Dermatology #1 Flashcards
MC organism for folliculitis
Staph Aureus
Treatment for Folliculitis
Topical Mupirocin, Clindamycin, or Benzoyl Peroxide
Stephen Johnson Syndrome (SJS) is sloughing involving ______% of the body surface. Most common causes are
<10%
- Medications (Sulfa drugs, anticonvulsants, and Lamotrigine, Allopurinol)
- Infections
Toxic Epidermal Necrolysis (TEN) involves _____% of the body surface
> 30%
Symptoms of SJS and TEN
- Positive Nikolsky Sign
- Involves at least 1 mucous membrane
- Widespread flaccid bullae beginning on trunk and face
Treatment for SJS and TEN
- Discontinue offending agent
- Supportive (treat like severe burns)
MCC of Erythema Multiforme
Herpes Simplex
Treatment for androgenetic alopecia
-Topical Minoxidil and Oral Finasteride (5-alpha reductase type 2 inhibitor)
MCC of Onychomycosis
-T. Rubrum
Diagnostic for onychomycosis
- Make sure to determine it is a fungal infection before treatment
- KOH wet mount prep (rapid and sensitive)
- Periodic acid-Schiff test (most sensitive)
Treatment for onychomycosis
-Systemic Antifungals: Terbinafine
A Paronychia is MCC by ______. It is a painful, red swollen area around proximal or lateral nail folds at the cuticle. Treatment includes
S. Aureus
- Warm water or antiseptic soaks
- Cephalexin or Dicloxacillin are first line oral-therapy
Which spider has systemic and neurologic symptoms within 30 minutes to 2 hours of bite and what is the most prominent feature
- Black Widow
- Muscle spasms, muscle pain, rigidity
Treatment for black widow spider bite
- Wound and pain control
- Muscle relaxants
- Antivenom if not responsive to above medications
Erythema Infectiosum is caused by which virus
Parvovirus B19
Describe Rubeola
- Caused by Measles virus (Part of Paramyxovirus family)
- Cough, coryza, conjunctivitis, + high fever
- Koplik Spots: white or blue papules with erythematous base on buccal mucosa
- Morbilliform/maculopapular rash begins at hairline and spreads cephalocaudally that darkens
Complications of Rubeola
- Diarrhea
- Pneumonia (MCC of Measles related death)
Cellulitis is MCC by ________ and is characterized by localized macular erythema, not sharply demarcated margins, swelling, warmth, and tenderness.
Group A Strep
Treatment for Cellulitis
- Oral: Cephalexin, Dicloxacillin
- IV: Cefazolin
- Cat bite: Augmentin, Doxy
If you think MRSA, what are the treatment options
- Oral: Clindamycin, Doxy, Bactrim
- IV: Vanco
Erysipelas is caused by _____ and is characterized by
Group A Strep (S. Pyogenes)
- Intensely erythematous raised area with sharply demarcated borders, tenderness, warmth
- Usually on lower extremities and face
Treatment for Erysipelas
- Oral: Penicillin, Amoxicillin, Cephalexin
- IV: IV Cefazolin, Ceftriaxone
Treatment for Impetigo and causes of Impetigo
- MCC is Staph A
- Mupirocin x 10 days
Dermatophytosis (Tinea) Treatments
- Tinea Capitis: Oral Griseofulvin, Oral Terbinafine
- Tinea Pedis: Topical Antifungals (Butenafine, Azoles)
- Tinea Cruris: Topical Antifungals (Clotrimazole, Butenafine)
- Tinea Corporis: Topical Azoles
MCC of Dermatophytosis
-T. Rubrum
Diagnostics for Tinea
- KOH prep: best initial test (segmented hyphae)
- Woods Lamp: No fluorescence with T. Rubrum
- Culture: Definitive Diagnostic
Intertrigo MCC and where does it occur
- In intertriginous areas (inguinal folds, axillae, intergluteal folds)
- Candida Spp. Most Common Cause
Symptoms of Intertrigo and risk factors
- Erythematous, beefy red macerated plaques with erythematous satellite lesions
- Warm moist environments, obesity, DM, immunocompromised
Diagnostic for Intertrigo
KOH prep shows budding yeast with or without pseudohyphae
Treatment for intertrigo
Topical Antifungals (Azoles)
Drug of choice for Scabies
-Permethrin Topical
- Other options: Lindane (do not use after shower due to seizure risk, Teratogenic in kids)
- All clothing and bedding placed in bag for at least 3 days and then washed and dried on high heat
Symptoms of Condyloma Acuminata
-Soft, fleshy, cauliflower like lesions in genital regions or oropharynx
Diagnostic for Condyloma Acuminata
-Acetic acid application: whitening of the lesion
Risk Factors for Squamous Cell carcinoma
- Sun exposure
- HPV infection
- Lighter skin
- Chronic Wounds, Old scars or burns
- Chronic Immunosuppression
Symptoms of SCC
- Erythematous, elevated thickened nodule with adherent white scaly or crusted, bloody margins
- Nonhealing ulceration or erosion
- On lips, hands, head or neck
Treatment for Squamous Cell Carcinoma
-Surgical excision with clear margins
What is Bowen’s Disease?
-Squamous Cell Carcinoma in Situ (has not invaded the dermis)
Most common type of malignant melanoma
-Superficial Spreading (trunk in men and legs in women)
Explain ABCDE for malignant melanoma
- Asymmetry
- Borders (Irregular)
- Color (Variation)
- Diameter ( 6mm or greater)
- Evolution
Diagnostic for Malignant Melanoma
-Full thickness wide Excisional Biopsy + Lymph Node Biopsy
Treatment for Malignant Melanoma
-Complete wide surgical excision
Symptoms of Eczema (Atopic Dermatitis)
- Pruritus
- Common in flexor creases
- Nummular: coin shaped lesions on dorsum of hands, feet, knees, elbows
Treatment for Eczema
- Topical Corticosteroids
- Antihistamines for itching
- Wet dressings (Burrow’s Solution)
- Topical Calcineurin Inhibitors (Tacrolimus, Pimecrolimus)
Pityriasis Rosacea Symptoms
-Herald patch (solitary salmon-colored macule) for 1-2 weeks, then smaller, pruritic round or oval salmon colored papules with scaling in a Christmas Tree Pattern (along cleavage lines) on trunk and extremities
Pathophysiology of Psoriasis
- Keratin hyperplasia and proliferating cells in the stratum basal + stratum spinous due to T cell activation and cytokine release
- This causes Accelerated epidermis turnover
Symptoms of Psoriasis
- Plaque: raised, well-demarcated pink-red plaques with thick silvery white scales on extensor surfaces
- Auspitz Sign: punctate bleeding with removal of plaque
- Koebner’s Phenomenon: new lesions at sites of trauma
- Nail involvement: pitting, discoloration under nail (oil spot)
Guttate Psoriasis appears after
-Strep Pharyngitis
Treatment for Psoriasis
- Mild Moderate: Topical Corticosteroids (Calcipotrene), Tazarotene
- Calcineurin Inhibitors (Tacrolimus) on face and penis
- Moderate Severe: Phototherapy, UVB, PUVA
- Severe: Cyclosporine, Retinoids, Etanercept (Systemic Tx)
Pityriasis Versicolor is caused by overgrowth of ________
Yeast Malassezia Furfur
Symptoms of Pityriasis Tinea Versicolor
- Hyper or hypo pigmented well-demarcated round or oval macule with fine scaling
- Skin fails to tan with sun exposure
Diagnostics for Tinea Versicolor
- KOH prep: Hyphae and spores (spaghetti and meatballs appearance)
- Wood’s Lamp: Yellow-green Fluorescence
Treatment for Versicolor
-Selenium Sulfide, Sodiu Sulfacetamide, Zinc Pyrithione, & Azoles
Stages of Pressure Ulcer
- Stage 1: Superficial, Nonblanchable redness that does not dissipate after pressure is relieved
- Stage 2: Extends into dermis. Resembles blister or abrasion.
- Stage 3: Full thickness, may go into subcutaneous layer.
- Stage 4: Deepest. Into muscle, tendon, bone.
Treatment for Stage 1 Pressure Ulcer
Wound care with moist wound environment. Pain control Debridement if necrotic tissue present Pressure redistribution -Transparent film for protection
Treatment for Stage 2 pressure ulcer
- Dressing that maintains moist wound environment
- Occlusive dressings (Hydrocolloid or Hydrogels) if no infection
Treatment for hidradenitis Suppurativa
-Clindamycin topical
Roseola is MCC by
Human Herpesvirus 6
-Sixth Disease
Symptoms of Roseola
- High fever then abrupt onset of maculopapular, blanch able rash
- Rash begins on trunk and neck then spreads to face
- Nagayama Spots: erythematous papules on soft palate and uvula
Rubella is MCC by
Rubella Virus (Togavirus family)
Symptoms of Rubella
- Fever, LAD, Exanthem (maculopapular rash that starts on face and spreads to trunk).
- Rash lasts 3 days
- Forchheimer Spots: small red macules on soft palate
True or False: Rubella is teratogenic in the first trimester
True!
