and penic. they are an alternative steroids and are less potentially deforming
42
steroids cause atrophy of skin bc
they inhibit collagen formation and growth, they try and convert all amino acids into glucose for gluconeogensis
43
Psoriasis
treatment of extensive disease
1. uv light
2. antitumor necrosis factor (TNF) inhibitors (etanercept, adalimumab, infliximab). these agents can be miraculous in efficacy for svere disease
3. methotrexate: used last bc of adverse effects on the liver and lung, it is a drug of last reosrt except for psoriatic arthritis
44
tnf inhibitors can activate
tb so screen with a ppd prior to useing them
45
Pityriasis Rosea
idiophatic, tansient dermatitis that starts out with a single lesion (herald patch) adn then disseminates. it can look like secondary syphilis but is pares the palms and soles. it is transietn, but if sypmtomatic it is treated with steroids or uv light
diffuse erythematous largely macular lesions
46
Seborrheic dermatitis (dandruff)
seborrheic dermattisi is a hypersensitivity reaction to a derma infection with nonvinasive dematophye organisms. this is why both topical steroids (hydrocortisone, alclometason) and antifungal agents (ketoconazole) are useful.
47
Seborrheic dermatitis (dandruff)
is increased in
aids
parkinson disease
48
the term seborrheic is synonymous with
benign
49
Blistering Diseases
pemphigus vulgaris
bullous pemphigoid
poephyria cutanea tarda
50
Pemphigus Vulgaris
etiology
although idiopathic, associate with:
ace inhibitors
penicillamine
phenobarbital
penicillin
51
Pemphigus Vulgaris
patho
autoantiboides split the epidermis resulting in:
bullae that easily rupture bc they are thin walled
involvemnt of the mouth
fluid loss and infection if widespread, they act like a burn
52
Pemphigus Vulgaris
most characteristic finding
nikolsky sign - the loss of denuding of skin from just mild pressure. it is the removal of the superficial layer of skin in a single sheet while pulling on it with afiners worth of pressure
53
Pemphigus Vulgaris
most accurat diagnostic test
biopsy showing antibodies on immunofluorescent studies
54
Pemphigus Vulgaris
treatment
1. systemic steroids (prednisone)
2. azathioprine or mycophenolate to wean the pt off steroids
3. rituximab (anti-cd20 antibodies) or IVIG in refractory cases
55
w/o treatment Pemphigus Vulgaris
is fatal
56
Bullous Pemphigoid
bullae stay intact and there is less loss of fluid and infection
mouth involvement is uncommon
not as severe as pemphigus
57
Bullous Pemphigoid
most accurate test
biopty with immunofluirescent stains
58
Bullous Pemphigoid
best initial therapy
prednisone. to get pts off streoids, use azathioprine, cyclophosphamide, or mycophenolate
59
Bullous Pemphigoids
mild
responds to erythromycin, dapsone, and nictoineamide (not niacin)
60
nikolsky sign is absent in
Bullous Pemphigoid
61
Porphyria Cutanea Tarda
a lbistering skin disease of skin exposed areas in those with a hx of:
```
liver disease (hep c or alcoholism)
estrogen use
iron overload (hemochromatosis)
```
62
most frequently test assocaiton with Porphyria Cutanea Tarda
hep c
63
Porphyria Cutanea Tarda
look for involvement of the
backs of the hands and the face
64
Porphyria Cutanea Tarda
diagnostic tests
most accurate is increased uroporphytins in a 24 hour urine collection
65
Porphyria Cutanea Tarda
treatment
it is a deficiecny or uroporphyrin decaroxylase activity, correct the underlying cause (stop alcohol or estrogens) and remove iron with phlebotomy
66
Porphyria Cutanea Tarda is a hypersensitivity
of the skin to abnormal oprphyrins when they are exposed to light
67
Skin infections
impetigo
erysipelas
cellulitis
folliculitis, furuncles, carbuncles
fungal
68
impetigo
the most superficial of the bacterial skin infections. staph and stre invade the epidemris, resulting in weeping, crusting, oozing, and draining of the skin
69
impetigo
treatment: mild disease
mupirocin
retapamulin
bacitracin
70
impetigo
treatment: severe disease
oral agents
dicloxacillin or cephalexin
71
impetigo
treatment for community-aquired MRSA
doxycycline
clindamycin
bactrim
72
Erysipelas
more severe than imptetigo bc it occurs at a deper level in the skin. more often from strep than staph. invades the dermal lymphatics and causes bacteremia, leukocytosis, fever, and chills. untreated can be fatal
73
Erysipelas
presentation
look for a bright, red, hot, swollen lesion on the face. leukocysotis can occur bc it is more often a systemic disease.
74
Erysipelas
treatment: overall
although it is more often from strep you must cover for staphy unless you have a culture
75
Erysipelas
treatment: midl disease
use oral meds
dicloxacillin, cephalexin, cefadroxyl
penicllin allergi: erythromycin, clarithromycin, or clindamycin
mrsa: doxy, clinda, bactrim
76
Erysipelas
treatment: severe disease (fever present)
use iv meds
oxacillin, nafcillin, cefazolin
penicillin allergic: clindamycin, vanco
mrsa: vvanco, linezolid, daptomycin, tigecycline, ceftarolined
77
skin infections with group a beta hemolytic strep can cause glomerulonephritis but not
rhuematic fever
78
cross rxn between penicillins and cephalosporings is
less than 5%
79
with Erysipelas they will test
route of administration, they will test this wth all things
80
Cellulitis
an infection of the soft tissue of the skin. it extends from the dermis into the subutaneous tissue. the skin is warm, red, swollen, and tender. Cellulitis inovles the legs more often thean the arms. it does not have collections of walled off infection; taht is an abscess. cellulitis is not only at the hair follicle; that is folliculitis, furuncles, and carbuncles
81
cellulitis
diagnostic tests
no diagnositic testing is needed to establish a diagnosis of celluilitis. the most accurates test is to inject sterile saline into the skin and apsirate it for culture. the yield is only 20%. staph is much more common than strep
82
antistaphylococcal penicllins
ox
clox
diclox
nag
83
Cellulitis
treatment
same as erysipelas
mild disease:
use oral meds
dicloxacillin, cephalexin, cefadroxyl
penicllin allergi: erythromycin, clarithromycin, or clindamycin
mrsa: doxy, clinda, bactrim
Severe disease
use iv meds
oxacillin, nafcillin, cefazolin
penicillin allergic: clindamycin, vanco
mrsa: vvanco, linezolid, daptomycin, tigecycline, ceftaroline
84
why wont topicals cover MRSA
the infection is below the deraml/epidermal junction and topical antibiotics will not reach it
85
Folliculitis, Furuncles, Carbuncles
these infections originate around hair follicles. the different terms do not have precise definitions, and there is no cutoff poin in size that distinguishes them from one another
86
skin infectino is cause by
staph aureus not s epidermids bc it lives on the skin as part of the normal flora
87
Folliculitis, Furuncles, Carbuncles
size of the infection
folliculitis is the earliest and mildest
furuncles is a small abscess or collection of infected material
a carbuncle is a collection of furuncles
88
Folliculitis, Furuncles, Carbuncles
severe disease=
fever, chills, bacteremia
89
Folliculitis, Furuncles, Carbuncles
treatment
same as erysipelas
mild disease:
use oral meds
dicloxacillin, cephalexin, cefadroxyl
penicllin allergi: erythromycin, clarithromycin, or clindamycin
mrsa: doxy, clinda, bactrim
Severe disease
use iv meds
oxacillin, nafcillin, cefazolin
penicillin allergic: clindamycin, vanco
mrsa: vvanco, linezolid, daptomycin, tigecycline, ceftaroline
90
cellulitis is
bright red, warm and tender.ther is no weeping of purulent aterial as occurs in impetigo
91
ceftarolin=
only cephalosporin that covers MRSA
92
Penicillin Allergy
if the reation is just a rash
use cephalosporing
93
Penicillin Allergy
if the rection is a anaphylaxis
mild infetion: macrolides, clindamycin, doxycycline, or Bactim
severe infection: vancomycin, linezolid, daptomycin, tigecycline, or ceftaroline
94
medications that cover staph but are not speifice for skin infections
second gen cephalosporins (defoxitin, cefotetan, cefuroxime)
beta lactam/beta lactamase combos
amox/clavulanate
ticarcillin/clavulanate
ampicillin/sulfbactam
piperacilin/tazobactam
these meds are not used for first line agents for skin infections bc they would be considred excessive in terms of specturm. they are cover more than is necesary. however, if the pt is alread on one of these medications, you do not need to add anythign to cover skin infection.
they cover additional gram neg organisms
95
Antistaph meds
IV
mrsa: vvanco, linezolid, daptomycin, tigecycline, ceftaroline
oral
mrsa: doxy, clinda, bactrim
96
Fungal infection
definition
dermatophyte=superfiical fungal infection=tinea
the protper term for superficial fungal ifnections is finea folowed by the name of the body part in latin
97
tinea corporis
body
98
tinea manus
hand
99
tinea pedis
foot
100
tinea cruris
goin
101
Fungal infection
best initial test
koh perparation, it dissolves epidermal skin cells and leaves the fungi intact so they can be visualized
102
Fungal infection
most accurate test
culture
103
Fungal infection
best initial therapy
topical antifungal agent if no hair or nails are involved
104
Fungal infection
best initial therya for hair and nail
terbinafine, itraconazole is lcose in efficacy
105
Fungal infection
topicals
```
clotrimazole
keotconazole
econazole
miconazole
nystatin (effective only in yeast infections)
ciclopirox
```
106
ketoconazole is
antiandrogenic, so orally it will cause gynecomastia
107
griseofulvin
has less efficacy compared to terbinafine or itraconazole
108
oral and vaginal candidiasis
these two infections arethe same disease
koh is best initial test
fungal culutre is most accurate test
however, with a clear presentation of the disease wht you will do next is treat with a topical antifungal from the perious list
109
the drugs that cause hypersensitivity reacsion of the dkin are the same that caues
heomlysis, interstitial nephritis, and often drug-induced thrombocytopenia (exept heparin)
110
Drug reactions
common drugs
```
penicillins
sulfa (thiazides, furosemide, and sulfonylureas)
allopurinol
phenytoin
lamotrigin
nsaids
```
111
hypersensitivity rxns vary in severity
morbilliform rash
112
Drug reactions
Morbilliform rash
mildest reaction skin stays intact without mucous membrane involvment. no specific therapy
113
Drug reactions
erythema multiforme
widespread, small, target lesions; most are on the turnk. no mucous membrane involvement. may also be from hepres or mycoplasma. prednisone may benefit some patients
114
Drug reactions
stevens-johnson syndrome
very severe. involves the mucous membanres.sloughs off respiratory epithelium and may lead to repsiratoyr failure. streoids not clearly beneficial. use ivig
115
Drug reactions
toxic epidermal necrolysis
rash with mucous membrane involvement, adds nikolsky sign. steroids definitely do not help, treat with ivig
116
the skin comes off simulating a burn
ten
117
Staphylococcal scalded skin syndromea nd toxic shock syndrome
different severities of the same event. Staphylococcal scalded skin syndrome looks similar to TEN including nikoslky sign. TSS has teh sameskin ivlovmenet as well as life-threatening multiorgan involvement like:
```
hypotension
renal dysfuntion (elevated BUN and creatinine)
liver dysfunction
CNS involvement (delirium)
```
118
Staphylococcal scalded skin syndromea nd toxic shock syndrome
treatment
both are treated with supportive care and antistaph meds from earlier. in the absence of penicillinallergy and with a sensitive organism, oxacillin or nafcillin are the most effective medications. cefazolin is interhvangeabel to treated staph. antibiotics do not reverse the disease, but they kill the staph that is producing the toxin
119
mild acne treatment
use topical antibacterials such as benzoyl peroxide. if this is ineffective, add topical antibiotics such as clindamycin or erythromycin
120
moderate acne treatment
add topical vitamin a derivatives such as tretinoin, adapelene, or tazarotene to topical antibiotics. if there is no response to topical vit a derivatives and antibiotics, use oral antibiotics such as inocycline or doxycycline
121
severe acne treatment
add oral vitamine a, isotretinoin to oral antibiotics. isotretinoin causes hyperlipidemia
122
vitamine a derivatives
are extremely teratogenic. do a prengancy test. only treate pts on suitable hormonal and barrier birth control
