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