Rapid Review Derm Flashcards
Stuck on appearance
Seborrheic keratosis
Red plaques with silvery white scales and sharp margin
Psoriasis
Most common type of skin cancer
Lesion pearly-colored papule with translucent surface and telangiectasias
Basal cell carcinoma
Honey crusted lesions
Impetigo
Febrile pt w/ Hx DM presnts with red, swollen, painful LE
Cellulitis
Positive Niklosky’s sign
Pemphigus vulgaris
Negative Niklosky’s sign
Bullous pemphigoid
55 yo obese pt presents with dirty, velvety patches on back of beck
Acanthosis nigricans-check FBG to r/o DM
Dermatomal distribution
Varicella zoster
Flat topped papules
Lichen planus
Iris like target lesions
Erythema multiforme
Lesion characteristically occurring in linear pattern in areas where skin comes into contact with clothing or jewelry
Contact dermatitis
Presents with herald patch, Christmas tree pattern
Pityriasis rosea
Pinkish, scalding flat lesions on chest and back, KOH prep has “spaghetti and meatballs” apperance
Tinea (pityriasis) versicolor
4 characteristics of nevus suggestive of melanoma
Asymmetry
Border irregularity
Color variation
Diameter increasing
Premalignant lesions from sun exposure that can lead to SCC
Actinic keratosis
Dewdrops on rose petal
Lesions of primary varicella
Cradle cap
Seborrheic dermatitis
Tx conservatively with bathing and moisturizer
Associated with Propionibacterium acnes and changes in androgen levels
Acne vulgaris
Painful, recurrent vesicular eruption of mucocutaneous surfaces
Herpes simplex
Inflammation and epithelial thinning of anogenital area, predominantly in postmenopausal
Lichen sclerosus
Exophytic nodules on skin with varying degrees of scaling or ulceration; 2nd most common skin cancer
SCC
Macule
flat lesion that differs in color from surrounding skin <1 cm diameter
Patch
small circumscribed area differing in color from the surroundings surface >1cm diameter
Papule
Elevated solid lesion that is generally small <5mm
Plaque
Elevated solid lesion >5 mm
Cyst
Epithelial lined sac containing fluid or semisolid material
Vesicle
Fluid-filled, very small (<5 mm) elevated lesion
Bulla
Large vesicle >5 mm
Wheal or hive
Area of localized edema that follows vascular leakage and usually disappears within hours
Erosion
Circumscribed, superficial depression resulting from loss of some or all of epidermis
Ulcer
Deeper depression than erosion resulting from erosion of epidermis and upper dermis
Scale
Abnormal shedding or accumulation of stratum corneum in flakes
Crust
Hardened deposit of dried serum, blood, or purulent exudates
LIchenification
Thickening and hardening of skin with accentuation of normal skin marking
Scar
Healing defect of dermis
Type I hypersensitivity reaction - describe and give mechanism
Anaphylactic and atopic
Antigen crosslinks IgE on PRESENSITIZED mast cells and basophils- release vasoactive amines (histamine and LT) – reaction due to preformed ab
Type II hypersensitivity reaction - describe and give mechanism
Cytotoxic
preformed IgM and IgG bind antigen an enemy cell - lysis via complement or phagocytosis (MAC)
Type III hypersensitivity reaction - what are 3 types?
Immune complex
Serum sickness
Arthus reaction
Immune complex: type of hypersensitivity and mechanism
Type III
Ag-Ab complexes activate complement-attract PMN-release lysosomal enzymes
Serum sickness: type of hypersensitivity and mechanism
Ab to foreign proteins produce in about 5 d - immune complexes form and deposit in membrane- lead to tissue damage due to complement fixation
Arthus reaction: type of hypersensitivity and mechanism
Type III
Local reaction to antigen by preformed Ab charactized by vascular necrosis and thrombosis
Type IV hypersensitivity reaction - describe and give mechanism
Delayed/cell mediated
Sensitized T cells encounter antigen and release lymphokines that activate macrophages
Because is cell mediated is NOT TRANSFERABLE BY SERUM
Anaphylaxis, asthma, urticarial drug reaction ,wheal and flare - what type of hypersensitivity run
Type I- anaphylactic and atopic
AI hemolytic anemia, erythroblastosis fetalis, Goodpasture, rheumatic fever - what type of hypersensitivity run
Type II-cytotoxic
Polyarteritis nodosa, immune complex GMN, SLE, RA - what type of hypersensitivity run
Type III: immune complex
Drug reaction- what type of hypersensitivity run
Type III: serum sickness
Hypersensitivity pneumonitis- what type of hypersensitivity run
Type III: arthus reaction
Rarely occurs 4-12 hrs after vaccination
TB skin test, transplant rejection, contact dermatitis- what type of hypersensitivity run
Type IV: delayed/cell mediated
Psoriasis cause
T cell mediated - dermal inflammation and epidermal hyperplasia
Tx seborrheic dermatitis
Selenium sulfide
Zn pyrithione
Topical steroid
Topical antifungal
Tx psoriasis
Steroid + keratolytic, tar, anthralin
IV
Methotrexate if bad
Retinoids and D3
Rash of extensor surface
Psoriasis
Rash of flexor surface
Atopic dermatitis
Associated with psoriasis
Seronegative arthritis
Tx hives/urticaria
Antihistamine
If anaphylaxis: antihistamine, Epi, IVF, airway
Tx drug eruption
Stop drug, antihistamine, topical steroid
Number of days before cutaneous drug reaction seen
7-14
Major trigger Erythema multiforme
HSV lip
Total body surface area of exfoliation SJS vs TEN
SJS 30%
Tx SJS and TEN
Tx like burn: IVF, cover skin, watch lytes, careful of infection, thermoregulation problems,
Can use systemic steroids and IVIG in early stages
Etiology SJS/TEN vs SSSS
SSSS- infection
SJS/TEN- drug
Tx erythema nodosum
NSAIDs, remove offending agent
Tx bullous pemphigoid vs pemphigoid vulgaris
Bullous: Steroids, azothioprine
Vulgaris: high dose steroids, + immunomodulator-IVIG, MMF, rituximab; azothioprine, cyclophosphamide
Tzanck smear
Dx HSV: multinuclear giant cell
Tzanck goodness its not herpes!
Tx HSV
acyclovir oral or IV
Can use valacyclovir, famciclovir
Daily Tx if > 6 outbreaks per yr
Tx VZV
Acyclovir
Vaccine available
Molloscum contagiosum-type of virus; Dx
Poxvirus
Giemsa or Wright stain shows inclusion bodies
Tx molloscum contagiosum
Freezing, curetting, trichloroacetic acid
Tx verrucae
Cryotherapy, podophylllin, trichloroacetic acid, imiquimod, 5FU
Tx eryspelas
Penicillin (usu. GAS infection)
Tx impetigo
Abx w/ staph coverage- cephalosporins, erythromycin, topicals
Topical usu good enough but oral to prevent spread
Scarlet fever, cause, Tx
Strep pyogenes
Penicillin
Tx salmonella typhi
Fluoroquinolone and 3rd cephalosporin
If chronic carrier consider cholecystectomy
Ludwing angina- what; presentation?
What: bilateral cellulitis of submental, submaxillary, sublingual spaces that results from infected tooth
S/S: dysphagia, drooling, fever, red warm mouth- can asphyxiate
Most common cause cellulitis
GAS, Staph (MRSA)
Tx cellulitis
7-10 oral abx if mild; 10-14 d cephalosporin or beta lactamase resistant abx
IV abx if DM, bad, old, hand or eye, etc
If MRSA: vanc or linezolid
Necrotizing fasciitis
Causes
Signs
Tx
S pyogenes
Mixed: S aureus, E coli, C perfringens
S/S: tissue necrosis, putrid discharge, bullae, pain, gas production
Tx: Strep 1. Pen G 2. Clinda
Anaerobic: Metronidazole or 3rd ceph
Folliculitis - causes, hot tub
Staph, Strep, Gram N, sometimes Candida
Pseudomonas- hot tub
Furuncle vs carbuncle
Furuncle deep infection of hair follicle, progressed from folliciltis
Carbuncle many furuncles
Tx 1. comedonal acne
- pustulocystic or inflammatory
- sever cystic
- topical tretinoin + benzoyl peroxide
- benzoyl peroxide + topical abx (erythromycin or clindamycin), oral if resistant to topical
- Isoretinoin- test LFT, chol, TG, beta HCG
Tx pilonoidal
I and D
Abx cause serious photosensitivity
Tetracycline and doxycycline
KOH prep reveals spaghetti and meatballs
Tinea versicolor
Cause tinea versicolor
Malasezia furfur
Tx tinea versicolor
Ketoconazole or selenium sulfide
Candidiasis Tx
- oral
- skin
- diapr
- oral fluconazole, nystatin swish and swallow
- topical antifungal
- topical nystatin
Dermatophyte - 3 common bugs
Trichophyton
Microscporum
Epidermophytin
Tx dermatophyte
Topical antifungals ok
Capitis must be oral
Tx scabies
5% permethrin from neck down
can use oral ivermectin
Tx lice
head: pyrethrin (RID), benzoyl alcohol, remove nits
Body: wash, permethrin or pyrethrin
Pubic: RID
Tx rosacea
topical metronidazole
Tx vitiligo
Psoralens, sunlight, PUVA
Tx actinic keratosis
Cryotherapy
5FU
Imiquinod
Biopsy
Commonest causes SCC
Sun
Arsenic
Examples of macule
Cafe au lait spot Vitiligo Freckle Junction nevi Ink tattoo
Examples of Patch
Nevus flammeus
Vitiligo
Tinea corporis
Examples of Papule
Acrochordon (skin tag) Basal cell carcinoma Molloscum contagiosum Intradermal nevi Lichen planus
Example Plaque
Bowen disease Mycosis fungoides Psoriasis Eczema Tinea corporis
Examples of Nodule
Rheumatoid nodule Tendon xanthoma Erythema nodosum Lipoma Metastatic carcinoma
Examples of wheal
Urticaria
Dermographism
Urticaria pigmentosa
Examples of vesicle
Herpes simplex
Herpes zoster
Dyshidrotic eczema
Contact dermatitis
Examples of bulla
Pemphigus vulgaris
Bullous pemphigoid
Bullous impetigo
Examples of pustule
Follicultis
Impetigo
Acne
Pustular psoriasis
Examples of cyst
Acne
Epidermoid cyst
Pilar cyst
Hidranitis suppurativa - define, bugs, Tx
Chronic follicular occlusion and apocrine inflammation 2/2 recurrent abscess
Bugs: Staph
Tx: I and D, cephalosporin
Mom pregnant and has chicken pox
Give immunoglobulin b/c can transmit to newborn
Enzyme def in prophyria cutanea tarda
Hepatic uroporphyrinogen decarboxylase
Tx porphyria cutanea tarda
Phlebotomy
Low dose chloroquie
Sunscreen
Avoid triggers: estrogen, alcohol, tobacco
Hereditary angioedema cause
Lack of C1 esterase inhibitor
Swelling of kips eyelids, airway, bowel
AD, C4 is low