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
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
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
4
Q
Neonatal acne
A
- newborn to 8 weeks
- lesions limited to face
- responds to topical ketoconazole 2% cream
5
Q
Isoretinoin
A
- most effective medication for acne vulgaris
- ADR: dry skin and lips (MC), hightly teratogenic, increased triglycerides and cholesterol
6
Q
Rosacea triggers
A
- alcohol
- hot or cold weather
- hot drinks
- hot baths
- spicy foods
- sun exposure
7
Q
Rosacea clinical manifestations
A
-Acne-like rash (papulopustules) and centrofacial erythema, facial flushing, telangiectasias, skin coarsening w/burning and stinging
8
Q
Rosacea physical exam
A
- absence of comedones (blackheads)
- rhinophyma (red, enlarged nose)
9
Q
Rosacea treatment
A
- mild-moderate: topical metronidazole 1st line, azelaic acid, topical ivermectin
- facial erythema: topical brimonidine
- clonidine for flushing
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
11
Q
Erythema multiforme
A
type IV hypersensitivity reaction of the skin often following infections or medication exposure
12
Q
Erythema multiforme risk factors
A
- herpes simplex virus MC, mycoplasma app. (esp in children)
- medications: sulfa drugs, beta-lactams, phenytoin, phenobarbital
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
14
Q
Erythema multiforme treatment
A
-symptomatic: discontinue offending drug, antihistamines, analgesics, skin care; corticosteroids + lidocaine + diphenhydramine mouthwash for oral lesions
15
Q
Steven-Johnson Syndrome (SJS)
A
- severe mucocutaneous reaction characterized by detachment of the epidermis and extensive necrosis
- sloughing <10% body surface
16
Q
Toxic Epidermal Necrolysis (TEN)
A
- severe mucocutaneous reactions characterized by detachment of the epidermis and extensive necrosis
- > 30% body surface area
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)
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
19
Q
SJS/TEN cause
A
sulfa drugs and anticonvulsants are MC cause
20
Q
SJS/TEN diagnosis
A
clinical, biopsy* (shows full thickness skin necrosis/necrotic epithelium)
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
