Dermatology Flashcards
dermatologic terminology
MAD:
Morphology - type of individual lesion
- primary lesion: macule, patch, papule, plaque, nodule, vesicle, bulla, pustule
- secondary lesion: crusts, erosions, ulcers, fissures, scars, scale
Arrangment - solitary, grouped, linear
Distribution - where located on body
skin cancer risk factors
fair complexion light hair/eyes hx of blistering sunburn (child) inc. sun exposure family hx
actinic keratosis (solar keratosis) - characteristics and tx
pre-malignent lesion
- can transition to squamous cell carcinoma
sun-exposed areas (ears, face)
small, lightly pigmented
rough to touch (scaly, flaky)
tx: cryosurgery (liquid nitrogen)
- 5-fluorouracil (Efudex)
- imiquimod (Aldara)
squamous cell carcinoma - characteristics
arises from actinic keratosis
varied appearance: usually sun-exposed areas; can slowly erode
- if lasting over 1 month, consider SCC until proven otherwise
cure rates high if treated
can have METS
Bowen’s disease
squamous cell carcinoma (SCC) in situ - confined to original location (no METS)
squamous cell carcinoma - treatment
excision is best treatment
basal cell carcinoma - characteristics and tx
slowly enlarging nodule with central depression and pearly border
- 90% on head and neck (sun-exposed areas)
- telangiectasias (tiny blood vessels)
- bleeding common
- metastasis rare
tx: surgical excision
melanoma - characteristics
arises from pre-existing dysplastic nevi (mole)
- flat or raised
- vary in appearance
- vary in color (red, white, black, blue)
- can appear anywhere on body
prognosis: related to thickness (how deep it has penetrated skin)
- Breslow depth
Hutchinson’s sign: periungual pigmentation (around nails)
mole evaluation - ABCDEs
More likely melanoma (vs. nevi):
A: asymmetry B: border irregular C: color mottled (vs. consistent) D: diameter > 6mm E: evolving (changing)
melanoma - tx
surgical excision
seborrheic keratoses - characteristics and tx
benign age-related plaques (older population); common
beige-brown-black
“waxy, stuck-on lesion”; can have “rough” appearance
3-20mm diameter
tx: none needed
NOTE: sudden, acute eruption should alert you to internal malignency
atopic dermatitis - characteristics
pruritic (“itch that rashes”) - results in exudative to lichenified eruption
- face, neck, upper trunk, wrists, hands, flexural folds (elbows and knees)
- personal of family hx of allergic manifestations
- more common in kids
atopic dermatitis - treatment
therapeutic lifestyle (avoid itching, keep moisturized)
topical corticosteroids
systemic steroids only for extensive severe cases
contact dermatitis (irritant)
result of chemical exposure
- erythema, scaling, well-demarcated
- area affected: hands most common
- everyone will have a reaction with sufficient exposure
- can be acute or chronic
contact dermatitis (allergic)
develops after exposure to chemicals to which individual has been sensitized
- initially confirmed to area of contact, later spreads
- progression: erythema-papules-vesicles-erosions-crusts-scaling
- ex: poison ivy
- not everyone will have a reaction
contact dermatitis (allergic and irritant) - treatment
avoid irritants topic steroids: calm things down Burow's solution: helps to dry up lesion if wet oral antihistamines: for itching emollients: hydrate if dry
diaper dermatitis - characteristics and tx
type of contact dermatitis from prolonged exposure to urine/feces
- often get overlying candida infection (satellite lesions)
- erythematous patches with pustules
tx:
- nystatin (rx - mycostatin)
- clotrimazole (OTC)
- miconazol (OTC)
nummular eczema
“coin-shaped” plaques of papules/vesicles on erythematous base
- mild to severe pruritus
- on extremities
- adults (typical = older male, ETOH abuse)
tx:
- hydration and systemic antihistamines
- topical steroids
- phototherapy if resistant
perioral dermatitis (aka muzzle rash) - characteristics and tx
tender, small red papules, pustules
- spares vermillion border
- tingling, burning
- mainly adult females (age 16-45)
- tends to be chronic
tx:
- topical metronidazole (Flagyl), erythromycin
- NOTE: avoid steroids (will worsen)
seborrheic dermatitis - characteristics and tx
red, scaly rash (M>F), pruritus varies
- nasal folds, eyebrows, eyelids, postauricular, scalp
- seen w/ oily skin/hair
- common, recurs (chronic)
- may be fungal
tx:
- frequent cleansing of area
- shampoo w/ selenium sulfide (head and shoulders), ketoconazole
- mild topical steroid (1% hydrocortisone)
- ketoconazole cream (2%)
stasis dermatitis - characteristics and tx
vascular etiology: redness, scaling, ulcerations
- often in lower extremities
- large area of skin change
tx: geared to improving blood flow
- compression stockings
Weeping lesions: burow’s compresses, petroleum jelly, topical hydrocortisone, ABX if infected
dyshidrosis (pompholyx, dyshidrotic eczema) - characteristics and tx
disorder of hands and feet
- adults (30s)
pruritus w/ sudden onset of “tapioca-like” blisters; later scaling and fissures
tx:
- topical corticosteroids
- oral prednisone if severe
lichen simplex chronicus (circumscribed neurodermatitis) - characteristics and tx
intense itching causes self-perpetuating scratch-itch cycle
- circumscribed, lichenified lesions
- neck and extremities common
- see exaggerated skin lines
tx:
- patient education
- STOP scratching!!
- occlusion to prevent further trauma
- topical steroids
lichen planus (P’s) - characteristics and tx
lesions are plentiful, pruritic, purple, polygonal, papular, planar
- Wickham’s striae on surface (white, lacy pattern on skin)
- oral (erosions) and nail (splintering) manifestations
- Koebner’s phenomenon (new lesion develops in area of minor trauma)
- Note: can be associated with Hep C (test)
tx:
- topical steroids w/ occlusion
- oral steroids (severe)
- photo therapy (large areas)
Koebner’s phenomenon
new lesion develops in area of minor trauma
- see with lichen planus and psoriasis
pityriasis rosea - characteristics and tx
oval erythematous to fawn-colored discrete lesions w/ collarette scale
- Herald patch (days to wks prior) - annular lesion with central clearing
- mainly on chest, trunk along cleavage lines (“christmas tree pattern”)
- mainly seen in young females
completely BENIGN
tx:
- self-limiting
- resolves in 6 wks
drug eruptions -characteristics and tx
widely varying presentations
- days to wks into tx
- usually self-limiting (occasionally severe = skin peeling)
Penicillin and sulfa drugs most common
immune compromised at increased risk
tx:
- discontinue offending drug
- supportive care
erythema multiforme (EM) - characteristics and tx
symmetrical, target lesions (<2 cm)
- mainly children, young adults
- commonly spares trunk
- related to herpes simplex, but most idiopathic:
- NOTE: drugs are not often cause
tx:
- supportive (oral antihistamines, topical steroids)
Stevens-Johnson syndrome (SJS) - characteristics and tx
fever, HA, cough, aches, EM-like rash
- asymmetric areas of dusky erythema with truncal involvement
- mucous membranes involved (oral, anus, genitals)
- skin blisters, epidermis shears off; susceptible to infection
- SJS: < 10% body SA affected
cause: almost always drugs (ABX, anticonvulsants, NSAIDs)
tx: life-threatening (requires specialized managment in burn unit)
toxic epidermal necrolysis (TEN) - characteristics and tx
fever, HA, cough, aches, EM-like rash
- asymmetric areas of dusky erythema with truncal involvement
- mucous membranes involved (oral, anus, genitals)
- skin blisters, epidermis shears off; susceptible to infection
- TEN: > 30% body SA affected
cause: almost always drugs (ABX, anticonvulsants, NSAIDs)
tx: life-threatening (requires specialized management in burn unit)
bullous pemphigoid - characteristics and tx
pruritic blisters on normal or erythematous skin; rupture & crust
- autoimmune disorder
- usually >60 y/o
- constitutional sxs rare
tx: mos - yrs
- topical potent steroids if limited
- oral steroids if widespread
- dapsone: oral lesions
psoriasis (plaque-type) - characteristics and tx
silvery scales on bright red, well demarcated plaques
- chronic dz (waxes and wanes)
- genetic predisposition (extreme cell turn-over)
- scalp, extensor surfaces of elbows and knees most common areas
- can get nail pitting and joint problems
Note: positive Auspitz sign (pin-point bleeding where scale is scraped off)
- see Koebner’s phenomenon
Tx: localized
- topical corticosteroids (ointment and cover)
- tar preparations
- avoid stress and ETOH
Tx: generalized dz
- phototherapy (UVB outpatient or UVA more severe)
guttate psoriasis -characteristics and tx
teardrop-shaped, pink/salmon, scaly plaques
- usually on trunk
- NOTE: almost always a hx of strep throat infection
Tx: UV-B phototherapy, natural sunlight
tinea corporis -characteristics and tx
dermatophyte infection
- transmitted directly or by animals
round, angular lesion; scaly patch with central clearing and slightly raised border
- sharply marginated
Dx: put scale in KOH = hyphae
Tx:
- topical azoles, terbinafine
- continue tx for 1-2 wks after cleared
tinea pedis (aka athlete’s foot)
asymptomatic scaling in between toes or on other surfaces of feet
- most common in young, adult men
Dx: hyphae on KOH exam
Tx:
- prevention: shower shoes
- dry/scaly: topical azaleas, terbinafine
- macerated: Burow’s wet dressings (aluminum acetate)
tinea versicolor (pityriasis versicolor) - - characteristics and tx
yeast on skin
hypopigmented lesions on upper trunk, neck, shoulders
- can be hyper pigmented on darker skin
- adolescents and young adults in summer
- recurrence common
Dx: blunt hyphae and budding spores w/ KOH (“spaghetti and meatballs”)
Tx:
- topical selenium sulfide lotion/shampoo
- topical or systemic ketoconazole
folliculitis
inflammation or obstruction of hair follicles (bumps)
- itching and burning in hairy areas
- pustules in hair follicles
- many causes (obesity inc. risk)
tx: varies depending on cause
- gram stain, culture needed
irritated: remove irritant (lotion, loosen colar)
infection: oral ABX with staph coverage (cephalosporins, clindamycin, augmentin)
pseudofolliculitis barbae
dots on beard area from ingrown hairs
tx: let beard grow out; use electric razor, shave in direction of hair growth (not against)
cellulitis
bacterial infection of dermis and subcutaneous tissue
- pain, erythema, edema, warmth, fever, lymphadenopathy
GAS and S. aureus most common
Tx:
- mild: oral ABX
- severe: admit for IV ABX
erysipelas (aka St. Anthony’s Fire) - characteristics and tx
bacterial infection that involves dermis and lymphatics
- mostly in adults (cheeks common)
- prodromal sxs (fever, chills, fatigue) followed by fiery red rash (well demarcated, shiny - like orange peel, smooth, hot)
Note: can spread very quickly so needs to be recognized quickly… and treated
Tx: IV ABX first 48 hrs, supportive care
impetigo - types, characteristics, tx
causes by staph aureus or strep pyogeness
- more common in kids
- highly infectious
multiple presentations:
- nonbullous: transient, small, vesicle/pustules w/ honey-colored crusts
- bullous: superficial fragile bullae on normal skin
Tx:
- mupirocin (bactroban); bacitracin for small areas
- oral ABX for larger area and bullous
verrucae (warts)
viral infection caused by HPV presentations: - common wart (hands) - plantar warts (feet) - flat warts
Benign
Tx:
- OTC salicylic acid
- cryotherapy
- CO2 laser surgery
- surgical excision
- duct-tape occlusion
condylomata acuminata -characteristics and tx
viral sexually-transmitted infection
- HPV types 6 and 11
- see warts
Can be painful, friable, and/or pruritic
Highly infectious (but partner screening is not recommended)
Tx: goal is removal of symptomatic warts; cannot eradicate infection
- Podofilox (Condylox), imiquimod (Aldara), cryotherapy
herpes simplex -characteristics and tx
viral infection (HSV 1 and HSV 2)
- herpes simplex labialis (cold sores)
- genital herpes (STD)
Prodrome (tingling) then painful, vesicular lesions on erythematous base
Tx: prophylaxis if frequent (anti-virals)
- acyclovir, famciclovir, valacyclovir)
herpes zoster (shingles) -characteristics and tx
re-activation of varicella zoster in nerve root - activates when people become immunocompromised or older; travels down nerve root
- vesicles in unilateral, dermatomal pattern
- vesicles rupture and crust over
- post-herpetic pain can persist for months or yrs
- if in eye = ophthalmic emergency!
tx:
- anti-viral (acyclovir, valacyclovir, famciclovir)
- supportive
- oral steroids in immunocompetent helps reduce pain
Note: prevention through vaccination
molluscum contagiosum -characteristics and tx
viral infection - DNA pox virus
- transmit via direct contact
HINT: Pearly, dome-shaped papules with central umbilication
Benign / self-limited
- kids: trunk, face
- adult: inner thigh, genital (sex-transmit)
Tx:
- will resolve spontaneously
- currettage, cryosurgery to get rid of if wanted
acne vulgaris - characteristics
Primary: comedones (black heads and white heads), papules, pustules, cysts Secondary: pits and scars (severe) - common in adolescents and adults - mainly on face and chest - improves in summer
acne vulgaris - treatment
mild: topical
- retinoids (runic acid, tazarotene)
- benzoyl peroxide
- clindamycin, erythromycin
moderate:
- add oral ABX (minocycline or doxycycline)
severe:
- systemic isotretinoin, intralesional injection triamcinolone
rosacea -characteristics and tx
papules/pustules, erythema, telangiectasias on nose, cheeks, chin forehead
- NO comedones
- middle-aged (females)
tx:
- metronidazole (Flagyl) - antibacterial and antiprotozoa
vitiligo -characteristics and tx
hypopigmented, nonscaling patches on face, hands, arms, legs, genital area
- BENIGN
- autoimmune etiology (?)
Tx:
- topical corticosteroids, UVB/PUVA
- protective sunscreen
acanthosis nigricans - characteristics and tx
symmetrical, hyper pigmented, velvety plaques in any location
- axillae, groin, posterior neck common
- associated w/ obesity, insulin resistance, meds
tx/management:
- screen for internal malignancy, DM, insulin resistance
- weight loss
- cosmetic tx
burns - general info and estimation of body surface area affected
ABCs
- check airway, breathing, circulation
Transfer is based on severity of burn and amount of surface area affected
Rule of 9’s - 9% head, arms, 18% legs and front/back of trunk
burns - transfer criteria
partial thickness (2 degree) and > 10% TBSA
full thickness burns (3 degree), in any age group
burns to face, hands, feet, genitalia, major joints
electrical, chemical, inhalation burns
pediatric burns w/out qualified personnel
burns - degrees (1st, 2nd, 3rd)
first-degree: redness w/o changes to texture, intact sensation (superficial)
second-degree: blister formation, pink to mildly pale, intact sensation (partial thickness)
third-degree: white, leathery, no sensation (full thickness)
burns - treatment
gently drape burns with dry material
do not damage skin
do not break blisters
chemical burns: irrigation, irrigation, irrigation
hidradenitis suppurativa -characteristics and tx
chronic inflammatory dz of apocrine glands
- tender, inflammatory nodules, abscess formation, scarring, sinus tracts
- waxes and wanes
- postpubertal females most common (obese)
Tx:
- reduce friction and moisture
- oral ABX for acute exacerbations
- I&D abscesses
- intralesional steroids for nodules
urticaria -characteristics and tx
pruritic, pink or red wheals of varying size, well-defined
- any area of body
- can be acute or chronic
- can be allergic vs. non allergic (hx is key)
Tx:
- antihistamines
- short course of steroids (if needed)
- avoid triggers
dermatographism
raised skin to trauma
melasma -characteristics and tx
hyper-pigmentation of sun exposed areas
- females, reproductive age
- hormons, meds, thyroid, cosmetics (?)
Tx: tough
- SUN avoidance
- hydroquinone cream (depigmenting agent)
lipomas -characteristics and tx
benign tumor of mature fat cells
- mobile, round, discrete, 2-10cm
- slow growing, non-painful
- overlying skin is normal
Tx:
- removal via excision or liposuction
- fine needle aspiration will r/o liposarcoma
liposarcoma - characteristics
not mobile, overlying skin may be ulcerated, faster growing
Any concern: fine needle aspiration
epidermoid cyst - characteristics and tx
firm, round, mobile mass formed from implantation of epidermal elements in dermis
- can express foul-smelling, cheese-like material
Tx:
- none needed
- triamcinolone if inflamed, oral ABX if infected
- I&D, excision
kaposi sarcoma
cancerous tumor of endothelial cells (line vessels that carry blood and lymph)
- mucocutaneous nodules/plaques
- purplish-brown, firm to hard
- associated with LE lymphedema
- asymptomatic, can develop anywhere
- associated with HIV/ AIDS
decubitus ulcers - definition
ischemia due to immobility-related pressure (“pressure sores”)
- wetness, poor nutrition
decubitus ulcers - stages
stage I: intact skin w/ impending ulceration
stage II: partial-thickness loss involving epidermis, possibly dermis
stage III: full-thickness loss with extension into subcutaneous tissue
stage IV: full-thickness loss w/ extension into muscle, bone, tendon, or jt capsule
pediculosis (lice) -characteristics and tx
oval 1-2 mm nits (eggs) seen on hair
- pruritus w. excoriation
- can be in hair, body, of genital region
- spread by contact
Tx: all intimate contacts
- body: topical permethrin (also scabies)
- pubic: permethrin cream rinse (1%)
- head: permethrin cream rinse (1%)
clean/dispose of infected clothing, linen
Scabies -characteristics and tx
Cause by mite
- extremely pruritic
- vesicles and pustules in “runs” / burrows
- spread by physical contact
Tx:
- permethrin 5% cream, use 2x one week apart
- antihistamines (itching continues for several wks even if mites killed)
- clean clothing and bedding
- tx contacts
black widow spider bite - characteristics and tx
generalized muscle spasms, pain, and rigidity
- female has red, hourglass on underside
- most venomous spider in US
Tx:
- supportive care
- parenteral opioids (pain meds)
- muscle relaxants
- calcium gluconate 10%
brown recluse spider bite - characteristics and tx
progressive local necrosis possible, fever, chills, N/V
Tx: no agreed upon best tx
- excision of bite site
alopecia areata - characteristics and tx
rapid hair loss, round patches
- benign, cause unknown, waxes and wanes
- HINT: exclamation point hairs
Tx:
- intra-lesional corticosteroid (triamcinolone)
- photo therapy
Minoxidil (Rogaine)
androgenetic alopecia - characteristics and tx
typical hair loss
effects both men and women
- men: receding hairline at temples and hair loss at vertex
- women: loss of hair over central scalp, no frontal loss
Tx:
- minoxidil (Ragaine)
- finasteride (propecia) - men only
onychomycosis - characteristics and tx
dystrophic nail growth from fungal infection
- yellowish nails with lines
- microscopy and culture helpful
risk factors: age, family hx, warm climate, poor health
tx:
- oral antifungals (long course): terbinafine, itraconazole
- topical generally ineffective
Note: slow regrowth
paronychia
breakdown of protective barrier b/t nail and nail fold
Acute:
- erythema, pain, swelling
- history of nail trauma (S. aureus #1 organism)
- tx: I&D if abscessed, oral ABX and warm soaks
Chronic:
- worsens with water exposure (dishwashers)
- candida is #1 organism
- tx: keep dry, topical antifungals
dermatologic manifestations of systemic disease
viral exanthems
infectious diseases
sexually transmitted diseases
nutritional disorders
cutaneous markers of internal malignancy
