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.