Dermatology Flashcards

Question

Stevens Johnson sn vs Toxic epidermal necrolysis

Answer 1

SJS - less severe -skin sloughing - epidermal detachment limited to less than 10% of body surface area TEN - at least 30% skin detaching Always involves mucous membranes labs: low H&H elevated AST, ALT ``` Tx: Stop offending agent Corticosteroids Analgesia IVF Burn unit Admit Acyclovir if HSV hx ```

Answer 2

Chronic relapsing dermatitis associated with sebaceous glands -can be caused by Malassezia furfur Erythematous plants with greasy looking yellowish scales Tx: Scalp: medicated shampoo - ketoconazole, selenium sulfide, ciclopirox Alt - tar containing shampoo Skin: low potency topical steroids or topical antifungal Cream - ketoconazole

Answer 3

Noncancerous skin growth that originates in keratinocytes Various presentations: flat, raised, tan colored, warty, "pasted on" appearance No treatment needed

Answer 4

Skin hydration: emollients - petroleum jelly or other low water content creams Topical steroids Calcineurin inhibitiors - tacrolimus or pimecrolimus Severe or resistant cases - UV light therapy, systemic steroids, immunosuppresants - methotrexate, cyclosporine, azathioprine Abx for open lesions - cover S. aureus and Strep spp.

Answer 5

Extensor surfaces Bleed when scale removed - Auspitz sign Bx: thickened epidermis, absent granular layer, nucleated cells in stratum corneum 20% with arthritis Tx: Mild to mod: Topical steroids and emollients Alts: tar based products, topical retinoids (tazarotene), topical vitamin D (calcipotriene), anthralin, calcineurin inhibitors - tacrolimus, pimecrolimus ``` Severe: Photo therapy Oral retinoids Immunosuppressants - methotrexate, cyclosporine Adalimumab, etanercept, infliximab ```

Answer 6

Papular lesions on trunk and extremities in Christmas tree pattern Herald patch 2-5 cm Tx: Self-limited 4-6 weeks Mod - potency topical steroids for pruritis Severe - UV therapy, acyclovir, erythromycin

Answer 7

Inflammation of the subcutaneous fat septa Painful erythematous nodules - anterior tibia, trunk Delayed immuno rxn to infection, vascular dz, drugs Accompanied with malaise, arthralgias, fever Labs: + ASO, elevated ESR Bx - fatty inflammation ``` Tx: self limited NSAIDs Potassium iodine Corticosteroids ``` ``` Causes: SPUDBITS Strep Pregnancy Unknown Drugs Behcet dz IBD TB Sarcoidosis ```

Answer 8

Young - assoc HIV; older - Hep C Skin: pruritic, purple, polygonal papules and plaques - shiny and flat, common on flexor surface of extremities (wrist) Wickham's striae - white, lace-like pattern on surface of papules/plaques Mucous membrane: Wickham's striae in lateral buccal mucosa and possible erosive lesions may be come infected with Candida Genital involvement - limited to violaceous papules on glans penis and vulva Tx: corticosteroids - medium to high potency - topical, interlesional, oral if topical unsuccessful Acitretin - oral retinoid

Answer 9

Stage 1: pressure related alteration in intact skin - change in color, consistency, sensation or temperature Stage 2: superficial ulcer, abrasion, or shallow crater Stage 3: Full thickness skin loss with damage to the subcutaneous tissues - deep crater Stage 4: extensive destruction or necrosis; damage to muscle, bone or supporting structures

Answer 10

eczematous dermatitis with inflammatory papules, scaly and crusted erosions, increased pigmentation, stippling with recent and old hemorrhages, possible ulceration Dx: duplex U/S - venous reflex ``` Tx: wt loss compressive dressings or stockings leg elevation topical steroids vein ablation ```

Answer 11

Flaccid bullae - easy to rupture (+ Nikolsky) Oral lesions Anti-desmosome Ab - epidermis Tx: High-dose systemic steroids Azathioprine or mycophenolate mofetil (steroid-reducing adjuvant) Abx for secondary infections Prognosis: fatal if untreated, mortality of 5% with treatment

Answer 12

Tense bullae Rare oral lesions Anti-hemidesmosome Ab - dermal-epidermal junction (BM) ``` Tx: Topical - clobetasol Oral prednisone if topicals not possible Chronic management: mycophenolate mofetil, azothioprine or methotrexate Prognosis better than pemphigus ```

Answer 13

Deficiency in hepatic uroporphyrinogen decarboxylase Risk: Hep C, alcohol abuse, excess iron Chronic blistering of sun exposed skin - facial hypertrichosis, hyperpigmentation, pseudoscleroderma Dx: elevated plasma porphyrins Tx: phlebotomy Hydroxychloroquine Avoid sun, alcohol, estrogens, iron supplements

Answer 14

Systemic symptoms Abdominal pain, vomiting Neuropathy Mental disturbances elevated urinary porphyrobiligen

Answer 15

Precancerous skin lesion Risk: sun exposure Erythematous papules with rough,, yellow brown scales Bx: dysplasia of epithelium Tx: topical 5FU, imiquimod and cryotherapy -> squamous cell carcinoma

Answer 16

Skin cancer of squamous cells of epithelium Risk: UVB exposure, arsenic exposure, fair complexion, radiation Painless, well demarcated, scaly patch or plaque, erythematous, scaling Tx: surgical excision (Mohs), radiation 5-10% mets

Answer 17

Most common skin cancer Pearly papule with telangiectasias, +/- rolled edges with ulceration Tx: surgical excision (Mohs), radiation, cryotherapy less than 0.1% met

Answer 18

Malignant melanocytes tumor - rapid spread Risk: sun exposure, fair complexion, FHx, numerous nevi Types: Superficial spreading - MC, grows laterally before vertically Acral lentiginous - least common, found on palms, soles, nail beds Lengito maligna - slow growth, 10-50 yrs before vertical growth Bx: atypical melanocytes with invasion of dermis >0.76 mm risk mets Tx: surgical excision Insitu - 0.5 cm margin less than 2 mm thick - 1 cm margin >2 mm thick - 2 cm margin +/- LN dissection Chemo/rad if mets Mets -> lung, brain, GI tract

Answer 19

Dark skin discoloration, in pregnant women and those taking OCPs or HRT Minimizing sunlight exposure and opaque sunscreen - titanium dioxide or zinc oxide Triple combo cream - tretinoin, hydroquinone, mid-potency topical steroid - flucinolone

Answer 20

Sharply demarcated patches of complete depigmentation - due to loss of melanocytes - Borders are hyperpigmented - MC in acral areas, around body orifices Skin texture is normal Assoc with graves' disease, autoimmune thyroiditis, pernicious anemia, T1DM, primary adrenal insufficiency, hypopituitarism, alopecia areata, autoimmune hepatitis MC 20-30 yo ``` Tx: Sunscreen to minimize tanning Dyes and make up Topical mid-pot corticosteroids first line (low potency kids) Tacrolimus or pimecrolimus Psoralens (topical or PO) + UV light Surgical minigrafting Hydroquinone for depigmentation - last resort ```

Answer 21

Brown to black velvety hyperpigmentation of the skin Associated with T2DM, hyperinsulinemia and visceral malignancies Tx underlying disorder Tretinoin - topical Calcipotriene - topical vit D analog

Answer 22

Uncomplicated - gradually resolve within the first two years of life, observation best treatment Complicated - oral propranolol, systemic glucocorticoids, vincristine, interferon alpha

Answer 23

Asymptomatic, inflammatory, non-scarring areas a complete hair loss Maybe precipitated by stress Regrowth after first attack in 30% by 6 mo, 50% by 1 yr, 80% by 5 yr R/o other cause - get syphilis screen, CBC, BMP, ESR, TSH, ANA R/o trichotillomania ``` Tx: intralesional steroid injections topical corticosteroids Topical minoxidil Topical immunotherapy Topical anthralin Oral corticosteroids ```

Answer 24

diffuse stress related hair loss | tx: reassurance, stress avoidance

Answer 25

Hormonal and genetic causes DHT causes follicular miniaturization -> replacement of terminal hairs by short, thin hairs Tx: finasteride - 5a-reductase inhibitor Topical minoxidil