Dermatology Flashcards
1
Q
What is acne vulgaris characterized by?
A
areas of
- open comedones (blackheads) incomplete blockage
- closed comedones (whiteheads) complete blockage
- papules
- pustules
- nodules or cysts
- may result in scarring
2
Q
What is category I of acne vulgaris?
A
comedonal: comedones (+/-small amounts of papules and pustules)
3
Q
What is category II of acne vulgaris?
A
papular: moderate number of lesions, little scarring
4
Q
What is category III of acne vulgaris?
A
pustular: lesions >25, moderate scaring
5
Q
What is category IV of acne vulgaris?
A
nodulocystic: severe scarring
6
Q
What is the treatment of most acne vulgaris?
A
topical retinoids
7
Q
What is the treatment of cystic acne?
A
tetracyclines, than oral retinoids - isotretinoin
8
Q
What are the side effects of isotretinoin?
A
dry lips, liver damage, increased triglycerides/cholesterol, pregnancy category X
-must obtain 2 pregnancy tests prior to starting it and monthly while on it
9
Q
Androgenetic alopecia
A
gradual conversion of terminal hairs - indeterminate - vellus hair
- genetic predisposition (androgen)
- Males 20-40 yo, W MC after 50
- Men > women
- MC in white men
10
Q
What is the dx of androgenetic alopecia?
A
- microscopic examination of cut or plucked hair fibers and scalp biopsies may provide additional information that is helpful for diagnosis
- Biopsy: telogen and atrophic follicles
- Trichogramma: increased telogen hairs
- Hormones: testosterone, DHEA, prolactin
- Treatable: thyroid (TSH), anemia (CBC), autoimmune (ANA)
11
Q
What is the tx of androgenetic alopecia?
A
- topical: minoxidil/rogaine 2%, 5% (hair loss first before regrowth)
- finasteride 1 mg - inhibits.T and DHT
- spironolactone - blocks DHT
12
Q
What are the characteristics of atopic dermatitis?
A
- pruritic
- eczematous lesions
- xerosis (dry skin)
- lichenification (thickening of the skin and an increase in skin markings)
13
Q
Where are the most common spots for atopic dermatitis to be in adolescent?
A
flexor creases (antecubital and popliteal folds)
14
Q
What kind of hypersensitivity is atopic dermatitis?
A
IgE, type 1 hypersensitivity
15
Q
Where are on an infant is atopic dermatitis?
A
face and scalp
16
Q
How do you dx atopic dermatitis?
A
History and physical
- conduct patch testing to verify
- allergy referral
- skin prick tests NOT used for contact derm
17
Q
What is the treatment for atopic dermatitis?
A
- review medications: OTX, RX, homeopathic, hot water, humidifier
- antihistamine (hydroxyzine or Benadryl), animals
- avoid agent, topical or oral steroids
- PUVA phototherapy
18
Q
What are the MCC of burns?
A
scalding, direct thermal, and flame burns
19
Q
What is a first degree burn?
A
Sunburn
- erythema of involved tissue
- skin blanches with pressure
- the skin may be tender
20
Q
What is a second degree burn?
A
Partial Thickness
- skin is red and blistered
- the skin is very tender
21
Q
What is a third degree burn?
A
Full Thickness
- burned skin is tough and leathery
- skin non-tender
22
Q
What is a fourth degree burn?
A
into the bone and muscle
23
Q
What is the rule of 9’s?
A
- head 9%
- each arm 9%
- chest 9%
- abdomen 9%
- each anterior leg 9%
- each posterior leg 9%
- upper back 9%
- lower back 9%
- genitals 1%
24
Q
What is the palmar method?
A
patient’s palm equate to 1%
-used for small burns
25
What is the overall treatment for burns?
monitor ABCs, fluid replacement, sulfadiazine
26
What is the treatment for mild burns?
- clean with soap and water
- drain and debris bullae
- cover with 1% silver sulfadiazine
27
What is the treatment for moderate/severe burns?
cover with dry dressing and admit to hospital
28
What labs needs to be done on burn patients?
ABG, CBC, CK, CMP, UA, carboxyhemoglobin
29
What burn patients get fluid replacement?
-children with >10% total body surface area and adults with >15% total body surface area burns needs formal fluid resuscitation
30
What IV fluids are given to that patient?
IV Fluids: LR via 2 large bore
- adults: LR 4 ml x wt (kg) x %BSA
- children LR 3 ml x wt (kg) x %BSA
- half given her the first 8 hours, then 16 hours
31
What is contact dermatitis?
a skin rash caused by contact with a certain substance
32
What are acute contact dermatitis characteristics?
erythema, vesicles, bullae burning, itching, erythema
33
What are chronic contact dermatitis characteristics?
scaling, lichenification, fissure, well-demarcated Ford
34
What is the allergic etiology of contact dermatitis?
- nickel, poison ivy, etc.
| - type 4 hypersensitivity
35
What is irritant etiology of contact dermatitis?
a direct toxic effect of an offending agent on the skin (cleaners, solvents, detergents, urine, feces)
36
How is contact dermatitis dx?
History and physical
- conduct patch testing to verify
- allergy referral
- sick prick tests NOT used for contact dermatitis
37
What is the treatment of contact dermatitis?
- review medications: OTX, RX, homeopathic, hot water, humidifier
- Antihistamine (hydroxyzine or Benadryl), animals
- Zinc oxide (diaper rash)
- avoid agent, topical (triamcinolone cream 0.1%) or oral steroids, Burow's solution (aluminum acetate)
- PUVA phototherapy
38
What is diaper dermatitis?
rash on buttocks region, common in infants 3 weeks - 2 years
39
What causes diaper dermatitis?
wet, dark, friction, urine, feces, and microorganisms
40
What are the symptoms of diaper dermatitis?
fussiness, crying with diaper change, diarrhea, shiny erythema with dull margins
41
What secondary infections can occur with diaper dermatitis?
- satellite lesions - candidiasis
- impetigo (s. aureus)
- herpes simplex virus (child sexual abuse)
42
What is the dx of diaper dermatitis?
laboratory tests are not necessary but may help confirm the diagnosis in recalcitrant cases
- KOH prep and fungal culture of skin scrapings for candida
- viral culture, mineral oil slide for scabies
- culture for skin lesions for s. aureus or group A streptococcus
43
What is the tx of diaper dermatitis?
Keep area dry to allow airflow
- barrier creams zinc oxide/petroleum jelly
- Candidiasis: nystatin, clotrimazole, econazole x 2 week
- discuss proper diaper changes, disposable, avoid tight-fitting
44
What is perioral dermatitis?
- young women, papulopustular, plaques, and scales around the mouth
- lip margin (vermillion borde) is spared
45
What is the dx of perioral dermatitis?
clinical, a biopsy may help
46
What is the tx of perioral dermatitis?
-topical metronidazole, avoid steroids
47
What is the tx of mild perioral dermatitis?
- topical alone 1st line
- topical pimecrolimus 0.1%
- erythromycin solution q12h
- metronidazole 0.75% gel q12h
- clindamycin lotion q12 hours
- oral abx: doxycycline if necessary - no gels, solutions, or lotions on eye
48
What is the tx of moderate perioral dermatitis?
topical + oral ABX
49
What is drug eruptions?
an adverse cutaneous reaction in response to the administration of a drug; usually within the past 6 weeks
50
Where does the most common adverse drug reaction occur on the body?
skin
51
What drugs commonly cause drug eruptions?
- penicillin such as amoxicillin, ampicillin
- bactrim
- allopurinol
- NSAIDs
- calcium channel blockers
- sulfonamides
- anticonvulsants
52
What is the dx of drug eruptions?
typically clinical
- any new medications taken in the past 6 weeks should be appropriately documented
- complex drug eruption should be worked up
- CBC, CMP should be ordered to evaluate liver and kidney functions
53
What is the tx of drug eruptions?
remove the offending drug once identified is the first treatment measure
54
What is erythema multiform?
an acute, self-limited and sometimes recurring skin condition that is considered to be a type IV hypersensitivity reaction affecting the skin and mucous membranes
55
What is the most common cause of erythema multiform?
infection, herpes simplex, mycoplasma pneumonia, upper respiratory infections
56
What are the less common causes of erythema multiform?
drugs (sulfonamides, Beta-lactams, phenytoin), often idiopathic
57
What are the common clinical findings of erythema multiform?
- target (iris) lesions, dull "violet" red
- macules, vesicles, central bull with pale red rim and peripheral red halo
- blanching and lack of itchiness help characterize this rash
58
What is major erythema multiform?
causes widespread skin lesions and affects 2+ mucosal sites
59
What is minor erythema multiform?
affects a limited region of the skin and 1 type of mucosa (usually oral)
60
What is the dx of erythema multiform?
- presents as raised (papular), target lesions with multiple rings and dusky center (as opposed to annular lesions in urticaria)
- negative nikolsky sign
61
What is the tx of erythema multiform?
Remove the offending agent
62
What is the tx of mucocutaneous lesions of erythema multiform?
- IV fluids if needed
- oral compound solution (throat soothe/magic swizzle)
- systemic steroids for severe(prednisone 40-60 mg)
63
What is the tx of ocular lesions of erythema multiform?
immediate referral/consult
64
What is the tx of recurrent erythema multiform?
antiviral QD
65
What is erythema infectious (fifth disease)?
- Parvovirus B19 - "slapped cheek" rash on face - lacy reticular rash on extremities, spares palms and soles
- resolves in 2-3 weeks
- treatment is supportive, anti-inflammatories
66
What is hand-foot-and mouth disease?
- children <10 years old caused by coxsackievirus type A virus producing sores in mouth and rash on the hands, feet, mouth, and buttocks
- usually clears up on its own within 10 days
- treatment is supportive, anti-inflammatories
67
What are the 4 C's of measles (rubeola)?
cough, coryza, conjunctivitis, and cephalocaudal spread
68
What does the rash of of measles (rubeola) look like?
- morbilliform- maculopapular, brick red rash on face beginning at hairline then progressing to palms and soles last - rash lasts 7 days
- koplik spots (small read spots in buccal mucosa with blue-white pale center) precedes rash by 24-48 hours
69
What is the treatment of measles (rubeola)?
supportive - anti-inflammatories, isolate for 1 week after onset of rash
-MMR vaccine (12-15 months, 4-6 years)
70
What is rubella (German measles)?
"3-day rash" pink light-red spotted maculopapular rash first appears on face, spreads caudally to the trunk and extremities and becomes generalized within 24 hours (lasts 3 days)
71
What is the spread of rubella (German measles)?
-cephalocaual spread of maculopapular rash, lymphadenopathy (posterior cervical, posterior auricular)
72
What is Roseola (sixth disease)?
- herpesvirus 6 or 7, only childhood exanthema that starts on the trunk and spreads to the face
- high fever 3-5 days then rose pink maculopapular blanch able rash on trunk/back and face
73
What is the treatment of Roseola (sixth disease)?
supportive and is most cases, roseola is a benign and self-limited disease
- fever can be controlled with antipyretics if it is associates with discomfort
- the rash resolves without treatment
74
What is impetigo?
a highly contagious skin infection
| -area of superficial skin trauma
75
What are the most common locations of impetigo?
face and extremities
76
What is impetigo most commonly caused by?
S. aureus
77
What are the pain symptoms are impetigo?
- red sores that form around the nose and mouth
| - the sores rupture, ooze for a few days, then form a yellow-brown crust
78
What is the most common form of impetigo?
non-bollous
79
What is the most common cause of non-bollous impetigo?
S. aureus, GABHS
80
What are the characteristics of non-bollous impetigo?
vesicles, pustules "honey-colored" and weeping
81
What is the most common cause of bullous impetigo?
S. aureus
82
What are the characteristics of bullous impetigo?
Bullae, varnish-like crust, fever, diarrhea
83
What is the dx of impetigo?
gram stain and culture, (-) Nikolsky
84
What is the tx of impetigo?
warm water soaks 15-20 min then
| -1st line topical bactroban (mupirocin) x 5 days
85
What is the tx of widespread infection from impetigo?
- cephalexin or erythromycin x 1 week
- MRSA: docyclcline
- sick + MRSA: vancomycin
- bullous or severe: PO ABC
86
what are the complications of impetigo?
post streptococcal glomerulonephritis
87
What are the characteristics of lice?
pruritic scalp, body or groin
- nits are observed as small white specs on the hair shaft
- body (corporis)
- pubic (pubis)
88
What is the tx of lice?
launder potential formats such as sheets in hot water
- permethrin topical is the drug of choice
- Capitis: permethrin shampoo x10 minutes
- Pubis: permethrin lotion x 8 hours
89
What is lichen planus?
a chronic papulosquamous inflammatory dermatosis of unknown etiology, probably autoimmune in origin
90
What are the characteristics of lichen planus?
- appears as purplish, itchy, flat-topped bumps
- on mucous membranes, such as in the mouth
- forms lacy white patches, sometimes with painful sores
91
What are the 5 P's of lichen planus?
- purple
- papule
- polygonal
- pruritus
- planar
92
What is Wickham striae?
whitish lines visible in the papule of lichen planus and other dermatoses
93
What is the treatment of lichen planus?
topical steroids
94
When does pityriasis rosea occur?
children and young adults
95
What is pityriasis rosea characterized by?
an initial herald patch, followed by the development of a diffuse papulosquamous rash in Christmas tree pattern
96
What is a herald patch?
large oval plaque with central clearing and scaly border
| -1st sign of pityriasis rosea
97
What is the tx of pityriasis rosea?
self limiting: topical or systemic steroids and antihistamines are often used to relieve itching
-asymptomatic lesion do not require treatment
98
What is scabies?
pruritic papules: S-shaped or linear burrows on the skin
- often located in web spaces of hands, wrists, waist with sever itching
- worse at night
99
How is scabies diagnosed?
microscopic observation of mite, egg or feces after skin scrape
100
What is the treatment of scabies?
- topical permethrin 5% - apply to entire body and wash after 8-14 hours - repeat in one week (>2 months old)
- sulfur 5-10% ointment (<2 months)
- all clothing bedding, towels washed and dried using heat and have no contact with the body for at least 72 hours
101
What is the treatment of scabies for extensive involvement or immunocompromised individual?
oral ivermectin
- (0.2 mg/kg) - often 3 mg tabs take four now and repeat in 2 weeks
- do no use in pregnant/breastfeeding women or children <15 kg
102
How long may the pruritus with scabies last?
2-4 weeks after treatment
103
What is Stevens-Johnson syndrome?
a rare, serious hypersensitivity complex that affects the skin and the mucous membranes
-usually a reaction to a medication or an infection commonly caused by anticonvulsant and sulfa drugs
104
How much of you body does Stevens-Johnson syndrome cover?
3-10%
105
What are the characteristics of Stevens-Johnson syndrome?
- begins with prodrome of flu-like symptoms, followed by a painful red or purplish rash the spreads and blisters
- layers of skin peel away in sheets (+) Nikolsky's sign (pushing blisters causes further separation from the dermis)
106
What is the difference between Stevens-Johnson syndrome and toxic epidermal necrolysis?
less than 10% of body surface area detachement
107
What is the dx of Stevens-johnson syndrome?
skin biopsy shows necrotic epithelium
108
What are the ddx of Stevens-Johnson syndrome?
erythema multiforme, viral exanthema, drug rash
109
What is the tx of Stevens-Johnson syndrome?
stop all offending medications, early admission to burn unit, manage fluid/electrolytes/nutrition, airway stability, eye care
- IVIG
- steroids used to be tx of choice but now thought to increase risk of sepsis
110
What is tinea?
superficial fungal infections of the skin, hair and nails are characterized by erythema, scaling, changes in color and pruritus
111
What are the risk factors of tinea?
increased skin moisture, immunodeficiency (HIV, DM),, peripheral vascular disease
112
How do you dx tinea?
KOH
113
What does the KOH of dermatophytes look like?
long, branching fungal hyphae with septations
114
What does the KOH of candidiasis look like?
budding yeast, pseudohyphae
115
What does the KOH of tinea versicolor look like?
short hyphae and clusters of spores ("spaghetti and meatballs")
116
What is tinea barbae?
papules pustules, around hair follicles
117
What is the treatment of tinea barbae?
oral anti fungal therapy is necessary - two or four week course of griseofulvin microsize or oral terbinafine, itraconazole and fluconazole are also effective for dermatophyte folliculitis
118
What is tinea pedis?
athlete's foot: pruritic scaly eruptions between toes
119
What is the most common dermatophyte to cause athlete's foot?
trichophyton rubrum
120
What is the treatment for tinea pedis?
topical antifungals - azoles (1% clotrimazole, 2% ketoconazole), allylamines, butenafine, ciclopirox, tolnaftate, and amorolfine
121
What is tinea unguium (dermatophyte onychomycosis)?
infection of the nail
122
What is the treatment of tine unguium?
terbinafine is the first-line oral agent for mild to moderate dermatophyte onychomycosis
123
What is tinea cruris?
"jock itch" diffusely red rash in the groin or on the scrotum
124
What is the treatment for tinea cruris?
topical antifunals - azoles (1% clotrimazole, 2% ketoconazole), allylaines, butenafine, ciclopirox, and tolnaftate is effective
-nystatin is not effective for dermatophyte infections
125
What is the most common fungal infection in the pediatric population?
tinea capitis
126
When does tinea capitis mainly occur?
```
prepubescent children (between ages 3 and 7 years)
-asymptomatic carriers are common and contribute to spread
```
127
What is the treatment of tinea capitis?
systemic therapy warranted to penetrate the hair shaft
- oral griseofulvin (drug of choice)
- in addition, topical therapy of 2.5% selenium sulfide or ketoconazole shampoo twice weekly surpasses viable spores
- laboratory monitoring is not needed
128
What is tinea corporis?
ringworm
| -usually seen in younger children or in young adolescents with close physical contact with others (wrestlers)
129
What is the treatment for tinea corporis?
topica asole antifungals (1% clotrimazole, 2% ketoconzole) or 1% terbinafine cream applied twice daily for 2-4 weeks
130
What is tinea versicolor caused by?
Malassezia furfur
131
What is tinea versicolor?
- a yeast found on the skin of humans
| - lesions consist of hypo and hyperpigmented macule that do no tan
132
What is the treatment of tinea versicolor?
selenium sulfide 2.5% applied to the affected skin for 10 minutes
-wash off thoroughly, apply daily for 7-10 days, monthly applications may help prevent recurrences
133
What is not an effective treatment for dermatophyte infections?
nystatin
134
What is toxic epidermal necrolysis?
a rare, life-threatening skin condition that is usually caused by a reaction to drugs
135
How much of your body does toxic epidermal necrolysis cover?
30%
136
What is the difference between Steven Johnsons Syndrome and Toxic epidermal necrolysis?
older patients and >30% of body surface affected
137
What is the dx of toxic epidermal necrolysis?
biopsy (necrotic epithelium)
138
What is the tx of toxic epidermal necrolysis?
admit to burn unit with supportive care, consult ophthalmology if eyes affected, cyclosporine and possibly plasma exchange for severe cases
139
What is urticaria?
hives a skin rash triggered by a reaction to certain foods, medications, stress or other irritants
140
What are the symptoms of urticaria?
blanchable, pruritic, raised, red or skin-colored papules, wheels, or plaques on the skin's surface, usually disappear within 24 hours
141
What is the Darier's sign?
localized urticaria appearing where the skin is rubbed (histamine release)
142
Does urticaria have a positive or negative daters sign?
positive
143
What is angioedema?
painless, deeper form of urticaria affection the lips, tongue, eyelids, hand, and genital
144
What is the dx of urticaria?
extensive lab testing not indicated, skin or IgE testing limited to the specific history of provoking allergen
145
What is the tx of urticaria?
hives usually go away without treatment but antihistamine medications are often helpful in improving symptoms
- second generation antihistamine blockers (H1) are first-line treatment (Allegra, Claritin, Clarinex, Zyrtec)
- first generation antihistamine for sleep disturbances: hydroxyzine/diphenhydramine
- H2 antihistamine as adjuvants: cimetidine, ranitidine
- steroids for exacerbations avoid chronic use
146
What is used for anaphylaxis?
epinephrine
147
What is verrucae (ReelDx)?
warts
148
What are all warts caused by?
Human papilloma virus - most resolve without treatment over 2 years
149
What are verruca vulgaris?
- common warts
| - skin-colored papillomatous papules
150
What is verruca plana?
- flat warts
| - hands, face, arms, legs
151
What is verrucae plantaris?
- plantar warts
| - bottom of foot, rough surface, dark spot (thromboses capillaries)
152
What is condyloma acuminatum?
- venereal warts
| - flesh-colored, cauliflower appearance genital warts caused by HPV types 6 and 11
153
What is epidermodysplasia verruciformis?
a rare, lifelong hereditary disorder characterized by chronic infection with HPV
154
What is the tx of warts?
most resolve without treatment over 2 years
- cryotherapy with liquid nitrogen may be applied with a cotton swab or with a cryotherapy gun
- self-administered topical therapy such as salicylic acid
