Nail, inflamm nodules, pruritic disorders Flashcards

Question

# ONYCHOMYCOSIS Dx and Tx

Answer 1

▸ Diagnosis: KOH exam, Periodic Acid-Schiff test - most sensitive ▸ Practice: PAS nail clipping ▸ Boards: **oral terbinafine because they are the most effective** ▸ Practice: Topical antifungal agents like ciclopirox lacquer, efinaconazole topical solution. ▸ Over The Counter: Vicks

Answer 2

PARONYCHIA

Answer 3

General: ▸ Inflammation of the skin around a finger or toenail ▸ Acute (<6 weeks) or Chronic ▸ Etiology: ▸ Skin flora - Staphylococcus aureus, Group A streptococcus ▸ Oral flora if nail biting ▸ Chronic - Candida ▸ Pathophysiology ▸ Commonly occurs after penetrating skin trauma

Answer 4

▸ Rapid onset of painful erythema and swelling to the proximal and/or lateral nail folds, usually within 2 to 5 days of localized trauma. ▸ May have purulent discharge or superficial abscess

Answer 5

▸ Mild: warm water or antiseptic soaks with chlorhexidine, povidone-iodine + topical antibacterial agent ▸ Moderate: oral antibiotic- cephalexin, dicloxacillin, augmentin if nail biting ▸ MRSA: trimethoprim sulfamethoxazole DS, clindamycin, doxycycline ▸ Abscess: incision and drainage, followed by warm soaks +/- antibiotics if cellulitis present

Answer 6

Closed space infection/ abscess of the fingertip pulp space ▸ Can be a progression of paronychia ▸ Most commonly occurs after penetrating skin trauma

Answer 7

Clinical Manifestations: ▸ Severe throbbing pain, erythema, swelling, and fluctuance to the pad of the fingertip ▸ Treatment: ▸ Early without fluctuance - elevation, warm water/saline soaks, oral antibiotics (cephalexin) ▸ Fluctuant - incision and drainage

Answer 8

▸ Benign, subcutaneous tumors composed of mature adipocytes enclosed by thin, fiber outs capsule. ▸ Most common benign soft tissue neoplasm

Answer 9

▸ Soft, painless, subcutaneous nodules that are easily mobile ▸ Most commonly found on the trunk, neck, upper extremities

Answer 10

▸ Diagnosis: clinical ▸ Indications for biopsy: pain, rapidly enlarging, firm, restricts movement ▸ Treatment: observation ▸ Can be excised for cosmetic purposes or if symptomatic

Answer 11

EPIDERMAL INCLUSION CYST

Answer 12

Benign, encapsulated, subepidermal nodules filled with fibrous tissue and keratinous material ▸ Most common in 30s and 40s, males: females affected 2:1 ▸ Pathophysiology: Results from plugging of the follicular orifices

Answer 13

▸ Asymptomatic, skin colored dermal, freely mobile, compressible cyst or natural, often with a clinically visible central punctum ▸ Ruptured, infected cyst become fluctuate, painful, larger, erythematous +/- foul-smelling discharge

Answer 14

clinical Treatment ▸ Not infected: no treatment necessary. ILK. Can be excised for cosmetic purposes or recurrently symptomatic ▸ Infected: incision and drainage

Answer 15

Furuncle: deep infection of the hair follicle Carbuncle: coalescence or interconnection of several furuncles into a single mass with purulent drainage from multiple follicles Etiology: Staphylococcus aureus, Streptococcus

Answer 16

FURUNCLE & CARBUNCLE

Answer 17

▸ Mainstay: incision and drainage ▸ Antibiotics: trimethoprim-sulfamethoxazole, doxycycline, clindamycin

Answer 18

Painful, chronic, inflammatory supportive condition involving the skin and subcutaneous tissue

Answer 19

Obesity, females, smoking, history of acne, family history

Answer 20

Recurrent, painful, deep-seated inflammatory nodules and abscesses, draining tracks, and fibrotic hypertrophic scars that most commonly affects intertriginous skin

Answer 21

HIDRADENITIS SUPPURATIVA

Answer 22

Dx: Clinical Treatment: ▸ Lifestyle Modifications: avoid high glycemic foods, smoking cessation, local skin care, eliminate irritants, weight loss ▸ Inflammatory lesions only: topical clindamycin+/-Antiangiogenic drugs, metformin ▸ Inflammatory lesions with sinus tracks or scarring: oral tetracycline (doxycycline) or Clindamycin + rifampin ▸ Refractory: Surgical excision

Answer 23

A highly contagious skin infection due to the mite Sarcoptes scabiei ▸ Pathophysiology: ▸ Female mites burrow into the skin to lay eggs, feed, and defecate - these particles are what precipitate a hypersensitivity reaction

Answer 24

Multiple, small, evidence papules with excoriations, **linear burrows (hallmark)** ▸ Red, itchy happy wheels or nodules on the scrotum, genitalia, or body folds are pathognomonic ▸ **Intense pruritus, especially at night**

Answer 25

clinical, mineral oil prep

Answer 26

Drug of choice: *topical* permethrin x 2 applications 1 week apart (for pregnant) ▸ Oral available for non-pregnant adults ▸ Lindane: cheaper option but cannot be used after bathing - increased risk of seizure. Contraindicated in pregnancy, children<2 years old

Answer 27

Treat all close contacts All clothing, bedding, etc. should be placed in plastic bags for at least 72 hours, then washed and dried using high heat

Answer 28

Person to person transmission through either direct contact, fomite exposure, or sexual transmission ▸ Strongly related to poor hygiene practices. ▸ Can affect any body part and serve as a vector for disease ▸ Head lice: girls>boys, most commonly affecting children ages 3–12 years old ▸ Body lice: typically live in the seams of clothing or bedding and move onto the skin to feed

Answer 29

Chief complaint: pruritus ▸ May visualize lice or nits - white, oval shaped egg capsules at the base of hair shafts

Answer 30

Head lice: drug of choice: topical permethrin x 2 applications 1 week apart, fine-tooth combing to remove nits ▸ Alternative: Malathion, lindane (remember this is neurotoxic) ▸ Body lice: hygiene practices are first line, topical permethrin 5% cream ▸ Pubic lice: topical permethrin 1% cream or pyrethrins, typically repeat in 10 days after initial treatment ▸ Treat all sexual contacts

Answer 31

hygiene improvement ▸ contact items should be laundered in hot water with detergent and dried and hot dryer for 20 minutes, toys that cannot be washed or place an airtight plastic bags for two weeks - avoid sharing contact items

Answer 32

Acute or chronic inflammatory mucocutaneous papulosquamous dermatitis ▸ Cell mediated immune response ▸ Most commonly seen in middle-aged adults ▸ Increased incidence with hepatitis C infection ▸ Can be medication induced, associated with graft vs. host, or lymphoma

Answer 33

Lichen Planus

Answer 34

Lichen Planus

Answer 35

6P’s: purple, polygonal, planar, pruritic, papules or plaques with fine scaling ▸ Borders May have wickham’s striae - fine, gray white lines on the skin and/or oral mucosa ▸ Koebner’s phenomenon - trauma induced lesions

Answer 36

Diagnosis: clinical Treatment: ▸ High or super-high potency topical corticosteroids, Oral antihistamines ▸ Intralesional corticosteroids ▸ Generalized or refractory: oral glucocorticoids ▸ Most patients have spontaneous resolution in 6-12 month

Answer 37

Skin thickening secondary to repetitive rubbing and scratching

Answer 38

Scaly, well demarcated, rough, hyperkeratotic plaques with exaggerated skin lines

Answer 39

no Dx mentioned.. Avoid scratching the lesions ▸ High potency topical corticosteroids, antihistamines ▸ Intralesional kenalog commonly used in practice

Answer 40

LICHEN SIMPLEX CHRONICUS

Answer 41

NEURODERMATITIS

Answer 42

Diffuse excoriations secondary to chronic itch, repetitive rubbing, scratching, and/or picking at skin ▸ Can see lichenified skin as a secondary finding ▸ Associated with mood disorders

Answer 43

Diagnosis: clinical ▸ Treatment: antihistamines, topical corticosteroids, wound care ▸ Avoidance of scratching ▸ Management of mood disorder