DERMATOLOGY PANRE Flashcards
Acne vulgaris (Level 2) what is it?
Obstruction of pilosebaceous units (i.e. hair follicles & sebaceous glands), with/without
inflammation → formation of:
○ Comedones (whiteheads or blackheads) → non-inflammatory acne( blackheads incomplete blockage and complete bloakage-white heads )
○ Papules, pustules, nodules and/or cysts → inflammatory acne
Acne vulgaris (Level 2) presentation?
Lesions typically develop on face & upper trunk, most often in adolescents
Comedones can become inflamed from Propionibacterium
○ Comedonal (mild)
○ Papulopustular (moderate)
○ Nodulocystic (severe)
Acne vulgaris (Level 2) Dx?
Clinical
Acne vulgaris (Level 2) tx?
Comedones: Topical retinoid (e.g. tretinoin)
○ Mild inflammatory acne: Topical retinoid alone, or with topical antibiotics (e.g.
erythromycin, clindamycin), benzoyl peroxide, or both
○ Moderate acne: Oral antibiotics (e.g. tetracycline ) + topical tx as for mild acne
○ Severe acne: Oral isotretinoin (teratogenic)
■ When taking isotretinoin, patients, providers & pharmacists must be
registered with iPledge (pregnancy testing, oral contraceptive pills for
women, etc)
○ Cystic acne: Intralesional triamcinolone
○ Mild/moderate acne usually heals without scarring by mid-20s
○ Patients should avoid triggers (e.g. cosmetics)
○ Severe acne can result in physical & psychological scarring → appropriate
referral is indicated
Actinic keratosis (Level 2) -what is it?
Precancerous changes in skin cells due to many years of sun exposure; most often seen in
fair-skinned individuals
Actinic keratosis (Level 2) CM?
White, pink or red, poorly marginated, scaly or crusty macules,
papules or plaques of varying thickness
Actinic keratosis (Level 2) Dx?
Clinical; biopsy for definitive dx
Actinic keratosis (Level 2) Tx?
Minimizing UV light exposure (e.g. protective clothing, sunscreen)
○ Dermatologic consultation/referral (cryotherapy or curettage with
electrocautery, topical 5-fluorouracil [5-FU])
AKA: Hives, wheals → migratory, well-circumscribed, red, itchy or burning plaques on the
skin that occur due to mast cell & basophil release of histamine & other vasoactive
substances; acute lesions have a duration <6 wks
What is Acute urticaria
Acute urticaria (Level 2) two types?
Immune-mediated: IgE activated mast cell degranulation
○ Allergic reaction: Food (e.g. shellfish, peanuts), drugs (e.g. penicillin)
● Non-immune-mediated: non-allergic activation of mast cells
○ Non-allergic drug effect, emotional or physical stimuli (stress; heat or cold
exposure)
Acute urticaria (Level 2) Dx ? TX?
Dx: Clinical
● Tx:
○ Try to identify the offending agent
○ Antihistamines (e.g. cetirizine, diphenhydramine) → First-line tx
○ Epinephrine for angioedema of airway structures
What is Drug eruptions (Level 2)
Drug eruptions typically occur in any patient who is taking medication & suddenly
develops a symmetric, cutaneous eruption
● Can mimic a wide range of dermatoses including morbilliform, urticarial, papulosquamous,
pustular & bullous lesions
What typically cause Drug eruptions (Level 2)?
Common culprits: Antibiotics, anti-epileptics, NSAIDs
Drug eruptions (Level 2) dx? Treatment?
Dx: Clinical; biopsy, immunoserology, skin patch testing
● Tx: Stop offending agent, symptomatic treatment; most are self-limited
Do drug eruptions occur in the sam or different spot?
Fixed drug eruptions typically occur in the same location each time
What is Atopic dermatitis (Level 2)? What is it associated with ?
Atopic dermatitis (AKA: eczema) is a chronic inflammatory disorder of the skin characterized by intense itching & various skin lesions ○ Associated with IgE (i.e. asthma & allergies
At what age does Atopic dermatitis (Level 2) presents?
Usually starts early in life & is a chronic, relapsing condition
Common triggers of Atopic dermatitis (Level 2)
ollen, dust, sweat, harsh soaps, rough fabrics, fragrances
Atopic dermatitis (Level 2) CM? (Acute and chronic)
Acute: Red, edematous, scaly patches or plaques that may be weepy; ± vesicles
○ Chronic: Dry, lichenified lesions due to chronic scratching
○ Usually occurs over flexor creases in older children & adults
Atopic dermatitis (Level 2) dx? Tx?
Dx: Clinical
● Tx:
○ Mainstay: Topical corticosteroids
○ Antihistamines for pruritus
○ Supportive skin care: non-soap cleansers, moisturizers
○ Avoidance of precipitating factors, if identified
What is Basal cell carcinoma (Level 1)
Superficial, slow-growing carcinoma derived from basal keratinocytes
● Commonly occurring in fair-skinned people with a history of sun exposure
What is the most common skin CA?
Basal cell carcinoma
Basal cell carcinoma (Level 1) CM
Most common clinical manifestations: Small, shiny, firm, pink nodule with a pearly border; telangiectasias that usually occur on the face; recurrent ulceration; crusting of the
lesion are also common.
Slow growing
● “Classic” description → Central crater with rolled border (“Rodent ulcer”)
Basal cell carcinoma (Level 1) dx ? Treatment
Dx: Clinical & biopsy
● Tx: Surgery, topical chemotherapy (e.g. imiquimod, 5-FU)
Burns (Level 2)
Injury to skin or other tissues caused by thermal exposure (e.g. heat or cold), electricity,
chemicals, or radiation
First degree burn
painful red skin (e.g. sunburn)
First degree burn
Epidermis only painful red skin (e.g. sunburn)
3rd degree burn
Epidermis & dermis (full thickness burn) →often ↓ or no pain, dry, waxy or
leathery appearance, loss of hair follicles & glands
4th degree
Burn extending to deep tissues (fat, muscles, tendons, bone)
Burns dx?
Dx: Clinical; appropriate tests for associated conditions (e.g. endoscopy for inhalation
injury)
Burns Tx?
ABCs
○ IV fluids (e.g. lactated Ringers) for burns >10% BSA (guided by Parkland formula)
○ Wound cleaning, dressing & serial assessment
○ Surgery for deep partial thickness & full thickness burns
○ Supportive measures, pain control
○ Management at burn center for select patients, PT, OT
Burns Tx?
ABCs (airway breathing circulation)
○ IV fluids (e.g. lactated Ringers) for burns >10% BSA (guided by Parkland formula)
○ Wound cleaning, dressing & serial assessment
○ Surgery for deep partial thickness & full thickness burns
○ Supportive measures, pain control
○ Management at burn center for select patients, PT, OT
Electrical burns tx?
Skin findings may not correlate with underlying tissue damage;
measure creatine kinase & check for myoglobinuria for evidence of muscle damage (Skin appears normal but underneath skin is a big mess)
What are the complications for burns?
Hypovolemia & infection
Most common organisms of Cellulitis (Level 3)?
Group A beta, Staphylococcus aureus (methicillin-resistant S. aureus [MRSA] → common
What are organisms are typical of Cellulitis (Level 3)
Pasteurella, Pseudomonas aeruginosa, Vibrio vulnificus, Group B streptococci
What organism for Cellulitis (Level 3) is common in neonates?
Group B streptococci (e.g. S. agalactiae
Cellulitis (Level 3)-Haemophilus influenzae is found in what type pts ?
Children
Cellulitis (Level 3)-Pseudomonas aeruginosa is found in what type pts ?
with DM or neutropenia, hot tub/spa users,
hospitalized patients
Cellulitis (Level 3)-Vibrio vulnificus is found in what type pts ?
Marine environments
Cellulitis (Level 3)-Pasteurella multocida is found in what type pts ?
Cat/dog bites
Cellulitis (Level 3)-Eikenella corrodens
Human bites
Cellulitis (Level 3) CM of skin? Other CM?
Involved skin is red & hot with indistinct borders, tender, edematous & induratedn (NOT FLUCTUANT): Fever, chills, tachycardia, headache; May have lymphangitis, lymphadenopathy, petechiae, vesicles & bullae
Cellulitis (Level 3) dx? imaging?
Clinical; lab tests → Leukocytosis; cobblestoning on ultrasound
Cellulitis (Level 3) Tx?
Tx: Antibiotics targeted at suspected organism
○ Strep/staph → dicloxacillin, cephalexin
○ Penicillin allergic pts → clindamycin; azithromycin
○ MRSA → trimethoprim/sulfamethoxazole, clindamycin, doxycycline
Cellulitis (Level 3) Complications?
Abscess formation, necrotizing subcutaneous infection, bacteremia with
sepsis
Erysipelas (Level 3)-What is it?
Superficial bacterial skin infection that involves dermal lymphatics
Erysipelas (Level 3) Risk factors?
Risk factors: Infants, children, elderly, lymphatic obstruction, lymphedema, immune
deficiency states
Erysipelas (Level 3) cm?
Clinical manifestations: Fever, chills, malaise; involved skin has red, shiny, raised,
indurated, tender plaques with sharp, demarcated borders; classically on face or legs
Erysipelas (Level 3) dx? MC organism?
Clinical; Group A beta-hemolytic streptococci
Erysipelas (Level 3) cm?
Clinical manifestations: Fever, chills, malaise; involved skin has red, shiny, raised,
indurated, tender plaques with sharp, demarcated borders; classically on face or legs; Pruritic, edematous, painful, DEMARCATED BORDERS
Contact dermatitis (Level 2)? TYPES?
Acute inflammation of the skin caused by irritant or allergens
● Irritants (immune system not activated): Chemicals, soaps, plants
● Allergic response: Type IV cell-mediated hypersensitivity reaction (e.g. poison ivy)
○ Id reaction: Activated T cells migrate to different location & cause dermatitis at site
remote from initial trigger
Contact dermatitis (Level 2)-most common in pts with ?
atopic disorders
Contact dermatitis (Level 2) cm?
Pain (irritants), pruritus (allergens), involved skin can range from
erythema to blistering & ulceration
○ Rash may take the shape of the object (e.g. watch)
Contact dermatitis (Level 2) -(dx)
Clinical; possibly patch testing
Most comedones (acne) become inflamed from?
Propionibacterium
Contact dermatitis tx?
Mainstay: Topical or oral corticosteroids
○ Avoid offending agents
○ Supportive care (e.g. Burow solution compresses, antihistamines)
Erythema multiforme (Level 1)
Inflammatory reaction to an infectious agent or drug
Etiology:
○ Herpes simplex virus → most common
○ Drugs, vaccines
Erythema multiforme (Level 1) CM ?
Sudden onset of asymptomatic, symmetric erythematous
macules, papules, wheals, vesicles, bullae, or a combination of lesions
○ Usually starts on distal extremities (including palms & soles), then moves centrally
Erythema multiforme (Level 1) Classic findings?
Target lesions, oral lesions (intraoral vesicles, erosions)
What is the most common etiology Erythema multiforme (Level 1) ?
Herpes simplex virus → most common
Erythema multiforme (Level 1) dx and tx?
Dx: Clinical
● Tx: treat underlying cause; supportive tx
What is Herpes simplex virus (Level 2)?
Herpes simplex virus infections commonly cause recurrent infections affecting the skin,
mouth, lips, eyes & genitals
Etiology of Herpes simplex virus (Level 2)?
Etiology: ○ Herpes simplex virus type 1: Usually causes gingivostomatitis, herpes labialis & herpes keratitis (saliva transmission) ○ Herpes simplex virus type 2: Usually causes genital lesions (sexual contact
How is Herpes simplex virus (Level 2) reactivation stimulated by?
Sunlight, fever, physical/emotional stress,
immunosuppression
CM of Herpes simplex virus (Level 2)
Mucocutaneous lesions are usually clusters of small, painful
vesicles on an erythematous base
How is Herpes simplex virus (Level 2) dx?
Clinical; confirmation testing – Tzanck smear, culture, PCR, direct
immunofluorescence or serology
Treatment care of Herpes simplex virus (Level 2)
If treatment is begun early for primary or recurrent lesions, mainstay: antivirals
(e.g. acyclovir)
What is Dermatophyte infections (Level 2)
Fungal infections of keratin in the skin, hair and nails
○ Tinea ____ → pedis (foot), cruris (groin), corporis (trunk, limbs), unguium (nails) &
versicolor (AKA: pityriasis versicolor)
Transmission of Dermatophyte infections (Level 2)
Usually person-to-person or animal-to-person
Most common organisms of Dermatophyte infections (Level 2)
Trichophyton
○ Microsporum
○ Epidermophyton
○ MALASSEZIA FURFUR (tinea versicolor
Clinical of characteristics Dermatophyte infections (Level 2)
Varies by location, host susceptibility & hypersensitivity
○ Usually very little inflammation; ASYMPTOMATIC → MILD ITCHING
○ Lesions are usually erythematous, SCALY ANNULAR PATCHES with a distinct border &
CENTRAL CLEARING
How is Dermatophyte infections (Level 2) diagnose?
Dx: Clinical, KOH wet mount, culture of plucked hairs
Tx of Dermatophyte infections (Level 2)
Topical antifungals (e.g. terbinafine, clotrimazole) ■ Topical steroids should be avoided because they promote fungal growth ○ Oral antifungals for nail & scalp infections
Hidradenitis suppurativa (Level 2)
CHRONIC inflammatory condition of hair follicles & associated structures → rupture of
follicles, development of abscesses, sinus tracts & scarring
Hidradenitis suppurativa (Level 2) CM:
Swollen, tender nodules usually develop in axillae or groin
○ 2° bacterial infection can occur
○ Inflamed nodules can coalesce into PALPABLE CORDLIKE FIBROTIC bands
Hidradenitis suppurativa (Level 2) Dx: TX?
Dx: Clinical; Topical antibiotics (clindamycin), intralesional corticosteroids & oral antibiotics
(e.g. tetracycline)
○ Surgery
What is What is Impetigo (Level 2)? What are the RF? What are the organisms?
Superficial skin infection commonly occurring in infants & children
● Risk factors: Moist environment, poor hygiene
● Organisms: Staph aureus (most common); also Strep pyogenes, or both
Impetigo (Level 2) CM, what are the 2 types of presentations?
Nonbullous: Erythematous macule becomes clusters of vesicles or pustules that
rupture & develop a HONEY-COLORED CRUSTY EXUDATE over the lesions
○ Bullous: Similar, but VESICLES ENLARGE RAPIDLY to form bullae which then rupture &
expose a larger base covered by a similar crusty exudate
○ PRURITUS IS COMMON → scratching which can spread the infection to other sites
Impetigo (Level 2) Dx and TX?
Dx: Clinical
● Tx:
○ Mainstay: Topical mupirocin; ORAL ANTIBIOTICS for more SEVERE cases
○ Wash crusty areas with mild soap & water
Wha tis Lipomas (Level 2)
Common benign tumor made of ADIPOSE TISSUE
Cm of Lipomas
SOLITARY, SOFT, MOVABLE SUBCUTANEOUS (right below surface) nodules, commonly
occurring on proximal limbs, trunk, or neck
○ Multiple lipomas = familial, or associated with various syndromes
Lipomas Dx and TX?
Dx: Clinical
● Tx: surgical excision only if painful
What are Epidermal inclusion cysts
Most common benign cutaneous cyst
What are the MC benign cutaneous cyst?
Epidermal inclusion cysts