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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
Q

Vehicle is AKA ? and defined as ?

What are the 5 types of vehicles?

A

Base- substance containing active ingredient; determines rate of absorption

Foam Ointment Gel Solution
Cream Lotion

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26
Q

Define Cream

These are best used for ? located ?

A

Chemical Oil Preservative Water mixture

Best: exudative inflammation
Most useful:
Rectal Axilla Groin

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27
Q

Define Ointment

Why are ointments used

When is this vehicle not used?

A

Petroleum jelly/grease w/out preservatives, MOST lipophilic

Moisturize, occlusion

Eczema inflammation Intertriginous areas

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28
Q

Define Gel

When are these useful?

What part of the body are these particularly useful for?

A

Greaseless jelly of Water Alcohol Propylene glycol

Ivy exudative inflammation

Scalp

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29
Q

Define Solution and Lotion

What type of effect do they exert?

Where are these vehicles MOST useful for use?

A

Water Alcohol Chemical mixture

LEAST lipophilic

Scalp- greasy hair penetration

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30
Q

When are foams useful?

What is the name of the super potent foam and directions for use?

A

Scalp dermatoses
Eczematous inflammation: Ivy Psoriasis

Olux-Clobetasol propionate
Not for PTs <12y/o
Only used <2wks

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31
Q

Occlusions can increase steroid potency by ?

Consider ‘natural’ occlusion when prescribing for ?

A

100x

Redundant folds
Axilla
Inguinal folds
Diaper areas

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32
Q

What benefit does hydration have on topical CCS therapy

Steroid application post ? or w/ added ? increases absorption rates

A

Stretches intracellular connections to increase absorption 4-5x

Post-bathing
Moist wraps/occlusions

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33
Q

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?

A

Stratum corneum of face/eye lids

Soles/Palms

Steroid acne/Folliculitis

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34
Q

What are the local adverse effects of topical steroid therapy?

A 
AWARDS BPH
Atrophy
Worsening infection- tinea
Acne/folliculitis
Rebound phenomenon
Dryness- cream/lotions
Striae
Burn/Bruise
Pigmentation, hypo
Hypertrichosis
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35
Q

Contact allergies can occur from topical CCS due to exposure to ?

If contact allergy occurs due to the steroid component, how does it present?

A

Preservatives
Color
Steroid itself

Chronic dermatitis not exacerbated or improved by CCS

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36
Q

If suspected contact allergy to steroid exists, what is the next step?

What are systemic adverse effects that can occur from topical CCS usage?

A

Skin test (patch testing)

Cataracts
Cushing syndrome
Failure to thrive
AAxis suppressed (<2, teen)
Glaucoma
Stunted growth
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37
Q

What type of steroid is usually used for intralesion injections?

What are the benefits and risk of administering steroids IM?

A

Triamcinolone

Long lasting, easier
Atrophy w/ short needles

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38
Q

What are the four MC mistakes of topical steroid therapy?

Define FTU

A

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

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39
Q

Define “Rule of Hand”

Four hand areas is equivocal to ?

A

One hand area= 1% TBSA

1g of medication

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40
Q

When using topical CCS, don’t use more than ?g of group one per week

What is the recommended schedule for this group?

A

45-60g

QD-BID
Pulse therapy: 2wk on, 1wk off to avoid tachyphylaxis

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41
Q

How often are Group 2-4 CCS used?

? is the MC inflammatory skin dz and the three types

A

BID x 2-6wks

Eczema-
Dyshidrotic
Asteatotic
Nummular

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42
Q

What are the characteristics of eczematous inflammation that all PTs have?

What are the three stages of the dz?

A

Pruritus Erythema Vesicels Scales

Acute Subacute Chronic

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43
Q

How does acute eczema present

What are the etiologies of this condition

How is it Tx

A

Vesicles Itch Bulle Erythema

Pompholyx
Contact allergy- Rhus
Nummular eczema
Stasis dermatitis

Cold wet compress
ABX (secondary infxn)
CCS

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44
Q

Subacute eczema is the ? phase that presents as ?

What are the etiologies

How is it tx

A

Dry:
Fissures Parched Itch Erythema

Contact allergy
Astetotic eczema

Topical steroid
Emollient
Antihistamine/ABX

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45
Q

How does chronic eczema present

What are it’s etiolgies

How is it Tx

A

Fissuring
Accentuated lines
Itch
Lichenification

Habitual scratching
Atopic dermatitis
Lichen simplex chronicus

Topical steroids
Emollient
ABX/Antihistamine

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46
Q

Define Dyshidrotic Eczema

How does it present

A

Pompholyx-
Reaction pattern of symmetric hand/foot dermatitis

MC in teen-middle aged w/ itching preceding vesicles

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47
Q

What are the suspected etiologies of Dyshidrotic Eczema

PTs may also have ? underlying condition?

A

Irritants*
Atopic dermatitis relationship
Stress

Hyperhidrosis

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48
Q

What is the morphology of Dyshidrotic Eczema?

What part of the body is involved?

A

Tapioca lesions- deep vesicle w/ erythema

Palms/lateral finger
Soles

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49
Q

How are Dyshidrotic Eczema PTs managed/Tx?

What is the last line of Tx tried for Dyshidrotic Eczema

A 
Bland emollients, avoid water
Hydroxizine/Diphenhydramine
Antihistamines
Psoralen + UVA radiation
Steroids

Low dose methotrexate

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50
Q

Define Asteatotic Eczema

This is AKA ?

A

Excess drying from showers/cold in atopic elderly PTs
More itch than rash

Eczema craquele
Winter Itch

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51
Q

What part of the body does Asteatotic Eczema involve?

How are these PTs managed/Tx

A

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

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52
Q

Define Nummular Eczema

What PT population does it present in and how

A

Latin- money; intense pruritic coin shaped plaque

> 50y/o in same spot every winter w/ intense itching

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53
Q

What part of the body does Nummular Eczema involve?

How are PTs w/ Nummular Eczema managed/Tx

A

Dorsal hands
UE
Lower legs

Antipruritics
Group 1-3 steroids
Emollient, humidifier

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54
Q

Define Lichen Simplex Chronicus

What can precipitate Lichen Simplex Chronicus

A

Neurodermatitis from habitual scratching

Seborrheic Atopic Contact dermatitis
Nummular eczema

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55
Q

What ongoing issue can lead to increased itching of Lichen Simplex Chronicus?

What is the name of the nodules seen in Lichen Simplex Chronicus

A

Nerve entrapment

Prurigo nodularis

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56
Q

How is Lichen Simplex Chronicus managed/Tx

A

Break itch-scratch cycle:

1st Gen antihistamine for sleep scratching

Biofeedback/behavior modification

Thick areas= Group 1

Kenalog intralesion steroids

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57
Q

Define Stasis Dermatitis

What PT population is this dangerous in?

A

Dec LE circulation causing inflammation

DM

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58
Q

How is Stasis Dermatitis Tx

Define Atopic Dermatitis

A

Compression socks
LE elevation
Emollients
Topical steroids

Chronic eczema rash beginning in childhood

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59
Q

What may be seen in Hx of PTs w/ atopic dermatitis

What can cause flare ups?

A

Hayfever Atopy Allergies Asthma Sinusitis

Pollen Stress Temps

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60
Q

What is the etiology of Atopic Dermatitis

What type of infection are these PTs at risk for?

What may be seen on PE?

A

Itch that rashes-
Dry - Crack - Itch - Rash

Autoinnoculation Staph

Dermographism

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61
Q

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?

A

Dry red scaling on cheeks

Flexural areas
Face/scalp

Bilateral flexor creases
Spares face except eyelid

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62
Q

Define Dennie-Moargan folds

Where do Atopic Dermatitis PTs tend to get palmar hyperlinearity

Why would PT have a ‘ghost-like face’?

A

Atopic pleats on lower eye lids

Thenar emminence

Pityriasis alba

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63
Q

Associated features of Atopic Dermatitis

A

Follicular prominence

Allergic shiners

Dennie Morgan folds: atopic pleats on lower lids

Keratosis pilaris

Ichthyosis vulgaris- scaling shins

Pityriasis alba

Palmar/plantar hyperlinearity

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64
Q

What are the triggers of Atopic Dermatitis

A 
LEFTIE AC
Low humidity
Excessive washing
Food
Temp changes
Irritants
Emotional stress
Aeroallergens
Contact allergy
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65
Q

How is the inflammation of atopic dermatitis Tx w/ concurrent steroids and emollients

A

Adults: mid-high potency
Fluocinonide
Triamcinolone

Kids: low potency
Hydrocortisone
Desonide

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66
Q

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?

A

Hydroxyzine
Diphenhydramine

Calcineurin Inhibitors:
Pimecrolimus
Tacrolimus

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67
Q

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?

A

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

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68
Q

Define Keratosis Pilaris

How is it Tx

A

Atopic Dermatitis variant: ASx during childhood; spiny keratotic papules on etensors of proximal arms/thighs

Urea/lactic acid lotion
Mid-potency steroid

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69
Q

What are the two main types of contact dermatitis

If unable to ID a causative agent, what is this the Gold standard for Dx?

A

Irritant- non-immunologic; damages barrier
Allergic- absorbs Ag (sensitization) w/ f/u exposure causing immunologic response

Patch testing

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70
Q

What are the MC types of irritant dermatitis

What is the morphology of irritant dermatitis

A

Occupational- hand
Diaper

Acute: Cracked Inflamed, Fissured skin
Chronic- scaly, flaky, lichened w/ less erythema

71
Q

How are cases of irritant dermatitis managed/Tx?

What is the MC and 2nd MC cause of allergic contact dermatitis?

A

Avoidance
Topical steroids
Emollient- protective barrier
Cool compress

Nickel
Poison ivy

72
Q

How do Allergic contact dermatitis cases present?

How is allergic contact dermatitis Tx

A

Well defined/sharply demarcated

Sev: PO steroid x 2wks w/ taper
Wet compress
Antihistamine
Mild-mod: topical steroid

73
Q

Define Urticaria

Define Angioedema

A

Recurrent whealing of skin; come and go <24hrs

Rapid/deep swelling in dermis and Sub-Q/submucosal tissue

74
Q

What are the different types of urticaria?

What is the PathoPhys behind urticaria?

A 
Physical- trigger stimulus
Ordinary
Vasculitis- seen on biopsy
Contact- bio/chemical
Angioedema

Mast cell degranulation, histamine mediated

75
Q

What are the different type s of physical urticaria

A 
Delayed pressure
Adrenergic- Nor/Epi
Cold
Dermographism
Aquagenic
Cholinergic
Solar
Localized heat
Exercise induced
Vibratory
76
Q

How does urticaria present?

How long does physical urticaria last?

How is urticaria classified?

A

Firm pink plaque w/ central pallor/orange peel appearance

30-60min

Acute <6wks
Chronic >6wks

77
Q

What labs are ordered during an urticaria case?

How are PTs w/ acute urticaria managed/Tx?

A

CBC LFT UA ESR

H1 antihistamine
Anaphylaxis- benadryl CCS Epi

78
Q

How is chronic urticaria Tx

How is physical urticaria Tx?

A

2nd Gen Anti-histamine
H2 blockers
Oral steroids, short
Elimination diet

Self limiting
Avoid
Pre-Tx w/ H1 blockers

79
Q

Angiodedema involves deeper tissues what additional Sxs can they present w/?

What parts of the body are more commonly affected?

A

Dysphagia
Abdominal pain
Dyspnea

Tongue Trunk Hands
LIps Eyes Genitals

80
Q

How is angioedema Tx

Define Koplik spots

A

Antihistamines
PO steroids
Epi

White spots on buccal mucosa during prodrome of rubeola/measles/First Dz

81
Q

How do measles spots spread?

Once the rash is gone, what remains?

A

Centrifugal spread- head to feet w/ blanching rash

Brown discoloration/fine scales

82
Q

How are PTs w/ Koplik spots Tx

How does Hand Foot Mouth Dz present

A

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
Q

How are PTs w/ Hand Foot Mouth Dz Tx

What is ‘5th Dz’?

A

Antipyretics/histamine
Diet adjustment

Erythema infectiosum-
Slapped cheek w/ macular lacy rash

84
Q

How is Erythema Infectiosum Tx

When are these PTs contagious

A

Support

Prodromal period

85
Q

Mucocutaneous Lymph Node Syndrome is AKA ?

Who/how does this present

A

Kawasakis

Unresponsive high fever, cervical adenopathy and rash

86
Q

What are the 3 phases of Kawasakies

A

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
Q

What is the MC adverse effect of drugs?

What are the 3 MC types

A

Cutaneous eruption

Maculopapular*
Urticarial
Fixed drug eruption

88
Q

Maculopapular exanthematous drug eruptions can be easily confused w/ ? Dx

How is the drug eruption different?

A

Viral exanthem

Spares face

89
Q

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?

A

Glans penis- MC
Face Lips Hands Feet

Same predictable reaction in the same predictable location

Antihistamines
Steroids Class 3-5

90
Q

What are the 4 types of hypersensitivity syndromes

A

Erythema Multiform/Nodosum
Stevens Johnson Syndrome
Toxic Epidermal Necrolysis

91
Q

How does Erythema Multiforme present?

What are the two types?

A

Immune mediated response causing target/iris lesions

Major- severe mucosal involvement
Minor- mild/no mucosal involvement

92
Q

What are the two etiologies leading to Erythem Multiforme?

How do PTs present?

A

Infection: HSV-(MC) M-pneumonia
Medication reaction

20-40y/o PT w/ fever malaise and myalgia

93
Q

What are the two morphologies of Erythema Multiforme

A

Prototypical- target/iris, vesiculo-bullous lesions

Atypical: persistent urticarial plaques

94
Q

What parts of the body can Erythem Multiforme be seen on?

How are these PTs Tx

A

Dorsal hand*
Palm/sole
Mucous membranes
Extensor limbs

Cyclovir
Antihistamine
Mild topical CCS
Prednisone

95
Q

When do PTs w/ Erythema Mutliforme need stat referrals?

What parts of the body does SJS affect w/ ? PE finding

A

Ocular mucosa involvement

Genitals Eyes Mouth Skin
Bullae 1-14days after prodrome

96
Q

How does SJS present?

What medications are these PTs commonly on?

A

Membrane Sxs preceded by URI w/ fever
Stinging eyes/painful swallowing 1-3 days before cutaneous Sxs

Seizure ABX Gout

97
Q

How do SJS lesions spread?

What finding is noted 1-14 days after the prodrome?

A

Trunk Neck Face ProxUE

Bullae

98
Q

What drugs are most likely to cause SJS?

What infection can cause this?

A

Lamotrigine
Allopurinol
SMX-TMP
-oxicam NSAIDs

Mycoplasma pneumonia

99
Q

Define Toxic Epidermal Necrolysis

How doe these PTs present?

A

SJS-like mucous membrane dz progressing to skin sloughing

Sudden red/tender skin
Conjunctivitis
Stomatitis

100
Q

How/why does Toxic Epidermal Necrolysis have such a high mortality rate?

What part of the body is spared from having the Nikoldky Sign?

A

Sepsis infection

Scalp
GI tract

101
Q

What is the constant feature unique to Toxic Epidermal Necrolysis?

How do PTs present if respiratory tract is involved?

A

Severe ocular involvement

Dyspnea Hypersecretion Hypoxemia

102
Q

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 ?

A

Plasma exchange
IVIG
Cyclosporine A
Cyclophosphamide

CCS

Erythema Multiforme

103
Q

What are the 3 grade classifications of SJS/TEN?

A

SJS: mucosal erosions and <10% epidermal detachment

Overlap SJS/TEN: 10-30% detachment

TEN: >30% detachment

104
Q

Define Erythema Nodosum

What PT populations are more likely to develop this?

A

Nodular erythematous eruption limited to extensor aspects of extremeties d/t hypersensitivty reaction

Females, Sarcoidosis

105
Q

How does Erythema Nodosum present

How are these PTs Tx

A

Red node/swelling of shins
Week 1: hard/tense/pain
Week 2: fluctuant

Self limited
NSAIDs

106
Q

Define Pyoderma Gangrenosum

Pyoderma Gangrenosum is associated w/ PTs that have ? Dx

A

Non-infectious neutrophilic ulcerating skin dz

IBDz

107
Q

How does Pyoderma Gangrenosum spread on the body?

How long do these lesions last?

A

Peripherally spreading necrotic ulcer from primary lesion

Months-years

108
Q

Define Acne Vulgaris

What are the 3 etiologies of this condition

A

Multifactorial disease of pilosebaceous unit

Bacterial colonization/inflammation
Excess sebaceous secretion
Duct obstructions

109
Q

What type of bacteria live in the pilosebaceous glands and cause inflammation?

How doe these microbes cause inflammation?

A

Propionbacterium acnes

Break down sebum into free fatty acids

110
Q

What hormone causes an increase of sebaceous gland size/activity leading to inc sebum

What are the two classifications of acne?

A

Testosterone

Non-inflammatory: comedones

Inflammatory: Papules Pustules Nodule Cysts

111
Q

What part of acne vulgaris directs Tx efforts?

How long is Tx tried before need to re-evaluate?

A

Type/number of lesions

4-8wks

112
Q

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?

A

PO OCP
Spironolactone- ineligible for Accutane

Tazarotene- retinoid
Azelaic acid- topical ABX

113
Q

What is the MOA of Isotretinoin

What are the 4 therapeutic targets it ihits?

This med is approved for use in what two situations?

A

Dec sebaceous gland activity
Normalizes keratinization

PAcnes Inflammation Comedogensis Sebum*

Nodular acne
Recalcitrant acne

114
Q

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?

A

6mon f/u time
D/c everything

LFT Lipid CBC UA HCG

Hx of IBDz

115
Q

What instructions are given to PTs while on Isotretinoin

A 
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
Q

Why would PTs have to d/c Isotretinoin

A

Pregnancy
HA w/ vision changes
HA not relieved by OTC meds
Suicide/Homicide ideations

117
Q

How does Adult Female Acne present

How are these PTs managed/Tx

A

<39y/o PT w/ acne flares w/ menses along jaw/chin

PO OCPs
Spironolactone
Tretinoin cream- 2nd line
Erythromycin- last chance

118
Q

Define Perioral Dermatitis

A

Characteristic: cheek pustules adjacent to nasolabial fold, MC young females
Clear zone around vermillion border

119
Q

Etiology unknown, what is Perioral Dermatitis associated w/?

What self Tx may be in Hx that caused their condition to worsen

A

Moisturizing creams

Topical steroids
Benzoyl peroxide

120
Q

How is Perioral dermatitis Tx

What etiological agent catalyzed Acne Roseacea prevalence

A

Doxy x 2-4wks
1% HC cream

Demodex folliculorum

121
Q

How does Acne Roseacea present

How are these PTs managed/Tx?

A

Telangiectasias, Rhinophyma
Flushing w/ hot drinks/ETOH

Topical Metronidazole
Azelaic acid
Tetracycline 
Sunscreen
Responds to dietary changes
122
Q

What is used for refractory Acne Rosacea

Define Pomade Acne

A

Isotretinoin
Elective surgery- correct rhinophyma

Small non-inflamed papules in PTs that use oils/creams

123
Q

Where does Pomade not/affect PTs?

How is it Tx

How is Milia Tx

A

Forehead Temple Side, face
Spares sebaceous areas

Benzoyl Peroxide
Tretinoin at night

Excise Tretinoin

124
Q

Define Miliaria

What are the two types

How is it Tx

A

Heat rash- forehead, cheeks, trunk

Miliaria crystallina/rubra

Air out, cool off
Antihistamines

125
Q

Define Hidradenitis Suppurativa

What pathognemonic sign may be seen on exam?

A

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
Q

How are PTs w/ Hidradenitis Suppurativa managed?

Other than Staph A, what else can cause Staph Folliculitis

A

D/c smoking
ABX- TCN Doxy Emycin Mcycline

Strep epidermis

127
Q

How is Staph Folliculitis Tx

A

Isolate: Topical Mupirocin/Clinda

Extensive: PO Dicloxacillin/Cephalexin

Recurrent: Clinda, Mupirocin, Hibiclens washes

128
Q

What can be done for PFB shaving techniques

A

Benzoyl peroxide wash
Glycolic acid/Aveeno cream
Desonide/HC after shaving
Topical retinoid

129
Q

Define Epidermal Inclusion Cyst

Pilar cysts are AKA ? and less common than ?

A

Dysfunctional follicles due to trauma, fill w/ sebum

Wen, on top of head
EIC

130
Q

Define Psoriasis

What are the classic presentations in descending frequency?

A

Immune mediated skin/joint inflammatory dz w/ hyperkaratosis

Chronic Guttate Pustular Inverse

131
Q

What is the name of lesions after trauma in PTs w/ psoriasis

What is the morphology of CPP?

A

Koebner phenomenon (LP)

Red flat scale progressing into silvery white scales

132
Q

What happens if CPP scale is removed?

What is the distribution of this condition?

A

Auspitz sign- pin point capillary bleeding

Extensor surfaces
Pitting/oil spot nails

133
Q

What meds and microbes can worsen CPP

Criteria and Tx for Mild-Mod CPP

What medication is used prior to steroids for scale removal?

A

Lithium BBs Steroids
Strep

<5% BAS; 
Clobetasol/Fluocinonide
UVB
Calci Hydrate + Betameth Dipro
Tazarotene- topical retinoid

Keralytic (salicylic acid)

134
Q

What Vitamin D3 analogues are used in Tx of CPP

What is used for scalp therapy?

A

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

135
Q

What is the criteria and Tx for Mod-Severe Psoriasis

A 
>5% BSA
Methotrexate
Acitretin
Cyclosporine
Isotretinoin
UVA
136
Q

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?

A

Guttate ‘tear drop’ psoriasis

Strep throat
Viral URI

Scaling papules on trunk/extremities
Spares palms/soles

137
Q

How are Guttate Psoriasis PTs Tx

How does Pustular Psoriasis present

A

First line= UVB x 6wks
Topical steroid/Vit D analog
Emollients

Deep yellow pustules on palms/soles that dry, fall off

138
Q

How is Pustular Psoriasis Tx and what is avoided

What is a key part to PT education and Tx

A

Class 1 topical- Clobetasol
No PO steroids

Smoking cessation

139
Q

What type of pustular psoriasis presents w/ ‘lakes of pus’?

Define Psoriasis Inversus

A

von Zumbusch

Flexura/intertriginous plaques that scale, macerate and disperse

140
Q

What nail changes may be sen in psoriasis PTs?

Seborrheic dermatitis may AKA ?

A

Onycholysis
Subungual debris
Oil spot*- pathognemonic

Dandruff/Cradle cap- chronic inflammatory dz in skin w/ high sebum

141
Q

What PT populations would have more severe cases of Seborrheic Dermatitis

This condition is one of the MC cutaneous manifestations of ? Dx

A

Elderly w/ neuro problems

AIDS

142
Q

What microbe is prevalent in Seborrheic Dermatitis?

What parts of the body are least likely to be involved in Seborrheic Dermatitis?

A

Malassezia furfur: lipophilic yeast normally in flora

Presternal Ubilicus Groin
Axilla

143
Q

How is Seborrheic Dermatitis Tx

What ABX/anti-fungals may be used?

A

Ketaconazole*
Selenium sulfide/Tar based
Hydrocortisone, desonide- face
Fluocinolone- Class 4, diffuse scalp scaling

Diclox Itraconazole Cephalexin

144
Q

Define Pityriasis Rosea

What is the name of the visible sudden onset sign?

What is the uncommon presentation of this condition?

A

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

145
Q

What words may be used to describe Pityriasis borders?

How are these conditions Tx

What is used if severe case?

A

Collarette of scale w/in plaque border

RPR- r/o secondary syphilis
Group 5 topical for itch
Sunlight

Prednisone
UVB
PO acyclovir

146
Q

Lichen Planus lesions can have an association w/ ? infective Dz

What are the 6 Ps of this condition

A

HCV

Pruritic Planar Polygonal
Purple Papule/plaque Persistent

147
Q

What type of appearance can Lichen Planus lesions have?

What type of distribution can this have?

How is the Dx confirmed?

A

Wickham striae- white lacy pattern w/ crisscrossed lines

Acral- wrist/ankles
Scalp Oral Nail Genital

Punch biopsy- r/o SCC

148
Q

How is Lichen Planus Tx

What is used for generalized cases?

What med is used to help control itching?

A

Group 1-2 topicals BID
Membranes- Clobetasol Flucinonide Triamcinolone
Azathioprine if resistant

Prednisone

Hydroxyzine

149
Q

Define Lichen Sclerosis

Where are these MC seen on the body?

A

Lichen Sclerosis et atrophicus- inflammatory dz of superficial dermis/mucosa

Vulva Perianal Groin

150
Q

How is Lichen Sclerosis Tx

Define Necrobiosis Lipoidica

A

Phototherapy- PUVA
Clobetasol ointment

Red advancing border w/ yellow/brown center and waxy/telangiectasis

151
Q

Necrobiosis Lipoidica may be seen in ? PT population or precursor indicating ? Dx

Where do almost all lesions occur?

A

DM

Anterior tib/fib

152
Q

Rarely, Necrobiosis Lipoidica can progress into ?

How are they Tx

A

SCC

Pentoxifyline

153
Q

How does Granuloma Annulare present

Generalized form is associated w/?

A

Papules MC on dorsal hand/feet that undergo central involution

HIV/DM

154
Q

How is Granuloma Annulare Tx

What can be done for disseminated cases?

A

Topical steroid occlusion

PUVA
Hydroxychloroquine Isotretinoin Dapsone

155
Q

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?

A

Symmetrical brown thickening of skin w/ velvet texture

Axilla

Gastric

156
Q

How is Acanthosis Nigricans Tx

Define Xanthomas

A

Ammonium lactate- softens lesion
Tretinoin cream- thins hyperkeratotic skin

Lipid deposits on skin/tendons secondary to hyperlipidemia

157
Q

What are the 5 major types of Xanthomas

A 
Xanthelasma- MC
Eruptive
Plane
Tuberous
Tendinous
158
Q

Define Xanthelasma

How do eruptive xanthomas present?

What does their presence suggest?

A

MC form of xanthoma, superficial flat plaques.
PT has not lipid abnormality

Pressure points

HyperTg

159
Q

Where do tuberous xanthomas present?

This type can be a sign of ? underlying issue

A

Extensor surfaces
Palms

HyperTg
Biliary cirrhosis

160
Q

What is the MC location for tendinous xanthomas to appear?

What can these indicate is an ongoing issue?

A

Achilles

HyperTg
Biliary cirrhosis

161
Q

How are xanthomas Tx on top of the dyslipidemia

Kaposi sarcomas are ? and can be placed into what 5 subgroups

A

Trichloroacetic acid

Vascular neoplasms
Classic
African cutaneous
African lymphadenopathic
AIDS
ImmSupp
162
Q

? is the MC tumor in AIDS PTs

What PT population do these occur in and where on the body?

A

Kaposis sarcoma

Older men
Trunk Head Neck

163
Q

How are Kaposi Sarcomas differentiated from Lichen Planus

What is the etiology of Kaposi Sarcomas

How is it Dx

A

Dec size w/ firm pressure
Inc w/ release of pressure

HHV-8 in ImmSupp PTs

Biopsy shows proliferation of blood vessels w/ neopalstic cells

164
Q

How are Kaposi Sarcomas Tx

What may be seen on PE in PTs w/ hyperthyroid

A

Liquid N cryotherapy
Excision
Vinblastine chemo <1cm
Radiotherapy for larger mass

Thyroid apropachy- clubbing
Plummer nails- onycholysis w/ concave nails

165
Q

What type of Derm finding may be seen in PTs w/ Graves Dz

Define Carotenemia and who is it seen in?

A

Pretibial Myxedema- orange peel appearance

Yellow tint to palms/sole in HypoThryoid

166
Q

How are bullous d/os classified by histology?

Pemphigus is Greek for ?

A

Level of skin where separation occurs

Blister, bubble

167
Q

How is Pemphigus characterized?

What is the PathoPhys behind this condition?

What other Dx is this condition associated w/?

A

Intraepidermal blisters due to loss of adhesion to keratinocytes

IgG Ab against desmoglein 1/3

M Gravis

168
Q

Pemphigus Vulgaris has near universal involvement of ? area of the body w/ blisters?

What issue precedes the blisters?

A

Oral mucosa

Painful erosions

169
Q

How doe Pemphigus Vulgaris primary lesions present?

How is it Dx

How is it Tx

A

Non-pruritic flaccid blisters that erupt like Nikolsky sign

Biopsy for light microscopy

Refer to Derm for ImmModd/ImmSupp
Predisone
Plasmapheresis

170
Q

? is the MC autoimmune sub-epidermal blistering dz

How does it present?

A

Bullous Pemphigoid

> 60y/o w/ pruritic bullous eruptions

171
Q

What are the two most important DDx for Bullous Pemphigoid

How is this Tx

A

Simple urticaria
Erythema multiforme

Group 1 topical and PO CCS
Mod-Sev: refer to Derm

172
Q

Define Dermatitis Herpetiformis

What other Dx is this associated w/?

What PT population is more likely to have this?

A

Chronic intense buring vesicular skin dz

Celiac dz

M>F w/ North European decent

173
Q

How does Dermatitis Herpetiformis present?

How is it Dx

How is it Tx

A

Bilateral extensor surfaces w/ burning/itching

Punch biopsy
Serologic testing for Celiac

Dapsone- short term
Gluten free diet- long term

174
Q

Dermographism is a type of ?

Viral exanthems

A

Urticaria

Measles
HFM Dz
Erythema infectiosum
Kawasakie

ipap (212 decks)

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