Dermatology Flashcards
terminology primary lesion
flat: macule/ patch: cutaneous color raise: 1. papule/patch 2. vesicles/bulla- fluid filled 3. pustules 4. wheals- cutaneous elevation caused by dermal edema dermal lesion 1) nodule/tumor 2) cyst- nodule with expressible material
secondary lesion
scaling-desquamation of stratum corner crusting-dried exudate pigmentation changes exoriations-linear erosions caused by fingernail scratches scars-thicked fibrotic dermis ulcer-lack of epic/some of dermis atrophy-thinning of epic/dermis fissue-linear crack through dermis
configuation
linear, annular, acuate (semi-circle), grouped, discrete
acral
hands, feet buttock
woods light
pigmentary changes dermatophytes
scraping
fungus-10% KOH exudate hyphae
look for mites eggs feces-scabies
base of vesicle scraped for HSV
hyperkeratosis
need keratolytics like salicylic acid, urea, acids
topical corticosteroid SE
systemic- only if potent and on damaged skin. adrenal suppression,
local SE- more common- w/in days of tx: arena, hirsutism, folliculitis, striae, hyper/hypopigmentation, atrophy, ecchymoses, telangiectasias, tachyphylaxis
antiinflam agents
steroids, tracrolimus ointment (for atopic dermatitis), 1-5% sulfer for acne. tar- eczema, psoriasis
inflammatory D
contact dermatitis, atopic dermatitis, seborrheic dermatitis, pityriasis rosea, psoriasis, miliaria rubra (heat rash)
contact dermatitis
sensitizing agent cause infm of epidermis and superficial dermis
1) allergic contact dermatitis: direct T cell mediated: initial sensitization then rechallenge, not dose dep- poison ivy/oak, jewelry, cream. see: erythematous papule and vesicles. tx- corticosteroid and avoidance
2) primary irritant contact dermatitis: caustic substance irritate skin, dose dep, no sensitization. ex- diaper dermatitis. erythema papules. tx- clean + no moisturizers, change diaper. low potency corticosteroid
seborrheic dermatitis
infant and adolescents. unknown et-maybe hypersensitive to yeast. P: red scales and crusts in area with sebaceous gland= scalp, face, chest, groin. greasy skin lesion
infant- limit to scalp= cradle cap
low potency corticosteroid, ulcer, zine or salicylic acid shampoo, topical anti fungal med
pityriasis rosea
uncommon
psoriasis
3% in kids. 30% first sign in childhood.
etio: if in kid likely auto dom inheritance caused by immune dysregs –> epi prolif
P: scaling papuls, plaques. scalp, nongreasy, hair loss, ears, elbow,. silvery scale. koebner phenomenon- new lesion dev at trauma sites
nail involvement common= pits, distal thickening, lifting of nail med/ destruction
arthritis uncommon in kids
manage- mod-high pot CS, UV light, bit D, 3% salicylic acid, retinoids, anthralin
miliaria rubra (heat rash)
disrupted sweat ducts near upper dermis- occlusion or friction. sweat into skin –> inflm –> more sweat -> more occlusion –> rash
small erythematous pruritic papule or vesicles in rubbed area-inguinal, axilla, chest, neck
tx: no med, avoid occlusive clothes- decr sweating
hypersensitive D
urticaria, serous sickness, erythema multiform, toxic epidermal necrolysis
serum sickness
~urticaria, systemic sign=fever, arthralgia, = organ injury. cause med meds~ cephalosporin
erythema multiform
HS to multi stimuli, drug, viruses etc
EM minor, EM major, steven johnson. all has target lesion= fixed, dull red, oval macule with dusky center containing a papule or vesicle.
toxic epidermal necrolysis
drug rxn. widespread epidermal neurosis, sloughing >30% skin loss.. no target lesion. Nikolsky sign- skin peal with lateral pressure. 10-30% mortality bc sepsis, dehyration, electrolyte abn
skin infection
fungal, bacterial, viral, ectoparasites
fungal
etio- child, urban, humid, crowded
category: hair, skin nails
dx: KOH scraping, wood light
tinea capitis
fungal hair loss cause by trichophyton tonsuring from human-human contact.
P: patchy cair loss -black dot ringworm. scales and pustules, kerio= boggy nodule red, occipital posterior cervical lymphadenopathy
tx- systemic oral antifungal. topical bad.
tinea corporis/pedis/cruris
infect body, foot, groin. et: M canis corporis- ringwarm= oval scaly circal erythematous patches with partial central clearing pedis- athlete's foot, can have vesicles cruris- scales and erythema tx: topical antifungal
tinea unguium (onychomyocisis)
fungal nail infection. yellow
tinea versicolor
pityrosporum oribularea= yeast invade stratum corneum. scaly macule on trunk, proximal arm, face. hypo/perpig. more prominent with sun.
dx- circular spore or hyphae on koh. spaghetti and meatball appearance
slenium sulfid
viral exanthem
skin associated with viral infection. morbilliform- measles like. scarlatiniform- scarlet fever like- papular, vesicular, petechial
erythema infectious (fifth disease)
fifth grade= school age.
etio: parvovirus B19- respiratory secretion
also see aplastic crisis, prolong anemia, fetal hydrous, miscarriage
P: begin with URI then 1-2 wk bright red macular rash on cheeks = slapped cheek= not contagious. lacy reticular rash, arthralgia
tx: supportive
roseola infantum
gianotti crosti= papular acrodermatitis
varicella
dew drop on rose petal= vesicle on red background. crops of lesions –> crust. fever common. if at risk for complication give acyclovir
herpes simplex 1/2
neonatal. 2/3 by 2. gingivostomatitis - most common HSV in infancy alway by 1. on lip, mouth, tongue. pain on swelling, drooling, fever
grouped vesicles on erythematous base
newborn- scalp contact with mom lesion- sepsis, meningoencephalitis.= emergency
herpetic whitlow- oral lesion + finger sucking= finger lesion
latent in dorsal ganglia- retrigger by sunlight, fever, stress, trauma
dx: tzanck preparation= microscope with direct fluorescent ab or culture base of lesion, pcr if test csf
hand-foot-mouth disease and herpangina
coxsackievirus A16. vesicle papule, pustule. if only oral lesion= herpangina. fever. supportive tx
warts
HPV. ireg, discrete flesh colored papules, smooth or rough. contagious. condylomata acuminata= multiple in genital
spontaneously resolve in 1-2y. liq Nitrogen, recurrence high
molluscum contagiosum
poxvirus. fresh colored papule with central umbilication. on haired skin though face, extremity trunk. contagious. HIV associated. self resolve
ectoparasites
louse infestation or scabies
louse infestation
lice in head/body (pedicures humanus), groin (phthirus pubis). ingest blood. nits- eggs on hair shaft- white oval.
body- papule and pustules
pubic- nits and black crusted papule or blue macule
1% permethrin shampoo, comb
12hr application of 1% benzene hexachloride lotion
scabies
sarcoptes scabiei. pruritic papules or vesicles. itching severe. S shaped burrows. tx- 5% permethrin lotion or 1% lindane. highly contagious
pigmentation D
hypopig, neurocutaneous D, nevocellular nevi
hypopig
postinflm hypopig, pityriasis alba (atopic dermatitis, cheeks), vitiligo (complete loss of pig in patchy area cause by melanocyte destruction, no tx), oculocutaneous albinism- genetic defect in melanin synthesis (photophobia, nystagmus, blue eyes, white skin/hair)- no tx.
Tuberous sclerosis
ash-leaf, angiofirboma= adenoma sebaceum. shagreen patch- orange peel appearance. ungual fibroma. infantile spasm, #1 cuase of neonatal cardiac tumor
NF I
cafe au lait. lis nodules (iris hamartoma)
Nevocelular nevi
congenital: any color papule or plaque detected btw birth-6mo - all have incr risk of ca. giant nevi (>6cm) = high risk of melanoma= excision + observe other nevi
acquired nevi: peak 2-3/11-18. most junctional nevi. risk of ca lower than congenital.
hair disorder
alopecia areata, tinea capitis (common cause of hair loss), traumatic alopecia, telogen effluvium
alopecia areata
AI injury to follicle. complete hair loss in well remarked scalp areas w/o inflm. sudden with smooth skin. pitting nail in 40%. most regrow in 1y. topical CS or minoxidil speed it up.
traumatic alopecia
trichotillomania: perifollicular petechiae and excoriations
traction alopecia: due to friction/ traction of tight hair braids, curlers etc. thinner but few broken hair
telogen effluvium
2nd most common alopecia after male pattern baldness. due to acutely stressful event ~ preg. convert hair from growing phase (anagen) to resting phase (telogen) lose>100/d. spontaneous regrow.
acne vulgaris
most common skin disease. androgen stimulate sebum production - obstructed = comedones –> inflm bc bacteria- propionibacterium acne. benzoyl peroxide good for both inflm and noninfm (black/white heads). systemic isotretinoin (actuate) good for all. but test for preg bc incr teratogenic
atopic dermatitis
eczema. itch that rashes. irritation- scratch- rash
tx: lubricate skin, use anti-inflm in bursts, tx associated skin infection
