Dermatology Flashcards by Jenny Schreiber

“Neutrophilic abscess” on biopsy of a skin lesion is?

Dermatitis herpetiformis (celiac skin manifestation)

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Best way to treat dermatitis herpetiformis?

Remove gluten from diet

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Pathology of bullous pemphigoid?

antibodies against hemidesmosomes (detached from basement membrane)

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Pathology of pemphigus vulgaris?

antibodies against desmosomes (intra epithelial lesions)

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Treatment for pemphigus vulgaris?

Steroids (if life threatening IVIG)

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Blistering disease that involves the mucosa?

pemphigus vulgaris (oral mucosa)

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Treatment for bullous pemphigus?

systemic steroids

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Blisters that easily tear - what is the sign called and which one has it?

Nikolsky sign = pemphigus vulgaris

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Best way to diagnose dermatitis herpetiformis?

diagnose celiac sprue (antibodies and egd) - NOT biopsy (but if you do and it says neutrophilic abscess = dermatitis herpeteformis)

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Bullae on sun exposed regions, dx?

porphyria cutanea tarda (pt is also hairy!)

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How do you diagnose porphyria cutanea tarda?

coral red urine under Wood’s lamp; 24-hr urine collection for uroporphyrins

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What conditions are associated with porphyria cutanea tarda (4)?

1) hemochromatosis; 2) hep C; 3) EtOH; 4) OCPs

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Nail pitting - dx?

Psoriasis

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What is seborrheic dermatitis in an infant referred to as?

Cradle cap

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Symmetric, well-demarcated silvery scales - dx?

Psoriasis

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Workup for pityriasis rosea? Tx?

Clinical (may do RPR to rule out syphilis); none, self limiting

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Treatment for lichen planus?

topical steroids

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Treatment for psoriasis?

UV light is first line; topical steroids sparingly; oral steroids for severe disease (then can think about immune modulators like tacrolimus)

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Flat salmon-colored macule?

herald patch = pityriasis rosea (then more will pop up and they will scale but the scaling does not reach the border - called a trailing scale)

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Intensely pruritic raised purple lesion with thin white lines on the surface - dx?

lichen planus

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Treatment for seborrheic dermatitis?

selenium shampoo (it’s a fungal infxn)

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Red rash on the eyebrows and scalp - dx?

Seborrheic dermatitis

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Treatment of eczema in a child?

Avoid triggers (removal of foods - likely allergen to food)

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Dry, itchy, red rash on the extensor surfaces of a child?

Eczema

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Volume overload with a hyperpigmented rash where fluid accumulates?

stasis dermatitis

Rash in the shape of a shoe sandal?

contact dermatitis

What type of hypersensitivity reaction is contact dermatitis?

Type IV

Rash in the shape of a watch?

Contact dermatitis

Treatment for stasis dermatitis?

Compression stockings, leg elevation

Who gets hand dermatitis and what's the tx?

people who wash too much (health care or food service worker); moisturizers and avoidance of harsh soaps

Circular raised red lesion after a bee sting - dx?

Urticaria

Treatment for SJS or TENS?

Remove ALL medications, do NOT give steroids, treat supportively as if burn pt

Every time a sulfa drug is started the pt gets a dot on his thumb, dx and tx?

fixed drug eruption; don't need to do anything, it's okay to give pt drug (just may be annoying to them)

Treatment for SSSS (staphylococcus scalded skin syndrome)?

Clindamycin

What % BSA differentiates SJS from TENS

SJS is less than 10% BSA, and TENS is greater than 30%

First thing to do if you see anaphylaxis?

SubQ Epi!!!

When does a drug reaction occur? How do you tx?

7-14 days after drug exposure; diphenydramine

What type hypersensitivity reaction is urticaria?

Type 1 (IgE induced mast cell degranulation leading to histamine release leading to leaky capillaries)

Targetoid lesion on palms and soles = ?

syphilis or erythema multiforme

What is Bowen's disease?

Squamous cell carcinoma in situ (it is midway between actinic keratosis and full on SqCC)

Erythematous with yellow or brown scale in a person who loved the sun, dx?

squamous cell carcinoma

A black lesion on the lower lip of a pt who likes being in sun, dx?

squamous cell carcinoma

What does ABCDE stand for?

``` Asymmetry Border irregularity Color mixed Diameter large (gt 5mm) Evolving ```

How do you diagnose melanoma?

wide excisional biopsy

Treatment for actinic keratosis?

local = cryoablation; diffuse = 5-FU

Brown, greasy lesion, on some old guy's face = ?

Seborrheic keratosis

Treatment for Kaposi's sarcoma (first line)?

HAART

Squamous cell carcinoma that suddently got better on its own, dx?

Keratocanthomas (can't tell difference btwn it and SqCC until biopsied)

What is the SqCC ulcers called that fail to heal?

Marjolin's ulcer

Diagnosis of vitiligo?

Biopsy shows no melanocytes annd wood's lamp shows no pigment

Hypopigmented macule that lights up on Wood's lamp in a child = ?

Ash leaf spot, think tuberous sclerosis

Patchy discoloration of varying color (both dark and light) = ?

Tinea versicolor (Malassezia furfur)

Treatment for tinea versicolor?

Selenium sulfide (and/or ketoconazole)

You find an ash leaf spot, what do you do?

Get a CT scan to find tubers in brain

Spaghetti and meatballs on KOH prep - dx?

Tinea versicolor (hyphae and spores)

Total lack of pigment - dx?

Albinism

Absent pigmentation on wood's lamp = ?

Vitiligo

How do you diagnose tinea capitis?

KOH prep for fungal assessment (Wood's lamp doesn't work)

Exclamation point sign (thinner hair by the scalp) and alopecia - dx?

Alopecia areata (autoimmune disease!)

Treatment for tinea capitis?

Oral griseofulvin (oral because if you don't tx it could permanently lose hair)

Treatment for male pattern baldness in a woman (2 options)?

OCPs and/or spironolactone

Treatment for alopecia areata?

steroids

Patchy alopeica with hair in different lengths of regrowth - dx?

Trichotillomania

Treatment for male pattern baldness?

Minoxidil topically, finasteride orally (choose minoxidil first)

Circular, well defined bald spot, dx?

alopecia areata (give steroids) or tinea capitis (give anti-fungals) - make sure to r/o fungal infxn

Tx for chemotherapy induced hair-loss?

None (wig)

What organism cuases acne?

Propionibacterium acnes

Erysipelas is __ infxn in __. Treatment for erysipelas?

Strep; lymphatics (shaped like tracks or lines); amoxicillin

You're going to start someone on isotretinoin; you must first?

Rule out pregnancy (it's teratogenic)

First line tx for impetigo? What if 1st line doesn't work for impetigo?

Amoxicillin (or mupirocin if local); clindamycin (go after staph!)

What is the 4 pronged ladder for treating acne?

Comedones = topical retinoids Inflamed comedones = topical retinoids + benzoyl peroxide Severe pustular = oral abx (doxy) Resistant disease = isotretinoin

Which two tinea infxns require oral tx and what is the tx?

Onychomycosis = terbinafine Tinea capitis = griseofulvin (the rest can have topical antifungals)