Dermatology Flashcards
[diagnose]
Erythematous papules and predominantly open and closed comedones of the face, chest, back.
Pustule and post-inflammatory macules
Dx: Acne vulgaris
Hallmark: Comedone
DOC for mild non-inflammatory acne: Topical retinoids
DOC for severe nodulocystic acne unresponsive to other therapy: synthetic retinoid isotretinoin
what is the clinical hallmark of acne vulgaris?
comedones
[diagnosis
22/M, rash on the extensor surface of his elbow and gluteal area.
PE: Well demarcated small and large erythematous plaques with adherent silvery scales, nails present as pitting
Dx: Psoriasis
Etiology: T-cell mediated disorder leading to epidermal hyperproliferation
What is the most common variety of psoriasus?
plaque-type
What is the treatment for localized psoriatic lesion?
mid-potency topical steroids
What is the treatment for widespread psoriatic lesion ?
UV light
Start treating if >30% body surface area
What agent should not be used for the treatment of psoriasis?
Oral sterids
____ phenomenon is the development of lesion to the site of an epidermal injury
Koebner phenomenon
[diagnose]
small erythematous, scaling papules, frequently after the upper respiratory tract infection with beta hemalytic streptococci
Guttate or eruptive psoriasis
___ sign
removal of the scale causes pinpoint bleeding
Auspitz sign
The classic form of psoriatic arthritis involves this joint?
DIP predeominant
[Diagnose]
Sausage digits, telescoping fingers due to resorption of bones in hands and wrist
Arthritis mutilans
A vitamin D analogue that is used as an alternative treatment to psoriasis?
calcipotriene
A retinoid used as an alternative treatment for psoriasis
tazarotene
DMARD that is effective in patients with psoriatic arthritis
Methotrexate
[diagnose]
20/M history of brinchial asthma presents with intensely pruritic rash on his forearms and back of the knee.
PE: antecubital fossae, lichenified and hyperpigmented
Dx: Atopic dermatitis
Pathogenesis: Impaired epidermal barrier
What is the most prominent characteristic of atopic dermatitis?
Pruritus
What treatment regimen is commonly employed in patients with atopic dermatitis?
low to mid-potency glucocorticoids
What topical immunosuppressants in atopic dermatitis can be used to decrease dependence on steroid use?
- Tacrolimus
2. Pimecrolimus
[diagnose]
18/M intensely pruritic rash on both hands and on her left chee
PE: vesicles and erythematois plaques arranged linearly with slight crusting. no history of eczema.
Dx: Allergic Contact Dermatitis
Type of hypersensitivity rection: Type IV
Wha tis the definitive diagnostic test for contact dermatitis?
patch testing
What is the most appropriate treatment for allergic contact dermatitis?
avoid exposure of of allergen
[Irritant vs Allergic CD]
hands, burning, pruritus, dry fissured skin, less distinct border
irritant
[Irritant vs Allergic CD]
exposed areas of the skin, pruritus, vesicles and bullae, distinct angles, lines, border
allergic
[diagnosis]
40F dishwasher; fluid filled rash forming on her hands that are painful and sometimes itchy. Noted deep-seated vesicles on palms and lateral fingers
Dx: Dyshydrotic Eczema
Tx: Identify irritant or allergen exposure
[diagnosis]
highly pruritic vesicles on the sides of the fingers, thenar and hypothenar eminence
dyshydrotic eczema
[diagnose]
30M, pruritic rash on the face, scalp, back of the ear.
PE: erythema and yellowish scale in the nasolabial folds and eyebrows,
Dx: Seborrheic dermatitis
Tx: topical antifungal (ketoconazole)
What is the more common location of seborrheic dermatitis?
scalp
[diagnose]
scaly, greasy, flaky skin fpund on a red base of the scalp, around the eyebrown, and nasolabial fold
seborrheic dermatitis
[diagnose]
60M with a history of DVT, multiple scaly, erythematous oozing patches with non-tender ulcers on the right ankle area
Dx: Stasis dermatitis
Typical location: Medial aspect of the ankle
Tx: leg elevation and compression stockings
[diagnose]
32F presents with flulike symptoms, mouth sores, and rash on the chest and arm. Recently took co-trimoxazole for UTO.
PE: febrile, symmetric erruption of targetoid patches, with central vesicle, over the chest, arms and face
Dx: SJS
Diagnostic test: Frozen section skin biopsy
Wha tis the most common cause of all drug-induced reactions (SJS)?
morbilliform or maculopapular eruption
[diagnose]
fever >39 deg C, sore thriat, conjunctivitis, acute onset of painful dusky atypical, target-like lesions
blister and mucosal/epidermal detachment <10% surface area
SJS
[diagnose]
fever >39 deg C, sore thriat, conjunctivitis, acute onset of painful dusky atypical, target-like lesions
blister and mucosal/epidermal detachment >30% surface area
TEN
the most severe form of EM is
SJS
The most severe form of SJS
TEN
Drugs that commonly cause SJS or TEN
- Sulfonamides
- Allopurinol
- Anticonvulsant
- NSAID (oxicam)
- Lamotrigine
- Nevirapine
What is the second most common type of cuteaneous drug reaction presentation?
Urticaria
red wheals of varying size
Most comon: Morbilliform rash
What is the drug of choice of morbilliform or maculopapular eruptions?
antihistamine and emollients
What is the mainstay therapy for urticaria/angioedema?
Epinephrine
[diagnose]
19/M few bumps on his lips that are painful; burning sensation progressing to small group of bumps on the same area.
PE: small groups of vesicles in an erythematous base
Dx: Herpes simplex
Next step: start antiviral treatment
Inital test: Tzank smear
What is the most accurate test for HSV?
viral culture
What is the drug of choice for acyclovir-resistant herpes?
Foscarnet
[diagnose]
60M severe pain on the right side of his chest and back; rash on the same side
PE: group vesicles on an erythematous base in a unilateral dermatimal distribution
Dx: Herpes zoster or shingles
Next step: antiviral treatment
Initial test: tzank smear
Accurate test: viral culture
What is the initial presenting symptom of shingles?
pain
What is the most common debilitating complication of shingles?
- Pain with acute neuritis
2. Postherpetic neuralgia
Blindness due to zoster infection of the trigeminal nerve
zoster ophthalmicus
___ syndrome
- Pain and veiscle of the external autditory canal
- Loss taste in anterior 2/3 of the tongue
- Ipsilateral facial palsy
Ramsay Hunt Syndrome
What is the antiviral preferred for herpes zoster virus?
- Acyclovir 800mg 5x per dat for 7-10 days
[Diagnosis]
dewdrops on a rose petal
Varicella zoster/chickenpox
[diagnosis]
“herald” patch
Erythematous and salmon colored skin with fine scales (cigarette paper)
christmas tree pattern on the back
pityriasis rosea
What is the treatment of choice for mild pityriasis rosea?
Topical steroid and antihistamine
What is the treatment of choice for refractory pityriasis rosea?
UVB phototherapy
What disease will you also rule out for patients with pityriasis rosea?
Syphilis
by RPR/VDRL
What is the best initial test for primary syphilis?
Dark field microscopy
What is the best initial test for secondary syphilis?
VDRL/RPR
[Diagnosis]
scaling erythematous papules, few linear burros, extremely pruritic at night
Dx: Scabies
Initial therapy: permethrin, ivermectin
Diagnostic testing: scrape organsism after mineral oil is applied to burrow
What is the drug of choice for hyperkeratotic/norweigian scabies?
Ivermectin
[Diagnose]
Hypo/hyperpigmented skin patch
spaghetti and meat-balls
Dx: Tinea versikolor
Etiology: Malassezia furfur
Test: KOH preparation
Tx: Antifungal
[diagnose]
circular patches with advancing red, sharp, irregular border with central scaling, pruritic eruptions
Dx: Tinea corporis
Etiology: dermatophytes
diagnostics: KOH
Tx: Itraconazole or terbinafine
The most aggressive and most common life-threatening dermatologic disease
melanoma
[Diagnose]
central ulceration, pearly, rolled, telangiectatic tumor border, locally aggressive but rarely metastatic
Basal Cell CA
Dx: skin biopsy
Tx: ecision
What is the most common skin cancer?
basal cell CA`
[diagnosis]
crusting, ulcerated nodule or erosion with ill-defined margins; can potentially metastasis
Dx: Squamours cell CA
Diagnostics: skin biopsy
Tx: excision
What is the second most common skin cancer?
squamous cell CA
{diagnose]
dotted or coiled vessels
Squamous cell CA
[diagnose]
multiple violaceous papules on the neck, back, face
Kaposi sarcoma
