Dermatology MDT's Flashcards
Folliculitis Most commonly infectious etiology
Most frequently due to S. aureus (+/- MRSA)
Streptococcus species, Pseudomonas (contaminated H20 contamination) Use of hot tubs or saunas
Non-Infectious
Mechanical Folliculitis (Skinny Jeans Syndrome)
Pseudo-folliculitis barbae (PFB)
Pseudomonas folliculitis appears as a
widespread rash, mainly on the trunk and limbs
The clinical hallmark of folliculitis
hair emanating from the center of the pustule.
Initial care for folliculitis
Mupirocin ointment applied TID for 10 days
Cephalexin: 250-500 mg PO QID (7-10 days)
Dicloxacillin: 250-500 mg PO QID (7-10 days
MRSA:
(a) Bactrim DS: 1-2 tablets BID PO (5-10 days)
(b) Clindamycin: 300 mg PO TID (10 to 14 days)
(c) Doxycycline: 50-100 mg PO BID (5-10 days)
Treatment of PFB
Treatment Approach 1 - Medical Treatment with Grooming Modifications (for Mild to Moderate PFB)
Topical retinoid or eflornithine 13.9% (if available) and a temporary waiver of
facial hair standards for up to 60 days.
Treatment Approach 2 - Laser Hair Reduction with grooming modifications (moderate to severe PFB)
Primary impetigo vs Secondary impetigo
Primary= invasion of normal skin
Secondary= Invasion at sites of minor trauma
A contagious, superficial, intraepidermal infection occurring prominently on exposed areas of the face and extremities
Impetigo
Bacteria that cause impetigo
Staphylococcus aureus alone or combined with group A β-hemolytic streptococci
A deeper, ulcerated impetigo infection often with lymphadenitis
Ecthyma
Most common form of impetigo. Formation of vesiculopustules
that rupture, leading to crusting with a characteristic golden appearance
Nonbullous impetigo:
Staphylococcal impetigo that progresses from small to large flaccid bullae (newborns/young children) caused by
epidermolysis toxin release; ruptured bullae leaving brown crust
Bullous impetigo
Impetigo Risk Factors
Warm, humid environment
Minor trauma, insect bites, breaches in skin
Poor hygiene, poverty, crowding, epidemics, wartime
Familial spread
Complication of pediculosis, scabies, chickenpox, eczema/atopic dermatitis
Complications of impetigo
(1) Ecthyma
(2) Cellulitis
Unilateral lower-extremity involvement is typical and systemic symptoms are
usually absent
Most common portal of entry for lower leg cellulitis is toe web intertrigo with fissuring,
2/2 interdigital tinea pedis.
Cellulitis
Useful diagnostic testing for cellulitis
Plain radiographs, CT, or MRI are useful if osteomyelitis, fracture, necrotizing fasciitis,
retained foreign body, or underlying abscess is suspected.
US to r/o Deep Vein Thrombosis (DVT)
initial Cellulitis Treatment
Demarcate area w/a sharpie to measure progress once you start treatment.
Immobilize and elevate involved limb to reduce swelling.
Sterile saline dressings or cool aluminum acetate compresses for pain relief
Acetaminophen +/- NSAIDs for pain relief
Tetanus immunization if needed, particularly if there is an open wound.
Medication for cellulitis
Non-purulent cellulitis
1) Cephalexin 500 mg
2) Dicloxacillin 500 mg
Purulent cellulitis
1) Clindamycin 450mg
2) Trimethoprim-sulfamethoxazole
3) Doxycycline 100 mg
Human/animal Bites
1) Amoxicillin + clavulanic acid (Augmentin)
Necrotizing Fasciitis Treatment
Prompt and wide surgical debridement is the cornerstone of treatment.
Broad-spectrum antibiotics should be administered once diagnosis of NSTI is
suspected.
A well-circumscribed, painful, suppurative inflammatory nodule at
any site that contains hair follicles
Furuncle (AKA boil)
A collection of pus within the dermis and deeper skin tissues.
Skin abscess
A coalescence of several inflamed follicles into a single inflammatory mass with purulent drainage from multiple follicles
Carbuncle
Typically presents with systemic symptoms and fever
What is the mainstay of treatment for an abscess, furuncle, or
carbuncle.
Incision and Drainage
the most common benign cutaneous cysts.
Epidermal cysts
The most common benign mesenchymal neoplasm in adults and are composed of
mature white adipocytes.
Lipoma
Most common cause of paronychia
Most commonly caused by Staphylococcus aureus, Streptococcus pyogenes infection in
the periungual tissues
Paronychia Treatment
Early treatment with warm compresses or soaks
Antibiotic therapy if warranted that includes coverage for Staph and strep.
Bactrim/Septra DS in areas where MRSA is common and based on results of sensitivity
testing.
Fluctuant or visible pus should be drained using scalpel blade inserted between the nail
and nail fold
Skin incision is unnecessary.
Felon Treatment
Prompt incision, with division of the fibrous septa to ensure adequate drainage by dermatologist
IDC should treat with antibiotics.
(a) MSSA- Systemic antibiotics - Dicloxacillin or Keflex are indicated.
(b) If MRSA suspected, trimethoprim/sulfamethoxazole, clindamycin, or doxycycline,
should be used
Candidiasis and fungal treatment
First Line (Topical)
1) Clotrimazole Vaginal Cream (Gyne-Lotrimin)
2) Miconazole Nitrate Vaginal Cream (Monistat)
Second Line (Oral)
1) Fluconazole (Diflucan)
Tinea infections
Pedis = foot
capitis = head
Curis= balls
Corpis = body
What causes tinea infections
Dermatophytes can subsist on protein, namely keratin and can cause disease in keratin rich structures such as skin, nails, and hair.
Infections result from contact with infected persons/animals
Tinea versicolor caused by
Pityrosporum orbiculare, which is part of the normal skin flora
likes sebum
excess heat and humidity predispose to infection
Not linked to poor hygiene
Presentation of tinea versicolor
Velvety tan, pink or white macules that do not tan.
Treatment of tinea versicolor
Selenium Sulfide 2.5% applied from neck to waist wash off after 5-15 minutes, repeat daily x 7 days. Repeat weekly x 1 month, then monthly for maintenance.
Ketoconazole 2% shampoo chest and back, wash off after 5 minutes. Repeat
weekly.
Oral treatment is used for patients with extensive disease and those who do not
respond to topical treatment
Ketoconazole 400 mg in a single dose with exercise to point of sweating
after ingestion. Single dose is not always effective.
Fluconazole 300 mg (2 capsules weekly x 2 weeks) has similar efficacy.
Treatment onychomycosis
Confirmation of infection is required prior to treatment due to potential for liver
toxicity of treatment with oral antifungals
Potassium hydroxide (KOH) preparation (confirms presence of infection) and
fungal culture (determines the type/species of the actual infecting organism).
A contagious parasitic infection of the skin caused by the mite Sarcoptes scabiei, var. homini
Scabies
Scabies rash appears how long after exposure
2-6 weeks
Cardinal feature of scabies
intense pruritus
A burrow is the classic lesion; a linear, curved or S-shaped slightly elevated vesicle or
papule up to 1-2 mm wide.
Finger webs, wrists, sides of the hands and feet, the penis, buttocks and scrotum.
Labs/Studies/Imaging for scabies
Ink test: Rub a black felt-tip marker across an affected area. Remove excess ink is wiped away with an alcohol pad, burrow appears darker than the surrounding skin because of ink accumulation in the burrow.
Treatment of scabies
Permethrin or lindane as well as removal of all clothes and bedding
Common, acute, self-limited papulosquamous skin rash that most commonly seen in
individuals 10-35 years old.
Pityriasis Rosea
Prodromal symptoms are reported in as much as 69% of patients for
Pityriasis Rosea
Begins with a solitary herald patch that appears on the trunk or proximal
limbs that precedes secondary eruption by 7-14 days.
Pityriasis Rosea
What does Pityriasis Rosea look like
Christmas tree pattern” on back
V-shaped pattern on upper chest
Treatment of Pityriasis Rosea
Antihistamines and corticosteroids but not necessary
Antiviral therapy treatment for HSV 1 is indicated in
(a) Healthy persons with frequent outbreaks
(b) Moderate to severe cases of primary infection in healthy persons
Symptomatic treatment of HSV 1 includes
analgesics and adequate hydration.
Diffuse pox-like eruption complicating atopic dermatitis; sudden appearance of lesions in typical atopic areas (upper trunk, neck, head); high fever, localized edema,
adenopathy
Eczema herpeticum
Localized infection of affected finger with intense itching and pain, followed by
vesicles that may coalesce with swelling and erythema. Mimics pyogenic paronychia;
neuralgia and axillary adenopathy are possible; heals in 2 to 3 weeks.
Herpetic whitlow
Herpes zoster infection is found most commonly in
adults greater than 60 years of age
acute neuritis and symptoms may begin before herpes zoster rash by how many days
1-5 days and pain is described as burning, throbbing or stabbing
Herpes zoster rash locations
on the dermatomes usually unilateral
Occurrence of pain for months or years in the same dermatomal distribution as was affected by the herpes zoster.
Post herpetic neuralgia
herpes zoster that frequently involves the ophthalmic division of the trigeminal nerve.
Herpes Zoster Opthalmicus
Vesicles on the tip/side of the nose precedes the development of
HZO
Hutchinson’s Sign
name for warts
verruca vulgaris, plantaris, and planna
Treatment for warts
salicylic acid, cryotherapy or duct tape application
connotes some scaling, crusting, or serous oozing as opposed to
mere erythema.
Eczematous
Non-immunologic reaction to substance or action producing direct damage to skin by
chemical abrasion or physical irritation
Irritant Dermatitis
Due to a delayed immunologic response (type IV hypersensitivity) to a cutaneous or
systemic exposure to an allergen to which the patient has been previously sensitized.
Allergic Contact Dermatitis
the most common
causes of allergic (cell-mediated) contact dermatitis in the United States
Poison ivy, poison sumac, and poison oak
Nickel is the most common cause of metal dermatitis and a common cause of allergic contact dermatitis
Irritant Dermatitis Presentation
The hands are most often affected. Both dorsal and palmar surfaces can be affected.
Erythema, dryness, painful cracking or fissuring and scaling are typical. Vesicles
may be present.
) May show juicy papules and/or vesicles on an erythematous patchy background
with weeping and edema.
Persistent, chronic irritant dermatitis is characterized by lichenification, patches of erythema, fissures, excoriations and scaling
Treatment of irritant dermatitis
(a) Early diagnosis, treatment and preventative measures can prevent the development
of a chronic irritant dermatitis.
(b) Medium or high-potency topical steroid ointment applied BID for several weeks can
be helpful in reducing erythema, itching,
swelling and tenderness.
(c) Antihistamines (except for their sedative effect) are ineffective in contact dermatitis.
(d) Frequent application of a bland emollient to affected skin is essential.
Allergic Contact Dermatitis (ACD) presentation
Characterized by vesicles, edema, redness and extreme pruritus. Strong allergens
such as poison ivy produce bullae.
Distribution first confined to the area of direct exposure. May spread beyond areas
of direct contact if exposure is chronic.
Itch and swelling are key components of the history. Itch predominates the burning sensation.
Allergic Contact Dermatitis (ACD) treatment
Topical treatment using topical corticosteroid. Discontinue all moisturizers, lotions and topical products
Apply wet dressings with Burrow’s solution every 2-3 hrs.
Topical class I–II glucocorticoid preparations. In severe cases, systemic
glucocorticoids may be indicated.
Also knonw as dandruff were are the primary places it effects
Seborrheic Dermatitis
Chronic, superficial, recurrent inflammatory rash affecting sebum-rich, hairy regions of the body, especially the scalp, eyebrows, and face
Seborrheic Dermatitis treatment
1) Zinc pyrithione (Head & Shoulders)
2) Selenium Sulfide (Selsun Blue)
3) Ketoconazole (Nizoral)
4) Salicylic Acid (T/Sal)
5) Coal tar (T/Gel)
A chronic, inflammatory disorder most commonly characterized by cutaneous
erythematous plaques with silvery scale.
Psoriasis
Plaque (vulgaris): Most common variant
Distribution favors scalp, auricular conchal bowls, and postauricular area; extensor
surface of extremities,
Sign that indicates Plaque Psoriasis
Auspitz sign: Pinpoint bleeding with removal of scale
Treatment of Psoriasis
initial therapy: medium-potency corticosteroids daily, Topical retinoids
Systemic therapy
Patients with Psoriasis involving more than 20% of the body surface or who are
very uncomfortable should consider systemic therapy.
(3) Phototherapy (light box Therapy)
(a) Targeted exposure to UVR in dermatology.
Treatment Guidelines acne
Comedonal (noninflammatory) acne
(a) Topical retinoid
Mild comedonal + papulopustular acne
(a) Topical antimicrobial (BP alone or BP +/topical antibiotic)
(b) Topical retinoid
OR
(c) Topical antimicrobial (BP) Topical antibiotic (for patients who cannot tolerate retinoids
Moderate papulopustular and mixed acne
(a) Topical retinoid
(b) Oral antibiotic
(c) Topical Benzolyl peroxide
Severe acne (nodulocystic acne)
(a) Oral isotretinoin monotherapy
How do you determine scarring and nonscarring alopecia
Present follicular markings suggest a nonscarring alopecia.
(Absent follicular markings suggest a scarring alopecia.
Most common form of male hair loss affecting 30-50% of men by age 50
Androgenetic alopecia
type of alopecia that is Believed to be an immunologic process. Patches that are perfectly smooth and
without scarring.
Alopecia areata:
alopecia that may occur following any type of trauma or inflammation that may
scar hair follicles.
Cicatricial Alopecia
will not grow back
Phenotypic characteristics that confer high susceptibility to sunburn
fair skin, blue eyes, and red or blond hair.
Needs at least SPF of this magnitude to protect from sunburns
Broad spectrum sunscreens (UVA & UVB with SPF 30+
Treatment of sunburns
Cool compresses or soaks, Calamine lotion, Aloe Vera based topical products.
Working up a patient for Urticaria requires the IDC to rule-out or rule-in the common
causes which are?
(a) Ingestants (common)
(b) Inhalants
(c) Injectants
(d) Infections
(e) Internal Diseases -
Patient needs to sign what form when performing toe nail removal
SF 522
Most common of all injuries to the upper extremities; typically results from a direct
blow to the fingernail or a squeezing-type injury to the distal finger
Subungual hematoma
Most common acquired benign epithelial tumor of the skin. O
Seborrheic Keratosis.
there there little bear
begin as circumscribed tan brown patches or thin plaques.
Seborrheic Keratosis
Because seborrheic keratoses are benign and slow-growing lesions, treatment is
generally not required. However, lesions that are symptomatic or that cause cosmetic
concerns can be removed.
result from the proliferation of atypical
epidermal keratinocytes.
Actinic keratosis
represent early lesions on a continuum with squamous cell carcinoma (SCC) and
occasionally progress to SCC.
Actinic keratosis
Actinic Keratosis treatment
Dermatology
(a) Topical 5-fluorouracil 5% cream (Efudex)
(b) Imiquimod 5% cream
(c) Electrodessication & curettage
(d) Application of liquid nitrogen (cryotherapy)
the most fatal form of skin cancer
Melanoma
Melanoma
Lesion will be the “Ugly Duckling”, and different than the other nevi.
1) A) Asymmetrical
2) B) Irregular borders
3) C) Color changes
4) D) Diameter > 6mm
5) E) Evolving
Another word for mole
Nevi/Nevus
Phases of Wound Healing
(1) Phase I - Initial Lag phase
(a) Days 0-5: No gain in wound strength
(2) Phase II - Fibroplasia phase
(a) Days 5-14: Rapid increase in wound strength occurs. At week 2, the wound has achieved only 7% of its final strength.
(3) Phase III - Final Maturation phase
(a) Day 14 until healing is complete: Further connective tissue remodeling. Up to 80%
of normal skin strength achieved
Laceration repair timelines
12 hours for all besides face which is 24 hours do not suture animal or human bites and do not suture puncture wounds
