Dermatology Flashcards
What do you do if you see this rash?
tx for lyme - oral doxycycline or amoxicillin
How to tx fungal infections of skin?
topical ketoconazole, clotrimazole, econazole, terbinafine, miconazole
How do you treat primary and secondary syphilis?
one dose of IM penicillin
if allergic - desensitize and tx wtih penicillin or doxy for 2 weeks
*pt can develop what looks like sepsis/anaphylaxis due to killing off the syphilis and endotoxin release. tx with NSAIDs or aspirin
What is this and how do you tx?
chronic dz, not fungal *maybe autoimmune
tx with selenium sulfide every 2-3 weeks to reduce color difference
How to treat psoriasis?
Use salicyclic acid to remove the scaly material, then use topical steroids
In severe dz can use coal tar or anthralin derivatives (creams)
*can also use vit D (calcipotriene) and vit A (tazarotene) derivatives
What is the best initial test for syphilis?
darkfield exam
*RPR and VDRL will not be positive yet when chancre is present
How to treat fungal infections of the nails?
oral terbinafine or itraconazole
(at least 6 wks for fingernails and 12 wks for toenails)
check liver fx and don’t drink
*could do griseofulvin for fingernails for 6-12 months (less efficacy but less toxic)
How does secondary syphilis present?
generalized copper-colored, maculopapular rash on palms and soles of feet, otherwise feeling well.
*can also have mucous patch, alopecia areata, condylomata lata
How do you treat Lyme disease that is causing cardiac abnormalities (heart block) or neurologic symptoms (bilateral CN7 palsy)?
IV Ceftriaxone for 14-28 days
tele monitoring
How to confirm HSV dx?
Tzanck smear of ulcer showing multinucleated giant cells
viral culture (takes 24-48 hrs)
Serology can tell you chronic or new (but not really useful)
How to treat herpes zoster?
- oral acyclovir, valacyclovir, and famciclovir
- aluminum acetate soaks can be helpful for skin lesion pain
- analgesics for post-herpetic neuralgia - gabapentin, amitriptyline, lidocaine patch, pregabalin
- in immunocompromised - use IV acyclovir and hospitalization
How to treat herpes simplex?
suppress the disease based on active lesions
tx wtih oral acyclovir, famiciclovir, or valacyclovir
What is the work up with erythema nodosum?
CXR (look for sarcoid, TB), if neg…
labs, infectious work up
can be idiopathic
How can you confirm herpes zoster (usually don’t need to, just clinical)?
Tzanck test and viral culture
What are characteristics of melanoma?
asymmetry
irregular borders
Color variation
diameter > 6 mm
What is this diagnosis and how do you get rid of it?
melanoma
excision
How do basal cell cancers present?
most common skin cancer
shiny or pearly appearance
What is the Ramsay Hunt Syndrome?
Herpes Zoster that causes cranial nerve 7 palsy
*lose sense of taste and ipsilateral facial palsy
look for vesicles in the ear canal
How do you dx and tx squamous cell cancer?
biopsy
treat with surgical removal or radiotherapy if the lesion cannot be treated surgically
What causes tinea versicolor and what does it look like on KOH?
malassezia furfur
“spaghetti and meatballs pattern”
What is seen with tinea versicolor?
light skin - often well demarcated hyperpigmented lesions over back/shoulders/abdomen worse in summer/spring
dark skin - can look hypopigmented
What is the natural history fo lyme disease?
rash at 7-10 days, goes away in a couple weeks, then joint pain and can progress to cardiac manifestations or neurologic manifestations
How to treat fungal infections of the scalp or beard?
- terbinafine or itraconzaole oral is best
- could also do oral griseofulvin for 6-8 wks
How to dx superficial fungal infections?
KOH test of leading edge of lesion
*KOH desolves tissue, but leaves fungus
What causes erythema nodosum?
inflammation of the skin that is commonly assoc with infections/inflammatory conditions (pregnancy, strep, coccidio, histoplasmosis, sarcoidosis, IBD, syphilis, hepatitis, TB
Who should get the herpes zoster vaccine?
everyone at age 60!
helps decrease shingles by 50% and post-herpetic neuralgia by 66%
What is this?
HSV (could be 1 or 2)
How does primary syphilis present?
genital chancre (can happen in oral cavity too) - painless ulcer with heaped-up, indurated edges
How do squamous cell carcinomas present?
common on lip, sun-exposed areas
often ulcerates
What test do you use for secondary syphilis?
VDRL and RPR test
Then confirm with treponemal specific tests
How do you dx and tx basal cell carcinoma?
need a shave or punch biopsy
tx is surgical removal - Mohs microsurgery is best (go until you have clean margins)
How do you treat eczema from mild to severe?
moisturize w/ ointments
topical steroids
tacrolimus
What is the natural hx of erythema nodosum?
lasts 4-6 wks
do not ulcerate
very tender
What is this dz?
Herpes Zoster (Shingles)
What is the most common type of melanoma?
superficial spreading melanoma
