DERM Flashcards
Management of HOT TUB folliculitis? What if there is ecthyma gangrenous?
Supportive Care
Pseudomonal coverage
Rx of condyloma Acuminata?
What vaccine to give?
Topical Imiquimod
Give HPV vaccine
What is associated molluscum contgiousum (very infections)
HIV
Disseminated zoster, and zoster in immunocompromised condition. What isolation?
Respiratory isolation.
Tinea pedis is a portal of entry to what?
Cellulitis. Can cause recurrent episodes of cellulitis.
How to tell difference from dystrophic nails and nail fungus?
Send nail clipping/and nail scrapings to lab.
What tinea infections need oral therapy?
Nail, Profunda, Capitatis
Rx for Head lice and scabies?
Permethrin 1% or Oral ivermectin.
After Solid Organ Transplant what is the most common cause of cancer?
Squamous Cell Carcinoma
Concerning size for Melanoma?
> 6cm
What is associated with porphyria Cutanea Tarda ?
What else is associated with Hep C?
Hep C.
If they don’t have hep C then phlebotomy.
Lichen Planus
What should you test for with pityriasis?
RPR for syphilis
Diffuse Erythroderma resembling Sunburn that involves both the Skin and the Mucous membranes. Associated with infection, wounds, nasal packs, or menstruation
TSS
Arthralgia, myalgia, and arthritis are seen in 30% to 60% of patients. The skin findings are edematous Red-Purple Plaques on the Trunk and Extremities. Occurs after GI or Respiratory illness, associated with MALIGNANCY.
Sweet syndrome
History of psoriasis who are treated with systemic glucocorticoids may develop ?
Acute Pustular Psoriasis
65-year-old man presents with an asymptomatic Large Brown Patch on his cheek. It has been present for many years and is enlarging slowly, retired farmer?
Lentigo Maligna
A form of Neuropathic Itch, is characterized by a deep, Crawling, or Tingling Sensation on the Forearms, Shoulders and Upper back; however, there are no visible skin findings.
Brachioradial Pruritus
Skin condition in which patients develop skin lesions after exposure to sunlight
Polymorphous Light Eruption (PMLE)/(Solara Urticaria) - Allergic to the Sun
Drug induced photosensitive rash characterized by erythematous annular scaly patches (IE pt who has psoriasis, started on Adalimumab (anti-TNF) - develops rash months later) Dx?
Drug Induced Lupus
(Subacute Cutaneous lupus Erythematosus)
Stop Offending Agent
Anti-TNF is common contributors
Older people, Skin eruption that is itchy and painful worsening for past few weeks.
Physical exam shows Tense Bullae on an Erythematous base and Scattered erosions on the trunk and extremities.
Dx?
Autoimmune Bullous Disease
Two biopsies are often performed ( Of the lesion and Around the Lesion) for direct immunofluorescence - for immunoglobulin and complement deposits.
Common in young adults, asymptomatic, oval-to-round, minimally scaly, hyperpigmented or hypopigmented macules that can coalesce into patches on the trunk and upper extremities. Rx?
Pytriasis/ Tinea Versicolor
Shampoos Selenium Sulfide or Ketoconazole
Mildly pruritic, thin erythematous-to-brown plaques with thin scale and an overlying wrinkled appearance and maceration in intertriginous areas such as the axillae, groin, and inframammary areas
Erythasma
Painful wheals on the upper legs and back that have been present for 2 weeks. Individual lesions resolve with bruising in 3 to 4 days. The patient also reports some associated joint pain, particularly of the small joints in her hands.
Dx?
What test must be done?
Urticarial vasculitis
Skin Biopsy
Longitudinal brown pigmentation of the nail plate; it can be a normal variant in persons with darker skin types, but it may also occur as a result of systemic disease, medication, infection, or an underlying melanocytic lesion. When should biopsy definitely be performed?
Melanoychia
One isolated lesion and associated Hutchinson Sign (small macule surrounding on finger)
> 6 weeks duration, loss of cuticle with tender, edematous nail folds involving multiple fingers; Wet Work can cause Maceration and Predispose to this condition?
What organism is associated with it?
Chronic paronycia - associated with candida
Acute - associated with staph
Rx for Moderate to Severe Psoriasis ?
Methotrexate
Rx for pruritic urticarial papules and plaques of pregnancy?
Low to Medium Potency Steroids
Heat +Superficial Clear Vesicles or as multiple discrete red papules ?
They rupture and wipe off easily.
Seen especially in Hospitalized Immobile Patient.
Heat Rash Milaria
After Connsumption of B-lactam abx, presents as punctate nonfollicular sterile Pustules ON FACE on a background of erythema
Acute Generalized Exanthematous Pustulosis
Pt is evaluated for a 4-day history of a worsening pruritic rash on the chin. She is a kindergarten teacher. Its yellow honey crusting.
Dx?
Rx?
Impetigo
Topical muprirocin
Elderly male smokers with long-standing rheumatoid arthritis and high titers of rheumatoid factor; They have small or medium-sized rash (blood blisters), palpable pupura and may affect nerves and other organs?
Rheumatoid vasculitis
Rapidly Growing pink Nodules with a crusted Hyperkeratotic Core or Central crater (filled with KeratinO) of crust and scale (“volcaniform”)
- Keratocanthomas
Violaceous plaques, nodules, Granulomatous inflammation of the skin and around the nares for 5 months associated with joint pain. Seen in black people.
Lupus Pernio. (Cutaneous Sarcoidosis)
Tricolored Targetoid plaques on the extremities and face, after HSV or Mycoplasma infection or drug.
Rx?
Next step if it keeps reoccurring ?
Erythema Multiforme
Supportive care
Check for HSV infection. HSV PPx
Age-related Capillary Fragility and Bleeding Under Atrophic skin; minor trauma can cause impressive Purpuric Macules and Patches, most commonly on the forearm.
Actinic purpura
Acquired hypermelanotic condition most commonly affecting women of childbearing age; it is characterized by tan-brown reticulated patches in the centrofacial, malar, and mandible areas.
Melasma
Patients with Diabetes may Develop orange, atrophic plaques on their anterior shins
Necrobiosis lipoidica
Purple, pruritic, polygonal papules that most commonly develops on the flexural surfaces, especially the wrists and ankles. Dx? Associated with what dz?
Lichen planus Hep C (Like Porphyria)
Red pruritic papules on the chest, flanks, and back associated with dry skin, heat, and sweating. (Excessive Sweating)
Transient Acantholytic Dermatosis
Well-circumscribed, Brown/Black Macules that most commonly occur on the lower lip
Melanotic Macule
Associated with kidney disease Subcutaneous nodules or plaques with overlying red-brown discoloration and often superimposed angulated purpuric patches
Calciphylaxis
Light Therapy:
- Rx for Extensive Psoriasis?
- Rx for Actinic Keratosis?
- Narrowband UV B therapy
- Photodynamic Therapy
Small pits and punctate erosions primarily on the plantar aspects of the feet; risk factors include increased perspiration (hyperhidrosis). BAD FOOT ODOR.
Pitted Keratolysis
Red, thin plaques with variable amounts of scale in the axillae, intergluteal cleft, and perineum, and under the breasts and pannus. Fails to respond to antifungal therapy?
Inverse psoriasis
Rx for Pyoderma Gangrenosum?
What do you want to avoid?
Steroids
Debridement this lesion exhibits Pathergy.
Associated with vitiligo, Chronic autoimmune disease that results in smooth, hairless patches of skin, most commonly appearing on the scalp
Alopecia Areata
In addition to a gluten free diet, what is the treatment of dermatitis herpetiformis?
Dapsone (check for G6PD)
Pt presents with R Inner Thigh Pain, Swelling, Erythema and Fever.
Pain out of proportion to examination.
There are Small Vesicles with PINK fluid.
Pt recently had R inguinal repair.
He has hx of DM.
Dx?
Rx?
Necrotizing Fasciitis
Abx and Surgical Debridement
EMERGENCY Surgical Consultation
Rx for Dermatitis Herpatiformis?
Dapsone (Avoid in G6PD)
Rx of Acne
- Comedonal (Non Inflammaotry) Mild ?
- Inflammatory Moderate (Inflammatory w/ Papules & Pustules) ?
- Moderate Severe Inflammatory?
- Severe Nodulocystic ?
- Topical Retinoids (No use in Pregnancy
- Topical Abx (Clindamycin or Erythromycin) + Benzyl Peroxide
- Combination causes lesss resistance
- Oral Abx (Doxycycline)
- Acutane (Avoid in Pregnancy)
IIH
Hypertriglyceridemia- PancreatitisOCPs increase steroid binding proteins
Triggers for Psoriasis? (3)
Beta Blockers, Lithium, Oral Steroid Tapers (Erythroderma and Pustular Psoriasis)
