Dermatology Flashcards
what is Cholasma?
also known as melasma
“Mask of pregnancy”
sun spots of the face
what is straie gravidarum?
stretch marks
normal age related skin changes
loss of elastin, collagen & subcutaneous fat
**sweat glands & sebaceous glands decrease _> decrease thermoregulatory _> increases risk for heat stroke
what is NOT a normal age related skin change?
Dermatophytes - fungus infection on skin when in sun, skin turns darker pigment (expected) except for area with fungi infection which turns lighter
what is an example of a macule vs patch?
Macule is small (<1cm) = flat nevi (freckle)
Patch = bigger macule >1cm = mongolian spot, vitiligo, chloasma
location of tinea curis vs corporis vs capitis
cruris = peri area corporis = body (ringworm) capitis = head (cradle cap in babies)
what is the tx for tinea capitis?
grisefulvin 500mg daily 4-6 weeks.
Take with high fat meals to improve absorption.
avoid sun exposure
may reduce efficacy of oral contraceptives
monitor for clay stool
when can children return to school after diagnosed with tinea capitis?
after treatment initiated
what could the diagnosis of a skin lesion that appears hypo or hyperpigmented with slightly scale macules on the trunk, neck, and upper arems?
Tinea Vesicolor (superficial fungal infection)
Treatment for Tinea fungal infection?
Topical : “-azole” creams (Clotrimazole 1%, miconazole 2%, ketoconazole 2%, econazole 1%)
Oral: Griseofulvin 125mg/250mg.
Derived from PCN, possible cross sensitivity
Take with high fat meal to improve absorption
Contraindicated in pts with hepatic dysfunction
after 3 weeks of antifungal therapy pt still has infection what should the provider do?
NOTHING. fungal infections take 4-8 weeks of antifungal therapy to resolve.
DO NOT change tx before this time frame
Most common causative agent of cellulitis?
Group A streptococcus
***If purulence is present think Staph/MRSA
Treatment for Group A streptococcus cellulitis?
- PCN
- if allergic to PCN –>
1st gen cephalosporin (cephalexin) or macrolide (azithromycin)
Assessment of psoriasis
silvery scales on erythematous base
-often on extensor surfaces (outer surfaces) elbows, knees, scalp, gluteal cleft, fingernails, palms & soles of feet
-Nails may be pitted
what is an Auspitz sign?
what does it indicate?
Auspitz sign = pinpoint bleeding when plaque removed
Indicates PSORIASIS
differentiates psoriasis vs eczema
Treatment for Psoriasis
Keep skin hydrated with emollient
Topical steroids - low dose first
scalp: strong- potency steroid in alcohol base
Face: low potency
Tar solutions
Salicylic acid gel
*** no more then 50G/week for steroids
pt with psoriasis has salicylic acid sensitivity and should be instructed to avoid?
ALMONDS
what type of skin cancer arises from epithelial tumors from keratinocytes of the epidermis. Often are red, tan, brown and pearly gray
Squamous cell carcinoma (SCC)
What type of skin cancer develops in the basal cell layer of skin in middle aged men and appear pearly domed nodule?
Basil cell carcinoma (BCC)
Malignant melanoma
arising from melanocytes (pigment producing cells)
what is the most deadly form of skin cancer?
Malignant melanoma
ABCDE mnemonic
Asymmetry Border irregular color variation diameter >6mm (size of pencil eraser) Evolving (elevation, hypo/hyper pigmentation, bleeding, scaling, texture)
HARMM risk tool evaluates what?
what does it stand for?
Melanoma risk model
Hx of previous Age >50 Regular derma visits missing Mole changing male gender
Pagets disease (breast cancer)
uncommon form of breast CA
Scaley, exzema like lesion that may weep, erode, crust
indicative of ductal breast cancer in situ
Peau d’orange
“orange peel breast”
breast dimpling or edema, thickened with enlarged pores
what is Herpes Zoster (HSV-3)
Shingles
reactivation of varicella-zoster virus (chickenpox) that lays dormant in nerve cells, typically along a single dermatome
Can you transmit shingles to others?
Pts who have shingles are NOT able to transmit shingles to susceptible pts on transmit chickenpox virus to susceptible pts
-Older, immunocompromised, or pregnant pts should avoid contact with anyone with shingles
Phases of herpes zoster virus
prodrome - occurs along 1/more dermatome from 1-10 days. fatigue, itching, burning, ect.
Acute phase - rash erupts over 3-4 days. maculopapular rash progresses to groupd vesicles. fever, malaise, headache, pain
Convalescent phase - w/in 2-3 weeks rash resolves. pain can last for more than 30 days
what is post herpatic neuralgia and what is the tx?
pain for more than 30 days after HSV 3 rash resolved.
tx
- gabapentin
- lyrica
Prevention of herpes zoster
VACCCINATION- shingrix, 2 doses 2-6 months apart
can you give antiviral medications to pts with HSV 3?
yes, may shorten length and severity of illness if given within 48-72 hours of symptom presentation
Symptom management for shingles
OTC analgesics
Capsaicin top cream - can lead to irritation of eyes and mucous membranes
antipuritic - calamine lotion, colloidal oatmeal bath
topical lidocaine (xylocaine) & nerve blocks
steroids
What is eczema?
chronic pruritic skin eruption - common in pts with other atopic illness (asthma, allergic rhinitis)
Assessment findings for eczema
pruritus, erythema, dry skin
patchy plaque on flexural surfaces (bends of the body - inside elbows, back of knees, ankles)
Non pharm tx for atopic dermatitis/eczema
bathing, moisturizer applied 1-3 mins after patting skin dry
superfatted soaps best, low or neutral pH
prevent skin trauma /burns
soak in warm water for 20 mins prior to applying emollient
cool wet compress (burrows solution) if lesions are weeping or oozing
bleach baths 3x week (1/4c bleed in full bath, 2-3 mins)
can you use ointments for oozing atopic dermatitis?
no. wait for lesions to dry
pt has eczema would you give steroids?
Only low dose topical steroids
- Alclometasone dipropionate/Aclovate 0.05%
- Flucinolone acetonide 0.01%
- Hydrocortisone buyrate 0.1%
High dose topical steroids
Betamethasone dipropionate 0.05%/0.25%
Amcinoide 0.1%
Desoximetasone 0.05%, 0.25%
Pharm management for eczema (general)
low dose topical steroids
antihistamine (oral/topical)
emollients (eucerin, lubriderm, cetaphil)
intralesional steroid injection
topical calcinerun inhibitors - pimecrolium cream 1% or tacrolimus ointment 0.03%
Pt presents with inflammation and excoriated skin of the skin of the perineum, buttocks, lower abdomen and inner thighs.
what is the probable diagnosis and treatment?
Diaper dermatitis
Tx: Zinc oxide (skin barrier)
what is a chronic superficial disorder affecting hairy area of the body where many sebaceous glands are present?
seborrheic dermatitis
What is dermatyphytosis / dermatophytes
Fungal infection of the skin that causes pathologic changes
- when in sun, skin turns darker pigment except for area with fungal infection which turns lighter
tx: griseofulvin or other antifungal
superficial dermatophytosis that attacks hair shafts on the scalp, eyebrows, and elelashes is known as…
tinea capitis
can dermatophytes associated with tinea pedis survive for months in bathrooms, changing rooms and around swimming pools?
YESS = athletes foot
what is the most common cause of onychomycosis ?
Trichophyton rubrum
When sebaceous glands produce excessive sebum leading to comedones, pustules, papules, systic nodules, and scarring… what is this?
Acne Vulgaris
what is the treatment of Acne Vulgaris?
Topical ABX + Benzoyl peroxide = combo prevents microbial resistance
erythromycin or clindamycin
Store in refigerator
what is pediculus?
LICE
pruritis d/t allergic reaction
Probable diagnosis for intensely pruitic skin infection with mite that burrows into the upper layer of the skin ?
Scabies. (Sarcoptes scabiei)
HIGHLY contagious
Assessment findings for scaibes
Itching - more noticeable at night, small itching blisters in a thin line, scaling, erythema
Mites burrow between finger webbing, feet, wrists, axilla, scrotum, penis, waist, buttocks
Vesicles/papules may appear as a black dot or scab at end of a burrow
Treatment for scabies
non pharm - wash all clothing, bedding, towels used w/in 4 days. vacuum/mop floors as usual.
Pharm- MUST tx all members of house at same time!
topical scabicides - inhibit nerve function in the mites producing paralysis and death.
3 days of treatment
-Permethrin 5% - ok in immunocompromised kids
wash off after 8-14 hours.
-Sulfur 6%
-Ivermectin (antiparasitic)
Retreat in 14 days if warranted
what is paronychia?
inflammation of the perionchium = skin bordering the nails
tx: vinegar/water soaks –> fix green colored nail
mupirocin ointment
** if exposed to oral flora (nail biting/thumb sucking) then Amoxicillin/Clavulanate or Clindamycin
antigen induced development of pruitic edematous circular plaques is known as….
Urticaria
Fluorouracil (Carac) classification and use for treatment
Antineoplastic
Tx actinic keratosis
Contraindicated : Pregnancy
what is Nystatin (Mycostatin) used for
topical antifungal agent
what is pimecrolimus (Elidel) indicated for the treatment of…
Atopic dermatitis
potential systemic reaction to imiquimod (Aldara) used to treat superficial BCC is….
flu like symptoms
Minocycline (Dynacin) classification of abx and use for derm
Tetracycline
tx of acne / some skin infections
Which of the following is NOT a topical pediculicide?
a. Benzyl alcohol
b. Ivermectin
c. Permethrin
d. Selenium sulfide
Selenium sulfide - used for dandruff not pediculidcide
potential adverse reaction r/t use of sulfacetamide (klaron) topical, indicated for the tx of seborrheic dermatitis is….
SLE
Sulfa medications reactions : SLE, agranulocystosis, acute hemolytic anemia, aplastic anemia, purpura hemorrhagic, steven-johnson syndrome, toxic epidermal necrolysis ect
Half life of Trimethoprim - sulfamethoxazole (bactrim)
10 hours.
What is a Fingertip Unit (FTU)?
measured from the very tip of the finger to the first crease (DIP joint) in the finger.
-Each FTU is approx = to 0.5g (Men) and 0.4 grams (women) of ointment.
Estimate of number of FTUs required to cover various areas of the body as: Head/neck = 4.5, Trunk (front/back) = 7, arm = 3, hand = 1, leg = 6, foot = 2.
Diclofenac (Solaraze), an antiflammatory, is used in the tx of…
Actinic keratosis
applied to lesion BID
Tetracycline in children younger then 9 may cause…
bone growth retardation
tissue hyperpigmentation
enamel hypoplaisa
PERMANENT tooth discoloration
