Dermatology Flashcards by Walter The-Cat

Review sunscreen guidelines.

Apply SPF 30 while outside either every 2 hours and with every water exposure

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True or false: fluocinonide 0.05% is a low-medium potency steroid.

False

It is a high-potency steroid.

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Compared to seborrheic keratosis, actinic keratosis looks more ____________.

scaly and dry

Seborrheic keratosis looks like a benign mole that is stuck on. Actinic keratosis can be like a raised faint red area (the “felt-more-than-seen” phenotype) or a dry scaly appearance.

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When should you biopsy a suspected actinic keratosis lesion?

Any signs of potential transformation to squamous cell carcinoma:
- Size greater than 1 cm
- Tenderness
- Rapid growth

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What are three ways to treat actinic keratosis lesions?

Cryotherapy
Imiquimod
Fluorouracil

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What lifestyle interventions help treat acne?

Using water-based makeup for women
Use a pH-neutral cleaner with warm water twice daily. Use gentle scrubbing to avoid aggravating acne.

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What is the technical term for shaving rash?

Pseudofolliculitis barbae

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What can decrease the risk of pseudofolliculitis barbae?

Pseudofolliculitis barbae results from hair curling into the skin, either the interfollicular space or within the follicle. By using a single-blade razor you cut the hair less deep which helps. Straight razors cut the hair not at an angle with also helps. Warm compresses prior to shaving also help. The man may need to discontinue shaving to allow the skin to heal.

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Review the recommended treatment for localized and widespread actinic keratosis.

Localized lesions should be treated with topical cryotherapy and widespread lesions should be treated with 5-fluorouracil or imiquimod.

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Review the characteristics of lichen planus.

The P’s:
- Papular
- Purple
- Pruritic
- Polygonal

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Lichen planus in the mouth shows up as __________.

whitish lines on an erythematous base (Wickham striae)

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You need to do __________ to diagnose lichen planus.

biopsy

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Salicylic acid takes how long to work on verruca vulgaris?

2-3 weeks

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True or false: erysipelas rarely has bullae.

False

Bullae, a well-demarcated erythema, and a peau d’orange appearance are all characteristic of erysipelas.

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The two most common sites of erysipelas are __________.

face and leg

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What facial finding suggests erysipelas rather than cellulitis?

Ear involvement (called Millan sign)

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Erythema multiforme is most associated with _________ and ___________.

infections (HSV, Mycoplasma); malignancy

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The _________ sign is when you put gentle pressure on the lesion and it sloughs off.

Nikolsky

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True or false: SJS/TEN usually affects the hands and feet.

False

It usually spares the hands and feet.

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TEN covers _________ skin than SJS.

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When you see a patient with suspected SJS/TEN, use the ___________ tool to help predict their prognosis.

SCORETEN

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Generalized pustules after starting a med could be what rash?

Acute exanthematous pustulosis

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DRESS rarely involves the _________ surfaces.

mucosal

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Scaling red skin that covers almost all the body is ___________.

scleroderma

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Scleroderma is associated with what disease?

Cutaneous T-cell lymphoma

True or false: Pityriasis rosea is typically not pruritic.

False It usually is pruritic.

Explain the pathophysiology of pityriasis rosea.

It's not totally known what causes it, but it is thought to be a post-viral infection. It resolves in 8-12 weeks.

Sudden photosensitivity should make you think of what?

Lupus Medication side effects (tetracyclines)

How long after starting a new medicine does DRESS usually start to develop?

Usually 2-4 weeks, but it can take up to 16 weeks

What genetic syndrome presents with an unusual amount of epidermoid cysts?

Gardner syndrome

Eczema (atopic dermatitis) generally affects the _________ surfaces.

flexural

Atopic dermatitis can cause accentuation of the lines under the eyes called __________ lines.

Dennie-Morgan lines

The difference between vesicles and bullae is _________.

size Bullae are greater than 1 cm.

The difference between are erosion and an ulcer is ___________.

depth Erosion goes into the epidermis. Ulcer goes into the subcutaneous tissue.

Rash appearing after a fever is classic for what diagnosis?

Roseola (aka Sixth Disease) from HHV6

When is chickenpox contagious?

2 days before and 5 days after the exanthem starts

HSP is now called?

Immunoglobulia A vasculitis (IGAV)

A patch is the larger (>1 cm) version of a _____________.

macule

True or false: crust means dead skin layers.

False Dead skin layers is scale. Crust implies that some drainage has dried on the skin (e.g., impetigo).

The only steroid that comes in a 1 lb tub is _____________.

triamcinolone

The ________ layer of the skin appears shiny.

dermis

What is AGEP?

Acute Generalized Exanthematous Pustulosis This is a diffuse erythema studded with nonfollicular sterile pustules. Usually, it appears after starting an antimicrobial agent (ampicillin, amoxicillin, metronidazole, and terbinafine).

How should you manage AGEP?

Stop the drug that caused it and admit

Staphylococcal scalded skin syndrome usually results after what type of Staph infection?

Perinasal impetigo

SSSS causes desquamation in what areas?

Intertriginous

Pityriasis rosea usually follows the __________ lines.

Langer

How much (in grams) ointment does it take to cover the body of an adult?

30 g

What infectious lab should be checked in patients with erythema nodosum?

ASO (provided they have a history of potential strep infection)

What is unique about graphite foreign bodies?

If not removed through excision (of surrounding tissues, too), then the graphite will likely lead to a tattoo.

Review the BSA of SJS, SJS/TEN, and TEN. .

SJS: < 10% SJS/TEN: 10%-30% TEN: > 30%

The circular telangiectasias seen on those with liver disease are also called _______________.

spider nevi These are red, maculopapular rings that do not blanch.

A "targetoid lesion w/ central necrosis" is what rash?

E. multiforme

Erythema migrans is which infection?

Lyme disease

What is Brodie sign?

An area of blackness that can indicate necrotizing fasciitis

Gummas (erosive, ulcerating lesions) are associated with what disease?

Tertiary syphilis

__________ is thought to be the most mild form of SJS/TEN.

Erythema multiforme

Review the stages of pressure ulcer by structure exposed.

I: non-blanching erythema II: dermis eroded but no fat visible III: fat exposed but no muscle, tendon, or bone exposed IV: muscle, tendon, or bone exposed

True or false: pemphigus vulgaris usually does not involve the mucous membranes.

False Bullous pemphigoid usually does not involve the mucous membranes. Vulgaris usually does.

What is the pathophysiology of SJS/TEN?

Cytotoxic T-cell destruction of keratinocytes

Fixed drug eruptions tend to appear how?

Violaceous, pruritic macules that may have bullae

SJS after a cough?

MIRM: Mycoplasma-induced rash and mucositis

True or false: crusted shingles lesions are not contagious.

True The progression goes erythematous papules/vesicles -> hemorrhagic papules/vesicles -> crusted lesions. The crusted lesions are the first non-contagious lesions.

What are the causes of erythema nodosum?

Infection: - S pyogenes (most common) - Mycoplasma - Chlamydia Autoimmune diseases: - Sarcoid - IBD - SLE Meds; - Sula - Peniicillin - OCPs - Phenytoin Neoplasm: - Lymphoma Idiopathic

What are the lesions called in scabies?

Burrows

What is the mechanism of heat rash?

Sweat glands get blocked and rupture under pressure.

Both Parvovirus and HHV6 present with rash after a fever. How are they different?

Parvo starts on the face and then descends. HHV6 starts on the trunk.

How long is a typical course of clotrimazole for tinea?

4 weeks, and instruct the patient to continue it 1 week after resolution of the rash

Topical steroids and topical _______________ are the first-line treatments for atopic dermatitis.

calcineurin inhibitors (like topical tacrolimus)

How is infantile eczema different from childhood and adult eczema?

Infantile eczema is most often on the face and extensor surfaces, whereas childhood and adult eczema is on the flexural surfaces and wrists.

What is the most common type of skin cancer?

BCC

Describe the two ways the rash from disseminated N. gonorrhea presents.

Necrotic center with erythematous base Purulent center with erythematous base

True or false: SSSS usually spares the mucous membranes.

True

What is papular acrodermatitis?

Also called Gianotti-Crosti syndrome, papular acrodermatitis is a post-viral rash that usually affects children younger than 5. It presents with flat-topped papules that are erythematous. It is associated with HBV, EBV.

Why should you not try to remove an inflamed epidermal cyst?

The wall is more friable when infected/inflamed, so full removal is unlikely.

Which sites are most common for fixed drug eruption?

Hands Feet Genitals

True or false: fixed drug eruptions are always painless.

False They can be painless or present with burning or pruritus.

Exposure to which heavy metal increases risk for SCC?

Arsenic "ArSKINic"

True or false: those with bullous pemphigoid should receive doxycycline.

True

Lupus pernio (violaceous rash on the cheeks and nose) are often seen in what rheumatologic disorder?

Sarcoidosis

What is the treatment for bullous pemphigoid?

Prednisone