Dermatology

Question 1

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?

Answer 1

SEVERE seborrheic derm. assoc with HIV and parkinsons. CHECK FOR HIV!

Question 2

Alopecia Areata treatment?

Answer 2

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.

Question 3

Pemphigus Vulgaris causes? sx? tx?

Answer 3

AI, Ab to desmosomes cause: Idiopathic, ACEi, Penicillamine sx: nikolsky sign, painful, mucosal ulcers, life-threatening, 30s-40 yoa tx: steroids

Question 4

Bullous Pemphigoid sx? tx?

Answer 4

ab to hemidesmosomes sx: deep blisters & thick bullae but are less likely to rupture, will usually resolve, seen in 70s-80s, tx: steroids

Question 5

Porphyria Cutanea Tarda(PCT) cause?

Answer 5

disoder or porphyrin metabolism resulting in photosensitivity reaction to an abnormally high accumulation of porphyrins

Question 6

Things associated with Porphyria Cutanea Tarda(PCT)

Answer 6

alcoholism, liver disease, Chronic hepatitis C, Oral contraceptives, liver disease(hemochromatosis), diabetes

Question 7

sx of Prophyria Cutanea Tarda(PCT)

Answer 7

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)

Question 8

tx of Porphyria Cutanea Tarda(PCT)

Answer 8

avoid triggers, use sunblocks, phlebotomy to remove iron, Deferoxamine, Chloroquine

Question 9

Stevens-Johnson Syndrome(SJS) vs Toxic Epidermal Necrolysis(TEN)

Answer 9

SJS = 10-15% of the body and mucous membrane involvement TEN = 30+%, nikolsky’s

Question 10

side effect of terbinafine

Answer 10

hepatotoxic

Question 11

Erysipelas sx? tx?

Answer 11

GAS> staph sx: fever, chills, bacteremia, BRIGHT RED ANGRY SWOLLEN APPEARANCE TO THE FACE tx: abx

Question 12

Scabies tx?

Answer 12

permethrin or oral ivermectin

Question 13

Seborrheic Keratosis

Answer 13

benign hyperpigmented lesions occuring in elderly = stuck on appearance

Question 14

Actinic Keratosis sx? tx?

Answer 14

precancerous lesions on sun-exposed areas of the body. usually asymptomatic tx: cryotherapy, topical 5FU, etc.

Question 15

Squamous Cell Carcinoma of the skin sx? tx?

Answer 15

sun exposed areas & seen with some ummunosupressive drugs, often presents as ulcer tx: surgical removal

Question 16

Basal Cell Carcinoma of the skin sx? dx? tx?

Answer 16

sun exposed areas, shiny or pearly appearance dx: shave or punch bx tx: Mohs Microsurgery = EM surgery = great for delicate places

Question 17

Kaposi’s Sarcoma dx? tx?

Answer 17

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

Question 18

Psoriasis sx? tx?

Answer 18

sx: silvery scales develop on the extensor surfaces, nail pitting, tx: emollients, salicylic acid, steroids, vit D/A

Question 19

Atopic Dermatitis sx? tx?

Answer 19

AKA ECZEMA! sx: hx of atopy, red, itchy plaques of the flexor surfaces, high IgE levels tx: topical steroids, antihistamines, coal tars, phototherapy

Question 20

Seborrheic Dermatitis sx? tx?

Answer 20

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

Question 21

Pityriasis Rosea

Answer 21

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.

Question 22

Acne treatment hierarchy

Answer 22

Benzoyl peroxide > Clindamycin,erythromycin, sulfacetamide > topical retinoids >> oral abx(minocyclin, tetracyclin, clindamycin) & oral Retinoic acid = isotretinoin(strong teratogens)

Question 23

Rosacea sx? tx?

Answer 23

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

Question 24

PV or Bull pemphgoid. which will give you oral ulcers?

Answer 24

PV

Question 25

Treatment of wart? For how long?

Answer 25

Salicylic acid - can weeks to months, can also use liquid nitrogen but may need to repeat q2-3 weeks till reslved

Question 26

First line treatment for scabies?

Answer 26

Permethrin 5% - leave on for 8 hours then shower off, repeat treatment in 1 week.

Question 27

How many doses is the shingles vaccine?

Answer 27

Two doses 2 to 6 months apart approved for individuals 50 or older

Question 28

Drug of choice for treatment of scabies how often do you treat?

Answer 28

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.

Question 29

Treatment of folliculitis lasting more than 2 to 3 weeks

Answer 29

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

Question 30

Treatment of hot tub folliculitis that has severe and not resolving

Answer 30

Most hot tub folliculitis is caused by pseudomonas and can be treated with ciprofloxacin

Question 31

Treatment of pseudofolliculitis barbae?

Answer 31

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.

Question 32

First line treatment For impetigo

Answer 32

Pearson 2% three times a day. If extensive can you also use Keflex are doxycycline. If you suspect Mersa can use clindamycin or Bactrim

Question 33

Rosacea treatment options

Answer 33

Topical Flagyl and benzodperoxide. Can also use topical clindamycin but this is less effective. PO carvedilol for flushing

Question 34

Treatment of seborrheic dermatitis

Answer 34

Try to treat low potency topical steroids, topical antifungal such as ketoconazole b.i.d. until better

Question 35

Treatment of Peri orbital dermatitis

Answer 35

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.

Question 36

What color will tinea versicolor show up as Underwood’s lamp?

Answer 36

Yellow

Question 37

Erythrasma Is commonly caused by what bug? What colors is Underwood’s lamp? Treatment?

Answer 37

Corynebacterium; shows up as coral pink under a woods lamp. Treated with topical clindamycin, erythromycin or clotrimazole(works even though it’s not fungal)

Question 38

Excision for epidermal cyst is best done how many weeks after inflammation has resolved?

Answer 38

4-6 weeks

Question 39

How much storage do inject into a keloid and how often?

Answer 39

0.1-0.5 ml of triamcinolone 5–40 mg/ml untill keloid blanches. Repeat in one to four weeks