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Clinical medicine > Dermatology 1 > Flashcards

Dermatology 1 Flashcards

1
Q

Skin anatomy

A

epidermic- .5-1.5 mm, Dermis-.3-3 mm, contains, melanocytes, langerhans, merkel, collagen, elastic, reticular connective tissue, papillary and reticular dermis, subcutaneous layer

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2
Q

Hair anatomy

A

5 mil hair follicles at birth, changes due to androgens, infundibulum, isthmus, inferior segment

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3
Q

Nail anatomy

A

nail plate, nail fold, cuticle, matrix (synthesizes 90% of plate), lunula, hyponychium

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4
Q

Macule

A

a circumscribed flat discoloration that may be brown, blue, hypo or apigmented

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5
Q

Papule

A

elevated solid lesion up to .5 cm in diameter, may become confluent to form plaques

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6
Q

Plaque

A

circumscribed, elevated, superficial, solid lesion more than .5 cm in diameter

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7
Q

Nodule

A

circumscribed, elevated, solid lesion of more than .5 cm in diameter, large is called tumor, more depth to lesion than plaque

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8
Q

Pustule

A

circumscribed collection of leukocytes or pus that varies in size

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9
Q

Vesicle

A

circumscribed collection of free fluid up to .5 cm in diameter

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10
Q

Bulla

A

circumscribed collection of free fluid more than .5 cm in diameter

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11
Q

Wheal

A

firm edematous plaque resulting from infiltration of the dermis with fluid, wheals are transient and may only last for a few hours

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12
Q

Scales

A

excess dead epidermal cells that are produced by abnormal keratinization and shedding

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13
Q

Erosion

A

a focal loss of epidermis; erosions do not penetrate below the dermoepidermal junction and therefore heal w/out scarring

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14
Q

Ulcer

A

focal loss of epidermis and dermis, heal w/ scarring

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15
Q

Atrophy

A

depression in skin resulting from skinning of the epidermis or dermis

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16
Q

Scar

A

abnormal formation of connective tissue implying dermal damage

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17
Q

Eczema

A

most common inflammatory skin disease, 3 stages, can start at any stage and move to any stage

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18
Q

Eczema and dermititis

A

all eczema is dermatitis but not all dermatitis is eczema

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19
Q

Acute eczema

A

caused by contact w/ specific allergens, ie poison ivy, inflam. varies from mod to intense, vesicles, bullae, excoriations may be present, intense itching, temporarily relieved w/ hot showers due to pain, heat aggravates; hrs-d

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20
Q

Acute eczema treatment

A

cool wet dressing, oral corticosteroids, antihistamines, and abx if there are signs of superficial 2nd infection

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21
Q

Subacute eczema

A

erythema and scales are present in various patterns usually w/ indistinct borders, not itching- intense itching, initial or follows acute, can resolve spontaneously w or w.out scarring

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22
Q

Subacute eczema treatment

A

topical steroids, topical macrolide, immune suppresants, lubricants

23
Q

Examples of subacute eczema

A

atopic dermatitis, nummular eczema, irritant hand eczema

24
Q

Chronic eczema

A

may be caused by prolonged irritation of subacute, or lichen simplex chronicus, thick plaques and deep parallel skin markings are said to be lichenified, sites common w/ habitual scratching, mod- intense itching, thickening of skin

25
Q

Chronic eczema treatment

A

High potency topical steroids, intralesional injection

26
Q

Hand eczema

A

inflammation of the hands, embarassment, 5.4% F:M 2:1, may be irritant contact dermatitis, atopic hand eczema, or allergic contact dermatitis, cleaners 21.3%, relapsingdifficult to dx

27
Q

Irritant contact dermatitis

A

housewives eczema, dishpan hands, detergents, most common hand eczema, environmental factors, inflammation varies

28
Q

Treatment of contact dermatitis

A

prevention, lubrication, topical steroids

29
Q

Atopic hand eczema

A

most common adult atopic dermatitis, backs of hands and fingers, chapping and erythema, edema, vesiculation, crusting, excoriation, scaling and lichenification

30
Q

Allergic contact dermatitis

A

inflammation reaction that follows absorption of antigen applied to the skin and recruitment of previously sensitized antigen-specific T-Lymph into the skin, affected area corresponds to allergen coverage, nickle, K dichromate, rubber, formaldehyde

31
Q

Rhus dermatitis

A

poison ivy, poison oak, poison sumac, cashew, mango, ginko, japanese laquer trees, presentation varies w/ quantity of oleoresin that contacts skin and susceptibility

32
Q

Rhus dermatitis treatment

A

prevention, immediate washing w/ soap and H2O, barrier vreams, wet compresses, topical steroids, prednisone dose pack, IM triamcinolone

33
Q

Pompholyx

A

unknown etiology, symmetric vesicular hand and foot dermatitis, mod-severe itching precedes the vesicles on the palm sides of the fingers, vesicles slowly resolve in 3-4 weeks, erythema, and dyshidrosis, stress induced

34
Q

Pompholyx treatment

A

topical steroids, cold wet dressing, abx, may use oral steroids or low dose methotrexate

35
Q

Statis dermatitis

A

eczematous eruption that occur in the lower legs in pts w/ venous insufficiency, unknown cause, allergic response to protein antigen, skin compromised more susceptible to irritation

36
Q

Atopic dermatitis

A

chronic, pruritis eczematous disease that nearly always begins in childhood, follows a remitting course that may continue throughout life, flared w. stress, infection, climate change, irritants, 7-17% prevalence,

37
Q

Pathogenesis of atopic dermatitis

A

elevated IgE, 20% have normal IgE, eosinophilia- major effector cells, correlates roughly w. disease severity, disordered cell-mediated immunity, pts may develop severe diffuse cutaneous infection, itching

38
Q

Diagnostic criteria of AD

A

must have- pruritis, age-specific patterns, relapse, facial, neck or extensor involvement in kids, current flexural lesions any age, sparing groin and axilla; may have- early age onset, fam hx, IgE reactivity, xerosis, ocular changes

39
Q

Differential of AD

A

rule out scabies, seborrheic dermatitis, contact dermatitis,, cutaneous t-cell lymphoma, psoriasis, immune def, erythroderma of other causes

40
Q

Treatment of AD

A

topical mild steroids, retinoids, and moisturizers

41
Q

Keratosis pilaris

A

xerosis, ichthyosis vulgaris, hyperlinear palmer creases, pityriasis alba, atopic pleats, cataracts and keratoconus

42
Q

ichthyosis vulgaris

A

disorder of keratinization characterized by development of dry rectangular scales, “fish scales”

43
Q

Triggering factors of keratosis pilaris

A

temp change, sweating, dec humidity, excessive washing, contact allergy, aeroallergens, staph infection, foods, emotional stress

44
Q

Treatment goals of keratosis pilaris

A

prevent triggers, eliminate inflammation and infection, preserve and restore the stratum corneum barrier, control pruritus, treat as per stage of inflammation

45
Q

Reasons for failure of treatment

A

poor pt compliance, allergic contact dermatitis to topical med, simultaneous occurrence of asthma or hay fever, inadequate sedation, continued stress

46
Q

Topical therapy for keratosis pilaris

A

topical steroids until clear, safe in children, group V topical steroids (fluticasone propionate .05%) up to 4 weeks in children and 3 months in adults, Group V creams or ointments for red scaly skin, Group 1 or 2 for lichenoid skin

47
Q

Other therapy options for keratosis pilaris

A

tar, main stay treatment before steroids, effective but slow; lubrication- petroleum, effect after bath, mild soaps, NSAID- pimecrolimus cream 1% (Elidel), tacrolimus .03%, .1% ointment (Protopic)

48
Q

Antihistamines keratosis pilaris

A

control pruritus and induces sedation and sleep, hydroxyzine, doxepin cream 5%, short term for 8 days

49
Q

Treating severe cases keratosis pilaris

A

oral or intramuscular steroids, cyclosporin, azathioprine, light therapy

50
Q

Urticaria

A

hives, wheal, 20% have one episode, majority are acute- hrs-w, chronic urticaria last more than 6 weeks more common in middle aged women

51
Q

Pathophysiology of urticaria

A

histamine is most important mediator, causes endothelial cell contraction, allows vascular fluid to lead between vessel wall, contributes to edema, H1- vasodilation/pruritis, H2- vasodilation

52
Q

Clinical features of urticaria

A

circumscribed, erythmatous, pruritic, nonpitting edematous plaque, changes size and shape by peripheral extension, lesion may vary in size from 2-4 mm papules to single lesion covering extremity, round, oval or polycyclic, varying colors, angioedema is more uniform and has much deeper edema

53
Q

Initial evaluation of urticaria

A

skin exam, detailed hx about food drugs, infections, chronic illness, acute or chronic, dermographism

54
Q

Treatment of urticaria

A

nonsedating H1 antihistamine (allegra, zyrtec, claritin); sedating H1 are more effective- use to treat severe cases, doxepin effective in anxious and depressed pts, H2 blockers (Zantec, pepsin)- not much efficacy, oral corticosteroids for refactory cases, immunotherapy

Clinical medicine (19 decks)

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