Derm- my own review Flashcards
Rosacea
small, red, pus filled bumps
Middle aged woman (30-50)
Tx for Rosacea
Mild: Flagyl (metronidozaole)
Mod- severe: Tetracyclines
Severe: Accutane
Tx the Redness: Brimonidine “Mirvaso” causes constriction of the tiny blood vessels
Tx of mild Folliculitis
Mupirocin “Bactroban”
Tx of more sever Folliculitis
Keflex
Tx for Superficial ThromboPhlebitis
Elevation
Compress
NSAIDs
Antibiotics (sever)
Cause of Superficial Thrombophlebitis
blood clot just below surface of skin
inflammatory condition of the veins
What causes Stasis Dermatitis
Scaly, itchy, red-brown plaque, fine fissuring, erosions, crust
Venous insufficiency
What causes Venous insuff
valves of the deep veins aren’t working properly so the blood backs up into the superficial veins
Stasis Dermatitis can lead to —>
“inverted champagne bottle”
LIpodermatosclerosis
chronic inflammation and fat necrosis
Loss of hair
Shiny, atrophic skin
Elevating legs does NOT help
Pain/claudication at rest
Arterial insuff
Pyoderma Gangrenosum is a
Derm emergency
Tx with Steroid and Tacrolimus
Tacrolimus
non-steroid
treats itch and inflammation
What is Tacrolimus
an immunosuppressant
Tx for Tinea on the Foot
Terbinafine “Lamisil”
Lamisil is a brand name for
Terbinafine
Which one of the tinea is not caused by fungus, but actually a YEAST
Tinea Versicolor
Tx for Tinea Versicolor
Topical shampoos including:
Selenium sulfide
Ketoconazole
Zinc
Leave on for 10 min then rinse
Visible scale that is not visible until rubbed w finger
Tinea Versicolor
Low potency steroids
Desonide
Hydrocortisone
Tx for Candidal Intertrigo
Clotrimazole cream
Erythema Multiforme
Hypersensitivity rxn
Infection or
Meds
Erythema Multiforme presentation
Target lesions
dusky central area surrounded by pale ring of red
Where is Erythema Multiforme usually located?
Trunk and Arms/Legs
Nikolsky sign
when the skin detaches after you touch it
NOT present in Erythema Multiforme
Tx for Erythema Multiforme
Steroid
Lidocaine
Benadryl
Tx for Erythema Multiforme if Mycoplasma related
Abx
If HSV–> Acyclovir
SJS
<10 %
TEN
> 30%
Most common Med Culprits of SJS/TEN
Sulfa
Anticonvulsant
Lamotrigine “Lamictal”
“Lamictal” aka Lamotrigine
Tx Seizures, Bipolar
Tx for SJS/TEN
Burn unit
Pain control
Stop offending med
Fluid, electrolyte replacement
Common Anticonvulsants
Carbamazepine Lamictal (Lamotrigine) DiazePAM LorazePAM Ethosuximide ClonazePAM
Paronychia
infection around lateral and proximal nail folds
Tx of Paronychia
Mupirocin “Bactroban” (ointment)
Oral Keflex, Dicloxacillin (a PCN)
Tx of Paronychia if a/w Nail Biting
Augmentin
Clindamycin
Which one of the spider bites has Antivenom available?
Black Widow
but only used if other stuff doesnt work, often after consult with Toxicology
Tx of Black Widow bite
Local sx: pain at bite site
Systemic sx: muscle pain!! spasm, rigid
Wound care, Pain control, NSAIDs, opioids, Muscle Relaxants
Classic view of Black Widow bite
Blanched circle w surrounding Red perimeter, central punctum
“target lesion”
Black Widow bite
Muscle spasm, pain, rigid BUT
usually self-resolve within 1-3 days
Brown Recluse bite
Nastier looking bite, but stays local
Necrotic
Burning and Redness
“red halo” –> hemorrhagic bulla that turns eschar formation
Tx of Brown Recluse
Wound care, Pain control (NSAIDs)
Tetanus
Debridement if necrotic
Abx is secondary infection
5th disease
Erythema Infectiosium
Parvovirus
Lacy, reticular
Malaise –> red rash –> “Slapped cheek”
Bad, bad things about Erythema Infectiosum
Fetal loss during pregnancy
Aplastic crisis in Sickle cell
Tx for 5th Dz, Erythema Infectiosum
Anti-inf: NSAIDs
Koplik spots then Brick red rash starting at forehead and –> towards toes
Rubeola (Measles)
3 C’s
Measles:
cough, coryza (swollen nares), conjunctivitis
Tx options for Measles
Tylenol, Ibuprofen, hydrate
Vitamin A
high risk for comp: Measles immune globulin
Complications of Measles (Rubeola)
Diarrhea most common, but
PNA most common cause of DEATH
Summer fall
Fecal oral or oral-oral spread
Painful vesicles on hand,feet,mouth
Hand foot and mouth
Coxsackie
Supportive tx: antipyretics, hydrate, Topical Lidocaine for the painful vesicles
Complications of Hand foot and mouth
Aseptic meningitis
Guillian Barre
Guillan Bare
starts at feet—–> spreads upwards
“Ascending paralysis”
plasma therapy and immune globulin can help
TRAb antibodies
Grave’s dz
TPO and TgAb antibodies
Hashimoto’s
Main cause of Cellulitis and Erysipelas
Strep, (GAS)
Tx for Cellulitis
Keflex
Dicloxacillin (a PCN)
Tx for Cellulitis if caused by Cat, dog, or human bite
Augmentin
If you suspect MRSA for Cellulitis
Oral: Doxy, Clinda
IV: Vanco
Erysipelas
sharply demarcated borders
often a/w SYSTEMIC MANIFESTATIONS (fever, chills, elevated wbc)
Oral tx for Erysipelas
Keflex, PCN, Amoxicillin
A safe grab to treat Cellulitis, Erysipelas, and Lymphangitis
Keflex (oral)
Lymphangitis
the red streaks that can come from cellulitis site
Treatment for MRSA
Doxy, Clinda
What is the most common type of Impetigo?
“honey crusted”
Nonbullous
papules, vesicles, and pustules with weeping –> honey crusted
Most common cause of Impetigo
Staph
Tx for Impetigo
Mupirocin 3x/day for 10 days
“Bactroban”
If Impetigo becomes systemic, what can you use to treat it?
Keflex
surprise surprise
What types of lesions are flat?
Macule (<10 mm)
Patch (>10 mm)
Tx for Tinea Capitis
on the head
Griseofulvin
Tx for Tinea Cruris “Jock itch”
Topical antifungal
Clotrimazole
Terbinafine
Tx for Tinea Corporis “Ringworm”
wrestlers
Topical antifungal “azoles”
Clortimazole
Ketoconazole
Intertrigo (skin folds)
yeast
Tx
Ketoconazole
Nystatin
Clotrimazole
Tx for Scabies and Lice
Permethrin cream
Highly contagious, dome shaped pearly-white waxy papules 2-5 mm wtih central umbilical
Molluscum Contagiosum
Tx for Molluscum Contagiosum
generally not needed, most resolved in 3-6 mo
Tx for severe Molluscum
Topical Retinoid
HPV warts “Condyloma Acuminata”
painless, soft, cauliflower like
Dx: whitening of lesion with Acetic Acid application
Tx for HPV warts
80% have spontaneous resolution
Cryotherapy
Electrocauterization
Surgical excision, all can lead to scarrin
Vaccine for HPV warts
“Gardisil 9”
if younger than 15: 2 shots
if older: 3 shots
Fair skinned old person
Velvety warty lesion, “stuck on” appearance
Seborrheic Keratosis
No tx needed
If cosmetic desire: Cryotherapy
AK
Actinic Keratosis
most common Pre-CA condition
—-> Squamous cell
2nd most common type of skin CA
Squamous cell
What is the Pre-CA that can lead to Squamous cell?
AK
Actinic Keratosis
“sandpaper” pre-CA
Actinic Keratosis, AK
Bowen’s Dz
Squamous cell CA that is only in the epidermis, has not invaded the dermis
Clinical sx of Squamous Cell CA
White scaly or crusted
Nonhealing ulcer
Hands, neck, head, lips
Tx of Squamous Cell CA
Surgical excision w clear margins
What is the big concern with Melanoma?
Agressive, can become systemic and METS
Most common type of Melanoma
Superficial spreading
Men: Trunk
Women: Legs
Diagnosing Melanoma
Full thickness wide excision
+
lymph node biopsy
Tx for Melanoma
Get it out!
wide surgical excision
+ don’t forget to biopsy the lymph nodes
Most common type of skin CA
Basal cell
slow growing
Small, raised, rolled borders and central ulcer, overlying telangiectasia
Bleeds easily
Tx for Basal cell ca of face
Mohs
