Dermatology/ ID Flashcards
<6mm, macule/papule, well-defined border, homogenous color [brown or pink]
benign mole
> 6mm, ill-defined border, irregular color
Atypical Nevi
Asians; ‘old & unchanged’ = benign; ‘new or changed’ = EVALUTE IMMEDIATELY
Blue nevi
hereditary; ↑sun exposure; fade without sun
freckles
sun exposed area; tx w/topic agents/laser/cryotherapy
Lentigines [sunspots]
benign; beige/brown. VELVETY or thick/scaly papules/plaques; stuck-on appearance. If unbothersome leave alone, may use cryotherapy otherwise
Seborrheic Keratosis
flat/raised; red, white, blue, black; RECENT CHANGE IN APPEARANCE – SUSPECT; tumor thickness = prognostic factor
Malignant Melanoma
MOST COMMON FORM OF SKIN Cx, sun-exposed areas – light-skinned pt; papule/nodule + central scab or erosion, slow-growing, waxy pearly appearance + vessels easily visible; BACK / CHEST; dx: punch/shave biopsy; MOHs = HIGHEST CURE RATE; High recurrent follow-up annually
Basal Cell Carcinoma
red, conical hard nodule ulcerate + bleed; NO HEAL; Mohs excision; follow-up 2x/yr
Squamous Cell Carcinoma
narrow linear crack into the epidermis, exposing dermis (athletes’ foot)
fissure
flat, discoloration <1cm, (freckle)
macule
flat discoloration >1cm, (vitiligo)
patch
skin thickening usually found over pruritic or friction areas atopic dermatitis, areas of recurrent scratching
Lichenification
raised, flaking lesion (dandruff, psoriasis)
scale
loss of dermis/epidermis (pressure sore)
ulcer
a vesicle-like lesion with purulent content (acne, impetigo)
pustule
raised lesion >1cm same or different color than surrounding skin (psoriasis)
plaque
in streaks (poison ivy)
linear
in a ring (erythema migrans)
annular
along neurocutaneous dermatome (herpes zoster)
dermatomal
circumscribed area of skin edema (hives, urticaria)
wheal
fluid fluid <1cm (varicella)
vesicle
fluid-filled, >1cm blister (2nd-degree burn0
bulla
raised lesion, <1cm, same or diff color than surrounding skin (raised nevus)
papule
raised lesion >1cm, usually mobile (epidermal cyst)
nodule
dry skin (atopic dermatitis)
xerosis
net like cluster
reticular
multiple lesions blend together
confluent
Small flesh-colored, pink macule/papule, feels rough like sandpaper, TENDER when brushing a finger over, affects sun-exposed area. Consider pre-malignant and may progress to SCC
Actinic Keratosis
Treatment for AK
cryotherapy
Treatment for BCC
Mohs
Treatment for Lentigines
topic agents/laser/cryotherapy
Treatment for Seborrheic keratosis
cryotherapy if bothersome
Treatment for SCC
Mohs
ORANGE-RED or GRAY WHITE with GREASY or white dry scaling macules/papules of varying size. Redness/scaling occurring in regions where sebaceous glands. Are most active – FACE & SCALP
Seborrheic dermatitis
Treatment for seborrheic dermatitis
topical ketoconazole and selenium sulfide – shampoo [zinc pyrithione or selenium – use daily WASH HEAD TO TOES]; ketoconazole 1-2% 2x/week; Tar shampoo – scalp; low potency steroid cream 1-2.5% flares
Treatment for blepharitis
J&J baby shampoo daily
Silvery scales on bright red well-demarcated plaque; knees, elbows, scalp; onycholysis associated joint pain; <10% BSA
Psoriasis
injury or irritation of normal skin may cause a flare of psoriasis
Koebner phenomenon
the appearance of small bleeding pt after layers of scale are removed [pinpoint bleeding]
Auspitz sign
These drugs may cause Flare / Exacerbate existing plaque
BB, antimalarial, statins, lithium
A drug that may cause a severe rebound of psoriasis
systemic corticosteroids
1st line of treatment for psoriasis
high-ultra potent topical steroids 2-3x/wk MAX
Treatment for plaque psoriasis
calcipotriene ointment 0.005% or calcitriol ointment 0.003% vit D analogs BID [start with both steroid + vitD 2x/day until plaques improve à continue vitD daily x2 more weeks; Tar shampoo [scalp daily]; 6% salicylic acid gel [Keralyt] @ night with shower cap – wash out in AM
VELVETY TAN or pink macules DON’T TAN; fine scales not visible / seen with scraping lesion; CENTRAL UPPER TRUNK; HIGH RECURRENCE RATE – YEAST. Dx: KOH prep; re-pigmentation may take wk-months
tinea versicolor
Treatment for tinea versicolor
SELENIUM SULFIDE LOTION: neck-waist daily 5-15m wash off [once x7d, once per week x4wk, monthly]; ketoconazole shampoo [leave on 5m BEFORE rinsing]; ketoconazole PO daily [SWEAT! No shower 8-12hr]
Ring-shaped lesion; scaly border; central clearing; ANYWHERE ON BODY
Tinea Corposis (ringworm)
Treatment for tinea corposis
topical antifungals [OTC 7-14d after clearing]; NO CORTISONE [lotrisone]; griseofulvin 350-500mg BID 4-6wk
SIGNIFICANT ITCHING intertriginous areas + peripherally spreading sharply demarcated centrally clearing erythematous lesion; CANDIDIASIS bright red + satellite
tinea crusis (jock itch)
Treatment for tinea crusis
drying powder MICONAZOLE
Asymptomatic scaling; fissures or maceration between toes; moccasin distribution; CELLULITIS COMPLICATION; itching/burning/stinging
tinea pedis (Athlete’s foot)
Treatment for tinea pedis
PREVENTION! Drying powders
[miconazole]; griseofulvin, itraconazole, terbinafine = SEVERE cases
Localized violaceous red plaques; scaling follicular plugging; atrophy dyspigmentation & telangiectasia; PHOTOSENSITIVITY; malar rash = BUTTERFLY
Lupus
Lupus medication triggers
hctz, CCB, H2 blockers, PPI, ACE-I, terbinafine;
type of lupus that occurs on face/scalp – thumbtack like
DLE
lupus that occurs on the trunk
SCLE
Lupus treatment
PROTECT SKIN FROM SUNLIGHT, SPF>50 uva/uva coverage; NO RAD TX; high potency corticosteroid cream EVERY PM with an occlusive dressing
Scaling, red plaque on breast [uni or bil]; intraductal mammary carcinoma
Paget’s Disease
Squamous cell carcinoma in situ – abnormal growth of cells in epidermis [outer layer]; 0.5-3cm slightly raised pink-red plaque, excision; develop into SCC 3-5% RARE
Bowen’s Disease
Unpigmented white macules 0.5-5cm; MEN/WOMEN
Vitiligo
Treatment for vitiligo
wear protective clothing/sunscreen; topical corticosteroids, phototherapy, >40% BSA = sx graft or perm depigmentation
HSV 1 occurs where?
Mouth
HSV 2 occurs where?
Genital
Triggers for HSV 1 flare
surgery, stress, sun exposure, fever
A cluster of vesicles on erythematous base; mouth; STINGING/BURNING before; crust & heal in 1 week
Herpes Simplex
Bleeding/ulceration are the most ominous sign of:
malignant melanoma
single most important prognostic factor in malignant melanoma
tumor thickness
Key clinical feature of atopic dermatitis
itching
a cardinal sign of secondary infection in atopic dermatitis
infra-auricular fissure
the most common form of erythema multiforme minor
herpes simplex
initial treatment for herpes simplex
valtrex 1g TID 7-10 days
treatment of recurrent HSV
initiate @ 1st signs 12-24hr Valtrex 500mg PO BID x3d
suppressive treatment therapy for HSV
Valtrex 500mg once a day x1yr [up to 5-7yr] WEAR CONDOMS
Clusters of lesions [unilateral] on FACE/TRUNK – dermatome w/pain along that nerve [pain occurs 48hr+ BEFORE rash
herpes zoster
pain/burning that persists after herpetic infection
post-herpetic neuralgia
vaccine for zoster
Shingrix Vaccine: 2 doses [1 now; repeat 2-6mo] born before 1980 should have antibodies – if you test and it’s NEG = need varicella vaccine [1 today, another 4wk later = 2 doses]
referral needed to __________ if zoster on face
ophthalmology
treatment for post-herpetic neuralgia
TCAs or gabapentin
Pruritic ‘tapioca’ vesicles PALMS/SOLES/SIDES OF FINGERS. May have scaling/fissures after vesicles dry. Associated with ATOPIC DERMATITIS. Increased occurrence with stress or may be driven by nickel allergy. Must check for tinea pedis
POMPHOLYX VESICULOBULLOUS – Hand Eczema [Dyshidrosis]
Treatment for dyshidrosis
TOPICAL CORTICOSTEROIDS; RECURRENT; AVOID IRRITANTS – EMOLLIENT AFTER WASHING
Erythema, scaling perineal area; URINE/FECES; beefy red sharply demarcated w/satellite lesions
Primary Irritant Contact Dermatitis
Treatment for primary CD
ZINC OXIDE; if >3d diaper rash = CANDIDA ALBICANS = Nystatin
Hx of venous insufficiency/immobility; irregular shaped ulceration on LE above malleolus [edema, hyperpig brawny edema, scaling, erythema à breakdown]; 1st check ABI <0.7 = Vas Sx
leg ulcer r/t venous insuff
treatment for leg ulcer
Compression TED hose + wound care (unna boot if ABI WNL); Pentoxifylline 400mg TID accel healing
Asians/NA/AA 90%, blue-black lumbosacral area; fade as skin darkens; NOT ABUSE
Mongolian Spot
Light brown oval macule; ANYWHERE ON BODY; develops as pt ages
CAFÉ AU LAIT
If 6 or more Cafe Au Lait > 1.5cm present increased risk for?
neurofibromatosis (NF-1)
Red rubbery vascular plaque/nodule; regresses by 9yo
hemangioma
Treatment for hemangiomas
PO propanolol
caused by HPV
warts
Treatment for warts
vaccine Gardasil 9yr [27 max G, 22 B]; fever, pain, fainting, site rx; monitor 15m post inj; liquid nitro, keratolytic agents 40% salicylic acid
Treatment for genital warts
podophyllum resin
STAPH; itching/burning hair follicle; hot tub 1-4d after [pseudomonas]; TENDER, pruritic pustular lesion + fatigue, low-grade fever, malaise
folliculitis
Treatment for folliculitis
SILVADENE BID or cipro if recurrent
Deep-seated abscess entire hair follicle + adj tissue; STAPH AUREUS
furuncle/ boil
several furuncles
Carbuncle
Treatment for furuncle/boils
I&D + PO abx
Firm, benign growth of upper portion of hair follicle; black comedone or punctum; foul-smelling cheesy material on I&D
epidermal inclusion cyst
SEVERE ITCHING AT NIGHT + burrows interdigits
scabies
treatment for scabies
15-20m close physical contact or bedding; plastic bag x14d or high heat 60C; permethrin 5% 1 app neck down 8-12hr rinse repeat 1wk; triamcinolone cream for persistent itching
hands, palms, soles, MM; herpes simplex. TARGETOID LESIONS clear centers concentric; erythematous rings “iris” lesions
erythema multi-forme minor
trunk; <10% epidermal detachment; caused by medication
erythema multi-forme major
Medications that may cause erythema multi-forme major
sulfa, NSAID, allopurinol, anticonvulsants STOP DRUG; >30% ADMIT
itching + nits in hair
pediculosis (lice)
treatment for pediculosis
permethrin 5% cream on scalp
Located on Upper trunk body [no palms, soles], erythematous, blanching except in skin folds (Pastia sign) fine macules, sandpaper-like rash. Fever occurs 1-2 days prior. Not pruritic
scarlet fever
petechiae on the palate, strawberry tongue, Group A beta-hemolytic strep culprit, circumoral pallor, enlarged tonsils
scarlet fever
Treatment for scarlet fever
PCN or erythromycin/ clinda with PCN allergy
Starts with FEVER caused by parvovirus spread through respiratory secretions. Affects face and thighs, Erythematous “slapped cheek” pink papules and macules in lacy reticular pattern, low grade fever, pruritic. Contagious 1 week prior to rash
erythema infectiosum (5ths Dz)
pregnant women may develop this complication with 5ths disease which increases risk for fetal demise
Hydrops fetalis
Prominent feature is abrupt onset of fever 102-105 degrees for 3-8 days which resolves abruptly then faint maculopapular pink spots that blanch upon pressure that develop on FACE FIRST, then spreads down body. Transmitted through respiratory secretions. Incubation period 9 days. Caused by human herpesvirus 6 or 7
Roseola
Incubation period 9-14 days. Prodrome of fever, cough, conjunctivitis, and coryza. Koplik spots appear 1-2 days prior to and after onset of rash. Maculopapular rash cephalocaudally [face/hairline down body over 3 days] then becomes confluent. Supportive treatment only
Rubeola (Measles)
lasts 3 days, incubation period 4-14 days. Prodrome of respiratory symptoms, low-grade fever, conjunctivitis. Characteristic post-auricular and sub-occipital adenopathy. Most infectious 1-5 days after rash appears. Starts on face then spread to extremities and trunk while fading from face.
Rubella “3 day German Measles”
Unilateral parotid swelling progressing to bilateral and salivary gland swelling. Prodromal features last 3-5 days low-grade fever, headaches, malaise/myalgias, loss of appetite. May have an earache. Transmitted through respiratory droplets. May cause aseptic meningitis, pancreatitis, orchitis, and miscarriage in 1st trimester. Symptomatic treatment: NSAIDs, warm/cold packs, Tylenol, rest/fluids
Mumps (rubulavirus)
Widely scattered red macules and papules followed rapidly by vesicles, pustules then crusting in 5-7 days. New crops stop after 5-7 days. Contagious usually 1-2 days before rash appears and until lesions crust over. Spread primarily through droplets and direct contact with lesions. Pruritus usually intense.
Varicella
Prevention and treatment of Varicella
Varivax, 12mo & 5yr booster. May give 72hr from exposure.
Incubation 1-2 months after exposure. 2-3 day prodrome of malaise leads to febrile illness. Major complaint is pharyngitis and generalized adenopathy, splenomegaly and hepatomegaly common. Heterophile antibodies may not be detectable until 2nd week of illness. Symptomatic treatment. Avoid contact sports for 6-8w. Followup LFTs/ultrasound if indicated.
Infectious Mononucleosis
Caused by Cocksakie Type A rash found on tongue, oral mucosa, hands, and feet. Associated with fever (1st symptom), malaise, and sore throat.
Hand-Foot-Mouth
Oval, fawn-colored, scaly eruption that follows the cleavage lines of the trunk “Christmas Tree Pattern” Herald Patch occurs 1-2 weeks prior to lesions. Oval plaques up to 2 cm in diameter- crinkled or cigarette paper appearance- tiny scale on the edges but clear in the center. Appears mostly in Spring/Fall. If plantar, palmar, or mucous membrane lesions are present- screen for secondary syphilis. Consider UV treatment
Pityriasis Rosea
Macules, vesicles, bullae, pustules, and honey-colored crusts Contagious – staphylococci or streptococci
Face and other ‘exposed’ body parts. Soaks and scrubbing can be helpful- clears the pus.
Topical agents such as bacitracin and mupirocin (Bactroban) are indicated the first line
Impetigo
Single or multiple dome-shaped, waxy papules, 2-5 mm in diameter with umbilication. Initial appearance are firm, solid, flesh-colored lesions but change to soft, white, pearly gray in color that may have suppuration.
Spread by wet skin-to-skin contact. Estimated time to remission is approximately 13 months. Can be treated with liquid nitrogen, curettage, or light electrocautery.
These lesions should spontaneously resolve without treatment.
Molloscum Contagiosum
Scaly red plaques (no thickening as with psoriasis) – can be long term with weeping- consider staph infections. Face, neck, upper trunk, wrists, hands, and antecubital and popliteal folds. Family hx of asthma, allergic rhinitis, or atopic dermatitis (Triangle of A).
Dx criteria: Must have pruritus, typical morphology and distribution (flexural lichenification, hand eczema, nipple eczema, eyelid eczema in adults), onset in childhood with chronicity.
Atopic Dermatitis (Eczema)
Erythematous macules, papules, and vesicles- look for patches, such as where something may have rubbed or brushed against the skin. Results from contact with an allergen or chemical. Soaps, detergents, solvents, metals, antimicrobials such as bacitracin or polysporin, artificial nails, adhesive tape, etc. Consider latex as well. Treatment: prompt and thorough washing of affected area with liquid dishwashing soap to remove the oils must be done within 30 minutes to decrease the effects of the irritant. McPhee suggests Dial Ultra. Barrier creams – applied prior to exposure- include Stokogard, Hollister Moisture Barrier, and Hydropel. treat the itching with caladryl, calamine, Benadryl cream OR Benadryl tablets, Vistaril, etc. New treatment option- Zanfel- may prove beneficial- according to the package instructions- it may be used anytime after exposure. Reports 10 year half life (15 treatments per box)
Contact Dermatitis
Comedomes are hallmark although papular, pustular, cysts or nodules may be present. Treatment begins with educating the patient- treatment can take 6-8 weeks to make a difference- avoiding topical oils found in cosmetics and hair products is helpful. Comedones respond well to topical retinoids such as Retin A (tretinoin). Benzoyl peroxide 2.5% will do well (and cause less irritation than the 10%)- may be combined with an antibiotic for topical application (Benzaclin, Bezamycin). Papular or Cystic Acne- same initial treatment as comedones- if no response- then consider oral antibiotics such as doxycycline, minocycline, etc. Severe Acne: Accutane: NOT RESPONDING TO TX; supply 1mo at a time; 2 forms of effective of birth control (abstinence can be 1 form) must be utilized INFORMED CONSENT; enroll in a monitoring program (iPledge); MUST HAVE two serum preg tests before starting tx
Acne Vulgaris
Erythema and telangiectasia with a tendency to flush easily. May have associated flares with acne- papules and pustules. Hyperplasia of the soft tissue of the nose- rhinophyma. May be triggered by heat, hot/spicy food/drink, sunlight, exercise, alcohol, emotions, or hormones (menopause). Burning and stinging may accompany the flushing. avoid triggers- use broad spectrum sunscreen (although this might take some experimenting to find one that is well tolerated). Metronidazole gel, 0.75% can be applied bid or 1% applied qd. Another alternative is clindamycin gel. Oral medications can be used when topical are not effective.
Rosacea
36-58hr to transmit; borrelia burgdorferi spirochete, gram- bacteria; REFER TO ID; stage 1 erythema migrans 3-30 day incub; viral illness “summer cold” that resolves 3-4wk without tx; stage 2: FATIGUE, cardiac, neuro; stage 3: musc mo-years after infection; ELISA, western blot; all ages + preg. Erythema migrans “bullseye” Treatment: doxy 200mg PO x1 proph; active tx: 14-21 days in early stage doxy >8yr or amox
Lyme Disease
Treatment for cat bites
prophyl PCN + ceph or augmentin
Treatment for all bites
AUGMENTIN if allergic to PCN— clinda+doxy or Bactrim or a fluoroquinolone 5-7 days
Monkey bites add?
Valtrex
38.3C or 101F needs >3wk of fever to diagnose. Infections account for most cases in children and adults cancer.
FEVER OF UNKNOWN ORIGIN
fluoroquinolone single dose [>10d watery stool C&S + O&P]
TRAVELERS DIARRHEA
Highest attack rate in children <6y with a peak from 6m-2y. Stools are watery but may have mucous and blood which may indicate shigellosis. Fever, abdominal pain and diarrhea associated with bacteremia especially in newborns/infants.
Salmonella Gastroenteritits
shorter incubation 2-4 hours; vomiting is main symptom, no fever
Staph food poisoning
resembles salmonellosis clinically, must culture to differentiate
campylobacter
Treatment for salmonella
antibiotics in infants <3m, SSD, immunocompromised, severely ill children. 3rd generation cephalosporin and fluoroquinolones for adults. Plus PROBIOTICS
