Derm Obj with more detail (derived from Enoch's cards) (15%) Flashcards
1
Q
What are the factors associated with development of acne vulgaris?
A
Increased sebum production
Follicular hyperkeratinization
Proliferation of cutibacterium acnes
Inflammation
2
Q
What triggers acne in puberty?
A
Androgen stimulation of pilosebaceous unit
Changes in keratinization at follicular orifice
Hormones and keratinization
3
Q
When does the follicular ostium dilate in acne?
A
Comedo formation
4
Q
When does rupture of the follicular wall occur in acne?
A
Nodule/cyst
5
Q
Which gender usually has more acne?
A
Women
6
Q
Specifically in adult women, what kind of acne papules are found and where?
A
Deep seated & tender red papules along the mandibular jaw.
7
Q
What are drug-induced acneiform eruptions usually composed of?
A
Monomorphic inflammatory papules and pustules
8
Q
What is mod for comedone #?
A
20-100
above = severe
below = mild
9
Q
What is mod for papules/pustules #
A
15-50
above = severe
below = mild
10
Q
What is mod for nodule #?
A
<5
> 5 = severe
11
Q
What could itchy acne be and what do we do then?
A
If itchy, could be papules that we can do KOH prep on.
Check for pityrosporum folliculitis (tx with keto shampoo)
12
Q
MOA of retinoid
A
Decreases cohesion and increases turnover of epidermal cells
stops skin from being sticky and increases cellular death so that there is not time for acne to grow
13
Q
t/f you can have retinoids in preggo?
A
FALSE
14
Q
your patient has taken a lot of abx and you are worried about antibiotic resistance, so you consider ____ for treatment of their acne
A
benzoyl peroxide (BPO)
No bacterial resistance
15
Q
SE of benzoyl peroxide (BPO)
A
Skin irritation
Bleaching of hair/clothing
B = Bleach
16
Q
In what type of acne is topical abx indicated?
A
Papulopustular
think bacteria d/t puss
17
Q
1st line topical abx
A
Clindamycin or erythromycin (my son has acne)
Often combined with BPO
18
Q
when are oral abx indicated for acne?
A
Moderate acne: inflammatory papules or deep-seated lesions
20-100 comedones
15-50 papules/pustules
< 5 cysts
19
Q
What are the oral abx for acne?
remember, indicated for moderate acne
A
Doxycycline
Minocycline
-cycline
3 month tapered course
20
Q
MOA of oral abx for acne
A
inhibition of C. acnes
21
Q
CI for tetracylcines used as oral ABX for acne
A
preggo or young
can use macrolides (mycin) if this is an issue
22
Q
If a patient is not able to have -cycline or -thromycin for oral abx treatment for mod acne, what are the 2nd line options?
A
Bactrim DS
Keflex (safe in preggo but not that effective)
23
Q
Treatment of severe resistant nodular/cystic acne
A
Isotretinoin (accutane)
last resort monotherapy
24
Q
MOA of isotretinoin (Accutane)
A
Same as others: inhibition/decrease in C acnes
25
Apart from being CI in preggo, what is another CI of isotretinoin?
Use with an oral tetracycline
-cycline
26
You must monitor CMP/lipids this often () with isotretinoin and stop or use a statin if lipids reach ()
monthly
700-800
27
What is interesting regarding your blood when you are on isotretinoin?
You may not donate it
28
What is perioral dermatitis and MC demographic?
Discrete erythematous micropapules
MC in females
29
RFs for perioral dermatitis
Topical fluorinated glucocorticoids + inhalers
Fluroinated toothpaste
OCP
Fluorine
## Footnote
patient will likely be on one of these in a case scenario
30
Tx for perioral dermatitis
D/C Steroids
31
What is the most common form of alopecia?
**Androgenic alopecia**
Aka sex pattern hair loss
32
What is the underlying pathophysiology of androgenic alopecia?
____ are regressed into _______ hairs due to _____.
**Terminal hairs** are regressed into **indeterminate/vellus** hairs due to **androgens**.
Terminal hairs are affected by hormones!
33
What androgenic alopecia classification describes females vs males?
Females = Ludwig-Savin
Males = Norwood Hamilton
## Footnote
Women wear wigs
Alexander Hamilton was a man
34
What hormone specifically causes androgenic alopecia and the long-term result of exposure to it?
**DHT**
Successive cycles will produce **shorter and thinner hairs**
35
If I do a biopsy of androgenic alopecia, what do I expect to see?
Telogen phase & atrophic follicles
36
Minoxidil is typically the treatment for androgenic allopecia, but this medication () can be used for men and this () can be used for women
**Finasteride** **for men** (5-alpha-reductase inhibitor that inhibits conversion of T to DHT)
**Spironolactone** for women (prevents DHT from working but does not have direct affects on T)
37
what is the triad of atopy?
1. Atopic dermatitis
2. Allergic rhinitis (hay fever)
3. Asthma
## Footnote
3 As
38
What is the cycle of atopic dermatitis?
Dry skin
Pruritis
Increased inflammation (from itching)
Lichenification
39
What are the three pathophysiologic causes of dry skin d/t atopic dermatitis?
Impaired filagrin production
Reduced ceramide levels
Increased trans-epidermal water loss
40
what inflammatory markers are expressed in atopic dermatitis?
IL-4
IL-13
41
Hallmark sign of atopic dermatitis
**Intense pruritis**
## Footnote
Leading to lichenification as you keep scratching. Also can lead to 2ndary infections.
42
Presentation of someone with atopic dermatitis
Chronic: periorbital plaques
Hyperpigmentation
Hyperlinear palms
Keratosis pilaris
**Hx of allergies**
43
What is the primary thing that clues you into atopic dermatitis?
Hx and FHx
44
What is the tx for atopic dermatitis?
Gentle cleansers
Low strength steroids
45
How do you manage striae in atopic dermatitis?
Ointment without preservatives
Damp skin or under occlusive dressings
AVOID soap except in body folds
46
Cream for localized dermatitis
**Low potency**: **desonide** **BID**
Medium potency: Triamcinoline/mometasone/fluocinolone BID
Non-steroidals (only use if >2y): Tacrolimus/pimecrolimus/crisaborole
47
Systemic tx for atopic dermatitis
**Dupulimab** SC
48
Tx for pruritis in atopic dermatitis
Antihistamines
## Footnote
makes sense
49
How do you differentiate between irritant contact dermatitis vs allergic contact dermatitis?
ICD: confined to area, sharply marginated, **never spreads**
ACD: **spreading, type IV HSR**
50
your male patient comes in with dermatitis of the face, neck, upper chest, forearms, and palms - what type of dermatitis do you suspect?
Airborne contact dermatitis
## Footnote
sun exposed skin
51
Diagnosis of contact dermatitis
Hx
**Patch testing (**(+) still requires you to clinically correlate)
**Do not use skin prick test, which only tests Type 1 HSR**
## Footnote
Patch testing is not the same as skin prick testing
52
What is the underlying physiology of allergic contact dermatitis?
____, which bind to a carrier and cause a Type _____
**Haptens**, which bind to a carrier and cause a **Type IV HSR**
Re-exposure to a substance already sensitized to
53
apart from avoid offending agents, how do you treat allergic contact dermatitis pharmacologically?
**Steroids** (topical/oral)
54
What non-pharmacological therapy can help with contact dermatitis?
PUVA Phototherapy
## Footnote
psoralen utraviolet A
55
what is miliaria?
blocked sweat ducts
56
what type of dermatitis can miliaria cause?
Diaper dermatitis
57
Apart from barrier creams and targeting the offending agent, this patient education for bathing is important for diaper rash
Dry well
## Footnote
Fungus loves a wet, warm environment
58
What is ectothrix?
A grey patch with a scaly appearance
Hair shafts are broken off and brittle
**An infection OUTSIDE of the hair shaft**
## Footnote
for tinea capitis
59
What is endothrix?
**Black dot appearance**
Infection within the hair shaft
## Footnote
for tinea capitis
60
MC demographic for tinea capitis
AA children
61
How does non-inflammatory tinea capitis appear?
Scaling
Pruiritis
Alopecia
Adenopathy
62
Gold, mercury, and hep C are associated with this skin condition
Lichen Planus
63
How does inflammatory tinea capitis present?
**Painful**
**Tender**
Alopecia
64
How do the black dots appear in tinea capitis?
## Footnote
and MCCs
Broken off hairs => swollen shafts
Diffuse and poorly circumscribed
**MCC**: T tonsurans or violaceum
**TV**s in the house (endothrix is inside)
65
What does KOH prep show for tinea versicolor?
Hyphae and budding yeast spaghetti and meatballs
very colored
66
What are the 3 common types of verrucae seen in kids?
Verruca **vulgaris**: common (very) wart
Verruca **plantaris**: plantar wart
Verruca **plana**: flat wart (plain wart)
67
Dermoscopy with oil of these small, flat-topped papule has white lines around it. What are these white lines and what condition is it?
Whickham striae seen in Lichen Planus
68
How does verruca vulgaris present?
1-10mm papules
Isolated or multiple
Red and brown spots: thrombosed papilla capillary loops (seen on dermatoscope)
69
Jetliner with a trail
Dermoscopy finding for **scabies**
70
MCC of verruca vulgaris
trauma, hands/fingers/knees
71
How does verruca plantaris present?
Shiny plaques with a rough, hyperkeratotic surface
Thrombosed capillaries
Skin lines decrease
Usually uncomfortable
Tender
reminds me of a cigarette butt
## Footnote
of the foot
72
How does verruca plana present?
Sharply defined
1-5mm
Flat surface
Skin colored or light brown
Round, oval, polygonal, or linear
73
MC location of verruca plana
face, beard, dorsa of hands and shins
73
74
Management options for verrucae
**Salicyclic acid
**Cryotherapy
**Imiquimod**
**Cantharidin** (blister beetle)
Electrosurgery + vacuum to prevent aerosolization
## Footnote
Podofilox not mentioned, maybe cause it doesn’t really spread?
75
What does SA do?
**Desquamation of hyperkeratotic epithelium**
10-30% conc for small
40% conc for big lesions
76
What else should you do when applying SA?
Sanding/filing
77
# What is cantharidin?
What is cantharidin?
Blister beetle substance, which causes a blister on the wart.
78
Where is pediculosis capitis MC and how does it present?
**Lice**
MC in schools, day-cares, SNFs, dorms, prisons
**Intense pruiritis of the scalp**
**MC in white school aged girls/mothers**
## Footnote
Warmer months
79
What does a louse look like vs nits?
**Louse** **1-3 mm long**, flattened brownish-gray, 3 pairs of legs and claws
**Nits** are **1 mm** and opalescent (eggs)
## Footnote
Humanus are in clothing, capitus on hair shafts
80
lifespan of a louse (lice)
14-18 days
81
What do lice and nits do to the scalp? What does microscopy show?
Mauculae cerulae or purpuritic stains may suggest infestation
Occipital lymph node involvement
**Microscopy** shows an **oblong structure** attached to hair an an **acute angle** with a **breathing appartus at its superior end**
82
Diagnostic pearls for pediculosis capitis
Pyoderma + occipital/cervical **LAN suggest infestation**
Nits are oval and tenacious; they stay stuck
**Nits fluoresce under Wood’s lamp**
83
Best tests for pediculosis capitis
Microscope
Wood’s lamp of nits
84
Management of pediculosis capitis
Permethrin has increasing resistance
**Manual combing via fine comb**
85
Should you treat a kid with empty nit cases?
**No**
Only live lice or eggs
86
OTC tx for pediculosis capitis
**Permethrin** (**Nix**): dry hair then rinse after 10m. Repeat in 1-2 weeks
Pyrethrins + piperonyl butoxide(RID, Pronto): same as above
87
Rx tx for pediculosis capitis
**Spinosad/Natroba: children > 4y First line tx**
Malathion lotion
Ivermectin lotion: **6 months or older & not preggo**
88
Tx for eyelid involvement of pediculosis capitis
Petrolatum BID for x8d
89
What causes scabies and MC mode of transmission?
**Mite**: Sarcoptes scabiei var. hominis
**MC**: Direct contact
fomite spread is rare
90
Overview of scabies
10-20 mites per infestation
Extremely pruiritic 2-6 weeks later
**Persists without tx!**
91
Presentation of scabies and where it most often occurs (how does this differ from lice?)
**Worse at night**
Diagnostic sign: **fine, thread-like line with tiny black speck at the end.**
Small, erythematous papules
**Rarely on head or neck**
## Footnote
lice is most often on head (head lice)
**scabies** is MC on the **s**hins
92
Who is crusted scabies/norwegian scabies MC in?
Immunocompromised
Institutionalized
93
What is crusted scabies like?
Thousands to millions of mites
94
Tx of crusted scabies
**Topical** **Permethrin** 5% overnight
+
**Oral ivermectin** x5 dosing
95
Best tests for scabies
Scabies prep via **scraping and microscopy and mineral oil**
**Add on KOH for crusted scabies**
96
Management of scabies
**First-line**: **permethrin** 5% or Rid
Last resort: Lindane (Avoid in crusted)
Oral ivermectin (2nd line, 0.2mg/kg/d)
97
What is the MCC of Pityriasis Rosea?
HHV6 & 7
| spring/fall
## Footnote
Herald patch on the trunk
or Christmas Tree Rash
98
what occurs first - christmas tree rash or herald patch for Pityriasis Rosea?
**herald patch** followed by christmas tree rash 1-2 weeks after
99
Describe the exanthem associated with Pityriasis Rosea
Fine scaling papules and patches
Dull pink, salmon red
## Footnote
The **Ps** of Pityriasis = papules/patches
100
What is used in the tx of Pityrasis Rosea? (4)
Oral antihistamines
Topical antipruritic lotions (Sarna)
Topical Triamcinolone BID x 4 weeks
Oral steroids
## Footnote
antihistamines
**tri**amcinolone = **tree**
101
What is the MCC of Lichen Planus?
idiopathic
## Footnote
we don't know
102
What kind of condition is Lichen Planus?
**Inflammatory Dermatosis** of the skin +/- mucuos membranes
Acute or chronic
103
What does Lichen Planus look like?
Flat topped papules
Annular, **purple** pruritic
## Footnote
kinda look like RBCs to me
104
Where does Lichen Planus tend to occur?
Wrists (flexor)
Lumbar
Shins
Scalp
Penis
Mouth
105
Which Lichen Planus type involves cicatricial/scarring alopecia?
Follicular
## Footnote
think hair follicles
106
Which Lichen Planus variant is associated with Bullous Pemphigoid?
Vesicular
## Footnote
think of how vesicles progress into bullae
107
Involvement of this area with Lichen Planus is concerning?
Mouth
108
If Lichen Planus occurs in the hair and nails, what may happen?
**Scarring alopecia**
Nail Bed destruction + longitudinal splintering
109
What is the most concerning variant type of Lichen Planus that we need to consider DDx for?
Papular
## Footnote
lichen **p**lanus **p**apular
110
For cutaneous lesions of Lichen Planus, the preferred tx is…
**Triamcinolone** under occlusion BID x 4 weeks
Can also use ILK
111
For Lichen Planus in the mouth, the preferred tx is…
Cyclosporine and Tacrolimus MOUTHWASH
## Footnote
LP and CT of th mouth
112
Systemic tx of Lichen Planus can use 3 drugs and 1 therapy, which are…
Cyclosporine
Prednisone
Retinoids (adjunctive)
PUVA therapy
113
What is the underlying pathophysiology of SJS & TEN?
Cytotoxic event **destroying keratinocytes**
114
what is the shape of a SJS TEN rash?
Target lesions with rapid confluence
115
When do you want to give to IV steroids and IVIG for SJS/TEN?
ASAP
