Dermatology Flashcards
25 yo hx dandriff, cc nonpainful occational puritic rash. PE: erythematous plaques on the eyebrows, nasal bridge, nasolabial folds, upper chest & back. Plaques have indistinct margin & are covered by fine, greasy scales. dx? wht text should u order? y?
SEVERE seborrheic derm. assoc with HIV and parkinsons. CHECK FOR HIV!
Alopecia Areata treatment?
Topical or intralesional corticosteroids are the treatment of choice for patients with alopecia areata. Patient education and information is also the key part of treatment. Patients should be made aware that: (1) the disease is usually benign, (2) they can have multiple relapses in spite of treatment, and (3) most patients have normal hair growth within the next one to two years even without treatment. They should also be informed that treatment with steroids, either intralesional or topical, can restore normal hair growth but does not cure the disease. After a steroid injection, new hair growth is usually seen in the next four to six weeks.
Pemphigus Vulgaris causes? sx? tx?
AI, Ab to desmosomes cause: Idiopathic, ACEi, Penicillamine sx: nikolsky sign, painful, mucosal ulcers, life-threatening, 30s-40 yoa tx: steroids
Bullous Pemphigoid sx? tx?
ab to hemidesmosomes sx: deep blisters & thick bullae but are less likely to rupture, will usually resolve, seen in 70s-80s, tx: steroids
Porphyria Cutanea Tarda(PCT) cause?
disoder or porphyrin metabolism resulting in photosensitivity reaction to an abnormally high accumulation of porphyrins
Things associated with Porphyria Cutanea Tarda(PCT)
alcoholism, liver disease, Chronic hepatitis C, Oral contraceptives, liver disease(hemochromatosis), diabetes
sx of Prophyria Cutanea Tarda(PCT)
nonhealing blisters on sun-exposed areas of the body such as the BACKS OF HANDS & FACE, hyperpigmentation of the skin, hypertrichosis of the face(lots-o-hair)
tx of Porphyria Cutanea Tarda(PCT)
avoid triggers, use sunblocks, phlebotomy to remove iron, Deferoxamine, Chloroquine
Stevens-Johnson Syndrome(SJS) vs Toxic Epidermal Necrolysis(TEN)
SJS = 10-15% of the body and mucous membrane involvement TEN = 30+%, nikolsky’s
side effect of terbinafine
hepatotoxic
Erysipelas sx? tx?
GAS> staph sx: fever, chills, bacteremia, BRIGHT RED ANGRY SWOLLEN APPEARANCE TO THE FACE tx: abx
Scabies tx?
permethrin or oral ivermectin
Seborrheic Keratosis
benign hyperpigmented lesions occuring in elderly = stuck on appearance
Actinic Keratosis sx? tx?
precancerous lesions on sun-exposed areas of the body. usually asymptomatic tx: cryotherapy, topical 5FU, etc.
Squamous Cell Carcinoma of the skin sx? tx?
sun exposed areas & seen with some ummunosupressive drugs, often presents as ulcer tx: surgical removal
Basal Cell Carcinoma of the skin sx? dx? tx?
sun exposed areas, shiny or pearly appearance dx: shave or punch bx tx: Mohs Microsurgery = EM surgery = great for delicate places
Kaposi’s Sarcoma dx? tx?
purplish lesions found on the skin predominantly of patients with HIV and CD4 counts <100 = HHV8 dx: clinical! tx: HART to raise CD4 + ADRIAMYCIN & VINBLASTINE
Psoriasis sx? tx?
sx: silvery scales develop on the extensor surfaces, nail pitting, tx: emollients, salicylic acid, steroids, vit D/A
Atopic Dermatitis sx? tx?
AKA ECZEMA! sx: hx of atopy, red, itchy plaques of the flexor surfaces, high IgE levels tx: topical steroids, antihistamines, coal tars, phototherapy
Seborrheic Dermatitis sx? tx?
AKA DANDRUFF sx: oversecretion of sebaceous material, HSR to superficial fungal organism = PITYROSPORUM OVALE, often seen on face around eyebrows/nasolabial foles, elderly tx: topical hydrocortisone, topical antifungal ketoconazole
Pityriasis Rosea
idiopathic/transient dermatitis, pruritis eruption that begins with a herald patch, erythematous salmon colored that can look like syphilus that spares the palms and soles.
Acne treatment hierarchy
Benzoyl peroxide > Clindamycin,erythromycin, sulfacetamide > topical retinoids >> oral abx(minocyclin, tetracyclin, clindamycin) & oral Retinoic acid = isotretinoin(strong teratogens)
Rosacea sx? tx?
inflammatory pustules of rosacea that can look like acne, redness of the nose and cheeks
Tx: First line: Topical Flagyl, 2nd: topical azelaic acid or topical ivermectin, 3rd: Sodium sulfacetamide lotion.
-if topical doesnt work, PO doxy can be used x 2-3 months; for severe disease isotretinoin
PV or Bull pemphgoid. which will give you oral ulcers?
PV
Treatment of wart? For how long?
Salicylic acid - can weeks to months, can also use liquid nitrogen but may need to repeat q2-3 weeks till reslved
First line treatment for scabies?
Permethrin 5% - leave on for 8 hours then shower off, repeat treatment in 1 week.
How many doses is the shingles vaccine?
Two doses 2 to 6 months apart approved for individuals 50 or older
Drug of choice for treatment of scabies how often do you treat?
Permethrin 5% cream applied below the neck and repeat one week later. Alternatively can use ivermectin 200 µg/kg and repeat in 1 to 2 weeks.
Treatment of folliculitis lasting more than 2 to 3 weeks
Most will resolve on their own, do not shave in the area however if lasting more than 2 to 3 weeks can use Keflex or Bactrim
Treatment of hot tub folliculitis that has severe and not resolving
Most hot tub folliculitis is caused by pseudomonas and can be treated with ciprofloxacin
Treatment of pseudofolliculitis barbae?
Not a true folliculitis do to shaving and the hairs growing back abnormal. Treatment is to not shave the area for a period of time.
First line treatment For impetigo
Pearson 2% three times a day. If extensive can you also use Keflex are doxycycline. If you suspect Mersa can use clindamycin or Bactrim
Rosacea treatment options
Topical Flagyl and benzodperoxide. Can also use topical clindamycin but this is less effective. PO carvedilol for flushing
Treatment of seborrheic dermatitis
Try to treat low potency topical steroids, topical antifungal such as ketoconazole b.i.d. until better
Treatment of Peri orbital dermatitis
Mild Involvement can use topical Pimecrolimis BID, More moderate involvement use the same antibiotics as you would treating acne such as a tetracycline twice a day, doxycycline or minocycline.
What color will tinea versicolor show up as Underwood’s lamp?
Yellow
Erythrasma Is commonly caused by what bug? What colors is Underwood’s lamp? Treatment?
Corynebacterium; shows up as coral pink under a woods lamp. Treated with topical clindamycin, erythromycin or clotrimazole(works even though it’s not fungal)
Excision for epidermal cyst is best done how many weeks after inflammation has resolved?
4-6 weeks
How much storage do inject into a keloid and how often?
0.1-0.5 ml of triamcinolone 5–40 mg/ml untill keloid blanches. Repeat in one to four weeks
