Derm Cases Part 1- Feirstein Flashcards
What bacteria causes acne vulgaris?
Propionibacterium
Tx for mild acne vulgars?
Topical Benzoyl Peroxide wash
OR
Topical Retinoid
Tx for moderate acne vulgaris?
COMBO: Topical BP AND Topical Retinoid
Tx for severe acne vulgaris?
Combo therapy (BO + Retinoid)
AND
Topical Abx (erythromycin/clindamycin)
Tx for very severe acne vulgaris?
refer to derm and give tetracycline or doxy (oral abx +BP)
Dermatologist will give oral isotretinoin as well.
What kind of diet is recommended for pts with acne vulgaris?
low glycemic diet
How long do topical agents take to work for acne vulgaris?
2-3 mos
When should you re-evaluate pt with acne vulgaris?
8 weeks
Etiology of roseola infantum (6th disease)?
HHV 6
Sx of roseola infantum (6th disease, HHV6)
prodrome of:
fever
palpebral edema
cervical lymphadenopathy
mild URI sx
Roseola infantum is a _________
viral exanthem
Describe the exanthem found in roseola infantum (6th disease, HHV6)
pink macules and papules surrounded by white halo
Where does the viral exanthem of roseola infantum begin?
trunk
Tx of roseola infantum (6th disease, HHV6)
supportive care
tx atypical cases/immunocompromised pts
Clinical px of guttate psoriasis
“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)
Where will you find guttate psoriasis on the body?
trunk & extremities
Is there oral, palm or sole involvment with guttate psoriasis?
NO, it is found only on the trunk and extremities
Tx of Guttate psoriasis if it is limited
potent topical steroids
Tx of guttate psoriasis if it is extensive
narrow band UVB phototherapy
What is the following?
“mobile, dermal nodule with overlying punctum”
Epidermal cyst/epidermal inclusion cyst
NOT a sebaceous cyst
Does an epidermal inclusion cyst arise from a hair follicle?
YES
Tx of epidermal inclusion cyst
surgical excision: remove entire cyst wall
“dermatomal rash that does not cross the midline”
What is this?
Shingles
Can shingles be in multiple dermatomes?
YES
When do you want to get vaccinated for shingles?
in a year or two
What is the main complication we are concerned about with shingles?
post-herpetic neuralgia
What can put you at risk for developing shingles?
Heavy steroid use (due to immunocompression)
“rolled, curly borders, telangiectasia, central umbilication”
What dz?
Basal Cell Carcinoma
Dx of BCC
shave biopsy
Tx of BCC
Mohs surgery
Describe Mohs surgery and what condition you would do it for.
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
Tx of contact dermatitis
remove irritant
low potent steroid
“easy flushing, erythema, telangiectasias, papules/pustules, rhinophyma (nose changes).”
What dz?
Acne Rosacea
Tx of acne rosaca
topical metronidazole for inflammation
What if topical metronidazole doesnt work for acne rosacea?
What is the next line of tx?
Oral tetracycline
Triggers of acne rosacea
alcohol
sunlight
heat
spicy food
emotional stress
Can hormones trigger acne rosacea?
NO
“papular, purple, pruritic, polygonal, planar”
What dz?
Lichen Planus (5P’s)
Where do you most commonly find Lichen Planus?
bilateral flexor surfaces of extremities
Tx of Lichen planus
topical steroids
antihistamines for itchiness
Tx of refractory cases of lichen planus
systemic steroids
“small, skin colored/pink dome shaped papules often with central umbilications”
What dz?
Molluscum Contagiousum
Molluscum Cont. is MC in which population?
young school children
How long does molluscum cont. last and what is the average duration?
months-years
avg: 13 months
Main Tx of molluscum cont.
supportive
What tx can you do if Molluscum contagiosum is not found on the face?
cryotherapy
What tx can you give in office for molluscum cont?
cantharidin
How is molluscum contagiosum spread?
skin-skin by fomites
“herald patch on trunk that becomes a christmas tree pattern and spreads to the extremities”
What dz?
Pityriasis rosea
T/F: Pityriasis is usually asymptomatic
TRUE
T/F: Pit. Rosea can be itchy and associated with flu like sx
TRUE
“oval salmon colored patches with minor scale, oval patches follow skin tension lines on back”
What dz?
Pityriasis Rosea
Tx of pityriasis rosea
self limiting, that resolves in 8 weeks w/o tx
T/F: You may need to tx Pit. rosea with erythromycin for 2 weeks.
TRUE
“appears on dorsal hands, arms and face”
HPV is causative agent
What dz is this?
Verruca planae
Tx of verruca planae
refer because it is on the face
