PANCE Prep- Derm Flashcards
What do the following describe?
- Macule
- Papule
- Plaque
- Vesicle
- Bulla
- Wheal
- Pustule
- Petechaie
- Nodule
- Patch
- Macule: flat nonpalpable <10mm
- Papule: solid, raised <5mm
- Plaque: raised, flat-topped lesion >10mm
- Vesicle: circumscribed, elevated fluid-filled <5mm
- Bulla: circumscribed, elevated fluid-filled >5mm
- Wheal: transient, elevated lesion (local edema)
- Pustule: pus-filled vesicle or bulla
- Petechaie: small punctate hemorhages that DONT blanch
- Nodule: solid, raised >5mm
- Patch: flat, nonpalpable >10mm
Clinical Manifestation:
- Smooth discrete circular patches of complete hair loss that develops over a period of weeks
- Exclamation point hairs- short hairs broken off a few mm from the scalp at the margins of the patches with tapering near the proximal hair shaft
- Nail pitting or fissuring
Alopecia areata *commonly associated w/ other autoimmune disorders (thyroid, Addison’s disease, etc) *non-scarring immune mediated hair loss targeting the anagen hair follicles
Management of alopecia areata
if Local: inralesional corticosteroids
if extensive: topical corticosteroids
*may be observed if mild
**Relapse is common
Clinical Manifestations:
Varying degrees of hair thinning and nonscarring hair loss MC affecting the temporal scalp, midfront scalp or vertex area of scalp
Androgenetic alopecia
Management of androgenetic alopecia
- Minoxidil
- Oral Finasteride (5-alpha- reductase inhibitor) –> androgen inhibitor which inhibits the conversion of testosterone to DHT
SE of finesteride
5-alpha-reductase inhibitor (androgen inhibitors)
- Decreased libido or sexual function
- ED
Diagnose
Androgenetic Alopecia
Diagnose
Alopecia Areata
What is the atopic triad? and its pathophysiology
- Eczema
- Allergic rhinitis
- Asthma
**Starts in childhood
Type 1 Hypersensitivity, IgE mediated: Altered immune reaction in genetically susceptible people when exposed to certain tiggers–> T cell mediated immune activation and increase IgE production
Clinical Manifestations:
- Prurtic, erythematous, ill defined blisters/papules/plaques –> later dries, crusts over and scales
- +/- dermatographism (localized development of hives when the skin is stroked)
Atopic dermatits aka eczema
Where is Eczema most commonly found
flexor creases (antecubital and popliteal folds)
-Starts on face in infancy and then spreads to extremities w/ age
Treatment/plan for atopic dermatitis (eczema)
- topical corticosteroids for 14 days (steroid before moisturizer)
- antihistamines for itching (diphenhydrame, hydroxyzine)
- Daily skin hydration w/ emollients: Eucerin or Aquaphor
- Short baths a few times a week
- Educate: Avoid irritants (soaps, detergents, freq. baths, perspiratoin, heat), Chronic condition
- If infected: oral cephalexin or topical mupirocin x 7 days
Diagnose
Atopic Dermatitis (Eczema)
Clinical Manifestations:
Sharply defined discoid/coin-shaped* lesion especially on the dorsum of the hands, feet, and extensor surfaces (knees, elbows)
Nummular eczema
Diagnose:
Nummular Eczema
*sharply defined discoid/coin-shaped lesions on dorsum of hands, feet, and extensor surfaces (knees, elbows)
Treatment/Plan for contact dermatitis
- Avoid irritants
- Topical Corticosteroid
Describe and diagnose
Contact dermatitis (diaper rash) with possible candidiasis satellite lesions
erythematous macular rash along the skin folds where the diaper rubs, with possible annular satellite lesions
Treatment/Plan for diaper rash
- Frequent diaper changes
- hydrocortisone 1% cream or a diaper rash ointment such as Desitin or A & D.
- Candida diaper rash (satillite lesions)- Nystatin cream for 7 days
Clinical Manifestations:
- Pruritic “tapioca-like” tense VESCILES* on the soles, palms and fingers (lateral digits)
- Triggers: sweating, emotional stress, warm and humid weather, metals (nickel)
Dyshidrosis (dyshidrotic eczema) (Pompholyx)
Describe/Diagnose and treat
Dyshidrosis (dyshidrotic eczema)- tense VESICLES
- Topical steroids (med-high) ointment preferred
- cold compresses
Clinical Manifestations:
Scaly, well-demarcated, rough hyperkeratotic plaques w/ exaggerated skin lines*
Lichen Simplex Chronicus (neurodermatitis)
- skin thickening in pts w/ eczema
- secondary to repetitive rubbing/scratching- itch/scratch cycle
Describe/Diagnose and Treat
Lichen Simplex Chronicus (neurodermatitis)- scaly, well-demarcated rough hyperkeratotic plaques w/ exaggerated skin lines
- topical steroids (high strength)
- Educate: Avoid scratching the lesions (can use antihistamines)
What are the 5 P’s of Lichen Planus
- Purple
- Polygonal
- Planar
- Pruritic
. Papules w/ fine scales and irregular borders
Describe the clinical manifestations of lichen planus
- 5 P’s: purple, polygonal, planar, pruritic papules w/ fine scales and irregular borders
- MC on flexor surfaces of extremities, SKIN, MOUTH, SCALP, GENITALS, NAILS, and mucous membranes
- +/- Koebner’s phenomenon: new lesions at sites of trauma
- Wickham Striae***- fibe white lines on the skin lesions or on the oral mucosa, nail dystrophy
Describe/Diagnose and Treat
Lichen Planus- purple, polygonal, planar, prurtic papules w/ fine scales and irregualr borders and wickham striae (fine white lines on the skin lesions or on the oral mucosa)
- Topical corticosteroid
- antihistamines for itch
- 2nd line: PO steroids
There is an increased incidence of ___ skin rash with hepatitis C
lichen planus
Clinical Manifestation:
- Herald patch* (solitary salmon-colored macule) on the trunk 2-6cm in diameter–> general exanthem 1-2 weeks later: smaller, very pruritic 1 cm round/oval salmon colored papules w/ white circulare (collarette) scaling along cleavage lines* in a christmas tree pattern*
*Confied to trunk and proximal extremities (face usually spared)
Pityriasis rosea
Treatment of Pityriasis rosea
- NONE NEEDED: Resolves in 6-12 weeks
- antihistamines, topical corticosteroids for pruritis
- can mimic syphilis so order RPR if pt is sexually active
- Educate: generally thought not to be contagious but unknown cause- possibly viral
Describe and Diagnose
Pityriasis rosea
- Herald patch* (solitary salmon-colored macule) on the trunk 2-6cm in diameter–> general exanthem 1-2 weeks later: smaller, very pruritic 1 cm round/oval salmon colored PAPULES w/ white circulare (collarette) scaling along cleavage lines* in a christmas tree pattern*
*Confied to trunk and proximal extremities (face usually spared)
Pathophysiology of Psoriasis: keratin hyperplasia (proliferating cells in the ___ + ___ due to ___ and ____–> greater epidermal thickenss and increased epidermis turnover)
Stratum basale + stratum spinosum due to T cell activation and cytokine release
Clinical Manifestations:
- raised, dark-red palques/papules w/ thick silver/whilte scales* MC on extensor surface of elbows, knees, scalp, nape of neck
- Nail pitting- yellow/brown discoloration under the nail (oil spot**)
- Auspitz sign- punctate bleeding w/ removal of plaque/scale
- Koebners phenomenon: new lesions at site of skin trauma
Plaque Psoriasis
Describe and diagnose
Plaque Psoriasis:
- raised, dark-red palques/papules w/ thick silver/whilte scales* MC on extensor surface of elbows, knees, scalp, nape of neck
- Nail pitting- yellow/brown discoloration under the nail (oil spot**)
- Auspitz sign- punctate bleeding w/ removal of plaque/scale
- Koebners phenomenon: new lesions at site of skin trauma
Treatment and Plan for Plaque Psoriasis
- Mild-mod: topical steroids (high strength)+/- Vit. D analogs (Calcipotriene)
- Mod-severe: phototherapy (UVB), methotrexate (systemic tx)
Describe and diagnose
Guttate psoriasis- small, erythematous PAPULES with fine scales, discrete lesions and confluent papules
Clinical Manifestations:
- hyper/hypopigmented, well-demarcated round/oval MACULES w/ fine scaling. Often coalesce into patches on the trunk, face, extremities
- The involved skin fails to tan w/ sun exposure
Pityriasis (tinea) versicolor
How do you diagnose and treat tinea versicolor?
Dx:
- KOH prep frob skin scraping: hyphae and spores- “spaghetti and meatball appearance”
- Wood’s lamp: yellow-green fluorescene
**Overgrowth of the yeast Malassezia furfur- part of normal skin flora**
TX: Topical antifungals: selenium sulfide**, sodium sulfacetamine,
“azoles” (itraconazole or fluconazole) if widespread or fail topical tx
Describe and diagnose
Tinea Versicolor- hypopigmented, well demarcated round/oval macules with fine scaling
Clinical Manifestations:
- erythematous plaques with fine white scales (MC on scalp) (dandruff), eyelids, beard mustache, nasolabial folds, trunk (chest) and intertriginous regions of the groin
Seborrheic dermatitis
(Aka “cradle cap in infants”)
Describe/Diagnose and treat
Seborrheic dermatitis
- Topical selenium sulfide, sodium sulfacetamide, ketoconazole (shampoo or cream) or steroids
- oral antifungals
Acral lentiginous melanoma may occur where?
on the palm, sole, nail bed, or mucus membrane
__ is characterized by cough, coryza, and conjunctivitis, along with a fever as a prodrome. Koplik spots appear prior to the onset of the typical erythematous, maculopapular rash
Rubeola (measles)
Koplik spots appear prior to the onset of the typical erythematous, maculopapular rash and are pathognomonic for ___.
rubeola
___ produces erythematous red tender nodules, especially on the shins.
Erythema nodosum
Medications are most frequently implicated in toxic epidermal necrolysis. These usually include:
- analgesics (NSAIDs),
- antibiotics (Ampicillin) and
- anticonvulsants (Carbamazepine)
__ is the acquired loss of pigmentation due to the absence of epidermal melanocytes presenting on the back of hands, face, or body folds.
Vitiligo
____ is the treatment of choice for isolated superficial actinic keratosis.
Cryotherapy
Multinucleated cells found on Tzanck smear indicate ___
herpes
Ring-shaped lesions with scaly borders and central clearing are most likely caused by ____ which can be diagnosed by ____
- fungal infection
- Microscopic examination of scrapings reveals hyphae on KOH prep
__ is the most common cause of skin cancer
Basal cell cancer
*usually occurring on sun-exposed areas.
__ is one of the major Jones criteria for the diagnosis of acute rheumatic fever
Erythema marginatum
People living in warm, tropical climate, people wearing occlusive clothing or shoes, obese patients, and those with hyperhidrosis are at increased risk for ____ which can be diagnosed by ____
- erythrasma
- demonstration of a coral red fluorescence.
Acetowhitening is used to facilitate the diagnosis of ___
condyloma acuminata lesions.
Potassium hydroxide tests are used to rule out the presence of ___
dermatophyte (fungal and yeast) infections.
Wood’s light fluoroscopy is used in the assessment of:
dermatophyte infection and a bacterial infection known as erythrasma.
__ is used to kill the scabies mite
Permethrin
Telangiectatic vessels are often visible skin findings with __
basal cell carcinoma.
___ is an acute eruption of fine scaling fawn-colored papules and plaques that are distributed along the cleavage lines of the trunk. A single plaque, called a herald patch, precedes the secondary eruption by 1-2 weeks.
Pityriasis rosea
-rash along cleavage lines of trunk is often referred to as a Christmas tree pattern.
__ is a common benign plaque in the elderly that characteristically has a velvety or warty surface associated with a stuck on appearance and greasy feel.
Seborrheic keratosis
___ most commonly are seen on the dorsum of the hand and appear as flat brown spots, often with sharp borders.
Lentigines
__ usually present as small patches of flesh-colored, pink or yellow-brown lesions often with an erythematous component. The lesions are better felt than seen, having a rough, sandpaper feel and are often tender to palpation.
Actinic keratosis
Wood’s light examination reveals a “milk-white” fluorescence over the lesion.
Vitiligo
Those who received a killed MMR virus immunization between __ and __ should receive a live attenuated booster vaccination
1963 and 1967
Tx of Molluscum contagiosum
- mechanical (curettage, laser, or cryotherapy with liquid nitrogen or nitrous oxide cryogun),
- chemical (trichloroacetic acid, tretinoin), or
- immunologic (imiquimod)
If the area of affected skin of Impetigo is limited, __ is an effective therapy
mupirocin
* topical mupirocin therapy and has been shown to be more effective than the other topical antibiotics (i.e., neomycin, bacitracin, polymyxin B, and gentamicin).
Malignant acanthosis nigricans is associated with __
with an intestinal cancer such as gastric carcinoma
Describe The Rules of Nines for Burns
- head and neck, 9%;
- arm (each), 9%;
- trunk (anterior), 18%
- trunk (posterior), 18%
- leg (each), 18%;
- genitalia, 1%
__ is described as the “mask of pregnancy.”
Melasma, also referred to as chloasma,
