Each Derm Disease (per Card) Flashcards
A pt presents at onset of puberty with multifactorial disease of the pilosebaceous glands/ units
+excess sebaceous gland secretion
+duct obstruction
+bacterial colonization (P. Acnes)
Think
Acne Vulgaris
Can be Dx on presentation
Tx for the long haul
Mild soap and water, mild exfoliation, Avoid occlusion
Retinoids are effect over all sympotoms of acne
(Apply at bedtime)
+/benzaclin (benzoyl peroxide +clinda)
What is the approach to mild inflammatory acne
Start with retinoid + benzoyl peroxide and topical ABX
If pustules remain after 2-4 weeks add oral ABX
-Doxy, tetra, or minocylcine
Min of 3 month trial
Tx approach to moderate to severe acne
Start with triple therapy
Topical retinoid
+benzoyl peroxide
+ oral ABX
(Doxy, TCN, Minocycline)
Taper after 2-4 months
Consider intralesional steroid injections
(Triamcinolone)
If treatments fail: Refer to DERM for accutane
If a female pt fails candidacy for accutane what is alternate treatments for mod to severe inflammatory acne
BCPs
Spironolactone
(if not a candidate for Accutane)
A pt presents with signifigant inflammation, papules, pustules, NODULES, CYSTS, and SCARING
(Embarrassing lesions, missing school work)
With Sinus tracts and mild facial edema
MC to the face, neck, chest, and back
With a family Hx of acne on the male side
Think
Severe nodulocystic acne
Treat with referral to derm for accutane (oral retinoid)
(Isotretinoin)
Intralesional steroids for large nodules
What is role of Isotretinoin
Approved indications
- nodular acne
- recalcitrant acne
Must be followed for 6months
Dc all tetracyclines and topical retinoids expecailly vit A
Order CBC, UA, LFTS, LIPIDS, and HCG!
Repeat labs at each f/u
MUST BE ON 2 methods of BC
Ask about family hx of IBD
Instruct pt to use SUNSCREEN!
Cannot donate blood and only give out 1 month of Rx at a time
When should you D/c Isotretinoin
Pregnancy
(its highly teratogenic)
Signs of possible ICH
-HA with visual changes
Or not relieved by OTC
(Look for papilledema)
-mood swings with SI/ HI
A 20-30 year old female pt presents with hormonally sensitive acne that flares with menses and occasionally begins during pregnancy
Is very inflamed red papules and comedones along the chin and jaw line
Think
Adult female acne
Tx with OCP
Spirinolactone
Tretinoin Cream (2nd line)
If all above fails: Erythromycin
A young female pt presetns with mildly puritic and reccurnty small papules and pustules that “resembles acne:”
Confined to the chin and nasolabial folds with pustules on the cheeks adjacent to the nasolabial folds
CLEAR ZONE AROUND VERMILLIAN BORDER
Think
Perioral dermatitis
Assoc with use of moisturize creams
Tx with dc of creams + doxy for 2-4 weeks then tapper for 8 weeks
+/- 1% HC cream for Inflammation
A pt presents with erythema , papules and pustules, telangiectasias, swelling of the cheeks and forehead with RHINOPHYMA 2/2 demodex folliculorum
Often in fair skinned people
That burns or stings
Think
Acne Rosacea
Treat with avoidance of triggers
+ sunscreen
Metronidazole works against the mite
Azelaic acid or tetra for severe or resistant
If refractory:
Isotretinoin or surgical correction of rhinophyma
A pt presents with small non inflamed papules and comedones after application of oil/cream to the hair lin
Think
Pomade Acne/ Acne Cosmética
Tx with stopping the offfending agent
Benzoyl Peroxide 10% if tolerated for light exfoliation
Add tretinoin .025% at bedtime
Inflamed lesions - topical antibiotics
A pt presents with sudden onset acne 2-4 weeks after starting a PO steroid
Is a teen or YA
Often pruritic in a uniform symmetric distribution
No scarring
Think
Steroid ACne
Tx by Dc steroid if able
Topically tx with benzoyl peroxide or sulfacetamide lotion
Hydroxyzine or diphenhydramine prn for itching
Should heal without scarring
A pt presents with small epidermal cycsts WITHOUT opening around the eyes
2/2 sun damage or physical trauma
Think
Milia
Tx with incise over the lesion and extract contents if only a few lesions
If many lesions use tretinoin for several weeks until resolution
A pt presents with “prickly heat”/ “heat rash”
2/2 sweat retention from occluded eccrine glands
Often in hot humid weather
Common in babies
Feels very stinging/ pruritic
Think
Miliaria
Tx is often self limited
Remove from warm environment to a cool area
Cool compress and antihistamines
A pt presents with chronic suppurative, scarring of the skin and subQ tissue
Often with a familial hx of scarring acne
Hyperkeratosis over the apocrine glands with secondary bacterial infection
In the axialla, groin, or under the breasts
Usually is obese, always after puberty
Think
hHidradenitis Suppurativa
Has a DOUBLE COMEDONE
With sinus tracts and scarring
Tx with stop smoking
Long term ABX (Main stay)
(TCN, Doxy, Erytho, minocyline)
Hot compress
If large I&D cysts or abcesses
Or Intralesional injections if smaller
If communicating tracts the surgical excision and grafts
(Gen SRGRY consult)
A pt presents with tender foliculitis, low grade fever, after shaving or a break in the skin
Anywhere hair is present…
Think
Staphylococcus Folliculitis
Treat with topical mupirocin or Clindamycin
If extensive the PO dicloxacillin or cephalexin
If recurrent the Clinda x 10 days
Wash area with hibiclens TID x5 days
Change towel and pillow case daily
What is the tx for pseudo foliculitis barbae
modify shaving technique
- hydrate and soften beard
- wash with benzoyl
- shave with grain
Rx: Topical steroids group VI -VII after shaving
Temporary profile
Psuedo Folliculits barbae of the nape of the neck
Think
Acne Keloidalis Nuchae
Tx with no short or shave haircuts
If pustular or exudative then culture and treat with ABX x 3 months (TCN)
3 step plan for control:
Topical Clindamycin bid (Cleocin)
Fluocinonide (Lidex) bid 3-6months
Tretinoin .05% cream bid x 12 months
What is the treatmetn for epidermal inclusion cysts
Will have a visible but dysfunctional pore
Can occur anywhere
No MGMT necessary if aS/s
If desire removal of non inflamed lesions along skin lines
Excise intact if possible
Inflamed: Intralesion injection and excision post inflammation reduction
If ruptured: Excision after I&D
What is a Pilar Cyst
Similar to epidermal inclusion cyst but can calcify
Tx by excision
A pt presents with rough skin that is DRY, with white scales that become thick brown scales
MC on the hands and Lower legs
+/- itching and burning
Think
Xerosis Cutis
Treat with Emolients and 12% lactate lotion
A pt presents with allergic rhinitis, and asthma
Also has drying, hallmark pruritus and inflammation of erythematous lesions the FLEXOR creases that SPAREs the face (except eyelids)
MC in children
Think
Eczema
Part of the atopic triad
DX: clinical or IgE
Treat acutely with topical steroids and Anithistamines + wet dressings
If infected add ABX
Chronicly treat with mild soap (dove) , skin hydration and emollients BID S/p bath
Trigger avoidance and antihistamines for itching
A pt presents with éczema that is coin shaped lesion in pts older than 50
Mc on the dorsum of the Hand, feet, or extensor surfaces
“Itch that rashes”
Think
Nummular eczema
A pt presents with itching that precedes to vesicles of the hand or foot , symmetric distribution
“Tapioca like”
Scales to lichenification to crackling to fissuring
Think
Dyshidriotic Eczema / Pomphylx
Treat with antihistimes and avoid triggers
Start with potent steroids and wean to less potent steroids
+wet compress
+PUVA
LAST RESORT: methotrexate
A elderly pt presetns in the winter with lower extremity dryness, that has intense itch that becomes a rash with dry scales on skin lines
Think
Asteatotic Eczema
Treat with emollients immediately s/p bath
Group III-IV steroids and emollients
Change bathing habits and avoid hot showers
If severe then add wet compress and ABX
