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Clinical Medicine > Dermatology Lecture 1 pt 2 > Flashcards

Dermatology Lecture 1 pt 2 Flashcards

1
Q

Types of eczematous eruptions

A
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2
Q

Atopic Dermatitis

A
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3
Q

Atopic dermatitis

A
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4
Q

Atopic dermatitis diagnosis and treatment?

A

Diagnosis: bacterial culture if infected or recurrent/failed treatments

Primary Treatment:
-hydration with fragrance-free topical emollients

-avoid hot showers and moisturizer after

-Antihistamines and topical corticosteroids

-(antibiotics/antivirals if indicated)

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5
Q

Lichen Simplex Chronicus (neurodermatitis) presentation

A

Lichenification-thickening of
skin with accentuation of skin
markings

Well-defined lichenified plaques
and/or papules occurring in
areas chronically scratched in
atopic dermatitis

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6
Q

Lichen Simplex Chronicus (neurodermatitis) diagnostics and treatment

A

Laboratory: KOH to r/o fungus

Treatment: topical steroid (high potency)
-antihistamines for itching
-Stop scratching

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7
Q

Contact Dermatitis presentation

A

Acute-Well-defined areas of
erythema and plaques. Vesicles,
erosions, crust and urticaria may
be present

Chronic- Lichenification and excoriations usually present

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8
Q

Contact dermatitis symptoms/causes

A

-Patients complain of itching and/or burning
* Contact with cleaning supplies, solvents, oils, abrasives, oxidizing or reducing agents, dust
* Fake Jewelry/accessories distribution in Nickel allergies
* Hand eczema is the most common; 80% of occupational contact derm
* Female < Male; 20-59 yo

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9
Q

Most common cause of Rhu dermatitis?

A

urishiol oil

type of contact dermatitis; oils from poison ivy

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10
Q

Contact dermatitis diagnostics and treatment

A

Laboratory: Patch testing, Cultures if infected

Treatment:
-Avoid/remove offending agent
* Burrow’s solution/Epsom salts cool compresses and topical steroids
* Systemic corticosteroids if Severe
* Antihistamines, soapless cleansers, oatmeal preparations for the itching

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11
Q

Nummular Dermatitis presentation

A

Erythematous, coin-shaped
plaque, with small vesicles that
have coalesced.

  • Crusting and excoriations may be
    present

Pruritic, inflammatory disorder that typically affects young adults and the elderly and often occurs in the winter

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12
Q

Nummular Dermatitis diagnostics and treatment

A

Laboratory: Cultures if infected

  • Treatment: Emollients and topical steroid, bathe in lukewarm water, humidification
  • Intralesional triamcinolone
  • Crude Coal Tar 2-5% ointment (may be combined with glucocorticoid
    preparation) *

Systemic antibiotics if secondary infection (S aureus is common)

  • PUVA or UVB 311nm Therapy (Phototherapy)
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13
Q

Perioral dermatitis presentation?

A

Erythematous, papulopustules in
the area around the mouth that
may become confluent with
plaques and scales.

more common in female

Satellite lesions may be present

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14
Q

Perioral dermatitis diagnostics and treatment

A

Laboratory: Culture to R/O Staph

  • Treatment: Topical Metronidazole or erythromycin, gentle cleansers
  • Oral minocycline, doxycycline, or tetracycline

Avoid topical glucocorticoids – they will only aggravate this condition or induce
steroid acne. “ZERO THERAPY”

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15
Q

Seborrheic Dermatitis presentation/cause?

A

-Yellowish red, often greasing, or white dry
scaling macules and papules of varying size

-Oily skin

-Caused by lipid-dependent Malassezia

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16
Q

Seborrheic dermatitis diagnostics and treatment?

A

Occurs in central areas of the body where sebaceous glands are most
active-scalp, face, ears, chest, groin

-biphasic. more common in men

-lights up under Wood’s lamp

Treatment: topical steroids, ketoconazole shampoo, topical sulfa prep

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17
Q

Identify images

A

Statsis Dermatitsis

Inflammatory papules, scales,
crusting often occurring in the
presence of edema and
varicosities.

  • Ulcers are present in ~30% of
    patients

Usually bilateral

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18
Q

What are risks of developing stasis dermatitis?

A

Chronic venous insufficiency;
Female > Male * Age * FHx * Standing job * Obesity * Hx DVT

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19
Q

Stasis Dermatitis diagnostics and treatment?

A
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20
Q

Identify and describe

A

Dyshidrosis or Dyshidrotic Eczema or dishwasher eczema

  • Early in disease-Pruritic, small
    vesicles in clusters (tapioca
    appearance) most commonly on
    hands/feet. Occasionally, bullae
    form

Late in disease- Papules, scaling, lichenification, and erosions from ruptured vesicles. Painful fissures may develop.

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21
Q

Dyshidrosis diagnostics and treatment

A

Laboratory: KOH to R/O fungus
Culture to R/O bacteria

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22
Q

What are papulosquamous diseases?

A

Acrochordons * Drug Eruptions * Lichen Planus * Pityriasis Rosea * Psoriasis

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23
Q

Identify and describe

A

Skin tags - Acrochordons
* Small flaps of skin attached by a stalk
* Typically, in areas of friction
* More common in obese and diabetic

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24
Q

Acrochordons treatment

A

Do not need to remove – but may use cryosurgery, scissors, electrocautery
* Lidocaine –epi, shave off or snip off

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25
Drug eruptions presentation
* Erythematous macular and/papular symmetric eruption that is very pruritic * Severe drug eruptions may be accompanied by eosinophilia, lymphadenopathy, and liver function abnormalities
26
Drug eruption treatment?
Treatment: Withdrawal offending drug -Systemic Prednisone, Antihistamines and topical steroids, cool oatmeal baths
27
Two common example of drug eruptions?
Mononucleosis patients taking amoxicillin or AIDS patients taking sulfa drugs frequently experience this reaction. (antibiotics, sulfonamides)
28
Identify image
Drug eruption This symmetric, morbilliform (measles-like), blanching eruption may eventually become confluent or forming into unusual shapes, leading to an exfoliative dermatitis
29
Identify image
Fixed Drug Eruption * This red to violaceous, pruritic, sharply demarcated patch is a cutaneous reaction to a drug * Repeated exposure will cause a similar reaction in the same location, ex NSAIDs
30
Identify image4
Looks similar to measles but it is actually drug eruption from amoxicillin
31
Identify condition
Drug induced photosensitivity (photodermatoses) Linearly distributed, pruritic vesicles in a photodistribution make the diagnosis (actinic prurigo) * The distribution of the rash is limited to sun-exposed areas.
32
Common drugs causing drug-induced photosensitivity?
Carbamazepine, amiodarone, doxycycline, furosemide, phenothiazines, and sulfonamides
33
Identify condition
Sun-exposed Distribution Porphyria Cutanea Tarda Explanation: blisters and erosions of porphyria cutanea tarda. Associated with Hep C
34
What laboratory test can confirm lichen planus
Biopsy and immunofluorescence often seen 30-60 yrs
34
Identify condition
Lichen Planus Explanation: Flat-topped, shiny, violaceous papules with surface white lines (Wickham striae) that appear to be grouped and can coalesce. Associated with Hep C
34
Where is Lichen Planus most commonly seen?
Most commonly occur on the flexor aspects of the wrists, lumbar area, eyelids, shins, and scalp * Mucosal lesions occur on the glans penis and in the mouth, and are usually painful and often ulcerate
35
Topical treatment for Lichen Planus?
Topical Therapy (under occlusive dressing) * Glucocorticoids, Intralesional triamcinolone * Cyclosporine –used as a retention “mouthwash” for severely symptomatic oral lesions
36
Systemic treatment of lichen planus?
-Cyclosporine – 5mg/kg/d for very resistant and generalized cases * Glucocorticoids – short tapered course (ie 70mg initially tapered by 5mg) Extras: * Systemic Retinoids (Acitretin or Etretinate) – helpful in adjunctive measure in severe cases * PUVA photochemotherapy – symptomatic individuals with resistance to topical therapy
37
What is this condition?
Pityriasis Rosea Explanation: Erythematous, dull pink to fawn colored, plaques with fine adherent scales that are oval (Circinate) or round that is symmetrical and follows the Langerhans lines giving a Christmas tree pattern. Characterized by Herald patch, which is largest
38
Unique patterns of Pityriasis Rosea?
Christmas tree pattern (langerhans lines) Herald patch (largest patch)
39
Identify condition
Pityriasis Rosea -Herald patch
40
Additional features of Pityriasis Rosea
Very pruritic (itchy) Caused by virus so condition is self-limiting
41
What is treatment of Pityriasis Rosea?
Treatment: Reassure patient most likely cause is a virus and expect the rash to spontaneously resolve in 5-12 weeks. Emollients or even low to mid potency cortisone for the itching * Antihistamines if significantly pruritic * UVB or natural light can be helpful, if started during the 1st week of the eruption
42
What is this condition?
Pityriasis Alba Explanation: -white, scaly, macular -indistinct or hypopigmented borders -Mild erythema, scaling may procede hypopigmentation
43
What makes Pityriasis Alba worse?
Worsen with sun exposure. Worse in darker skin
44
Treatment for Pityriasis Alba?
Self-limited: months to years Treatment: low potency corticosteroids or tacrolimus (depending on site)
45
How is psoriasis described?
Well marginated, erythematous plaque or papules with silvery-white surface scale; removal of scale results in the appearance of small blood droplets (Auspitz Phenomenon)
46
What condition?
Psoriasis is commonly associated with pitting of the nails and thickening of nail beds. Pt may also have psoriatic arthritis in distal joints of hands and feet, typically asymmetric
46
What type of disease and disorder is psoriasis?
Papulosquamous Disease Chronic, recurrent disorder 40% have family hx
46
What parts of the body is psoriasis commonly found?
Commonly found on knees, elbows, and buttocks, scalp, and palms. Effect *Extensor surfaces
47
What is Koebner's phenomenon?
Occurs in psoriasis Pruritus is common and scratching leads to more lesions. Lesions that appear at sites of local skin trauma in a previously healthy tissue
48
What is this condition?
Psoriatic erythroderma Lesions involve entire skin and is an exfoliative and serious condition
49
What type of Psoriasis?
Guttate (drop-like): acute eruption in disseminated pattern typically appearing after strep pharyngitis * Abrupt appearance
49
What type of Psoriasis?
Pustular psoriasis (von Zumbusch’s syndrome) It is an abrupt life-threating condition characterized by widespread pustules that coalesce to form lakes of pus; fever, malaise, and leukocytosis are seen
50
What are the different severities of Psoriasis
Mild psoriasis = < 2% of body surface area (BSA) affected 2. Moderate psoriasis = 3% to 10% of BSA 3. Severe psoriasis = > 10% of BSA * Most patients have a mild form of psoriasis -Psoriasis mc found in immunocompromised
51
Main Treatments for Psoriasis?
-Maintain cutaneous hydration (ointments) * Topical glucocorticoids (does not prevent Koebner Phenomenon) * Coal tar ointment, Topical vitamin D analog (calcipotriol), topical retinoids
52
Second Line treatments for psoriasis
Phototherapy UV light (PUVA when UV is used in combination with psoralens) These prescribed by derm alone: * Methotrexate (must monitor CBC, Cr., and LFTs) or cyclosporin (nephrotoxic) for severe advanced disease * Adalimumab (Humira) or Etanercept (Enbrel), or Ustekinumab (Stelara) – moderate to severe plaque Psoriasis who are not candidates for other therapies. Check PPD.
53
Alternative treatments for Psoriasis?
Treatment (Con’t) * Acitretin (Soriatane) is a retinoid used especially for pustular * Biologics: * Etanercept (Enbrel), Infliximab (Remicade), and Adalimumab (Humira) are anti-TNF agents * Ustekinumab (Stelara) is a human monoclonal antibody that targets IL-12 and IL-23
54
What is this condition?
Characterized by small and large erythematous plaques with adherent silvery scale. * Moderate –severe psoriasis
55
What is this condition?
Examples of psoriasis
56
Types of Desquamation
* Staph TSS and SSS * Erythema Multiforme * Stevens-Johnson Syndrome * Toxic Epidermal Necrolysis
57
What organism Staphylococcal Toxic Shock Syndrome? Where is it located
Staph Aureus. Found in 50% of adults. common in nares, skin, vagina, and rectum
58
Causitive agents in Staph TSS? What causes infections?
Toxic shock syndrome toxin-1 (TSST-1) and Staphylococcal enterotoxin B Wound packing and retain packing (tampon or nasal)
59
What happens in TSS
Super antigens: cause an exaggerated, dysregulated hyperimmune cytokine response. T-cells attack the whole body leading to fever and organ failure
60
TSS- Staph symptoms
-**Fever** greater than 102F and -**Rash** that is diffuse macular erythroderma and -**hypotension**: systolic less than 90 mmHG and -**Desquamation:** 3-7days after onset of illness particularly on palms and soles | Can involve multisystem involvement of 3 or more organ systems
61
Important differentials to consider for Staph TSS
Scarlet fever, RMSF, Steven-Johnson syndrome, viral exanthem, heat stroke
62
Identify condition
Staph TSS (mild) | Sunburn appearance
63
What is this?
Erythroderma rash from Staph TSS. Skin desquamates (peels off). Full thickness loss of entire layer
64
What labs to order for Staph TSS?
CBC, CMP, Lactate level, blood culture x 3, wound culture. CPK (Important for necrotisis or myostisis) | extras: serology for ticks/parasites, cxr/ct on location risk factors
65
Diagnositic steps of Staph TSS
* Isolation of bacteria not necessary, but useful * Exploration of vagina, wounds * Admit ICU and treat for sepsis * Consult ID
66
# [](http://) First Part of Staph TSS treatment
Aggressive management of shock * 10-20 liters/ day * Anasarca possible (diffuse edema due to capillary leakage) * Vasopressors if needed: norepinephrine DOC * Central venous monitoring
67
What is the empirical treatment of Staph TSS
vancomycin and ceftriaxone OR piperacillin/ tazobactam (Zosyn®) | If MRSA suspected then vanc and clindamycin
68
Known culture treatment of Staph TSS
Clindamycin (protein synthesis inhibitors) and nafcillin
69
What is this condition?
"Staph" scalded skin syndrome Exists on a continuum – they may have just a few bullous lesions or they can have generalized exfoliation of all their skin Happens in children less then 6yrs in summer/fall
70
Staph Scaled Skin Syndrome Treatment
Treat Staph with penicillinase-resistant penicillin. * Skin is treated as though it is a burn * Skin care * If this is "drug induced," the drug should be discontinued, and steroids may be helpful and antibiotics would NOT be given.
71
What is the condition? How would you describe?
Erythema Multiforme Typical target lesions consist of three components: a dusky, central area or blister, a dark red inflammatory zone surrounded by a pale ring of edema, and an erythematous halo on the extreme periphery of the lesion
72
3 most common causes of Erythema Multiforme?
Drug reaction (penicillins and sulfonamides) Concurrent HSV Mycoplasma infection
73
Treatment of Erythem Multiforme
-Avoid offending substance * If herpetic trigger, the patient should be placed on suppression therapy with Valacyclovir(Valtrex), Acyclovir, or Famciclovir(Famvir) * Antihistamines, NSAID for pain relief extras * Systemic steroids for severe cases * Prevention of secondary infection and maintenance of nutrition and fluid/electrolyte balance are critical
74
What condition and describe?
75
What are symptoms/presentations of SJS
Patients present with fever, photophobia, sore throat * By definition involves less than 10% BSA in SJS. Note the target lesions on the hands of this patient, as well as the mucosal involvement on the lips. 90% will have mucocutaneous erosion
76
What is the definition of SJS and TEN
Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are rare, severe mucocutaneous reactions triggered, in most cases, by medications and characterized by extensive necrosis and detachment of the epidermis.
77
What are associated drugs causing SJS?
Sulfonamides, Aminopenicillins, quinolones, cephalosporins, tetracyclines, phenobarbital, carbamazepine, phenytoin, valproic acid, oxicam, allopurinol and corticosteroids.
78
What is going on in this image?
complete corneal epithelial defect from SJS Oral mucosal involvement may take the form of erosions, blisters, and hemorrhagic cheilitis
79
What is this condition?
SJS
80
What is this condition and how would you describe it?
Toxic Epidermal Necrolysis (TEN) Generalized, macular eruption with some target-like lesions which rapidly developed epidermal necrosis, positive Nikolsky's sign, bulla formation, and denuded erosive areas
81
What condition and describe what is happening?
TEN The initial bullae have coalesced, leading to extensive exfoliation of the epidermis
82
What is the treatment of SJS and TEN
Treatment: -Prompt withdrawal of the offending agent * If extensive necrolysis, the patient should be managed in the burn unit * Control pain and secondary infection Fluid/electrolyte management CONTROVERSY: 1)Corticosteroids, some say yes, others no 2)Antibiotics because these are also potential causative agents

Clinical Medicine (5 decks)

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