Dermatology (15%) Flashcards
What is the primary cause of increased sebum production in acne vulgaris? When does this most commonly occur?
Increased androgens After puberty
How do you diagnose dermatophytosis (tinea)?
What would be seen upon inspection under a woods lamp?
DX: KOH smear
Wood’s lamp: green fluorescence if due to Microsporum.
Scabies are caused by the mites ______ ______, and are spread via ____ or ____. They cannot survive off of the human body for ____ days.
Sarcoptes scabiei skin to skin contact or fomites >4 days
Patients with erythema multiforme frequently have a ______ as well
fever
Atopic dermatitis is a _____ -mediated reaction with increased ____ production.
T cell mediated immune activation
increased IgE production
Describe the appearance of tinea barbae
Papules, pustules, and hair follicles
Androgenetic alopecia is characterized by hair (thinning/loss) that is (nonscarring/scarring) and most commonly affects what 3 parts of the scalp?
Hair loss
Nonscarring
Temporal, midfront, and vertex area of the scalp
What is the mode of transmission of pediculosis?
person to person
fomites (hats, headsets, clothing, bedding)
What part of the body is usually spared in pityriasis rosea?
the face
What are Pastia’s Lines?
linear petechial lesions seen at pressure points, axillary, antecubital, abdominal or inguinal areas.
Underarm, elbow, and groin skin creases may become brighter red than the rest of the rash
Is a deep partial thickness burn a 1st degree, 2nd degree, 3rd degree, or 4th degree burn?
To what depth does a deep partial thickness burn go?
What does it look like?
Painful/Painless?
Describe the capillary refill.
What is the prognosis? (healing time, scarring, etc)
2nd degree
Epidermis into deep portion of dermis (reticular)
Red, yellow, pale white, dry, (+) blistering
Not usually painful, (+/-) pain with pressure, may have decreased 2 point discrimination
Absent capillary refill
3 weeks-2 months to heal, scarring common (may need skin graft or excision to prevent contractures)
Where on the body does atopic dermatitis most commonly present?
flexor creases i.e. antecubital and popliteal folds
What types of medications typically cause urticarial rashes in regards to cutaneous drug reactions?
abx, NSAIDs, opiates, radiocontrast media
What is the hallmark sx of atopic dermatitis?
pruritis
What is the recommended management of diaper dermatitis?
Frequent diaper changes every 2 hours or when soiled.
Open air exposure.
Topical Zinc oxide or petroleum jelly.
1% Hydrocortisone (use for <2 weeks).
May need topical antibiotics.
_______ can occur in infants who have prolonged exposure to urine and or feces
Diaper rash (contact dermatitis)
What is staphylococcal scalded skin syndrome otherwise known as?
In what age group is it most commonly seen in?
Ritter disease
Infants or children <5 y/o
In what population are seborrheic keratoses most commonly seen in? With what history?
Fair skinned elderly with prolonged sun exposure
Describe bullous impetigo. What is the difference in the crusts of nonbullous and bullous impetigo?
Vesicles form large bullae (rapidly) that then rupture and form thin “varnish like crusts” as opposed to honey colored in nonbullous impetigo.
Nonbullous impetigo is associated with _____ lymphadenopathy and is most commonly caused by an infxn by _______, and second most commonly caused by ______.
regional Staph aureus GABHS
Mild, moderate, or severe acne? “Comedones, larger amounts of papules and or pustules” Tx?
Moderate Topical retinoids, Benzoyl peroxide, topical abx, OCPs + oral abx, +/- antiandrogen agents (i.e. spironolactone)
How is erythema multiforme managed?
If it is oral?
If it is severe?
Symptomatically
Steroids/lidocaine/diphenhydramine mouthwash
Systemic steroids
What are some potential risk factors for developing dermatophytosis (tinea)?
increased skin moisture (ex. occlusive gear), Immunodeficiency (HIV, OM), peripheral vascular disease
Describe the appearance of tinea corporis.
What distinguishes this rash from erythema migrans?
What is the recommended management for this condition?
What may be ineffective in tx?
erythematous plaques (circular rash with clear center & defined borders), scaling, cracking & vesicles.
The presence of scales in tinea corporis distinguishes it from erythema migrans.
Topical antifungals
PO Griseofulvin is ineffective
What are nits?
White oval shaped egg capsules at the base of the hair shafts, can be removed with a fine toothed comb
What is the recommended course of tx for milia?
None, usually disappears by the 1st month of life, may be seen up to 3 months old
How do you diagnose a pt with scabies?
Clinically Can scrape skin of burrows with mineral oil to ID mites or eggs under microscopy
Describe the presentation of port wine stains.
What happens to them over time?
Where do they occur most commonly?
Are they usually unilateral or bilateral in presentation?
Where are they most commonly seen?
What other abnormalities may they be associated with?
Pink-red sharply demarcated, blanchable macules or papules in infancy
Over time, they grow and darken to a purple (port-wine) color and may develop a thickened surface
They occur most commonly on the head and neck
Usually unilateral or segmental
MC seen on the face, but may occur anywhere
Glaucoma, spinal abnormalities
Describe the appearance of cafe au lait macules.
Color?
What are they caused by?
Uniformly hyperpigmented macules or patches with sharp demarcation. Either present at birth (or developing early in childhood).
Varying colors from light brown to chocolate brown.
Due to increased number of melanocytes and melanin in the epidermis.
Erythema multiforme is a(n) (acute/chronic) self-limited type (1/2/3/4) hypersensitivity reaction most commonly seen in what age population?
Acute
4
young adults 20-40 y/o
How do you dx a pt with ritter dz?
What can you cx?
What can you bx? What are you looking for?
- Clinical diagnosis. Intact bullae are sterile.
- Cultures from urine, blood & nasopharynx.
- Skin biopsy: lower stratum granulosum layer splitting.
What is the recommended course of management for a pt with ritter dz?
First line?
What if MRSA is suspected?
- Antibiotics: Penicillinase-resistant penicillin 1st line:* Nafcillin or Oxacillin ± Clindamycin
Vancomycin if MRSAis suspected of if failed penicillin treatment.
- Supportive skin care: maintain clean & moist skin, emollients to improve barrier function.
- Fluid and electrolyte replacement
The Gardasil vaccine is administered to young women ___-___ y/o, and protects against ___% of HPV strains, including HPV __, __, __, and __.
Gardasil 9 targets the same strains of Gardasil, in addition to HPV types __, __, __, __, and __.
11-26 y/o
70%
6, 11, 16, 18
31, 33, 45, 52, 58
What is first line management of tinea capitus?
PO Griseofulvin = 1st line
PO Terbinafine, Itraconazole of Fluconazole 2nd line tx.
Erythema toxicum is thought to be due to ____ ____ ____ and is seen in up to __% of neonates.
immune system activation
70%
What is second line treatment for pediculosis?
Why?
Lindane
Neurotoxic (HAs, sz) do not use after showering!
______, ______ pain or _____ pain may accompany a cutaneous drug reaction
fever, abd pain, joint pain
Describe the presentation of Miliaria Crystallina.
In what patient population is this most commonly seen in?
Tiny, friable clear vesicles (due to sweat in the superficial stratum corneum)
MC in neonates (especially in 1 week old neonates).
How do you manage tinea (pityriasis) versicolor?
- Topical antifungals: Selenium sulfide, Sodium sulfacetamide, Zinc pyrithione, “azoles”.
- Systemic therapy: Itraconazole or Fluconazole in adults if widespread or if failed topical tx. Must not shower for 8-12 hours afterwards because azoles are delivered to the skin via sweat.
What is Sturge-Weber Syndrome?
What is the classic triad?
What may a patient with Sturge-Weber Syndrome develop?
congenital disorder associated with classic triad:
- Facial port wine stain (especially along trigeminal distribution area and around the eyelids)
- Leptomeningeal angiomatosis
- Ocular involvement (ex. glaucoma)
May develop hemiparesis contralateral to the facial lesion, seizures or intracranial calcification & learning disabilities
Oral Finasteride is a _____________ medication that inhibits the conversion of ____ to _____. It can be used to treat androgenetic alopecia and has side effects that include what 3 things?
5 alpha reductase inhibitor
testosterone to dihydrotestosterone (DHT)
decreased libido, sexual and ejaculatory dysfunction
Most warts typically resolve spontaneously w/in _____ years
2
What is the Rule of Nines?
What type of burn is it not applicable to?
No applicable to first degree burns
What is pediculosis commonly referred to as?
Lice
Describe erythema multiforme’s cutaneous presentation.
Target (iris) lesions, dull dusty violet red, purpuric macules/vesicles or bullae in the center surrounded by a pale edematous rim and a peripheral halo
Describe the appearance of tinea capitus
What is the common name for tinea capitus?
Varied presentation: annular, scaling lesions & broken hair shafts. Inflamed plaques with multiple pustules (kerion) with scarring & alopecia
“Ring worm” = common name
What is the most common premalignant skin condition? What malignancy can it develop into?
Actinic keratosis Squamous cell carcinoma
Describe the cutaneous presentation of SJS/TEN
widespread blisters that begin on the trunk and face erythematous/pruritic macules >=1 membrane involvement with epidermal detachment
How do you diagnose a pt with tinea (pityriasis) versivolor?
- KOH prep from skin scraping: hyphae & spores“spaghetti & meatball” appearance.
- Wood’s lamp: yellow-green fluorescence (enhanced color variation seen with versicolor).
What are the three different types of pediculosis louse?
head louse (pediculosis humanus capitus), body louse (pediculus humanus corporis), and pubic louse (phthirus pubis)
What causes sebaceous glands to become clogged in acne vulgaris?
increased production of follicular keratinocytes
What possible colors could a seborrheic keratosis be?
flesh-colored, brown, grey, and black
Seborrheic dermatitis when presenting on an infant along the scalp is called?
Cradle cap
What is tinea (pityriasis) versicolor?
Overgrowth of the yeast Malassezia furfur (formerly Pityrosporum) - part of the normal skin flora.
What are the three types of cutaneous HPV verruca (warts)?
Common (vulgaris) Plantar (plantaris) Flat (plana)
Is angioedema painless/painful?
Painless
What is the first step in management of a cutaneous drug reaction?
Discontinue the offending medication.
Is a superficial burn a 1st degree, 2nd degree, 3rd degree, or 4th degree burn?
To what depth does a superficial burn go?
What does it look like?
Painful/Painless?
Describe the capillary refill.
What is the prognosis? (healing time, scarring, etc)
1st degree
Epidermis
Erythematous, dry
Painful
(+) capillary refill intact, blanches with pressure
Heals within 7 days, no scarring
How does a patient with Ritter dz typically present?
Where is the erythema worst?
What will be positive?
What may also be observed in the eyes of a patient with ritter dz?
What body parts will not be affected in a patient with ritter dz?
- Malaise, fever, irritability, extreme skin tenderness –> cutaneous, blanching erythema - bright skin erythema often starting centrally & around the mouth before spreading diffusely.
Erythema is worse in the flexor areas and around orifices - especially the mouth.
After 1-2 days develop sterile, flaccid blisters especially in areas of mechanical stress (hands, feet, flexural areas & buttocks)
POSITIVE NIKOLSKY SIGN
Desquamative phase - skin that easily ruptures, leaving moist, denuded skin before healing.
- Inflamed conjunctiva may be seen (may become purulent) but mucous membranes are not involved.
What physical finding is pathognomonic for common and plantar warts?
Thrombosed capillaries
Inflammatory acne vulgaris has _____ and _____ surrounded by inflammation
papules and pustules
What is the recommended course of management for pompholyx?
Topical steroids
How do you definitively dx an actinic kertosis?
Punch or shave bx
Describe the dermatologic presentation of lichen simplex chronicus/neurodermatitis
Scaly, well-demarcated, rough, hyperkeratotic plaques with exaggerated skin lines
The three most common triggers of urticaria are ___, ___, and ____.
food, medications, infections Also: insect bites, drugs, envr, stress, heat, cold
To what depth does a 4th degree burn go?
What does it look like?
Painful/Painless?
Describe the capillary refill.
What is the prognosis? (healing time, scarring, etc)
Entire skin into underlying fat, muscle, bone
Black, charred, eschar, dry
PAINLESS
Absent capillary refill
Does not heal well, usually needs debridement of tissues and tissue reconstruction
What should be done with bedding and clothing after a pediculosis dx?
laundered in hot water, detergent, hot drier for 20 minutes, toys should be placed in an air tight plastic bags x14 days if cannot be washed
Open comedones are called (black/white) heads, and closed comedones are called (black/white) heads. Which is an incomplete or a complete blockage?
Black (incomplete) White (complete)
What are the three different types of miliaria?
Miliaria Crystallina
Miliaria Rubra
Miliaria Profunda
_______ is best used if the onset of androgenetic alopecia is recent and is involving a smaller area
Minoxidil
What is the clinical manifestation of a patient with pediculosis?
Intense itching (esp. occipital area), papular urticaria near the lice bites
What is the difference between steven johnson syndrome (SJS) and toxic epidermal necrolysis (TEN)?
BSA affected: SJS = <10%, TEN = >30%
Is angioedema a shallower/deeper form of urticaria?
Deeper
What is recommended for pain management in burn patients?
Acetaminophen and NSAIDS can be used alone or in conjunction with opioids
Describe a (+) Nikolsky sign
May use a pencil eraser to test for Nikolsky sign–> The eraser is placed on the skin and gently twirled back and forth. If the test result is (+), a blister will form in the area, usually w/in minutes. A (+) result is usually a sign of a blistering skin condition (i.e. SJS/TEN)
What is Scarlet fever also called?
What is it due to?
Scarlatina
Diffuse skin eruption that occurs in the setting of GABHS (Streptococcus pyogenes) infection
Due to Type IV (delayed) hypersensitivity reaction to a pyrogenic (erythrogenic toxin A, B or C)
What are the 5 types of cutaneous drug reactions? Describe each and how they are mediated.
Type 1: IgE mediated (urticaria and angioedema) Immediate. Type 2: cytotoxic, Ab-mediated Type 3: immune antibody-antigen complex Type 4: delayed (cell-mediated), morbiliform reaction (i.e. erythema multiforme) Nonimmunologic: cutaneous due to genetic incapability to detoxify certain medications
After the herald patch, when does the general exanthem of pityriasis rosea then occur?
1-2 weeks later
What type of burns do not require dressing?
Superficial
If a pt were to present to the office complaining of condyloma acuminata, what are they complaining of? What would they look like? Would they be painful/painless?
Genital warts (could also present in the oropharynx) Soft, fleshy, cauliflower like lesions Painless
Children with >/=6 Cafe au lait macules (especially when accompanied with _____ or _____ freckling) should be evaluated for possible ________.
axillary or inguinal
Neurofibromatosis type I
Where is lichen planus most commonly located on the body?
Flexor surfaces of extremities, skin, mouth, scalp, genitals, nails, and mucous membranes
Atopic dermatitis is otherwise known as _____.
eczema
Where on the body does angioedema usually present? What serious complication can occur in tandem with angioedema?
lips, tongue, eyelids, hands, feet, and genitals Anaphylaxis
What time of year is pityriasis rosea most commonly seen?
spring/fall
________ is a type 1 HSN (Ig___) or complement-mediated edematous reaction of the dermis and or SQ tissues
Urticaria (IgE)
Port wine stains (otherwise known as _____ _____ or ____ _____) are due to ______.
capillary malformations
nevus flammeus
Vascular malformations of the skin –> due to superficial dilated dermal capillaries
How to tx/manage cradle cap?
Baby shampoo, ketoconazole, topical corticosteroids
What are the 5 P’s of lichen planus?
Purple
Polygonal
Planar
Pruritic
Papules, with fine scales and irregular borders
What is a Mongolian Spot and what is it due to?
In what populations are they most commonly seen?
Congenital dermal melanocytosis due to mid-dermal melanocytes (melanin producing cells) that fail to migrate to the epidermis from the neural crest
May be seen in >80% of Asians & East Indian infants. Increased in African-Americans.
What is the recommended tx for scarlet fever?
First line?
Same as strep pharyngitis.
- May return to school 24 hours after antibiotic initiation*
1. Penicillin G or VK 1st line: Amoxicillin, Amoxicillin/clavulanic acid (Augmentin)
2. Macrolides if PCN allergic
Other alternatives include Clindamycin, Cephalosporins
What type of blisters should be removed/debrided?
Ruptured blisters
Management of clean and intact blisters is contorversial
What is the Parkland formula and what is it used for?
Calculates fluid requirements for burn patients in a 24-hour period.
Use in adult patients with burns. Children have larger TBSA relative to weight and may require larger fluid volumes.
Lactated Ringers 4ml/kg/%TSA. IV xfirst 24 hours
1/2 in 1st 8 hours, the other 1/2 over the remaining 16 hours.
What differentiates erythema multiforme minor from major?
Mucosal membrane involvement (major = mucosa involved)
Actinic keratosis is most commonly seen in people with what type of skin? With what kind of history?
Fair skinned elderly with prolonged skin exposure
What is the recommended course of management for SJS/TEN?
tx like a severe burn, fluid and electrolyte replacement, wound care
After a scabies dx, all clothing/bedding/etc should be placed in a plastic bag for at least ___ hours, then washed and dried using heat.
72
What are potential complications seen in a patient with ritter dz?
Secondary infections: sepsis, pneumonia, cellulitis;
Excessive fluid loss
Electrolyte imbalances
What is the recommended management of an actinic keratosis?
Observation, cryosurgery, or topical 5 flourouracil or Imiquimod
Erythema multiforme usually presents acrally, which means…
That it affects the distal portions of limbs
What tx is recommended for pityriasis rosea?
None needed
If pruritis is significant, use PO antihistamines
What are some possible etiologies of diaper dermatitis (diaper rash)?
Risk factors for developing?
- Wearing diapers: contact dermatitis, miliaria, candida.
- Rash in the diaper area as well as other areas: atopic dermatitis, seborrheic dermatitis.
- Affects diaper area irrespective of diaper use: scabies, bullous impetigo.
Risk factors: Friction and moisture from urine & feces
When does an urticarial cutaneous drug reaction rash typically occur following drug administration?
within minutes to hours
Describe the appearance of tinea cruris.
What is it commonly known as?
What is the recommended management for this condition?
What may be ineffective in tx?
Diffusely red rash on the groin or on the scrotum
“jock itch”
Topical antifungal
PO Griseofulvin is ineffective
What is dermatographism?
local pressure to the skin may cause wheals in that area
Topical abx should be applied to any _____ burn
nonsuperficial
Describe the appearance of a Mongolian Spot.
Are they permanent?
Blue or slate gray pigmented macular lesions most commonly seen in presacral / sacral-gluteal area (may be seen on the shoulders, legs, back and posterior thighs as well) with indefinite borders. May be solitary or multiple.
Spots usually fade over the first few years of life (before 10 y/o)
What are the three different types of mucosal HPV manifestations?
Genital warts (condyloma acuminata) Cervical dysplasia/cancer Anogenital carcinoma (intraepithelial)
How long does it usually take for the general exanthem of pityriasis rosea to resolve?
6-12 weeks
What is the recommended tx for a seborrheic keratosis?
None needed (benign) Cryotherapy for cosmesis
Erythema toxicum usually presents as?
Is this condition self limited or does it require specific tx?
Small erythematous macules or papules –> pustules on erythematous bases 3-5 days after birth
Does NOT involve the palms or soles
Individual lesions may spontaneously disappear
Self-limited –> usually resolves spontaneously in 1-2 weeks
What is a nevus simplex otherwise referred to as?
Stork Bite
How could you describe the vesicles of Pompholyx?
Pruritic, tapioca-like tense vesicles on the soles palms and fingers
Describe the presentation of the general exanthem of pityriasis rosea
smaller, very pruritic, 1 cm round/oval salmon colored papules with white circular (colarette) scaling along cleavage lines in a Christmas tree pattern, confined to the trunk and proximal extremities
Condyloma acuminata can be treated with _______, in addition to the treatments for verucca vulgaris and plantaris
Podophyllin
What is commonly used topically on 2nd-3rd degree burns?
Who is it contraindicated in?
Where on the body should it not be used? Why?
Silver sulfadiazene (SSD)
CI in pts w/ sulfa allergies, pregnant women, and children <2 y/o
Should NOT be used on the face due to possible side effect of discoloration
What is the most common benign skin tumor?
Seborrheic keratosis
Describe the presentation of miliaria profunda.
What is it caused by?
flesh-colored papules
due to sweating in the papillary dermis
Where does impetigo most commonly occur?
At sites of superficial skin trauma on exposed part of the face and extremities
What other physical finding is pathognomonic for scabies?
red itchy papules/nodules on the scrotum, glans, or penile shaft, body folds
What types of medications typically cause exanthematous/morbilliform rashes in regards to cutaneous drug reactions?
abx, NSAIDs, Allopurinol/ thiazide diuretics
When taking into consideration the management and wrapping of burns on the hands/feet/fingers/toes, what should be done to prevent maceration?
Fingers and toes should be individually wrapped with gauze placed in between them
Maceration: the softening and breaking down of skin resulting from prolonged exposure to moisture.
What is the recommended management for contact dermatitis?
For diaper dermatitis?
Avoid irritants, wet dressings (Burrows solution i.e. Domeboro), and topical corticosteroids
Topical petroleum or zinc oxide, and frequent diaper changes
_______ is localized development of hives when the skin is stroked.
Dermatographism
Describe the appearance of tinea pedis.
What is is commonly referred to as?
What is the recommended management for this condition?
What may be ineffective in tx?
Pruritic scaly eruption rash between toes
“athlete’s foot”
Topical antifungal
PO Griseofulvin is ineffective
In what population is perioral dermatitis most commonly seen? With what history?
Young women, hx of topical corticosteroid use
Is a full thickness burn a 1st degree, 2nd degree, 3rd degree, or 4th degree burn?
To what depth does a full thickness burn go?
What does it look like?
Painful/Painless?
Describe the capillary refill.
What is the prognosis? (healing time, scarring, etc)
3rd degree
Extends through entire skin
Waxy, white, leathery, dry
PAINLESS
Absent capillary refill
Months, does not spontaneously heal well
What are the 3 types of impetigo? Which is the most common? Which is the least common?
- Nonbullous (MC) 2. Bullous 3. Ecthyma (LC)
What medications are most commonly responsible for an erythema multiforme presentation of a cutaneous drug reaction?
Sulfonamides, PCNs, phenobarbital, dilantin
What are some examples of irritants that can cause contact dermatitis?
What is the mechanism by which this reaction occurs?
chemicals, detergents, cleaners, acids, prolonged water exposure, metals
Delayed hypersensitivity
Describe what an actinic keratosis looks like
Dry, rough, scaly, sandpaper skin lesion or erythematous hyperkeratotic (hyperpigmented) plaques +/- projection on the skin (horns)
________ is an idiopathic, cell mediated immune response which presents in an increased incidence in individuals with Hepatitis C
Lichen planus
When is an escharotomy recommended in a burn patient?
When the burn is circumfrential, used to prevent compartment syndrome
In pts with perioral dermatitis, there is usually a confluence of ________ on a(n) _____ base. There may be ____ lesions present. Usually, the ________ is spared.
papulopustules
erythematous
satellite
vermillion border
What is the tx for lichen simplex chronicus/neurodermatitis?
Avoid scratching lesion, topical steroids
What is the recommended tx for perioral dermatitis?
What should be avoided?
Metronidazole or Erythromycin
Avoid topical corticosteroids
Where do verruca plana typically present?
Face, hands, and shins
Describe nonbullous impetigo
vesicles, pustules, with a characteristic “honey colored crust”
What other condition is pityriasis rosea oftentimes confused with?
How can you r/o the other condition?
Syphilis
Order an RPR, if the patient is sexually active
After taking what medications does SJS/TEN most commonly occur?
Sulfa and anticonvulsant medications
What is the name of the condition described below? “Progressive loss of the terminal hairs on the scalp in a characteristic distribution (pattern)”
Androgenetic Alopecia
What is onychomycosis? Describe it.
Where is it most commonly found on the body?
What is the recommended tx?
What serious side effect are systemic antifungals associated with?
Nail infection by various fungi (ex. tinea, candida). Opaque, thickened, discolored & cracked nails with subungual hyperkeratinization.
Occurs MC on great toe.
Management: Itraconazole & Terbinafine.
Systemic antifungals: Griseofulvin, ltraconazole & Terbinafine & Griseofulvin associated with hepatotoxicity & drug interactions.
Topical Ciclopirox.
What skin type does HPV infect?
Keratinized
What does tinea (pityriasis) versicolor look like?
Hyper/hypopigmented, well-demarcated round/oval macules with fine scaling. Often coalesce into patches on the trunk, face, extremities.
The involved skin fails to tan with sun exposure.
Is a superficial partial thickness burn a 1st degree, 2nd degree, 3rd degree, or 4th degree burn?
To what depth does a superficial partial thickness burn go?
What does it look like?
Painful/Painless?
Describe the capillary refill.
What is the prognosis? (healing time, scarring, etc)
2nd degree
Epidermis + Superficial portion of dermis (papillary)
Erythematous, pink, moist, weeping, (+) blistering
Most PAINFUL of all burns, very TTP
(+) capillary refill intact, blanches with pressure
Heals within 14-21 days, no scarring but +/- pigment changes
Where is a common location on the body for common and plantar warts to appear?
Hands
Most cutaneous drug reactions are ______ reactions, and are self-limited
hypersensitivity
What is recommended for management of a port wine stain?
When?
Pulse dye laser treatment
Best if used in infancy for best outcomes
Describe the appearance of cradle cap.
Erythematous plaques with fine white scales
Mild, moderate, or severe acne? “Comedones, +/- small amounts of papules and or pustules” Tx?
Mild Topical retinoids, Benzoyl peroxide, topical abx, OCPs
________ is the key androgen leading to androgenetic alopecia
Dihydrotestosterone (DHT)
What is the topical drug of choice in the tx of impetigo?
Mupirocin (Bactroban) TID x10 days Wash gently with soap and water as well
What is the condition described below: “Skin thickening in patients with eczema, secondary to repetitive rubbing and scratching”
Lichen simplex chronicus (neurodermatitis)
(Male/Female) mites burrow into the skin to do what? What is the scabies mite fecal matter called?
Female lay eggs, feed, and defecate scybala, which causes a hypersensitivity reaction in the skin
Other than cutaneous presentation, what else may patients with SJS/TEN present with?
Fever and URI sx
What are milia?
Where are they commonly located?
1-2 mm pearly white-yellow papules (due to keratin retention within the dermis of immature skin)
Seen MC on the cheeks, forehead, chin, and nose
For extensive impetigo, or for systemic sx, what is the treatment of choice?
Systemic abx (Cephalexin)
What is the most common skin eruption associated with cutaneous drug reactions? 2nd most common type? 3rd?
- Exanthematous/Morbiliform rash 2. Urticarial 3. erythema multiforme
What is the topical drug of choice for tx of pediculosis?
Permethrin
What are the rashes that can affect the palm and soles? (x8)
Coxsackie (Hand Foot & Mouth)
RMSF (especially if wrist/ankles involved)
Syphilis (secondary)
Janeway lesions (cutaneous finding of endocarditis, along with osler nodes)
Kawasaki
Measles
Toxic Shock Syndrome
Reactive Arthritis (Keratoderma Blenorrhagica)
Meningococcemia
What are some potential risk factors of developing impetigo?
warm humid conditions, poor personal hygiene
What does the child Rule of Nines breakdown look like compared to the adult?
Describe urticaria
blanchable, edematous pink papules, wheals, or plaques (oval, linear, irregular)
What is Koebner’s phenomenon?
What other condition is it seen in, in addition to lichen planus?
New lesions at sites of trauma
(also seen in psoriasis)
Describe the appearance of a seborrheic keratosis
Small papule/plaque velvety warty lesion with a greasy/stuck on appearance
Impetigo is or is not a highly contagious vesiculopustular skin infection?
IT IS
How would a pt with scarlet fever present?
Where does the rash most commonly start and then spread to?
What will the rash typically do over time?
What is the rash commonly associated with in the mouth?
- Fever, chills, pharyngitis (strep throat)
- Rash: diffuse erythema that blanches with pressure plus many small (1 - 2 mm) papular elevations that feels like “SANDPAPER” when palpated “sunburn with goosebumps”.
MC starts in the groin and axillae then rapidly spreads to the trunk and then the extremities.
The rash often desquamates over time (usually spares the palms & soles)
Often associated with a flushed face with CIRCUMORAL PALLOR & STRAWBERRY TONGUE
What is the cutaneous presentation of scabies? Where are they commonly found? Where will they not be found?
Intensely pruritic papules and vesicles and linear burrows Intertriginous zones, including web space between fingers/toes, scalp (usually spares neck and face)
What is the atopic triad?
- Eczema
- Allergic rhinitis
- Asthma
Describe the presentation of miliaria rubra.
Where does it present compared to miliaria crystallina?
severely pruritic papules (may develop pustules).
Deeper in the epidermis
Mild, moderate, or severe acne? “Nodular (>5mm) or cystic acne” Tx?
Severe Isotretinoins (highly teratogenic!)
Ritter disease is caused by the disseminated exfoliative exotoxins produced by the bacterium ____ _____ (esp. strains __ and __). These toxins may cause ____ and _____ of the intra epidermal desmosomes of the skin.
Staphylococcus aureus
71 and 55
proteolysis and destruction
How do you definitively diagnose mucosal HPV?
Whitening of the lesion when in contact with acetic acid
_______ acne will often heal with scarring
nodular/cystic
Bullous impetigo is often associated with sx of _____ and _____ and is most commonly caused by what infective agent? Is this condition rare or common?
fever and diarrhea staph aureus RARE
What are the 4 main pathophysiologic factors that lead to acne vulgaris?
- Increased sebum production
- Clogged sebaceous glands
- Propionibacterium acne (P. acne) overgrowth
- Inflammatory response
What does the herald patch in pityriasis rosea look like?
Where is it located?
How large is it?
Solitary salmon-colored macule
on the trunk
2-6cm in diameter
What is a nevus simplex/stork bite due to?
Where are they most commonly seen?
How are they managed?
Do they darken over time?
Areas of surface capillary dilation
MC seen on the nape of the neck, eyelids, and forehead
- Observation: most will resolve spontaneously by 2 y/o and do not usually darken over time.
- Laser therapy will reduce the appearance of the lesions.
What less-expensive medication used in the management of scabies can cause sz? How/why? What should be avoided?
Lindane Do not use after bath/shower d/t increased absorption through open pores Teratogenic, avoid pregnancy
What is the recommended treatment for chronic atopic dermatitis?
daily hydration and emollients (eucerin and aquaphor)
Pityriasis rosea is associated with ______ infections and is primarily seen in what population?
viral infections (HHV7)
children and young adults
What is Darier’s sign? What is another name for this?
localized urticaria appearing where the skin is rubbed (urticaria pigmentosa)
What is nummular eczema?
Where is it usually located on the body?
sharply defined coin shaped/discoid lesions
dorsum of the hands and feet and extensor surfaces (i.e. knees and elbows)
What is the drug of choice for the tx of scabies?
Permethrin topical
Ecthyma is described as a(n) ______ ______ caused by what infective agent? Does this condition heal with scarring? Common or uncommon?
ulcerative pyoderma
GABHS
Yes, scars
UNCOMMON
Describe an exanthematous/morbilliform rash. When does the rash typically present after medication initiation?
Generalized distribution of bright red macules and papules that coalesce to form plaques. 2-14 days
______ cells release ______ during an urticarial reaction, causing (vasoconstriction/vasodilation) of the venules, leading to ____ of the dermis and SQ tissues.
Mast cells histamines vasodilation edema
When cleansing a burn, what should you use?
What should you not use?
How long should you irrigate a chemical burn with running water for?
Wash the wound using only mild soap and water –> (skin disinfectants may actually inhibit healing)
Do NOT apply ice directly to a burn! (cool compresses can be used to stop thermal burning)
Chemical Burns: irrigate profusely with running water for at least 20 minutes.
Fungal skin infections are most commonly caused by _______, and also Microsporum, Epidermophyton.
Infects _____ tissues in the stratum corneum of the skin, hair & nails by ingesting _____.
Trichophyton
keratinized, keratin
What is miliaria caused by?
Describe how it comes to be present.
What skin flora become increased in number?
Blockage of eccrine sweat glands (especially in hot & humid conditions)
This leads to sweat into the epidermis & dermis
Increased counts of skin flora (S. epidermis, S. aureus)
Erythema multiforme is most commonly associated with what virus?
What agent most commonly affects children?
Herpes Simplex virus
Mycoplasma
What is the recommended treatment for acute atopic dermatitis?
topical corticosteroids and antihistamines
topical calcineurin inhibitors (tacrolimus, pimecrolimus)
Crisaborole (Eucrisa) –> nonsteroidal for 2 y/o +
Verruca vulgaris and plantaris can be managed with what types of treatments?
salicylic acid, cryotherapy, laser
What is Pompholyx otherwise known as?
Dyshidrosis (Dyshidrosis eczema)
What medication is the treatment of choice for urticaria?
Oral antihistamines (H2 blockers)
What are examples of triggers of atopic dermatitis?
heat, perspiration, allergens, contact irritants (wool, nickel, food)
What medications most commonly cause erythema multiforme?
Sulfa drugs, beta lactams, phenytoin, phenobarbital
