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Dermatology > Miscellaneous Skin Conditions > Flashcards

Miscellaneous Skin Conditions Flashcards

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Dermatology Board Prep flashcards
1
Q

Epidemiology of Psoriasis

A

Men = Females
Hereditary
More prevalent further from the equator

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2
Q

Pathophysiology of Psoriasis

A

Cell turnover: 4 days
Normal cell keratinization does not take place
Subnormal blood vessel dilation
Autoimmune component: T lymphocytes

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3
Q

Psoriasis Risk Factors

A

Family Hx
Strep infection can trigger guttate psoriasis
Medications: beta blockers, lithium, anti-malaria
Smoking, obesity, & alcohol
Vitamin D deficiency?

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4
Q

Presentation of Psoriasis

A

Bimodal age distribution: 30-39, 50-69
Gradual or sudden in onset
Pruritus common
Hx of improvement with sun exposure

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5
Q

Associated Conditions with Psoriasis

A 
Psoriatic arthritis
CV disease
Malignancy
DM
Metabolic syndrome
HTN
IBD
Serious Infections
Ocular involvement: swollen lids, conjunctivitis, xerosis, uveitis
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6
Q

Types of Psoriasis

A 
Plaque
Inverse
Guttate
Erythrodermic
Pustular
Nails
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7
Q

Where does plaque psoriasis typically appear?

A 
Knees
Scalp
Elbows
Lower back
Can affect the nails
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8
Q

Plaque Psoriasis Presentation

A

Salmon pink papule & plaques
Sharply marginated with marked silvery-white scaling
Scales are loose, easily removed by scratching
Auspitz sign
Koebner’s phenomenon

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9
Q

Define Auspitz Sign

A

Pinpoint bleeding under the scale

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10
Q

Define Koebner’s Phenomenon

A

Psoriasis plaques that form at the site of a skin injury

Occurs 1-2 weeks after injury

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11
Q

What can Koebner’s phenomenon occur from?

A 
Bug bites
Bruises & scrapes
Poison ivy or poison oak
Burns (sun & chemical)
Constant pressure & rubbing
Injections or vaccinations
Skin blemishes from acne, herpes, or chickenpox
Acupuncture or tattoo needles
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12
Q

Distribution of Psoriatic Lesions

A

Symmetrical
Favors elbows, knees, intertriginous areas
Can be localized or all over the body
Extensor surfaces

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13
Q

Inverse Psoriasis Locations

A 
Axilla
Groin
Naval
Submammary region
Palms
Scalp
Soles
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14
Q

Inverse Psoriasis Characteristics

A

Common in overweight persons
No scales
Biopsy to differentiate from candidiasis

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15
Q

Define Guttate Psoriasis

A

Eruptive psoriasis

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16
Q

Characteristics of Guttate Psoriasis

A

Small teardrop shape erythematous papule

Scattered diffusely on proximal extremities & trunk

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17
Q

Treatment of Guttate Psoriasis

A

Self limiting (weeks to months)

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18
Q

Erythrodermic Psoriasis Presentation

A

Erythema & scaling head to toe
Inflammatory
Severe pruritis & pain as skin reddens & sheds

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19
Q

What is erythrodermic psoriasis have a high risk of?

A

Systemic infection

Electrolyte imbalances

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20
Q

Presentation of Pustular Psoriasis

A 
Acute onset
Widespread erythema, scaling, & sheets of pustules with erosions
Malaise
Fever
Diarrhea
Leukocytosis
Hypocalcemia
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21
Q

WHICH SKIN conditions can be life-threatening?

A

Erythrodermic psoriasis
Pustular psoriasis
Pemphigus
Bullous Pemphigoid

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22
Q

Nail Psoriasis

A

Associated with psoriatic arthritis

Appear before onset of cutaneous psoriasis

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23
Q

Presentation of Nail Psoriasis

A

Nail pitting
Oil drop sign
Subungual hyperkeratosis

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24
Q

Treatment of Plaque Psoriasis

A

Exacerbating factors
Topical therapy
Systemic therapy

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25
Q

Drugs That May Exacerbate Psoriasis

A 
Beta-blockers
NSAIDs
Lithium
ACEi
Digoxin
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26
Q

Topical Therapy for Plaque Psoriasis

A 
Emollients
Steroids
Vitamin D analogues
Topical retinoids
Calcineurin inhibitors
Coal tar preparations
Phototherapy: UVA, UVB
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27
Q

MOA of Emollients

A

Hydrate stratum corneum
Decrease water evaporation
Soften the scales

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28
Q

Examples of Emollients

A

Eucerin
Lubriderm
Moisturel

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29
Q

Education of Emollients

A

Apply after bathing while skin is still damp

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30
Q

What is first line for plaque psoriasis?

A

Topical steroids

31
Q

What are topical steroids used in conjunction with?

A

Topical vitamin D analoge
Topical retinoid
UVB therapy

32
Q

When do you use Calcipotriol (Dovonex), a vitamin D analogues?

A

Mild to moderate plaque psoriasis

33
Q

SE of Calcipotriol (Dovonex)

A

Hypercalcemia

Hypercalcuria

34
Q

Where can you not use Calcipotriol (Dovonex)?

A

Face

Groin

35
Q

Example of a Vitamin D Analogue

A

Calcipotriol

36
Q

Example of a Vitamin A Derivative

A

Tazarotene (Tazorac)

37
Q

MOA of Tazarotene (Tazorac)

A

Modulates differentiation & proliferation of epithelial tissue
Exerts some degree of anti-inflammatory & immunological activity

38
Q

Examples of Topical Calcineurin Inhibitors

A

Tacrolimus (Protopic)

Pimecrolimus (Elidel)

39
Q

MOA of Topical Calcineurin Inhibitors

A

Inhibt T-lymphocyte activation by binding to an intracellular protein & complex with calcineurin dependent proteins to inhibit calcineurin phosphatase activity

40
Q

Coal Tar Topical Preparations

A

Enhance effects of UVB therapy
OTC
Stains clothes & odor
Add-od therapy

41
Q

MOA Phototherapy

A

Anti-proliferative effects by slowing keratinization & anti-inflammatory effects by inducing apoptosis of pathogenic T-cells

42
Q

Systemic therapy for psoriasis

A 
Methotrexate
Acetretin: Psoriatane
Systemic calcineurin inhibitor: cyclosporine
Infliximab (Remicade)
Hydroxyurea
Azathiprine
43
Q

Define Urticaria

A

Hives

Immune mediated skin eruption of well-circumscribed wheals on an erythematous base

44
Q

Define Angioedema

A

Hypersensitivity reaction involving the deep layers of the skin

45
Q

Where does angioedema usually occur?

A 
Lips
Eyelids
Palms
Soles
Genitalia
46
Q

Pathophysiology of Urticaria & Angioedema

A

Allergen
IgE antibody attached to mast cell
Sudden release of immunologic mediators
Inflammation

47
Q

Presentation of Urticaria

A

Characteristic edematous, erythematous, well-circumscribed blanching wheals
Serpiginous borders

48
Q

Define Dermatographism

A

Gentle stroking of the skin produces immediate wheal & far response

49
Q

Define Pressure Urticaria

A

Pressure to skin at right angle results in red swelling after latent period of up to 4 hours

50
Q

Define Cold Urticaria

A

Eruptions within minutes following application of cold

51
Q

Define Cholinergic Urticaria

A

Punctate hives triggered by exercise or hot shower

52
Q

Define Aquagenic Urticaria

A

Hives after contact with water

53
Q

Define Solar Urticaria

A

Hives develop following exposure to UV light

54
Q

Management of Urticaria & Angioedema

A

Avoidance of etiologic agents

Avoidance of substances that may aggravate: ASA, NSAIDs, ETOH, ACEi

55
Q

Symptomatic Relief for Urticaria & Angioedema

A

Antihistamines: H1-blockers, H2-blockers, Doxepin (Sinequan)
Steroids: systemic or local
SubQ Epinephrine: anaphylaxis

56
Q

Important Principles of Urticaria & Angioedema

A 
Chronic urticaria can be frustrating
EDUCATION
Investigate for thyroid or H. pylori
Epipen
Referral to allergist
57
Q

Where do vitiligo lesions occur?

A 
Face
Upper trunk
Finger tips
Hands
Arm pits
Genitalia
Bony prominences 
Perioral region
58
Q

Define Vitiligo

A

Destruction of melanocytes

59
Q

Pathophysiology of Vitligo

A

Autoimmune: antibodies to melanocytes

Occurs with pernicious anemia & Hashimoto’s thyroiditis

60
Q

Treatment of Vitiligo

A

Some regimentation with topical steroids, tacrolimus, psoralens, UVA, UVB, surgical skin grafting
Need psychological support

61
Q

Describe Pemphigus

A

INTRA-epidermal blistering secondary to an autoimmune process

62
Q

Define Pamphigus

A

Chronic, potentially fatal disease of the mucous membranes & skin

63
Q

Clinical Presentation of Pemphigus

A

Flaccid bullae
Bullae tender & painful
Nikolsky’s sign
Skip biopsy

64
Q

Where are the bullae most present?

A 
Oropharynx
Scalp
Face
Chest
Axillae
Groin
65
Q

Treatment of Pemphigus

A

Recognize & refer
Hospital admission
Systemic steroids & immunosuppressives

66
Q

Define Bullous Pemphigoid

A

Chronic, SUB-epidermal blistering autoimmune disease

67
Q

Common Presentation of Bullous Pemphigoid

A

Widespread blistering eruption

68
Q

Epidemiology of Bullous Pemphigoid

A

Triggered by drug reaction or infection
Exclusively in the elderly (>60)
Increased mortality

69
Q

Describe Blisters of Bullous Pemphigoid

A

Tense

Fluid filled

70
Q

Treatment of Bullous Pemphigoid

A

Recognize & refer
1st: topical high dose or oral steroids
Immunosuppressants (maybe)

71
Q

Synonyms of Epidermoid Cyst

A

Sebaceous cyst
Infundibular cyst
Epidermal cyst
Cutaneous cyst

72
Q

Describe Epidermoid Cyst

A

Cystic enclosure of epithelium
Cysts filled with keratin & lipid-rich debris
Rupture common: painful inflammatory mass
May be secondarily infected

73
Q

Define Dermatofibroma

A

Button-like dermal nodule

Lesion may be tender

74
Q

Define Lipoma

A

Soft, rounded, & movable against the overlying skin

Composed of fat cells

Dermatology (13 decks)

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