Dermatology Flashcards

1
Q

flat spot less than 1cm (non-palpable, just visible)

ex:freckles, tattoos

A

macule

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2
Q

flat spot>1cm

ex:port wine stain

A

patch

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3
Q

solid, elevated lesion

A

papule

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4
Q

same as papule but >!cm and flat-topped

ex: psoriasis

A

plaque

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5
Q

palpable, solid lesion >1cm, not flat-topped
ex: small lipoma
erythema nodosum

A

nodule

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6
Q

elevated circumscribed lesion

A

vesicle

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7
Q

same as vesicle but >5mm (large blister)

ex. contact dermatitis, pemphigus

A

bulla

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8
Q

Itchy, transiently edematous area

ex:allergic reaction

A

wheal

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9
Q

erysipelas

A

upper dermis
superficial lymphatics

may appear raised with clear line of demarcation

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10
Q

cellulitis

A

deeper dermis

subcutaneous fat

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11
Q

risk factors for erysipelas and cellulitis

A
chronic skin problems
diabetes mellitus
chronic swelling of LE
IV drug use
immunocompromiased state
penetration of skin (surgery/trauma)
previous cellulitis
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12
Q

Diagnosis and labs in cellulitis and erysipelas

A

Clinical diagnosis
increased WBC count, ESR, CRP
blood cx

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13
Q

Common organisms in cellulitis

A
  1. beta- hemolytic strep
    s. pyogenes, group B strep
  2. s. aureus common in abscesses
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14
Q

How do we treat cellulitis

A

non-purulent cellulitis:
PO- dicloxacillin
cephalexin
clindamycin

IV- cefazolin
nafcillin
clindamycin

purulent cellulitis:
PO- clindamycin
TMP-SMX
Doxycycline
Linezolid

IV abx-
vancomycin

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15
Q

Skin abscesses

A

collection of pus within dermis and deeper skin tissues

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16
Q

Furuncle (boil):

A

infection of hair follicle
purulent material extends through dermis into subQ tissue

often drains spontaneously

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17
Q

Carbuncle

A

coalescence of several inflamed follicles

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18
Q

Diagnosis of abcess, furuncle, carbuncle

A

clinical

culture is indicated for bacterial idenfication
-s.aureus in 75% of cases

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19
Q

Treatment of skin abscess

A

let the pus out

if large,
incision and drainage
for patients at risk of endocarditis: vancomycin 1hr prior to incision and drainage

oral: clindamycin, tmp-smx, doxycycline, linezolid

IV: vancomycin

antibiotics are often unsuccessful because you need to get the pus out

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20
Q

Hidradenitis suppurative

A

recurrent infection/occlusion of apocrine glands

MC site: axilla

Tx:
-general measures: avoid skin trauma, gentle cleansing, smoking cessation, weight loss

-mild disease: topical clindamycin daily, punch debridement

second line: clindamycin with rifampin

severe disease: oral doxycycline or minocycline, more invasive surgical debridement
-alternative treatments: intralesional steroids, anti-adrenergic drugs, TNFa inhibitors, oral retinoids

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21
Q

necrotizing fasciitis

A

infection spreading along fascial plane

polymicrobial- anaerobes, gram +, gram -
GAS
often in the setting of some systemic disease

H and P:
unexplained, excrutiating pain in the absence of or beyond areas of cellulitis

bulla, necrosis, crepitus

Dx: surgical exploration is the only way to definitively diagnose, as well as to treat

rapidly worsening cellulitis with severe pain

Xray: crepitus, subcutaneous air can be seen with plain film on an xray

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22
Q

Fournier gangrene

A

perineal cellulitis with abrupt onset and rapid spread

this is a urological emergency

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23
Q

What is the general treatment for necrotizing fasciitis?

A

immediate aggressive surgical debridement

abx:
1. carbapenem (imipenem or meropenem)
or beta-lactam plus beta-lactamase inhibitor (piperacillin +tazobactam)
PLUS
2. clindamycin
PLUS
3. vancomycin

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24
Q

Gangrene

A

significant amounts of body tissue necrosis

a chronic condition compared with necrotizing fasciitis

dry gangrene (chronic, distal, severe ischemia) treat with revascularization or allow auto-amputation

wet gangrene: bacterial infection in moist tissue: debridement, possible amputation

gas gangrene: caused by clostridium perfringens

  • debridement
  • hyperbaric oxygen
  • antibiotics
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25
Impetigo
contagios skin infection among young children s. aureus is MCC (MSSA) s. pyogenes vesicles that form and rupture to form thick crust, most commonly on the face Treatment: mild- mupirocin moderate-severe: dicloxacillin, cephalexin MRSA: clindamycin, TMP-SMX, doxycycline
26
Acne vulgaris
1. hyperkeratosis - retinoic acid (tretinoin) - isotretinoin is PO, potent 2. sebum overproduction - isotretinoin - tretinoin - spironolactone (anti-androgen, decreases testosterone and cortisol) - OCP 3. propionibacterium acnes proliferation - erythromyicin PO - tertracycline PO - doxycycline PO - minocycline PO - clindamycin PO - topical clindamycin - benzoyl peroxide 4. inflammation - steroids affecting areas that have hormonally- sensitive sebaceous glands
27
isotretinoin side effects
``` hepatotoxicity teratogenic drying and cracking of skin and lips depression elevated TG ```
28
Acne drugs that can cause photosensitivity
tetracycline doxycycline tretinoin
29
Rosacea
cause is not understood inflammation, UV damage, vascular damage middle- aged patient facial erythema with telangiectasias starting at nose and cheeks recurrent facial flushing provoked by various stimuli including hot/spicy foods, alcohol, temperature extremes, emotional reactions no comedones, but otherwise looks a little like acne ocular blepharitis, conjunctivitis, keratitis bumpy nose (sebaceous gland hyperplasia)- rhinophyma Topical treatment: - metronidazole - azeleic acid Systemic treatment: - tetracycline, doxycycline, minocycline - isotretinoin for severe refractory cases - laser therapy for rhinophyma
30
HSV
recurrent viral infection of mucocutaneous surfaces HSV1- oral disease viral genetic disease in sensory areas cold sores every month, every 5 years small painful vesicles around the mouth, lasting several days eyes, esophagus Herpetic whitlow- cutical, painful Dx: Tzanck smear on a q-tip viral culture serology Tx: treats symptoms, can't be cured acyclovir famciclovir valacyclovir contagious even when you don't see lesions Vertical transmission can cause disseminated disease Newborns can get herpes temporal lobe encephalitis
31
Varicella
primary disease- chickenpox secondary- shingles clinical features: prodrome of malaise, fever, pharyngitis, HA, myalgia for 24 hours prior to rash onset pruritic evolving rash with teardrop vesicles, crusting over face, trunk, extremities, spreads over 2-4 days, crusted over by 6 days superinfection may occur (s. pyogenes) adults may develop PNA or encephalitis
32
Treatments for children with chickenpox?
antihistamines for pruritis cut fingernails closely to avoid excoriations leading to bacterial superinfections acetaminophen for fever no need for acyclovir in otherwise healthy children younger than 12 acyclovir if: - >12yo - hx of chronic cutaneous or cardiopulmonary disorders - taking intermittent oral or inhaled steroids - chronic salicylates prevention: varicella vaccina now given at 1 year and 4 years old
33
Shingles
reactivation of herpes zoster virus painful, grouped vesicles in a dermatomal distribution postherpetic neuralgia possible transmission through direct contact with active lesion (not as transmissible as chickenpox) ``` treatment: antivirals if presenting within 72 hours -valacyclovir -famciclovir -acyclovir: high dosing frequency but low cost ``` Analgesia with opioids Corticosteroids (prednisone tapered over 7 days) only if severe symptoms and no contraindications. Usually the high risk of side effects outweighs the only modest benefits. ppx: shingles vaccine for everyone over 50 year do not give to pregnant women, or immunocompromised
34
Treat postherpetic neuralgia
months, years, fades over time ``` gabapentin pregabalin TCAs lidocaine patches capsaicin cream ```
35
Acne treatment
``` benzoyl peroxide topical retinoid or antibiotic oral antibiotic OCPs spironolactone isotretinoin ```
36
Rosacea treatment
topical metronidazole or azeleic acid laser therapy systemic treatment: - tetracycline - doxycycline - minocycline - isotretinoin
37
Warts
benign epithelial growths caused by HPV 1-4 (skin) Genital warts HPV 6 and 11 Treatment options for cutaneous warts: - 2/3 resolve spontaneously within 2 years - salicylic acid (first line) - liquid nitrogen - 5-FU and imiquimod - curettage, trichloroacetic acid, cantharidin (blister juice from beetles), surgical excision
38
Molluscum contagiosum
seem most commonly in children | adults with HIV, perineal region
39
tinea versicolor
- malassezia furfur - hypopigmented or light brown or pink macules often found on back and shoulders - hyphae and spores (spaghetti and meatballs) seen microscopically will scale when scraped ``` Treatment: ketoconazole 2% shampoo topical antifungal (terbinafine) selenium sulfide PO antifungal for extensive disease (ketoconazole, fluconazole, itraconazole) dandruff shampoo can also be affective ```
40
Tinea
``` capitis (scalp) corporis (body) cruris (groin) pedis (foot) unguium (nails) ``` caused by microsporum, trichophyton, epidermophyton pruritic, erythematous, blisters, scaly plaques, central clearing diagnose with KOH, hyphae present Treatment: SKIN- topical (clotrimazole, terbinafine, nystatin) PO- (terbinafine, itraconazole, fluconazole) Scalp: PO (griseofulvin, terbinafine, itraconazole, fluconazole) Nails: PO (terbinafine, itraconazole, fluconazole); topical (cilcopirox, efinaconazole) check LFT before starting these meds
41
Intertrigo
candida albicans looks like diaper rash common in skin creases irritant dermatitis by contrast, won't have satellite lesions, and won't be as much in the folds KOH shows pseudohyphae Treat with topical clotrimazole or terbinafine
42
Scabies
RF: crowded living conditions poor hygiene Severe pruritis with burrows and papules located on extremities and between fingers and toes Skin scrapings will show mites and eggs under microscope treat with permethrin cream diphenhydramine and corticosteroids help with itching wash everything in hot water infection of close contacts is a common complication
43
lice and crabs
diagnosis by direct visualization all cause pruritis Pediculosis capitis: - treat with permethrin cream or shampoo, rinse after 10 minutes, then comb out lice and nits - alternatives: topical malathion or ivermectin Pediculosis corporis: body louse -treat with permethrin cream and leave on for 8-10 hours Pediculosis pubis: groin lice - Treat with permethrin or pyrethrin cream and rinse out after 10 minutes, and then comb - Alternatives: topical malathion and ivermectin - sexually transmitted
44
Hypersensitivity reactions in the skin (mainly 1 and 4)
Type 1: mast cell degranulation: IgE, immediate allergy Type 4: delayed type, cell-mediated immune memory response Morbilliform rash days after 2nd exposure to allergen Common causes: plants, nickel, soaps, latex ``` Stop offending agent remove contact with allergen topical steroids oral antihistamines oral corticosteroids IM epinephrine ```
45
Erythema multiforme
erythema multiforme: deposition of immune complexes into superficial microvasculature and mucous membranes often a drug reaction (PCN, sulfonamides, NSAIDs, PO contraceptives, anticonvulsant medications) HSV and mycoplasma pneumoniae are common infectious causes that can lead to erythema multiforme Appearance: skin lesion, target, pale zone, darker outer ring can be anywhere lesions develop over 10+ days: macule> papule> vesicles/bullae in the center of the papule common sites: hands/forearms, sole/feet, elbows and knees, penis and vulva Severe form (EM major) always involves the mucuous membranes and can become SJS/TEN
46
Treatment for erythema multiforme
stop inciting medication symptomatic treatment with antipruritics if severe- systemic glucocorticoids (although no proven effectiveness) if patient also has history of HSV, then antiviral such as acyclovir or valacyclovir
47
SJS and TEN
SJS is severe EM, always involves mucous membranes | skin sloughs,
48
TEN
>30% of BSA full-thickness epidermal necrosis treat in a burn unit IV fluids Labs: decreased H/H increased ALT, AST IV hydration acyclovir
49
Seborrheic dermatitis
chronic relapsing dematitis a/w sebacious glands possible cause is malassezia furfur erythematous plaques with greasy- looking, yellowish scales Treatment: scalp: medicated shampoo (ketoconazole, selenium sulfide, ciclopirox); alternative is tar- containing shampoo skin: low-potency topical steroids or topical antifungal cream (ketoconazole)
50
What diseases are a/w increased incidence of seborrheic dermatitis?
Parkinson, HIV, psoriasis, immunocompromised patients (transplant patients) Exacerbations are common in emotional stress and hospitalizations Severe intractable seborrheic dermatitis may point to HIV infection
51
Seborrheic keratosis
various presentations, variable size, pasted on no treatment needed dark warty
52
Actinic keratosis
precancerous lesion a/w sun exposure
53
Atopic dermatitis
oozing, crusty often found in children asthma allergies dry vesicles treatments: skin hydration: emollients topical steroids calcineurin inhibitors: tacrolimus or pimecrolimus severe or resistant cases: UV light therapy, systemic steroids, immunosuppressants (methotrexate, cyclosporine, azathioprine) antibiotics for open lesions (cover s.aureus and streptococcus)
54
side effects a/w calcineurin treatment
lymphoma | keep duration short
55
psoriasis
immune- mediated red plaques on knees and elbows pustules silvery scales clinical diagnosis skin biopsy: thickened epidermis absent granular layer nucleated cells in stratum corneum are you having joint pain as well? check for arthritis
56
psoriasis treatment
mild to mod disease: - topical steroids and emollients - alternatives: tar-nased products, topical retinoids (tazarotene); topical vitamin D (calcipotriene), anthralin, calcineurin inhibitors (tacrolimus, pimecrolimus) Severe disease: - phototherapy - oral retinoids - immunosuppressants (methotrexate, cyclosporine) - adalimumab, etanercept and infliximab
57
Pityriasis rosea
benign, self- limited inflammatory disease, in children or young adults with possible viral association, seen on trunk herald patch: 2-5 cm, precedes christmas tree, pink, confirm lack of hyphae with KOH prep clinical diagnosis ``` Treatment: self- limiting moderate-potency topical steroid for pruritis severe disease: UV therapy acyclovir erythromycin ```
58
Erythema nodosum: cause SPUD BITS
shins, trunk, etc delayed immunologic reaction to drugs, infection, IBD ``` Streptococcal infection Pregnancy Unknown (idiopathic) Drugs Behcet disease Inflammatory bowel disease Tuberculosis Sarcoidosis ``` ``` H and P: malaise arthralgia tender erythematous nodules (pretibial) fever ``` Labs: possible +ASO increased ESR Bx: fatty infiltration ``` Treatment: self- limited NSAIDs potassium iodid corticosteroids ```
59
Lichen planus
pruritic purple polygonal plaque, shiny and flat, commonly on the flexor surface (wrist, etc) Wickham's striae is a white, lace-like pattern on the surface of the papules/plaques Mucous membrane involvement: Wickham's striae in the lateral buccal mucosa and possibly erosive lesions that may become infected with Candida Genital involvement: usually limited to violaceous papules on the glans penis in men, vulva of women RF: HIV Hep C Treatment: corticosteroids of medium to high potency (topical or intralesional, oral if topical is unsuccessful) acitretin (oral retinoid)
60
Decubitus ulcers
stage 1: pressure-related, change in color, skin intact stage 2: superficial ulcer stage 3: full thickness with damaged tissue stage 4: full thickness with damage to muscle, etc ``` Treatment: good nutrition and hydration remove pressure on ulcer debridement wound care antibiotics ```
61
Stasis dermatitis
RF: chronic venous insufficiency. LE eczematous, inflammatory papules, increased pigmentation, stippling, old hemorrhages clinical diagnosis venous reflux is confirmed using duplex ultrasound
62
Treatment for stasis dermatitis
``` weightloss compressive dressings of stocking leg elevation topical steroids vein ablation ```
63
Medications most commonly associated with erythema multiforme
``` penicillins sulfonamides OCPs NSAIDs anticonvulsants ```
64
EM vs. SJS vs. TEN
EM: milder disease no sloughing of skin SJS: skin-sloughing limited to 30% of BSA
65
Psoriasis- what does it look like?
red plaques with silvery scales extensor surfaces Auspitz sign
66
classic presentation of erythema nodosum
pretibial nodules within subcutaneous fat | -painful and erythematous
67
classic presentation of pityriasis rosea
herald patch, followed by rash in Christmas tree patten no treatment needed
68
classic presentation of lichen planus
pruritic, purple, polygonal, plaques and papules on flexor surfaces of extremities
69
Pemphigus vulgaris
flaccis, easy to rupture blisters, +Nikolsky almost always with oral lesions antibodies in epidermis anti-desmosome antibody Tx: high dose systemic steroids, azathioprine or mycophenolate mofetil (steroid-reducing adjuvant) antibiotics for 2ndary infection fatal without treatment
70
Bullous pemphigoid
tense bullae rare oral lesions (10-30%) antibodies found at dermal- epidermal junction antihemidesmosomes, with better prognosis than pemphigus topical steroids (clobetasol) PO steroids (prednisone) if topical steroids aren't possible chronic management: mycophenolate mofetil azathioprine methotrexate
71
Porphyria cutanea tarda
deficiency in uroporphynogen decarboxylase porphyrin accumulates acute porphyria -nervous system:neuropathy, abd pain, mental disturbances cutaneous porphyria: -excess porphyrins near the surface of the skin risk factors: hepatitis C, alcohol abuse, excess iron classic presentation: blistering lesions chronic skin thickening on sun-exposed areas, hyperpigmentation, calcification, facial hypertrichosis diagnosis: elevated urinary porphybilinogen diagnosis: elevated plasma porphyrins treatment: phlebotomy hydroxychloroquine avoidance of sun, alcohol, estrogens, iron supplements
72
Actinic keratosis
precancerous skin lesion RF: sun exposure erythematous papule with rough, yellow-brown scales biopsy: dysplasia Treatment: topical 5-FU, imiquimod, cryotherapy 0.1%/year risk of squamous cell carcinoma
73
Squamous cell carcinoma
skin cancer of squamous cells of epithelium RF:sun exposure, arsenic exposure, fair complexion, radiation- especially UVB painless, well-demarcated, scaly patch or plaque, erythematous, scaling Treatment: surgical excision (Mohs), radiation 5-10% metastesize
74
Basal cell carcinoma
mc skin cancer least likely to metastesize pearly papule rolled edges treatment: surgical excision (Mohs), radiation, cryotherapy
75
Melanoma
malignant melanocyte tumor RF: sun exposure, fair complexion, family history, numerous nevi Types: -superficial spreading is most common, grows laterally before vertically (back on men, legs on women) -nodular: only grows vertically and becomes invasive rapidly -acral lentiginous: least common, found on palms, soles, and nail beds lentigo maligna: slow growth, 10-50 years before vertical growth Labs: excisional biopsy shows atypical melanocytes and possible invasion into the dermis (>.76 mm is associated with increased risk of metastasis) Treatment: 0.5 cm margin if in situ 1cm margin if 2mm thick +/- lymph node dissection chemotherapy and radiation if metastasis Most commonly mets to brain, lung, GI tract periodic skin checks if history of sun exposure or family history of melanoma
76
ABCDE of melanoma
``` Asymmetry Border irregularity Color Diameter >6mm Evolving ``` Do not shave; excisional biopsy
77
Most important prognostic indicator in melanoma
depth of lesion
78
BCC appearance
pearly papule telangiectasias rolled edges if ulcerated
79
Squamous cell carcinoma appearance
papule or ulcer scaling or keratinization irregular or disorderly appearance either painless or painful
80
split-thickness graft
graft composed of epidermis and part of the dermis abdomen, thighs, buttocks extensive, large surface areas
81
full-thickness graft
face and hand defects
82
composite graft
fat, nailbed, etc, site-speficit reconstructions are the indication
83
fasciocutaneous flap
skin+subQ tissue+vascular supply donor sites: forehead, groin, deltopectoral region, thighs indicated for large defects
84
muscle flap
may include skin (myocutaneous) donors: TFL, gluteal muscle, lat indications- deep tissue injury, radiation injury
85
Melasma
dark skin discolration common in pregnant women and those taking OCPs or hormone replacement therapy Tx by minimizing sunlight exposure and sunscreen titanium and zinc oxide Triple combo cream: tretinoin, hydroquinone, mid-potency topical steroid (flucinolone)
86
What are characteristic features of vitiligo
sharply demarcated patches of complete depigmentation (due to loss of melanocytes) - borders are hyperpigmented - more common at acral areas and around body orifices Skin is of normal texture (excludes morphea and lichen sclerosis) Associated with thyroid disease in 30% of patients (especially women) mo most common age 20-30
87
Autoimmune disorders associated with vitiligo
``` GRaves autoimmune thyroiditis pernicious anemia type I DM primary adrenal insufficiency hypopituitarism alopecia areata autoimmune hepatitis ```
88
Treatment for vitiligo
sunscreen to minimize tanning of normal skin, which would increase the contrast dyes and make-up to camofluage depigmented area topical corticosteroids (first line) Tacrolimus or pimecrolimus (calcineurin inhibitors) Psoralens (topical or oral) + UV light (PUVA or UVB) for extensive disease surgical mini-grafting is an option when medical therapy fails hydroquinone for depigmentation of normal skin to match regions of vitiligo (ast resort)
89
Acanthosis nigricans
velvety hyperpigmentation most commonly seen on lateral folds of axilla, neck, groin associated with hyperinsulinemia and visceral maligancies Treat underlying disorder: diabetes weightloss discontinuation of medication (glucocorticoids, OCPs), or treatment of malignancy Tretinoin (topical) Calcipotriene (Vit D topical analog)
90
blue mass that does not regress
cavernous hemangioma (venous malformation)
91
Treatment for infantile hemangioma
uncomplicated infantile hemangiomas will gradually resolve within the frist 2 years of life, therefore observation is usually the best treatment Complicated infantile hemangiomas: oral propanolol, systemic glucocorticoids, vincristine, interferon alpha
92
Clinical features of alopecia areata
asymptomatic, inflammatory, non-scarring areas of complete hair loss may be precipitated by stress regrowth after 1st affack in 30% by 6 months, in 50% by 1 year, in 80% by 5 years 10-30% will not regrow hair 5% progress to total hair loss ``` obtain syphilis screen CBC BMP ESR TSH ANA (to rule out pernicious anemia, chronic active hepatitis, thyroid disease, SLE, Addison) ``` Rule out trichotillomania (pulling out one's hair): look for broken hair shafts of different lengths, consider shaving a small patch oand observe over a few weeks for growth ``` Treatment: intralesional steroid injection topical corticosteroids minoxidil topical topical immunotherapy anthralin cream (children) oral steroids ```
93
What name is given to diffuse stress-related hair loss? | What is the treatment?
Telogen effluvium self- limited reassurance, stress relief
94
androgenic alopecia
causes are both hormonal and genetic dihydrotestosterone causes follicular miniturization leading to replacement of terminal hairs by short, thin hairs inheritance involves both paternal and maternal factors Treatment: Finasteride (5alpha-reductase inhibitor) Minoxidil (topical)
95
Caused by complete lack of melanocytes
vitiligo
96
Hair loss associated with effects of dihydrotestosterone on hair follicles
androgenic alopecia
97
Most common co-morbidity in vitiligo
TSH
98
purple-red lesion on face that does not regress with age
port wine stain
99
infant with bright red lesion that regresses over months-years
strawberry hemangioma
100
benign, small papule that appears on skin with age
cherry hemangioma
101
bright red papule with radiating blanching vessls
spider angioma
102
blue, compressible mass that does not regress
cavernous hamengioma
103
red-pink nodule on a child that is often confused with melanoma
Spitz nevus
104
anti-centromere abs
CREST scleroderma