Dermatology

Question 1

Acanthosis nigricans
Path:
Pt:
Tx:

Answer 1

Path: obese patient with insulin resistance
Pt: Asx
Tx: treat insulin resistance

Question 2

Acne vulgaris
Path:
Pt:
Tx:

Answer 2

Path: Blockage of follicular opening from hyperkeratinization; Increased sebum production: inflammation
Pt:
Noninflammatory: closed comedones (white heads); open comedones (black heads)
Inflammatory: papules, pustules, nodules cysts
Nodulocystic: inc chance of permanent scarring
Tx: skin care
topical retinoids
topical antimicrobials (benzoyl peroxide, dapsone)
oral abx (tetracycline, doxycycline)
hormonal therapy (combo OCPs, spironolactone)
isotretinoin

Question 3

Urticaria
Path:
Pt:
Dx:
Tx:

Answer 3

Path: Type I hypersensitivity rxn
IGE-mast cell-> release histamine; capillary dilated, gets leaky, leaks protein fluid

Pt: Annular, red papule that blanches-> Wheels

Dx: Dx-> clinical
recognize anaphylaxis-> hypotension

Tx: Steroids, H1 + H2 blockers (antihistamine)
anaphylaxis-> IM epi

Question 4

Drug Eruption
Path:
Pt:
Dx:
Tx:

Answer 4

Path: Sulfa, pcn=cephalosporins, Anti-retroviral, Anticonvulsants

Pt: Pink morbilliform symmetric widespread
7-14 days after start of new med

Dx: clx

Tx: remove offending agents
Antihistamines
Steroids
F/U fixed drug eruption; same rash, same place after same drug

Question 5

Steven-Johnson Syndrome
Path:
Pt:
Dx:
Tx:

Answer 5

Path: basal layer, dusky, looks like erythema multiforme
<10% BSA
carbamazepine #1 med cause this type of drug eruption, 2nd MC mycoplasma pneumonia infection

Pt: Sloughing skin
Hemorrhagic erosions w/ a grayish white membrane on mucous membranes
Severe conjunctivitis

Dx: bx, + nikolsky

Tx: Stop all meds
Burn unit
F/U oral, ophthalmology-> at risk for losing vision

Question 6

Toxic epidermal necrolysis
Path:
Pt:
Dx:
Tx:

Answer 6

Path: ull-thickness, sheets of skin
>30% BSA
carbamazepine #1 med cause this type of drug eruption, 2nd MC mycoplasma pneumonia infection

Pt: Sloughing skin
Hemorrhagic erosions w/ a grayish white membrane on mucous membranes
Severe conjunctivitis

Dx: bx, + nikolsky

Tx: Stop all meds
Burn unit
F/U oral, ophthalmology-> at risk for losing vision

Question 7

Alopecia Areata 
Path:
Pt:
Dx:
Tx:

Answer 7

Path: Immune-mediated disorder that causes recurrent, non-scarring hair loss

Pt:
Autoimmune disease
Complaining of hair loss
PE: patches of smooth, non-scarring hair loss w/ patches of smaller hairs termed exclamation hairs

Dx: Positive pull test: individual hairs are easily dislodged

Tx:
Corticosteroids creams or injections
Minoxidil
Phototherapy
Topical immunotherapy