Dermatology Part 2 Flashcards
What is the medical name for the bullseye-type lesion scene in Lyme Disease?
Erythema migrans
Describe the S/S associated with each stage of Lyme disease.
1: erythema migrans, fever, fatigue, malaise, etc.
2: arthritis, myocarditis, bilateral Bell’s palsy
3: chronic arthritis and encephalopathy
What is the most common causative agent of Lyme Disease and what is the treatment?
Cause: Borrelia burgdorferi
Tx: doxycycline, amoxicillin in kids or pregnant
What are the “ABCDE” S/S associated with melanoma?
A: asymmetry B: border irregularity C: color variation D: diameter E: evolution
What is the most important factor in determining the severity of melanoma?
Depth
How is melanoma treated?
Excision –> interferon reduces recurrence
Describe melasma and state in what patients it will be seen.
Dark, well-demarcated, patches on the face. Seen in pregnancy or patients taking OCPs.
What is the treatment for melasma?
Sunscreen and sun avoidance with combo therapy –> tertinoin plus hydroquinone or flucinolone.
In what patients is moluscum contagiosum seen and what is the common presentation?
Seen in school aged children –> multiple waxy, dome-shaped papules with umbilicated appearance (small central pit) that spare the palms and soles and have no systemic symptoms.
What is the causative agent of moluscum contagiosum and what is the treatment?
Poxivirus –> self-limiting infection
Differentiate the treatment of community acquired MRSA from that of hospital acquired.
Community: PO doxycycline, clindamycin, or Bactrim
Hospital: IV vancomycin
Describe the S/S associated with nummular eczema.
Small, grouped vesicles coalesce to form coin-shaped plaques with erythematous base and well-demarcated borders –> crusting/excoriations common
In what patients and at what time is nummular eczema more commonly seen?
Men > women, seen in young adults and elderly –> more common in winter.
Define onychomycosis and state the treatment.
Under nail fungus –> treatment is PO terbinafine after LFTs are checked.
Define and describe paronychia.
Staph aureus infection of the lateral nail fold.
What is the common term for pediculosis capitis and what are the S/S?
Head lice –> child with pruritis on the head and visible nits (eggs) or lice.
What is the treatment for pediculosis capitis?
Permethrin on day 0 and repeated on day 9
What are the S/S of pilonidal disease?
painful, fluctuant area (abscess) at sacrococygela cleft
What is the treatment of pilonidal disease?
Surgical drainage with abx
Describe the S/S of pityriasis rosea
Large lesions (herald patch) followed one week later by a rash on the back/trunk in a Christmas-tree distribution.
What is the treatment of pityriasis rosea
Self-limiting –> topical corticosteroids or PO antihistamines for symptoms.
Describe the S/S associated with psoriasis.
Rash with silvery scales, Auspitz sign, nail pitting, and Koebner phenomenon on the extensor surfaces.
Define Auspitz Sign and Koebner phenomenon.
Ausptiz: scale removal produces blood droplets
Koebner: plaque formation on site of prior trauma
What is the first line treatment for psoriasis?
Topical corticosteroids
Describe the S/S associated with Rocky Mountain Spotted Fever.
Abrupt onset of severe headache, photophobia, vomiting, diarrhea, and myalgia with a maculopapular rash on the palms and soles.
What is the causative agent and treatment of Rocky Mountain Spotted Fever?
Cause: rickettsia
Treatment: Doxycycline
Describe the S/S of rosacea.
acne-like rash on the forehead, cheeks and nose that gets worse with ingestion of ETOH, hot drinks and spicy foods.
What is the treatment of rosacea?
Topical metronidazole
What are the common S/S associated with scabies?
Small papules, vesicles, and burrows in webbed spaces of fingers and toes with pruritis described as “the worst itching of my life”.
What is the first line treatment for scabies?
Permethrin cream applied to the entire body and washed off after 8 hours.
Describe the S/S associated with seborrheic keratosis.
Lesion, flat or raised, smooth or velvety with a “stuck-on” appearance noted on the face, shoulders, chest, and back
Describe the relationship of seborrheic keratosis to cancer.
Does not lead to cancer but a biopsy is required to rule it out.
Describe the progression of a brown recluse spider bite.
Initial bite is painless –> dark colored, depressed center 1-2 days after bite –> dry eschar and ulceration –> necrosis
What is the treatment for a brown recluse spider bite?
No antivenin available –> wound care, pain control, td vaccine, supportive care, dapsone may be considered.
What is the classic PE finding associated with Steven Johnson syndrome?
Vesicles and bullae involving < 10% of the body surface area but present on mucous membranes
What is the most common cause of Steven Johnson syndrome and what is the treatment?
Cause: medications, usually Bactrim
Tx: refer to burn center, steroids are mainstay
What rash is commonly associated with SLE?
Malar (aka butterfly) rash
What medications are most likely to induce SLE?
HIPPS –> Hydralazine, Isoniazid, Procainamide, Phenytoin, Sulfonamides
Define telogen effluvium and list the most common causes.
Transient, diffuse hair loss caused by child birth, major illness/surgery, stress, medications, malnutrition
Differentiate the treatment of tinea capitis from treatment of tinea in other areas.
Tinea capitis must be treated with systemic antifungal agents because topical agents do not penetrate the hair.
Describe toxic epidermal necrolysis.
Mucocutaneous blistering disorder, most often caused by drug reaction - sulfonamides, aminopenicillins, quinilones, cephalosporins, phenytoin, vlaproic acid, allopurinol, steroids.
Differntiate toxic epidermal necrolysis from Steven Johnson Syndrome.
TEN has a high fever, more epidermal separation and loss than SJS, and cover a larger TBSA ( > 30%)
Describe the S/S associated with varicella zoster.
Painful, papulovesicular rash preceded by tingling or hyperesthesia with a dermatomal rash that does not cross midline.
Describe Hutchinson’s sign as it relates to varicella zoster.
Zoster infection at the tip of the nose that often precedes ophthalmic involvement.
What is the treatment for varicella zoster?
Antivirals –> acyclovir, valacyclovir, and famciclovir
Define verrucae and state the causative organism.
Plantar wart –> HPV
What is the most common treatment for verrucae?
Salicylic acid plasters
Describe the S/S associated with vitiligo.
White, non-scaling, well-demarcated areas of hypopigmentation on the neck, upper back, and chest.
