Dermatology Flashcards
What is cellulitis? Treat or refer?
Cellulitis is an infection near a break in skin. You must refer to PCP so it can be treated with oral antibiotics.
How does cellulitis present?
red, swollen, warm area of skin likely near a break
This topical skin disorder is common in kids, spread by direct contact, and requires PCP referral for oral antibiotics.
impetigo (topical staph skin infection)
How is pediculosis treated? (5 different options)
permethrin 1%, oral ivermectin, spinosad, topical ivermectin, malathion
Describe the presentation of scabies.
raised, red areas of skin that cause extreme pruritus – refer to PCP
What are the treatment options for scabies?
permethrin 5%, crotamiton cream, oral ivermectin
Herpes zoster most often present in patients who are > _____ y.o. with a history of ____________.
40, chicken pox infection
Describe the presentation of herpes zoster and what can trigger it.
presents as tender red papules that progress to scabs – can be triggered by stress, old age, immunosuppression
How is herpes zoster treated?
oral antivirals (valacyclovir) and some tx for acute postherpetic pain (opioids, gabapentin)
Of the three kinds of skin cancer, which is the most common? the most deadly?
most common - BCC
most deadly - melanoma
Which kinds of patients are most at risk for developing skin cancer?
fair skinned, light eyes, light hair (red or blonde)
Where does xerosis most often present?
feet and lower extremities, hands, elbows, face
What is first-line treatment for xerosis?
emollients (help with itching and restoration of skin)
if ineffective, recommend alteration of bathing habits
What are Dr. Martin’s rules of 3’s?
(1) bathe NMT 3x/week
(2) use tepid water 3-5 degrees above body temperature
(3) bathe for 3-5 minutes
(4) apply emollients w/in 3 minutes of showering
(5) apply emollients 3x daily
What are some agents a patient can use to reduce itching if emollients are ineffective?
methol/camphor
pramoxine (anesthetic)
hydrocortisone (anti-inflamm)
aluminum acetate 0.2%
Differentiate between acute, subacute, and chronic dermatitis.
ACUTE: red patches or plaques that may blister, itchiness
SUBACUTE: more dry than red, crusting, oozing, skin beginning to thicken
CHRONIC: thickening, lichenification, scaling, less itching
Differentiate between allergic and irritant acute contact dermatitis.
allergic: immunologic response to some antigen
irritant: non-immunologic reaction from frequent contact with everyday substances
Topical therapy is okay for poison ivy treatment if NMT ___% of BSA is involved.
10
What factors must be taken into account when determining whether to treat or refer a poison ivy patient?
extent of damage, amount of body area affected
What are the benefits of soaks in treatment of acute dermatitis?
In oozing, weeping, crusting lesions, soaks not only help control symptoms, but can help dry out the area as well. Use wet dressings in acutely inflamed/wet areas.
What directions should you give patients for wet dressing use?
apply to linen or cheese cloth and put on until dry BID-QID, take off and replace with dry dressing
What method can be used to enhance penetration of topical corticosteroids?
occlusion: apply then cover with plastic wrap and a bandage or shirt, leave on for 6 hours
Which grades of topical steroids are safest for long-term maintenance use?
grades 5-7 (hydrocortisone, desonide)
Give some examples of mid-potency (grade 3-5) steroids.
betamethasone, triamcinolone, mometasone
What are some examples of high potency (grades 1-2) steroids?
clobetasol, halobetasol, fluocinolide
What are the advantages and disadvantages of using topical calcineurin inhibitors for dermatitis?
adv: no risk of atrophy, equivalent to mid-potency steroids, fewer side effects
disadv: very high cost, only indicated for short-term use due to malignancy risk
Why are steroid dose packs not useful in treatment of dermatitis?
do not provide treatment for long enough – will need at least 10-14 days of treatment
What is the atopic triad?
atopic dermatitis, asthma, allergic rhinitis
What is the clinical presentation of atopic dermatitis?
pruritus (most common sx)
red papules or plaques
scaling/redness/inflammation
dryness
What are common triggers of atopic dermatitis?
detergents, linens, allergens, smoke, dust, infections, frequent bathing
What are the non-pharmacological methods for treating atopic dermatitis?
lukewarm/tepid baths
elimination of triggers
emollients
bleach baths if extreme
What are the pharmacological treatments of atopic dermatitis?
topical CS/calcineurin inhibitors, phototherapy, immunosuppressants
Poor circulation is the most common cause of _______ ________ is patients greater than 50 y.o.
stasis dermatitis
How does stasis dermatitis typically present?
red, scaly, crusting swellings, discomfort, hyperpigmentation
How is stasis dermatitis treated? (think of the sx)
emollients for dryness/itching, topical CS, compression legwear for edema, oral abx for local infection
treatment of chronic dermatitis
same as subacute (emollients, topical CS), UV light
Most topical fungal infections are treated with OTC antifungals, but what conditions would warrant a PCP referral?
systemic symptoms, immunocompromisation
Treatment of diaper rashes
remove irritant, air dry, keep clean, topical antifungals, protectants (apply over anti fungal)
treatment options for seborrheic dermatitis
medicated shampoo (selsun blue, head&shoulders), low strength topical CS
