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derm wk 5 Flashcards

1
Q

erythematous brown hyperpigmented plaque

w fine fissuring and scale located above the medial malleolus

A

Stasis dermatitis

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2
Q

Stasis Dermatitis

A

Presents with redness, scale, itchy, erosions, exudate, and crust

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3
Q

Stasis Dermatitis

A

Common on lower 1/3 of legs
Lichenification may develop
Pitting edema

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4
Q

Scaly and erythema

A

Stasis Dermatitis

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5
Q

What is causing Stasis Dermatitis?

A

Venous insufficiency

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6
Q

What is causing Venous insuff

A

When the valves in the deep or perforating veins are not working, so there is BLOOD REFLUX/ backup into the superficial system

“Venous hypertension”

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7
Q

Risk factors for venous insuff

A 
Genes
Older
Female
Pregnant
Obese
Prolonged standing
Prior injury or surgery
Prior DDVT
Sedentary life
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8
Q

What is Lipodermatosclerosis?

A

Stasis dermatitis can –> lead to this

fat necrosis looking like “inverted champagne bottle”

can have acute inflammatory episodes with pain and redness

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9
Q

Lipodermatosclersosi

A

Chronic inflammation and Fat necrosis

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10
Q

Complication of venous insuff

A

Recurrent ulcer
Cellulitis
Contact dermatitis
Venous clot

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11
Q

Tx of Stasis Dermatitis

A

Super high and High potency STEROIDS
Elevate
Compression
Change wraps at least weekly

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12
Q

Ulcers from venous insuff generally look like

A

Tender, shallow, irregular ulcer with fibrinous base

always below the knee

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13
Q

What to do if you diagnose a Venous insuff ulcer?

A

Measure the blood pressure in the Left arm and Left ankle

to make sure there is not also arterial disease goin’ on

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14
Q

Compression therapy is CONTRA if

A

ABI is <0.5
OR
Absolute ankle pressure is <60 mmHg

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15
Q

Normal ABI

A

> 0.8

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16
Q

What should you perform with all pts with Venous insuff?

A

Pulse exam
Venous duplex US
ABI

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17
Q

Should you use Abx on Venous ulcers?

A

NO

can lead to contact dermatitis

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18
Q

arterial ulcers

A

“punched out”
well-demarcated
pale base

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19
Q

Arterial ischemia

A

loss of hair

Shiny atrophic skin

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20
Q

Arterial insuff

A

leg elevation does not help!

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21
Q

Pain and claud at rest

A

Arterial insuff

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22
Q

PG is often mistaken for a spider bite

A

If you think someone has spider bite, consider PG or MRSA

PG= pyoderma gangrenosum

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23
Q

PG= Pyoderma Gangrenosum

A

Auto-inflammatory process
Ulcerative

Starts small pustule, breaks down and rapidly expands forming an ulcer with an UNDERMINED (can probe underneath) violaceous border

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24
Q

Pyoderma Gangrenosum

A

Rapid progression
Usually happens on lower legs

Can be V painful

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25
What do patients experiencing PG (pyoderma gangrenosum) often have also?
ARTHRITIS!! | or IBD, RA, Hematologic pathy, or CA
26
Pyoderma Gangrenosum is triggered by
TRAUMA i.e. insect bite, surgical debridement, grafting
27
Pyoderma Gangrenosum
DERM EMERGENCY Tx: Topical therapy- superpotent Steroid, Tacrolimus Systemic- Steroid, Cyclosporine, Tacrolimus, Cellcept, Thalidomide, TNF- inhibitor
28
Dermatitis in general ACUTE vs CHRONIC
Acute: red, vesicles, itching Chronic: dry, scaly, lichenification, fissure, itching (still)
29
Two types of Contact Dermatitis
Irritant | Allergic
30
How does Allergic Contact Derm work?
Sensitization process: 10-14 days Upon re-exposure: 12-48 hours
31
Most common type of Allergic Contact Derm
Rhus dermatitis - poison ivy - poison oak - poison sumac
32
How long does poison ivy last?
10-21 days | about 1-3 weeks
33
How long is the first episode of poison ivy?
Up to 6 weeks the first one is the longest
34
What can you use to treat poison ivy if Clobetasol ointment doesn't work?
2 week taper of Oral prednisone
35
What to consider when treating poison ivy with oral steroids
If given for a short amt of time, pt may relapse. avoid short bursts of steroids GIVE LONGER DURATION
36
Tx of Allergic Contact Derm like poison ivy
Mild- mod: topical steroids, maybe systemic steroids short course Oatmeal bath, soothing lotion If extensive oozing: wet dressing
37
Chronic case or if Allergic Contact derm is taking up >10% BSA
Refer to Derm
38
Scaling and redness b/w the toes with associated maceration
Tinea Pedis- Interdigital type
39
Tinea Pedis- Moccasin type aka Hyperkeratotic type
Sharply marginated scale Lateral borders of feet, heels, and soles Often a/w fungal infection of nails
40
Moccasin Type/ Hyperkeratotic often presents with
ONE HAND involvement "One hand, two feet" syndrome
41
Tinea pedis- Vesicular type
Grouped vesicles or bullae, often on medial foot Itchy or painful
42
Tinea pedis- Ulcerative
Worsening of interdigital Ulcer and erosion in web space
43
Tinea pedis- ulcerative
Seen in: Immunocompromised Diabetic
44
Best diagnostic exam w fungal infections
KOH dissolves keratinocytes making it easier to see Fungal hyphae
45
Tinea Versicolor
"Spaghetti and Meatballs"
46
Tinea capitis
Spores can be inside or outside hair shaft
47
KOH exam prep
``` Clean skin w alc Collect sample Put on glass slide Add 1-2 drops KOH Let sit for 10 min Examine at low power, then --> 10X to study Hyphae ```
48
Moccasin foot Tx
Terbinifine cream BID for 2 weeks
49
1st line Tx for Tinea Pedis
Terbinafine Naftifine Butenafine cream or gel BID for 1-2 wks All are Allylamines
50
2nd line tx for Tinea Pedis
Clortimazole Miconazole BID for 4-6 wks
51
How many grams to Rx for Tinea Pedis tx?
30-45 g to cover both soles BID for 1 month
52
1st line tx for Tinea Pedis
Terbinafine BID for 1-2 wks
53
Sharply marginated, Erythematous annular plaque w central clearing and scaling at edges
Ringworm | tinea corporis
54
Tinea corporis
Annular lesion with central clearing
55
Tinea Corporis tx duration
4-6 wks total Until resolution, then 2 more weeks after that
56
Tinea corporis "ringworm" 1st line tx
Terbinafine Butenafine Naftifene (more expensive)
57
Tinea corporis | "ringworm" 1nd line (less expensive)
Clotrimazole Miconazole (Imidazoles)
58
When to use ORAL tx for ringworm?
Poor response to topical Animal is source Large surface area
59
ORAL tx for "ringworm"
Terbinafine daily 7-14 days
60
Oral Terbinafine SE
Taste loss or disturbance in 3% people taking this
61
How to describe toe fungus
Nail thickening and Subungual debris
62
Most common type of Onychomycosis
Distal subungual onychomycosis thickened nail bed subungual debris separation from nail plate
63
1st line tx for Onychomycosis
Terbinafine 250 mg daily for 90 days
64
Risk of Onychomycosis oral tx
Liver toxic Taste disturbance (reversible) Drug intxns Skin rxn Failure to cure. only 50%. To help this, also add Topical Antifungal therapy
65
Tinea corporis "ringworm" 1st line tx
Terbinafine Butenafine Naftifene (more expensive)
66
Tinea corporis | "ringworm" 1nd line (less expensive)
Clotrimazole Miconazole (Imidazoles)
67
When to use ORAL tx for ringworm?
Poor response to topical Animal is source Large surface area
68
2nd line tx for Onychomycosis
Fluconazole Itraconazole (IF)
69
Oral Terbinafine SE
Taste loss or disturbance in 3% people taking this
70
Tinea Versicolor is different from other tinea, how?
NOT caused by dermatophyte, but rather my a YEAST Malassezia furfur
71
Most common type of Onychomycosis
Distal subungual onychomycosis thickened nail bed subungual debris separation from nail plate
72
1st line tx for Onychomycosis
Terbinafine 250 mg daily for 90 days
73
Option for pts concerned about long term liver issues
PULSE THERAPY short bursts of oral tx given (either until nail is healthy or for a total of 3 bursts)
74
1st line for mostly all fungal infections: Tinea and Onychomycocis
Terbinafine | onychomycosis is Oral
75
Maintenance therapy for tinea versicolor
Topical shampoo 1-2x per week Selenium sulfide Ketoconazole Zinc leave on 10 min b4 rinsing off
76
2nd line tx for Onychomycosis
Fluconazole Itraconazole (IF)
77
How to describe Tinea Versicolor
Well-demarcated, hyperpigmented macules and patches across the back
78
More about Malassezia (Tinea versicolor)
Lipophilic yeast that's actually a normal resident in the keratin of skin and hair follicles of those at puberty and beyond
79
Diagnostic feature of Tinea Versicolor
Visible scale not present until rubbed with finger or scalpel Evoked scale dissappears after tx
80
Tx for Tinea Versicolor topical is 1st line
SHAMPOOS- Selenium sulfide Ketoconazole Zinc pyrithione IMIDAZOLE cream- Ketoconazole Clotrimazole (for limited areas, more $)
81
Two tx classes for Intertrigo
Imidazoles- Clotrimazole, Miconazole, Econazole (more effective but may burn) OR Polyene- Nystatin (not as affective but benefit is can be powder and ointment)
82
What can you apply to Candidal Intertrigo to improve the burning and itching?
Low strength steroid | Desonide or Hydrocortisone ointment, BID x 1-2 wks
83
Intertrigo
inflammation of large skin folds
84
Classic signs of Intertrigo complicated by Candida yeast
Burns | Satellite macules, papules, pustules around the redness in the fold
85
Satellite papules
Candidal intertrigo
86
Best tx for Intertrigo
Clotrimazole cream
87
Prevention of Intertrigo
Dry area after bathing Weight loss Loose clothing made of cotton
88
Tx options for Seborrheic derm
Topical Ketoconazole Low potency steroid (Desonide, Hydrocort) Antidandruff shampoo
89
Chronic conditions req maintenance tx
Tinea versicolor | Seborrheic derm
90
Seborrheic dermatitis
Common, inflammatory rxn to Malassezia yeast that thrives on Seborrheic oil producing skin
91
Seborrheic derm
Inflammatory rxn to normal flora chronic condition, can be controlled (but not cured)
92
Red scaling patches on scalp, hairline, eyebrow, eyelids, central face, nasolabial folds, central chest
Seborrheic derm worse in HIV pts
93
Central chest | Red and scaly
Seborrheic derm
94
Tx for Seborrheic derm
Desonide cream
95
Chronic conditions req maintenance tx
Tinea versicolor | Seborrheic derm
96
Tx for Candidal Intertrigo
``` Clotrimazole cream (preferred) Nystatin powder (may be easier tolerated) ```
97
Is Intertrigo usually caused by fungus?
No, usually just from irritation to skin by warmth, moisture, etc
98
Tx for PVD - veins
Exercise, Leg elevation | Compression stockings
99
Tx for PAD - arteries
Fixed distance walking/ exercise Stop smoking Cilostazol (pharm) Angioplasty Revascularization (surgery)
100
PAD tx
exercise meds- cilostazol surgery- revascularization

Clinical Prep (41 decks)

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