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DERM > ECZEMATOUS & PAPULOSQUAMOUS DISORDERS > Flashcards

ECZEMATOUS & PAPULOSQUAMOUS DISORDERS Flashcards

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Dermatology Board Prep flashcards
1
Q

“HERALD PATCH”

A

pityriasis rosea

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2
Q

Christmas tree distribution rash

A

pityriasis rosea

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3
Q

PITYRIASIS ROSEA ETIOLOGY

A

unclear, but likely viral

is self-limiting

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4
Q

PITYRIASIS ROSEA

A
  • ETIOLOGY = unclear, but likely a viral source
  • is self-limiting
  • *First sign = “HERALD PATCH” –> then multiple new lesions appear, usually on the central trunk
  • *may appear as a “christmas tree distribution” on the back
  • lesions are often oval with long-axis paralleling the lines of skin stress
  • lesions resolve in 6-10 weeks
  • may be pruritic
  • not contagious

TREATMENT
if needed for pruritus = give medium potency topical steroids
Acyclovir or Phototherapy for severe cases

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5
Q

first sign of pityriasis rosea

A

herald patch –> then multiple new lesions appear, usually on central trunk

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6
Q

is pityriasis rosea contagious?

A

NO

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7
Q

treatment for pityriasis rosea

A

TREATMENT
if needed for pruritus = give medium potency topical steroids
Acyclovir or Phototherapy for severe cases

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8
Q

Wickham’s Striae

A

Lichen Planus

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9
Q

Polygonal

A

Lichen Planus

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10
Q

1st line treatment for lichen planus

A

topical corticosteroids (high or super-high potency)

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11
Q

Lichen Planus Treatment

A

⦁ 1st line = Topical corticosteroids (high or super-high potency) on trunk / extremities

⦁ Intralesional steroid injections can be useful in patients with hypertrophic lichen planus

⦁ Patients with widesprerad cutaneous disease may benefit from phototherapy, Acetretin (Psoriatane - systemic retinoid), or a short course of systemic glucocorticoids

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12
Q

STASIS DERM TREATMENT

A

TREATMENT = aimed at prevention of edema & blood pooling with compression stockings & elevation of the legs

o Skin cleansing, emollients, topical steroids for pruritus, wet dressings for crusts or open lesions

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13
Q

what causes stasis dermatitis

A
  • occurs from blood pooling in lower extremities due to chronic venous insufficiency
  • increased pressure in the capillaries with subsequent extravasation (leaking out)
  • Hemosiderin from the blood cells stain the skin
  • can develop venous stasis ulcers
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14
Q

__________ from the blood cells stain the skin in stasis derm

A

HEMOSIDERIN

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15
Q

Seb Derm may be widespread in ______ & ________

A

HIV & Parkinson’s disease

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16
Q
  • Have erythematous scaling patches that develop in areas of sebaceous glands (scalp / face / trunk)
A

seborrheic dermatitis

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17
Q

Malassezia furfur (pityrosporum ovale)

A

tinea versicolor & seborrheic dermatitis

seb derm = hypersensitivity to malassezia

tinea versicolor = overgrowth of malassezia

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18
Q

Thought to be caused by Saprophyte infection by Malessezia (aka pityrosporum ovale)
⦁ colonization noted on the skin of affected individuals
⦁ normal skin flora but to a lesser degree

A

seb derm

thought to be a hypersensitivity to Malessezia

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19
Q

clinical manifestations of seb derm

A 
⦁	erythema (reddish or pink color)
⦁	swollen & greasy appearance
⦁	white or yellowish scale
⦁	some pruritus
⦁	Distribution = Lateral sides of nose, eyebrows, glabella, scalp, and can also involve the chest, upper back, and axillae
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20
Q

DIAGNOSIS OF SEB DERM

A

usually can be made by physical exam

  • on Biopsy = have
    ⦁ Mounds of parakeratotic scale around hair follicles
    ⦁ Mild superficial inflammatory cell infiltrates of lymphocytes
    ⦁ Increased # of Malessezia furfur spores in stratum corneum
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21
Q

Seb derm treatment for scalp

A

o Scalp = T-gel, Selenium sulfide (Selsun blue), Zinc Pyrithione (Head & shoulders, DHS)

Ketoconazole 2% (rx > 1% OTC) or Ciclopirox shampoo 1%
⦁ use shampoo 2x/week x 4 weeks, then prn for maintenance

22
Q

seb derm treatment for skin

A

o Skin = Ketoconazole 2% cream or gel (BID x 4 wks), Ciclopirox 1% cream (BID x 4 weeks, then QD x 4 weeks),

Tacrolimus 0.03%, Pimecrolimus 1% cream

  • Severe cases = add low potency topical corticosteroid x 1-2 weeks, then taper off to prn
23
Q

perioral dermatitis Etiology = unknown, but does have a strong correlation with _________

A

topical steroid use

24
Q

clinical manifestations of perioral dermatitis

A

⦁ 1-2 mm clustered erythematous papules, papulovesicles or papulopustules with or without scale
⦁ occurs most often around the mouth, spares the vermillion border
⦁ can be asymptomatic, or associated with burning or stinging

25
Q

FINDINGS SUGGESTIVE OF PERIORAL DERM

A

⦁ sparing of skin adjacent to vermillion border
⦁ co-existing feature of eczematous dermatitis
⦁ burning/stinging
⦁ recent use of topical, nasal or inhaled steroids
⦁ hx of lesions worsening after withdrawal of steroids in the past

diagnosis = clinically based on PE and above hx

26
Q

perioral dermatitis treatment

A
  • may resolve on its own
  • FIRST LINE = topical calcineurin inhibitor (Protopic, Elidel), or topical Erythromycin or topical Metronidazole
  • for moderate to severe cases = systemic agents: Tetracycline, Doxycycline or Minocycline
  • systemic therapy for KIDS = ERYTHROMYCIN
27
Q

first line tx for perioral dermatitis

A

topical calcineurin inhibitors (protopic / elidel)
topical erythromycin
topical Metronidazole

28
Q

systemic therapy for perioral dermatitis in kids

A

ERYTHROMYCIN

29
Q

diaper dermatitis caused by a combination of

A

wetness, pH elevation and friction

a secondary infection may occur with Candida albicans

30
Q

elevated pH activates _______ enzymes that injure the skin

A

proteolytic

elevated pH activates proteolytic enzymes that injure the skin

31
Q

clinical presentation of diaper dermatitis

A

⦁ erythema in diaper area
⦁ if predominantly in the creases and satellite lesions are present = most likely dealing with a candidal infection as well
⦁ need to determine if rash is from wetness, irritation from the diaper, or yeast infection

32
Q

treatment for diaper dermatitis without candida infxn

A

frequent diaper changes, and barrier treatment with Vaseline or Desitin

33
Q

treatment for diaper dermatitis with candida infxn

A

topical antifungals such as: Nystatin, Miconazole or Clotrimazole.

Barrier lubricants such as Vaseline;

No steroids!

34
Q

treatment of thrush (oral candida)

A

o Thrush
⦁ Nystatin
⦁ Clotrimazole

35
Q

treatment of intertrigo (cutaneous candida)

A

o Skin
⦁ Nystatin powder for macerated areas
⦁ Clotrimazole (Lotrimin), Ketoconazole
⦁ if failure of topical therapy = give oral fluconazole (diflucan)

36
Q

cause of contact dermatitis

A
  • direct exposure to a substance –> allergy or irritation
  • most common plant causes in North America = Oleoresin Urushiol = found in Poison ivy, poison oak, poison sumac, skin of mangoes, gingko fruit
  • may spread from pets or from oils trapped under fingernails

Other common allergens
⦁ Nickel (jewelry, buttons, belts)
⦁ Formaldehyde, quanternium-15 (clothing, nail polish)
⦁ perfumes, cosmetics
⦁ preservatives (topical medications, cosmetics)
⦁ rubber & chemicals in shoes
⦁ topical hydrocortisone, topical antibiotics (neomycin, bacitracin), topical meds (benzecaine, thimersol)
⦁ Laundry detergents - may be a rare cause

37
Q

CLINICAL PRESENTATION OF CONTACT DERMATITIS

A

⦁ intense pruritus
⦁ rash
⦁ papular, erythematous lesions
⦁ papules from fluid in the epidermis and in severe cases produces vesicles & serous oozing

  • exposure may have been as far back as 2 weeks ago
  • may develop a rxn to products that you have used for months to years
38
Q

TREATMENT OF CONTACT DERMATITIS

A

TREATMENT
o Plant-based Contact Dermatitis
⦁ symptomatic therapy - oatmeal baths, cool/wet compresses, Calamine lotion, Burrow’s or domeboro solution for weeping lesions, Zanfel soap
⦁ Antihistamines - used for sedation, as this is NOT due to histamine release
⦁ Topical Corticosteroids: high potency = Clobetasol
⦁ Systemic Steroids if needed for large areas, face or genitals = give 2-3 week taper of prednisone

o Treatment of Contact Dermatitis
⦁ remove offending agent
⦁ topical symptomatic therapy
⦁ medium to high potency topical steroids = Clobetasol cream
⦁ Systemic steroids in severe cases (> 10% BSA) = medrol dose pack or prednisone taper
⦁ Burrow’s solution for weeping blisters
⦁ Antihistamines for treatment of pruritus
⦁ treat any recognized secondary bacterial infections

39
Q

dyshidrotic eczema

A
  • Cause = unknown
  • Vesicular eruption on the skin of hands & feet - marked by intense itching
  • vesicles are deep
  • scaling, fissures and lichenification may follow

Triggers = sweating, emotional stress, warm & humid weather, metals (nickel)

40
Q

treatment for dyshidrotic eczema

A
  • High potency topical steroids
  • may need to be given with occlusion
  • hydration of skin with emollient cream
41
Q

-term used to describe what occurs as a result of chronic eczematous changes and scratching

A

Lichen Simplex Chronicus

42
Q

Lichen Simplex Chronicus

A
  • term used to describe what occurs as a result of chronic eczematous changes and scratching
  • circumscribed plaque of thickened skin with increased markings with some scaling
  • stop the scratching and lesions may regress
43
Q
  • eczema (atopic dermatitis) that is described as coin shaped lesions
A

nummular eczema

44
Q

2 pathogenesis theories for atopic dermatitis (eczema)

A
  • 2 theories
    1) Impaired epidermal barrier function due to intrinsic structural & functional abnormalities in the skin; abnormal epidermal barrier = primary defect

2) immune function disorder in which Langerhans cells, T-cells and immune effector cells modulate an inflammatory response to environmental factors

45
Q

hallmark of atopic dermatitis

A

pruritus

46
Q

locations of eczema for adults & children

A

o ADULTS = location: neck, wrists, behind ears, antecubital & popliteal flexure areas

o CHILDREN = all the above areas + cheeks/face

47
Q

atopic dermatitis treatment

A

o Eliminate exacerbating factors (triggers: heat, low humidity, perspiration, stress, anxiety)

o Antihistamines used to treat pruritus
⦁ Doxepin or Vistaril = antidepressants with antihistamine SE

o HYDRATION, HYDRATION, HYDRATION!!!

o Topical steroids
o Burrow’s solution for oozing lesions
o Treat skin infections when appropriate

FOR MILD/MODERATE CASES
- topical corticosteroids & emollients
⦁ topical steroids can be applied 1-2x daily x 2-4 weeks
⦁ for mild/mod = use low potency steroid cream/ointment = Desonide or HC
⦁ Mod cases = use medium to high potency steroids = fluocinolone, TAC, betamethasone

  • for patients who require therapy to the face or skin folds for more than 3 weeks = can treat with protopic / elidel
    ⦁ less SE ; can be used BID
    ⦁ as effective as medium potency topical steroids
    ⦁ immunomodulators
48
Q

SE OF TOPICAL STEROIDS

A 
⦁	atrophy
⦁	telangiectasias
⦁	purpura
⦁	striae
⦁	acneform eruption
  • the higher the potency of the steroid, the more likely to have SE
  • limit higher potency steroids to no more than 45g/week x no longer than 2 weeks
  • use less potent steroids for the face, dorsum of hands and genitalia
  • only use low potency preparations around the eyes
49
Q

BBW OF TOPICAL CALCINEURIN INHIBITORS

A

***may increase incidence of skin cancer & lymphoma with long term use

50
Q

2nd line atopic derm agents

A

topical calcineurin inhibitors

51
Q

when and when not to use topical calcineurin inhibitors

A
  • not for use under age 2, and not for continual use
  • not for use in immunocompromised patients
  • use for lesions on the face, eyelids, neck & skin folds (as steroids cause more atrophy here)
52
Q

if contact dermatitis is caused by an irritant, the reaction is usually ____________

if caused by an allergen, rxn may be _________

A

immediate

delayed

DERM (12 decks)

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