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Derm Identification and Treatment > Inflammatory Conditions and Nail Disorders > Flashcards

Inflammatory Conditions and Nail Disorders Flashcards

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Dermatology Board Prep flashcards
1
Q

acne vulgaris

A

disease of sebaceous glands beginning at puberty

-present on face, neck, trunk

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2
Q

follicular thickening

A

hyperkeratosis and thickening of the hair follicle above sebaceous duct–> blockage vs. regular shedding

  • blockage= comedone
  • follicle ruptures into dermis–>inflammatory rxn–>papules, pustules, nodules, and cysts
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3
Q

sebum production

A
  • circulating androgens stimulate, estrogens can suppress
  • sebum formed by gland when cells of gland are broken down/converted into lipids
  • P. acnes, found on normal skin flora, produce lipase–>breaksdown triglycerides–>FFAs
  • FFAs are irritants and comedogenic
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4
Q

open comedomes

A
  • primary lesion

- blackheads (black from oxidation of tyrosine to melanin in follicular orifice

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5
Q

closed comedomes

A
  • primary lesion

- whiteheads

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6
Q

secondary lesions

A

scarring and pitting excoriations

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7
Q

associated findings of acne

A

pain or pruritis, emotional upset and depression

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8
Q

treatment of acne

  1. superficial acne
  2. deep acne
  3. both deep and superficial acne
A

multiple medications; address each patient individually, tailor plan to specific acne; promote good hygiene

  1. topical agents
  2. PO meds
  3. topical and PO meds
    - practice prevention, NOT spot tx
    - once breakout has happened, damage already done, stress pt education
    - if cannot get acne under control–>refer derm
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9
Q

nonpharmalogical tx

A
  • ensure compliance of pt with therapy
  • proper cleansing technique–>wash BID with facial cleanser
  • avoid face creams, cold creams, or any type of grease on face
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10
Q

tx for hormonal deep cystic acne

A

women only

  • spiranolactone 100 mg qday
  • low estrogen oral contraceptives
  • if abx and hormonal approaches fail–>accutane (isotretinoin)
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11
Q

tx of non-hormonal deep cystic acne

A

oral abx or accutane (if abx fail)

  • amoxicillin 500 mg BID
  • minocycline 100 mg BID
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12
Q

tx of surface red bumps and papules acne

A
  • topical abx–>clindamycin soln, lotion, or gel BID

- benzoyl peroxide agent

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13
Q

tx of comedones (black heads and white heads)

A

exfoliating/keratolytic agents: retina A, taxorac, differin qhs to qohs

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14
Q

isotretinoin: function and tx plan

side effects?

A
  • inhibits sebaceous gland function and keratinization
  • tx for 15-20 weeks, than an interval of 6 months, retreat as needed

side effects: teratogenic, hepatotoxic, extreme dry skin, hyperlipidemia

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15
Q

papules and pustules occurring on face often with ERYTHEMA, FLUSHING, and TELANGIECTASIAS

-age 40-70

A

rosacea

tx:
prevention: avoid ETOH, hot beverages etc. (redness)
Topical: metronidazole BID; clindamycin, erythromycin solt.
systemic: abx like acne–>tetracycline, minocycline, doxycycline

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16
Q
  • females>males
  • pruritus or burning
  • discrete or clustered, papules or pustules around the mouth, nasolabial folds
  • may become scaly or superinfected
A

perioral dermatitis

tx: wash gently with mild soap
- metronidazole (metrogel) qhs or BID
- discontinue steroid use
- oral abx: tetracycline 500 mg BID; minocycline 50-100 mg BID
- refer if persistent (patch testing for allergies)

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17
Q
  • inflammatory condition of apocrine gland
  • AUTOIMMUNE condition
  • lesions aseptic
  • part of follicular _____ _____
A 
Hidradenitis Suppurativa
Occlusion Tetrad:
1. acne conglobata
2. pilonidal cyst
3. folliculitis decalvans
4. hidradenitis suppurativa

tx: oral abx (helps inflammation), humira

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18
Q

-one or more nails separated at the hyponycium
-signs of 2ndary infection
Etiology?
If all nails involved?

A

onycholysis: separation of nail from nail bed

Etiology: commonly idiopathic; systemic causes: psoriasis, eczema, tines, poor peripheral circulation

all nails involved: phototoxic rxn or thyrotoxicosis

tx: idiopathic–>resolves spontaneously
2ndary infection: may prevent reattachment
-keep nails clipped as short as possible to reduce further trauma

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19
Q
  • subungual hyperkeratosis, onycholysis, yellow-white in color
  • yellow streaks/yellow oncholytic areas in central portion of nail plate
A

onychomycosis

tx: oral meds (check LFTs)–>lamisil; 3 mo for fingernails and 4 mo toenails
- sporonax: pulse dosing x 3 months
topicals: pen-lac lacquer (Ciclopirox)–> tx for 6 months

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20
Q
  • horizontal trough across nail plate of all nails

- 3 months post-precipitating event

A

Beau’s lines

tx: patient reassurance–>deformity will grow out within 4 months

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21
Q
  • posterior nail fold feels spongy
  • nail becomes more curved
  • distal phalanx enlarges
A

clubbed nail/fingers

tx: important physical sign and cause should be saught-rarely noticed by patient
- pulmonary, CV, and miscellaneous etiologies

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22
Q

concavity of nails

A

Koilonychia
etiology: thinning and softening of nail plate; congenital cause, 2ndary to iron deficiency anemia, Reynaud’s, physical or chemical trauma

tx: treat underlying cause, nails usually return to normal

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23
Q

minute “pits” which occur in a random or uniform pattern across nail plate
-usually all nails affected

A

pitted nails

etiology: inflammatory skin conditions–> psoriasis, alopecia areata, atopic dermatitis 2ndary to parakeratosis

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24
Q

longitudinal depression in the nail

A

habit tic- habitually stroking top of thumb nail

  • can be associated with anxiety
    tx: behavioral modification, occlusion of nail preventing occurrence
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25
Q

white spots on nails

A

leukonychia- common complaint

etiology: 2ndary to nail trauma
- NO association with Ca deficiency

26
Q

red or brown pigmented, linear, splinter-like lesions

A

splinter hemorrhages: tiny subungual hemorrhages

etiology: most commonly trauma, can be associated with SLE, endocarditis

27
Q

brown nails

A

nail hyperpigmentation

etiology: most commonly from dyes (textile workers), nicotine, or other meds

28
Q

splitting of nail into its component layers

A

lamellar nail dystrophy

etiology: 2ndary to repeated wetting and drying out of nails
tx: reassurance! reinforce gloves while immersing nails in water

29
Q

proximal 2/3 of nail plate is white and the distal 1/3 normal pink nail bed

A

Terry’s nails: rare

etiology: CHF, hypoalbuminemia

30
Q

malignant melanoma vs. nail trauma

A

inspect nail fold for Hutchinson’s sign: black discoloration of proximal nail fold at base of pigmented streak = melanoma

31
Q

abnormal, delayed rxn to sunlight exposure

A

polymorphic light eruption–>1st exposure to sun of the year–>autoimmune

tx: mid-potency topical steroids

32
Q
  • erythema and blistering of hand

- common with travelers to tropical destinations drinking citrus drinks

A

phytophotodermatitis: cutaneous phototoxic inflammatory eruption

33
Q

common inducers of drug-induced photosensitivity

A

tetracyclines, fluoroquinolones, NSAIDs, diuretics, retinoids
(counsel pts when putting them on these meds)

34
Q

drug eruption: skin sxs, labs, txs.

A

-can mimic a wide range of dermatoses

skin sxs: morbilliform, urticarial, papulosquamous, pustular, and bullous

labs: CBC, CMP, ANA, punch biopsy
tx: DISCONTINUE drug
- antihistamines for pruritus and urticaria
- epi for emergency
- corticosteroids for severe cases

35
Q

a drug eruption can turn into?
skin sxs?
labs?
tx?

A

erythema multiforme: acute, self-limited, and sometimes recurrant type IV hypersensitivity reaction

skin sxs: lesion development over 10 days; macule–>papule–>vesicle–>bullae in center of papule, dull redness, TARGETOID LESIONS

labs: HSV viral cx if indicated, biopsy to confirm dx
tx: drug discontinuation; oral acyclovir; severe cases: prednisone

36
Q

erythema multiforme

drug causes
infection causes
other

A

drug: sulfonamides, phenytoin, barbiturates, penicillin, allopurinol

infection: s/p HSV infections, mycoplasma
- idiopathic

37
Q
  • generalized pruritis precede rash by several days

- severe mucocutaneous papules/vesicles develop to desquamation

A

-steven-johnson syndrome (<10% epidermal detachment)

-toxic epidermal necrolysis
>30% detachment

38
Q

steven-johnson syndrome/toxic epidermal necrolysis

Causes:

  1. drugs
  2. genetic factors
  3. infectious causes
A
  1. phenytoin, barbiturates, valproic acid, carbamazepine, sulfur derivatives (bactrim)
  2. HLA antigens
  3. HSV, HIV, coxsackie, influenza, hepatitis
39
Q

steven-johnson syndrome/toxic epidermal necrolysis

  1. describe general sxs: prodrome vs. syndrome
  2. labs
  3. tx
A
  1. prodrome: cough, HA, malaise, arthralgias
    Syndrome: inflammation and desquamation of oral mucosa, esophagus, pharynx, larynx, anus, vagina, urethra, sometimes severe ocular sxs
  2. TNF-alpha, IL-2, IL-6, CRP, biopsy
  3. agent withdrawal (if drug induced); admission; oral/IV prednisone; fluid management
40
Q
  • large 3.0-20 cm deep seated subcutaneous nodules
  • only appreciated on palpation
  • bilateral on pretibial surfaces, possibly knees/arms, rarely face/neck
  • usually in women and due to oral contraceptives
A

erythema nodosum- inflammation in fat

tx: tx underlying condition
- when symptomatic: bedrest or compression stocking
- NSAIDs, salicylates for 2-4 wks
- systemic steroids (when you know cause and infections are excluded)

41
Q
  • present for < 30 days

- large, transient wheals

A

acute urticaria

antihistamines, avoid triggers

42
Q

large transient wheals for >30 days

A

antihistamines, mast cell stabilizers, and prednisone

43
Q

direct pressure on the skin–>urticaria secondary to an exaggerated response of the skin to trauma resulting in histamine release from mast cells

A

dermatographism

condition ultimately resolves, but can take yrs

44
Q

ordinary urticarial swellings that are more paindul and pruritic after prolonged pressure

A

pressure urticaria

recovery spontaneous

45
Q

same as urticaria except involves the deep dermis and subQ tissue

A

angioedema

46
Q

dermal papules and annular plaques

A

granuloma annular

tx: topical vs. intralesional steroids

47
Q
  • velvet-like hyperkeratosis
  • insulin-induced
  • most common on peripheral neck and flexural areas
A

acanthosis nigricans

tx: keratolytics

48
Q

cholesterol deposition at medial canthus/upper eyelids

A

xanthelesma

not easily treated

49
Q
  • NON-blanchable small-vessel vasculitis
  • RA, IBD, SLE have been implicated
  • skin often asymptomatic, pts may report itching, burning, pain
A

hypersensitivity vasculitis

tx: underlying condition if one is determined
leg elevation and compression

50
Q

-descending vasculitis, usually after a strep infection

A

Henoch-Schoenlein Purpura

tx: abx if followed bacterial infection

51
Q

irregular plaques and patches of orange-brown pigmentation on lower limbs

A

Schaumberg’s disease

tx: none, leg elevation and compression can slow progression

52
Q

-lesions feel “wooden”

A

morphea
-localized collagen deposition

tx: often self-limited; topical steroids

53
Q
  • chronic inflammatory condition mostly affecting genital areas
  • can obliterate vaginal structures–>atrophy and band-like sxs
A

lichen sclerosis

tx: high potency topical steroids and refer to OBGYN

54
Q

autoimmune-mediated depigmentation

A

vitiligo

tx: if lesions <6 mo old, can usually re-pigment using topical steroids or protopic ointment

55
Q

grouped excoriations, urticarial plaques, papules, and vesicles on the extensor surfaces of elbows, knees, buttocks, and back

A

dermatitis herpetiformis

tx: gluten avoidance–>improvement of skin sxs can take several months

[autoimmune blistering disorder assoc. w/ gluten-sensitive enteropathy]

56
Q

erythmatous, papular, urticarial lesions–>bullae form

  • bullae are large, tense, firm-topped oval or round lesions
  • mucous membrane not involved
  • (+) nikolski sign
A

bullous pemphigoid

tx: PO/IV prednisone; azathioprine

57
Q

oral lesions–>sole sign for months before other lesions arise
-skin: flaccid blister with painful affected skin

A

pemphigous vulgaris

tx: coricosteroids- long term
- sulfasalazine

58
Q

erythematous, confluent, macular BUTTERFLY eruption (MALAR rash) with fine scaling, erosions, and crust

A

systemic lupus erythematosus

tx: depends on severity
- hydrochloroqine

59
Q

localized loss of hair in round or oval patches WITHOUT skin inflammation
-exclamation point hairs

A

alopecia areata

[possible autoimmune process due to association with other autoimmune diseases]

tx: no curative process; palliative for cosmesis
- psychological support
- tx underlying disease
- tx options: intralesional/topical steroid, UVA therapy

60
Q

autoimmune hair loss with signs starting before age 40; can only affect scalp hair vs. affecting all scalp and body hair

A

alopecia totalis/universalis

starts as alopecia areata and progresses to diffuse lose

tx: none successful, only for early stage of alopecia areata

61
Q
  • daily dramatic hair shedding

- preceding traumatic event 6-16 wks prior to hair loss

A 
telogen effluvium (think beau lines)
-regrows in 4-6/12 months

Tx: reassurance!!

Derm Identification and Treatment (2 decks)

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