Dermatology

Question 1

Pruritic, scaly, erythematous lesions which are usually poorly demarcated

Answer 1

• *Eczematous rashes
  1. atopic dermatitis
  2. nummular eczema
  3. seborrheic dermatitis
  4. Stasis dermatitis (due to venous insufficiency)
  5. Dishydrotic eczema
  6. Contact dermatitis

Question 2

Erythematous, sometimes violaceous, papules and plaques with an overlying scale

Answer 2

• *Papulosquamous rashes
  1. Psoriasis
  2. Lichen planus
  3. PItyriasis Rosea
  4. Tinea corporis
  5. Secondary syphilis
  6. Discoid lupuserythematous

Question 3

Blisters containing non-purulent fluid

Answer 3

Vesiculobullous rashes
Fragile vesicles:
1. Varicella zoster or herpes zoster
2. Herpes simplex
3. Bullous impetigo
4. Pemphigus
5. Contact dermatitis
Non-fragile vesicles (tense, intact blisters)
6. Pemphigoid
7. Bullous SLE
8. Phototoxic drug reaction

Question 4

Blisters contain purulent fluid

Answer 4

• *Pustular rashes
  1. Acne vulargis
  2. If no comedones, acne rosacea, perioral dermatitis
• If infectious in appearance
  3. Folliculitis
  4. Impetigo
  5. Candidasis

Question 5

Erythematous rashes with varying appearances

Answer 5

Reactive rashes

1. Urticaria- itchy macular erythema, often with welts that are transient
2. Erythema nodosum- tender, erythematous nodules on the shins
3. Erythema multiforme- target lesions on palms, soles and mucous membranes.

Question 6

Tx of Tinea capitis

Answer 6

1. Oral griseofulvin 20mg/kg/day (max 1000mg) for 6-8 weeks

Question 7

poorly demarcated areas of hair loss with a smooth appearance to the scalp and no broken hairs

Answer 7

Aloplecia areata

• autoimmune rxn in the hair follicle
• *Tx are not effective

Question 8

anxious child that is constantly pulling at and breaking, pulling out their hair
-Broken hairs will be present and the areas affected are usually around the face and sides of the head.

Answer 8

trichotillomania

Question 9

Tx of trichotillomania

Answer 9

Treatment is aimed at reducing the child’s anxiety.

Question 10

annula hypopigmented lesions appear w/ sun exposure and are very well demarcated

Answer 10

Tinea versicolor

*fungal infection which grows unseen on skin

Question 11

Tx of Tinea versicolor

Answer 11

1. topical antifungals including ketoconazole or selenium sulfide for 2 weeks
   * It takes many weeks for the color to return to the affected areas and patients should be made aware of this.

Question 12

very poorly demarcated areas of hypopigmentation which affect children with darker skin.

Answer 12

Pityriasis Alba

Question 13

Tx of Pityriasis Alba

Answer 13

Treatment is really aesthetic, and consists of encouraging the parents to use sunscreen on the affected area so the distinction in skin pigmentation is not as obvious.

Question 14

The lesions are annular, well-demarcated, and contain small broken hairs

-Some children, usually of African ancestry, can present with small areas of hair loss, with broken hairs (along part lines), due to traction hair breakage from tight braids or similar hair styles

Answer 14

Tinea capitis

*fungal infection almost exclusively seen in children of african ancestry

Question 15

Occasionally, the Tinea capitis will worsen and the child will develop a___, a fluctuant mass in the area of hair loss, with pustules visible.

Answer 15

kerion

Question 16

Compare Tinea Corporis vs Nummular eczema

Answer 16

Tinea corporis- central clearning

• begin as a solid, annular lesion before it grows large enough for the center of it to have clear skin
• present <1 week
• Very contagious

Nummular eczema: chronic lesions

BOTH: pruritic

Question 17

Tx of tinea corporis

Answer 17

1. topical antifungals such as ketoconazole for 2 weeks

2. keep lesions covered w/ clothing bc it is very contagious to other areas of skin

Question 18

Describe the initial presentation of atopic dermatitis

Answer 18

• 1st step in the atopic march
• can get superimposed bacterial infection

1. begins on face in infancy and later spreads to extremities

Question 19

Tx of atopic dermatitis

Answer 19

1. educate about chronicity of the condition (frustrating for parents to clear up skin only to have it recur again)
2. short baths a few times a week, daily moisturizing (even when skin is clear) with emollients like Lubiderm or Vaseline
3. topical steroids for 14 days (lowest potency) when the skin is rough and red (active flare)
   * apply topical steroid first and then emollient on top
4. oral anti-pruritics (Diphenhydramine and hydroxyzine) in affected patients as the more they scratch, the worse the rash will become

Question 20

Do not use higher potency topical steroids, other than low potency, on the face and skin folds in atopic dermatitis as overuse/overdose does lead to __

Answer 20

skin striae

Question 21

What should you use if atopic dermatitis/ eczema become infected

Answer 21

oral cephalexin or topical mupirocin x 7 days

Question 22

What is the cause of impetigo

Answer 22

GAS or staphylcoccus

*Fairly common in children

Question 23

-Honey-colored crusts typically around nose and mouth

Answer 23

Impetigo

Question 24

Tx of impetigo

Answer 24

• *Highly contagious but is difficult to cover due to spots typically involved (mouth and nose)
  1. educate about good handwashing to prevent spread
  2. Oral cephalexin or dicloxacillin or topical muprirocin x 7 days
• *Children are contagious until they have completed 24 hours of antibiotics so they need to be out of school during this time

*Note that dicloxacillin is 4x/day dose, foul-tasting and in a fairly dilute solution (read: have to take lots of it!) so I avoid it. I prefer to use oral cephalexin over topical mupirocin, especially in younger children. The oral antibiotic avoids the spread of the infection due to its systemic effect, while the topical treatment may require the family to “chase” new lesions as the child spreads the infection around.

Question 25

How do you tx Bullous impetigo

Answer 25

the organism and tx are the same as impetigo

The use of topical mupirocin might be a nice option in this case because the child’s skin will be covered by a diaper, preventing them (in theory) from spreading the infection to other areas

*almost exclusively occurs in diaper babies

Question 26

Diaper rash with macular erythema to the central portion of the rashed area with the erythematous annular lesions on the periphery. The annular lesions are referred to as ___ and indicate the spreading margins of a the infection with candidiasis.

Answer 26

satellite lesions

Question 27

Tx of candidal diaper rash

Answer 27

1. nystatin ointment or cream for 7 dyas
2. check mouth fro thrush (often occur together)
3. expose the skin to air when txing as the moist environment of the diaper impedes recovery (careful for mishaps)

Question 28

Tx of contact dermatitis diaper rash

Answer 28

1. hydrocortisone 1% cream or a diaper rash ointment such as Desitin or AandD
2. with a question of satellite lesions, I would probably treated with hydrocortisone and nystatin together for 7 days.
3. expose the skin to air when txing as the moist environment of the diaper impedes recovery (careful for mishaps)

Question 29

With contact diaper dermatitis when there is skin breakdown from diarrhea or new diapers, etc., it isn’t unusual to get a secondary infection with ___, so don’t hesitate to treat for it.

Answer 29

candidiasis

• Examine closely to be sure you aren’t missing a bullous impetigo.
• a hydrocortisone cream or Desitin ointment would be very helpful to heal this skin.

Question 30

Mongolian spots occur almost exclusively on children with __

Answer 30

darker skin tones.

Question 31

• a well-demarcated “birth mark” look to them or more of a “bruise” look
• occur on lower back and buttocks

Answer 31

Hyperpigmentation/Mongolian spot

Question 32

How do you assess Hyperpigmentation/Mongolian spot

Answer 32

1. Because they can sometimes look like bruises, you can always press on the spots if you are concerned. Any child with this extent of a black and blue bruise would certainly protest them being pressed on, whereas mongolian spots are not painful.
   * typically fade as child gets older

Question 33

• Clustered, salmon colored papule w/ an umbillicated center

- Can occur anywhere on the body

Answer 33

Molluscum Contagiosum

Question 34

Molluscum contagiosum is a __ skin infection common in ___

Answer 34

viral

young children, usually under the age of 7 years.

Question 35

Tx of Molluscum contagiosum

Answer 35

1. untxed- the immune system will attack the viurs and the lesion will resolve in about 1 yr (parents are sometimes not willing to wait that long)
2. 1-2 tx of liquid nitrogen spaced about 2 weeks apart (The treatment is painful, and do to the age of the kids, can be a significant challenge)
3. Studies have shown that duct tape application is effective at “irritating” the lesions causing them to resolve. It requires nightly application for several weeks.

Question 36

What is scabies

Answer 36

• mite infestation, which is highly contagious among household contacts
• caused by the immune system responding to the fecal material of the scabies mite being deposited under the skin

*The patient will have been infected about a week before the first rash occurs, allowing time for the immune system to respond to foreign material– In subsequent infestations, however, the rash will develop very quickly due to immune response memory.

Question 37

Compare the presentation of scabies in older children/adults vs infants

Answer 37

older: lesions are most commonly on the hands and around the waist, although over time they can spread to other places on the body. They are usually small papules with “burrows” connecting the papules.
- It is an intensely itchy rash.

Infants: larger papules, often no appearance of burrows and a predilection to infect the axilla and chest.
- It is an intensely itchy rash/irritable due to itch

*Ask about household contacts with a similar rash as that is an important clue to scabies infestation.

Question 38

Tx of scabies

Answer 38

1. tx all household members w/ 10% permethrin lotion, applied chin to toes, esp. under fingernails (sleep w/ lotion on and then shower it off in morning)
2. All bedding and clothing that has been worn since the infestation needs to be laundered in hot water.
   - A second treatment and laundering should occur 1 week later.
3. Patients should know that it takes up to 2 weeks for the rash to resolve as they skin needs to heal once the scabies mite has been eliminated.

NOTE: treating a scabies rash with hydrocortisone, thinking it is a contact dermatitis or inflamed bug bites, will improve the rash as it tames the inflammatory reaction to the scabies. This may confuse the picture in later visits when the parents or patient report that the rash improved with hydrocortisone.

Question 39

Describe the contagiousness of head lice

Answer 39

It is not highly contagious and doesn’t fly around, but young kids do play closely together and often exchange coats and hats, leading to a spread of lice.

*common in elementary school aged children

Question 40

How can you estimate how long a child has had lice?

Answer 40

Lice lay their eggs (tiny oval drops) very close to the scalp end of the hair shaft, so it is possible to estimate the length of time the child has had head lice by how far out on the hair shaft, the egg is attached
-Hair grows about a centimeter per month

ex. nits about 1.5cm out from the scalp, indicate an infestation starting about 6 weeks ago
* This becomes important as parents sometimes find nits that are 6cm out on the hair shaft and are concerned about a recurrent infestation. -As long as there are no nits closer to the scalp to indicate a new infestation, the nits are dead leftovers from the previous infestation

Question 41

Tx of head lice

Answer 41

1. 1% permethrin creme rinsed (Nix, Rid) combed through dry hair then rinsed and shampooed 10 minutes later
2. Then use nit comb to remove dead lice and as many eggs as possible
   * *It isn’t necessary to remove all eggs
3. repeat tx a second time in 7 days
4. bedding and clothing need to be washed, furniture vacuumed, brushes, items which annot be washed hair ties sealed into bags for 2 weeks
5. The laundry and vacuuming need to be repeated after the 2nd crème rinse treatment. It is not necessary to use lice sprays, etc. on furniture, toys, etc.

Question 42

Why is a second head lice tx indicated for 7 days after initial tx

Answer 42

Some eggs will survive the neurotoxic crème rinse treatment because the developing nit has not yet developed a nervous system that can be affected. However, once that nit hatches, it will be in a larval state not yet able to reproduce but very susceptible to the neurotoxic crème rinse. Therefore, it is imperative that patients are treated a second time in 7 days. Most lice treatment failures are caused by skipping the second treatment.

Question 43

Consider ___ as a cause of urticaria

Answer 43

GAS pharyngitis

*ask about sore throat and fever

Question 44

Tx of urticaria in peds

Answer 44

• symptomatic
  1. Benadryl at 5mg/kg/day divided q6hrs – usually effective at complete resolution in about 24 hrs
  2. Non-sedating antihistamines such as Loratatdine, certirizine, etc. when sedation is an issue (QD dosing)

Question 45

a sandpaper, sunburn looking rash is present on the groin

-soft palate petechiae

Answer 45

Scarlet fever w/ GAS pharyngitis

Question 46

tx of Scarlet fever

Answer 46

• same as GAS pharyngitis
  1. Amoxicillin x 10days w/ 2nd line tx in those who are allergic, consisting of cephalexin

*pts are contagious until they have completed 24hrs of tx so they have to stay home from school until so

Question 47

Fifths disease AKA ___ is caused by __

Answer 47

Erythema infectiosum

Parvovirus

Question 48

Children usually present with a facial rash, known as “slapped cheek”, or with the lacy, macular rash pictured here on their arms and/or legs.

• It is usually faintly pruritic.
• They are otherwise well appearing but may have a history of a vague, slightly febrile illness preceding the rash by about 1 week. The rash on the arms and legs will become more erythematous with exposure to warmth such as a bath

Answer 48

Fifth Disease (Erythema Infectiosum)

Question 49

Tx of Fifth Disease (Erythema Infectiosum)

Answer 49

At the time the rash appears, the children are no longer contagious and treatment of the rash is purely supportive. Their prodromal illness was their time of contagiousness

*there is not tx

Question 50

___ has significant implications if the child has exposed a pregnant woman during their prodromal illness so be sure to mention this to parents. The pregnant woman needs to contact her OB provider to advise them of her exposure and seek their guidance for testing and follow-up.

Answer 50

The parvovirus of Fifth Disease

Question 51

Parvovirus causes:

Answer 51

1. Fifths dz
2. Roseola Infantum (almost exclusively in children less than 2y/o)

• At the time they present with rash, they are actually almost finished with the virus.

Question 52

Presentation of Roseola infantum

Answer 52

1. fever (high: 102-104)
2. irritability (for 2-4 days)
3. erythematous posterior pharynx
4. and/or erythematous TMs
5. 1-2 days after fever defervesces, child develops a face and neck rash which is maculopapular spreading rapidly to their trunk (well appearing at this time w/ good appetite)

*The child may have been placed on antibiotics for these findings, and when their rash appears, are thought to have an allergic reaction.

Question 53

Tx of Roseola Infantum

Answer 53

1. no tx is needed
2. The child is contagious until the rash completely resolves. However, most older children have had this virus and so have immunity, so the only concern is exposure of other young children.

Question 54

lesions are elliptical, slightly raised and rough feeling. They are usually faintly pruritic. They may distribute across the trunk in a downward, diagonal pattern known as the “christmas tree distribution”.

Answer 54

Pityriasis Rosea

*pts often develop a single lesion called “herald patch” although this is often difficult to ascertain as they don’t present for care until they have mulitple lesions

Question 55

Tx of pityriasis Rosea

Answer 55

1. no specific tx- resolve in a couple weeks

* generally though to not be contagious

Question 56

What is hand, foot, and mouth syndrome and who does it usually effect?

Answer 56

1. caused by cocksackie virus- extension of herpangina

2. effects kids <6y/o

Question 57

Presentation:

• fever (<102) w/ sore throat and mouth lesions, sometimes spreading out to the perioral area
• painless vesicular lesion on palms and soles
• diapered babies tend to get lesion in the diaper area and down their thigh

Answer 57

Hand, foot, and mouth

*mouth lesions are painful but hand/feet ones aren’t

Question 58

Tx of Hand, foot, and mouth syndrome

Answer 58

1. supportive w/ ibuprofen or acetaminophen for pain

2. pts are contagious until all the vesicles and mouth blisters have resovled

Question 59

when measuring derm lesions use ___

Answer 59

metric system (cms and mms)

1in= 2.54 cm

Question 60

describe the presentation of 1st degree burns

Answer 60

1. superficial erythema of the epidermins w/ a warm and dry surface
2. tender to palpation

Question 61

tx of 1st degree burns

Answer 61

1. minimal w/ cool soaks or compresses to reduce surface temp.
2. use acetaminophen or ibuprofen for discomfort
3. use of OTC burn creams is controversial as they don’t usually speed up healing or greatly improve acute sx

Question 62

describe the presentation of 2nd degree burns

Answer 62

1. deep erythema of the epdiermis and partial dermis
2. appears as warm, wet, “shiny” surface and blisters are usuallly present
3. if blisters are larger than 1cm they are called bulla (smaller ones are called vesicles)

Question 63

__ burns are the most common from hot liquids. They are usually painful with and without palpation and treatment varies based on location and size of the injury

Answer 63

Scalding

Question 64

tx of 2nd degree burns

Answer 64

1. cooling the surface of the skin
2. bulla should be left intact to prevent infection, but if bulla becomes too painful or cumbersome, it can be drained but leave the outer layer intact
3. use topical ABX creams (ie. silver sulfadizaine- Silvadene) — used short term if pt does not have sulfa allergy

Question 65

A ‘blister’ greater than 1cm is called a __.

Answer 65

bulla

Question 66

describe the presentation of 3rd degree burns

Answer 66

1. full thickness burns as they go through the dermis and affect deeper tissues
2. result in white or black, charred skin that may be numb or do not cause pain as they damage nerves
3. skin that is dry and leathey and skin appearance can change to black, white, brown or yellow
4. peripheral tissue can be edematous

Question 67

tx of 3rd degree burns

Answer 67

• depends of pt age, general health, and additional injuries and severity of burn
• Burn severity is determined by the amount of body surface affected, where on the body the burn is located and the depth of the burn.
• usually require inpatient management

Question 68

___ is characterized by pruritic papules and vesicles on an erythematous base.

Answer 68

Acute allergic contact dermatitis

*. Individuals with allergic contact dermatitis typically develop the condition within a few days of exposure, in areas that were exposed directly to the allergen

Question 69

Acute allergic contact dermatitis lesion can be caused by many different stimuli but the most common triggers are:

Answer 69

1. poison ivy- often causes linear lesions and possible bulla
2. metal allergy from jewlery
3. belt buckles
4. jean buttons/snaps

Question 70

Describe the chemical that causes allergic contact dermatitis from poison ivy

Answer 70

Urushiol

*There is a misconception that the bulla fluid contains urushiol and you can spread the lesions if the fluid comes into contact with intact skin. This is untrue. Once the skin has been washed and no urushiol remains, the dermatitis is mediated by an induced immune response. Urushiol acts as a hapten, leading to a Type IV hypersensitivity reaction.

Question 71

vascular reaction of the skin marked by the transient appearance of smooth, slightly elevated papules or plaques (wheals) that are erythematous and that are often attended by severe pruritus. Individual lesions resolve without scarring in several hours.

Answer 71

Uritcaria (hives)

*Acute urticaria is generally diagnosed based on a detailed patient history and physical examination

Question 72

urticaria may be confused with a variety of other dermatologic diseases that can be similar in appearance and are pruritic, including

Answer 72

1. atopic dermatitis,
2. maculopapular drug eruptions,
   3 contact dermatitis,
3. insect bites,
4. erythema multiforme,
5. pityriasis rosea, and others.

Question 73

Hallmark features of urticaria

Answer 73

1. papules/plaques/wheal that are erythematous
2. a lack of epidermal change,
3. the intense pruritus,
4. the complete blanching of the lesions with pressure, and
5. are the transient nature of the lesions

Question 74

Tx of urticaria

Answer 74

1. Management centers around antihistamines and
2. ice packs and
3. few cases require oral glucocorticoids (prednisone).

Question 75

Types of immune mediated urticaria

Answer 75

1. The type I allergic immunoglobulin response is initiated by antigen-mediated IgE immune complexes that bind and cross-link receptors on the surface of mast cells and basophils, thus causing degranulation with histamine release.
2. The type II allergic response is mediated by cytotoxic T cells, causing deposits of immunoglobulins, complement, and fibrin around blood vessels. This leads to urticarial vasculitis.
3. The type III immune-complex disease is associated with systemic lupus erythematosus and other autoimmune diseases that cause urticaria.

Question 76

Non-immune mediated urticaria (complement-mediated) includes

Answer 76

1. viral and
2. bacterial infections,
3. serum sickness, and
4. transfusion reactions.

Question 77

___ is a soft tissue infection around a fingernail that begins as cellulitis but may progress to a definite abscess.

Answer 77

Paronychia

Question 78

Describe the cause of the 2 types of paronychia

Answer 78

Acute: caused by staphylococci

Chronic: caused by fungal infection

Question 79

tender, swollen, erythematous and fail fold w/o fluctuance, nail plate becomes thickened and discolored w/ pronounced transverse ridges and cuticles and nail folds may separate from the nail plate, forming a space for the invasion of various microorganisms

Answer 79

Chronic paronychia

Question 80

painful, purulent, erythematous and swollen area (pus may collect under the skin of the lateral fold)

Answer 80

Acute paronychia

Question 81

Tx of acute paronychia

Answer 81

1. warm soaks 3-4 times daily
2. short course of Abx
3. if abscess has developed, incision and drainage must be performed

Question 82

Tx of chronic paronychia

Answer 82

1. avoidance of inciting factors such as exposure to moist environment or skin irritants
2. keep affected lesion dry (essential for proper care)
3. Any manipulation of the nail, such as manicuring, finger sucking, or attempting to incise and drain the lesion, should be avoided; these manipulations may lead to secondary bacterial infections.
4. Mild cases of chronic paronychia may include the application of topical antifungal agents. Topical miconazole may be used as the initial agent. Oral ketoconazole or fluconazole may be added in more severe cases.
5. Patients with diabetes and those who are immunocompromised need more aggressive treatment because the response to therapy is slower in these patients than in others.

Question 83

__ , or ingrown nail, usually involves the great toenail.

Answer 83

Onychocryptosis

Question 84

Anatomic and behavioral factors that contribute to ingrown toenails

Answer 84

1. improper trimming
2. repetitive or inadvertent trauma
3. genetic predisposition
4. hyperhidrosis
5. poor foot hygiene

Question 85

Patients will present with a toe that has minimal to significant erythema, tenderness to severe, disabling pain and some will have purulent drainage.

Answer 85

Onychocryptosis, or ingrown nail,

Question 86

Tx of Onychocryptosis, or ingrown nail,

Answer 86

1. soaking foot in warm, soapy water
2. placing cotton wisps or dental floss under the ingrown nail edge and gutter splinting
3. Surgical approaches: partial nail avulsion or complete nail excision w/ or w/o phenolization

*Most of these treatments can be done in a primary care setting or for patient with recurrent cases may be referred to podiatry.

Question 87

__ is a fungal infection of the toenails or fingernails that may involve any component of the nail unit, including the matrix, bed, or plate

Answer 87

Onychomycosis

Question 88

Sx of Onychomycosis

Answer 88

1. complaints about appearance of nail w/o physical sx
2. as dz progresses, they may complain about interfrence w/ standing, walking, exercising, paresthesia, pain, discomfort, and loss of dexterity as well as loss of self esteem

Question 89

Management of Onychomycosis

Answer 89

1. fungal culture- ID organism and guide tx: . Clippings are taking from the affected area and sent to an appropriate lab.
   - Fungal cultures usually take 3-6 weeks before an organism is identified.
2. topical Ciclopirox olamine 8% nail lacquer solution and oral terbinafine.
3. Non-surgical management options may include laser treatment or mechanical, chemical, or surgical nail avulsion, which are usually done in a podiatry clinic.

Question 90

vesicular lesions in different stages of development on the face, trunk, and extremities.

Answer 90

Varicella/ chicken pox

Question 91

a painful, unilateral vesicular eruption, which usually occurs in a restricted dermatomal distribution
-erythematous papules, which quickly evolve into grouped vesicles or bullae on an erythematous base. Within three to four days, these vesicular lesions can become more pustular or occasionally hemorrhagic.

Answer 91

Varicella zoster

*The thoracic and lumbar dermatomes are the most commonly involved sites of herpes zoster.

Question 92

When are shingle lesions no longer considered infectious

Answer 92

after 7-10 days when the lesions crust over

*The development of new lesions more than a week after presentation should raise concerns regarding possible underlying immunodeficiency.

Question 93

A more serious infection of shingles such as ____, can result from involvement of the ophthalmic branch of the trigeminal cranial nerve. These can be sight-threatening infections and need prompt referral to an ophthalmologist.

Answer 93

zoster keratitis or zoster ophthalmicus

Question 94

Describe the prodrome pain of shingles

Answer 94

• occurs in 75% of pts in the dermatome where the rash subsequently appears
  1. constant or intermittent and preceeds rash by days to weeks
  2. deep burning or stabbing or itching
  3. some only have pain when the area is touched

Question 95

Postherpetic neuralgia (PHN) refers to

Answer 95

1. pain persisting beyond four months from the initial onset of the rash.
2. Sensory symptoms can include pain, numbness, dysesthesias, and allodynia in the affected dermatome.
3. Immunosuppressed patients have a higher incidence of PHN.

Question 96

Tx of zoster

Answer 96

1. Antiviral therapy should be initiated within 72 hours of onset of symptoms to maximize the potential benefits of treatment.
   - Begin antiviral therapy after 72 hours of symptoms onset only if new lesions are appearing at the time of presentation, as this indicates ongoing viral replication.
2. There is likely minimal benefit of antiviral therapy in the patient who has lesions that have encrusted.
3. If lesions have developed a bacterial infection, initiate antibiotics.
4. Pain management w/ Tylenol or narcotics
5. TCAD or gabapentin for PHN

Question 97

___ is the most common cutaneous disorder affecting adolescents and young adults.

Answer 97

Acne vulgaris

*Post-adolescent acne predominantly affects women, in contrast to adolescent acne, which has a male predominance.

Question 98

Typically, acne vulgaris occurs on areas of the body with hormonally-sensitive sebaceous glands, including:

Answer 98

face, neck, chest, upper back, and upper arms.

*Open comedos, closed comedos, and inflammatory papules, pustules, or nodules may be seen. The term “cystic acne” is a misnomer, as true cysts are rare in acne vulgaris. Adult women may present with lower face and neck acne associated with premenstrual flares.

Question 99

Tx for mild acne vulgaris

Answer 99

1. OTC medications, such as benzoyl peroxide or topcial retinoid

Question 100

Tx for moderate acne vulgaris

Answer 100

BP + Abx or
BP + retinoid or
BP + Abx + retinoid

Question 101

__ is a common chronic skin disorder most commonly characterized by well-demarcated erythematous plaques with silver scale.

Answer 101

Psoriasis

*Although psoriasis can begin at any age, the disease is less common in children than adults. There seem to be two peaks for the age of onset: one between the ages of 30 and 39 years and another between the ages of 50 and 69 years.

Question 102

Presentation of chronic plaque psoriasis

Answer 102

1. symmetrically distrubted cutaneous plaques- plaques are erythematous with sharply defined margins that are raised above the surrounding normal skin (1-10cm in diameter)
2. scalp, extensor elbows, knees and back are MC
3. The extent of involvement can range from limited localized disease to involvement of the majority of the body surface area. Involvement of intertriginous areas (inverse psoriasis), the ear canal, umbilicus, palms, soles, or nails also may be present
4. In patients with dark skin, post-inflammatory hyperpigmentation may be a prominent feature. A thick silvery scale is usually present,

Question 103

The ___, which describes the development of skin disease in sites of skin trauma, may occur in patients with chronic plaque psoriasis.

Answer 103

Koebner phenomenon

Question 104

Describe the presentation of Guttate Psoriasis

Answer 104

1. ABRUPT appearance of multiple small (<1cm) psoriatic papules and plaques
2. tunk and prox. extremitie are the primary sites
3. occurs typically in someone w/o hx of psoriasis–> strong association w/ recent streptococcal infection (usually pharyngitis)

Question 105

Describe the tx of Guttate Psoriasis

Answer 105

1. may spontaneously remit, typically over the course of several weeks to several months, may intermittently recur, or may persist and progress into chronic plaque psoriasis.
   * Given the possibility for spontaneous remission of guttate psoriasis within several weeks or several months, foregoing treatment is an option for patients who prefer to avoid therapy.
2. First-line treatments include phototherapy and topical agents.

Question 106

Nail disease is more common in patients with __ and may be one of the strongest clinical predictors for concomitant [__]

Answer 106

psoriatic arthritis,

psoriatic arthritis

Question 107

___ is a common cancer arising from malignant proliferation of epidermal keratinocytes.

Answer 107

Cutaneous squamous cell carcinoma (SCC)

Question 108

Where does SCC most commonly occur?

Answer 108

Fair skinned: sites frequently exposed to the sun.

In black individuals: legs, anus, and areas of chronic inflammation or scarring

Question 109

___ typically presents as a well-demarcated, scaly patch or plaque. Lesions are often erythematous but can also be skin colored or pigmented.

Answer 109

Cutaneous SCC in situ (Bowen’s Disease)

*SCC in situ lesions tend to grow slowly, enlarging over the course of years. Unlike the inflammatory disorders that may resemble SCC in situ, lesions are usually asymptomatic. These lesions are managed by a Dermatologist.

Question 110

__ is the most common skin cancer in the United States.

Answer 110

Basal Cell Carcinoma (BCC)

*Sun exposure is the most important environmental cause of BCC, and most risk factors relate directly to a person’s sun exposure habits or susceptibility to solar radiation. These risk factors include having fair skin, light-colored eyes, red hair, northern European ancestry, older age, childhood freckling, and an increased number of past sunburns

Question 111

What are the 3 different groups of BCC

Answer 111

1. Nodular 60%
2. Superficial
3. Morpheaform

Question 112

Presentation of Nodular BCC

Answer 112

1. present on the face as a pink or flesh-colored papule.
2. has a pearly or translucent quality and a telangiectatic vessel is frequently seen within the papule.
3. often described as having a “rolled” border, where the periphery is more raised than the middle.
4. Ulceration is frequent, and the term “rodent ulcer” refers to these ulcerated nodular BCCs.
   * BCC’s are excised and treated through Dermatology.

Question 113

Describe the ABCDE’s of detecting Melanoma

Answer 113

1. Asymmetry (if a lesion is bisected, one half is not identical to the other half)
2. Border irregularities
3. Color variegation (brown, red, black or blue/gray, and white)
4. Diameter ≥6 mm
5. Evolving: a lesion that is changing in size, shape, or color, or a new lesion

Question 114

Where do men and women most commonly get Melanoma

Answer 114

Men have more lesions on the back and women on their lower legs since these are common areas of sunburn and sun exposure; screening of those sites as well as the scalp and soles of the feet could aid early detection.

Question 115

Individuals at increased risk of developing a melanoma include:

Answer 115

1. Hx of previous melanoma
2. Individuals with a large number of nevi and/or many clinically atypical nevi
3. strong FHX of melanoma
4. Individuals with the familial atypical multiple mole melanoma syndrome
5. Organ transplant recipients
6. Very sun-sensitive individuals and/or those with “red hair phenotype”