Dermatology Flashcards
To diagnose an autoimmune bullous disease, two biopsies often are performed:
one of lesional skin for histology and one of perilesional normal skin for direct immunofluorescence
Presents in young adults as asymptomatic, oval-to-round, minimally scaly, hyperpigmented or hypopigmented macules that can coalesce into patches on the trunk and upper extremities.
Pityriasis versicolor
The initial treatment for atopic dermatitis consists of good skin care with mild cleansers and thick emollients along with:
topical glucocorticoids to decrease inflammation and pruritus
__________ should be performed to evaluate for urticarial vasculitis when individual urticarial lesions are present for longer than 24 hours.
Skin biopsies
Side effects from topical glucocorticoids include
thinned skin, striae distensae (stretch marks), and easy bruising, and are likely to occur when they are used for extended periods of time, especially in skin folds or areas of occlusion.
Typically presents as a painful, vesicular eruption confined to a single dermatome and is most commonly seen in immunocompromised or elderly patients.
Herpes zoster (shingles), recrudescent varicella zoster virus
Is a longitudinal brown pigmentation of the nail plate; it can be a normal variant in persons with darker skin types, but it may also occur as a result of systemic disease, medication, infection, or an underlying melanocytic lesion.
Melanonychia
Appears as a loss of cuticle with tender, edematous nail folds involving multiple fingers; wet work can cause maceration and predispose to this condition?
Chronic paronychia
Moderate to severe psoriasis (30% or more BSA) is best treated with
Systemic agents. These include TNF inhibitors (etanercept, adalimumab, and infliximab), acitretin, methotrexate, IL-23 and IL-17 inhibitors, and phototherapy.
NOTE: avoid prednisone as a therapy for psoriasis.
First-line therapy for pruritic urticarial papules and plaques of pregnancy (PUPPP)?
Low- to medium-potency topical glucocorticoids
Can appear as superficial clear vesicles or as multiple discrete red papules due to the occlusion of eccrine sweat ducts.
Miliaria or “heat rash”
Is indicated for severe nodulocystic and recalcitrant acne?
Isotretinoin; it is associated with severe birth defects and must be administered through the federal regulatory program iPLEDGE.
Presents with skin findings characteristic of dermatomyositis, but without clinical or laboratory evidence of muscle disease; it carries risks for underlying malignancy.
Amyopathic dermatomyositis
What is the strongest prognostic indicator in Stevens-Johnson syndrome/toxic epidermal necrosis (SJS/TEN)?
Body surface area involvement
Note: SJS involves less than 10%, SJS-TEN overlap involves 10% to 30%, and TEN involves greater than 30%.
Is a common cutaneous viral infection that initially appears as firm, umbilicated flesh-colored to yellow papules; in adults it is considered a sexually transmitted infection that frequently involves the genital area.
Molluscum contagiosum
Is a chronic autoimmune blistering disease that predominantly affects elderly patients; it presents with urticarial plaques with tense bullae on the trunk and upper legs?
Bullous pemphigoid
Note: Pemphigus vulgaris is the most common intraepidermal ABD, and its incidence increases with age. It presents with oral and/or vaginal erosions and flaccid vesicles. Pemphigus vulgaris is associated with a positive Nikolsky sign whereby light friction on perilesional skin induces a blister.
First-line therapy for localized impetigo?
A topical antibacterial agent, such as Mupirocin
Typically occurs in elderly male smokers with long-standing rheumatoid arthritis and high titers of rheumatoid factor; it can appear as a small or medium-sized vasculitis and may affect nerves and other organs.
Rheumatoid vasculitis
Is frequently diagnosed as a drug-induced photosensitive rash characterized by erythematous annular scaly patches.
Subacute cutaneous lupus erythematosus. Treatment is to discontinue Adalimumab.
Evaluation of the interdigital toe spaces and treatment of the maceration and fissuring in the web spaces and modification of other predisposing factors such as edema, obesity, eczema, and venous insufficiency can decrease the risk of recurrent
Cellulitis
Actinic keratoses that do not resolve with cryotherapy or other appropriate therapy will require
A biopsy to rule out an invasive neoplasm
Appears as asymptomatic translucent telangiectatic papules on sun-exposed areas in fair-skinned persons
Basal cell carcinoma
Is sarcoidosis of the nose and central face, manifesting as violaceous subcutaneous plaques or nodules, often with some overlying scale
Lupus pernio
A form of margin-controlled surgery that minimizes loss of normal tissue, is particularly useful for basal cell tumors in areas such as the head and neck, for large or recurrent tumors, for histologically high-risk tumors, or when cosmetic outcome is crucial.
Mohs surgery
Is recognized by targetoid lesions accompanied by mucous membrane involvement; a drug or infection (herpes simplex virus or Mycoplasma pneumoniae) can trigger this rash.
Erythema multiforme major
Is caused by age-related capillary fragility and bleeding under atrophic skin; minor trauma can cause impressive purpuric macules and patches, most commonly on the forearm.
Actinic purpura
Is typically characterized by edema, erythema, scaling, and pruritus on the lower legs and occurs in patients with venous insufficiency or other causes of chronic lower extremity edema.
Stasis dermatitis
Is the most appropriate treatment for bothersome epidermal inclusion cysts since the epithelial lining must be removed for complete treatment.
Excision
Is a generalized nonscarring alopecia triggered by a physically traumatic event such as surgery, parturition, or fever; it usually spontaneously resolves in about 6 to 12 months if the trigger is removed or treated.
Telogen effluvium
Is an acquired hypermelanotic condition most commonly affecting women of childbearing age; it is characterized by tan-brown reticulated patches in the centrofacial, malar, and mandible areas.
Melasma
Patients with new or explosive onset of seborrheic dermatitis, or seborrheic dermatitis that is severe or extensive, found in unusual locations, or is resistant to treatment, should be evaluated for
HIV infection
Is characterized by red pruritic papules on the chest, flanks, and back associated with dry skin, heat, and sweating.
Transient acantholytic dermatosis
Are well-circumscribed, brown-to-black macules that most commonly occur on the lower lip, although they may be seen on the gingiva, buccal mucosa, or tongue?
Melanotic macules
Is characterized as isolated sclerotic circumscribed plaques; it is not associated with Raynaud phenomenon or systemic disease and does not include sclerodactyly? Also, often appears in areas of friction and pressure, such as the waistband area or inframammary regions.
Localized scleroderma (morphea)
Is typically found on the head and neck region of older persons; it is associated with frequent chronic ultraviolet light exposure?
Melanoma in situ, lentigo maligna subtype
Management of dermatologic conditions during pregnancy with
Topical agents should be considered before prescribing systemic medications because they are lower risk, with the exception of tazarotene (category X).
Rash include erythematous papules coalescing into plaques, often with some pruritus, and no accompanying systemic symptoms. Eruptions begin 4 to 14 days after the initiation of a new medication?
Morbilliform drug reaction
Is an autoimmune disease that causes the loss of melanocytes and subsequent depigmentation of the skin appearing as completely white, regular, well-demarcated macules or patches with no scale.
Vitiligo
Is characterized by inflammatory abscesses, sinus tracts, and scarring in intertriginous areas; it is associated with smoking, obesity, and the metabolic syndrome?
Hidradenitis suppurativa
presents as a painful, exudative ulcer with a purulent base and ragged, edematous, violaceous, “overhanging” border; it may be idiopathic but it can be associated with an underlying disease such as IBD.
Pyoderma gangrenosum
Is the standard form of phototherapy used in the treatment of extensive psoriasis?
Narrowband ultraviolet B (UVB)
Note: Morphea (localized scleroderma) has been shown to benefit from exposure to UVA phototherapy.
Patients experience tender subcutaneous nodules from vascular inflammation, stellate erosions, or ulcerations from ischemia in the watershed of the affected vessels, and may develop livedo reticularis or livedoid purpura?
Cutaneous-only polyarteritis nodosa
Is recommended in the evaluation of erythema nodosum to assess for the presence of lymphoma, sarcoidosis, tuberculosis, and fungal infection such as coccidioidomycosis?
A chest radiograph
Is a superficial bacterial infection characterized by small pits and punctate erosions primarily on the plantar aspects of the feet; risk factors include increased perspiration (hyperhidrosis) and prolonged occlusion of the feet?
Pitted keratolysis
The mainstay of venous ulcer treatment consists of:
Compression therapy
Psoriasis can flare to erythroderma following brief use of
Oral glucocorticoids
Diagnosis of dermatophyte infection can be performed by examination of the scale with
potassium hydroxide; the presence of branching hyphae is diagnostic.
Lesions are intensely painful, angulated, retiform purpuric patches with areas of black necrotic tissue that may form bullae, ulcerate, and leave a hard, firm eschar in patients with end-stage kidney disease?
Calciphylaxis
Primary treatment for abscess with no systemic signs of infection is ?
Incision and drainage; antibiotics should be added only if systemic symptoms or signs are present.
Are benign pigmented macules or papules with a surrounding “halo” of hypopigmented or depigmented skin, most frequently presenting on the back of teenagers and young adults.
Halo nevi
Is characterized by red, thin plaques with variable amounts of scale in the axillae, intergluteal cleft, and perineum, and under the breasts and pannus?
Inverse psoriasis
First-line treatment of dermatitis herpetiformis?
Dapsone should be used in conjunction with a gluten-free diet
Neomycin and bacitracin can cause allergic contact dermatitis that mimics a wound infection; the most appropriate initial management?
Discontinue its use
Treatment of hand dermatitis includes?
Topical emollients such as petrolatum to repair the skin barrier; hand washing should be minimized.
First-line treatment for comedonal acne because they are comedolytic and normalize keratinization of the hair follicle
Topical retinoids
Note: Topical antibiotics are important in inflammatory acne when pustules and inflammatory papules are present. They work to inhibit P. acnes and decrease inflammation. They are not comedolytic and would not be effective in treating comedonal acne. Isotretinoin is an oral retinoid used to treat severe nodulocystic acne with scarring or when other traditional therapies have failed.
Itching can persist for several weeks following treatment of scabies and does not constitute a treatment failure; persistent itching can be treated with?
Antihistamines, topical glucocorticoids, and, if severe, oral glucocorticoids.
is characterized by burning, itching, dryness, or a foreign body sensation; blepharitis, chalazia, and chronic eye infections can develop. Also, history of facial flushing and intermittent pustules on the nose and cheeks. The flushing is worse during times of stress and with exercise.
Ocular rosacea
a form of panniculitis, is often triggered by hormones, including oral contraceptives, hormone replacement therapy, and pregnancy, as well as certain infections and other inflammatory diseases
Erythema nodosum
An ABI less than 0.9 is indicative of peripheral artery disease. In patients with arterial insufficiency ulcers, as with this patient with ABI 0.7?
Surgical revascularization to improve the lower extremity circulation is often necessary to facilitate wound healing.
Presents with skin fragility and small, transient, easily ruptured vesicles in sun-exposed areas, mainly on the hands; these eventually rupture, forming erosions, dyspigmentation, and scarring.
Porphyria cutanea tarda
A suspicious melanocytic lesion in a pregnant patient should be?
biopsied promptly during pregnancy because dermatologic surgery under local anesthesia is safe during pregnancy; a diagnosis of melanoma should not be delayed.
Is the preferred initial treatment for pyoderma gangrenosum?
Prednisone
Severe allergic contact eruptions such as those from poison ivy may necessitate a
2- to 3-week taper of systemic glucocorticoids; because of the risk of rebound dermatitis, shorter courses are not recommended.
Treatment of tinea of non–hair-bearing skin includes
Topical antifungal agents such as imidazole, miconazole, clotrimazole, ketoconazole, ciclopirox, or terbinafine; topical nystatin is not effective, and oral ketoconazole should be avoided.
Is a systemic drug hypersensitivity reaction that presents with rash, prominent facial edema, lymphadenopathy, and fever 2 to 6 weeks after the initiation of the causative drug
Drug reaction with eosinophilia and systemic symptoms (DRESS)
Pruritus in the absence of skin findings should be evaluated for underlying systemic causes; many medications such as
hydrochlorothiazide, calcium channel blockers, opiates, or NSAIDs can also cause generalized pruritus without skin findings
Non-infiltrating basal cell carcinomas on low-risk areas such as the trunk and extremities are best treated with?
Electrodesiccation and curettage
is a chronic autoimmune disease that results in smooth, hairless patches of skin, most commonly appearing on the scalp?
Alopecia areata
Skin manifestations are present in 30% to 40% of patients and include generalized waxy appearance, ecchymoses with minor pressure (“pinch purpura”), ecchymoses around the eyes (“raccoon eyes”), yellow waxy papules and plaques especially in a periorbital location, dystrophic nails, and macroglossia
Amyloid light chain amyloidosis
Characterized by yellow papules with surrounding erythema, with a number of these patients also having a diagnosis of diabetes mellitus.
Eruptive xanthomas, are pathognomonic of hypertriglyceridemia
Are benign firm brown or reddish papules about the size of a pencil eraser that most commonly occur on the lower extremities; they “dimple” when lateral pressure is applied to the lesion with the thumb and first finger
Dermatofibromas
Acanthosis nigricans presents as skin thickening and darkening of the intertriginous areas, particularly the axillae and neck; it can be associated with
Insulin resistance or present as a paraneoplastic syndrome
