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Clinical Medicine > Dermatology Lecture 2 > Flashcards

Dermatology Lecture 2 Flashcards

1
Q

Tinea capitis affects these populations more than others:

A 
Children
African American
Decreased personal hygiene
Low SES
Overcrowding
Asymptomatic carriers
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2
Q

How is tinea capitis acquired?

A

direct contact with infected individual or animal; with a contaminated object - comb, brush, hat, wig, tiara

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3
Q

Clinical presentation of tinea capitis:

A

scaly patches with alopecia
patches of alopecia with black dots - “stubble”
widespread scaling with subtle hair loss
kerion - raised spongy legions
favus - most severe - crusty, “cup shaped”; typically in someone with immune deficiency

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4
Q

Associated signs with tinea capitis

A

cervical adenopathy - lymph drains infection
dematophytid reaction - can start after anti-fungal tx
erythema nodosum (rare)

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5
Q

Treatment of associated signs with tinea capitis

A

go away on own

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6
Q

How to dx tinea capitis?

A

Physical exam, KOH prep, dermascope, Wood’s lamp, and culture

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7
Q

Tx of tinea capitis?

A

Systemic anti-fungal therapy with GRISEOFULVIN for 6-12 weeks

Other tx as well

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8
Q

Tinea Corporis occurs in what populations?

A

Caregivers for children with tinea capitis; athletes with skin-skin contact - tinea corporis gladiatorum

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9
Q

Possible result of tinea corporis in immunocompromised?

A

infection and prolific spreading

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10
Q

Appearance of tinea corporis

A

pruritic, annular, erythematous plaques, central clearing, and raised, advancing border (test through palpation)

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11
Q

Dx fungal infections typically through

A

history and physical exam –> KOH prep to confirm –> culture if needed

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12
Q

Tinea corporis is distinguished from erythema annulare centrifugum by:

A

NO raised border in EAC

Trailing scales

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13
Q

Tinea corporis is distinguished from granuloma annulare by:

A

no raised border

no scales

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14
Q

Tx for tinea corporis?

A

TOPICAL (most common) antifungal - clotrimazole for TWO weeks
Systemic (in special circumstances) - itraconazole

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15
Q

Improper tx of tinea corporis alters appearance and results in

A

tinea incognito

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16
Q

What happens when you use steroid cream on tinea corporis?

A

Won’t work. Can cause atrophy of skin. Expensive. Can advance to Mojocchi’s Granuloma

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17
Q

Tinea cruris is a fungal infection that begins where?

A

inguinal fold

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18
Q

Factors that contibute to tinea cruris?

A

male gender, sweaty/humid, obesity/skin folds, occlusive clothing, athlete’s foot - spreading

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19
Q

Tinea cruris presents clinically with:

A

Well-marginated, scaly, annular plaque with raised border, extends from inguinal fold to inner thigh, scrotum usually spared.

Pruritic. Painful. Can be chronic and progressive

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20
Q

Tinea cruris dx by:

A

History/physical exam, KOH prep to confirm, culture if needed

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21
Q

Tx of tinea cruris:

A

TOPICAL antifungal: clotrimazole

SYSTEMIC for resistant cases: ITRACONAZOLE

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22
Q

What is the most common dermatophytosis in the world?

A

tinea pedis

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23
Q

Risk factors for tinea pedis?

A

occlusive footwear, communal baths, showers, pools

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24
Q

Acute tinea pedis presents as:

A

self-limited, intermittent, and recurrent infection

itchy/painful vesicles (blisters) or bulla following sweating

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25
Q

Secondary ____ infections are common with acute tinea pedis.

A

staph; may need to tx so be viligant

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26
Q

Chronic tinea pedis presents as:

A

slowly progressive infection that persists indefinitely.

erosions/scales between toes (esp 3rd and 4th toes)
interdigital fissures - opportunity for infection

moccasin ringworm

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27
Q

What is moccasin ringworm?

A

sharp demarcation with accumulated scale in skin creases

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28
Q

Chronic tinea pedis may present with _______ ________.

A

tinea manuum - two feet, one hand - hand that itches

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29
Q

How is tinea pedis dx?

A

History and physical exam –> KOH prep –> culture to confirm

Gram stain if bacterial infection suspected.

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30
Q

Tinea pedis is treated _______ to tinea corporis/tinea cruris but _________.

A

Similarly. LONGER.

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31
Q

Tx for tinea pedis?

A

topical: clotrimazole - for 4 weeks

systemic, oral: itraconazole

32
Q

What is onychomycosis?

A

infection of nail by fungus, yeast, or non-dermatophyte molds (rare)

33
Q

Risk factors for onychomycosis?

A

Advanced age, tinea pedis, genetics, immunodeficiency, household infection

34
Q

Onychomycosis is primarily _________.

Can be _____.
Increases risk of other ________ especially in what population?

A

Cosmetic.
Painful.
Infections in immunocompromised populations

35
Q

In what different ways does onychomycosis present?

A

Distal subungual onychomycosis

Proximal subungual onychomycosis

White superficial onychomycosis

Fingernails - usually caused by yeast

36
Q

How does distal subungual onychomycosis present?

A

Starts with great toe but all can be affected
White/brown/yellowish discoloration starts at distal corner and spreads towards cuticle.
Distal end of nail breaks exposing nail bed.

37
Q

What is the most common form on onychomychosis?

A

Distal subungual

38
Q

How does proximal subungual onychomycosis?

A

Starts near the cuticle and progresses distally.
Relatively uncommon.
Usually seen in severely immunocompromised population - AIDS.

39
Q

Which form of onychomycosis typically affects severely immunocompromised patients?

A

proximal subungual onychomycosis

40
Q

How does white superficial onychomycosis present?

A

starts with dull white spots on surface of nail plate –> spreads centrifugally until entire nail is involved –> lesions can be scraped for lab sample

41
Q

What is common cause of fingernail onychomycosis?

A

Yeast - due to candida albicans

42
Q

How does fingernail onychomycosis present?

A

thickening of nail with yellow/brown discoloration; may cause chronic paronychia - secondary infection of nail margins

43
Q

What is paronychia? What disease is it associated with?

A

secondary infection of nail margin; fingernail onychomycosis

44
Q

How to dx onychomycosis?

A

KOH prep of nail scrapings, culture if needed, histopathology if needed

45
Q

Onychomycosis treatment is ____ ________.

Should be considered if the patient:

A

Not obligatory

has hx of cellulitis
is diabetics
desires cosmetic improvement
complains of discomfort/pain

46
Q

Tx for onychomycosis considerations:

A
    • topical medications are generally ineffective
    • high rates of failure/reoccurence
  • -should use systemic
47
Q

Dermatophyte (fungal) onychomycosis tx:

A

Terbinafine - ORAL

    • 6 weeks for fingernails
    • 12 weeks for toenails
48
Q

Nondermatyophyte (yeast) onychomycosis

Typically affects what?

A

itraconazole

    • 6 weeks for fingernails
    • 12 weeks for toenails

Fingernails.

49
Q

What is intertrigo?

A

Any infectious or noninfectious inflammatory condition of two closely opposed (intertriginous) skin surfaces

50
Q

What is intertrigo often due to?

A

Candida species

51
Q

Risk factors for intertrigo?

A

Moisture/humidity - incontinence
Skin friction - obesity, sumo
Immunocompromised

52
Q

What does candidal intertrigo present like?

A

Erythematous, macerated plaques and erosions

Satellite papules/pustules

Fine peripheral scaling

53
Q

Dx of candidal intertrigo?

A

Physical exam –> KOH prep –> culture

54
Q

Tx of candidal intertrigo

A

Nystatin - topical

Intraconazole - systemic

55
Q

Tinea versicolor

A

normal fungal skin flora that becomes pathologic when it transforms into mycelial form

56
Q

What is tinea versicolor caused by?

A

malassezia species

57
Q

Tinea versicolor is common in what populations?

A

Tropical climate
Adolescents/young adults
Risk factors: hyperhidrosis, genetics, immunosuppression, not contagious

58
Q

Tinea versicolor appearance

A

macules, patches, plaques, on trunk/UE
can coalesce
often have fine scale
typically asympomatic but can be mildly pruritic

Versicolor means variety of colors - hypopigmented, hyperpigmented, erythematous

59
Q

Tx of tinea versicolor

A

Clotrimazole for two weeks
Selenium sulfride for one week
Zinc pyrithione for two weeks

Systemic - itraconazole

Tinea versicolor takes a while to calm down even if treatment is successful.

60
Q

Scabies is a ______ infection.

A

Parasitic

61
Q

For scabies, host harbors ________ female mites.

A

3-50

62
Q

Female mites for scabies excavate a _______ in the _________ in which she lays 2-3 eggs/day for 30-day lifespan.

A

burrow; stratum corneum

63
Q

How long can scabies live away from host

A

3 days

64
Q

How is scabies transmitted?

A

Transmission by direct contact

65
Q

Classical presentation for scabies:

A

initial lesion, burrow is pathognomonic (dx is certain), located everywhere but back and head

Severe pruritus, worse at night

66
Q

Scabies presentation in immunocompromised. Tx required.

A

crusted scabies - Norwegian scabies

Fissures provide avenue for bacteria which can lead to sepsis.

REQUIRES ORAL MEDICATIONS.

67
Q

Scabies is dx by:

A

visualization of burrow, microscopic identification of mite, eggs, or fecal pellets, dermatoscope

68
Q

Scabies typically treated:

A

permethrin 5% cream - initial tx + 2nd application 10-14 days later or oral ivermectin - single dose repeated two weeks later

69
Q

To prevent scabies from spreading:

A

treat household and close contacts simultaneously; postscabetic itch can persist up to two weeks; oral antihistamines and emollients can provide symptomatic relief; wash linens in hot water and dry in high head

70
Q

Pubic lice

A

can be seen by naked eye; also parasites but larger than scabies

71
Q

Pubic lice are transmitted via

A

sexual contact

72
Q

How does pubic lice present?

A

Itching in groin/axilla

73
Q

How does pubic lice affect?

A

teens and young adults

74
Q

How is pubic lice dx?

A

visualizing lice or nits, using a microscope helps.

75
Q

How is pubic lice tx?

A

permethrin 1% cream - repeat/recheck in ten days

treat sexual partners

abstain from sex until treated

check for other STIs - 30% of the time, they have another STI

Clinical Medicine (5 decks)

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