Dermatology Flashcards
Why use a wet compress?
Use to decrease inflammation, mild wound debridement, anti-bacterial benefits
Antibacterial: aluminum acetate, acetic acid, silver nitrate
topical steroid groups
1-7
Group 1: strongest
Group 7: weakest
Disorder of the pilosebaceous follicles → increased sebum production, altered keratinization, inflammation, bacterial colonization
Acne Vulgaris
What is considered mild acne?
moderate acne?
Severe?
Mild → less than ¼ of face without scarring or nodules, moderate → ½ of face, severe → ¾ face
characterized by comedones, erythematous papules, pustules and nodules
Acne Vulgaris
Acne differentials
Milia
Rosacea
Perioral Dermatitis
Sebaceous Hyperplasia
How long does it take for acne medicine to take effect
6-12 weeks
First-line tx for acne
Topicals are first line: tretinoin (retin-a), adapalene (differin), tazarotene, azelaic acid, benzoyl peroxide, salicylic acid
Oral Antibiotics for Acne
Oral abx: for inflammatory acne and used for severe cases, unresponsive to topicals, scarring prone pts, lesions on trunk and back
Minimum 6 weeks; once improvement is achieved, d/c and stick to retinol
Most used: minocycline (most effective), doxycycline, erythromycin, tetracycline
Hormone Therapy to Tx Acne
ombined oral contraceptives, spironolactone, drosperidone
Antiandrogen meds that cause sebaceous gland suppression
What to know about Isotretinoin
Severe acne ONLY; monitored by derm, monthly triglyceride and hepatic function monitoring, 2 forms of birth control for women
Best way to differ rosacea from acne
rosacea does NOT have comedones
Rosacea that coexists with acne; most often seen between 30-50 y/o women, men are more severely affected if they have it
Acne Rosacea
…end up having psoriasis arthritis, autoimmune disorder, T cells have a key role, environmental triggers can bring a flare, immune stimulation of epidermal keratinocytes that builds up the layers and creates the plaques/ lesions
Psoriasis
5 types of Psoriasis
Plaque (most common)- \_\_\_\_ Guttate-\_\_\_\_\_\_ Inverse- \_\_\_\_\_\_ Pustular-\_\_\_\_\_\_\_ Erythrodermic - \_\_\_\_\_\_\_
5 types:
Plaque (most common)- grey, crusty
Guttate- young adults and children, water droplet scaly
Inverse- mistake it for fungal
Pustular- looks dry and mistake for tines pedis
Erythrodermic - broad and hot
when to use Emollient creams and lotions
Dry lesions
Loss of cutaneous moisture, epidermal lipids and proteins
Best if you applied to damp skin
Creams with urea and lactic acid work best
Thicker is better
Warnings for topical steroid level I (psoriasis, hand eczema)
ex. Clobetasol
not for face, axillae, groin or under breasts! Limit use to 14 days
Warnings for topical steroid levels II and III (atopic dermatitis adults)
ex. Difloorasone, Desoximetasone
not for face, axillae, groin or under breasts!
Limit use to 21 days
Warnings for topical steroid levels IV and V (atopic dermatitis in children)
ex. Triamcinolone
Hydrocortisone valerate
Limit use in children to 7-21 days, limit in intertriginous areas
Warnings for topical steroid levels VI & VII
ex. Desonide, Hydrocortisone
(eyelid dermatitis, diaper dermatitis)
reevaluate if not responded in 28 days - avoid long term use continuous in any areas
benign Dilated venules, <0.5cm, mostly found on trunk
After the age of 30 y.o
Red and are 3-5mm
Not associated with disease process
Tx = cosmetic- electrodessication, laser
cherry angioma
Small skin flaps, attached by a stalk
can occur anywhere on the body, increase with weight gain, increase the frequency with age
Skin Tags
Autoimmune disorder; causes chronic inflammatory response at bulbs of hair and breaks easily (cycles of growth and loss) → stress, Addison dx, lupus, thyroid dx causes
Alopecia areata
Common tx for Alopecia Areata
Topical Minoxidil
Most common type of hair loss : heredity thinning of hair, effects anagen (growth) phase, polygenetic
tx?
Men: receding hairline at temples, thinning frontal and vertex; women: diffuse thinning, frontal-parietal areas most affected
Androgenic alopecia
Other name for atopic dermatitis
eczema
Patho: We see it on cheeks in children, AC
Risk Factors:
Children
Environmental triggers (soy, fish, dust mites, molds, staph)
Atopic Dermatitis / EZCEMA
2 phases of Atopic Dermatitis / EZCEMA
Acute phase: weep, red, scales
Chronic: Lichenified skin due to scratching- dry - > Risk for infection
Form of eczema, allergies response
Resolutions takes 3 weeks
Remains sensitive to offending substance
Treatment
Avoid triggers, topical creams, lotions, corticosteroids
Contact Dermatitis
Patho:
Benign but if untreated -> squamous cell carcinoma
Risk Factors:
Sun exposure, tanning beds, fair skin, blue/ green eyes
Actinic Keratosis
How to manage Actinic Keratosis
Refer for tx Liquid nitrogen (freeze-thaw technique)
Topical 5-fluorouracil (Efudex, Carac) or imiquimod (Aldara)
hair prematurely enters telogen (shedding of mature hair) phase → sudden hair loss
Women, men, infants affected; causes: childbirth, high fevers, medications, endocrine abnormalities, anemia, malnutrition
Telogen Effluvium
Patches of hair loss on scalp, eyebrows, eyelashes, beard (men)
Alopecia areata
How to tx alopecia in women? men?
Minoxidil (rogaine) only FDA approved for women, finasteride (Propecia) preg cat X
Important to ask about with alopecia?
History!
Ask about sx (scalp itching, pain, flaking) → differentials
Diagnostics for bites?
C-reactive protein, sed rate for tx response
Radiographs for fractures, foreign bodies, soft tissue injury, subq gas, osteomyelitis
How to manage a bite?
DO NOT CLOSE IT
Irrigate wound with sterile NS, pack if necessary
Bites to face → debride, preemptive abx, primary closure, then ED/plastics referral
Cat and human bites, puncture wounds, infected wounds, wounds >6-12 hours old should be left open r/t infection risk
hand/foot wounds: immobilization 1-3 days
Qday outpatient monitoring
Abx tx for bites?
Prophylaxis only for high-risk bites or patients; cat/hand 5-7 days prophylactic abx
amox/clav (augmentin)
5-7 days; clindamycin + doxy for pcn allergy
Older infected bites → IV abx in hospital
What to do if possibly rabies bite?
wash immediately with soap and water OR 1% iodine solution
Watchful waiting for most bites
If animal becomes ill, patient should be treated; high risk bites should be treated
If bite is on head/neck, do not do watchful waiting for tx → TX IMMEDIATELY
Tx: immunization of human rabies immune globulin (HRIG) or purified chick embryo vaccine (PCEV); active immunization with human diploid cell vaccine (HDCV) or PCEV days 0,3,7,14
Firm, intradermal nodules in skin; mostly found in women on the legs
-Typically asymptomatic, but pruritic/tender if sx occur, Variable color
Fitzpatrick sign
Cosmetic or discomfort purposes → deep excision necessary, inform pt scar may be more unattractive than lesion itself
dermatofibroma
What is Fitzpatrick sign?
(dimple sign)
Squeeze lesion with thumb and forefinger → lesion will dimple
-> dermatofibroma
Skin lesion varying size from 2mm-3cm (Present as waxy or verrucous appearing papules or plaques that have a “stuck on” appearance; variable color)
Family members, advancing age, anywhere on body (frequently trunk, no palms or soles)
seborrheic keratosis
Most common benign non-melanocytic skin lesion on body
seborrheic keratosis
how to tx seborrheic keratosis?
when to be concerned?
Bx or referral to derm for atypical lesion
Cryotherapy, shave biopsy or curettage
Worried if Change in SK, irregular borders, color changes, unusual black or blue
First line abx. med mgmt for insect/ spider bites?
Amox-clav first line
Allergies: Cephalosporin or Bactrim + clindamycin
Cleansing. IRRIGATION
Autoimmune disorder: large, tense, subepidermal blisters occurring on normal or erythematous skin
-> presence of circulating IgG antibodies for hemidesmosomal BP against proteins of dermal-epidermal junction
Bullous Pemphigoid
What phase of Bullous Pemphigoid?
mild to severe pruritis with erythematous, eczematous papules or urticarial lesions lasting several weeks to months; early sign of dx, delays diagnosis
Prodromal phase
What phase of Bullous Pemphigoid?
presents suddenly intense pruritus, widespread blister formation
Lower abd, flexor aspects of arms and legs including axillae, groin and thighs, oral lesions common
Bullous phase
Risk factors/ triggers for Bullous Pemphigoid lesions
> 60 y/o
Triggers for lesions: trauma (burn, UVR, radiotherapy), drugs (lasix, enalapril, ibuprofen, abx), herpes virus, EBV
(ability to split dermis from epidermis with pressure) negative in BP(Bullous Pemphigoid) pt
Nikolsky sign
Gold standard diagnostic for Bullous Pemphigoid?
direct immunofluorescence (DIF) microscopy of skin bx;
goals with tx eczema
PREVENT ITCH/ hydrate =goal
moisturizer/ rehydration - after bath
3 months of age, SUPER itchy
Acute phase: weep, red, scales
Chronic: Lichenified skin due to scratching- dry
Risk for infection
Turns to this if untreated and continuous scratching
Atopic Dermatitis
1st line tx for chronic atopic dermatitis/ eczema if infected with staph or strep?
first line cephalosporins - cephalexin
Rash 24-72 hours from contact - oils, so SHOWER
Vesicles
Does Not follow dermatome
Itchy
Plant Dermatitis
… Domeboro- compress wet dressing, dries it up
Greasy, white or yellow scales, itchy
Ear or around nose (nasal folds)
Redness
Cradle cap→ baby shampoo to keep it clean
Can be mistaken for yeast if in diaper area
PE: looks and flakes like dandruff
Seborrheic (dermatitis)
Inflammation or infection of hair follicles, typically result of an infection
Occurs in regions with hair that is thick, long, and dark; area under occlusion → head, neck, axillae, groin, buttocks
- Topical benzoyl peroxide
Abx if needed
Superficial should resolve on own
Folliculitis
Candida is resistant to ____
Nystatin
how to manage candida?
Treat the mother and the baby BOTH
Clotrimazole 10 mg dissolve in mouth 5x/day for 14 days
Nystatin- 4-6ml swish and spit 3-4x/day 7-14 days CONTINUE AFTER symptoms resolved
Fluconazole 200mg by mouth first day, 100mg for 2-3 weeks
Cutaneous dermatophyte infection -> Circular ring and central clearing
CONTAGIOUS- athletes (wrestlers)
Cruris Corporis - ringworm
How to tx Cruris Corporis - ringworm
Oral (more severe/widespread): itraconazole 200 mg 1x/day or terbinafine 250mg 1x/day for 2-3 weeks (watch the liver)
topical anti-fungal: mild to moderate lesions BID 7-10 days after lesions resolve
Use clean towel
4 types of Pedis- Athlete’s foot (fungal)
Chronic hyperkeratotic- pattern of lesions, scale and thick
Chronic intertriginous- the skin breaks between the toes
Acute ulcerative-
Vesiculobullous -
Crusty, red ring with central clearing on foot
Pedis- Athlete’s foot
how to tx Pedis- Athlete’s foot
K+ hydroxide
Drying agents: anti-fungal powders (miconazole), gentian violet
Keep feet dry, dont use corn starch (hold moisture and promotes growth of dermatophytes)
Oral (more severe /widespread): itraconazole 200 mg 1x/day for month or terbinafine 250mg 1x/day for 2-6 weeks
Brought on by autoimmune disease… blackheads in small pitted areas of the skin.. Often occur in pairs
Red tender bumps
Painful, pea-sized under skin , Itching and burning, Occurs where skin rubs against skin or hair follicle… can occur anywhere there is hair but often in axilla
Women, obese, smoker, ance, family hx, 20-29 y.o, may resolve after menopause
Hidradenitis suppurative & hyperhidrosis (autoimmune)
superficial/partial thickness: epidermis only, glossy, red, painful
1st degree burn
partial-thickness: dermis involved, dull or glossy with pink, red or white pigmentation; may blister → very painful
2nd degree burn
full thickness to sq fat: matte, white, brown, red or black; insensate is hallmark
3rd degree burn
what labs to check with serious burns?
cbc, glucose, electrolytes (high K+-cell breakdown), BUN, creat- rhabdo, renal fxn, tissue perfusion, , UA-myoglobin=ATN,; chest xray (inhalation), culture of site if delayed healing
Periungal tissue induated with infectious matter
Antibiotics appropriate for likely causative organisms
Nail may need to be removed if nail has separated from the bed
paronchial Infections
Caused by trauma to the nail
May result in loss of nail… usually grows back
If no hx of trauma, consider Proteus or Pseudomonas infection
subungal hematomas
inflammatory dermatitis, co-exist with acne
Later in life 30-50 y.o
Spicy foods, ETOH
Clinical Manifestations:
On the face, looks like flushing, burns
manage w/ Topical metronidazole 3-4 months
Pityriasis Rosacea (rash)
T cells have a key role, environmental triggers can bring a flare, immune stimulation of epidermal keratinocytes that builds up the layers and creates the plaques/ lesions
Psoriasis (rash) - Autoimmune
(most common Psoriasis)- grey, crusty, over bigger areas of skin
Plaque
type of psoriasis- young adults and children, water droplet scaly
Guttate
type of psoriasis … broad and hot
Erythrodermic
How to manage autoimmune psoriasis
Severe (>20%- refer to dermatology); if joint swelling/ joint pain refer to rheumatology
High potency topical steroid - hard to be absorbed because of the plaque
UV light therapy
Immunosuppressive drugs- biologics
skin cancer warning signs
Open sore that does not heal for 3 weeks
A spot or sore that burns, itches, stings, crusts, or bleeds
Any mole or spot that changes in size or texture, develops irregular borders, appears pearly, translucent, or multicolored
Changes that occur over a month or more should be evaluated
Most common skin cancer-> sun exposure
Lesions vary from normal, flesh-colored lesions to slightly pigmented
Typically have raised, shiny appearance with pearly borders
>3 weeks- think BCC
They can spread
Basal Cell Carcinoma: rise up a little more
Lesion is typically roughened, scaling area that does not heal and readily bleeds when scraped
Keratinization can lead to heaped-up, flaky appearance
Don’t spread
… needs total excision
Squamous Cell Carcinoma
Most fatal skin cancer; heavy sun exposure
UV radiation → DNA damage, gene mutation, immunosuppression, oxidative stress, inflammatory response
Surgical cure- IF CAUGHT EARLY, if spread- deadly
Immunotherapy
melanoma
ABCDE of melanoma
Asymmetry of the border; Border irregularities; Color variability within lesion; Diameter >6mm (¼ in); Elevation
common MM sites in African Americans, Asian Americans, and dark-skinned individuals
nails, hands and feet
primary skin lesion vs secondary?
Primary skin lesions are present at the onset of a disease
secondary skin lesions result from changes over time caused by disease progression, manipulation (scratching, picking, rubbing), or treatment.
elevation in the skin with smooth surface and sloping borders (usually) light pink ranges from 3mm- 20 cm
ex. mosquito bite
Wheal
raised lesion up to 1cm in diameter filled with clear fluid
ex: herpes simplex (early stages)
Vesicle
Raised lesion > 1cm in diameter, filled with clear fluid
ex:
bulla
raised lesion filled with pus
ex: acne
pustule
a spot, circumcised, up to 1 cm; not palpable; not elevated above or depressed below surrounding skin surface; hypopigmented, hyperpigmented, or erythematous
ex. freckle
Macule
a spot, circumcised, greater than 1 cm; not palpable; not elevated above or depressed below surrounding skin surface; hypopigmented, hyperpigmented, or erythematous
ex. Cafe au lait spots, Mongolian spots
Patch
A bump, palpable and circumcised, elevated and less than 5 mm in diameter, might be pigmented, erythematous, or flesh-toned
ex. elevated nevus
Papule
similar to papule, diameter of 5mm- 2cm, may have significant palpable dermal component
ex. fibroma, xanthoma, intradermal nevi
nodule
usually well-circumcised lesion with large surface area and slight elevation
ex. psoriasis, lichen planus
plaque
painful burning, usually unilateral, lesions last about 7-10 days
Herpes Zoster
Pustules on the skin, recently in hot tub
Folliculitis
How to dx and tx herpes zoster?
dx with Tzank smear
Tx: with an antiviral (acyclovir, valacyclovir)
Folliculitis tx?
benzol peroxide
if necessary: penicillins (others work too)
