Derm Conditions Flashcards
christmas tree sign think / Herald patch
Pityriasis Rosea (not ringworm)
DDX for generalized rash w/ fever (5)
- measles (viral WILL blanch)
- rubella
- rocky mtn spotted fever
- viral exanthem
- scarlet fever
DDX for generalized red rash w/ bullae (4)
- erythema multiforme (major)
- toxic epidermal necrolysis
- pemphigus vulgaris
- bullous pemphigoid
does the rash blanch?
diascopy
scabies test
mineral oil preparation
stain for HSV sore
Tzanck smear
bathing over 15 min will _____ skin–although soak 10-15 min before ______ application will ^ absorption
dry,
steroid
If its ____ wet it, if its _____ dry it.
dry,
wet
use of corticosteroids near eye can cause
glaucoma
greasy lotions–“moisturizers”
emollients
best combo for itchy rash
topical antihistamine and oral steroid
most common skin disorder
ezcema (atopic dermatitis–itchy rash
the “itch that rashes”
eczema (itch-scratch cycle)
eczema is a
IgE Type I hypersensitivity rxn
eczema typically on
flexeral surfaces
flat red blotches as eczema
maculo-papular
eczema sufferer likely to have (3)
- family hx
- allergy
- asthma
PRURITUS!
eczema (atopic dermatitis)
If eczema goes on too long
lichenification (highest potency steroid appropriate for location and pt)
pathogens associated w/ secondary ifx of eczema
- Staph (yellow crusting)
- candida
- molluscum contagiosum
- HSV
Tx for atopic dermatitis
Triamcinolone ointment + anti-itch meds + tx for secondary infx
(2) types of contact dermatitis CD
- allergic: poison ivy–Type IV hypersensitivity rxn (nickle)
- irritant: inflammation due to chemicals
Tx for contact dermatitis
high-potency corticosteroid
zit =
papule
small flat discolored area of skin–usually less than 1 cm
macule
“end stage” disease of a variety of PRURITIC and ECZEMATOUS disorders
Lichen Simplex Chronicus esp. atopic dermatitis
Tx for lichen simplex chronicus (3)
- break itch/scratch cycle
- ^ potency flucocorticoid
- tight time sedation w/ oral antihistamine
adolescents/young-middle aged rash more common in females, “papulopustular”–aggravated by topical glucocorticoids
perioral dermatitis TX w/ METRONIDAZOLE gel (antiinflammatory)
candida think
satalite lesions
“cradle cap” similar presentation to lupus
seborrheic dermatitis (presents as severe DANDRUFF on head and face/ear canals)
yellowish –> white greasy scales over erythematous patches/plaques
seborrheic dermatitis
cause of seborrheic dermatitis
Yeast–pityrosporon ovale
^ risk groups for seborrheic dermatitis (3)
- Parkinson’s
- stroke
- HIV+
Tx seborrheic dermatitis
ketoconazole and selenium sulfide shampoo
-babies: olive oil and shampoo
rash secondary to venous incompetence and chronic edema
stasis dermatitis (extremely common)
easily mistaken for cellulitis–rash in pt’s w/ diabetes or DVT
stasis dermatitis
stasis dermatits is a
cutaneous marker of venous insufficiency
tx for stasis dermatitis
- leg elevation
- compression stockings
- emolliants for rash
dyshidrosis aka
pompholyx
Atopy
hyperallerfic disorder IgE (eczema, allergic rhinitis, asthma)
Dyshidrosis triggers (2)
- emotional stress
2. hot/humid weather
“tapioca-like” rash of small papules and vesicles
pompholyx – always examine soles of feet if lesions found on hands
(2) stages of dyshidrosis
- vesicular stage
2. fissure stage
treatment for almost all derm disorders
topical steroid
morbilliform
“measles -like”
drug eruption characteristics (4)
- utricarial
- papulosquamous
- pustular
- bollous
Tx for drug eruption (IgM thing)
- discontinue offending drug
- oral antihistamine
formation of a solitary erythematous patch or plaque that will recur at same site w/ re-exposure to the drug
fixed drug eruption
targe lesions think
erythema multiforme minor
erythema multiforme associated w/ (
- pregnancy
- radiation therapy
- internal malignancy
- mycoplasma pneumonia
- herpes
rash plus MUCOSAL INVOLVEMENT think
erythema multiforme MAJOR (more groin involvement)
erythema multiforme
systemic drug rxn–like steven-johnson syndrome
Tx for erythema multiforme major
tx as if burn (like SJS)
type IV hypersensitivity Sulfa drug rxn
Steven-Johnson syndrome (around mouth, face, eyes)
Use drug again?
Morbilliform drug rxn:
Fixed drug rxn:
SJS:
- yes (not allergic rxn)
- no
- no
chronic inflammation connected w/ drugs, metals, and Hep C–“gray-white lines”
Lichen Planus (LP)
gray-white lines
Whickham straie (pathognumonic) –Lichen Planus
lichen planus most commonly on (4)
- wrists
- shins
- lower back
- genitalia
Tx lichen planus
topical or systemic glucocorticoids–occlusion dressing
herald patch
pityriasis rosea PR – looks like ring worm–“heralds” rash by a week
christmas tree pattern
pityriasis rosea–along cleavage lines of trunk
pityriasis rosea course and tx
self-limiting,
antipuritics + antihistamine
common chronic inflammatory process w/ acute flairs–“scurf”
psoriasis–genetic component T-cells
2 peaks for psoriasis first onset
- 20-30 yo
2. 50-60 yo
psoriasis typically on
extensor surfaces – areas of thick skins
pick off loose skin:
eczema:
psoriasis:
- no bleeding
- bleeding
psoriasis classifications based on morphology (5) slide 93
- plaque
- inverse/flexural
- guttate
- erythrodermic
- pustular
well-demarcated plaque overlying SILVERY SCALE
psoriasis
life threatening form of psoriasis
pustular psoriasis – DON’T give ORAL CORTICOSTEROIDS
oppposite presentation of normal psoriasis–lack scales
Inverse/flexural – don’t confuse w/ candida
“raindrop” type psoriasis–w/ scales –often preceded by strep pharyngitis
Guttate psoriasis
bright red entire skin surface–fever, chills, malaise
psoriatic erythroderma
psoriasis due to corticosteroid withdrawal, must hospitalize,
pustular psoriasis
- don’t prescribe _____ ________ for acute psoriasis
oral steroid
> 50% of _____ ________ sufferers have fingernail involvement and JOINT PAIN
psoriatic arthritis (pitting) – if so ask about joint pain
psoriasis tx
gauge area of rash–topical steroids–UV therapy – refer to derm
NO ORAL STEROIDS FOR ACUTE FLAIRS
autoimmue bullous disorder in elderly pt’s
bullous pemphigoid–60-80 yo’s
*erythema doesn’t always correspond w/ bullae/vesicels:
erythema always corresponds w/ blisters:
- bullous pemphigoid
- bullous empetigo
tx for bullous pemphigoid (2)
- oral prednisone
2. azathioprine
(3) types of acne vulgaris
- comedonal (non-inflammatory)
- papulo-pustular (inflammatory)
- nodular (inflammatory)
acne vulgaris happens where sebaceous glands are abundant i.e. (4)
- face (T-zone)
- neck
- upper trunk
- upper arms
Comodone type (4)
- whitehead (closed)
- blackhead (open)
- inflammed papule
- inflammed pustule
4 factors leading to acne vulgaris
- androgens
- sebaceous gland activity
- plugging of the hair follicle resulting from abnormal keratinization
- P. acnes in hair follicles (breaks down oil to free fatty acids –> inflammation)
don’t chart acne vulgaris w/
“acne” – describe lesions
severe nodular and scarring acne vulgaris
isotretinoin (acutane)
moderate papular, pustular, nodular acne vulgaris w/out scarring
oral antibiotic w/ topical retinoid and topical benzoil peroxide
acne vulgaris is related to _______ vs. rosacea (not sebaceous gland issue) which is not
androgens
Nevi
BENIGN lesion of skin
an inflammatory disorder predominately affecting the CENTRAL FACE
Rosacea– NO COMODONES
inflammatory disorder related to flushing tendency (heat, emotions, alcohol, hot drinks, spicy foods)
rosacea (more Papules than Pustules)
Rhinophyma
rosacea
rosacea tx
topical or systemic antibiotics
Nevi:
Brown moles, flat or raised, halo, may not pass ABCDE–>bx
nevomelanocytic nevus
looks black –>
blue nevus (resembles melanoma)
under diaper, deeper pigmentation, more ethnic individuals, non-blancheable, will fade in 2-3 yrs, painless
mongolian spot
small bright red moles, vascular related, NON-blanching
cherry angioma
verrucous
“wart” like appearance
“stuck-on” appearance
seborrheic keratosis
benign skin tumor appearing after 30 years mostly in males
seborrheic keratosis
brown fleshy plaque w/ warty surface–face, trunk, upper extremities
seborrheic keratosis–shave bx
pre-cancerous to squamous cell carcinoma–sun damage to keratinocytes
actinic keratosis–solar keratosis >males
1:1000 actinic keratosis will turn into:
tx:
- squamous cell carcinoma-
1. cryosurg
2. retinoids
3. laser
most common type of skin cancer
basal cell carcinoma BCC–don’t metastasize
types of basal cell carcinoma (translucent or “PEARLY”) (5)
- nodular (translucent–pearly) Only need to know this one
- ulcerating (“Rolled borders”)
- sclerosing (whitish sclerotic patch)
- superficial (slightly scally thin plaque–not sun related)
- pigmented (dark lesion–confused w/ melanoma)
BSS dx and tx
- biopsy
- Mohs surgery
UV / HPV related “non-healing” rough, scally patch resembline actinic keratosis
squamous cell carcinoma SCC
SCC dx and tx
- bx
- cryosurgery, 5-fluorouracil cream, Mohs surg
Melanoma mnemonic
MMRISK M: mols atypical (dysplastic or large) M: moles: common moles >50 R: Red hair and freckling I: inability to tan Types 1-2 S: Sunburn K: kindred: family history
AIDS related, nonpruritic, lesion similar to lichen planus
Kaposi sarcoma–purple, fleshy lesions
Kaposi sarcoma distribution
lower extremities, head, and neck
Kaposi sarcoma think
HIV–CD4 counts and viral load
HAART
highly active antiretroviral therapy
lice aka
pediculosis
lice love
healthy clean hair
nits are _____ if they haven’t hatched, _____ if they’ve hatched
black,
white
“the great masquerader”
scabies
tx lice w/ ______and repeat in_________
1% permthrine,
7 days for nits
ues ______ when resistant to permethrin
malathion
severe night-time ITCH–spread skin-skin–thick skin bug and tx
- scabies
2. 5% permethrin–or lindane
Itching at night think
scabies (high complaints–low physical findings)
-scaby burrows and lays eggs–>^itch
dx scabies (2)
- mineral oil on slide dig out burrow
2. burrows
mild utricaria –> full-thickness skin necrosis
spider bite
concerns w/ spider bites
secondary infx–assume worst and treat for bac
mild local rxn from arthropod bite feeds only on mammal and bird blood
flees and bed bugs,
Dx: PAPULAR URTICARIA
multiple, soft, coalescing filiform papules,
HPV–Condyloma acuminatum
cauliflower on genitals and anus
condyloma acuminatum
tx for condyloma acuminatum (3)
- aldara (guardacil)
- crysurgery
- surgical removal
viral exanthems blanket term ex’s (4)
- measles
- rubella
- chickenpox
- 5th disease
- etc.
cutaneous eruption, erythematous, diffuse/generalized papules and macules all over body and throat (BLANCHING)
viral exanthems
with viral exanthems make sure not
measles (present w/ fever and mellase) or rubella
herpangina–back of throat rather than herpes in front
cocksacki
Herpes simplex stages (2)
- primary (asymptomatic or w/ bleeding vesicles)
2. recurrent (cold sore)
Tzanck smear–Giant cells think
Herpes simplex
“central umbilication” – skin-skin
molluscum contagiosum (pox) – cottage cheese filled
tx molluscum contagiosum (3)
- aldara cream
- cryosurg
- supportive
“dewdrops on a rose petal” –> papule –> vescicle –> pustule –> crust (vesicles on a erythematous base)
Varicella-zoster virus
Varicella-zoster virus forms (2)
- primary–chicken pox
2. recurrent–shingles
once VZV lesions crust over…
they’re no longer contagious
Viral:
- all at same stage (2)
- different stages (1)
- Molluscum contagiosum, shingles
- chicken pox
verrucae aka
warts
common wart type
verruca vulgaris
wart on sole –may turn black
Verruca plantaris
flat wart
verruca plana
tx for warts
salicylic acid (compound W)
bac inflammation of hair follicle aka
FURuncle aka boil
multiple furuncles
carbuncle
verrucae etiology
HPV
can feel the edges of the abscess
induration w/ palpation
boil tx
I&D, antibiotics, pack and leave open if large–culture drainage
cellulitis vs
erysipelas (both warm, tender, swollen)
Sharply demarcated, GLISTENING, smooth skin infection–>strep pyogenes
erysipelas
common location:
cellulitis:
erysipelas:
- lower leg
- central face/ cheeks
infection of hair follicle:
ingrown hair:
- folliculitis
- pseudofolliculitis
“hot tub” folliculitis
pseudomonas infx–> folliculitis Tx w/ Cipro
Folliculitis causes: (gram stain)
DM pts:
chronic antibiotics:
- Staph
- Klebsiella and E. coli
“Bright erythematous w/ Satellite lesions”
candidiasis
moist, dark, warm candidiasis etiology
candida albicans –^DM and obesity
“White lacy network on erythematous base”
candidiasis
tx for candidiasis
topical: nystatin
oral: nystatin, fluconazole
tinea versicolor (not a dermatophyte) aka
pityriasis versicolor
tinea versicolor etiology
pityrosporum ovale (yeast) opportunistic infx
tinea versicolor/ pityrosporum ovale dx
- KOH: “spaghetti and meatballs”
- woods lamp
tinea aka
dermatophyte
most common dermatophyte infx–highly contagious –central clearing w/ scale in middle
tinea corporis aka ringworm
athlete’s foot aka
tinea pedis
tinea pedis types (6)
- interdigital
- dry
- moist (macerated)
- moccasin
- vesicular
- ulcerative
confirm tinea unguium w/
culture instead of KOH prep
See ______ ________ think diabetes
acanthosis nigricans –“velvety thickening”
painful nodules on shins
erythema nodosum
suppurative dz w/ open double comedones–Apocrine glands
hidradenitis suppurativa–
benign subQ fat cell tumor–moveable
lipoma
epithelia inclusion cyst aka
epidermal inclusion cyst –very common
cystic enclosure filled w/ keratin and debris
epithelial inclusion cysts
“black spot” associated w/ pregnancy and oral contraceptive, aka
melasma aka cholasma or mask of pregnancy
pilosebaceous glands w/ keratin –> folliculitis –> edema/occlusion –> pilonidal abscess
pilonidal disease
sacrococcygeal region –painful, fluctuant mass
pilonidal disease (stinky)
wheels think
utricaria
phototoxic eruption rom contact w/ light-sensitizing botancial subastance and UVR (i.e. lime juice)
phytophotodermatitis
TRANSIENT EDEMATOUS PAPULES/PLAQUES
Hives aka utricaria
melanocytes destroyed leading to depigmentation
vitilago
dx vitilago
- bx
2. wood’s lamp