Derm Test 1 Flashcards
Acne Vulgaris Story
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.
Atopic Derm
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.
Atopic Derm Story
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.
Nummular Eczema
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).
Nummular Eczema Story
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.
Dyshidrotic Eczema
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.
Dyshidrotic Eczema Story
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.
Contact Derm
Contact Dermatitis – Acute/Chronic inflammatory reactions to substances – Irritant (diaper) or Allergic (poison Ivy/metals).
Allergic Contact Derm
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.
Allergic Contact Derm Story
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.
Irritant Contact Derm
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.
Irritant Contact Derm Story
Rubbing is racing, but also rashing, it leads to red scaley scratches, but there are no allergens. Don’t rub, don’t rash.
Diaper Derm
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.
Perioral Derm
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
Stasis Derm
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.
Seborrheic Derm
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).
Lichen Simplex Chronicus
Neurodermatitis
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
Molluscum Contagiosum
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.
Non-Genital Verruca (Warts)
> 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.
Veruca Vulgaris (Common Wart)
Ages 5-20
Risk with Frequent Water exposure
Usually on Hands/palms/periungual/nail folds
Pinpoint to >1cm papules with rough grayish surface
Veruca Plana (Flat Wart)
Children and young adults
2-4mm flat-topped flesh-coloured papules
Grouped together on face/neck/wrists/hands
Verruca Plantaris (Plantar Wart)
Appear anywhere on the sole, but classically at pressure points on ball/heel. Sometimes grouped or several contiguous “Mosaic Wart”
Dermatophyte Infections
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).
Tinea Versicolor
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)
