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Dermatology Flashcards

1
Q

Acne vulgaris clinical manifestations

A
  • Open comedones (blackheads): incomplete blockage
  • Closed comedones (whiteheads): complete blockage
  • Inflammatory: papules or pustules surrounded by inflammation
  • Nodular or cystic: often heals w/scarring
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2
Q

Acne Vulgaris diagnosis

A
  • Mild: comedones, small amounts of papules and/or pustules
  • Moderate: comedones, larger amounts of papules and/or pustules
  • Severe: nodular (>5mm) or cycstic acne
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3
Q

Acne Vulgaris treatment

A
  • Comedones only: topical retinoid
  • Papulopustular +/- comedones: topical retinoid + benzoyl peroxide
  • Mild: topical - azelaic acid, salicyclic acid, benzoyl perozide, retinoids; tretinoin or topical abx (i.e. clindamycin or doxycycline)
  • Moderate: as above + oral abx (i.e. minocycline or doxycycline)
  • Severe (refractory or nodular acne): oral isotretinoin
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4
Q

Neonatal acne

A
  • newborn to 8 weeks
  • lesions limited to face
  • responds to topical ketoconazole 2% cream
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5
Q

Isoretinoin

A
  • most effective medication for acne vulgaris

- ADR: dry skin and lips (MC), hightly teratogenic, increased triglycerides and cholesterol

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6
Q

Rosacea triggers

A
  • alcohol
  • hot or cold weather
  • hot drinks
  • hot baths
  • spicy foods
  • sun exposure
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7
Q

Rosacea clinical manifestations

A

-Acne-like rash (papulopustules) and centrofacial erythema, facial flushing, telangiectasias, skin coarsening w/burning and stinging

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8
Q

Rosacea physical exam

A
  • absence of comedones (blackheads)

- rhinophyma (red, enlarged nose)

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9
Q

Rosacea treatment

A
  • mild-moderate: topical metronidazole 1st line, azelaic acid, topical ivermectin
  • facial erythema: topical brimonidine
  • clonidine for flushing
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10
Q

Folliculitis

A
  • superficial hair follicle infection or inflammation
  • etiology: staph aureus
  • clinical manifestations: singular of clusters of perifollicular papules and/or pustules
  • treatment: topical mupirocin
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11
Q

Erythema multiforme

A

type IV hypersensitivity reaction of the skin often following infections or medication exposure

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12
Q

Erythema multiforme risk factors

A
  • herpes simplex virus MC, mycoplasma app. (esp in children)

- medications: sulfa drugs, beta-lactams, phenytoin, phenobarbital

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13
Q

Erythema multiforme clinical manifestations

A
  • characterized by target lesions consisting of 3 components: a dusky, central area or blister, a dark red inflammatory zone surrounded by a pale ring of edema and an erythematous halo on the extreme periphery of the lesion
  • negative nikolsky sign (no epidermal detachment)
  • minor: target lesions with no mucosal membrane involvement
  • major: target lesions with mucosal membrane involvement; no epidermal detachment
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14
Q

Erythema multiforme treatment

A

-symptomatic: discontinue offending drug, antihistamines, analgesics, skin care; corticosteroids + lidocaine + diphenhydramine mouthwash for oral lesions

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15
Q

Steven-Johnson Syndrome (SJS)

A
  • severe mucocutaneous reaction characterized by detachment of the epidermis and extensive necrosis
  • sloughing <10% body surface
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16
Q

Toxic Epidermal Necrolysis (TEN)

A
  • severe mucocutaneous reactions characterized by detachment of the epidermis and extensive necrosis
  • > 30% body surface area
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17
Q

SJS/TEN clinical manifestation

A
  • prodrome of fever and URI sx’s followed by widespread flaccid bullae
  • pruritic targetoid lesions (erythematous macules with purpuric centers) or diffuse erythema with involvement of at least 1 mucous membrane involvement with epidermal detachment (Nikolsky’s sign)
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18
Q

SJS/TEN treatment

A
  • prompt discontinuation of causative agent
  • supportive therapy: burn unit admission, pain control, fluid + electrolyte replacement, wound care
  • IVIG for SJS
  • no steroids fo SJS, lead to sepsis
  • ophtho for TEN if eyes involved
  • cyclosporine for severe TEN
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19
Q

SJS/TEN cause

A

sulfa drugs and anticonvulsants are MC cause

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20
Q

SJS/TEN diagnosis

A

clinical, biopsy* (shows full thickness skin necrosis/necrotic epithelium)

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21
Q

Alopecia Areta

A
  • nonscarring immune-mediated hair loss
  • associated with other autoimmune disorders
  • clinical manifestations: smooth, discrete, circular patches of complete hair loss
  • physical exam: exclamation point hairs (shorts hairs broken off a few mm from the scalp w/tapering near the proximal hair shaft); nail abnormalities (~30%, nail fissuring, trachyonychia)
  • management: local - intralesional corticosteroids
22
Q

Androgenetic alopecia

A
  • typical male pattern baldness
  • patho: dihydratestosterone (DHT) is the key androgen leading to androgenetic alopecia
  • diagnosis: clinical
  • management: topical minoxidil, oral finasteride (5-alpha reductase type 2 inhibitor)
23
Q

Alopecia causes

A
  • 90% of cases are caused by the following disorders:
  • tinea capitis
  • alopecia areata
  • traction alopecia
  • telogen effluvium
  • androgenic alopecia
24
Q

Onychomycosis

A
  • etiology: dermatophytes –> trichophyton and epidermophyton; T.rubrum MC
  • diagnosis: confirmation of fungal infection is essential prior to tx; periodic acid-schiff test most sensitive test
  • management: systemic antifungals –> most effective tx; terbinafine 1st line for dermatophytes
  • systemic antifungals associated with hepatotoxicity and drug-drug interactions
25
Q

Paronychia

A
  • etiologies: staph aureus MC
  • clinical manifestations: painful, red, swollen area around the proximal or lateral nail folds at the cuticle
  • management:
  • ->paronychia without abscess: mild use warm water or antiseptic soaks, moderate use oral abx (cephalexin or dicloxacillin)
  • ->paronychia with abscess: I&D
26
Q

Felon

A
  • closed-space infection of the fingertip pulp space
  • etiologies: staph aureus MC
  • clinical manifestations: severe throbbing pain, erythema, swelling + fluctuance to the pad of the fingertip
  • management:
  • ->fluctuant: I&D
27
Q

Brown Recluse Spider Bite

A
  • brown recluse spiders (Loxosceles reclusa) may have a violon pattern on its anterior cephalothorax
  • clinical manifestations:
  • ->local effects: “red halo” for 24-72h followed by a hemorrhagic bulla that undergoes eschar formation
  • management:
  • ->local wound care + pain control the mainstay of management
  • ->local wound care: most wounds heal spontaneously
  • ->pain control: NSAIDs (opioids for severe)
28
Q

Black Widow Spider Bite

A
  • patho: black widow spider produces a neurotoxin
  • characteristic red hourglass shape on the underside of its belly
  • clinical manifestations:
  • ->local symptoms - pain at the bite site w/the onset of systemic + neurologic symptoms within 30 minutes to 2 ours - muscle pain (most prominent feature), spasms + rigidity
  • ->usually self-limited
  • physical exam blanched circular patch w/a surrounding red perimeter + central punctum (target lesion)
  • management:
  • ->mild: wound care + pain control
  • ->moderate to severe: muscle relaxants (i.e. benzos + methocabamol)
29
Q

Erythema Infectiosum

A
  • AKA Fifth disease
  • etiology: parvovirus B19
  • clinical manifestations:
  • ->prodrome sequence w/low-grade fever
  • ->erythematous malar rash w/a “slapped-cheek” appearance + circumoral pallor followed by lacy, reticular maculopapular rash on the extremities
  • ->arthropathy or arthralgias in older children and adults
  • ->associated with increased fetal loss during pregnancy
  • ->may cause aplastic crisis in pts w/sickle cell disease
  • diagnosis: clinical
  • tx: symptomatic
30
Q

Rubeola (Measles)

A
  • The 4 C’s: cough, coryza, conjunctivitis, cephalocaudal spread
  • caused by the measles virus, part of the paramyxovirus family
  • clinical manifestations:
  • ->URI prodrome 1-3 days, high fever, 3 C’s (cough, coryza, conjunctivitis)
  • ->Koplik spots: small 1-3 mm pale white or blue papules with an erythematous base on the buccal mucosa
  • exanthem: morbilliform (maculopapular), brick-red rash beginning at the hairline; lasts for 7 days
  • diagnosis: clinical, measles IgM antibodies or measles virus RNA
  • management: supportive, isolate for 1 week after the onset of rash
  • complications:
  • ->diarrhea MC
  • ->PNA MC cause of measles-related deaths
31
Q

Hand, Foot and Mouth Disease

A
  • caused by Coxsackie virus (especially type A)
  • MC in summer and early fall
  • clinical manifestations:
  • ->oral enathem: painful oral lesions surrounded by a thin halo erythema
  • ->exanthem: greyish-yellow vesicular, macular or maculopapular lesions on hands, feet and buttocks
  • ->fever, sore throat, feeling unwell, irritibility and loss of appetite
  • diagnosis: clinical
  • tx: supportive, usually clears up on its own within 10 days
32
Q

Rubella (German Measles)

A
  • distinguished from measles by –> confluent macolopapular rash, coryza (stuffy nose) and koplik spots (in measles)
  • clinical manifestations:
  • ->”3 day rash”: 1st appears on the face, spreads caudally to the trunk and extremities and becomes generalized within 24 hours (lasts 3 days)
  • ->cephalocaudal spread; spreads more rapidly than measles, rash does not darken or coalesce
  • ->teratogenic in 1st trimester
  • diagnosis: clinical
  • tx: supportive care, vaccines (MMR - at 12-15 mos and 4-6 y/o)
33
Q

Roseola (Sixth Disease)

A
  • AKA exanthem subitum
  • caused by Herpesvirus 6 or 7
  • MC 6 mos - 3 years
  • only childhood exanthem that starts on the trunk –> spreads to the face
  • clinical manifestations: high fever for 3-5 days then maculopapular blanchable rash
  • diagnosis: clinical
  • tx: supportive, bening and self-limiting
34
Q

Cellulitis

A
  • MC caused by Group A Strep
  • staph aureus is an important but less common cause
  • H. influenzae or strep pneumoniae in children
  • clinical manifestation: localized macular erythema (flat margins NOT sharply demarcated)
  • diagnosis: culture if purulent
  • management:
  • -oral abx: cephalexin + dicloxacillin (clinda/erythro if PCN allergy)
  • -IV abx: cefazolin
  • -cat bite (pasteurella multocida): amoxicillin-clavulanate
  • MRSA:
  • -oral: clinda, doxy, trimethroprim-sulfamethoxazole
  • -IV: vancomycin
35
Q

Erysipelas

A
  • group A strep (s. pyogenes) MC
  • clinical manifestatins: intensely erythematous, raised area WITH sharply demarcated borders; most commonly involves the lower extremities
  • diagnosis: wound culture –> antistreptolysin titer O
  • management:
  • -oral: PCN G, amoxicillin, cephalexin
  • -IV: cefazolin, ceftriaxone
36
Q

Impetigo

A
  • MC caused by s. aureus
  • clinical manifestations: non-painful, pruritic lesions on the face, red sore around nose and mouth
  • types:
  • -nonbullous: MC type, papules, vesicles + pustules, begins as a single red macule then later develops into “honey-colored, golden crusts”
  • diagnosis: clinical, culture can be useful
  • management:
  • -mild: mupirocin topically initial drug of choice (TID x 10d)
  • -extensive disease or systemic sxs: systemic abx - cephalexin
37
Q

Lesion Types

A
  • macule: falt, nonpalpable lesion <10mm
  • patch: flat, nonpalpable lesion >10mm
  • papule: solid, raised lesion <5mm in diameter
  • nodule: solid, raised lesions >5mm in diameter
  • plaque: raised, flat-topped lesion >10mm
    vesicle: circumscribed, elevated fluid-filled lesion <5mm
  • bulla: circumscribed, elevated fluid-filled lesion >5mm
  • pustule: pus-filled vesicle or bulla
  • wheal: transient, elevated lesion (local edema)
  • petechiae: small, punctate hemorrhages that don’t blanch
38
Q

Candidiasis

A
  • fungal infection typically on the skin or mucous membranes caused by candida
  • typically in infants
  • clinical manifestations: “beefy” red with sharp, marginated border with pinpoint satellite pustules
  • diagnosis: KOH –> budding yeast, hyphae, pseuohyphae
  • vulvovaginal candidiasis
  • candidiasis of skin and nails
  • oral thrush
  • management: nystatin cream QID
39
Q

Dermatophytosis infections

A

superficial fungal skin infections: trichophyton

40
Q

Tinea capitis

A
  • trichophyton
  • risk factors: preadolescents
  • patches of alopecia with black dots: multiple black dots are due to broken hair shafts + pruritis due to endothrix infection
  • scaly patches with alopecia: singe or multiple patches with hair loss; erythema and pruritis may be present
  • kerion: severe manifestation
  • management: use one topical and one systemic medication
  • -oral griseofulvin: 1st line tx, can cause hepatitis
  • -2nd line: oral terbinafine
  • -topical: ketoconazole 2% or 2.5% selenium sulfide shampoo
41
Q

Tinea pedis

A
  • “athlete’s foot”
  • MC dermatophyte infection
  • clinical manifestation: interdigital –> MC, pruriticm erythematous erosions or scales between the toes
  • management: topical antifungals 1st line, 1% clotrimazole or 2% ketoconazole) BID for 4 weeks
42
Q

Tinea cruris

A
  • superficial fungla infection of the groin and inner thighs, “jock itch”
  • trichophyton (T. rubrum MC)
  • clinical manifestations: pruritis is hallmark, annular patches or plaques, diffuse erythema with sharply demarcated raised border
  • diagnosis: KOH –> best initial diagnostic test
  • management: topical antifungals 1st line (clotrimazole, butenafine, terbinafine), 1% clotrimazole or 2% ketoconazole) BID for 4 weeks
43
Q

Tinea corporis

A
  • superficial fungal infection
  • trichophyton and microsporum, T. rubrum MC
  • transmission: direct contact, common in preadolescent
  • clinical manifestations: pruritic, circular or oval plaques or patches with central clearing and well-demarcated raised borders
  • diagnosis: KOH prep –> best initial test
  • management: topical antifungals 1st line, 1% clotrimazole or 2% ketoconazole) BID for 4 weeks
44
Q

Tinea versicolor

A
  • caused by Malassezia furfur
  • clinical manifestations: hypo or hyperpigmented macules that do not tan
  • diagnosis: KOH prep –> short hyphae and clusters of spores (“spaghetti and meatballs”)
45
Q

Lice

A
  • pruritic scalp, body or groin
  • head lice girls>boys, African American less common
  • body lice can be a vector for diseases
  • nits are observed as small white specs on the hair shaft
  • clinical manifestations: pruritis, in head lice can have papular urticaria near lice bites
  • diagnosis: clinical, obeservation of nits
  • management: permethrin topical, lindance (neurotoxic, can cause seizures), oral ivermectin for resistant cases
  • aftercare: contact items (i.e. bedding, clothing) should be laundered in hot water (> 131 F or 55 C) with detergent and dried in hot drier for 20 minutes
46
Q

Intertrigo

A
  • inflammatory condition of the intertriginous areas
  • candida spp MC
  • risk factors: warm, moist environments (i.e. skin folds), obesity, immunocompromised (i.e. DM, HIV)
  • clinical manifestations: pruritis
  • PE: erythematous “beefy red” macerated plaques, erythematous satellite lesions
  • diagnosis: clinical, KOH prep –> budding yeast with or w/o pseudohyphae
  • management: topical antifungals 1st line
47
Q

Scabies

A
  • Sarcoptes scabiei
  • patho: female mites burrow into the skin to lay eggs, feed + defecate
  • clinical manifestation: intense pruritis especially at night
  • PE: small erythematous papules, excoriations, linear burrows (pathognomonic) found in the intertriginous zones and web spaces
  • -red itchy, pruritic papules or nodules on the scrotum, glans or penile shaft or body folds are pathognomonic
  • management:
  • -permethrin tropical drug of choice
  • -lindane: can cause seizures, teratogenic not usually used in breast women + children <2
  • all clothing, bedding, etc should be placed in a plastic bag at least 72h than washed and dried using heat
48
Q

Molluscum Contagiosum

A
  • poxviridae/poxvirus
  • clinical manifestations: single or multiple firm dome-shaped, flesh-colored to pearly white, waxy papules with central umbilication
  • management; no tx needed in most cases (spontaneous resolution in 3-6 months); imiquimod (Aldara)
49
Q

Common, Flat and Plantar Warts

A
  • caused by Human Papillomavirus infection
  • clinical manifestations: thrombosed capillaroes are pathognomonic
  • management: most warts spontaneously within 2 years
  • -cryotherapy with liquid nitrogen
  • -OTC topical salicyclic acid
50
Q

Condyloma Accuminata

A
  • AKA condyloma acuminata
  • caused by HPV infection 6 and 11
  • clinical manifestations: painless, soft, fleshy, cauliflower-like lesions
  • diagnosis:
  • -acetic acid application: whitening of the lesion with acetic acid
  • vaccines:
  • -gardisil 9 (preferred): types 6, 11, 16, 18
51
Q

Herpes Simplex

A
  • there are eight types of herpes viruses known to affect humans
  • they are called the Herpes Human Viruses (HHV)
  • there are two types of Herpes Simplex viruses:
  • -HSV 1- Oral lesions
  • -HSV 2 - Genital lesions
52
Q

Varicella-Zoster Virus Infection

A
  • Chickenpox: vesicular lesions in different stages of development; “dewdrop on a rose petal”
  • Shingles: pain precedes rash groups of vesicles in a unilateral dermatomal pattern
  • diagnosis: Tzanck prep is positive for multinucleated giant cells
  • Hutchinson’s sign - lesion on the nose; concern for eye involvement
  • management:
  • -supportive care AND
  • -antivirals - oral acyclovir, valacyclovir, or famciclovir

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