Dermatology

Question 1

Treatments for Atopic Dermatitis

Answer 1

Emmolients
Topical steroids
Immunomodulators
- Topical tacrolimus/pimecrolimus
- Topical crisaborole (PDE4)
- Methotrexate
- Mycophenolate mofetil
- Cyclosporine (acute control of bad disease)
- Dupilumab (IL-4/13 inhibitor)

Question 2

Associations with Sebhorreic dermatitis (esp if severe)

Answer 2

HIV, Parkinson’s Disease

Question 3

Safest acne treatments in pregnancy

Answer 3

1) Clindamycin
2) Erythromycin
3) Azelaic acid

Question 4

CREST Antibody

Answer 4

Anticentromere

Question 5

Zinc Deficiency (Acrodermatitis enteropathica)

Answer 5

Alcoholics, elderly, eating disorders, immunosuppressed
Discoloration/rash favors acral and periorificial sites
Zinc levels may be normal
- consider copper to zinc ratio (absorbed competitively)

Question 6

Urticarial Vasculitis vs Urticaria

Answer 6

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

Question 7

What defines moderate to severe psoriasis? How is it treated?

Answer 7

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%

Question 8

What is miliaria?

Answer 8

Heat rash

- superficial clear vesicles or multiple discrete red papules

Question 9

What are some features and causes of cutaneous lupus erythematosus

Answer 9

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

Question 10

What is acantholytic dermatosis?

Answer 10

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)

Question 11

What conditions is pyoderma gangrenosum associated with?

Answer 11

1) Ulcerative colitis/Crohn disease
2) Leukemia
3) myeloma
4) Hepatitis C
5) SLE

Treatment: topical glucocorticoids, systemic glucocorticoids, AZA, cyclosporine, infliximab

Question 12

Describe features of polyarteritis nododa

Answer 12

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

Question 13

Erythroderma

Answer 13

Redness, chills, scaling, erosions covering >80% of BSA

- Can be seen following sudden withdrawal of systemic -steroids in patients with underlying psoriasis vulgaris

Question 14

Treatment for dermatitis herpetiformis

Answer 14

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

Question 15

What can topical antibiotics cause if applied to venous stasis ulcers?

Answer 15

Look out for contact dermatitis, especially with neomycin/polymyxin B/bacitracin ointment

Commonly mistaken for cellulitis

Question 16

Treatment options for tinea pedis

Answer 16

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

Question 17

Drugs implicated in drug-induced pruritis (usually has no associated skin findings)

Answer 17

1) HCTZ
2) CCBs
3) Opiates
4) NSAIDs

Be sure to rule out other systemic causes for pruritis (HIV, hyperthyroidism, hepatobiliary disease, lymphoma, PCV)

Question 18

What is vismodegib used for?

Answer 18

Locally advanced or metastatic basal cell carcinoma

Inhibitor in the hedgehog signaling pathway

Question 19

Skin findings in amyloidosis

Answer 19

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

Question 20

What condition are eruptive xanthomas associated with

Answer 20

Hypertriglyceridemia
- also seen in diabetes mellitus

Eruptive xanthomas are yellow papules with surrounding erythema, located on extensor surfaces of the extremities and buttocks

Question 21

What is erythrasma

Answer 21

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