Derm Exam I Flashcards
1
Q
Initial approach to derm
A
Examine before taking history to avoid tunnel vision in diagnosis
2
Q
Flat, non palpable lesion less than 10mm in diameter, discolored but not elevated
A
Macule - Patch if larger
3
Q
Palpable lesion less than 5mm in diameter - raised
A
Papule
4
Q
Elevated or depressed lesion, flat or rounded, greater than 10mm
A
Plaque
5
Q
Firm lesion that extends into the dermis tissue
A
Nodule
6
Q
Clear fluid filled blisters under 10mm in diameter
A
Vescicle
7
Q
Clear fluid filled blister over 10mm
A
Bulla
8
Q
Vesicle that contains pus
A
Pustule
9
Q
Wheals or hives characterized by elevated lesions caused by localized edema
Red
A
Urticaria - lasts for 24 hours
10
Q
Heaped up accumulation of horny epithelium
A
Scale
11
Q
Dried serum, blood or pus on the skin
A
Crust
12
Q
Open areas of the skin from a partial loss of the epidermis
A
Erosion
13
Q
Linear erosion caused by picking or scratching
A
Excoriation
14
Q
Due to loss of epidermis and part of the dermis
A
Ulcer
15
Q
Non-blanchable, small purle lesions
A
Petechiae
16
Q
Larger, non-blanchable, possibly palpable purple
A
Purpura
17
Q
Ciggarette paper, dry skin
A
Atrophy
18
Q
Areas of fibrosis replacing damaged skin
A
Scar - Keloid extends beyond injury boundaries
19
Q
Foci of permanently dilated blood vessels that may occur with sun damage
A
Telangiectasia
20
Q
Cavity containing liquid that looks superficial with a central punctate
May be deep
Yellow, blue, skin color
A
Cyst
21
Q
ABCDE for melanoma
A
Asymmetry
Borders
Color
Diameter (larger than pencil eraser)
Elevation/Enlargement
22
Q
Nummular
A
Coin like
23
Q
Patters of skin lesions
A
Symmetric
Exposed area
Sites of pressure
Intriginous area
Follicular
24
Q
Location of skin lesions
A
Single
Localized
Generalized
Universal
25
One thing that can help psoriasis
Sun exposure
26
Fitzpatrick skin type I
Pale skin with light or read hair
Prone to freckles and burn easily
27
Fitzpatrick type II
May gradually tan but still sunburn
Beige
Still higher risk of cancer
28
Fitzpatrick type III
Light olive skin, burns with long exposure, usually tans
29
Fitzpatrick type IV
Tans easily, does not burn easily, medium brown
30
Fitzpatrick type V
Naturally brown skin, burns only with excessive exposure
Skin easily darkens further
31
Fitzpatrick Type VI
Black skin with dark eyes and black hair
Skin easily darkens further
Can still get skin cancer
32
Diascopy
Press glass slide over lesion to determine capillary extravasation
33
Etiology of acne
Increased sebum production
Follicular hyperkertinization
Proliferation of cutibacterium acnes
Inflammation
Typically begins in puberty as a result of androgen stimulation
34
Stages of acne
Open comedo - Black head
Close comedo - White head
Papule
Pustule
Nodule/Cyst - Rupture of follicular wall
35
Medication causing acne
Steroids
36
Things to consider in acne
Over-cleansing of face, Protective sports gear, Working in fast food - occlusion
37
Diagnosis for acne
Clinical - skin biopsy in case of doubt
38
Moderate acne
20-100 Comedomes
15-20 Papules/Pustules/Nodules/Cysts with less than 5 of the last two
30-125 Total lesions
39
IGA acne severity scale
0 - Clear skin
1 - Almost clear
2 - A few inflammatory lesions
3 - No more than one small nodule
4 - Many lesions
40
Pityrosporum folliculitis
Itchy acne on the upper back/shoulders/scalp
KOH testing and ketoconazole treatment
41
Management pearls in acne
Often resolves after teens
COnsistent care over months for results
Educate on medication us
42
Mild acne treatment
Topical retinoids
Benzoyl peroxide
Topical antibiotics
43
Retinoids
Tretinoin - Acutane
Apply peas sized amount to face
Tazarotene - Strong
Adapalene - Less intense
Trifarotene - Good for trunk/back
Build up tolerance to avoid allergic reactions (once every 3 days for starting out) - causes dryness, photosensitivity and CI in pregnancy
44
MOA of retinoids
Decreases cohesion and increases turnover of epidermal cells
45
Benzoyl peroxide
No bacterial resistance
Titrate dose up
Skin irritation, can bleach hair and clothes
46
Topical abx for acne
Clindamycin or Erythromycin
BPO first to reduce resistance -no monotherapy
SE: Skin irritation
Mild to moderate acne
BID
47
Oral abx for acne
Tetracyclines - Doxy or mino
100mg BID
Inhibits bacteria
Macrolides for pregnancy
Second line Bactrim or Keflex
48
Oral retinoids
Isotrentoin - Acutane
Dries sebaceous gland and decreases C. acnes
Monotherapy
4-6 month course w/ largest meal of the day - high fat
CI with tetracycline - pseudotumor cerebri
49
Birth control during acutane
Need to be on 2 forms of birth control during use
50
Tx for noninflammatory comedonal acne
Topical retinoids
51
Tx for mild papulopustular acne
BPO+ABX AND retinoid
52
Tx for Moderate papulopustular acne
Topical retinoid+BPO+Oral ABX
Hormonal therapy
53
Tx for severe nodular ance
Topical retinoid+BPO+Oral ABX
Hormonal therapy
Oral isotretinoin
54
Patient education with acne
6-8 weeks to improvement - might get worse before it gets better
Washing BID
Some association with dairy
Avoid touching face
55
Rosacea
Usually in fitzpatrick 1-2
Between 30 and 50
Linked to demodex mites
Telangiectasia and other lesions on eyes, nose, cheeks, etc. - Central
56
Types of rosacea
Erythematotelangiectatic rosacea
Papulopustular rosacea
Phymatous rosacea
Ocular rosacea
57
Difference between acne and rosacea
NO open comedomes
58
Erythematotelangiectatic rosacea
central portion of face with stinging or burning
59
Papulopustular rosacea -
Acneiform papules/pustules
60
Phymatous rosacea
Inflammation and edema with sebaceous hyperplasia - bulbous cobblestoning
61
Ocular rosacea -
Conjunctivitis, blepharitis and hyperemia, itchy eyes
62
Non-pharm tx for rosacea
Avoid triggers - spicy foods, hot steam, SUNLIGHT
Use good sunscreen
Cover-ups
63
Pharm therapy for rosacea
Metronidazole prep BID gel for oily, cream for dry
Ivermectin
Sodium sulfacetamide - Lotion, cream cleanser
Azelaic gel
Brimonidine gel - Daily - can have revound erythema (oxymetazoline can help)
Permethrin
64
Systemic tx for rosacea
Doxy daily
Flagyl
Z max
Isotretinoin for severe/refractory
65
Other tx for rosacea
Camoflauge
Surgery for rhinophyma
66
Perdermal dermatitis presentation and tx
Discrete micropapules/microvescicles around the mouth
May be due to steroid and toothpaste use
D/C any triggering steroids and use topical/oral abx
67
Pregnancy testing with accutane
Twice before starting and once monthly after starting
68
Impetigo
MC d/t staph
Can present with bullae
Can be from breaks in the skin
69
Bullous impetigo
S aureus in older children
Large bullae
70
Clinical presentation of non-bullous impetigo
Painful and tender
Erosions with crusts
1-3cm lesions
Regional lymphadenopathy
Scattered discrete lesions
Common around nares
71
Presentation of bullous impetigo
Vescicles progress quickly to bullae
No erythema
Collapse in 1-2 days leaving erosions and crusts
72
Dx of Impetigo
Gram stain and culture to determine agent
73
Tx for impetigo
Warm water soak 15 -20 minutes BID followed by Mupirocin (Bactroban) 5 days
Widespread - 7 days Keflex or Erythromycin
MRSA - Doxy or Vanc or Linezolid
Severe/Bullous PO abx
74
Pt education for impetigo
Hygeine
Clip nails
BPO wash for prevention
Avoid contact w/ others 24 hours post abx
75
Impetigo tx for allergy to PCN
Macrolide or Clinda
76
Folliculitis presentation
Infection of hair follicle
Pustules in the ostium
Non-tender/Slightly tender
Pruritis
77
Risk factors for folliculitis
Shaving hair areas
Occlusion of hair areas
Hot tub usage
Systemic abx
Diabetes
78
Causative agents of folliculitis
S aureus
Pseudomonas - hot tub!
Herpetic/Milluscum - Viral
Fungal - Candida, Malassezia
Syphillis
79
Gram negative folliculitis presentation
Acne patient worsens with abx administration
80
Dx of folliculitis
Clinical:
Gram stain, C&S, KOH for confirmation
81
Tx for mild folliculitis
Mild - Warm compress, wash with BPO, abx if no resolution in 2-3 weeks
82
Tx for moderate folliculitis
Topical abx - Clinda BID or Mupirocin TID
83
Tx for severe folliculitis MSSA or MRSA
MSSA - Keflex
MRSA - Doxy/Bactrim
84
Folliculitis prevention
BPO or chlorohexadine wash
85
Presentation of an abcess
Can be in skin, dermin, SQ fat, or muscle
Tender, red, hot, indurated nodule may have fever and constitutional symptoms
86
Tx for abcess
I&D
IV for more serious - ie. rapid progress
Educate to avoid squeezing
Plastic surgery for more difficult areas - face, genitals....
87
Indications for abx post abcess
Over 2cm abcess
Multiple lesions
Surrounding cellulitis
Immune suppression
Systemic toxicity - Fever
Inadequate response to I&D
Indwelling medical device
High risk for transmission - Jails, etc.
88
Furuncle
Acute, deep seated red hot tender nodule of abcess - boil
1-2cm
Cavitation after drainage
From staph folliculitis
In a hair bearing region
89
Tx for furuncle
Warm compress for 10 minutes daily
PO abx
Bactrim, Clinda, or Doxy for 7-10 days
90
Carbuncle
Deeper infection of interconnecting abcesses
Fever with constitutional symptoms
MC on nape of neck, back, thighs
"All the furuncles get in the car"
91
Tx for uncomplicated and complicated carbuncle
Bactrim, Clinda, or Doxy PO
Admit if toxic appearing for IV vanc daily - complicated
92
Necrotizing fasciitis
Rapid progression of infection with extensive necrosis of soft tissues and overlying skin
Polymicrobial - Strep, P. aruginosa, Clostridium
Starts with deep site at non penetrating minor trauma
93
DIagnosis of necrotizing fasciitis
Skin necrosis is not obvious with signs of sepsis
Severe pain, Indurated swelling, Bullae
Redness, edema, warmth, pain
94
Red flags for necrotizing fasciitis
Severe, contant, out-of proportion pain, Dirty dishwater discharge
Crepitus in soft tissues
Edema beyond erythema
Progression despite abx
95
Tx for necrotizing fasciitis
Surgical debreidment
CT/MRI
Broad spectrum abx - Carbepenem, Unasyn, Clinda, Vanc - depends of C&S/Gram stain
96
Erysipelas
Acut superficial infection - MC beta hemlytic strep in children and older adults
Raised, indurated plaque with signs of sepsis, slapped cheeks
97
Cellulitis etiology
MC staph aureus
Cat/Dof trauma - Pasturella
Water - Aeromonas
98
Presentation of cellulitis
Fever, chills, anorexia, malaise
Red, edematous lesion with non distinct borders - non raised
99
Dx for cellulitis
Clinical
Labs only needed if presenting with systemic symptoms
100
Abx tx for cellulitis
IV abx in spreading, systemic, or resistant conditions
101
Tx for dermatitis and erysipelas
Clinda first line PO for MRSA
Keflex for MSSA PO
IV Vanc for inpatient MRSA, daptomycin second
Cefazolin or Clinda inpatient MSSA
102
Tx for special case dermatitis
Augmentin - Bite
Cipro - Water
Doxy - Salt water
103
Lymphaniitis tx
Distal wound with proximal infection
Can be herpetic
Clinical dx labs if systemic
Dicloxacillin with 1st gen cephalosporin
Clinda or Bactrim for MRSA
104
Lymphangiitis follow up
24-48 hours
Abx for toxic patients or those with no improvement
105
Cutaneous candidiasis
Neonates, elderly, body folds
Candida albicans
106
Presentation of cutaneous candidiasis
Pruritic, tender, painful, macerated, erythematous patch with satellite lesions
107
Dx for cutaneous candidiasis
Clinical - KOH prep can be done
108
Tx for cutaneous candidiasis
Topical antifungals - Ketoconazole or other azole for 2-3 weeks
Oral fluconazole for severe 2-3 weeks
109
Cutaneous candidiasis prevention
Keep areas dry
Powders, Hair dryer, avoid occlusive clothing
110
Balantitis
Inflammation of glans penis
Candida, Trichomonas, Gonorrhea, Strep
Improved hygeine and topical steroid to treat
111
Dermatophyte
Fungi that can infectnonviable cutaneous structures such as hair and nails - tinea etc.
112
Dx for dermatophytes
KOH prep for hyphae and spores
Green fluorescence under woods lamp
Fungal culture - takes a long time!
Skin biopsy when uncertain
113
Tx for dermatophytes - topical
Imidazoles - Clotrimazole, Ketoconazole
Allylamines - Naftfine, Terbinafine
114
Systemic treatment for dermatophytes
PO -azole or Terbinafine(MC)
115
Presentation of tinea capitis
Gray scaly patch - ectothrix or black dot - endothrix
Can be inflammatory or noninflammatory
116
Kerion
Inflammatory tinea capitis - boggy and purulent
Can lead to permanent hear loss
117
Favus
Honeycomb tinea capitis
Yellow crust
118
Tx for tinea capitis
Culture to r/o staph infection
PO terbinafine or griseofulvin
Ketoconazole shampoo
119
Tinea cruris
Jock itch in inguinal folds
Typically with tinea pedis
Scaling with centrally cleared plaques - scale goes away when treated
120
Tx for tinea cruris
Ketoconazole/Econazole
Drying powder
PO griseo fulvin for tx failure
121
Prevention of tinea cruris
Wear shoes in locker room
Put on socks before pants
BPO wash
122
Presentation and tx of tinea corporis
Asymptomatic - may be pruritic
Central clearing
Topical antifungals, PO for large area
Terbinafine for 4 weeks
123
Presentation of tinea pedis
Erythema, scaling, maceration with or without bullae
Often in wet climates
124
Interdigital tinea pedis
MC between 4th and fifth toe
Maceration, hyperhidrosis, fissuring, scaling
125
Moccasin tinea pedis
Well demarcated, scaling w/ erythema
Soles and lateral feet bilaterally
126
Inflammatory tinea pedis
Vescicles or bullae with clear fluid (pus=bacteria too)
Rupture erosions with ragged ringlike border
MC sole and web spaces
127
Ulcerative tinea pedis
Extension of interdigital onto the plantar and lateral foot
May have secondary S. aureus
128
Tx for tinea pedis
Topical antifungal - Keto or Eco
Oral terbinafine for hyperkaratotic
129
Tinea versicolor
Not a dermatophyte, not contagious
Overgrowth of malassezia furfur
MC in adolescents and oily skin
130
Presentation of tinea versicolor
Itching may be present
Macules, papules, and fine scales
Often an aesthetic concern
131
Dx for tinea versicolor
KOH prep - spagghetti and meatballs=hyphae and budding yeasts
132
Condyloma acuminata
Genital warts - HPC with 6 and 11 as MCC
STD - active lesions don't need to be present
Any skin to skin lesions
2-3 month incubation
133
Presentation of condyloma acuminatum
Look like skin tags in the genital or anal area
Cauliflower floret appearance
Keratotic warts
Flat topped papules/plaques - cervix
May persist in dormant state
Solitary or scattered
134
Complication of condyloma
May result from immune compromise
Can get infected if they get too big
Can spread via shaving
135
Dx for condyloma acuminatum
Pap smear and dermatopathology (biopsy)
May do viral subtype
Gardasil to prevent
136
Penile pearly papules
Benign, normal little dots all around the glans of the penis
137
Tx for condyloma
Imiquimod, Podofilox, trichloracetic acid
May also do cryosurgery or electrotherapy
Follow up monthly until lesions are gone
138
Dosing of gardasil
2 doses in 9-14
3 doses in 15+ 0,2,6
139
Imiquimod MOA
Immune modulator that induces the immune system to recognize and destroy lesions
140
Application of imiquimod
Apply small amount at bedtime 3 times per week
Wash off upon awakening
Up to 16 weeks to work
141
SE of imiquimod
Localized inflammation, may need an holiday
Avoid sexual contact
142
MOA of podofilox
Prevents cell division and causes cell necrosis
143
Application of podofilox
Cotton tipped application Q12 for 3 days on four days off over 5 max weeks total
144
Area and volume restriction for podofilox use
Area 10cm squared or less
Volume 0.5 ml/day or less
145
SE and education of podofilox
Skin irritation
Flammable
Avoid sex
CI in pregnancy
146
MOA of trichloracetic acid
Burns, cauterizes and erodes skin lesions
Apply vaseline for a barrier when using
6-8 weeks
147
Molluscum contagiosum
Viral infection - POX
Easily transmitted via water - swimmers
STD in adults
148
Presentation of Molluscum contagiosum
Smoothed dome shaped papules with umbilicated center
In adults in groin or abdomen
Flesh colored
Curd like material filling
149
Tx of molluscum contagiosum
0.5-2 years to regress
Cryotherapy maybe curettage
Podofilox or salicylic acid
DO NOT PICK
150
Verrucae
Warts
HPV etiology from direct skin contact
151
3 types of warts
Verruca vulgaris - Common
Verruca Plantaris - Plantar wart
Verruca Plana - Flat Warts
152
Presentation of verrucae
1-10 mm papules
Isolated or multiple often located in areas of trauma, hands/ fingers, or knees
May see red or brown spots
153
Presentation of verruca plantaris
Plaques with black thrombosed vessels
Painful - effect waliing
154
Verruca plana
Areas that are shaved
Sharply defines 1-5mm
Round, oval polygonal, or linear
155
Dx for verruca
Clinical biopsy if concern for cancer
156
Pharm Tx for verrucae
May resolve in months to years
Salicylic acid
Imiquimod
Cantharidin
157
Salicylic acid MOA
Keratolytic agent
Desquamates hyperkeratotic epithelium
158
Salicylic acid use
Soak lesion, Sand down, then apply
159
Canthrone AKA Catharidine
Derived from blister beetle
For warts or viral lesions
Painless - leave on for 4-6 hours
160
Crytherapy with verruca
Made need to file down and freeze multiple times for the same wart
161
Herpes Zoster
Dermatome-following infection
10-20% lifetime incidence
Passes from skin to sensory fibers
162
Phases of herpes zoster
Prodrome
Active infection
Post herpetic neuralgia
163
HZV prodrome
Mimics angina or acute abdomen - followed by rash
Paresthesias and flu-like symptoms
164
Progression of herpetic lesions
Papules - 24 hours
Vescicles - 48 hours
Pustules - 96 hours
Crusts - 7-10 days
165
Diagnosis for HZV
Often clinical
Tzank, DFA, Viral culture
MOST SENSITIVE - Viral PCR
166
Tx for HZV
Educate on vaccination
Close follow up
Ophthalmology if eye involved
167
Pharm for HZV
Valcyclovir, Famcyclovir, Acyclovir
7 days normal
10 days for immune compromised
168
Supportive care for HZV
Bed rest
NSAID
Neurontin
Nerve block if severe
169
For how long can new HZV lesions present
A week
170
Pediculosis capitis
Head lice
Intense pruritic breakout
171
Hair louse
1-3mm long
with lifespan of 14-18 days
Nits are 1mm and see-through
172
Presentation of pediculosis capitis
MC in females - white school aged children and mothers
Alopecia - hair loss
Seeing lice
Maculae, cerulae and purpuric lesions
May see lymphadenopathy
173
Scalp exam for pediculosis capitis
Start at the base of the hair and examine it in sections - lice will run away from you into the scalp
174
Household management after lice
Wash all clothes, scrunchies, etc. Bag up andything that can't be washed for 2 weeks
175
Lice removal
Oil hair and work through in sections, discarding lice from comb after each pass
176
Dx for Pediculosis Capitis
Demonstration of lice or nits visually or microscopically
Woods lamp to fluoresce nits
177
Management of pediculosis capitis
Manual extraction with a topical as well
Standard and contact precautions
178
Pharm for Pediculosis capitis
OTC before prescription
Only treat if you see active lice/eggs
Permethrin - apply to dry hair and rinse after 10 minutes
Pyretherin
179
List of drugs that can be used to pediculosis capitis
Spinosad - children 4+
Malathion
Permethrin - Off label, 2 months+
Ivermectin 6 months+, no pregnant
Oral Ivermectin - 5+ years and can't apply, all over
180
Eyelid involvement for pediculosis capitis
Apply petrolatum twice daily for 8 days
181
Pediculosis corporis
Usually in very hairy people
Hides in clothing seems
Macules and papules
Associated with poor hygeine
182
Presentation of peduculosis corporis
Erythematous papule - bites
Maculae cerulea - blue gray macules - pathognomic for pediculosis corporis
May see excoriations from scratching
183
Parasitic melanoderma
Vagabond skin
Thickening and darkening after chronic lice infection
184
Management for pediculosis corporis
Standard and contact precautions
Check for secondary infection
OTC or prescription medication
Permethrin cream for heavy infestation
185
Pediculosis pubic
STI - lice in the perineal area
NOT from house pets
May see scalp infestation
186
Louse lifespan
Less than a month
Less than a day off human body
Take 7-10 days to hatch
187
Presentation of peduculosis pubis
Lesions on dermoscopy
Macules, papules, wheals
Pinpoint bleeding on underwear
Inguinal node swelling
188
Diagnosis of pediculosis pubis
Use dermoscopy
Woods lamp
Tape
Eval ALL hair baring areas
Finding a louse or nit is best
189
Tx for pediculosis pubis
Treat any STI
Wash clothes at highest setting
2 week isolation for non washable
Avoid sharing clothes
Some OTC treatments, Shaving area
190
Meds for pediculosis pubis
Permethrin cream 1%
191
MOA of permethrin and use
For lice
Neurotoxin resulting in parasite resp paralysis
CI in under 2 months
192
Pyrethrin/Piperonyl peroxide MOA
Neurotoxin with adjuvant
For lice and scabies
193
Pyrethrin/Piperonyl peroxide SE and dosing
Pregnancy category C
Apply to wet, infested areas, leave for 10 minutes, wash
Transient burning, stinging, pruritis
194
Malthion
For head lice
Neurotoxic via cholinesterase
CI in 6 or younger
Pregnancy category B
195
Dosing for Malathion
Leave on for 7-10 hours
Flammable
196
Lindane
Last resort for lice
Highly neurotoxic - causes louse seizures - BBW
Do not wash before use
Illegal in CA
Pregnancy C
197
Scabies
Intensely pruritic eruption caused by a mite
Extremely contagious
Common in children
198
Typical scabies infestation
10-20 mites
Mites burrow below stratum corneum
Worst itch of life
Burrows seen on skin - line with a pinhead dot
199
Dx for scabies
Look for burrows
Aggressive scraping and dermoscopy to visualize mite
Negative prep does not rule out
200
Crusted scabies
Severe and highly contagious
Have hundreds to thousands of mites all over
Permethrin AND Oral Ivermectin
201
Scabies prep
Best test for scabies
Scrape and observe for mites with microscope
202
Scabie management
Permethrin first line as topical
Oral Ivermectin - Second line
Separate treatments by 1-2 weeks
203
Pt ed for scabies
Itching can last after treatment can give an antihistamine or even steroid
204
Potential sources of error in scabies prep
Not enough specimen
Not enough time to dissolve in KOH
Abrasion resulting in blood contamination
205
Black widow spider
Neurotoxic venom
Commonly live in wood piles
Red hourglass on back
206
Presentation of black widow bite
Cholinergic excess!!
Hypertension, tachycardia, severe abdominal pain, salivation
Halo rash around bite
207
Brown recluse bite presentation
Initially painless
Pain swelling, bullae minutes to hours later
Disseminated intravascular coagulopathy can occur
208
Brown recluse spider
Brown and violin shaped spider
209
Funnel-Web Spiders
PNW
Hobo spider
210
Presentation of funnel web spider bite
Neurotoxic
Severe pain and systemic symptoms
Can be fatal if venom injected
211
Tarantula irritation
Hairs cause urticaria, ocular problems, and rhinitis
212
Things to look for in a spider bite
2 small puncta
Erythema and edema
Necrotic area with red dusky center
213
Dx of spider bite
Done based on hx
Spider collection is ideal
214
Monitoring for spider bites
Brown recluse bites can cause hemolysis
Serial hemoglobin and monitoring for rhabdomyolysis
Culture and purulent drainage
215
Tx for spider bite
Compress, elevation of extremity
Antivenom
Tetanus prophylaxis
Dapsone for necrotic lesions within 36 hours
216
Atopic dermatitis
IgE mediated
Asthma, Eczema, Hay fever
217
Cycle of atopic dermatitis
Dry skin followed by itching followed by disruption and thickening of skin
218
Transepidermal water loss
Mechanism in atopic dermatitis due to compromised barrier
Water out, irritant in
219
Acute atopic dermatitis
Erythema, vescicles, weeping, crusts
220
Subacute atopic dermatitis
Scaly plaques, papules, round erosions
221
Chronic atopic dermatitis
Lichenifications, follucular eczema, and skin thickening
222
Envionmental triggers for atopic dermatitis
Heating house
Detergent
Abrasive clothing
Alcohol in perfumes
Smoking
Stress - allergies to eggs milk, peanuts
223
Presentation of atopic dermatitis
Itching causing scratching causing thickening
Water loss and cutaneous infections
224
Secondary infections to atopic dermatitis
Staph
Coxsackie virus
HSV
Vaccina virus
225
Common locations for atopic dermatitis
Neck, elbows, hands, cheeks, popliteal fossa
226
Peds atopic derm signs
Dennine Morgan lines
Allergic shiner
Nasal crease
Open mouth with recessed lower jaw
227
Tests for atopic dermatitis
Fam hx
Serum IgE
Culture or skin biopsy can help
Often a clinical dx
228
Management for atopic dermatitis
Avoid triggers:
Hit water, stress, irritants
Clearance with Lowest strength steroid
Ointments without preservatives
229
Skin care for atopic dermatitis
Gentle skin cleanser - CerVe, Cetaphil, Vanicream
230
Medium potency steroids for atopic derm
Triamcinolone
Mometasone
Flucinolone
231
Low potency steroid for atopic derm
Desonide
232
Nonsteroidal tx for atopic derm
Not for children under 2
Tacrolimus
Pimecrolimus
Crisaborole
233
Systemic tx for atopic derm
Dupilumab - (Dupixent) - Injected
234
Treatment for pruritis of atopic derm
Diphenhydramine
Hydroxyzine
Cetirizine hydrochloride
Loratadine
235
Contact dermatitis
Acute or chronic inflammatory reaction to a skin exposure to substance
Allergic or Irritant - Allergic is DELAYED
236
Allergic contact dermatitis presentation
Break out 48 hours AFTER exposure
237
Presentation of acute contact dermatitis
Erythema, Vesicles and bullae
238
Presentation of chronic contact dermatitis
Scaling, lichenification, fissures and cracks
Geometric shapes
239
Causes of contact derm
Soaps
Cement
Industrial chemicals
Fiberglass
Plants
240
Tests for contact derm
Hx and PE are best
Patch testing for allergren verification - will need additional worup after
241
Allergic contact derm causes
Diverse, T-cell mediated reaction
Erythema, papules, vesicles, erosions, then crusts
242
Nickle allergy presentation
Nelow umbilicus from belt buckle or around jewelry
243
Management for contact derm
Review meds
Time of showers - too long can be aproblem
Use a humidifier
Pets
Avoid offending agent, topical and potentially oral steroids
All creams
244
Low potency steroids for contact derm
Hydrocortison
Desonide
245
Medium potency steroids for contact derm
Triamcinolone
Mometasone
Flucinolone
All creams
246
High potency contact derm steroids
Clobetasol
Halbetasol
Betamethasone
Flucinonode
Desoximetasone
All creams
247
Phototherapy for contact derm
PUVSA treatment
248
Diaper dermatitis presentation
Cutaneous candidiasis around the perineal reion
Miliaria - Blocked sweat ducts
Fussy w/ vescicles, papules, erosions
249
Management for diaper dermatitis
Prompt changing of diapers
Not too tight
Dry bottom after bathing
Zinc oxide barrier cream
Nystatin, Clotrimazole, or Econazole for candidiasis
250
Nummular eczema/dermatitis
Coin shaped plaques
Associated withfrequent bating, low humidity
skin trauma, hep C interferon therapy, irritating fabrics
Venous stasis on legs
251
Presentation of nummular dermatitis
Similar to atopic dermatitis - itch that rashes
50-65 years old men MC
No personal of fam hx
Scaly paques, erosions, and crusts
Coalescence of lesions
252
Best tests for nummular derm
Culture for bacteria
Scrape for fungi
Biopsy if needed
253
Seborrheic dermatitis
Common inflammatory papulosquamous condition
Face scalp, neck, upper back, and chest
Caused by malassezia yeast
254
Presentation of seborrheic derm
Dandruff fulminant rash
Dryness, prutitis, erythema, fine scaling
Change in pigmentation of dark skin
255
Risk factors in seb derm
HIV and parkinsons
Look for erythematous plaques
May be associated with rosacea
256
Tests for seborrheic derm
Clinical
Biopsy if refractory/resistant
Scraping if fungus suspected
257
Management for seborrheic derm
No cure
Salicylic acid, Tar, or Ketoconazole shampoo
Clobetasol, Betmethsone, Flucinolone steroids
258
First line for seb derm
Ketoconazole shampoo
259
Presentation of stasis dermatitis
Due to venous dermatitis
Pruritis, heaviness, and edema in lower legs
Bilateral
Erythema and browning
Lichenification and loss of hair
260
Management for stasis derm
Treat underlying conditions
Clean with water
Triamcinalone or Clobetasol
Compresion stockings
261
Complications of stasis derm
Cellulitis
Wounds - non-healing
Consult vascular
262
Lichen simplex chronicus
Repetitive lichenification of an area
From chronic skin conditions or habit forming scratching
263
Findings of lichen simplex chronicus
Often found on scalp, ankles, lower legs, upper thighs, forearms, pubic region
Plaques, thick skin, excoriations, Hyperpigmentation
264
Management for Lichen simplex chronicus
Stop scratch itch cycle
Cut fingernails
Benadryl
Apply dressing with mositurizer
Triamcinalone for hydration
265
Peri-oral dermatits
Erythymatous papules and pustules of unknown origin
Fine scaling
May itch, burn, or not
Lip and chin distribution
266
Management for peri-oral derm
May biopsy if uncertaib
Taper steroids to low potency
Will flare up after termination of topical steroid - use pimecrolimus to taper
Topical erythromycin, metro, clinda
267
Dyshydrotic derm
Hands and feet
Tapioca vescicles on later aspect of digits
May do C&S or patch testing
Biopsy is diagnostic
268
Tx for dyshidrotic eczema
Topical steroids for two weeks
PUVA (light) therapy
269
Tx for secondary infection in dyshydrotic eczema
PO abx
Avoid irritants or over-exposure to water/excessive hand washing
270
Emollients
Non cosmetic moisturizers
Increase skin moisture and flexibility - retinol preparations can make it worse
Apply w/o excessive rubbing
Use after flare is controlled
Cream, Lotion or Ointment
271
Cream
Cream - best for most dermatoses, thick with blanced fat and water, moderate moisturizing effect
272
Lotion
More water with less fat
Less effective for moisturizing, useful for hair covered areas
273
Ointment
Greasy - bad for weeping skin or eczema
Preferable for dry/thickened skin
274
Topical corticosteroids MOA - 4 aspects
Reduces the immune response via:
1.Stabilizes leukocyte/macrophage activity
2. Contstriction of capillaries
Decreases
3.Decreases activation of compliment cascade
4.Reduces fibroblast proliferation and collegen deposition which leads to reduced scar formation
275
Indication for topical steroids
Atopic derm
Contact derm
Nummular derm
Chronin Lichenification
Psoriasis
276
CI for steroids
Bacterial infection
Use on eye
Caution in chronic use - growth stunting in children
Pregnancy category C
277
SE of steroids
Depends on potency and area
Atrophy, striae, rosacea, glaucoma in eyes
278
Steroid ointment
Most potent vehicle
Semi occlusive
Increase active ingredient absorption
279
Steroid creams
Less potent than ointment
Better feel
280
Steroid lotion
Least potent
Less residue
Cooling effect and feel
281
Steroid powders
Good in wet skin conditions
282
Steroid gel
Oil and water in alcohol
Good for scalp with no residue
283
Steroid foam
Easy to spread but more expensive
284
Steroid solution
Low viscosity, alcohol causes a drying effect
285
Classes of steroids
Determine strenght
I - strongest (clabetasol)
VI - Weakest (Hydrocortisone)
286
Dosing for topical steroids
Daily or BID
Gradual taper
Use class I for under 3 weeks
Class ii-IV for 6-8 weeks
Class V or VI chronic or 1-2 week face, fold, genital limit
287
Tachyphylaxis
Decrease in response to drug after prolonged exposure - need a holiday
288
MOA of pimecrolimus and tacrolimus
Inhibition of T lymphocyte and release of cytokines
Used for atopic derm
289
CI, SE and BBW for immune modulators
Skin malignancy - rare
CI under 2
Pregnancy category C
Burning sensation, URI, Fever
No skin atrophy like steroids
290
Selenium sulfide
Reduces corneocyte production
seb derm and tinea versicolor
291
Dosing and SE of selenium sulfide
Shampoo, lotion or foam
May have transient burining or stinging
292
Pyrithione zinc
Reduces cell turnover in hair and skin
Seb derm
Shampoo for bar form
