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Clin Med I > Derm Tx > Flashcards

Derm Tx Flashcards

1
Q

Atopic Dermatitis Tx

A
  1. Education: to avoid exacerbating factors and hydrate the skin
    - vasline is best or other ltion -BID and after bathing
  2. Topical Corticosteroid
    -mild: low potency 1-2x per day x2-4 wks
    -moderate: med-high pot
    -acute: med-very high pot for up to 2wks then replaced with lower potency.
  3. Topical Calcinereurin Inhibitors -
    Pimecrolimus(Elidel) cream and Tacrolimus(protopic)
    -steroid sparing and antiinflammatory because they imped production of proinflammatory cytokines.
    -.1% for adults
    -.03% for 2-15
    -BID for mild eczema on face, eyelids, skin folds
    -2-3x per week for maintanance
    may have bruning or itching during the first week of use
  4. Oral antihistamines prn pruitis, antibiotics for 2nd infection, oral steroids for severe or wide spread cases.
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2
Q

Topical Corticosteroid warning

A

Face, groin, and skin folds have higher absoprtion so use caution when applying to those locations
-skin atropy, rosacea, striae, bruisng, telangiectasis, hypertrichosis

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3
Q

Lichen Simplex Chronicus Tx

A

Want patient to stop the rubbing!
1. High Potency topical steroid
then:
2. Moisturizers
3. Antidepressants: Paroxetine(paxil) or Sertraline(zoloft)
4. for nocturnal pruritis: 1st gen antihistamine, hydroxyzine(Visatril) or Tricyclic antidepressent

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4
Q

Dyshidrotic Eczema Tx

A

Primary:
1. Reassurance -usually resolve in 2-3wks
2. Topical Steroids (maybe at night with occlusion)
Secon:
3. Wet dressings (burow’s soaks)

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5
Q

Keratosis Pilaris Tx

A

No really good treatment

pt. may try: exfoliating scrubs, topical retnoid, salicylic acid, alpha-hydroxy acids

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6
Q

Contact Dermatitis Tx

A

Discontinue exposure or decrease hand washing
and wear protective clothing
- use a bland emollient like vasaline or aquaphor
*Topical corticosteroid 1-2 days x 7-14days
or oral corticosteroid if on face or more than 20% of the body

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7
Q

Tx for common cutaneous drug reactions

A

Discontinue drug!!!
-sytemic corticosteroids to come the immune system
-topical steroids or antihistamines prn for pruitis
-cousel to avoid crossreactive drugs in the future
Typically resolved in 5-14 days
may be left with post inflammatory hyper-pigmentation

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8
Q

SJS and TEN Tx:

A 
Discontinue Medication!!!!
Hospital admission if severe usually to ICU or Burn Unite
Supportive care:
-nutritional and fluid replacement( B/C mouth sores)
-Temperature maintance
-Pain relief
-Occular managment 
-Wound care and sterile handling
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9
Q

Tinea Capitis at risk populations

A

Children, african americans, homeless, poor hygeine, low SES, and overcrowding

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10
Q

Tinea Capitus Cause/Presentation

A

Fingual infection (Trichophyton/Microsprorin)
From direct contact
-Scaly patches with alopecia
-black dots with alopecia
-widespread scaling with subtle hair loss
- Kerion
-Favus (multiple cup shaped yellow crusts): usually with immunocomp pt.

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11
Q

Tinea Capitus Associated Signs

A

Cervical adenopathy, Dermatophydid reaction ( eczema like,in response to treatment), and rerely erythema nodosum (tender nodules)

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12
Q

Tin Cap Dx

A

KOH prep, physical exam, culture, dermascope,woods lamp

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13
Q

Tin Cap Tx

A

Systematic antifungal therapy

  1. Griseofulvin x 6-12wks for microsporin or empiric tx
  2. Terbinafine x2-4wks if tricophyton
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14
Q

Tine Corporis Risk factors

A

Cargivers of children c tinea cap
athletes with skin contact (tinea corporis gladiatroum)
immunocomp

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15
Q

Tinea Corporis Presentation

A

Pruritic, annular, erythematous plaque

with a central clearing , raised advancing border

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16
Q

Tinea corp,cruris,pedis Dx

A

Physical exam. KOH prep, and culture

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17
Q

Tinea Corp,Cruris,Pedis Pharm Tx

A

Topical antifungus
-Cotrimazole at least 2 wks (4wks if pedis)
Systemic only in special circum
-Intraconazole

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18
Q

Improper treatment of Tinea infections can lead to what?

A

Usually if you accidentally use steroids

  • Tinea Ingognito
  • Mojpcchi’s granuloma
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19
Q

Tinea Cruris Risk factors

A

Male, sweaty/humid, obese/skinfolds, athletes foot, and occulusive clothing

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20
Q

Tinea Cruris Presentation

A

Begins at the inguina folds
well marginated, scaly, annular, with raised border
scrotum is typically spared
-Pruritis, pain

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21
Q

Tinea Cruris tx non Pharm

A

Drying powder, avoid tight clothing, weightloss

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22
Q

Tinea Pedis Risk Factors

A

occlusive footwear, communal baths or showers

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23
Q

Acute Tinea Pedis presentation

A

self limited, intermittnet, recurrent infection

  • itchy/pain vessicles following sweating
  • secondary staph infections may occur*
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24
Q

Chronic Tinea Pedis Presentation

A

slowly progressive that may persist indefinatly

  • erosions between the toes (oft bw 3-4)
  • interdigital fissures
  • May progress to Mocassin Ringworm (along the whole bttom of the foot, with shapr demarcations of accumulated scale
  • Tinea Manuum ( two feet one hand)
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25
Q

Tinea Pedis non pharm Tx

A

Burrows wet dressing 20min BID-TID
Treat secondary infections
Food powers, proper footwear

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26
Q

Onycomycosis Etiology

A

Nail infection caused by fungus, yeast, or non-dermatophyte molds
- typically yeast(candida albicans) with fingernails

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27
Q

Onycomycosis Risk factors

A

Old Age, Tinea Pedis, Genetics, Immunodeficiency, Household infection

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28
Q

Onycomycosis Presentation

A

Typically Cosmetic but may be painful

  • brown/yellowing of the nail and nail thickening
    1. Dista Sugungual: most common and starts from distal corner and moves proximal. Distal nail bed may break exposing nail bed
    2. Proximal Subungual: near cutical and extends up usualy seen in immunocomprimised patients
    3. White superficial: begins with dull white spots that will extend out. These spots are soft
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29
Q

Onycomycosis Dx

A

KOH prep, culutre, histopathology

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30
Q

Onycomycosis Tx

A

Not neccessary but considered if Hx of cellulitis, diabetic, desires cosmetic improv, or discomfort

  • topical meds inefffective and high rate of failure
    1. Dermatophye:Oral Terbinafine (6wks fingernails, 12wks toenails
    2. Non-Dermatophyte: oral intraconazole (same duration as above)
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31
Q

What drugs treat both Onycomychosis and Tinea infections

A

Terbinafine- tinea capitus

Intraconazole - other tinea inf

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32
Q

Candidial Interrigo etilogy and Risk Factors

A

infectious or noninfection skin condition of two closely opposed skin surfaces

-moisture, skin friction, immunocompromised

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33
Q

Candidal Interrigo Presentation

A

typically affects the groin,mammary/ab folds, web spaces, and axilla

  • erythemous, maccerated(soggy) palques or errosions
  • sattelite papules/pustules
  • fine peripheral scaling
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34
Q

Candidal Intertrigo Dx

A

-Physical Exam, KOH prep, culutre

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35
Q

Candidal Intertrigo Tx

A

Prevent:
-drying agents, weight loss, address underlying med cond.
Pharm:
Topical x2-4 wks: Nystatin (for yeast)
Syestemic for resistant/severe: Fluconazole 2-5wks

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36
Q

Tinea Versicolor Cause/ Risk Factors

A

Caused by malassezia- normal skin flora of the skin that becomes pathologic
Seen in tropical climates, adolecents/ young adults, hyperhidrosis, genetics, immunosupression
NOT contageous

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37
Q

Tinea Versicolor Presentation

A

Macules, patches/plaques of the trunk and UE, can coalesce, often have fine scale, maybe erythemous

  • often asymptomatic but may be mildly itchy
  • often hypopigemented on dark skin and hyperpigmented on lighter skin
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38
Q

Tinea Versicolor Dx

A

Physical, KOH prep, Woods lamp (sometimes yellow/green flourescense)

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39
Q

Tinea Versicolor Tx

A

Topical
- Clotrimazole (2wk), Selenium sulfide( lotion, foam, shampoo x1wk), or Zinc Pyrinthione shampoos x2wk
Systemic
-oral intraconazole 5-7days
- only insevere cases and failed topical, not used in children
*note pigmentation can persist for months which makes it hard to nknow if the treatment has worked

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40
Q

Scabes etilogy/ risk factors

A

Parasitic infection- sarcoptes scabiei mite

  • female mites and their eggs
  • eggs hatch in 10 days

All groups affectes and it is transfered through direct contact

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41
Q

Scabes Presntation

A

Intial lesion and burrow (pathonomonic)
- locations: groin, rists, waist
severe pruritis which is often morse at night
In immunocomprimised people: Norwgian or crusted scabies
-will have severe fissures and requires oral medication

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42
Q

Scabies Dx

A

-Visualization of the burrow , microscopic identifcation of the mite, eggs, or fecal pellates with dermatoscope

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43
Q

Scabies Tx

A

Permethrin 5%- first treatment and then 2nd dose 10-14 days later
Oral Ivermectin- single dose repeated 2 weeks later

Edu: treat house and close contacts simulaneously, itching may persist for 2 wks( can treat with antihistamines and emoilliants), wash linens under high heat

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44
Q

Pubic Lice etilogy/ presentation

A

Parasites that are larger than Scabies

  • crab louse (phthirus pubis)
  • transmitted through sexual contact
  • presents as itching in the groin or axilla
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45
Q

Pubic Lice Dx/Tx

A

Visualize the lice or nits with a microscope

Tx: Permithrin 1% cream and repeat in 10 days
and treat sexual partners
* often have another type of STI*

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46
Q

Important things to note when diagnosing acne vulgaris

A
  • possible workup for hyperandrogenism for female patients with other sx
  • rapid acne with other signs of virilication may be becuase of ovarian or adrenal tumor
  • medication history may reveal acnes causing medications
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47
Q

Comedonal (non-inf) acne Tx

A

Topical retnoid

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48
Q

Mild papulopustuar and mixed acne Tx
Moderate
Sever

A

BP +/- topical antibiotic and topical retnoid

BP + topical retnoid+ oral abx (tetracycline class)

BP+ top ret+Oabx
OR oral isotrtinoin monotherapy

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49
Q

What acne meds are teratogenic ? What are okay?

A

Topical retnoid and not okay during pregnancy and BP is not really known
- oral erythromycin, topical clindamycin, and topical azelaic acid

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50
Q

Solar Lentigo

A

Age spot or freckles

  • local proliferation of melanocytes and from UV damage
  • well circumscribed
  • brown macules
  • often found in group
  • no treatment required
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51
Q

Seborrheic Keratosis (SK)

A

-benign epidermal lesion proliferation of immature keratinocytes
- usually after age 50
warty, waxy, stuck on apperance
-well circumscribed
-back,head, neck

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52
Q

Irritated SK

A

caused by rubbing of friction of the SK

- may have pruitis, pain, or bleeding

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53
Q

Leser-Trelat sign

A

sudden onset of multiple SK +skin tahs + acanthosis nigrican
- possible associated with GI and Lung cancer

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54
Q

SK eval and managment

A

Dx- clinical presentation and biopsy if necessry

Tx: reassurance and possible removal for some ISKs. Shave off or use cryotherapy.

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55
Q

Keratoacanthoma Presetation

A

rapid growth- 6-8wks

  • round, flesh colored nodule with central keratin plug
  • same risk factors as skin cancer
  • benign but some say it pseudo-malignancy
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56
Q

Karatonacanthoma Managment

A

Majority will resolve on their own in 6-9mo
Difficult Dx: requires biopsy and treatment
- typically excisional biopsy is typically preferred

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57
Q

Actinic Keratosis etiology andRisk Factors

A

AK
“pre cancer” may progress to SCC
M>F
light skin, history of UV exp, immonsuppression, ^age

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58
Q

AK presentation

A
  • Erthematous, scaly/gritty macule or papule
  • may be tender
  • often felt easier than seen
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59
Q

AK dx

A

clinical
dermatoscope
Shave or punch biopsy if unable to differentiate from SCC (>1cm, rapid growth, ulcer)
*if >6mm then we just consider it SCC in situ

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60
Q

AK tx

A

may spont resolve but usually treat anyway
- Cryotherapy or surgical intervention
Field Treatment: if you have multiple lesions
-topical flourouracil cream (preferred)
-Photodynamic therapy (PDT)
-Imiquimod (Aldara)

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61
Q

Basal Cell Carcinoma Etiology

A

Most common type of skin cancer

- arised from the basal layer of the epidermis

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62
Q

BCC presentation

A

nodular

  • flesh colored
  • pearly* papule
  • has telangiectasia*
  • may have central ulcer with *rolled boreder
  • most common on the head and neck
  • may be pink patch to AK or SCC in situ.
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63
Q

BCC tx

A 
Surgical is preffered
-currettage or desiccation
-excision within 4mm margins
-Mohs for high risk or cosmetic 
Nonsurgical
-radiation if poor surgical canidate 
-Imiquimod cream
-5% fluoroiracil cream
-Photdynamic therapy
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64
Q

Squamous cell carcinoma etilogy

A

2nd most common
-originated from keeratinocytes and AK
M>F
- can arise from previous area of skin injuries like scars

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65
Q

SCC presentation

A

papule, plaque, nodule
- not as sandpapery as a AK
pink, red, skin colored
- get a scaly appearance, friable, indurated
-not as nice of a border
-often asymptomatic but van be very irritable

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66
Q

SCC tx

A 
Surgical 
- wide excision or mohs 
Non surgical 
- Radiationfor poor surgical canidate or residual tumor
-Curettahe and Desiccation or cryotherapy ( good for SCC in situ which is low risk) 
-5-fluorouracil therapy
-Imiquimod 
-PDT
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67
Q

Malignant Melanoma Etiology + Risk

A

high morbidity and Mortality
>5 atypical nevi or >25 nevi in gen
Risks: fair skin, blue eyes, red/blonde hair, freckling, immunosupression, family history

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68
Q

Melanoma presentaion

A

-usually asymptomatic and arise usually de novo but some can arise from pre-existing nevus
- pigmented papule, plaque, or nodule
ABCDE

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69
Q

Superfiial spreading melanoma

A
  • most common
  • confined to epidermis
  • often in younger pop
  • radial spread> verticle spread
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70
Q

Nodular Melanoma

A

Rapid verticle growth and minimal radial growth

  • very agressive
  • nodule is inflammed and friable
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71
Q

Lentigo Maligna

A

Elderly pt with chronic sun exposure

  • slightly less common
  • slowl progression and usually spead radially and remains superficial
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72
Q

Acrak Lentiginous

A

More in darker skin and AA pop

  • M>F
  • spreads superficial more than verticle
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73
Q

Breslow depth and Melanoma

A

How deep the lesion is related to the prognosis of the skin cancer

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74
Q

Melanoma Tx

A 
Wide surgical clearing -2cm margins
- typically dont use Mohs 
-regional lymph node dissection
If really large or advanced: radiation, chemo, immuno
3mo follow up
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75
Q

Erthymatotelangiectatic rosacea

A

Chronic redness of central face, flushing (wet or dry), skin sensitivity, dry appearance, telangiectasias

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76
Q

Papulopustular rosacea

A

papules and pustules
inflammation can be confluent
but there are no comedones

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77
Q

Phymatous rosacea

A

only rosacea that is more common in men than women

  • tissue hypertrophy causing irregular contours
  • mostly on nose and can involve cheeks, forehead, and chin
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78
Q

Occular rosacea

A

in addition to one of the other 3 types

  • may preceded, coincide, or follow
  • dry eyes, pain, itching, blurry vision, photosensitivity
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79
Q

Erythematotelangiectatic rosacea Tx

A
  1. Modify behavior to avoid triggers, gentle skin care, and avoid sun exposure
  2. Laser pulse light therapy or topical brimonodine (vasoconstrictor)
80
Q

Papulopustular rosacea Tx

A

Mild:

  • metronidazole
  • Azelaic acid
  • then: ivermiectin or sulfacetamide-sulfur
81
Q

Phymatous rosacea Tx

A

Early- Isotretinoin( retinoid)

Advnced- surgical debulking or laser ablation

82
Q

Scorpion sting Grades 1-4

A

1: local pain c paresthesiaa at sting site
2. local symp + remot pain and parasthersias
3. Either cranial nerve or somatic skeletal neuromuscular disfunction
4. Both cranial and somatic skeletal dysfunction

83
Q

Scorpion Sting Dx

A

-clinical
Tap Sign: local pain made worse by tapping near the stinging sight
cranial nerve disfunction: hypersalivation, abnormal eye move, blurred vision, slurred speech, tongue fascicilations
Skeletal dis: fasiculations, shaking or jerking, emprosthotonos (tetanic forward flx), fever

84
Q

Scorpion tx

A 
Pain managment 
cleansing of sting site
tetanus prophylaxis 
observe for 4hrs 
Severe cases:
-treat for respiratory comprimise, MI, Hyperthermia, Rhabdomyolysis, multiple organ failure 
-fentanyl for pain
-IV benzodiazepines 
-Antivenom** cannot use with the benzos
85
Q

Bee sting LLR

A

Rare
- exagerated erythema and swelling
-gradually elnarges over 5-10days
Tx; cold compress and prednisone, antihist, NSAID

86
Q

Bee sting complications

A
  1. Secondary bacterial infection- worsening after 3-5 days of it getting better
  2. Anaphylaxis
    - treat with epinephrine and refer to speciallist
87
Q

Widow bites

A

-found near human habitats
- small local reaction (often no venom inj)
-blanched circular round patch with central punctum
- venom causes catacholamine relase> intermitant radiating pain, ab/chest/back spasm, sweating, HA/N/V
Tx: local wound care, antiemetics, narcotic analgesics, tentanus, muscle relaxers, maybe antivenom

88
Q

Recluse spider bite

A

usually happen indoors
-painless initially> red plaque/papule c central pallor> possible vessiculation
- necrosis can occur +N/V/Ha» rareley renal failur, rhabdo, anemia, hypotension
Tx: cleansing, cold compress, analgesics, antibiotics, surgical excision for necrosis only fter the wound has stabilized

89
Q

Tx of vitiligo

A
  • screen for other autoimmune disorders
    Tx: topical and systemic corticosteroids, calcineurin inhibitors, narrow band UV B phototherapy, skin grafts
  • edu on sunscreen
90
Q

Hidradenitis Supprativa etiology/ risk factors

A

chronic inflammatory skin dis of the hair follicle
female>males usually around 23
genetics, mechanical stress, smoking obesity
from a cycle of occlusion and rupture

91
Q

Hidradenitis Supprativa presentation

A 
Nodules in the axilla and groin
more form as the disease progresses 
may form abscess(collection of pus)
-sinus tracts can form 
-comedomes 
-scaring
92
Q

Hidradenitis Supporativa Dx

A

Clinical based off lesion, location and history of relapse

93
Q

hidradenitis supprativa Tx

A
  1. Lifestyle Mod: avoid skin trauma, hygeine, no smoking, weight managment, diet
  2. Pharm:
    - Topical clindamycin
    -intralesional corticosteroids
    -anti-androgenic agents
    -Surgery ( punch debredment or wide exicion)
    Super sever> TNF inhibitors, oral retnoids
94
Q

Complications asso. c Hidradenitis supprative

A

fistulae, contractures(melted skin appearance), Lymphatic obstruction, infection, SCC, depression

95
Q

Measles Etiology

A

Rubeola
-Virus Paramyxovirus
highly contageous- maintain in an area for 2hrs
spread via cough sneezes, close breathing

96
Q

Measles Clinical Stages

A
  1. Incubation: 2-3 wks - typ asymptomatic
  2. Promodone: anorexia, malaisw, fever 105+
    followed by 3C’s cough, coryza, conjunctivitis
  3. Enanthem: *Koplik spots
  4. Exanthem: blanching and maculopapular
    - starts on face head to toe and spares the hands and the feet
97
Q

Measles Dx

A

Reportable disease!

  • serum and throat swab for histologic analysis
  • serology: measles specific IgM
98
Q

Measles complications

A

Common:
-diarrhea > ottis media
Severe and less common:
-Pneumonia ( common in children), Encephalitis, subacute sclerosing panencephalitis (1-2 yrs later)
High risk: preg, immunocomp, young or old

99
Q

Measles Tx

A 
Symptomatic treatment nly 
- vitamin A may lessen severity 
Patient education
- avoid contact with pregnant women
*vaccination!!!!
100
Q

Erythema Infectiosum Etiology

A

Fifths disease- parovirus B-19

  • transmitted by respiratory secretions
  • common in children
101
Q

Erythema Infectiosum Presentation

A

can last from weeks to years

  1. Incubation : 7-14 day
  2. prodorome: no specific flu sx
    - low grade fver, coryza, HA, Nauseae, diahreeha, malaise, sorethroat
  3. Facial Rash- Slapped Cheek
  4. Body Rash: 2-3 days later
    - lacey rash- paink macular rash on extensor surfces
    - may get polyarthropath (pain in joins)
102
Q

Erthyema indectiosum Dx/ complications

A
  • based on clinical presentation

Compl:

  • transient aplastic crisis
  • in preg: *hydrops fetalis
103
Q

Erthyema Indectiosum managmentn

A

reassurance and tell them to avoid pregnant women

  • will go away on its own
  • a lot of people have already had it
104
Q

Rubella

A

German Measles
Rubella virus
- large particles in the air

105
Q

Rubella presentation

A
  1. Incubation 12-23 days
  2. Prodorone 1-5 days
    - may have rash during
    - low fever, *lymphadenopathy, cold symptoms
  3. Rash appears
    - erythemous papules and purpura- pin point pink
    - can be contageous for 7 days
    * * head to toe progresson**
106
Q

Rubella Dx

A

clinical presentations - often resolve on its own

- may do serology if you cant tell

107
Q

Rubella Complications

A

Congenital rubella syndrome- in pregnant women and is lethal to bany
blue berry muffin rash

108
Q

Rubella Managment

A

treat symptoms and avoid pregnant women

  • rubella titer is drawn at first prenatal visit!
  • prevention via immunization
109
Q

Roseola Infantum etiology

A

Herpes virus 6 is most common

  • infants and younger children
  • transmission is not understood
110
Q

Roseola Infantum present

A
  • high fever that comes and then resolves abruptily
  • then a rash comes out of nowhere
  • this story is very classic
    1incubation: 9-10 days
    2. Prodrome: febrile maybe higher than >105 with abrupt end
    3. Rash: neck to trunk and then it will go toface
  • blanching, pink, maculopapular rash
  • not itchy usually
111
Q

Roseola Infantum Dx/ tx

A

Clinical presentation
- serology is the pt is immunocomprimised

Tx: suppotive treatment -antipyretucs

112
Q

Hand, Foot, and Mouth Disease Etiology

A

Cozsackie A16 virus

  • mostly children 1-5
  • fecal oral or oral respiratory secretions
113
Q

HFM disease presentation

A
  1. incubation: 3-5 days
  2. Prodorome 12-24 hrs
    - no symptoms, fever, fussiness, abdominal pain, diarrhea
  3. Oral enanthem/exanthem- oral more
    - sore throat and vessicles on buccal mucose and toungue
    - vessicles on hands* feet* and buttocks
114
Q

HFM dx/Tx

A

Dx: clinical presentation
- usually by based on location
Tx: symptomatic maybe litocaine gel and prevent with good hygeine

115
Q

Molluscum Contagiosum etiology/risk factors

A

Poxvirus
common in children/ immunocomp
-direct physical contact with fomites (towel, lines etc.) or skin
- can also autoinoculation via scratching or clothing or shaving

116
Q

Molluscum Contagiosum Presentation

A

Lesions: flesh colored and umbilicated
located anywhere except palms and soles!
- usually no associated symptoms
- self limiting but super duper contagious

117
Q

Molluscum Contagiosum Dx/Tx

A

Clinical presentation
Tx: you dont really need treatment
- home: podophyllotoxin cream ( not in preg)
-office: quick cyotherapy, currettage, canatharidin

118
Q

HPV types

A
  1. mucosal: condyloma acuminata

2. Cutaneous: common, plantar, and flat wart

119
Q

HPV condyloma accuminata etiology/pres/Dx/tx

A

genital warts
- most commonanorectal infection in MSM
transmission- sexual contact
Present: cauliflower like lesions, perianal growth, mild pruritis
Dx; clinical presentation may need to evaluate for internal lesions (anoscopy or proctosigmoidoscopy)
Tx: Topical posophyllin, electrocautery, laser, cryother. excision

120
Q

HPV verruca Vulgaris etiology

A 
more common in kids and younger adults 
Common Warts   
-transmission skin to skin contact 
- spont resolution  1-2 yrs 
- reoccurance is common
Present:  raised rough surfaced lesions wih tiny pigmented **thrombosed cappillaries** "seeds". Common on hands and feet.
121
Q

HPV verruca vulgaris dx/tx

A

Dx: clinical presentation- may scrape of with 15 blade to visualize the thrombosed cappilaries
Tx: may spont resolve, salicylic acid, cryotherapy, electrodessication,

122
Q

Varicella etiology/transmission

A

Chicken pox
Varicella Zoster virus- a herpes vaccine
- through aerosolized droplets and is highly contagious
- reoccurance can occur

123
Q

Varicella Presentations/Dx

A
  1. incubations 10-21 days
  2. Prodorome 2-5
    -fever, malaise, paryngitis, anorexia
  3. Rash vesicular rash
    -pruritic
    rash occurs in stages paipule> blister> ulcer Dx: clinical typically but a Tzanck smear will show mononucleated giant cells
124
Q

Varicella complications

A
  • group A strep
  • Encephalitis and reye syndrome (uncommon)
  • most complications occur in immunocomp pt.
125
Q

Varicella tx:

A

sypotomatic treatment

  • contagious until all lesion have crusted over
  • avoid pregnant females!!
  • acyclovir in imminosup pts.
  • vaccines
126
Q

Herpes Zoster presentation

A
  1. Prodrome:
    - acute neuritic pain precedes eruption 3-5 days
    - throbbing stabbing burning senstions
    - itching fever, headade, allodynia
  2. Rash Active
    - development of grouped vessicles on a erythematous base
    - follows dermatome and unilateral most often
    - thoracis distribution most common
127
Q

Herpes Zosters chronic complications

A
  1. . post herpetic nerualgia: lanciating pain that lasts months after resoltution of lesions
  2. Herpes Zosters Qphthlmicus- sight threatening linked to trigemial ganglion
    - begins with sign on nose (hutchinsons sign)
  3. Other retinal problems or nerve palsies
128
Q

Herpes Zosters Tx

A

treat early -72hrs ( lower pain/severity)
Antiviral: Famciclovir 500mg TID 7days
Valacyclovir 1g TID x 7days
- hydration, keep skin clear, pain managment
- NSAIDs, narchotic, topical anesthetics for acute
- Chronic; tricyclic antidepressets, gabapentin, pregablin
* if ocular involvment send right away to an eye doctor (emergency)

129
Q

Herpes Zosters Infectious precautions

A
  • can transmit virus to give someone chickenpox but can not give shingles
  • avoid pregnent women, infants, and immunocomp
  • infectious until crusts have healed
    Prevention: Zostavax or Shingrix** vaccines
  • approved >50 yo and recommended for >60
130
Q

Herpes Symplex Virus -1

-location and transmis.

A

Most common oral- cold sores and transmitted by direct contact during viral shedding
- can have a very severe primary presentation ( Pharygitis, mouth pain, fever )

131
Q

Herpes symplex Virus II

-location and trans.

A

Most often genital

  • sexually transmitted
  • pt may be asymptomatic and still spread the disease
  • genital herpes can also comes from HSV-1
132
Q

HSV presentation

A

Prodrome: burining, tingling, or pruritis
Lesions appear: grouped vesicles on an erythematous base> may crust later
- can have lymphadenopathy

133
Q

HSV dx

A
  1. clinical presentation
  2. Can do viral culture
  3. Direct microscopy via Tzanck smear use wright stain> see giant mononucleated cells ( just pos for herpes)
134
Q

HSV tx

A

Start early!!- 72 hours
Valcyclovir, Famciclovir, or Acyclovir
- can treat before outbreak or chronic suppression which decreases recurrences and asymptomatic sheading

135
Q

Epidermal Inclusion Cyst Presentation/ Tx

A 
epidermpid cyst 
- soft, mobile, often central punctum
- if infected> erythema and pain 
Tx:
- may spontaneously go away but recur often
-kenalog injection, I&D, excision
- if infected then I&D, oral abx
136
Q

Lipomas

A

Composed of adipose tissue and most common soft tissue tumor
Present: soft, mobile, non tender
Tx: surgical removal
- there is a concern of maligncancy with deeper tumors

137
Q

Sarcoma

A

Rare malignant tumor -usually of soft tissue
Presentation: enlarging, painless mass of extremities or trunk
Managment: imaging of primary lesion MRI, core needle biopsy, surgical resection, chest CT to rule out metastasis

138
Q

Seborreheic Dermatitis risk factors

A

infants and then again as teenagers
M>F
in 3rd 4th decade
- cause is unknown but possibly a fungus malessezia furfur

139
Q

Seborrehic Dermatitis presentation

Infants

A

Dandruff
common, chronic, relapsing dandruff or inflammation
- gets worse with stress and when it is cold and dry
Infants: yellow greecy scale “cradal cap” and you will see it in the diaper region and axilla
Adults: erythematous coalescing macules, patches or plaques areas where there is hair, scalp, eybrows
^ with HIV and parkinsons

140
Q

Seborrheic Blepharitis

A

dandruff around the eyelid
- have yellow crust with a greasy appearing flakes and edges are pink
Tx: warm compress and eyelid scrubs

141
Q

Sebhorrheic Dermatitis Dx Tx

A

Clinical diagnosis
Tx: warm compress for cradal cap and baby shampoo. Can use olive oil to losen up
Scalp: antifungal shampoo and topical steroid
Ketoconazole (shampoo or cream)
Senlenium Sulfide or antidandruff shampoo
Face: low pot top steroid, topical antifungal, or combination

142
Q

Pityriasis Rosea Etiology

A

Benign viral exanthems

- common in teens and young adults in the spring or fall

143
Q

Pityriasis Rosea Present

A

Possible prodroms- fver or malaise
Herald patch (2-5cm) as primary lesion which is larger than the other ones on the trunk and secodnary lesion 1-2 wks later
-pink or slamon, fine scale (collarette scale), oval papulaes and plaques
-Christmas tree pattern
- usually asymptomatic possible itching

144
Q

Pityriasis Rosea Dx/ Tx

A

Tx: self limiting and will go away on its own

  • antihistamine for itching and possibly topical steroid ( just for itching)
  • sun helps it go away faster
  • can do a KOH prep to make sure its not funcgal
145
Q

Lichen Planus presentation

A

Prurutuc, purple, polygonal, papulaes (4 Ps)
-papulosquamous eruption
- skin (itchy) genitals nails, scalp, most common- wrist, ankles, shins back and MOUTH (painful)
Wickhams striae- tiny white lines running through papules

146
Q

Lichen Planus cause

A

idiopathic: dont know why
- 30-60yr olds
- immune mediated response
- drugs can cause
association with hep C
Koebner phenomenon- development of lesions in site of trauma

147
Q

Lichen Planus Dx/Tx

A

Dx: punch or shave biopsy
Tx: self limiting disorder and resolved 1-2 yrs
- topical steroids (high pot)
- injection intralesional triamcinolone
then: oral steroids, phottherapy, oral retinoids

148
Q

Psorisis Etiology/ Risks/

A

hyperproliferation inflammatory skin disorder
-overactive T cells to cause inflamation which shortens skin cell cycle so skin pile up.
M=F
20-30 and 50-60 yo
genetic- usually have 1st degree relative
Risks: genes, infections (strep), medications, stress/skin inj, weather(cold and dry), tobacco or heavy alch

149
Q

Psorisis presentation

A

erythematous with silvery white scale
- itchy or burning
- can be local or generalized
may also have nail pitting and psoriatic arthritis

150
Q

Psorisis Vulgaris

A

most common form
- plaques with scale and defined margins
- the plaques are symetrical on the body and smaller ones can clump together
Koebner phenomenon and auspitz sign

151
Q

Guttate Psorisis

A

Strep infection often preceded this onset

  • will often resolve on its own but you may get plaque psorisis
  • little droplets
152
Q

Pustular psorisis and palmplantar psorisis

A

Pustular- such wide spread inflamation may have fever> treated in hospital
Palm- debilitating becuase fissures will form so hard to walk and use hands and usually require more exstensive treatment

153
Q

Psorisis Tx

A

sunshine, warm baths, emollients (reduce pruritus), occlusive dressing, rest,
* do NOT use oral steroids*
Topical:
1.Group 1 or II corticosteroids (high pot) 2-3wks [ good if small TBSA and not in genitals, hand, face]
2.steroid sparing agents [can be used in combination therapy]
- synthetic vIt D
- coal tar
- topical retinoids- tazarotene
-totcal caliceurin inhibitors (tacrolimus and pimecrolimus)
> use topicals after soaking
3. Phototherapy
Moderate to sever: >5% TBSA requires care by derm and wil need photo therp or systemic

154
Q

Psoriatic Arthritis Etiology/ present

A

inflamatory arthritis

  • 1/3 of pt with psorisis will have this
  • pain and stiffness usually worse in the morning
  • usually asymetric
  • typically of the smaller joints (hands fingers) but also spine
  • enthesitis and dactylitis (sausage digets)
155
Q

Psoriatic arthritis Dx

A 
lab findings non-specific - will have elavated sedimentation rate and leukocytosis 
- usually negative for RF factor
lab tests are just to rule out other Dx 
***usually just a history and physical 
- possbile additional immaging
156
Q

Inverse psorisis

A

Will often appear in the axilla, genitals

- often not as scaly as other types

157
Q

Folliculitis Cause/ presentation

A

itchy Inflammation of the hair follicle with pustules and papules
Infectious:
-s. aureus (most common)
-“hot tub folliculitis) - gram neg Pseudomonas
possibly from a drug interaction

158
Q

If folliculitis gets worse what can happen?

A

can turn in a furnucle and then possibly a carbuncle abscess

159
Q

Folliculitis Tx

  • saphylococcal
  • gram neg
A 
Usually no tx  (self limiting)
Staphylococcal folliculitls
- topical: mupirocin
- oral abx: cephalexin 
If MRSA: clindamycin or doxycyclin
Gram Negative folliculitis 
- Ciprofloxacin
160
Q

Impetigo eitology and risks

A

Contagious superficial bacterial infection
Kids>adults
1.S. aureus- bullous and non bulllous
1. Ecthyma is usually strep

161
Q

Impetigo types

A

Honey colored crusting- typically on face neck and extremities

  1. Nonbullous: most common
    papules. vessicles> pustules> hone colored ccrusting
  2. Bullous- vesicles enlarged and forms bulla
  3. Ecthyma- punched out ulcers with overlying crusts
    - like cigarrette burns
162
Q

Impetigo Dx/Tx

A 
typically clinical  possible culture 
TX: 
1. non bullous and bullous: 
- - mild abs : mupirocin
- mod/sever: dicloxicillin cephalexin
2. Ecthema is always oral therapy (ones above)
163
Q

Cellulitis etiology and risks

A

Risks: skin trauma, lymphedema, venous indufficency, obesity, immunosup

  1. pus- strep
  2. no pus- s. aureus
    - caused by beta-hemolytic strep, staph
164
Q

Types of cellulitis

A

Expanding redness and not really well demarcated. Pain and swelling
1. Nonpurulent (non pus)- cellulitis or erysipelas
- erythema edema warmth
2. Purulent: absess or purulent cellulitis
painful fluctuant and erythematous nodule

165
Q

Erysipelas

A 
Type of non-purulent cellulitis 
-streptocci bacteria 
Well demarcated and perfect border of erythema 
-usually on cheeks and lower extremities
- warm. with fever and chills 
 usually in the elderly
166
Q

Abscess etiology

A

Type of purluent cellulitis
enclosed collection of pus
-painful fluctuant erythematoud nodule

167
Q

abscess Dx/ Tx

A

clinical diagnosis- maybe U/S

Tx: I and D - sometimes we test with culture and may need additional abs ( IC, very red

168
Q

Cellulitis tx
Erysipelas
purulent

A

Cellulitis: oral cephalexin or IV cefazolin
Erysipelas: beta-hemolytic strep therapy
-cefazolin, ceftiaxone
Purulent infection:
1. abscess- I&D +/- abx
- trimethoprim-sulfamethoxazole, doxycycline, clindamycin
2. Purulent cellulitis- sim abx to above

169
Q

MRSA prevention and control

A

Hand hyfeine, enviornmental cleaning, contact precautions

- decolonization with chlorohexidine wash and mupirocin ointment intranasally

170
Q

MRSA risk factor

A

Abx, invasive device, chronic wound, hospitalization, group settings, colonization of MRSA,

171
Q

MRSA tx

A

Oral abx: trimethoprim-sulfamethoxazole, doxycycline, clindamycin
- tailored to culture results
IV abx may be necessary (vancomycin):
-if extensive involvement, toxicity, rapid progression, failure PO tx, immunocomp

172
Q

Systemic Lupus Cutanious manifestations

A
  1. Discoid lupus: scaly plaques, annular on sun exposed areas
  2. Malar/butterfly rash
    - erythema on cheeks and bridge of the nose
    - nasolabial folds are spared !
173
Q

Lupus Rash DX/Tx

A

Dx: autoimmune connective tissue disease workup
sun protection and smoking cessation
- topical or intralesional steroids
- Hydroxychloroquine
* some people are on medications that cause a lupus rash*

174
Q

Erythema Multiforme

A

acute, immune mediated conditions distinct target like lesions
can be associated with viral, bacterial or functions
- herpes is most common
- can be associated with NSaIDS or abx

175
Q

Erythema Multiforme Dx/Tx

A

Dx: clinical dx
may have labs will be non specific inflammatory markers, leukocytosis
Tx: symptomatic tratment
- usually self limiting
-topical steroids, oral antihistamines, anestetic mouthwash
- antiviral meds are not indicated

176
Q

Dermatitis Herpetiformis etilogy

A

autoimmune skin condition associated with gluten sensitivity (possibly celiac disease)
Sx: pruruitic papules and vesicles
herpeticform pattern- forearm, knees, scalp, butt
Dx: markers for seriological, biopsies of the lesions (looking through direct immunoflourescence)***
Tx: gluten elimination and dapsone

177
Q

Pemphigus Etioogy

A

life thretening blistering disorder on epidermis

  • autoimmmune:antibodies can cause acantholysis
  • genetic, idopathic, drug induced
178
Q

Pemphigus presentation

A

Accantholysis: separation of the epidermis
Mucosal involvment
- flaccid bullae
Nikolsky sign: gentle pressure causes superficial layer to slough off

179
Q

Pemphigous Dx/Tx

A

Physical: acantholysis and Nikolsky sign
-biopsy and perilesional skin biopsy
later can do IIF and ELISA
Tx: always indicated
systemic corticosteroids and immunosupressive agents

180
Q

Pemphigoid etilogy

A

Chronic autoimmune subepithelial blistering condition

181
Q

Pemphigoid Presentation

A
  • begin with prurirtis eczematous or uticarial lesions
    Classic: *tense bullae**urticarial erythematous plaque. on trunk and extremities
    +/- mucosal involvment
182
Q

Pemphigoid Dx/Tx

A

Dx: biospy *perilesional direct immunoflourensense**
Tx: topical and/or systemic corticosteroids
- immunosupressive agents

183
Q

Melasma/Cholasma

A

aquired hyperpigmentation of the skin.
- often with hormones like the pill of pregnancy
- regresses within a year
Tx: skin lightener and sun protection

184
Q

Acanthosis Nigricans

A

hyperpigmentation velvety plaques

- associated with insulin resistance

185
Q

Hirsutism

A

male pattern hair growth in women

- caused by a variety of things

186
Q

Adrenal excess on skin

A

Cushing syndrome

- increase sebum, acne, androgenic alopecia, hirsutism, striae

187
Q

Adrenal insufficency of skin

A

Addisons disease

- hyperpigmentation of the gums, buccal mucosa, elbows, knees, palms, genitalia

188
Q

Thyroid effects on skin

A

Hyperthyroidism: warm moist skin
-pretibial myxedema
- non pitting, scaly, orange peel skin
Hypothyroidism: dry cool skin

189
Q

Porphyria Cutanea Tarda cause /Sx/ risks

A

deficiency of uroporphyrinogen decrarboxylase- suppose to break down porphyrins
Sx: painless sub-epidermal blistering on sun exposed areas
Risk: genetic, tobacco, etoh, estorgens, liver disease

190
Q

Porphyria Cutanea Tarda Dx/TX

A

Dx; ^ serum/ urinar porphyrins, ^ liver tests irons stores
Tx: discontinue potential cause
phlebotomy for the the ^iron
wear sun protective clothing

191
Q

Pressure injury stages

A

1: intact skin with localized erythema
2. partial thickness loss with exposed dermis
- no adipose visible and no eschar
3. full thickness
- adipose is visible with rolled edges but no facia or muscle visible
4. Full thickness skin and tissue loss with esposed muscle, tendon or bone
- eschar with rolled edges

192
Q

Pressure injury tx:

A
  • redistiribute pressure
  • local wound care
    1. transparent film for protection
    2. dressings that maintain moisture
    3. debridement of necrotic tissue with appropriate dressing +/-abx
193
Q

Tick removal

A
  • grasp tick as close to skin surface
  • wash area
    >36hrs ^ risk for lymes
    RMSF can be after only 6 hrs
194
Q

Erythema Migrans

A

Etiology: borrelia Burgdorferi
Pres: bulls eye rash
- fatigue, HA, arthralgia,fever
- later: cardiac, arthritis, beuro, bells palsy
Tx: doxycycline or amoxicillin
- can do 200mg dose of doxycycline for prophylaxis is >36hrs

195
Q

Rocky Mountain Spotted Fever

A

Etiology: rickettsia rickettsia
1. non specific symptoms: Fever, HA, arthralgias, nausea 2-14 after tick bite
* do not wait for the rash becuase some people dont get it
Rash: petechial lesion on ankles wrists then trunk

196
Q

Rocky Mountain spotted fever Dx and Tx

A

Dx: clinical because the serology is retrospective
Tx: doxycycline

Clin Med I (14 decks)

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