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Dermatology Flashcards

1
Q

Acne

Epidemiology

A
  • 85% of those 12-24 years old
  • Duration ~ 4 years
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2
Q

Acne

Distribution

A
  • Face, neck, chest, upper arms and back
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3
Q

Acne

Contributing factors

A
  • Hormones (Cushing’s, PCOS, adrenal hyperplasia)
  • Mechanical
  • Environmental
  • Emotions
  • Drugs (anabolic steroids, bromides, corticosteroids, lithium, Dilantin)
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4
Q

Acne

Differentials

A
  • Rosacea: mostly central face, pustules, flush reaction, telangectasia
  • Perioral dermatitis: only pustules, mostly around the mouth
  • Folliculitis: pustules around beard area
  • Acneiform: drug reaction
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5
Q

Acne

Classifications

A
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6
Q

Acne

Complications

A
  • Scarring, pain, self-esteem, social life
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7
Q

Acne

Lifestyle

A
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8
Q

Acne

Referral

A
  • Acne fulminans, cystic acne, acne conglobata
  • Acne scarring (consider abrasion, laser therapy (Grade D))
  • Resistance to ordinary treatment (candidates for isotretinoin treatment)
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9
Q

Acne

Pharmacotherapy

A
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10
Q

Dermatitis

Clinical features

A
  • Chronic prutitic inflammatory skin deases, relapsing course
  • During flares: inflamed, red, blistered, weeping skin
  • Between FLares: normal or dry, thickened and itch
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11
Q

Dermatitis

Distribution

A
  • Babies: face, scalp, neck, extensor surface
  • Children: flexural surfaces
  • Adults: hands, feet, flexures, face, wrists
    *sparing on the groin or axillary
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12
Q

Dermatitis

Associated features

A
  • Atypical cascular responses (eg: facial pallor, white dermographism, delayed blanching response)
  • Keratosis pilaris/pityriasis alba/ hyper linear palms/ ichthysosis
  • Ocular periorebital changes
  • Perifollicular accentuation/ lichenification/ prurigo lesions
  • often associated with asthma or hay fever
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13
Q

Dermatitis

Differentials

A
  • Scabies
  • Sebhorrheic dermatitis
  • Cutaneous T-cell lymphoma
  • Psoriasis
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14
Q

Dermatitis

Pharmacotherapy

A
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15
Q

Dermatitis

Clinical features

A
  • Cutaneous inflammation characterized by erythema/ vesiculation, dryness/ lichenification/ fissuring in response to an external agent
  • Often multifactorial (irritant, atopic, allergic)
  • Potential causes: topical abx (consider petrolatum or other bland emollient for post-op wound care), corticosteroids, anesthetics
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16
Q

Dermatitis

Diagnosis

A
  • Patch testing if suspicious of allergic contact dermatitis (any patient with chronic or persisten dermatitis or if previously well controlled with topical therapy but no longer well controlled)
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17
Q

Dermatitis

Management

A
  • Avoidance - avoid allergens/irritants
  • Protection - gloves (with cotton lining and barrier cream), clothings
  • Substitution of soaps/ detergents with emollients

-Rx: topical steroids or tacrolimus
-Rx: Phototherapy, systemic immunomodulators

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18
Q

Dishydrotic eczema
* Clinical features

A
  • papulovesicular dermatitis of hands and feet, followed by painful cracking/fissuring
  • Not caused by sweating, may be precipitated by emotional stress
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19
Q

Dishydrotic eczema
* Pharmacotherapy

A
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20
Q

Nummular dermatitis
* Clinical features
* Pharmacotherapy

A
  • annular, coin shaped, pruritic, erythematous plaques, dry scaly lichenified
  • Rx: moisturizer, potent topical corticosteroids
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21
Q

Seborrheic dermatitis
* Clinical features
* Pharmacotherapy

A
  • Greasy, erythematous, yellow, non-pruritic scaling papules
  • Infants (cradle cap), children (scalp, flexural) adults (scalp, eyebrows, beard, face, trurnk, body folds, sternum)

Pharmacotherapy
* Face: Ketoconazole (Nizoral) cream
* Scalp: Ketoconazole shampoo, selenium (Selsun), zinc pyrithione (Head + Shoulders) sterroid lotion

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22
Q

Laceration

History + Physical

A
  • PMhx: Diabetes, immune problem, keloid former
  • Check neurovascular + ?fractures
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23
Q

Laceration

Wound healing

A
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24
Q

Laceration

Tetanus risk

A
  • > 6 hours, >1cm deep
  • Crush, burn, gunshot, puncture
  • Contaminated, foreign body
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25
# Laceration Basic suturing
26
# Laceration Anesthetic
27
# Laceration Suture types
28
# Laceration Excision
29
# Laceration General suture care
30
# laceration Laceration of the face * Suture * Removal
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# Laceration General laceration * Suture * Removal
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# Laceration Bites * Pathogens * Investigations * Treatment
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# Laceration Suture types
34
# Psoriasis Epidemiology
* Prevalence 3.2% * Two peaks of onset: 20-30 y/o, then 50-60 y/o * Women = male
35
# Psoriasis Risk factors
* 1/3 of patients will have a first degree relative with the condition * Smoke increases the risk + severity * Obesity is associated with psoriasis * EtOH use/ abuse is associated with psoriasis
36
# Psoriasis Clinical features/ Classifications
37
# Psoriasis Triggers
* Infection, emotional/physiologic/environmental sterss, trrauma * Meds: BB, lithium, NSAID, tetracycline
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# Psoriasis Complications
39
# Psoriasis Severity
40
# Psoriasis Comorbidity (regularly assess for)
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# Psoriasis Differential
* atopic dermatitis * contact dermatitis * lichen planus * secondary syphilis * mycosis fungoides * tinea corporis * pityriasis
42
# Psoriasis Lifestyle
* Prevention: avoid sunburns and drugs that exacerrbated (B-blockerrs, lithium, corticosteroid rebound phenomenon)
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# Psoriasis General pharmacotherapy
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# Psoriasis Nail Psoriasis
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# Psoriasis Scalp psoriasis
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# Psoriasis Palmoplantar psoriasis
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# Psoriasis Inverse (intertiginous) Psoriasis
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# Psoriasis Special Populations
49
# Rashes Chickenpox (varicella-zoster virus (VZV) * Description * Diagnostic Clues
**Description** * Rash starts on face and spreads inferiorly to trunk and extremities * Papules evolve into vesicles ("dewdrop on a reose petal") and eventually to pustules that crust * Incubation 14-21d, infectivity 1-2d pre rash until vesicles crust over * **Diagnostic Clues** * All forms of lesion present at the same time * Can get vesicles on nasal, conjuntival, GI tract and genital mucosa * Uncommon prodrome consisting of H/A, malaise in children ## Footnote Reportable disease
50
# Rash Kawasaki disease * Epidemiology * Diagnosis/Complications * Management
51
# Rash Lyme disease (Borrelia Burgdorferi) * Description * Diagnostic clues
**Description** * Macula or papule at tick bite site * Progresses to pathognomic erythema migrans (80 - 90%): single expanding red patch or target (bull's eye) that expands **Diagnostic clues** * Hx of tick exposure * Secondary erythematous macular lesions * Borrelia lymphocytoma | Reportable disease
52
# Rash Measles * Description * Diagnostic clues
**Description** * Begins on the face + shoulders, spreads inferiorly * Macular rash * Fades in 4-6d, incubation 10-14d, infectivity 4d pre rash **Diagnostic clues** * URTI prodrome (coryza, bark-like cough, malaise, fever, photophobia) * Rash starts on 4th febrile day * Koplik's spot (white spot in mouth) 1-2d prior to rash | Reportable
53
# Rash Parvovirus (Fifth's disease/slapped cheek) * Description * Diagnostic clues
**Description** * Bright red facial rash ("slapped cheeks") * Progress to lacy reticular rash * May wax + wane for 6w, incubation 4-14d, infectivity pre-rash **Diagnositc clues** * Prodrome fever + anorexia * Rash usually starts after resolution of fever * *Complications*: Severe aplastic anemia in pts with chronic hemolytic anemia
54
# Rash Rocky Mountain spotted fever * Description * Diagnostic clues
**Description** * Evolves from pink macules to red papules and petechiae * Starts on wrists and ankles * Spreads towards center * Palms + soles late in disease **Diagnostic clues** * Hx of tick exposure * Typically abrupt onset of feverm sever H/A, myalgias * RRash starrts 4d later * Can have bradycardia + leukopenia
55
# Rash Roseola (HHV-6) * Description * Diagnostic clues
**Description** * Diffuse macular rash, usually spares the face * Resolves 2-3d, incubation 5-15d **Diagnostic clues** * Fever for 3-4d, rash follows within 2-3d
56
# Rash Rubella * Description * Diagnostic Clues
**Description** * Pink macules and papules starton the forerhead and spread downwards to the extremeties within 1d * Rash fades in reverse order * Incubation 14-21d, infectivity 7d prer rash to 5d post rarsh **Diagnostic clues** * Prodrome common in childrren * Adults may have mild URTI, anorerxia, malaise, H/A, prodrome * May have petechiae on the soft palate (Forchheimer spots) | Reportable
57
Rosacea * Description * Treatment
58
Scarlet Fever * Description * Diagnostic clues
**Description** * Punctated rash * Starts on trunk and spreads to extremities * Flushed face with peri-oral pallor * Rash fades in 4-5d, followed desquamation **Diagnostic clues** * Acute strep infection * Linear petechiae in atecubital and axillary folds (Pastia's sign) * Rash appears 2-3d after strep infection * Initially "white strawberry tongue" followed by "red strawberry tongue"
59
# Skin Cancers Counseling on Prevention
* Limiting sun exposure (especially 11:00 - 16:00, use shade) * Wearing protective clothing (wide brim hats, UV-A/B sunglasses) * Using sunscreen and protective lip balm (≥ SPF 30, reapply q2hrs) * Avoiding indoor tanning * Protecting children and teens (avoid sun exposure if ≤ 6 months) * Getting vitamid D safely (supplements + fortified foods) * Self-examining the skin (q3mo if high risk patient) -No evidence for MD doing routine screening of general population
60
# Skin Cancers T cell lymphoma (cutaneous) * Clinical features * Treatment
61
# Skin Cancers Melanoma * Definition * Risk factors
**Definition** * Malignant neoplasm of melanocytes and nevus cells * Incidence 1:100 **Risk Factors** * numerous moles, fair skinn, red head, personal/famHx, large congenital nevi
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# Skin Cancers Melanoma * Identifying risk
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# Skin Cancers Melanoma * Clinical features * Treatment * Prognosis
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# Skin Cancers Non-Melanoma Skin Cancer (NMSC) * Identifying risk
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# Skin Cancers Basal Cell Carcinoma (BCC) * Definition * Risk Factors * Clinical features * Distribution * Treatment * Prognosis
66
# Skin Cancers Squamous Cell Carcinoma (SCC) * Definition * Clinical features * Distribution * Treatment * Prognosis
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# Skin Infections Candidiasis * Clinical features * Pharmacotherapy
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# Skin Infections Tinea * Clinical features * Distribution * Pharmacotherapy
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# Skin Infections Onychomycosis * Management
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# Skin Infections Impetigo * Etiology * Clinical features * Distribution * Pharmacotherapy
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# Skin Infections Lice * Clinical features * Pharmacotherapy
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# Skin Infections Scabies * Clinical features * Distribution * Pharmacotherapy * Other Management

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