Derm Cases Part 1- Feirstein

Question 1

What bacteria causes acne vulgaris?

Answer 1

Propionibacterium

Question 2

Tx for mild acne vulgars?

Answer 2

Topical Benzoyl Peroxide wash

OR

Topical Retinoid

Question 3

Tx for moderate acne vulgaris?

Answer 3

COMBO: Topical BP AND Topical Retinoid

Question 4

Tx for severe acne vulgaris?

Answer 4

Combo therapy (BO + Retinoid)

AND

Topical Abx (erythromycin/clindamycin)

Question 5

Tx for very severe acne vulgaris?

Answer 5

refer to derm and give tetracycline or doxy (oral abx +BP)

Dermatologist will give oral isotretinoin as well.

Question 6

What kind of diet is recommended for pts with acne vulgaris?

Answer 6

low glycemic diet

Question 7

How long do topical agents take to work for acne vulgaris?

Answer 7

2-3 mos

Question 8

When should you re-evaluate pt with acne vulgaris?

Answer 8

8 weeks

Question 9

Etiology of roseola infantum (6th disease)?

Answer 9

HHV 6

Question 10

Sx of roseola infantum (6th disease, HHV6)

Answer 10

prodrome of:

fever

palpebral edema

cervical lymphadenopathy

mild URI sx

Question 11

Roseola infantum is a _________

Answer 11

viral exanthem

Question 12

Describe the exanthem found in roseola infantum (6th disease, HHV6)

Answer 12

pink macules and papules surrounded by white halo

Question 13

Where does the viral exanthem of roseola infantum begin?

Answer 13

trunk

Question 14

Tx of roseola infantum (6th disease, HHV6)

Answer 14

supportive care

tx atypical cases/immunocompromised pts

Question 15

Clinical px of guttate psoriasis

Answer 15

“water splashed” lesions on trunk & extremities

1-10mm salmon pink with fine scales

does not follow skin tension lines

preceded by a strep infection (S. pharyngitis) (GABHS infection)

Question 16

Where will you find guttate psoriasis on the body?

Answer 16

trunk & extremities

Question 17

Is there oral, palm or sole involvment with guttate psoriasis?

Answer 17

NO, it is found only on the trunk and extremities

Question 18

Tx of Guttate psoriasis if it is limited

Answer 18

potent topical steroids

Question 19

Tx of guttate psoriasis if it is extensive

Answer 19

narrow band UVB phototherapy

Question 20

What is the following?

“mobile, dermal nodule with overlying punctum”

Answer 20

Epidermal cyst/epidermal inclusion cyst

NOT a sebaceous cyst

Question 21

Does an epidermal inclusion cyst arise from a hair follicle?

Answer 21

YES

Question 22

Tx of epidermal inclusion cyst

Answer 22

surgical excision: remove entire cyst wall

Question 23

“dermatomal rash that does not cross the midline”

What is this?

Answer 23

Shingles

Question 24

Can shingles be in multiple dermatomes?

Answer 24

YES

Question 25

When do you want to get vaccinated for shingles?

Answer 25

in a year or two

Question 26

What is the main complication we are concerned about with shingles?

Answer 26

post-herpetic neuralgia

Question 27

What can put you at risk for developing shingles?

Answer 27

Heavy steroid use (due to immunocompression)

Question 28

**"rolled, curly borders, telangiectasia, central umbilication"** What dz?

Answer 28

Basal Cell Carcinoma

Question 29

Dx of BCC

Answer 29

shave biopsy

Question 30

Tx of BCC

Answer 30

Mohs surgery

Question 31

Describe Mohs surgery and what condition you would do it for.

Answer 31

Do it for BCC incremental surgery while pathologist is on site and taking off more and more of the tumor until the malignancy is gone

Question 32

Tx of contact dermatitis

Answer 32

remove irritant low potent steroid

Question 33

**"easy flushing, erythema, telangiectasias, papules/pustules, rhinophyma (nose changes)."** **What dz?**

Answer 33

Acne Rosacea

Question 34

Tx of acne rosaca

Answer 34

topical metronidazole for inflammation

Question 35

What if topical metronidazole doesnt work for acne rosacea? What is the next line of tx?

Answer 35

Oral tetracycline

Question 36

Triggers of acne rosacea

Answer 36

alcohol sunlight heat spicy food emotional stress

Question 37

Can hormones trigger acne rosacea?

Answer 37

NO

Question 38

**"papular, purple, pruritic, polygonal, planar"** What dz?

Answer 38

**Lichen Planus (5P's)**

Question 39

Where do you most commonly find Lichen Planus?

Answer 39

bilateral flexor surfaces of extremities

Question 40

Tx of Lichen planus

Answer 40

topical steroids antihistamines for itchiness

Question 41

Tx of refractory cases of lichen planus

Answer 41

systemic steroids

Question 42

**"small, skin colored/pink dome shaped papules often with central umbilications"** **What dz?**

Answer 42

Molluscum Contagiousum

Question 43

Molluscum Cont. is MC in which population?

Answer 43

young school children

Question 44

How long does molluscum cont. last and what is the average duration?

Answer 44

months-years avg: 13 months

Question 45

Main Tx of molluscum cont.

Answer 45

supportive

Question 46

What tx can you do **if Molluscum contagiosum is not found on the face?**

Answer 46

cryotherapy

Question 47

What tx can you give in office for molluscum cont?

Answer 47

cantharidin

Question 48

How is molluscum contagiosum spread?

Answer 48

skin-skin by fomites

Question 49

"**herald patch on trunk** that becomes a **christmas tree pattern** and spreads to the **extremities**" What dz?

Answer 49

**Pityriasis rosea**

Question 50

T/F: Pityriasis is usually asymptomatic

Answer 50

TRUE

Question 51

T/F: Pit. Rosea can be itchy and associated with flu like sx

Answer 51

TRUE

Question 52

**"oval salmon colored patches with minor scale, oval patches follow skin tension lines on back"** What dz?

Answer 52

Pityriasis Rosea

Question 53

Tx of pityriasis rosea

Answer 53

self limiting, that resolves in 8 weeks w/o tx

Question 54

T/F: You may need to tx Pit. rosea with erythromycin for 2 weeks.

Answer 54

TRUE

Question 55

**"appears on dorsal hands, arms and face"** HPV is causative agent What dz is this?

Answer 55

Verruca planae

Question 56

Tx of verruca planae

Answer 56

refer because it is on the face