Green PANCE book :) Flashcards
What is the first step in an accurate diagnosis of skin disease?
Thorough history!
What should be investigated as part of the history?
Past medical history, medication history, family history, psychological factors, recreational and employment risk, and diet and environmental/travel exposures
What is the Darier sign?
Rubbing a lesion causes urticarial flare
What is the Auspitz sign?
Pinpoint bleeding after a scale is removed
What is the Nikolsky sign?
Pushing a blister causes further separation of the dermis
What is the Photopatch test?
Documents photoallergy
Patch test?
Demonstrates hypersensitivity reaction
Koebner phenomenon?
Minor trauma leads to new lesions at site of trauma
How is Diascopy performed?
Glass slide or diascope pressed against the skin
What are the results of diascopy?
Blanching indicates intact capillaries; extravasated blood (purpura) does not blanch
What does a KOH prep affect?
Dissolves keratin and cellular material but does not affect fungi
What does KOH prep identify?
dermatophyte infection
How do you prepare a Potassium hydroxide preparation (KOH prep)?
Microscopic examination of skin scrapings mounted in KOH
What type of instruments facilitate specimen collections?
Blunt and sharp instruments
What type of examination is used to assess changes in pigment or fluoresce infectious lesions?
Wood’s light examination
What is the MAD criteria?
How to describe a lesion; M: morphology, A: arrangement, D: distribution
What is Shagreen skin?
Oval-shaped nevoid plague. Skin is colored or pigmented on the trunk or back and is associated with tuberous sclerosis
What is used to facilitate the examination of warts?
Acetowhitening using acetic acid
Which is indicated if pathologic confirmation is necessary?
Biopsy- excisional, incisional, shave or punch
Dilated, small, superficial blood vessel
Telangiectasia
What kind of light should the physical exam be carried out under?
Natural or direct lighting
Thickened skin with distinct borders, often result of excessive scratching or prolonged irritation
Lichenification
Swollen and softened by an increase in water content (appearance when skin left in water too long)
Macerated
Irregular, rough, and convoluted surfaces
Verrucous
Solid, palpable lesion
Papule
Solid, palpable lesion >5mm in diameter
Nodule
Flat, non palpable lesion
Macule
Flat, non palpable lesion >10mm in diameter
Patch
Plateau-like lesion >10mm in diameter, mat be a group of confluent papules
Plague
Circumscribed, elevated lesion containing serous fluid
Vesicle
Circumscribed, elevated lesion containing serous fluid >5mm in diameter
Bulla
Transient, elevated lesion caused by local edema
Wheal
Minute hemorrhagic spots that cannot be blanched by diascopy
Petechiae
Hard, rough surface formed by dried sebum, exudate, blood, or necrotic skin
Crust
Heaped up piles of horny epithelium with a dry appearance
Scale
Vesicle or bulla containing purulent material
Pustule
Defect of the epidermis; heals without a scar
Erosion
Defect that extends into the dermis or deeper; heals with a scar
Ulcer
Are eczema and dermatitis used interchangeably?
YES :)
Caused by chemical irritants, such as cleaners, solvents, and detergents in contact with the skin
Irritant contact dermatitis
What is irritant contact diaper dermatitis?
Diaper rash; due to prolonged contact with urine, feces, or detergents from washable diapers
What bacterial infection is irritant contact diaper dermatitis often associated with?
superimposed Candida infection characterized by satellite lesions
What type if allergy does allergic contact dermatitis denote?
Allergic type IV cell-mediated hypersensitivity reaction
What are the common causes of allergic contact dermatitis?
Occupational or personal contact with irritants, such as cleaning supplies, solvents, oils, abrasives, oxidizing or reducing agents, dust, nickel, enzymes, and plants ( eg poison ivy)
What do patients complain of in contact dermatitis?
Itching and burning in the affected area
What types of acute lesions are seen with contact dermatitis?
Well demarcated areas of erythema and possibly exudative lesions, vesicles, erosions, and crusts may develop
What types of chronic lesions are seen with contact dermatitis?
Plaques and scaling with lichenification. Satellite papules and excoriations are common.
What lab studies will support a diagnosis of contact dermatitis?
Patch test that results in similar reactions
What is the main tx for contact dermatitis?
Avoid/remove the offending agent
A chronic relapsing disorder that occurs in childhood. Type I immunoglobulin E-mediated hypersensitivity reaction..
Atopic dermatitis
What other conditions are seen with atopic dermatitis (triad)?
Asthma and allergic rhinitis
-Papules and plaques (with or without scales) may be associates with edema, erosion, and crusts -Patient complains of pruritus and dry, scaly skin
Atopic dermatitis
What bacteria most commonly causes secondary infection in atopic dermatitis?
Staph aureus
Where on the body is atopic dermatitis most often seen?
Flexural surfaces, neck, eyelids, forehead, face, and dorsum of the hands and feet
Dermatographism is characteristic in which dermatitis?
Atopic dermatitis
What is the treatment for atopic dermatitis?
- Antihistamines to help reduce itching
- Topical corticosteroids are the mainstay of tx
- hydration and topical emollients are key to management
- Avoid: soaps, vigorous rubbing, frequent bathing, and irritant clothing (wool)
Pruitic inflammatory disorder that typically affects young adults and the elderly. Typically occurs in fall and winter.
Nummular dermatitis
Small, grouped vesicles coalesce to form coin-shaped plaques with an erythematous base and clearly demarcated borders most commonly on the extremeties. Crusting and excoritations can occur.
Nummular dermatitis
Tx for Nummular dermatitis?
Responds to moisturizers and topical steroids. Tar baths or UVB phototherapy can be helpful for refractory cases
Dermatitis where sebacious glands are most active (body folds, face, scalp, genitalia). Common during infancy and puberty and in young to middle aged adults
Seborrheic dermatitis
Scattered yellowish or gray, scaly macules and papules with a greasy look. Sticky crusts found behind the ears. Manifests as cradle cap in infants and dandruff in adults.
Seborrheic dermatitis
Tx for seborrheic dermatitis
- Shampoos containing selenium or zinc and ketoconazole shampoo for acute flare ups
- tar shampoo or topical steroids for severe cases
- cradle cap: olive oil compresses and baby shampoo
- UV radiation can also be helpful
Papulopustules form on erythematous bases and may become confluent with plaques and scales. Vermillion border is spared and satillite lesions are common
Perioral dermatitis
What causes perioral dermatitis?
Often young women with a history of prior topical steroid use in the area
What tx should you avoid with perioral dermatitis?
TOPICAL STEROIDS…they caused it silly ;)
Tx for perioral dermatitis?
Topical metronidazole or erthyromycin
Chronic venous insufficiency due to valvular incompetency leads to edema, dermatitis, hyperpigmentation fibrosis, and ulceration
Stasis dermatitis
Who is more often effected by Stasis dermatitis?
Women are 3x more often effected. Pregnancy will exacerbate this
What will a patient complain of in stasis dermatitis?
heaviness or aching in the legs that is aggrevated by standing and alleviated by sitting
Inflammatory papules, scales, and crusts. Stippled pigmentation and excoriations. Ulcerations can be seen in 30% of patients.
Stasis dermatitis
What will confirm chronic insufficiency in stasis dermatitis?
Doppler studies, sonography, or venography
Tx for stasis dermatitis?
- Chronic insufficiency: compression stockings
- Vascular bypass, endothelial thermal ablation, or angioplasty/stenting of obscured veins MAY benefit severly compromised areas
What is lichenification?
Long-term manifestation of atopic dermatitis due to repetitive scratching and rubbing
Well-circumscribed plaques that are highly pruritic. Sets up a cycle of itch-scratch lesions
Lichen simplex chronicus
Solid, firm, thick plaques with little to no scaling. Light touch precipitates a strong desire to scratch. Common areas include nuchal area, scalp, ankles, lower legs, upper thighs, exterior forearms, or genitial areas
Lichen simplex chronicus
What lab studies should be done for lichen simplex chronicus?
- KOH prep to rule out fungal infection
- Biopsy: shows hyperplasia and hyperkeratosis
Management of lichen simplex chronicus
Stopping the itch-scratch cycle. Antihistamines to reduce itching
Tx of lichen simplex chronicus
Occulusive dressing w or w/o topical steroids or tar prep
What is characteristically seen before Pityriasis rosea?
Herald patch
What causes Pityriasis rosea?
Viral (Human herpes virus 7)
What does the herald patch look like?
Solitary, round or oval pink plaque with a raised border and fine adherent scales in the margin. Usually precedes rash by 1 week
Where does the Pityriasis rash start? What does it look like?
Trunk as round or oval, salmon-colored, slightly raised papular and macular lesions usually about 1cm in diameter
What does the distribution of the Pityriasis rosea resemble?
Christmas tree-like distribution
Tx for Pityriasis rosea
Self limiting (usually 3-8 weeks) other than lotions or emoillents for the scales
What prodrome can be seen before the onset of the Pityriasis rosea rash?
Mild URI
Viral disease of the skin and mucous membranes caused by poxvirus
Molluscum contagiosum
Where are lesions commonly seen in adults in Molluscum contagiosum?
Groin areas and lower abdomen
Can Molluscum contagiosum be trasmitted through sexual activity?
YES! Wrap that shit ;)
Delicate, flesh-colored, waxy dome-shaped, umbilicated papules that range in size from 3-6 mm and appear in groups. A white-curd like material can be expressed from under the depression of the lesions
Molluscum contagiosum
What labs should be done for Molluscum contagiosum?
Biopsy may be needed for immunocompromised patients to rule out fungal dissemination
Tx for Molluscum contagiosum
Self limiting, but sometimes local destruction of lesions need to be done in more severe cases
What are the 4 P’s in Lichen planus?
- Purple
- Polygonal
- Pruritic
- Papule
Lesions are flat-topped, shiny, violaceous papules with fine white lines on the surface (Wickham straie). Typically grouped.
Lichen planus
Where does Lichen planus most commonly occur on the body?
Flexor aspect of the wrists, lumbar area, eyelids, shins, and scalp
What phenomenon can be seen with Lichen planus?
Koebner phenomenon
Where can mucosal lesions be seen in Lichen planus?
Vagina, glans, penis, and mouth
What varients can be seen with lichen planus?
Follicular, vesicular, actinic, and ulcerative lesions
What labs are needed to confirm lichen planus dx?
Biopsy and immunofluroescence
What should you screen for with lichen planus?
Hep. C because higher prevelance of anti-hep. C virus antibodies in patients with lichen planus
Tx for lichen planus?
Topical steroids with occlusive dressings
What tx if used for oral lesions in lichen planus?
Cyclosporine mouthwash
What is the tx for severe cases of lichen planus?
- Intralesional steroids or topical tretinion for severe localized lesions
- Systemic therapy
- Psoralens plus Ultraviolet A radiation therapy for generalezed eruptions
Develops in people younger than 40 years old. Eruptions follow stress or occur in hot, humid weather. Half of affected people also have atopic background
Dyshidrotic eczemtous dermatitis
What is seen in early disease of dyshidrotic eczematous dermatitis?
- Pruritis common
- small vesicles in clusters (tapioca-like appearance)
- occasionally bullae form on fingers, palms, and soles
What is seen in late disease of dyshidrotic eczematous dermatitis?
- Papules, scaling, lichenification, and erosions from ruptured vesicles
- painful fissures may develop
- predilection for hands and feet
What labs need to be done with dyshidrotic eczematous dermatitis to rule out other disease?
- Culture to rule out secondary infection
- KOH prep to rule out dermatophytosis
Tx for dyshidrotic eczematous dermatitis?
Wet dressings with Burrow’s solution
Additional tx for more severe dyshidrotic eczematous dermatitis?
- Fissures treated with topical collodion
- topical and severe steroids
- systemic antimircobials if secondary infection
What % of the population is affected by Psoriasis?
2% (3-5 million people)
Chronic, inflammatory, scaling condition of the skin that also may involve the mucous membranes
Psoriasis
What is the pathology of psoriasis?
greatly enhanced epidermal cell turnover (28x normal)
Raised, pink to red papules and plaques with distinct margins and loosely adherent silvery scales
Psoriasis
What sign can be seen with Psoriasis?
Auspitz sign
Where is psoriasis most often found on the body?
Scalp and extensor surfaces of the elbows and knees
What inflammatory dx can occur with psoriasis?
- Psoriatic arthritis in 5-10% of patients
- Involves distal joints of hands and feet, typically asymmetric
- can be seen without skin lesions
How do you dx psoriasis?
History and appearance
What are variants of psoriasis?
Psoriasis vulgaris, psoriatic erythroderma, guttae psoriasis, and pustular psoriasis
What is psoriasis vulgaris?
Most common variant of psoriasis. Involves chronic recurring scaling papules and plaques
What is psoriatic erythroderma?
- lesions involve entire skin surface
- exfoliative amd serious
What is Guttate psoriasis?
- characterized by acute eruption of typical and atypical lesions in a disseminated pattern
- spares palms and soles
- often appears after streptoccal pharyngitis
What is pustular psoriasis (von Zumbusch syndrome)?
- abrupt life threatening condition
- characterized by widespread pustules that coalesce to form lakes of pus
- fever, malaise, leukocytosis
What is tx for mild psoriasis?
Topical corticosteroids and topical Vit. D prep (calcipotriene)
What tx does molderate psoriasis respond to?
Tazarotene gel (topical retinoid)
What tx is used for more serious cases of psoriasis?
UVB phototherapy, PUVA, and methotrexate but carry risks of skin cancer, cataracts,
