Derm Test 1 Flashcards

1
Q

Acne Vulgaris Story

A

Acne Vulgaris is Androgenous (Both young men and women and adults) Mostly men, because androgenopus men can be women, Follicles are inflamed, Hyper(keratinization) Cuti(bacterium) Seabums. More seabums mean more Cutis. There are closed white Keratin doors, and open black melanin doors that lead to worse conditions. Don’t be to quick to judge, PCOS hyperandrogenous people can also be like cuti Kids. (check the Endos). Careful of drugs, thin skin and heavy metal can lead to more cutis. In class we have black and white doors (no red), Red doors, and the Super Red Head, ScarN.

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2
Q

Atopic Derm

A

IgE – Itch that rashes – Flexor, Neck, Eyelids, Face, Dorsum (hands/Feet), inguinal – Pruitic (caused by Mast Cells and Basophils) – Triggered by environment etc - Hyperkeratosis, acanthosis, and excoriation are common – 60% of cases in first year of life – May become generalized, scaley, red. Occasionally oozing plaques – Symmetric – post inflammatory hyper/hypo pigmentation – Xerosis (rough dry skin), Dennie-Morgan lines (extra line below eyelid), Hyperlinear Palmar Creases (extra palm crease)

Differential = Contact Derm, Scabies, Psoriasis

Tretament = Topical steroids (Creams aesthetic but dry, Ointments/Gels potent but greasy), Antihistamines, Topical immunomodulators (tacrolimus etc), PDE4 Inhibititors, Biologics, PO antibiotics (if secondary infection), Avoid Triggers, bathe with Cetaphil, use Emolients.

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3
Q

Atopic Derm Story

A

Atopic Derm, The inspector General (IgE) of rashes, gets in all the Flexor creases to scratch that itchy Mast Base. If you Trigger him he can be rough and Picky for the first year. His office plaque is a Red Oozy Scale that mirrors itself. His assistant Dennie-Morgan has shifty eyes, but thick hands. Sometimes he’s mistaken for his Brother Contact, but he deosn’t have scabies or Sore Eyes. He likes to stay on top with steoids and immunemodulators, and occasionally takes an antihistamine. He has sensativeskin, so its best if he bathes with Cetaphil and moisturizes.

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4
Q

Nummular Eczema

A

Nummular Eczema – Coin Shaped (often clustered) patches/plaques (often in Atopic PTs), may clear centrally – Legs – Hyper/Hypo pigmentation

Diagnosis = Clin Appearance and negative KOH

Differential = Tinea Corporis or +KOH fungal

Treatment= Topical Steroid (acute = intermediate strength, Chronic =less potent).

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5
Q

Nummular Eczema Story

A

Nummular Eczema works for the IgE of Rashes. He mostly puts coins on the legs, sometimes he also throws rings, He’s easy to recognize he doesn’t hang out with KOH like the Fungus does. The Tinea Corps and the KOH crew try to impersonate him. He also stays on Top with Steroids.

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6
Q

Dyshidrotic Eczema

A

Dyshidrotic Eczema – (Hidden Sweat/Wet Eczema) – Vesicles just under the skin – Appear on hands and feet – Pruitic

Treatment = Cetaphil, Emolient/protective gloves to avoid irritants, Burow’s solution (antibacterial astringent), Topical corticosteroids (high/med), Topical Immunomodulators.

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7
Q

Dyshidrotic Eczema Story

A

Dyshidrotic Eczema – Pools hidden under the Keratin sky. They make your hands and feet itch, so you need to clean them with Cetaphil or Burow in to drain the water. Top steroids and immunomodulators are waiting to go.

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8
Q

Contact Derm

A

Contact Dermatitis – Acute/Chronic inflammatory reactions to substances – Irritant (diaper) or Allergic (poison Ivy/metals).

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9
Q

Allergic Contact Derm

A

Allergic Contact Dermatitis – Type IV delayed Hypersensitivity to allergen – Well demarcated linear pruritic rash at contact site – Itching/Burning (linear “juicy” papules/vesicles for plant)

Differential = Herpes Zoster

Treatment= Remove allergen, cool shower, Burow’s solution, Potent/Super potent Topical Steroids, Systemic steroid in severe case.

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10
Q

Allergic Contact Derm Story

A

IV allergen users build clearly bordered greenhouses filled with juicy plants. Don’t mix these up with shingled homes. Make sure to avoid the Juicy Allergens if you visit, if they get to close rinse off ot dry out in a burrow. Top Steroid users and Super Top steroid users sometimes aren’t enough, be ready to go systemic.

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11
Q

Irritant Contact Derm

A

Direct toxic reaction to rubbing/friction/maceration or exposure chem/thermal – Erythematous/scaley/eczematous not caused by allergen

Diagnosis = HX and r/o allergic derm

Treatment = avoid agent or contact.

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12
Q

Irritant Contact Derm Story

A

Rubbing is racing, but also rashing, it leads to red scaley scratches, but there are no allergens. Don’t rub, don’t rash.

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13
Q

Diaper Derm

A

Erythema/scale/papules/plaques (can ulcerate if untreated) caused by overhydration/chafing/soaps/urine/feces in the area covered by a diaper – spares the creases

Treatment = Zinc Oxide ointment, diaper changes, OTC hydrocortisone

**look for beefy red skin, may indicate presence of Candida Albicans.

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14
Q

Perioral Derm

A

Occurs in young women/children

Clustered papulopustules w/erythematous base, may have scales - Found around mouth

May be related to epidermal barrier dysfunction/induced by top steroids/hormonal changes/cosmetics

Treatment = Top Antibiotics - Metronidazole/erythromycin or Oral mino/doxycycline (severe cases)

**Avoid Top Steroids

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15
Q

Stasis Derm

A

Eczematous eruption on lower legs( due to venous insufficiency) starts as scale develops erythema/edema/erosions/crusts/ secondaryinfection. Can Hyperpigment with thickened skin “woody” appearance, can ulcerate.

Patho = Bad Valves=>secr. venous return=> increased hydrostatic pressure=> edema=> tissue hypoxia. (often seen in women w/predisposition to varicosities)

Treatment = Compression stockings, Burow’s Solution, Mod Top Steroid, Secondary infection with Abx (Keflex)

Bad Veins, Bad Pressure, Bad Legs, Bad Rash, Bad Ulcers, Compress/Astringe/Steroid.

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16
Q

Seborrheic Derm

A

Inflam Derm caused by yeast P. Ovale. Pruritic yellow/gray scaley macules with “greasy look” distributed over sebaceous areas scalp/face/body folds. Cradle Cap/Dandruff.

Treatment = Scalp (Zinc/Ketoconazole shampoo) Face, intertriginous areas (low Pot Top Steroids Desonide/Valisone cream).

17
Q

Lichen Simplex Chronicus

Neurodermatitis

A

Chronic solitary/pruritic eczematous eruption caused by rubbing/scratching.

Focal plaque/Multiple plaques on the nape of neck/vulvae/scrotum/wrist/extensor forearms/ankles/pretibial areas/groin.

Differential = Tinea Cruris/Candidas, Inverse Psoriasis if in inguinal creases perianal area.

Diagnosis = Apparent based on clinical grounds.

Treatment = Intermediate Strength Top Steroid (triamcinolone), Occlusion. Oral Antihistamines, Immunomodulators.

Unilateral

18
Q

Molluscum Contagiosum

A

Common Peds Virus (Poxvirus MCV-1-4) affecting Young Children/sexually active adults/Immunosuppressed - Transmitted by skin to skin (easily in pools), gym equip, Autoinnoculation - Virus replicated in epithelial cells.

Non Pruritic flesh-coloured dome-shaped papule (3-6mm) - Curd like material may be expressed - Classicly over face/trunk/extremities/groin, but can be anywhere.

Differential = Warts/milia

Diag = Clin exam/Hx, Punch Biopsy

Treatment = Usually not needed - resolves in months to years - Non-FDA Tx Topical cantharadin, Cryotherapy - irritate the skin to initiate immune system in the area.

19
Q

Non-Genital Verruca (Warts)

A

> 100 HPVs - Most HPV types cause specific Wart types favoring certain locations, others can be anywhere - Infection may be visible, seen with aided exam, or latent.

Diag = Clin Exam/Punch Biopsy

Tx = No Tx is an option 65% of warts regress within 2 years - Tx recommended for extensive/spreading/symptomatic warts or warts present for more than 2 years. - Cryotherapy/Salicylic acid/Occlusive dressing/Intralesional injection of Bleomycin.

20
Q

Veruca Vulgaris (Common Wart)

A

Ages 5-20

Risk with Frequent Water exposure

Usually on Hands/palms/periungual/nail folds

Pinpoint to >1cm papules with rough grayish surface

21
Q

Veruca Plana (Flat Wart)

A

Children and young adults

2-4mm flat-topped flesh-coloured papules

Grouped together on face/neck/wrists/hands

22
Q

Verruca Plantaris (Plantar Wart)

A

Appear anywhere on the sole, but classically at pressure points on ball/heel. Sometimes grouped or several contiguous “Mosaic Wart

23
Q

Dermatophyte Infections

A

Superficial fungi - germinate on dead outer horny layer of skin - Results in epidermal scale (Tinea Pedis/Versicolor), thickened Crumbly nails (Onychomycosis), Hair loss (Tinea Capitis).

24
Q

Tinea Versicolor

A

Malassezia Furfur (yeast) - Common in Humid Climates - Hypo/hyper pigmented macules that do not tan. - PT is asymptomatic notices during the summer - Well defined round macules with scaling on trunk/arms or Face.

Diag = KOH scraping show Hyphae and Spores (Spaghetti & Meatballs), Wood’s light fluorescence an orange mustard color.

Differential = Vitiligo (complete depigment, no scale)

Tx = Daily Selenium sulfide shampoo 15 mins x 7 days

Topical Ketoconazole QD x 3W

Oral Ketoconazole 200 mg QD x 2W (watch LFTs)

25
Q

Tinea Corporis (Ring Worm)

A

Contact w/Organism increased incidence with Wrestlers. Pruritic or asymptomatic Scaley annular lesion peripheral enlargement with central clearing. “Active border”, Asymmetric distribution face/trunk/extremities.

Diag = +KOH or fungal cultures

Differential = Acute Lyme (Erythema w/out scale, target lesion)

Tx = Topical Antifungals, Naftin/Ketonocazole cream BID x 2W

26
Q

Tinea Pedis

A

Young Men - Pruritic feet (may have inflammation/fissures) scale/maceration in toe web spaces as well as “moccasin” distribution on plantar surface Distinct borders.

Diag = KOH+ or fungal cultures

Tx = Keep foot dry, Miconazole powder, Top Antifungals (Naftin/Ketoconazole/Lortrimine) BID, Lostrisone cream x 1W (steroid+antifungal) if severe.

27
Q

Vitiligo

A

Autoimmune destruction of Melanocytes (mostly idiopathic), Anyone any time hypopigmentation macules may occur focally, generalized pattern (hair in areas becomes white)

Diag = Clinical or Punch Biopsy, Wood’s Light shows milky white appearance

Tx = Sunscreen, avoid sun (high risk of skin cancer), Immunomodulators, Excimer laser.

28
Q

Varicella

Chickenpox

(Varicella Zoster Virus)

A

90% occur in children <10, but teen disease in tropics - 10-21 day incubation - Transmission by direct contact with lesion and respiratory route - infectious 4 days before and 5 days after appearance of rash. Self-limiting in healthy kids morbidity increases in adults/immunocompromised.

Rash/Malaise/Low-grade temp, initially faint macules that develop into vesicular eruptions “teardrop” vesicles on an erythematous base. Starts on scalp/face/trunk, then spreads to extremities palms/soles. New vesicles appear for a few days starting on trunk/face/oral mucosa. They are pruritic become pustular then crusted. Crusted lesion not infections. Beware secondary staph or strp infection, adult PTs risk pneumonia.

Diag = Clinical, Tzank smear from vesicle show multinucleated giant cells

Tx - Healthy Children (<13) - Supportive, Oatmeal baths/Calamine lotion/Antihistamines, avoid ASA (Reyes)

Immunocompetent Adults (>13) - Oral Acyclovir within 24H of onset (dec severity/duration) for 5 days.

Immunocompromised - IV acyclovir

Immunization = Single dose for children 1-12, >13 should receive 2 4-8 weeks apart.

29
Q

Herpes Zoster

Shingles

A

Reactivation of VZV (Chicken pox), dormant in sensory dorsal root ganglion (DRG) cells - Inflammation in DRG w/ hemorrhagic necrosis of nerve cells resulting in neuronal loss/fibrosis - Rash corresponds to the sensory fields infected - Incidence increases age >50 4% have recurrence.

Pain precedes rash - 55% thoracic, 20% cranial, 15% lumbar, 5% sacral - Burning, electrical, throbbing pain, mild to severe. Lesions classically unilateral, can be disseminated in immunocompromised - Papules/Plaques of erythema develope into vesicles may become hemorrhagic or bullous - New lesions for 1-5 days. 2-3 weeks duration (6 in elderly) - Rarely may have pain with no lesion.

Hutchinson’s sign” = lesions on he side and tip of nose indicates Ophthalmic division of trigeminal - PT needs ophthalmologist due to complications of retinal necrosis, glaucoma, and optic neuritis.

Differential = Angina Pectoris, Plant Derm - Impetigo, Biliart or renal colic, appendicitis

Diag = Clinical upon lesion appearance, Tzanck Smear

Tx = Antiviral w/in 3-4 days => rapid resolution of lesions/pain (Valacyclovir or famciclovir x7 days), Prednisone, Domboro solution, Pain management (APAP/NSAIDS/Narc/Lidoderm patch)

Vaccine = Zostervax >60

Complications = Post herpetic neuralgia (Pain continues past one month), refer to Neuro for Neurtonin, tricyclic antidepressants, Gabapentin.

30
Q

Herpes Simplex

A

HSV1 (Oro-labial) - HSV2 (genital) >30% of adults have HSV1 - Initial exposure through secretions (sexual oral/genital, Autoinoculation (Herpetic Whitlow i.e. finger to lip), Vertical mother to baby) - Lifelong infection - Virus loc HSV1 (trigeminal ganglia) HSV2 (Presacral ganglia)

Replication/shedding can be asymptomatic - present prior to lesion remains until healed - Incubation 2-20 days - Recurrences correlate to # neurons infected - Triggered stress/menses/fever/infection/sunlight - Risk inc with more partners/early first sex.

Primary infection may be asymptomatic - Prodrome of fever, myalgia, malaise - Orolabial grouped vesicles/blisters “cold sore” last 1-2 weeks Reoccur precedes with tingling/itchiness - Genital grouped blisters/erosions on vag/rectum/penis into new blisters 1-2 weeks - Herpetic Whitlow occurring on the fingers periungual tender deep-seated blisters.

Diag = Fluorescent Antibody test/Western blot (diff HSV 1 &2) Tzank Smeak (Giant Nucleated Cells)

Tx = No cure, Decrease duration/symptom/shedding.

Primary - Acyclovir 200mg 5x a day FXD, Valacyclovir 1gm bid FXD

Suppressive: >9 cases a year - Acyclovir 400 mg bid, Valtres 1gr QD

Recurrent: <24 hrs of onset - Acyclovir 400mg TID x 5 days, Valtrex 2gm BID x 1 day

31
Q

Paronychia

A

INflammatory reaction in folds around fingernail - Starts with skin break associated with eponychium/nail fold trauma, and maceration of proximal nail fold.

Acute (manicure/nailbiting, usually Gram+ Staph A.) - Erythema/Swelling/Pain starting as red/warm/painful swelling around nail - may form pus separating skin from nail.

Chronic (frequent handwashing/water contact, Pseudomonas A. or Candida A.) - Swollen/erythematous/tender without fluctuance, nail may become thickened w/ transverse ridges, lasts 6 or more weeks.

Differential = Herpetic whitlow

Diag = Fluctuant Paronychia (usually bacterial) culture, gram stain, KOH wet mounts (hyphae indicating yeast in chronic), Clinical Hx, PE

Tx = Acute - Warm water soak 3-4 x a day, PO Abx for Gr+ Staph A. (Augmentin 2gm x 5 days), Top Steroid cream, I&D if abcessed.

Chronic - Avoid inciting factor (water/manicure) Warm Soaks, Topical Cream/Antifungal (Spectazole)

32
Q

Onychomycosis

A

Infection of finger/toe nail by yeast or fungi - most common w/ other nail problems (nail trauma, immunocompromised, vascular insuf, Downs) - Hands (T. mentagrophytes), Feet (C. albicans) - Nail thickening and subungual hyperkeratosis (scale build up), nail distrophy or onycholysis (nail plate elevation from nail bed) - usually asymptomatic.

Diag = KOH+ or fungal/yeast culture

Tx = Non Tx ok, Topicals ineffective (Penlac Lacquer/ciclopirox solution, Jublia/efinaconazole solution), Oral (Lamisil 250mg qd x 6-12w) cure rate <40% (check LFTs before/after)