Dermatologic Disorders Flashcards
side effects of oral isoretinoin
teratogen, hepatotoxicity, hypertriglyceridemia, pancreatitis, suicidal ideation
adverse effect of combining oral isoretinoin with tetracycline
pseudotumor cerebri
treatment for necrotizing fascitis caused by streptococcus or clostridia
penicillin G +/- clindamycin
general empiric treatment of necrotizing fascitis
impinem +/- vancomycin
treatment for MRSA skin infections
10-14 day course of: bactrim + rifampin clindamycin + rifampin minocyclin + rifampin linezolid \$\$$
classic presentation of rosacea
facial erythema with telangiectasias starting at the nose and cheeks
provoked by various stimuli including spicy foods
rhinophyma (sebaceous gland hyperplasia of the nose)
treatment for rosacea
topical:
sulfacetamide + sulfur
metro-gel, metronidazole
rhinophyma may require laser therapy
systemic treatment:
tetracycline, doxycycline, or accutane
when antibiotics should be used in the treatment of skin abscesses
if abscess is > 5cm or if patient has comorbidities: diabetes, immunocompromised
preferred medication in treatment of scabies
permethrin soap
second line: oral ivermectin
characteristic features of necrotizing fasciitis
necrosis, purple, woody texture, crepitus, pain extends beyond region of cellulitis
treatment for dry gangrene
auto-amputation
treatment for wet gangrene
debridement or amputation
medication options for treatment of acne vulgaris
first line: topical retinoin
second line: oral/topical antibiotic or benzoyl peroxide
other options: OCPs, spironolactone, or oral isoretinoin for cystic acne
time-frame in treatment of varicella
antivirals if within 72 hours
side-effects from oral isoretinoin
hepatotoxicitiy, suicidal ideation, teratogenic effects, elevated triglycerides and pancreatitis
appearance of molluscum contagiosum
painless shiny papules with central umbilication
treatment for molluscum contagiosum
self-limited, most resolve within 3 years
chemical, laser, or cryotherapy for removal
imiquimod will induce inflammatory reaction against lesion
treatment for tinea capitis
oral griseofulvin, terbinafine
topical will not work because the tinea is INSIDE the hair follicle
lichen planus features
pruritis, purple, polygonal, papules, and plaques
shiny and flat on flexor surfaces
associated with HIV and hepatitis C
treatment of lichen planus
topical or intralesional medium to high-potency steroids
acitretin (oral retinoid)
stages of decubitous ulcers
stage I: pressure related alteration in intact skin such as change in color, consistency, or temperature
stage II: superficial ulcer, abrasion, or shallow crater
stage III: full thickness skin loss
stage IV: extensive destruction or necrosis, damgage to muscle or bone
treatment of decubitous ulcers
address nutrition to help body heal
relieve pressure, soft mattress, elevate heels
debride if necessary with hydrocolloid dressing
stasis dermatitis
caused by vascular insufficiency
increased pigmentation, scaly and crusted erosions, ulcers
treat with compressive stockings, elevation of legs, topical steroids, consider horse chestnut seed extract, aspirin to accelerate healing of ulcers
medications that cause erythema multiforme
penicillins, sulfonamides, NSAIDs, OCPs, anti-convulsants
distinctions between erythema multiforme, stevens-johnson, and TEN
erythema multiforme: target lesions, no sloughing of skin
stevens-johnson: 30% body sloughing, decreased WBC, decreased H/H, elevated LFTs
classic presentation of pityriasis rosea
herald patch followed by christmas tree rash 1-2 weeks later
treatment for pityriasis rosea
self-limited, consider UV therapy
clinical features of pityriasis versicolor
salmon/light brown hypopigmented macules that will scale when scraped off
wood-lamp shows blue-green scales
treatment for pityriasis versicolor
ketaconozole, selenium sulfide
classic presentation of erythema nodosum
associated with IBD, streptococcus, sarcoidosis
pretibial, tender, painful nodules
classic presentation of lichen planus
pruritic, purple, polygonal, papule, plaque
treatment for seborrheic dermatitis
selenium sulfide, tar, ketoconazole, topical steroids
treatment options for psoriasis
topical steroids (NOT ORAL) tar, anthrolin, salicylic acid, UV therapy, anti-TNF agents in refractory cases
diagnosis and management: melasma
hyperpigmentation of skin associated with pregnancy
minimize sunlight exposure
hydroquinone (inhibits tyrosine kinase to block melanin production)
mix with flucinolone, tretinoin
diagnosis and management: vitiligo
sharply demarcated patches of complete depigmentation, loss of melanocytes, borders are hyperpigmented
associated with thyroid disease in 30% of patients
sunscreen, corticosteroids if <10% skin is affected
tacrolimus, pimecrolimus (can use around eyes unlike steroids), psoralens, UV light, surgical minigrafting, or depigmentation of normal skin using hydroquinone
diagnosis and management: acanthosis nigricans
hyperpigmentation of skin in creases of body
treat diabetes, weight loss, discontinue steroids, survey for visceral malignancy
topical retinoin, steroids, fish oil
purple-red hemangioma on face that does not regress with age
port-wine stain
associated with sturge-weber
infant with bright-red lesion that regresses over months-years
strawberry hemangioma
most spontaneously resolve, use systemic steroids if periorbital, in airways, or associated with high-output heart failure
benign small red papule that appears on skin with age
cherry hemangioma
bright red papule with radiating blanching vessels
spider angioma
associated with cirrhosis
blue compressible mass that does not regress
cavernous hemangioma
red-pink nodule on a child that is often confused with melanoma
spits nevus
diagnosis and management: alopecia areata
asymptomatic, non-inflamamtory, non-scarring areas of hair loss, often precipitated by stress
rule out other causes: CBC, BMP, ESR, TSH, ANA, SLE, syphillis, addison’s, trichotilliomania
treatment: fluocinolone oil/shampoo, intralesional steroid injections, topical minoxidil, anthralin cream, SADBE, topical steroids ineffective due to poor scalp penetration
diagnosis and treatment: androgenic alopecia
male-pattern hair loss, check serum testosterone, DHEA, prolactin
men: finasteride +/- minoxidil
women: minoxidil +/- sprionolactone
most important prognostic indicator of melanoma
depth of lesion
skin condition associated with obesity, diabetes, or malignancy
acanthosis nigricans
pigmented plaques that appear to be stuck onto the skin
seborrheic keratosis
black velvety plaques on flexor surfaces and intertriginous areas
acanthosis nigricans
rough lesions on sun exposed skin easier to feel than see
actinic keratosis
circular rash with central clearing on the trunk or arms
tinea corporis
classic appearance of basal cell cancer
pearly lesion with central ulceration and telangiectasias
classic appearance of squamous cell cancer
erythematous papule with scaling or keratinized growths in sun-exposed area, may bleed or ulcerate
classic appearance of porphyria cutanea tarda
blistering on sun-exposed skin, erosions and hyperpigmented skin
how might pemphigus vulgaris be distinguishable from bullous pemphigoid
positive nikolsky test for pemphigus vulgaris
treatment options for actinic keratosis
topical 5-FU or imiquimod, cryotherapy
purple-red hemangioma on face that does not regress with age
port wine stain
infant with bright-red lesion that regresses over months to years
strawberry hemangioma
benign small red papule that appears on skin with age
cherry hemangioma
bright red papule with radiating blanching vessels
spider hemangioma
blue compressible mass that does not regress
cavernous hemangioma
red-pink nodule on a child that is confused with melanoma
spitz nevus
treatment available for androgenic alopecia
men: finasteride +/- minoxidil
women: minoxidil +/- spironolactone
underlying causes of alopecia areata
trichotillomania, stress, autoimmune disorders, lupus, addison’s disease
round, firm, rapidly growing papule with a central crater
keratoacanthoma
rough surfaced, sharply demarcated, round, firm papule whose color may be gray, yellow, brown, or gray-black
wart
friable, rapidly enlarging, erythematous, vascular-appearing papules with a collarette of scale
pyogenic ganuloma: most commonly develop at sites of previous minor injuries
(misnomer, more appropriately known as lobular capillary hemangioma)
treatment: surgical excision, curettage, or electrodesiccation
