Rashes 2 Flashcards
What is erythema multiforme caused by?
Herpes virus
What to always ask pt before stating Benadryl or doxepin HS
Any balance issues?
What tx for eyelid dermatitis
Aquaphor at night
If itches - give Protopic 0.03?
Tachyphylaxis
Diminishing response to drug
Diminishing response to drug
Tachyphylaxis
Which drug not to use for Hair Loss in male with prostate cancer
Propecia (finasteride)
LPP tx
Can try topical Betamethasone lotion on scalp
If not improvement, start Doxy 100 qHS with dinner and sunscreen
PLUS
IL Kenalog (half Ken, half saline) - inject at 90 degrees 1 cm apart
RTC in 8 weeks
Which oral med for Bullous Pemphigoid (BP)>
Standard tx:
Doxy 100 BID with SS and food
Plus
Topical Clobetasol compounded in aquaphor (wrap bad areas in seran wrap)
If no improvement/refractory:
Prednisone
What is chilblains
Redness and swelling of toes hands feet nose ears and face due to cold
Especially in kids
Ask about which recreational activity in pt presenting with itch?
Do you smoke? (Cancer)
If SCCis and BBC superficial to edge in the same location (dorsal hand) - how to tx
Aldara
Can’t do bx when pt just finished FUDEX or Aldara for how long?
For 2 weeks (till skin calms down)
If SCCis to base, how to tx
Always excise or MOHS (because could be deeper than SCCis)
SCCis to edge, how to tx
EDC
Aldara is indicated for
BCC (SUPERFICIAL Only)
And AKs
Angular cheilitis is also called
Perleche
How long is Aldara tx
For BCC: M-F x 6 weeks qHS
For AK: 2 weeks on/2 weeks off/2 weeks on
Only 80% of ppl respond and flu like sx in 1 %
Can FUDEX be used on SSCis
Yes, x 3-4 weeks, but not FDA approved
Or for 6 weeks per JOB, check at 1 month after stopping
Besides FUDEX, what other tx for AKs
Solarace (3% diclofenac) BID x 12 weeks
Picato qHS x 3 days
PDT blue light
Aldara
Which SCC requires URGENT MOHS?
MODERATELY differentiated AND immunocompromised pt
Tx of MM to base
Any depth to BASE is going to plastics
Furfuraceous meaning
Fluffy scales
Oral tx for TINEA versicolor and directions
Intraconaze 200 mg QD x 5 days and.
And tell pt to sweat 30 min after taking pill
Maintenance: same BID once per month
S/I congestive heart failure
SE neuropathy Liver
Or FLUCONASOLE 400 once and repeated monthly
What recreational activity makes dyshydrotic eczema worse?
Smoking
Also stress and sweating
Tx of Nodular BCC to base and edge
EDC ok if small
Excise if big
Oral tabs for scabies
Ivermectin
If not responding to permethrin?
Which labs to order for itchy rash, when ddx BP
BP 180 (IgG antibodies) (more sensitive) BP 230. CBC CMP ANA
Cicatricial meaning
Scarring
What strength of Kenalog for face pimple
2.5 mg Kenalog: mix .1 Kenalog with .3 saline (total .4)
At 30 degree angle till blanches
Less than 0.1 cc
Pt presents with hand rash, where else to always check
Feet - TINEA pedis can cause ID reaction on hands (as dyshydrotic eczema or degeralized dermatitis)
What to always tell pts with psoriasis of scalp - pt education
Be gentle when washing hair and when cloning hair
Scalp psoriasis tx
Betamethasone lotion BID x 2 weeks
PLUS
TGel (to decrease redness and itch) and T SAL (helps with crusting)
Alternate shampos - wash hair every day!
If not better, IL Ken, if not better, ECZEMER laser(scalp, hands, feet)
Pt presents with thick, well demarcated plaques, where else to look
Elbows, knees, butt
Doxy is used for
LPP
Hydradenitis Supporativa
Bullous Pemphigoid
Oral med for LPP
Doxy
Oral med for LP not responding to regular tx
Flagyl (can’t drink)
Does frontal fibrosing alopecia (FFA) ever go away
FFA cause
Yes but not sure when
Cause is unknown. It;s inflammation of hair follicles which eventually leads to permanent hair loss (so best to tx it on)
Best tx for FFA and LPP
IL kenalog to prevent permanent hair loss but it’s not a cure - have to come back every 6 weeks?
IL kenalog lasts couple of mounths
For LPP - DOxy
But not for FFA?
Another tx option for scalp psoriasis
Eczemer laser
Start tx with Beta lotion BID, TGEL and TSAL, RTC in 6-8 wks
If not better, IL Ken and RTC 6-8 wks
In not better, then make sure NOT picking and Eczemer laser
If not better, compound betameth in olive oil, shower cap overnight, and compound TSAL with 6 % SA
How to tx benign angiomas?
Vascular laser
There is chance they will come back
Or Electrocautery for cherry angiomas
Scalp sores that won’t heal after procedures
Chronic erosive pustulosis of scalp
Why people get skin cancer
Due to sun damage - DNA mutations accumulate in skin
And due to senescence - our immune system weakens as we become older (we don’t need a PNA vaccine at 30, but at 60)
When pt with h/o of aggressive skin cancer presents with a new lipoma like bump on body - do what
Send to oncology for PET scan and fine needle aspiration (of what - lymph node?)
Pt who had a lipoma on right posterior scalp With ho of invasive SCC
Tx for TINEA pedis
Common name for t pedis
Lamisil (terbinafine) otc
Athletes foot
Hand dermatitis that’s not improving on topical steroids and histamines - what to do next
Patch testing: nickel and balsam of Peru
If allergic to nickel, may be ingesting nickel through legumes
If allergic to balsam of Peru, ingesting cinnamon, baked goods
RTC 6 weeks
Pt presenting with lipoma or a skin cyst/bump, ask what?
Any history of cancer or skin cancer?
Dolls eye
Toothbrush bristles
Folliculitis Decalvins
Is folliculaitos decalvins scarring Alopecia
Yes inflammation of hair follicles leads to permanent hair loss
Folloculitis and crusts around Hair
Grey skin due to hydroquinone
Ochronosis
What may bleach clothing
EpiDuo forte
PanOxyl soap
Warning to pts on EpiDuo forte or
PanOxyl soap
May bleach clothing
TINEA versicolor causes
Looks like
Aka
Aka pityriasis versicolor
Caused by yeast called pitirosporum (basically body dandruff)
Pink or hypopigmented scaly patches/plaques on upper back and chest, armpits
Normal skin yeast grows out of control so not contagious
Causes: oily skin, hot climate, sweating, low immunity
Is ringworm (tinea) contagious
Yes, dermatophyte fungus, get from people, pets, objects, floors, soil. Common where you sweat
T versicolor is not bc natural skin flora out of control
Ramsey hunt happens in what disease
In shingles
Sx: dead, vertigo, face drip, taste changes
ER: send to ENT?
Herpes rash often appears where
Low back at t bone
Most common areas for LP
Flexor writs (inner wrists), dorsal hands
Shins (rare risk of SCC), medial things, ankles
Axialla
Trunk low back
Anus, Glans penis, vulva (dispareunia) ddx:lichen sclerosis
Maybe face, palms, soles
What s aspartame broken down into and what disease important to ask in?
Breaks down into formaldehyde
Ask pts with allergic contact dermif taking Montelukast(has aspartame) or if drink diet soda see
Yellow orange flat or veruccous lesion on face neck or scalp of child (or adultt?) is called
Nevus sebatious
Intertrigo that never goes away
Haley Haley
Genetic
Fissures and bleeding of stretch skin
How to ddx intertrigo from Haley Haley
Intertrigo is seasonal, worse with heat and in heat area
Benign growth on upper palate
Torus palantines
Very thick yellow flakes on scalp that come off easily
Pityriasis amiantacia
Ear bumps - inflamed cartilage
Chondrodermatitis Nodularis
CNCH
3 common nail conditions
Paronychia infection or inflamm
Trachyonychia (washboard rough nails)
Onycholysis
Pt presenting with nummular rash on legs, check what else?
And do what to rule out what?
Feet for TINEA pedis and do KOH to r/o TINEA
Does 2 weeks on off apply to scalp Betamethasone lotion?
No
Can use QD,doesn’t thin skin on scalp
What type of rosacea is soolantra best suited for
Rosacea due to demodex mites (red bumps with telangectasia on cheeks)
Soolantra am
Nizoral pm (for associated den derm and pitirosporum folliculitis)
Doxy 20 BID without food
MC yeast to cause folliculitis
Pitirosporum (aka Malassezia)
Usually itch but can be asx
Pitirosporum yeast is aka
Malassezia
Cause of scalp folliculitis
Which blood work to order in AA (alopecia areata?)
TSH
Also history of Dermatitis and vitiligo??
Micropustules on scalp are caused most likely by which organism?
Pitirosporum (Malassezia) yeast which is found in seb derm
Cause of regular rosacea
Demodex mites
Soolantra is best
What makes HS worse? (2 things)
Smoking and rubbing so avoid tight clothing
Tx for HS
Doxy 100 BID with food and SS x 12 weeks PanOxyl body soap but make sure use only old towels because can bleach towels Cleocin T Gel Warm compresses but don’t squeeze eMedicine.com
Can’t use Aldara on which pts
Never on pt with organ transplant bc can systemically rev up immune system against transplant
What to tell pt about HS
1% of people get it, it runs in families, comes and goes almost like acne (boils)
NO SMOKING
No tight clothing worse with rubbing
What to ask pt if doing a bx on LIP
Any joint replacement, heart dz, artificial valves because it’s a dirty biopsy
Lichen mitosis
??????
Flesh colored bumps in kids
Feloxor, dorsal hans, penis, buttocks, chest and
Ear anatomy
Scapha, then antihelix then fossa then
Concha
Difference between scabies and bed bugs
Scabies can get under clothes
Bed bugs affect areas exposed to air, can’t get under clothes
What does dermal hypersensitivity reaction looks like on BX
Tumid Lupus
When bx comes back as Dermal Hypersensitivity reaction, what dx are you concerned with
Urticarial phase of BP (do punch DIF for BP)
Painful bump or non healing ulcer on leg
Pyoderma Gangrenosum
Tx for bad TINEA versicolor
Oral itraconazole 200 mg QD X 1 week with ACIDIC DRINK
also go wxcercise for 1 hour and sweat so Med goes through sweat
Maintain with head and shoulder or z bar
Pt instructions for oral itrakonazole
With acidic drink and exceeds x1 he and sweat
Lichenidied papules or plaques
Rubbed at
Yellow plaque on eyelids
Xantholasma
High LDL
Pt edu for FUDEX follow up
Maintain results with SS And hat
HC 2.5 Bid x 1 week, redness will go away and then it will peel
Rash that occurs in the same spot after taking a Med
Fixed drug eruption
Name of dry chapped lips in kids and cause of it
Tx
Lip lick dermatitis
Due to pursing lips all together
Tx HC 2.5 OINTMENT QD prn (ok longer that 1 week)
Infection or inflamm of nailfold
Paronychia
Washboard nails
Trachyonychia
Topical for off weeks for Psoriasis?
Dovonex (calcipotriene)
Phenomenon in prosiasis
Kebnarization (psoriasis spreads to areas of precious trauma - froze a wart and psoriasis spread to the area)
Name of response when after shingles resolve you get granuloma Annulare
Isotopic response (each spot gets GA)
Each spot gets GA in unilateral dermatomal distribution after which dz?
Name of response
After shingles can get GA, call isotopic response
If metro cream doesn’t help rosacea, what’s next tx options
Doxy 20 bid without food
And compound Ivermectin 1% with Clindamycin 1% BID
Once gets better: dc doxy and do cream QD
When to never use comp hose
What to test
When suspect arterial insufficiency (lateral side) in stasis pt - don’t use hose: just elevate in recliner and send to vein surgeon
Test dorsal foot pulses bilaterally
Lady with venous and arterial insufficiency with some small leg sores (her edema wasn’t florid)
Tx plan
Tx: medicines for sores to dry them up and elevate
Tx for molluscum
Cantharidin
What other disorder does Rosacea commonly coexist with?
With Seb derm
=Oral med tx for LPP and FFA
Doxy 100 with dinner or 20 BID without food
Plus betameth lotion BID indefinitely
Plus IL Ken 5 mg (mix 50-50)
Tx for pruritic nodules and excoriation
NAC 600 BID
White gloves
Clip nails to no white
MediHoney !!!
Circinate
Circular
Sx of LPP and FFA and tx
Itchy scaly - betameth lotion BID for itch
Perfollicular crusting and inflamm - Doxy 100 with dinner or 20 BID without food
IL Ken 5 mg
What angle to inject IL Ken for LPP and FFA
At 70-90 degree angle
Pt education when starting rogaine
Change pillow cases often so that medication doesn’t get on skin (causes hair growth)
Odd rash on abdomen - pale pink circular patches all over abdomen and chest, non itchy, non scaly, BX back - viral hives drug rxn
How to describe
Somewhat circinate surpigenous pale erythematous BLANCHEABLE non-scaly patches (don’t use macular popular description)
Only Abx proven to interfere with OCP
Rifampin
1% of BSA is equivalent to
1 palm
Questions to ask for work up for Biologic
H/o of cancer, lupus, MS, TB, CONGESTIVE heart disease, chronic infections like Hepatitis, HIV
CXR smoking
How to ddx Granuloma Annulare from interstitial granulomatous dermatitis
GA can also present with papules and plaques but normally on dorsal hands and feet. Less associated with autoimmune dz
IGD is more trunk and arms/hands - plus more associated with autoimmune disorders
Interstitial granulomatous drug reaction lesion description and distribution
Erythematous annular plaques with indurated border (woman had pink papules closely grouped in annular configuration), sometimes with central clearing
Favor creases (groin, axilla, popliteal) but also trunk, proximal extremities, palms and soles (woman had bilateral inner writs, ventral mid forearm, anticubital fossa, upper back, both trunk sides resolving, a little on ankles)
Itch is minimal or none
No mucosal involvement
CNCH is
Chondrodermatitis Nodularis (chronicus?) Helicus
A thick firm white bump on palm
Dupuytren’s contracture
Fascial fibromatosis
Fascial palmer fibromatosis
Dupuytren’s contracture
Fibrous overgrowth of dermal and subq CT develop tumors called fibromas. Benign
Runs in families
Arises from fascia
Lichenoid means and looks
Flat topped instead of dome shaped, kebranization, confluence, PIH when resolves (almost cayenne pepper look like pigmented purpura)
Band sheet like of inflammation under the dermis (or in papillary dermis - band like infiltrate of lymphocytes
C&C
Curettage and cryo
Dupuytren’s contracture
Progressive shortening and thickening of Palmer fascia leading to digital contractures. Use 4 and 5th digits
On path Lichenoid vs Dermatits vs granulomatous on path
Lichenoid: always has a band-like infiltrate of lymphocytes under SK or AK or in LP
Dermatitis: spongiotic, edema
Granulomatous: chronic inflammation with nests of macrophages, giant cells or neutros, eos, histiocytes
Warts on penis are called
Anogenital warts
Condylomata
Why does acne look worse when starting Accutane
BC it’s bringing acne from deep below to the surface
Tx options for SSCis with negative margins
EDC or FUDEX BID for 3 weeks and RTC in 3 weeks (can give pt option for cosmetic results)
Med for FFA?
Dudasteride 0.5 mg QD (anti testosterone med used for men with enlarged prostate) (but it doesn’t work for LPP even though FFA is a type of LPP)
Also Betameth and IL KEn 5 mg
Some pacemaker are not resistant to magnet - must do what with pt who has pacemaker 6 cm from cautery
Call cardiologist to confirm that pace is resistant to magnet
Central Centrifugum Cicatricial Apopecia CCCA
In black women, same thing as LPP but in blacks. Tx IL Ken and rogaine
Which face soap for acne pts
Cetaphil soap
Which soap for background rosacea
sulfacetomide 10%/ sulfur 5% wash (can compound if too expensive )
klaron? Is brand
LPP tx
Start with steroids, then IL Ken, if not better (looking for decrease in crusting and inflammation/redness) - then start Doxy100 with dinner and sun screen
Always ask pt on Accutane what questions (4)
Any depression, HA, any JOINT/muscle aches, any nausea/blood in urine or stool, back pain, blurred vision
Which labs to order when suspecting LP
Hep panel
Ask what meds on and check mouth
Another name for xerotic dermatitis is
Asteototic dermatitis
Which rashes are super itchy
LP (Allegra)
BP
DYSHYDROTIC eczema
LP tx
Betameth oint 2 wks on/off
Sun
Flagyl ( not a sip of alcohol) BID x 3 wks
Flagyl SE
No alcohol!!!!!!!!!!!
Dizziness
Upset stomach
How long Flagyl for LP
BID X 3 wks
Toothbrush like Hairs on scalp is what?
Folliculitis decalvons
Tx doxy
Glabella is
Between eyebrows
Stop Accutane at which triglyceride level and why
Stop when >400 (at 700-800 get pancreatitis)
If >300, watch and let Dr. O know
If Flagyl fails for LP or lichenoid drug rxn
Use excimer laser
What else to order besides blood work when initiating biologic for Psoriasis
CXR PA and lat
Order ovarian transvaginal US in which dz?
Dermatomyocitis
Don’t undermine which excision?
Excisions bx of MM (take 2 mm margins)
What disorder are angiofibromas associated with and what are the other cutaneous/ systemic findings
Tuberous Sclerosis
