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
- Usually Fhx of eczema, hayfever or asthma (60-70%)
- 7-15% of general population
Atopic dermatitis
End result of what condition?
Rosacea
A women had this reaction after using neomycin ointment
Allergic contact dermatitis
- Common (2-5%)
- Chronic inflammatory disease
- Pityrosporum ovale
- Genetics, stress, and dietary factors affect onset of disease
Seborrheic dermatitis
- Sites: wrists (MC), forearm, ankles, ant legs, lumbar regions, and genitals
- Up to 5% have mucous membrane and 10% nail (split ridge etc)
Lichen planus
- All skin types (10-20%)
- Females > male, around age 20 first onset
- Spring, early summer - 2-24 hours after 1st sun exposure - lasts 7-10 days
Polymorphous light eruption
- Lip licking
- oven cleaner
Irritant contact dermatitis
ID the condition on the image
Erythema multiforme
ID the condition on the image
polymorphous light eruption?
- Like acne protocol
- Loose clothing
- Avoidance of heat, humidity, shaving, depilation, deodorants
- Warm compresses
- Zinc- 90mg/day- 2 months
Hidradenitis suppurativa?
- Centrally affects the face, forehead, cheeks, nose, and chin
- May include iritis or blepharoconjunctivitis
Rosacea
- Five p’s: pruritic, planar (flat-topped), polygonal, purple papules, 2-10mm in diameter
Lichen planus
- Papulopustules on an erythematous base that may have occasional itching, burning, feeling of tightness
Perioral dermatitis
- Triggers include drugs, infection or unknown
Erythema multiforme
- Acute inflammatory/immunologic rx of subcutaneous fat leading to painful, red, swollen nodules on the extensor aspec of the extremities
- Prodrome: fever, malaise, later arthralgias, arthritis and hilar adenopathy
Erythema nodosum
- Pruritic, papulovesicular or scaly coin-shaped lesions
- Negative KOH test
Nummular eczema
ID the condition in the image
Psoriasis
- A pt. noticed a correlation with wearing a bra and these lesions
Type lv delayed. HS- allergic dermatits
30-35% have ocular symptoms (iritis, scleritis, keratitis, chalazia, blepharoconjunctivitis)
Rosacea
Top 10 list: Nickel sulfate (10-15%), neomycin sulfate, balsam of peru, fragrance mix, thimerosal, sodium gold thiosulfate, formaldehyde, quaternium-15, cobalt chloride, bacitracin
Allergic contact dermatitis
Cradle cap
Seborrheic dermatitis
This phenomenon results from the release of cytokines that develop in a distal primary dermatitis i.e. tinea pedis, stasis derm etc
ID reaction
Tx- first try warm, moist compresses, it may resolve, if not consider incision/drainage
Boil/furuncle
Tx- Topical tx- Mupirocin (pseudomonic acid)
Bollous impetigo
Dietary recommendations may include: whole foods high in fat, low to moderate protein, high complex carbohydrates, low glycemic diet to stabilize blood glucose, dairy and wheat elimination
Acne vulgaris?
Triggers include drugs, infection or unknown
Erythema multiforme
- Recurrent
- Self resolving condition of unknown etiology
Pompholyx/Dyshidrotic eczema
Caused by beta-hemolytic strep
Ecthyma
Fluoresces coral- red w/ wood’s lamp
Erythrasma
Telangiectasia is commonly found in association with what condition?
Rosacea
Herald patch
Pityriasis rosacea
Chronic itch-rash-scratch cycle
- Negative for fungal, bacterial or viral
Lichen simplex chronicus
- Older woman claims this scaly dry rash on her leg returns every winter. She has no other dermatitis hx, with hx yo determine she is deficient in EFA’s
Asteatotic eczema
This chronic skin condition is a minor feature in what condition?
Keratosis Pilaris
ID condition in the image
Impetigo
Enlarged swollen mass with purulent material begining to exude from several points on the surface
curbuncle?
Possibly associated with fluoride and sodium lauryl sulfate, but not considered ACD.
Perioral dermatitis
- Recent sore throat
- Numerous papules giving a sandpaper- like texture to the skin
Scarlet fever
- Relevant food allergies (70-80%) of cases
- Major: eggs, milk, peanuts, soy, fish, wheat
- Minor: citrus, tomato, strawberries, corn, chocolate, food preservatives and coloring
- Inhalants: aeroallergens, animal dander, dust mites
Atopic dermatitis
- Negative KOH
- Negative Hx of topical creams
- Negative blood tests
Rosacea
- Streptococcal pharyngitis 1 week before rash
- Resolves spontaneously in weeks to months
- Teardrop shaped spots, red, small, scaly
- Acute onset 1-2 days
- Self resolve in 3-4 mo
Guttate psoriasis
What is the most common cause of this dermatitis?
Nickel allergy
Common condition for what condition?
Psoriasis
- Acute vesicles
- linear lesion is a sign of dragged over the skin while scratching
Allergic contact dermatitis
Present in 5-20% of FST I-II
Atypical nevi
- Chronic, unchanging macular lesions
- Benign on biopsy
Junctional melanocytic nevi
- Over 50 y/o,, Male:Female ratio 2:1
- Possible viral etiology
- Rapid growth 2-5 cm w/in a few weeks to months
- Can self-resolve in months to years (bad scar)
- Removal recommended- r/o BCC, SCC, wart, AK
- Single lesion-mc cheeks, nose, ears, hands (post), but can be any location
Keratoacanthoma
- Acquired loss of pigmentation
- Pathogenesis is not known
- Theories: autoimmune, neurogenic, self-destruct, genetic background (30%)
- Age of onset any, 10-30 yrs (50%)
- Incidence: common up to 1%
- All skin types, equal in all sexes
- lesion- white macules, sharple marginated, 5mm- 5cm
- Can affect any area most common on face and extremities. Accentuated with sun exposure
Vitiligo
- Exclamation point hairs
- Course: remission is common (80%)
- Management: Stress reduction, topical onion juice, topical intralesional or systemic glucocorticoids, can add topical minoxidil, wig in severe cases, or refer for topical immunotherapy
Alopecia Areata
White horn cysts
Seborrheic Keratosis (sign that this may not be melanoma). But Bx still indicated.
ID this condition in the image
Stork bite lesion
- Can arrise with no known cause, or it may appear in people with a genetic
- Mc in people ages 20-40
- solitary lesions that are: infrequent, inconsequential, represent spontaneous mutations
- On compression, invaginate into a slit-like defect in the skin = “buttonhole” sign
Neurofibroma
Rapid growth within few weeks, can self-resolve within month-year
keratoacanthoma
- Very common, button-like dermal nodule
- Pink, brown, tan, darker at center
- Leg > arms > trunk
- Few mm to 1 cm
- ‘Dimple sign’ with lateral compression
- Tx- leave alone, excision, cryotherapy
Dermatofibroma
Multiple benign lesions- ID
Seborrheic Keratosis (rough type)
Treated 5-FU or Curaderm - ID
BCC superficial
Benign condition - ID
Intradermal nevi
- Dilated vessels deep in dermis and subcutaneous tissue
- Spontaneous resolution, surgery, interferon, propranolol, intralesional and topical corticosteroids, vincristine and cyclophosphamide
Hemangiomas of infancy (deep)
- Painful lesions
- Early central crust
- Apex- mc
- Long standing
- Dense rolled edge
Chondritis nodularis helicis
- Vascular malformation
- Flat, unilateral patches
- Irregular, reddish-blue color
- MC face, neck
- Prominent, macular hemangioma
Port-wine stain (nevus flammeus)
Filled with clear gelatinous viscous fluid
Digital mucous cyst
Asymptomatic, soft benign papule, from dilated venule
venous lake
- Develops after a minor trauma
- Bleeds easily
- <30 y/o
Pyogenic granuloma
ID condition in this image
Spider Angioma
- 25% remit with decrease sun exposure
- Antioxidants, fruit, vegetables, green tea etc.
- 5-FU
- Black salve (iris, red clover, sanguinaria)
- Vitamin A
- Curaderm
- Cryotherapy (3-10 sec max/3 w/5FU)
- Sunscreen Type I &II skin
- Excision for large lesions
Actinic keratosis
Black horn cyst - ID
Seborrheic Keratosis
- A reactive hypermelanosis of the skin that occurs as a sequela of cutaneous inflammation
- A common disorder that can occur at any age and has an equivalent incidence in males and females
- May occur regardless of skin color, but is clinically more significant with darker skin pigmentation
postinflammatory hyperpigmentation (PIH)
ID image
Milia
Painless slow growing mass in the lid
Tx hot compresses 10-15 min qid/2-3 wks
Meibomian cyst
- Most common tumor of the intraepidermal eccrine sweat glands
- Women > Men
- Autosomal dominant
- Usually symmetrical distribution
Serangioma
- Most common skin disorder in adolescents
- Typical age range 12-25 years
- 79 - 95% of adolescents aged 16-18
Acne?
- Filled with clear gelatinous mucin
- Dorsal wrist MC
Ganglion cyst
ID image
Lipoma
- Small tumors of enlarged sebaceous glands
- 1-3mm
- Telangiectasia
- Central umbilication
- Soft
- > age 30 (25%pop)
- Unknown etiology
Sebaceous hyperplasia
- Very common fibrous lesion
- Begin in second decade
- Soft, skin-colored to slightly pigmented
- Pedunculated papule-neck, axilla, groin, eye, mouth
Skin tags / Chordons
ID condition in the image
Epidermal incusion cyst
- Present in 5-20% of Northern European heritage population
- Can occur anywhere
- Acral and mucosal surface of other FST
- Potential precursors to superficial spreading melanoma (SSM)
- Increase risk for developing primary melanoma
Atypical nevi
- Usually deeper than an epidermal inclusion cyst
- May feel rubbery but is usually not malleable
- If lesin feels quite firm, a malignant tumor must be considered
Lipoma
- Abnormal scarring in susceptible individuals
- More common in darker skin types
- 1% - 6% of the population in response to trauma (acne, body piercing, tattoos, insect bites, vaccinations, surgery)
- Age 10-30 years
Keloid
ID condition in the image
Skin tag / Chordon
- Wheals-transient edematous papules and plaques
- Usually pruritic
- 15-25% of pop will have at least one episode at during their lifetime
- Duration: hours-months
- Histamine is the most important mediator
Urticaria
- Autoimmune disease causing localized hair loss w/o signs of inflammation(asymptomatic)
- About 2% of population have at least one episode
- Etiology-autoimmune, can be assoc with Hashimoto’s thyroiditis, vitiligo, myasthenia gravis
Alopecia areata
- Chronic, recurrent, intensely pruritic vesicles, papules, and urticarial plaques that are arranged in groups
- Can resemble hrepes: therefore the designation of herpetiformis
- Almost universally associated with celiac disease (1% of pop)
- Age on onset 20-60 years
- Prevalence in Caucasians, M:F 2:1, 10-39 per 100,000 persons
Dermatitis herpatiformis
- Thickened, hyperpigmented skin in the axillae and groin
- Often associated with obesity and hyperinsulinemia
- Can be congenital
- Increased circulating insulin causes dermal fibroblast and keratinocyte
Acantosis nigricans
- Localized proliferation of melanocytes due to chronic sun exposure (esp. sunburns)
- 1-3 cm macules
- > 40 y/o esp. Type I-III skin
- Roughly 75% of FST I-III people over 60 have one or more
Solar lentigo (liver spots, senile freckles)
