Dermatology Flashcards
Psoriasis
Chronic inflammatory pruritic skin disorder characterized by rapid proliferation of epidermal cells
* Patients may have frequent exacerbations or remissions
May have significant impact on social behavior and self-esteem
Psoriasis Signs and symptoms
Hallmark signs:
*Plaque-type lesions, with silvery white scales on erythematous base
*May distribute on scalp, elbows, palms, soles, fingernails, nail pitting
*Auspitz Sign: pinpoint bleeding under the skin’s surface
*Gluteal pinking: where the gluteal folds are pink and smooth
Psoriasis treatment
Treatment
Topical steroids with plastic occlusion
* *Start with lowest dose possible
o *Especially on face and sensitive skin areas
* May cause thinning of the skin
* May get rebound after steroids are withdrawn
Psoriasis Education:
Education:
o striae can develop with overuse
o only use low doses on the face
* F/U in 2 weeks
UV light
- Cellulitis signs, symptoms,
S/S: swelling, warmth, tenderness of site; fever/chills/malaise
- Acne Vulgaris
Inflammation and infection of the pilosebaceous units
* Causes: genetic, hormonal changes, bacterial infections, PCOS
* Most common during puberty
* Girls > boys, however, boys are worse when it does occur
* Locations: commonly seen on the face, shoulders, chest and back
Mild Acne Vulgaris treatment plan
-generally treated with topical only
1st line: Topical retinoid and antimicrobial (mycins) combo
* Ex-adapalene, alitretinoin, tazarotene, tretinoin
* Pharm: retinoids accelerate the turnover of keratin plugs and decrease comedome formation
* Start at the lowest dose
* *Side effects: redness, drying, scaling of the skin, photosensitivity especially in the first 2-4 weeks (acne may seem to worsen at first) after about 6 weeks the acne will improve
o F/u in 8 weeks after initiation of treatment
o If no improvement, consider adding:
Benzyl peroxide and antimicrobial(mycins)
- Moderate Acne treatment
Presence of papules and pustules (infected comedomes)
Treatment
* Continue with prescription topicals (retinol/benzyl/antimicrobial-mycins)
* *Now add oral abx (TCN) ”-clines” for up to 6 months
o *Do NOT given < age 13 y/o (d/t teeth discoloration)
o *Do NOT give to anyone pregnant or breastfeeding
o Can get photosensitivity
o Take with a full glass of water d/t esophageal ulceration/irritation
o IF allergies to TCN, give macrolide for 3 months
-“mycins”
- Severe nodulocystic acne
Painful indurated nodules (cysts, abscess, nodules)
*Consider referral to derm
Treatment:
* Accutane (Category X)
o *Can only be prescribed by providers with special cert (iPledge program)
o PT must be on 2 forms of contraception
o *Pregnancy test must be performed before and after treatment
o *Can only be prescribed 1 month at a time
o *Requires monthly pregnancy tests (PhD must see results)
o Side effects: abd pain(pancreatitis/hepatitis), depression
o *Good documentation is a MUST
Lyme Disease
A multisystemic disease transmitted by a specific tick
lyme disease signs, symptoms,
S/S: flu-like, weakness, joint pain, unique rash (erythema migrans/’bullseye”)*
* Rash/lesion may come within 7-14 days, but may last 3-30 days after bite
* Lesion will usually spontaneously resolve
* Common areas: belt line, axilla, behind knees, groin
* Common in the NE of the US
*
lyme disease diagnosis
Diagnostics
* 1st: Elisa test (blood or CSF)
If Elisa is negative, no other tests needed
If Elisa is positive, or indeterminate, move onto Western Blot
* 2nd: Western Blot
Looking for IgG or IgM antibodies
lyme disease treatment plan
- Treatment
- For prophylaxis -initiate within 72 hours of tick removal
Single dose: Doxy 200mg - For positive tests or noted bullseye lesion
Doxy-14-21 days
Do NOT give during pregnancy or breastfeeding - If pregnant, will need IV abx
- Also educate that OCP are less effective while on Doxy
DO NOT use in children < 7 years old - Use amoxicillin instead
- F/U depends on stage and severity
Seborrheic Dermatitis
- Chronic superficial disorder that affects the hairy areas of the body where sebaceous glands are present (caused by genetics and/or environment)
*
Seborrheic Dermatitis signs, symptoms,
Scalp, face, eyebrows
* Ex: Cradle cap (in babies)
Fine, white, yellow greasy scales on erythematous base
Usually resolves by 8-12 months
* In Adults : yellow greasy scale on face, nasolabial folds, scalp, ear canals
Usually symmetrical and itchy
Seborrheic Dermatitis treatment plan
Treatment
Sunlight
Shampoo frequently
Warm olive oil in the evening and letting it sit overnight
RX shampoos
Hydrocortisone (be cautious)
* Education:
o striae can develop with overuse
o only use low doses on the face
Atopic Dermatitis
Eczema
Chronic inherited skin disorder marked by extremely pruritic rashes
* Found on hands, Flex folds, neck
* Exacerbated by stress and environmental (seasons/winter), allergies/asthma/allergic rhinitis
* Itching can cause scaling and lichenification (thick, leathery skin)
Atopic Dermatitis signs, symptoms,
Presentation
* Can reappear in adulthood after occurrence during childhood
* pruritis, erythema, dry skin, erythema on infraorbital folds, antecubital fossa, posterior patella, scalp
* on infants lesions are erythematous and papular, vesicles may ooze
can be on cheeks
lichenification
Atopic Dermatitis treatment plan
Treatment
* Topical steroids (hydrocortisone) and emollients
Eucerin, baby Oil, antihistamine for itching
RX-Vistaril/hydroxyzine for itching
Contraindicated in patients with infected lesions or rosacea
* Avoid using harsh soaps or chemicals
* Use cold water when bathing
* Use education when using topical cortisones
* Education:
striae can develop with overuse
only use low doses on the face
Melanoma
Malignancies arising from melanocytes (pigment-producing cells)
* Usually diagnosed in the early 40’s
* Risk factors: UV exposure
*
Melanoma signs, symptoms,
*Major: Change in size, change in color, change in shape
* *Minor: presence of inflammation, bleeding, sensation, diameter > 6mm
* Prevention: avoid sun exposure; use sunscreen
* Remember ABCDE
ABCDE
common characteristics of melanoma: think alphabetically – the ABCDEs of melanoma.
asymmetry,
border,
color,
diameter
evolving
Shingles treatment
- Virus from Herpes Zoster
- Treatment
- Early treatment can limit the post-herpetic neuralgia
Begin treatment 48-72 hours after onset of pain/breakout - Antiviral
Acyclovir (5x day), valcyclovir (2 x day, but $$$$) - TCA (for post-herpetic neur.)
Amytriptaline - Anticonvulsants (for post-herpetic neur.)
Gabapentin - Lidocaine patch
- *Immediate referral for lesions near the eye
- Shingles signs, symptoms,
Papules or vesicles on a red base that rupture and become crusted
* *Along a dermatome/unilateral (Dermatomes are areas of skin on your body that rely on specific nerve connections on your spine. In this way, dermatomes are much like a map.)
* More common in elderly, especially immunocompromised
* *Prodromal pain, or pain with lesions
* Can last 2-4 weeks or longer
* Post-herpetic neuralgia can last for months or longer
Shingles treatment plan
- Treatment
- Early treatment can limit the post-herpetic neuralgia
Begin treatment 48-72 hours after onset of pain/breakout - Antiviral
Acyclovir (5x day), valcyclovir (2 x day, but $$$$) - TCA (for post-herpetic neur.)
Amytriptaline - Anticonvulsants (for post-herpetic neur.)
Gabapentin
Lidocaine patch - *Immediate referral for lesions near the eye
*
Dermatomes
Dermatomes are areas of skin on your body that rely on specific nerve connections on your spine. In this way, dermatomes are much like a map. The nature of that connection means that dermatomes can help a healthcare provider detect and diagnose conditions or problems affecting your spine, spinal cord or spinal nerves.
shingles vaccine
Vaccine for > age 50 y/o
* Even if they have had shingles
* *Efficacy wanes after 5 years
* *Repeat if the vaccine was received before age 60, or if it has been > 10 years
Rosacea
Chronic and relapsing inflammatory skin disorder
* More common in people who are lighter color (Irish, Scottish, English…)
* Also more common in blond or red hair people
* 4 subtypes
Rosacea signs, symptoms,
Hallmark signs:
* light skinned adult c/o red cheeks
* small papules around mouth, nose, chin
* telangiectasia on cheeks
* pt blushes easily
* c/o dry eyes or chronic blepharitis (ocular rosacea)
Rosacea treatment plan
Treatment
* Aimed at symptom control and avoidance of triggers that cause exacerbations
Spicy foods, alcohol, sunlight
Avoid irritating skin products
Apply moisture frequently
* Topical gels
Metronidazole
* Oral TCN over several weeks
* Patient education if using topical steroids
striae can develop with overuse
only use low doses on the face
- Mongolian Spots signs, symptoms, treatment plan
*
The most common type of pigmented skin lesion in newborns
* Blue to black colored patches
* Usually located in the lumbosacral area, but can be anywhere
* More common in darker-skinned babies
* Usually, fade by 2-3 years
* No need to be concerned
Hemangiomas signs, symptoms
“strawberry”
* Raised vascular lesion
* Can be between <0.5cm-4 cm
* Red color, soft to palpation
* Usually on head and neck
* Grow in the first 12 months of life
*
Hemangiomas treatment plan
Treatment
* Watchful waiting
* Can be referred to derm
PDL therapy (pulse, dye, laser)
* Reassurance
- Café Au Lait Spots signs, symptoms, treatment plan
*
Flat light or dark brown spots that are > 5mm
* Risk factors are unknown (may be genetic)
* *If 6 or more spots are > 5mm, r/o neuro causes
* May see sz or learning disorders
* Neurofibromatosis
- Herpes Simplex Virus Type 1
“cold sores”
* Blisters mostly on the face, lips, eyes
* Usually have prodromal pain, burning, tingling before lesion erupts
* Treatment
Antivirals: Acyclovir, valacyclovir during the prodromal phase
- Herpes simplex virus type 2
- “genital warts” or oral
- Painful lesions that are recurrent
- Viral shedding is greatest on the initial outbreak, then lessens with each additional outbreak
- Prevention
Condoms may help - Best to treat during prodromal phase
- Treatment
Antiviral: acyclovir, valacyclovir
HPV
May exist without signs
* Can be asymptomatic for many years
* Increases incidence of cervical cancer,
* And Laryngeal or esophageal cancers
* Risk factors: multiple sexual partners, prior STD, circumcised, men with men
HPV Warts treatment plan
Treatment destroys wart tissue (~45-90% will clear but can return)
* Aldera (Imiquimod) cream
* Podophyllin cream
* May also try laser treatment for external warts
* For cervical warts, refer for biopsy before treatment
* During pregnancy/lactation, warts will grow rapidly, then will regress
* Cryotherapy can be used or TCA; other creams are contraindicated
* F/u in 1-2 weeks
* Screen for other STDs
* Gardisil vaccine is important prior to age of sexual activity
most important for exzema
Implement a daily bathing and moisturizing routine; skin hydration is imperative
emollients after bathing
Emollients
Emollients are ingredients in skin creams, lotions, moisturizers or ointments that form a film on your skin. These ingredients can relieve dryness, itching and scaling. Emollients can help your skin feel more comfortable if you have eczema, psoriasis, dry or sensitive skin.
when is shingles not infectious?
after lesions have crusted over
Retinoids
Retinoids are a class of medications that are chemically derived from vitamin A
demarcated
set the boundaries or limits of.
Basal Cell Carcinoma
Tumors that arise from the basal cell layer of the skin
* Most common in 40-60 y/o
* *Sites: head and neck (80%)
* Men>women
Basal Cell Carcinoma Presentation
- Presentation
Pearly dome nodule with telegenetic vessels
Squamous Cell Carcinoma
Tumors arising from the epidermis
* Sites: face, nose, lower lip (smokers)
* Indistinct borders, firm surface, scaly, irregular, bleed easily
Red, tan, brown, grey
* Metastasis in 10%
difference between squamous cell and basal cell
Basal cell carcinoma most commonly appears as a pearly white, dome-shaped papule with prominent telangiectatic surface vessels. Squamous cell carcinoma most commonly appears as a firm, smooth, or hyperkeratotic papule or plaque, often with central ulceration.
