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DERM FINAL Flashcards

1
Q

HSV 1 and 2

A

-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

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1
Q

Rosacea

A

-rhinophyma- treat with lasers
-metronidazole
-minocycline + doxycycline low dose
-sodium sulfacetamide for pustules

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2
Q

molluscum contagiosum

A

-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

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3
Q

zoster

A

-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

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4
Q

Imiquimode

A

-a topical immune-activating medication
-can treat BCC

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5
Q

SCC treatment

A

-SCC’s can have “skip areas” -> MOHS is not fool proof
-lymph bx for invasive
-radiation when surgical resection not possible
-immunotherapy- cetuximab

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6
Q

melanoma tx

A

-Interferon-2a for stage II and III
-sentinel node bx

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7
Q

HSV tx vs Zoster

A

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

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8
Q

pemphigus

A

-positive nicholsky sign

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9
Q

pityriasis rosea

A

Unknown Cause
Possibly triggered by viral infection
Not Contagious
Herald Patch
Can be Itchy
Self limiting
Can last weeks to years!

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10
Q

contact dermatitis tx

A

-topical steroid
-Steroid shot (IM)
-Calamine lotion
-Oral antihistamines are not suggested for PI

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11
Q

drug eruption tx

A

-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

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12
Q

actinic keratosis tx

A

-cryotherapy
-blue light
-5-FU field therapy- topical chemo
-mutation in p53

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13
Q

basal cell carcinoma- appearance, variants

A

-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

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14
Q

perioral dermatitis tx

A

-DC all topical creams
-non steroidal:
-Tacrolimus
-Pimecrolimus
-Topical erythromycin, clindamycin- can burn
-Metronidazole 1%*
-Sometimes miconazole with zinc (zinc soothes)

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15
Q

hidradenitits suppurativa

A

-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

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16
Q

satellite pustules

A

-candidiasis
-scaling
-plaques

17
Q

atopic dermatitis

A

-sometimes bx -> spongiosis
-yellow crusting
-Topical Calcineurin inhibitors tacrolimus, pimecrolimus
-no oral steroids

18
Q

cellulitis

A

-plaque
-lymphangitic spread- lymphangitis

19
Q

stasis dermatitis

A

-deep venous thrombosis
-overweight

20
Q

drug reactions

A

-morbilliform rashes and hives
-4-14 days

21
Q

DRESS: causes, tx

A

-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

22
Q

epidermis and dermis

A

-stratum corneum*- dead, keratin, barrier
-stratum lucidum- thick, hairless, palms+soles
- stratum basale- mitosis, melanocytes
-vitamin D
-tempature
-5% CO
-sensation

-DERMIS- collagen

23
Q

descriptors

A

-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

24
rate limited barrier to percutaneous drug delivery
-stratum corneum
25
factors affecting absorption
-surface area -occlusion -strength/dose -area of skin -thickness of vehicle -hair follicles -cutaneous circulation
26
oitment
-water in oil -no preservatives -do not put on burn bc its occlusive
27
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
28
steroids names
-cheetahs are faster than humans -1- clobetasol 0.05% -2- fluocinonide 0.05% -4- triamcinolone 0.1% -7- hydrocortisone 2.5%
29
inflammatory cascade
-mast cells- histamine -> vasodilation -macrophages and leukocytes -> cytokines -> chemotaxis -leukocytosis (b and t cells) -> increase WBC -RED -HEAT -PAIN -SWELLING
30
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
31
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
32
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
33
dermatitis herpetiformis
-vesicular rash
34
hand, foot, and mouth disease
-coxsackie (A16) -macular rash -> vesicles -HIGH fever -loss of appetite, malaise, irritability, sore throat, headache -tx- hydrate, tylenol
35
pityriasis rosea
-gutate*** -herald patch 1st sign -> biggest area** -christmas tree distribution** -tx- self limited -> steroids if itchy
36
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
37
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*
38
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
39
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
40
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

DERM (10 decks)

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