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Derm: Block 1 Flashcards

1
Q

What are the 5 layers of skin?

A

Corneum: primary barrier of dead cells

Lucidum: thin lucent layer in thick skinned areas

Granulosum: keratinocytes lose nucleus, flatten= granular

Spinosum: keratinocytes connected by desmosomes, location of Langerhan cells

Basal: constantly dividing keratinocytes, location of melanocytes

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2
Q

What are the 4 parts to a derm PE?

What are the Primary Lesion words

A

Primary lesion
Distribution
Fitzpatrick phototype
Secondary/Special lesions

Papule Wheal Plaque Macule Vesicle Bulla Nodule Pustule

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3
Q

How are lesions described by distribution

How are lesions described by configuration?

A 
Dermatomal
Flexor/Extensor
Intertriginous
Linear
Multiple- local/general
Solitary

Serpinginous (larva migran)
Annular- ring (tiea)
Cluster/Group (Herpes)

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4
Q

Define Macule

Define Patch

A

Flat circumscribed discoloration =1cm

Macule >1cm

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5
Q

Define Papule

Define Plaque

A

Elevated solid lesion 0.5cm or < in diameter

Circumscribed, elevated superficial lesion 0.5cm or > in diameter; often confluent papules

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6
Q

Define Nodule

Define Pustule

A

Circumscribed, elevated solid lesion 0.5cm or > (tumor)

Collection of leukocytes and pus

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7
Q

Define Vesicle

Define Bulla

A

Collection of serous fluid <0.5cm in diameter

Collection of free fluid >0.5cm in diameter

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8
Q

Define Wheal (Hive)

What terms are used to describe a secondary lesion

A

Firm edematous plaque from fluid infiltration

Fissure Atrophy Crust Erosion Scale Ulcer Scar

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9
Q

Define Scales

Define Crust

A

Excess dead cells from abnormal keratinization and shedding

Dried serum and debris; scab

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10
Q

Define Erosion

Define Ulcer

A

No dermoepidermal junction penetratoin; no scarring

Focal loss of epi/dermis, heal w/ scarring

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11
Q

Define Fissure

Define Atrophy

A

Linear loss w/ sharp/defined walls

Depressed skin from thinning of epi/dermis

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12
Q

Define Scar

What are the Special Skin Lesions

A

Abnormal formation of CT from dermal damage

PCM BELT PC
Purpura Comedone Milia
Burrow Excoriation Lichenification Telangiectasia Petechiae Cyst

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13
Q

Define Excoriation

Define Comedone

A

Linear erosion from scratching

Plug materials in hair follicles
Black (dilated)
White (narrow)

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14
Q

Define Milia

Define Cyst

A

Superficial keratin cyst w/ no opening

Circumscribed lesion w/ wall and lumen

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15
Q

Define Telangiectasia

What are the 4 main treatment categories

A

Dilated superficial blood vessels; BCS until Dx

Topical Systemic Photo therapy Surgical

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16
Q

What is the purpose of topical therapy?

Dry cutaneous lesions have lost ?

How is this corrected?

A

Restore skin function after insult that removed water, lipid, proteins

Epidermal lipid/protein/water

Emollient cream
Lotion

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17
Q

Define Xerosis Cutis

When is this condition worse and what part of the body is affected?

How is it Tx?

A

Rough skin w/ fine white - thick brown scales
Severe: crisscross, fissures

Dry winter months, hands/lower legs

12% lactate lotion
(Lac-Hydrin, AmLactin)

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18
Q

How do emollient creams/lotions provide benefit?

What types have special lubricating properties?

Which one is thicker and more lubricating?

A

Restore water and lipids

Added urea/lactic acid

Creams

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19
Q

Define Wet Skin Dzs

How are they managed

A

Inflammatory dz leaking serum

Wet compress- suppress inflammation, debridement
Restore lipid/proteins w/ cream/lotion

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20
Q

What are the four benefits of wet dressings?

A

Wound debridement- macerates vesicle/crust

Antibacterial w/ added aluminum acetate, acetic acid, silver nitrate

Inflammation suppression faster than CCS

Drying effect

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21
Q

What are examples of exudative skin dzs that would benefit w/ wet dressings?

A

BI SHIT PENS
Bullous impetigo
Insect bites

Stasis dermatitis/ulcer
HS/Zoster
Intertrigo
Tinea pedis- vesicle/macerated

Poison ivy
Eczematous skin w/ 2 infxn
Nummular eczema
Sunburn blisters

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22
Q

What are the three types of Wet Dressings and what are they used for?

A

Tap Water- Poison ivy Non-infected exudatives Sunburn

Burow’s Solution- Athletes foot Insect bites Poison ivy Acute inflammation

Silver Nitrate- Exudative infected lesions (stasis ulcer/dermatitis)

Acetic acid- vinegar dilution; Pseudomonas/Gram Neg

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23
Q

What groups of steroids are the strongest/weakest potency?

What effects do topical CCS exert?

A

Strong: 1
Weak: 7, OTCs

Anti inflam/mitotic
Vasoconstriction

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24
Q

What are the keys to appropriate use of topical CCS?

How long do PTs use topical CCS before need to re-eval condition is needed?

A 
Accurate Dx
F/u
Appropriate Tx duration
Proper strength/vehicle
Sufficient quantity

1-4wks

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25
Vehicle is AKA ? and defined as ? What are the 5 types of vehicles?
Base- substance containing active ingredient; determines rate of absorption Foam Ointment Gel Solution Cream Lotion
26
# Define Cream These are best used for ? located ?
Chemical Oil Preservative Water mixture Best: exudative inflammation Most useful: Rectal Axilla Groin
27
# Define Ointment Why are ointments used When is this vehicle not used?
Petroleum jelly/grease w/out preservatives, MOST lipophilic Moisturize, occlusion Eczema inflammation Intertriginous areas
28
# Define Gel When are these useful? What part of the body are these particularly useful for?
Greaseless jelly of Water Alcohol Propylene glycol Ivy exudative inflammation Scalp
29
# Define Solution and Lotion What type of effect do they exert? Where are these vehicles MOST useful for use?
Water Alcohol Chemical mixture LEAST lipophilic Scalp- greasy hair penetration
30
When are foams useful? What is the name of the super potent foam and directions for use?
Scalp dermatoses Eczematous inflammation: Ivy Psoriasis Olux-Clobetasol propionate Not for PTs <12y/o Only used <2wks
31
Occlusions can increase steroid potency by ? Consider 'natural' occlusion when prescribing for ?
100x Redundant folds Axilla Inguinal folds Diaper areas
32
What benefit does hydration have on topical CCS therapy Steroid application post ? or w/ added ? increases absorption rates
Stretches intracellular connections to increase absorption 4-5x Post-bathing Moist wraps/occlusions
33
What parts of the skin are thin and susceptible to easy steroid absorption? What areas of the body are thick and would reduce absorption? What is a potential s/e from long term daily steroid use?
Stratum corneum of face/eye lids Soles/Palms Steroid acne/Folliculitis
34
What are the local adverse effects of topical steroid therapy?
``` AWARDS BPH Atrophy Worsening infection- tinea Acne/folliculitis Rebound phenomenon Dryness- cream/lotions Striae Burn/Bruise Pigmentation, hypo Hypertrichosis ```
35
Contact allergies can occur from topical CCS due to exposure to ? If contact allergy occurs due to the steroid component, how does it present?
Preservatives Color Steroid itself Chronic dermatitis not exacerbated or improved by CCS
36
If suspected contact allergy to steroid exists, what is the next step? What are systemic adverse effects that can occur from topical CCS usage?
Skin test (patch testing) ``` Cataracts Cushing syndrome Failure to thrive AAxis suppressed (<2, teen) Glaucoma Stunted growth ```
37
What type of steroid is usually used for intralesion injections? What are the benefits and risk of administering steroids IM?
Triamcinolone Long lasting, easier Atrophy w/ short needles
38
What are the four MC mistakes of topical steroid therapy? Define FTU
Steroid too weak Not enough given F/u failure Too strong for kids*/face Finger tip unit- 5mm diameter= 0.5gm 0.5FTU= one hand area or 0.25g of ointment
39
# Define "Rule of Hand" Four hand areas is equivocal to ?
One hand area= 1% TBSA 1g of medication
40
When using topical CCS, don't use more than ?g of group one per week What is the recommended schedule for this group?
45-60g QD-BID Pulse therapy: 2wk on, 1wk off to avoid tachyphylaxis
41
How often are Group 2-4 CCS used? ? is the MC inflammatory skin dz and the three types
BID x 2-6wks Eczema- Dyshidrotic Asteatotic Nummular
42
What are the characteristics of eczematous inflammation that all PTs have? What are the three stages of the dz?
Pruritus Erythema Vesicels Scales Acute Subacute Chronic
43
How does acute eczema present What are the etiologies of this condition How is it Tx
Vesicles Itch Bulle Erythema Pompholyx Contact allergy- Rhus Nummular eczema Stasis dermatitis Cold wet compress ABX (secondary infxn) CCS
44
Subacute eczema is the ? phase that presents as ? What are the etiologies How is it tx
Dry: Fissures Parched Itch Erythema Contact allergy Astetotic eczema Topical steroid Emollient Antihistamine/ABX
45
How does chronic eczema present What are it's etiolgies How is it Tx
Fissuring Accentuated lines Itch Lichenification Habitual scratching Atopic dermatitis Lichen simplex chronicus Topical steroids Emollient ABX/Antihistamine
46
# Define Dyshidrotic Eczema How does it present
Pompholyx- Reaction pattern of symmetric hand/foot dermatitis MC in teen-middle aged w/ itching preceding vesicles
47
What are the suspected etiologies of Dyshidrotic Eczema PTs may also have ? underlying condition?
Irritants* Atopic dermatitis relationship Stress Hyperhidrosis
48
What is the morphology of Dyshidrotic Eczema? What part of the body is involved?
Tapioca lesions- deep vesicle w/ erythema Palms/lateral finger Soles
49
How are Dyshidrotic Eczema PTs managed/Tx? What is the last line of Tx tried for Dyshidrotic Eczema
``` Bland emollients, avoid water Hydroxizine/Diphenhydramine Antihistamines Psoralen + UVA radiation Steroids ``` Low dose methotrexate
50
# Define Asteatotic Eczema This is AKA ?
Excess drying from showers/cold in atopic elderly PTs More itch than rash Eczema craquele Winter Itch
51
What part of the body does Asteatotic Eczema involve? How are these PTs managed/Tx
Anterolateral lower legs w/ accentuation of skin lines Plaques w/ thin fissures Group 3-4 steroids Emollients after bathing Dec showers Wet compress/ABX if Ooze Infxn Crust
52
# Define Nummular Eczema What PT population does it present in and how
Latin- money; intense pruritic coin shaped plaque >50y/o in same spot every winter w/ intense itching
53
What part of the body does Nummular Eczema involve? How are PTs w/ Nummular Eczema managed/Tx
Dorsal hands UE Lower legs Antipruritics Group 1-3 steroids Emollient, humidifier
54
# Define Lichen Simplex Chronicus What can precipitate Lichen Simplex Chronicus
Neurodermatitis from habitual scratching Seborrheic Atopic Contact dermatitis Nummular eczema
55
What ongoing issue can lead to increased itching of Lichen Simplex Chronicus? What is the name of the nodules seen in Lichen Simplex Chronicus
Nerve entrapment Prurigo nodularis
56
How is Lichen Simplex Chronicus managed/Tx
Break itch-scratch cycle: 1st Gen antihistamine for sleep scratching Biofeedback/behavior modification Thick areas= Group 1 Kenalog intralesion steroids
57
# Define Stasis Dermatitis What PT population is this dangerous in?
Dec LE circulation causing inflammation DM
58
How is Stasis Dermatitis Tx Define Atopic Dermatitis
Compression socks LE elevation Emollients Topical steroids Chronic eczema rash beginning in childhood
59
What may be seen in Hx of PTs w/ atopic dermatitis What can cause flare ups?
Hayfever Atopy Allergies Asthma Sinusitis Pollen Stress Temps
60
What is the etiology of Atopic Dermatitis What type of infection are these PTs at risk for? What may be seen on PE?
Itch that rashes- Dry - Crack - Itch - Rash Autoinnoculation Staph Dermographism
61
What is the distribution of atopic dermatitis in PTs 0-2y/o What is the distribution in PTs 2-12y/o? How does Atopic Dermatitis present in PTs >12y/o?
Dry red scaling on cheeks Flexural areas Face/scalp Bilateral flexor creases Spares face except eyelid
62
# Define Dennie-Moargan folds Where do Atopic Dermatitis PTs tend to get palmar hyperlinearity Why would PT have a 'ghost-like face'?
Atopic pleats on lower eye lids Thenar emminence Pityriasis alba
63
Associated features of Atopic Dermatitis
Follicular prominence Allergic shiners Dennie Morgan folds: atopic pleats on lower lids Keratosis pilaris Ichthyosis vulgaris- scaling shins Pityriasis alba Palmar/plantar hyperlinearity
64
What are the triggers of Atopic Dermatitis
``` LEFTIE AC Low humidity Excessive washing Food Temp changes Irritants Emotional stress Aeroallergens Contact allergy ```
65
How is the inflammation of atopic dermatitis Tx w/ concurrent steroids and emollients
Adults: mid-high potency Fluocinonide Triamcinolone Kids: low potency Hydrocortisone Desonide
66
What meds can be used for breaking the itch/scratch cycle of Atopic Dermatitis? What medication may be used by dermatologists but has black box warnings for Ca?
Hydroxyzine Diphenhydramine Calcineurin Inhibitors: Pimecrolimus Tacrolimus
67
What are the restrictions for using Topical Calcineurin Inhibitors What medication is used for mild-mod atopic dermatitis that failed steroid Tx What Interleukin-4 inhibitor may be used?
Only as second line agent in non-reponsive/intolerant PTs Avoid in ImmSupp/<2y/o Crisaborole Dupliumab- >12y/o and for mod/recalcitrant cases Topical Tx failures
68
# Define Keratosis Pilaris How is it Tx
Atopic Dermatitis variant: ASx during childhood; spiny keratotic papules on etensors of proximal arms/thighs Urea/lactic acid lotion Mid-potency steroid
69
What are the two main types of contact dermatitis If unable to ID a causative agent, what is this the Gold standard for Dx?
Irritant- non-immunologic; damages barrier Allergic- absorbs Ag (sensitization) w/ f/u exposure causing immunologic response Patch testing
70
What are the MC types of irritant dermatitis What is the morphology of irritant dermatitis
Occupational- hand Diaper Acute: Cracked Inflamed, Fissured skin Chronic- scaly, flaky, lichened w/ less erythema
71
How are cases of irritant dermatitis managed/Tx? What is the MC and 2nd MC cause of allergic contact dermatitis?
Avoidance Topical steroids Emollient- protective barrier Cool compress Nickel Poison ivy
72
How do Allergic contact dermatitis cases present? How is allergic contact dermatitis Tx
Well defined/sharply demarcated Sev: PO steroid x 2wks w/ taper Wet compress Antihistamine Mild-mod: topical steroid
73
# Define Urticaria Define Angioedema
Recurrent whealing of skin; come and go <24hrs Rapid/deep swelling in dermis and Sub-Q/submucosal tissue
74
What are the different types of urticaria? What is the PathoPhys behind urticaria?
``` Physical- trigger stimulus Ordinary Vasculitis- seen on biopsy Contact- bio/chemical Angioedema ``` Mast cell degranulation, histamine mediated
75
What are the different type s of physical urticaria
``` Delayed pressure Adrenergic- Nor/Epi Cold Dermographism Aquagenic Cholinergic Solar Localized heat Exercise induced Vibratory ```
76
How does urticaria present? How long does physical urticaria last? How is urticaria classified?
Firm pink plaque w/ central pallor/orange peel appearance 30-60min Acute <6wks Chronic >6wks
77
What labs are ordered during an urticaria case? How are PTs w/ acute urticaria managed/Tx?
CBC LFT UA ESR H1 antihistamine Anaphylaxis- benadryl CCS Epi
78
How is chronic urticaria Tx How is physical urticaria Tx?
2nd Gen Anti-histamine H2 blockers Oral steroids, short Elimination diet Self limiting Avoid Pre-Tx w/ H1 blockers
79
Angiodedema involves deeper tissues what additional Sxs can they present w/? What parts of the body are more commonly affected?
Dysphagia Abdominal pain Dyspnea Tongue Trunk Hands LIps Eyes Genitals
80
How is angioedema Tx Define Koplik spots
Antihistamines PO steroids Epi White spots on buccal mucosa during prodrome of rubeola/measles/First Dz
81
How do measles spots spread? Once the rash is gone, what remains?
Centrifugal spread- head to feet w/ blanching rash Brown discoloration/fine scales
82
How are PTs w/ Koplik spots Tx How does Hand Foot Mouth Dz present
Antipyretics Respiratory isolation PO lesions first 2-10 painful lesions Hand/foot lesions: papular lesions on dorsal aspects, palms/soles, arms/legs, butt/face
83
How are PTs w/ Hand Foot Mouth Dz Tx What is '5th Dz'?
Antipyretics/histamine Diet adjustment Erythema infectiosum- Slapped cheek w/ macular lacy rash
84
How is Erythema Infectiosum Tx When are these PTs contagious
Support Prodromal period
85
Mucocutaneous Lymph Node Syndrome is AKA ? Who/how does this present
Kawasakis Unresponsive high fever, cervical adenopathy and rash
86
What are the 3 phases of Kawasakies
Acute- fever x 7-14 days, strawberry tongue, tender edema on palms/soles Subacute- end of fever around day 25, desquamation begins Convalescent- normal ESR
87
What is the MC adverse effect of drugs? What are the 3 MC types
Cutaneous eruption Maculopapular* Urticarial Fixed drug eruption
88
Maculopapular exanthematous drug eruptions can be easily confused w/ ? Dx How is the drug eruption different?
Viral exanthem Spares face
89
Where do the round, sharply demarcated red plaques of fixed drug eruptions occur? What would be seen if PT is re-exposed to drug in the future? How are these PTs managed?
Glans penis- MC Face Lips Hands Feet Same predictable reaction in the same predictable location Antihistamines Steroids Class 3-5
90
What are the 4 types of hypersensitivity syndromes
Erythema Multiform/Nodosum Stevens Johnson Syndrome Toxic Epidermal Necrolysis
91
How does Erythema Multiforme present? What are the two types?
Immune mediated response causing target/iris lesions Major- severe mucosal involvement Minor- mild/no mucosal involvement
92
What are the two etiologies leading to Erythem Multiforme? How do PTs present?
Infection: HSV-(MC) M-pneumonia Medication reaction 20-40y/o PT w/ fever malaise and myalgia
93
What are the two morphologies of Erythema Multiforme
Prototypical- target/iris, vesiculo-bullous lesions Atypical: persistent urticarial plaques
94
What parts of the body can Erythem Multiforme be seen on? How are these PTs Tx
Dorsal hand* Palm/sole Mucous membranes Extensor limbs Cyclovir Antihistamine Mild topical CCS Prednisone
95
When do PTs w/ Erythema Mutliforme need stat referrals? What parts of the body does SJS affect w/ ? PE finding
Ocular mucosa involvement Genitals Eyes Mouth Skin Bullae 1-14days after prodrome
96
How does SJS present? What medications are these PTs commonly on?
Membrane Sxs preceded by URI w/ fever Stinging eyes/painful swallowing 1-3 days before cutaneous Sxs Seizure ABX Gout
97
How do SJS lesions spread? What finding is noted 1-14 days after the prodrome?
Trunk Neck Face ProxUE Bullae
98
What drugs are most likely to cause SJS? What infection can cause this?
Lamotrigine Allopurinol SMX-TMP -oxicam NSAIDs Mycoplasma pneumonia
99
# Define Toxic Epidermal Necrolysis How doe these PTs present?
SJS-like mucous membrane dz progressing to skin sloughing Sudden red/tender skin Conjunctivitis Stomatitis
100
How/why does Toxic Epidermal Necrolysis have such a high mortality rate? What part of the body is spared from having the Nikoldky Sign?
Sepsis infection Scalp GI tract
101
What is the constant feature unique to Toxic Epidermal Necrolysis? How do PTs present if respiratory tract is involved?
Severe ocular involvement Dyspnea Hypersecretion Hypoxemia
102
How is Toxic Epidermal Necrolysis Tx in the burn unit? What Tx is avoided in these PTs? Traditionally SJS and TEN are considered more severe forms of ?
Plasma exchange IVIG Cyclosporine A Cyclophosphamide CCS Erythema Multiforme
103
What are the 3 grade classifications of SJS/TEN?
SJS: mucosal erosions and <10% epidermal detachment Overlap SJS/TEN: 10-30% detachment TEN: >30% detachment
104
# Define Erythema Nodosum What PT populations are more likely to develop this?
Nodular erythematous eruption limited to extensor aspects of extremeties d/t hypersensitivty reaction Females, Sarcoidosis
105
How does Erythema Nodosum present How are these PTs Tx
Red node/swelling of shins Week 1: hard/tense/pain Week 2: fluctuant Self limited NSAIDs
106
# Define Pyoderma Gangrenosum Pyoderma Gangrenosum is associated w/ PTs that have ? Dx
Non-infectious neutrophilic ulcerating skin dz IBDz
107
How does Pyoderma Gangrenosum spread on the body? How long do these lesions last?
Peripherally spreading necrotic ulcer from primary lesion Months-years
108
# Define Acne Vulgaris What are the 3 etiologies of this condition
Multifactorial disease of pilosebaceous unit Bacterial colonization/inflammation Excess sebaceous secretion Duct obstructions
109
What type of bacteria live in the pilosebaceous glands and cause inflammation? How doe these microbes cause inflammation?
Propionbacterium acnes Break down sebum into free fatty acids
110
What hormone causes an increase of sebaceous gland size/activity leading to inc sebum What are the two classifications of acne?
Testosterone Non-inflammatory: comedones Inflammatory: Papules Pustules Nodule Cysts
111
What part of acne vulgaris directs Tx efforts? How long is Tx tried before need to re-evaluate?
Type/number of lesions 4-8wks
112
What Tx is added for female PTs w/ Mod-Sev acne after initial Tx fails? What meds are alternatives or 2nd/3rd line options for Tx?
PO OCP Spironolactone- ineligible for Accutane Tazarotene- retinoid Azelaic acid- topical ABX
113
What is the MOA of Isotretinoin What are the 4 therapeutic targets it ihits? This med is approved for use in what two situations?
Dec sebaceous gland activity Normalizes keratinization PAcnes Inflammation Comedogensis Sebum* Nodular acne Recalcitrant acne
114
What does the screening process for Isotretinoin consist of What labs need to be ordered prior to referral? What FamHx needs to be screened for?
6mon f/u time D/c everything LFT Lipid CBC UA HCG Hx of IBDz
115
What instructions are given to PTs while on Isotretinoin
``` Oil-free moisturizer Sunscreen Avoid ETOH Dispense 1mon supply at time for female PTs No blood donation during Tx ``` Must be on two forms of contraception HCG qmon HCG 1mon after d/c
116
Why would PTs have to d/c Isotretinoin
Pregnancy HA w/ vision changes HA not relieved by OTC meds Suicide/Homicide ideations
117
How does Adult Female Acne present How are these PTs managed/Tx
<39y/o PT w/ acne flares w/ menses along jaw/chin PO OCPs Spironolactone Tretinoin cream- 2nd line Erythromycin- last chance
118
Define Perioral Dermatitis
Characteristic: cheek pustules adjacent to nasolabial fold, MC young females Clear zone around vermillion border
119
Etiology unknown, what is Perioral Dermatitis associated w/? What self Tx may be in Hx that caused their condition to worsen
Moisturizing creams Topical steroids Benzoyl peroxide
120
How is Perioral dermatitis Tx What etiological agent catalyzed Acne Roseacea prevalence
Doxy x 2-4wks 1% HC cream Demodex folliculorum
121
How does Acne Roseacea present How are these PTs managed/Tx?
Telangiectasias, Rhinophyma Flushing w/ hot drinks/ETOH ``` Topical Metronidazole Azelaic acid Tetracycline Sunscreen Responds to dietary changes ```
122
What is used for refractory Acne Rosacea Define Pomade Acne
Isotretinoin Elective surgery- correct rhinophyma Small non-inflamed papules in PTs that use oils/creams
123
Where does Pomade not/affect PTs? How is it Tx How is Milia Tx
Forehead Temple Side, face Spares sebaceous areas Benzoyl Peroxide Tretinoin at night Excise Tretinoin
124
# Define Miliaria What are the two types How is it Tx
Heat rash- forehead, cheeks, trunk Miliaria crystallina/rubra Air out, cool off Antihistamines
125
# Define Hidradenitis Suppurativa What pathognemonic sign may be seen on exam?
Scar/band forming dz of tissue due to hyperkeratosis over apocrine glands w/ secondary bacterial infection Double comedome sign- black head w/ two/+ communicating tracts
126
How are PTs w/ Hidradenitis Suppurativa managed? Other than Staph A, what else can cause Staph Folliculitis
D/c smoking ABX- TCN Doxy Emycin Mcycline Strep epidermis
127
How is Staph Folliculitis Tx
Isolate: Topical Mupirocin/Clinda Extensive: PO Dicloxacillin/Cephalexin Recurrent: Clinda, Mupirocin, Hibiclens washes
128
What can be done for PFB shaving techniques
Benzoyl peroxide wash Glycolic acid/Aveeno cream Desonide/HC after shaving Topical retinoid
129
# Define Epidermal Inclusion Cyst Pilar cysts are AKA ? and less common than ?
Dysfunctional follicles due to trauma, fill w/ sebum Wen, on top of head EIC
130
# Define Psoriasis What are the classic presentations in descending frequency?
Immune mediated skin/joint inflammatory dz w/ hyperkaratosis Chronic Guttate Pustular Inverse
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What is the name of lesions after trauma in PTs w/ psoriasis What is the morphology of CPP?
Koebner phenomenon (LP) Red flat scale progressing into silvery white scales
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What happens if CPP scale is removed? What is the distribution of this condition?
Auspitz sign- pin point capillary bleeding Extensor surfaces Pitting/oil spot nails
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What meds and microbes can worsen CPP Criteria and Tx for Mild-Mod CPP What medication is used prior to steroids for scale removal?
Lithium BBs Steroids Strep ``` <5% BAS; Clobetasol/Fluocinonide UVB Calci Hydrate + Betameth Dipro Tazarotene- topical retinoid ``` Keralytic (salicylic acid)
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What Vitamin D3 analogues are used in Tx of CPP What is used for scalp therapy?
Topical Calcitriol Calcipotriene Calciportiene Hydrate and Betamethasone dipropionate- Vit D + Steroid Keratolytic gel Tar shampoo Triamcinolone spray Fluocinolone solution Diffuse/Thick- Calcipotriene Betamethasone dipropionate lotion
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What is the criteria and Tx for Mod-Severe Psoriasis
``` >5% BSA Methotrexate Acitretin Cyclosporine Isotretinoin UVA ```
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What condition indicates PT may have psoriasis and is seen in younger PTs What illness may precede the eruption by 1-2wks Where/how does this present?
Guttate 'tear drop' psoriasis Strep throat Viral URI Scaling papules on trunk/extremities Spares palms/soles
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How are Guttate Psoriasis PTs Tx How does Pustular Psoriasis present
First line= UVB x 6wks Topical steroid/Vit D analog Emollients Deep yellow pustules on palms/soles that dry, fall off
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How is Pustular Psoriasis Tx and what is avoided What is a key part to PT education and Tx
Class 1 topical- Clobetasol No PO steroids Smoking cessation
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What type of pustular psoriasis presents w/ 'lakes of pus'? Define Psoriasis Inversus
von Zumbusch Flexura/intertriginous plaques that scale, macerate and disperse
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What nail changes may be sen in psoriasis PTs? Seborrheic dermatitis may AKA ?
Onycholysis Subungual debris Oil spot*- pathognemonic Dandruff/Cradle cap- chronic inflammatory dz in skin w/ high sebum
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What PT populations would have more severe cases of Seborrheic Dermatitis This condition is one of the MC cutaneous manifestations of ? Dx
Elderly w/ neuro problems AIDS
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What microbe is prevalent in Seborrheic Dermatitis? What parts of the body are least likely to be involved in Seborrheic Dermatitis?
Malassezia furfur: lipophilic yeast normally in flora Presternal Ubilicus Groin Axilla
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How is Seborrheic Dermatitis Tx What ABX/anti-fungals may be used?
Ketaconazole* Selenium sulfide/Tar based Hydrocortisone, desonide- face Fluocinolone- Class 4, diffuse scalp scaling Diclox Itraconazole Cephalexin
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# Define Pityriasis Rosea What is the name of the visible sudden onset sign? What is the uncommon presentation of this condition?
10-35y/o PT in colder months, possibly due to HHV 6, 7 w/ Hx of preceding URI Herald patch- salmon pink patch w/ Christmas tree distribution Reverse pityriasis- neck, face, arms legs, palm/sole involvement
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What words may be used to describe Pityriasis borders? How are these conditions Tx What is used if severe case?
Collarette of scale w/in plaque border RPR- r/o secondary syphilis Group 5 topical for itch Sunlight Prednisone UVB PO acyclovir
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Lichen Planus lesions can have an association w/ ? infective Dz What are the 6 Ps of this condition
HCV Pruritic Planar Polygonal Purple Papule/plaque Persistent
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What type of appearance can Lichen Planus lesions have? What type of distribution can this have? How is the Dx confirmed?
Wickham striae- white lacy pattern w/ crisscrossed lines Acral- wrist/ankles Scalp Oral Nail Genital Punch biopsy- r/o SCC
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How is Lichen Planus Tx What is used for generalized cases? What med is used to help control itching?
Group 1-2 topicals BID Membranes- Clobetasol Flucinonide Triamcinolone Azathioprine if resistant Prednisone Hydroxyzine
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# Define Lichen Sclerosis Where are these MC seen on the body?
Lichen Sclerosis et atrophicus- inflammatory dz of superficial dermis/mucosa Vulva Perianal Groin
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How is Lichen Sclerosis Tx Define Necrobiosis Lipoidica
Phototherapy- PUVA Clobetasol ointment Red advancing border w/ yellow/brown center and waxy/telangiectasis
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Necrobiosis Lipoidica may be seen in ? PT population or precursor indicating ? Dx Where do almost all lesions occur?
DM Anterior tib/fib
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Rarely, Necrobiosis Lipoidica can progress into ? How are they Tx
SCC Pentoxifyline
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How does Granuloma Annulare present Generalized form is associated w/?
Papules MC on dorsal hand/feet that undergo central involution HIV/DM
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How is Granuloma Annulare Tx What can be done for disseminated cases?
Topical steroid occlusion PUVA Hydroxychloroquine Isotretinoin Dapsone
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What does Acanthosis Nigricans look like on PE? Where is this PE finding MC seen? What type of Ca is MC known to cause this manifestation?
Symmetrical brown thickening of skin w/ velvet texture Axilla Gastric
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How is Acanthosis Nigricans Tx Define Xanthomas
Ammonium lactate- softens lesion Tretinoin cream- thins hyperkeratotic skin Lipid deposits on skin/tendons secondary to hyperlipidemia
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What are the 5 major types of Xanthomas
``` Xanthelasma- MC Eruptive Plane Tuberous Tendinous ```
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# Define Xanthelasma How do eruptive xanthomas present? What does their presence suggest?
MC form of xanthoma, superficial flat plaques. PT has not lipid abnormality Pressure points HyperTg
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Where do tuberous xanthomas present? This type can be a sign of ? underlying issue
Extensor surfaces Palms HyperTg Biliary cirrhosis
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What is the MC location for tendinous xanthomas to appear? What can these indicate is an ongoing issue?
Achilles HyperTg Biliary cirrhosis
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How are xanthomas Tx on top of the dyslipidemia Kaposi sarcomas are ? and can be placed into what 5 subgroups
Trichloroacetic acid ``` Vascular neoplasms Classic African cutaneous African lymphadenopathic AIDS ImmSupp ```
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? is the MC tumor in AIDS PTs What PT population do these occur in and where on the body?
Kaposis sarcoma Older men Trunk Head Neck
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How are Kaposi Sarcomas differentiated from Lichen Planus What is the etiology of Kaposi Sarcomas How is it Dx
Dec size w/ firm pressure Inc w/ release of pressure HHV-8 in ImmSupp PTs Biopsy shows proliferation of blood vessels w/ neopalstic cells
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How are Kaposi Sarcomas Tx What may be seen on PE in PTs w/ hyperthyroid
Liquid N cryotherapy Excision Vinblastine chemo <1cm Radiotherapy for larger mass Thyroid apropachy- clubbing Plummer nails- onycholysis w/ concave nails
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What type of Derm finding may be seen in PTs w/ Graves Dz Define Carotenemia and who is it seen in?
Pretibial Myxedema- orange peel appearance Yellow tint to palms/sole in HypoThryoid
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How are bullous d/os classified by histology? Pemphigus is Greek for ?
Level of skin where separation occurs Blister, bubble
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How is Pemphigus characterized? What is the PathoPhys behind this condition? What other Dx is this condition associated w/?
Intraepidermal blisters due to loss of adhesion to keratinocytes IgG Ab against desmoglein 1/3 M Gravis
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Pemphigus Vulgaris has near universal involvement of ? area of the body w/ blisters? What issue precedes the blisters?
Oral mucosa Painful erosions
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How doe Pemphigus Vulgaris primary lesions present? How is it Dx How is it Tx
Non-pruritic flaccid blisters that erupt like Nikolsky sign Biopsy for light microscopy Refer to Derm for ImmModd/ImmSupp Predisone Plasmapheresis
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? is the MC autoimmune sub-epidermal blistering dz How does it present?
Bullous Pemphigoid >60y/o w/ pruritic bullous eruptions
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What are the two most important DDx for Bullous Pemphigoid How is this Tx
Simple urticaria Erythema multiforme Group 1 topical and PO CCS Mod-Sev: refer to Derm
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# Define Dermatitis Herpetiformis What other Dx is this associated w/? What PT population is more likely to have this?
Chronic intense buring vesicular skin dz Celiac dz M>F w/ North European decent
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How does Dermatitis Herpetiformis present? How is it Dx How is it Tx
Bilateral extensor surfaces w/ burning/itching Punch biopsy Serologic testing for Celiac Dapsone- short term Gluten free diet- long term
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Dermographism is a type of ? Viral exanthems
Urticaria Measles HFM Dz Erythema infectiosum Kawasakie

IPAP (212 decks)

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