Dermatology Flashcards
Diagnosis of bullous pemphigoid
Biopsy both lesional skin for histology + perilesional normal skin for direct immunofluorescence
Pityriasis (tinea) versicolor presentation
- young adult + asymptomatic + oval to round hyper or hypogpigmented macules
Treatment of pityriasis versicolor
Topical antiseborrheic shampoos or lotions (selenium sulfide or ketoconazole)
Tinea diagnosis
KOH prep using scale showing fungal hyphae
Tinea infection presentation
Annular + peripheral scale + central clearing
Eczematous dermatitis treatment (specific treatment)
- topical glucocorticoids
- mild cleansers, emollients (petrolatum)
eczema location
antecubital and popliteal fossa
diagnosis of urticarial vasculitis
Skin biopsy
Presentation of urticarial vasculitis
Short duration urticarial wheels that resolve + painful + leave bruise-like changes
Diagnosis of allergic contact dermatitis
Epicutaneous patch testing
Treatment of striae and atrophy from topical steroids
Stop topical steroids
Chickenpox (varicella) presentation
Pruritic papules and vesicles on umbilicate center that appear in crops and then crust over
What is melanonychia?
Brown longitudinal pigmentation of nail plate
What is paronychia?
Loss of cuticles, tender, edematous nail folds involving multiple fingers
Definition of moderate to severe psoriasis
30% or more body surface area involvement
Treatment of moderate to severe psoriasis
Systemic agents (MTX, TNF inhibitors – etanercept, adalimumab, infliximab)
Other indications for systemic therapy with psoriasis
- psoriatic arthritis, pustular psoriasis, or groin/scalp involvement
Treatment of pruritic urticarial papules and plaques of pregnancy (PUPPP)
Topical steroids
Treatment of intrahepatic cholestasis of pregnancy
ursodeoxycholic acid
What is miliaria + presentation
- “heat rash”
- multiple discrete red papules due to the occlusion of sweat ducts
- often due to sweat gland occlusion from patient being immobilized (after surgery)
Candida clinical features
Intertriginous areas
Treatment of severe nodulocystic acne
Oral isotretinoin
What is amyopathic dermatomyositis?
skin findings characteristic of dermatomyositis but without clinical or laboratory evidence of muscle disease
Characteristic findings of dermatomyositis
Heliotrope sign, shawl sign, gottron papules
Mixed connective tissue disease clinical features
Features of SLE + systemic sclerosis + polymyositis
Strongest prognostic indicator in Stevens-Johnson syndrome/toxic epidermal necrosis (TEN
Body surface area
Bullous pemphigoid clinical features
Elderly person + trunk and upper legs + intact/nonruptured blisters
Treatment of impetigo
IF mild –> mupirocin ointment
More severe –> oral abx (dicloxacillin, erythromycin)
Impetigo clinical features
Honey-colored crust + common in kids
Rheumatoid vasculitis clinical features
Elderly male smoker + long-standing RA history +
Presentation of actinic purpura
Age and sun damage-related capillary fragility + bleeding under atrophic skin
Presentation of subacute cutaneous lupus erythematous (SCLE)
Photodistributed + worsens with sun exposure + erythematous annular scaly patches
Common causes of drug induced SLE
HCTZ ACEinhibitors NSAIDs PPIs Terbinafine
Management of recurrent cellulitis
Source control (treat intertrigo and maceration between toe spaces + treat edema + eczema + venous insufficiency)
Cellulitis presentation
Well-demarcated + warm + tender
Management of recurrent actinic keratosis
Biopsy to rule out neoplasm (can’t completely cut it out because histology is necessary to guide treatment)
Presentation of actinic keratoses
Red scaly papules and plaques that occur in sun-exposed areas in old people
Treatment of actinic keratoses
IF single –> Cryotherapy
IF grouped –> 5-Fu or imiquimod
Standard treatment of basal cell carcinoma
Typically wide local excision
Basal cell carcinoma clinical features
Asymptomatic + translucent/pearly + sun-exposed areas + telangiectasis
Keratoacanthoma presentation
(look at picture)
- rapidly growing pink nodule with crusted core and central crater (volcaniform)
- rapidly grow, then slowly involute, eventually resolving completely
Squamous cell carcinoma presentation
(see picture)
- pink hyperkeratotic papule or nodule
SCC compared with basal cell
SCC’s have scale and do not have translucent, pearly appearance
What is lupus pernio
Sarcoidosis of the nose and central face
Presentation of lupus pernio
Violaceous subcutaneous plaques or nodules
Management of basal cell tumor on the face or genitals
Mohs surgery (also used for large or recurrent tumors, tumors with aggressive features)
Erythema multiforme clinical features
Target lesions + mucous membrane involvement + often triggered by drug or infection (mycoplasma or HSV)
Disseminated gonorrhea presentation
Vesiculopustular or hemorrhagic macular skin lesions + polyarthralgia
Actinic purpura is
age-related bruising due to capillary fragility and bleeding under atrophic skin
clinical features of stasis dermatitis
Edema + erythema + scaling + pruritus + more often bilateral
treatment of stasis dermatitis
Start with compression stockings and leg elevation
Can also use topical steroids and emollients
stasis dermatitis vs. cellulitis
Cellulitis = tender, not pruritic, hot to the touch, less scaling than stasis dermatitis
Psoriasis clinical features
Well-demarcated + erythematous plaques with silvery scale + nail changes
Treatment of epidermal inclusion cyst
Excision (NOT I&D, only I&D if they rupture)
Term for hair loss with pregnancy + why it happens
Telogen effluvium
- triggered by physically traumatic event (surgery, parturition)
seborrheic dermatitis clinical features
Erythematous patches w/ greasy scale + located on scalp, nasolabial folds and chest
Seborrheic dermatitis associations
HIV Neurologic conditions (Parkinson disease)
Derm conditions associated with chronic hep C
Porphyria cutanea tarda
Lichen planus
Transient acantholytic dermatosis clinical features
Red pruritic papules on the chest, flanks, and back + due to dry skin, heat, and heavy sweating
Allergic contact dermatitis clinical features
Pruritic eruption of patches and plaques + vesicular
Lichen planus presentation
Pruritic, purple, polygonal papules that coalesce into plaques
Melanotic macule clinical feaures
Small, well-circumscribed, brown-to-black macule + often on lower lip but can be on any mucosal surface
Precursor to squamous cell carcinoma
Actinic cheilitis
Actinic cheilitis clinical features
Chronic red-to-tan scaly patches + typically lower lip
localized scleroderma clinical features
isolated sclerotic circumscribed plaques
lentigo maligna clinical features
Subtype of melanoma that arises on head and neck of old people + indolent
Most aggressive form of malignant melanoma
Nodular melanoma
Treatment of mild inflammatory acne in pregnant woman
Topical erythromycin + topical benzoyl peroxide
Describe morbilliform drug rash
- Most common form of cutaneous adverse drug reactions
- Erythematous papules coalescing into plaques = often pruritus + no systemic symptoms + peripheral eosinophilia + delayed (several weeks after)
Treatment of morbilliform rash
Antihistamines + topical steroids
DRESS clinical features
Delayed (2-6 weeks) + eosinophilia + skin pain/facial edema + …
Viral exanthem vs. morbilliform rash
- Viral exanthem occurs immediately after infection, morbilliform rash is delayed several weeks after medication
Treatment for vitiligo
Topical steroids or immunomodulators
Chancroid presentation
Painful ulcerations + inguinal lymphadenopathy
Pyoderma gangrenosum clinical features
Painful, exudative ulcer + purulent base + ragged, edematous, violaceous border
Pyoderma gangrenosum primary association
IBD
Pyoderma gangrenosum treatment
Topical or oral steroids or immunosuppressive agents (azathioprine, cyclosporine, infliximab)
Calciphylaxis presentation
Painful subcutaneous nodules or plaques + overlying red-brown discoloration + superimposed purpuric patches, often with central necrosis
Phototherapy used for psoriasis
Narrowband (ultraviolet B) therapy (not absorbed by DNA)
Presentation of cutaneous-only PAN
Tender, subcutaneous nodules from vascular inflammation + livedo reticularis
Systemic PAN clinical features
GI bleeds + HTN + preceding chronic viral hepatitis
What is leukocytoclastic vasculitis?
- A finding, not a diagnosis
- palpable purpura secondary to another condition (SLE, RA, medications)
Erythema nodosum associations
- lymphoma, sarcoidosis, TB, fungal infections (coccidioidomycosis), strep, hormones (OCP, pregnancy), IBD, NOT SLE
Erythema nodosum
CLINICAL – acute onset of tender nodules on bilateral shins typically in a young woman. Biopsy not necessary.
Pitted keratolysis clinical features
Bacterial infection of feet leading to waxy/scaly plaques + thickening of plantar skin + punctate erosions in the plaques that may coalesce to form broader erosions and odor
Erythrasma clinical features
Bacterial infection of intertriginous areas (axilla) – skin has wrinkled, cigarette paper texture
Management of venous stasis ulcers
Compression therapy
Most common leg ulcers
Venous stasis ulcers
Location of venous stasis ulcers
Distal lower leg + often medial aspect of the ankle
Venous stasis ulcers clinical features
Surrounding venous stasis (irregular border + surrounding hyperpigmentation) + pts often have varicose veins and peripheral edema
Why is cilostazol given in PAD?
Increase peripheral blood flow for the treatment of intermittent claudication
Term for diffuse erythema following steroids + why this occurs
erythroderma (steroids precipitate erythroderma in patients with underlying psoriasis)
DRESS presentation + timing
- weeks after receiving medication
- rash + facial edema + peripheral eosinophilia + LAD
Presentation of dermatophyte infection
Erythematous annular patches + surface scaling + pruritic + (doesn’t necessarily have central clearing?)
Tzanck preparation used for
Herpes infection
HSV description
Grouped vesicles on an erythematous base
Wood lamp used for
Vitiligo (to evaluate hypo and depigmentation lesions)
Calciphylaxis lesions
- intensely painful, black necrotic tissue, may form hard eschar in ESRD patients
- typically in thighs and lower abdomen
- calcium-phos product greater than 60 typically
Nephrogenic systemic fibrosis clinical features
- yellowish, thickened papules and nodules with skin tightening and sclerosis in ESRD patients on HD exposed to gadolinium-containing contrast dyes
Management of an abscess
- IF no systemic signs of infection – I&D
- IF systemic signs of infection – I&D + abx
Clinical features of inverse psoriasis
Red plaques with variable amounts of scale in the axillae, intergluteal cleft ,and perineum
Treatment of dermatitis herpetiformis
dapsone (and check for G6PD deficiency)
Common cause of ulceration superimposed on venous stasis
Contact dermatitis from topical abx (neomycin, bacitracin)
Treatment of hand dermatitis
- FIRST LINE: topical emollients (petrolatum) + minimize hand washing
SECOND LINE: topical steroid
Hand dermatitis etiology + clinical features
- type of irritant dermatitis
- frequent water exposure from over hand washing, AICD, atopic dermatitis
- scaling, fissured skin on palm or dorsal hand
Treatment of comedonal acne
Topical retinoid
Presentation of comedonal cacne
- open and closed comedones + no inflammatory papules or pustules
Management of severe nodulocystic acne with scarring when other therapies have failed
Isotretinoin
When topical antibiotics are used for acne
- pustules and inflammatory papules are present
Treatment of postscabetic pruritus
- (itching can persist for several weeks after scabies treatment)
- antihistamins + topical steroids
Other triggers for erythema nodosum
- hormones, OCPs, hormone replacement therapy, pregnancy
Lipodermatosclerosis clinical features
woody indurated tissue in patient with chronic venous stasis
Arterial ulcer management
Surgical revascularization
arterial ulcer locations
- most commonly tips of and between digits
- also at sites of increased pressure (lateral malleolus, metatarsal heads, sites of previous trauma)
Porphyria cutanea tarda clinical features
see photo online
- fragile skin + easily ruptured vesicles in sun-exposed areas (hands primarily + these then rupture, forming erosions, dyspigmentation and scarring
Workup of patient diagnosed with PCT
evaluate for liver disease (hep C and hemochromatosis)
Bullous pemphigoid clinical features
- pruritic red plaques that then develop into large bullae + typically on trunk
Preferred initial treatment of pyoderma gangrenosum
Prednisone
Treatment of severe allergic contact eruptions from poison ivy
Prolonged systemic glucocorticoids
Treatment of tinea pedis
topical antifungals (any of the azoles or terbinafine) *can't use topical nystatin
DRESS features + timing
- rash (morbilliform)
- prominent facial edema
- lymphadenopathy
- fever, hypotension
- 2-6 weeks after initiation of drug
DRESS treatment
- cessation of drug
- systemic steroids with a long taper
Typical cause of pruritus in the absence of skin findings
- medications
Meds that can cause pruritus in the absence of skin findings
- hctz, calcium channel blockers, opiates, NSAIDS
Management of basal cell carcinoma
IF low risk + on trunk and extremities –> electrodessication and curettage
IF high risk OR cosmetically sensitive locations –> mohs surgery
Alopecia areata clinical features
+ acute onset hairloss + smooth, hairless patches of skin (most commonly on scalp)
+ commonly in patients with other autoimmune disorders
Treatment of alopecia areata
High potency topical steroids
Skin manifestations of amyloidosis
- generalized, waxy appearance
- ecchymoses with minor pressure
- ecchymoses around the eyes (racoon eyes)
- yellow waxy papules and plaques perioribitally
Description of heliotrope rash in dermatomyositis
- purple or lilac erythema of the eyelids accompanied by edema
eruptive xanthomas clinical features
- yellow papules with surrounding erythema
Association of eruptive xanthomas
pathognomic of hypertriglyceridemia
lipid deposits around eyes associated with
hypercholesterolemia
Dermatofibroma clinical features
- see picture online
- benign firm brown or reddish papules + size of pencil eraser + dimple when pressure applied
Pyogenic granuloma clinical features
- similar to cherry hemangiomas (but more firable and tend to bleed)
Neurofibromatosis type 1 features
neurofibromas + cafe-au-lait macules + lisch nodules (pigmented hamartomas of the iris)
Pretibial myxedema clinical features
- firm nodules and plaques with “peau d’orange” appearance on pretibial area
pretibial myxedema association
hyperthyroidism
Etiology of pityriasis versicolor
fungal infection
What does morbilliform mean?
- Rash that looks like measles (red macules + may be confluent in some places)
AK description
- red, rough, scaling patches
- hx of a lot of sunburns
- can be multiple
- forehead, face, legs, arms
treatment of AKs
5-Flourouracil cream
Management of lacerations
- IF penetrating the subcutaneous tissue OR overlying a joint – suture closed
- check tetanus vaccine status
clinical features of body lice
- homeless patient
- itchy
- arms, legs, and trunks
- linear excorations
lichen planus clinical features
- Lichen planus commonly presents as intensely pruritic, pink-to-purple, flat-topped papules or plaques; Wickham striae, a reticulated network of fine, white lines, can be seen on the surface.
Acute pustular psoriasis clinical features
- diffuse erythematous rash
- following steroids
- painful
- patches and plaques, with pustules
Sweet syndrome clinical features
- fever + arthralgia + myalgia + arthritis + often preceding respiratory or GI illness
Management of onychomycosis
Nail clipping for fungal culture (50% of nail dystrophies are caused by conditions other than fungal infection. infection with yeasts and nondermatophyte molds are becoming more common)
brachioradial pruritus clinical features
- deep, crawling, tingling sensation of forearms, shoulders, upper back + no visible skin findings