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
What is the treatment for Nummular eczema
Group I-III steroids + occlusion and emollients, and antihistamines for itch
A pt presents with a habitual scratch-itch- cycle that is red papules that become a red scaly plaque along the skin lines
Think
Lichen Simplex Chronicus
Treat by stop scratching, Group I ointment
1st gen antihistamine
+/- kenalog
A pt presents with inflammation of the lower extremities 2/2 poor circulation
With itching, scales, and hyperpigmentation that leads to ulcers
Think
Stasis dermatitis
Treat underlying condition
+ emollients and topical steroids
A pt presents with spiney keratotic papules on the EXTENSOR surfaces
MC to the arms and legs
Usually aS/s
Think
keratosis pilaris
Tx: lotions with urea or lactic acid
Short course of steroid
(mid potency)
A pt presents with ertythema, edema and vessicles that progress to bulluae after contact with nickel, or poison Ivy
That is intensely itchy
Think
Contact dermatitis
Damage to the stratum corneum
Treat with avoidance, and emollients
Cool compress and if severe topical steroid
A pt presents with a blistering disorder that is a type II RXN that involves IgG and Desmoglein
MC assoc with Myathenia Gravis
Has universal involvement of the oral mucosa with skin blisters that progress to deep ulcers that Easily rupture
And are NOT ITCHY
Think
Pemphigus Vulgaris
Dx with Bx
( IgG row of tombstones)
Tx: refer to derm
+ prednisone
+immunomodulaltors
A pt presents with the most common autoimmune subepithelia blistering d/o
Mc in pts older than 60 and chronic
Has a generalized bullous, puritic disruption of the epithelium
Localized erythema plaque because dark red and cyanotic over 1-3 weeks then vesicles and bullae appear
NEGATIVE Nikolsky sign
Think
Bullous Pemphgoid
Tx with GroupI topical AND oral steroids
If severe treat as Pemphigus Vulgaris-
refer to derm and treat with prednisone
A pt presents with chronic burning and puritic vessicles and also has celiac dz
MC in white males, and is on the bilateral EXTENSOR surfaces, also on the scalp or butt
Think
Dermatitis Herpetiformis
Dx with punch Bx and test for celiacs
Tx: Gluten free diet
+ dapsone (short term)
A DM pt presents with oval purple patches with advancing red border with a woody induration that progresses to ulcers on the ant Tib/fib
Think
Necobius Lipoidica
TxL topical or intralesional steroids
Systemic PO steroids for 3-5 weeks
And pentoxifylline for 1 month
A Dm pt presents with a ring of small red flesh colored papules
That start flesh colored and progress to red, on the lat dorsal hands and feet
Think
Granuloma Annular,
Assoc with HIV!
Tx: none necessary,
Cosmetically: topical steroids and occlusion
If disseminated: PUVA + dapsone
An obsese pt presents with a velvety hyperpigmented plaque
Mc to the axilla
Think
Acanthosis Nigricans
Tx underlying cause
Usually a D/o of insulin
(DM or cushings)
Ammonium lactate can soften the plaque
Tretinoin cream can thicken the skin
A pt priests with lipid deposits, flat yellow plaques around the eyes think
Xanthomas
Tx underlying dylipedma
Can be eruptive
(Small yellow with red halo)
Tuberous
(Slow painless plaques on the knees, elbows, extensors, or palms) (billiary Cirrohisis)
Or Tendonous (MC to the Achilles)
All are a sign of High Tri Gs
A pt presents with oval, raised, elongated, RUST colored infiltrates, that decrease in size with pressure applied, and progress to ulcers
Assoc with HPV 8
And is classically seen in older men on the hands, feet, LE
Think
Kaposi’s Sarcoma
If on the trunk think AIDS/HIV
Vascular cancer associated with HPV 8
Dx with Bx
(Blood vessels with neoplastic epithelium)
Tx with Nitrogen Cryo therapy
Or excision
+/- intralesional chemo
(Vinblastine)
A pt presents with moist warm skin, that is smooth
Has a bronze tint to the skin
Thin hair, and clubbing concave finger nails
(Thyroid acropachy)
And pretibial myxedema
Think
Hyperthyroidism
Pretibial myxedema is on the front of the skins and has an orange peel appearance and is non pitting edema
Also associated with graves Dz
A pt presents with swollen, cool, waxy dry skin, with increased wrinkles, eyelid puffiness, and a yellow tint to the skin
(Carotemia)
+ alopecia to the lateral eyebrows
+ vitalligo
Think
Hypothyroidism
A pt presents with red flat papules that coalesce to oval plaques
Think adherent silvery scales
+auspitz sign
MC to the extensor surfaces
+pitting/ oil spots on the nails
That worsens with stress
Think
Chronic plaque psoriasis
Immune mediated skin/ joint dz
Hyperkeratosis
+koebner phenomenon
If less than 5%
Tx with group I/II topical steroids and taper
Avoid tachyphylaxis with steroid holidays
+/- salysilic acid to remove scales
Topical D3 and steroids are the best combo
A pt with chronic plaque psoriasis that covers more than 5% TBSA
What is the Tx
Biologics : methotrexate or cyclosporine
A pt prestns with a 2 week hx of strep or viral URI
And now has sudden scaling papules on the trunk and extremities
That SPARES the palms and soles
Has a “teardrop” distribution of tiny red papules with thick white scales
Think
Guttate psoriasis
MC in children and YA
Tx with throat culture
And 1st line is UVB
+emollients
A pt presents with deep creamy yellow pustules on the middle of the palm or foot
That becomes a dry crust that does not rupture
Think
Pustular psoriasis
Treat with Group I topical
(Clobetasol)
+/- occlusion
+/- PUVA
Do NOT use PO steroids
Encourage smoking cessation
Generic Varient leads to lakes of puss and is fatal
A pt presents with red plaques in skin folds that a macerated and dispersed
Think
Psoriasis inversus
DDx candida
A pt presents with find white or yellow flakes, and red papules with an inflamed base, plus pruritus
MC to the scalp, and scalp margins, eyebrows, and nasolabial folds
“Dandruff”
Think
Seborrhic Dermatitis
Tx with proper hygiene, Ketoconazole shampoos and creams
Selenium Sulfide
Head and Shoulders
Baby shampoo if at eye lids
Topical steroids to reduce inflammation PRN
+/-ABX
Oral anitfungal if severe
How does seborrhic dermatitis present in infants
Cradle Cap
A pt presents with a HERALD patch (salmon colored) following a viral infection with HPV 6/7
Common in Children and YA
MC tot he trunk and proximal extremities
Is distributed in a Xmas tree like pattern
Think
Pityriasis Rosea
R/o syphillis infection
No MGMT needed, only reassurance
If severe:
Prednisone + UVB
Acyclovir or Erythromycin as needed
A pt presents with a purple, polygonal, planar (flat), pruritic plaque
+wickams striae
+koebner phenomenon
MC to the hands, feet, ankles, wrists, involves the oral mucosa genitals and scalp
Think
Lichen planus
Dx with Bx
Tx with Group I/II steroid and intralesion injection
Steroids in the oral mucosa need added oral base
Generalized: prednisone x 2-4 weeks
treat itch with Hydroxyzine
R/o SCC
What should you R/o in lichen planus
SCC
A pt presents with small smooth overly flat papules that becomes plaques (porcelain) and are atrophic
Mc to the vulva, perianal region, and groin
Think
Lichen Scelrosis
Dx with Bx
Tx with Clobestol BID x 1month
+ PUVA
Has a high assoc with cancer risk
A pt presents with a nodular erythematous eruption on the extensor surfaces of the extremities
With a low grade fever, arthralgias, and arthritis
“Red nodes over the shins”
Starts out tense and hard and becomes fluctuant
Think
Erythema Nodosum
Assoc with sarcoidosis
Tx is self limited and NSAIDS
A pt presents with ulcerating skin dz associated with IBS
That is a necrotic ulcer with a purulent base
Think
Pyoderma Gangrenosum
A pt presetns with recurrent wheels
And itching with SOB and dysphagia
Has a firm red plaque/ faint pink with a central pallor
Can present with an orange peel appearance and fades within 24 hours
Think
Uticaria
IgE
Treat acutely with irritant avoidance
H1/H2 blockers
And be prepared for anaphylaxis
Tx chronicly with 2nd gen antihistamines, H2 blockers
Short course of steroid
And diet elimination
A pt presents with deep swelling of the neck, tongue and face
That is burning and painfully itchy
+dysphagia, Dyspnea, abd pain
Think
Angioedema
Tx with removal of irritant
IM/PO antihistamine
And PO steroids if able to swallow
Be prepared to treat anaphylaxis and airway
A pt present with a high fever, Cough, coryea, and conjunctivitis
+koplik spots
And a Erthyematous macular popular rash
Think
Measles
2/2 viral measles
Starts at the head/ faces and moves to the trunk and down
Dx with IgG for measles
Tx is supportive and isolation
Contact the CDC
Treat fever, give fluids, ect
A pt presents with red papules that become painful lesions on the hands feet and mouth
Think
Hand Foot Mouth Dz
2/2 cocksackie
MC in children under 5
Often on the dorsal surfaces
Tx is supportive
And give antihistamines and antipyretics
Change the diet to accommodate oral sores
A pt presents with a slapped cheek appearing rash to the face
Think
5th disease
Aka erythema inectioiusm
2/2 parovirus b19
Tx is supportive
Pt is not infectious during the rash phase
A pt presents with conjuctivitis, maculoapupular rash, tender edema to the extermeities, cervical adenopathy,a CN mucositis
Think
Kawasaki’s Dz
C/R/E/A/M
Strawberry tongue is the dead give away
Tx with immunoglobulin and aspirin
A pt has a cutaneous reaction following initiation of a new drug
Tx with dc the rx
Antihistmines
And PO/Topical steroids III-V (weaker/ mod)
A pt presents with target lesions, that are dark red macules with central color changes
Mc to the dorsal hands, palms, soles, extensor limbs, and mucus membranes
Think
Major or Minor erythema multiforme
Major( mucus membranes)
Minor (without)
Tx: can heal spont, with 2 weeks
Tx s/s with mild steroids, Anithistamines, orajel
+/- prednisone and acyclovir
MC CAUSE HERPES
If lesions are on eyes; optho referral
A pt presents with mucosal lesions on the conjunctiva, nasal, oral , and genitals
That progress to Bullae in 1-14 days
Preceeded by a URI with a high fever 1-3 days prior
Think
Steven Johnsons
Covers 10% TBSA
Detachment of the epidermis +severe necrosis
Tx: D/c Rx and admit to burn unit
IV fluids and optho consult as needed
+ ABX and Airway MGMT
A pt presents with full thickness necrosis, 2/2 Rx, and covers 30% TBSA
Think
Toxic Epideraml Necrolysis
Will have a red macular sun burn look
+Nikolsky sign
“Wet cigarrette paper look”
Tx is refer to burn unit ASAP and Airway MGMT
Avoid Infections (MC CAUSE of death)
DO NOT GIVE STERIODS!
