Derm II (Babcock) Flashcards
Most common pre-cancerous skin lesion resulting from chronic, cumulative sun exposure in susceptible individuals?
Actinic Keratosis
What cancer typically comes from actinic keratosis
squamous cell carcinoma
Actinin keratosis: treatment
cryotherapy**
other:
Topical fluorouracil
Topical imiquimod
Actinic keratosis: prevention
sunscreen with UVA/UVB
Describe Actinic keratosis
erythematous or brown rough, scaly papules and plaques found on sun exposed skin. Coarse, sandpaper-like**
Seborrheic Keratosis
- benign
- common
- oval, slighty raised, tan/light brown to black well-demarcated papules or plaques <3cm in size
- appear to be “stuck-on” waxy greasy verrucous appearance
- Trunk, scalp, face, neck, extremitities
What is the most common malignancy of the skin?
basal cell carcinoma
Basal cell carcinoma: risk factors
- heavy, cumulative sun exposure
- Fair-skinned males 20-40s
Basal cell carcinoma: clinical findings
- translucent
- telangiectatic pearly papule/nodule
- rolled border and ulcerated center**
- 85% on head and neck
Basal cell carcinoma: treatment
biopsy for diagnosis…
-excision, curettage, MOHS surgery
What is the second most common skin cancer?
squamous cell carcinoma
What do squamous cell carcinoma typically arise from?
actinic keratosis
Which antibiotic is associated with side effect of blue discoloration of the gums?
minocycline
Squamous cell carcinoma: clinical findings
-solitary, slowly evolving keratotic or eroded erythematous, yellowish, or skin-colored papule or plaque found on sun exposed areas
Squamous cell carcinoma: risk factors
- long-term sun exposure
- Exposure to industrial carcinogens
- HPV
- immunosuppression
Any isolated keratotic or eroded papule or plaque present >1 month should be considered _____until proved otherwise by biopsy
squamous cell cancer
Most malignant skin cancer
melanoma
Most common cancer among women 25-29
maligant melanoma
Malignant melanoma: risk factors
- age
- fair skin
- blue eyes
- red or blonde hair
- freckles
- multiple nevi
- atypical nevi
- blistering sunburns before puberty
- Tanning bed
Which malignant melanoma is most common?
superficial spreading
men: back
women: back and legs
Which malignant melanoma grows fast, vertically and is most aggressive?/
Nodular (Breslow’s depth)
The demodex mite is associated with which skin condition?
Rosacea
What are the ABCDE of malignant melanoma?
Asymmetry Border - irregular, jagged Color-multi Diameter - >6mm (pencil eraser) Evolving - changing
What is the single most important prognostic factor for malignant melanoma?
Thickness of lesion
Increased breslow’s depth = decreased survival
How often should you perform skin exams for melanoma to look for recurrence?
every 6 months for 2 years
Kaposi Sarcoma: general
vascular* neoplastic condition linked to Human Herpes Virus-8
Kaposi Sarcoma: clinical findings
red, brown, or purple macules, plaques and nodules on trunk, extremities, face
What lab is important to perform for Kaposi Sarcoma?
Test for HIV. Need to know because AIDS is associated with a more aggressive form
Kaposi Sarcoma: treatment (non-AIDs)
- cryotherapy
- radiation
- chemotherapy
Name the epidermal dermatophytosis (affect stratum corneum)
- Tinea pedis
- Tinea corporis
- Tinea cruris
-red, scaly, maceration, warm moist environment
Dermatophytosis of hair and hair follicles
Trichomycosis (ex. Tinea capitis)
Dermatophyte of the nail apparatus
onychomycosis
-nail thickening, subungual debris
How is Tinea pedis, tinea, corporis, tinea cruris treated?
KOH (to see hyphae)
Tinea pedis, tinea corporis, tinea cruris: treatment
Clotrimazole, miconazole, terbinafine cream for 4-6 weeks
Tinea capitis: diagnosis
fungal culture
Tinea capitis: treatment
Griseofulvin (or terbinafine) for 8 weeks
Onychomycosis: diagnosis
Fungal culture, KOH of subungual debris
Onychomycosis: treatment
Oral terbenafine x12 weeks
Tinea Versicolor: infective agent
Malessezia furfur (superficial yeast infection)
Tinea versicolor: clinical findings
hypo or hyperpigmented coalescing scaly macules of varying color on trunk, upper extremities (tan, salmon)
Tinea versicolor: Diagnosis
KOH: spaghetti and meatballs**
Wood’s lamp: blue-green fluorescence
Tinea versicolor: treatment
Shampoos: selenium sulfide, ketoconazole, zinc pyrithione
Creams: ketoconazole, clotrimazole
Oral: fluconazole, itrazonazole
Intertrigo
inflammation of skin folds
Candidiasis (Candida albicans): general and risk factors
-intertrigo (inflammation of skin folds)
Risk factors: moisture, warmth, breaks in skin barrier, antibiotics, glucocorticoids
Candidiasis: clinical findings
papules and pustules on erythematous base ->confluence and erosion ->beefy red patches with satellite lesions**;
burning > pruritis
Candidiasis (candida albicans): diagnosis
KOH: pseudohyphae, spores, fungal culture (most sensitive)
Candidiasis: treatment
-Keep area dry and cool
-loose clothing
topical antifungal - miconazole, clotrimazole, nystatin
-Topical steroid to help burning (low potency 1% hydrocortisone ointment)
What should be done for a lesion with suspicion for melanoma?
refer to dermatology for excisional biopsy
Condyloma acuminate: treatment
- surgery
- electrocautery
- laser
- Imiquimod
Verruca vulgaris: appearance and distribution
hyperkeratotic, exophytic papules on fingers, hands, knees
-punctate black dots are thrombosed capillaries
What reaction is associated with verruca vulgaris?
Koebner reaction - spreads with skin trauma
Verruca plana
flat warts
Verruca plana: appearance
skin colored or pink smooth slightly elevated flat-topped papules on dorsal hands, arms and face
Describe palmoplantar warts
thick, endophytic papules on palms or soles of feet
- can cause callus
- pain with walking
Palmoplantar warts: treatment
- can go away on its own
- Irritate or destroy: Acids, cryotherapy, retinoid crem, surgical removal, duct tape, laser
- Imiquimod, candida antigen - immune stimulating
Herpes Zoster (Shingles)
reactivation of varicella-zoster virus latent in the nerve ganglia
Herpes Zoster: describe prodrome
stinging pain
Herpes Zoster: treatment
valacyclovir or famciclovir PO within 48-72 hours
What is Hutchinson’s sign?
herpes zoster with ocular involvement
-nasociliary branch of trigeminal nerve
Molluscum contagiosum: description
small (2-6mm) smooth, firm, shiny, dome-shaped flesh-colored papules with central umbilication*
Molluscum contagiosum: causitive agent
DNA poxvirus
Molluscum contagiosum: treatment
- Cryotherapy
- curettage
- acids
- cantharidin
- Retinoids (topical)
Impetigo: cause
- staphylococcus aureus
- streptococcus pyogenes
Impetigo: clinical findings
small vesicles or pustules rupture ->erosions with yellow honey colored crusts**
Impetigo: treatment
mupirocin or retapamulin
Erysipelas: cause
Group A strep
Erysipelas: describe
upper dermis infection (more superficial than cellulitis)
- well demarcated
- gets worse fast!
Erysipelas: treatment
oral PCN or amoxicillin
IV antibiotics if systemic
Cellulitis: describe
infection in deep dermis and subcutaneous fat
Cellulits: most common pathogens
strep pyogenes
Cellulitis: treatment
Alcohol ingestions: recognize s/sx and lab findings IV or cephalexin oral
(beta-hemolytic strep and MRSA coverage)
Scabies: infective agent
Sarcoptes scabiei
-Intense itching especially worse at night**
Scabies: treatment
Permethrin 5% topical lotion/cream
others: lindane, oral ivermectin
Pediculosis (lice): treatment
permethrin 1% OTC or 5% overnight (if resistance)
or
5% benzyl alcohol (Ulesfia)
Spider bite: most common presentation from non-poisonous spider bites
papular urticaria
Brown recluse spider bite: treatment
- Ice/elevation
- Antibiotics (erythromycin, cephalosporins)
- tetanus toxoid
Describe the difference in Brown recluse spider bite and black widow spider?
Brown recluse - necrotizing
Black widow - neurotoxic
Alopecia aerata
- focalized hair loss
- Autoimmune attack on hair follicles
- Exclamation point hairs**
Alopecia aerata: treatment
reassurance - spontaneous resolution in 6 months
-regrowth is fine, thin, white color
- Topical steroid (potent)
- Topical minoxidil
Paronychia: description
Bacterial infection of the proximal or lateral nail bed
-Throbbing pain, swelling, tenderness
Paronychia treatment
warm compresses (mild) cut it open + antibiotics (severe)
Vitiligo
- Autoimmune melanocyte destruction
- “chalky” white macules on hands, face, elbows, knees, skin folds, genitals
Vitiligo: treatment
sunscreen
repigmentation - topical glucocorticoids and tacrolimus, PUVA, grafting
Melasma
“mask of pregnancy”
melanocytes produce large amount of pigment when stimulated by UV light or increase in hormone levels
Acanthosis nigricans
hyperpigmented, symmetrical velvety plaques in the neck, skinfolds
- obesity is a risk factor
- associated with polycystic ovarian syndrome, diabetes
Acanthosis nigricans: treatment
- check fasting glucose
- lactic acid cream, urea cream, retinoids, salicylic acid
Pressure ulcers (Decubitus ulcers)
“punched out” ulcer -> necrosis with grayish pseudomembrane
