Dermatology - Sheet1

Question 1

CTCL

Answer 1

Cutaneous T cell lymphoma (CTCL) is a class of non-Hodgkin’s lymphoma, which is a type of cancer of the immune system. Unlike most non-Hodgkin’s lymphomas (which are generally B-cell related), CTCL is caused by a mutation of T cells. The malignant T cells in the body initially migrate to the skin, causing various lesions to appear.

Question 2

Ultraviolet Light Therapy

Answer 2

Narrow band UVB (311nm)
PUVA (Psoralen plus uva light at 320-400nm)

Forms pyrimidine dimers in DNA and reduces langerhans cell and leukocytes.
Actions: Anti-inflammatory
Immunosuppressive

Uses: psoriasis, pruritus, eczema, CTCL….
Tox: burns, carcinogenic, photoaging

Question 3

Alopecia

Answer 3

hair loss

Question 4

Androgenetic Alopecia

Answer 4

“Simple Baldness”, “Hereditary Alopecia”,
“Pattern Alopecia”.
Nonscarring.
Cause: Genetically determined miniaturization of follicles triggered by androgens.
Area: Top of Scalp.
Treatment: Minoxidil, Finasteride, Hair Transplants

Question 5

Telogen Effluvium

Answer 5

“stress hair loss”.
Nonscarring.
Cause: Disrupted growth cycle of hairs causing premature shift from anagen to telogen.
Triggers: Pregnancy, Surgery, High Fever, Extreme diet,…..

Area: Diffuse scalp involvement.
“Coming out in Bunches”

Treatment: Remove the trigger.
Minoxidil?
Time + Reassurance

Question 6

Alopecia Areata

Answer 6

Autoimmune.
-Can associate with other AI disease.

T-cells attack the hair bulb
(“Swarm of Bees”)

HLA determined.
Area: Circular patches on scalp or beard.
-A. Totalis=all scalp hair lost.
-A. Universalis=all body hair lost.
Treatment: Can be difficult.
-Watch and wait.
*Topical or Intra-Lesional steroids.
-Minoxidil.
-Anthralin.
-Protopic/Elidel?

Question 7

Tinea Capitis

Answer 7

Fungus growth on scalp and hair shafts.
African-American kids most common.
Possible Scarring!
Cause: Trichophyton tonsurans mostly, also microsporum canis (blue-green under Wood’s lamp).
‘Kerion’-intense inflammatory reaction due to zoophilic fungi.
Treatment: Griseofulvin is the standard.
microsized 15-25mg/kg/day
ultramicrosized 10-15mg/kg/d
Terbinafine? Itraconazole?

Question 8

Discoid Lupus

Answer 8

Discoid lupus of the scalp results in destruction of hair units.
Often Scarring.
Only 5% have a +ANA test.
Area: Discoid (round) patches with redness, scale, scarring anywhere on scalp or beard.
Treatment: Topical or systemic steroids.
Hydroxychloroquine.

Question 9

Pediculosis

Answer 9

Head Lice (Pediculus humanus capitis).
Pubic Lice (Pthirus pubis)

Treatment: Permethrin (Nix, Elimite)
GBH (Kwell, Lindane)
Vaseline-for eyelids.
Cetaphil cleanser-new
Remove nits.
Hot water and dryer for clothes and bedding.
Unwashables in bag for 2 weeks.

Question 10

Paronychia

Answer 10

Def’n: inflammation of the nail folds.

Can be infectious or noninfectious.

Cause varies but often determines the clinical presentation.

Question 11

Acute Paronychia

Answer 11

Def’n: inflammation of the nail folds.
Acute—
Caused by trauma, bacteria, contact dermatitis, acute eczema flair.

Question 12

Chronic Paronychia

Answer 12

Chronic
Caused by irritant contact dermatitis, eczema, psoriasis, Candida….

Def’n: inflammation of the nail folds.

Question 13

Onychomycosis

Answer 13

Fungal growth on or under the nail.
Common organism: Trichophyton rubrum or T. mentagrophytes.
Culture nail clippings.
Treat: terbinafine (Lamisil)
          itraconazole (Sporonox)