Dermatology - Over Simplified Flashcards
Herpes simplex
cause: Herpes simplex virus 1/2 Presentation: Vesicles -> weeping -> yellow crusting Treatment: Acyclovir Complications: Superinfection with staph, dissemination in primary infection
Varicella zoster
cause:
Herpes simple virus 2/chickenpox in children
Presentation;
Unilateral vesicles along dermatomes, dissemination in immune compromised
Treatment: Acyclovir
Complications: Neuralgia, superinfection
Viral warts
Cause: Human papilloma virus Presentation: Papilomous cauliflower like lesions with moist macerated vascular surface Coalesce to form huge fungatating plaques Treatment: Preventative with HPV vaccine Imiquimod - immune modulator that causes wart regression Complications: Cervical, facial, vaginal, anal cancers
Molluscum contagiosum
Cause: Pox virus Presentation: Umbilicated pappules with dimpled center Treatment: Destructive methods, iodine Complications: Superinfection
Lichen planus
Cause:
T lymphocytes produce cytokines (ICAM-1) in the dermo-epidermal junction causing keratinocytes apoptosis
Drugs (beta blockers, quinine, captopril), hepatitis
Presentation:
Planar (flat-topped), purple, polygonal, pruritic papules and plaques on extremities
Treatment:
Stop drugs or any cause
Topical steroids (clobetasol), retinoids
Antihistamines → for itch
Systemic prednison + UVA/B → 1-3 months
Dermatopyte infection
Cause:
Trichophyton, microsporum, epidermophyton
Presentation:
Foot- soggy interdigital plaques, diffuse dry scaling on soles, reoccurring vessication Nails- yellow, crumbly nails, spereation of nail from bed, thickening of nail,
Groin- sharp, well demarcated plaques with peripheral scaling
Trunk/limbs- plaques with scaling and erythema
Scalp inflammation, bald spots with scaling
Treatment:
Clotrimazole, fluconazole, intraconazole, griseofusin
Complications:
Permanent scaring alopecia
Onychomycosis
Thickening of nail that leads to nail bed separation seen in fungal nail infections such as tineapedis
Candida
Cause:
Candida albicans
Presentation:
Oral thrush usually in immune compromised, nail bed infection
Treatment:
Topical or systemic imidazoles, fluconazole, amphotericin
Pityriasis versicolor
Cause:
Commensal yeast (pityrosporium orbiculare)
Presentation:
Flaky discoloured patches on chest and back
Treatment:
Imidazoles, fluconazole
Erysipelas
Cause:
Streptococcus pyogenous infection of dermis/hypodermis
Presentation:
Flu like symptoms, well defined advancing edges of redness, blistering of skin
Treatment:
Penicillins, anti staph penicillins
Complications: Sepsis
Staph skin infection
Cause: Staphylococcus aureus
Impetigo- bulbous with well demarcated borders
Furcolosis- infection of hair follicles, red tender nodules with puss Carbuncle- swollen, painful, pussing hair follicles
Scaled skin syndrome/toxic shock syndrome
Treatment:
Penicillin to vancomycin to 4th gen cefalosporins
Scabies
Cause: Mites
Presentation:
Itch, fissure on skin with eggs
Treatment: Permethrin
Atopic dermatitis
Cause: IgE response to certain stimuli Presentation: Itch, leathery dry skin that started with vesicles and weeping, on flexor surfaces Treatment: Emollients, topical steroids
Contact eczema
Cause:
Delayed type 4 hypersensitivity due to contact with known stimulus, ie. Poison ivy
Presentation:
Erythema, vesicles, weeping at the sight of contact with allergen
Treatment:
Stay away from allergen
Topical corticosteroids fo temporary relief
Seborrhoeic eczema
Cause:
Body overreaction to yeast that lives on skin, stress, cold dry weather, immune system response
Presentation:
Dry scales around nose, scalp, or trunk. Dandruff
Treatment:
Shampoo with ketoconazole, hydrocortisone, topical corticosteroids/calcineurin inhibitors tacrolimus
Angioedema
Cause:
Diffuse swelling due to edema in subcutaneous tissue
Presentation:
Abrupt and short-lived swelling of the skin and mucous membranes. All parts of the body may be affected but swelling most often occurs around the eyes and lips
Treatment:
antihistamines, oral corticosteroids (prednisone), immunosuppressants (ciclosporin)
Types of urticaria
Cause: Mast cell degranulation due to interaction with potential stimuli Presentation: red itchy Wheel lasting less than 24h Types: Physical (cold, solar, heat, cholinergic, dermatographism, delayed pressure) Hypersensitivity Autoimmune Parmalogical Contact Treatment: Antihistamines,
Stevens Johnson syndrome and Toxic epidermal necrolysis
Difference:
1-10% of body covered is SJS, >30% is TEN
Cause:
Drugs (sulfonemides, antiepileptics, allopurinol)
Presentation:
Prodromal period with fever/ malaise
Painful macular exanthem (skin is red, painful, detaches in sheets) Nikolski sign positive
Treatment:
Identify and stop cause
Symptomatic management (topical steroids, emollients)
Erythema Nodosum
Cause:
Inflammation of subcutaneous fat due to a type 4 hypersensitivity in response to an infection
Presentation::
Tender red nodules on the legs and forearms
Treatment:
Identify and eliminate cause Symptomatic treatment, NSAIDs, potassium iodide
Leucocytoclastic vasculitis
Cause:
Damage to small vessels due to lodged immune complexes
Presentation:
Painful palpable purapura pappules with centers of necrosis
Treatment:
Identify and remove cause
Antihistamines
Colchine/ dapsone
Systemic steroids if there is other organ involvement
Polyarteritis nodosa
Cause:
Certain drugs, B cell lymphoma, immunotherapy, hep B/C cause necrotizing vasculitis of medium sized vessels
Presentation:
Tender subcutaneous nodules along lines of arteries
Ulceration or stealth patches of necrosis or purpura on nodules
treatment:
Systemic steroids/cyclophosphamide
Low dose systemic steroids if purely cutaneous
Wegeners granulomatosis
Cause: Unknown cause of vasculitis Presentation: Symmetrical ulcers or papules on extremities Antineutrophil antibodies (C-ANCA w/ anti-PR3) Treatment: Cyclophosphamide w/ systemic steroids
Erythema multiforme
Cause: Infection (HSV) or drugs Presentation: Annular non scaling plaques on acral sites Lesions may overlap to cause target lesions (iris looking) Treatment: Find and remove cause Symptomatic treatment with antihistamines, topical steroids if mucous membranes involved Systemic steroids in severe cases
Pityriasis rosea
Cause:
Reactivation of HSV 7 or HSV 8
Presentation:
Herald plaque on lower back Round red/pink scaly plaques
Treatment: Self limiting, symptomatic treatment, Most cases resolve within days to weeks.
Pityriasis rubra
Cause:
Epidermal hyperproliferation
Presentation:
Erythema and scaling on face and scalp spreading to limbs and trunk Red/orange plaques join
Perifolicular papules and follicular plugs
Treatment:
Emollients, keratolytics, systemic retinoids, TNF alpha inhibitors
Pemphigoid
Cause:
Autoimmune with IgG to hemidesmosomes bp180 and bp230
Presentation:
Itchy blistering disease
Smooth itchy red plaques that evolve into tense vesicles or bullae
Treatment:
Mild can be controlled with potent topical steroids Predisone
Azathioprine, methotrexate, dapsone if not responding
Pemphigus
Cause:
IgG to antigens within the epidermis ie. Desmoglandin 1/3
Presentation:
Flaccid blisters that easily rupture leaving erosions
Treatment:
Predisone
Azathioprine, cyclophosphamide, mycophenylate mofetil
Dermatitis herpetiformis
Cause:
Granular deposits of IgA and C3 in the tips of dermal papillae and in basement membrane Closely associated with celiac disease
Presentation:
Very itchy grouped vesicles on elbows, knees, buttocks, and shoulders
Treatment:
Gluten free diet Dapsone or sulfapyridine
Linear acquired IgA bulbous disease
Cause:
IgA deposits in basement membrane Autoantibodies directed towards bp180
Presentation:
Blisters on urticarial plaques on extensor surfaces String of pearls in some affected children
Treatment: Dapsone
Acquired epidermolysis bullosa
Cause:
Autoantibodies to type 7 collagen in the dermis
Presentation:
Blisters in response to trauma on normal skin Milia on healing skin
Epidermolysis bullosa
Cause:
Genetic mutations
Presentation:
Blisters on skin after minimal trauma but each type on a different layer of skin
Types - layer- mutation:
Simplex- intraepidermal- keratin 5/14
Junctional- lamina lucida- hemidesmasome anchoring filament Dystrophic- below lamina densa- type 7 collagen
Acquired- dermal side of lamina densa
Treatment:
Avoidance of skin trauma Symptomatic treatment
Acrosclerodermia - Limited scleroderma
Cause:
Autoimmune condition
Presentation:
Usually only on extremities and face
Raynaud’s phenomenon -> immobile, hard, shiny fingers -> abnormal calcium deposits over pressure points -> telangiectasia on fingers and flat mat like on face
Treatment: Symptomatic Immunosuppressants Physical therapy
Systemic sclerosis - systemic scleroderma
Cause: Autoimmune Anti DNA topo -1 antibodies Presentation: Raynaud’s phenomenon concurrent with skin changes and sclerodactyly sclerosis on face, scalp, trunk Beak like nose Wrinkles around the mouth Loss of hair follicles Treatment: Symptomatic Immunosuppressants Physical therapy
Lichen sclerosus
Cause: Autoimmune Antibodies to extracellular matrix 1 Presentation: Non indurated white shiny macules with plugging in follicles Ivory colored lesions around vulva and anus in women Adhesions between foreskin and glandus of penis in men Treatment: Topical corticosteroids
Mixed connective tissue disease
Cause: Overlap of SLE and scleroderma or dermatomyositis Presentation: Swollen hands and sclerodactyly Alopecia Treatment: Treatment based on what organs involved
Dermatomyositis
Cause: Autoimmune Presentation: Discoloration around eyes Malar erythema and edema Lilac scaly papules over knuckles (Gottrons papules) Weakness of muscles Treatment: Systemic steroids Immunosuppressants
Pyoderma gangreosum
Cause:
IBD - Inflammatory bowel disease
Conditions that cause polyarthritis Hematological malignancies
Presentation:
Inflamed nodule or pustule break to form central growing ulcer Bluish edge
May have pustular or bulbar lesions
Treatment:
Systemic or topical steroids Cyclosporine
Anti TNF- alpha agents
Acne Vulgaris
Cause:
(1) follicular epidermal hyperproliferation with subsequent plugging of the follicle
(2) excess sebum production
(3) the presence and activity of Propionibacterium acnes)
(4) inflammation
Presentation:
Blockage and/or inflammation of hair follicles and sebaceous gland
Noninflammatory
Open or closed comedones and by inflammatory papules, pustules, and nodules
Treatment:
Erythromycin, topical dapsone
Retinoidlike agents - adapalene
Antibiotics doxycycline
Estrogen/progestin combination oral contraceptive pills
Acne rosacea
Cause:
Genetic, Blood vessels damage by sunlight, Bacteria (H. pylori)
Presentation:
Redness on your cheeks, nose, chin, and forehead
Blood vessels might show through your skin, which can thicken and swell up
Treatment:
Mirvaso - Tighten blood vessels
Azelaic acid
Metronidazole (Flagyl) and doxycycline - Antibacterial
Ivermectin
Sunburn
Cause:
Sun stimulates release of pro inflammatory cytokines and enzymes -> increase in nitric oxide -> dermal vasodilation and redness
Presentation:
Skin turns red and hurts. Severe burn, you can develop swelling and sunburn blisters
Treatment:
Menthol gell, NSAIDs (ibuprofen), Hydration, vitamin D
Melasma (chloasma)
Cause:
Hormonal changes - “mask of pregnancy”, oral contraception - usually hispanic women
Presentation:
Hyperpigmented plaques on the face
Treatment: hydroquinone topically, sunscreen
Porphyria cutanea tarda
Cause:
Genetic predisposition. Appears in alcoholics (men), estrogen treatment (women), hep C, iron overload
Presentation:
Blisters, erosions one sun-exposed areas (face, hands Leads to scars, hair loss
Treatment:
Avoidance of cause (alcohol, estrogen, iron)
Ichthyosis vulgaris
Cause:
Mutation in filaggrin gene —> defective desquamation
Presentation:
Dry, scaly skin, especially on the extensor surfaces and trunk.
Associated with atopic dermatitis
Treatment: Emollients, Take baths in salt water, Remove dead skin with a product that contains salicylic acid
Keratosis pilaris
Cause:
Genetic predisposition
Presentation:
Follicular plugs with perifolicular erythema on extremities
Treatment:
Keratolytics (salycilic acid, uric acid), emollients
Acanthosis nigricans
Cause:
Epidermal hyperplasia
Associated with insulin resistance/visceral malignancies (gastric cancer)
Presentation:
Velvety, hyperpigmented plaques on the axilla and posterior neck
No treatment: Management
Weight management (reduce insulin), stop birth control pills
Keratoderma of palms and soles
Cause:
Metabolic diseases, potentially cancers (esophageal). Symptoms of other derm diseases (pytiriasis rubra pilaris, lichen planus)
Presentation:
Thickening of the skin of palms and soles
Types:
Punctuate, diffuse, striate
Treatment: Emollients, keratolytic agents, topical retinoids, topical vitamin D, oral retinoids
Darier’s disease (keratosis follicularis)
Cause:
Genetic - high concentration of calcium in the Endoplasmic reticulum
Presentation:
Small pink/brown papules on trunk and behind ears, wart-like lesions on the backs of the hands, pits on palms and soles, nail dystrophy
Treatment:
Laser excision, topical keratolytics, prevention of infections
Hailey-Hailey disease
Cause: Genetic - suprabasal acantholysis Presentation: Flaccid vesicles, erosions that form plaques at the sites of skin friction Treatment: Topical steroids, antibiotics
