Dermatology I Flashcards

Question

1) How can you treat dyshidrotic eczema? (2 ways) 2) What abt severe cases?

Answer 1

1) Strong steroids, IL steroids 2) PO prednisone

Answer 2

1) Localized lichenification in circumscribed plaques 2) Usually > 20 y/o, F>M 3) Caused by repetitive rubbing & scratching -(i.e. pts with meth addictions, pts with anxiety/ psych issues, etc) 4) Chronic, usually relapsing

Answer 3

1) Scalp, neck, extensor forearms, scrotum & lower legs 2) Thickened skin, excoriations 3) D/c scratching!, occlusive bandages, topical steroids, tar preps, IL steroids (small lesions), PO hydroxyzine

Answer 4

1) Chronic, inflammatory 2) Coin-shaped plaques of grouped small papules & vesicles on erythematous base 3) Etiology unknown 4) Most > 50 y/o, M>F

Answer 5

1) Highly pruritic [coin shaped lesions] 2) Legs & upper extremities 3) Moisturizer, topical steroid, PUVA or UVB

Answer 6

1) Can be acute or chronic 2) Stinging, itching, burning, pain with fissures, weeps, crusting 3) Plastics, chemical residues on clothes, plants Working in the yard? Plant exposure?

Answer 7

1) Well-demarcated erythema and edema, non-umbilicated vesicles or papules 2) Remove etiologic agent, wet dressings/Burrow’s solution (OTC,) topical glucocorticoids, PO prednisone (if severe)

Answer 8

1) Related to venous insufficiency (pitting edema usually) 2) Inflammatory papules, hyperpigmentation, scaly and crusted erosions in lower legs and ankles 3) Avoid scratching, emollients throughout the day, topical corticosteroids, **wrap legs/compression stockings** (takes a while to Tx) 4) No

Answer 9

1) Acute, subacute, chronic relapsing 2) Common in infancy, itch-scratch cycle 3) Frequent /w personal or FHx AD, allergic rhinitis, & asthma 4) Skin barrier dysfunction, IgE reactivity

Answer 10

1) Eliciting/exacerbating factors: inhalants, microbials, aeroallergens, foods, season (winter,) and emotional stress 2) Dry skin, pruritis; “The itch that rashes”: -Itch > scratch > rash > itch > scratch > rash 3) Poorly-defined erythematous patches, papules, & plaques with or without scaling

Answer 11

1) Infantile, child, & adult types 2) (acute/chronic): Avoid scratching -Wet dressings -Topical steroids -Topical or PO antibiotics -Hydration, emollients, or topical calcineurin inhibitors -PO H1 antihistamines 3)Only for severe intractable cases

Answer 12

1) Infancy, puberty, 20-50 years old, M>F 2) Chronic and relapsing. -Worse in fall/winter (dry environment and stress). Summer: worse in some, better in others 3) Immunosuppressed (HIV, Parkinson’s, and nutritional deficiencies (zinc)) 4) Scalp, face, trunk, genitalia and body folds. -“Cradle Cap”: yellow greasy scales on scalp -Often seen in hair bearing regions (eyebrows, central face, scalp): looks like dandruff

Answer 13

1) Pruritis, red plaques, greasy looking. Yellowish scales may be present on areas with a plethora of sebaceous glands. 2) **Selenium sulfide (Selsen BLUE, Head and Shoulders,)** topical antifungals, tar shampoo (Neutrogena T-gel,) mild topical steroids

Answer 14

1) Erythematous grouped papulopustules may become plaques with scales. Can have satellite lesions. May include perinasal and periorbital skin 2) Spares vermillion border 3) Most common in females 20-45

Answer 15

1) Fluorinated toothpaste, topical corticosteroids 2) Eliminate steroids and irritants (cosmetics/skin care products) topical metronidazole, erythromycin or pimecrolimus

Answer 16

1) Adverse cutaneous reaction to ingested drug 2) Solitary (or multiple) erythematous patch or plaque 3) Usually asymptomatic (may have pruritis, pain, burning)

Answer 17

1) Sharply demarcated macule, round or oval -Initially erythematous, then dusky red to violaceous -May evolve to bulla, then erosion 2) TCN, sulfa, NSAIDs, barbiturates, OCPs, quinine, yellow food coloring

Answer 18

1) Resolves in a few weeks after d/c offending agent 2) **D/c drug** topical steroids (non-eroded), antibiotic ointment (eroded), PO steroids for severe mucosal lesions

Answer 19

1) Acute or chronic inflammation involving skin or mucous membranes (In mouth/ vaginal mucousa appears white and lacy) 2) 4 Ps: Papule, purple, polygonal, pruritic (and flat topped) 3) Creases of arms and legs

Answer 20

1) 30-60 y/o, F>M 2) Idiopathic 3) Topical & PO steroids, cyclosporine

Answer 21

1) Irritant: chemical (ex/hands) -Soaps, detergents, solvents (Table 2-1, Fitzpatrick’s) 2) Allergic: Nickel/jewelry, plants (Table 2-2, Fitzpatrick’s)

Answer 22

1) Acute rash, self-limited course, more common in fall 2) Initial single, primary (“herald”) patch usually on trunk (80% of patients) 3) Generalized secondary eruption 1-2 weeks later -Fine scaling papules & patches in “Christmas tree” pattern (lines of cleavage) on back

Answer 23

1) Resolves spontaneously in 6-12 weeks 2) Probable: reactivation HSV-7 & HSV-6 3) Herald patch: oval, salmon-red plaque or patch 2-5 cm with fine collarette peripheral scale

Answer 24

1) PO or topical antihistamines 2) Topical steroids 3) UVB phototherapy or natural sunlight 4) PO steroids (usually just treating Sx)

Answer 25

1) Usually a + FHx; All ages; M=F 2) Worse with stress, obesity 3) Psoriatic arthritis

Answer 26

1) Pruritic well-demarcated, erythematous plaques with silver “scales” (when scraped off reveal pinpoint bleeding) -usually on knees, elbows, nails, palms, and soles of feet 2) Causes pitting in nails

Answer 27

1) Eruptive: inflammatory, “raindrop” (guttate) 2) Chronic: stable (plaque) psoriasis

Answer 28

1) Triggers: physical trauma, strep (guttate,) stress, drugs, alcohol 2) Clinical -Biopsy for uncertain diagnosis 3) Eczema; Lichen simplex chronicus

Answer 29

1) Drop-like scattered (scaly) red to pink lesions- diffuse (not necessarily on extensors) 2) Strep infection 3) Usually in children or young adults< 30; M=F 4) May self remit in several weeks to several months

Answer 30

1) Plaque psoriasis <30% 2) Pityriasis rosea, tinea corporis 3) Phototherapy, topical corticosteroids

Answer 31

1) Topical Steroids and emollients – *meds need to be able to penetrate skin* 2) Kenalog intralesional injections - scalp 3) UVB light therapy 4) Biologic Agents- Humira, Remicade, Embrel, Methotrexate ("big guns")}

Answer 32

Based on treatment; Biologic agent treatment needs annual labs and chest x-ray

Answer 33

1) 50% patients <20 y/o, M>F 2) Cutaneous reaction (drugs, idiopathic), most commonly due to herpes simplex virus 3) Target lesions mucous involvement (oral/genital, + palms/soles, corneal ulcers, anterior uveitis), + pruritic or burning

Answer 34

1) Typical target-like lesions & symmetry 2) Major: m/c 2/2 drug reaction, **always mucosal involvement**, fever, arthralgias, lesions in pharynx & larynx -Minor: **without mucous involvement** or systemic symptoms, lesions on extremities & face-@ herpes outbreak

Answer 35

1) Lesions develop over >10 days. Macule > papule >vesicles and bullae 2) Hands, feet, palms, soles, elbows, knees, mouth, torso, face, genitals 3) Clinical (biopsy may help confirm)

Answer 36

1) Topical corticosteroids, PO steroids for disabling oral lesions 2) PO antihistamines 3) Wet dressings 4) Medicated (lidocaine, diphenhydramine) mouthwash for oral mucosal lesions 5) Ophthalmology referral for ocular lesions

Answer 37

Continuous antiviral therapy for recurrent HSV-associated EM

Answer 38

1) Acute, life-threatening mucocutaneous reaction -Necrosis and detachment of epidermis 2) % of body surface involved

Answer 39

1) SJS <10% epidermal detachment 2) TEN >30% epidermal detachment (overlap 10-30%)

Answer 40

1) Mucous membranes (ocular, oral, and genital) 2) Rarely present on palms/soles 3) Idiopathic or drug-induced: anti-seizure meds, sulfa, allopurinol, NSAIDS 4) Higher incidence in HIV & active cancer. F>M.

Answer 41

1) Usually 4 days to 4 weeks after drug exposure; Fever, malaise, and arthralgias (influenza like sx) for 1-3 days…THEN… 2) Skin is sloughing off and painful – burning, paresthesia, etc! Conjunctival burning/itching, and painful mouth lesions 3) Ill-defined, coalescing, erythematous macules with purpuric centers or diffuse erythema; *pain out of proportion* 4) On face and thorax and symmetric

Answer 42

1) Admit to ICU or burn center, d/c offending agent/drug 2) IV fluids and electrolytes (treat as burn patient) 3) Narcotics for pain 4) Systemic glucocorticoids controversial (contraindicated late in disease course) 5) IVIG (if started early) 6) Surgical debridement not recommended 7) Lasts approximately 8-12 days

Answer 43

1) The ability to extend the area of superficial sloughing by applying gentle lateral pressure on the surface of the skin at an apparently uninvolved site. 2) Pemphigus, TEN

Answer 44

1) Autoimmune disease of elderly patients (60-80yrs) with pruritic, large, tense, bullae scattered but also in groups. 2) Urticarial eruption. Don’t rupture as easily as pemphigus.

Answer 45

1) Axillae, medial thigh, groin, flexor UE, lower LE, can be in mouth 2) PO, topical steroids 50-100 mg QD or immunosuppressives

Answer 46

1) Chronic or acute, bullous autoimmune disease, adults 40-60 2) Scalp, face, chest, axillae, groin, umbilicus 3) Usually starts in mouth, no pruritis, but burning and painful

Answer 47

1) Vesicles and bullae, easily rupture, flaccid and weeping. + Nikolsky sign, 2) Dermatologist, high dose steroids and immunosuppression

Answer 48

1) Inflammation of pilosebaceous units 2) Seen with comedones (must have for diagnosis,) cysts, pustules and/or nodules 3) Occurs primarily in young people; on face, trunk, upper arms and sometimes buttocks

Answer 49

1) Can result in pits, depressions, scars or hyperpigmentation 2) More severe in males than females 3) Less often in Asians and African Americans 4) Cystic acne can be familial

Answer 50

1) Follicular keratinization, androgens, Propionibacterium acnes 2) Comedone; traps sebum->androgens produce more sebum-> bacteria produce inflammatory response

Answer 51

1) Meds: lithium, isoniazid, steroids, OCP, 2) Androgens; stress 3) Occlusion/pressure (hand on face) 4) Cosmetics 5) Pomade 6) Sweat

Answer 52

1) Worse in fall and winter 2) Nodulo-cystic type 3) Open= blackheads Closed = white heads 4) Yes; required for acne diagnosis

Answer 53

1) None required 2) Often clears by early 20’s, flares in winter and with onset of menses

Answer 54

1) Scar prevention 2) Remove plugging, treat bacteria

Answer 55

1) Topical antibiotics (clindamycin and erythromycin 3%, 5% BID) and benzoyl peroxide gels 2%, 5%, 10%) **this bleaches fabrics** can get in combo 2) Topical retinoids **gradual increase in strength from 0.01%, 0.025%, 0.05% cream, gel, liquid, or ointment (retinoic acid, adapalene (now OTC), tazarotene)** can NOT use if pregnant 3) Combination therapy

Answer 56

-Same regimen for minor plus PO antibiotics (Minocycline 50-100mg/d or doxycycline 50-100mg BID tapered to 5o mg/d as acne lessens.) -Spironolactone 25-50mg QD.

Answer 57

Same as above with the addition of PO isotretinoin for cystic or refractory acne.

Answer 58

1) Complete remission in most cases for months to years. 2) inhibiting sebaceous gland function and keratinization. 3) **Is extremely teratogenic**

Answer 59

1) Teratomas 2) MUST have effective contraception and 2 neg pregnancy tests prior to initiating. C 3) Pseudotumor cerebri

Answer 60

1) Lipids and transaminases prior to therapy as can cause elevated triglycerides and mild to moderate elevations of transaminases (normalize with dose reduction.) 2) Causes extremely dry skin and mucosa. 3) Can cause depression.

Answer 61

1) Chronic inflammation of facial pilosebaceous units 2) 30-50 y/o, F>M 3) Episodic erythema, “flushing & blushing”

Answer 62

1) Stages I, II, & III: persistent erythema, telangiectasias, papules, tiny pustules, nodules **NO comedones** 2) Hot liquids, spicy foods, alcohol/wine, aged cheese, exposure to sun & heat, stress 3) Days, weeks, months

Answer 63

1) Localized swelling of soft tissues of face due to variable combinations of fibrosis, sebaceous hyperplasia, + lymphoedema. 2) Nose 3) Forehead 4) Eyelids 5) Cauliflower ears 6) Chin

Answer 64

1) Rhinophyma, metophyma, blepharophyma, otophyma, gnatophyma 2) Symmetric on face. Rarely on neck, chest, back, & scalp. 3) Recurrences common; usually lifetime

Answer 65

1) Reduce or eliminate alcohol & caffeine 2) Metronidazole gel or cream, ivermectin cream 3) Topical antibiotics 4) PO antibiotics better than topical (minocycline, doxycycline, TCN) in papulopustular rosacea 5) PO isotretinoin for severe disease 6) Surgery for rhinophyma; telangiectasia (lasers)

Answer 66

1) Inflammation or infection of superficial hair follicles 2) Perifollicular papules and/or pustules with surrounding erythema; hair bearing skin; often pruritic 3) More common in males

Answer 67

1) Prolonged antibiotic use, topical corticosteroids, hot tubs 2) Most common staph aureus; hot tub > pseudomonas aeruginosa

Answer 68

1) Benzoyl peroxide wash (bleaches) topical mupirocin, clindamycin, erythromycin. 2) PO Cephalexin

Answer 69

1) Chronic, suppurative 2) Apocrine gland skin; Axillae, inguinocrural, anogenital, inframammary, rarely scalp 3) F (axillae)>M (anogenital)

Answer 70

1) NC acne & HS 2) Unknown etiology 3) Obesity, smoking, genetic predisp. to acne

Answer 71

1) Tender open & double comedones, red nodules/abscesses (foul smelling), sinus tracts, “bridge” scars, hypertrophic & keloidal scars, contractures 2) Follicle plugging > dilated follicle & apocrine duct > inflammation > bacterial growth > extension of suppuration/tissue destruction > ulceration, fibrosis, sinus tracts > scarring

Answer 72

1) Usual spontaneous remission at >35 y/o 2) Intralesional steroids, then I&D abscess -Prednisone for severe pain & inflammation -Surgery (excision, skin grafting) -PO antibiotics (chronic low-grade disease) -**Isotretinoin for early disease adalimumab (Humira)** -Psychological