Dermatology Flashcards
organisms for impetigo?
staph aureus
organism for verrucae vulgaris
HPV
flat lesion <0.5cm
macule
papable lesion <0.5 cm
papule
flat lesion >0.5 cm
patch
palpable >0.5 cm
nodule or plaque
clearn fluid <0.5 cm
vesicle
clear fluid >0.5 cm
bulla
purulent fluid
pustule
Thickened skin with accentuated skin markings
LIchenifications
Thickened skin with loss of elasticity and skin appendages
sclerosis
Linear split extending through the epidermis
fissure
what type lesions usually blanch
vascular lesions
Shallow depression with moist base
Erosion
what rash burns or stings?
shingles
circle with clearing in the center
annular
how do you test for fungi and dermatophytes?
potassium hydroxide (KOH)
what is the test for herpesvirus and varicella-zoster virus infections?
Tzanck test (cytologic examination)
Test for Tinea versicolor
wood light examination for the yellowish gold fluorescence
test for scabies?
skin scrapings
do you treat acne in kids?
No
what is the goal for tx for acne?
decrease keartin plugging
treat bacteria
what bacteria causes acne pustule formations?
Propionibacterium acnes
what drugs help to take off the keratin
topical retinoids
first line therapy for acne
topical retinoids
combo w/ benzoyl peroxide as second line
other treatments for acne
topical antibiotics (erythromycin, clindamycin) oral antibiotics (tetracycline, erythromycin) Oral retinoids (severe nodules)
inherited disorder w/ hardened skin. Disorder of scaling of stratum corneum , dry, hard “fish scales”
autosomal dominant
Ichthyosis
Inherited disorder. Blistering disease. AD forms milder, AR can be fatal. will have frequent skin infections, pain, and esophageal strictures. 3 different layers it can occur in
Epidermolysis Bullosa
tx of ichthyosis
ammonium lactate
membrane of thickened skin with crackles or fissures. Can be lethal if lungs can’t develop
Collodion baby (ichthyosis)
hardening of the stratum corneum
ichthyosis
tx for epidermolysis bullosa
topical ointments, non stick dressing
padding
intermittent abx for infections
Non-infectious, inflammatory epidermal conditions. The rash will itch
Eczematous conditions
Red itchy papules and vesicles with oozing and crusting crusting – Cheeks, forehead, scalp, trunk and extremities.
infantile form of atopic dermatitis
Circumscribed, scaly patches on wrists, ankles, and popliteal fossa
childhood phase of atopic dermatitis
Dry thick confluent papules; lichenified plaques
adult phase (>12) atopic dermatitis
what does the nummular form of atopic dermatitis look like?
round, “coins”, prurtitic
a person with atopic dermatitis is likely to also ahve what?
food allergies
asthma
tx of atopic dermatitis
emollient (lubricants 2-4x per day, oil based)
reduce bathing
avoid allergens
steroid creams/ ointments (use lowest potency that works)
pruritic vesicular rash of hands or feet. manifestation of ezcema. May see it after little blisters popped
Dyshidrotic eczema
when does dyshidrotic eczema usually occur
summer into winter or winter into summer
tx for Dyshidrotic eczema
antiperspirants and high potency topical steroids
Erythematous, often moist rash
Excessive moisture, skin maceration leads to inflammation
Intertrigo
where does intertrigo often occur
neck and thigh folds of chubby infants
any folds of obese patients
tx of intertrigo
Drying, mild topical steroids (avoid ointments)
Diaper or napkin rash
Present within hours of exposure
Involved areas have had direct contact with irritant
Irritant contact dermatitis
tx for irritant contact dermatitis
clean and dry
use barrier
Erythema, papules, vesicles, oozing
Intense pruritis
Delayed presentation after exposure – 18 hrs to 2 days
Allergic contact dermatitis
causes of allergic contact dermatitis
poison ivy, oak
nickel
neomycin (topical)
tx of allergic contact dermatitis
corticosteroid (topical or systemic) d/t allergic part
Common in infants and toddlers, also present in older children who have poor oral habits
Papular erythematous perioral rash
perioral dermatitis
tx for perioral dermatitis
behavior change
mild steroid cream (don’t want it on mucus membranes)
vaseline at bedtime (Barrier)
Greasy, yellow (or salmon) colored, scaling lesions lesions. most common scalp
May spread over face, intertriginous and flexural areas, trunk, and groin.
non-pruritc
seborrheic dermatitis
tx for seborrheic dermatitis
topical steroids and antiseborrheic shampoos
Mongolian Spots (slate-grey, blue patch)
Melanocytic Nevi
Salmon patches, nevus simplex, port-wine stain
Hemangiomas
Birthmarks
up to how many cafe au lait spots are normal
up to 5
freckling where can indicate cafe au lait spots?
axilla or flexor spaces
depper hemangioma. Deep vascular malformations
cavernous angioma
is there increased risk of malignant melanoma with congenital melanocytic nevi?
Yes, a slight risk
what is a term that describes the multi-color nevi.
Variegated
Do congenital melanocytes get bigger?
No, they don’t and they don’t increase in proportion to the baby
what are ash leaf spots?
white spots
Cutaneous distribution of
1st br of trigeminal nerve
-MR, seizures, glaucoma
Sturge Weber Syndrome
when does a hemangioma reach their maximum size?
6-8 months
how do hemangiomas start off?
Flat macule and grow into recognizable cherry or strawberry appearance
when do deep, cavernous hemangiomas reach max size?
12-14 months
Hemangiomas should be followed careful by who?
dermatologist/ ENT
Primarily an adult disease but 30% of cases start in childhood
Chronic and relapsing course
Well demarcated, erythematous, scaly papules and plaques
Psoriasis
psoriasis that can follow strep infection.
Guttate psoriasis
tx for psoriasis
Topical steroids ,Coal tar, Sunlight, moisturizers, methotrexate in diffuse or pustular cases
what has a herald patch. starts off with single lesion then oval patches. X-mas tree distribution
Pityriasis Rosea
Oval shaped ring or patch on torso, upper thigh 2-5cm
1-2 weeks prior to rash.
Last several weeks to months
Usually asymptomatic, 25% pruritis
Pityriasis Rosea
tx for Pityriasis Rosea
no txmt
antihistamines , low potency steroid for itch
honey colored crust”with red base, often nasolabial area
Impetigo
causative agents of impetigo
staph aureus
but GAS can cause it
where is impetigo most often found
near nose and mouth
tx for impetigo
antistaph abx
cephalexin
clindamycin
Mupirocin (localized dz)
how do you tx bullous impetigo?
systemic antibiotics
complications of impetigo
Acute Post-streptococcal Glomerulonephritis (APSGN)
Rapidly spreading warm macular erythema
Most common on face in infants and young children
Erysipelas
what causes erysipelas
strep pyogenes
tx for erysipelas
pen G or equivalent
Deep, indurated erythema -> fluctuant mass
Commonly staph
Cellulitis/ Abscess
tx for cellulitis/ abscess
anti-staphylococcal antibiotics
drain abscess
if there is streaking what is the cellulitis/ abscess caused by?
strep
Discrete pustules with surrounding erythema
Scalp where hair is pulled, under diaper, areas of chafing
Folliculitis
what causes folliculitis
staph and strep
what causes hot tub foliculitis
pseudomonas
how do you tx folliculitis
topical (cleaning +/- topical anitbiotics)
Epidermolytic toxins cause loss of cell to cell adhesion
Tender erythroderma turn to pustules to bullae.
Systemic sign include fever, irritability, vomiting
staph scalded skin
tx for staph scalded skins
staph abxs
Annular or nummular scaling red plaques
Often with “trailing scale”
Pruritic
Tinea corporis
tx for tineas
topical therapy
imidazoles, clotrimazole, miconazole, econazole
do you use nystatis for tinea?
no
what are ring like lesions that can look like tinea but aren’t
Nummular eczema (will be scaly in center) granuloma annulare
target lesions with rings and central clearing. allergic rxn
erythema multiforme
Patients often note scaling red areas on scalp
May have hair loss
More severe cases may have pustules or fluctuance
Itch
Tinea capitis
what is a much deeper infection and form of tinea capitis that need oral abx.
kerion
how do tx tinea capitis
topical is ineffective
griseofulvin or other oral meds
similar to tinea corporis but in groin
tinea cruris
is athlete’s foot common in kids?
No, often eczema
similar to tinea corporis but in groin
tinea cruris
Very superficial scaling in polycyclic pattern with reduced tanning
Involved areas pale on tan skin and dark on pale skin
Most often involves back and upper arms
Tinea versicolor
tx for tinea versicolor
selenium sulfide
topical anti-fungals
treatment for candida
Nystatin (oral for thrush, cream for diaper)
Involves intertriginous areas
Erythematous, sometimes moist
Satellite lesions
Diaper rash (thrush)
treatment for candida
Nystatin (oral for thrush, cream for diaper)
tx for flat warts
retin-A
what should be avoided in tx for warts
surgical excision or electrocautery
tx for condyomata acuminata
podophyllin
what should be avoided in tx for warts
surgical excision or electrocautery
what causes moluscum contagiosum in kids?
atopic dermatitis
tx of molluscum contagiosum
curettage
liquid nitrogen
podophyllin
Firm, umbilicated pearly papules with waxy surface pearly grey
moluscum contagiosum
tx for scabies
Permethrin 5% (Elimite®)
Lindane (Kwell®), potentially neurotoxic in infants
tx for lice
Permethrin (Nix® or Elimite ®)
pyrethrum (Rid ®) or
lindane (Kwell ®) shampoos
nit comb
causes of erythema nodosum
strep infections IBD drug rxn primary TB idiopathic
Tender nodules over shins/legs, +/-fever
Erythema nodosum
what cauess erythema multiforme
HSV mycoplasms pneumonia other infections drug reactions idiopathic
Minor upper respiratory infection, and a few days later the patient suddenly becomes very unwell.
Red blistered, eroded, bloody or crusted lips (cheilitis), mouth (stomatitis) and genitals (mucosal ulceration)
Red, sticky and painful eyes (conjunctivitis), which may become scarred , can affect cornea
will have fever, systemic toxicity, swollen lymph glands.
Stevens Johnson Syndrome
Meds than can cause SJS syndrome
antibiotics containing penicillin, sulfa, tetracycline, bactrin
NSAIDs- naproxen, ibuprofen
anticonvulsants- carbamazepine, phenytoin
Blistering and peeling of top layer of skin
seem more with Drug reaction ( or infection reaction / malignancy) >30% of surface area.
Severe form of SJS (same causes)
Toxic epidermal necrolysis (TEN)
Blistering and peeling of top layer of skin Drug reaction ( or infection reaction / malignancy) >30% of surface area.
Toxic epidermal necrolysis (TEN)
Prodome presents with Cough, conjunctivitis and Coryza (cold), high fever and possibly Koplik spots
Measles
How does the measles macular rash spread?
Head and neck first then spreads cephalocaudal
how do you tx measles
supportive
what virus causes rubella?
Rubivirus
presents with non-specific respiratory symptoms that then have retroauricular, posterior cervical and posterior occipital lymphadenopathy.
Rubella (german measles)
how does rubella rash spread?
beginning of face and progressing to toes
what type rash is rubella?
maculopapular
tx for rubella
supportive
caused by HHV6 and HHV7 common in the spring.
will have a URI, nasal congestion, red TM”s, irritable
Roseola Infantum
Sixith dz
age range common for roseola infantum
6 months-3 years
rash for roseola infantum
Diffuse maculopapular rose-colored rah
patient presents with firm, red cheeks that are warm “slapped cheeks” and lacy pink macular rash on torso and extremities. For prodrome stage will have low grade fever, HA and URI.
Parvo B19 virus
what can Parvo B19 virus cause for the baby of a pregnant women?
Hydrops
Tx for Parvo B19 virus
supportive
Vascular rash in varying stages of development. Common in late winter/ early spring.
“dew drop on a rose”
Varicella
how does varicella rash spread?
Starts on trunk then goes to face and extremities
when can a child with varicella go back to school
Once all the vesicles have crusted
Where do you get the varicella vaccine?
12-15 months and again at 4-6 years
what can you give to accelerate cutaneous healing of shings as well as help w/ the resolution of acute neuritis and reduce the risk of postherpatic neuralgia
oral antivirals
When and whom is coxackie A16 common? what is its common name?
Hand, Foot, and Mouth dz
summer and fall
<5 years old
Low-grade fever for 2-3 days followed by onset of sores in mouth and vesicles on palms and soles
Oral lesions typically involve tongue, gingiva, buccal mucosa
Hand and foot lesions asymptomatic
Hand, foot and fouth dz
Coxsackie A16
(sometimes Enterovirus 71 or other enterovirus (can be severe)
tx for hand foot and mouth
symptomatic
bright red, acutely painful skin – most obvious periorally, periorbitally, and flexural areas of neck, axilla, popliteal, groin
Due to circulating toxin from Staphlococcus species
scalded skin syndrome
what type cellulitis spreads more easily?
Strep (GAS)
what type cellulitis is localized w/ purulent center.
Staph (coag positive)
Occurs in the epidermis or uppermost layer of skin cells is called…
Epidermolysis bullosa simplex (EBS)
Occurs in the lamina densa and upper dermis (deeper layers of skin cells) is called …..
Dystrophic epidermolysis bullosa (DEB)
Occurs in the lamina lucida within the basement membrane zone (layer lying between the epidermis and dermis) is called…
Junctional epidermolysis bullosa (JEB)
