Derm: Block 1 Flashcards
What are the 5 layers of skin?
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
What are the 4 parts to a derm PE?
What are the Primary Lesion words
Primary lesion
Distribution
Fitzpatrick phototype
Secondary/Special lesions
Papule Wheal Plaque Macule Vesicle Bulla Nodule Pustule
How are lesions described by distribution
How are lesions described by configuration?
Dermatomal Flexor/Extensor Intertriginous Linear Multiple- local/general Solitary
Serpinginous (larva migran)
Annular- ring (tiea)
Cluster/Group (Herpes)
Define Macule
Define Patch
Flat circumscribed discoloration =1cm
Macule >1cm
Define Papule
Define Plaque
Elevated solid lesion 0.5cm or < in diameter
Circumscribed, elevated superficial lesion 0.5cm or > in diameter; often confluent papules
Define Nodule
Define Pustule
Circumscribed, elevated solid lesion 0.5cm or > (tumor)
Collection of leukocytes and pus
Define Vesicle
Define Bulla
Collection of serous fluid <0.5cm in diameter
Collection of free fluid >0.5cm in diameter
Define Wheal (Hive)
What terms are used to describe a secondary lesion
Firm edematous plaque from fluid infiltration
Fissure Atrophy Crust Erosion Scale Ulcer Scar
Define Scales
Define Crust
Excess dead cells from abnormal keratinization and shedding
Dried serum and debris; scab
Define Erosion
Define Ulcer
No dermoepidermal junction penetratoin; no scarring
Focal loss of epi/dermis, heal w/ scarring
Define Fissure
Define Atrophy
Linear loss w/ sharp/defined walls
Depressed skin from thinning of epi/dermis
Define Scar
What are the Special Skin Lesions
Abnormal formation of CT from dermal damage
PCM BELT PC
Purpura Comedone Milia
Burrow Excoriation Lichenification Telangiectasia Petechiae Cyst
Define Excoriation
Define Comedone
Linear erosion from scratching
Plug materials in hair follicles
Black (dilated)
White (narrow)
Define Milia
Define Cyst
Superficial keratin cyst w/ no opening
Circumscribed lesion w/ wall and lumen
Define Telangiectasia
What are the 4 main treatment categories
Dilated superficial blood vessels; BCS until Dx
Topical Systemic Photo therapy Surgical
What is the purpose of topical therapy?
Dry cutaneous lesions have lost ?
How is this corrected?
Restore skin function after insult that removed water, lipid, proteins
Epidermal lipid/protein/water
Emollient cream
Lotion
Define Xerosis Cutis
When is this condition worse and what part of the body is affected?
How is it Tx?
Rough skin w/ fine white - thick brown scales
Severe: crisscross, fissures
Dry winter months, hands/lower legs
12% lactate lotion
(Lac-Hydrin, AmLactin)
How do emollient creams/lotions provide benefit?
What types have special lubricating properties?
Which one is thicker and more lubricating?
Restore water and lipids
Added urea/lactic acid
Creams
Define Wet Skin Dzs
How are they managed
Inflammatory dz leaking serum
Wet compress- suppress inflammation, debridement
Restore lipid/proteins w/ cream/lotion
What are the four benefits of wet dressings?
Wound debridement- macerates vesicle/crust
Antibacterial w/ added aluminum acetate, acetic acid, silver nitrate
Inflammation suppression faster than CCS
Drying effect
What are examples of exudative skin dzs that would benefit w/ wet dressings?
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
What are the three types of Wet Dressings and what are they used for?
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
What groups of steroids are the strongest/weakest potency?
What effects do topical CCS exert?
Strong: 1
Weak: 7, OTCs
Anti inflam/mitotic
Vasoconstriction
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?
Accurate Dx F/u Appropriate Tx duration Proper strength/vehicle Sufficient quantity
1-4wks
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
Define Cream
These are best used for ? located ?
Chemical Oil Preservative Water mixture
Best: exudative inflammation
Most useful:
Rectal Axilla Groin
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
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
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
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
Occlusions can increase steroid potency by ?
Consider ‘natural’ occlusion when prescribing for ?
100x
Redundant folds
Axilla
Inguinal folds
Diaper areas
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
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
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
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
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
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
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
Define “Rule of Hand”
Four hand areas is equivocal to ?
One hand area= 1% TBSA
1g of medication
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
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
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
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
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
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
Define Dyshidrotic Eczema
How does it present
Pompholyx-
Reaction pattern of symmetric hand/foot dermatitis
MC in teen-middle aged w/ itching preceding vesicles
What are the suspected etiologies of Dyshidrotic Eczema
PTs may also have ? underlying condition?
Irritants*
Atopic dermatitis relationship
Stress
Hyperhidrosis
What is the morphology of Dyshidrotic Eczema?
What part of the body is involved?
Tapioca lesions- deep vesicle w/ erythema
Palms/lateral finger
Soles
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
Define Asteatotic Eczema
This is AKA ?
Excess drying from showers/cold in atopic elderly PTs
More itch than rash
Eczema craquele
Winter Itch
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
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
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
Define Lichen Simplex Chronicus
What can precipitate Lichen Simplex Chronicus
Neurodermatitis from habitual scratching
Seborrheic Atopic Contact dermatitis
Nummular eczema
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
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
Define Stasis Dermatitis
What PT population is this dangerous in?
Dec LE circulation causing inflammation
DM
How is Stasis Dermatitis Tx
Define Atopic Dermatitis
Compression socks
LE elevation
Emollients
Topical steroids
Chronic eczema rash beginning in childhood
What may be seen in Hx of PTs w/ atopic dermatitis
What can cause flare ups?
Hayfever Atopy Allergies Asthma Sinusitis
Pollen Stress Temps
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
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
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
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
What are the triggers of Atopic Dermatitis
LEFTIE AC Low humidity Excessive washing Food Temp changes Irritants Emotional stress Aeroallergens Contact allergy
How is the inflammation of atopic dermatitis Tx w/ concurrent steroids and emollients
Adults: mid-high potency
Fluocinonide
Triamcinolone
Kids: low potency
Hydrocortisone
Desonide
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
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
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
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
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
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
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
Define Urticaria
Define Angioedema
Recurrent whealing of skin; come and go <24hrs
Rapid/deep swelling in dermis and Sub-Q/submucosal tissue
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
What are the different type s of physical urticaria
Delayed pressure Adrenergic- Nor/Epi Cold Dermographism Aquagenic Cholinergic Solar Localized heat Exercise induced Vibratory
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
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
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
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
How is angioedema Tx
Define Koplik spots
Antihistamines
PO steroids
Epi
White spots on buccal mucosa during prodrome of rubeola/measles/First Dz
How do measles spots spread?
Once the rash is gone, what remains?
Centrifugal spread- head to feet w/ blanching rash
Brown discoloration/fine scales
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
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
How is Erythema Infectiosum Tx
When are these PTs contagious
Support
Prodromal period
Mucocutaneous Lymph Node Syndrome is AKA ?
Who/how does this present
Kawasakis
Unresponsive high fever, cervical adenopathy and rash
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
What is the MC adverse effect of drugs?
What are the 3 MC types
Cutaneous eruption
Maculopapular*
Urticarial
Fixed drug eruption
Maculopapular exanthematous drug eruptions can be easily confused w/ ? Dx
How is the drug eruption different?
Viral exanthem
Spares face
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
What are the 4 types of hypersensitivity syndromes
Erythema Multiform/Nodosum
Stevens Johnson Syndrome
Toxic Epidermal Necrolysis
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
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
What are the two morphologies of Erythema Multiforme
Prototypical- target/iris, vesiculo-bullous lesions
Atypical: persistent urticarial plaques
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
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
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
How do SJS lesions spread?
What finding is noted 1-14 days after the prodrome?
Trunk Neck Face ProxUE
Bullae
What drugs are most likely to cause SJS?
What infection can cause this?
Lamotrigine
Allopurinol
SMX-TMP
-oxicam NSAIDs
Mycoplasma pneumonia
Define Toxic Epidermal Necrolysis
How doe these PTs present?
SJS-like mucous membrane dz progressing to skin sloughing
Sudden red/tender skin
Conjunctivitis
Stomatitis
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
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
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
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
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
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
Define Pyoderma Gangrenosum
Pyoderma Gangrenosum is associated w/ PTs that have ? Dx
Non-infectious neutrophilic ulcerating skin dz
IBDz
How does Pyoderma Gangrenosum spread on the body?
How long do these lesions last?
Peripherally spreading necrotic ulcer from primary lesion
Months-years
Define Acne Vulgaris
What are the 3 etiologies of this condition
Multifactorial disease of pilosebaceous unit
Bacterial colonization/inflammation
Excess sebaceous secretion
Duct obstructions
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
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
What part of acne vulgaris directs Tx efforts?
How long is Tx tried before need to re-evaluate?
Type/number of lesions
4-8wks
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
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
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
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
Why would PTs have to d/c Isotretinoin
Pregnancy
HA w/ vision changes
HA not relieved by OTC meds
Suicide/Homicide ideations
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
Define Perioral Dermatitis
Characteristic: cheek pustules adjacent to nasolabial fold, MC young females
Clear zone around vermillion border
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
How is Perioral dermatitis Tx
What etiological agent catalyzed Acne Roseacea prevalence
Doxy x 2-4wks
1% HC cream
Demodex folliculorum
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
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
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
Define Miliaria
What are the two types
How is it Tx
Heat rash- forehead, cheeks, trunk
Miliaria crystallina/rubra
Air out, cool off
Antihistamines
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
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
How is Staph Folliculitis Tx
Isolate: Topical Mupirocin/Clinda
Extensive: PO Dicloxacillin/Cephalexin
Recurrent: Clinda, Mupirocin, Hibiclens washes
What can be done for PFB shaving techniques
Benzoyl peroxide wash
Glycolic acid/Aveeno cream
Desonide/HC after shaving
Topical retinoid
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
Define Psoriasis
What are the classic presentations in descending frequency?
Immune mediated skin/joint inflammatory dz w/ hyperkaratosis
Chronic Guttate Pustular Inverse
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
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
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)
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
What is the criteria and Tx for Mod-Severe Psoriasis
>5% BSA Methotrexate Acitretin Cyclosporine Isotretinoin UVA
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
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
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
What type of pustular psoriasis presents w/ ‘lakes of pus’?
Define Psoriasis Inversus
von Zumbusch
Flexura/intertriginous plaques that scale, macerate and disperse
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
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
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
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
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
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
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
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
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
Define Lichen Sclerosis
Where are these MC seen on the body?
Lichen Sclerosis et atrophicus- inflammatory dz of superficial dermis/mucosa
Vulva Perianal Groin
How is Lichen Sclerosis Tx
Define Necrobiosis Lipoidica
Phototherapy- PUVA
Clobetasol ointment
Red advancing border w/ yellow/brown center and waxy/telangiectasis
Necrobiosis Lipoidica may be seen in ? PT population or precursor indicating ? Dx
Where do almost all lesions occur?
DM
Anterior tib/fib
Rarely, Necrobiosis Lipoidica can progress into ?
How are they Tx
SCC
Pentoxifyline
How does Granuloma Annulare present
Generalized form is associated w/?
Papules MC on dorsal hand/feet that undergo central involution
HIV/DM
How is Granuloma Annulare Tx
What can be done for disseminated cases?
Topical steroid occlusion
PUVA
Hydroxychloroquine Isotretinoin Dapsone
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
How is Acanthosis Nigricans Tx
Define Xanthomas
Ammonium lactate- softens lesion
Tretinoin cream- thins hyperkeratotic skin
Lipid deposits on skin/tendons secondary to hyperlipidemia
What are the 5 major types of Xanthomas
Xanthelasma- MC Eruptive Plane Tuberous Tendinous
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
Where do tuberous xanthomas present?
This type can be a sign of ? underlying issue
Extensor surfaces
Palms
HyperTg
Biliary cirrhosis
What is the MC location for tendinous xanthomas to appear?
What can these indicate is an ongoing issue?
Achilles
HyperTg
Biliary cirrhosis
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
? 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
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
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
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
How are bullous d/os classified by histology?
Pemphigus is Greek for ?
Level of skin where separation occurs
Blister, bubble
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
Pemphigus Vulgaris has near universal involvement of ? area of the body w/ blisters?
What issue precedes the blisters?
Oral mucosa
Painful erosions
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
? is the MC autoimmune sub-epidermal blistering dz
How does it present?
Bullous Pemphigoid
> 60y/o w/ pruritic bullous eruptions
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
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
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
Dermographism is a type of ?
Viral exanthems
Urticaria
Measles
HFM Dz
Erythema infectiosum
Kawasakie
