Derm misc- in class lecture Flashcards
Which derm condition?
- Non-scarring focalized hair loss
- Higher incidence in younger ages
- autoimmune attack on the hair follicles by autoreactive CD8 T-cells
Alopecia areata
Clinical presentation of which derm condition?
- Abrupt onset
- well-demarcated bald spots on scalp/other parts of body
- _*Exclamation point hairs*_
Alopecia areata
How do you tx Alopecia areata?
- Spontaneous remission in ~6mo often occurs
- Topical corticosteroids (superpotent- under occlusion, or potent- combo w/ minoxidil)
- Topical Minoxidil
- Intralesional corticosteroids (1st line in adults)
What is the first line tx of Alopecia areata in adults
Intralesional corticosteroids
How do you manage Alopecia areata?
- Psychological support, support groups
- Refer to derm if involvement of larger areas
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
Paronychia
How do you tx a parnoychia WITHOUT an abscess?
- Warm compresses/soaks
- topical abx
- more severe cases- oral Cephalexin or dicloxacillin
How do you tx a parnoychia WITH an abscess?
I&D
Which derm condition?
- Hypermelanosis at sun-exposed areas of face
- Common in pregnancy or people taking OCPs
Melasma
Clinical presentation of which derm condition?
- Brownish macules w/ irregular borders
- Symmetric
- On face
- Sun exposure intensifies lesions
Melasma
How do you tx melasma?
- Sun protection and avoidance
- Hypopigmenting agents (hydroquinone, azelaic acid, tretinoin, etc)
T/F: Melasma is chronic and recurrence is common
True
Better prognosis if pregnancy related
Which derm condition?
- Progressive, autoimmune destruction of melanocytes leading to depigmentation
Vitiligo
Which derm condition?
- Chronic inflammatory dermatosis related to chronic venous insufficiency
- Predisposing factors- vericose veins, prolonged standing, etc
Stasis dermatitis
How do you dx and tx Stasis dermatitis?
- 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
Which derm condition?
- Localized, lichenification from repetitive rubbing/scratching
- Highest prevalence: women, >20 years old, atopic individuals
Lichen Simplex chronicus
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
Liche Simplex Chronicus
What are the 2 treatments for Lichen Simplex Chronicus?
1. Stop scratchig/rubbing
- Topical Corticosteroids
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
Lichen Planus
What is the 1st line treatment for Lichen Planus?
1st line= Topical, intralesional, or oral corticosteroids (if severe)
Can also tx w/ retinoids, photochemotherapy and cyclosporine
What are the 4 stages of pressure ulcers?
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
What are the 3 complications of pressure ulcers?
- Complications:
- local infection
- osteomyolitis
- sepsis
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)
Hidradenitis suppurativa
Which derm condition?
- Recurrent inflammed nodules
- Draining sinus tracts
- comedones
- scarring
Hidradenitis suppurativa
How do you manage Hidradenitis Suppurativa?
- Pt education, psychosocial support
- Avoid skin trauma
- Hygiene- topical antiseptic washes
- smoking cessation
- weight management
How do you treat MILD Hidradenitis Suppurativa?
1st line= topical Clindamycin
adjunct treatment= intralesional corticosteroids
How do you tx MODERATE Hidradenitis Suppurativa?
Oral tetracyclines (e.g. Doxy)
What is surgical tx for Hidradenitis suppurativa?
–Punch debridement (de-roofing), wide excision
The following are complications of which derm condition?
–Fistulae
–Strictures and contractures
–Lymphatic obstruction
–Malaise, depression, suicide
–Infectious complications
Hidradenitis Suppurativa
Which derm condition?
- ~90% from HSV infection (can also be from meds)
- _**Target lesion**_
Erythema multiforme
Does Erythema multiforme major or minor have mucosal involvement?
Major= mucosal involvement
Minor= NO mucosal involvement
What is the course of Erythema multiforme and how do you tx?
- Course- resolves in 2wks
- Tx: tx cause, supportive care
Which derm condition?
- Chronic, relapsing-remitting, autoimmune blistering disease in people >60y/o
- Pruritic
- subepithelial blisters (doesn’t break easily)
- Mucosal involvement rare
Bullous pemphigoid
(bolded/underlined info is how to differentiate from Pemphigus vulgaris)
What is the gold standard for diagnosing Bullous pemphigoid?
Skin bx w/ direct immunofluorescence testing
What is 1st line tx for Bullous pemphigoid?
- Topical Corticosteroid (high potency)–> Clobetasol 0.05% cream
- Systemic corticosteroid is an alternative 1st line tx
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
Pemphigus vulgaris
(bold/underlined = how dif from bullous pemphigoid)
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)?
Pemphigus vulgaris
How do you diagnose Pemphigus vulgaris?
skin biopsy of fresh lesion
& direct immunofluourescence of perilesional skin for antibody detection
How do you manage pemphigus vulgaris?
- HOSPITALIZATION for IVF and nutrient repletion
- Systemic glucocorticoids and immunosuppressive therapy
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)
Acanthosis nigricans
How do you tx Acanthosis nigricans?
•treat the underlying condition
Which derm condition?
- common in older adults
- bleed profusely w/ trauma
- Only tx for cosmetic reasons
Cherry angioma
Which derm condition?
- Persistent dilatations of small capillaries in the superficial dermis
- Clinical diagnosis
- Tx: for cosmesis
Telangiectasia
How do you diagnose and tx a lipoma
- clinical diagnosis
- •Tx: for pain, cosmesis, or for reassurance–-> Surgical removal
What derm condition?
- soft
- painless subcutaneous nodule
Lipoma
What is the MC cutaneous cyst?
Epidermal cyst
Which derm condition?
- Skin colored dermal nodules w/ central punctum
- clinical dx
Epidermal cyst
How do you tx an epidermal cyst?
Intralesional triamcinolone, I&D, excision (must remove intact to decrease chance of recurrence)
Which derm condition occurs at or near the upper part of the natal cleft of the buttocks
Pilonidal cyst
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
Acute pilonidal cyst
How do you treat an acute pilonidal cyst?
–Acute abscess: I&D
–Cellulitis without abscess: antibiotics
What are the sxs of a chronic pilonidal cyst and how do you tx?
Sxs: recurrent/persistent drainage and pain
Tx: surgical tx to destrol all sinus tracts and skin pores
Which derm condition?
- abnormal cutaneous response after light exposure
- often associated w/ meds (tetracyclines, sulfonamides, FQs, NSAIDs, retinoids, etc)
Photosensitivity Reactions
How do you treat Vitiligo?
- Sunscreen, cosmetic camouflage
- psychologic support
- Repigmentation done by derm (topical corticosteroids, UV radiation therapy, Calcineurin inhibitors, topical Vit. D, skin grafting)
Which Derm condition has the following presentation?
hyperpigmented plaques on lower legs/ankles, erythematous scales, edema
Stasis Dermatitis
What are the “4P’s” of Lichen Planus?
- Purple (violaceous)
- Polygonal
- Pruritic
- Papules/plaques
How do you diagnose pressure ulcers?
- Clinical diagnosis
- +/- Skin biopsy: to help with staging or to exclude other causes of skin ulcers
- Imaging to evaluate for complications
How do you treat pressure ulcers?
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
How do you treat refractory moderate-severe Hidradenitis suppurativa? (3)
Oral retinoids
Hormonal Therapies
Biologics
What are 3 complications of Pemphigus vulgaris?
- Malnutrition
- Dehydration
- Sepsis
**can be life threatening!**
