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Senoir 21-2 > DERM III > Flashcards

DERM III Flashcards

1
Q

Bullous impetigo is caused by

A

S. Aureus

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2
Q

Non Bullous impetigo is caused by

A

Group A beta-hemolytic Strep

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3
Q

How does Non Bullous impetigo present

A

Common in kids

Warm moist climates

Starts as stratum corneum pustule or vesicle ->ruptures to expose a red, moist base

Progresses to adherent “honey crusted”, weeping lesion!

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4
Q

What is the treatment for non Bullous impetigo

A

Cool or warm soaks to remove crust

Antibiotics:
-Limited number of lesions:
Topical mupirocin

-If widespread: Systemic antibiotics
Dicloxacillin or Cephalexin

Prevent acute glomerulonephritis!
Post-strep glomerulonephritis (PSGN) may follow impetigo

Dressing to prevent spread

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5
Q

ABX for limited vs widespread non Bullous impetigo

A

Limited number of lesions:
Topical mupirocin

If widespread: Systemic antibiotics
Dicloxacillin or Cephalexin

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6
Q

Define Bullous Impetigo

A

Staphylococcal impetigo!
(Non Bullous caused by strep)

Common, any age, MC in infants to adolescents

Bullous - less exudative crusting

  • 1 or more vesicles enlarge rapidly to form bullae
  • Turn from clear to cloudy
  • Center collapses & leaves an inner tube-like rim

Honey colored crust at center, if removed leaves bright red, moist, base that oozes

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7
Q

What is the treatment for Bullous impetigo

A

Strict hand washing

Warm or cool soaks, to remove crusts

Antibiotics:
Topical ointment if limited:
-Mupirocin 
Systemic antibiotics if widespread:
-Dicloxacillin, Cephalexin, Erythromycin, Clindamycin

Check local resistance rates

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8
Q

What is the approach to recurrent Impetigo

A

Patients with recurrent impetigo should be evaluated for carriage of Staphylococcus aureus

Culture and treat with mupirocin if found

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9
Q

Most common agent of cellulitis

A

Grp A beta-hemolytic strep (GABHS)

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10
Q

Cellulitis is DM pt

A

Pseudomonas

Read the question, does the infected pt have DM.!!??

Tx with ciprofloxacin

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11
Q

Cellulitis in kids under 2, what is the most common agent

A

Haemophilus influenzae
- kids under 2

Decreased incidence with immunizations

Tx with cephalosporins

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12
Q

Red streaks with swollen lymph nodes

Think

A

“Streaking” lymphangitis

Often seen with cellulitis

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13
Q

Treatment for Cellulitis

A

Cool compresses and extremity elevation

Outpatient
Dicloxacillin, Cephalexin, Clindamycin, TMP-SMX

Inpatient
IV nafcillin
IV vancomycin (if PCN allergic)

Pseudomonas (DM)- Aminoglycosides

H. FLu- (kids under 2) - cephalosporins

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14
Q

A pt presents with slightly raised plaque with a SHARP DEMARCATION, that is red, warm and painful,

Think

A

Erysipelas
(+lymphadenopathy)

(2/2 Strep pyro)

Tx with Systemic antibiotics orally or IV, depending on pt status

PO: Amoxicillin, Cephalexin, dicloxacillin

IV: Cephazolin, ceftriaxone

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15
Q
A

Blistering Distal Dactylitis

Superficial infectionx of anterior fat pad of fingertips

Progression: Faint erythema, vesicles to oval 1-3cm bullae, and exfoliation

MC in 2-16 yo

Tx: I&D and Oral ABX (STREP) x 10 days

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16
Q

What is the most common form of Folliculitis

A

Staph Folliulitis

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17
Q

How do you culture a folliculitis ?

A

Culture pustules: Scrape off entire pustule w/ 15 blade scalpel & deposit onto cotton swab of transport medium kit

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18
Q

Tx approach to Folliculitis

A

Removal of occlusion/irritants/etc

Good skin hygiene

Oral Antibiotics, 7-10 days
-Emycin, Clindamycin, Diclox, Cephalexin

Benzoyl peroxide (keratolytic/antibacterial) as adjunct

If persistent or deep

(ex: sycosis barbae)
- Use systemic antibiotics, up to 4-8 wks

If in scalp and long term
-Treat for folliculitis decalvans

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19
Q

What is Sycosis Barbae

A

Sycosis Barbae—inflammation of entire follicle

Staph impetigo of beard
-Razor spreads infection from follicle to follicle

Treat same as staph impetigo
-Oral antibiotics for at least 2 wks

If severe or antibiotic treatment failure:

  • Eval for dermatophyte infx
  • Remove hairs for culture
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20
Q

Define Furnuncle

A

boil/abscess
– walled off collection of pus
– painful, firm or fluctuant mass

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21
Q

Define Carbuncle

A

multi-headed boil

Frequently assoc’d with Cellulitis

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22
Q

What is the MC cause of Furnuncle/ Carbuncle

A

Both are painful perifollicular deep infection of hair follicle

MC in friction prone or traumatized areas
-Thighs, buttocks, groin, axillar, waist

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23
Q

Tx for Furnuncle/ carbuncle

A

Primary management is
Incision & Drainage (I&D)

Moist heat to localize and spontaneously rupture &/or to ease I&D

Systemic antibiotics not necessary after I&D but speed healing and prevent recurrence
-Necessary if associated cellulitis present !

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24
Q

What is the treatment of Furnuncle and carbuncle with asssoc Cellulitits

A

Systemic ABX

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25
Q

What is the common agent of recurrent furnuculosis

A

MRSA

Tx:
Mupirocin twice daily for 5-10 days in nares
-Chlorhexidine or dilute bleach baths are alternatives

Abx selection based on culture & sensitivity

  • Trimethoprim/sulfamethoxazole DS
  • Clindamycin
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26
Q

Why does SSSS effect infants and kids

A

Decreased renal toxin clearance

Of the staph aureus

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27
Q

Does SSSS effect the mucous membranes?

A

NO!

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28
Q

What is the Tx for SSSS

A

Depending on severity

Severe - requires hospitalization and parenteral abx

Mild - oral β-lactamase-resistant antibiotic (dicloxacillin, cephalexin) for 7-10 days

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29
Q

If you see DM in a vignette

Think

A

Pseudomonas

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30
Q

How does pseudomonas look like under woods lamp

A

Produces green pigment

Pyoverdin which fluoresces light green with Wood’s lamp

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31
Q

How does pseudomonas folliculitis present

A

AKA hot tub folliculitis
Infection 8 hrs – 5+ days after exposure

Develops multiple pruritic, round, urticarial plaques w/ central papule or pustule

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32
Q

What is the treatmetn for Pseudomonas Folliculitis

A

Usually self-limited, 7-10 days
May take up to 3 mo

Antihistamines PRN

Localized Dz - Vinegar soaks (acetic acid 5%), Domeboro’s, or Burrow’s

More involved/severe - ciprofloxacin 500-750mg BID x 5 days

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33
Q

Treatment for pseudomaonsa toe web infections

A

Keep it clean & dry

Open toed shoes whenever possible

Acetic acid soaks

3 tbsp white vinegar + 1 quart warm water, soak for 10min BID

Drysol (aluminum chloride) AAA BID
prevents hyperhidrosis and recurrence of maceration

Gentamycin cream once dried

Oral Ciprofloxacin if no response to topical therapy

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34
Q

A pt presents with white colored hair, that is very very odorous

A

Trichomycosis axillaris

Corynebacterium Infection of hair of axilla

Tx: Shave the area
-Topical erythromycin or clindamycin

-Topical naftifine (Naftin) – useful for superficial fungal infxs and has antibacterial properties

Control hyperhidrosis

  • Antiperspirants
  • Drysol
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35
Q

Define erythrasma

A

Skin infection caused by excessive proliferation of Corynebacterium minutissimum

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36
Q

MC site of Erythrasma

A

Most common site is 4th interdigital space

Also in bilateral inguinal area, axillae, inframammary fold

Does not spare the scrotum or labia (different from Tinea)

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37
Q

Coral red under woods lamp

Think

A

Erythrasma

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38
Q

What is the tx for Erythrasma

A

Keep area clean, dry

Topical (BID x 2 wks)

  • Erythromycin
  • Clindamycin

Systemic (if severe/recalcitrant)

  • Erythromycin 250mg QID up to 2 wks, or
  • Clarithromycin 1 gram x 1 dose
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39
Q

Multiple 1-3 mm pits to weight-bearing areas of feet

Think

A

Pitted Keratolysis 2/2 Kytococcus sedentarius, which produces exoenzymes that digest keratin

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40
Q

What are the distinctive features of pitted keratolysis

A

Hyper hydros is + Malodor and sliminess of skin are distinctive features

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41
Q

What is the treatment for pitted keratolysis

A

Clean daily, promote dryness, change socks frequently, rotate footwear
(MC Cause for occlusive footwear)

TOC: Topical erythromycin ointment, or clindamycin solution, or

Mupirocin ointment (BID for 7-10 Days)

Drysol (20% aluminum chloride) BID

Oral erythromycin – alternative Txt, if unresponsive to topicals

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42
Q

What is the treatment for litter keratolysis

A

Clean daily, promote dryness, change socks frequently, rotate footwear

TOC: Topical erythromycin ointment, or clindamycin solution, or

Mupirocin ointment (BID for 7-10 Days)

Drysol (20% aluminum chloride) BID
Oral erythromycin – alternative Txt, if unresponsive to topicals

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43
Q

What is the treatment for Verruca Vulagaris

A

Aka Common warts

Treatment

  • Liquid nitrogen (LN2), repeated in 2-4 wks
  • Topical salicylic acid (may take months)
  • Topical Imiquimod 5% (Aldara)
  • Cantharidin (clinician applied)
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44
Q

What is the approach to filiform warts?

A

Finger like warts on the face

Tx: Curettage or Cryotherapy/ Light electrocautery

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45
Q

What is the treatment for verruca plana

A

Aka flat warts on the forehead, mouth or back of hands
(Shaved areas)

Treatment

  • Cryosurgery
  • Imiquimod 5% cream (Aldara)
  • Tretinoin cream
  • 5-fluorouracil cream
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46
Q

How do you DDX plantar warts from corns

A

Shave and look for black dots and lack of skin lines (corns have skin lines)

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47
Q

Tx for plantar warts

A

Not required if painless – will regress over time

Debride (pare) and warm water soak prior to Tx

  • Salicylic acid (Occlusal-HP, Duoplant)
  • 40% salicylic acid plasters
  • Imiquimod 5% cream (Aldara) – with occlusion
  • LN2 (blistering may cause pain)
  • Cantharidin, with occlusion

Blunt dissection

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48
Q

Most cervical dysplasia’s and cancers are related to…

A

HPV

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49
Q

Most dangerous HPV strains

A

High-risk HPV subtypes (cervical)

  • 16 & 18 = cellular changes/cancer, esp. 16
  • 6 & 11 rarely associated with cervical Ca
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50
Q

What are the provider administered HPV treatments

A

Trichloroacetic acid

Podophyllin resin

Cryosurgery

Scissor excision, curettage, or electrosurgery

Carbon dioxide laser

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51
Q

What are the patient applied HPV treatments

A

Podofilox gel
-Apply to warts for 3 days, 4 days off for 4-6 weeks

Imiquimod 5% cream
-Apply at bedtime every other day for 16 weeks

5-Fluorouracil cream
-Last line

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52
Q

What are pearly penile papules

A

Angiofibromsas of the corona

DDX for HPV

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53
Q

What are Bowenoid Papules

A

Small, brown or pink, flat or slightly irregular, discrete grouped papules on the penis or vulva

Resemble flat or genital warts

Etiology – Sexually transmitted

  • HPV - oncogenic types
  • Quasi-premalignant
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54
Q

If molluscum contagiosum is found on the groin or genitals

Suspect

A

Abuse

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55
Q

What is the best treatment for Molluscum Contagiosum

A

Few lesions
-Curette (best)

Use anesthesia
Control bleeding

-LN2
May need multiple applications

  • Cantharidin
  • Potassium hydroxide – requires TID application

-Topical retinoid
Limited data

Multiple lesions
-Trichloroacetic acid peel

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56
Q

What is the best treatment for few vs multiple lesions of molluscum contagiosum

A

Few: Curette

Multiple: Trichloroacetic acid peel

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57
Q

What is the agent of Molluscum Contagiosum

A

DNA poxvirus

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58
Q

When can HSV be cultured

A

Virus can be cultured for approx. 5 days when pt presents with active genital lesions

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59
Q

What is herpes gladiatorum

A

HSV contracted from contact sports

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60
Q

How does herpes present in the eyes

A

Dendritic pattern on fluorescein stain

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61
Q

Gold standard to test for HSV

A

PCR is the gold standard

Swab of: Cervix, rectum, urethra, vagina

Same day result, differentiates HSV 1 vs 2

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62
Q

How does HSV look on Tzanck smear

A

“multinucleated giant cells”

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63
Q

What is the time frame to treat shingles

A

Treat within first 72 hrs

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64
Q

How do you skin scrape a dermatophyte

A

KOH Prep - scrape with #15 blade at the active border; look for branching fungal hyphae that are uniform in width

DTM Culture (dermatophyte test medium) turns red in approx. 7-14 days if dermatophytes present

Obtain Cx for suspected fungal infxn of hair & nails

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65
Q

Tx for superficial Tinea Corporis

A

(Topicals) Clotrimazole, miconazole, ketoconazole, terbinafine, naftifine

All usually applied BID x 2-4 weeks

Continue application for 7 days after erythema resolves!!

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66
Q

Tx for extensive/ deep tinea corporis

A

Extensive/deep – use oral agent

Terbinafine, itraconazole, fluconazole

Griseofulvin - kids

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67
Q

What is the Rx for extensive tinea corporis in kids

A

Griseofulvin

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68
Q

Rx for interdigital tinea pedis

A

Topicals if interdigital

  • Terbinafine 1% cream
  • Clotrimazole 1% cream
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69
Q

What is the tx for moccasin- type tinea pedis

A

Oral if moccasin - type

  • Terbinafine
  • Itraconazole
  • Fluconazole
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70
Q

DDX of tinea Cruris vs erythrasma

A

DDX – Erythrasma

  • Fluorescence coral-pink color with Wood’s lamp
  • Does not spare the scrotum or labia
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71
Q

Tx for Tinea cruris

A

Need to keep clean and dry

Usually treated with agent that will cover fungal and candida

-Clotrimazole, miconazole, ketoconazole

AAA BID min of 2 weeks – treat at least 2cm beyond active border

Oral agents for extensive/refractory – same as for Tinea corporis

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72
Q

Tx for Tinea Capitits in adults vs children

A

Must treat with systemic/oral agents

Children
-Griseofulvin

Adults

  • Griseofulvin
  • Terbinafine, Itraconazole
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73
Q

What is Keroin

A

Inflammatory tinea capitis

Tinea capitus with painful inflammation and tender, boggy nodules that drain

Txt with oral antifungal
-Griseofulvin or terbinafine preferred

Consider use of oral steroid

74
Q

What is tinea incognito

A

Fungal infx treated with topical steroids

Alters characteristics of fungi

Margin scaling often absent

Diffuse erythema, scale, pustules
Absence of border

Inflammation improves while fungus flourishes

MC on groin, face, dorsal hands

75
Q

What is the Dx for candidiasis

A

Clinical

Satellite lesions commonly present
-Esp. in intertriginous areas

KOH prep
-Pseudohyphae with budding spores

76
Q

Tx for Candidiasis vulvovaginitis

A

Fluconazole (Diflucan) 150 mg po x 1 dose
-Don’t use in pregnancy

Topical – azoles or nystatin
(safe in Pregnancy)
-Clotrimazole & miconazole most widely used

Multiple forms – suppositories, creams, vaginal tablets, etc.

3 day regimen recommended

77
Q

Tx for Oral Candida

A

Nystatin oral suspension
(infants and kids)

Clotrimazole troche (sucker)

Fluconazole po

78
Q

Tx for Angular Cheilitis

A

Topical antifungal followed by Group V steroid

D/C steroid when inflammation resolved

79
Q

What is the agent of Pityriasis (Tinea) Versicolor

A

Pityrosporum orbiculare & P. ovale

Formerly known as Malassezia furfur

80
Q

How does tinea versicolor appear

A

Begin as multiple oval to round macules of various colors (white, brown, pink)

Typically turns darker in lighter phototypes & lighter in darker
Phototypes

Becomes more conspicuous in summer months, less in winter

MC site: Mid chest & upper back

81
Q

How does tinea versicolor look under KOH

A

Numerous short, broad hyphae and clusters of budding cells

“Spaghetti and Meatballs”

82
Q

What is the treatment for tinea versicolor

A

Topical

Treatment of choice is ketaconazole 2% shampoo

  • Apply to whole body, leave on for 5 minutes, then wash off
  • Use for 3 days

Selenium sulfide suspension 2.5% (Selsun or generic)

  • Apply, leave on for 10 minutes, then wash off
  • Use for 7 days

Oral
-azoles
(Exercise afterwards, no shower x 12 hours)

83
Q

What is the tx to prevent Tinea Versicolor recurrences

A

Ketoconazole 2% shampoo AAA x 5-10 minutes once weekly

84
Q

What is the MC subcutaneous infection

A

Sporotrichosis

MC found in florists, farmers, hunters

Inoculation by trauma

“Hand pricked by rose thorn”

85
Q

What is the presentation for sporotrichosis

A

Initial lesion - painless papule/nodule/ulcer

Lesions increase in number over weeks

Lymphatic pattern - sporotrichoid
(Lymphatic streak)

Finger MC site

86
Q

What is the treatment for sporotrichosis

A

Itraconazole 100-200 mg PO QD

May take as long as 3-6 months

87
Q

3 phases of hair growth

A

Anagen (growing phase)
90-95% of hairs
~100 follicles enter anagen phase each day

Catagen (transitional phase)

Telogen (resting phase)
5-10% of hairs
Lose ~100 telogen hairs from head each day

88
Q

What is telogen effluvium

A

Diffuse loss of resting hair

89
Q

What are stressors that can cause hair loss

A

Severe physical/emotional stressors
Delivery of child
Profound weight loss/crash diet
High fevers, surgery

90
Q

What are the topical treatments for Androgenetic Alopecia

A

Minoxidil - topical

91
Q

Ophiasis pattern for Alopecia areata

A

Presents as band-like hair loss in the parietotemporooccipital area

92
Q

Tx approach for alopecia areata in pts less than 10 years old

A

Potent topical steroid + 5% minoxidil

93
Q

Tx for alopecai areata in pts older than 10 years old

A

<50% of scalp affected
-Intralesional steroid (triamcinolone acetonide, 10 mg/ml)
5% minoxidil

May use both, IL steroid typically attempted first and resolution assessed

> 50% of scalp affected

  • Minoxidil +/- topical steroid
  • Topical immunotherapy
  • Anthralin
  • Systemic corticosteroids
  • Prosthesis
94
Q

Define: brittle hair 2/2 over working ->Weak points/nodes in hair shaft

Can cause permanent loss due to scarring

A

Trichorrhexis Nodosa

Must stop all hair treatments
Consider screening for hypothyroidism

95
Q

Define folliculitis decalvans

A

Chronic pustular eruption of the scalp

Patchy permanent alopecia due to scarring

96
Q

What is the treatment for folliculitis decalvans

A

Clindamycin 300 mg BID x 10 weeks

97
Q

What is the treatement for dissecting cellulitis of the scalp

A

Isotretinoin

98
Q

What is the MC cuase of anovulatory infertility and hirsutism

A

Polycystic Ovary Syndrome (PCOS)

Can also be 2/2: 
Cushings 
Androgen secreting tumors 
Steroids 
Obestiy
99
Q

Tx for Hirsutism

A

Cannot be cured, only suppressed

  • Oral contraceptives
  • Low dose corticosteroids
  • Spironolactone
  • Eflornithine HCL (Vaniqa) – facial hair removal cream
  • Laser, electrolysis
  • Waxing, tweezing, plucking
100
Q

Nail manifestations in psoriasis

A

Oil spots/ pitting

And Onycholysis

101
Q

What are the nail findings of lichen planus

A

Most common findings are longitudinal grooving and ridging

102
Q

What ABX have nail changes

A

Tetracycline ABX

103
Q

What is tinea unguium

A

Tinea of the nails

Look for psoriasis
and DDX with KOH and culture

104
Q

What is the treatment (oral agents) for Onchymycosis

A

Terbinafine x 12 weeks
(6 weeks for fingernails)

Itraconazole x 12 weeks

NO Tylenol NO ALCOHOL
(Monitor CBC and LFTs)

105
Q

What are the topical agents for onychomycosis

A

Ciclopirox nail lacquer
(Can’t have lunula involvement)

Efinaconazole
(50% cure rate)

106
Q

What is the MGMT for chronic exposure nail deformity

Nail polish

A

Rehydrate the nail

Moisturizer/lubricant, protective gloves, nail enamel weekly

B-complex vitamin biotin (B7), to increase thickness

107
Q

What is the treatment for subungal hematoma

A

If severe – Treatment: trephination ASAP

Field expedient – heated paperclip to melt small hole in surface of nail

108
Q

Defect consists of longitudinal band of horizontal grooves with yellow discoloration

A

Habit-tic deformity

Pt may have psychiatric d/o (OCD)

Treatment: stop manipulating nails

109
Q

What is the treatment for acute paronychia

A

Treatment:
I&D of abscess
Antistaphylococcal antibiotics

110
Q

If the Nail plate turns green-black in color

Suspect

A

Pseudomonas Infection

Treatment: use mixture of chlorine bleach and water, or vinegar
(acetic acid).

Ciprofloxacin if severe/txt failure

111
Q

What are Beaus Lines

A

Transverse depressions of all nails that appear at the base of lunula weeks after a stressful event has temporarily interrupted nail formation

Will grow out with nail, at normal rate

No treatment necessary

112
Q

What is yellow nail syndrome

A

Occurs before, during, or after respiratory diseases and in diseases assoc. with lymphedema

Seen in AIDS pts

Nail plate becomes curved, turns yellow, and usually all nails are involved

Treatment: may spontaneously improve, or may try vitamin E (oral or topical)

113
Q

DDX for clubbed nails

A

May be assoc. with heart & lung Dz, cirrhosis, colitis, and thyroid Dz

114
Q

What is lovibonds angle

A

Angle of the nail bed

> 180 = clubbing

115
Q

What is koilonychia

A

Spooned nails

Seen with iron-deficiency anemia

Treatment: improves with anemia correction

116
Q

What are Mee’s lines

A

Transverse white line in nail plate

Associated with sepsis, renal failure, arsenic poisoning, hepatic failure, CHF, and chemotherapy

Treatment: treat underlying problem
grows out with nail and resolves

117
Q

What are terrys nails

A

White or light pink but retain a 0.5- to 3-mm normal, pink, distal band

Associated with cirrhosis, chronic congestive heart failure, adult-onset diabetes mellitus, and age

118
Q

Transmission of Scabies

A

SKin to skin

119
Q

What is the Dx criteria for Scabies

A

Burrows or typical sx’s w/ characteristic lesions

120
Q

Tx for Scabies

A

Permethrin 5%

Retreat in 7 days
(DO NOT APPLY TO THE FACE)

Antihistamines PRN (Ithcing)

If inflamed: 1% hydrocortisone x24 hrs ->Elimite

121
Q

What is the Tx for scabies if the pt is institutionalized

A

Ivermectin :

Used in institutionalized patients, nursing homes, & those who fail topical therapy

Also for Norwegian Scabies and HIV

12 mg PO at day #1 & day #8
93% clearance

2-6 weeks of scabies activity is common after tx

Worsening symptoms 2-3 day after oral therapy - not failure

122
Q

Is Lindane used first line for Scabies

A

NO!

ToXIC!

Don’t use in kids of preg

If you are going to use it at all, must pretreat with steroids

123
Q

A pt presents w/ Norwegian Crusted scabies

Think

A

HIV

Variant of scabies with thousands of mites, but very little itch
Highly contagious

124
Q

How does Lice look like on WOods Lamp

A

Wood’s light fluoresces lice and nits (yellow-green to blue-green)

125
Q

Tx for Head lice

A

Permethrin 1% (Elimite or RID) lotion

Leave on for 10 min

Don’t shave head

Comb out nits after rinsing

Repeat in 7 days

126
Q

Tx for lice in the eyelashes

A

Eyelashes coat with Vaseline, wash with baby shampoo TID x 5 days

127
Q

Tx for body lice

A

Permethrin 5% cream (Elimite)
Head to toe
Leave on x10 minutes
Repeat in 7-10 days

128
Q

What is the MGMT for fleas

A

Symptomatic treatment

  • Antihistamine
  • Topical Abx – 2’ infxn
  • Topical steroids

Get rid of fleas – Treat family pets and bedding

129
Q

A pt presents with rows of 3-5 bites in exposed sleeping skin

Think

A

Bed Bugs

130
Q

What is the agent of bed bugs

A

Cimex lectularius

131
Q

What is the MGMT for Bed Bugs

A

Get rid of bugs

Symptomatic Tx

Antihistamines, topical steroids

132
Q

What is the presentation and MGMT for Chiggers

A

Legs and belt line - areas of constriction
Intense itch

Tx:
Symptomatic Tx
OTCs
Chigg-Away

DO NOT PUT NAIL POLISH OVER BITES!

133
Q

What is the MGMT for FIre ants

A

Fire ants are in the same family as wasps
(Watch for anaphylaxis)

Management

  • Kill the fire ant colony
  • Symptomatic treatment
  • Cool compress
  • Sarna lotion (OTC anti itch prep)
  • Antihistamine
  • Steroids, if severe
134
Q

What is the markings of a Brown recluse

A

Violin-shape pigment on thorax

135
Q

A pt presents with a painless bite that becomes firm

Becomes a hemorrhagic blister (24hrs) that becomes blue

Then central area becomes ecchymotic (1week)

And then forms an ulcer

Think

A

Brown recluse (loxosceles)

136
Q

What spider has red white and blue bite sign

A

Brown recluse

137
Q

What is the MGMT for Brown recluse bites

A

No commercial spider antivenom

Supportive measures; Analgesics as needed

Tetanus prophylaxis and daily wound care

Antibiotics if infection develops

Most wounds heal without intervention

Consider Surgical Debridement for Ulcers:
> 2 cm size and 2 - 3 wks after the bite

Dapsone and Hyperbaric Oxygen used sporadically

No clear evidence supporting use

138
Q

Threshold for Surgical Debridment for Brown Recluse Ulcers

A

Consider Surgical Debridement for Ulcers:

> 2 cm size and 2 - 3 wks after the bite

139
Q

What is a Letrodectus spider

A

Black widow

140
Q

Black widow venom releases what physiological chemicals

A

Massive release of Neurotransmitters

Acetylcholine & Norepinephrine

141
Q

What is the clinical Dx for a black widow bite

A

Pain + Target Lesion + Muscle Spasms

142
Q

MGMT for black widow spider

A

Supportive care

Tetanus prophylaxis and wound cleansing/care

Analgesics (Opioids) for pain

Benzodiazepines to relax muscle spasms

Antivenom reserved only for severe hospitalized cases

143
Q

What is the MC skin disease among travels to tropical regions

A

Cutaneous Larva Migrans

144
Q

What is the causative agent of cutaneous larva migrans

A

Caused by accidental invasion of dog and cat hookworm

Burrows 1-2mm qd

Long serpiginous lesion

Larva eventually dies

145
Q

What is the MGMT for cutaneous larva migrans

A

Topical
->Topical steroid to decrease inflammation

Oral - severe cases
->Ivermectin (200mcg/kg in a single dose)
1-2 repeated courses if resistant
->Albendazole (400-800 mg/day x 3-7 days)

Can use topical version in small children
->3 x 400mg tabs crushed in 12g of petroleum jelly

146
Q

How does SSSS present

A

Prodrome of malaise, fever, irritability, and tenderness of the skin

Diffuse, tender erythema appears
->Sandpaper-like texture

Often accentuated in flexural and periorificial areas

No involvement of mucous membranes

Within 1 or 2 days the skin wrinkles, forms transient bullae, and peels off in large sheets
+ Nikolsky Sign

147
Q

multiple pruritic, round, urticarial plaques w/ central papule or pustule after being in a hot tub think

A

Pseudomonas Folliculitis

148
Q

What is pseudomonas cellulitis

A

Common in dm pts
Or SOLIDERS IN SWAMPS!

Tx with Acetic acid (5% white vinegar) or Domeboro (aluminum acetate) soaks to dry out area

Systemic antibiotics

  • Oral Ciprofloxacin 500-750mg BID
  • Severe infxn: IV
149
Q

RSK fx for Erythrasma

A 
Warm humid climate
Poor hygiene
Hyperhidrosis
Obesity
Diabetes mellitus
Advanced age
Immunosuppression
150
Q

How deep to warts effect the skin

A

Confined to the epidermis

Do not have ‘roots’

151
Q

What is the Dx sign of warts

A

cylindrical projections, which may become fused and produce a mosaic pattern on surface (diagnostic sign)

152
Q

What is the treatment approach to warts under the nail

A

A wart next to the nail may simply be the tip of the iceberg; much more wart may be submerged under the nail

Cuticle biting may spread the warts

More resistant to both chemical and surgical methods
Tx: 
Cryosurgery
Cantharidin (provider applied) 
Salicylic acid

Duct tape occlusion – 6 days, 12 hour break, 6 more days – repeat up to 2 months

153
Q

Small discrete 2-5mm flesh colored papules, dome shaped
W/ Central umbilication

Express caseous material when opened

Think

A

Molluscum Contagiosum

154
Q

What are the prevention for Herpes zoster

A

Zostavax (zoster vaccine live)
Shingrix (recombinant zoster vaccine)

Both for patients ≥ 50 y/o

155
Q

What is a dermatophyte

A

Group of fungi that infect the stratum corneum (keratin layer), hair, and nails

Cannot survive on mucosal surfaces

Responsible for the vast majority of skin, nail, and hair fungal infections

156
Q

What is the most common superficial fungus of the skin

A

Trchophyton rubrum

157
Q

What is a tinea

A

A fungal infection

158
Q

Tx for tinea manuum

A

More common in men

Txt same as tinea pedis

Usual involvement is 2:1 ratio

159
Q

tx for tinea barbae

A

Oral agents only

160
Q

What is the tx for tinea of the face

A

Topicals unless near the eye

161
Q

Most common type of tinea capitis

A

Black dot type MC (hairs broken at orifice)

162
Q

How do you culture or dx tinea Capitis

A

Gauze or toothbrush technique preferred over scraping

Sterile toothbrush rubbed over affected scalp ->inoculate fungal culture medium

163
Q

What is the treatment for Candida in the diaper or genital area

A

Keep area clean and dry (as possible)

Hygiene education

Topical azoles BID
Miconazole, ketoconazole, clotrimazole

164
Q

How does tinea versicolor look under woods lamp

A

Wood’s lamp may accentuate areas of altered pigmentation

165
Q

How do you culture sporotrichosis

A

Punch or excision biopsy
1/2 for special stains/microscopic exam
1/2 for culture

166
Q

Pull test for hair loss

A

Grasp 60 hairs And pull

Negative: 6 or fewer hairs

Positive: 6 or more hairs

(Do not use shampoo for 24 hours prior to test)
(Conduct on 4 areas of the scalp)

167
Q

What is the cause of male pattern baldness

A

Due to progressive shortening of successive anagen cycles

168
Q

Which hair follicules are androgen sensitive

A

Top/vertex - androgen sensitive

Sides - androgen independent

169
Q

What are the oral treatments for male (androngenic) hair loss

A

Finasteride – oral (1 mg/day)

Dutasteride – oral (0.5 mg/day)

170
Q

MOA of Fineasteride

A

Inhibits conversion of testosterone to dihydrotestosterone, slows further hair loss, inhibits miniaturization of hair follicles, and improves hair growth/weight

Also marketed as Proscar (5mg) for BPH

Efficacy evident within 3 mo. of tx

Tx continued indefinitely

Sexual side effects in 4-5% during first year of Tx

171
Q

Minoxidil works on what phase of hair loss

A

Increases duration of anagen, causes follicles at rest to grow, and enlarges miniaturized follicles

172
Q

MOA of dutasteride

A

Inhibits conversion of testosterone to DHT

3x more potent than finasteride

173
Q

What is the w.u for female hair loss

A

Consider checking Dehydroepiandrosterone sulfate

(DHEA-S), prolactin, testosterone, SHBG

174
Q

Who does dissecting cellulitis most affect

A

Black men

175
Q

What is hypertrichosis

A

Excessive hair growth (density, length) beyond accepted limits of normal for age, race, sex in areas that are not androgen-sensitive

May be localized or generalized

May involve lanugo, vellus, or terminal hair

Spares palms and soles

176
Q

What are the 4 drugs that can lead to hypertrichosis

A

Minoxidil, phenytoin, cyclosporine, corticosteroids,

177
Q

What is hutchinsons sign

A

Can be a sign of melanoma is black people

Craig has one of these

178
Q

How do you Dx Onychomycosis

A

15 scalpel to scrape nail surface and obtain subungual debris

Obtain KOH & Culture to confirm species of fungus before starting oral antifungal tx

Nail clipping

179
Q

Most common pattern of onychomycosis

A

Distal subungual onychomycosis

180
Q

How to treat lice in the eyelashes

A

Eyelashes ->coat with Vaseline, wash with baby shampoo TID x 5 days

181
Q

Loxosceles spider=

A

Brown recluse

182
Q

What is the systemic reaction from brown recluse bites that are more common in children

A

Fever, Chills, N/V, Myalgias, Arthralgias, Petechiae

Senoir 21-2 (77 decks)

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