Dermatology Flashcards
Acne treatment
( topical retinoid —> topical antibiotics—> oral antibiotics —> accutane)
Mild acne
1. Comedon —> topical retinoid
2. Papule/pustule —> topical retinoid + topical antimicrobial
Moderate acne
- papule/pustule —> oral antibiotic + topical retinoid ± BPO
- nodule —> oral antibiotics + topical retinoid + BPO
Severe acne
- nodule/ conglobate —> oral isoretinoin (accutane)
Rosacea
- middle aged women + flushed red face ( combination of sunburn & acne —> kind of malar rash)
- Associated with ocular problems
- Management: avoid sun exposure, alcohol, hot/spicy food
- Treat with:
- metronidazole
- azeliac acid
- ivermectin
Kerato-acanthoma
- low grade, rapidly growing, dome-shaped tumor with centralized keratinous plug
- management: reassurance of patient ( because it will self-resolve)
Seborrheic dermatitis
(associated with HIV/AIDS & Parkinson disease )
- affects scalp, skin, nasolabial folds, over eye brown, over hairline
- causes scaly patches + stubborn dandruff + red skin + scales/skin flaking
- associated with HIV/AIDS & Parkinson disease
- treatment: selenium sulfide shampoo or easels (?)
Contact dermatitis
- Type 4 hypersensitivity reaction ( activation of memory T cells)
- Caused by:
1. Poison Ivy
2. Latex allergy
3. Neck contact with certain metals
Symptoms:
- very itchy + can blister
Treatment:
- topical steroid
Pityriasis Rosea
- starts as herald patch
- later creates bunch of macule that are arranged in a Christmas tree pattern
- not contagious
- self resolve after 1-3 months
- treated with: anti-histamine
Erythema Multiforme (EM)
- type 4 hypersensitivity reaction
Present as:
- messy looking target lesion ( more radish than erythema migran)
Caused by :
- Allergic reaction to medication, infection, malignancy, connective tissue
- sulfa drugs (penicillin & NSAIDS) or HSV ( painful genital ulcer)
Group of mucocutanous disease spectrum
( Go from mild to more severe)
- Erythema multiforme (EM)
- common in hand/forearm
- target lesion
- oral lesion
- lesion < 10% - Steven Johnson syndrome (SJS)
- most common in children
- URI-like symptoms
- most due to drug reaction
- > 2 mucosal sites
- admit to burn center
- lesion is < 10% - Toxic Epidermal Necrolysis (TEN)
- most common in elderly
- high risk in HIV
- abrupt onset
- positive Nikolsky sign
- mucous membrane involvement
- admit to burn center
- lesion is > 30%
Steven Johnson syndrome (SJS)
Caused by drug reaction to —> APPLE PCS
- Allopurinol ( gout)
- Phenytoin ( seizure)
- Phenobarbital ( seizure, sedation)
- Lamotrigine ( seizure)
- Ethosuximide (absence seizure)
- Penicillin ( syphilis)
- Carbamazepine ( trigeminal neuralgia)
- Sulfas
Note:
- if the lesion is > 30% than admit as (TEN)
pemphigus Vulgaris —> autoimmune disease
(Common types)
- young patient (40-60 years)
- mucus membrane involvement
- antibodies against desmoglein 3
- blister location at superficial intraepidermal
- flaccid, rupture easily blisters
- positive nikolsky sign
- poor prognosis
Treat with: steroid
Bullous pemphigoid
- older patient (> 60)
- rare mucus membrane involvement
- antibodies agains hemi-desmosomes
- blister location deep suepidermal
- tense & firm blister
- negative nikolsky sign
- good prognosis
Treat with:
1. Topical High- potency corticosteroid
2. Systemic: corticosteroid, doxycycline
Zoster vaccine
- given at 60 years to prevent Herpes Zoster (HZV = HHV3)
—> shingles:
1. Burning vesicles appears along one dermatome along the rib (most common V1, V2, V3)
2. Complication: post-herpetic neuralgia (PHN)
Positive nikolsky skin
1.People with a positive sign have loose skin that slips free from the underlying layers when rubbed
- Seen with TEN & pemphigus Vulgaris
Dermatophytes ( superficial fungal infection)
( peripheral scaling & central clearing )
- dermatophytosis or tinea, refers to a group of fungal infections that can affect the skin, hair, and nails.
- Ringworm/tinea lesion —> rough/scaly with central clearing
Types:
- Tinea Capitis ( scalp ringworm)
- Treat with: oral Griseofulvin (antifungal) - Tinea Corporis (trunk ringworm)
- treat with: PHENYLEPHRINE (topical witch Hazel) - Tinea cruris ( Jock itch, genital region)
- treat with: PHENYLEPHRINE
- treat with: anti-fungal drugs (clotrimazole)
- confirmed with: potassium hydroxide preparation of skin scraping
- - Tinea pedis ( athlete foot )
- treat with: PHENYLEPHRINE (topical witch Hazel)
-steroid cream to use alongside antifungal cream
Scabies
- infestation of the skin by the human itch mite ( check finger web area)
Symptoms:
- intense itching and a pimple-like skin rash ( very itchy at night)
Treatment:
1. Topical Permethrin
Actinic keratosis
- rough, scaly patch on the skin that develops from years of sun exposure
- example:
1. Elderly person who worked under the sun for their whole life —> developed rough/scaly patch on head or arm
Treatment:
1. Topical 5-fluorouracil
Note:
1. Need to biopsy sample —> has increased risk for malignant transformation to squamous cell carcinoma
Basal cell carcinoma (BCC) vs. squamous cell carcinoma ( SCC)
BCC:
1. Dome-shape Pearly telangiectasia & shiny & dilated blood vessels
Marjollin ulcer (MU)
- malignant tumor that arise in the setting of chronic wound, longstanding scar, injured skin
- also seen with diabetic ulcer that has not healed ( heal than reopen) -> can progress to SCC
- increase in size + foul smelling + x-ray shows chronic osteomyelitis (indicates malignant transformation; squamous cell sarcoma)
- Diagnosis: biopsy
Anaphylaxis
- due to food allergy or bee sting
- wheezing, difficulty breathing, hives appearing all over the body, hypotensive
- treatment: epinephrine (IM)
Psoriasis
( areas exposed to friction)
- chronic, erythematous plaques with white or silver scales ( not itchy, not painful)
- located on extensor surface ( knee, elbow)
- treatment:
1. Topical High-potency glucocorticoids
2. Vitamin D derivative ( calcipotriene)
3. Severe cases -> require phototherapy or systemic treatment
Pseudofolliculitis barbae
(Painful papule in the beard area)
- small, painful papule in the beard area
- management: discontinue shaving
Skin condition & associated diseases
- Acanthosis Nigricans
- insulin resistance
- GI malignancy - Multiple skin tags:
- insulin resistance
- pregnancy
- crohn disease - Porphyria cutanea tarda + cutaneous leukocytoclastic vasculitis ( palpable purpura) secondary to cryglobulinemia
- hepatitis C - Dermatitis herpetiforms:
- celiac disease
- itchy papule/vesicles in the elbow, knee, back & buttock
- treat with: dapsone & gluten-free diet - Sudden-onset severe psoriasis + recurrent herpes zoster + DIC
- HIV infection - severe seborreheic dermatitis:
- HIV infection
- Parkinson disease
- Explosive onset multiple, itchy seborrheic keratosis:
- GI malignancy - Pyoderma gangrenosum:
- IBD ( UC, CD)
- large, painful sores (ulcers) to develop on your skin, most often on your legs.
Nummular eczema
- idiopathic inflammatory disorder
- round, itchy, scaly plaque
- located on extremity
- treat with: topical glucocorticoids
Urticaria
(Case 1)
Medication
1. Injection ( 3 doses)—> wait 2 hours observation —> every 4 weeks
2. Oral medication —> anti-histamine drugs
- Itchy raised wheels, hives
- Not associated with angioedema
- anti- IgE medication ( types 1allergy disorder)
Symptoms
1. history of previous urticaria
2. pruritus
3. lasts a few hours
4. resolves spontaneously
Physical exam
well-circumscribed erythema and edema on skin
blanching, raised, and palpable wheals
linear
annular
serpiginous
can coalesce
can occur anywhere on the body
dermotographism (urticaria from light scratching)
indicates very sensitive skin
assess for angioedema of lips
assess for mucosal lesions
may have neutrophilic vasculitis
painful as well as pruritic
purpuric and hyperpigmented lesions
systemic systoms such as arthralgias and GI symptoms
H
Psoriasis vulgaris or drug-induced psoriasis (beta-blockers, lithium, antimalarial drugs, and ACE inhibitors)
(Case 2)
- Jak inhibitor
- Imifliximab —> for 12 weeks —> leison still appearing
- Scaly scalp lesion, hand/feet contain pastural lesion
- Fixed drug reaction ???
beta-blockers, lithium, antimalarial drugs, and ACE inhibitors.
Mf (Mungus fungoisi)
Allergic contact dermatitis vs. urticaria (hives)
Allergic contact dermatitis
- delayed type 4 (IgE-mediated)
vs. urticaria (hives)
- type 1 (release histamine from mast cell)—> pruritus
Vulgaris (not induced by anything)
Epidermolysis bullosa (EB)
- inherited disorder —> mutation in adhesion molecule of basement membrane
- lead to epithelial fragility (bullae, erosion, ulcer)
- types: simplex, junctional, dystrophic, kindler syndrome
—> EB Simplex: mutation in keratin gene —> in children & young adult with friction-induced blister at palm & soles
Chronic urticaria
(Case 3)
- body’s immune system attack its own
- daily itchy whealing of the skin for more than 6 weeks
- affect children or adults
- chronic inducible urticaria is more common than chronic spontaneous urticaria
- adult have high association with: atopic dermatitis, asthma, allergic rhintis
chronic spontaneous urticaria
1. ( functional igG autoantibodies to IgE)
2. Associated with H.pylori & bowel parasites, SLE, Thyroid disease, celiac disease.
3. Wheals is aggravated by: heat, viral infection, tight clothing, drugs psuedoallergy, food peudoallergy
Treatment:
1. Taken for
Urticaria vs. urticaria vasculitis
—> urticaria that lasts for 72 hours is urticaria vasculitis
Molluscum contagisum (MC)
- benign poxvirus infection spread via skin to skin contact (sexual activity or contact sport)
- small, firm, skin colored papule with intended center ( amorphous yellow center can be viewed with dermatoscopy)
- pruritus & inflammation can present or not
- patient with widespread or persistent lesion should undergo HIV testing
- treatment:
1. cryotherapy with liquid nitrogen
2. curettage
3. topical therapies (cantharidin)
Genna and gold treatment for asthma
Echo
Drug-induced hypersensitivity type 1
- immediate onset
- developed IgE on mast cell/ basophils towards offending drug, once encountered again
- symptoms:
1. Mild: urticaria, itchy, flushing
2. Severe: angioedema of the larynx, anaphylaxis
Treatment:
1. For urticaria & itchiness —> anti-histamine
Female & male pattern of hair loss
- chronic & progressive hair loss
1. Male: vertex, frontal hairline, temporal area
2. Female: vertex, center of scalp (sparing hair line)
Treatment:
1. Male: topical minoxidil, finasteride
2. Female: topical minoxidil
Onychomycosis
( caused by Trichophyton rubrum infection)
- chronic dermatophyte infection of the nail
Risk factor:
1. Advanced age
2. Tinea pedis
3. Diabetes
4. Peripheral vascular disease
Examination:
1. Thick, brittle, discolored nails
Diagnosis:
1. KOH
2. Periodic acid-Schiff stain
3. Culture
Treatment:
1st line: Terbinafine, itraconazole
2nd line: Griseofulvin, fluconazole, ciclopirox
Drug-induced acne
- acne can be caused as side effect from:
1. Glucocorticoid
2.
Characterized by:
1. Monomorphic papule without associated comedone/ cyst/nodule
Drug-induced acne —> does not respond to typical acne treatment, but respond rapidly on discontinuation of offending agent
Seborrheic keratosis
- well-demarcated, hyper-pigmented lesion with stuck-on appearance
- aged or elderly individual
Acrochordon
- skin tags
Doxycycline
- induces phototoxicity
—> making eyes or skin so sensitive to sun light
—> exaggerated sunburn reaction with erythema, edema, & vesicle in sun-exposed area
severe burn complicated by wound infection & sepsis
- severe burn complicated by wound infection & sepsis
Most common infection:
1. Staph aureus ( immediately after injury)
2. Pseudomonas (5 days after injury)
3. Candida ( 5 days after injury)
Symptoms:
1. Temperature < 36.5 Or > 39
2. Progressive tachycardia (> 90)
3. Progressive tachypnea (> 30)
4. Refractory hypotension (SBP <90)
Signs for wound infection in a burn:
- change in burn wound appearance or loss of skin graft
Porphyria cutanea tarda
- most common porpharya disorder
- deficiency in uroporphyrinogen decarboxylase
- can be triggered by:
1. Alcohol
2. Estrogen (OCP) - associated with hepatitis C
- CLINICAL:
1. photosensitivity with blisters & skin fragility
2. Blisters, scarring, hypo/hyperpigmented on sun exposed area
3. Scaring & calcification similar to scleroderma
Pressure ulcer
Stage 1 —> nonblanchable with localized redness
Prevention:
1. Proper patient position for pressure redistribution
2. Mobilization
3. Careful skin care
4. Moisture control
5. Maintenance of nutrition
Mixed Cryoglubinemia
- associated with chronic Hepatitis C virus
- Palpable purpura
- Glumerulonephritis
- Low complement level
Bullous pemphigoid
- autoimmune disease
- autoantibodies against basement membrane ( homodesmosene)
- in elderly ( > 60)
- supepidermal
- begin as: pruritic papule
- large, tense blister/ babullae
- nikolsky negative
Pemphigoid vulgaris
- younger ( 40-60)
- involves mucous membrane
- flaccid blister
- nikolsky positive
Dermatophytes ( onchymycosis )
Erythema between toe webs, scales, eczematous, pain, thickening & discoloration of toe nail
- skin swab ( for ( fungus culture)
- skin scraping ( sent for KOH to check presence of fungus)
Whipple disease
Symptoms:
1. fever + Diarrhea + weigh loss + arthritis + lymphadenopathy
Caused by:
- gram positive bacillus ( tropheryma whippellii)
Diagnosis :
1. Small intestinal biopsy: periodic acid-schiff (PAS) positive macrophage
Diabetes notes
- impaired fasting glucose = from 100-126
- fasting blood glucose ( 8 hours)—> below 126 in normal, above 126 in abnormal
- two fasting below 126 —>
- < 5.6 % is normal level of Ha1c & > 6.5 is diabetes & 5.7-6.4 is prediabete
- random blood glucose > 200 + symptoms ( polyuria + polydepsia + weight loss)
- challenging test==> expose body to high amount glucose in short time —> ( 75 g glucose, after 1 hour = 140 , after 2 hours not exceed 200)
- candidas infection is clinical sign of diabetes
- DPP-4 enzyme in intestine BREAK DOWN GLP-1 = cells in intestine produce GLP-1
- (-GLIBTIN) —> DDP-4
- (GLP-1) —(-TIDE)
- (SGLT-2) prevents mortality due to CVD
- glucose in urine —> by dipstick (180) ( renal threshold, after 180 of glucose the kidney excrete)
- incretin- based therapy is helpful with obesity and uncontrolled glucose
HBA1c Management:
- 2% reduction with lifestyle modification
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