Dermatology - Turnham Zoom Flashcards
1
Q
ABCDE of skin moles/cancer
A
A - Asymmetry B - Borders (outer edges uneven) C - Color (dark black/multiple colors) D - Diameter (> 6mm) E - Evolving (change in size, shape, color)
2
Q
Benign Mole
A
- < 6 mm
- Macule/Papule
- Well-defined border
- Homogenous Color (brown or pink)
3
Q
Atypical Nevi
A
- > 6 mm
- ill-defined border
- Irregular Pigmentation
4
Q
Blue Nevi
A
- Asian ethnicity
- “Old & Unchanged” = Benign
- “New or Changed” = Eval IMMEDIATELY
5
Q
Freckles
A
- Hereditary
- Increase with sun exposure
- Fade without sun exposure
6
Q
Lentigines
A
- AKA Sun Spots
- Tx with topical agents/laser/cryotherapy
7
Q
Seborrheic Keratosis
A
- Benign
- Beige/Brown
- 3-20 mm in size
- Velvety or thick/scaly papules/plaques
- “Stuck-on” Appearance
- Tx: Cryotherapy if irritated
8
Q
Malignant Melanoma
A
- Flat/Raised
- Red, White, Blue, Black
- Pigmented lesion w/recent change in appearance, suspect malignancy
- Tumor thickness = Prognostic factor
- Bleeding and ulceration are ominous signs
- Larger # of moles, higher risk of Melanoma
9
Q
Malignant Melanoma
Tumor Thickness Survival Rate %
A
- < 1 mm = 95%
- 1-2 mm = 80%
- 2-4 mm = 55%
- > 4 mm = 30%
- Lymph node involvement: 62% @ 5 years, but if distant metastasis = 16%
- Moh’s surgical excision, CLOSE F/U
10
Q
Atopic Dermatitis
Characteristics
A
- Involves face, neck, upper trunk, wrists, hands, antecubital/popliteal folds
- Recurrent
- Onset usually in childhood, rare when > 30 yo
- Fam Hx of asthma, allergic rhinitis, or atopic dermatitis (Triangle of A)
11
Q
Atopic Dermatitis
Diagnosis
A
- Must have pruritis
- Typically morphology and distribution (flexural lichenification (thickening), hand eczema, nipple eczema, eyelid eczema in adults)
- Itching is key clinical feature
- Scaly red plaques (no thickening like with Psoriasis)
- If long-term with weeping, consider staph infection
- INFRA-AURICULAR FISSURE is a caridnal sign of secondary infection
12
Q
Atopic Dermatitis
Prevention
A
- Avoid triggers or anything that irritates the skin
- Limit baths when possible
- Pat skin dry, no rubbing with towel
- Use emollient creams/lotions
- Cotton fabrics or synthetic wool may exacerbate s/s
13
Q
Seborrheic Dermatitis
Characteristics
A
- Less pruritic
- More scalp/central face involvement
- Greasy, scaly lesions that respond quickly to tx
- Often co-exist with Psoriasis, but not always
14
Q
Seborrheic Dermatitis
Treatment
A
- Zinc Pyrithione or Selenium shampoos used daily
- Ketoconazole shampoo (1% or 2%) used 2x weekly
- Tar shampoo may be effective on scalp
- Low potency corticosteroid creams (1-2.5%) can be used, BUT NOT ON FACE
- If eyelids are involved (blepharitis) consider washing eyelids w/J&J baby shampoo daily
15
Q
Psoriasis
Characteristics
A
- Silvery scales on bright red well-demarcated plaque
- Most common on knees, elbows, scalp
- Pitting and Onycholysis (painless detachment of nail from nail bed)
- May have associated joint pain (psoriatic arthritis)
- These pts have higher risk for CV events, metabolic syndrome, and lymphoma
- Limited disease if < 10% body surface area affected
16
Q
Psoriasis
Treatment
A
- High-ultra potent topical steroids 2-3x week MAX
- Numerous small plaques would respond best to photo therapy
17
Q
Psoriasis
Complications - Koebner Phenomenon
A
- Injury or irritation of normal skin results in plaque forming
18
Q
Psoriasis
Complications - Flare/Exacerbation
A
- Can be due to beta blocker, antimalarial medication, statins, or lithium
19
Q
Psoriasis
Complications - Auspitz sign
A
- Appearance of small bleeding pt after layers of scale are removed (pinpoint bleeding)
20
Q
Pityriasis Rosea
Characteristics
A
- Oval, fawn colored, scaly eruption that follows cleavage lines of the trunk “christmas tree pattern”
- Up to 2cm diameter, crinkled/cigarette paper appearance, tiny scale on edged w/central clearing
- Herald Patch (erythematous, 2 to 10 centimeter, round to oval scaly patch or plaque with a depressed center and raised border) occurs 1-2 wk prior to lesions
- Occasional pruritus
- 50% more common in females than males
- Usually clears in 6-8 wks
- If plantar, palmar, or mucous membrane lesions present screen for secondary syphillis
- Treat symptoms only, UV therapy if necessary
21
Q
Mycotic Infections of the Skin
A
- Superficial
- Tinea corporis/Tinea cruris
- Dermatophytosis of the feet/hands
- Tinea Unguium (Onychomycosis - Nail fungus causing thickened, brittle, crumbly, or ragged nails)
- Tinea Versicolor
- Confirmed by KOH prep, culture, biopsy
- Corn starch can exacerbate s/s
22
Q
Tinea Corporis (Ringworm) Characteristics
A
- Ring shaped lesion
- Scaly border
- Central clearing
- ANYWHERE on body
23
Q
Tinea Corporis (Ringworm) Treatment
A
- Topical antifungal (OTC 7-14 days after clearing)
- Griseofulvin 350-500mg BID x4-6 weeks
- NO CORTISONE
24
Q
Tinea Cruris (Jock Itch) Characteristics
A
- SIGNIFICANT ITCHING intertriginous areas + peripherally spreading, sharply demarcated, centrally clearing, erythematous lesion
- Candidiasis bright red + satellite papules outside main border
25
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Tinea Cruris (Jock Itch)
Treatment
```
- Miconazole (drying powder)
26
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Tinea Pedis (Athlete's Foot)
Characteristics
```
- Asymptomatic scaling
- Fissures or maceration between toes
- Moccasin distribution
- Itching, burning, stinging
27
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Tinea Pedis (Athlete's Foot)
Treatment
```
- Miconazole (drying powder)
| - Severe cases: Griseofulvin, Itraconazole, Terbinafine
28
Tinea Versicolor
| Characteristics
- VELVETY TAN or pink macules that DON'T TAN
- Located on central upper trunk
- High recurrence due to yeast
29
Tinea Versicolor
| Treatment
- Selenium Sulfide lotion: use on neck to waist daily then wash off after 5-15 mins
- Use daily x7 days, then weekly x1 month, then 1x monthly
- Ketoconazole shampoo: leave on for 5 mins then rinse
- Ketoconazole PO: daily
- SWEAT! No shower for 8-12 hrs
- Fluconazole 300mg x1 dose then repeat in 14 days
30
Lupus
| Characteristics
- Localized violaceous (violet color) red plaques usually on face/scalp
- Atrophy dyspigmentation & telangiectasia (small, widened blood vessels on the skin)
- Photosensitivity (use > 50 SPF)
- Butterfly (Malar) rash
31
Lupus
| Triggers
- HCTZ
- CCB
- H2 blockers
- PPI
- ACE-I
- Terbinafine
32
Lupus
| Treatment
- High-potency corticosteroid cream EVERY PM with occlusive dressing (saran wrap)
33
Actinic Keratosis
| Characteristics
- Small (0.2-0.6mm), flesh colored
- Pink macule/papule
- Feels rough like sandpaper
- TENDER WHEN FINGER BRUSHES OVER
- CONSIDERED PRE-MALIGNANT
- May progress to SCC
- Sun exposed areas on fair skinned pt
34
Actinic Keratosis
| Treatment
- Cryotherapy
| - May require more than 1 tx
35
Pagets Disease
- Scaling, red plaque on breast that resembles eczema
| - Intraductal mammary carcinoma
36
Bowen Disease
- Abnormal growth of cells in epidermis (SCC in situ)
- 0.5-3 cm slightly raised pink-red plaque
- Rare to develop into SCC (3-5%)
Tx: Excision
37
Herpes Simplex
| HSV 1 vs HSV 2
- HSV 1 = oral lesions
- > 85% of adults will test +
- Can be provoked by sun exp, surgery, stress, fever, infections
- HSV 2 = genital herpes
38
Herpes Simplex
| Characteristics
- Cluster of vesicles on erythematous base
| - Usually near mouth (HSV1): stinging, burning before...then crusts over and heals x 1 week
39
Herpes Simplex
| Treatment
- Acyclovir 400mg PO 5x/day x 7-10 days
- Recurrent: Valtrex 500mg PO BID x3 days (initiate within 12-24 hours of first sign)
- Genital: Valtrex 500mg PO BID x7-10 days
- Suppressive tx: Valtrex 500mg QD x 1 year (up to 5-7 years) and wear condoms
40
Herpes Zoster
(Shingles)
Characteristics
- Follows a dermatome, pain along that nerve
- Cluster/group of lesions
- Unilateral - very unusual to have bilateral
- Face or trunk
- Immunosuppressed = more common
- Pain precedes eruption by 48 hrs or more, and may persist after lesions clear (Post-herpetic Neuralgia)
- Different from poison ivy/oak - those are pruritic, herpes is PAINFUL
- HSV 1/2 does not usually follow dermatome
- Refer to ophthalmology if lesions on the face
41
Herpes Zoster
| Treatment
- Zostavax approved for > 50yo, but recommended > 60yo
- Effective in preventing zoster even if hx of zoster/PHN present
- Shingrix Vaccine
- 2 doses: 1 now and repeat in 2-6 months
42
Pompholyx Vesiculobullous
| Hand Eczema, aka Dyshidrosis
- Pruritic "tapioca" vesicles on palms, soles, and sides of fingers
- Increase w/stress or allergy (nickel)
43
Pompholyx Vesiculobullous
(Hand Eczema, aka Dyshidrosis)
Treatment
- Topical Corticosteroids
| - Avoid irritants and use emollient after washing hands
44
Impetigo
| Characteristics
- Macules, vesicles, bullae, pustules, and HONEY COLORED CRUSTS
- Contagious - staph or strep
- Face and other "exposed" body parts
- Soaks/scrubbing can be helpful
45
Impetigo
| Treatment
- Topical agents
- Bacitracin
- Mupirocin (Bactroban)
- Systemic abx for widespread infection
- Keflex, Doxy
- Bactrim for possible MRSA
46
Contact Dermatitis
| Characteristics
- Contact w/allergen or chemical (soap, detergent, solvent, metal, antimicrobial, adhesive, latex, etc.)
- Poison Ivy/Oak - Linear pattern
- Tiny vesicles w/weepy to crusted lesions
- Erythematous macules, papules, and vesicles
- Look for patches where something may have rubbed against skin
47
Contact Dermatitis
| Treatment
- Prompt and thorough washing of affected area with liquid dishwashing soap to remove oils (must be w/in 30 mins to decrease effects of irritant)
- Barrier creams (Stokogard, Hydropel) - applied prior to exposure
- Symptomatic tx w/monitoring for subsequent cellilitis
- Treat itching w/Calamine, Benadryl, Vistaril
- Zanfel (10 year half-life)
48
Primary Irritant CD
(Diaper Dermatitis)
Characteristics
- Caused by prolonged contact of skin with urine/feces
- Beefy red
- Sharply demarcated w/satellite lesions
49
Primary Irritant CD
(Diaper Dermatitis)
Treatment
- Zinc Oxide
| - > 3 days = Nystatin
50
Acne Vulgaris
| Characteristics
- From premenstrual to menopause (possible)
| - Comedones are hallmark although papular, pustular, cysts, or nodules may be present
51
Acne Vulgaris
| Treatment
- Educate pt that tx can take 6-8 wks to make difference
- Avoid topical oils found in cosmetics & hair products
- Retin A
- Benzoyl Peroxide 2.5%, may be combined w/abx for topical application (Benzaclin, Bezamycin)
- Papular/Cystic acne: if no response to 1st line, then consider oral abx such as Doxy or Minocycline
52
Severe Acne
- Accutane
- Only for those who don't respond to conv therapy
- NEVER IN PREGNANCY - 2 serum neg pregnancy tests before tx, another neg test before each month prescription renewed
- Only allowed to give one month at a time
- 2 forms of effective birth control must be used, abstinence can be 1 of them
- Informed consent form must be signed
53
Rosacea
| Characteristics
- Common chronic disorder, affects the face
- Erythema and telangiectasia (small red/purple clusters) w/tendency to flush easily
- Hyperplasia of soft tissue of nose (rhinophyma)
- Triggered by heat, hot/spicy foods, sunlight, exercise, alcohol, emotions, or hormones
- Burning/stinging may accompany flushes
54
Rosacea
| Treatment
- Broad spectrum sunscreen
- Metronidazole gel 0.75% BID or 1% QD
- Clindamycin gel
- Oral meds if topicals are ineffective
- Avoid harsh chemicals, find good moisturizer and gentle cleanser
- Laser therapy if necessary to treat veins in the face
55
Folliculitis
| Characteristics
- Itching/burning in hair follicles
- Typically staph infections, may be more frequent in DM pt
- Pseudofolliculitis - beard area (ingrown hair from shaving)
- Hot tub folliculitis appears 1-4 days after being in hot tub/swimming pool from pseudomonas
- Tender, pruritic pustular lesions
- Fatigue/malaise, low grade fever
56
Mucocutaneous Candidiasis
(Thrush)
Characteristics
- Itching
- Beefy red areas with or without satellite vesicopustules
- White curd-like concretions on mucosa
- Keep dry and open to air as much as possible
57
Mucocutaneous Candidiasis
(Thrush)
Treatment
- Diflucan (Fluconazole) 150mg PO X1 for perineal infections
- Skin - Nystatin ointment or powder BID for at least 7 days
- Balanitis - topical Nystatin
- Mastitis - Nystatin or Clotrimazole cream
- Oral - Nystatin swish and swallow or Diflucan
58
Urticaria
(Hives)
Characteristics
- Eruptions of wheals or hives
| - Intense itching
59
Urticaria
(Hives)
Treatment
- Avoid alcohol, ASA, NSAIDs
- Anti-histamine and consider adding H2 receptor agonist (Cimetidine), both BID X 7-14 days
- Consider using Singular as well
60
Angioedema
| Characteristics
- Non-pitting subcutaneous edema
- Well demarcated
- May be associated w/anaphylaxis if on face, hands, buttocks, genitalia, abdomen, laryngeal
- Triggers: ACE-I, NSAIDs, ASA
- ACE-I angioedema is NOT an allergic reaction, but is an accumulation of bradykinin and doesn't respond to typical angioedema tx
- ACE-I induces angioedema in AA 2-4X more often
61
Erythema Multi-Forme (EMF)
| Stevens Johnson Syndrome
- Abrupt onset symmetrical erythematous skin lesions
- Macular, papular, urticarial, bullous, or purpuric
- "Target" lesions with central clearing, concentric erythematous rings (iris) lesions - RARE in drug associated erythema multiforme
- Erythema Multiforme major is more likely found on trunk, Minor more likely on hands, palms, soles, mucous membranes
- HSV is most common form of EMF
- Meds are most common form of EMF
- Sulfonamides, NSAIDs, Allopurinol, Anti-convulsants
62
Erythema Multi-Forme (EMF)
Stevens Johnson Syndrome
Treatment
- Stop offending drug
- If > 30% of BSA is affected, consider burn unit/hospitalization
- Monitor hydration and nutrition
63
Erythema Migrans
- Early stage of Lyme disease
- Flat or slightly raised red lesion that expands with central clearing
- "Bulls Eye"
- Appears 3-30 days after tick bite
- Accompanied by HA, stiff neck, joint pain, malaise, fatigue
64
Cellulitis
| Characteristics
- Diffuse spreading erythema of localized tissue w/accompanying edema, warmth, and tenderness
- Frequently in LE, may have pain, chills, and fever
- Typically from group A beta-hemolytic strep and staph aureus.
65
Cellulitis
| Treatment
- Oral antibiotics may be sufficient...
HOWEVER
- IV abx may be necessary
- Be aware of possible MRSA risks including previous infections, personal hx of MRSA, or exposure to MRSA
66
Warts
| Characteristics
- Plantar and genital are common, caused by HPVs
| - Plantar warts will have tenderness when pressure is applied, anogenital warts itchy
67
Warts
| Prevention and Treatment
- Prevention:
- HPV vaccine between age 9-22 in both male/female
- Girls may have Gardasil up to age 27, boys to age 22
- If male having sex with male (MSM) or immunocompromised, they may have vaccine up to age 27
- SE of vaccine are fever, pain, site reaction, fainting - Pt should be monitored for 15 mins post vaccine
- Tx:
- Cryotherapy
- Keratolytic agents (40% salicyclic and occlusion)
- Podophyllum resin for genital warts
68
Molloscum Contagiosum
| Characteristics
- Single or multiple dome shaped, waxy papules, 2-5mm with umbilication
- Initially firm, solid, flesh colored but change to soft, white, pearly gray and may have suppuration
- Spread by wet skin to skin contact
- Approx 13 months for remission
Tx:
- Cryotherapy
- Curretage
- Light electrocautery
- Should spontaneously resolve w/o treatment
69
Mongolian Spot
- Blue black macule found over lumbrosacral area in 90% of NA, AA, Asian descent infants
- May be found over shoulder and back, may extend over buttocks
- Lesions often fade as skin darkens
70
Cafe au Lait Macule
- Light brown oval macule (dark brown on brown/black skin)
- May be found anywhere on body
- Remains throughout lifetime, may develop more as pt ages
- Presence of 6 or more over 1.5cm is major dx tool for neurofibromatosis type 1 (NF-1)
71
NF-1 may develop:
- Intracranial low-grade gliomas and hamartomas
- Learning disabilities
- Speech abnormalities
- Seizure disorder
- Macrocephaly
- Cerebrovascular disease (Moyamoya Disease, rare)
- HTN associated w/renal artery stenosis
- Pheocromocytoma
- Malignancies: Leukemia, Wilms' Tumor
- CNS Tumors: meningiomas, astrocytomas
72
Hemangiomas
- Red rubbery vascular plaque or nodule w/characteristic growth pattern
- Max regression occurs by 9 yo
- Immediate tx required for visual/airway obstruction or cardiac decompensation
Tx:
- Propranolol PO tx of choice
- Pulsed dye laser therapy is an option as well
73
Basal Cell Carcinoma
- Most common form of skin cancer
- Sun exposed skin, more often in fair skinned pt
- Papule or nodule that may have central scab or erosion
- Slow growing, only 1-2 cm diameter after years of growth
- Waxy, "pearly" appearance with vessels visible
- Mostly on back/chest
74
Basal Cell Carcinoma
| Treatment
- Punch or shave biopsy to confirm dx
- Moh's surgical excision has highest cure rate
- BCC has high recurrence rate and pts should be evaluated annually
75
Squamous Cell Carcinoma
- Mostly on sun exposed areas of skin in fair skinned pt who sunburn easily and/or tan poorly
- Small red, conical, hard nodule that occasionally ulcerate
- Excision is tx of choice
- F/U should be at least 2X/year
76
Scabies
- Generalized, severe itching accompanied by burrows, vesicles, and pustules (finger webs and wrist creases)
- burrows are short, irregular marks, 2-3mm long and width of a hair
- Head and neck are typically not affected
- May be acquired through close physical contact for 15-20 min or contact w/infected bedding
- Dx through skin/lesion scraping
77
Scabies
| Treatment
- Pt, family, roommates, and BEDDING must be treated
- Bedding/clothes placed in plastic bags for 14 days or laundered in high heat (>60*C)
- Permethrin 5% cream is highly effective and safe, single application from neck down, leave in place for 8-12 hrs then rinse off and REPEAT IN 1 WEEK
- Itching may continue for weeks after tx, Triamcinolone may help reduce itching
78
Pediculosis (lice)
- Itching, presence of nits or lice on skin or in hair
- Head/body lice similar in appearance, 3-4mm long
- Body lice may be found in seams of clothing
Tx:
- Permethrin 5% cream can be used as with scabies but this time to scalp - may use 1% for scalp alone if preferred
79
Furuncle (Boil)
- Deep seated infection/abscess that involves hair follicle as well as adjacent tissue
- Usually staph aureus
- Carbuncle - several furuncles that coalesce to form a deep mass or pocket w/multiple draining points
- WBCs are seldom elevated w/localized infections, can culture the drainage for sensitivities
- I&D recommended for all lesions
- Oral abx often given
80
Epidermal Inclusion Cyst
- Firm, benign growth of upper portion of hair follicle
- Overlying black comedone or punctum
- May express foul smelling cheesy material
- Inflamed lesions = I&D
81
Leg Ulcer d/t Venous Insufficiency
- Hx of venous insufficiency/immobility
| - Irregular shape on lower leg, typicall above malleolus
82
Leg Ulcers r/t Venous Insufficiency
| Treatment
- Check ABI, if < 0.7 = Venous sx
- Compression TED hose + wound care
- Pentoxifyline 400mg TID to accel healing
83
Vitiligo
- Unpigmented white macules 0.5-5 cm
- Men/women affected equally
- Generalized > 10% BSA involvement
84
Vitiligo
| Treatment
- Topical corticosteroids
- Phototherapy
- > 40% body surface affected = skin graft or permanent depigmentation
