Dermatology Flashcards
Atopic Dermatitis (Eczema) is associated w/ atopic triad (eczema, allergic rhinitis, and asthma). Pruritus is HALLMARK. MC found in _____ (part of body).
Flexor creases
Treatment for eczema involves:
Topical corticosteroids and antihistamines (benadryl, hydroxyzine)
____ occurs in areas of high sebaceous gland over secretion (scalp, face, brows, body folds). Called “cradle cap” in infants.
Sebhorrheic Dermatitis
*Tx- Selenium sulfide, ketoconazole shampoo/cream, Systemic antifungals- ‘azoles’
____ is used to treat perioral dermatitis.
Topical Flagyl
Want to AVOID _____ when treating perioral dermatitis.
Topical steroids
Dyshidrosis (Dyshidrotic Eczema) is triggered by sweating and emotional stress. S/s include: pruritic “tapioca-like” tense vesicles on the soles, palms, and fingers.
Treatment= Topical steroids
Common drugs that cause Erythema Multiforme are:
Sulfas, PCNS, phenobarb, dilantin
Meds for specific rashes…
- Exanthematous/Morbilliform= oral antihistamine
- Drug induced urticaria/angioedema= systemic corticosteroids, antihistamines
- Anaphylaxis= IM Epi
- Erythema Minor= symptomatic therapy
Erythema Multiforme is associated with ___ (specific infectious cause).
HSV
*Also- Mycoplasma in kids and certain meds (sulfas, PCNs, etc)
S&S of erythema multiforme are:
TARGET lesions. Purpuric macules/vesicles or bullae in the center surrounded by pale rim & a peripheral red halo
- Often febrile
- <10% of BSA, NO EPIDERMAL DETACHMENT
What meds are MC related to SJS and TEN?
Sulfas, anticonvulsants, NSAIDs, Allopurinol, ABX
To be classified as TEN > ___% of BSA must be sloughing off.
> 30%- May develop skin necrosis
How are SJS and TEN treated?
Treated like burns–> burn unit admission, fluids and electrolytes!, wound care
_____ is associated with 5 P’s. Purple, Polygonal, Planar, and Pruritic Papules. There is an increased incidence with Hep C.
Lichen Planus
- WICKHAM STRIAE
- Tx: Topical corticosteroid AND symptomatic tx
_____ can mimic syphilis. It is associated with a HERALD PATCH on the trunk w/ general exanthem 1-2 weeks later that appear in a CHRISTMAS TREE PATTERN.
Pityriasis Rosea
*Tx: None need, usually resolves in 6-12 weeks
Keratin hyperplasia leading to PLAQUE that is MC seen on extensor surfaces of elbows/knees, scalp, and nape of neck is known as _____.
Psoriasis
*Also nail pitting w/ yellow-brown discoloration under the nail (oil spot)
“Pencil in cup” deformity is associated with what condition?
Psoriatic arthritis
-Sausage digits!
Treatment of Psoriasis involves:
Mild-Moderate: topical steroids
Moderate-Severe: Phototherapy
-Systemic treatment- methotrexate, cyclosporine, retinoids, etc.
_____ is an autoimmune blistering skin disease.
Bullous Pemphigoid
*Esp in groin, axilla, abdomen, and flexural areas
**Treatment= topical corticosteroids if mild, applied to early lesions to prevent blisters
_____ is an autoimmune d/o that affects young patients (30s-40s) and involves oral mucosa/membrane erosions and ulcerations that bleed easily.
Pemphigous Vulgaris
- Dx- skin biopsy
- Treatment- high-dose corticosteroids, MTX
_____ is a result of increased sebum production.
Acne vulgaris
Treatment of acne at different levels of severity…
- Mild: topical retinoids, benzoyl peroxide, topical ABX (clinda), OCPs
- Moderate: See above + oral ABX +/- anti-androgen agents (Spironolactone)
- Severe (nodular or cystic): Isotretinoin (Accutane)
* Be sure to monitor psych, LFTs, TG, lipids, etc
* *Highly TERATOGENIC!!
Vasomotor instability that is MC in males >30y and triggered by ETOH and hot foods/weather/baths is known as _____.
Rosacea
*NO comedones- distinguished it from acne
_____ is 1st line treatment for Rosacea.
Flagyl (Metronidazole- think you get “flushed” when you’re on the hot Metro).
____ is MC in elderly w/ prolonged sun exposure. It is a premalignant condition to squamous cell carcinoma.
Actinic Keratosis
- Dx- punch or shave biopsy
- *Treatment- observation, surgical, or medical (topical 5-FU)
____ is MC benign skin tumor. Appears as a small papule/plaque velvety, warty lesion that can be grey, brown, black or flesh-colored.
Seborrheic Keratosis
____ is used to treat Lice.
Permethrin (2nd line= Lindane)
Mites are transmitted through prolonged skin to skin contact or fomite. When the females burrow under the skin and lay eggs, creating very itchy lesions and LINEAR BURROWS this is known as ______.
Scabies
*Burrows commonly found in intertriginous zones (finger/toe webbings, scalp, groin; spares neck and face)
How is scabies treated?
Permethrin topical
Blanched area with erythematous margin, “red halo” is associated w/ what type of bite?
Brown Recluse
*Tx- Symptom relief, Tetanus prophylaxis, debridement in some cases, and ABX if infxn present
Muscle pain, spasms, and rigidity are associated with what type of bite?
Black widow
*Tx- wound care and pain control, antivenom if unresponsive to other treatments
____ is MC skin cancer in US. It is slow growing!
Basal Cell Carcinoma
Flat firm area with small, raised, translucent/pearly/waxy papule and central ulceration that may have overlying telangiectatic vessels describes what?
Basal cell carcinoma
Basal cell managed how?
Electrodessication/curettage (nonfacial tumors)
-Mohs micrographic surgery for facial involvement
____ is often preceded by actinic keratosis.
Squamous cell carcinoma
Describe what squamous cell carcinoma looks like.
Red, elevated thickened nodule w/ adherent white-scaly or crusty, blood margins
*Tx- Wide local surgical excision
_____ is a connective tissue cancer that is MC in immunosuppressed patients or HIV.
Kaposi’s Sarcoma
-Tx-HAART therapy
_____ is the MC skin cancer-related death. High METS potential :(
Melanoma
S&S of melanoma: “ABCDE”
Asymmetry, Borders: irregular, Color: variation, Diameter: usually > 6mm, Evolution: recent/rapid change in appearance
____ is the most important prognostic factor for METS with melanoma.
Thickness
- < 1mm= 95%, 1-2mm= 80%, 2-4mm= 55%, >4mm= 30%
- Tx= complete wide surgical excision w/ LN biopsy +/- adjuvant therapy
Androgenic Alopecia v. Alopecia Areata
- Androgenic Alopecia
- DHT is key androgen leading to androgenic alopecia
- Tx: Minoxidil (Rogaine) or Oral Finasteride (inhibits conversion of Testosterone to DHT) - Alopecia Areata
- Immune-mediated (can be assoc. w/ thyroid conditions or Addison’s for example)
- Smoother circular patches of complete hair loss that develop over weeks
- Tx: Corticosteroids
____ is a fungal nail infxn MC on big toe.
Onychomycosis
-S&S: opaque, thickened, discolored and cracked nails
____ and ____ can be used to dx Onychomycosis.
KOH smear and Woods lamp
*Tx- Itraconazole and Terbinafine or Systemic antifungals like Griseofulvin and Itraconazole
____ is an infxn around the nail margin that is treated with ABX like Cephalexin or I&D.
Paronychia
A generalized skin eruption secondary to systemic infection is known as an _____.
Exanthem- usually preceded by prodrome
MC exanthems in childhood:
- Rubeola (measles)
- Rubella (german measles)
- Varicella (chicken pox)
- Roseola (sixth disease)
- Erythema infectiosum (fifth disease)
The 3 C’s of Rubeola are:
Cough, Coryza, Conjunctivitis
Small red spots in buccal mucosa w/ pale white center are known as _____ and are associated with Rubeola.
Koplik Spots
Rash on face beginning at hairline and going down to extremities that darkens and coalesces is seen in what diagnosis?
Rubeola
- Tx- supportive, anti-inflammatories
- *Complications- diarrhea and otitis media
Compared to rubeola, ___ spreads more rapidly and does not darken or coalesce. It is associated with transient photosensitivity and joint pains.
Rubella
Rubella is TERATOGENIC, esp in 1st trimester
fyi
_____, also known as sixth’s disease, is associated with a prodrome of HIGH FEVER that lasts 3-5 days followed by a pink maculopapular rash on trunk/back once fever resolves.
Roseola
*Child appears well and alert during febrile phase
Pain > 3 months with hyperesthesias or decreased sensation and treated with Gabapentin or TCAs is known as _____.
Postherpetic Neuralgia
_____, also known as Herpes Zoster Oticus, is associated with otalgia, lesions on ear, auditory canal, TM; facial palsy w/ possible tinnitus, vertigo, ataxia, and deafness.
Ramsay-Hunt Syndrome
*Tx- oral acyclovir + corticosteroids
A lacy, reticular rash on extremities with a “slapped cheek” rash on face is known as _____.
5th disease- Erythema Infectiosum
*Tx- supportive, anti-inflammatories
______ is associated with parotid gland pain and swelling.
Mumps
- Tx- supportive, anti-inflammatories
- *Complications- orchitis, oopohoritis, encephalitis, aseptic meningitis
______ is MC cause of acute pancreatitis in kids.
Mumps
_____ is MC in children, sexually active adults, and patients with HIV. S&S includes: single or multiple dome shaped pearly-white, waxy papules w/ central umbilication. It is a benign viral infection and HIGHLY CONTAGIOUS.
Molluscum Contagiosum
*No treatment needed for most
______ is an acute, spreading infection of dermal, sub-q tissues; MC caused by S. aureus.
Cellulitis
Medical management of different skin infections…
- Cellulitis- Cephalexin or Dicloxacillin (Clinda or Erythro if PCN allergic). Vanc if MRSA suspected.
- MRSA- IV Vanc or Linezolid. Oral options- Bactrim, Clinda, Doxy, Linezolid
- Cat/Dog/Human bites- AUGMENTIN
- Puncture wound through tennis shoe- Cipro
______ is a highly contagious vesiculopustular skin infection that is assoc w/ superficial skin trauma. The MC type is nonbullous and that is known for its pustules w/ “honey-colored crust.”
Impetigo
*MC culprit= Staph aureus
_____ is DOC in treatment of Impetigo.
Mupirocin (Bactroban)
*If extensive disease or systemic then try Cephalexin
Folliculitis is an infxn of the superficial hair follicle that is MC caused by _____.
Staph aureus
*Tx- Bactroban, Clinda, Erythro
____ (boil) is a deeper infection of hair follicle- tender nodule.
Furuncle
____ is a larger, more painful interlocking furuncles/abscesses w/ multiple openings + cellulitis.
Carbuncle
How are carbuncles treated?
Heat compresses to bring to head and if fluctuant then I&D–> remove loculations or infxn may recur!
______ is defined by chronic abscesses of apocrine sweat glands or sebaceous cysts w/ tract formation. MC in obese women.
Hidradenitis Suppurative
*MC areas: axilla, groin, under breasts, anogenital area
How is Hidradenitis treated?
Mild: topical Clinda, Intralesional injections of Triamcinolone
Deep, recurrent: unroofing and washout, I&D for painful ones
Systemic ABX: Tetracycline, Clinda, Cipro
Surgical excision of apocrine glands may prevent recurrence if SEVERE
_____ are subcutaneous benign tumors of adipose tissue.
Lipomas
*MC- trunk and extremities
What is melasma?
Hypermelanosis of sun exposed areas of skin
- RFs- high estrogen exposure (OCPs, pregnancy), sun exposure
- *Dx- Wood’s lamp
- **Tx- sunscreen
Management of pilonidal disease involves:
- I&D
- ABX
- Excision of pilonidal sinus and tracts recommended if recurrent
Pressure ulcer staging
I: non blanchable redness
II: epidermal damage extending into dermis (blister/abrasion)
III: full thickness of skin and may extend to sub-q
IV: deepest; extends beyond fascia into muscle, tendon, and bone
Vitiligo treatment options:
Topical corticosteroids, systemic phototherapy
_____ is the ONLY TINEA INFXN that MUST be treated systemically.
Tinea Capitis
*Tx= GRISEOFULVIN
Athlete’s foot (Pedis), Jock itch (Cruris), and Ringworm (Corporis) can be treated with a topical _____.
Antifungal and PO GRISEO if ineffective
Diagnosis of fungal infections done with:
- KOH smear
- Wood’s lamp (green fluorescence if positive)
Treatment for tinea versicolor=
- Topical: Selenium sulfide, or topical ketoconazole
2. Oral: Ketoconazole
