Dermatology 💆🏽 Flashcards
immunomodulating medications (particularly TNF-α inhibitors) may ↑ the
risk for developing ? cancer
Lymphoma
What can be used to help
distinguish chronic eczema from tinea.
Potassium hydroxide (KOH) prep
Dx of atopic dermatitis
Characteristic exam findings and history are sufficient
What is erythema toxicum neonatorum? How to Mx
- 1 to 3 days after delivery
- presents with red papules, pustules, and/or vesicles with surrounding erythematous halos
- ↑ eosinophils are present in the pustules or vesicles.
- Resolves in 1 to 2 weeks with no treatment.
1st line for atopic derm flare
Topical corticosteroids
Best Tx for pruritus (night and day)
H1 blockers. A first-generation H1
-blocker (eg,hydroxyzine) would be appropriate for nighttime use.
Topical calcineurin inhibitors are used in what incidence inn atopic derm
useful as steroid-sparing agents for moderate to severe eczema for patients >2 years of age. A second line
Neomycin has a history of causing what kind of skin reaction?
contact dermatitis
Dx of contact dermatitis
exam and history are sufficient. Patch testing can be used to establish the causative allergen after the acute-phase
eruption has been treated.
Tx of contact dermatitis
topical corticosteroids and allergen avoidance. In severe cases = systemic corticosteroid
are patch test affected by steroid or by antihistamines
steroids only!
Tx of Seborrheic Dermatitis
adults = ketoconazole, selenium sulfide, or zinc pyrithione shampoos for the scalp
and topical antifungals (ketoconazole cream) and/or topical corticosteroids for other areas.
Cradle cap often resolves with routine bathing and application of emollients in infants.
meds that can worsen psoriasis
β-blockers,
lithium, and ACEi’s
dx of psoriasis?
exam findings and history are sufficient. Biopsy if uncertain
Local psoriasis Mx
topical steroids, calcipotriene (vitamin D derivative), and retinoids such as tazarotene or acitretin (vitamin A derivative).
Severe psoriasis/psoriatic arthritis Mx
Methotrexate or anti–tumor necrosis
factor (TNF) biologics (etanercept, infliximab, adalimumab). Other agents such as ustekinumab (anti-interleukin [IL]-12/23), secukinumab (anti-IL17), and ultraviolet (UV)
light therapy can be used for extensive skin involvement, except in immunosuppressed
patients who can develop skin cancer from UV light.
Dx for urticaria
Exam and history are sufficient. Positive dermographism may help. If in doubt, drawing a serum tryptase can help clinch the diagnosis.
Urticaria Tx
Treat urticaria with systemic antihistamines. Anaphylaxis (rare) requires intramuscular
epinephrine, antihistamines, IV fluids, and airway support
If a patient reacts within 1 to 2 days of starting a new drug, is it likely the drug causing it?
it is probably not the causative agent.
Mx of drug induced rash (generally)
Discontinue the offending agent; treat symptoms with antihistamines and topical steroids to relieve pruritus. In severe cases, systemic steroids and/or IV immunoglobulin (IVIG) may be used.
most common cause of erythema multiforme
HSV
erythema multiforme major vs minor
vs SJS
EM major = minor + mucous membrane involvement. SJS is unique to this and can become TEN, is nikolsky +ve (and is usually from drugs not microbes)
Tx of erythema multiforme
systemic corticosteroids are of no benefit. EM minor can be managed supportively; EM major should be treated as burns.
TEN vs SJS
The epidermal separation of SJS involves <10% of body surface area (BSA), whereas TEN involves >30% of BSA
Drugs causing SJS?
sulfonamides, penicillin, seizure medications (phenytoin, carbamazepine), quinolones, cephalosporins, steroids, nonsteroidal anti-inflammatory drugs (NSAIDs)
Dx of SJS?
Biopsy needed = shows full-thickness eosinophilic epidermal necrosis.
Dx of SJS?
Biopsy needed = shows full-thickness eosinophilic epidermal necrosis.
Tx of SJS/TEN
Early diagnosis and discontinuation of offending agent = critical
+ thermoregulatory, electrolyte
help, wound dressings, fluids.
Data on pharmacologic therapy with steroids, cyclosporine, and IVIG are mixed.
Causes of erythema nodosum
NO cause (60% idiopathic)
Drugs: sulfa, iodides, penicillins
Oral contraceptives
Sarcoidosis
Ulcerative colitis/Crohn disease
Microbiology (TB, leprosy, histoplasmosis, chronic infection)
Patients with erythema nodosum may have a false-⊕ what?
Venereal Disease Research (non trep test)
erythema nodosum workup?
Clinical Dx. Workup with an ASO titer, PPD in high-risk patients, and CXR to rule out sarcoidosis, or inflammatory bowel disease workup based on the patient’s complaints.
most accurate dx test for b.pemphigoid and p.vulgaris?
skin biopsy and immunoflourescent ELISA
Stage this decubitus ulcer:
involves intact skin with nonblanchable
erythema.
stage 1
Stage this decubitus ulcer:
involves partial-thickness loss of dermis; however, deeper structures are
intact.
stage 2
Stage this decubitus ulcer:
involves full-thickness loss of epidermis and subcutaneous fascia; however,
muscle and bone are not exposed.
stage 3
Stage this decubitus ulcer:
involves full-thickness tissue loss with exposed
underlying structures such as muscle or bone.
stage 4
when is a decubitus ulcer Unstageable
Unstageable ulcers are covered with black
eschar, making it difficult to determine depth of injury.
Tx of decubitus ulcers
low-grade lesions = routine wound care, including hydrocolloid dressings.
High-grade lesions = surgical debridement.
Tx for gangrene generally
Emergency surgical debridement. Antibiotics should be given as an adjuvant to surgery. Hyperbaric oxygen can be used after debridement in gas gangrene.
acanthosis Tx
Typically not treated. encourage weight loss and treat the underlying issue.
lichen planus tx?
Mild cases = topical corticosteroids
severe disease = systemic corticosteroids and phototherapy
Severe/ocular rosacea tx?
oral doxycycline or macrolide. Can do lid scrubs too.
Phymatous rosacea tx?
oral isotretinoin or laser therapy
Papulopustular rosacea tx?
topical metronidazole. Tetracyclines second line
Erythematotelangiectatic rosacea tx?
topical brimonidine or laser therapy
main difference between secondary syphilis and pityriasis rosea in terms of presentation of rash?
syphilis involves the palms/soles… P.R. does not
Tx of P.R?
Supportive therapy: emollients and antihistamines.
who gets systemic GCs in vitiligo
For patients with rapidly progressive vitiligo
some options to treat stable vitiligo
Topical corticosteroids, tacrolimus ointment, JAK inhibitors, UV, and laser therapy
mutation associated with ichthyosis vulgaris
filaggrin (like atopic derm)
Tx for mild sunburn?
cool, moist compresses and emollients with aloe vera for topical relief and NSAIDs for pain relief.
Tx for Seb keratosis
Cryotherapy, shave excision, or curettage.
tx for actinic keratosis. Consider if local AK or field cancerization present
Cryotherapy if local AK , topical 5-FU/ topical imiquimod if diffuse AK or so called Field Cancerization. (recall diclo/imi joke). Patients should be advised to use sun protection.
what is marjolins ulcer
SCC coming from scar/wound
how to confirm SCC Dx
shave biopsy
Tx for SCC
Surgical excision or Mohs surgery
Multiple BCCs appearing early in life
and on non–sun-exposed areas suggest what?
Gorlins syndrome
how to confirm BCC Dx, then thus Tx it if positive. When to do MOHS. Second line treatment.
shave biopsy/or excisional biopsy. If positive do 4mm margin excision. Do MOHs surgery if high risk areas. Topical FU/ imiquimod 2nd line
Melanoma’s confined to the skin are Tx’d how?
are treated by excision with margins.
Tx for recurrent or metastatic melanoma?
radiation and chemo-therapy… also biologicals
most common HIV associated malignancy?
Kaposi
Tx for kaposi sarcoma? consider if HIV+, small/local, or systemic
HAART therapy if patient is HIV⊕. Small local lesions can be treated with radiation or cryotherapy. Widespread or internal disease is treated with systemic chemotherapy
Bacillary angiomatosis Tx of chocie
erythromycin (lesions look red too = erythro)
dermatitis that is chronic and resistant to treatment… consider what?
could be mycosis fungoides… so do biopsy (sezary cell!)
Persistent strawberry hemoangiomas may be treated with?
topical or oral β-blockers
PYOGENIC GRANULOMA is seen usually in what setting
pregnancy
Tx options for pyogenic granuloma
surgical excision, laser therapy, or topical silver nitrate.
NECROBIOSIS LIPOIDICA
= talk to me about it
Red-brown to yellow annular plaques found on the lower extremities of patients with DM. Usually pretibial and in women.
Tx for HSV infections
acyclovir… IV if severe or CNS
dermatitis herpetiformis Tx?
dapsone and a gluten-free diet
HSV lesions… best Dx, and quickest Dx?
Viral culture or PCR test of lesion. Direct fluorescent antigen is the most rapid test.
who requires the varicella Vx
children in two doses at ages 1 and 4. Also recommended for adults over 60 years of age. May be given to HIV patients with CD4+ cell count >200.
Tx for postherpetic neuralgia
neuropathic agents (gabapentin, pregabalin, tricyclic antidepressants)
Tx for preherpetic neuralgia
Pain control with NSAIDs
VZV infx Tx in adults
systemic acyclovir to treat symptoms and prevent complications
Who needs post exposure prophylaxis to VZV (within 5 or 10 days of exposure).
immunocompromised individuals,
pregnant women, and newborns should receive varicella-zoster immune globulin within 10 days of exposure. Immunocompetent adults should receive a varicella vaccine within 5 days of exposure.
Tx for molluscum contagiosum
Curettage, cryotherapy, laser ablation, or applying cantharidin
How is respiratory papillomatosis acquired in infants?
Mothers with genital warts can transmit HPV to the infant by aspiration during delivery.
Most accurate test for HPV wart
PCR of the lesion
name 3 chemical treatments for HPV warts. Which are CI’d in pregnancy
podophyllin (contraindicated in pregnancy), trichloroacetic acid, and imiquimod (contraindicated in pregnancy).
Bullous impetigo is almost always caused by what bacteria. Meaning it can evolve into what?
exfoliative toxin-producing strains
of S aureus and can evolve into SSSS.
Do we need a gram/culture before starting Abx for impetigo?
No
Mild localized impetigo Tx
Topical antibiotics (mupirocin) are sufficient.
Severe impetigo (non-MRSA) or ecthyma Tx
Oral cephalexin or dicloxacillin.
Severe impetigo Tx (MRSA likely)
Oral trimethoprim-sulfamethoxazole, clindamycin, or doxycycline.
SSSS Tx
Nafcillin, vancomycin, and wound care.
When can a child return to school following impetigo
24 hours after the initiation of therapy.
Tx for scarlet fever
Penicillin
Tx for salmonella typhi
fluoroquinolones and third-generation cephalosporins
General cellulitis: Oral or topical Abx?
Oral. Infx too deep for topical
IV antibiotics are indicated when in cellulitis
if there is evidence of systemic toxicity, comorbid conditions, DM, extremes of age, or hand or orbital involvement.
Is the abx regime for cellulitis similar to impetigo?
Yes
Tx for suspected necr fasciitis.
Discuss Abx: if strep, to decrease exotoxin, and if anearobic?
Surgical emergency: Early and aggressive surgical debridement is critical.
Systemic broad-spectrum coverage is necessary. If Streptococcus is the
principal organism involved, penicillin G is the drug of choice. Clindamycin is added to ↓ exotoxin production. For anaerobic coverage, give metronidazole or a third-generation cephalosporin
What is Fournier gangrene
necr fasciitis localised to the groin area
what is eosinophilic folliculitis
Eosinophilic folliculitis can occur in AIDS patients, in whom the disease is intensely pruritic and resistant to therapy.
mild superficial folliculitis Tx
topical mupirocin
more severe folliculitis Tx
with cephalexin or dicloxacillin orally, escalating to clindamycin or doxycycline if MRSA is suspected
hot tub folliculitis Tx
self-limiting and does not usually require treatment—severe disease can be treated with ciprofloxacin.
Head or pubic lice Tx
Treat with topical permethrin, pyrethrin, benzyl alcohol, and mechanical removal.
Body lice Tx
Wash body, clothes, and bedding thoroughly. Rarely, topical permethrin is
needed.
scabies Tx
Patients should be treated with 5% permethrin from the neck down (head to toe for infants) for at least two treatments separated by 1 week, and their close contacts should be treated
as well. Oral ivermectin is also effective.
crusted scabies Tx
oral ivermectin and topical permethrin combo
bed bug Tx
Treat pruritis with topical steroids and antihistamines; use insecticides or heat to remove infestation.
Cutaneous Larva Migrans Tx
Ivermectin
does steroid induced acne respond to normal acne Tx
No! discontinue CSs is the only way
Mild acne Tx ideas
Topical retinoids are the most effective topical agent for comedonal acne. Topical benzoyl peroxide kills C acnes. Consider adding a topical antibiotic (clindamycin, erythromycin) if response to other topicals is inadequate.
Moderate and severe acne Tx ideas
Topical treatment same as mild acne, add oral antibiotics such as doxycycline or minocycline. When acne is severe and all treatments are failing, oral retinoids (isotretinoin) are the most effective treatment. All other acne medications are stopped.
Isotretinoin monitoring required
liver function, cholesterol, and triglycerides. female patients must be on two forms of contraception and should have serial pregnancy (hCG) tests done
general succession on acne Tx
topical benzoyl peroxide, retinoid,
or antibiotic → oral antibiotic → oral isotretinoin
Tx of pilonidal cyst
incision and drainage of the abscess followed by sterile packing of the wound. Excision of sinus tract if present. Abx only if cellulitis present
Tuberculoid and lepromatous leprosy Tx
Treat tuberculoid leprosy with dapsone and rifampin. Add clofazimine for lepromatous or multibacillary leprosy
Bets initial test for tinea versicolor
KOH preparation of the scale revealing “spaghetti and meatballs” pattern
of hyphae and spores
Tx of tinea versicolor
topical ketoconazole or selenium sulfide (selsum blue)
Best initial test for suspected candida skin infx
KOH preparation of a scraping of the affected area. KOH dissolves the
skin cells but leaves the Candida untouched such that Candida spores and pseudohyphae become visible.
Most accurate test for candida skin infection Dx
culture
Oral candidiasis tx
Oral fluconazole tablets; nystatin swish and swallow, clotrimazole Troches.
Esophageal candidiasis tx
Systemic fluconazole, echinocandins, amphotericin B.
Superficial (skin) candidiasis tx
Topical antifungals; keep skin clean and dry.
Vulvovaginal candidiasis tx
Topical antifungal, single dose of oral fluconazole.
Diaper rash tx
Topical nystatin.
Tinea (ringworm)
Best initial test: ?
Most accurate test: ?
- KOH skin scraping showing hyphae
- Fungal culture
Wood’s lamps exam can used for microsporon
indication to use oral antifungals for tinea infections
if escalation needed, captitis, nail involved, immunocomp (rest = give topicals)
sporotricosis Tx
itraconazole
Dx
Small papule following minor trauma. Rapidly enlarges to form ulcer despite antiseptics. 55 year old women. No fever. Pain and pustular, and has irregular violaceous boarders
Pyoderma Gangrenosum
Tx for pyoderma gangrenosum
GCs
Workup for pyoderma gangrenosum
Biopsy to rule out infx and ca
Describe the rash in porphyria cutanea tarda
Painless blisters, heal with scarring, hyperpigmentation,
Itchthyosis usually spares where
Spares axilla and face. Affects the extensor legs most
When is deep shave biopsy, or punch biopsy ok in suspected melanomas?
Only if very large or in problematic place (face).
Recall perianal dermatoses (3 of them)
how would you describe the rash in SSSS
Sun burn - like
SJS and TEN have what symptoms before cutaneous lesions
flu like prodrome
limited vitiligo Tx?
topical steroids
extensive/unresponsive vitiligo tx?
oral GCs or topical calcineurin inhib
Dx this
Patient with bullae and erosion of skin, when using them a lot. Hx of oral ulcers as baby. Thickening of soles of feet
epidermolysis bullosa
(dx - biopsy and IF)
(tx - supportive)
First line Tx for Tinea
topical azole/terbinefine. 2nd line is griseofulvin
Dx this
chronic, scaly, irregular, erythematous, central hypopog and peripgery of outer pigmentation.
discoid lupus
Tx of SSSS
naficillin or vanco. And supportive wound care
common precipitants of guttate psoriasis
strep, RA (add more)
causes of erythema nodosum
infx, IBD, sarcoid, abx, COCP
which drugs can increase risk for lichen planus
ACEi’s, Bb and thiazides
Lichen planus Tx
High dose GC’s
what is neonatal cephalic pustulosis
papules and pustules usually around 3 weeks after birth, limited to the face. Self limited and requires soap and water washes. ketoconazole is severe
molluscum C. mx
don’t need biopsy. go straight for liquid nitrogen cryotherapy. do HIV test if patient young/lesion in genital area/many lesions.
First line Tx for Tinea
topical azole/terbinefine. 2nd line is griseofulvin
patient has sudden onset of severe psoriasis… test for what?
HIV test!
BCC Tx overview
Surgical excision.
Mohs for high risk or face CA
5FU or imiquimod 2nd line
Dx and Tx
Keratosis Pilaris. Give emollient creams and topical keratolytics
Sun protection advice
Avoid where can. Avoid 10am-5pm. Where clothes and hats. Sunblock above factor 30 (apply ~30 mins prior and reapply every 2hrs or after swimming).
Treatment of Acute paronychia. And if it’s with abscess or Felon?
Can do warm soaks. If abcess or felon present, so incision and drainage. Oral antibiotics after
When to use wet to dry dressing and what is it
It involves applying a moist dressing, such as saline-soaked gauze or a hydrogel, directly onto a wound bed. As the dressing dries, it adheres to the wound surface and absorbs excess wound exudate, debris, and bacteria. During the removal process, the dried dressing is gently peeled away, which helps in debriding the wound by removing dead tissue and promoting a clean wound bed. Wet-to-dry dressings are commonly used for wounds that require regular cleaning and debridement, such as infected or necrotic wounds
What is moisture retaining, non adherent dressing
creates a moist environment while preventing the dressing from sticking to the wound. Good for clean wounds that are ready to heal (have granulation)
Where are pressure ulcer most common
sacrum, ischial tuberosities, malleoli, heels, and 1st or 5th metatarsal head.
Risk factors for pressure necrosis
impaired mobility, malnutrition, abnormal mental status (eg, dementia), decreased
skin perfusion, and reduced sensation.
Mx overview for pressure ulcers
repositioning of the patient to reduce
pressure, pain control, and nutritional support. Shallow ulcers can be managed with occlusive or semipermeable
dressings to maintain a moist wound environment. Full-thickness wounds may require more complex dressings
and surgical intervention for debridement or closure.
Strange symptom seen in HSP
Testicular swell and ache
Describe the rash in secondary syphilis
Scaly and involves palmes and soles. Hx of chancre.
HSP rash and arthritis is in upper or lower limbs more
Lower
Ruptured baker cyst symptoms
A ruptured Baker cyst may cause pain, warmth, and erythema in the popliteal fossa and posterior
calf.
Risk factors for lichen planus
• Hepatitis C
associations • Medications: ACE inhibitors, thiazide diuretics
Formation of lesions at sites of trauma. Called what? Seen mainly in?
Köbner phenomenon, seen in Lichen Planus
Prognosis of cutaneous LP vs mucosal oral LP
Unlike cutaneous LP, which is self-limited and often resolves within
2 years, oral LP often has a prolonged course with relapsing symptoms over many years.
Bed bugs presentation
Pruritic, small puncta & maculopapules in
linear groups (“breakfast, lunch, dinner”
patter) on unclothed skin
One sentence to describe scabies rash
Pruritic burrows or hemorrhagic crusts in
intertriginous areas
Source in infx in SSSS… neonates vs kids
In neonates, the source of infection is often the umbilicus or circumcision site, whereas in older children, there may be nasopharyngeal colonization or a primary skin lesion (eg, pustule)
Type II reaction rashes and Type III reaction rashes
Type Il rashes are more likely to manifest as blisters or bullae (eg, pemphigus vulgaris, bullous pemphigoid) than papules. Type Ill rashes tend to be more erythematous and maculopapular.
Neonatal cephalic pustulosis
Reaction to malazzazzia in 3 wk year olds. Presents as acne. Not due to sebaceous gland stimulation like normal acne. Mx with soap and wash, unless severe you can do topical CS or ketoconazole
Miliaria Rubra
Erythematous, papular rash on occluded & intertriginous areas, due to overheating.
Mx Avoid overheating (eg,
cool environment,
thin/cotton clothing)
If severe, topical
corticosteroid
Erythema toxicum neonatorum
• Birth to
age 3
days
• Pustules with
erythematous
base on trunk &
proximal
extremities
Mx Observation
• Resolves within a
week
Milia
Milia
• Birth presentation
• Firm, white
papules on face
Observation
Resolves within a
month
Neonatal
pustular
melanosis
• Birth presentation
Nonerythematous
pustules
-
evolve into
hyperpigmented
macules with
collarette of scale
• Diffuse, may
involve palms &
soles
Observation
Pustules resolve
within days
Hyperpigmentation
may last months
Contrast acute and chronic tinea pedis
Acute: pruritus, burning pain,
erythematous vesicles/bullae
• Chronic: pruritus, erythema,
interdigital
scales/fissures/erosions with
extension onto the sole, side, or
dorsum of the foot
Tinea pedis interdigital vs moaccasin
Tinea pedis most commonly occurs between the toes (interdigital pattern), but in chronic cases can cause a hyperkeratotic rash extending up the sides of the feet (moccasin pattern).
Erythema neonatorum toxicarum presentation
ETN typically presents by age 3 days in full-term neonates. The rash usually begins as small, poorly
demarcated erythematous macules and papules that classically involve the trunk and proximal extremities but may occur anywhere except the palms and soles (where no hair follicles are present). Lesions often evolve into small, firm pustules on erythematous bases. The rash is asymptomatic, and infants are otherwise well- appearing.
Pseudofollicultis Barbae is due to follicle penetration. What are the two types
through the lateral wall of the follicle
(transfollicular penetration) or by curving back down into the skin after exiting the follicle (extrafollicular
penetration).
Mx overview of pseudofollicutlits barbae
Discontinuation of shaving is first-line
treatment and results in improvement in a few weeks. Subsequently, adjustment of shaving routine (eg, single
blade, warm compresses prior to shaving) or use of alternative shaving methods (eg, hair clippers to leave hair
longer) can be adopted. Chemical depilatories, laser hair removal, and topical eflornithine (which slows hair
growth) can also be used.
3 causes of Nikolsky positive
(positive Nikolsky sign, seen in staphylococcal scalded skin syndrome, TEN and pemphigus vulgaris).
Can cherry hemangiomas be seen on mucosa
No
D element to the ABCDE of melanoma, is what
Diameter of more than 6mm
Pyogenic granuloma. Facts
Usually less than 1cm
High in fingers and Muscosa
Seen in high estrogen states like preg
Resolve postpartum
Bleed with minor trauma
How is nickel allergenic
Nickel (eg, belt buckles, watches, jewelry) is a common trigger for chronic ACD; corrosion of metal alloys by electrolytes in sweat releases soluble metal ions that trigger the hypersensitivity reaction.
How do topical retinoids work? How does benzoyl peroxide work
topical retinoid (eg, tazarotene, tretinoin), which inhibits comedogenesis, and benzoyl peroxide, which has bactericidal activity against C acnes.
Common drugs causing photosensitivity
Antibiotics
Tetracyclines (eg, doxycycline)
Antipsychotics
Chlorpromazine, prochlorperazine
Diuretics
Furosemide, hydrochlorothiazide
Others
Amiodarone, promethazine, piroxicam
Advice to patients starting tetracyclines regarding sun
Patients being
prescribed tetracyclines should be advised to minimize sun exposure and use appropriate sunscreens and
barrier solar protection when outdoors.
Difference between phototox and photoallergy
Topical (eg, sunscreens) and systemic medications can cause photoallergic reactions, in which ultraviolet light alters the structure of the drug, which then induces a delayed hypersensitivity reaction. These skin manifestations are typically eczematous in appearance. Whereas phototox from say tetracycline or amiodarone will generate react with UV to generate free radicals
Eczema herpeticum. And Tx
Painful vesicular rash
Herpes simplex type 1
“Punched-out” erosions & hemorrhagic herpeticum crusting
Tx with systemic cyclovirs
Ichthyosis vulgaris overview
Gene
Presentation
Histology feature
Tx?
Loss of fillagrin gene. Diffuse scaling of skin, palmer hyperlinearity, increased atopic disease. Dx is clinical but can do biopsy which shows absent granular layer. Tx with warm baths, emollients and moisturiser and consider keratolytics
Anal Strep derm presentation . Tx?
Infants through school-
aged children
• Bright, sharply
demarcated erythema of
perianal/perineal area
• Oral antibiotics (eg,
amoxicillin)
Tx of diaper contact derm
Topical barrier (eg,
petrolatum, zinc oxide)
Perinatal baby rash: Erythematous papules,
plaques? Spares skinfolds….
Candida or diaper?
Diaper
Perinatal baby rash
Beefy-red, confluent
plaques
• Involves skinfolds
Satellite lesions
Candida or diaper
Candida
Standard interventions to prevent pressure ulcers in high-risk patients include:
• Proper patient positioning
• Mobilization
• Careful skin care
• Moisture control
• Maintenance of nutrition
Intermittent pneumatic compression vs stockings…. Use?
Intermittent pneumatic compression devices are used to prevent deep venous thrombosis in patients
with contraindications to anticoagulant therapy. Stocking are used to orient venous insuff
How would you describe the rash of discoid lupus
chronic, scaly, irregular, erythematous plaques with ulceration and central hypopigmentation
surrounded by hyperpigmentation.
Patient with discoid lupus…. How many get SLE? What signs can show you they are at high risk of getting SLE
(SLE) eventually develops in up to 30% of patients. Risk factors for progression
to SLE include widespread lesions, concurrent arthralgias/arthritis, and high antinuclear antibody titers.
How would you device the rash of PCT
fragile blisters and erosions. Sun exposed areas
What to do in case of nodular melanoma instead of ABCDE
7-point checklist. The typical ABCDE is more for superficial melanoma
What is the 7 point checklist for melanoma
(1 major or 3 minor is
suspicious)
• Major criteria: change in size, shape, or color
• Minor criteria: size 7 mm, local inflammation, crusting/bleeding,
sensory symptoms
Infants with epidermolysis bullosa l.. presentation
Infants with EB simplex may develop oral blisters with bottle-feeding, but mild cases often do not lead to definitive diagnostic testing.
Dx and Tx of epidermolysis bullosa
Suspected EB warrants biopsy of a fresh blister for immunofluorescence microscopy; genetic testing is available for confirmation. Treatment primarily involves careful wound care and supportive measures.
What is Idiopathic guttate hypomelanosis
Idiopathic guttate hypomelanosis is a common finding with aging and is characterised by small macules in sun-exposed areas.
Tinea vs vitiligo.
Which is depig which is apigmentation
Tinea = depig
Vitiligo = apigmentation
Guttate psoriasis description, and main preceding infx?
scattered, scaly, erythematous papules or small plaques, typically following an acute streptococcal infection.
Sudden-onset, severe psoriasis
• Recurrent herpes zoster
› Disseminated molluscum contagiosum
Severe seborrheic dermatitis
test for what?
HIV test
Multiple skin tags… 3 diseases associated with it
Preg, insulin resistant, crohns
Main causes of erythema nodosum
infection (eg, Streptococcus), inflammatory bowel disease (eg, Crohn disease), sarcoidosis, and malignancy. It can also be triggered by medications, such as penicillins, sulfonamides (eg, trimethoprim-sulfamethoxazole) and oral contracentives
Two main superinfx in eczema
HSV and impetigo
How would you describe the prodrome of TEN/SJS
Acute influenza-like prodrome
Can a patient have vitiligo only on the genital or oral mucosa.
Yes (recall weird vulval Q)
Blisters, bulla, scarring, hypopigmentation/hyperpigmentation on sun-exposed skin (eg, back of hands, forearms, face). Dx?
PCT
Dx?
Nummular eczema
Miliaria rubra pathophys
In infants when, eccrine sweat glands within the epidermis are not fully developed or have delayed patency. As a result, hot or humid environments lead to sweat accumulation within the glands and an inflammatory reaction.
Mx overview of Miliaria rubra
Management involves avoidance of overbundling and synthetic fabrics and switching to thin clothing made of
breathable material (eg, cotton). Overheating and sweating can also be reduced by creating a cooler
environment (eg, air conditioning, fan) when possible. If the rash is severe or associated with pruritus, topical
low/mid-potency corticosteroids may be used as adjunctive therapy.
Lichen lands from drugs induced cause.
Drug-induced LP typically has a more diffuse presentation than idiopathic LP, which is frequently limited to the flexor surfaces of the wrists and ankles, oral mucosa, and genitalia.
Main bacteria to cause cellulitis via nail puncture
Pseudomonas aeruginosa
When to do X-ray to check for osteomyelitis in DM ulcer
Therefore, foot imaging (eg, ×-ray, MRI) is generally recommended for all diabetic foot ulcers that
are:
• deep (eg, exposed bone, positive probe-to-bone testing).
• long-standing (eg, present >7-14 days).
• large (eg, ≥2 cm).
• associated with elevated erythrocyte sedimentation rate/-reactive protein.
• associated with adjacent soft tissue infection.
RFs for Tinea
- Concurrent dermatophyte infection (autoinoculation)
• Occlusive clothing - Obesity
• Peripheral artery disease
• Diabetes mellitus
• HIV infection
• Systemic glucocorticoid therapy
3 skin conditions associated with HCV
porphyria cutanea tarda (erythema and
bullae in sun-exposed areas), **lichen plans* (pruritic, pink/purple papules and plaques predominantly located at
wrists and ankles), and leukocytoclastic vasculitis (palpable purpura).
What is telegen effluvium
Acute, diffuse, noninflammatory hair loss
Clinical findings
• Scalp & hair fibers appear normal
• Hair shafts easily pulled out (hair pull test)
Triggers
• Severe illness, fever, surgery
• Pregnancy, childbirth
• Emotional distress
• Endocrine & nutritional disorders
What is the hair pull test and how does it relate to telogen effluvium
. In the hair pull test, small tracts of hair (50-60 fibers) are pulled firmly; extraction of >10%-15% of fibers is abnormal and suggests TE.
What is trichorrhexis nodosa
Trichorrhexis nodosa is characterized by fragility of hair with breaking of strands.
Angiosarcoma and breast cancer relationship
patients with breast cancer who undergo radiation therapy or axillary lymph node dissection (with subsequent chronic lymphedema) are at substantially increased risk of secondary angiosarcoma approximately 4-8 years after therapy.
Bullous pemphioid vs pemphigus vulgaris (itch or pain)
Itch and pain resp.
bullous pemph and pemph vulgaris have a prodrome of what rash
Urticaria/eczematous
Associated disorders with bullous pemphigoid
Neuro disorders. Like Parkinson’s and Alzheimer’s
Pathergy in pyoderma gangrenosum
Small injury will form ulcer in days/weeks
Risk factors for onychmycosis
Age, DM, PVD
Koilonychyia
Explain the sensory, ANS, motor owners to diabetic neuropathy/ulcer
Sensory: awareness, and pressure on first
ANS: lower blood flow foot, dry skin which is more vulnerable to fissuring
Moto: unopposed large lower leg muscle clawing, increased pressure on metatarsal head
How to tell a lipoma from an epidermal inclusion cyst
Lipoma are usually soft Irregular. Epidermal inclusion cyst are firm, regular, and do not change shape with pinched. Inclusion cyst may recur also
Insitu SCC vs invasive SCC appearance
Insitu is bowens, and appears as a flat patch that is well demarked. If invades becomes nodular and ulcerative.
Tinea Mannum
superficial mycosis of the palm, dorsum, or interdigital folds of one or both hands. Usually annular and looks like Dr Fotinis issue. Associated with Tinea pedis
Dx this:
Recurrent, acute episodes
• Deep-seated, pruritic vesicles & bullae at hands & feet
Acute palmoplantar eczema (dyshidrotic eczema)
Tx of Acute palmoplantar eczema (dyshidrotic eczema)
• Topical emollients
• High/super high-potency topical corticosteroids
Is whitlow painful or pruritic
Painful
Congenital melanoma… size matters?
Yes. Large ones have higher melanoma risk. So remove them. Smaller ones are often removed more for cosmetic reasons
Red flags for Mongolian blue spots
Different colours, fade quickly, tender. Likely bruises
Nevis simplex vs negus flammeus
Nevus simplex lesions are typically located on the eyelids, glabella, and nape of the neck and fade
with time; nevus flammeus lesions (port-wine stains) do not regress with time and are usually unilaterally located on the face.
presents with enlarging vesicles, which progress into flaccid bulla filled with yellow fluid.
The lesions rupture, leaving a classic collarette of scale (eg, resembles a collar or necklace) at the periphery of the lesion. Dx?
Bullous impetigo (staph)
Bullous impetigo vs herpes signs
Impetigo grows rapidly and scales
Cradle cap is caused by what infection
Seborrhoeic dermatitis – Malassezia. Not tinea capitis
Management for a child with cradle cap/a bit of other seborrhoeic dermatitis
Cradle cap yourself resolve. But can do non-medical shampoos.
If persistent can start to add low-dose steroid, topical antifungal et cetera
IGA nephropathy weird finding
Scroll to swell
Neonatal Catholic pustulosis. How do you treat, and what is the likely cause
Just treat with the daily cleansing with soap and water. If severe can do corticosteroid/ketoconazole topically.
It’s most likely reaction to Malassezia
Why might somebody with recurrent blistering on the back of the hands, fatigue and low haemoglobin, and history of high LFTs
Porphyria cutanea tarda patient secondary to chronic hep C
Baby groin rash. Beefy read satellite lesions Skin folds involved. Versus plaques/papules sparing skinfolds. Versus well defined rash around anus with fissures
Candida, diaper rash, strep perianal dermatitis
Have a quick look at discoid lupus on the Internet. Should be able to see hyperpigmented edges, hypopigmented centres within ulceration in the middle
Woman with hair loss and sitting around the vertex in mid scalp
This is normal female pattern hair loss. Can give me an minoxidil
If someone is having recurrent tineawhat is important to do
Search other areas, like the foot, due to autoinoculation ri
If two excisional biopsy of skin cancer, and it’s margina are CA positive do what
Remove an extra 4 mm off the margins
Telogen effluvium
Just a lot of hair coming out. Triggered by stress, and a crime, poor nutrition, illness, fever, surgery. Do the whole hair tug test (more than 20% of five as well come out)
How does psoriasis look if it’s on the hands of scalp
Often is small plaques. Have a quick look on the Internet
Russian back, small red macules on Lines of tension
Pityiariasis
Name me to hypertensive medication is that a risk factors for lichen planus
Thiazide and ACE inhibitor
Clear sign to tell between bullous impetigo and contact dermatitis
Impetigo is going to be more painful, where is dermatitis will be very itchy
When and why do we do an x-ray on chronic ulcers of the foot for example
Essentially to rule out osteomyelitis. Chronic/deep/large/systemic symptoms can point towards a high risk of osteomyelitis
Treatment for erythema multiform
Antihistamine and topical glucocorticoid
What is aCute Paronychia and a felon
And infection of the nail. Can form an abscess, and can reach the pulp of the nail bed which is a felon. Paronychia alone you can do warm soak. Abscess or fell on you need oral antibiotics and incision and drainage
Discuss the dressings for infected tissue
Start off with wet to dry. This allows removal of devitalise tissue. Eventually you should get a nice red and moist wound (granulation). Now do moist retaining non-adherent dressing, which can allow the granulation tissue to form
The D in ABCDE, is what
Diameter, above 6 mm
When would you decide on topical five FU or imiquimod versus cryotherapy for actinjc keratosis
If it’s more diffuse, or the signs of field cancerisation (cirrhosis, pigment change) et cetera pick the topical ones
Long term immunomodulators can increase risk of
Lymphoma
Eosinophilia has a role in Dx atopic dermatitis
No
Other than nasolabial fold, Where else can seborrhoeic dermatitis be found commonly
Eyebrows and posterior ears, scalp. Also of course cradle cap
Other than Parkinson’s… who else gets diffuse seb derm
Psychotic disorders and HIV
Name three medication psoriasis
ACEI, BB, Li
Local psoriasis management
Topical corticosteroids, topical vitamin D, topical vitamin A
If somebody has extensive is psoriasis. Which are following treatments is CI in an immunosurpressrd 
UV… can cause skin cancer
How long after drug exposure does a patient usually have medication induced morbilliform rash. If it’s not within this time period what do you consider
It’s usually one to 2 weeks after medication. If patient has it a couple of days after medication, it’s probably not the cause 
What is the difference between erythema multiform E minor and major. Is there any risk aggression to toxic epidermal necrolysis
Minor only on the skin, major also on the mucous membrane. There is no risk of progression
EM, TEN, SJS are what reaction
Type 4
Management of EM minor and major
Symptomatic treatment. Supportive, major should be treated as a burn. No corticosteroid
Comprehensive list of TEN causing Medz
Sulfas , penicillin, most seizure medication, quinolones, cephalosporins sporrans, steroids, NSAID
Other than well known ones: main causes of erythema nodosum
Behcets, other chronic infx (strep, yersinia etc.) sulfas, OCP
Often erythema nodosum patients have false non strep test….
If erythema nodosum persists after cold compress NSAID etc
Give KI
Lim bullous pemphigoid. Before the blisters, what occurs
Eczematous or uriticarial like lesions
Pyoderma G. Painful or painless
Painful
Most rapid test for HSV
Flourescent Ag test. (PCR or culture best though). Tzanck smear more supportive Dx
General rule for time frame of when to give antiviral in HSV or VZV in severe or immunocomp
Within 72 hours of symptoms to really help
If someone has severe frequent HSV recurrences. What to do
Daily acyclovir
Consider what, in an HSV infx lasting more than 1month. And even resistant to Tx
AIDs
Key overview of management for varicella. Consider if child, adult. Consider treatment for acute, subacute, postherpetic neuralgia.
For child, self-limited. Adults should have systemic acyclovir. For acute and subacute neuralgia give NSAID. For postherpetic give neuropathic S
Molluscum contagiosum. Treatment in adults for children
Adults can do various methods of removal. In children usually resolve and Are left on treated.
Treatment overview of gangrene
Surgical debride meant. Antibiotics can be given, but are often ineffective due to lack of blood flow. Hyperbaric oxygen gas gangrene
Papulopustular rosacea treatment
Topical metronidazole
Oval Erica matters plaques covered in a white find scale (cigarette paper
Pityriasis Rosa
Do you need to do steroids for pityriasis
No
First line therapy for hydradenitis
Topical clindamycin, or oral antibiotics. Drainage, wound care, even surgical excision and skin graft.
Itchthyosis is worse in what weather
Cold dry
