Dermatology Overview Flashcards
1
Q
seborrheic dermatitis
A
- Chronic, relapsing dermatitis of areas with high sebum production (Scalp, face, upper trunk, intertriginous areas)
- May be role of Malassezia yeast in producing lesions
- Scattered greasy, scaly macules/papules, may be thick sticky crusts if left untreated (Greasy is a good descriptor for subderm)
- Common in babies as cradle cap, dandruff in adults
- Scalp erythema, scaling
- Erythema, scaling of face and nasolabial folds
- Sometimes its mistaken for tinea or fungal infections
- If pts wash regularly, this will go away and can be controlled
2
Q
tx of seborrheic dermatitis
A
- Treatment includes topical steroids, antifungals, emollients, regular washing (especially sulfur based will decrease the amount of yeast on the skin); treat acute sx until resolves (roughly five days), then weekly for maintenance with antifungals (more helpful on scalp, less helpful on skin); UV light
- Scalp: antifungal shampoos, aquaphor is helpful (this is an emollient)
- Face: topical steroids (low potency) acutely then antifungal cream weekly
- Body: topical steroids (mid potency) or topical antifungal or combo
3
Q
contact dermatitis
A
- Acute, subacute or chronic inflammation of epidermis and dermis caused by external agents, toxicity or allergic reaction and characterized by pruritis or burning feeling
- All ages
- Race: dark skin is less susceptible
- History is key to diagnosis
4
Q
contact dermatitis lesions
A
-Acute: irregular well-demarcated patches of erythema and edema may have vesicles with serum or crusting
-Subacute: patches of mild erythema showing small, dry scales; may have small, firm red papules
-Chronic: patches of lichenification with small firm, rounded or flat-topped papules, excoriations, pigment changes
Think poison ivy or poison oak
5
Q
contact dermatitis treatment
A
- Treatment: identify causative agent (Topical steroid creams - May need to use mid or even high potency steroid (unless face and in that case start low potency), Use systemic if the problem is in eyes, mouth, genitals)
- Acute CD from sunblock cream
6
Q
acute contact dermatitis
A
- Irritant dermatitis to wrist watch; common in nickel allergy (Nickel allergy is VERY COMMON –> another place that is common for this contact dermatitis is right below the belly button because the button on the jeans is made of nickel )
- Contact Dermatitis (Irritant was Benzoyl Peroxide)
7
Q
chronic contact dermatitis
A
- Chronic Allergic Contact Dermatitis (fYou get thickened plaques because you have chronic irritiation and you scratch it, so it looks like tree bark
- Chronic Irritant Contact Dermatitis
8
Q
lichen planus
A
- Acute or chronic inflammatory dermatitis
- Occurs in adults 30-60 yo, females>males, not common (<1%)
- May affect skin, oral cavity, genitalia, scalp, nails or esophagus
- Etiology unknown; drug induced eruptions may occur
- Biopsy and immunofluorescence confirm diagnosis
- Respond to steroids –> need high potency
9
Q
lichen planus appearance
A
- Flat top, shiny, violaceous papules with white lines (Wickham’s striae) in wrist flexor, lumbar, eyelid, shin, scalp
- May cause scarring alopecia, destruction of nail beds with longitudinal splintering
- Described by 4 P’s: purple, polygonal, pruritic, papule
10
Q
lichen planus tx
A
- Cutaneous lesions usually spontaneously resolve 1-2 yrs; other lesions tend to be chronic, painful
- Topical steroids (high potency) with occlusive dressings
- Intralesional steroids or topical tretinoin for severe lesions
- Systemic therapy with steroids, retinoids, or cyclosporine in severe, painful cases
- PUVA for generalized eruptions
- Psoralen plus ultraviolet A (PUVA) photochemotherapy combines the administration of psoralens, a class of phototoxic plant-derived compounds, with an exposure to ultraviolet A radiation (UVA). PUVA is used for the treatment of a variety of skin diseases, including psoriasis, mycosis fungoides, eczema, vitiligo, and graft-versus-host disease.
11
Q
urticaria
A
- Group of disorders with many causes (Food/drug allergies, heat, cold, stress, infxn; No cause found up to 80% cases)
- 15-20% population
- Hives or wheals on skin or mucosa caused by histamines and other vasoactive chem causing small blood vessels to leak resulting in intradermal edema
- Acute, chronic or physical
- Acute: self limiting lasting minutes to hours, often IgE mediated allergic rxn
- Chronic: lasting >6 wks, typically lesions wax and wane; cause often idiopathic, females more than males, assoc with stress
- Physical: reaction to heat, cold, sun, water, exercise; dermatographism can be bothersome
12
Q
treatment of urticaria
A
- Antihistamines for acute and chronic, before exposure for physical (H1 blockers, H2 blockers)
- Recurrent or severe may require steroids
- Epipen if concern for anaphylaxis
- H1 blockers: diphenhydramine (Benadryl), hydroxyzine (Atarax/Vistaril), cetirizine (Zyrtec)
- H2 blockers: famotidine (Pepcid), ranitidine (Zantac) – may be added to H1 blocker regimen
13
Q
vitiligo
A
- Autoimmune destruction of melanocytes causing macules of hypopigmentation
- 1% of population worldwide; 30% pts have fam hx; every age, race, gender equally
- May be focal, segmental, or generalized pattern; Wood’s lamp exam highlights area
- Treatment involves repigmentation therapies: steroids, PUVA, others
- Causes may be idiopathic or due to thyroid dz, pernicious anemia, DM, Addison’s dz, lupus (other autoimmune d/o)
14
Q
Vitiligo tx
A
-Tacrolimus and pimecrolimus are topical immunomodulatory agents that affect the T-cell and mast-cell function and inhibit the synthesis and release of multiple proinflammatory cytokines, including interferon-gamma, tumor necrosis factor-alpha, interleukin (IL)-4, IL-5, and IL-10. In contrast with topical corticosteroids, topical calcineurin inhibitors do not induce skin atrophy, striae, or telangiectasias and are increasingly used for the treatment of facial vitiligo.
15
Q
lipoma
A
- Adipose tumors, benign neoplasms of mature fat cells
- Superficial, subcutaneous, soft, asx
- Biopsy indicated if sx, rapidly growing, hard/firm
- Excision may be done
