Derm Final Flashcards
- Group A beta-hemolytic streptococci.
Infection extends into dermis. - Heals with scar (because ulcerative)
Ulcerative bullous impetigo
- Chronic itch in a postmenopausal women
- Negative KOH
- Presents as chronic itch-scratch- cycle
lichen simplex chronicus
Dimple sign with lateral pressure
Dermatofibroma
- Painful itchy condition
- Recurrent and lasts 2-3 weeks then clears.
- Starts with deep seated blisters between the fingers
no other lesions can be found. - Not infectious in its cause
Irritant contact dermatitis (clue is stand alone lesion, confined to hands & fingers, vesicular or blistering
- Pruritic inflammatory condition.
- Often with a personal or Fhx of similar eruptions.
- Diffuse erythema, some vesicular eruption and mild overlying scaling on the face, scalp, flexural surfaces
Atopic dermatitis
Infected area tender, deep, red and swollen
Cellulitis
superficial infection of the dermis
Erysipelas
- Sun exposed areas of skin
- Male > Females
- Pre-malignant
- 1 out of 1000 lesions develop into SCC annually
- 5-10% over a lifetime
Actinic keratosis
Is this patient with AK amenable for surgical removal of lesions?
If not, what is the standard of care 1st line tx?
No. too many lesions
5 fluorouracil applied topically 5% cream for 4 weeks
- Acquired light or dark-brown hyperpigmentation
- Age of onset - young adults
- Female > male (10%)
- Race - brown or black skin type
Incidence/etiology: hyperinsulinemia, pregnancy, combo hormone replacement, thyroid dysfunction, genetics, UV radiation, cosmetics, anti seizure medication
Melasma/ chloasma
- Presentation: maculopapular, urticarial, pustular and nodular eruptions
- Prevention: sunblock should be used, but not always helpful
- Systemic tx:
- Beta-carotene, 60 mg tid 2 weeks before sun
- Niacinamide, 2-3 g/day (helped 60% of pts in one study)
- Vit B-6, 150-200 mg, taken 30 min before sun, or 100 mg/hr for 8-10 hrs before sun
- Antimalarial drugs
Polymorphous light eruption
- Nodular mass of dilated vessels
- 80-90% resolves spontaneously within 5-8 years
Superficial hemangioma
- Superficial bacterial infection of the hair follicles
- Most commonly S. aureus
- Caused by friction blockage of follicle, shaving
- Papule or pustule confined to hair follicle, often surrounded by erythematous halo
- No scarring
Folliculitis
- Fair-skinned individuals with excessive sun exposure in childhood at highest risk
- Location: top of the ear and crossing vermillion borders of the lips
- Exposure to chemical carcinogens (pitch, tar, crude paraffin oil, creosote, lubricating oil)
- Arsenic (flower’s soln. for psoriasis)
- Other etiologies (HPV, immunosuppression)
SCC
- Most common areas:
lower legs, scrotum, vulva, anus pubis, wrists, ankle and elbow, upper eyelids, back and side of neck, ear-orifice and fold - Scalp-picker’s nodules
Lichen simplex chronicus
HT for scalp-picker nodule that bleeds
Calc carb
- Caused by gram positive cocci
- Bollus condition (blisters)
- Ulcers
- Tx with topical mupirocin
Bullous impetigo
- Single or scattered discrete lesions on sun exposed areas
- Adherent hyperkeratotic scales “rough texture”
- Better felt than seen
- A sore that doesn’t heal
Actinic keratosis
An acute, deep-seated, red, hot tender nodule or abscess
Furuncle
- Lesion present for 20 years
- Superficial
- Asymmetrical
- Poorly demarcated orders
- Punch biopsy was malignant
Superficial spreading melanoma
Infection of the dermis and subcutaneous tissue
- Caused by group A Streptococcus and s. aureus in adults
- Hemophilus influenza B - kids
- Most often on legs and face
- Port of entry- crack, abrasion, bite, or other wound to skin
- Warm, tender, swollen, red area
- Possible fever, enlarged nodes, red streak
Cellulitis
What is the HT remedy for a pt presenting with:
- woke up with bright red cheeks, super hot, red, minimally swollen, accompanied by a h/a, very dry
- Mental emotional predisposition went from normally calm individual to an extremely violently oriented person this morning due to the inconvenience of her condition.
Belladona
Belladonna acute can appear like a ______ , Ht remedy that is chronic
Calc carb
- Painful swollen sweat glands in the axilla
hidradenitis suppurativa
- Hutchinson’s sign present
- Periungual spread from nail towards the proximal finger
Acral lentiginous melanoma
- Scaling to ulcer
- Elevated nodule to tumor
- indurated, eroded nodule that ulcerates and bleeds easily
- Common on lower lip, top of ears, tongue, head, neck, back of hands
SCC
- Maceration of toes and knees
- Often malodorous
- Tx - wear cotton socks (change frequently)
- Consider agents to reduce moisture- powder
- Topical antibiotic may be necessary
Pitted keratolysis
- Papule or nodule
- Pearly or translucent
- Telangiectasia - haphazard
- Can be pigmented/sclerotic
- Translucent when stretched
BCC
- Bacterial infection (corynebacterium minutissimum) - Gram positive rod
- Diffuse brown, scaly plaque resembles tinea
- 3rd and 4th toe web most common, also genital-crural region
Erythrasma
What could be identified on a wood’s lamp exam with Erythrasma
A coral red fluorescence
Which pre-malignant (1 out of 1000 lesion annually) develop into SCC, 10% over lifetime?
AK (Actinic Keratosis)
- For smaller and isolated lesions- Tx includes: cryosurgery, radio surgery, hypercation or electrodes desiccation
5-Fluorouracil- 5% applied bid for 2-4 weeks- very irritating - Acetaminophen with codeine often given for pain
- Petrolatum often used between applications to soothe skin
AK
- Red, swollen, painful periorbital
Periorbital cellulitus
- Condition managed with gluten free diet, topical dapsone and sulfapyridine
- Vesicular eruptions that mimics a herpes simplex but with diffuse involvement in a non contiguous pattern across the body
Dermatitis herpetiformis
- Pinpoint papules
- Desquamation fo the tips and toes
- Strawberry tongue- day 4-7 in untreated cases
- Pastia’s sign
Scarlatina/scarlet fever
- Primary-painless chancre (contagious)
- Secondary (contagious) disseminated
Syphilis
- Possible association with fluoride and sodium lauryl sulfate
Perioral dermatitis?
- Locally invasive, aggressive, destructive
- On the face
BCC
Associated with an acute inflammatory process at a distal site
ID reaction
- No radial growth, so early metastasis
- Most common in 6th decade of life
Nodular melanoma?
Herald patch
Pityriasis rosea
- Itchy since the introduction of food 3 months ago
- Both parents have asthma
Atopic dermatitis
Spilled oven cleaner
Irritant contact dermatitis
- 1 year duration
- Moderate pruritus
- Wickham’s striae
Lichen planus
- Culture positive for pseudomonas
Folliculitis
Caused by gram positive rod from raw fish or meat contact
Cellulitis
Delayed abnormal reaction to UV radiation
Polymorphous light eruption
What is this condition?
Psoriasis
- Chronic itch rash
- Remembers having a rash in cubital and popliteal fossa as a child
Atopic dermatitis
- Hyper proliferative skin disorder in generally predisposed individuals
- 2% of world pop (range 0.4-4.7%)
Psoriasis
- Chronic lesion on elbow
- Picking at it reveals pinpoint bleeding
Psoriasis
- No pruritus
- Neg KOH
- Neg ANA
seborrheic dermatitis
Oil accentuates the lacy, white Wickham’s striae
Lichen planus
ID. by looking at the characteristic sites
Lichen simplex chronicus
- Chronic itchy lesions
- Resistant to tx
- Neg KOH
- Neg culture
- Biopsy-spongiosis
Nummular dermatitis
Hyperproliferative skin disorder in genetically predisposed individuals
Psoriasis