DERM FINAL Flashcards
HSV 1 and 2
-primary, latent, recurrent
-fluid
HSV 1:
-Most people have been exposed
-Skin to skin contact
-Viral shedding when there are no active sores
-Kissing, Sharing utensils…
-1 day tx
HSV 2:
-20% sexually active adults carry
-Female
-Have other sexually transmitted
-Weakened immune system
-10 days tx
Rosacea
-rhinophyma- treat with lasers
-metronidazole
-minocycline + doxycycline low dose
-sodium sulfacetamide for pustules
molluscum contagiosum
-Benign
-not a wart
-Lesions that appear anywhere on the body
-White, pink or flesh colored
-Umbilicated
-Itchy, red sore and swollen
-Highly contagious
-pox virus*
-tx:
-Cryotherapy (oweeeeeee)
-Cantharone
-Podophyllin, Acids, Retin A, imiquimod
-trigger inflammatory casade
zoster
-Reactivation of Chickenpox virus
-Virus lives in the dorsal nerve root and becomes activated
-Stress?
-Illness
-Imuno compromised
-Infection follows lines of Langer
-Rarely crosses midline!
-tzank smear- not dx but can differentiate from herpes -> PCR*
-tx:
-Famciclovir 500mg po q 8hrs x 7 days
-Acyclovir 800mg po q 4 hrs x 7-10 days
-Valacyclovir 1000mg po q3x a day x 7 days
-Pain meds prn
-PHN- Post Herpetic Neuralgia
Imiquimode
-a topical immune-activating medication
-can treat BCC
SCC treatment
-SCC’s can have “skip areas” -> MOHS is not fool proof
-lymph bx for invasive
-radiation when surgical resection not possible
-immunotherapy- cetuximab
melanoma tx
-Interferon-2a for stage II and III
-sentinel node bx
HSV tx vs Zoster
ZOSTER
-Famciclovir 500mg po q 8hrs x 7 days
-Acyclovir 800mg po q 4 hrs x 7-10 days
-Valacyclovir 1000mg po q3x a day x 7 days
HERPES
-within first 72 hrs
-topical or oral
-Famvir
-Zovirax cream
-Valtrex
-frequent infections -> prophalax with antiviral Valtrex
-Cold sores 2 grams 2x a day for 1 day
-Genital Herpes 1 gram 2x a day for 10 days
pemphigus
-positive nicholsky sign
pityriasis rosea
Unknown Cause
Possibly triggered by viral infection
Not Contagious
Herald Patch
Can be Itchy
Self limiting
Can last weeks to years!
contact dermatitis tx
-topical steroid
-Steroid shot (IM)
-Calamine lotion
-Oral antihistamines are not suggested for PI
drug eruption tx
-Discontinuation of offending drug
-Antihistamines
-Steroids oral and topical
-Should be considered in any unexplained skin rash
-Base diagnosis on clinical observation
-Make sure to get a DETAILED history of prescription meds, OTC meds and supplements
actinic keratosis tx
-cryotherapy
-blue light
-5-FU field therapy- topical chemo
-mutation in p53
basal cell carcinoma- appearance, variants
-pearly, shiny
-teleangiectasia
-Variants- nodular, pigmented, superficial, morpheaform (AKA infiltrative)
-Morpheaform can grow deep and not noticeable on the epidermis
-MOHS * - elliptical excision with wide margins
-ED+C x3
-radiation for unresectable tumors
-cryosurgery
perioral dermatitis tx
-DC all topical creams
-non steroidal:
-Tacrolimus
-Pimecrolimus
-Topical erythromycin, clindamycin- can burn
-Metronidazole 1%*
-Sometimes miconazole with zinc (zinc soothes)
hidradenitits suppurativa
-follicular rupture release keratin and bacteria
-vigorous inflammatory response
-abscess and sinus tract -> scarring
-MILD-topical and oral antibiotics, intralesional steroid injections, oral antibiotics, spironolactone
-MODERATE- TNF (tumor) Inhibitors, dapsone, cyclosporine, oral retinoids, isotretinoin
-SEVERE- excisions and de-roofing
satellite pustules
-candidiasis
-scaling
-plaques
atopic dermatitis
-sometimes bx -> spongiosis
-yellow crusting
-Topical Calcineurin inhibitors tacrolimus, pimecrolimus
-no oral steroids
cellulitis
-plaque
-lymphangitic spread- lymphangitis
stasis dermatitis
-deep venous thrombosis
-overweight
drug reactions
-morbilliform rashes and hives
-4-14 days
DRESS: causes, tx
-type 4 hypersensitivity
-2-6 weeks
-damage occurs due to overreaction from immune system, involves the activation of t-cells and release of cytokines
-looks red and dry
-genetic predisposition to DRESS syndrome
-inability of liver to metabolize certain drugs
-reactivation of certain viruses, such as epstein barr virus (EBV) or human herpesvirus 6 (HHV6)
-tx:
-supportive
-early systemic corticosteroids (suppress immune)
-STOP DRUG
epidermis and dermis
-stratum corneum*- dead, keratin, barrier
-stratum lucidum- thick, hairless, palms+soles
- stratum basale- mitosis, melanocytes
-vitamin D
-tempature
-5% CO
-sensation
-DERMIS- collagen
descriptors
-papule < 1cm- raised
-macule < 1cm- flat
-plaque > 1cm- raised -> wheal
-patch > 1 cm- flat
-nodule- dermis
-vesicle < 1 cm fluid filled
-bulla- > 1cm- fluid filled
-erosion- superficial, epidermis, no scar -> weep
-ulcer- part of dermis, scar -> decubitus
rate limited barrier to percutaneous drug delivery
-stratum corneum
factors affecting absorption
-surface area
-occlusion
-strength/dose
-area of skin
-thickness of vehicle
-hair follicles
-cutaneous circulation
oitment
-water in oil
-no preservatives
-do not put on burn bc its occlusive
steroids
-1-7
-group 1- 2 weeks -> 1 week rest -> hands
-2-7- 2-6 weeks
-6-7- diapers, no more than 10 days
SIDE EFFECTS
-burning, itching, irritation, dryness
-hypertrichosis of face- hair growth
-hypo/hyper pigmentation
-milia/folliculitis after occlusion
-ocular hypertension/cataracts
-acne
-rebound phenomenon- once you stop using it comes back
-skin atrophy- thinning
-striae- lines that look like stretch marks, red
-systemic absorption
-tinea incognito- makes fungal infections worse
-skin blanching from acute vasocontriction
-nonhealing leg ulcers (steroids retard the healing process) WHY??? -> steroids stop inflammatory cascade -> slows healing
-YOU CANT use steroids on areas of infection
-steroid rosacea
-perioral dermatitis
-thins skin - can see the vasculature
steroids names
-cheetahs are faster than humans
-1- clobetasol 0.05%
-2- fluocinonide 0.05%
-4- triamcinolone 0.1%
-7- hydrocortisone 2.5%
inflammatory cascade
-mast cells- histamine -> vasodilation
-macrophages and leukocytes -> cytokines -> chemotaxis
-leukocytosis (b and t cells) -> increase WBC
-RED
-HEAT
-PAIN
-SWELLING
HPV
-mats- fomites
-black dot in center* thrombosed capillaries
-condyloma accuminatum
-plantar (foot) and acral (hand) -> 1,2,4
-genital -> 6,7
-break in barrier
-16, 18, 31, 33 -> cancer
-16,18- cervical
-tx-
-women- refer
-acids, lazers, glue, banana peels (organic matter -> acid -> irritant ), garlic, liquid nitrogen, cantharidin (outer layer of beetle), surgery
-high dose oral cimetidine
-imiquimode cream- immune response modifier
-podophylin- not in pregnancy
bullous pemphigoid
-elderly
-TENSE
-neurological disease before -> dementia, parkinsons, epilepsy
-basement membrane targeted by autoantibodies
-puritic urticarial rash -> bullae
-bx edge of intact bullae -> DIF -> IgG
-bilateral, symmetric, trunk and flexural extremities
-tx:
-drain
-mild- steroids and oral tetracycline
-moderate-severe- steroids and methotrexate
pemphigus vulgaris
-older -> 38-72
-assoc with autoimmune disease -> thyroid, myastania gravis, sjrogens and RA
-superficial blisters*
-crusted erosions
-ORAL INVOLVEMENT
-head, upper trunk, intertriginous zones
-positive nicolsky sign
-2 biopsies
-tx:
-mild- steroid, swish and spit
-moderate-severe- oral steroids, rituximab, methotrexate
-MONITOR FOR INFECTION!!!! -> BC SUPERFICIAL
dermatitis herpetiformis
-vesicular rash
hand, foot, and mouth disease
-coxsackie (A16)
-macular rash -> vesicles
-HIGH fever
-loss of appetite, malaise, irritability, sore throat, headache
-tx- hydrate, tylenol
pityriasis rosea
-gutate*
-herald patch 1st sign -> biggest area
-christmas tree distribution**
-tx- self limited -> steroids if itchy
black widow spider bites
-abdominal rigidity and or cramping
-N/V, chills, tremors, sweating
-1-3 days of symptoms
-tx- muscle relaxers, pain meds -> last resort -> antivenom
-2 fang marks
-red, swelling -> spreads to abdomen and chest
brown recluse spider
-intially red -> then blister
-ulceration* if untreated
-necrosis within 4 hours
-blue halo around
-dark flat center
-pain
-child is more serious
-fever, chills, nausea, weakness, joint pain
-tx- soap and water, antibiotic ointment, pain meds, ice, elevation, tetanus shot*
scabies
-sarcoptes scabiei
-transmitted by direct contact (or fomites)
-30 day life cycle within epidermis
-trail of eggs and feces
-high contagious
-rash from hypersensitivity
-papules - hands, wrists, arms, trunk, genitals
-short wavy red line (burrow*)
-bx, dermoscopy, tape pull
-tx- permethrin 8-14 hrs -> repeat 1 week later
head lice
-pediculosis capitis
-blood sucking
-sesame seed
-30 day life cycle -> lays 5-10 eggs
-discard clothes or wash 149 degree
-tx- permethrin for 10 mins -> repeat 7-10 days preg cat b
-ivermectin- leave on 10 mins -> rinse -> repeated 1 week preg cat c
bed bugs
-cimex lectularius
-4 star hotels to homeless shelters!
-Blood sucking Parasitic arthropods-
-Brown, oval, wingless
-Size of an apple seed
-Attracted to heat and carbon dioxide
-Feed on exposed skin
-Hide during day- feed at night
-Survive up to a year without a blood meal
-Disease vector- 45 pathogens HepB, HIV, Staph
-Linear or clustered groups of 3 “breakfast lunch and dinner”
-Eradicate source
-Treat with oral antihistamines, topical steroids, antibiotics if necessary
