Dermatology Flashcards
What are risk factors for skin cancer?
> 50 y.o
male
fair/freckles/ ruddy complexion with light colored hair or eyes
sunburns easy
exposure to arsenic/coal tar and petroleum
repeated trauma or irritation to skin
overexposure to frost/wind/UV light/radium/x-rays
living near the equator or high altitude, family history of skin cancer
precancerous dermatoses such as actinic keratosis
dysplastic nevus
“Slapped cheek” red rash on face
s/s fever, runny nose, H/A rash
transmitted via respiratory secretions
What condition is described here?
Fifth’s disease
During adolescense is acne more common in Males or females?
During adolescence acne vulgaris is more common in males
During adulthood acne is more common in women or men
During adulthood acne is more common in women
When an adolescent comes to your clinic and asks about pathophysiology of acne, how would you explain?
There are different factors playing a role in acne vulgaris
Genetics play a key factor
There are also 4 different factors such as release of inflammatory markers into skin, follicular hyperkeratinization with subsequent plugging of the follicle, follicular colonization with Propionibacterium acnes, and excess sebum production
What is your first line therapy for all patients with acne ?
Topical retinoid and antimicrobial cotherapy
What is your key education with isotretinoin (Accutane) in teenagers
We as providers should use caution in teenagers suspected of depression and SI- suicidal ideation
we nee to make sure to always teach them to monitor their mood
What is another key education for Isotretinoin as far as pregnancy concern?
Isotretinoin is teratogenic and is category X
No indication to use during pregnancy
Pt must take pregnancy tests monthly
What are some side effects of isotretinoin (Accutane)
Dry lips (cheilitis)
hypertriglyceridemia
elevated hepatic enzymes
What are your treatment (pharmacological and non-pharmacological) options for mild acne?
clean skin regularly
avoid oil-based make up
benzoyl peroxide or combinations with erythromycin or clindamycin as monotherapy
What is the treatment option for moderate-severe acne?
Benzoyl peroxide with a topical retinoid or systemic antibiotic therapy, BCPs, Accutane (isotretinoin) for severe
Pt comes to your clinic and says the acne meds not helping. He has been taking them for 2 weeks now
What is your answer will be?
Meds take 4-8 weeks to work sometimes longer so patience is needed.
Cystic nodules is associated with what. stage of acne?
Stage 3 also has significant inflammation, severe papules/pustules, cystic nodules present, high risk for scarring and post-inflammatory hyperpigmentation
If a child younger than 4 and comes to your clinic with pruritis and eczematous changes , what question will you make sure to ask while taking a thorough history?
Personal history of asthma or hay fever
or a history of atopic diseases in 1st-degree relatives?
If mom brings an infant with atopic dermatitis (eczema)
where will you see the rash?
Infantile atopic dermatitis common on face
Where would you expect to see rash in atopic dermatitis(eczema) in children up to 2 years?
Onset from birth and up to 2 years, pruritis, erythema and scaling of cheeks, sparing of perioral, perinasal areas, diper area( moist area) ,may involve flexors and extensors
Where will provider expect to find pruritus ( the itch that rashes) and erythema in children and adults, what areas?
commonly found on flexor surfaces
not face like infants
pruritus and erythema scale Lichenification, antecubital and popleteal fossae, neck, eyelids, postauricular, wrists, may become generalized
Atopic dermatitis is far more prevalent in children or adults?
It is much more prevalent in children and remember it is an itch that rashes
What will be your treatment for someone with atopic dermatitiis?
Moisturizers/lubricants… very important …. petrolatum, aquafor, atopiclair, mimyx
Topical steroids—- hydrocortisone, triamcinolone, betamethasone
Immonomodulators—- tacrolimus, pimecrolimus omalizuman,
Probiotics, orla antihistamine
Cool wet dressings—-DO NOT APPLY HEAT PADS
Maintain cool room temperatures at night
You need to educate your patient on eczema triggers…. What are they?
Dry skin—- so moisturize skin with petrolatum, aquaphor, atopiclair, mimix
Irritants
Stress—- is a big one
Heat/ SWEATING—- no hot tubs
Infections— stay away from bugs and those who carry them
Allergens—- think of asthma and asthma irritants
What age group is impetigo common?
2-5 years old
Is impetigo bacterial or viral infection?
It is bacterial
What causes impetigo, what organisms and where is mostly seen?
Staphylococcus aureus
A streptococci
or mix of both
any body site but more likely in the diaper area
There are two types of impetigo……
nonbullous and bullous think of where you will see them
nonbullous impetigo—- honey- colored crusts on the face and extremities
bullous impetigo— large flaccid bullae more likely in intetriginous areas
Treatment for nonbullous impetigo which is 70% of cases
topical antimicrobial—mupirocin (Bactroban)
Treatment for bullous impetigo which 30 % cases
oral antimicrobials such as augmentin,,,, keflex( cephalexin), clindamycin, doxycycline
What is the most common bacterial infection in children?
Impetigo
If you given a picture with impetigo around umbilicus what would be your treatment plan?
Systemic appropriate abx: such as augmentin, keflex, doxycycline, clindamycin
How long does it take for impetigo to resolve?
1-2 weeks without scarring or sequelae
Pt comes with folliculitis after being in several days ago in jacuzzi with his friends.
He is asking you to rx abx, what is your teaching?
Folliculitis is caused by pseudomonas aeruginosa and usually settles by itself within a few days
A patient comes to your clinic that has recently travelled to tropical country and comes with tracks of red itchy lesions or thread like lesions, says they growing each day
When you assess this patient where do expect to see these lesions and what is your diagnosis with differentials?
I expect to find the thread-like red itchy lesions on a patient’s hands, feet, upper thighs, buttocks
This diagnosis is cutaneous larvae migrans—— so the hookwarm the creeping eruption is causing the tracks of itchy red marks
Differentials—– tinea, urticaria, scabies.
What is your treatment for cutaneous larvae migrnas?
Ivermectin antihelmintics , abendazole po, thiabendazole suspension topically
Is lichen planus infectious skin condition ?
No, it is chronic, inflammatory cutaneous and mucous membrane reaction unknown etiology
What are some differentials with pt coming with flat topped polyangular purple papules, reticulated whitish lines (lacey)
drug eruption
psoriasis
thrush
leukoplakia
cancer
Hep C
What is your treatment plan for lichen planus.
steroids—- orabase
aristacort
antihistamine for itching
cancer treatment
How can you rememember lichen planus lesions?
In Planus p stands for purple papules
How can you prevent herpes zoster?
Protection
condoms
avoid triggers sun and stress
shingrix vaccine 50+ get vaccine regardless you have chickenpox or not
How soon should you start treatment for herpes zoster (shingles)?
initiate treatment within 72 hours with acyclovir (zovirax), valcyclovir (valtrex) po, topical therapy creams abreva and denavir ….. make sure you provide adequate analgesia with lidocaine gel
nonpharm—– keep them clean and dry
