exam 2 - derm Flashcards
Common diagnoses in primary care
- acne
- dermatitis
- pyoderma
- tinea
- benign neoplasm
- candida
- eczema
Most prescribed meds in primary care for derm
- antihistamines
- topical anti-infectives
- adrenal corticosteroid
Why don’t we treat skin disorders with steroids and antifungals
- often times steroids will exacerbate tine and fungal presentations
Steroids: Class 1 vs Class 7
- Class I: super potent
- class 7: very low potency
Steroid: class 1
- clobetasol propinate
Steroid for hands/soles of feet
- high potency, class I: clobetasol propinate
Steroids for armpits, face, groin
- low potency, class 7: desonide
steroid vehicles (less potent to most potent)
lotion (less potent)
gel
cream
ointment (most potent)
Steroid go-to’s
Super potent - clobetarol
med-high: triamcinolone
low: desonide
General rash: chemicals and chronic illness
Chemicals: contact dermatitis (skin has touched something causing rash)
Chronic illness (dermatitis hepetiformis, seborrheic dermatitis)
- Seborrheic
dermatitis:
eyebrows, folds of nose, ears, chest; manageable not curable.
Tx: anti fungal topical - ketoconazole
Insect and arthropod exposure + occupational exposures
- insect bites
- Lyme disease - tx: doxy
- Rickettsialpox
- Rocky mtn spotted fever (small spots, blisters, hands, wrists, feet)
- scabies
Occ exposures: contact dermatitis –> RNs washing hands
Rash: plant exposures, sexual hx, travel
plant: contact dermatitis
Sexual hx: HiV acute exanthem, secondary syphyllis (cankers, palmar rash)
Travel: insect bites, Lyme disease, rocky mtn spotted fever, rickettsialpox
Recent Systemic Sx: Fever
- 5th disease
- HIV acute exanthem
- Kawasaki
- Meningococcemia
- Roseola
- Rubeola
- Scarlett fever
- Varicella
- Viral exanthem
Pinpoint Lesion
- folliculitis (inflame of hair follicle –> bacteria can be involved)
- keratosis pilaris (over production of sebum, kids often grow out of it)
- scarlet fever (scarletina rash –> looks like goosebumps)
1mm - 1cm lesions
- guttate psoriasis
- insect bites
- lichen Planus
- milaria rubra
- Rocky Mountain spotted fever
- roseola
- rubella
- scabies
- varicella
1-25 cm lesions
- lyme disease
- nummular eczema (coin)
- tine corporis (fungal, annular, circumscribed red raised borders)
- urticaria
Variable-sized lesions
- atopic dermatitis
- contact dermatitis
- drug eruption
- erythema multiforme
- fifth disease
- HIV acute exanthem
- Kawasaki disease
- pityriasis rosea
- meningococcemia
- plaque psoriasis
seborrheic dermatitis - secondary syphilis
- SJS
- toxic epidermal neecrolysis
- viral exanthem, non-specific
- staph scalded skin syndrome
Erythrodermic lesions
- atopic dermatitis
- drug eruption
- plaque psoriasis
- sezary syndrome –> T-cell lymphoma
- TSS
Generalized rash w fever (viral infections that manifest into rash)
- 5th disease
- Measles
- Roseola
- Erythema multiforme
- Scarlet fever
Generalized rash with bullae
- can lead to dehydration
TENS - denuding of skin, secondary to drugs - sulfa
Bullous Pemphigold - elderly, risk of infection
tx: systemic corticosteroid
SJS - denuding of the skin secondary to drugs - sulfa
Generalized red rash with pustules
- pustular eruptions after chlorpromazine
- generalized pustular psoriasis
skin biopsy
generalized rash with vesicles
- disseminated herpes simplex complex (immunocomp)
- vesicular drug reaction
- varicela
varicela
- earlier in life
- unilateral, does not cross center of body
- follows dermatomes
Tx: antivirals - famcyclovir - 48-72 hours after onset to decreased chance of postherpetic neuralgia
generalized red rash with scaling
erythroderma
Generalized wheals and soft-tissue swelling
- severe angioedema (idiopathic, ACEIs)
- urticaria (idiopathic)
Hives tx: antihistamines, corticosteroids
generalized purpura
- purpura fulminans (at risk for DIC)
- purpuric drug eruption
- petechiae due to thrombocytopenia (low PLTs)
Generalized palpable purpura
- vasculitis –> systemic
underlying inflammation - leukocytoclastic vasculitis
- infective endocarditis
Multiple skin infarcts - systemic issues
- meningoccemia
- gonococcemia
- DIC
Localized skin infarcts
- warfarin infused skin necrosis
- atheroembolism
- thromboangiitis obliterans
distal ends
facial inflammatory edema w fever
- Erysipelas
similar to cellulitis, but instead of thicker infection, limited to just epidermis of skin. possible fever. Bacterial infection (ABX) - Systemic lupus erythematosus (SLE)
Malar rash
