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clinical medicine > Other Dermatoses > Flashcards

Other Dermatoses Flashcards

0
Q

How does acanthosis nigricans present?

A
  • symmetrical hyperpigmented VELVETY* plaques
  • skin folds (posterior neck most common in kids)
  • usually asymptomatic (possible mild pruritus)
  • unclear if friction and sweating play a role
  • “dirty neck”-brownish
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1
Q

What are the “other dermatoses”?

A 
acanthosis nigricans
hidradenitis suppurativa
lipomas
epidermal inclusion cysts
melasma
pilonidal cyst
pressure ulcers
urticaria
vitiligo
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2
Q

What is acanthosis nigricans caused by?

A

possible factors that stimulate epidermal proliferation: INSULIN

  • association w/ insulin resistance & obesity
  • check plasma insulin level
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3
Q

What is the treatment for acanthosis nigricans?

A
  • treat underlying disease (weight loss, diabetes)

- improve appearance: keratinolytics, topical retinoids– these meds “thin out” plaques, make them peel off

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4
Q

Is there malignancy associated with acanthosis nigricans?

A
  • not common
  • associated with GI malignancy (underlying tumor aggressive)– can cause itchiness
  • appear abruptly and widespread
  • oral cavity may be involved
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5
Q

What is hidradenitis suppurativa? (HS)

A
  • “disorder of the terminal follicular epithelium apocrine gland bearing skin”
  • chronic
  • starts at puberty
  • females>males
  • axillae, groin, inframammary, butt
  • patients otherwise healthy!
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6
Q

What are the clinical features?

A
  1. erythema–>painful papules/nodules–>abscess–>discharge–>scarring
  • recurs (CLASSIC FEATURE)
  • scarring results in dermal contractures, rope like scar tissue formation, and open comedones
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7
Q

How is the HS diagnosis made?

A

clinically: typical lesion, distribution, recurrence

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8
Q

What is the treatment for HS?

A
  • no cure
  • surgery to remove glands (recurrence possible)
  • antibiotics
  • corticosteroids
  • pain management
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9
Q

What are lipomas?

A
  • benign, subcutaneous fatty tumors, made of fat cells
  • discrete rubbery mass, 2-10 cm (feels like jelly)
  • trunk/proximal extremities
  • mild tenderness possible
  • usually adults
  • familial trait if multiple
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10
Q

What is the treatment for lipomas?

A

Not necessary

can surgically excise if bothersome (give local anesthetic)

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11
Q

What is an epidermal inclusion cyst?

A
  • benign
  • proliferation of epidermal cells within a circumscribed space in dermis
  • may start as pimple or ingrown hair
  • usually asymptomatic
  • cheesy foul smelling contents
  • can be inflamed
  • Flesh colored firm round nodule ** - size varies, may have punctum (black head looking thing in middle)
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12
Q

What is the treatment for an epidermal inclusion cyst?

A
  • no treatment necessary
  • excision: must get out ALL of the lining or lesion will recur, if you just incise and drain, the lesion will recur because not all of the lining is removed
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13
Q

What is melasma?

A
  • hypermelanosis of sun exposed skin
  • hyperpigmentation: large patches or smaller individual lesions
  • face
  • females>males, due to hormonal influence (on OCP or w/ pregnancy)
  • asymptomatic
  • SUN EXPOSURE most important causative factor
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14
Q

What is the treatment for melasma?

A
  • difficult to treat
  • sun avoidance
  • high SPF sunscreen
  • avoid hormonal meds
  • hydroquinone-bleaching agent
  • topical retinoid
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15
Q

What is vitiligo?

A
  • acquired pigmentary disorder of skin and mucous membranes
  • melanocyte destruction
  • depigmented macules or patches
  • well demarcated
  • asymptomatic
  • hands, arms, feet, face, but can occur anywhere
  • perioral & periocular
  • hair may whiten
  • progressive & not contagious
16
Q

What are the causes of vitiligo?

A
  • not completely known

- autoimmune, genetic, inherent defect of melanocytes

17
Q

How is vitiligo diagnosed?

A
  • clinically

- associated with thyroid disorders (check thyroid labs)

18
Q

How is vitiligo treated?

A
  • no cure, difficult to treat, no standard treatment
  • the more distal, the more difficult to treat*
  • high SPF
  • systemic phototherapy to stimulate melanocytes (2-3x/wk, >6 months to see results, high risk of burning)
  • excimer laser for small patches (like phototherapy)
  • topical therapy (topical steroids, immunomodulators-protopic, elidel)
  • depigmentation therapy–permanent!
  • surgical: skin grafting, tattooing
  • mental health referral
19
Q

What is urticaria?

A

hives, most common derm presentation

  • raised, well circumscribed lesion of erythema and edema (wheal)
  • dermis + epidermis
  • VERY pruritic
  • lasts 6 weeks
20
Q

What are causes of urticaria?

A
  • release of histamine and other vasoactive substances in the dermis
  • causes: infection, foods, meds, skin pressure, heat, cold, stress, pregnancy, sun exposure, chronic mental illness
21
Q

What are other clinical features of urticaria?

A
  • dermographism-scratching cuases hives
  • angioedema-swelling of deeper tissue: lips, tongue, larynx
  • fever, arthralgias, weight changes
22
Q

What is the workup for urticaria?

A

no labs needed unless chronic:

CBC, TSH, ANA

23
Q

What is the treatment for urticaria?

A
  • ED if life threatening allergic reaction
  • antihistamines (first line, usually works)-benadryl
  • avoid systemic steroids
  • xolair: biologic for chronic idiopathic urticaria
  • remove offender
  • epipen rx
24
Q

What are pressure ulcers?

A
  • an area of unrelieved pressure over a defined area, usually over a bony prominence, resulting in ischemia/cell death/tissue necrosis
  • due to many factors: immobility, nutritional status, malignancy, incontinence
25
Q

What are the stages of ulcers?

A

Stage1- intact skin w/ signs of impending ulceration-initially non blanchable erythema = reactive hyperemia
Stage 2 - partial thickness loss of skin involving epidermis and dermis
Stage 3 - full thickness loss of skin: into subcutaneous tissue but not through underlying fascia
Stage 4 - full-thickness tissue loss with extension into muscle, bone, tendon or joint capsule
*unstageable - full-thickness tissue loss –base of ulcer covered by slough or eschar so much that cannot determine full wound depth

26
Q

What is the work up for pressure ulcers?

A
  • wound cultures, blood cultures (rule out sepsis)
  • CBC, UA, protein, albumin
  • Xray, bone scan, MRI (osteomyelitis)
27
Q

What is the treatment?

A
  • divided into operative and nonoperative messages
  • stage 1 & 2 ulcers: conservative (nonoperative)
  • stage 3 & 4: surgery, flap reconstruction, some must be treated conservatively due to coexisting medical problems
  • 70-90% pressure ulcers are superficial and heal by second intention
  • reduce pressure
  • debridement of necrotic & devitalized tissue
  • meticulous wound care
28
Q

What are the complications of pressure ulcers?

A
  • osteomyelitis
  • pyarthrosis
  • sepsis
  • malignant transformation
29
Q

What is the prognosis for pressure ulcers?

A
  • 60,000 deaths/year due to complications

- for patients w/ same underlying illness, the patient with the pressure ulcer as 4.5x higher risk of death!

30
Q

What is pilonidal disease?

A
  • cyst that occurs near the tailbone at the top of the cleft of butt
  • hair punctures skin and becomes embedded
  • infection results in a painful abscess
  • most common in young men
31
Q

What are risk factors of pilonidal disease?

A
  • obesity
  • sedentary lifestyle
  • excess body hair
  • poor hygiene
32
Q

What are the symptoms that occur with abscess formation in pilonidal disease?

A

erythema
pain
discharge

33
Q

What is the treatment of pilonidal disease?

A

incise and drain abscess
antibiotics
lesions recurrent after incision and drainage
complete excision for recurrent lesions

clinical medicine (12 decks)

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