Lecture 12: Misc Derm Disorders Flashcards
What ethnicity is Acanthosis Nigricans MC in?
African Americans
If you see Acanthosis nigricans in a patient who is not obese or diabetic, it should raise your suspicion for…
Malignancy
Gastric carcinoma
Esp if not on the classic neck or axilla
The MC drug that can induce acanthosis nigricans is
Niacin
Acanthosis can be inherited via a (genetic pattern)
Autosomal dominant
The two classic locations for Acanthosis nigricans are…
- Neck folds
- Axillae
What is diagnostic for acanthosis nigricans?
Not required
Skin biopsy
Two chronic conditions commonly associated with acanthosis nigricans are…
- DM
- PCOS
I feel like he might ask you what labs to order if you see this
If a non-obese, non-diabetic, non-PCOS patient presents with acanthosis nigricans on their knuckles, you should consider sending them to…
GI for endoscopy
Gastric carcinoma
The MCC of pressure injuries overall is…
Impaired mobility
The MC 2 locations for pressure injuries are…
- Sacrum
- Hip
Pressure injuries place patients with same risk factors at () times greater risk of death
4.5x
The 2 MC hospital units/depts that pressure injuries occur in are…
- Orthopedics
- ICU
T/F: A pressure injury is generally wider at the base.
True
NPUAP staging for pressure injuries is specially for….
Initial evaluation + documentation
NOT TO EVALUATE WOUND PROGRESS
Also can’t reverse stage by healing.
Stage 1 pressure injury buzzwords
- Skin is intact
- Non-blanchable hyperemia
Skin intact is automatically stage 1
Stage 2 pressure injury buzzwords
- No visible SC tissue
- No granulation or eschar
Stage 3 pressure injury buzzwords
- Full thickness skin loss
- Exposed SC tissue
- Eschar or granulation
- Epibole: rolled wound edge
Stage 4 pressure injury buzzwords
- Full thickness skin loss + tissue loss
- Visible muscle/bone/cartilage
Unstageable pressure injuries are characterized by…
Covered in slough or eschar
Will be at least a stage 3.
T/F: You should remove a stable eschar in order to properly stage a pressure injury
False
Do not remove for staging purposes
A foul odor associated with a pressure injury indicates…
Anaerobic infection
The 3 mainstays of reducing risk factors for pressure injuries include…
- Nutrition (more protein/calories)
- Redistribute pressure (Q2h turns, head < 30deg to reduce sacrum pressure, massage)
- Clean skin (mild cleansing) and keep dry
Local wound care of a stage 1 pressure injury is…
Cover with transparent film for protection.
Local wound care for a stage 2 pressure injury uses…
Transparent or hydrocolloid dressings.
Hydrocolloid wound dressings cannot be used in…
Active infection
Local wound care for stage 3/4 pressure injuries is…
Debridement
A pressure ulcer scale score will (inc/dec) with healing
Decrease
Your patient with a stage 1-2 pressure injury wants to know how long it will take for their wound to heal.
1-2 weeks
Your patient with a stage 3/4 pressure injury wants to know how long it will take them to heal.
6-12 weeks
The MC complications associated with pressure injuries is…
Infection
Hidradenitis suppuritiva is a chronic suppurative disease of the () gland bearing skin areas
Apocrine
Hidradenitis suppurative MC is found in (sex) and begins at …
Females at onset of puberty
The Characteristic finding on physical exam for hidradenitis suppurativa is…
Open comedones
Blackheads
Immediate treatment of acute lesions in hidradenitis suppurativa uses 3 options:
- Intralesional steroids followed by I&Ds of abscesses
- Oral abx: B-lactamase PCN, cephalos, augmentin, clinda
- Oral steroids
Recurrent hidradenitis suppurativa lesions can be treated pharmacologically with oral …
- Clinda + isotreinoin
- Systemic biologics (tx-resistant, mod-severe): adalimumba/humira or infliximab/remicade
Kinda similar to just acne tx
Surgical treatment in hidradenitis suppurativa is only for… and requires () margins
Chronic recurrent, fibrotic nodules, or sinus tracts with WIDE MARGINS
T/F: You should advise patients to use cold compresses with Burow solution for Hidradenitis suppurativa.
False, should be warm
What are the 3 types of acute photosensitivity?
- Sunburn
- Rash
- Urticarial
The terms used to describe chronic photosensitivity changes to skin are…
- Dermatoheliosis
- Photoaging
Which UV band causes acute sunburn?
UVR
All of them? does UVR just mean UV radiation
In a patient with severe sunburn, they may appear like they have ()
FLS
Fever, chills, fatigue, weakness, tachycardia
Timing wise, sunburns will develop after () hours and peak after () hours
6-24 hours
The topical tx for acute sunburns are… (3)
- Cool, wet dressings
- Topical glucocorticoids
- Aloe vera
SPT I/II should avoid sun exposure between the hours of…
10AM-2PM
There are two types of drug/chemical reactions related to photosensitivity, which are…
- Phototoxic: similar to irritant contact dermaitis or sunburn.
- Photoallergic: Type IV HSR like allergic eczematous contact dermatitis
Xerosis is characterized by dry skin with a () texture and is often (symptom)
- Scaly
- Pruiritic
What is the underlying pathophysiology of xerosis?
- Low lipid levels in stratum corneum
- Deficiency in water-binding capacity
By the age of (), you would expect most patients to have some degree of xerosis
60
The 3 MC locations for xerosis are…
- Lower extremities
- Trunk
- Dorsal hands
The 3 possible organs you should consider for underlying cause in xerosis are…
- Thyroid
- Renal
- Liver
A patient pearl for improving xerosis is after showering…
- Pat skin to keep it moist
- Place lotion onto DAMP SKIN
ty mak best derm PA i know
Ichthyosis vulgaris is inherited via an ()
Autosomal dominant pattern
Ichthyosis is characterized by () skin texture and is seen often with conditions like (2)
- Fish-skin-like scale
- Atopic Dermatitis
- Keratosis pilaris
Abnormal Cornification
Generally, ichthyosis vulgaris presents between the months of () and resolves in ()
3-12 months, but alleviates in adulthood.
Its like childhood xerosis
Adulthood onset ichthyosis vulgaris is associated with…
Systemic disease + malignancy
Besides fish skin, you should look for (2) on the palm in ichthyosis vulgaris
- Accentuated palmar creases
- Scaly palms
The diagnosis of ichthyosis vulgaris is made…
Clinically, but biopsy is characteristic
The mainstay of therapy for ichthyosis vulgaris is…
Emollients
Esp after bathing.
Use non-drying soaps like Dove or non-soap cleansers like cetaphil.
You can use mid-potency topical steroids for ichthyosis vulgaris if there is associated (2)
Itching or dermatitis