Dermatology Flashcards
Macule?
___ (usually less than ___ in diameter), ____ or ____ that can be ____, ___, ___, or ___ and has some texture as surrounding skin
usually ____
Small (usually less than 1cm in diameter), flat blemish or discoloration that can be brown, tan, red, or white and has some texture as surrounding skin
usually non-palpable
Bulla?
___, thin walled ____ greater than ___ in diameter, containing _____
Raised, thin walled blister greater than 0.5cm in diameter, containing clear or serous fluid
Vesicle?
___ (less than ___ in diameter), ___, raised ___ containing ___, ___, ___ or ___ fluid
Small (less than 0.5cm in diameter), thin-walled, raised blister containing clear, serous, purulent or bloody fluid
Pustule?
___, ___- or ___- filled, ___ lesion that varies in diameter and may be ___ or ___ and ___ or ___
Circumscribed, pus- or lymph- filled, elevated lesion that varies in diameter and may be firm or soft and white or yellow
Wheal?
Slightly ___, ___ lesion of variable size and shape, surrounded by ___; skin may be __ or __
Slightly raised, firm lesion of variable size and shape, surrounded by edema; skin may be red or pale
Nodule?
___, ___, ___, ___ lesion ___ in diameter with possible skin ___
Small, firm, circumscribed, elevated lesion 1-2cm in diameter with possible skin discoloration
Papule?
___, ___, ___ lesion less than ___ in diameter, with ___ to ___ skin ___
Small, solid, raised lesion less than 1cm in diameter, with red to purple skin discoloration
Tumor?
___, ___ mass unusually larger than ___ in diameter, with possible ___
Solid, raised mass unusually larger than 2cm in diameter, with possible skin discoloration
What are primary lesions?
those lesions that arise ___
examples: (7+)
Bulla: a circumscribed, elevated fluid-filled lesion greater than 1 cm in size (e.g. epidermolysis bullosa, bullous impetigo).
Macule: a circumscribed, flat lesion with color change up to 1 cm in size that is not palpable (e.g. ash leaf macules, café au lait macules).
Nodule: a circumscribed, elevated solid lesion with depth up to 2 cm e.g. cyst.
Papule: a circumscribed, elevated solid lesion up to 1 cm in size, elevation may be accentuated with oblique lighting, e.g. Mila, acne, verrucae.
Plaque: a circumscribed, elevated, plateaulike, solid lesion greater than 1 cm in size (e.g. psoriasis).
Pustule: a circumscribed, elevated lesion filled with purulent fluid, less than 1 cm in size (e.g. erythema toxicum neonatorum, acne).
Vesicle: a circumscribed, elevated, fluid-filled lesion up to 1 cm in size (e.g. herpes simple
What are secondary lesions?
lesions that are brought about by ____ of the ____ either by the individual with the lesion or through the natural evolution of the lesion in the environment.
Atrophy: localized shrinking of the skin which results in paper-thin, wrinkled skin with easily visible vessels. Results from loss of epidermis, dermis or both. Dermal atrophy manifests as a depression in the skin which can occur secondary to intralesional steroid injections. Epidermal atrophy manifests as thin almost transparent skin; may not retain normal skin lines which can occur secondary to topical steroid use.
Crust: occurs from dried exudate overlying and impaired epidermis. The exudate can be composed of blood, serum, or pus. e.g impetigo, epidermolysis bullosa.
Erosion: intraepithelial loss of epidermis, usually heals without scarring, moist, circumscribed, usually depressed lesion due to loss of all or part of the epidermis e.g. herpes simplex.
Fissure: linear, often painful breaks within the skin surface, as a result of excessive xerosis (dryness of skin).
Scale: occurs due to increased shedding or accumulation of stratum corneum as a result of abnormal keratinization and exfoliation (e.g. seborrheic dermatitis, postmaturity desquamation). Types of scale include pityriasiform which is branny and delicate, psoriaform which is thick, white and adherent, and icthyosiform which is fish-scale-like.
Scar: permanent fibrotic skin changes that develop as a consequence of tissue injury in which normal tissue is replaced by fibrous connective tissue at the site of injury to the dermis. Scars may be hypertrophic, atrophic, sclerotic or hard due to collagen proliferation. Reflects pattern of healing in the affected area.
Ulcer: full-thickness loss of the epidermis with damage into the dermis, heals with scarring (e.g. ulcerated hemangiomas, aplasia cutis congenita).
Topical medication administration?
___ -> ___ -> ___ -> ___ (most potent)
Lotions -> Creams -> Gels -> Ointments
Infectious dermatological conditions:
F____ (2)
B____ (3)
V____ (5)
Fungal
Tinea—dermatophytes
Tinea/Pityriasis versicolor
Intertrigo—candida
Bacterial
Impetigo
Cellulitis
Follicular
Folliculitis
Furuncle
Carbuncle
Hydradenitis
Viral
Herpes simplex
Herpes Zoster
Mollusum
HPV/Warts (Verruca)
Pityriasis rosea
Tinea?
___ infection in the ___
Tinea, dermatophytes
= Tinea means a _____ of the ___ , ___, or ___
Majority caused by 3 fungi/dermatophytes:
- ____,
- ___ ___ (most common),
- ____
Dermatophyte is ___ that ___ and ___ in the ____ (___)
Rarely ____ ___ or ___ (Majocchi’s granuloma) -> superficial
Classified according to Latin term for body location: ___ —head; ___—foot; ___—groin; corporis—body
Predisposing factors: (7)
Transmitted via ___ with ___, ___, ___
Diagnosed via ___ – Looking for ___
___ is possible but takes up to 6 weeks for results
___ can also be used to confirm presence of dermatophyte (takes a while)
Avoid using ___ -> may exacerbates sx and confuse dx (Tinea Incognito),
treat ___ cause first use ____
Fungal infection in the epidermis
Tinea, dermatophytes
= Tinea means a superficial fungal infection of the hair, skin, or nails
Majority caused by 3 fungi/dermatophytes:
- Epidermophyton,
- Trichophyton Rubrum (most common),
- Microsporum
Dermatophyte is fungus that invades and proliferates in the nonviable keratinized layer of skin—stratum corneum
Rarely penetrate skin or hair follicle (Majocchi’s granuloma) -> superficial
Classified according to Latin term for body location: capitis—head; pedis—foot; cruris—groin; corporis—body
Predisposing factors: male, humid environment, gym, wrestling, smoking, sweating, hx of diabetes
Transmitted via direct contact with infected person, animal, or environment
Diagnosed via KOH slide– Looking for hyphae
Culture is possible but takes up to 6 weeks for results
DTMs can also be used to confirm presence of dermatophyte
Avoid using steroids -> may exacerbates sx and confuse dx (Tinea Incognito)
treat infectious cause first use antifungal
Tinea Capitis?
Fungal infection of ___ -> ___ (secondary alopecia)
Can be associated with ___ (3)
Causes: (2)
More common in ___
Incubation period of ___
Presence of ___ helps differentiate from ___ (black dot sign)
May have ___: (6)
Fungal infection of scalp -> bald spots (secondary alopecia)
Can be associated with scalp injury, chronically moist hair (i.e. sweating), poor hygiene
Causes: sharing hats, barber’s tools
More common in black children
Incubation period of 2-4 days
Presence of broken hair shafts helps differentiate from alopecia (black dot sign)
May have Kerion: swollen, boggy, fever, pain, lymphadenopathy, pus
Tinea Capitis treatment:
Rx: ___ PO x ___ vs ___ weeks with ___
Other Rx options: (3)
all these options can be ___
Topical RX ineffective as ___
However–use of ___ ___ on weekly basis may discourage ___ (____ ___ times ___)
Rx of household members ___ as may be ___
Antifungal shampoo leave on for ___ then ___ ___
Don’t ___ (3)
Have pets checked by vet if suspected partner in crime
Rx: Griseofulvin Microsize PO x 4-6 weeks vs 8-12 weeks with food
Other Rx options: Terbenifine (Lamisil), itraconazole (Sporanox), fluconazole (Diflucan)
all these options can be hepatotoxic
Topical RX ineffective as monotherapy
However–use of antifungal shampoos on weekly basis may discourage recurrence (ketoconazole 2% shampoo 1-3 times weekly)
Rx of household members recommended as may be asx carriers
Antifungal shampoo leave on for 5 min then rinse 3x/wk
Don’t share combs, towels, hats
Have pets checked by vet if suspected partner in crime
Tinea Corporis
Typically begins as ___, ___, ___, ___ patch that spreads ____-> ___ ___
___ edges compared to central portion
* ___- ____ borders
hallmark signs:
___, ____ borders with ___ ___
Most common differential includes: ___ ___
May be seen in:
Adults caring for children with Tinea capitus
Athletes w/skin-to-skin sports (wrestling)
Immunosuppressed
Rx: Topical antifungals recommended 1st line
____ (ex)
____ (Lamisil) or ___ (Loprox) - safe in ___ or ___
_____ if immunosuppressed
Typically begins as pruritic, circular, erythematous, dry, scaling patch that spreads centrifugally-> central clearing
Raised edges compared to central portion
* Well-defined borders
hallmark signs:
Distinct, well-demarcated borders with central clearing
Most common differential includes: nummular eczema
May be seen in:
Adults caring for children with Tinea capitus
Athletes w/skin-to-skin sports (wrestling)
Immunosuppressed
Rx: Topical antifungals recommended 1st line
Imidazoles (econazole, ketoconazole, miconazole, etc)
Terbinafine (Lamisil) or Ciclopirox (Loprox)- safe in pregnancy or breastfeeding
Oral tx if immunosuppressed
Tinea Cruris
___ or “___” (2)
___, ___ usually spared
May be assoc. w/ ___ or ___
Often ___ via ___ ___
Presentation: begins as small ___ patch w/___ & ___ that spreads peripherally w/___ (scalloped) ___-___ ____
Rx: topicals usual recommendation continue Rx ____ past sx clearing
: Usually requires _____ - prepare pt!
Oral agents ____ if severe or non-responsive to topicals
Treat tinea pedis if present to prevent reinfection
Keep area ___ and ___ as much as possible
_____ ; boxers, not briefs; loose-fitting, cotton clothes
Groin or “crural fold” (upper, inner thighs)
Scrotum, penis usually spared
May be assoc. w/sweating or exertion
Often self-innoculated via tinea pedis
Presentation: begins as small erythematous patch w/crust & scaling that spreads peripherally w/curved (scalloped) well-defined edges
Rx: topicals usual recommendation continue Rx 1 week past sx clearing: Usually requires 2-4 weeks tx - prepare pt!
Oral agents x2 wks if severe or non-responsive to topicals
Treat tinea pedis if present to prevent reinfection
Keep area dry and well vented as much as possible
Zeazorb powder; boxers, not briefs; loose-fitting, cotton clothes
Tinea Pedis
Very ___, ___ condition
Related to ___ (4)
May be accompanied by ___ (___)
Presents as ____ ____ ___ in the interdigital web spaces or as dull erythema with scaling with ___ on plantar surfaces of feet
Types: ___ (most common), ___, ___
Always examine between ___ and ___ digits
Assess for possible ___ ___ infection
Rx: Topical ___ (4) for _____
Severe cases or if immunosuppressed: ____ for ____
Keep area dry and well vented as much as possible
Very common, chronic condition
Related to moisture/hyperhidrosis, poor ventilation in shoes, immunosuppression, prolonged oral steroids
May be accompanied by onychomycosis (nail fungus)
Presents as macerated hyperkeratotic plaques in the interdigital web spaces or as dull erythema with scaling with hyperkeratosis on plantar surfaces of feet
Types: Interdigital (most common), Moccasin, Vesiculobulous
Always examine between 4th and 5th digits
Assess for possible 2ndary bact infection
Rx: Topical antifungals (Econazole, Nafitine, Ketoconazole, Terbinafine) for 2- 4 weeks
Severe cases or if immunosuppressed: oral tx for 2 wks
Keep area dry and well vented as much as possible
Tinea/Pityriasis Versicolor:
___, ___, ____ infection
Prevalent in ___ climates: up to 40%
Caused by yeast genus Malassazia furfur or P. Ovale
Common in ___ ____ especially in ___
Presentation: ___ scale, ___ or ___ patches appear that are ___ or ___ macules and patches in pale skin & ___ macules in dark skin w/delicate scaling
Typically ___
Treatment ___, ___, shampoo application to skin. Takes several weeks to work and it often recurs
= ____ or ____ Shampoos – must leave on skin at least ___, then rinse. Can be applied overnight and rinsed in AM.
PO ___ _mg – advise pt to ___ 30 min later
Note: ____ is ineffective for this condition
Chronic, asymptomatic, superficial infection
Prevalent in warm humid climates: up to 40%
Caused by yeast genus Malassazia furfur or P. Ovale
Common in young adults especially in Summer
Presentation: Fine scale, guttate or nummular patches appear that are pink or brownish macules and patches in pale skin & hypopigmented macules in dark skin w/delicate scaling
Typically asymptomatic
Treatment topical, oral, shampoo application to skin. Takes several weeks to work and it often recurs
Selenium Sulfide or Ketoconazole Shampoos – must leave on skin at least 10 minutes, then rinse. Can be applied overnight and rinsed in AM.
PO fluconazole 300mg – advise pt to exercise 30 min later
Note: Terbinafine is ineffective for this condition
Intertrigo:
Most commonly occurs in ___ ___ and/or ___ ___
Usually caused by ___ ___ d/t (3)
Risk factors: (7)
Presentation: ___ patches, ___, ___, ___, ___. May have satellite lesions.
Rx: Topical ___ BID until 1 wk after sx resolve; cont 2x/wk after to prevent recurrence
___ ointment or an ___ ointment BID
Eliminate predisposing factors
Keep area dry via clothing, ___ or ___ powders
Most commonly occurs in mucosal surfaces and/or skin folds
Usually caused by Candida Albicans d/t moisture, heat, friction
Risk factors: obesity, diabetes, recent ABX or steroid use, immunosuppression, chronic moisture or friction
Presentation: Erythematous patches, erosions, fissures, itching, burning. May have satellite lesions.
Rx: Topical antifungals BID until 1 wk after sx resolve; cont 2x/wk after to prevent recurrence
Nystatin Ointment or an imidazole ointment BID
Eliminate predisposing factors
Keep area dry via clothing, Zeazorb or Nystatin powders
Onychomycosis:
\_\_\_ infection (typically \_\_\_) Occasionally _-\_\_\_\_ -> mold or yeast
Dx via KOH
Culture or nail clip bx if cannot isolate via KOH
Rx:
High failure and recurrence rates
Newer topicals are effective (___ – depends on ins coverage)
Oral ____ (Lamisil) considered 1st line
Can use other oral ____–? lower efficacy &/or safety concerns
6-8 weeks fingernails, 4 months toenails
Consider pre tx and 1-2 wk into tx ____ eval
ADVISE PT—may not see improvement for 6-12 months
If nail __ not involved-> tx with topical laquer. If matrix involved -> do ___ or send for nail ___ and PAS stain and treat with PO ___ 250mg daily w/meals for 3-4 months. Must monitor for ____.
Nail infection (typically dermatophyte) Occasionally non-dermatophyte -> mold or yeast
Dx via KOH
Culture or nail clip bx if cannot isolate via KOH
Rx:
High failure and recurrence rates
Newer topicals are effective (Jublia – depends on ins coverage)
Oral terbinafine (Lamisil) considered 1st line
Can use other oral antifungal–? lower efficacy &/or safety concerns
6-8 weeks fingernails, 4 months toenails
Consider pre tx and 1-2 wk into tx hepatic eval
ADVISE PT—may not see improvement for 6-12 months
If nail matrix not involved -> tx with topical laquer. If matrix involved -> do culture or send for nail biopsy and PAS stain and treat with PO terbinifine 250mg daily w/meals for 3-4 months. Must monitor for liver dx.
Bacterial Infections:
___ – superficial bacterial infection
Usually a Staph or Strep infection
___ - deeper in the skin
Infection of dermis & subq
\_\_\_ (involving the hair follicle) Folliculitis Furuncle Carbuncle Hydradenitis Suppurativa
Impetigo – superficial bacterial infection
Usually a Staph or Strep infection
Cellulitis- deeper in the skin
Infection of dermis & subq
Follicular (involving the hair follicle) Folliculitis Furuncle Carbuncle Hydradenitis Suppurativa
Impetigo:
___ skin infection
Typically ___ ___; occasionally ___
Typically on __, __, __, __
Most common skin infection in children ages ___
Highly ___
__ -> __ -> ___
Non-bullous impetigo- ___, ___ , 70% of cases
Always obtain ___ if any doubt of dx
Classic ‘___’ may not be seen in everyone
Risk factors: (6)
Typically ___ scar – reassure patients and parents
Superficial skin infection
Typically Staph aureus; occasionally Group A strep pyogenes
Typically on face, hands, neck, extremities
Most common skin infection in children ages 2-5
Highly contagious
Papules -> vesicles -> golden crust
Non-bullous impetigo- no blisters, localized, 70% of cases
Always obtain bacterial cx if any doubt of dx
Classic ‘golden crust’ may not be seen in everyone
Risk factors:
hot, humid climate,
poor hygiene, daycare
Skin trauma
Hx of scratching an insect bite
Bullous impetigo- less common, starts as bullae, more widespread
Typically does NOT scar – reassure patients and parents
Impetigo treatment:
Topical ___
____ 2% Oint __ for ___
Consider tx in nares if hx of frequent, repeat infection
Antibacterial cleansers (Dial, Chlorhexidine wash)
Oral antibiotics if lesions are bullous, case is severe, widespread, & not responsive to topical tx, or if fever is present
____ (4) (if MRSA suspected)
Tx for ___
Always ask about any hx of allergies
Topical Antibiotics
Mupirocin 2% Oint TID for 5-7 days
Consider tx in nares if hx of frequent, repeat infection
Antibacterial cleansers (Dial, Chlorhexidine wash)
Oral antibiotics if lesions are bullous, case is severe, widespread, & not responsive to topical tx, or if fever is present
Dicloxacillin, Augmentin, Cephalexin, Clindamycin (if MRSA suspected)
Tx for 10 days
Always ask about any hx of allergies
Cellulitis:
A bacterial infection involving the \_\_\_ & \_\_\_ tissue Typically caused by \_\_\_ and \_\_\_ Unless caused by \_\_\_\_ Usually only occurs on \_\_\_ Most cases occur on \_\_\_\_ May occur after \_\_\_ or \_\_\_ Other risk factors: (3)
Note- hx very ___, ___
-> consider ___
*Never treated with ___ treatment alone. Needs ___ ___
Bacteria breaches ___ -> __, __, __ and __
Involves ___ and __
Usually ___ (4)
Tx: ___ for ___.
If MRSA is suspected (3)
___ affected area & if edema–hydrate skin to prevent cracking
Marking ___ of erythema w/indelible pen may help monitoring status
Recheck in ____ (sooner if greater concern)
Do not expect reduction within ___ but want to ensure ___
If systemic s/s infection (3), significant co-morbidities -> need eval in ____, consider (3)
Assess for any signs of systemic illness and significant comorbidities: (7)
A bacterial infection involving the dermis & subcutaneous tissue Typically caused by staph and strep Unless caused by animal bite Usually only occurs on one limb Most cases occur on lower legs May occur after trauma or wound Other risk factors: Surgery, venous stasis, recent hospitalization
Note- hx very rapid progression, febrile
-> consider necrotizing fascitis
*Never treated with topical treatment alone. Needs systemic ABX
Bacteria breaches skin barrier -> erythema, edema, tenderness and warmth
Involves subcutaneous tissue and fat
Usually beta-hemolytic strep, strep pyogenes, staph, MRSA
Tx: Antibiotics: 5-7 days. If MRSA is suspected (Bactrim, Clinda, Doxy) – See table in following slides
Elevate affected area & if edema–hydrate skin to prevent cracking
Marking border of erythema w/indelible pen may help monitoring status
Recheck in 48 hours (sooner if greater concern)
Do not expect reduction within 48 hours but want to ensure not increasing
If systemic s/s infection (fever, tachy, altered mental status), significant co-morbidities -> need eval in ED and/or admission for IV ABX
Sepsis, osteomyelitis and necrotizing skin infection are uncommon complications
Assess for any signs of systemic illness and significant comorbidities: high fever, toxic appearance, leukocytosis, DM, neutropenia, immunosuppression, ulcers -> need IV antibiotics
Folliculitis:
Folliculitis: superficial ____ of ___ -> __ collects in ___
Usually ___ , from nose or can be sterile
Carbuncle: a ___ of several (2 or more) inflamed ___ into a ___ mass with purulent drainage from multiple follicles
Furuncle (or “boil”): infection of the hair follicle extending into ___
-> small ___ formation
Presents as ___ that develop rapidly around hair follicles. Usually caused by ___. Always consider possible ___.
Can be caused by (3)
Folliculitis: superficial bacterial infection of hair follicle -> pus collects in epidermis
Usually staph aureus, from nose or can be sterile
Carbuncle: a coalescence of several (2 or more) inflamed follicles into a single inflammatory mass with purulent drainage from multiple follicles
Furuncle (or “boil”): infection of the hair follicle extending into subcutaneous tissue
-> small abscess formation
Presents as pustules that develop rapidly around hair follicles. Usually caused by bacteria. Always consider possible MRSA.
Can be caused by friction, a/w pregnancy or HIV
Pseudofolliculitis Barbae (PFB):
Inflammatory ___, ___ due to inflammation of the ___ and ___ skin
Most common in ___ men, but can occur in anyone, especially with ___ hair
Typically occurs immediately after ___ (advise to use ___)
Patient may report __ or __
Complications:
___
___
Treatment:
Topical ___ are treatment of choice
____ 1% _ (lotion, foam, gel)
____ 5% as a wash or topical gel 1-2 times daily
PO __ rarely required, but may help if severely ___ (2)
Discuss ___
If recurrent and severe, consider ___
Inflammatory papules, pustules due to inflammation of the follicles and peri-follicular skin
Most common in black men, but can occur in anyone, especially with coarse, curly hair
Typically occurs immediately after shaving (advise to use electric clippers)
Patient may report pain or pruritus
Complications:
Post inflammatory hyperpigmentation (PIH)
Keloids (less common)
Treatment:
Topical ABX are treatment of choice
Clindamycin phosphate 1% BID (lotion, foam, gel)
Benzoyl Peroxide 5% as a wash or topical gel 1-2 times daily
PO ABX rarely required, but may help if severely inflammatory (Doxy and Minocycline)
Discuss shaving techniques: not too many blades, no dull blades, never dry shave, use warm water
If recurrent and severe, consider laser hair removal
Follicular: Furuncle treatment
Only definitive treatment is ___ if organized (fluctuant)
Until organized, frequent ____ will either resolve or organize so can ___
PO \_\_\_ are \_\_\_ recommended Unless \_\_\_ (2)
Only definitive treatment is I&D if organized (fluctuant)
Until organized, frequent warm compresses will either resolve or organize so can I&D
PO Antibiotics are NOT recommended
Unless accompanying cellulitis OR hx of DM or immunocompromised
