Dermatology 5% Flashcards
lesh-colored, pink or yellow-brown lesion with a rough sandpaper feel
Occurs on sun-exposed surfaces and is a precursor to squamous cell carcinoma
Actinic keratosis
Treat with observation (many resolve on their own), cryosurgery, 5 FU cream, electrodesiccation or Imiquimod
autoimmune - attack against hair follicles. Onset usually prior to 30 years of age; men and women are equally affected. Well-documented genetic predisposition.
Alopecia areata
Scalp disorder characterized by the thinning or shedding of hair resulting from the early entry of hair in the telogen phase (the resting phase of the hair follicle)
Telogen effluvium
Alopecia is preceded by a psychologically or physically stressful event 6–16 weeks prior to the onset of hair loss.
white waxy lump or a brown scaly patch, raised pearly and rolled borders, telangiectasis, a central ulcer on sun-exposed areas, such as the face and neck
BCC
basal cells
Basal cells produce new skin cells as old ones die. Limiting sun exposure can help prevent these cells from becoming cancerous
How to treat BCC?
fluorouracil (FU) and imiquimod, photodynamic therapy (PDT), and surgical excision with clear margins
autoimmune subepidermal blistering skin disorder caused by linear deposition of autoantibodies (IgG) against hemidesmosomes in the epidermal-dermal junction
(-ve) Nikolsky sign
Bullous pemphigoid is less severe than pemphigus vulgaris, does not affect mucous membranes and has a negative Nikolsky sign
Dx of bullous pemphigoid
Diagnosis is made by skin biopsy with direct immunofluorescence exam shows deposition of IgG and C3 basement membrane
Treat with systemic corticosteroids
large number of pruritic, tense, subepidermal bullae across her upper thighs. There was no mucosal involvement and skin biopsy showed subepidermal bullae filled with eosinophils and neutrophils.
Bullous pemphigoides
treatment for bullous pemphigoides
High-potency topical corticosteroids (eg, clobetasol 0.05% cream) should be used for localized disease and may reduce the required dose of systemic drugs.
Prednisolone (an anti inflammatory agent) and azathioprine (an immunosuppressant) can also be used in the treatment of bullous pemphigoid.
nicotinamide is used in combination with tetracycline or erythromycin to treat bullous pemphigoid
Dapsone Is particularly effective in mucous membrane lesions.
Acute bacterial skin and skin structure infection of the dermis and subcutaneous tissue;
characterized by pain, erythema, warmth, and swelling. Margins are flat and not well demarcated.
Caused by Staphylococcus and Streptococcus in adults
H. influenzae or strep pneumonia in children
Cellulitis
Mild cellulitis treatment MSSA
Cephalexin or Dicloxacillin
How to treat MRSA cellulitis?
Trimethoprim-sulfamethoxazole (TMP-SMZ) 1 DS tab PO BID
Clindamycin 300–450 mg PO
Doxycycline 100 mg PO BID
IV Vancomycin or Linezolid
an indication for workup in patients with suspected cellulitis?
Tachypnea
Flesh-colored, cauliflower appearance genital warts caused by HPV types 6 and 11
Condyloma acuminatum (also known as genital warts or anogenital warts) refers to an epidermal manifestation attributed to the epidermotropic human papillomavirus (HPV)
well-demarcated erythema, erosions, vesicles
contact dermatitis
Allergic: Type 4 hypersensitivity
Nickel, poison ivy
Tx for contact dermatitis?
Avoid offending agent. Burrow’s solution (aluminum acetate), topical steroids, zinc oxide (diaper rash)
Pruritic, eczematous lesions, xerosis (dry skin), and lichenification (thickening of the skin and an increase in skin markings). Most common on flexor creases (ex. antecubital and popliteal folds)
Atopic dermatitis
IgE, Type 1 hypersensitivity
TX with:
Topical corticosteroids and emollients, topical calcineurin inhibitor (ie, tacrolimus or pimecrolimus)
Coin-shaped/disc-shaped
Treat with?
Nummular eczema
Tx: High- or ultra-high potency topical corticosteroids, phototherapy, systemic corticosteroids, methotrexate, cyclosporine
Erythematous, yellowish greasy scales, crusted lesions.
Infants- scalp (cradle cap)
Adults/adolescents- body folds
Seborrheic dermatitis
Scalp: antifungal shampoo
Face: low potency steroid cream
Treatment for seborrheic dermatitis?
Ketoconazole shampoo
What is treatment for perioral dermatitis?
Topical metronidazole
erythromycin
Topical steroids are contraindicated as they may cause flare of lesions
Acrylates and methacrylates have been significantly associated with contact allergy and allergic contact disease
T/F
True
acrylic nail sources and wound dressings represent emerging sources of sensitization. A separate study found that acrylates and methacrylates were significantly associated with allergic contact dermatitis.
Potassium hydroxide preparation or fungal culture is often indicated to exclude tinea in dermatitis of the hands and feet
T/F
T
Potassium hydroxide preparation and/or fungal culture to exclude tinea are often indicated for dermatitis of the hands and feet. This helps identify disorders such as tinea pedis.
why Patients should avoid using topical antihistamines, including topical doxepin w/ contact dermatitis?
because of the risk for iatrogenic allergic contact dermatitis to these agents; additionally, sedation can occur if large amounts of doxepin cream are applied.
Shorter courses of corticosteroids may allow poison ivy dermatitis to relapse
T/F
True
what is contraindicated as treatment for genital warts in pregnancy?
Podophyllum resin
Condylomata acuminata is caused by
HPV
Young women. Papulopustular, plaques, and scales around the mouth.
Treatment
Perioral dermatitis
Treatment: Topical metronidazole, avoid steroids
What is the correct dosage of epinephrine for the actute treatment of anaphylaxis?
epinephrine 0.2–0.5 mg (1:1000 [1 mg/mL] solution) IM every 5–15 min prednisone may be given to prevent recurrence.
a pruritic vesicular eruption comprised of clear, deep-seated vesicles without erythema erupting on the lateral aspects of fingers, the central palm, and plantar surfaces.
Tapioca pudding
dyshidrosis
Tapioca vesicles on hands and feet following stress or hot humid weather
1st line treatment for dyshidrosis
Topical HIGH STRENGTH steroids and cold compress
raised, edematous, circumscribed, hot, erythematous area, with or without vesicles or bullae frequently involving the central face or lower extremity.
Erysipelas
is a type of superficial cellulitis with dermal lymphatic involvement
Looks like cellulitis but it is well-demarcated and caused by group A strep (strep pyogenes)
Must rule out MRSA
primary etiological agent of erysipelas is
Beta-hemolytic streptococcus
MILD Erysipelas Treatment?
Mild can be treated with Penicillin G
Patients with allergy to penicillin can be treated with erythromycin or clindamycin
Moderate erysipelas Treatment>
Trimethoprim-sulfamethoxazole (TMP-SMX)-DS: 1–2 tablets PO BID AND penicillin VK 500 mg PO QID
or
cephalexin 500 mg PO QID
Severe erysipelas treatment?
IV and linezolid 600 mg IV/PO BID or vancomycin IV or daptomycin 4 mg/kg IV q24h.
Skin lesions predominantly involving the extremities (hands, feet, and mucosa). Target-like shape, raised, blanching, and lack of itchiness help characterize this rash.
Erythema multiforme (EM) is an acute, self-limited, and sometimes recurring skin condition that is considered to be a type IV hypersensitivity reaction
ASsociated with:
HSV
Sulfa drugs
The most common cause of erythema multiforme minor is
HSV
EM major (involvement of mucous membranes and systemic signs)
Symptomatic treatment with oral antihistamines and topical corticosteroids for mild cases; mouthwashes or topical steroid gels for oral disease.
EM minor (no mucous membrane involvement and no systemic signs) is usually self-limited
Supportive care
Early treatment with acyclovir may lessen the number and duration of cutaneous lesions for patients with coexisting or recent HSV infection.
The child has had a low-grade fever, headache, and sore throat for the past week. Four days ago, he suddenly developed a bright red rash on his cheeks, which during the past 2 days has spread to the trunk, arms, and legs.
DX
5th disease
MCC: Parvovirus-B19
Diagnosis is based primarily on clinical observations, history, and physical exam
Serology: associated with ENLARGED nuclei with peripherally displaced chromatin
PARVO B19-specific IgM antibodies and PCR
Erythema
Migrans
Lyme disease
Erythema MARGINATUM
Rheumatic fever
Erythema NODOSUM
Mono
Erythema
Infectiosum
Parvovirus-B19 ;
5th disease
MCC of hand foot mouth disease?
Coxsackie VIRUS type A
children< 10 years old with vesicles on pharynx, mouth, hands, feet
sores in the mouth and a rash on the hands, feet, mouth, and buttocks
hand foot mouth disease
The virus usually clears up on its own within 10 days
Treatment is supportive, anti-inflammatories
The 4 C’s - cough, coryza, conjunctivitis and cephalocaudal spread
Measles (Rubeola)
Morbilliform - maculopapular, brick red rash on face beginning at hairline then progressing to palms and soles last - rash lasts 7 days
Measles (Rubeola)
Koplik spots (small red spots on buccal mucosa with blue-white pale center) precedes rash by 24-48 hours.
Measles (Rubeola)
Cephalocaudal spread of maculopapular rash, lymphadenopathy (posterior cervical, posterior auricular)
Rubella
Cephalocaudal spread of maculopapular rash, lymphadenopathy (posterior cervical, posterior auricular)
Rubella
Teratogenic in 1’st trimester - congenital syndrome - deafness, cataracts, TTP, mental retardation
How to differentiate between rubEOLA
vs
rubELLA?
Rubella rash =spread is much more rapid, and the rash does not darken or coalesce
Herpesvirus 6 or 7, only childhood exanthem that starts on the trunk and spreads to the face
Roseola
(6th disease)
High fever 3-5days
then rose pink maculopapular
BLANCHABLE rash on
Trunk–>then face
The lesions are erythematous papules or pustules. They are usually not painful but may burn
Folliculitis
MCC of folliculitis
MCC of hot tub folliculitis
S.aureus
Pseudomonas
Treatment for folliculitits?
1st line:
–Mupirocin ointment
—Topical benzoyl peroxide
Severe folliculitis treatment?
MRSA:
PO ABX: DICLO-xacillin + CEPHALExin
MRSA tx TMP-SMX,
Clinda
or
Doxy
Chronic follicular occlusive disease manifested as recurrent inflammatory nodules, abscesses, sinus tracts, and complex scar formation
Hidradenitis suppurativa
Pea- to marble-sized nodules under the skin that can be painful and tend to enlarge and drain pus.
They usually occur where skin rubs together, such as in the armpits, groin, and buttocks.
Hidradenitis suppurativa
Treatment of
Intralesional triamcinolone is 1’st line treatment
Oral and topical antibiotics, hygiene, warm soaks, and sometimes surgery can help manage symptoms
A highly contagious skin infection that causes red sores on the face
The main symptom is red sores that form around the nose and mouth. The sores rupture, ooze for a few days, then form a yellow-brown crust
“honey-colored” and weeping
Impetigo
MCC impetigo?
Treatment
Complication for impetigo?
S.aureus
Treatment is topical mupirocin, dicloxacillin, cephalexin for more severe illness
Complications: poststreptococcal glomerulonephritis
“grains of sands” on a red base on the buccal mucosa opposite the second molars.
Complication of measles x3
Rubeolla Koplik spot
Measles
- Encephalitis
- Bronchopneumonia
- Otitis media
First sign of measles observed?x2
High fever >104F + Koplik spots
the quickest method of confirming acute measles?
capture immunoglobulin M (IgM) antibody assay
supplementations has been associated with reductions in morbidity and mortality in patients with measles?
Vitamin A
Purple, red, or brown skin blotches are a common sign.
lesions to grow in the skin, lymph nodes, internal organs, and mucous membranes lining the mouth, nose, and throat. It is associated with human herpesvirus 8 and is an AIDS-defining cancer
Kaposi sarcoma
Treatment may include radiation or chemotherapy. Rarely, surgery may be needed
Pruritic scalp, body or groin. Nits are observed as small white specs on the hair shaft
Body (corporis); Pubic (pubis)
LICE
Treat with permethrin 1%
For resistant cases consider oral ivermectin
Screen for other STIs in patients with pubic lice - abstain from sexual contact until the infestation clears
purplish, itchy, flat-topped bumps. On mucous membranes, such as in the mouth, it forms lacy white patches, sometimes with painful sores
Clinically characterized by 5Ps purple, papule, polygonal, pruritus, planar
Wickham striae: whitish lines visible in the papules of lichen planus and other dermatoses
Lichen planus (LP)is a chronic papulosquamous inflammatory dermatosis of unknown etiology, probably autoimmune in origin
–Treatment: Topical steroids
a chronic dermatitis resulting from chronic, repeated rubbing or scratching of the skin. Skin becomes thickened with accentuated lines (“lichenification”). The constant scratching causes thick, leathery, brownish skin
Treatment?
Lichen simplex chronicus
Treatment: Break the itch-scratch cycle (anti-histamines, occlusive dressing)
benign fatty tumors, generally slow-growing, and usually harmless
just under the skin and move easily when pressure is applied. They commonly occur in the neck, shoulders, back, abdomen, arms, and thighs
If the presenting lesion is fast-growing, suspect another diagnosis
Lipomas
Treatment generally isn’t necessary, but if the lipoma is bothersome, painful, or growing, surgical excision or liposuction may be needed
Painless:
solitary, soft, well defined, mucin-filled lesions
Characteristically, they have a smooth surface and a small opening to the surface of the skin, known as a punctum
The term epidermal inclusion cyst refers specifically to an epidermoid cyst that is the result of the implantation of epidermal elements in the dermis
Treatment includes close observation of the tumor in asymptomatic cases and surgical management, if necessary
Usually a pigmented lesion with an irregular border, irregular surface, or irregular coloration
Asymmetrical, unevenly pigmented patch/plaque with a nodule and an irregular border
Melanoma occurs when the pigment-producing cells that give color to the skin (melanocytes) become cancerous
What is prognosis of melanoma strongly associated with?
Prognosis of melanoma is most strongly associated with the depth of the lesion, based on the Clark Classification System of Microstaging
Clark Classification System of Microstaging
Level I to V
I–> confined to epidermis
II–> papillary dermis
III: papilary reticular interface
IV: reticular dermis
V: subQ fat
Treatment of melanoma?
Treatment may involve Mohs surgery, radiation, medications, or in some cases chemotherapy
Skin condition due to ↑ in estrogen during pregnancy or from sun exposure
Appear as dark, irregular, well-demarcated macules/patches,
Melasma
Also known as chloasma = “mask of pregnancy”
In women, melasma often fades on its own after pregnancy or after an affected woman goes off birth control pills
Melasma treatment?
Treat with sunscreen and topical hydroquinone (bleaching agent)
caused by the poxvirus, pearly papules with central umbilication
Molluscum contagiosum
MCC-> POXVIRUS
Treatment: The bumps usually disappear on their own
May be removed with IMIQUIMOD (Aldara)
curettage, cryotherapy, or acid or exfoliative peel - tretinoin,
WORKUP for ONYCHOMYCOSIS
Treatment?
Fungal culture +
KOH prep
Terbinafine x6weeks for fingernails
12 for toenails
What to monitor with antifungal regimens like terbinafine?
LFTs
Superficial inflammation of the lateral and posterior folds of skin surrounding the fingernail or toenail
Caused by candida if chronic
and
staph aureus if acute
Paronychia
Paronychia
Treatment:
Without abscess formation
topical antibiotics and warm water or antiseptic soaks (eg, chlorhexidine, povidone-iodine)
When is paronchyia needs Emperic oral ABX?
in more severe cases: An antistaphylococcal agent such as dicloxacillin (250 mg four times daily) or cephalexin (500 mg three to four times daily) is appropriate first-line therapy
Paronychia with abscess
I & D
tetanus booster prn
An abnormal skin growth located at the tailbone that contains hair and skin
Will usually present as a teenager with pain, discomfort and swelling above the anus or near the tailbone that comes and goes
Often includes drainage of pus or blood
Pilonidal disease
Treatment involves drainage and surgical removal of the cyst - look for sinus tract
Herald patch: Large oval plaque with central clearing and scaly border. 1st sign
pityriasis rosea
Pruritic erythematous plaque with central scale in Christmas tree pattern on the trunk
Langer’s lines (cleavage lines) in a Christmas tree-like pattern.
The rash consists of oval scaly lesions that line up along skin folds (Langer lines); it often resembles a “CHRISTMAS TREE” distribution
Pityriasis rosea is self-limiting and usually lasts for 3-8 weeks and disappears spontaneously
The cause is unknown but is thought to be viral. It is thought to be caused by herpesvirus 7
How to treat pityriasis rosea?
The disease is self-limiting: topical or systemic steroids and antihistamines are often used to relieve itching. Asymptomatic lesions do not require treatment
erythema of localized area, usually non-blanching over the bony surface
Stage I pressure ulcer aggressive preventive measures, thin-film dressings for protection
—partial loss of dermal layer, resulting in pink ulceration
–full dermal loss often exposing subcutaneous tissue and fat
Stage 2
occlusive dressing to maintain healing, transparent films, hydrocolloids
Stage 3
full-thickness ulceration exposing bone, tendon, or muscle. Osteomyelitis may be present
Stage 4 Debridement of necrotic tissue. Exudative ulcers will benefit from absorptive dressings such as calcium alginates, foams, hydrofibers. Dry ulcers require occlusive dressing to maintain moisture, including hydrocolloids, and hydrogels.
a well-demarcated, erythematous plaque with silvery scaling. Patients may also present with no rash and only joint symptoms - pain in both hands and nail changes such as pitting and onycholysis
Psoriasis is an immune-mediated disease that causes raised, red, scaly patches to appear on the skin
What is Auspitz sign?
and
Kobner’s phenomenon associated with?
Psoriasis Auspitz sign (bleeds when the scale is picked), Koebner’s phenomenon (minor trauma causes new lesion)
Psoriasis Vulgaris: most common. Noted on extensor surfaces
Guttate Psoriasis: children, after URI. small lesions
Inverse Psoriasis: intertriginous areas.
Pustular Psoriasis: contains pustules
How to treat psoriasis?
Mild
Severe
Topical steroids
Vitamin D analogs
when severe, methotrexate, oral retinoids, immunomodulatory agents (biologics), or immunosuppressants.
How to Dx psoriasis?
Diagnosis is based on appearance and distribution of lesions.
Biopsy is confirmatory and will be consistent with Plaque psoriasis
Elevated: ESR + Serum uric acid levels
women aged 30-50,
facial erythema, telangiectasias, papules, may cause rhinophyma.
Triggers include heat, alcohol, spicy foods
Rosacea
Differentiate from acne by lack of comedones (blackheads)
treat with topical metronidazole
Pruritic papules. S-shaped or linear burrows on the skin. Often located in web spaces of hands, wrists, waist with severe itching (worse at night)
what is the common site?
SCABIES
WRist is common site
How to treat scabies?
Treat with topical permethrin 5%, all clothing bedding, towels washed and dried using heat and have no contact with body for at least 72 hours
Oral ivermectin
waxy “stuck-on” appearance.Most common benign skin tumor seen in fair-skinned elderly patients with prolonged sun exposure
Brown, black, or tan growth with waxy, “stuck on” appearance, commonly referred to as barnacles of old age
Seborrheic keratosis is not premalignant and needs no treatment unless the lesions are irritated, itchy, or cosmetically bothersome
Necrotic wound - Local tissue reaction causes local burning at the site for 3-4 hours → blanched area (due to vasoconstriction) → central necrosis erythematous margin around an ischemic center “red halo” → 24-7 hours after hemorrhagic bullae that undergoes Eschar formation → necrosis
Brown violin on the abdomen
Brown Recluse: = necrotic
How to treat brown recluse bite?
Treatment:
For brown spider bites, use wound care, local symptomatic measures, and sometimes delayed excision
Neurologic manifestations - May not see much at bite site:
–toxic reaction: nausea, vomiting, HA, fever, syncope, and convulsions
Black Widow:
Red hourglass on the abdomen
How to treat black widow bite?
For black widow spider bites treatment includes wound care, local symptomatic measures, sometimes parenteral opioids, benzodiazepines.
Treat with anti-venom available for elderly and kids
serious hypersensitivity complex that affects the skin and the mucous membranes.
begins with a prodrome of flu-like symptoms, followed by a painful red or purplish rash that spreads and blisters. Layers of skin peel away in sheets (+) Nikolsky’s sign (pushing blister causes further separation from dermis)
SJS
Stevens-Johnson syndrome (SJS) is a milder form of toxic epidermal necrolysis (TEN) with LESS THAN 10% of body surface area detachment
Treatment: Treat the underlying cause and supportive (burn unit)
A highly contagious, fungal infection of the skin or scalp. KOH - long, branching fungal hyphae with septations
Tinea infections
-papules pustules, around hair follicles
–Athlete’s Foot: pruritic scaly eruptions between toes. Trichophyton rubrum is the most common dermatophyte causing athlete’s foot
Tinea Barbae
Treatment: Oral antifungal therapy is necessary - two- to four-week course of griseofulvin microsize (500 mg per day) or oral terbinafine
Tenia PEDIS
Topical antifungals - azoles (1% clotrimazole, 2% ketoconazole),
–“Jock Itch” diffusely red rash in the groin or on the scrotum
-(ringworm): usually seen in younger children or in young adolescents with close physical contact with others (i.e. wrestlers)
Tinea Cruris:
Topical antifungals - azoles (1% clotrimazole, 2% ketoconazole)
Tinea corporis:
Topical azole antifungals (1% clotrimazole, 2% ketoconazole) or 1% terbinafine cream
Most common fungal infection in the pediatric population. Occurs mainly in prepubescent children (between ages 3 and 7 years). Asymptomatic carriers are common and contribute to spread
Tinea capitis:
Systemic therapy warranted to penetrate hair shaft Oral griseofulvin (Drug of Choice):
caused by Malassezia furfur, a yeast found on the skin of humans. Lesions consist of hypo or hyperpigmented macules THAT DO NOT TAN
A 20-year-old male with no significant past medical history presents complaining of patchy tanning. He states that he has been out in the sun without a shirt several times. Areas on his chest and back just don’t tan, and he is becoming self-conscious
Tinea versicolor: short hyphae and clusters of spores (“spaghetti and meatballs”)
Treatment: selenium sulfide 2.5% applied to affected skin for 10 minutes.
Wash off thoroughly. Apply daily for 7–10 days. Monthly applications may help prevent recurrences
Candidiasis: budding yeast, pseudohyphae
A rare, life-threatening skin condition that is usually caused by a reaction to drugs
TEN is > 30% of body
in toxic epidermal necrolysis older patients
Confirm the diagnosis by biopsy
how to treat SJS/TEN?
treat SJS/TEN in a burn unit and with intensive supportive care
Consult ophthalmology if the eyes are affected
Cyclosporine and possibly plasma exchange for severe cases
blanchable, pruritic, raised, red, or skin-colored papules, wheels or plaques on the skin’s surface
(+) Darier’s sign:
Urticaria Angioedema: painless, deeper form of urticaria affecting the lips, tongue, eyelids hand and genital
If anaphylaxis give epinephrine: 0.3–0.5 mg
localized urticaria appearing where the skin is rubbed (histamine release)
(+) Darier’s sign:
a rare, lifelong hereditary disorder characterized by chronic infection with HPV
Epidermodysplasia verruciformis
The most ugly warts on bilateral feet picture
Loss of skin color can affect any part of the body, including the mouth, hair, and eyes. It may be more noticeable in people with darker skin
Vitiligo is caused by autoimmune destruction of melanocytes causing these pigment-producing cells to die or stop functioning
Wood’s light exam: a “milk-white” fluorescence over the lesion
Vitiligo Sharply demarcated ivory white patches
How to treat vitiligo?
Treat with sunscreen, cover-up, corticosteroids, tacrolimus (an immunosuppressive drug), and vitamin D
Treatment may improve the appearance of the skin but doesn’t cure the disease
