Dermatitis

Question 1

WHich dermatitis is called “the itch that rashes”?

Answer 1

Atopic Dermatitis

Question 2

Which dermatitis is characterized by pruritic, erythematous, dry patches of skin, often with scale?

Answer 2

Atopic Dermatitis

Question 3

Atopic dermatitis is associated with what findings?

Answer 3

Family/personal history of atopy
Xerosis or dysfunction of skin barrier
IgE reactivity

Question 4

Which dermatitis is an immunological response due to cytokine production (not histamine)?

Answer 4

Atopic Dermatitis

Question 5

Which dermatitis appears as dryness, patches and/or fissures on the palms of the hands and soles of the feet?

Answer 5

Dyshidrotic eczema

Question 6

What are some triggers for dyshidrotic eczema?

Answer 6

metals

stress

Question 7

What is the treatment for dyshidrotic eczema?

Answer 7

Moderate corticosteroids

Question 8

What is the treatment for atopic dermatitis?

Answer 8

Mild to moderate topical corticosteroid - not >2wks

Topical calcineurin inhibitors (>2yo)

Question 9

What does an atopic dermatitis superinfection look like?

Answer 9

Honey crusted lesions

Question 10

What is the treatment for an atopic dermatitis superinfection?

Answer 10

Topical: mupirocin (Bactroban - also for impetigo)

Oral cephalexin or penicillin

Question 11

Name an atopic dermatitis differential.

Answer 11

Herpes

Can do herpes culture to differentiate

Question 12

Which dermatitis presents with single or multiple coin like plaques that occur anywhere on the body?

Answer 12

Nummular eczema

Question 13

Which dermatitis is more common in cold weather?

Answer 13

Nummular eczema

Question 14

What is the treatment for nummular eczema?

Answer 14

Hydration/emollient

Low-moderate topical corticosteroids

Question 15

Name one differential for nummular eczema.

Answer 15

Tinea corporis (ringworm)

Tinea have sharply demarcated borders with scale at the edge and central clearing. Limited in number.
Do a skin scraping + KOH = hyphae

Eczema dx = xerosis + age + hx of atopy +early onset + relapsing

Question 16

Which dermatitis reacts to metal from jewelry, leather from sandals or make up on the face?

Answer 16

Contact dermatitis

Question 17

What is the treatment for contact dermatitis on the forehead?

Answer 17

Low potency TCS

Question 18

What is the treatment for contact dermatitis on the back of the neck?

Answer 18

Moderate potency TCS

Question 19

Which dermatitis presents with a vesicular rash in a linear fashion?

Answer 19

Contact dermatitis from poison ivy exposure.

This is a cell mediated reaction - the more they are exposed the more severe it gets.

Question 20

What is the treatment for poison ivy?

Answer 20

Moderate potency TCS (gel)
Antihistamine
Calamine lotion
Domeboro soaks for itching

Question 21

Which dermatitis is called the “lime and sunshine” rash?

Answer 21

Phytophotodermatitis

The oil in the lime gets on the skin and breaks out when exposed to the sun.

Question 22

What is the treatment for phytophotodermatitis?

Answer 22

Avoid sun exposure - will fade over time.

Hyperpigmentation can last for weeks

Question 23

Which dermatitis is chapped, shiny and parchment like and spares the skin folds?

Answer 23

Diaper dermatitis

Question 24

If diaper dermatitis appears with a rash in the inguinal folds what should you consider?

Answer 24

Fungal infection

Appears beefy red with satellite lesions

Question 25

What should you consider if treating dermatitis that does not improve?

Answer 25

Fungal infection

Question 26

What is the treatment for diaper dermatitis?

Answer 26

``` Barrier/zinc oxide, Aquaphor Avoid scented wipes Frequent diaper changes Air exposure Hydrocortisone 0.5-1% thin layer 3x/d (5d max) ```

Question 27

Which dermatitis is known as cradle cap?

Answer 27

seborrheic dermatitis

Question 28

Which dermatitis presents as an erythematous rash with yellow flakey scales on the scalp, forehead, eyebrows and ears?

Answer 28

seborrheic dermatitis

Question 29

Which dermatitis peaks in infancy, again in adolescents and older patients with Parkinson's'?

Answer 29

seborrheic dermatitis

Question 30

What is a complication of seborrheic dermatitis?

Answer 30

blepharitis

Question 31

What is the treatment for seborrheic dermatitis in infants?

Answer 31

Mineral oil 5-10 min before washing Gentle brushing of scales Frequent washing

Question 32

What is the treatment for seborrheic dermatitis in adolescents and adults?

Answer 32

Scalp Tar, salicylic acid, ketoconazole, selenium sulfide If severe, topical corticosteroid solution or foam Face Ketoconazole topical cream or shampoo Intermittent low potency topical steroid

Question 33

A child has irritant contact dermatitis with lesions on the extremities and face. Which treatment is recommended for this patient? a. Antihistamines b. Medium- to high-potency topical corticosteroids c. Oral corticosteroids d. Topical calcineurin inhibitors

Answer 33

ANS: C When periorbital regions or more than 20% of the body surface area is involved, the use of an oral steroid is appropriate. Antihistamines produce relaxation and improve sleep, but do not reduce the pruritus associated with contact dermatitis. Topical calcineurin inhibitors may be used in place of topical steroids, but oral steroids are indicated in this instance.

Question 34

A patient who has been exposed to poison ivy presents with inflammation and a vesicular rash on one arm. The provider recommends a topical steroid, but the next day the patient calls to report similar lesions appearing on the face. What will the provider tell this patient? a. The rash is spreading through self-inoculation. b. The vesicles may continue to develop for up to 2 weeks. c. The rash may spread over the next 8 weeks. d. The patient must have been re-exposed to the irritant.

Answer 34

ANS: B Exposure to poison ivy resin results in vesicles and bullae that develop for up to 2 weeks. Once the resin is washed off, no further spread occurs. With insufficient treatment, the rash may persist, but not spread, for up to 8 weeks.

Question 35

Which is the primary symptom causing discomfort in patients with atopic dermatitis? a. Dryness b. Erythema c. Lichenification d. Pruritis

Answer 35

ANS: D | Itching is incessant, and patients usually develop other signs at the site of itching.

Question 36

A patient with atopic dermatitis asks what can be done to minimize the recurrence of symptoms. What will the provider recommend? a. Calcineurin inhibitors b. Lubricants and emollients c. Oral diphenhydramine d. Prophylactic topical steroids

Answer 36

ANS: B Emollients and lubricants are used long-term to reduce flare-ups. Calcineurin inhibitors can be helpful for managing chronic moderate to severe eczema. Oral diphenhydramine helps with symptoms of itching but is not used to prevent symptoms. Corticosteroids should be used sparingly to treat symptoms and stopped once the inflammation has subsided.

Question 37

A patient who has atopic dermatitis has recurrent secondary bacterial and skin infections. what will the provider recommend to help prevent these infections? a. Bleach baths twice weekly b. Frequent bathing with soap and water c. Low-dose oral antibiotics d. topical antibiotic ointments

Answer 37

ANS: A Bleach baths and intranasal mupirocin have been shown to reduce bacterial superinfections of the skin. Frequent bathing with soap and water may increase flare-us and increase the risk for superinfections. Oral and topical antibiotic prophylaxis are not recommended.

Question 38

Which dermatitis is common in younger adults (20-40)?

Answer 38

Dyshidrotic eczema

Question 39

An adult patient has greasy, scaling patches on the forehead and eyebrows suggestive of seborrheic dermatitis. What is included in assessment and management of this condition? Select all that apply. a. Begin first-line treatment with a topical antifungal medication b. Evaluate the scalp for dry, flaky scales and treat with selenium sulfide shampoo c. Teach the patient that proper treatment is curative in most instances d. Topical antibacterial medications may be used to prevent Malassezia proliferation e. Use topical steroids for several weeks to prevent recurrence of symptoms

Answer 39

ANS: A, B First-line therapy may include topical antifungals or corticosteroids. Adults with symptoms on the face or eyebrows are likely to have scalp lesions, since this is usually a “top-down” disorder. The condition is chronic and recurrent. Antibacterial medications are used for secondary bacterial infections but do not treat Malazessia, which is a fungus. Topical steroids should be used on a short-term basis.

Question 40

A patient with chronic seborrheic dermatitis reports having difficulty remembering to use the twice daily ketoconazole cream prescribed by the provider. What will the provider order for this patient? a. Burrow’s solution soaks once daily b. Oral corticosteroids c. Oral itraconazole (Sporanox) d. Selenium sulfide shampoo 2.5% as a daily rinse

Answer 40

ANS: C Itraconazole is effective for moderate to severe symptoms and is an alternative for those who do not wish to use topical treatment. Burow’s solution and selenium shampoo rinses are not indicated. Oral corticosteroids are usually not given.

Question 41

An infant is brought to clinic with bright erythema in the neck and flexural folds after recent treatment with antibiotics for otitis media. What is the treatment for this condition? A. 1% hydrocortisone cream to affected areas for 1 to 2 days B. Oral fluconazole 6 mg/kg on day 1, then 3 mg/kg/dose for 14 days C. Topical keratolytics and topical antibiotics for 7 to 10 days D. Topical nystatin cream applied several times daily

Answer 41

ANS: D

Question 42

A school­ age child has several annular lesions on the abdomen characterized by central clearing with scaly, red borders. What is the first step in managing this condition? A. Fluoresce the lesions with a Wood’s lamp. B. Obtain fungal cultures of the lesions. C. Perform KOH­ treated scrapings of the lesion borders. D. Treat empirically with antifungal cream.

Answer 42

ANS: D

Question 43

A child has several circular, scaly lesions on the arms and abdomen, some of which have central clearing. The primary care pediatric nurse practitioner notes a smaller, scaly lesion on the child’s scalp. How will the nurse practitioner treat this child? A. Obtain scrapings of the lesions for fungal cultures. B. Order prescription­ strength antifungal creams C. Prescribe oral griseofulvin for 2 to 4 weeks. Correct D. Recommend OTC antifungal creams and shampoos.

Answer 43

ANS: C

Question 44

A child is diagnosed with tinea versicolor. What is the correct management of this disorder? A. Application of selenium sulfide 2.5% lotion twice weekly for 2 to 4 weeks B. Oral antifungal treatment with fluconazole once weekly for 2 to 3 weeks C. Sun exposure for up to an hour every day for 2 to 4 weeks D. Using ketoconazole 2% shampoo on lesions twice daily for 2 to 4 weeks

Answer 44

ANS: A

Question 45

An adolescent who had cradle cap as an infant is in the clinic with thick crusts of yellow, greasy scales on the forehead and behind the ears. What will the primary care pediatric nurse practitioner recommend? A. Daily application of ketoconazole 2% topical cream B. High ­potency topical corticosteroids applied daily C. Mineral oil and shampoo on the affected areas D. Selenium sulfide shampoo twice weekly to the face

Answer 45

ANS: A