DERM Flashcards
What causes rhinophyma if left untreated?
Rosacea
Patho- chronic inflam, acneiform, of pilosebacceosu units. w/ increased reactivity of caps to heat resulting in flushing and telangectasia. Who?- 30-50yr olds, > F, light skin.
CP- Worse w/ alcohol, stress, hot foods Sym-pattern on cheeks, nose, forehead, paulopustules on cheeks, nose, forehead. comps: rhinophyma- large, thicken nose-M untreated
TX- metronidazole topical 0.75% AVOID EtOH, hot bevs
What is T-cell activated and has rapid cell turnover of 3-4d?
PSORAISIS WHO-2% by 20. M=F, PATH- immune mediated hereditary
CP-graudal mild itch, ‘SALMON PINK” lesions, wax and wan, chronic red scaling papules circular plaques. silvery white Red border thick d/t neutrophils well defined borders sym BiL scalp, pitting nails, Extensor surface of limbs SACRUM-MC oil slicks and pits on nails. Plaque psoriasis MC MC-scalp, elbows, knee, groin, ears Comps- CV, DM, HTN, metabolic, IBD, flu-like sx
TX- Pt education no scrath ITch -topical steroids/antihist Topical corticosteroids- RISK-skin atrophy, abosrbs Saran wrap w/ steroid then emollient Wks-months Sun 15min
What has a “christmas tree” pattern that is viral?
PITYRIASIS ROSEA
Who? 10-35Y, 2%
PATH? viral w or w/o pruritis.
CP-maculopapular, red scaling eruption TRUNK. HERALD patch=larger first lesion. Lesions w/ fine scaling oval shapes macules and papules on erythematous base. ***Christmas Tree.
TX- viral, so self-limiting. pruritis- doxepin 5% cream, or Calamine lotion. 2 MONTHS
If a patient never had chicken pox or vaccinatin, what MAY they get in older age?
VARICELLA
WHO- KIDS, vaccin 12-18mo, 4-5
PATH- varicela zoster virus, !!contagious
CP- dew drop on a rose petal crusty
TX- RARE treatment oatmeal baths antihistamine 24 hr after crusty return to school
DANGER Elderly PT NO HX OF VARICELLA/VAC- HIGH RISK >AGE. MUST HAVE 1ST B4 SHINGLES ALL IF VAC- RISK OF SHINGLES
What do you scrape off with little bit of bleeding/Pt discomfort then treat with cryotherapy?
VERRUCA VULGARIS (warts)
WHO: F. kids, rare > 25 adults have immunity PATH: HPV. Contagious!!!No itchy. No Pain.
CP- raised firm papules/plaques, lesions: 1-10mm, hyperkeratonic, skin colored. **Cauliflower appearance. Reddish brown dots.
TX-topical: 3-6 TX Q3WKS 1. scrape off dead tissue 2. salicylic acid, or liquid nitrogen, 4-duct tape 3. Laser treatment for resistant warts.
What grows on bottom of feet?
Verruca plantaris
WHO- 5-25, F
PATH-soles of feet ONLY
CP- skin flushed
TX-resolve spontaneously. Shave and salicylic acid. Cryotherapy
What is umbilicated not itching firm papules related to poxvirus?
MOLLUSCUM CONTAGIOSUM TANA FAV
WHO: M, KIDS /ADULTS-SEX/
PATHO: Poxvirus, sex
CP: discrete FIRM umbilicated(BELLY BUTTON, pit/depression in middle) pearly-white papules. isolated or generalized. Neck, anogenital region, eyelids. TRUNK and extremities NO itching
TX: Self Limiting. AVOID KIDS BC LESS SCAR liquid nitrogen, electrocautery, curettage SCAR lesions last 2-3 mos
Pt has very painful finger. What is the sign and TX?
HSV 1
WHO young adults
PATH-HSV type 1 or 2 genital. Virus in CV trigenimal nerve ganglia. V1-3Ophthalmic, maxillary, mandibular.
CP: **grouped vesicles on an erythematous base**, malaise, lymphadenopathy, fever.
KIDS: gingivostomatitis MC primary sx.
Lesions do not cross midline.
COMPS: herpetic whitlow: painful infection of finger w/ herpes.
TX- acyclovir topical or oral, supportive treatment. Anelgelsic. Key-treat early before tingling and rash
primary lesions are self-limiting,
What is tingling and itching before onset of lesions?
PRODROME of HSV
CP-prodrome of tingling, itching or burning
24 hr later vesicles in groups
Maybe umbilicated, papules, bleed and crust.
TX- cold sores are self-limiting.
topical acyclovir
oral outbreaks-suppress oral antivirals.
What is difference btwn HSV and HZV?
Herpes zoster virus
WHO? >50.
PATH? Immunosuppression, compromise, stress. Contageous!
VZV CP-VERY PAINFUL!!! prodrome 3-5 days, burning, numb, tingling. Pain w/ eruption, wanes over time. malaise, fever, lymphadenopathy acute, bullous eruption dermatome.
Herpeteform lesions- beefy red base, crusts, w w/out pustules and bleeding. 50% on thorax, 10-20% trigenimal (eye)
TX-Narcotics
Oral acyclovir: high dose asap.
antiviral IV. lesions: 2-3 weeks.
COMPS-50% postherpetic neuralgia,
GABA meds
Urgent referral to opth if eye/ tip of nose HUTCHINGSON SIGN
What has no distinct margins, mergining to macular erythema. Warm, tender. 2nd to impetigo, follulitis? What is treatment?
Cellulitis
PATH-Disruption of cutaneous barrier, venous/lymphatic compromise, h/o, S. aureus/B-hemolytic strep.
Continuum of skin infxns: impetigo, folliculitis, carbuncles, and abscesses.
CP-
- NO distinct margins.
- Confluent macular erythema,
- swelling, warmth, tenderness,
- LAD, systemically–fever, chills, myalgias (more in sick and elderly)
- abscess
- LABS-blood and skin culture Deeper
TX- slow.
- Oral: Cephalexin x10-14d.
- Alt’s: Clindamycin or levofloxacin.
- IV: vanco, OR cefazolin or nafcillin**
What is treated with Vanco in the hospital?
WHO: sports teams, jails, day cares
PATHO- NOT spider bites, know local resist. Poor hygiene. Recurrent
CP: compromised skin integrity
TX=
- Culture a wound DOC=Vacomycin IV, *not oral -c.diff
- Bactrim (+rifampin to dec resistanc)
- clindamycin (+/- rifampin or linezolid)
- tetracyclin (mino, doxy) + rifampin,
- Never use rifampin or linezolid alone-d/t inc. resistance
What leads to crusty vesiculpapular skin infx of face the crust?
WHO: varies PATH: S. aureus, B-hemolytic strep. poststrep glomerulonephritis or rhematic fever
CP-Superficial **vesiculopapular skin infxn on face and extremities–> rupture and “honey crust”.
TX:Topical Mupirocin for small, non-bullous lesions. Oral: Erythro, Dicloxacillin, cephalexin, or clindamycin x 7d
Folliculitis
PATH:Nasal carriage of S. aureus, exposure to whirlpools, hot tubs, abx use-flora, use of steroids, P. aeruginosa hot tub
CP- multiple, red, pruritic, <5mm, cluster NO systemic. Purulent
TX-WARM COMPRESS topical antibiotics no shaving
Furuncles
PATH-Inflam nodule of hair follicle. Follows episode of folliculitis. Caused by Staph
TX- w/ warm compresses; surgical I/D;
systemic sx’s req abx’s: dicloxacillin or cephalexin
How to prevent Recurrent Furunculosis?
Nasal Mupirocin ointment.
Vitamin C.
Low dose clindamycin supressive therapy for patients who really continue to get infections (usually immunocomp pts)
Carbuncles
PATH-Series of abscesses in the subcutaneous tissue that drain via hair follicles.
CP-Swollen lump under skin: White/yellow center, weep, ooze, or crust. May have systemic sx’s
Tx w/ warm compresses to promote drainage; surgical Incision; Drainage;
systemic sx’s req abx’s: dicloxacillin or cephalexin
What is polymicriobial and my have complications?
Abscess
WHO: DM or immunosuppressed, VDU, nasal colony of staph,
PATH: Minor local skin trauma (insect bite, abrasion); IDeeper than carbuncles. May be polymicrobial. MC S. aurues. Localized accumulation of PMN leukocytes with tissue necrosis involving the dermis and subcutaneous tissue. NOT associated with hair follicles. Infxn tracks in from skin to deep skin layers. Localized accumulation of PMN leukocytes w/ tissue necrosis
CP
- Local pain, swelling, erythema, fluctuance, warmth;
- cellultis around the abscess;
- regional adenopathy;
- spont drainage of purulent material;
- UNUSUAL to have systemic sx’s (fever, chills) indicates necrotizing fasciatis.
- LABS-Large numbers of microorg’s present. Celluitis surrouding the abcess is normal.
TX:
- I/D: fluctuance or “pointed”,
- send purulence for C/S testing. I/D at the Point. ID to open even more.
- If theres no point, do NOT I/D, tell patient to put warm compress erryday till point forms.
- Pack after Oral abx: Dixcloxacillin
- -secondary, cephalexin, clindamycin,
- NOT AN INGROWN HAIR.
Why do we draw a line around cellulitis?
Necrotizing Fascitis
CP-Very Painful. Systemic symptoms (fever, chills) Don’t confuse with an Abscess. DRAW outline If growing w/ 1-2h
TX-Surgical emergency. Vanco. Send to ED. All tissue must be removed.
WHat are complication of absesses?
Fournier’s Gangrene
WHO:Bed ridden patients.
Gonads TX- Surgical emergency. All tissue must be removed. Vanco.
What is MC in armpit, or groin, genitofolds, but is inflammed follicule?
Hidradenitis Suppurative
WHO- women
PATH- follicular occulsive dz interignous skin, terminal follicular obstruction, rupture of follicle, inflammation
CP - not purulent, not inflammed ishlymph node, small pain. ITchy, erthema, burning. May ruptudre
TX; cant I/D.send to OR. NO cure.
- Exp surgeon for cysts
- Antiperspiratns not deordorants
- no shaving
- wt dec, stop smoking
- Oral ABX for persistent
What is the MC malignancy of Caucasians?
BASAL CELL CARCINOMA
PATH:basal layer of epidermis, LOW METASTIC. UV as child
Grow deep and moundlike- 7mm above skin, 7mm bel
CP: surrounding ulceration w/ pearly rolled border. small translucent nodule w/ telangiectatic vessels. Leads to central necrosis
Hyperpigmentation dots w/in
DX- biopsy
TX- electrodesssciation/curettage ED/C. Scars
Monitor Q6m for 1 yr, than annually
What is dangerous and metastasis quickly?
Squamous Cell Carcinoma
Oral
PATH: Malignant tumor from keratinocytes.
UV, chron inflam changes, chem carcinogens, immunosupp and viral infxn, transplant. Destructive growth and metastasizes via lymph
CP: small, erythematous papules, plaques, nodules, dome shaped, slightly raised, warty, pink dull red. Yellow-white scale. Progress to extensive non healing ulcerative necrosis
TTP
DX- biopsy
TX-Excision MC w/ histology of margins
MOHS tech 98%cure rate
What proliferation of atypical epidermal keratinocytes,SCALY, and overtime forms a cutaneous horn?
Actinic keratosis
WHO; M, Fair skin, elderly, solid organ transplant Pts.
PATH; proliferation of atypical epidermal keratinocytes.
Sun damaged areas. ***Progress to SCC.
CP-Scaly, hyperkeratotic, sandpaper-like, dry, rough, (seborrheic more greasy looking). Face or scalp
DX- biopsy
TX: Prevention, Cryotherapy. Topical 5-fluorauracil, IMIQUIMOD- FIELD TX
Tinea corporis (Ring worm)
PATH: Long-term wetness of skin, poor hygiene/ Fungis=ringworm (dermatophyte)
CP: Contagious!!! Itchy, no pain.
- Itching; small area of red, raised spots/pimples, ring-shaped w/ raised border and a clearer center
- LAB/DX-KOH test to see if it’s a fungus.
- TX;
- Keep skin dry and clean.
- BID x4wksTopical antifungal creams: miconazole, clotrimazole, ketoconazole work but it just takes a while. . Avoid steroids (hydrocortisol)
What is itchy, stinging around groin?
Tinea cruris (jock itch)
WHO; children, youngs
CP; erythematous border. Peripheral scalling.
Kerion = inflammatory reaction causing induration body papule, with pustules. Most seen in children
TX- orals, topicals don’t work.
TX;ORAL up to 3 months:Chronic resistant infections, nail infections, scalp infections (kerion) require oral meds for . Monitor LFTs
What is the athletes’s foot?
Tinea pedis
PATH- Hyphae molds (tinea fungus)
Cracked, flaking, peeling skin btwn toes; red, itchy burning
LAB- KOH prep
TX- AVOID steroids- grow cholesterol membrane growth
What is significant difference btwn ersipideas and 5th dz?
Erythema infectiosum
- caused by parvovirus B19. A person usually gets sick with fifth disease within four to 14 days after getting infected with parvovirus B19.
5thMC skin rash
Erythema nodsum
causes painful red bumps under the skin shins
What is term for tinea that is subungal and req long term oral meds?
Onychomycosis
Itraconazole
Pt “christmas tree” pattern with upper trunk only that is hypopigmented in summer only?
Tinea (Pityriasis) Versicolor
WHO; Adolescence /young adults summer months.
PATH; Superficial fungal Infection caused by Malassezia Yeast.
CP-Hypopigmented or hyperpigmented or erythematous macules, usually upper trunk
DX- KOH prep will confirm the diagnosis. NOT woods lamp**.
TX:
- Antifungal Shampoo or creams x2w selenium sulfide or ketoconazole. itraconazole -
- ORAL 400 mg if resistant.
What is rash under breast with SATILITE LESIONS treated with antifungal cream?
Candida
WHO; obesity, occlusive clothing, incontinence, hyperhidrosis, DM, steroid/ABX use
PATH; in between toes, in between fingers. skin folds. Superficial yeast (balls) infection of intertriginous areas (skin folds)
CP; erythematous macerated plaques and erosions with delicate peripheral scaling. ***satellite lesions.
TX
- Antifungal creams/powders BID for 1-2 weeks or until resolved.
- Remove exacerbating factors.
- Probiotics.
- Keep area clean and dry. Severe or recalcitrant infections give oral fluconazole daily or 150 mg weekly x 2-6 weeks.
What is the most common tumor arising in HIV infected persons?
Kaposi Sarcoma
WHO- HIV, Iatrogenic- IMC drug therapy, renal transplant
PATH- HHV-8 angioproliferative d/o slow growth, but then rapid
CP- purple reddins, blue, dark brown lowe extremities. Oral and skin, LE
DX- biopsy
TX-HIV ART
systemic chemo
What is BACTERIA in upper dermis, extends to superFIC cutaneous lymph?
Erysipelas
WHO
PATH- more serious, STREP CP- FACE, TENDER, RED, DEFINED MARGIN STEAKING COMPS- abscess, nephrotic syndrome, IMC, DM, IVIV, surgery breast, Edema
TX- PCN 5d strep, NSAIDs, hydrate, cold Saline dressing
What in situ tumor is a progression from Actninc Kerotosis?
Bowmen Disease
PATH- has not invaded other tissue
involve epidermis ONLY
CP- if not sure provide steroids, wil not repsond
TX-topical chemo w/ 5-FU IMIQUIMOD
What is very itcy btwn fingers?
Scabies
PATH- sarcoptes scabeii. GAS
WHO- <3MO. Daycare, SNFs, schools
CP- VERY ITCHY! Very contagious via direct contact. wrists and fingers!!!! Interdigital, writst flexors.
DX- KOH prep. Scrape the scabes off the skin and put on a slide
TX-Topical Permethrin 5% cream - apply to entire body below neck, wait 8-12 hours then wash off, repeat in 1 week. All toys need to be washed in hot water or in air tight bag to kill the mites.
Pediculosis (pediculosis capitis nits, Pediculosis pubis lice & nits))
PATH- direct contact
- AKA-crabs, body lice, head lice, pubic lice,
- Pediculosis corporis -clothing.
- Pediculosis capitis and pubis- skin/hair.
TX- preventions**
- Topical insecticides: DOC Permethrin Pyrethrins, Malathion
- Special combs help remove nits;
- occlusive dressing with petroleum to suffocate lice.
- Retreat in 7-10 days to kill any newly hatched lice.
A 56 year-old, right hand dominant, Physical examination reveals a nontender left thumb with a 6 mm macular lesion located under the distal nail bed. It is mixed dark brown and black in color, with irregular borders. The most likely diagnosis is
MELANOMA
WHO- 20-30y, fair skin, FH., UV child
PATH- MC fatal maligant skin tumor. rapid prolif,
CP- dark, irregular border, thickness MC prognosis, >6mm. Recent changes in moles. 3+ colors, nail changes, itching/bleed
Acral Lentiginous- palms, soles, nails
Amelanotic
Lentigo-sun damage skin, gradually enlarges
DX- biopsy w/ 1-3mm
TX- ASAP specialist
wide surgical excesion
What is Auspits phenomenon?
Psorasis rxn when scraped, blood droplets
How to differentiate btwn Tinea corporis?
scales on periphery
psorasis- scales entire lesion
How to differentiate btwn ezema/AD?
AD very itchy
AD flexor areas psorasis extensor
How do you distinguish lesion on nose crease?
Seborrheic dermatitis ONLY in nose crease greasy, NO auspitz psorasis - flaky
How to distinguish psorasis btwn lichen simplex chronicus?
Lower legs for LSP
psorasis vs. chronic contact derm?
History- FH psorais
Intense itch- contact derm
What is Koebner phenom?
Trauma- l/t irratated skin/psorasis around Hair scalp waits.
diffuse psoarsis
What are alternatives if topical don’t work?
- Calipotriene-
- Vit D
- Coal tar- shampoo
- Tazaroten-
- Retinoid- skin irritation Anthralin
When should psoaris be refer to rheumatologist
Psoratic Arthriis TX- systmic Destroys jt fast
