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Foundations of Clinical Practice II > Derm I (Babcock) > Flashcards

Derm I (Babcock) Flashcards

1
Q

epidermis

A

-scaly rashes
outermost layer
-stratum corneum

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2
Q

Dermis

A
  • blood vessels
  • nerves
  • connective fibers
  • accessory organs - hair follicles, sebaceous glands, sweat glands, nails
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3
Q

Subcutaneous fat lesion example

A

-ex. lipoma

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4
Q

Macule

A
  • Circumscribed area of change in skin color
  • <1cm
  • Flat
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5
Q

Patch

A

macule >1cm

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6
Q

Papules

A
  • circumscribed

- solid superficial elevations <1cm

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7
Q

Nodules

A

papule > 1 cm

  • Palpable
  • Dermis or subcutaneous tissue
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8
Q

Plaques

A
  • well defined
  • Elevated
  • Confluence of papules > 1 cm
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9
Q

Vesicles

A
  • Circumscribed epidermal elevation
  • <0.5cm
  • contain serous fluid*
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10
Q

Bulla

A
  • Large vesicle

- >0.5cm containing serous fluid

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11
Q

Pustules

A

small circumscribed with purulent exudate

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12
Q

Wheals

A

Plateau-like edematous elevations

ex. hives

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13
Q

Secondary changes

A
  • Scales: dry or greasy flakes of stratum corneum
  • Crusts (scabs): dried serum, blood, or pus with debris on skin surface
  • Excoriation: stractch marks
  • Erosions: (ex. ulcer) loss of all or portions of epidermis from physical abrasions
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14
Q

Atopic Dermatitis

A
  • Disruption of the skin surface (xerosis= dry skin)
  • ATOPIC TRIAD***
  • Itch comes before rash**
  • “the itch that rashes”
  • Worse in winter
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15
Q

Atopic Dermatitis: Classic distributions

A

Infants/toddlers: cheeks, forehead, scalp, extensor surfaces

Older kids/adolescents: flexural surfaces; neck, elbows, wrists, ankles, behind knees

Adults: hands, wrists, ankles, feet, face, lichenification

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16
Q

Seborrheic Dermatitis “dandruff”: definition

A

chronic inflammatory dermatitis accompanied by -overproduction of sebum*
associated with yeast (ex. malessezia furfur)*

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17
Q

Seborrheic Dermatitis: clinical findings

A

erythema with yellow-orange greasy scales of scalp, face (eyelids, eyebrows, nasolabial folds*), ears, perineum

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18
Q

Seborrheic Dermatitis: treatment

A
  1. Selenium sulfide shampoo
  2. 2% ketoconazole shampoo
  3. Topical steroid (low potency)
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19
Q

Dyshidrotic Eczema: clinical findings

A
  • confluent
  • symmetric tapioca-like vesicles**on fingers, finger webs, palms, soles
  • Secondary change: crusts, scaling, fissures, lichenification
  • VERY ITCHY
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20
Q

Dyshidrotic Eczema: treatment

A
  1. Topical steroids
  2. Emollient care
  3. Oral antibiotics for secondary infections
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21
Q

Stasis Dermatitis: definition

A

chronic dermatitis from venous insufficiency

  • hyperpigmentated plaques on lower legs and ankles
  • +/- painful ulceration on the medial ankles
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22
Q

Statis dermatitis: risk factors

A
  • Older age
  • Female
  • Pregnancy
  • Varicose veins
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23
Q

Stasis dermatitis: treatment

A
  • Topical steroid
  • Antibiotics (for secondary infections
  • Reduce edema - compression wraps, treat veins
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24
Q

Lichen Simplex Chronicus: definition

A

localized, lichenification from repetitive scratching

  • Women
  • > 20
  • Atopic patients*
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25
Q

Lichen Simplex Chronicus: clinical findings

A

Well-defined plaques made by confluent papules, thickened skin, dull red can progress to brown or black

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26
Q

Lichen Simplex Chronicus: Treatment

A
  • Stop itching and scratching!

- Topical corticosteroids +/- occlusion at night

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27
Q

What is the most common drug eruption?

A

Exanthematous drug eruption

28
Q

Exanthematous drug eruptions: description

A
  • Symmetric
  • Erythematous macules and papules on trunk, then spreading to extremities
  • Morbilliform = measles-like
29
Q

What drugs commonly cause exanthematous drug eruptions?

A
  1. Sulfonamides
  2. Beta-lactam
  3. NSAIDs
  4. Barbituates
  5. Nitrofurantin
  6. Isoniazid
  7. Gold salts
30
Q

Drug eruptions: treatment

A
  • stop the offending drug
  • antihistamines
  • topical steroids
31
Q

Lichen Planus: 4 P’s

A

Pruritic
Purple (violaceous)
Polygonal
Papules/plaques

32
Q

Lichen Planus: body locations

A
  • Volar wrists
  • Shins
  • Ankles
  • Mucous membranes*
  • Genitalia
  • Scalp
  • Nails
33
Q

What phenomenon is common with Lichen planus?

A

Koebner Phenomenon - shows up after local trauma of the skin

34
Q

Pityriasis Rosea: definition

A

Herald patch
exanthematous eruption characterized by a primary plaque (herald patch) usually on the trunk that develops into a secondary generalized scaling eruption 1-2 weeks later

35
Q

Pityariasis Rosea: herald patch

A
  • oval
  • slightly raised plaque 2-5 cm
  • Salmon red
  • Marginal collarette scale
  • Christmas tree distribution: Fine scaled, pink, oval papules and plaques distributed in the lines of cleavage
36
Q

What is the name of condition and the lab that need to be ruled out and ordered for Pityriasis Rosea?

A

RPR to rule out syphillis!

37
Q

Psoriasis vulgaris: clinical presentation

A
  • Localized or generalized
  • Pustular
  • Erythrodermic

Well-demarcated erythematous plaques with silvery scale typically on extensor surfaces, scalp, sacrum

  • Auspitz’s sign - removal of scale result in blood droplets
  • Koebner’s phenomenon - rubbing/scratching (physical trauma) stimulates proliferative process
38
Q

Psoriasis vulgaris: triggers

A

physical trauma, infections, drugs (b-blockers, lithium), stress, smoking, alcohol, streptococcal- guttate)

39
Q

Psoriasis vulgaris: treatments

A

Mild to moderate: topical steroids, emollients, vitamin D analogues, coal tar, UV therapy, retinoids

Moderate to severe (>10% TBSA): Methotrexate, cyclosporine, oral retinoids (acitretin), Biologics (etanercept, infliximab, adalimumab)

40
Q

Erythema Multiforme: overview

A
  • reactive, inflammatory skin lesions

- symmetric distribution, predominantly on extremities caused by drugs (sulfa, phenytoin, PCN), viral syndromes (HSV)

41
Q

What is wickham’s striae in the mouth associated?

A

whitish lines in the mucosa of the mouth

42
Q

What infection is associated with Lichen Planus?

A

Hep C

43
Q

Erythema multiforme: clinical findings

A

-Target or iris lesions***
dull red macules and papules. May have vesicles/bullae develop in the center of the lesion
-Severe Erythema multiforme: constitutional symptoms such as fever, weakness, malaise

44
Q

Erythema multiforme: treatment

A

Symptomatic - oral antihistamines, topical steroids

Recurrent - oral antiviral (acyclovir, valcyclovir) in suppressive doses

45
Q

Stevens-Johnson Syndrome: overview

A

severe mucocutaneous reaction often triggered by a medication by can be idiopathic

  • Extensive necrosis and sloughing of epidermis (<10%)
  • Prodrome - fever, flu-like symptoms, conjunctival itching
46
Q

Common causes of Stevens-Johnson Syndrome

A
  1. NSAIDs
  2. Sulfonamides
  3. Anticonvulsants
47
Q

Which mucosa are involved most often in SJS?

A

Eyes (MC**)

Oral (hemorrhagic crusts on lips)

48
Q

Describe the clinical course of SJS?

A

generalized lesions initially with target-like appearance -> confluent bright red -> rapid progression into painful bullae and erosions

49
Q

Toxic Epidermal Necrolysis (TEN)

A

-Severe form of Stevens-Johnson syndrome

> 30% epidermal loss
Only 30% survive (septicemia (acute renal failure)

-Nikolsky’s sign**

50
Q

Bullous pemphigoid: overview

A

Chronic, autoimmune bullous disorder

  • > 60 years old
  • Subepithelial blisters and immunoglobulin deposits
51
Q

Bullous pemphigoid: how is this diagnosed?

A

punch biopsy with immunofluorescence

52
Q

1st degree burn [sunburn]

A

red, dry, painful, often sloughs the next day

53
Q

1st degree burn [sunburn] treatment

A

symptom control: acetaminophen, cool compresses, emollient

54
Q

What virus is implicated in Erythema multiforme?

A

Herpes Simplex

so, one treatment is oral antiviral

55
Q

Second Degree burn when to admit to burn center

A
  1. > 10% TBSA younger than 10, or older than 50
  2. > 20% TBSA in 10-50
  3. Burn on the face, genitalia, perineum, hands, feet, major joints
  4. Chemical burns, inhalation injury, electrical burns, pre-existing medical conditions
56
Q

Second Degree burn treatment

A

Silvadene, mupirocin with dressings and pain control

57
Q

Third Degree burn

A

loss of tissue, full thickness of skin, some of the SQ tissue, scarring

58
Q

Third degree burn: treatment

A

skin graft

59
Q

Rosacea: overview

A
  • centrofacial area
  • telangiectasias
  • flushing
  • erythematous papules and pustules
  • Fair skinned adults
  • Rhinophyma**- enlarged bulbous nose in men
60
Q

Rosacea: triggers

A

stress, alcohol, heat (vasodilators)

61
Q

Rosacea: treatment

A
  • sun protection
  • Metronidazole gel
  • Doxycycline/tetracycline
  • intense pulsed light/broad band light
  • Laser surgery for telangiectasias
62
Q

Hidradenitis suppurativa: overview

A

chronic inflammatory disease of the apocrine glands characterized by recurrent abscess formation, rupture, suppuration.
-Can lead to sinus tract formation and scarring

63
Q

Hidradenitis suppurativa: clinical findings

A
  • recurrent abscess formation
  • double comedones
  • very tender, erythematous inflammatory nodule/abcess
64
Q

Hidradenitis suppurativa: differences in distribution of men and women

A

women: axillae, breasts

Men: anogenital, groin

65
Q

Hidradenitis suppurativa: treatments

A
  • antibiotic (tetracycline, minocycline, erythromycin)
  • Intralesional steroids
  • Isotretinoin
  • Surgery

Foundations of Clinical Practice II (25 decks)

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