Dermatology Flashcards
Treatments for Atopic Dermatitis
Emmolients Topical steroids Immunomodulators - Topical tacrolimus/pimecrolimus - Topical crisaborole (PDE4) - Methotrexate - Mycophenolate mofetil - Cyclosporine (acute control of bad disease) - Dupilumab (IL-4/13 inhibitor)
Associations with Sebhorreic dermatitis (esp if severe)
HIV, Parkinson’s Disease
Safest acne treatments in pregnancy
1) Clindamycin
2) Erythromycin
3) Azelaic acid
CREST Antibody
Anticentromere
Zinc Deficiency (Acrodermatitis enteropathica)
Alcoholics, elderly, eating disorders, immunosuppressed
Discoloration/rash favors acral and periorificial sites
Zinc levels may be normal
- consider copper to zinc ratio (absorbed competitively)
Urticarial Vasculitis vs Urticaria
1) Urticarial vasculitis lasts >24 hours
2) Often painful, burning
3) Leave bruise-like changes after resolving
4) Often seen in those with underlying autoimmune disease
What defines moderate to severe psoriasis? How is it treated?
1) 30% or more of BSA involved
2) Systemic agents
- TNF inhibitors (enteracept, adalimumab, inflixamab)
- acitretin
- methotrexate
- phototherapy
Consider topical only management for BSA <10%
What is miliaria?
Heat rash
- superficial clear vesicles or multiple discrete red papules
What are some features and causes of cutaneous lupus erythematosus
1) Worsens with sun exposure
2) Burns more than itches
3) Lighter pink-to-violet tone (compared to psoriasis)
4) Causes
- TNF inhibitors (e.g. adalimumab)
- HCTZ
- ACE-I
- NSAIDs
- PPI
- Terbinafine
What is acantholytic dermatosis?
AKA Grover Disease
- benign eruption, affects middle-aged to elderly men
- small discrete papules, which may be scaly
- usually located on the trunk
- may have associated pruritis
- triggered by excessive sweating
- topical glucocorticoids or moisturizes may be used if course is prolonged (usually transient)
What conditions is pyoderma gangrenosum associated with?
1) Ulcerative colitis/Crohn disease
2) Leukemia
3) myeloma
4) Hepatitis C
5) SLE
Treatment: topical glucocorticoids, systemic glucocorticoids, AZA, cyclosporine, infliximab
Describe features of polyarteritis nododa
1) Medium-vessel vasculitis, not associated with ANCA
2) cutaneous-only variant exists
3) tender subcutaneous nodules, stellate erosies, ulcerations, livedo reticularis
4) Systemic PAN: abdominal pain, GI bleeding, HTN, neuropathy (mononeuritis multiplex)
5) Cutaneous-PAN treatments
- systemic antihistamines
- colchicine
- dapsone
- AZA
Erythroderma
Redness, chills, scaling, erosions covering >80% of BSA
- Can be seen following sudden withdrawal of systemic -steroids in patients with underlying psoriasis vulgaris
Treatment for dermatitis herpetiformis
1) Gluten-free diet (even if no GI symtpoms)
2) Dapsone (test for G6PD) - for skin symptoms only, does not treat associated Celiac Disease
Pathology would show granular IgA in the dermal papillary tips
What can topical antibiotics cause if applied to venous stasis ulcers?
Look out for contact dermatitis, especially with neomycin/polymyxin B/bacitracin ointment
Commonly mistaken for cellulitis
Treatment options for tinea pedis
1) Imidazole
2) Miconazole
3) Clotrimazole
4) Ketoconazole
5) Ciclopirox
6) Terbinafine
Consider oral antifungal therapies for : tinea capitis, onychomycosis, majocchi granuloma (granulomatous response to infected hair follicles)
Avoid concomitant treatment with topical steroids due to risk of treatment failure
AVOID ORAL KETOCONAZOLE - risk of fulminant hepatitis
Drugs implicated in drug-induced pruritis (usually has no associated skin findings)
1) HCTZ
2) CCBs
3) Opiates
4) NSAIDs
Be sure to rule out other systemic causes for pruritis (HIV, hyperthyroidism, hepatobiliary disease, lymphoma, PCV)
What is vismodegib used for?
Locally advanced or metastatic basal cell carcinoma
Inhibitor in the hedgehog signaling pathway
Skin findings in amyloidosis
1) Generalized waxy appearance
2) Ecchymoses with minor pressure (“pinch purpura”)
3) Ecchymoses around the eyes (“raccoon eyes”)
4) Yellow waxy papules and plaques - periorbital
5) Dystrophic nails
6) Macroglossia
What condition are eruptive xanthomas associated with
Hypertriglyceridemia
- also seen in diabetes mellitus
Eruptive xanthomas are yellow papules with surrounding erythema, located on extensor surfaces of the extremities and buttocks
What is erythrasma
Superficial infection with Corynebacterium minutissimum
- seen in warm, moist areas (intertriginous)
- well-defined, pink-to-brown patches with fine scale
- Wood lamp: bright coral-red color