Dermatology: Wk 2

Question 1

Acne vulgaris, a disorder of:

Answer 1

Pilosebaceous follicles

Question 2

4 factors involved in formation of acne lesions

Answer 2

Inc in sebum
Keratin and sebum plug hair follicle
C. acnes proliferates in follicle
Inflammatory response

Question 3

Tx for moderate comedonal and inflammatory acne

without scarring

Answer 3

Benzoy peroxide + Topical retinoid cream

Question 4

Refer pts to derm if:

Answer 4

Cystic, Scarring, or difficult to control

Question 5

Adapalene, Tazarotene, and Tretinoin are all forms of

Answer 5

Topical Retinoids

Question 6

Which topical retinoid is category X and contra-indicated in pregnancy?

Answer 6

Tazarotene

Question 7

Topical Abx in the treatment of acne

Answer 7

Erythromycin 2%

Clindamycin 1%

Question 8

How do topical Abx work in the treatment of ACne

Answer 8

Reduce number of C. acnes and reduce inflammation

Question 9

What needs to be added when the acne is moderate- severe

Answer 9

Oral abx

Question 10

SE of Minocycline (an oral abx for acne)

Answer 10

Dizziness, ataxia, nausea, vomiting

Question 11

1st line Oral Abx tx for acne

Answer 11

Tetracycylines:

Tetra, Doxy, and Mino

Question 12

2nd line Oral Abx tx for acne

Answer 12

Macrolides

“mycins”

Question 13

Adverse effects to Tetracycline Abx

• tetracycline
• doxycycline
• minocycline

Answer 13

GI upset
Photosensitivity

Minocycline can cause vertigo, dizzy, and hyperpigmentation (GI upset and photosens are less common with Mino)

Question 14

Tetracyclines are CONTRA in who

Answer 14

Pregnant

Children younger than 8

Question 15

If pt has not responded after 3 mo of oral abx

Answer 15

Increase dose
Change abx
Refer to Derm

Question 16

Minocycline and pigmentation

Answer 16

CAUTION

brown or blue/gray
may occur in scars

may not fade after stopping med
if on long term Minocycline, screen. If see on gums or sclerae, stop med

Question 17

Oral Isotretinoin

Answer 17

For severe, nodulocystic acne failing other therapies

SE: xerosis, chelitis, elevated liver enzymes, hypertriglyceridemia

Question 18

Isotretinoin is NEVER used with what?

Answer 18

Tetracycline (tetra, mino, or doxy)

because both have small risk of developing pseudotumor cerebri

Question 19

Tx for acne in post-teen women

possibly associated with PCOS

Answer 19

Spironolactone

Question 20

Commonly used meds to treat hormonal acne- other than Spironolactone

Answer 20

Yaz
Ortho Tri-cyclen
Estrostep

Question 21

Acne Rosacea

Answer 21

looks similar to Vulgaris, but ABSENCE of comedones

Question 22

Red swollen distorted skin

Easy flushing, redness, telangiectasias, papules, pustules

Answer 22

Acne Rosacea

Question 23

Triggers to Acne Rosacea

Answer 23

Alcohol
Sun
Hot beverage
Spicy food 
Emotional stress

NOT related to hormones

Question 24

Acne Rosacea often also affects the

Answer 24

EYES

Question 25

Tx for Acne Rosacea

Answer 25

Topical and Oral tx improve the papules and pustules BUT will not reverse the underlying redness and flushing

Question 26

Periorificial Dermatitis Tx | around the mouth

Answer 26

- Topical steroid taper - Oral Tetracycline (older) or Oral Erythromycin (younger) - Topical Metronidazole, Erythromycin, and Pimecrolimus

Question 27

Periorificial Dermatitis

Answer 27

No comedones Papules and pustules with scaling Around the mouth, nose, eyes Itching or burning

Question 28

Pts with Periorificial Dermatitis often have history of

Answer 28

Steroid use this acne often flares when steroids are stopped

Question 29

Spreading redness Non fluctuant Streaks of lymphangitis spreading from affected area --> lymph nodes

Answer 29

Cellulitis

Question 30

Stasis Dermatitis

Answer 30

acute flare of chronic venous insufficiency

Question 31

Dryness in a net like pattern lower legs, not hot, can be oozing, crusting, fissuring

Answer 31

Asteatotic Eczema

Question 32

Cellulitis is most often caused by

Answer 32

Group A Strep

Question 33

Tx for Cellulitis that is Non purulent | covering for strep

Answer 33

Keflex Amoxicillin Augmentin Clindamycin

Question 34

Tx for Cellulitis that is Purulent, IVDU, or penetrating trauma Cover for MRSA: "B,C,D"

Answer 34

Bactrim Clinda Doxy + Amoxicillin

Question 35

How long for course of Abx to treat cellulitis?

Answer 35

5 days if not better after this, need to possibly revise treatment

Question 36

Abx that treat MRSA "B,C,D, L, V"

Answer 36

``` Bactrim Clinda Doxy Linezolid Vanco ```

Question 37

Clinda has what associated risk

Answer 37

C-DIFF!!! "Linda is a bish"

Question 38

Bactrim to treat MRSA

Answer 38

need to combine with Amoxicillin

Question 39

Macrolide to treat MRSA (Doxy or Mino)

Answer 39

need to combine with Amoxicillin

Question 40

Linezolid to treat MRSA

Answer 40

Expensive medication $$

Question 41

Vancomycin to treat MRSA

Answer 41

Parenteral DOC to treat severe infections

Question 42

Erysipelas

Answer 42

superficial cellulitis legs and face pain, bright red, plaque like edema- sharply defined margin high WBC chills, fever, HA, vomiting, joint pain

Question 43

SHARPLY DEMARCATED BORDERS

Answer 43

Erysipelas

Question 44

Erysipelas tx

Answer 44

Empiric Abx therapy cover Strep Pen C, Amoxicillin, Clinda, Macrolide

Question 45

Abx tx for Abscesses "B,C,D" covering for MRSA

Answer 45

Bactrim Clinda Doxy

Question 46

Most common affects kids age 2-5 contagious, easily spread most cases d/t Staph aureus

Answer 46

Impetigo

Question 47

Lesions start as papules surrounded by erythema--> pustules that enlarge and break down to form thick, adherent crusts w "HONEY CRUSTED APPEARANCE"

Answer 47

Non bullous Impetigo

Question 48

Bullous Impetigo

Answer 48

flaccid bullae with clear/ yellow fluid that later becomes purulent ruptured bullae leave thick, brown crust face, arms/legs, diaper area

Question 49

Ecthyma

Answer 49

goes DEEPER plaque that extendes into dermis "PUNCHED OUT" ulcers covered w yellow crust surrounded by raised margins heals slowly, may scar

Question 50

PUNCHED OUT ulcers

Answer 50

Ecthyma

Question 51

Tx for Impetigo "honey crusted"

Answer 51

Topical Mupirocin or Retapamulin ointment as long as localized infection and pt is otherwise healthy

Question 52

Oral Abx need to be used to treat Impetigo when multiple close contact (like family members) affected or if it's extensive

Answer 52

``` Dicloxacillin Keflex Erythromycin Clindamycin*** safe choice Augmentin ``` If MRSA: Clinda, Bactrim, or Doxy

Question 53

Rapidly progressing redness, edema, fever, systemic sx, crepitus, skin necrosis local anesthesia over plaque but over PAIN OUT OF PROPORTION in some cases

Answer 53

Necrotizing Fasciitis

Question 54

If you suspect Necrotizing Fasciitis

Answer 54

consult Surgery immediately

Question 55

Tx for Necrotizing fasciitis

Answer 55

Widespread debridement and broad spectrum Abx

Question 56

deeper form of impetigo that results in ulcers

Answer 56

Ecthyma

Question 57

Expanding, dusky, red plaque with blue discoloration and assoc anesthesia

Answer 57

Necrotizing Fasciitis