DERMATOLOGY Flashcards by Bao Truong

Multiple vesicular and vesicopustular lesions, some of which are crusted

What is this? Causal organism? Treatment?

Eczema herpeticum

HSV

Acyclovir

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Dry, plate-like (“fish-like”) scales over extensor surfaces of extremities

What is this? Finding on hand? Treatment?

Ichthyosis vulgaris

Hand finding = accentuated palmar and plantar markings

Treatment = moisturizing cream

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Multiple small, oval, scaling, pinkish papules over trunk, neck

What is this? Cause? Treatment?

Pityriasis rosea

Possible viral causes inflammation

Self-resolve

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Prepubertal girl with dysuria, serous vaginal discharge, sharply-dermacated intense erythema of the vulvar area.

What is going on? Causal organism

Vaginitis caused by Strep pyogenes (Group A strep)

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4-week-old girl with new crops of inflammatory vesicles and pustules distributed in a swirling pattern on trunk down to extremities.

What is going on? Cause?

Incontinentia pigmenti (1st phase)

An X-linked dominant genetic disorder

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What is characteristic finding on CBC in incontinentia pigmenti?

Eosinophilia

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Black newborn with multiple superificial pustule, also with slightly hyperpigmented, scaly macules. Pustular smea shows numerous neutrophils

What is going on? Treatment?

Transient neonatal pustular melanosis (TNPM)

Benign - self-resolve

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What are cutaneous side effects of topical steroid? (3)

1 - Atrophy
2 - Telangiectasia
3 - Hypopigmentation

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Antibiotics that can cause sunburn

Doxycycline

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Infant with sharply-dermacated cutaneous defect on scalp, not associated with delivery or monitor instruments

What is going on ? Cause? Treatment?

Aplasia cutis congenita

Failure of ectodermal fusion -> focal absence of epidermis / dermis

Conservative observation

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Multinucleated cells on Tzanck smear

What is going on?

Herpes infection

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Pruritic, multiple deep-seated inflamed vesicles on palms and lateral aspects of fingers

What is this condition? What is it most often associated with?

Dyshidrotic eczema

Associated with excessive sweating (hyperhidrosis)

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What is the most common sign of essential fatty acid deficiency

Eczematous dermatitis
(diffuse scaly rash on most skin surfaces)

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Multiple erythematous and inflamed follicular, papular, and pustular lesion on back and upper outer arms

What is the condition? Treatment for mild vs more severe?

Keratosis pilaris

Mild - treatment with moisturizing cream (lactic acid, urea, or glycolic acid)
More severe - low potency steroid

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Symmetric slightly edematous and erythematous papules symmetrically distributed on face, buttons, and extensor surface after viral infection

What is it?

Papular acrodermatitis

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What labs need to be taken in patient starting isotretinoin therapy?

1 - Pregnancy test (female)
2 - Serum triglycerides and cholesterol

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New reddish brown macules and papules that appear AFTER varicella starts crusting over.

What is going on ? Treatment?

PLEVA
(can associated with varicella - cause unknown)

treat with oral erythromycin (or tetracycline)

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What differentiates tinea pedis from juvenile plantar dermatosis?

Tinea pedis involves the webspaces (intertriginous area)

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Which condition is associated with alopecia areata?

Chronic autoimmune thyroiditis

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Which condition is associated with alopecia areata?

Chronic autoimmune thyroiditis

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Scaly papules and thick whitish plaques with crust-like scales in an immunocompromised patient

What is going on ? How to diagnose? Treatment?

Crusted scabies
Diagnosed by mineral oil exam of skin scrapings

Treatment = permethrin cream

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What is the most common cause of congenital heart block?
What is the associated skin finding?

Neonatal lupus erythematosus

sharply dermacated annular scaling plaques on cheeks and periocular areas

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What differentiate TEN from Stevens-Johnson (SJS)?

Epidermal detachment > 30% in TEN

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Slightly raised lesions with an umbilicated center?

What is it?

Molluscum contagiosum

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This rash is noted (prominent raised borders, appear to be made up of small papules and nodules) What are 2 possibilities ? How to tell them apart?

Granuloma annulare (smooth, non-scaly) vs. Tinea (scaly)

Ataxia, brain atrophy, recurring infections What is going on? What is another typical finding?

Ataxia telangiectasia Another typical finding is **ocular telangiectasia**

Prepubertal girl with atrophic, parchment-like skin around vuvla, with some subcutaneous hemorrhages extending into the perianal area What is the diagnosis? What is the treatment?

Lichen sclerosus Topical steroids

Multiple discrete, 2-8mm in diameter, "drop-like" papules with a pinkish hue; some are fine, scaly What is the diagnosis? What is associated with?

Guttate psoriasis Recent streptococcal infection

Painful ulcerative, tender papulopustule over lower extremities in a child with a chronic disease What is the diagnosis? What is it associated it?

Pyoderma gangrenosum

Significant mucositis (difficulty swallowing, chapped lips, oral mucosal erosions), markedly injected conjunctivae, few papulovesicles on skin What is the diagnosis? Treatment?

Mycoplasma pneumoniae-induced rash and mucositis (MIRM) Supportive care

Angiomyolipomas of kidneys and liver, seizures, cysts in hands What is the diagnosis?

Tuberous sclerosis

What is this ? What is it associated with ?

Ash-leaf spot Tuberous sclerosis (ash-leaf spot is the earliest skin finding)

What are these? What is it associated with? (3 main conditions)

Cafe-au-lait spots 1 - NF1 2 - McCune-Albright 3 - Fanconi anemia

How to distinguish cafe-au-lait spots from Becker nevus?

Becker nevus has hairs !!

What is this ? Treatment?

Becker nevus Benign. Might want cosmetic treatment

This develops 24-48 hours after hot tub What is it? Treatment?

Pseudomonas folliculitis Symptomatic treatment (lesions should resolve 1-2 weeks)

Recurring facial redness, with papulopustular component, often triggered by temperature changes, exercise, sun exposure or emotion. What is the diagnosis? What causes it? Treatment?

Rosacea Unknown cause Topical metronidazole (if there is a papulopustular component) Avoid triggers, avoid spicy food

Flaccid bullae that rupture and leave shallow, crusted erosions What is it? Cause ?

Bullous impetigo Staph aureus

KOH scrapping show hyphae and spores with a "spaghetti and meatballs" pattern. What is the skin lesion? Causal organism?

Tinea versicolor Malassezia species

Intensely pruritic, grouped papules and vesicles symmetrically distrbuted over extensor surfaces of knees and elbows. What are these? What is it associated with?

Dermatitis herpetiformis ("grouped" = "herpetiform") Celiac disease

Erythema nodosum, aphthous ulcer, and uveitis. What is the diagnosis?

Behcet disease

What is the work up for infantile acne that appears after 4 weeks of age

Evaluating for an androgen-producing condition (tumor or hyperplastic of adrenal gland) Consider measure 17-hydroxyprogesterone level

Recurring seizures, left hemispheric atrophy, leptomeningeal angioma What is the condition? What is the typical skin finding?

Sturge-Weber syndrome Cutaneous port-wine stain involving 1st or 2nd divisions of the trigeminal nerve

What is the condition usually associated with porphyria cutanea tarda?

Hepatitis C

Erythematous edematous papules symmetrically distributed over face, buttocks and extensor surfaces of extremities What is this? What is it associated with?

Papular acrodermatitis Associated with Hepatitis B

Dry, hacking cough, with noncaseating granuloma What is the diagnosis? What is a skin finding that indicates a good prognosis?

Sarcoidosis Erythema nodosum

What is the cause of erythema nodosum?

Inflammation of subcutaneous fat

3-week of asymptomatic narrow curvilinear collection of small hypopigmented, slightly scaly flattened papules What is this? Management?

Lichen striatus Reassurance (resolves over several months)

New intensely pruritic small papules and scaly patches from head-neck spread to trunk and extremities, a few days after diagnosed with tinea capitis What is going on? Treatment?

Dermatiophytid reaction Add topical steroid (do NOT stop antifungal treatment)

New intensely pruritic small papules and scaly patches from head-neck spread to trunk and extremities, a few days after diagnosed with tinea capitis What is going on? Treatment?

Dermatiophytid reaction Add topical steroid (do NOT stop antifungal treatment)

What are components of PHACE syndrome? (5)

1 - Posterior fossa abnormalities 2 - Hemangioma (segmental) 3 - Arterial anomalies 4 - Cardiac anomalies 5 - Eye anomalies

Transmission mode of head lice

"Head-to-head" contact with hair of infected individual

Erythematous, scaling patches where hair has broken away flush with scalp causing "black dot" appearance. What is this? Treatment?

**Tinea capitis** (aka ringworm of the scalp) Tx: **oral griseofulvin**

Large, very tender boggy nodule found on scalp of a patient with tinea capitis What is this called? Treatment?

Kerion (due to vigorous immune response to the dermatophyte) Tx: oral griseofulvin

How to differentiate SSSS vs TEN/SJS

TEN/SJS cause **full-thickness epidermal detachment** (sloughing) SSSS - cause **intraepidermal sloughing** as opposed to full-thickness

Target-like lesion on skin + erosion and crusting of oral mucosa What is it?

Stevens-Johnson syndrome (SJS)

Conjunctivitis, arthritis and urethritis. What is the condition? What is a penile skin finding?

**Reactive arthritis** Circinate (gyrate) balanitis - inflammed hyperkeratotic whitish plaques that spread centrifugally on glans penis

Inflammed hyperkeratotic whitish plaques that spread centrifugally on glans penis What is it? What is the underlying condition?

Circinate balanitis Reactive arthritis

Large patch of bluish-gray, speckled, and irregular coalescing macules over left forehead and left periorbital area since birth, but also noted on left buccal and nasal mucosa. What is this? What is a long term complication?

Nevus of Ota Long term complication = **glaucoma**

Smooth ("glazed") erythema and fine scaling of the toes and distal soles, sparing interdigital webs What is it?

Juvenile plantar dermatosis