Dermatology 2 Flashcards

Question

# Tinea Capitis General

Answer 1

Fungal infection of the scalp, involving the skin and hair. Typically Trichophyton tonsurans or Microsporum canis Typically affects children and immunocompromised individuals Increased incidence in African Americans Spread by contact - either by an infected individual or by fomites

Answer 2

Poor hygiene

Answer 3

Patches of alopecia with black dots or scaly patches of hair loss, commonly with erythema and pruritus. Kerion: characterized by the development of an inflammatory boggy edematous plaque with pustules, thick crusting, and/or drainage, with suppurative folliculitis. Painful and tender. Can lead to scarring.

Answer 4

clinical, can be confirmed with KOH or Wood’s Lamp Definitive diagnosis: fungal culture.

Answer 5

1st line: oral **griseofulvin** 2nd line: oral terbinafine Additional treatments: Anti-fungal shampoos at least twice weekly - treat all household members with too Avoid sharing hats, brushes/combs, hair clippers

Answer 6

Tinea corporis

Answer 7

Refers to dermatophytosis of the skin, usually affecting the trunk and limbs Pathogen: Trichophyton rubrum or microsporum Transmission is due to direct contact Very common in pre-adolescent age individuals

Answer 8

Solitary or multiple erythematous, scaly, circular or oval plaques or patches with central clearing and well-defined raised borders that spread outward Often pruritic

Answer 9

KOH prep – best initial test Fungal culture can be performed for definitive diagnosis

Answer 10

Topical antifungal – clotrimazole, ketoconazole, butenafine, terbinafine, ciclopirox - typically bid application x 1-3weeks Oral if refractory: terbinafine

Answer 11

A dermatophyte infection of one or both hands Typically Trichophyton species Results from contact with an infected individual; from another site of infection, particularly the feet or groin; or contact with a fomite

Answer 12

Manual laborers Hyperhidrosis Existing hand dermatitis

Answer 13

Erythematous, scaly patch or plaque with a raised, well-defined border Slow extending area of peeling, xerosis and mild pruritus May have increased skin markings or vesicles/bullae

Answer 14

Best initial test: KOH Definitive diagnosis: fungal culture Topical anti-fungal agents Oral terbinafine if refractory

Answer 15

Superficial fungal infection of the groin or inner thigh Typically caused by Trichophyton rubrum

Answer 16

Tinea cruris

Answer 17

Males Copious sweating Immunocompromised Existing fungal infection like tinea pedis

Answer 18

Hallmark : pruritus, annular, well-demarcated, hyperpigmented patches or plaques with diffuse erythema May have vesicles Typically spares the scrotum

Answer 19

clinical Best initial test: KOH Definitive diagnosis: fungal culture

Answer 20

Topical anti-fungals - clotrimazole, butenafine, terbinafine, Ketoconazole, ciclopirox General measures: desiccant powders, avoidance of tight-fitting clothing, put socks on before underwear

Answer 21

The most common fungal infection seen in developed countries Most commonly caused by the fungus Trichophyton rubrum Public showers, gyms are common sources of infection from direct contact and breaks in the skin

Answer 22

Most common: Scaling and redness between the toes, maceration may be present Look for “1 hand, 2 feet” syndrome Moccasin: Chronic, hyperkeratotic type - sharply marginated scale, distributed along the lateral borders of the feet, heels, souls and is often associated with onychomycosis Complete KOH prep to confirm diagnosis

Answer 23

tinea pedis

Answer 24

tinea pedis

Answer 25

First line: allylamines - terbinafine, naftifine or butenafine cream qd-bid x 1-2 weeks These are expensive! Second line: imidazoles - clotrimazole, miconazole, Ketoconazole cream bid x 4-6 weeks These are more commonly prescribed in practice! Ciclopirox cream is my personal go-to treatment Review hygiene practices with patients

Answer 26

Not caused by a dermatophyte - actually a colonization of a yeast, typically Malassezia furfur, that is a normal resident of the skin Tends to onset during summer months

Answer 27

Called “versicolor “because it can be light, dark, or pink to tan

Answer 28

Characterized by well-demarcated, hypopigmented or hyperpigmented macules, patches, occurring mostly on the trunk and arms Macules will grow, coalesce and various shapes and sizes are obtained in an asymmetric distribution **Visible scale is often not present but when rubbed scale is readily seen this is a diagnostic feature of tinea versicolor**

Answer 29

Tinea versicolor

Answer 30

clinical, confirmed by KOH

Answer 31

Shampoos – apply for at least 5 minutes daily to the affected area Imidazole creams: Ketoconazole cream, clotrimazole Oral: fluconazole 300mg 1 dose per week x 2 weeks Requires liver function studies due to risk of hepatotoxicity

Answer 32

Alopecia areata Telogen effluvium Tinea capitis

Answer 33

Androgenetic Alopecia Trichotillomania

Answer 34

Alopecia areata Androgenetic alopecia Tinea capitis Trichotillomania

Answer 35

Telogen effluvium Alopecia universalis Iron deficiency anemia Drug-induced hair loss

Answer 36

Examine the scalp for inflammation Compare part width of the top of scalp with the back of scalp Examine the entire scalp by making small parts in the hair Note location and extent of hair thinning/loss Perform a hair pull test and tug test

Answer 37

An extremely common, genetically determined disorder characterized by the gradual conversion of terminal hairs into indeterminate and then finally vellus hairs

Answer 38

Men: occurs in half of men by age 50 Frontal hairline recede, bitemporal thinning, then thinning on the top and crown Women: occurs in half of women by their 80s Unlike men, women tend to retain the shape of their hairline, but tend to go thin on the top and sides

Answer 39

Topical minoxidil 5% foam daily to the affected area Reassure patients that it will take 6 to 12 months to see improvement or halt progression of hair loss Oral finasteride or dustasteride daily

Answer 40

Cicatrical baldness / Androgenetic Alopecia

Answer 41

Androgenetic alopecia

Answer 42

Telogen effluvium results in faster cycling of the hair and loss of telogen hairs at the root Often triggered by major stress to the body - think illnesses requiring hospitalization, pregnancy, surgery, significant mental stressors. Usually resolves within 6 to 12 months of onset Lasts longer for some people especially those with subtle changes in hormone levels, use of retinoids, cortisol, ferritin, vitamin D3, beta blockers, and general anesthetics as these are involved in hair cycle regulation

Answer 43

Labs: TSH, T4, CBC, iron studies, vitamin D, possibly RPR

Answer 44

Iron deficiency

Answer 45

Reassurance is the mainstay of treatment if there is no underlying cause as determined by labs Tips for practice: most dermatology providers will recommend multivitamin supplementation and topical minoxidil to help stabilize hair loss if onset is relatively recent

Answer 46

An autoimmune attack on hair follicles by lymphocytes - the hairs will fall out in well-defined patches Associated with other autoimmune disorders, most commonly thyroid disease Unpredictable course, but usually results without treatment in about six months Regrowth can start with thin or white hairs Focal and rapid

Answer 47

consider Thyroid panel bc often associated with other autoimmune disorders like thyroid

Answer 48

Intralesional triamcinolone injections 2.5 - 10 mg/mL every 4 to 6 weeks ILK5 is most commonly used in practice Topical steroids - start with potent or ultra-potent steroids I recommend betamethasone valerate 0.01% foam or betamethasone dipropionate 0.05% lotion daily Topical minoxidil 5% foam If extensive - refer to dermatology

Answer 49

Trichotillomania

Answer 50

Caused by forceful pulling and removal of the hair Clinical Manifestations Different lengths of hair present within the patch May also have black dots from short hairs Lack scale or inflammation

Answer 51

Screen for anxiety and depression Behavioral interventions including habit reversal, self monitoring, competing reaction training, relaxation training, psychotherapy, hypnosis Medical therapy: SSRIs - fluoxetine, sertraline, fluvoxamine

Answer 52

A benign lesion formed due to abnormal mature capillary proliferation Most commonly seen in middle-aged and older adults

Answer 53

Cherry red to purple papules that may be flat topped or dome shaped Blanch with pressure Most commonly seen on the trunk Tend to bleed profusely if they are traumatized

Answer 54

Diagnosis : clinical Treatment: observation Can be removed for cosmetic reasons with electrocauterization or laser therapy

Answer 55

cherry angioma

Answer 56

Pyogenic granuloma

Answer 57

Benign vascular tumor of the skin or mucous membranes, characterized by **rapid growth and friable surface** Most common in children and young adults Seen after hormonal changes, such as pregnancy, or after the initiation of new medication or chemotherapy

Answer 58

Solitary glistening, friable, bright red rapidly-growing nodule or papule that often bleeds after minor trauma or ulcerates Found in arms, hands, legs or at sites of skin trauma

Answer 59

Diagnosis: biopsy Treatment: Excision with wound closure or curettage followed by electrocautery

Answer 60

Kaposi Sarcoma

Answer 61

Vascular cancer associated with Herpes virus 8 infection Most commonly seen in immunosuppressed patients - HIV Cutaneous KS typically seen on lower extremities, face, oral mucosa, genitalia

Answer 62

Painless, non-pruritic pink, brown, erythematous or violaceous macules, papules or plaque-like nodules

Answer 63

Diagnosis: biopsy Management: refer to oncology Chemotherapy, radiation HIV- Antiretroviral therapy

Answer 64

Inflammatory skin changes associated with chronic venous insufficiency

Answer 65

Erythematous to brownish or dark purple hyperpigmented patches or plaques with eczematous features (scale, pruritis, weeping erosions and crusting) Leg edema, increased leg circumference, variscosities are common - pulses are maintained

Answer 66

management of underlying venous insufficiency General measures: leg elevation, compression stockings, exercise Gentle cleansing Acute lesions: topical corticosteroids Severe or refractory: oral prednisone

Answer 67

Stasis dermatitis

Answer 68

Stasis dermatitis

Answer 69

Pressure ulcer Ulcers resulting from vertical pressure. Commonly seen on bony prominences – sacrum, calcaneus, ischium

Answer 70

Elderly, immobilization, incontinence

Answer 71

Decubitus ulcer

Answer 72

superficial, nonblanchable erythematous macule preventive measures, wound protection

Answer 73

epidermal damage extending into the dermis. Resembles a bulla or abrasion maintain a moist wound environment – hydrocolloids or hydrogels

Answer 74

Full thickness loss of the skin. May extend into the subcutaneous layer Wound cleansing, maintain a moist wound environment, debridement of necrotic tissue, and treatment of wound infection if necessary

Answer 75

Deepest. Extends beyond the fascia, into the muscle, tendon, or bone Wound cleansing, maintain a moist wound environment, debridement of necrotic tissue, and treatment of wound infection if necessary

Answer 76

Pyoderma gangrenosum

Answer 77

An auto-inflammatory ulcerative process mediated by an influx of neutrophils into the dermis Typically triggered by trauma, surgical debridement, or attempts to graft an area

Answer 78

misdiagnosed as a spider bite or an infection and debridement occurs it will worsen the condition

Answer 79

Can be associated with inflammatory bowel disease, rheumatoid arthritis, hematologic conditions, arthritis, and malignancy

Answer 80

Begins as a small pustules that breaks down and rapidly expands forming an ulcer with an undermined **violaceous border** - tends to have a rapid progression Satellite alterations may merge with the central larger ulcer Can occur anywhere on the body Can be very painful

Answer 81

refer to Dermatology - this is a DERMATOLOGIC EMERGENCY Topical: Superpotent steroids, tacrolimus Systemic: steroids, cyclosporine, tacrolimus, cellcept, thalidomide, TNF-inhibitors

Answer 82

Acute or subacute adverse cutaneous reactions to a medicine Most are hypersensitivity reactions Majority or self-limited the offending drug is discontinued.

Answer 83

Antigen from foods, insect bites, environmental, exercise induced, and infections

Answer 84

IgE-mediated e.g. Urticaria, angioedema ## Footnote slide 57 ppt2

Answer 85

Most commonly occurs 5 to 14 days after initiation of a new medication or within one to two days in previously sensitized individuals Type 4 T-cell mediated hypersensitivity reaction Common medication: penicillin, sulfas, NSAIDs, allopurinol, anticonvulsants (SAPAN)

Answer 86

Characterized by erythematous macules or small papules after initiation of a medication Generalized distribution that typically coalesce to form plaques, primarily involving the trunk and proximal extremities May have mild systemic symptoms including low-grade fever, pruritus

Answer 87

Stop attending medication Oral antihistamines, +/- short course oral corticosteroids

Answer 88

Morbilliform Drug Eruption

Answer 89

An acquired, chronic, depigmenting disorder of the skin, in which melanocytes are progressively lost It is widely accepted that vitiligo is a result of autoimmune destruction of melanocytes Appears in all races, all ages with ages 20-25 years most commonly affected, and both men and women appear to be equally affected A familial component is present as more than 20 to 30% of affected individuals report vitiligo in a first or second-degree relative

Answer 90

Associated with several other disease states Rheumatoid arthritis, insulin-dependent diabetes, B12 deficiency, SLE, alopecia areata, Addison disease, and other autoimmune dermatological conditions

Answer 91

Most common: complete loss of pigment in a single or multiple macules or patches of the skin with characteristic chalky or milky white coloration Typically asymptomatic, but can be pruritic Well defined with convex borders Small patches may coalesce together merging into more complex shapes Typically found in the sun exposed areas or in areas prone to repetitive trauma

Answer 92

Topical potent corticosteroids have mixed results New Janus Kinase inhibitor: Ruxolitinib (Opzelura) just FDA approved!