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More Rashes Etc Flashcards

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1
Q

Tx for scalp pruritic nodules

A

Betamethasone oint BID 2 wks on/off (never on face or groin - can cause thinning of skin)

NAC 600 BID

Cut fingernails
Wear cotton gloves

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2
Q

Protopic and Elidel are what type of drugs

A

Calcineurin inhibitors: immunomodulating/anti-inflammatory

Gen: tacrolimus

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3
Q

Tx for LP

A
  • Topical class 1 betameth oint BID
  • PROTOPIC (never mouth) or Elidel (both calcineurin inhibitors):
    IS THIS FOR WEEKS OFF STEROID?
  • Sun light outside 20-30 min TIW
  • Oral steroids OR
  • Flagyl 500 BID x 2-4 weeks (no alcohol) with TAC

Hydroxyzine HS for itch

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4
Q

Where to never use Protopic and what age

A

Mouth (kidney peoblems)
But ok on lips

Or less than 2 yo

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5
Q

Which type of CD4 response is atopic derm (eczema)
vs
Contact derm and psoriasis

A

Eczema is Th2:

  • IL4 increases IgE
  • IL5 increases Eosinophils
  • IL10 decreases immunity (so pts with AD get impetigo and fungal infections, T Pedis, T corporis)
  • Dupixent is anti IL4 so systemically decreases IgE (biologic for eczema)

Vs

Psoriasis/contact dermatitis is Th1:
- IL2
- IF GAMMA
- TNF (TB test - feel coming down with flu): Enbrel and Humira target TNF
- IL 12 (stilara is anti)
Th1 revves yo immune system while Th2 lowers it

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6
Q

What is dupixent and how does it work?

A

Systemic biologic for eczema

Anti IL4 - so decreases IgE systemically
IL4 causes increases IgE

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7
Q

Vasculitis is what type of immunity

A

Type 3

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8
Q

Type 4 immunity is

A

Delayed hypersensitivity = allergic contact dermatitis

TB rxn is type 4 (takes 3 days)

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9
Q

Type 1 immunity

A

Immediate hypersensitivity which is urticaria

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10
Q

Eczema tx education (percentages)

A

80% is topical steroids (end point is itch and lesion clear)
15% antihistamines for itch
5% is daily moisturizer

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11
Q

What age group can’t use antihistamines for AD eczema?

A

< 1 yo

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12
Q

What age is ok to use Protopic for eyelid eczema in kids

And what warning to give when using Protopic on eyelids?

A

> 2 yo

Will burn at first for the first 1-3 days but continue using it

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13
Q

Protopic has which black box warning

A

Skin cancer increases in rats after eating tubes of it and Bathing in it

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14
Q

What to use on nipple ezcema

A

Protopic

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15
Q

Eczema tx for <2 yo

A

HC 2.5 QD for face and groin
TAC .1% oint QD for rest until skin is clear and no itch daily moisturizer
Antihistamines ok >1 yo

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16
Q

Horrible eczema tx in kid >1 yo

A

Clobetasol x 5-7 days then switch to TAC right away QD

OR TAPER
clobetasol x 4days then 10 days of Fluocinonode 0.05, then TAC QD

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17
Q

What to tell pt about Patch testing

And Brand name for it / how many allergens has

A

Put on Monday and can’t shower for 5 days bc take off Friday

Done for allergic contact dermatitis

Brand name is TRUE test has 38 allergens

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18
Q

Which toothpaste to use if mouth or lip rash/ soreness

A

Arm and Hammer

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19
Q

Taper prednisone for severe contact derm

And what to check when doing taper?

A

40 mg x 1 week (20 BID)
20 mg x 2 weeks
Not more than 3 weeks

SE: jittery, adrenal suppression, joint aches

Check BP and DM (ok if controlled)
No glaucoma (ok but see eye doc next week - meaning ok to give cortisol to someone with glaucoma but tell them to see eye doc next week?)
Can worsen infection - can’t give if cocci, PNA

Rare risk: aseptic necrosis of hip = hip fracture

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20
Q

What to do if give IM Kenalog for contact derm

Max number of IM Kenalog shots per year

A

Pull back to make sure not in artery
40 mg IM

Max 2 per year (risk osteoporosis, muscle weakness)

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21
Q

Tx for seb derm on face

A

Am: ketoconazole cream wAM
PM: 2.5 HC
Use H&Sh aids on face

Alternate shampoos from Selsum, head and shoulders and nizerol bc yeast can build up resistance

Shaving is ok bc not a fungus

Caused by yeast not fungus

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22
Q

Which test to order in dermatomyocitis

Which is the #1 underlying cause of it?

A

Order transvaginal US (ovarian cancer is #1 cause of underlying malignancy - which is cause in 26% of DM)

Also order:
CBC
Sed rate
SPEP

(Also full body cat scans???)

All age appropriate screening:
Colonoscopy at 50 yo
Mammo at 40 yo

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23
Q

If pt is itching during exam, what is the likely etiology of itch

A

Paraneoplastic or drug induced: deep itch

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24
Q

What to tell a pt who is lying on abdomen for excision or EDC - during electrocautery

A

Make sure not to touch the metal rails on the bed during electrocautery

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25
Q

New guidelines for MM SNL biopsy, at which depth to offer SNL bx

A

At 0.80 mm -

Per Dr. O - he refers to plastics for SLN bx at 0.75 depth

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26
Q

Which type of cancer doubles the risk of MM?

A

Breast cancer (BRCA) double the risk of MM

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27
Q

MM puts a pt at risk of which other cancers?

A 
Breast
Pancreatic
Ovarian/uterine
COLON
Stomach
Prostate
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28
Q

Onycholisis is due to

A

Lifting of nail plate due to overwashong - nailtique

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29
Q

Fever and red tender rapidly expanding nodules/plaques (sometimes with vesicles or pustules) is associated with which disorder?

A

Sweet Syndrome

2-10 cm tender plaques, edematous or indurated

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30
Q

Do Sweets lesions itch?

A

No, but they burn

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31
Q

Most common distribution of Sweet’s lesions

A

face or cheeks, neck, upper trunk, extremities (so basically sun exposed areas)

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32
Q

Extracutaneous symptoms of Sweets

A

Fever in 50-80%
Arthritis, arthralgias, myalgias in 1-2/3
Conjunctivitis and episcleritis 30% +- periodontal inflammation, dacryoadenitis (inflammation of lacrimal gland), glaucoma
Oral lesions like aphthae in 2-3% but 10% if hematologic malignancy
Cough, dysplnea, pleuritis if pulmonary involvement

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33
Q

Subtypes of Sweets

A

Classic 71%
Associated with neoplasia 11%
Ass’d with inflammatory dz 16 %
Ass’d with pregnancy 2 %

Dusky bullous and necrotic lesions that overall with pyoderma gangrenous are ass’d with leukemia

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34
Q

Perioral dermatitis Tx

A

Start with Metro gel
If not better, add Doxy 20 BID
If not better, switch to Clindamycin Gel BID or Clind AM and Elidel 1% PM
+/- Sulfacetomide lotion 10% (Clayton lotion) IF NO SULFA ALLERGY
+/- Plesion cleanser 5% sulfa and 10% sulfacetomide (which is good for rocasea, acne, dandruff, perioral derm)

Soolantra is Ivermectin - great for demodex mites

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35
Q

Groin intertrigo - which steroid to use

Pt care instructions

A

Mometasone cream n AM
Ketoconazole cream in PM

Change to WHITE BOXERS
Hair dryer after shower then ZAsorb FA (has miconazole in it so anti fungal as well)

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36
Q

What to ask pt who presents with groin rash

A

Any other areas involved? Axilla?

Any h/o psoriasis?

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37
Q

Tx and pt instructions for groin rash

A

We have a list of recommendations to follow - not just one tx:

On good days: shower with lukewarm water only, HAIR DRY the area and apply ZAsrob AF in AM
Shower immediately after getting sweaty or work and do the same

On bad days:
Mometasone cream in AM
Ketoconazole PM

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38
Q

What does Erythema Annulare Centrifugum (EAC) look like

A

Red circles with scale at inner border
Central clearing and trailing inner scale behind an advancing, annular, red border

SLOW GROWING 2-3 MM/ DAY
DDx: GRANULOMA ANNULARE, TINEA, SUBACUTE CUTANEOUS LUPUS, MF

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39
Q

Which disease can precede malignancy by 2 years

A

Erythema Annulare Centrifugum EAC

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40
Q

Causes of EAC

A

Blue cheese, tomatoes
Drugs: antimalarials, cimetidine, spironolactone, gold, salicylate, piroxican, PCN, amitriptyline
Infection, cancer, sarcoidosis, other systemic illness, TB, Hodgkin Lymphoma (night sweats, fever, chills)

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41
Q

Tx for EAC

A

Topical steroids

Resolved on its own over months to years (can be recurrent up to 34 years)

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42
Q

Blue cheese and tomatoes can cause what

A

Erythema Annulare Centrifugum

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43
Q

Sweet syndrome is AKA

A

Acute Febrile netrophilic dermatosis

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44
Q

If pt with Sweet has oral lesions, its a risk factor for what

A

10% risk of blood cancer

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45
Q

4 types of Sweet syndrome (associations)

A

Classic 71%
Ass’d with neoplasia 11%
With inflammatory dz
With pregs 2 %

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46
Q

Sweet lesion - describe

A

Fast rapidly extending, tender red nodules/plaques can be 2-10 cm
On face neck upper trunk and extremities
Burn but don’t itch

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47
Q

What’s the best anti-itch and anti-hive medication on the market

A

Doxepin 10 mg, can increase to 50 mg qHS
WARNING: do not drive after taking, will make you tired, lasts 24 hours

Was originally an antidepressant in 150-300 mg

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48
Q

Which topical can use around eyes (during eczema)

A

Protopic

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49
Q

Steroid taper for severe eczema that’s not responding to topicals

Also add which medication?

A

Prednisone 40 mg x 1 week (20 mg in AM and 20 mg in PM is stronger than 40 together)
20 mg x 2 weeks

Add Doxepin for itch (best med for itch but tired)

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50
Q

What history questions to ask when starting spironolactone

What is it contraindicated in

Ask about which meds they are on

A

Do you have a h/o ovarian or breast cancer (don’t give it of positive)? Bc this is a hormonal tx

CI in PREGS - must be on OCP or IUD (must dc drug

If on Lisinopril or losartan - check CMP even if < 40 yo

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51
Q

Which topical steroid is ok for groin area

A 
For groin: Mometasone CREAM class 4
(It’s stronger that 2.5 HC, it’s same as TAC .1% ointment is class 4 but less risk of atrophy With Mometasone )

Mometasone Ointment is class 3 same as TAC 0.5% ibut less atrophy risk

HC valerate 2.5 is stronger

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52
Q

Aseptic necrosis of hip (hip fracture) is SE of which drug

A

Systemic steroids

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53
Q

Additional Tx for LPP

A

Doxy 100 qHS until decrease in pain itch and crusting and hairs regrow then 20 BID for years - helps some people

In additional to betameth lotion bid 2 weeks on/off?

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54
Q

Tell pts with MM to do what once per year

A

Eye exam

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55
Q

Make sure not to use what with perioral dermatitis?

A

Steroid cream makes it worse

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56
Q

Tx for comedonal acne only

A

Start wig EpiDuo qAM and Cetaphil face moisturizer

Can increase to Epiduo BID if not too drying (make sure wait and dry before bed cause can turn sheets orange)

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57
Q

Which one question to always ask acne patients

A

How much dairy are you consuming

Organic is ok

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58
Q

What is Necrobiosis lipoidica

What looks like

Where located

Due to which systemic dz

A

Granulomatous dz

Cigarette paper thin flat plaques - very atrophic, some with vessels through them

On shins

Due to DM

Does it look like lipodermatosclerosis??

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59
Q

Post herpatic neuralgia cream

A

GABA 6%
Elavil 1%
Ketamine 10%

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60
Q

Intertrigo (under breast tx)

What advise to pt

A

Ketoconazole 2% cream q hs
Mometasone 0.1% cream qAM

Use hair dryer and ZAsorb AF, shower after sweating

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61
Q

What to make sure is done to pt with excision on lower legs

A

Antibiotics for 1 week

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62
Q

Most common areas for granuloma Annulare

A

Wrist and ankles

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63
Q

Granuloma Annulare is more common in kids or adults

What dz it’s associated with in adults

A

Kids

Rarely DM (and thyroid?)

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64
Q

Does GA leave a scar when it goes away

What color is going away Lesion vs active lesion

A

No

Brown border when going away
Pink is active leasion

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65
Q

GA usually resolves in what time

A

Goes away in 1-2 years

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66
Q

What is the name of condition when scalp doesn’t heal

A

Chronic Erosive Postulosis of scalp

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67
Q

What can’t do while on Accutane (2 things)

A

Donate blood

Get pregs

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68
Q

What to look for and ask pt if suspect suture infection s/p excision

A 
Painful?
Fever?
Pus? (If pus - must culture)
Swelling
Warmth

If just red - fine

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69
Q

What advise to give pts with intertrigo

A

Use hair dryer after shower and apply ZAsorbFA once rash proves to prevent outbreaks

Rash gets worse in summer due to heat and increased sweating

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70
Q

What to ask pts when considering Accutane initiation? (6)

A 
Any depression?
Any bowel disease?
Any cholesterol issues?
Any liver disease?
Trying to get pregs?
Donate blood?
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71
Q

Acne tx for males

What to do if no improvement on standard tx

A

Doxy
EpiDuo
(+/- Clindamycin)

Next step - Accutane

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72
Q

What does it mean If no improvement in acne with Doxy or stopped improving on Doxy

A

Abx plateaued because bacteria became resistant to the Med

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73
Q

Which labs to order for Accutane and patient instructions

A

CBC
CMP (liver and lipids fasting)
Lipase (pancreas)??
hCG

Must be fasting and within 48 hours of next appointment

74
Q

What is Muir Torre syndrome

Which cancer

(Associated with which other cancers)

What percent risk

A

It’s a subtype of Lynch syndrome (hereditary nonpolyposis colorectal cancer)

80% risk of developing colon cancer
80% risk of endometrial cancer

Also ovarian and gastric/stomach cancers, urinary

75
Q

What is the yellow skin papule in Muir Torre syndrome

A

Sebatious adenoma

76
Q

What oral Med to use for granuloma Annulare?

A

Plaquenil

77
Q

Which meds could cause granuloma Annulare

A

Lisinopril and statins

78
Q

How to tell if granuloma Annulare is likely due to a drug?

A

If no improvement on plaquenil

79
Q

If pts labs on plaquenil come back anemic, ask pt what?

A

Are you up to date on colonoscopy and age appropriate screening

Consult pcp regarding anemia

80
Q

Causes of macrocytic anemia (high MCV)

A

Alcohol

B12 folate deficiency

81
Q

If a lesion is tender when scratched on exam, do what?

A

Do bx

82
Q

Is there a scar when granuloma Annulare resolves?

A

No

83
Q

Name of OCT urea

A

Exipial wrong! That’s the hand cream I like

84
Q

Rosacea tx

A

Metro gel and doxy 100 qHS

OR Clindamycin BID (to dry out) and doxy 100 qHS

soap: Cetaphil

RTC 6 wks

85
Q

What can be used in place of FUDEX for AKs

A

Solarace x 3 months (more gentle but less effective)

Aldabra (imiquimod) QD 2 wks on, 1 wk off, 2 wks on
But can cause flu sx

Blue light not effective - gets red x1 week bs 2 weeks on FUDEX

86
Q

What to ask pt before giving sulfacetomide wash or lotion

A

Allergic to Sulfa?

87
Q

Tx for inflamed cyst

A

Keflex 500 TID (if no allergy to PCN)

Plus warm compresses

88
Q

When putting pt on Clindamycin oral, make sure to tell pt what

A

Can cause C Diff - call us if diarrhea

89
Q

Plaquenil can cause which side effect

A

Dizziness

90
Q

Itchy and red eyes - 2 no no’s

A

No nail polish

No make up removers

91
Q

Tx for itchy and red eyelids

A

HC 2.5% BID but ONLY for 1 week at a time because can instigate glaucoma and cataracts

Do you have glaucoma?

92
Q

Warning for HC 2.5 around eyes

A

Only for 1 week at a time or can cause glaucoma and cataracts

93
Q

Which cream not to use for groin intertrigo

What else to advise pt

A

Nystatin cream - use ketoconazole instead bc its fingal (TINEA)

Use boxers

94
Q

What advice to give male pts with groin intertrigo?

A

Wear WHITE boxers

95
Q

Stress can cause what 2 extracutaneous events

A

Hair to fall out

Nails to fall out

96
Q

Brand name for mupirocin is

A

Bactorban

97
Q

What to ask pt presenting with groin and axilla rash or intertrigo?

Where else to look if pt present with groin rash?

A

H/o psoriasis? Could be inverse psoriasis - in groin, axilla, back

Look at elbows, knees, soles, mouth, scalp

Feeling ok otherwise, no joint aches?

98
Q

Can’t use which acne medications when pregs

A

EpiDuo

Retina

99
Q

Can’t use which acne medications when pregs

A

EpiDuo

Retina

100
Q

What looks like nipple eczema but only on 1 side?

A

Paget’s Disease

101
Q

95% of paget’s dz is what type of cancer

A

Ductal carcinoma

102
Q

Can paget’s be bilateral

A

Yes but rare

103
Q

When pt presents with unilateral nipple eczema, what do you do?

A

Tx with Mometasone BID x 1 month and have pt RTC: if still there MUST BX!!

104
Q

Which questions to ask when seeing a pt with nipple eczema? (2)

A

When was your last mammo?

Do you have a history of eczema?

105
Q

What does early Paget’s look like?

Which 2 questions to ask?

A

Looks like eczema

Last mammo
Ho eczema

106
Q

When see unilateral intertrigo or unilateral TINEA on groin, what to suspect?

A

Extramammory paget’s

107
Q

If see dried intertrigo on left groin approaching scrotal area, what to suspect and do?

A

Suspect extramammory paget’s

If on one side of groin - Bx it

108
Q

25% of extramammory Paget’s have what type of cancers and should see whom?

A

Have rectal, ureter, rostate cancers

Need to see GI/urology/rectal surgeon to r/o cancers in those areas

109
Q

What type of tx for confirmed Paget’s?

What frequency of F/U for Paget’s?

A

Mohs if not invasive

Plastic surgeon (wide excision) if invasive

RTC q3-4 months because often comes back

110
Q

Show much does finger nail grew per month and how long odes it take to grow out?

Same for toes

A

Fingernail - 2 mm per month, takes 6 months to grow out a fingernail

Toe- 1 mm per month - takes 12 months to grow out

111
Q

what is pathognomonic for Lichen Planus

A

Wickham straie

112
Q

Will PIH left by LP go away?

A

Yes

113
Q

What is the source of fingernail fungus?

A

Tap Water is full of yeast

114
Q

Which OTC supplement to help strengthen nails (and hair)

A

Biotin

Nailtique #2

115
Q

Who is the best expert on Merkel’s cell in Phoenix

A

Dr Mark Gimbel at MD Andersen in Mesa

116
Q

Cause and tx of brachioradial itch

A

Bone spurt (arthritic changes in c spine) and SUN
Tight bra is the cause???
Guys with wallet in front pocket - causes itch on thigh

Tx: zostrix cream

117
Q

If see more lines on palms, what does it mean

A

More prone to sensitive skin

118
Q

How to ddx lichenoid keratosis from bcc

A

LK has skin lines through it

bcc doesn’t

119
Q

LPP associated pain tx

A

Can use gabapentin (not if breast feeding)

LPP can regrow if caught early, scars after hair falls out several times (IL kenalog is more effective)

Can use dermasmooth in breast feeding

120
Q

Name of pemphigus antibodies

A

Desmoglien 1 and 3

If going up, ask if any new blisters

121
Q

Inflamed cyst

A

Manually depress or lance to get stuff out, keflex 500 TID X 7 day and warm compresses BID

lance it next time to get left over
If not better in 1week RTC

Any fever chills - come back

122
Q

Pt with bright red rash that doesn’t itch on lower extremities (almost punctuate but papular bumps):

Check where else?

A

Check inside mouth (he had wickem straie)

Check feet and soles

It was LP that was originally treated as Scabies with permethrin but didn’t improve (Scabies: Apply from neck down, shower in AM then repeat same in 1 weeks)

123
Q

How to describe LP to pts

A

It’s a benign rash that can resolve in 8-10 months

No sure what causes it, comes on and goes away mysteriously. Sometimes caused by drugs (lisinopril, BB) - taking any chronic medications?

124
Q

Valtrex for shingles

What to ask pt

A

1 g TID X 7 days with lots of water

Any kidney problems

125
Q

What has to be done when cauterizing a pt on oxygen

A

Turn off oxygen for a couple minutes ALWAYS

126
Q

What is brittle nails

A

Onychorrhexis

Use Biotin OTC
Nailtique #2 at Sally beauty supply store

127
Q

What does Haley Haley look like and how is it different?

A

Looks like chronic intertrigo but with fissures that bleed and had them all their lives

Hard to tx, inherited

128
Q

Which dz looks like chronic intertrigo but with fissures and bleeding

A

Haley Haley

129
Q

If see unilateral intertrigo, what’s on your DDx?

A

Paget’s (extramammory)

130
Q

Bluepheritis

A

Inflamm of eyelids

Allegra
Aquaphor for eyelids

131
Q

What is the name of the benign growth on the upper palate?

A

Torus palatines

132
Q

Which antibodies are associated with scleroderma

A

Scl-70 which are bad prognosis

It’s an autoimmune disorder with no good tx. Results in skin tightening and thickening, raynaud, and visceral dz.

Avoid cold, don’t smoke, PT to increase mobility of thickened skin

133
Q

What is the name of nose condition in rosacea

A

Rhinophyma

134
Q

What is erythrasma, how looks, cause

A

Axilla,

looks like intertrigo much more Copper than TINEA cruris

Caused by corynebacterium

135
Q

How to dx erythrasma

Tx

A

Wood lamp - coral color from porphorins

but no one uses lamp bc tx is same for all - erythrasma, TINEA cruris: ketoconazole has mild anti G+ and anti inflammatory effect. Also for all: keep area dry, white cotton boxers, ZAsorb, hairdryer, change socks/ boxes thru day

Top erythromycin or Clindamycin
Oral erythromycin and top miconazole

136
Q

What is balanitis

A

Inflammation of glans penis

137
Q

When looking at large sebatious hyperplasia, what’s on your ddx?

It’s associated with what disease?

A

Sebatious adenoma (benign but excise)

Muir Torre

138
Q

What is Muir Torre?

What to ask the pt?

A

Autosomal dominant (50% of your kids will inherit it so check/advise kids to get colonoscopy)

Any family history of colon cancer?
Have you had your colonoscopy?
Any history of bladder cancers? (Personal
Or family?) (ask PCP to check irons cytology)
Any history of breast cancer?

Also high risk of lymphoma and leukemia

139
Q

What can look like stye on eyelid?

A

Sebatious adenoma or carcinoma

140
Q

What does it mean if you have a sebaceous adenoma below the neck?

Or more than one SA?

A

Higher risk of Muir Torre syndrome

141
Q

When pt has rash when normally covered areas are exposed to sun

A

Polymorphous light eruption

142
Q

Lipomas around neck are called

A

Madelons

143
Q

What are 8 types of physical urticaria

What are the top 3 types of physical urticaria

A

Dermatograph is #1
Cholinergic #2 (increase in body temp thru exercise or hot baths)
Cold #3 (exposure to cold results in edema in those areas)

Heat (within 5 min of exp to heat >43F)
Adrenergic urticaria (by NE, within 15 min of emotional upset, coffee or chocolate, tx: propranolol (atenolol is not effective)

Solar urticaria (SS not effective, take antihistamine)

Pressure (3-12 hr after pressure, MC feet and buttocks after sitting)

144
Q

Fat bump in feet

A

Pezogenic petopapule

145
Q

Ear dandruff drops

A

DermOtic oil 0.01% (fluocinolone)
Sig: 5 drops in each ear BID

Change shampoo to nizerol otc

146
Q

Frontal fibrosing Alopecia is a subtype of which disorder and has what?

A

LPP

lose hairs

147
Q

The other tx for scabies

A

Ivermectin pills

148
Q

Nails that grow out without being cut

A

Onychogriphosis

149
Q

White spots on toes and nails

A

Leukonychia

150
Q

Cartilage proliferation

A

Weathering nodule (when bump is not inflamed)

151
Q

How long must be on 2 forms of OCP after stop accutane tx?

A

2 months after stop Accutane

152
Q

Benign reactive proliferation of capillary blood vessels is called

(and not to be confused with)

A

Pyogenic Granuloma

(Don’t confuse with Pyoderma gangrenous - ulcers rapidly enlarging and painful (neutrophilic dermatosis, not infection), Starts suddenly as smal pimple often at site of injury then breaks down to form an ulcer)

153
Q

ulcers that are rapidly enlarging and painful (neutrophilic dermatosis, not infection), Starts suddenly as smal pimple often at site of injury then breaks down to form an ulcer

A

Pyoderma Gangrenosum

Not infection

154
Q

Which disease is associated with Celiac?

A

Dermatitis Herpetiformis

90% of DH pts have celiac disease (but not all pts with celiac have herpetiformis)

155
Q

How to ddx T. Versicolor from Progressive macular hypomelanosis

A

T Versi has scale

156
Q

Skin discoloration/redness and swelling due to exposure to cold (2 names)

Where located: toes, ears, nose

And tx

A

Chilblains (pernio)

Tx: warm socks, keep dry, heating pads
Vasodilator :nifedipine 20 TID
Nicotinamide 500 TID
Sildenafil 50 BID

Spontaneous resolution within 1-3 weeks

157
Q

Name of subtype of KP that has crops of follicular papules in annular distribution or solitary, each papule with horny spine

A

Lichen spinulosus

Goes away as grow older but no good tx, 20% of people have it, normal

158
Q

Ecthyma is caused by what?

Distribution

Looks like

A

Strep or staph

Shins or dorsal feet

Looks like chronic impetigo on LE, depressed wet plaque with crust

Vehicle that enlarges and gets thickly crusted in a few days, ulcer is exposed when remove crust

159
Q

What is the tx of choice for dermatitis herpertiformis

A

Dapsone 50-200mg (only if can’t do gluten avoidance)

160
Q

What to check on pt before starting Dapsone

Which other labs to order before starting Dapsone

A

G6PD level

CBC (anemia0
CMP (can cause hepatitis)

AntiTTG and anti gliadin for Dermatitis Herpetiformis

161
Q

SE of Dapsone

A

Anemia
Hepatitis
LT motor neuropathy (ask numbness tingle or can they move ok)

162
Q

Is dermatits Herpetiformis itchy?

A

Very itchy

DDx: scabies

163
Q

What type of medication is Dapsone (anti eosinophilic or antineutrophilic)

A

Anti- neutrophilic

Vs in BP (bullous pemphigoid) - it’s eosinophils involved

164
Q

What is the other oral med for Dermatitis Herpetiformis

List it’s SE

Which labs to order

A

Colchicine 0.6 mg BID (also anti-neutrophilic but not as strong as Dapsone)

MC SE: upset stomach/nausea (especially if take TID)

Rare SE: agranulocytosis
Check CBC first month

165
Q

What is Dermatitis Herpetiformis confused for?

MC locations for DH?

What looks like?

A

Scabies bc comes in crops

Elbows, knees, low back, nape of neck

Itchy papules or blisters or excoriations

DDx: scabies but will be on other parts

166
Q

What causes Dermatitis Herpetiformis

A

Gluten (celiacs dz)

167
Q

Name of disease - mouth and eye ulcers (could lead to blindness)

Antigens overlap with which disorder

How many biopsies

A

Cicatricial Pemphigoid

Antigens overlap with BP 9BP 180 and BP 230)
It’s not BP if not on skin and only in mouth

2 bx:
For H&E (shave blister at edge)
Punch normal skin for Immunofluorescence

168
Q

Another name for cicatricial pemphigoid

Tx for CP Vs BP

A

Benign mucosal pemphigoid

CP: celcept, steroid, detox in

BP - topical steroids and doxy

169
Q

Tx for Lyme Dz and length of tx

A

Doxy 100 BID x 2 weeks (used to be x 3 weeks)

170
Q

What is the non classic presentation of Lyme dz and how long should the tick be attached

A

Red plaques (cellulite like)

Classic target like expanding annular lesions (tick bite papule in center) are in 25% olnly

171
Q

What to always do on a pt who is presenting with a new itchy rash

What to always ask

A

Pen test for dermatographism

New meds or OTC supplements
Also new soap, shampoo

172
Q

How long for a tick to transmit Lyme dz

A

Tick must be attached for 24 hours to transmit Borrhelia

Can do prophylactic Doxy BID x (1 days?)

173
Q

What is SCLE and how presents?

A

Subacute Cutaneous Lupus Erythmatosus

174
Q

What to Always document in the note of a pt with new rash (2 things)

A

No mucosal involvement
No new meds
(In case it turns into SJS)

175
Q

Most common areas for LP

A

Flexor writs (inner wrists), dorsal hands

Shins (rare risk of SCC), medial things, ankles

Axialla

Trunk low back

Anus, Glans penis, vulva (dispareunia) ddx:lichen sclerosis

Maybe face, palms, soles

176
Q

TSH needs to be ordered in which 2 types of hair loss

A

AA and Telogen Effluvium

177
Q

What other disorder does Rosacea commonly coexist with?

A

Seb Derm (caused by pitirosporum which is a yeast everyone has but not everyone get an inflammatory dandruff with it)

178
Q

What oral med for LPP and FFA

A

Doxy 100 with dinner or 20 BID without food
Plus Betameth lotion BID
Plus IL Ken 5 mg (mix 50-50 with saline)

179
Q

Circinate

A

Circular

180
Q

RF for androgenetic alopecia in females

A

SMOKING

Dermatology (8 decks)

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