derm Flashcards
alopecia areata
ass with autoimmune
exclamation point hairs
complete scalp hair loss: totalis
complete hair loss on scalp and body–> universalis
androgenic alopecia
minoxidil and oral finasteride- androgen inhibitor
eczema
triad: eczema, allergic rhinitis and asthma
increase IGE production: ALLERGEE
flexor creases- blisters/papules/plaques- then looks similar to psoriasis when it crus over (antecubital or popliteal folds)
nummular eczema
coin shaped lesions (knees and elbows)- sharply defined- tx is topical corticosteroids- antihistamines, wet dressings. tracolimus, pimecrolimus (good alternatives to steroids- topical calcineurin inhibitors)
maintain skin hydration
dyshidrosis
tense vesicles on soles, palms and fingers (lateral digitis)
tx: topical steroids
lichen complex chronicus
skin thickening in patients WITH ECZEMA due to rubbing/scratching
EXAGGERATED SKIN LINES
- dont scratch lesions- topical steroids
lichen planus
INCREASED INCIDENCE WITH HEP C!!
idiopathic- cell mediated immune response!!
purple, polygonal, planar, pruritic papules WITH FINE SCALES!!
skin, mouth, scalp, genitals, nails- mucous
KOEBNER’s phenomenon-
WICKHAM Striae- oral mucosa fine white lines
TX: corticosteroids
pityriasis rosea
viral infection- HHV7
HERALD PATCH- salmon colored macule on trunk - then smaller oval salmon-colored papules with circular scaling along cleavage lines IN A CHRISTMAS tree pattern
NO TX: antihistamines for pruritis, oatmeal baths
Psoriasis- plaque, pustular, or guttate
hyperplasia- proliferation cells in the stratum basale and stratum spinosum due to T cell ACTIVATION and cytokine release
plque: silver/white scales- extensor surface- elbows/knees/scalp/neck nape- nail pitting- oil spot (discoloration under nail)
auspitz sign- bleed when removing plaque
koebner - new skin lesions at trauma
psoriatic arthritis
inflammatory arthritis associated with psoriasis- join stiffness more than 30 minutes- relieved with activity
sausage digits- pencil in cup deformity
TX FOR PSORIASIS
topical steroids 1st LINE vitamin D analogs topical tar topical retinoids vitamin A analogs
sever: phototherapy, UVB, PUVA, methotrexate
TINEA versicolor
malassezia furfur- YEAST!
hypo or hyperpigmented macules with FINE scaling- fails to tan
KOH PREP- hyphae and spores- SPHAggeti and meatballs
wood lamp- yellow-green flourescene-
TX: ANTIFUNGALS- selenium sulfide, zinc, azoles, itraconazole or fluconazole
seborrheic derm
hypersens to MALAssezia furfur possibly?
IN AREAS OF HIGH sebaceous gland oversecretion- scalp, face, eyebrows, body folds
worse in winter
CRADLE CAP FOR INFANTS!!- red plques with fine white scales
ADULTS- SCALP, eyelids, folds
TX: selenium sulfide, ketoconazole shampoo, zinc, steroids, antifungals (itra, fluco, keto, terbinafine),
FOR BABY with cradle cap: ketoconazole, baby shampoo
hypersenstivity reactison
triggers: food, bites, drugs, exercise induced, infectious
type I: ige mediated- urticaria and angioedema- immediate
type 2: antibodies mediated= causes cell lysis
type 3/: immune antibody-angine complex
type Iv: delayed- erythema multiforme - morbilliform-
Morbilliofrm/erythematous- most common
urticaria
blanchable, edematous pink papules, wheals or plaques- hives disappear within 24 hours and new crops come
can have dermatographism- local pressure causes wheals in that area
darierls sign: when skin is rubbed- urticaria formed
USE ANTIHISTAMINES AS TX
erythema mulltiform
TYPE IV hypersensitivyt reaction
HSV MC
SULFA, BETA LACTAMS, phenytoin, phenobarbital!!!
TARGET LESIons! : dusty-violet red, purpric macules/vesciles or bullae in the CENTER- surrounded by edematous rim and red halo
EM MINOR
no mucosal membrane lesions
EM major
involvement of more than 1 mucous membranes (oral, genital or ocular)- NO EPIDERMAL DETACHEMENT!
TX: symptomatic, STEROIDS
SJS
SULFA or anticonvulsant meds- NSAIDS< allopurinol, abx
10% of sloughing of body surface area
blisters everywhere, fever, URI symptoms- involves more than 1 mucous membrane WITH EPIDERmal detachment- NIKOLSKY sign
TREAT AS SEVERE BURNS!!
TEN
sloughing of more than 30 % of body
acne
due to increased sebum
clogged sebaceous glands
propionibacterium acne overgrown
inflammatory resposnse
blackhead-s - open
closed (white heads)
severe: nodular or cystic acne
management of acne
mild: retinoids, benzoyl peroxide, topical abx, ocps
retinoids- inflammatory acne
benzoyl peroxide: decreases propionibacterium
topical abx: clinda
MODERATE: oral abx and anti androgen agents like doxy or minocycle= tetracyclines and spironolactone
SEVERE: isotretinoin- highly teratogenic- must ahve 2 pregnacy tests before therapy- 2 forms of contraception
rosacea
triggers are ETOH, increase temp, hot drinks, hot /cold weather, hot baths, spicy foods
acne like rash and redness, facial flusing, telngiectasia, skin coaresening, papulopustules with burn and stinging.
NO BLACKHEADS!!!- this is what distinguishes from acne
TX: METRONIDAZOLE
TX FOR ROSACEA
METRONIDAZOLE! TOPICAL!!!!
actinic keratosis
MC premalignant skin condition to squamous cell carcinoma
DRY ROUGH SCALY sandpaper skin lesion- HYPERKERATOTIC plques!!
Tx: cryosurgery
seborrheic KERATOSIS
sebborheic- means its benign= MC benign skin tumor- velvet, warty lesion- GREASY /stuck on appearance
NO TREATMENT
but cryoterhapy if you want
common plantar warts
thrombosed capillaries- has red brown punctations
verruca plana- flat warts
flesh colored papules- seen on face, hands, shins
genital- condyloma acuminata
painless, soft fleshy califlower
warts dx
whitening of lesion with acetic acid application- most will resolve within 2 years
gardasil vaccination
11-26 women
gardasil 9 treats for 6,11,16, 18 and other types of HPV
gardasil alone for 6,11,16,18
vitiligo
AUTOIMMUNE DESTRUCTION OF MELANOCYTEs- skin depigmentation
tx: corticosteroids, systemic phototherapy,
basal cell carcinoma
SLOW GROWING! MC type of skin cancer in US
translucent, pearly, waxy papul with CENTRAL ulcerations and RAISED, rolled borderes- face, nose, trunk
BLEEDS EASILY!
- telangiectatic vessesll
punch or shave biopsy
0 electro desiccation, mohs
malignant melanoma
UV RADIATION MOST COMMON REASON!
agressive- high mets potential!!!
ABCDE: assymetry, border,s irrgeular, color, diameter more than 6 mm, evolution
THICKNESS- used as prognastic for METS!!
full thickenss wide exciesional biposy plus lymph node biopsy
SQUAmous cell carcinoma
red, elevated, thickened nodule with WHITE SCALY or crusted, bloody margins
do biopsy
wide local surgical excision
kaposi
HHV- 8, HIV , HAART therapy
erythema nodosum
anterior shins- painful, erythematous- due to ESTROGEN exposure, sarcoidosis, IBS, coccidiodomycosis!!!
ipetigo
highly contagious- HONEY COLORED RUST!! staph AUREUS MC also can be GABHS tx: mupirocin- bactroban tid X 10 cephalexin- if systemic- 1st generation cephalosporin
folliculitis
hair follicle=- staph aureus-
topical mupirocin, clinda, erythromycin
furuncle (boil)
deeper infection of the hair follicle- Tender - fluctuant ABSCESS with CENTRAL plug- I AND D
heat compresses
carbuncle
larger more painful than furuncles- but interlocking- abscesses with MULTIPLE openings or plus cellulitis
cellulitis
mc caused by S. aureus!! and GROUP A beta hemolytic STREPtococcus - similar to impetigo cuases
erysipelas: strep A!!! mc - well demarcated margins of cellultis= intensely erytehmatous - involves FACE mostly!!!-
TX for erysipelas
IV penicillin, vanycomycin if pen allergy or mrsa suspected
cellulitis tx
cephalexin, dicloxacillin - 7-10 days
MRSa: iv vanco or linezolid
cat bite
pasteurella multocida- AMOX/clauvulanate FIRST LINE
doxy- if pcn allergic
dog bite
amox/clavulanate
human bite
amox/clavulantte
puncture wound through shoe
CIPRO- covers PSEUDOMANS
paronychia
infection of nail margin- MC staph
warm soaaks, or cephalexin , I and D
scabies
very itchy, linear burrows, intertriginous zones- web sapces between fingers/toes- more intense at night- papules or nodules on scrotum, glans or penile shaft, body folds- SCABIES!
tx for scabies
permethrine topical- FIRST line
or LINDANE- don’t use after bath or shower- causes siezures- not to be used on young children or teratogenic
molluscum
poxiridael family- highly contagious
DOME SHAPEd=- flehs colored pearly white, waxy papules with CENTRAL umbilication- no treatment
dermatophytosis
fungal skin infections: trichophyton, microsporum,
IF MICROSPORUM- you will see green flourescence in wood’s lamp
tinea capitus
alopecia- ring worm- po grisofulvin
tinea pedis
athlet’es foot- topical antifungal or po griseofulvin
onychomycosis
nail infection- itraconazole and terbinafine. systemic would be grisofulvin
pemphigus vulgaris
AUTOIMMUNE!!!- desmosome disruption- no more barrier function- ANTI DESMOSOME/anti epithelia ab- TYPE II HSN
painful FLACCID skin bullae- ruptures easily - nikolsky sign
IGG throuthout the epidermis- skin biopsy dx
HIGH DOSE CORTICOSTEROIDS OR METHOTREXATE!
bullous pemphigoid
ELDERLY!! type II just like- DRUG INDUCED!
TENSE BULLAE- dont rupture easily
NO NIKOLSKY!
systemic corticosteroids
MELASMA
too much estrogen (OCPS, pregnancy), sun exposure
tX: hydroquinone
BROWN RECLUSE SPIDER
local burning, then blanced area, erythematous margin around ischemic center, then heorrhagic BULLAE!!! NECROSIS!
local woundcare, pain control
BLACK WIDOW SPIDER
usually contact with spider–outdoor activities, furniture outside use, gardening
SYSTEMIC SYMPTOMS- black widow tortures you systemically - muscle pain, spasms and rigidity- OPIOIDS FOR PAIN!! or muscle relaxants
burn management
rule of 9 head: 9 whole arm: 9 Trunk : 36 lower limbs: 18 each genital is 1
burn!!!!
wash with mild soap and water- COOL COMPRESS!- do not apply ice directly!!!
debridement, remove the ruptured blisteres
aBX: silver sulfadiazine- DONT USE ON FACE!!! - no use if sulfa allergy or pregnancy or small children!!!
superficial burns- no dressing
cover partial and full thickness burns with sterile dressing to prevent infection
IV fluids
superficial burn
epidermis- red, DRY, painful, +refill inteact
superficial partial thickness- 2nd degree
epiderm and superficial portion of derm- pink, moist, weeping, +blistering
MOST PAINFUL OF ALL BURNS!!!- very tender
+refill intact
deep partial thickness burn- 2nd degree
epiderm into deep portion of dermis, +blistering- not very finally - absent capillary refill- scarring
full thickness - THIRD
WAXY, white, leathery, dry, painless no capillary refill
4th DEGREE
black, charred, dry, painless, absent capillary refill
carbon monoxide
odoroless, tasteless, colorless- 200 times more affinity to hemoglobin- seizures, brain hypoxia, coma, cardiac arrhtymias, diagnosed with ABG, give 100% oxygen
high voltage electric injuries
ECG- rhabdo
