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Rashes 2 Flashcards

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1
Q

What is erythema multiforme caused by?

A

Herpes virus

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2
Q

What to always ask pt before stating Benadryl or doxepin HS

A

Any balance issues?

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3
Q

What tx for eyelid dermatitis

A

Aquaphor at night

If itches - give Protopic 0.03?

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4
Q

Tachyphylaxis

A

Diminishing response to drug

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5
Q

Diminishing response to drug

A

Tachyphylaxis

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6
Q

Which drug not to use for Hair Loss in male with prostate cancer

A

Propecia (finasteride)

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7
Q

LPP tx

A

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

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8
Q

Which oral med for Bullous Pemphigoid (BP)>

A

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

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9
Q

What is chilblains

A

Redness and swelling of toes hands feet nose ears and face due to cold
Especially in kids

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10
Q

Ask about which recreational activity in pt presenting with itch?

A

Do you smoke? (Cancer)

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11
Q

If SCCis and BBC superficial to edge in the same location (dorsal hand) - how to tx

A

Aldara

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12
Q

Can’t do bx when pt just finished FUDEX or Aldara for how long?

A

For 2 weeks (till skin calms down)

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13
Q

If SCCis to base, how to tx

A

Always excise or MOHS (because could be deeper than SCCis)

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14
Q

SCCis to edge, how to tx

A

EDC

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15
Q

Aldara is indicated for

A

BCC (SUPERFICIAL Only)

And AKs

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16
Q

Angular cheilitis is also called

A

Perleche

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17
Q

How long is Aldara tx

A

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 %

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18
Q

Can FUDEX be used on SSCis

A

Yes, x 3-4 weeks, but not FDA approved

Or for 6 weeks per JOB, check at 1 month after stopping

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19
Q

Besides FUDEX, what other tx for AKs

A

Solarace (3% diclofenac) BID x 12 weeks

Picato qHS x 3 days

PDT blue light

Aldara

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20
Q

Which SCC requires URGENT MOHS?

A

MODERATELY differentiated AND immunocompromised pt

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21
Q

Tx of MM to base

A

Any depth to BASE is going to plastics

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22
Q

Furfuraceous meaning

A

Fluffy scales

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23
Q

Oral tx for TINEA versicolor and directions

A

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

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24
Q

What recreational activity makes dyshydrotic eczema worse?

A

Smoking

Also stress and sweating

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25
Q

Tx of Nodular BCC to base and edge

A

EDC ok if small

Excise if big

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26
Q

Oral tabs for scabies

A

Ivermectin

If not responding to permethrin?

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27
Q

Which labs to order for itchy rash, when ddx BP

A 
BP 180 (IgG antibodies) (more sensitive)
BP 230. CBC CMP ANA
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28
Q

Cicatricial meaning

A

Scarring

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29
Q

What strength of Kenalog for face pimple

A

2.5 mg Kenalog: mix .1 Kenalog with .3 saline (total .4)
At 30 degree angle till blanches
Less than 0.1 cc

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30
Q

Pt presents with hand rash, where else to always check

A

Feet - TINEA pedis can cause ID reaction on hands (as dyshydrotic eczema or degeralized dermatitis)

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31
Q

What to always tell pts with psoriasis of scalp - pt education

A

Be gentle when washing hair and when cloning hair

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32
Q

Scalp psoriasis tx

A

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)

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33
Q

Pt presents with thick, well demarcated plaques, where else to look

A

Elbows, knees, butt

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34
Q

Doxy is used for

A

LPP
Hydradenitis Supporativa
Bullous Pemphigoid

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35
Q

Oral med for LPP

A

Doxy

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36
Q

Oral med for LP not responding to regular tx

A

Flagyl (can’t drink)

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37
Q

Does frontal fibrosing alopecia (FFA) ever go away

FFA cause

A

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)

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38
Q

Best tx for FFA and LPP

A

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?

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39
Q

Another tx option for scalp psoriasis

A

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

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40
Q

How to tx benign angiomas?

A

Vascular laser
There is chance they will come back

Or Electrocautery for cherry angiomas

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41
Q

Scalp sores that won’t heal after procedures

A

Chronic erosive pustulosis of scalp

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42
Q

Why people get skin cancer

A

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)

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43
Q

When pt with h/o of aggressive skin cancer presents with a new lipoma like bump on body - do what

A

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

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44
Q

Tx for TINEA pedis

Common name for t pedis

A

Lamisil (terbinafine) otc

Athletes foot

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45
Q

Hand dermatitis that’s not improving on topical steroids and histamines - what to do next

A

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

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46
Q

Pt presenting with lipoma or a skin cyst/bump, ask what?

A

Any history of cancer or skin cancer?

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47
Q

Dolls eye

Toothbrush bristles

A

Folliculitis Decalvins

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48
Q

Is folliculaitos decalvins scarring Alopecia

A

Yes inflammation of hair follicles leads to permanent hair loss

Folloculitis and crusts around Hair

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49
Q

Grey skin due to hydroquinone

A

Ochronosis

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50
Q

What may bleach clothing

A

EpiDuo forte

PanOxyl soap

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51
Q

Warning to pts on EpiDuo forte or

PanOxyl soap

A

May bleach clothing

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52
Q

TINEA versicolor causes

Looks like

Aka

A

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

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53
Q

Is ringworm (tinea) contagious

A

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

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54
Q

Ramsey hunt happens in what disease

A

In shingles

Sx: dead, vertigo, face drip, taste changes

ER: send to ENT?

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55
Q

Herpes rash often appears where

A

Low back at t bone

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56
Q

Most common areas for LP

A

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

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57
Q

What s aspartame broken down into and what disease important to ask in?

A

Breaks down into formaldehyde

Ask pts with allergic contact dermif taking Montelukast(has aspartame) or if drink diet soda see

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58
Q

Yellow orange flat or veruccous lesion on face neck or scalp of child (or adultt?) is called

A

Nevus sebatious

59
Q

Intertrigo that never goes away

A

Haley Haley

Genetic
Fissures and bleeding of stretch skin

60
Q

How to ddx intertrigo from Haley Haley

A

Intertrigo is seasonal, worse with heat and in heat area

61
Q

Benign growth on upper palate

A

Torus palantines

62
Q

Very thick yellow flakes on scalp that come off easily

A

Pityriasis amiantacia

63
Q

Ear bumps - inflamed cartilage

A

Chondrodermatitis Nodularis

CNCH

64
Q

3 common nail conditions

A

Paronychia infection or inflamm
Trachyonychia (washboard rough nails)
Onycholysis

65
Q

Pt presenting with nummular rash on legs, check what else?

And do what to rule out what?

A

Feet for TINEA pedis and do KOH to r/o TINEA

66
Q

Does 2 weeks on off apply to scalp Betamethasone lotion?

A

No

Can use QD,doesn’t thin skin on scalp

67
Q

What type of rosacea is soolantra best suited for

A

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

68
Q

MC yeast to cause folliculitis

A

Pitirosporum (aka Malassezia)

Usually itch but can be asx

69
Q

Pitirosporum yeast is aka

A

Malassezia

Cause of scalp folliculitis

70
Q

Which blood work to order in AA (alopecia areata?)

A

TSH

Also history of Dermatitis and vitiligo??

71
Q

Micropustules on scalp are caused most likely by which organism?

A

Pitirosporum (Malassezia) yeast which is found in seb derm

72
Q

Cause of regular rosacea

A

Demodex mites

Soolantra is best

73
Q

What makes HS worse? (2 things)

A

Smoking and rubbing so avoid tight clothing

74
Q

Tx for HS

A 
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
75
Q

Can’t use Aldara on which pts

A

Never on pt with organ transplant bc can systemically rev up immune system against transplant

76
Q

What to tell pt about HS

A

1% of people get it, it runs in families, comes and goes almost like acne (boils)
NO SMOKING
No tight clothing worse with rubbing

77
Q

What to ask pt if doing a bx on LIP

A

Any joint replacement, heart dz, artificial valves because it’s a dirty biopsy

78
Q

Lichen mitosis

??????

A

Flesh colored bumps in kids

Feloxor, dorsal hans, penis, buttocks, chest and

79
Q

Ear anatomy

A

Scapha, then antihelix then fossa then

Concha

80
Q

Difference between scabies and bed bugs

A

Scabies can get under clothes

Bed bugs affect areas exposed to air, can’t get under clothes

81
Q

What does dermal hypersensitivity reaction looks like on BX

A

Tumid Lupus

82
Q

When bx comes back as Dermal Hypersensitivity reaction, what dx are you concerned with

A

Urticarial phase of BP (do punch DIF for BP)

83
Q

Painful bump or non healing ulcer on leg

A

Pyoderma Gangrenosum

84
Q

Tx for bad TINEA versicolor

A

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

85
Q

Pt instructions for oral itrakonazole

A

With acidic drink and exceeds x1 he and sweat

86
Q

Lichenidied papules or plaques

A

Rubbed at

87
Q

Yellow plaque on eyelids

A

Xantholasma

High LDL

88
Q

Pt edu for FUDEX follow up

A

Maintain results with SS And hat

HC 2.5 Bid x 1 week, redness will go away and then it will peel

89
Q

Rash that occurs in the same spot after taking a Med

A

Fixed drug eruption

90
Q

Name of dry chapped lips in kids and cause of it

Tx

A

Lip lick dermatitis

Due to pursing lips all together

Tx HC 2.5 OINTMENT QD prn (ok longer that 1 week)

91
Q

Infection or inflamm of nailfold

A

Paronychia

92
Q

Washboard nails

A

Trachyonychia

93
Q

Topical for off weeks for Psoriasis?

A

Dovonex (calcipotriene)

94
Q

Phenomenon in prosiasis

A

Kebnarization (psoriasis spreads to areas of precious trauma - froze a wart and psoriasis spread to the area)

95
Q

Name of response when after shingles resolve you get granuloma Annulare

A

Isotopic response (each spot gets GA)

96
Q

Each spot gets GA in unilateral dermatomal distribution after which dz?
Name of response

A

After shingles can get GA, call isotopic response

97
Q

If metro cream doesn’t help rosacea, what’s next tx options

A

Doxy 20 bid without food
And compound Ivermectin 1% with Clindamycin 1% BID

Once gets better: dc doxy and do cream QD

98
Q

When to never use comp hose

What to test

A

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

99
Q

Lady with venous and arterial insufficiency with some small leg sores (her edema wasn’t florid)

Tx plan

A

Tx: medicines for sores to dry them up and elevate

100
Q

Tx for molluscum

A

Cantharidin

101
Q

What other disorder does Rosacea commonly coexist with?

A

With Seb derm

102
Q

=Oral med tx for LPP and FFA

A

Doxy 100 with dinner or 20 BID without food
Plus betameth lotion BID indefinitely
Plus IL Ken 5 mg (mix 50-50)

103
Q

Tx for pruritic nodules and excoriation

A

NAC 600 BID
White gloves
Clip nails to no white
MediHoney !!!

104
Q

Circinate

A

Circular

105
Q

Sx of LPP and FFA and tx

A

Itchy scaly - betameth lotion BID for itch

Perfollicular crusting and inflamm - Doxy 100 with dinner or 20 BID without food

IL Ken 5 mg

106
Q

What angle to inject IL Ken for LPP and FFA

A

At 70-90 degree angle

107
Q

Pt education when starting rogaine

A

Change pillow cases often so that medication doesn’t get on skin (causes hair growth)

108
Q

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

A

Somewhat circinate surpigenous pale erythematous BLANCHEABLE non-scaly patches (don’t use macular popular description)

109
Q

Only Abx proven to interfere with OCP

A

Rifampin

110
Q

1% of BSA is equivalent to

A

1 palm

111
Q

Questions to ask for work up for Biologic

A

H/o of cancer, lupus, MS, TB, CONGESTIVE heart disease, chronic infections like Hepatitis, HIV

CXR smoking

112
Q

How to ddx Granuloma Annulare from interstitial granulomatous dermatitis

A

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

113
Q

Interstitial granulomatous drug reaction lesion description and distribution

A

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

114
Q

CNCH is

A

Chondrodermatitis Nodularis (chronicus?) Helicus

115
Q

A thick firm white bump on palm

A

Dupuytren’s contracture

Fascial fibromatosis

116
Q

Fascial palmer fibromatosis

A

Dupuytren’s contracture

Fibrous overgrowth of dermal and subq CT develop tumors called fibromas. Benign

Runs in families

Arises from fascia

117
Q

Lichenoid means and looks

A

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

118
Q

C&C

A

Curettage and cryo

119
Q

Dupuytren’s contracture

A

Progressive shortening and thickening of Palmer fascia leading to digital contractures. Use 4 and 5th digits

120
Q

On path Lichenoid vs Dermatits vs granulomatous on path

A

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

121
Q

Warts on penis are called

Anogenital warts

A

Condylomata

122
Q

Why does acne look worse when starting Accutane

A

BC it’s bringing acne from deep below to the surface

123
Q

Tx options for SSCis with negative margins

A

EDC or FUDEX BID for 3 weeks and RTC in 3 weeks (can give pt option for cosmetic results)

124
Q

Med for FFA?

A

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

125
Q

Some pacemaker are not resistant to magnet - must do what with pt who has pacemaker 6 cm from cautery

A

Call cardiologist to confirm that pace is resistant to magnet

126
Q

Central Centrifugum Cicatricial Apopecia CCCA

A

In black women, same thing as LPP but in blacks. Tx IL Ken and rogaine

127
Q

Which face soap for acne pts

A

Cetaphil soap

128
Q

Which soap for background rosacea

A

sulfacetomide 10%/ sulfur 5% wash (can compound if too expensive )

klaron? Is brand

129
Q

LPP tx

A

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

130
Q

Always ask pt on Accutane what questions (4)

A

Any depression, HA, any JOINT/muscle aches, any nausea/blood in urine or stool, back pain, blurred vision

131
Q

Which labs to order when suspecting LP

A

Hep panel

Ask what meds on and check mouth

132
Q

Another name for xerotic dermatitis is

A

Asteototic dermatitis

133
Q

Which rashes are super itchy

A

LP (Allegra)
BP
DYSHYDROTIC eczema

134
Q

LP tx

A

Betameth oint 2 wks on/off
Sun
Flagyl ( not a sip of alcohol) BID x 3 wks

135
Q

Flagyl SE

A

No alcohol!!!!!!!!!!!
Dizziness
Upset stomach

136
Q

How long Flagyl for LP

A

BID X 3 wks

137
Q

Toothbrush like Hairs on scalp is what?

A

Folliculitis decalvons

Tx doxy

138
Q

Glabella is

A

Between eyebrows

139
Q

Stop Accutane at which triglyceride level and why

A

Stop when >400 (at 700-800 get pancreatitis)

If >300, watch and let Dr. O know

140
Q

If Flagyl fails for LP or lichenoid drug rxn

A

Use excimer laser

141
Q

What else to order besides blood work when initiating biologic for Psoriasis

A

CXR PA and lat

142
Q

Order ovarian transvaginal US in which dz?

A

Dermatomyocitis

143
Q

Don’t undermine which excision?

A

Excisions bx of MM (take 2 mm margins)

144
Q

What disorder are angiofibromas associated with and what are the other cutaneous/ systemic findings

A

Tuberous Sclerosis

Dermatology (8 decks)

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