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Family Med EOR > Dermatitis, Hair & Nails, Dermatophyte Infections > Flashcards

Dermatitis, Hair & Nails, Dermatophyte Infections Flashcards

1
Q

What causes atopic dermatitis (eczema)?

A

heat
perspiration
allergens
contact irritants (wool, nickel, food)

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2
Q

What is the atopic triad?

A

eczema
allergic rhinitis
asthma

*Starts in childhood

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3
Q

What are the sx of atopic dermatitis (eczema)?

A

Hallmark = pruritus

  1. Acute lesions: Erythematous blisters/papules/plaques that crust over & become scales (MC in flexor creases)
  2. Nummular eczema: sharply defined discoid/ coin-shaped lesions (MC on dorsum of hands, feet, & extensors)
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4
Q

How do you manage ACUTE atopic dermatitis (eczema)?

A

topical corticosteroids, antihistamines for itching (diphenhydramine, hydroxyzine)

Wet dressings (Burrow’s solution). Abx if infection

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5
Q

What is an alternative tx for ACUTE atopic derm (eczema)? What is the benefit?

A

Topical calcineurin inhibitors (Tacrolimus, pimecrolimus) - inhibit cytokine synthesis

No skin atrophy like steroids

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6
Q

What are S/E of topical calcineurin inhibitors (Tacrolimus, pimecrolimus)?

A

Irritation

Lymphoma/skin CA risk

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7
Q

What are forms of health maintenance for atopic derm (eczema)?

A

Avoid triggers (soaps, detergents, frequent baths)

Maintain skin hydration w/ skin emollients (eucerin, aquaphor) & tepid baths

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8
Q

What causes contact dermatitis?

A

Irritants: chemicals, detergents, cleaners, acids, prolonged H2O, metals

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9
Q

What form of contact dermatitis is caused by prolonged exposure to urine/feces in infants?

A

Diaper rash

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10
Q

What are the sx of contact dermatitis?

A 
Burning 
Itching
Erythema 
Dry skin 
Eczematous eruption
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11
Q

How do you treat contact dermatitis?

A

Avoid irritants
Protective equipment
Wet dressings (Burrow’s solution)
Topical corticosteroids

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12
Q

How do you treat diaper rash?

A

Topical petroleum or zinc oxide

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13
Q

What causes dyshidrosis?

A

Sweating
Emotional stress
Warm/humid weather
Metals

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14
Q

What are s/s of dyshidrosis?

A

Pruritic “tapioca-like” tense vesicles on the soles, palms, & fingers (lateral digits)

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15
Q

How do you treat dyshidrosis?

A

Topical steroids *Ointments preferred

Cold compresses

Burrow’s sol

Tar soaks

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16
Q

What causes lichen simplex chronicus?

A

Repetitive rubbing/scratching

“itch-scratch” cycle

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17
Q

What are the s/s of lichen simplex chronicus?

A

Scaly, well-demarcated, rough hyperkeratotic plaques w/ exaggerated skin lines

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18
Q

How do you treat lichen simplex chronicus?

A

High dose topical steroids

Antihistamines

Occlusive dressings

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19
Q

What causes perioral dermatitis? What population is it most seen in?

A

Topical corticosteroid use

MC in young women

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20
Q

What are s/s of perioral dermatitis?

A

Papulopustules on an erythematous base
May become confluent into plaques w/ scales
May have satellite lesions
Spares the vermillion border

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21
Q

How do you treat perioral dermatitis?

A

Topical metronidazole or erythromycin

Oral tetracyclines

AVOID TOPICAL CORTICOSTEROIDS

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22
Q

What causes lichen planus? What condition increases incidence?

A

Idiopathic!

Hep C

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23
Q

What are the s/s of lichen planus?

A

5 Ps: Purple, Polygonal, Planar, Pruritic Papules w/ fine scales & irregular borders

Can develop Koebner’s phenomenon (new lesions at sites of trauma)

Wickham striae: Fine white lines on the skin lesions or oral mucosa.

Nail dystrophy

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24
Q

Where does lichen planus most commonly present on the body?

A

Flexor surfaces of the extremities, skin, mouth, scalp, genitals, nails & MMs

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25
Q

What is 1st line tx for lichen planus?

A

Topical corticosteroids

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26
Q

How do you treat the sx of lichen planus?

A

Antihistamines for pruritis, occlusive dressings

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27
Q

What is 2nd line tx for lichen planus?

A

PO steroids
UVB therapy
Retinoids (stimulate production of new cells)

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28
Q

What causes pityriasis rosea? Who is it most commonly seen in?

A

Uncertain etiology, a/w viral infections - HHV7

Older children & young adults

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29
Q

What can pityriasis rosea mimic? What seasons is it more commonly seen?

A

Syphilis!

Spring & fall

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30
Q

What are the s/s of pityriasis rosea?

A

Herald patch on the trunk

Salmon colored papules w/ white circular (collarette) scaling along cleavage lines in a Christmas tree pattern

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31
Q

What parts of the body is pityriasis rosea confined to?

A

Trunk & proximal extremities

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32
Q

How do you treat pityriasis rosea?

A

None needed

PO antihistamines, topical steroids, oatmeal baths for pruritus

UVB phototherapy if severe

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33
Q

What is alopecia areata? What causes it?

A

Nonscarring immune-mediated hair loss targeting the anagen hair follicles (scalp MC)

a/w other autoimmune disorders (thyroid, addison’s)

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34
Q

What are the s/s of alopecia areata?

A

Smooth discrete circular patches of complete hair loss that develops over weeks

Exclamation point hairs (tapering near the proximal hair shaft)

Nail abnormalities: pitting, fissuring, trachyonychia

35
Q

What term is used for complete hair loss of the scalp & body (including eyelashes)?

A

Alopecia universalis

36
Q

How do you treat alopecia areata?

A

If local –> intralesional corticosteroids

If extensive –> topical corticosteroids

37
Q

What is androgenic alopecia? What causes it?

A

Progressive loss of the terminal hairs on the scalp

Dihydrotestosterone (DHT)

38
Q

What are the s/s of androgenic alopecia?

A

Varying degrees of hair thinning & nonscarring hair loss (MC temporal/midfront/vertex of scalp)

39
Q

How do you treat androgenic alopecia?

A

Minoxidil

Oral finasteride (5-alpha reductase inhibitor) - androgen inhibitor (inhibits conversion of testosterone to DHT)

40
Q

What are the S/E of finasteride?

A

Decreased libido, sexual or ejaculatory dysfunction

41
Q

What is psoriasis?

A

immune d/o w/ genetic predisposition

42
Q

What are the s/s of “plaque” psoriasis?

A

MC type, MC on extensors
Raised, dark-red plaques/papules w/ thick silver/ white scales
Pruritus
Nail pitting. Oil spot
Auspitz sign (bleeding w/ removal of plaque)
Koebner’s phenomenon

43
Q

What are s/s of “pustular” psoriasis?

A

Deep, yellow non-infected pustules –> red macules on palms/soles

44
Q

What are s/s of “guttate” psoriasis?

A

Small, erythematous papules w/ fine scales, discrete lesions & confluent plaques

45
Q

What are s/s of “inverse” psoriasis?

A

erythematous (no scale)

MC seen in body folds

46
Q

What are s/s of “erythrodermic” psoriasis?

A

erythematous rash involving most of skin (worst type)

47
Q

What are s/s of psoriatic arthritis?

A

Joint stiffness > 30 mins, relieved w/ activity

Sausage digits

Pencil in cup deformity on radiograph

48
Q

How do you treat psoriasis?

A

Mild-Mod –> high dose topical steroids +/- Vit D (calcipotriene), topical tar, topical retinoids/vit A (Tazarotene)

Mod-severe –> phototherapy: UVB, PUVA &/or methotrexate, cyclosporine, retinoids (acitretin)

49
Q

What causes seborrheic dermatitis? Who is this MC in?

A

Unclear
Hypersensitivity to Malassezia furfur may play role

MC in adult men

50
Q

Where does seborrheic dermatitis occur? When does seborrheic derm worsen?

A

Areas of high sebaceous gland oversecretion (scalp, face, eyebrowns, body folds)

Stress & winter –> worsening sx

51
Q

What are s/s of seborrheic derm in infants?

A

“Cradle Cap”: erythematous plaques w/ fine white scales

52
Q

What are s/s of seborrheic derm in adults?

A

Erythematous plaques w/ fine white scales

When on scalp = dandruff

53
Q

How do you treat seborrheic derm?

A

Selenium sulfide, sodium sulfacetamide, ketoconazole or steroids. Zinc pyrithione

Oral antifungals

54
Q

How do you treat cradle cap?

A

Baby shampoo, ketoconazole, topical corticosteroids

55
Q

What causes tinea versicolor?

A

Overgrowth of Malassezia furfur (yeast) - part of normal skin flora

56
Q

What are the s/s of tinea versicolor?

A

hyper/hypopigmented, round/oval macules w/ fine scaling

Often coalesce into patches on trunk, face, extremities

Involved skin fails to tan w/ sun exposure

57
Q

How do you diagnose tinea versicolor?

A

KOH prep: hyphae & spores “spaghetti & meatball”

Woods lamp: yellow green fluorescence

58
Q

How do you treat tinea versicolor?

A

Topical antifungals: selenium sulfide, sodium sulfacetamide, zinc pyrithione, “azoles”

Itraconazole or fluconazole if widespread or failed topical tx

*Do not shower for 8-12 hrs after bc azoles are delivered to skin via sweat

59
Q

What are s/s of tinea corporis?

A

Erythematous plaques (circular rash w/ clear center & defined borders), scaling, cracking, & vesicles

60
Q

How do you distinguish tinea corporis from erythema migrans?

A

Presence of scales

61
Q

How do you treat tinea corporis & tinea pedis?

A

Topical antifungal

PO griseofulvin if failed topical tx

62
Q

What are the s/s of onychomycosis?

A

Opaque, thickened, discolored & cracked nails w/ subungual hyperkeratinization

MC = big toe!

63
Q

How do you treat onychomycosis?

A

Itraconazole & terbinafine

64
Q

What causes paronychia?

What is it? How does it occur?

A

Staph aureus MC, GABHS, Candida (if slow growing)

Infection of nail margin. MC occurs after skin trauma

65
Q

What can a paronychia progress to?

A

A felon (closed-space infection of the fingertip pulp)

66
Q

What are the s/s of a paronychia?

A

painful, red swollen area around the nail at the cuticle site

67
Q

How do you treat paronychia?

A

Warm soaks, I&D

Cephalexin

68
Q

Describe stasis dermatitis

A

See page 66-67 of PANCE Prep Pearls

69
Q

Describe a Type I cutaneous drug eruption

A

IgE mediated

Urticaria, angioedema, immediate

70
Q

Describe a Type II cutaneous drug eruption

A

Cytotoxic, Ab-mediated

71
Q

Describe a Type III cutaneous drug eruption. Provide an example.

A

Immune antibody-antigen complex

Ex. drug-mediated vasculitis & serum sickness

72
Q

Describe a Type IV cutaneous drug eruption

A

Delayed (cell-mediated) - morbiliform rxn

Ex. Erythema multiforme

73
Q

Describe a nonimmunologic cutaneous drug eruption

A

Due to genetic incapability to detoxify meds (anticonvulsants & sulfas)

74
Q

What are s/s of an exanthematous/morbiliform rash?

A

MC skin eruption

“Bright-red” macules & papules that coalesce to form plaques

Begins 2-14 days after med initiation

75
Q

What are s/s of a urticarial drug eruption?

A

Occurs within mins to hrs after drug administration

MC triggers = abx, NSAIDs, opiates, contrast

76
Q

What are s/s of erythema multiforme?

A

3rd MC drug eruption or caused by HSV

Target lesions, dull “dusty violet” red, purpuric macules/vesicles or bullae surrounded by red halo

MC meds: sulfas, PCNs, Phenytoin, Phenobarbital, dilantin

77
Q

What other sx may accompany a drug eruption?

A

Fever, abd, or joint pain

78
Q

How do you treat an exanthematous/morbiliform rash?

A

Oral antihistamines

79
Q

How do you treat drug-induced urticaria/angioedema?

A

Systemic corticosteroids, antihistamines

80
Q

How do you treat erythema multiforme minor?

A

Sx tx

81
Q

How do you treat anaphylaxis?

A

IM epi = Tx of choice!

82
Q

What is the difference btwn EM minor vs EM major?

A

Minor: No MM lesions

Major: involvement of ≥ 1 MMs, no epidermal detachment

83
Q

How do you treat erythema multiforme major?

A

Symptomatic

Antihistamines, analgesics, skin care

Oral: Steroid/lidocaine/diphenhydramine mouthwash

If severe –> systemic steroids

Family Med EOR (15 decks)

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