Exam 1 Flashcards
Seborrheic Keratosis (SK)
age-related benign hyperpigmentation
appears “STUCK ON”- warty, greasy
tan to black raised papule
Treatment: cryotherapy, curettage, biopsy
Keratoacanthoma
RAPIDLY GROWING benign neoplasm
resembles SCC
round, flesh-colored nodule
Treatment: biopsy
Actinic Keratosis (AK)
often precursor to SCC
SUN EXPOSURE
“barnacles on a boat” - scale or dry patch
Treatment: 5-FU cream, cryo, curettage
Basal cell carcinoma (BCC)
“PEARLY” or “WAXY” hard nodule or papule with depressed center
teleangiectasia
rolled borders
Treatment: biopsy, Mohs micrographic surgery
Squamous cell carcinoma (SCC)
ULCERATED hard plaque, papule or nodule
more aggressive than BCC but still low metastatic risk
Treatment: surgical resection, Mohs, may require chemo
Malignant melanoma
originates in melanocytes
often metastasize to lungs, brain and lymph nodes
SUN EXPOSURE
4 subtypes:
- superficial spreading (70%) - radial spreading
- lentigo maligna - horizontal growth in situ
- acral letiginous - spreads superficially (most common in African Americans)
- nodular - MOST AGGRESSIVE = rapid vertical growth with little to no radial growth - inflammed nodule
Treatment: wide surgical excision with clear margins, elective regional lymph node dissection, chemo, immunotherapy, follow up every 3 months
- Staging determines thickness and DEPTH OF PENETRATION
- ulcerated = worse prognosis
ABCDs A - asymmetry B - irregular borders C - variegated color D - diameter >6mm
Mycosis fungoides (cutaneous T cell lymphoma)
localized erythematous patches or plaques on trunk
pruritic with lymph node swelling
Treatment: biopsy
Measles (Rubeola)
etiology: Paramyxovirus
contagious via droplets (even after person leaves room)
3 C’s = cough, coryza (nasal inflammation), conjunctivitis
Koplik spots - white tiny papules on buccal mucosa
spreads head to toe and coalesces
Complications: diarrhea, otitis media, pneumonia, encephalitis
Treat symptoms
Erythema infectious (5th disease)
etiology: Parvovirus B-19
transmitted via droplets
non-specific flu-like before rash
malar rash - “SLAP CHEEK”
“LACY” body rash on extensor surfaces
Complications: transient aplastic crisis (anemia) requiring blood transfusion
HYDROPS FETALIS - increased fluid while pregnant may cause fetal loss
Rubella (German measles)
etiology: rubella virus
transmitted via droplets
erythematous papules/purpura
“3 day measles”
head to toe progression
arthritis in adults
Complications: congenital rubella syndrome (LETHAL) - “BLUEBERRY MUFFIN” appearance, hearing loss, mental retardation, CV and ocular defects
Roseola infantum
etiology: most commonly herpes virus 6 transmission sporadically (mostly infants)
3-5 days high fever with ABRUPT END followed by blanching erythematous maculopapular rash spreading from neck to trunk THEN face and extremities
Treat supportively with antipyretics
Hand, Foot and Mouth
etiology: Coxsackie A16 virus
mostly children
transmission usually fecal-oral
sore throat and vesicles on buccal mucosa
vesicles on hands, feet and butt that may create ulcers
Complications: decreased oral intake, dehydration, ASEPTIC MENINGITIS
Treatment: prevent with good hygiene, lidocaine gel for adults
Molluscum contagiosum
etiology: POX virus
very contagious transmitted via direct physical contact or with contaminated fomites
autoinoculation
pearly papules with UMBILICATION (2-5mm)
usually spontaneously resolves 6-12 months
treat if in genital region –> cryo, curettage, cantharidin (causes blistering - good for children)
Condyloma Acuminatum (genital warts)
etiology: HPV
transmitted via sexual contact
cauliflower-like lesions
pruritic
perinanal growth
Treat with topical cream or surgery
Verruca Vulgaris (common warts)
etiology: HPV
more common in children/young adults
transmitted via skin-to-skin contact
raised, rough surface lesions
tiny pigmented thrombosed capillaries
common on hands and feet (plantar)
spontaneous resolution in 1-2 years (recurrence common)
*15 blade scrape off prior to treatment
duct tape
Varicella (Chicken Pox)
etiology: varicella-zoster virus (VZV), a herpes virus
transmitted via droplets or direct contact
highly contagious
generalized pruritic vesicular rash
crusts over in 6 days (no longer contagious)
3 STAGES: papule –> blister –> ulcer
Complications: group A strep, encephalitis
Herpes zoster (Shingles)
etiology: varicella-zoster virus (VZV)
reactivation of latent VZV from dorsal root ganglia
more common in elderly or immunocompromised
acute neuritic pain 3-5 days prior to eruption
pruritic, allodynia, fever
DERMATOMAL DISTRIBUTION (usually thoracic)
grouped vesicles on a erythematous base
usually resolves 2-6 weeks
Complications: POST HERPETIC NEURALGIA (PHN)
HERPES ZOSTER OPTHALMICUS (HZO) - sight-threat
Treatment: start early with antivirals –> famciclovir, valacyclovir
Herpes Simplex Virus (HSV)
HSV-I (herpes labialis)
HSV-II (herpes genitalis)
virus remains remains latent in nerve root ganglion following primary infection
GROUPED VESICLES ON AN ERYTHEMATOUS BASE
crusting at later stages
burning, tingling, pruritic
Treatment: start early with antivirals (same as shingles)
Acanthosis Nigricans
hyperpigmented VELVETY plaques
commonly neck and skin folds
more in Hispanic, AA, Native Americans
Treat underlying condition –> obesity, diabetes
Melasma
acquired hyperpigmentation
melanocytes increase pigment when stimulated by UV light or increased hormone levels
“MASK OF PREGNANCY”
Lipomas
subcutaneous soft-tissue tumors
benign, soft and mobile
surgical removal
Epithelial inclusion cyst
cutaneous cyst
soft, mobile nodule –> fluctuant
often central puncture that starts to drain
Tinea capitis
etiology: tricophyton and microsporum species
risk factors: decreased personal hygiene, overcrowding, low SES
acquired via direct contact or with contaminated fomites
scaly patches with alopecia
kerion - boggy, edematous painful plaque
favus - yellow crusts “honeycomb”
KOH prep - “spaghetti and meatballs” - spores and hyphae
dermscopy - hair grows in tortuous manner
Treatment: fluconazole, itraconazole (oral antifungal)
Tinea corporis (ring worm)
etiology: T. rubrum
common in athletes with skin-to-skin contact
pruritic, annular, erythematous plaque
central clearing
advancing border
scaling across the top
KOH prep
Treatment: topical antifungals (-azole)
- nystatin doesn’t work
- do NOT treat with topical steroids –> changes appearance and doesn’t work – can cause skin atrophy/striae
Tinea cruris (jock itch)
etiology: T. rubrum
usually from auto inoculation of tinea pedis or onychomycosis
well-marginated, annular plaque with scaly raised border
inguinal fold to inner thigh (scrotum typically spared)
pruritic and painful
KOH prep
Treatment: topical antifungals, daily talcum powder
Tinea pedis (“athlete’s foot”)
etiology: T. rubrum
acute - self-limited, pruritic, painful vesicles/bulla after sweating
chronic - slowly progressive with erosions/scales between toes and interdigital fissures
KOH prep
Treatment: topical antifungals, oral (ie. fluconazole), proper footwear
Onychomycosis
etiology: T. rubrum or candida (yeast)
4 subtypes:
- Distal subungual (most common) - discoloration starts distally and spreads to cuticle
- Proximal subungual - opposite of distal
- White superficial - dull, soft white spots that can be scraped off for sample
- Yeast - thickening of nail with yellow/brown discoloration sometimes accompanied by paronychia
KOH prep
Treatment: oral terbinafine or fluconazole
*check liver function because meds can be hard on liver
Candidal Intertrigo
infectious or noninfectious inflammatory condition of 2 closely opposed (intertriginous) skin surfaces
erythematous, macerated plaques and erosions
pruritic
SATELLITE papules/pustules
KOH prep
Treatment: nystatin, topical or oral antifungals, weight loss
Tinea Versicolor (pityriasis versicolor)
etiology: malassezia – normal skin flora that becomes pathologic
risk factors: tropical climates, hyperhidrosis, genetics
macules, patches, plaques on trunk and UE
hypopigmentation, hyperpigmentaion or erythematous
typically asymptomatic
KOH prep or Wood’s Lamp (fluorescence)
Treatment: topical or oral antifungals
Acne Rosacea
common skin disorder on central face persisting for months, not well understood
Subtypes:
1. erythematotelangiectatic - flushing and skin sensitivity
treat with light therapy and behavior modifications (avoid triggers)
- papulopustular - papules and pustules on central face with inflammation
treat with topical or oral -cyclines and -mycins - phymatous - tissue hypertrophy with irregular contours (mostly on the nose)
treat with surgery - ocular (50% of rosacea cases) - may precede, coincide or follow other rosaces –> dry eyes, pain, pruritic, blurry vision, etc.
treat with referral to ophthalmologist
Triggers: emotions, alcohol, sunlight, exercise, cosmetics, etc.
Scabies
etiology: host-specific mite
transmission via direct contact
host harbors, excavates a BURROW in stratum corneum to lay eggs that then hatch in 10 days
initial lesion/burrow
severe pruritis, worse at night
primarily webbed spaces and groin (spares back and head)
Immunocompromised = CRUSTED SCABIES
Treatment: scabicide repeated in 1-2 weeks (eggs hatch)
antihistamines for itching
Bee stings
etiology: Hymenoptera species
*remove stingers ASAP
can cause anaphylaxis –> treat with IM epinephrine
local rxn - swelling and erythema for 1-2 days
treat with cold compress
large local rxn - exaggerated erythema and swelling resolves in 5-10 days
treat with cold compress, prednisone, NSAIDs, antihistamines
secondary bacterial infection = worse symptoms 3-5 days post sting that may cause fever and should be treated with antibiotics
Spider bites
Widows
blanched circular patch with red perimeter
central punctum
venom triggers catecholamine release –> sweating, N/V, h/a, ab pain, muscle spasms
TREAT - antiemetics, local wound care, tetanus
Recluse
specific geographical region
known for ulcerative necrotic bite –> dark, depressed center 1-2 days post-bite
painless initially followed by severe pain 2-8 hours later
usually resolved in 1 week
Hobo
no deaths or necrosis
not aggressive or found in the house
Vitiligo
acquired skin depigmentation via autoimmune process against melanocytes (none found in epidermis)
onset 20s-30s –> family history plays a role
milk-white macules with well-defined borders
slowly progressive
spontaneous repigmentation in 10-20%
Treatment: corticosteroids, UV light, skin grafts
Hidradenitis Suppurativa (acne inversion)
chronic inflammatory skin disorder involving the hair follicle
follicular occlusion –> follicular rupture –> associated immune response
inflammatory nodules
sinus tracts (2 lesions connect)
scarring
comedones (black heads)
Treatment: weight loss/diet, smoking cessation, hygiene, corticosteroids, retinoids, antibiotics
Complications: fistulae, SCC, depression/suicide, lymphatic obstruction
Atopic dermatitis (eczema)
type I hypersensitivity reaction (IgE mediated)
“the itch that rashes” - pruritic
ATOPIC TRIAD:
atopic dermatitis
sinus rhinitis (hay fever)
asthma
ill-defined erythematous scaly patches (mild)
edematous papules and vesicles (severe)
infants = face, scalp and extensor surfaces adults = flexor surfaces, hand/feet
Complications: excoriation, lichenification, painful fissures, secondary cellulitis
Treatment: avoid triggers, rubbing/scratching, use emollients, antihistamines prn pruritis, topical steroids if necessary
Lichen simplex chronicus
secondary skin condition from excessive scratching or rubbing
dry,leathery appearance with pigmentation
common on back of neck, wrists, forearms, lower legs
Treatment: topical steroids and moisturizers
Dyshidrotic eczema
deep-seated vesicles with TAPIOCA appearance
coalesce and rupture
80% on hands
INTENSELY PRURITIC
emotional stress and hot weather triggers
Keratosis pilaris (“chicken skin”)
keratinization disorder
horny plugs in hair follicles
rough, raise papules
improves with age
Treatment: scrubs, topical retinoids, salicylic acid
Contact dermatitis
Allergic
delayed hypersensitivity (ie poison ivy, nickel, latex)
linear appearance with lots of vesicles
TREAT with bacitracin
Irritant (80%)
repeated friction/mechanical irritation (i.e. water, detergents, saliva, etc)
treat with bland emollient (oil based)
Seborrheic Dermatitis
yeast
mild dandruff to more extensive inflammatory dermatitis
Infants - yellow, greasy scales “CRADLE CAP”
Adults - greasy scales and yellow-red coalescing macules, patches and papules
Treatment: Selenium sulfide or ketoconazole shampoo
Pityriasis Rosea
benign VIRAL skin eruption
large primary patch on trunk - “HAROLD PATCH”
secondary rash of fine scaled papules and plaques 1-2 weeks later in a “CHRISTMAS TREE” pattern
Treatment: self-limiting goes away in 6-12 weeks, oral antihistamines (ie. claritin, zyrtec, benedryl) to help symptoms
Lichen Planus
4 P’s - purple, pruritic, polygonal, papules
50% mouth, wrists, back, shins, scalp
WICKAM’S STRIAE = fine white lines on top of plaques
Treatment: topical or oral steroids, self-limiting 18 months
Psoriasis
chronic, recurrent, hyper proliferative skin disease
thickened red plaques with silvery scale
pitted nails, onycholysis, “OIL SPOTS”
Comorbidities: IBS, heart disease, metabolic syndrome
Vulgaris (most common)
AUSPITZ SIGN - removal of scale = punctate bleeding
KOEBNER PHENOMENON = plaques develop in areas of skin injury
Treatment: depends on type and severity sunshine/baths/emollients/rest
oral steroids = worse flare-up upon discontinuation
coal tar
phototherapy and Vit D analogs
retinoids
Discoid Lupus
purple-red plaques and scales with spiny projections when scale is removed
may see permanent hair loss or loss of pigmentation
lesions well-localized on head, neck, face and ears
Labs: ANA, double stranded DNA
Treatment: protect from sunlight and photosensitizing drugs (tetracyclines), injectable steroids into lesions once a month
Porphyria Cutanea Tarda
sub-epidermal blistering of skin on DORSUM of hand
may be associated with ingestion of estrogens, liver disease or hepatitis
Treatment: phlebotomy, stop potential meds, sun protection
Folliculitis
commonly caused by Staph aureus
pustules with hair growing out of them
pruritic and burning
complication: abscess
Treatment: antibiotics
Erythema migrans
pathogenesis: Borrelia burgdorferi
rash 3-32 days post tick bite (Lyme disease)
slightly raised, warm red with central clearing “TARGET”
Treatment: systemic antibiotics (ie. amoxicillin)
Erythema multiforme
immunologica reaction caused by circulating immune complexes
viral, bacterial, fungal, or drug eruption (typically NSAIDs, antibiotics or sulfonamides)
TARGET lesions
Treatment: symptomatic with either topical or systemic steroids, anti-viral if indicated
Erysipelas
B. hemolytic streptococci
superficial form of cellulitis seen on cheeks
pain, malaise, chills
edema, warm to touch, spreading and well-circumscribed papule/plaque
Treatment: IV antibiotics against Group A strep and staph
*can become toxic if not treated quickly
Cellulitis
bacterial infection of staph or group A strep
*deeper than erysipelas –> diffuse spreading
at risk: venous insufficiency and DM
swelling and STREAKING erythema and pain
Treatment: oral or IV antibiotics
Impetigo
bullous - intraepidermal bacterial infection of skin caused by Staph
non-bullous (most common) - lesions begin as papules and progress to vesicles with erythema
auto inoculation with satellite lesions
YELLOW CRUST appears over ruptured bull
Treatment: topical antibiotics (ie Bactroban), oral antibiotics (ie Dicloxicillin)
Toxic Epidermal Necrolysis
similar to Stevens-Johnson syndrome, but affects skin surface more (30% vs 10%)
caused by meds
bullae and SLOUGHING off of epidermal layers
Dermatitis Herpetiformis
intensely pruritic vesicular disease
IgA deposits in dermal papillae
75% have GLUTEN SENSITIVITY
Treatment: Dapsone
Pressure ulcers
pressure of soft skin over bony prominences causing ulcerations
best treatment is PREVENTION
categorized by stages 1-4
Hormonal effects on skin
Glucocorticoids
atrophy, striae, purpura
moonface/buffalo hump (Cushing’s disease)
ACTH adrenal failure (Addison's disease) causing hyper pigmentation of the skin especially the gingiva
Androgens (effects pilosebaceous unit)
increased sebum, acne, androgen alopecia and hirsutism
Growth hormone
epidermal hyperplasia and hyperpigmentation
Insulin-resistant DM Acanthosis nigricans (velvety)
Norepinephrine
profuse sweating
Thyroid hormone excess (hyperthyroidism and Grave’s Dss)
warm moist skin
pretibial myxedema - thickening of skin on anterior tibia
Hypothyroidism
dry cool skin and generalized thickening
Parathyroid hormone metastatic calcification (rare)
