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Family Medicine > Dermatologic > Flashcards

Dermatologic Flashcards

1
Q

Atopic dermatitis

A

Epi

  • h/o atopy
  • infants: face, scalp, ext surfaces
  • children: flexures
  • adults: hands, eyelids, nipples, flexures
  • d/t irritants, allergens, psych, envr, microbial

Sxs

  • chronic, itchy skin; rough red patch; scaling
  • acute flare - may have weeping area

Mgmt

  • topical steroids
  • PO anti-histamine (sedative)
  • secondary infection: abx
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2
Q

Contact dermatitis

A

Epi
- common allergens: plants, nickel, neomycin, terpentine, procaine

Allergic:

  • acute onset, pruritic, vesicles, weeping, crusts, erythema
  • sensitization after first contact; future contact results in allergic response

Irritant:

  • first exposure
  • chronic in nature; erythema w/scale and excoriations; burning/stinging

Mgmt:
- avoid irritants, wear gloves, barrier creams, topical steroids

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3
Q

Nummular eczematous dermatitis

A
  • groups of coin shaped plaques of papules and vesicles
  • plaques may be dry and scaly or exudative and crusty
  • lower legs of older men
  • consider ring worm but nummular is solidly scaly throughout
  • winter flares

Mgmt: topical steroids (can use higher potency on older men on lower legs)

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4
Q

Perioral dermatitis

A
  • often in adults who say they have never had acne before
  • superficial inflammatory papules in clusters on patches of erythema
  • itchy or asx

Mgmt:

  • PO abx + topical metronidazole or azelaic acid gel BID
  • abx: doxy, mino, erythro, ttc

come back in 6wk, if better, can reduce to daily

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5
Q

Seborrheic dermatitis

A
  • D/t: sebum production, overgrowth of Malassezia and immunologic abnormalities

Sx:

  • scalp, eyebrows, nasolabial fold, groin, chest
  • skin inflamed w/yellow or white greasy scale; mildly pruritic
  • worse in winter

adults: dandruff
peds: cradle cap

Mgmt:
- scalp: anti-seb shampoo* (zinc, selenium); ketoconazole shampoo twice weekly; tar shampoo mild case; topical corticosteroid solution

  • skin: low potency corticosteroid*
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6
Q

Stasis dermatitis

A
  • d/t chronic venous insufficiency

Sx:

  • itchy, eczematous, scaly rash on lower legs
  • fissures, ulcers
  • hyperpigmentation (hemosiderin) - “brawny”

Mgmt:

  • topical steroids
  • lubrication
  • elevation, compression stockings
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7
Q

Dyshidrotic eczema

A

Epi: atopy; outbreaks during hot, humid weather

Sx

  • pruritic, clear “tapioca-like” vesicles that progress to papules, scaling, lichenification
  • fingers, palms, soles

Mgmt: topical steroid

If concern for athletes foot, treat w/antifungal first and then switch to steroid for eczema

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8
Q

Lichen simplex chronicus

A

D/t habitual scratching –> leathery and lichenification [neck, wrists, extensor surfaces of forearms, legs, scrotum, vulva]

Sx

  • well circumscribed plaque of Lichenification arising from confluence of small papules*
  • pruritic

Mgmt: stop itch-scratch cycle

  • mid/high potency topical steroid x 3wk to thick lesion (less potency for thinner skin)
  • PO antianxiety/sedating meds may be beneficial to stop scratch at night
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9
Q

Drug eruptions

A

Type I: classic immediate hypersensitivity [urticaria, angioedema, anaphylaxis]

Type II: cytotoxic [hemolysis, purpura]

Type III: immune complex [vasculitis, serum sickness, urticaria, angioedema]

Type IV: delayed hypersensitivity [contact dermatitis, exanthematous rxn, photoallergic rxn]

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10
Q

Morbilliform eruptions

A

MC cutaneous drug reaction (Type IV) - 7-10d after starting drug

Sx: maculopapular eruption, itching, polycyclic erythema; symmetrical on trunk, extremities

Common drugs: PCN, NSAIDs, TMP-SMX, thiazides

Mgmt: D/c drug; antihistamine

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11
Q

Urticarial drug reactions

A

Onset depends on governing mechanism

Sx: hives/wheals; angioedema; anaphylaxis; pruritus; burning of palms/soles

Common drugs: ASA, PCN, blood products, radiographic dye, morphine

Mgmt: d/c drug, antihistamine, +/- systemic steroid

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12
Q

Fixed drug eruption

A

Presents soon after drug exposure (30min to 8hr); reappears same site each time drug is taken

Sx: dusky red, round, plaques/bullae

MC: glans of penis (location)

Common drugs: ASA, NSAIDs, sulfonamides, TTC, TMP-SMX

Mgmt: d/c drug, topical steroid
- eroded lesion: use bactroban (abx ointment)

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13
Q

Lichenoid drug reaction

A

Onset 3wk - 3yr from drug exposure

Sx: multiple purple, flat topped, itchy papules

  • heal w/brown post-inflammatory hyperpigmentation
  • oral mucosa can be affected

Common drugs: gold salts, antimalarials, TTC, ketoconazole, sulfonylureas, NSAIDs, BB, ACE, CCB, furosemide, thiazide

Mgmt: d/c drug +/- steroid; antihistamine

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14
Q

Drug hypersensitivity syndrome

A

W/in first 2mo of drug exposure

Dx criteria: hematologic abnormality, cutaneous eruption, systemic involvement

Sx: fever, facial edema; exfoliative dermatitis; erythematous papules; LAD; eosinophilia, leukocytosis, atypical lymphocytes

Common drugs: sulfonamides, AEDs, allopurinol, minocycline, CCBs, ranitidine

Mgmt: d/c drug, prednisone, topical steroids, PO antihistamine

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15
Q

Acute Generalized Exanthematous Pustulosis (AGEP)

A

5d after drug ingested

Sx: superficial inflammatory pustules all over; fever, chills, ill; leukocytosis

Common drugs: macrolides, PCN, diltiazem

Mgmt: d/c drug; refer to derm

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16
Q

Stevens-Johnson Syndrome

A

MC: AEDs, sulfa, PCN, cold/cough OTC, NSAIDs, analgesics

Sx: erythematous macules w/darker purpuric centers (2 zones of color)

  • extensive mucous membrane involvement
  • fever, malaise, myalgias

Mgmt:

  • ICU/burn unit
  • tx infection
  • d/c drug
  • +/- steroids
  • supportive treatment
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17
Q

Toxic epidermal necrolysis

A

Sx:

  • prodrome: flu-like sxs, fever, prior to mucus membrane lesions
  • mild/mod tenderness of skin to pain, burning, paresthesias
  • skin peels off, glistening
  • mouth lesions, conjunctival burning

Nikolsky sign: push on skin and it peels away

Mgmt: d/c drug

  • supportive, pain relief
  • IVIG
  • tx infection
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18
Q

Lichen planus

A

Epi: MC in women

Sx: 1-10mm flat-topped pink-purple pruritic, polygonal, papules (4Ps)

Wickman’s Striae: fine white lines

Dx confirmed w/bx

Mgmt:
- steroids, retinoids, immunosuppressive agents

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19
Q

Pityriasis rosea

A

Et: viral

  • older children, young adults
  • spring, fall

Herald patch: single 2-5cm Oval lesion, red with collarette of scale

Progress to exanthem (smaller, salmon patch)

“Christmas tree” distribution

Initially look like ring worm but widespread distribution w/in a few days

Mgmt: spontaneous resolution 6-12wk

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20
Q

Psoriasis

A

MC elbows, knees, scalp

Sx: silvery, dry scales on bright red well-demarcated plaques

  • mild pruritus
  • nail pitting or onycholysis
  • Koebner phenomenon: lesions at trauma site
  • Auspitz sign: pinpoint bleeding after removal of scale
  • Woronoff ring: blanching around healing plaque

Mgmt:

  • > 5% BSA = derm referral
  • do NOT use PO steroid
  • topical steroid: high/ultra high x 2-3wk then pulse
  • Pluse: calcipoteriene, retinoids, coal tar, salicylic acid
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21
Q

Types of Psoriasis

A

Plaque: localized area w/thick scale (MC on extensor surfaces)

Guttate: small red papules w/scale

Inverse: shiny red areas in flexures

Pustular: pustules on palms and soles

Erythrodermic: generalized redness, may require admit

Psoriatic arthritis: hand joints MC, nail involvement, requires systemic therapy

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22
Q

Erythema multiforme

A

Et: HSV (MC)

Sx: targetoid pink, dark red, purple macules

  • papules/plaques +/- vesicles and bullae on palms, soles, forearms, legs
  • 3 zones of color**

Mgmt:

  • d/c drug
  • tx infection; control HSV w/acyclovir
  • topical abx for eroded vesicles
  • prednisone taper
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23
Q

Acne vulgaris

A

Bacteria: propionibacterium acnes

Sx: inflammatory papules/pustules, cysts/nodules

  • open: blackheads
  • closed: whiteheads
  • ice pick/pock mark scars, keloids

Mgmt:

  • inflammatory: benzoyl peroxide cream +/- topical Abx
  • comedome: topical retinoid [tretinoin, adapalene, tazarotene]

can add: PO abx (doxy or other ttc)

wear sunscreen!

refer to derm

24
Q

Rosacea

A

Erythematous telangiectasia - fixed erythema w telangiectasia, intermittent flushing
Tx: metronidazole gel*

Papulopustular type
Tx: topical metronidazole gel + oral abx (doxy or mino)

25
Q

Actinic keratosis

A

Premalignant - BCC or SCC* dt sun exposure
Fair skin, older than 40

Sx: red brown scaly Papule without underlying induration, 1-6mm, usually asx

Skin checks q 6mo
Sun protection

Mgmt
Derm referral
Cryotherapy <15 lesions
Tx: topical 5fu, imiquimod, aminolevulinic acid pulse light therapy*

26
Q

Seborrheic keratosis

A

Mc after age 30
Sx: warty stuck on appearance anywhere except lips, palms, soles
Any color and variable size

Mgmt
Don’t have to treat unless cosmetics
Cryo, E&D

27
Q

Seborrheic keratosis subtypes

A

Dermatosis papulosa nigra- African descent smaller darker papules on cheek

Stucco keratosis: white papules on legs

Sign of leser trelat: can indicate internal malignancy

28
Q

Lice

A

Children
Hair shaft
Nits behind ears or near neck
Itching

OTC: permethrin 1% repeat in 9d
Rx: benzyl alcohol lotion 5% ivermectin and malathion lotion
Nit comb

29
Q

Scabies

A

Infants, I/c head and neck
Extremely pruritic papules and burrows seen abdomen hands feet axilla and genitals

Scabies prep: scrape lesion w 15 blade

Mgmt 5% permetherin cream repeat in 1 wk, ivermectin (not under 5y or pregnant females); tx family and close contacts

30
Q

Alopecia areata

A

Immunologic phenomenon - emotional physical mental stress
Sx: sudden hair loss, skin is NORMAL (no scarring erythema or scale)
Can regrow but lose hair in another area
Indicator: missing medial brows and eyelashes

Labs: thyroid, cbc, ana, cmp

Mgmt
Steroids w immunomodulator, control autoimmune condition

31
Q

Androgenic alopecia

A

Mc type of hair loss in men
Progressive loss of terminal hairs on scalp - anterior scalp, mid scalp, temporal and vertex

Mgmt: minoxidil, po finasteride

32
Q

Onychomychosis

A

Fungal infection of the nail, increased with age and immunosuppression

33
Q

Paronychia

A

Bacterial infection of lateral nail fold
Skin red, inflamed, warm, tender +/- pus

Mgmt
I&D
Bacterial infection: pcn or cph
Antifungal cream bid

34
Q

Condyloma accuminatum

A

Anogenital warts
Soft, single or multiple, flat, dome shaped, cauliflower, filiform, fungating, pedunculated, smooth, verruceous w variable color
Typically asx but sometimes pruritic

Mgmt
Pt applied: topical imiquimod, podophyllotoxin, sinecatechins
Clinician applied: cryo, trichloroacetic acid, surgery

35
Q

Measles (rubeola)

A

Prodrome: coryza, cough, Koplik spots (1-3mm grayish elevations w erythematous base, typically buccal mucosa)

Brick red erythematous maculopapular blanching rash beginning on face spreading down body

Supportive care

36
Q

Rubella (German measles)

A

Pink pinpoint maculopapules appearing on face and spreading cephalocaudal; generalized in 24hr

Anterior, posterior, and occipital LAD

SUPPORTIVE CARE

37
Q

Roseola infantum

A

Kids <2y
High fever for several days, followed by blanching maculopapular rash
Neck and trunk then spreads to face and extremities

Supportive care

38
Q

Erythema infectiosum

A

Parvovirus b19*
Slapped cheek rash
Followed by “lace-like” rash (reticulated blanching erythema) on trunk and extremities

Supportive care

39
Q

Scarlet fever

A

GAS (pyogenes)
Pastia lines - confluent petechiae in antecubital fossa
Diffuse erythematous sandpaper rash
Occurs w or preceded by pharyngitis

Mgmt
Resolute followed by desquamation or frank peeling
Tx strep

40
Q

HSV 1 Primary

A

Asx
Primary gingivostomatitis - lips oral mucosa involved, swollen bleeding gums
Vesicles become erosion

41
Q

HSV 1 recurrent

A

Trigger - uv exposure, abrasions, chapping, stress, hormones, illness
Prodrome- tingling, burning, itching
Eruption of tender vesicles on erythematous base (dew drop on rose petal)
A/w Bell’s palsy

42
Q

HSV 1 dx tx

A

Clinical dx
Viral culture or pcr
Thank smear

Mgmt
Mild - topical penciclovir or doconosol
Extensive, frequent - po antivirals

43
Q

HSV 2

A

Genitalia herpes

Tx po antiviral on hand

44
Q

VZV

A

Reactivation of varicella virus most over 60
Prodrome: burning, tingling, itching
Red patch - vesicles - rupture - crust
Dermatomal dist
Herpes zoster ophthalmicus- Hutchinson sign (tip of nose) risk for corneal involvement
Postherpetic neuralgia

Dx- tzanck and culture

Tx - po abx
Zostavax vaccine >50; one dose live vaccine

45
Q

Verrucae (warts) info and tx

A

Hpv infecting epidermis and mucous membranes
Direct contact and auto inoculation *
Rf- young age, sexual activity, I/c

Most resolve on their own 
Exfoliative - salicylic acid; retinoid 
Ablative - cryo, cantharidin, laser
Cytotoxic - bleomycin, 5fu, interferon 
Immunomod - imiquinod, candida antigen
Other - duct tape, pads, apple cider vinegar
46
Q

Types of warts

A 
1. Common
1-10mm hyperkeratotic outgrowth
Disruption of palmar crease
Red brown dot might bleed w scraping
Filiform - small base w elongated cap and digital projections
  1. Plantar
    Small shiny sharp marginated papule then plaque w rough hyperkeratotic surface studded w brown black dots
    Disrupt skin lines
  2. Flat
    1-5mm sharp defined flat papule
    Skin colored to light brown on dorsal hand face or shin
    Linear distribution
  3. Corn (not wart)
    Friction pressure - progress to tenderness w pressure
    Skin lines travel through lesion
    Shaved = glassy core w no cap bleed points
47
Q

Molluscum contagiosum

A

Child and sexually active adult
Smooth, pearly, dome shaped, umbilicated papule* often multiple lesions
Resolve on own, may use cryo, curettage, cantharidin, imiquimod

48
Q

Candidiasis

A

Sweaty area, skin fold
Red moist glistening papule with “satellite lesions”*
Dx KOH and culture

Manage - dry w powder, topical nystatin and azole

49
Q

Tinea versicolor

A

Superficial skin infection of trunk, neck, and upper arm
Velvety tan, pink, or white macules that may coalesce
Asx or mild itch
Likely to recur

Manage:
Topical - selenium sulfide or ketoconazole shampoo, antifungal azole cream
PO - itraconazole or fluconazole

50
Q

Tinea corporis/pedis

A

Pedis - athletes foot: erythema, scaling, maceration, itch
Capitis- head: black dot, scaling and broken hairs (require PO therapy)
Sx- ring shaped lesion w advanced scaly border and central clearing, mild pruritus
Dx - skin scraping for KOH

Mgmt
Local - topical therapy
Extensive or follicular - Po therapy

51
Q

Acanthosis nigricans

A

DM, hypothyroid, obesity, drug, malignancy
Velvety thickening and hyperpigmentation of skin may have skin tags super imposed on top
Axilla, posterior neck
Dx - FBG, TSH, imaging if suspicious for malignancy
Tx- underlying; DM; sxs

52
Q

Hiradenitis suppurativa

A

Apocrine gland, more common w F
Inflammatory papules/pustules, cysts, comedones, sinus tracts

Mgmt
Acne meds - Po abx, topical or Po retinoids 
Steroid injections 
I&d
Adalimumab
53
Q

Lipoma

A

SQ tissue neoplasm
Soft mobile, solitary or multiple round, lobulated, yellow masses
Well circumscribed, no overlying skin changes

Mgmt
Excision

54
Q

Epithelial inclusion cysts

A

Epidermis/epithelium of hair follicle
Soft, mobile nodule (may have overlying puncta)

Mgmt
Excision - white and shiny after extraction
I&d not effective

55
Q

Melasma

A

Harmless pigmentary seen on malar region of darker skin women commonly during pregnancy

Brown tan patches Mc on face
Irregular patches w well demarcated borders

Dx — HCG; TSH, cortisol (addisons), woods lamp
Mgmt
Gone after pregnancy
Hydroquinone
Limit sunlight exposure 
Topical retinoid

Family Medicine (17 decks)

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