Dermatology 1

Question 1

Skin anatomy

Answer 1

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

Question 2

Hair anatomy

Answer 2

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

Question 3

Nail anatomy

Answer 3

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

Question 4

Macule

Answer 4

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

Question 5

Papule

Answer 5

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

Question 6

Plaque

Answer 6

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

Question 7

Nodule

Answer 7

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

Question 8

Pustule

Answer 8

circumscribed collection of leukocytes or pus that varies in size

Question 9

Vesicle

Answer 9

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

Question 10

Bulla

Answer 10

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

Question 11

Wheal

Answer 11

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

Question 12

Scales

Answer 12

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

Question 13

Erosion

Answer 13

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

Question 14

Ulcer

Answer 14

focal loss of epidermis and dermis, heal w/ scarring

Question 15

Atrophy

Answer 15

depression in skin resulting from skinning of the epidermis or dermis

Question 16

Scar

Answer 16

abnormal formation of connective tissue implying dermal damage

Question 17

Eczema

Answer 17

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

Question 18

Eczema and dermititis

Answer 18

all eczema is dermatitis but not all dermatitis is eczema

Question 19

Acute eczema

Answer 19

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

Question 20

Acute eczema treatment

Answer 20

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

Question 21

Subacute eczema

Answer 21

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

Question 22

Subacute eczema treatment

Answer 22

topical steroids, topical macrolide, immune suppresants, lubricants

Question 23

Examples of subacute eczema

Answer 23

atopic dermatitis, nummular eczema, irritant hand eczema

Question 24

Chronic eczema

Answer 24

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

Question 25

Chronic eczema treatment

Answer 25

High potency topical steroids, intralesional injection

Question 26

Hand eczema

Answer 26

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

Question 27

Irritant contact dermatitis

Answer 27

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

Question 28

Treatment of contact dermatitis

Answer 28

prevention, lubrication, topical steroids

Question 29

Atopic hand eczema

Answer 29

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

Question 30

Allergic contact dermatitis

Answer 30

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

Question 31

Rhus dermatitis

Answer 31

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

Question 32

Rhus dermatitis treatment

Answer 32

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

Question 33

Pompholyx

Answer 33

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

Question 34

Pompholyx treatment

Answer 34

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

Question 35

Statis dermatitis

Answer 35

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

Question 36

Atopic dermatitis

Answer 36

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,

Question 37

Pathogenesis of atopic dermatitis

Answer 37

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

Question 38

Diagnostic criteria of AD

Answer 38

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

Question 39

Differential of AD

Answer 39

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

Question 40

Treatment of AD

Answer 40

topical mild steroids, retinoids, and moisturizers

Question 41

Keratosis pilaris

Answer 41

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

Question 42

ichthyosis vulgaris

Answer 42

disorder of keratinization characterized by development of dry rectangular scales, "fish scales"

Question 43

Triggering factors of keratosis pilaris

Answer 43

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

Question 44

Treatment goals of keratosis pilaris

Answer 44

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

Question 45

Reasons for failure of treatment

Answer 45

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

Question 46

Topical therapy for keratosis pilaris

Answer 46

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

Question 47

Other therapy options for keratosis pilaris

Answer 47

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)

Question 48

Antihistamines keratosis pilaris

Answer 48

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

Question 49

Treating severe cases keratosis pilaris

Answer 49

oral or intramuscular steroids, cyclosporin, azathioprine, light therapy

Question 50

Urticaria

Answer 50

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

Question 51

Pathophysiology of urticaria

Answer 51

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

Question 52

Clinical features of urticaria

Answer 52

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

Question 53

Initial evaluation of urticaria

Answer 53

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

Question 54

Treatment of urticaria

Answer 54

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