Hair/skin/nails

Question 1

What tinea conditions requires systemic treatment?

Answer 1

Tinea capitis - systemic treatment is needed to penetrate into the hair shafts

Question 2

What are the recommended topical treatments for plaque psoriasis?

Answer 2

Vitamin D and high-potency corticosteroids were equally effective when compared head to head, but the corticosteroids produced fewer local reactions.

Question 3

What is the treatment for rosacea? (Rosacea is a relatively common condition seen most often in women between the ages of 30 and 60. Central facial erythema and telangiectasias are prominent early features that may progress to a chronic infiltrate with papules and sometimes sterile pustules. Facial edema also may occur.)

Answer 3

Management includes avoidance of precipitating factors and use of sunscreen. Oral metronidazole, doxycycline, or tetracycline also can be used, especially if there are ocular symptoms. These are often ineffective for the flushing, so low-dose clonidine or a nonselective β-blocker may be added. Topical treatments such as metronidazole and benzoyl peroxide may also be effective, particularly for mild cases.

Question 4

What is first line treatment for lichen planus?

Answer 4

A high-potency topical steroid, such as clobetasol or betamethasone

Question 5

What is the natural pattern of hair cycling?

Answer 5

The recycling of scalp hair is an ongoing process, with the hair follicles rotating through three phases. The actively growing anagen phase hairs give way to the catagen phase, during which the follicle shuts down, followed by the resting telogen phase, during which the hair is shed. The normal ratio of anagen to telogen hairs is 90:10.

Question 6

What is telogen effluvium?

Answer 6

A non-scarring, shedding hair loss that occurs when a stressful event, such as a severe illness, surgery, or pregnancy, triggers the shift of large numbers of anagen phase hairs to the telogen phase. Telogen phase hairs are easily shed. Telogen effluvium occurs about 3 months after a triggering event and hair loss lasts 6 months after the removal of the stressful trigger.

Question 7

What is anagen effluvium?

Answer 7

The diffuse hair loss that occurs when chemotherapeutic medications cause rapid destruction of anagen phase hair.

Question 8

What is Behçet’s syndrome?

Answer 8

The original description of Behçet’s syndrome included recurring genital and oral ulcerations and relapsing uveitis. It is more common in Japan, Korea, and the Eastern Mediterranean area, and affects primarily young adults. The cause is unknown. Two-thirds of patients will develop ocular involvement that may progress to blindness. Patients may develop arthritis, vasculitis, intestinal manifestations, or neurologic manifestations. This disease is also associated with cutaneous hypersensitivity; 60%–70% of patients will develop a sterile pustule with an erythematous margin within 48 hours of an aseptic needle prick.

Question 9

What is the first line treatment for alopecia? (Autoimmune disease)

Answer 9

The initial treatment of choice for patients older than 10 years of age, in cases where alopecia areata affects less than 50% of the scalp, is intralesional corticosteroid injections.

Question 10

What is the most efficacious treatment for fungal nail infections?

Answer 10

Continuous therapy with oral terbinafine for 12 weeks has the highest cure rate and best long-term resolution rate

Question 11

What is the treatment for granuloma annulare (annular rash on the dorsum of the hands)?

Answer 11

No treatment (self-limited) or injected/topical corticosteroids may be used.

Question 12

What are potential causes of erythema multiforme?

Answer 12

Herpes simplex, Mycoplasma pneumonia, certain medications, and vaccines.

Question 13

What is Imiquimod (Aldara) FDA approved for?

Answer 13

External genital and perianal warts in patients 12 years of age and over. It has off-label use for other types of warts and molluscum contagiosum

Question 14

What is the preferred biopsy technique for a skin lesion suspicious for melanoma?

Answer 14

An elliptical excision with a small margin of normal-appearing skin. Adequate depth is necessary, as staging is based on depth.

Question 15

What is the recommended treatment for atopic dermatitis?

Answer 15

Emollients are a mainstay of chronic therapy for atopic dermatitis, but topical corticosteroids are the first-line treatment for flare-ups.

Question 16

What are high risk body areas for reoccurrence for basal cell carcinoma after removal (these areas should have Mohs micrographic surgery)?

Answer 16

High-risk locations include the “mask” areas of the face, which include the central face, eyelids, eyebrows, periorbital area, nose, lips (cutaneous and vermilion), chin, mandible, preauricular and postauricular skin/sulci, temple, and ear. Other high-risk sites include the genitalia, hands, and feet. Moderate-risk locations include the cheeks, forehead, scalp, and neck.

Question 17

What is the only FDA-approved oral treatment for papulopustular rosacea?

Answer 17

Subantimicrobial dosage of doxycycline (40 mg daily). This does not contribute to antibiotic resistance, even when used over several months, and is better tolerated than higher dosages. Can also use topical agents like azelaic acid.

Question 18

What treatment regimen has the highest cure rate for onychomycosis?

Answer 18

Terbinafine daily for 12 weeks

Question 19

What is the disease course of granuloma annulare?

Answer 19

It is generally self limited and will resolved within 2 years without treatment.