Dermatology II Flashcards
1) What is the most common benign epithelial tumor?
2) Demographic of this tumor?
3) What does it look like?
1) Seborrheic keratosis
2) Hereditary, rare before 30 y/o, M>F
3) Skin-colored, tan, brown, black
Small papules to larger plaques with warty surface (“stuck-on” appearance)
1) What does seborrheic keratosis look like?
2) What should you exclude?
3) What is the Tx?
1) Stippling on surface; face, trunk, upper extremities
2) Exclude SCC & melanoma
3) No treatment necessary, can use cryo if bothersome
What may be described as having a “stuck-on” appearance?
Seborrheic keratosis
Acanthosis nigricans:
1) What does it look like? Where?
2) What’s it related to?
1) Velvet, thickened, hyperpigmentation on neck, axilla, groin, other body folds
2) Obesity, endocrine disorders, diabetes, drugs (insulin, OCP and other hormone therapies, corticosteroids,) and malignancy
What is the Fitzpatrick skin type scale? Describe each type
1) Type 1: always burns, never tans
2) Type 2: usually burns, tans w. difficulty
3) Type 3: burns mildly, tans gradually
4) Type 4: rarely burns, tans w. ease
5) Type 5: never burns, tans very easily
Acanthosis nigricans:
1) When is it common?
2) Tx?
1) Can be common at the onset of puberty (endocrine issue)
2) Treatment: retinoids, address underlying disorders, difficult to completely eradicate
Cherry angioma (aka hemangioma):
1) What is it typically?
2) What color can it be?
3) What are the Sx?
1) Very common erythematous papule. Typically <3mm.
2) Can be violaceous or black
3) Asymptomatic, usually occur on trunk, benign
Cherry angioma (aka hemangioma):
1) Demographic?
2) What causes them?
3) Tx?
1) Age 30+
2) Dilated capillaries
3) Laser or electrocoagulation. Cryo not effective
List 2 examples of benign lesions
1) Seborrheic keratosis
2) Cherry angiomas
True or false: Actinic keratosis is precancerous [to SCC]
True
Actinic keratosis:
1) Is it painful?
2) Is it benign? Explain.
3) Tx?
1) Possibly tender, painful if excoriated
2) Precancerous (m/c precursor lesion of Squamous cell carcinoma)
3) Cryo- and laser surgery, 5- fluorouracil cream, imiquimod cream
Actinic keratosis:
1) What does it look like?
2) What skin does it occur in?
3) Demographics?
4) What size and texture?
1) Single or multiple discrete, pinkish, dry, rough, or adherent scaly lesions, not well demarcated
2) Habitually sun-exposed skin of adults (outdoor workers)
3) Middle age, M>F, Skin Type I-III
4) Usually < 1cm, round or oval-ish; rough, like coarse sandpaper
True or false: cryosurgery/ cryotherapy is used on focused, small spots that could turn into SCCs (like actinic keratosis, not melanomas)
True
List 2 derm parasites
Lice & scabies
What are the 3 members or pediculosis (lice) infestations?
1) Head lice: Pediculus Humanus Capitis
2) Pubic lice/ crabs: Phthirus pubis
3) Nits (eggs) on hair shafts (even eyelashes)
Pediculosis (lice):
1) How is it transmitted?
2) Sx? What can cause secondary infection?
1) Transmission: hats, caps, brushes, combs, pillows, theater seats (crowding, poverty, low personal hygiene,) SELFIES
2) Pruritis of scalp and back of neck (excoriations on scalp (r/o secondary infection)); possible posterior occipital lymphadenopathy; visible lice and nits
Pediculosis (lice):
1) DDx?
2) How is it diagnosed?
1) Seborrheic dermatitis, scabies, bed bugs, hair spray or gel, impetigo, LSC, delusions of parasitosis
2) Clinical detection of lice (louse comb), nits within 4 mm of scalp
Visible lice and nits and pruritis are Sx of what?
Lice
Treatment (capitus & pubis) for pediculosis: what is the OTC/ first line option?
Permethrin cream rinse (5% Elimite, 1% Nix) (resistance common
1) What are some prescription Txs for pediculosis?
2) What Rx is not used anymore?
1) Topical ivermectin lotion (most effective,) benzyl alcohol
Malathion (Ovide): > 6 y/o (volatile, flammable)
2) Lindane (Kwell): not 1st line (neurotoxicity, seizures), do not use in children. Not used in US
Pediculosis:
1) How are nits removed?
2) What else should be done (besides Rx)?
1) Remove nits using a special comb (wet combing)
2) Sanitize clothing and bedding (hot water)
Examine/treat close contacts at same time, especially children
Scabies (Sarcoptes scabiei):
1) What are its Sx?
2) Where does it typically occur?
1) Intense, generalized, intractable pruritis “Itching so bad I can’t sleep”
-Burrows, vesicles, nodules, excoriations
-Skin-colored, linear or serpiginous ridges
2) Interdigital web spaces, axilla, wrists, flexor areas waist, groin, waistband, genitals (usually spares head & neck in adults)
1) What are 3 DDx for scabies?
2) How is scabies diagnosed?
1) Can look like urticaria, drug reactions, eczema
2) Clinical, skin scraping for mites, eggs, & feces
Scabies: What are the 2 Rx options?
1) Elimite (5% Permethrin 60 gm): apply from neck down after bath (< 2 yo treat head also) leave on 8-10 hrs then rinse.
-Repeat in 1 wk. Do not use in children < 2 months old
2) Ivermectin 0.2 mg/kg/dose PO q2wk x 2 doses give w food if crusted or severe give more often
1) How long can scabies pruritis last? How is this extra itching treated?
2) What else is important to consider for scabies (besides Rx)
1) Pruritis can continue up to 2-3 weeks (Post Scabietic Dermatitis)
Topical steroids, Antihistamines (Atarax, Benadryl)
2) Clothes, sheets, etc. wash normally the next morning; bedspread, stuffed animals, pillows, coats put in plastic bag for 7 days
-Treat all family members on the same nights as patient
Latrodectism: Latrodectus (widow spiders):
1) When do black widow bites usually occur?
2) Where do most bites occur?
3) Are there Sx? Explain
1) Outdoor activities
2) ~75% on extremities
3) Initially asymptomatic or mild pain; systemic symptoms 30-120 min
Latrodectism: Latrodectus (widow spiders):
1) What are the primary Sx?
2) Is it a self-limiting condition?
3) What are some other Sx?
1) Muscle pain (extremities, abdomen, back), rigidity
2) Pain self-limited, resolves in 24-72 hours
3) Possibly tremor, diaphoresis, weakness, shaking, local paresthesia, nausea, vomiting, HA
Latrodectism: Latrodectus (widow spiders):
1) What does Tx depend on?
2) Explain Tx
1) Depends on severity
2) Wound care, PO analgesics
IV analgesics & benzos, consider Antivenom
Monitor vitals and breathing closely
Loxoscelism: Loxosceles (recluse spiders):
1) Where do these bites usually occur? What do they possibly look like?
2) Are there Sx?
3) Is it self-limiting?
1) Upper arm, thorax, inner thigh, LE
Red plaque or papule, vesicles possible
2) Usually asymptomatic, may have pain or burning
3) Most self-resolve in 1 week
Loxoscelism: Loxosceles (recluse spiders):
1) What may happen if a pt reacts to them? (not everyone reacts to them)
2) What are the rare systemic issues?
1) Develop dark, depressed center (24-48 hrs), then dry eschar & ulcer (~10% necrosis) red, white, blue lesions
2) Malaise, n/v, fever, myalgias, dark urine, pallor, jaundice, icterus
List and define the 2 primary types of alopecia
1) Scarring: inflammatory, permanent loss
2) Non-scarring: mild/non-inflammatory, non-permanent loss
What are some causes of non-scarring alopecia?
SLE, secondary syphilis, hyper/ hypothyroidism, Fe defic anemia, Vit D deficiency, pituitary insufficiency
1) The most common form (genetic) of alopecia is what?
2) What is the Tx?
1) Androgenic alopecia
2) Minoxidil 5% (OTC), finasteride (Propecia)
1) What is the etiology of alopecia areata?
2) Give some potential associations
3) What does it look like?
1) Unknown, possibly autoimmune
2) Hashimoto thyroiditis, pernicious anemia, Addison disease, vitiligo
3) Localized round oval patches, non-scarring
Alopecia areata:
1) What hair is involved?
2) What is its classic Sx?
3) What are the two different kinds?
1) May also involve beard, brows, or lashes
2) “Exclamation point hairs” (2-3 mm long)
3) Entire scalp (alopecia totalis), entire body (alopecia universalis)
Alopecia areata:
1) Is it ever self-limiting?
2) Tx?
1) 80% complete re-growth (focal)
2) PO steroids (severe), IL steroids
Telogen Effluvium
1) What is it?
2) Who is it most common in?
3) Tx?
1) Non-scarring, temporary hair loss after recent stress (up to 3 months prior)
2) Most common in middle-aged females
3) Supportive care, reassurance, self-care. Hair grows back over months when stress resolves
Telogen Effluvium
1) What is the first step of diagnosis?
2) What is a test for this condition?
3) What 2 labs should be done to rule out DDx?
1) Hx: major life event, illness, major weight loss
2) Hair pull test: Gently pull on small tuft of hair from different places on scalp. If > 4-6 hairs fall out with white bulbs at the root, then TE likely
3) Thyroid panel, vitamin deficiencies
List 2 disorders of the nails
1) Onychomycosis: toenail fungus
2) Paronychia
1) What is Onychomycosis (Tinea Unguium)?
2) What does it look like?
3) How do you confirm Dx?
1) Trichophyton (T. rubrum) infection of fingernails or toenails
2) Brittle, hypertrophic, yellowing & friable nails withsubungual debris
3) KOH prep (hyphae), fungal culture
Onychomycosis (Tinea Unguium)?
1) Is it difficult to treat?
2) What are some indications for Tx?
1) Yes; long therapy & frequent recurrence
2) Discomfort, inability to exercise, DM, immunocompromised
1) What are the 4 potential locations of tinea?
2) What does it look like under a microscope?
1) Capitis, corporis, unguium, pedis
2) Pears/ovals and septated sticks (hyphae)
1) What is the Tx of tinea unguium (onychomycosis) on the fingernails?
2) What abt the toenails?
1) Topical antifungals (limited); PO griseofulvin 500mg 1 PO BID w/high fat meal x 4mo, terbinafine 250 mg PO QD x 6 wk must monitor ANC and d/c if ANC< 1000 or itraconazole 200mg cap PO BID w food x 1 wk
2) PO terbinafine 250 mg PO QD x 12 wk must monitor ANC and d/c if ANC< 1000 (if no response to griseofulvin)
1) What must you do prior to treating tinea unguium (onychomycosis)?
2) What is not recommended & why?
3) What is a new Tx?
1) Must confirm dx prior to tx **Hepatic function test & CBC q4-6 weeks for PO antifungals
2) Ketoconazole not recommended for either form due to higher risk for hepatotoxicity
3) Lasers now available
Paronychia:
1) What is it?
2) What are the 2 types?
3) Risk factors?
4) Tx?
1) Infection of lateral & proximal nail folds, painful
2) Acute or chronic
3) Hangnail, thumb sucking, nail biting, DM, manicures, dishwashing
4) Skin care (warm water soaks,) PO antibiotics, triple antibiotic cream, *I&D abscess (acute/ flocculent)
Dermatophytosis: list all the types of tinea
1) Tinea pedis: foot
2) Tinea manum: hand
3) Tinea cruris: crural fold, groin “jock itch”
4) Tinea corporis, aka “ringworm”: body, extremities
5) Tinea facialis: facial
6) Tinea capitis: scalp hair
7) Tinea barbae: beard hair
List 6 viral skin conditions
1) Dermatophytes/tinea
2) Condyloma acuminatum
3) Molluscum contagiosum
4) Herpes simplex
5) Varicella-zoster virus infections
6) Verrucae
1) What does tinea/ dermatophytosis need to continue?
2) What is the Tx?
1) Moist environment
2) PO terbinafine, itraconazole, fluconazole
Topical clotrimazole, miconazole, ketoconazole
** remember to monitor LFTs and CBC/ANC
Tinea corporis (ringworm):
1) What is it?
2) How is it diagnosed?
3) Tx?
1) Circular lesion on the body with erythematous border and scales (ring-like), may have excoriation or vesicles. Pruritic.
2) Skin scraping, KOH prep
3) Topical antifungal (clotrimazole cream OTC = Lotrimin.) -PO antifungal if widespread or resistant to topical treatment.
What does tinea versicolor look like?
Random blotches of light or dark skin
Tinea versicolor:
1) Sx and timeline?
2) What causes it?
1) Hypo/hyper-pigmented, scaly, sharp margins, scattered, usually on trunk; waxes and wanes x years, hypopigmented areas can remain after effectively treated
2) Overgrowth of cutaneous flora – Malassezia
Tinea versicolor:
1) What will you see on a skin scraping?
2) How do you distinguish from vitiligo?
1) Round yeast and elongated hyphae = “spaghetti and meatballs” on microscopic exam prepared with KOH
2) Scale may fluoresce blue/green with woods lamp. Vitiligo remains white without scale
1) What are the tinea versicolor Microscopic spores and hyphae called?
2) Tx?
1) Malassezia; look like spaghetti and meatballs
2) Topical Selenium sulfide 2.5% shampoo, azole creams, terbinafine 1%soln
Condyloma acuminata:
1) What is it also called?
2) What causes it?
3) Sx and location?
1) Anogenital warts
2) HPV 6 and/or 11 most common
3) Soft flesh -colored papules “cauliflower -like”: external genitalia, perianal skin, perineum, or groin
Condyloma acuminata:
1) Tx?
2) Risk factors?
3) Tx?
4) Prevention?
1) Direct contact with skin or mucosa (STI)
2) Sex, immunosuppression; screen for other STIs
3) Cryotherapy, Imiquimod 5% cream, surgery
4) HPV vax, condoms
Molluscum contagiosum:
1) What causes it? Is it self-limiting? Explain
2) What does it look like?
3) Where on the body?
4) What is the common way of transmission?
1) Poxvirus; self limiting but remission is ~13 months.
2) Single or multiple dome-shaped, waxy papules 2-5 mm diam, umbilicated
3) M/c on face, lower abdomen, genitals
4) Autoinoculable (wet skin-skin contact,) shared towels
Molluscum contagiosum:
1) Can it be a STI?
2) Who is it common in?
3) Best Tx?
4) Other Tx?
1) STI: penis, pubis, inner thighs
2) Common in AIDS
3) Curettage or liquid nitrogen (cryotherapy)
4) Imiquimod cream, retinoid cream
Differentiate between HSV-1 and HSV-2
1) HSV-1 (oral): primary infection, then possible recurrent attacks due to sun exposure, orofacial surgery/lasers, fever, viral infections, stress
2) HSV-2 (genital): sexual contact, asymptomatic shedding
-Genital herpes may also be due to HSV-1
Herpes simplex:
1) Classic presentation?
2) Location?
3) What is another possible Sx?
1) Burning, stinging, grouped vesicles on erythematous base (“dew drops on a rose petal”)
2) Any location, most common on vermillion border, penile shaft, labia, perianal skin, or buttocks
3) Possible tender regional lymphadenopathy
Herpes simplex:
1) DDx
2) How is it diagnosed?
1) Chancroid, syphilis, trauma, other vesicular skin eruptions
2) Clinical (viral culture or PCR, Western blot, ELISA can also be done)
How do you treat herpes simplex during:
1) First episode
2) Mild recurrences
3) Frequent or severe recurrences
1) Acyclovir 400 mg PO TID x 7-10 d (or BID for suppression,) valacyclovir, or famciclovir
2) No therapy for most, may use 3-5 days of antivirals (above)
3) Suppressive antiviral therapy reduces outbreaks & viral shedding (labialis – valacyclovir 500 mg PO QD, genital 1000mg PO QD)
Varicella zoster virus (VZV) infections:
1) What is it?
2) When does it usually present? Is it contagious?
3) How are Sx different in peds vs adults?
4) Describe the rash
1) VZV/HHV-3 chickenpox (varicella)
2) Mostly during childhood, highly contagious.
3) Fever & malaise mild in children, marked in adults.
4) Pruritic rash: face, scalp, trunk & later extremities
Varicella zoster virus (VZV) infections:
1) Describe the rash over time
2) When is it more severe?
3) Tx?
1) Maculopapular > vesicles > crusts/excoriated
2) In older & immunocompromised
3) Uncomplicated in children require no antivirals; consider 5-7 days of acyclovir for patients > 12 y/o
Vaccination for what is > 98% effective (single or quad MMRV)?
Varicella zoster virus (VZV)
Varicella zoster virus (VZV):
1) What can it occur as in adults?
2) How?
3) Risk factors?
4) What is the pattern of lesions?
1) Shingles
2) VZV dormant in cranial nerve sensory ganglia & spinal dorsal root ganglia after primary infection
3) Immunosuppressed, biologic agents, older age, stress
4) Lesions resemble chickenpox but follow unilateral dermatomal pattern (thoracic & lumbar roots most common)
Varicella zoster virus (VZV):
1) Describe the pain
2) What are 2 potential complications?
3) What is a complication of one of those complications?
1) Pain often severe & usually precedes rash
2) HZ opthalmicus & Ramsay Hunt syndrome (VII)
3) Postherpetic neuralgia (60-70% pts with HZ & > 60 y/o)
Varicella zoster virus (VZV):
1) Tx?
2) Is the a vaccine?
1) Valacyclovir or famciclovir within 72 hrs (uncomplicated), tapering course steroids; IV acyclovir for extradermatomal complications
2) Yes, for pts > 50 y/o (2 doses, 2 months apart)
What are the 3 types of candidiasis?
1) Oral
2) Cutaneous
3) Genital
Oral candidiasis :
1) Sx?
2) Tx?
1) Can cause pain or changes in taste
2) Nystatin susp: swish and spit QID x 1w
Cutaneous candidiasis:
1) What causes it/ etiology?
2) Where does it occur?
3) Sx?
1) Fungal infection: Candida species (albicans)
2) Warm, humid environments
3) Very Pruritic, sometimes painful papules and patches, can become macerated (often mirror images in intrigenous areas) with satellite lesions
Cutaneous candidiasis:
1) Risk factors?
2) Where on the body?
3) Tx?
1) Obesity, DM, steroids
2) Oral, Interdigital, groin, perineal, intergluteal cleft, inframammary, axillae, intertrigo (satellite lesions)
3) Keep area dry, nystatin cream, PO antifungals if severe
Genital candidiasis:
1) Who is it very common in?
2) Risk factors?
3) How is it diagnosed? What is one Sx?
4) Tx?
1) Very common in females
2) HIV, DM, Pregnancy, uncircumcised, recent antibiotic use
3) Clinical diagnosis; Can have cottage cheese like discharge
4) PO Diflucan, can use topicals, but not as effective here
4) Can have cottage cheese like discharge
1) Verrucae are also called what?
2) What are the 3 types?
3) What are the Sx?
4) How can it be prevented?
5) Can it be self-limiting?
1) Warts (HPV)
2) Common, plantar, genital
3) Usually asymptomatic; tenderness (plantar), itching (anogenital)
4) Vaccination for anogenital HPV types (prevent infection & reduce cancer)
5) Yes, can have spontaneous resolution
1) How would you Tx ocular verrucae (aka HPV aka warts)?
2) What about for non-genital type?
3) What abt for in the genital area?
4) What abt the plantar region?
1) Oculoplastic surgery
2) Salicylic/lactic acid, imiquimod cream, cryotherapy (liquid nitrogen), laser, surgery
3) Cryotherapy, imiquimod, surgery
4) Paplex ultra (salicylic and lactic acid)
