Dermatology #4 (Clean Up)

Question 1

What is the first line treatment for all patients with more than mild acne vulgaris? (2 things)

Answer 1

Topical retinoid plus a topical antimicrobial agent

Question 2

another form of noninfectious folliculitis, is caused by ingrown hairs in the beard area from shaving in the direction against the grain of hair growth

Answer 2

Pseudofolliculitis barbae (razor bumps)

Question 3

First-line treatment for folliculitis

Answer 3

Mupirocin ointment and topical benzoyl peroxide cream

Question 4

What is the first line treatment if persistent or recurrent hot tub folliculitis (due to pseudomonas)

Answer 4

Fluoroquinolones (Ciprofloxacin orally)

Question 5

First-line treatment for rosacea

Answer 5

• Topical metronidazole, azelaic acid, or topical ivermectin (first line)
• Clonidine may be used for flushing
• Orał tetracyclines if patient fails topical treatment

Question 6

What characterizes the rash of erythema multiforme?

Answer 6

Target lesions with a dusky central area or blister, surrounded by pale ring of edema, and erythematous halo on extreme periphery of lesion

Question 7

Causes of erythema multiforme

Answer 7

• HSV virus MC
• Mycoplasma spp (in kids)
• Sulfa drugs, beta lactams, Phenytoin, Phenobarbital

Question 8

Although treatment for erythema multiforme is symptomatic in most cases, what drug, if given early, may reduce the number and duration of cutaneous lesions?

Answer 8

Acyclovir

Question 9

What is the key androgen leading to androgenetic alopecia?

Answer 9

Dihydrotestosterone (DHT)

Question 10

Describe molluscum contagiosum

Answer 10

Single or multiple firm dome-shaped flesh-colored waxy papules with central umbilication

Question 11

Molluscum Contagious is most common in who?

Answer 11

Children, sexually active adults, and patients with HIV

Question 12

Management of Molluscum Contagiosum

Answer 12

• No treatment needed in most cases (resolves in 3-6 months)

- Curettage (first line when therapy indicated)

Question 13

What is seen on histology if it is performed for molluscum contagiosum?

Answer 13

Henderson-Paterson bodies (keratinocytes containing eosinophilic cytoplasmic inclusion bodies)

Question 14

However, what is one common medication that is used in the treatment of molluscum?

Answer 14

Cantharidin (topical blistering agent)

Question 15

Describe a squamous cell carcinoma

Answer 15

• Erythematous, elevated thickened nodule with white scaly or crusted, bloody margins
• Nonhealing ulceration or erosion
• On lips, hands, neck, or head

Question 16

Treatment for squamous cell carcinoma

Answer 16

• Surgical excision with clear margins (MC used)
• Electrodessication and curettage for small superficial lesions
• Mohs Surgery: recurrent and sensitive areas

Question 17

What is a Kaposi Sarcoma?

Answer 17

Vascular cancer associated with HH8 infection

Question 18

Kaposi Sarcoma is MC seen in immunosuppressed patients, such as HIV with a CD4 < ____ or post-transplant. What is the treatment if associated with HIV?

Answer 18

CD4 < 100

HAART therapy

Question 19

Treatment for Kaposi Sarcoma

Answer 19

Chemotherapy or radiation for local disease

HAART therapy if associated with HIV

Question 20

MCC of skin cancer-related death

Answer 20

Malignant Melanoma

Question 21

Malignant melanoma most commonly mets to

Answer 21

regional lymph nodes, skin, liver, lungs, and brain

Question 22

MC type of malignant melanoma

Answer 22

Superficial spreading (trunk on men and legs in women)

Question 23

What type of malignant melanoma is seen in darker-skinned individuals? Most commonly seen on palms, soles, and nail beds?

Answer 23

Acral lentiginous

Question 24

Explain what ABCDE means in malignant melanoma terms?

Answer 24

A: Asymmetry
B: Borders (irregular)
C: Color (Variation)
D: Diameter (> 6 mm)
E: Evolution

Question 25

Diagnostics for malignant melanoma

Answer 25

-Full-thickness wide excisional biopsy + lymph node biopsy

DO NOT DO SHAVE BIOPSY

Question 26

MC type of skin cancer in the US

Answer 26

Basal cell carcinoma

Question 27

What is true about basal cell carcinoma?

Answer 27

Slow growing, locally invasive but low incidence of metastasis

Question 28

Describe a basal cell carcinoma

Answer 28

• Small, raised, translucent pearly or waxy papule with raised, rolled borders and central ulceration with overlying telangiectasic vessels. Often easily friable.
• MC on face, nose, neck, or trunk

Question 29

Diagnostic for basal cell carcinoma

Answer 29

• Punch or shave biopsy

- Or excisional biopsy

Question 30

Surgical management for basal cell carcinoma

Answer 30

• Mohs micrographic surgery for facial involvement

- Electrodesiccation and curettage for non-facial tumors

Question 31

Lichen Planus is associated with

Answer 31

Hepatitis C in adults

Question 32

Describe lichen planus (6 P’s)

Answer 32

• Purple
• Polygonal
• Pruritic
• Papules or Plaques with fine scales
• Planar

Question 33

What else can be seen in Lichen Planus?

Answer 33

Wickham Striae (fine white lines on the skin or on oral mucosa)

Question 34

What is Koebner’s Phenomenon in regards to Lichen Planus?

Answer 34

New lesions at sites of trauma

Question 35

Treatment for lichen planus

Answer 35

• Topical corticosteroids with occlusive dressings
• Antihistamines for pruritus
• The rash usually resolves in 8-12 months spontaneously