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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
Secondary ____ infections are common with acute tinea pedis.
staph; may need to tx so be viligant
26
Chronic tinea pedis presents as:
slowly progressive infection that persists indefinitely. erosions/scales between toes (esp 3rd and 4th toes) interdigital fissures - opportunity for infection moccasin ringworm
27
What is moccasin ringworm?
sharp demarcation with accumulated scale in skin creases
28
Chronic tinea pedis may present with _______ ________.
tinea manuum - two feet, one hand - hand that itches
29
How is tinea pedis dx?
History and physical exam --> KOH prep --> culture to confirm Gram stain if bacterial infection suspected.
30
Tinea pedis is treated _______ to tinea corporis/tinea cruris but _________.
Similarly. LONGER.
31
Tx for tinea pedis?
topical: clotrimazole - for 4 weeks | systemic, oral: itraconazole
32
What is onychomycosis?
infection of nail by fungus, yeast, or non-dermatophyte molds (rare)
33
Risk factors for onychomycosis?
Advanced age, tinea pedis, genetics, immunodeficiency, household infection
34
Onychomycosis is primarily _________. Can be _____. Increases risk of other ________ especially in what population?
Cosmetic. Painful. Infections in immunocompromised populations
35
In what different ways does onychomycosis present?
Distal subungual onychomycosis Proximal subungual onychomycosis White superficial onychomycosis Fingernails - usually caused by yeast
36
How does distal subungual onychomycosis present?
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
What is the most common form on onychomychosis?
Distal subungual
38
How does proximal subungual onychomycosis?
Starts near the cuticle and progresses distally. Relatively uncommon. Usually seen in severely immunocompromised population - AIDS.
39
Which form of onychomycosis typically affects severely immunocompromised patients?
proximal subungual onychomycosis
40
How does white superficial onychomycosis present?
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
What is common cause of fingernail onychomycosis?
Yeast - due to candida albicans
42
How does fingernail onychomycosis present?
thickening of nail with yellow/brown discoloration; may cause chronic paronychia - secondary infection of nail margins
43
What is paronychia? What disease is it associated with?
secondary infection of nail margin; fingernail onychomycosis
44
How to dx onychomycosis?
KOH prep of nail scrapings, culture if needed, histopathology if needed
45
Onychomycosis treatment is ____ ________. Should be considered if the patient:
Not obligatory has hx of cellulitis is diabetics desires cosmetic improvement complains of discomfort/pain
46
Tx for onychomycosis considerations:
- - topical medications are generally ineffective - - high rates of failure/reoccurence - -should use systemic
47
Dermatophyte (fungal) onychomycosis tx:
Terbinafine - ORAL - - 6 weeks for fingernails - - 12 weeks for toenails
48
Nondermatyophyte (yeast) onychomycosis Typically affects what?
itraconazole - - 6 weeks for fingernails - - 12 weeks for toenails Fingernails.
49
What is intertrigo?
Any infectious or noninfectious inflammatory condition of two closely opposed (intertriginous) skin surfaces
50
What is intertrigo often due to?
Candida species
51
Risk factors for intertrigo?
Moisture/humidity - incontinence Skin friction - obesity, sumo Immunocompromised
52
What does candidal intertrigo present like?
Erythematous, macerated plaques and erosions Satellite papules/pustules Fine peripheral scaling
53
Dx of candidal intertrigo?
Physical exam --> KOH prep --> culture
54
Tx of candidal intertrigo
Nystatin - topical | Intraconazole - systemic
55
Tinea versicolor
normal fungal skin flora that becomes pathologic when it transforms into mycelial form
56
What is tinea versicolor caused by?
malassezia species
57
Tinea versicolor is common in what populations?
Tropical climate Adolescents/young adults Risk factors: hyperhidrosis, genetics, immunosuppression, not contagious
58
Tinea versicolor appearance
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
Tx of tinea versicolor
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
Scabies is a ______ infection.
Parasitic
61
For scabies, host harbors ________ female mites.
3-50
62
Female mites for scabies excavate a _______ in the _________ in which she lays 2-3 eggs/day for 30-day lifespan.
burrow; stratum corneum
63
How long can scabies live away from host
3 days
64
How is scabies transmitted?
Transmission by direct contact
65
Classical presentation for scabies:
initial lesion, burrow is pathognomonic (dx is certain), located everywhere but back and head Severe pruritus, worse at night
66
Scabies presentation in immunocompromised. Tx required.
crusted scabies - Norwegian scabies Fissures provide avenue for bacteria which can lead to sepsis. REQUIRES ORAL MEDICATIONS.
67
Scabies is dx by:
visualization of burrow, microscopic identification of mite, eggs, or fecal pellets, dermatoscope
68
Scabies typically treated:
permethrin 5% cream - initial tx + 2nd application 10-14 days later or oral ivermectin - single dose repeated two weeks later
69
To prevent scabies from spreading:
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
Pubic lice
can be seen by naked eye; also parasites but larger than scabies
71
Pubic lice are transmitted via
sexual contact
72
How does pubic lice present?
Itching in groin/axilla
73
How does pubic lice affect?
teens and young adults
74
How is pubic lice dx?
visualizing lice or nits, using a microscope helps.
75
How is pubic lice tx?
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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