Derm Review Flashcards
layers of skin
describe what you see
describe me
-vesicles
-weeping
-oozing
-crusted
signs
-darrier’s sign- stroking lesion creates erythematous wheal associated with koebner phenomen
-auspitz- pin point bleeding when removing scale
-nicholsky - rub the skin off -> seen in steven johnson syndrome, scalded skin syndrome (staff) and pemphigus
psoriasis
-Raised, Pink, Scale, Silvery Plaques
-Extensor surfaces of elbows and knees but can be anywhere
-Variants- Vulgaris*, Pustular, Guttate (spares the palms and soles**)
-do you have aches, pain, swelling -> psoriatic arthritis
psoriasis treatment
-Mild- Topical Steroids
-Moderate- add UVB, Puva, descaler such as Retin A or Calcipotriene
-Severe- Methotrexate, Biologics
-When Psoriasis is diagnosed, look for signs of Psoriatic Arthritis and refer to Rheumatologist accordingly
pityriasis rosea
Unknown Cause
Possibly triggered by viral infection
Not Contagious
Herald Patch
Can be Itchy
Self limiting
Can last weeks to years!
lichen planus (not on exam)
4 Ps
Papular, Purple, Purulent, Polygonal
In mouth and mucal surfaces forms “lacy white patches”
Blisters that break to form scabs or crusts
Wickham Striae
Not Contageous
Precipitated by:
Hep C Infection
Flu Vaccine
Chemical exposure
Pain Relievers
Meds for Heart disease, HBP or arthritis
Increased risk of oral CA with oral or mucosal involvement
Scalp involvement can lead to scarring and hair loss
-tx:
-Corticosteroids
Hydroxychloroquine (Plaquenil)
Metronidazole (Flagyl)
Immune response medicines (Cellcept, Cyclosporine, methotrexate)
Antihistamines relieve itching
Photothrerapy (UVB)
Retinoids
eczema
-generictermforinflammatoryconditionsoftheskin,particularlywithvesiculationintheacutestage,typicallyerythematous,edematous,papular,andcrusting;followedoftenbylichenificationandscalingand
occasionallybyduskinessoftheerythemaand,infrequently,hyperpigmentation;oftenaccompaniedbysensationsof itchingandburning;thevesiclesformbyintraepidermalspongiosis;oftenhereditary andassociatedwithallergicrhinitisandasthma
eczema - atopic
Inflammatory Skin Condition
Dry itchy skin
Rashy patches
Blisters
Skin infections
common types of eczema
-Atopic
-Contact Dermatitis
-Dyshidrotic
-Hand Eczema
-Nummular
-Seborrheic Dermatitis
-Stasis Dermatitis- thinning skin, shins, pale, blood vessels
different causes of eczema
-Interaction Between Genes and Environment
-Switches on the Immune system
-Genetic Component – Protein Filaggrin deficiency*
-Triggers -
-Dry air
-Soaps
-Chemicals
-Fabrics
-Fragrance
-Emotional Stress!
eczema treatment
Topicals - Steroids, emollients
Bleach Baths
Imuno suppressants
Biologics
seborrheic dermatitis (not on test)
Red, scaly, greasy, itchy and inflamed skin
In babies, when found in scalp, called cradle cap
Dandruff is a milder form of condition without the inflammatory component
Malassezia yeast is believed to play a role
Not contagious
-not on test
-tx:
Antifungal cream –Ketoconazole
Salicyllic acid
Coal tar
Benzoyle Peroxide
Photo therapy
contact dermatitis
-Irritant and or Allergic
-What have you been doing?
-History
-What do you do for a living?
-Find the cause, cure the disease.
-More than 15,000 things that touch the skin can cause a reaction
-With PI look for linear presentation
-lines of condition on body -> water drips down and spreads
-tx:
-Figure out cause and STOP or avoid
-Steroid creams
-Oral steroids NOT short course
-Steroid shot (IM)
-Calamine lotion
-Oral antihistamines are not suggested for PI
drug eruptions
History Is SO important!*
Adverse drug eruption of the skin
Wheals or hives
Migratory
Pruritic
Can form plaques
Sometimes skin biopsy is necessary
-tx:
-Discontinuation of offending drug
-Antihistamines
-Steroids oral and topical
-Should be considered in any unexplained skin rash
-Base diagnosis on clinical observation
-Make sure to get a DETAILED history of prescription meds, OTC meds and supplements
acne
Acne Vulgaris
Presence of open and closed comedones, pustules, nodules, papules, and cysts of the skin
Socially debilitating Acne Vulgaris
Presence of open and closed comedones, pustules, nodules, papules, and cysts of the skin
Socially debilitating
Association with teenage depression
Mild Moderate and Severe
difference between wheel and hive
-hives disappear in a few hours
-wheels last longer
causes of acne
Excess oil
Clogged hair follicles (hyperkeratinization and obstruction)
Bacteria (c-Acnes involved in pathogenesis)
Friction or pressure on skin (helmets cellphones tight collars)
Most common skin disorder
Often appears during changes of hormone levels (rise in androgen levels)
Also common in adults
Genetic component
Possible smoking link
Things that worsen, not cause…
Stress
Chocolate!!!
Dairy
Certain oils found in hair and skincare products
treatment of acne
MILD
OTC meds containing benzoyl peroxide
Salicytic acids
Sulfur
Azeleic acids
Retinols
Also RX meds containing more of above
MODERATE - SEVERE
Moderate to Severe (RX plus)
Oral antibiotics
Females-Spironolactone (anti androgenic)
Oral contraceptives for females
Isotretinoin-Accutane
rosacea
-Flushing/Telangiectasia, enlarged oil glands, pustules and burning heat sensation
-3 Stages:
I. Flushing and diffuse redness
II. Add pustules papules and enlarged oil glands
III. Rhinophyma (most women don’t progress to this stage)**- large nose -> lasers
Accutane side effects
-no acutane with antibiotic of any other oral medications -> swelling of brain
baby acne
-no retinol
treatments for rosecea
-Metronidazole
-Azelaic acid
-Topical Ivermectin
-Lasers
-Topicals that reduce redness by constricting blood vessels
-Sodium Sulfacetamide for pustules
folliculitis
-Inflammation/infection of hair follicle
-Usually caused by bacterial or fungal infection
-Papules, pustules common
-Sweat (Staph or Pityrosporum)
-Hot tubs (pseudomonas)
-Shaving (pseudofolliculitis barbae)
-tx:
-Antibacterial soaps
Antibiotics oral and topical
Antifungals
Mupirocin
Warm compresses
erythema multiforme ***
Relatively common
Commonly associated with a preceding Herpes simplex infection, Mycoplasma Pneumonia and respiratory infections
Many other causes such as
Infectious agents
Allergens
Drugs-sulfas/phenytoin/barbituates/PCN
Connective tissue diseases
X-ray therapy
Pregnancy
Internal malignancies
Target Lesions-papules macules and sometimes vesicles
Dusky red, round maculopapules appearing suddenly in symmetric pattern
Backs of hands, feet, extensor surfaces of forearms and legs
Target lesions “Iris” with centrifugal spread
Unlike hives, lesions all mostly same sized
Bullae and erosions may present in the oral cavity
-tx:
-Mild cases not treated
-Topical steroids- no oral due to Herpetic factor
-With Herpes infection, oral acyclovir may be given as prevention for reoccurring cases
-May progress to SJS or TEN **
Toxic Erythema Necrolysis (TEN)>30%BSASteven Johnsons Syndrome (SJS) <10%BSA
Variants of the same condition
Rare, acute serious and potentially fatal reaction to a medication
Horrible blisters usually caused by drugs- antibiotics, anti-seizure meds and allopurinol and steroids
Sheet like skin and mucosal loss
Common in HIV infections
200+ medications associated
-Clinical Features
Fever >39*c
Sore throat difficult swallowing
Runny nose and cough
Conjunctivitis
Aches and pains
Abrupt onset of tender painful red skin rash beginning on trunk
Blisters form and merge to form sheets of skin detachment
-tx:
Stop Causative agent
Transfer to burn center
Other treatments –steroids, antibiotics IVIG all somewhat controversal
alopecia- androgenic (NOT ON TEST)
Males- Premature loss of hair in crown of scalp
polygenic
Gradual not abrupt
Minoxidil
Propecia blocks 5a reductase
Decreased libido erectile disfunction
Contra indicated in women
Females diffuse hair thinning central scalp
Polygenic
Gradual not abrupt
Minoxidil
alopecia areata (not on test)
Rapid onset of total hair loss in a sharply defined area (usually 1-4cm)
MC found children and young adults
Stress?
Lab tests
Thyroid, anemia, sex hormones,
Biopsy
-Treatment:
Topical steroids
Intradermal injections
onychomycosis
Distal subungal MC type
Many different species of fungus
Fungus infiltrates and causes the nail to lift off the nail bed
Trauma
Trichophyton Mentagraphytes- White fungus
Candida Albicans- yellow and brownish fungus
In proximal nail fungus T Rubrum is MC cause (AIDS)
-Treatment:
Topical anti fungals - Ciclopirox
Oral antifungals such as Lamisil, Sporonox, fluconazole -> worry about liver
Keep nails short
With orals, check liver function before and after treatment
cellulitis***
-non necrotizing inflammation of the skin and sub cutaneous tissue
-Breach in the skin- need a point of entry*
Erythema
Pain
Swelling
Warmth
-Lymphangitic spread - streak up arm **
-Treatment:
Cool compresses
Elevation (if leg involment)
Antibiotics aimed at staph and strep
erysipelas
Inflammatory form of Cellulitis
Lymphatic involvement (streaking)
More superficial
Malaise, fever chills
Well defined margins abrupt onset
Causative agent is mostly Streptococci
Also S. aurius, Pneumococcus organisms and Klebsiella
TREAT WITH Penicillin
impetigo**
Common
Contagious
Superficial
Strep or Staph aureus or combo*
After trauma or on normal skin
Bullous and non bullous (crusted)
Staph can colonize nose
MRSA
-honey colored crust
-tx:**
Mupirocin (Bactroban) ointment
Oral antibiotics
Watch out for post Streptococcal
Glomerulonephritis and nephritis
Serious secondary infections (infants)
HSV 1 and 2**
HSV 1:
Most people have been exposed
Skin to skin contact
Viral shedding when there are no active sores
Kissing, Sharing utensils…
HSV 2:
20% sexually active adults carry
Female
Have other sexually transmitted
Diseases
Weakened immune system
hsv triggers
Triggers
Stress
Illness
Fever
Sun exposure
Menstruation
Surgery
-tx:
Famvir
Zovirax cream
Valtrex
For frequent infections you can prophalax with an antiviral
Valtrex
Cold sores 2 grams 2x a day for 1 day
Genital Herpes 1 gram 2x a day for 10 days
molluscum contagiosum
Benign
Lesions that appear anywhere on the body
White, pink or flesh colored
Umbilicated
Itchy, red sore and swollen
Highly contagious
-pox virus*
-tx:
Cryotherapy (oweeeeeee)
Cantharone
Podophyllin
Acids
Retin A
imiquimod
-trigger inflammatory casade
zoster
Reactivation of the Chickenpox virus
Virus lives in the dorsal nerve root and becomes activated
Stress?
Illness
Imuno compromised
Infection follows lines of Langer
Rarely crosses midline!
-tx:
Famciclovir 500mg po q 8hrs x 7 days
Acyclovir 800mg po q 4 hrs x 7-10 days
Valacyclovir 1000mg po q3x a day x 7 days
Pain meds prn
PHN- Post Herpetic Neuralgia
malignant neoplasms- BCC
Most common form of primary cutaneous malignancy
Can occur at any age but primarily after 40
Rare in Asian and African Americans
Variants- nodular, pigmented, superficial, morpheaform
Pink or whitish pearly papule with underlying telangectasias
BCC treatment
Goal of treatment is to eradicate tumor
If criteria met, MOHS surgery is gold standard for removal
EDC
Topical chemotherapy
Imiquimode- a topical immune-activating medication
Risk factors include…
Light skin
Sunburns
Radiation
No genetic component but runs in families because of behaviorial practices
squamous cell carcinoma
-Invasive primary cutaneous malignancy-can be deadly
Primarily caused by accumulated UV light exposure
Other factors include
Radiation
Chemicals- hydrocarbons, arsenic
Tobacco
Burns
Hpv infections
Spread within skin and lymph system
Preceded by ACTINIC KERATOSES
SCC treatment
MOHS surgery is most effective but not fool proof
SCC’s can have “skip areas”
Lymph node biopsy for invasive types
Radiation therapy when surgical resection is not feasible
Immunotherapy- Cetuximab
melanoma
Increasingly common malignancy of melanocytes
Incidence continues to rise at a faster rate than any other cancer
Factors that increase risks
Fair skin (Types I ans II)
Atypical nevi
Personal or family hx of Melanoma
Hx of Blistering sunburns
Early signs include:
Change in existing mole size,shape and color
Itching
Tenderness
Bleeding
Ulceration
No one size shape or color is diagnostic
tx:
Biopsy Biopsy Biopsy (Punch)
Pathology will show Clarks Level or Breslow level
The Thinner the Melanoma, better!
Re excision of biopsy with appropriate margins
Lymph node dissection
Interferon-2a for stage II and III
Targeted immunotherapy advances
difference between HSV and zoster treatment
-dose
parkland formula
-1-2 questions
-body %
