Dermatology Flashcards
Describe these primary lesions
- Macules
- Papules
- Nodules
Describe these primary lesions
- Plaques
- Pustules
- Vesicles/Bullae
Describe these primary lesions
- Wheals
- Scales
- Crusts
Describe these primary lesions
- Erosions/Ulcers
- Fissures/Atrophy
- Scars
A 45 y/o male presents with a chronic rash that is present over his knees and elbows. Dx?
Psoriasis
Tinea Corporis
Psoriasis—Treatment
• < 20% of body involved – Topical corticosteroids – Calcipotriene (Dovonex) • Vitamin D3 analog – Tazarotene (Tazorac) – Anthralin (Anthraderm) – Tar – UVB – Intralesional steroids
• > 20% of body involved (phototherapy)
• Severe recalcitrant disabling (FDA approved)
– Methotrexate • Gold standard
– Acitretin (eg, Soriatane) (IIB)
- Plaque type – Cyclosporine (eg, Sandimmune) (IIB)
- Anti-TNF agents – Infliximab, etanercept, adalimumab
Herpes Zoster—Treatment
• Analgesics
• Wet compresses (Burow’s solution – aluminum acetate)
• Antiviral therapy
– Acyclovir (eg, Zovirax) • 800 mg QID x 7 days
– Famciclovir (eg, Famvir) • 500 mg q 8 hrs x 7 days
– Valacyclovir (eg, Valtrex) • 1 g TID x 7 day
• Oral corticosteroids (eg, Prednisone) – May decrease pain initially during acute phase – Does not reduce subsequent postherpetic neuralgia
Postherpetic Neuralgia—Treatment
- Anticonvulsants – Pregabalin (Lyrica) – Gabapentin (eg, Neurontin)
- Tricyclics
- Capsaicin
- Sympathetic nerve blocks – Bupivacaine – Must be given within 2 months of onset to be effective
Scabies
- Hypersensitivity reaction to Sarcoptes scabiei – Eggs, fecal pellets (scybala)
- Nocturnal pruritus – Scratching spreads mites to other areas
- Curved or linear burrows
- Vesicles or small papules
- Pustules indicate secondary infection
Scabies—Treatment
- Launder all bedding and clothes worn within 48 hrs in hot water, or dry clean
- Treat patient, intimate contacts, and family members in same household
- 5% Permethrin cream (Elimite) – Drug of choice – Apply below the neck, may repeat in 1 week
Rhus Dermatitis
- Caused by contact with urushiol (from sap)
- Found in plants from Anacardiaceae family, Rhus (Toxicodendron) genus – Poison ivy – Poison oak – Poison sumac – Cashew – Mango – Ginkgo – Japanese lacquer tree
- Linear lesions • Vesicles – Fluid does not contain resin and won’t spread rash • Erythema • May occur within 8 hrs or up to a week after exposure
Rhus Dermatitis—Treatment
• Decontamination within 10 min after exposure
– Not helpful after 1 hr • Wet compresses • Topical corticosteroids • Systemic corticosteroids
– Prednisone 60 mg (1 mg/kg) tapered over 14-21 days
Folliculitis
Folliculitis Types
- Folliculitis – Superficial bacterial infection of the hair follicles – Purulent material in the epidermis
- Carbuncle – Coalescence of several inflamed follicles into a single inflammatory mass – Purulent drainage from multiple follicles
• Furuncle (boil) – Infection of the hair follicle in which purulent material extends through the dermis into the subcutaneous tissue – Small abscess forms • Collection of pus within the dermis and deeper skin tissues
Furunculosis
• Furuncle (boil) – Infection of the hair follicle in which purulent material extends through the dermis into the subcutaneous tissue – Small abscess forms • Collection of pus within the dermis and deeper skin tissues
Folliculitis—Rx
- Lesions usually resolve spontaneously – With or without drainage
- Warm compresses may be applied three times daily
- Shaving should be avoided in involved areas
- Hot tub folliculitis
– Avoid exposure to the source of contaminated water
– Most cases – no further Rx needed
– Severe cases – can treat with ciprofloxicin
- Mupirocin – Persistent lesions with suspected Staph etiology
- Topical antifungals (azoles) – Suspected fungal etiology
Acne Vulgaris—Treatment
• Comedonal acne – Keratinolytic agent
-– Tretinoin (eg, Retin-A)
– Adapalene (eg, Differin)
• Mild inflammatory acne – Keratinolytic agent +/- BP/topical antibiotic
• Moderate inflammatory acne – BP/topical antibiotic +/- systemic antibiotic
• Severe (nodulocystic) acne – Isotretinoin
A 65 y/o woman presented with this painful rash on her face
Herpes Zoster
Use Acyclovir (eg, Zovirax) in the inital stages of this illness
