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Derm misc- in class lecture Flashcards

1
Q

Which derm condition?

  • Non-scarring focalized hair loss
  • Higher incidence in younger ages
  • autoimmune attack on the hair follicles by autoreactive CD8 T-cells
A

Alopecia areata

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2
Q

Clinical presentation of which derm condition?

  • Abrupt onset
  • well-demarcated bald spots on scalp/other parts of body
  • _*Exclamation point hairs*_
A

Alopecia areata

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3
Q

How do you tx Alopecia areata?

A
  • Spontaneous remission in ~6mo often occurs
  • Topical corticosteroids (superpotent- under occlusion, or potent- combo w/ minoxidil)
  • Topical Minoxidil
  • Intralesional corticosteroids (1st line in adults)
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4
Q

What is the first line tx of Alopecia areata in adults

A

Intralesional corticosteroids

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5
Q

How do you manage Alopecia areata?

A
  • Psychological support, support groups
  • Refer to derm if involvement of larger areas
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6
Q

Which derm condition?

  • Inflammation of the lateral or proximal nail folds
  • MC etiology- S. aureus
  • Risk factors: nail biting, picking at hang nails, DM, occupational risks
A

Paronychia

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7
Q

How do you tx a parnoychia WITHOUT an abscess?

A
  • Warm compresses/soaks
  • topical abx
  • more severe cases- oral Cephalexin or dicloxacillin
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8
Q

How do you tx a parnoychia WITH an abscess?

A

I&D

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9
Q

Which derm condition?

  • Hypermelanosis at sun-exposed areas of face
  • Common in pregnancy or people taking OCPs
A

Melasma

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10
Q

Clinical presentation of which derm condition?

  • Brownish macules w/ irregular borders
  • Symmetric
  • On face
  • Sun exposure intensifies lesions
A

Melasma

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11
Q

How do you tx melasma?

A
  • Sun protection and avoidance
  • Hypopigmenting agents (hydroquinone, azelaic acid, tretinoin, etc)
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12
Q

T/F: Melasma is chronic and recurrence is common

A

True

Better prognosis if pregnancy related

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13
Q

Which derm condition?

  • Progressive, autoimmune destruction of melanocytes leading to depigmentation
A

Vitiligo

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14
Q

Which derm condition?

  • Chronic inflammatory dermatosis related to chronic venous insufficiency
  • Predisposing factors- vericose veins, prolonged standing, etc
A

Stasis dermatitis

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15
Q

How do you dx and tx Stasis dermatitis?

A
  • Dx: clinical, ultrasound
  • Tx:
    • Direct tx towards venous insufficiency (leg elevation, continuous compression therapy, etc)
    • appropriate skin care and dressings
    • topical corticosteroids if pruritic
    • prevention/tx of ulcers
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16
Q

Which derm condition?

  • Localized, lichenification from repetitive rubbing/scratching
  • Highest prevalence: women, >20 years old, atopic individuals
A

Lichen Simplex chronicus

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17
Q

The following is the clinical presentation of which derm condition?

  • Well-defined plaques made by confluent papules,
  • Thickened skin - dull red color that can progress to brown or black
  • Excoriations
A

Liche Simplex Chronicus

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18
Q

What are the 2 treatments for Lichen Simplex Chronicus?

A

1. Stop scratchig/rubbing

  1. Topical Corticosteroids
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19
Q

Which derm condition?

  • MC 30-60y/o
  • 4Ps- Purple (violaceous), Polygonal, pruritic, papules/plaques
  • Koebner phenomenon (skin lesions along lines of trauma)
  • Wickman’s striae- fine white lines form network over papules
A

Lichen Planus

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20
Q

What is the 1st line treatment for Lichen Planus?

A

1st line= Topical, intralesional, or oral corticosteroids (if severe)

Can also tx w/ retinoids, photochemotherapy and cyclosporine

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21
Q

What are the 4 stages of pressure ulcers?

A

4 stages- ulcers classified by depth of soft tissue damage:

  • I: non-blancheable erythema of intact skin
  • II: partial-thickness skin loss involving epidermis, dermis, or both
  • III: full-thickness skin loss involving damage to or necrosis of subcutaneous tissue that may extend to the underlying fascia (but not through)
  • IV: full-thickness skin loss with extensive necrosis of or damage to muscle, bone, or supporting structures
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22
Q

What are the 3 complications of pressure ulcers?

A
  • Complications:
    • local infection
    • ​osteomyolitis
    • sepsis
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23
Q

Which derm condition?

  • Chronic inflammatory disorder involving hair follicle
  • MC area: intertrignous areas
  • Women 18-29y/o
  • Contributing factors: obesity, smoking, hormones, etc (also assoc. w/ DM/PCOS)
A

Hidradenitis suppurativa

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24
Q

Which derm condition?

  • Recurrent inflammed nodules
  • Draining sinus tracts
  • comedones
  • scarring
A

Hidradenitis suppurativa

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25
Q

How do you manage Hidradenitis Suppurativa?

A
  • Pt education, psychosocial support
  • Avoid skin trauma
  • Hygiene- topical antiseptic washes
  • smoking cessation
  • weight management
26
Q

How do you treat MILD Hidradenitis Suppurativa?

A

1st line= topical Clindamycin

adjunct treatment= intralesional corticosteroids

27
Q

How do you tx MODERATE Hidradenitis Suppurativa?

A

Oral tetracyclines (e.g. Doxy)

28
Q

What is surgical tx for Hidradenitis suppurativa?

A

–Punch debridement (de-roofing), wide excision

29
Q

The following are complications of which derm condition?

–Fistulae

–Strictures and contractures

–Lymphatic obstruction

–Malaise, depression, suicide

–Infectious complications

A

Hidradenitis Suppurativa

30
Q

Which derm condition?

  • ~90% from HSV infection (can also be from meds)
  • _**Target lesion**_
A

Erythema multiforme

31
Q

Does Erythema multiforme major or minor have mucosal involvement?

A

Major= mucosal involvement

Minor= NO mucosal involvement

32
Q

What is the course of Erythema multiforme and how do you tx?

A
  • Course- resolves in 2wks
  • Tx: tx cause, supportive care
33
Q

Which derm condition?

  • Chronic, relapsing-remitting, autoimmune blistering disease in people >60y/o
  • Pruritic
  • subepithelial blisters (doesn’t break easily)
  • Mucosal involvement rare
A

Bullous pemphigoid

(bolded/underlined info is how to differentiate from Pemphigus vulgaris)

34
Q

What is the gold standard for diagnosing Bullous pemphigoid?

A

Skin bx w/ direct immunofluorescence testing

35
Q

What is 1st line tx for Bullous pemphigoid?

A
  • Topical Corticosteroid (high potency)–> Clobetasol 0.05% cream
  • Systemic corticosteroid is an alternative 1st line tx
36
Q

Which derm condition?

  • Autoimmune blistering disease of the skin and mucous membranes
  • Blister in deep epidermis
  • Painful (not pruritic) flaccid blisters, occuring everwhere (NOT palms/soles)
  • Blisters fragile
  • Mucous membrane presentation MC
A

Pemphigus vulgaris

(bold/underlined = how dif from bullous pemphigoid)

37
Q

Which derm condition has the average age of onset of 50-70y/o is an automimmune dz and displays the Nikolsky sign (sloughing off of skin)?

A

Pemphigus vulgaris

38
Q

How do you diagnose Pemphigus vulgaris?

A

skin biopsy of fresh lesion

& direct immunofluourescence of perilesional skin for antibody detection

39
Q

How do you manage pemphigus vulgaris?

A
  • HOSPITALIZATION for IVF and nutrient repletion
  • Systemic glucocorticoids and immunosuppressive therapy
40
Q

Which derm condition?

  • Velvety, hyperpigmented, grey-brown plaques
  • Intertriginous sites (neck axillae)
  • MC in American indian, black and hispanics
  • assoc w/ insulin resistance (obesity, DM, PCOS)
A

Acanthosis nigricans

41
Q

How do you tx Acanthosis nigricans?

A

•treat the underlying condition

42
Q

Which derm condition?

  • common in older adults
  • bleed profusely w/ trauma
  • Only tx for cosmetic reasons
A

Cherry angioma

43
Q

Which derm condition?

  • Persistent dilatations of small capillaries in the superficial dermis
  • Clinical diagnosis
  • Tx: for cosmesis
A

Telangiectasia

44
Q

How do you diagnose and tx a lipoma

A
  • clinical diagnosis
  • •Tx: for pain, cosmesis, or for reassurance–-> Surgical removal
45
Q

What derm condition?

  • soft
  • painless subcutaneous nodule
A

Lipoma

46
Q

What is the MC cutaneous cyst?

A

Epidermal cyst

47
Q

Which derm condition?

  • Skin colored dermal nodules w/ central punctum
  • clinical dx
A

Epidermal cyst

48
Q

How do you tx an epidermal cyst?

A

Intralesional triamcinolone, I&D, excision (must remove intact to decrease chance of recurrence)

49
Q

Which derm condition occurs at or near the upper part of the natal cleft of the buttocks

A

Pilonidal cyst

50
Q

The following is the clinical presentation of which derm condition?

  • Sudden onset pain in intergluteal region with sitting or activities that stretch the skin over the natal cleft
  • Intermittent swelling
  • Mucoid, purulent, or bloody discharge
  • Fever, malaise
A

Acute pilonidal cyst

51
Q

How do you treat an acute pilonidal cyst?

A

–Acute abscess: I&D

–Cellulitis without abscess: antibiotics

52
Q

What are the sxs of a chronic pilonidal cyst and how do you tx?

A

Sxs: recurrent/persistent drainage and pain

Tx: surgical tx to destrol all sinus tracts and skin pores

53
Q

Which derm condition?

  • abnormal cutaneous response after light exposure
  • often associated w/ meds (tetracyclines, sulfonamides, FQs, NSAIDs, retinoids, etc)
A

Photosensitivity Reactions

54
Q

How do you treat Vitiligo?

A
  • Sunscreen, cosmetic camouflage
  • psychologic support
  • Repigmentation done by derm (topical corticosteroids, UV radiation therapy, Calcineurin inhibitors, topical Vit. D, skin grafting)
55
Q

Which Derm condition has the following presentation?

hyperpigmented plaques on lower legs/ankles, erythematous scales, edema

A

Stasis Dermatitis

56
Q

What are the “4P’s” of Lichen Planus?

A
  1. Purple (violaceous)
  2. Polygonal
  3. Pruritic
  4. Papules/plaques
57
Q

How do you diagnose pressure ulcers?

A
  • Clinical diagnosis
  • +/- Skin biopsy: to help with staging or to exclude other causes of skin ulcers
  • Imaging to evaluate for complications
58
Q

How do you treat pressure ulcers?

A

Tx:

  • PREVENTION (reposition q2hrs, etc)
  • wound management (cleanse w/ normal saline)
  • pain management (1st line= ASA/NSAIDs, opioids for mod-severe)
  • Nutritional management- assess for adequate protein and caloric intake
  • +/- surgical tx for stage IV
59
Q

How do you treat refractory moderate-severe Hidradenitis suppurativa? (3)

A

Oral retinoids

Hormonal Therapies

Biologics

60
Q

What are 3 complications of Pemphigus vulgaris?

A
  1. Malnutrition
  2. Dehydration
  3. Sepsis

**can be life threatening!**

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