Dermatology

Question 1

Describe these primary lesions

Answer 1

• Macules
• Papules
• Nodules

Question 2

Describe these primary lesions

Answer 2

• Plaques
• Pustules
• Vesicles/Bullae

Question 3

Describe these primary lesions

Answer 3

• Wheals
• Scales
• Crusts

Question 4

Describe these primary lesions

Answer 4

• Erosions/Ulcers
• Fissures/Atrophy
• Scars

Question 5

A 45 y/o male presents with a chronic rash that is present over his knees and elbows. Dx?

Answer 5

Psoriasis

Question 6

Answer 6

Tinea Corporis

Question 7

Psoriasis—Treatment

Answer 7

• < 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

Question 8

Herpes Zoster—Treatment

Answer 8

• 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

Question 9

Postherpetic Neuralgia—Treatment

Answer 9

• Anticonvulsants – Pregabalin (Lyrica) – Gabapentin (eg, Neurontin)
• Tricyclics
• Capsaicin
• Sympathetic nerve blocks – Bupivacaine – Must be given within 2 months of onset to be effective

Question 10

Scabies

Answer 10

• 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

Question 11

Scabies—Treatment

Answer 11

• 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

Question 12

Rhus Dermatitis

Answer 12

• 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

Question 13

Rhus Dermatitis—Treatment

Answer 13

• 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

Question 14

Answer 14

Folliculitis

Question 15

Folliculitis Types

Answer 15

• 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

Question 16

Answer 16

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

Question 17

Folliculitis—Rx

Answer 17

• 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

Question 18

Acne Vulgaris—Treatment

Answer 18

• 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

Question 20

A 65 y/o woman presented with this painful rash on her face

Answer 20

Herpes Zoster

Use Acyclovir (eg, Zovirax) in the inital stages of this illness