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Clin Med III > Derm Exam #2 > Flashcards

Derm Exam #2 Flashcards

1
Q

Anagen

A

Normal active hair growth phase

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2
Q

Catagen

A

Degenerative phase when hair growth stops - brief transition in which it detaches from blood supply

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3
Q

Telogen

A

Resting phase of hair - no nourishment

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4
Q

Exogen

A

Hair fall out

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5
Q

4 hair growth phases

A

Anagen
Catagen
Telogen
Exogen

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6
Q

Life cycle of scalp hair length

A

2-8 years

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7
Q

Life cycle of leg hair length

A

5-7 months

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8
Q

Life cycle of arm hair length

A

1.5-3 months

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9
Q

Life cycle of eyelash length

A

4-6 weeks

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10
Q

Lanugo hair

A

Soft fine fetal hair

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11
Q

Vellus hair

A

Peach fuzz - colorless hair that covers the body

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12
Q

Intermediate hair

A

Characteristics of vellus and terminal hair - appears on scalp

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13
Q

Terminal hairs

A

Thick, pigmented hair on scalp, bear, etc.

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14
Q

Hair pull test

A

Scalp is gently pulled - greater than 5 pulled is pathologic

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15
Q

Trichogram

A

Anagen to telogen ratio
Normal 80-90% in anagen phase

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16
Q

MC alopecia

A

Androgenic
Male or female pattern baldness -terminal becomes vellus

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17
Q

Alopecia classification for men, for women

A

Men -Norwood Hamilton
Women -Ludwig-Savin

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18
Q

Female pattern baldness

A

Hairline out - MC after 50

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19
Q

Dx for androgenic alopecia

A

Telogen phase and atrophic follicles on bx
Increase in telogen hairs on trichogram
Hormone studies

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20
Q

Tx for androgenic alopecia

A

Minoxidil (Rogaine)
2-5% BID must be continued long term

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21
Q

Finasteride

A

Oral androgenic alopecia medication for men only

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22
Q

Female alopecia pharm

A

Spironolactone to block DHT

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23
Q

Alopecia areata

A

Usually a fam hx
Damage to follicle in anagen phase
Leads to rapid transformation to catagen and telogen
No scarring

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24
Q

Presentation of alopecia areata

A

Bald patches
No scaring or atrophy of skin
Black dots on surface “exclamation hairs”

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25
Q

AA Totalis

A

Total loss of terminal scalp hair

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26
Q

AA universalis

A

Total loss of all terminal body and scalp hair

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27
Q

Ophiasis

A

Bandlike pattern of hair loss over periphery of scalp

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28
Q

AA of nails

A

Fine pitting “hammered brass” of dorsal nail plate

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29
Q

Dx for alopecia areata

A

Usually clinical to r/o:
Biopsy
RPR - Syphillis
KOH - FUngal
ANA - Autoimmune
Thyroid

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30
Q

Course of alopecia areata

A

Majority have spontaneous remission
Poor prognosis for early onset

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31
Q

Non-pharm Tx for alopecia areata

A

Psych, Wigs, Hair pieces, No cure

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32
Q

Topical Pharm tx for alopecia areata

A

Class 1 or 2 CS with minoxidil - 5%

Anthralin - see heair growth in 2-3 months NOT USED on face

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33
Q

Systemic pharm for alopecia areata

A

Short term
Pred 20-40mg daily, taper over a few weeks

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34
Q

Keratosis pilaris

A

Hyperkaritinazation of the skin and keratotic follicular plugging
50-80% of all adolescents

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35
Q

Presentation of keratosis pilaris

A

Plucked chicken skin
Becomes worse in winter - patients may pick/scratch - not always itchy
1-2mm raise papules

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36
Q

Dx of keratosis pilaris

A

Clinical dx
Biopsy for atypical presentation

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37
Q

Tx for keratosis pilaris

A

Hydration - gentle soap and moisturizers (Cetaphil, Lubriderm, Rx - Lac-Hydrin)2-3xd
Steroid creamor salicylic acid BID to reduce inflammation if needed

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38
Q

Lunula

A

Nail bed dital to cuticle

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39
Q

Onychocryptosis

A

Nail grows into the side of the paronychium(nail bed)
MC in males in their 20s

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40
Q

MC toe for onychocryptosis

A

Great toe

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41
Q

Tx for onychocryptosis

A

Warm soaks
Mupirocin BID until healed
Proper trimming
Training - cotton
Surgery

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42
Q

Tx post nail removal

A

Keep clean with soap and water
Mupirocin
Resume activity in 48-72 hours

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43
Q

Onychomycosis

A

AKA Tinea unguium
Fungus invades the nail

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44
Q

Presentation of onychomycosis

A

Asymptomatic
MC complaint - discoloration
Thickening and lifting from nail bed

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45
Q

RF for onychomycosis

A

Age
Fam hx
Poor health
Trauma - very active
Communal bathing/no shower shoes

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46
Q

Dx for onychomycosis

A

r/o melanoma if pigmented dark bands esp in caucasian
Nail clipping or scraping - biopsy clipping, KOH scraping

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47
Q

Tx for onychomycosis

A

Topical or oral antifungal - Ciclopirox or Efinconazole
Daily for 48 weeks
50/50 apple cider vinegar and water 10 minutes per day

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48
Q

Terbinafine for onychomycosis

A

6 weeks for fingers
12 weeks for toes
Monitor liver
May take up to a year for nail to grow back

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49
Q

Onycholysis

A

Detachment of nail from nail bed
Trauma, Psoriasis, HSV

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50
Q

Presentation of onycholysis

A

Gray to black = Air
Green = Bacteria
No inflammation and smooth nails

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51
Q

Dx for onycholysis

A

Clinical

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52
Q

Tx for onycholysis

A

Treat underlying cause

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53
Q

Paronycia

A

Inflammation of the proximal or lateral nail fold
Cellulitis to abcess
MCC trauma
2nd MCC bacteria

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54
Q

MC bacteria of paronychia

A

MCC - Staph
Green = Pseudomonas

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55
Q

Presentation of acute paronychia

A

Painful, Swollen, Tender, Erythematous, Pus

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56
Q

Dx for paronychia

A

Gram, C&S, KOH, etc.

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57
Q

Tx for acute paronychia

A

Warm soaks 3-4x daily until resolution
I&D if fluctuant
Consult hand surgeon

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58
Q

Oral abx for acute paronychia

A

When: Cellulitis, DM, Peripheral vasc disease, Immune comp

Augmentin 10 days
ALT: Clinda or Keflex

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59
Q

Presentation of CHRONIC paronychia

A

From repeated exposure
Inflammation waxes and wanes
Pain
Swelling
6+ weeks

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60
Q

Tx for chronic paronychia

A

Avoid triggers
Keep dry
Avoid manipulation
Warm antiseptic soaks
Topical antifungals (oral if severe

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61
Q

Herpetic whitlow

A

Distal involved herpes
HSV-1 or gingivostomatitis in children from sucking thumb/finger
HSV-2 Adults - healthcare workers

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62
Q

Presentation of herpetic whitlow

A

Burning and pruritis followed by vescicular eruption
Clinical dx - can use a Tzank smear

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63
Q

Tx for herpetic whitlow

A

NO I&D
Self limiting - 3 weeks
Contagious
OTC pain meds
Acyclovir/Valacyclovir

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64
Q

Felon

A

Soft tissue infection of the pulp space of the distal phalanx
Hx of penetrating injury, splint, paronychia

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65
Q

Presentation of Felon

A

Pain, Swelling, Erythema, Tenderness, Abcess usually in thumb or index finger

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66
Q

Complications of a Felon

A

Osteitis, Osteomyelitis, Septic joint, Tenosynovitis

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67
Q

Workup for felon

A

Gram stain with C&S
Tzank to r/o herpetic whitlow
XR

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68
Q

Management for Felon

A

Augmentin for 10 days
Surgical decompression

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69
Q

Nail clubbing

A

Due to persistent hypoxic state

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70
Q

Disorders that may cause nail pigmentation changes

A

Melanoma of the nailbed, P-J or L-H syndromes

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71
Q

Disorders causing nail pitting

A

Psoriasis or eczema

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72
Q

Diseases that cause splinter hemorrhages

A

Endocarditis, Vasculitis, Lichen planus

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73
Q

Terry’s nails

A

2/3 of nailbed appears whit with pink apex
Liver disease or HIV

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74
Q

Horizontal ridges/dents in one or more finger/toe nails

A

Zinc or iron deficiency

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75
Q

Actinic keratosis

A

Precancerous epithelial lesions on sun exposed areas of the body - light skin types

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76
Q

Presentation of actinic keratosis

A

Rough - sand paper keratotic lesions
Barely elevated
Felt more than seen
Sun exposed areas
May be tender/pigmented

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77
Q

Risks of Actinic keratosis

A

Risk of developing into non-melanoma skin cancer

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78
Q

Dx for actinic keratosis

A

Clinical - refer to derm if unsure - biopsy
Dermoscopy - erythema with pseudo-network around hair follicles
Classic gritty feel

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79
Q

Tx for actinic keratosis

A

Liquid nitrogen to freeze

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80
Q

Suspicious actinic keratoses

A

Lesions that keep coming back
Painful or tender

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81
Q

Patient Ed for actinic keratosis

A

Counsel on sunscreen and sun avoidance
Moisturizer with sunscreen
30+ SPF
Mineral based is best

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82
Q

Tx for actinic keratosis

A

Cryosurgery
Curettage
Shave excision

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83
Q

Topical Pharm for actinic keratosis - 4

A

5-Fluorouracil - MC 2-4 weeks
Imiquimod - 16 weeks
Picato - 2 days $$$
Diclofenac - 90 days

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84
Q

MOA of 5FU

A

Blocks DNA synthesis = aptoptosis and selective cell death

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85
Q

Dosing and SE for 5FU

A

BID for 2-4 weeks
Localized skin reaction - gonna happen!!

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86
Q

Imiquimod MOA

A

Immune modulator
Stimulates local cytokine induction

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87
Q

Use for imiquimod in actinic keratosis

A

Non hypertrophic AK on face or scalp

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88
Q

SE of imiquimod

A

Localized skin reaction -increased clearance rates
Wash hands!!!

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89
Q

Ingenol mebutate (picato) MOA and facts

A

Disrupts cell membrane followed by neutrophil cytotoxicity - 2 step
AK ONLY
Risk of SCC

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90
Q

Diclofenac MOA

A

COX-2 inhibitor - inhibits prostaglandin synthesis

Localized skin reaction is less severe than other agents

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91
Q

Field therapy for Actinic Keratosis

A

Less cost effective - needs a specialist
Cryopeeling, dermabrasion, chemical peels, Laser resurfacing, photodynamic

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92
Q

Actinic keratosis tx algorhythm 2 visits

A

1st visit - lesion targeted tx

2nd visit - f/u in 2-3 months, biopsy if recurrent, target if new, field therapy if numerous

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93
Q

THird visit follow up for Actinic Keratosis

A

6-12 months if lesion targeted
3-6 months if field therapy

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94
Q

Squamous cell carcinoma

A

Malignancy of cutaneous epithelial cells on sun exposed areas of the skin
May be proceded by actinic keratoses, HPV

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95
Q

Area with a greater risk for SCC metastasis

A

Oral mucosa or lip

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96
Q

Presentation of SCC

A

Thicker and more keratotic than AK
Hard, painful, come in many shapes and sizes
Bleed easily
Sun exposed or HPV areas

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97
Q

Risk factors for SCC

A

Chronic sun exposure
Low fitzpatrick
Skin grafts
Age
HPV

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98
Q

SCC in dark skin

A

May occur in scars - still happens!!

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99
Q

SCC in situ

A

SCC confined to the epidermis
AKA Bowens disease
More common in transplant/AIDS patients

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100
Q

Dx of SCC

A

Dermoscopy - Red vessels as dots, Scale/Crust, Shiny white structures
Coiled vessels
Keratin pearl - orange ovoid
Gray brown dots in pigmented
Biopsy if concerning

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101
Q

PE for SCC

A

Examination of refional lymph nodes

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102
Q

Histopathological findings suggestive of SCC - 4

A

Pleomorphic SC with variable nuclear size
Overlying parakeratosis
Kertinocyte mitoses
Dyskeratosis

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103
Q

Management for SCC

A

Excision with narrow margins (3-5mm) is choice
Mohs or 6mm borders in high risk lesions

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104
Q

Tx for SCC in non-surgical candidates

A

Electrodessication with curretage - leaves large circular scars
Radiation for very large

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105
Q

Pharm for SCC

A

Imiquimod
5FU

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106
Q

Patient ed for SCC

A

Watch for suspicious lesions - scars w/o trauma
SPF 30+ sunscreen
No tanning beds

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107
Q

Keratoacanthoma

A

Fast growing solitary SCC variant
Craterioform - volcano shape
Treat quickly -Mohs excision

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108
Q

Basal Cell Carcinoma

A

MC Skin Cancer
Neoplasm of basal keratinocytes
Sun exposed areas
Mostly a cosmetic issue - not frequently metastatic

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109
Q

5 types of BCC

A

Nodular
Ulcerating
Infiltrating
Pigmented
Superficial

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110
Q

Presentation of nodular BCC

A

Pearly papule
Well defined borders
Smooth and firm with telangiectasias
May have erosions

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111
Q

Presentation of ulcerating BCC

A

Translucent pearly smooth, firm, telangiectectic +/- elevated borders - rat eaten

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112
Q

Presentation of sclerosing BCC

A

Scar like plaque with pink/white with ill defined borders

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113
Q

Presentation of superficial BCC

A

Thin patch or plaque
Pink/Red
+/- scaling

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114
Q

Presentation of pigmented BCC

A

Firm papule/Nodule with or without umbilication
Smooth pearly surface
Pigmented or stippled

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115
Q

Prognosis for BCC

A

Really good - 3/5 will develop another one - follow
Non-healing or bleeding needs workup

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116
Q

Dx pearls for BCC

A

Sun exposed areas
More than one under 30 may mean nevoid BCC syndrome or ionizing radiation exposure
Larger than they appear

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117
Q

Histological findings suggestive of BCC - 4

A

Nests and cords with peripheral pallisading and central hahazard arrangement
Hyperchromic nuclei and scant cytoplasm
Marked solar elastosis
Apoptotic neoplastic cells

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118
Q

Patient ed for BCC

A

Sun protection
Follow with provider
Watch for suspicious lesions

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119
Q

Non-pharm tx for BCC

A

Cryosurgery,
Moh’s - high risk area or large lesion (over 2cm)

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120
Q

Hedgehog pathway drugs for BCC

A

end in ~degib
Hedgehog pathway inhibitors (Vismodegib, Sonidegib)

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121
Q

Common melanocytic nevi

A

Benign overgrowth of skin cells
Congenital or Acquired - often regress by 60

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122
Q

Presentation of common melanocytic nevi

A

Asymptomatic
Symmetric
Sharp borders
Uniform color

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123
Q

Dx for common acquired nevi

A

Dermoscopy

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124
Q

Indications for nevi excision

A

Scalp, anogenital, or mucosal
Rapid change
Irregular borders
Erosions
Persistent itching

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125
Q

Dysplastic melanocytic nevus and presentation

A

Precursor to superficial spreading melanoma
Asymptomatic
Irregular shape
Sharp and ill defined borders
Variegated color
Maculopapular

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126
Q

Dx for dysplastic melanocytic nevi

A

Usually clinical - biopsy if needed

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127
Q

Tx for dysplastic melanocytic nevi

A

Observation
Surgical excision with biopsy if changing or can’t be observed

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128
Q

F/u for dysplastic nevus

A

3 month if fam hx of melanoma
6-12 months if sporadic

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129
Q

Patient ed for dysplastic nevi

A

Monthly self exams
Skin exams for family members

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130
Q

Melanoma

A

Aggressive malignancy of color producing cells

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131
Q

4 types of melanoma

A

Superficial spreading - MC
Nodular melanoma
Lentigo maligna melanoma
Acral lentiginous melanoma - LC

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132
Q

Risk factors for melanoma

A

Over 25 nevi
Blistering sunburn before puberty
Tanning beds
Immune suppression

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133
Q

Presentation of melanoma

A

De novo (more common) or precursor from existing lesion
Radial growth then vertical growth leading to metastasis

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134
Q

Superficial spreading melanoma

A

Assymetric macule with variagated pigment trunk in men or LE in women
MC

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135
Q

Nodular melanoma

A

Dark brown bluish-black nodule that grows rapidly
May bleed/ulcerate
Trunk, head, or neck

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136
Q

Lentigo maligna melanoma

A

Assymetric brown to black macule or patch with color variegation and irregular borders
SLOW GROWING
Begins more weel defined

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137
Q

Acral lentiginous melanoma

A

Assymetric brown to black macule - palms, soles, nail apparatus

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138
Q

ABCDE of melanoma

A

A - Asymmetry
B - Borders
C - Color
D - Diameter
E - Evolving

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139
Q

Ugly duckling rule

A

Look for the Nevi that is not like the others on a patient with many lesions

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140
Q

Punch v. Shave biopsy

A

If you can punch the whole thing punch, if it is large - shave

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141
Q

3 ways to stage melanoma

A

Clark - Levels I-V (Epidermis, Dermisx3, Fat)
TNM Staging
Breslow

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142
Q

Need for Sentinel lymph node biopsy in melanoma

A

Breslow stage over 0.76

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143
Q

Margins for melanoma excision

A

0.5 cm for in situ
1 cm for under 1mm
1-2 cm for 1-2mm
2cm for over 2 mm

May depend on area - use slow Mohs for difficult area

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144
Q

When to refer melanoma patient

A

BCC or SCC - Every 6 months
Hx of Melanoma - every 3 months

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145
Q

Mohs micrographic surgery

A

Excisional procedure that allows for real time evaluation of tumor margins
Indicated for SCC and BCC
Spares healthy tissue

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146
Q

High areas for Mohs

A

Mask of face, genitalia, tops of hands and feet

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147
Q

Moderate risk Mohs areas

A

Rest of head, shins

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148
Q

Excisional biopsy/Excision

A

Cure rates not as good as mohs
Indications - Well defined BCC and low risk SCC

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149
Q

Punch biopsy

A

Punch and remove - creates oval
Apply in circular twisting motion
Suture or cauterize
CI in aftive infection

150
Q

Three types of UV light

A

UVA - Passes through window glass
UVB - Most burns does not pass through window glass
UVC - Absorbed by the ozone

All age the skin!!

151
Q

SPF meaning

A

Ratio of burn with sunscreen v. without
(ie. SPF 15 takes 15 times longer to burn)

152
Q

Pityriasis Rosea

A

Acute exanthemous eruption -single herald plaque
Becomes generalized later
Herpes 6 and 7

153
Q

Presentation of pityriasis rosea

A

Herald patch to general - oval or slightly raised
Salmon red
General exanthem with marginal collarette
Christmas tree pattern
Rarely involves face

154
Q

Dx of pityriasis

A

NOT ON FACE usually

155
Q

Tx for pityriasis rosea

A

Spontaneous remission in 6-12 weeks
Oral antihistamines
Topical anti-pruritic (Sarna)
Triamcinolone
Oral prednisone

156
Q

Lichen planus

A

Acute or chronic
Idiopathic - Believed to be CD8/CD45Ro cells
Exposure to metals?

157
Q

Presentation of lichen planus

A

4P’s
Polygonal or oval papules - annular, purple, pruritic
Violaceous white lines - Whickham striae - grouped or disseminated
Ciggarette paper skin

158
Q

Location of lichen planus

A

Wrist, Lumbar, Shin, Scalp, Glans penis, Mouth

159
Q

Hypertrophic LP

A

Large thick plaques

160
Q

Atrophic LP

A

White, bluish well demarcated papules and plaques with central atrophy

161
Q

Follicular LP

A

Follicular papules and plaques that lead to cicitricial alopecia

162
Q

Vesicular LP

A

Bullous pemphigoid w/ LP

163
Q

Pigmentosus LP

A

Hyperpigmented dark brown macules in sun-exposed area and flexural folds

164
Q

Actinicus LP

A

Papules in sun exposed areas

165
Q

Ulcerative/Erosive LP

A

Therapy resistant spots = ulcers

166
Q

LP in mucous membranes

A

40-60% have mouth involvement

167
Q

Reticular lichen planus

A

Lacy white hyperkeratosis on buccal mucosa, lips, tongue, gingiva

168
Q

Dx and course for LP

A

Months to years
Biopsy extremely helpful for dx

169
Q

Tx for LP

A

Topical steroids w/ triamcinolone 1st line
Under occlusion for cutaneous lesions

170
Q

Systemic tx for LP

A

Cyclosporine or prednisone
Retinoids as adjunct

171
Q

Granuloma anulare

A

Chronic condition of the dermis
Self limited
MC in females

172
Q

Presentation of granuloma anulare

A

Skin colored or red-brown
Shiny beeded papules
Hands, feet, elbows, knees
Looks like tinea

173
Q

Condition often associated with granuloma annulare - should be checked for it by PCP

A

Diabetes

174
Q

Dx of GA

A

Clinical but biopsy is diagnostic

175
Q

Pathological findings for GA

A

Foci of chronic inflammatory and hastocytic infiltrations in superficial and mid dermis
Necrobiosis of connective tissue surrounded by pallisading histocytes and multinucleated giant cells

176
Q

Tx for GA

A

Not always necessary - 70% go away in two years
Topical triamcinolone
ILK
Cryo may resolve but leaves scarring (worse with dark skin

177
Q

Erythema nodosum

A

Common acute inflammatory/immunologic reaction pattern of the SQ fat
Infection, Drugs, Inflammation, Sarcoidosis

178
Q

Age of onset and MC gender for erythema nodosum

A

20-30 years old
Females more common

179
Q

Presentation of erythema nodosum

A

Painful, tender, fever, malaise, arthralgia (esp. ankles)

180
Q

Lesions of erythema nodosum

A

Indurated, red nodules 3-20cm
Diffuse margins
Deep seated in fat
Bilateral but NOT symmetrical

181
Q

Dx and resolution time for erythema nodosum

A

Elevated ESR and CRP, leukocytosis
Spontaneous resolution in 6 weeks
2 punch biopsies to get dermis, then adipose fat - must get the fat!!!

182
Q

Tx for erythema nodosum

A

Bed rest
Compressive bandages
Wet dressings

183
Q

Pharm tx for erytema nodosum

A

NSAIDs and Prednisone

184
Q

Psoriasis

A

T cell mediated
Poorly understood

185
Q

2 Onset peaks of psoriasis

A

20-30
50-60

186
Q

Development of psoriatic lesions stage 1

A

Psoriatic without active lesion
Slight capillary dilation and curvature
Slight increase in dermal mononuclear cells and mast cells
Increase in epidermal thickness

187
Q

Second phase of psoriatic lesion

A

A developing lesion
Progressive capillary dilation and toruosity
Increase in mast cells, t cells, and degranulation of mast cells
Increasing epidermal thickness

188
Q

Fully developed posriatic membrane

A

10 fold increase in blood flow and epidermis
Increase in T cells
Neutrophils in stratum corneum

189
Q

Risk factors for psoriasis

A

Trauma d/t friction causes tetanerization
Immune and genetic

190
Q

Eruptive/Inflammatory psoriasis

A

Guttate or nummular psoriasis
Multiple small lesions with spontaneous remission
Follows strep pharyngitis

191
Q

Pustular psoriasis

A

Pustules instead of patches, papules and plaques
Corticosteroid withdrawal
Stinging, burning, pruritis

192
Q

Plaque psoriasis (chronic stable)

A

MC presentation
Classic lesions for months to years with little change
Dull red plaques, well demarcated

193
Q

Classic psoriatic lesion

A

Papule/Patch/Plaque
Silvery white scales that leave small blood droplets when scratched - Auspitz sign (easy removal)
Pruritis

194
Q

General presentation of psoriasis

A

Salmon/Pink papules 2-10 mm
Concentrated on trunk with scalp and extremity lesions
Resolves spontaneously or becomes chronic

195
Q

Common sites of psoriasis

A

Elbows
Knees
Scalp
Gluteal cleft - MC
Palms/Soles

196
Q

Palm/Sole psoriasis

A

Thick, adherent silvery white or yellow scaling
Painful cracking and fissures

197
Q

Scalp psoriasis

A

Sharply marginated
Intense pruritis
NO hair loss

198
Q

Intriginous psoriasis

A

Usually more macerated and moist

199
Q

Nail psoriasis

A

Pitting, onycholysis
Yellow/Brown oil spots

200
Q

Palmo-plantar pustular psoriasis

A

2-5mm pustules
Erupt into dusky red erosions/crusts
Persists for years

201
Q

Generalized “von Sumbusch” pustular psoriasis

A

Pustules coalesce into lakes
Nikolsky sign
LIFE THREATENING
May evolve to plaque psoriasis

202
Q

Psoriatic arthritis

A

Joint stiffness and pain with swelling, redness and tenderness

203
Q

Dx for psoriasis

A

Usually clinical -biopsy, strep test for acute inflammatory, KOH for fungal suspicion
Culture for pustular

204
Q

Treatment of psoriasis

A

Generalized - refer to derm
Psoriatic arthritis - to rheumatology

205
Q

Management for localized psoriasis

A

Apply high potency topical steroids after soaking lesions
Calcipotriol Vitamin D analog
Occlusive dressing

206
Q

Retinoids for localized psoriasis

A

Tazarotene with GC and UV therapy
Coal tar with salicylic acid
Emollients

207
Q

MOA of vitamin D analogs

A

Dovonex, Calcitrene (brand names)
Binds to Vitamin D receptor and regulates cell growth

208
Q

Vitamin D analog use

A

Psoriasis
Apply thin layer BID
May cause burning, itching, photosensitivity

209
Q

Calcitriol ointment

A

Also for psoriasis
Binds to vitamin D receptor and regulates growth

210
Q

Management of scalp psoriasis

A

Tar shampoo followed by medium-high potency lotion

211
Q

Management of palm/sole psoriasis

A

High potency topical steroid ointment with occlusive dressing
PUVA soaks
Oral retinoids

212
Q

Management of body fold psoriasis/intertriginous

A

Short term steroids (2-4 weeks) followed by:
Vitamin D analog OR Topical retinoid (tazarotine) OR topical calcineurin inhibitor (tachrolimus/pimecrolimus)

213
Q

Management of nail psoriasis

A

Long time to heal
PUVA
Oral retinoids
Biologics for complicated

214
Q

Psoriasis drug that is categor X for pregnancy

A

Tazarotine - retinoid

215
Q

Coal tar side effect that is unique

A

Stinks - odor

216
Q

Inflammatory psoriasis management

A

Refer to derm
UVB or Oral PUVA photochemotherapu

217
Q

Management for generalized pustular psoriasis

A

Hospitalization with IV fluids
In hospital derm consult
IV abx

218
Q

Management for generized plaque psoriasis

A

PUVA
UVB
Oral retinoid
Biologics

219
Q

Most improtant piece of information for cutaneous drug rxn hx

A

Timing!!

220
Q

Immediate drug reaction

A

Within an hour of first dose

221
Q

Delayed drug reactions

A

After an hour, usually within 6 hours but can be weeks to months

222
Q

Exanthemous drug reaction rash

A

Maculopapular rash
PCN administration in EBV and CMV
2-3 days immediate
Delayed 7-10 days

223
Q

High probability for exanthemous drug reaction drugs

A

PCN, Carbamazepine, Allopurinol, Gold salts

224
Q

Medium probability for exanthemous reaction drugs

A

Sulfonamides, NSAIDs, Isoniazid, erythromycin, streptomycin

225
Q

Low probability for exanthemous drug reaction drugs

A

Barbituates, BZDs, Phenothiazines, tetracyclines

226
Q

Management of exanthemous drug reactions

A

D/c drug usually - if we want to keep the drug treat with oral or topical steroids

227
Q

Fixed drug eruption

A

Patch or plaque at the same site upon exposure
Onset 30 min-8 hours

228
Q

Presentation of fixed drug eruptions

A

Shaply marginated, dusky red later, erythematous early
Glans penis is common site

229
Q

Management of fixed drug eruptions

A

Remove offending agent
Topical steroid for non-eroded lesion
Abx for eroded lesion
Antihistamine for pruritis

230
Q

Drug induced hypersensitivity syndrome drugs that cause it

A

Sulfonamides
Dapsone
Sulfasalazine
Phenytoin
Carbamazepine
Phenobarbital

231
Q

Adverse cutaneous drug reaction presentation

A

2-6 weeks after drug initiation or after increase in dose
Fever, facial edema
Lymphadenopathy and Hepatosplenomegaly

232
Q

Lesions of adverse cutaneous drug reaction

A

Maculopapular eruption starting on face
Oropharyngeal lesions

233
Q

Dx for adverse cutaneous drug eruption

A

Need three of:
Cutaneous drug eruption
Hematologic abnormalities
Systemic involvement (Lymphadenopathy >2cm; elevated LFT, Elevated BUN/Cr)

234
Q

Tx for drug induced hypersensativity syndrome

A

Stop all suspected medications
Topical steroid with mild/mod
Oral steroids if mod/severe

235
Q

Pustular drug eruption

A

Acute febrile eruption
Sterile pustules with erythematous base
Resolve over 2 weeks
Desquamate over 2 weeks

236
Q

Seborrheic keratosis

A

Common benign neoplasms appearing on the chest and back
Stuck on appearing with well defined borders
Unknown etiology

237
Q

Appearance of SK

A

Stuck on, greasy, itchy
Yellow to black/brown
Well demarcated
Waxy scale

238
Q

Lichenoid keratosis

A

Inlfamed seborrheic keratosis - pink siny plaque
Can be a sign of internal cancer

239
Q

Dermoscopy of seb ker

A

Ridges, fissures forming a cerebreform (brain like) pattern
Looped or hairpin vessels
Scaloped border

240
Q

Dx for Seb ker

A

Made clinically
Dermoscopy to differentiate between melanoma
Biopsy if concerned for cancer

241
Q

Histopathology suggestive of seb Ker

A

Sharply demarcated proliferation of monotonous epidermal keratinocytes
Small keratin cysts “horn cysts”

242
Q

Tx for Seb ker

A

Removed for cosmetic purposes
Reassure on chronic nature
Dermoscopy if suspicious

243
Q

Therapy for seb ker

A

Cryosurgery
Shave excision for large

244
Q

Melasma

A

Dark pigmentation usually on the face/maxilla
May be seen in pregnancy

Woods lamp can dx but not necessary

245
Q

Tx for melasma

A

Triluma which is Flucinolone, Hydroquinone, and Tretinoin

246
Q

Solar lentigo

A

Localized proliferation of melanocytes in caucasian patients
Brown oval with ill defined borders
Sun exposed areas

247
Q

Tx for solar lentigo

A

Cryotherapy of Laser tx

248
Q

Acrochordon

A

Skin tags
May become tender, orhemorrhagic
May be seen in metabolic syndrome

249
Q

Epidermal inclusion cysts

A

Often a plugged pilosebaceous gland
Symptomatic until infected

249
Q

Tx for acrochordon

A

Cryotherapy
Snipping
Electrodessication

250
Q

Presentation of epidermal inclusion cyst

A

Flesh colored firm nodules
Malodorous contents
Face, Trunk, Neck Scrotum

251
Q

Pt. Ed for EIC

A

Don’t pick at or squeeze

252
Q

Dx for EIC

A

Clinical, make refer to bx or FNA

253
Q

Tx for EIC

A

No tx if asymptomatic
I&D if inflamed
I&D and abx if infected
Excision - best performed when not inflamed

254
Q

Prognosis of epidermal cysts

A

May wax and wane - watch for non-healing but not common

255
Q

Lipoma

A

MC soft tissue tumor
Collection of fat cells in a fibrous capsule
MC on trunk

256
Q

Lipoma presentation

A

Soft, painless, slow growing nodule 1-10cm in size
Rubbery

257
Q

Lipoma dx

A

Clinical
Bx IF: Pain, movement restriction, rapid growth
May surgically excise if problematic

258
Q

Venous lake

A

Dark blue violaceous papule due to a dilated venule
MC on face, lips, ears
MC over 50
Lined with endothelial cells

259
Q

Dx characteristics of a venous lake

A

Compresses with pressure
Lightened with diascopy
Vascular on dermoscopy

260
Q

Tx for venous lake

A

Resect for cosmetic reasons - laser excision

261
Q

Urticaria

A

Pruritic, raised well-circumscribed areas of erythema and edema
WBCs cause extravasation of fluid to dermis

262
Q

Presentation of urticaria

A

Raised erythematous-pink-skin colored wheals with central pallor
Size and shape change rapidly
Resolves in 24 hours
May be able to draw on skin

263
Q

Management of urticaria

A

Can progress to angioedema or anaphylactic shock
H1+H2+Steroid is recommended

264
Q

H! antihistamines (3)

A

Loratadine, Fexofenadine, Cetirizine

1st gen but second line: Benadryl and Vistaryl

265
Q

H2 antihistamines (3)

A

Cimetidine, Famotidine, Rantidine

266
Q

Management of chronic urticaria

A

Antihistamines PRN

267
Q

Pyogenic granuloma

A

Rapidly growing vascular lesions following a trauma
Red and friable, smooth, may have crusts and erosions

268
Q

Tx for Pyogenic granuloma

A

Surgical excision
Electrodissection and Currettage

269
Q

Hemangioma

A

Cherry, Capillary, Or Strawberry
Vascular tumors in babies starting at 2-4 weeks of age
MC tumor in babies

270
Q

Presentation of hemangioma

A

Red, Soft, compressible papules or nodules 1-10cm

271
Q

Simple hemangioma

A

Resolve by 5-10 years old

272
Q

Deep hemangioma

A

aka Cavernous
Lower dermis or SQ fat
Purple/Bluish with telagiectasias

273
Q

Multiple hemangiomas

A

Under 2mm papules over the entire body

274
Q

Congenital hemangiomas

A

Present at birth

275
Q

Management of hemangioma

A

Check Doppler US for blood flow - may obstruct airway, etc.
Propranolol 1 st line - can be topical
Prednisone 2-3mg/kg daily
Laser an option

276
Q

Vitiligo

A

Depigmentation disorder causing absence of melanocytes
Often genetic

277
Q

Clinical manifestation of vitiligo

A

Chalk or white macules with sharp margins
Sun exposed areas
New macules in areas of recent trauma

278
Q

Generalized vitiligo

A

Symmetrical and widespread
Skin around mouth, fingers, toes, nipples genitalia

279
Q

Segmental vitiligo

A

Only on one part or side of the body in aband
Seen at a young age progresses over 1-2 years

280
Q

Localized vitiligo

A

Only 1-3 macules in a single site

281
Q

Vitiligo universalis

A

Over almost the entire body d/t confluence of macules

282
Q

Dx of vitiligo

A

Clinical
May do a bx or woods lamp exam

283
Q

Management for vitiligo

A

No cure - oral JAK inhibitors may helpSunburn precautions
May use glucocorticoids or phototherapy - UV

284
Q

Glucocorticoid use in treating vitiligo

A

D/c if no response in two months

285
Q

Other tx for vitiligo

A

Minigrafting
Depigmentation using hydroquinone

286
Q

Desmosome

A

Structures that adhere cells to one another

287
Q

Desmogleins

A

Proteins inside of the desmosomes

288
Q

What holds the epidermis together

A

Hemidesmosomes bind epidermal basement membrane to basal membrane

289
Q

Pemphigus

A

Loss of cell to cell adhesion d/t autoimmune disorder
IgG antibodies bind to desmogleins

290
Q

Pemphigus vulgaris

A

Flacid blisters on skin and erosions on mucous membranes
Starts in oral mucosa
Jewish/Mediterranean descent

291
Q

Pemphigus Foliaceus

A

Scaly and crusty lesions at 40-60 years
MC in Brazil

292
Q

Skin lesions of pemphigus

A

Depend on when presenting - Vesicles/Bullae, Flacid and leaking
May bleed, may be scattered
May see erosions

293
Q

Nikolsky sign

A

Dislodging of normal appearing epidermis by lateral finger pressure inlesion vicinity is positive

294
Q

5 MC areas for pemphigus

A

Scalp
Face
Chest
Axilla
Groin

295
Q

Dx for pemphegus

A

Biopsy at edge of blister
Direct immunofluorescence on normal appearing lesion-adjacent skin
Serology for ab to desmoglein

296
Q

Management for pemphegus

A

Leads to death if not treated
Prednisone 2-3 mg/kg until cessation, then taper
May use immune suppressors Azathioprine or mycophenolate
Wound care

297
Q

Pemphigus complications

A

Fluid/Electrolyte imbalance
Secondary infection
Osteoporosis from steroid tx

298
Q

Bullous pemphigoid

A

Rare autoimmune disease usually in the elderly
60-80
MC bullous autoimmune disease

299
Q

Pathogenesis of bullous pemphigoid - 4 steps

A

Development of auto-antibodies against basement membrane antigens BPAG1&2
Ab’s activate complement system
Weakening of adhesions between dermis and epidermis
Formation of bullae

300
Q

Presentation of bullous pempigoid

A

Starts as pruritis/Urticaria
Large tense firm topped bullae
NEGATIVE Nikolsky sign
Less severe/painful oral lesions

301
Q

Dx for bullous pemphigoid

A

Biopsy is Gold Standard - linear IgG deposits along basement membrane
Serology also possible

302
Q

Tx for bullous pemphigoid

A

Derm referral
Prednisone 50-100mg/day divided may couple with azathioprine

303
Q

Erythema Multiforme

A

Acute hypersensitivity reaction affecting the skin and mucous membranes
May have eye involvement
Infection or Drug related

304
Q

MCC of erythema multiformes

A

HSV

305
Q

Presentation of erythema multiforme

A

Erythematous papular or urticarial type lesions
Can have mucosal ulcerations and uveitis
Bilateral and symmetric - Usually

306
Q

EM minor - 4 characteristics

A

Little or no mucosal involvement
Vesicles but nobullae
No systemic symptoms
Confined to face and extremities

307
Q

EM major - 6 characteristics

A

Mucosal involvement
Confluence of lesions
+ Nikolsky sign
Constitutional symptoms
Chelitis/Stomatitis
Eye involvement

308
Q

MC etiology of EM major

A

Drug reaction

309
Q

Management of erythema multiforme

A

Antihistamine for pruritis
Low dose topical steroid
Antiviral for underlying HSV
High dose steroid gel or lido/benadryl topical oral solution

310
Q

Systemic tx for erythema multiform

A

IV fluids
Hospital admit
Systemic steroids for severe disease
Compresses of large lesions

311
Q

Steven Johnson Syndrome

A

Cytotoxic event caused by immune response resulting in keratinocyte destruction
MC d/t rx drugs

312
Q

Findings of SJS/TEN

A

Fever chills, Skin tenderness
Abrupt mucocutaneous lesions: Macule, Papule, Vesicle/Bulla, Erosion
Rapid confluence
+ Nikolsky sign
Red oozing dermis
Dermis off in sheets

313
Q

Distribution of SJS/TEN

A

Face and extremities

314
Q

SJS/TEN ocular

A

Conjunctivitis, Keratitis, etc.

315
Q

SJS/TEN emergency

A

Fever
HR over 120
Sloughing of epidermis

316
Q

Dx for SJS/TEN

A

Clinical, biopsy may aid - extent determines SJS vs. TEN

317
Q

SJS criteria

A

Under 10% of body surface

318
Q

TEN criteria

A

Over 30% of body surface

319
Q

Criteria that could be either SJS or TEN

A

10-30% of body surface affected

320
Q

Management of SJS/TEN

A

Stop insult
IV fluids
Parenteral nutrition
IV pain meds
Would care

321
Q

Acanthosis nigricans

A

Darkening of neck, elbows, etc. - body folds
May have skin tags

322
Q

8 types of acanthosis nigricans

A

Obesity
Cancer - worry if thin pt.
Drug - Niacin
Syndromic - Acromegaly or Autoimmune
Acral - From leaning on knees, elbows
Unilateral - Nevoid
Beinign - Auto dom
Mixed

323
Q

What to look for in acanthosis nigricans

A

Make sure it isn’t just dirt - use alcohol pad
Usually symmetric
Velvety thickening

324
Q

Dermatosis tera firma

A

Patient is dirty

325
Q

Tests for acanthosis nigricans

A

Usually clinical, esp. if hx of diabetes, obestity, PCOS
Biopsy if concern for malignancy etc.

326
Q

Management of acanthosis nigricans

A

Evaluate with other providers for underlying causes - endo, etc.

327
Q

Pharm for acanthosis nigricans

A

Retinoid and Vitamin D can be used

328
Q

Common locations for pressure injuries

A

Ischial tuberosity, trochanter, sacrum, maleolar, heel

329
Q

Pressure injury PE

A

May be deeper than appears - wider at base
May need pain meds for full exam

330
Q

Stage 1 pressure ulcer

A

Skin intact with non-blanchable erythema

331
Q

Stage 2 pressure ulcer

A

Partial loss of dermis
Shallow, open ulcer

332
Q

Stage 3 pressure ulcer

A

Full thickness skin loss with fat exposed

333
Q

Stage 4 pressure ulcer

A

Exposed bone, muscle or tendon

334
Q

Unstageable pressure ulcer

A

Covered with slough or eschar
Suspected deep injury if purple

335
Q

Foul odor pressure ulcer

A

May indicate an anaerobic infection

336
Q

Management for pressure ulder stage 1

A

Eliminate risk factors - redistribute pressure
Cover with transparent film for protection

337
Q

Management for Stage II pressure ulcer

A

Transparent or hydrocolloid dressing - CI in active infection

338
Q

Management for stage III-IV pressure ulcer

A

Debridement

339
Q

Monitoring for pressure ulcer

A

Measure size in cm
Exudate
Tissue type
Score 0-17 (lower is better)

340
Q

Prognosis for pressure ulcer healing

A

I-II in 1-2 weeks
III-IV in 6-12 weeks

341
Q

MC pressure ulcer complication

A

INfection

342
Q

Hidradenitis supperativa

A

Chronic supperative disease of the apocrine gland bearing skin areas (axillae, crural, etc.)
Females more common
Larger BMI or smokers, occlusive dress

343
Q

Pathophys of hidrenitis suppurativa

A

Infiltration, dialtion, and rupture of follicles - become connected leading to tx difficulty

344
Q

Presentation of HS

A

Recurrent painful supurrative lesions that leave scars
Open comedomes
Abcess, scarring, and sinus tracts

345
Q

Management of HS

A

Goal to reduce length, symptoms, scarring, and tunnelling
Combo of steroids, abx, retinoin, biologics, surgery used to be more popular

346
Q

Acute lesion tx for HS

A

I&D or “de-roof lesions

347
Q

Abx for HS

A

PCN, Cephalosporins, Augmentin, Clinda

348
Q

Tx for recurrent HS

A

Abx with retinoid (ie. Clinda and Isotretinoin)
Excision may be needed
Humira

349
Q

Lifestyle modifications for HS

A

Hygeine
Weight loss
Warm compress
Smoking cessation
Tea bags applied to lesions
Looser undergarments
Laser hair removal/Shaving change

350
Q

Photosensitivity

A

Abnormal response to light - sunburn, rash or urticaria

351
Q

Presentation of acute sunburn

A

Pruritis, pain, or tenderness
May have toxic or flu like illness if severe
Bright red

352
Q

Sunburn development

A

Develops after 6 hours, peaks at 24

353
Q

Management of sunburn

A

Cool wet dressings
Aloe vera
NSAIDs for systemic
Fluids and rest are improtant for severe cases

354
Q

Peak sun exposure hours - avoid sun

A

10AM to 2PM

355
Q

Sunscreen minimun requirement

A

At least 30spf applied every 80 minutes

356
Q

Drug or Chemical photosensitivity

A

Due to a chemical or allergen causing a photo-reaction - may be due to retinoids, amiodarone, etc.

Allergy is more eczematous

357
Q

Tx for phototoxicity

A

Non-delayed
Treat like sunburn

358
Q

Tx for photoallergy

A

Delayed reaction
Remove offending agent and steroid, antihistamine tx

359
Q

Xerosis

A

Dry skin
Ashiness, fine scale and fissuring
Pruritic and patchy, less shine

360
Q

Risk factors for Xerosis

A

Age - common over 60
Longer bathing
Moisturizing use

361
Q

Tx for Xerosis

A

Use moisturizer - low fragrences - Dove, cetaphil, cerave
Bathing in tepid water - not too often
Mist skin before applying moisturizers
Humidifier

362
Q

Topical agents for Xerosis

A

Lactic acid, ammonium lactate, alpha hydroxy acids

363
Q

Icthyosis

A

Autosomal dominant tough scale - like fish
Associated with atpoic derm
Extreme dryness

364
Q

When is icthyosis more common

A

Winter

365
Q

Presenting time of life for icthyosis

A

3-12 months of age

366
Q

Acquired icthyosis

A

Rare - may indicate malignancy

367
Q

Presentation of icthyosis

A

Dry, fine scaling skin, most obsvious in extensor extremities
Symptoms better in summer

368
Q

Dx for icthyosis

A

Clinical - may do a biopsy but not necessary

369
Q

Management of ichthyosis

A

Emollients are mainstay
Humidifier
Moisturizing soaps after bathing
Keratolytics

370
Q

Mohs surgery for cancer rule of thumb

A

Always for on the face
Depends on size elsewhere

Clin Med III (4 decks)

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