Infestation Bites and Stings

Question 1

Creeping eruption that does not penetrate the dermis, migrates 1-2 cm per day. Found in the intestine of dogs and cats, usually in warm, sandy climates.

Answer 1

Cutaneous Larva Migrans

Question 2

What medications treat Cutaneous Larva Migrans?

Answer 2

Antihistamines of symptomatic Itch.
Albendazole, Ivermectin
DOC- Thiabendazole all NOT for Pregancy.

condition is self limiting, and will resolve on its own in 4-6 weeks.

Question 3

Why shouldnt you perform punch biopsy of Cutaneous Larva Migrans?

Answer 3

the larva travel, odds are you will miss

Question 4

Pruritic, threadlike erythematous plaques

Answer 4

Cutaneous Larva Migrans

Question 5

Transmitted by sand flies.
Raised edges with central crater, often painless, regional adenopathy

Answer 5

Leishmaniasis

Question 6

With Leishmaniasis, what should you do if the infection is close to the mucosal?

Answer 6

TREAT SYSTEMICALLY

Question 7

inflammation at lateral and proximal nail folds
< 6 weeks usually one finger
digital pressure test can help with dx

Answer 7

acute paronychia

Question 8

Acute paronychia treatment;

Answer 8

warm soaks with vinegar
c/s
i&D of nail
mupirocin

Question 9

chronic onycholysis w/ black-blue-green discoloration
P. aeuginosa
triad of discoloration, distal onycholysis and proximal paronychia

Answer 9

green nail syndrome

Question 10

Dermatophyte Onychomycosis treatment

Answer 10

oral terbinafine 250mg q day, 6 wk for finger, 12 wk for toes
baseline liver function, repeat after one month of treatment.

Itraconazole 2nd line
200mg q day, 6 week for fingers, 12 week for toes
baseline liver function test, repeat after one month of treatment

topical therapy- ciclopirox, efinaconazole, tavaborole

Question 11

Yeast Onychomycosis

Answer 11

1st line itraconazole
2nd line terbinafine

Question 12

ABCDEF guidelines of pigmentation of nail

Answer 12

age 40-70 years;african, jap, chines, na
brown black band >3mm with variegated borders
change or lack of change in the nail band
digit most commonly involved (thumb, great toe, index finger)
extension of discoloration into skin surrounding nail (Hutchinson’s sign)
Family or personal history of Melanoma

Question 13

dermoscopy black dots in the scalp due to the hair being broken at the level of the scalp

Answer 13

alopecia areata
dissecting cellulitis
tinea capitis

Question 14

dermoscopy- yellow dots from accumulation of keratotic material or sebum on scalp

Answer 14

alopecia areata
DLE
male/female pattern hair loss

Question 15

fibrotic white dots on dermoscopy on scalp

Answer 15

CCCA

Question 16

If you suspect scarring vs non scarring alopecia

Answer 16

2 biopsy

Question 17

Labs for Hair Loss

Answer 17

THS, serum iron/ferritin, rpr to r/o syphillis

free and/or total testosterone and DHEA (must d/c ocp 2 months prior to lab work)

TE- cbc w/ diff to r/o anemia, cmp to r/o underlying disease & ths and iron studies

alopecia areata tsh, total and free t4 & 3 due to link to autoimmune thyroid disorder

Question 18

treatment of Alopecia areata

Answer 18

1st line ILK
2nd line- topical anthralin and diphenylcycopropenome

Question 19

treatment of Male pattern hair loss

Answer 19

1st line minoxidil topical, finasteride 1mg q day ( may take 12 months to see effect, must be continuued to maintain )