Dermatology Module 1A Flashcards
Alopecia is considered what type of disease?
Autoimmune disease
What is alopecia areata?
Patchy alopecia
What is alopecia totalis?
Face alopecia (hair loss)
What is alopecia universalis?
Hair loss over the entire body
What is the most common cause of permanent hair loss?
Androgenic alopecia (AGA) or male-pattern baldness
Androgenic alopecia has a polygenic inheritance pattern which means what?
Can be inherited from both parents
What are 2 important factors a clinician should consider in evaluation of alopecia?
Whether it’s scarring or non-scarring alopecia
And
Whether hair loss is in a small, well-circumscribed area (alopecia areata or trichotillomania) or generalized AGA
Scarring alopecia (cicatricial alopecia) causes what type of hair loss ?
Permanent hair loss and is not reversible
Non-scarring alopecia (noncicatricial alopecia) can be what?
Either temporary or permanent
Drugs that can cause hair loss include what classes? List some
Hormones
Anticonvulsants
Anticoagulants
Oral contraceptives
beta blockers
Antimetabolites
Antithyroid drugs
Excessive amount of vitamin A or topical Retin-A
What two things are helpful in the diagnosis of tinea capitis (ringworm)?
Potassium hydroxide and wood’s
light examination
What is trichotillomania?
Compulsive hair pulling
Telogen effluvium is caused by what?
Excessive shedding of scalp hair that results from an increase number of hair follicles entering the resting stage – can be caused by fever and certain drugs.
Can be caused by stress, pregnancy, and or childbirth, extreme weight loss, and general anesthesia
Alopecia areata is associated with what autoimmune endocrinopathies?
Hashimoto’s thyroid is, Addison disease, and pernicious anemia
Causes of scarring (cicatricial) alopecia can include what?
Trauma, which is physical or chemical, severe bacterial or fungal infections of the scalp, scleroderma, discoid lupus erythematosus, lichen planopilaris, and excessive radiation
A biopsy says useful in diagnosing, scarring alopecia, the specimens must be obtained from where?
Specimens must be obtained from the active border, rather than from the scarred central zone
Hair shedding is seen rapidly in a matter of days after stopping what medication?
Minoxidil (Rogaine)
Hair shedding is some more gradual over several months with what medication?
Finasteride ( Propecia )
What are the treatment options for extensive hair loss? ( greater than 50%)
Oral corticosteroids, topical, immuno, therapy, and immunomodulators
Finasteride is used in what type of population?
It is only approved for men only by the FDA
Why shouldn’t finasteride be used in women of reproductive age?
It can cause abnormalities of the external genitalia of male fetuses
What is the mechanism of action of finasteride?
Blocks effects of five alpha reductase and reduces the total amount of testosterone in the body
Finasteride is metabolized by what?
The liver
Minoxidil is for what population?
For men and women, and is available over the counter
What are the adverse effects of minoxidil?
Irritation, itching, trainers, scaling, and redness to the scalp. Can cause contact dermatitis
The larger the size of the Melanosomes has what effect of the skin color
The darker, the skin color
How is vitiligo described?
It is the total loss of skin, color and patchy areas of the body, recognize clinically as white vacuoles or patches that are usually located on the sun exposed areas
What is the theory for vitiligo being an autoimmune disorder?
The body produces antibodies against its own melanocytes.
Vitiligo occurs more often to individuals with autoimmune diseases, such as hyperthyroidism, adrenal insufficiency, alopecia, areata, and pernicious anemia
What are some lab tests you would do for vitiligo?
CBC, peripheral smear, thyroid function, studies, anti-nuclear antibodies, test, and an eye examination to rule out uveitis
What are some current treatments for vitiligo?
Topical corticosteroids, light therapy, UVA therapy, UVB, light, depigmentation with top of creams and surgical approach is including skin grafts
What is chloasma?
It is referred as a mask of pregnancy, it is a hyper pigmentation condition that is caused by increase levels of estrogen, progesterone, and melanocyte, stimulating hormone during pregnancy.
?
What are common areas affected in pts with chloasma?
Areas include the face, jaw line, nipples, genitals, and the linea Negra extending from the umbilicus to the pubis
Diagnosis of cold asthma, and the extent of epidermal/dermal involvement is determined by what?
Performing a wood’s lamp examination to visualize excess melanin in the epidermidis
Treatment of chloasma includes what?
Includes retinoic acid, hydroquinone, cream, tretinoin, and corticosteroids with Hydroquinone, azelaic acid or Kojic acid creams, glycolic acid peels, micro, dermabrasion, galvanic, or ultrasound facials, and various laser and intense pulsed light photo rejuvenation treatment
What is important to know about hydroquinone and treating chloasma/melasma?
It is not recommended for women who are pregnant or planning to become pregnant. Patient should be referred to obstetrician for management.
What should be done to rule out allergy to any bleaching agent?
A 24 hour skin touch test should be done to rule out any allergy to any bleaching agent
How often should a bleaching agent to be applied to treat melasma?
The cream can be applied twice a day for two months
What is the first line treatment for melasma?
Prescription, bleaching cream, such as hydroquinison and strict sun avoidance
What are some drugs that can cause diffuse hyper pigmentation?
Zidovudine, cyclophosphamide.
Skin discoloration has been reported in patients who have been taking amiodarone, chlorpromazine, and certain antimalarial drugs
What are laboratory findings of Addison’s disease?
Elevated is there an potassium and calcium, lo, serum, sodium, anemia, and elevated ACTH level
A variegated color or very dark color on one solitary nail should arouse suspicion for what?
Acral Melanoma
What does the mnemonic ABC DE stand for in regards to detecting skin cancer?
A is asymmetry
B is border irregularity
C is color variegation
D is diameter (greater than 6mm)
E is elevation or evolving
If Nighttime Pruritus is a symptom, the clinician should have high suspicion of what?
Scabies
If a pruritic rash does not respond to symptomatic treatment, a work up for systemic disease is in order, what labs?
CBC with differential, ESR, fasting, blood sugar, liver and renal function, test, thyroid, panel, and viral hepatitis panel
What is xerosis?
Dry skin
What’s important to know about the classic rash of mammary Paget’s disease?
Has a rash that looks like eczematous dermatitis of the nipple and areola.
Early in it’s disease, the pt can be asymptomatic except for a rash.
Usually on the nipple or areola, oval shaped with red scaling plaque and sharp margins
Patients with a mammary Paget’s disease should be referred to whom?
A breast specialist
If a rash on the nipple or areola region last longer than 2 weeks and does not resolve with topical steroids, refer to breast specialist
Toxic shock syndrome is an acute Illness caused by what?
Toxin producing S.aureus
What are symptoms of toxic shock syndrome?
Sudden onset of fever, vomiting, tingling sensation of hands and feet, myalgia, headache, diarrhea, weakness
What immunoglobulin is urticaria associated with?
IgE
Topical corticosteroids should not be applied to rashes that are suspected to be or what etiology?
Viral
Because it can make it worse
What meds should be avoided in pts who have urticaria?
Aspirin, ace inhibitors, and NSAIDs
The classic prescription antihistamine used for pruritus and urticaria is what?
Hydroxyzine 50 mg to reduce risk to day time drowsiness/sedation
Human scabies is caused by the itch mite ?
Sarcoptes scabiei var. hominis
What is the earliest physical sign of scabies?
1 to 2 mm red papilla located in areas of the body that are most attractive to mites
Where are the highest yield of mites located?
On the finger webs, penis or wrists
What diagnostic test should be done to test for scabies?
The burrow ink test
Explain the burrow ink test
The burrow ink test is performed by rubbing a blue/green marker/felt tip over the suspected burrow and wiping off with alcohol then use a drop of mineral oil and use 15 scalpel blade. The scrapings should be placed in a slide with a drop of oil then sealed to examine under microscope
Management of scabies includes what?
The patient, his/her close contacts and surrounding environment
What is the first line treatment for scabies?
Permethrin to treat scabies
Antihistamines and topical steroids for pruritus
Lindane has what effect on pts for scabies and not commonly used because?
It’s the most toxic, can cause seizures, irritability. Not good for pregnancy
When is follow up for uncomplicated scabies?
1 week after initial treatment
May need to repeat scabicide treatment
Pthirus pubis is called what kind of louse?
Pubis louse
Infects pubis primarily
Pediculus human capitis is called what louse?
The head louse
Affects scalp
Pediculus human corporis is what louse?
The body or clothing louse
Children ages 3 to 12 are affected most commonly by what louse?
The head louse
Which lice are associated with disease transmission?
Body lice
What is the earliest sign of lice infestation?
Small 2-3mm, red erytbematous macules or papilla that may be pruritic
children with Pediculosis pubis in their eyelashes or hair should alert the clinician of what ?
Possible sexual abuse
Eyelash infestation can be treated by what?
Applying petroleum jelly to the eyelid margins twice daily for 10 days
What is the first line treatment for pediculosis?
use permethrin 1% lotion or 5% cream (Nix)
Moniliasis is also known as what?
Candidiasis
A higher incidence of thrashes seen among which two types of patients?
AIDS patients and infants
In women with aids one of the earliest and most frequent opportunistic infections is what?
Vaginal candidiasis
Patients with oral candidiasis or thrush will complain of what?
Hey severe sore throat, painter, difficulty is noted during swallowing, especially with acidic foods
Patients with vaginal candidiasis or complaining of what typically?
Burning, itching, and irritation, either and/or the vagina. Burning may be noted during intercourse or urination.
Patients with vaginal candidiasis, has what kind of discharge?
Vaginal discharge is reported as white in color, with a cottage cheese, or thick texture appearance
What is balanitis?
It is the yeast infection of the glans penis
What is the typical complaint in men who have balanitis?
Sexually active adult male who complains of reddish rash and itching of the glans penis.
Sometimes has burning after intercourse but none with urination.
Some will report having sex with a female partner who is being treated for a yeast infection
What is intertriginous candidiasis?
It is a red itchy rash that occasionally “weeps” and is moist, sometimes accompanied by burning.
What are some locations for intertriginous candidiasis?
The groin, the perianal area, and traditional spaces are both hands and feet, the inframammary area
Usually in obese adults
What is candidal paronychia?
Fungal infection of fingertip
What is the classic description of candidal paronychia?
Extremely painful fingertip that is red, hot, and swollen. History of frequent water immersion of the hand.
What is subungal candida?
One of several discolored Yellow fingernails for several weeks to months
No pain or itching is associated
Excessive contact with dish water, bartending.
What is the cardinal symptom of candidiasis?
Pruritus and sometimes burning
What is a cardinal sign of cutaneous candidiasis infection ?
Bright red rash with macules or satellite lesions see on borders
What are the objective signs of balanitis?
Glans penis has small red and eroded patches that are tender to touch
Can also be small white round lesions with a red base on the glans
What does intertriginous candidiasis look like?
Found in areas of skin maceration (skin rubbing against skin) or increased heat and moisture can become easily colonized
Think axilla, groin, perianal, interdigital areas
For vaginal candidiasis infections the whiff test would be what? Pos or neg?
Negative
What tests are helpful in the diagnosis of vaginal candidiasis?
A saline wet mount, pH paper, potassium hydroxide test
What’s important to know about KOH test?
A positive exam establishes the diagnosis, a negative test is not rule out the disease
Topical antifungal creams are applied how often?
Think nystatin, miconazole, and clotrimazole
Twice per day for at least two weeks, can be up to four weeks
What is the first line treatment for mild oral candidiasis?
Clotrimazole 10 mg five times a day or miconazole 50 mg buccal tablet once a day for 7-14 days
What is the treatment for candidial paronychia?
Warm compress on the effective fingertip, will enhance drainage of purulent discharge and help relieve the pain
Subungual candidida is best treated how?
Best treated with systemic antifungal
Dermatophytoses is also referred to as what?
Tinea
What is dermatophytoses or tinea?
Superficial skin functions, cause predominately by three fungal species :
Epidermophyton, trichophyton, and microsporum
What are the modes of transmission for dermatophytoses?
Direct contact, contact with asymptomatic carriers
Tinea capitis is ringworm of what?
The scalp
Tinea corporis Is ringworm of what?
Ringworm of the body
Tinea circinata is also called what?
Tinea corporis/ ringworm of body
Tinea cruris is ringworm of what?
Of the groin know as “jock itch”
Tinea pedia is known as what?
Athlete’s foot
Tinea manuum us know as what?
Tinea of the hands
Tinea Versicolor is know as what?
Pityriasis versicolor
Tinea unguium is also called what?
Onychomycosis
what is the most outer layer of the skin called?
Epidermis
What is the middle layer of skin called?
Dermis
what is the inner most layer of skin called?
hypodermis
what layer of skin constantly sheds and new skins are produced every 30 days?
epidermis
what layer of skin has collagen, sebaceous gland, hair follicles, and blood vessel?
dermis
what skin condition is this?
Is this fungal, bacterial or viral?
Impetigo
Caused by bacteria
Describe impetigo
honey crusted appearance, has thin vesicles
How is impetigo spread?
It is spread through contact from hands, towels, and clothing
what is the treatment for impetigo?
Name ointment treatment and oral antibiotic treatment
Bactroban (Mupirocin) ointment TID for 7 days
oral antibiotics use for 7-10 days: dicloxacillin, Bactrim, cephalexin, clindamycin
If there is a recurrence of infection of impetigo, what should be evaluated?
Do a MRSA C&S swab of their nares to see if they are a carrier
what is the causative agent of impetigo?
staphylococcus aureus
what skin condition is this?
is this caused by fungal, bacteria, or viral?
Folliculitis
Caused by bacteria
what is the treatment for SUPERFICIAL folliculitis?
antibacterial soap scrub, topical mupirocin, and warm compresses three times daily
what are the 2 causative agents for folliculitis?
Staph aureus and pseudomonas (associated with hot tubs)
what is the treatment for pseudomonas caused folliculitis?
oral abx
Fluoroquinolone (cipro, Levaquin) or aminoglycoside (gentamicin, tobramycin)
what skin condition is this?
what is this caused by?
Furuncle (boil)
typically caused by staph
Describe a furuncle (Boil)
Similar to folliculitis but it extends to the dermis and subcutaneous outer layer
what is the treatment for simple lesion and severe infections?
simple: warm compresses
severe: drainage and abx
what skin condition is this ?
what does this initially start out as?
Carbuncle
Usually starts out as a furuncle (Boil)
what skin condition is this?
Cellulitis
what skin condition is this?
Erysipelas
what is the difference between cellulitis and erysipelas?
Cellulitis occurs deeper in the dermis and hypodermis.
Erysipelas occurs in the epidermis and superficial lymphatic area
what is the common pathogen species for a cat and dog bite?
Pasteurella species
what is the common pathogen for associated with a cat scratch?
bartonella pathogen most common
what is the 1st line treatment for a cat/dog bite?
Augmentin (amoxicillin-clavunlate)
other abx: levofloxacin and doxycycline
what is the treatment for a cat scratch?
azithromycin or clarithromycin
what skin condition is this?
Tinea pedis, athlete’s foot
Describe athlete’s foot
pruritic lesions, scaly with raised borders, can become fissured
What is the confirmation method for athlete’s foot?
KOH examination of foot scrapings
What is important to know about topical steroid creams and fungus?
Topical steroid creams are inappropriate for fungal infections as it can make the infection worse and contribute to treatment failure
what skin condition is this?
Name the dermatologic name
Tinea cruris
jock itch
what skin condition is this?
Tinea versicolor
Describe tinea versicolor
A fungal infection that has multiple patchy lesions with fine scales. Typically occurs on the back, neck, chest, and shoulders.
what is the treatment of tinea versicolor?
Ketoconazole 400 mg x 1 dose
Fluconazole and itraconazole
what skin condition is this?
Name the proper dermatologic term
Tinea corporis
Ringworm
what is the treatment for tinea corporis?
topical antifungal creams/ointment
Miconazole, ketoconazole
what is the dermatologic name for this?
Onychomycosis
what is the treatment for onychomycosis if less than half the toe is involved?
Penlac nail lacquer
what is the treatment for onychomycosis if whole nail is involved?
oral antifungal
Itraconazole, dose is longer for feet at 12 weeks, finger nail is at 6 weeks
If there is recurrent fungal infections whom should you refer to for onychomycosis?
Dermatologist or podiatrist
what is the dermatologic name for this?
Herpes simplex type 1
what is the dermatologic name for this?
Herpes simplex type 2
what is the dermatologic name for this ?
Herpes zoster (shingles)
what is considered chronic herpes viral infection? what is the recommendation?
More than 4 episodes a year
The recommendation is to take antiviral therapy daily
what is the Hutchinson’s sign?
Lesion on the tip of the nose, a sign of shingles. Refer to ophthalmology
Herpes zoster Opthalmicus what should you do?
refer to ophthalmology
what meds are used for post-herpetic neuralgia?
Lyrica, Neurontin, and Lidoderm patches
what pain meds can be given for herpes zoster?
antiviral: acyclovir, famiciclovir, valacyclovir
nerve pain: NSAIDS, gabapentin
The Zostavax vaccine is to be given at what age? how many doses?
age 55 to 60
one time dose
The Shingrix vaccine should be given at what age? how many doses?
age 50 and older
2 doses, 2nd dose to be given between 2 and 6 months after 1st dose
What is the window of time to give antiviral medication for shingles?
72 hours of onset
What is the dermatologic name for this skin condition?
Verruca
(warts)
What is the treatment for verruca?
cryotherapy with liquid nitrogen or salicylic acid
For the treatment of acne, how long should doxycycline/minocycline be prescribed for?
up to 6 months
what dermatologic skin condition is this?
Rosacea
what are the 4 treatments for rosacea? based on severity
Brimonidine 0.33% gel pea size daily
Metronidazole cream
Minocycline or doxycycline 50 to 100mg BID
Laser treatment, accutane
what is the treatment for seborrheic dermatitis?
OTC selenium sulfide shampoo or 2% ketoconazole shampoo (leave on for 5-20 minutes before rinsing)
Describe allergic contact dermatitis
popular pruritic rash resulting from allergen
what dermatologic condition is this ?
Urticaria (hives)
Describe urticaria
raised wheals, erythema, transient, migratory pruritic
what dermatologic condition is this
eczema
what is the treatment for eczema?
creams to hydrate, topical steroids for pruritis
what dermatologic skin condition is this
psoriasis
Describe psoriasis
thick silvery scales
common on elbows, knees, feet
what are the treatment modalities for psoriasis? list 3
UV light, high potency topical corticosteroid, methotrexate
Guttate psoriasis happens in what population?
children and adolescent
what dermatologic skin condition is this ?
Actinic keratosis
Describe actinic keratosis
pinkish white papules with thick yellow scaling
what is the treatment for a few lesion of actinic keratosis?
cryotherapy with liquid nitrogen
what is the treatment for multiple lesion of actinic keratosis?
efudex cream (fluorouracil) BID
Aldara twice weekly, wash off after 8 hours
what dermatologic skin condition is this ?
basal cell carcinoma
Describe basal cell carcinoma
waxy with central depression and pearly rolled borders; bleeds with mild trauma
what is the diagnosis for basal cell carcinoma?
shave or punch biopsy
what is the treatment for basal cell carcinoma if surgery is not indicated?
Efudex and Aldara cream
what dermatologic skin condition is this ?
squamous cell carcinoma
Describe squamous cell carcinoma
lesions are raised, firm, pink to flesh colored keratotic papules, may bleed easily
what dermatologic skin condition is this?
malignant melanoma
what dermatologic skin condition is this?
seborrheic keratosis
what is the measurement for UVA?
Protection factor (PFA)
what is the measurement for UVB?
Sun protective factor (SPF)
which causes more damage UVA or UVB?
UVA causes up to 80% of skin damage
what is the treatment for burns? and how often?
Silvadene, apply twice daily
Name five primary lesions are less than 1 cm
Macule, popular, vesicle, pustule, nodule
Describe a Macule
Flat and less than 1cm
Describe a papule
Raised and less than 1 cm
Describe a vesicle
Fluid filled, and less than 1 cm
Describe a pustule
Purulent fluid and less than 1 cm
Describe Nodule
Raised solid , and less than 1 cm
Describe a patch
Flat and greater than 1 cm
Describe a plaque
Raised and greater than 1 cm
Describe a tumor
Solid and greater than 1 cm
Describe a bulla
Fluid filled, and greater than 1 cm
Describe an abscess
Purulent discharge, and greater than 1 cm
Describe a fissure
Linear breaks in the skin often down to the dermis
Atrophy in the epidermal area, results in what?
Wasting away of the epidermidis, causing wrinkling increase underlying vascular prominence
What effect does atrophy I have on the dermal layer of skin?
Result in loss of fat or subcutaneous fat tissue
Blanching is a sign of what?
Vasodilation
What does xerosis mean?
Dry
what is the topical treatment options for impetigo in children?
list 2
Bactroban (mupirocin) ointment TID x7 days
or
Altabax ointment BID x 5 days
what is the oral antibiotic treatment options for impetigo in children?
Dicloxacillin
cephalexin
Clindamycin
x7 days
what two antibiotics are used for MRSA infections in kids?
Clindamycin and bactrim
what is the treatment of rehydration atopic dermatitis?
antihistamines, topical steroid creams, elidel or protopic cream BID
what is the treatment of hand-foot mouth disease?
supportive therapy
oral ulcers–use orajel or anbesol
what virus causes the hand-foot-mouth disease?
coxsackievirus A16
what is erythema infectiosum called and what is the virus causing it?
Fifth’s disease
Parvovirus B19
what rash has a Christmas tree like pattern on the back?
what rash has a Christmas tree like pattern on the back?
Pityriasis rosea
what is the treatment for pityriasis rosea?
calamine lotion, topical steroids, oral antihistamines
what is the therapy options for molluscum contagiosum?
Cryotherapy and laser ablation
what is the treatment for herpes simplex type 1?
abreva otc 5 x daily
what is the treatment for pediculosis?
OTC pyrethrin (RID) and permethrin (NIX) usually 2 treatments 7-10 days apart
what is the treatment for scabies?
permethrin (Elimite) cream applied from neck to feet, wash off after 8-14 hours, repeat in 10 days if needed
what is the treatment for keratosis pilaris?
emollients and mild exfoliation
how is 5th disease spread?
respiratory droplets
