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Skin > Disease 3 > Flashcards

Disease 3 Flashcards

1
Q

factors in acne pathogenesis

A
  1. sebaceous gland hyperplasia
  2. abnormal follicular desquamation
  3. propoinibacterium acnes colonization
  4. inflammation
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2
Q

microcomedo

A

acne
non-inflammatory comedones
open: blackheads
closed: whitehead

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3
Q

inflammatory lesions in acne

A

papules, pustules, nodules, cysts

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4
Q

benzoyl peroxide

A

topical
kills P.acnes, mild comedolytic, mild inflammatory
limits development of P. acnes antibiotic resistance
can combine with retinoid
AE: irritation, bleaching, allergic
Tx: mild acne

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5
Q

salicylic acid

A

less effective than benzoyl peroxide

Tx: mild acne

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6
Q

topical antibiotics for acne

A

kill P. acnes, anti inflammatory
clindamycin, erythromycin
AE: irritation, colitis with clindamycin
not recommended as mono therapy: resistance, slow onset, not comedolytic
add benzoyl peroxide: Benzaclin/Duac, Benzamycin

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7
Q

topical retinoids

A

FIRST LINE
comedolytic, anti-inflammatory, enhance penetration of other compounds
Tx: acne
AE: irritation
combination products with antibiotics are expensive

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8
Q

tazarotene

A

topical retinoid

do not use in PREGNANCY

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9
Q

tretinoin

A

topical retinoid

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10
Q

adapalene

A

topical retinoid

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11
Q

systemic antibiotics in acne

A 
moderate to severe inflammatory acne
antibacterial, anti-inflammatory
goal is maintenance with topical
tetracycline, doxycycline, minocycline
other: erythromycin, bactrim
well tolerated
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12
Q

tetracycline

A

oral
Tx: acne
AE: GI, tooth stain

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13
Q

doxycycline

A

oral
Tx: acne
AE: photosensitivity, esophagitis

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14
Q

minocycline

A

oral
Tx: acne
AE: dyspigmentation, lupus, pseudotumor cerebri, SJS, DHS

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15
Q

erythromycin

A

oral
Tx: acne
AE: GI

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16
Q

oral contracepties

A

suppresses sebum

Tx: females with moderate to severe inflammatory/mixed acne

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17
Q

isotretinoin

A

oral
decrease sebaceous glands size/activity, prevent new comedones, inhibits P.acnes, anti-inflammatory
Tx: severe, scar, refractory
AE: dry lips, skin, eyes, nosebleeds, mild headaches, muscle aches, backaches, TERATOGEN, DEPRESSION, SKELETAL, IBD?

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18
Q

Tx of mild comedonal acne

A

topical retinoid

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19
Q

Tx of mild inflammatory/mixed acne

A

topical retinoid and topical antibiotic

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20
Q

Tx of moderate inflammatory/mixed acne

A

topical retinoid and topical antimicrobial and oral antimicrobial

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21
Q

Tx of severe inflammatory acne

A

minimal scarring: topical retinoid and topical antimicrobial and oral antimicrobial
scarring or multiple treatment failure: Isotretinoin

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22
Q

basic Tx for acne

A

gentle fragrance free cleanser: 1-2/day
oil free moisturizer with SPF 30 2x/day and as needed
avoid OTC acne washes and topical: too irritating and drying

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23
Q

What part of the diet could cause acne?

A
  1. high glycemic index diet may lead to hyperinsulinemia and stimulate androgen synthesis
  2. lots of milk
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24
Q

When should you refer patients to dermatologist for acne?

A
  1. severe acne (cysts, nodules, scars)
  2. no/poor response after 12 wks
  3. systemic antibiotics needed for more than 1 year
  4. isotretinoin being considered (females need OCP)
  5. acne associated with systemic disease
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25
Q

Rosacea

A

over 30 yrs, fair, female
relapsing and remitting
Sx: redness, flushing, pimples

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26
Q

Possible causes of rosacea

A
  1. inflammation
  2. Demodex folliculorum
  3. genetics
  4. vascular abnormalities
27
Q

triggers of rosacea

A
  1. sunlight
  2. hot/cold
  3. exercise
  4. food
  5. alcohol
28
Q

types of rosacea

A
  1. erythematotelangiectatic
  2. papulopustular
  3. phymatous
  4. ocular
29
Q

Tx of rosacea

A

topical: metronidazole, azelaic acid, sodium sulfacetamide with sulfur
systemic: oral tetracycline
other: IPL, laser, sugery

30
Q

perioral dermatitis

A

periorificial
women, 20-45 yrs
rash or pimples around mouth: nose, eyes, labia
papules, pustules, vesicles
Tx: discontinue topical steroids, topical antibiotics (mild), oral antibiotics (severe), may need topical non-steroidal anti-inflammatory

31
Q

triggers for perioral dermatitis

A
  1. steroids (topical)
  2. OCP
  3. menstruation, pregnancy
  4. fluorinated toothpaste
  5. stress
  6. candida, demodex mites
32
Q

folliculitis

A

follicular based papules/pustules on hair bearing areas

Tx: antibacterial soap/wash, topical antibiotics/antifungals

33
Q

causes of folliculitis

A

most common: staph, strep, pseudomonas
fungal: Pityrosporum orbiculare
mites: Demodex folliculorum
mechanical

34
Q

eosinophilic folliculitis

A

HIV, transplant patients

35
Q

hidradenitis suppurativa (HS)

A

women
apocrine gland bearing areas: axillary, inguinal, inframammary folds
Sx: recurrent, persistant painful abscesses; chronic sinus tract drainage, scars
Tx: topical and/or oral antibiotics (mild)
Tx severe: IL steroids, TNFa inhibitors, surgery

36
Q

risk factors for hidradenitis suppurativa

A
  1. obesity
  2. cigarette smoking
  3. family Hx
37
Q

herpes simplex (HSV)

A

dsDNA: latent, recurrent, primary
cluster of monomorphous vesicle with erythematous base, punched out erosion and crusted papule
direct contact
primary infection: pain, burning, tingling, fever, malaise, LAD
recurrent: milder
trigger: fever, sun exposure, stress
Dx: Tzanck smear: giant multinucleated cells, viral culture, PCR
Tx: topical antiviral, systemic antiviral (oral or IV for moderate to severe)

38
Q

HSV-1

A

perioral, lips, oral cavity

39
Q

HSV-2

A

genital

40
Q

herpes zoster (VZV)

A

dsDNA: latent in dorsal root ganglia
after 60, immunosuppressed
shingles: reactivation of latent VZV
trigger: trauma, stress, fever, radiation, immunosuppression
Sx: prodrome (pain, pruritus, burning), grouped over a dermatome, trunk most common
resolves in 3-5 weaks, postherpetic neuralgia
Dx: Tzanck smear, viral culture, PCR
Tx: oral antivirals, pain meds
prevent: vaccine

41
Q

Vesicle location for VZV: trigeminal nerve

  1. V1: ophthalmic
  2. V2 or V3
A
  1. vesicles tip/side of nose (Hutchinson’s sign): nasociliary branch, eye: blindness
  2. facial palsy, ear: tinnitus, vertigo, deafness
42
Q

molluscum contagiosum

A

dsDNA: Pox virus
cutaneous infection: pink to skin colored 2-10 mm dome shaped waxy papule with/out central umbilication
face, upper chest, extremities
transmit: skin to skin, auto inoculation, fomites
resolve spontaneously within months to years
may leave scar
Tx: nothing
other: cutterage, cryotherapy, cantharidin, topical retinoids, keratolytics, topical imiquimod, intraleional antigens, cimetidine

43
Q

cantharidin

A

chemical vesicant extracted from blister beetle

Tx: molluscum

44
Q

warts

A

dsDNA: HPV
benign, involute
transmit: hetero/autoinoculation, fomites traumatized skin
incubate: 1-6 mo
duration: most 2 years
cell mediated immunity
Dx: black dots
Tx: none, destructive or immunomodulatory if painful/extensive/enlarging/subject to trauma/comsmetic objection
Tx depends on: age, personality, number, size, location, previous Tx

45
Q

verrucae vulgaris

A

common warts
hands: periungual, subungual, anywhere including mouth
single or multiple skin colored hyperkeratotic papule or plaques: dome shaped, exophytic, filiform (stalk)
Dx: black dots, disruption of normal skin lines

46
Q

verrucae plantaris

A

plantar warts
most symptomatic: weight pairing surfaces
mosaic wart: coalesce into clusters

47
Q

verrucae plana

A 
flat warts
face, neck, legs most common
smooth, skin-colored to slightly tan/pink flat-topped thin papules and/or plaques
few or many
shaving can facilitate
48
Q

condylomata acuminata

A

anogenital warts
transmit: sexual, perinatal, nonsexual hetero/autoinoculation, fomite
skin colored pink/tan soft papule 1-5 mm, usually multiple, may form large cauliflower-like masses
Sx: asymptomatic, irritation causing pain or bleeding

49
Q

tinea capitis

A

3-7 yrs
scalp ringworm
fungal infection of skin and hair of scalp
trichophyton tonsurans (AA), microsporum canis (white)
risk: large family, crowded living conditions, low socioeconomic status
Sx: posterior cervical, sub-occipital LYMPHADENOPATHY
Dx: FUNGAL CULTURE
Tx: systemic antifungals, GRISEOFULVIN, ketoconazole shampoo or selenium sulfide, fomite education, terbinafine
M. canis: require higher does, longer course, can’t use terbinafine

50
Q

tinea corporus

A

superficial fungal infection of skin
transmit: infected person or animal contact
young: M. canis > M. audouinii, T mentagrophytes
older child/adult: T. rubrum (if in young child, parent has tinea pedis and/ or onychomycosis), T. verrucosum, T. mentagrophytes, T. tonsurans
one or more well-defined angular scaly erythematous plaques with central clearing and a scaly, vesicular, papular, or pustular border
Dx: Hx, presentation, KOH prep (scrape active border), fungal culture
Tx: topical antifungal for 2-4 weeks, no improvement: reconsider Dx
systemic for severe/disseminated, IC’d host, Majocchi’s, tinea faciei

51
Q

tinea manuum

A

men
skin of hands: red/scaling, chronic dryness
palmar or dorsal pattern
T. rubrum, T. mentagrophytes, E. floccosum
Dx: KOH, fungal culture
Tx: topical antifungal for dorsum; palms require oral anti fungal

52
Q

tinea cruris

A

men
skin of groin: jock itch: pruritic, red, annular, scaly plaques over groin and medial thighs; penis and scrotum not affected
risks: obesity, heat, humidity
T. rubrum, T, menatgrophytes, E. floccosum
Dx: KOH, fungal culture
Tx: powder antifungal, oral anti fungal if refractory

53
Q

tinea pedis

A

men
athlete’s foot: itching, scaling on soles, between toes; blistering
Moccasin, vesiculobullous
risk: occlusive shoes, communal pools/showers
Dx: KOH, fungal culture

54
Q

tinea unguium (onychomycosis)

A

older males
nail infection
T. rubrum, T. mentagrophytes, E. floccosum
non-dermatophyte molds, yeasts
discoloration, thickening, onycholysis
pattern: distal subungual, proximal subungual, white superficial, candida
Dx: KOH prep (from sublingual debris), fungal culture/stain of nail clipping, PAS stain (periodic acid-Schiff)
Tx: systemic antifungals 6-12 weeks: terbinafine, itraconazole, fluconazole
risk: IS’d, DM, HIV, poor circulation, trauma, dystrophy

55
Q

superficial fungal infections: dermatophyte

A

(tinea or ringworm)
soil, animals, humans
digest keratin, invade hair skin, nails
trichophyton, microsporum, epidermophytom

56
Q

superficial fungal infection: yeast

A

tinea versicolor, candidiasis

57
Q

kerion

A

tinea capitis
marked inflammation may cause scarring and permanent hair loss
rapid aggressive therapy
Tx: consider systemic steroids

58
Q

griseofulvin

A

gold standard for tinea capitis
give with fatty food
AE: photosensitivity, morbilliform eruption, heme and hapatic toxicity, headache, GI
monitor: CBC, LFT

59
Q

terbinafine

A

SE: dizzy, drug interactions, hepatotoxicity, heme, GI headache
monitor: CBC, LFT

60
Q

moccasin tinea pedis

A

fine dry scale over soles

T. rubrum

61
Q

vesiculobullous tinea pedis

A

vesicles/bullae on soles esp. insteps

T. mentagrophytes

62
Q

tinea versicolor

A

pityriasis versicolor
adolescence
Malassexia furfur (Pityrosporum orbiculare or ovale)
multiple scaling, oval macules, patches and thin plaques over upper trunk, proximal arms, sometimes face and neck
hyper/hypopigmented
SUMMER
Tx: education (chronic), selenium sulfide or ketoconazole shampoo/lotion
severe Tx: systemic ketoconazole, fluconazole, use topical for maintenance

63
Q

candidiasis

A

inertriginous, paronychia, angular chelitis

Tx: anti yeast cream, decrease moisture

64
Q

chronic paronychia

A

nail dystrophy
candida albicans
Dx: stain/culture
Tx: topical ketoconazole if mild, oral fluconazole (monitor CBC, LFT)

Skin (8 decks)

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