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Setha: Derm! > Pance pearls > Flashcards

Pance pearls Flashcards

1
Q

Triggers of Dishydrosis

A

Sweating, emotional stress, warm weather, metals

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2
Q

Pruritus “tapioca pudding” tense vesicles on palms, soles and fingers

A

Dishydrosis

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3
Q

Management of Dishydrosis

A

Topical steroids (high strength)- ointments preferred

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4
Q

What is atopic dermatitis linked with?

A

Hay fever, allergy, allergic rhinitis, asthma, & other atopic dx

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5
Q

Altered immune reaction in genetically susceptible population when exposed to triggers –> T-cell mediated immune activation with increase in IgE production

A

Atopic dermatitis

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6
Q

Triggers of atopic dermatitis?

A

heat, perspiration, allergens, and contact irritants

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7
Q

What is the hallmark clinical manifestation of atopic dermatitis?

A

Pruritus- “itch-scratch cycle”

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8
Q

Tiny, erythematous, edematous ill-defined blisters –> dries/crusts over and scales. MC in flexor creases (anticubital & popliteal folds)

A

atopic dermatitis

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9
Q

Sharply defined coin-shaped lesions on dorsal hand, feet extensor surface

A

Nummular eczema

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10
Q

Management of atopic dermatitis

A

High strength topical steroids & antihistamines for itching

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11
Q

Skin thickening in patients with eczema secondary to repetitive rubbing/scratching

A

Lichen simplex chronicus

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12
Q

Scaly, well-demarcated rough plaques with exaggerated skin lines

A

Lichen simplex chronicus

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13
Q

Management of LSC?

A

Topical steroids (high strength) and avoid scratching

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14
Q

Where does lichen planus develop?

A

Flexor surfaces of extremities, mucous membranes on skin mouth, scalp, genitals, or nails

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15
Q

In which disease do you see lichen planus more often?

A

HCV infection

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16
Q

What are the 5 P’s for lichen planus?

A

Purple, polygonal, planar, pruritic papules with fine scales

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17
Q

What type of lesions can be seen in the oral mucosa with lichen planus?

A

Lacy lesions (Wickham striae)

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18
Q

Management of lichen planus?

A

Topical steroid ointment and antihistamines

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19
Q

Herald patch (solitary salmon-colored macule) on trunk –> general exanthem 1-2 weeks later with smaller, round/oval salmon-colored papules with white circular (collarette) scaling along cleavage lines. VERY PRURITIC

A

Pityriasis rosea

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20
Q

What rash pattern is seen with Pityriasis rosea?

A

Christmas tree

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21
Q

Management for Pityriasis rosea

A

None needed

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22
Q

What is the pathophysiology of psoriasis?

A

Keratin hyperplasia (proliferating cells in the stratum basale and stratum spinosum due to T-cell activation & cytokine release). Leads to epidermal thickening and continuous turnover of the dermis

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23
Q

Plaques seen in Psoriasis?

A
  • MC type
  • raised dark red plaques/papules with thick silver/white scales
  • found on extensor surfaces and scalp
  • Nail pitting in 25%
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24
Q

What signs/phenomenon are seen with Psoriasis?

A

Auspitz sigmn and Koebner’s phenomenon

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25
Q

Clinical manifestations of Pustular psoriasis?

A

Deep, yellow non-infected pustules –> red macules on palms/soles

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26
Q

Clinical manifestations of Guttate psoriasis?

A
  • small, erythematous papules with fine scales, discrete lesions, and confluent plaques
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27
Q

What inflammatory condition is seen with psoriasis?

A

Psoriatic arthritis

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28
Q

Sx of psoriatic arthritis?

A
  • Stiffness >30mins relived with activity
  • Sausage digits
  • X-ray: pencil in cup deformity
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29
Q

Management of psoriasis?

A
  • Topical steroids, tar-based anthralin, Vit. D analnogs & retinoid
  • UBV light therapy , immune agents
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30
Q

Occurs in areas of high sebaceous glands over secretion (scalp, face, eyebrows, body folds)

A

Seborrheic dermatitis

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31
Q

What do you have a hypersensitivity too in seborrheic dermatitis?

A

Pityrosporum ovale

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32
Q

What does seborrheic dermatitis present as in infants?

A

Cradle cap

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33
Q

Erythematous plaques with fine white scales common on the scalp (dandruff)

A

Seborrheic dermatitis

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34
Q

Management of seborrheic dermatitis?

A

Selenium sulfide, sodium sulfacetamide, ketoconazole (shampoo or cream), steroids, zinc pyrithione

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35
Q

Type I HSN (IgE) reaction of dermis or SQ tissues

A

Urticaria (Hives)

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36
Q

Triggers of Urticaria (Hives)?

A
  • foods
  • meds
  • infections
  • insect bites
  • drugs
  • environmental
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37
Q

What is the pathophys of Urticaria (Hives)?

A

Mast cells release histamine causing vasodilation of venules –> edema of dermis and SQ tissues

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38
Q

Blanchable, edematous pink papules, wheals, or plaques that are oval, linear, or irregular

A

Urticaria (Hives)

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39
Q

What is Darier’s sign?

A

Localized urticaria appearing where skin is rubbed (histamine induced)

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40
Q

What is the tx of choice for Urticaria (Hives)?

A

oral antihistamines

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41
Q

Acute, self-limiting type IV HSN rxn most common in adults 20-40 y/o

A

Erythema multiforme

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42
Q

What infections are assoicated with erythema multiforme?

A
  • HSV most common
  • mycoplasma
  • s. pneumo
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43
Q

What meds are associated with erythema multiforme?

A
  • sulfa drugs
  • beta-lactams
  • phenytoin
  • phenobarbital
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44
Q

What type of lesion is pathognomonic of erythema multiforme?

A

TARGET (iris) lesions

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45
Q

Dull, “dusty-violet” red, purpuric macule/vesicle or bullae in center surrounded by pale edematous rim & peropheral halo. Patient often FEBRILE

A

Erythema multiforme

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46
Q

What are the guidelines for erythema multiforme minor?

A
  • target lesions distributed acrally
  • no mucosal membrane lesions
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47
Q

What are the guidelines for erythema multiforme major?

A
  • target lesions with involvement of >1 mucous membranes (oral, genital, ocular mucosa)
  • <10% BSA acrally –> centrally
  • no epidermal detachment
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48
Q

Management of erythema multiforme?

A
  • Symptomatic: discontinue drug causing rash
  • can also use steroid mouthwashes for oral lesions
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49
Q

What most commonly causes SJS and TEN?

A

Drug eruptions esp. Sulfa and antioconvulsant meds and infections like Mycoplasma, HSV, HIV, malignancy

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50
Q

What % of sloughing of BSA is seen in SJS and TEN?

A
  • SJS: <10%
  • TEN: >30%
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51
Q

What sign is positive in SJS and TEN?

A

Nikolsky sign: pushing a blister causes further separation of the dermis

52
Q

What are the clinical manifestations of SJS and TEN?

A
  • Fever & URI sx
  • Widespread blisters begin on trunk/face
  • erythematous/pruritic macules >1 mucous membrane with epidermal detachment
53
Q

Management of SJS and TEN?

A

treat like severe burns

54
Q

4 main pathophysiologic factors of acne vulgarus

A
  • Increased sebum production: MC due to puberty (increased androgens)
  • Clogged sebaceous glands
  • Propionibacterium acne overgrowth in blocked pores
  • Inflammatory response
55
Q

Clinical manifestations of acne vulgaris?

A
  • Comedones
  • Inflammatory papules or pustules
  • Nodular or cystic acne –> often heals with scarring
56
Q

What is an open comedone?

A

Blackhead –> due to incomplete blockage

57
Q

What is a closed comedone?

A

Whitehead –> complete blockage

58
Q

What is seen in mild acne?

A

Comedones w or w/o small amounts of papules or pustules

59
Q

What is seen in moderate acne?

A

Comedones with larger amounts of papules and/or pustules

60
Q

What is seen in severe acne?

A

Nodular or cystic acne

61
Q

What is the management for mild acne?

A
  • topical retinoids
  • benzyl peroxide
  • topical abx
  • OCPs
62
Q

What is the management for moderate acne?

A

Same as mild acne but can add oral abx like doxy or minocycline and spironolactone (anti-androgen agent)

63
Q

What is the management for severe acne?

A

Isotretinoins

64
Q

What are the side effects of Isotretinoins?

A
  • Highly teratogenic
  • psych side effects
  • hepatits
  • increased triglycerides/cholesterol
  • MUST obtain 2 pregnancy tests prior to starting & monthly while on it
65
Q

What is considered “adult acne”?

66
Q

Triggers of Rosacea?

A
  • EtOH
  • increased temperature
  • hot drinks
  • hot/cold weather
  • hot baths
  • spicy foods
67
Q

Acne-like rash with erythema, facial flushing, telangiectasia, skin coarsening, papulopustules with burning/stinging

68
Q

What distinguishes rosacea from acne?

A

Absence of comedones

69
Q

What is first line treatment for rosacea?

A

Topical metronidazole and clonidine may be used for flushing

70
Q

Lifestyle modifications for rosacea?

A
  • sunscreen
  • avoid toners
  • astringent menthols
  • camphor
71
Q

What population is actinic keratosis most commonly seen in?

A

fair-skinned elderly with prolonged sun exposure

72
Q

What is actinic keratosis a premalignant condition to?

A

squamous cell carcinoma

73
Q

Dry, rough, scaly “sandpaper” skin lesions or edematous, hyperkeratotic plaques

A

Actinic keratosis

74
Q

How do you diagnose actinic keratosis?

A

epidermal/dermal cells with large hyper chromatic nuclei

75
Q

Management of actinic keratosis?

A
  • Observation
  • Surgical: cryotherapy or dermabrasion
  • medical: 5FU or imiquimod
76
Q

What is the pathophysiology of vitiligo?

A

Autoimmune destruction of melanocytes that leads to skin depigmentation

77
Q

Irregular macules & patches of total depigmentation

78
Q

Management of vitiligo?

A
  • Systemic phototherapy (may aid in repigmentation)
  • laser therapy (effective on limited areas)
79
Q

What is the most common benign skin tumor that is seen in fair-skinned elderly with prolonged sun exposure?

A

Seborrheic keratosis

80
Q

Small papule/plaque velvety warty lesion with “greasy/stuck on appearance”

varied colors: flesh-colored, brown, black, grey

A

Seborrheic keratosis

81
Q

Management of seborrheic keratosis?

A

Benign= NO TREATMENT NEEDED! :)

Can use cryotherapy for cosmetic reasons

82
Q

Most common type of skin cancer in the US

A

Basal cell carcinoma

83
Q

Where is basal cell carcinoma most commonly seen?

A

Fair-skinned with prolonged sun expsoure and xeroderma

84
Q

Slow growing

Locally invasive but very low incidence of metastasis

A

Basal cell carcinoma

85
Q

Flat, firm area with small, raised, translucent/pearly/waxy papule with central ulceration & raised, rolled borders

MC on face/nose/trunk

Often friable (bleeds easily)

A

Basal cell carcinoma

86
Q

How do you dx basal cell carcinoma?

A

Punch or shave biopsy

87
Q

What is the tx of choice for basal cell carcinoma?

A

Electric desiccation/curettage

88
Q

2nd MC skin cancer

A

Squamous cell carcinoma

89
Q

What often preceeds squamous cell carcinoma?

A
  • Actinic keratosis
  • HPV infection
  • Sun/envrio exposure
  • Xeroderma pigmentosum
90
Q

Where on the body is SCC most commonly found?

A

Lips, hands, neck & head

91
Q

Pathophysiology of SCC?

A

Malignancy pf keratinocytes of skin/mucous membranes: hyperkeratosis & ulceration

92
Q

What is Bowen’s disease?

A

SCC in situ –> slow growing

93
Q

Red, elevated nodule with white scaly or crusted bloody margins

A

Squamous cell carcinoma

94
Q

How do you dx SCC?

A

Biopsy: epidermal & dermal cells with large, pleomorphic, hyperchromatic nuclei

95
Q

Tx of choice for SCC?

A

Excision!!

96
Q

What % of cases of malignant melanoma are associated with UV radiation?

97
Q

Agressive with high METS potential

A

Malignant melanoma

98
Q

In which population is malignant melanoma most commonly seen?

A

Caucasian patient with light hair/eye color

Also pt’s with Xeroderma pigmentosum

99
Q

“ABCDE” of malignant melanoma

A
  • Asymmetry
  • Borders: irregular
  • Color: variation (dark blue, black)
  • Diameter: >6mm
  • Evolution (suspect in a lesion with recent/rapid change in appearance)
100
Q

What is the most important prognostic factor for METS in malignant melanoma?

101
Q

What is the MC skin cancer death?

A

Malignant melanoma

102
Q

How do you dx malignant melanoma?

A

Full-thickness wide excisional bx with LN biopsy

103
Q

Management of malignant melanoma?

A

Excision (lymph node bx or dissection)

104
Q

What is the MC neoplasm seen in HIV/immunocompromised?

A

Kaposi sarcoma

105
Q

Connective tissue cancer caused by HHV-8

A

Kaposi sarcoma

106
Q

Macular, popular, nodule, plaque-like brown/pink/red or violaceous lesions

A

Kaposi sarcoma

107
Q

Management for Kaposi sarcoma?

A

HAART therapy

108
Q

Highly contagious superficial vesiculopustular skin infection primarily on exposed surface of face and extremities

Usually multiple lesions

109
Q

Risk factors of impetigo?

A
  • warm, humid conditions
  • poor personal hygeine
110
Q

Where does impetigo most often occur?

A

@ sites of superficial skin trauma (eg insect bites)

111
Q

What is nonbullous impetigo?

A
  • Impetigo contagiosa: vesicles, pustules
  • characteristic “honey-colored crusts”
  • MC type!
112
Q

What is the MC and 2nd MC cause of nonbullous impetigo?

A

1st: S. aureus
2nd: GABHS

113
Q

What is bullous impetigo?

A

Vesicles form large bullae (rapidly) –> rupture –> thin “varnish like crusts”

114
Q

What is the MC cause of bullous impetigo?

115
Q

Is bullous impetigo common?

A

NO, but usually seen in newborn/young children

116
Q

What is ecthyma impetigo?

A

Ulcerative pyoderma caused by GABHS (heals with scarring)

Not common

117
Q

What is the DOC for impetigo?

A

Mupirocin (Bactroban)

118
Q

What tx is used for extensive impetigo dx?

A

Systemic abx (Cephalexin, Dicloxacillin)

119
Q

What is cellulitis?

A

Acute, spreading superficial infection of dermal, subcutaneous tissues

120
Q

What bacterias cause cellulitis?

A

S. aureus and group A strep

H. influenza/S. pneumonia in children

121
Q

How does cellulitis usually occur?

A

Break in the skin

122
Q

Local manifestations of cellulitis?

A

macular erythema (margins flat, not sharply dermarcated), swelling, warmth, and tenderness

123
Q

Tx for cellulitis?

A

Abx for 7-10 days: Cephalexin or Dicloxacillin

124
Q

Systemic manifestations of cellulitis?

A

Fever, chills, +/- tender lymphadenopathy, +/- lymphangitis (erythematous streaking), myalgias

vesicles, bullae, hemorrhage, and necrosis may form

125
Q

What abx should you use for cellulitis caused by a cat bite? :)

A

Augmentin for Pasteurella multocida

Setha: Derm! (4 decks)

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