Rashes 4 Flashcards
A lot of guttate talengectasias on lips, neck, chest
Hereditary hemorrhagic telasgictasias
Osler-Rendu-Webber
Or sleroderma
HHT Heredetary Hemmorhagic Telangectasia is aka
And has a risk of which disorders
Osler-Rendu-Weber syndrome
Inherited mutation, tendency for bleeding (recurrent nosebleeds)
Also tendency for brain and lung aneurisms
If Bowens on high risk areas (lip, penis, ear, temple) - which are ok to EDC and which must go to MOHS
If base not transacted,
Ok to EDC - temple, ear (even scapha)
NEVER EDC lip or penis - MOHS ONLY!
When doing path, check what on pt’s medical history
Transplant, CLL, immuno-compromised
If Bowens (SSCis) in a pt with CLL or transplant or low immunity, what tx
IF on arm - can EDC
If on face - MOHS
When see pale pink roundish rash that’s not too itchy, and do bx - what’s on ddx
GA v MF (CTCL) vs NUB
By how much is the risk of getting another skin cancer and within how many years
Have 50% chance of getting another cancer within 2 years.
Molluscum explanation to parents
- Wart virus that resolves in 1-1.5 yrs
- When inflamed - means immune system is attacking and going away so put HC 2.5
- Don’t be scared of irritation - going away
- CONTAGEOUS when touch (even when goes away for a bit) (ok if in pool water)
- Get once and done
Groin intertrigo in 10 yr
No baby wipes!
HC 2.5 +2 Rfs
What ear drops for psoriasis in ear canals and sig (and what type of med)
DermOtic 0.01% ear drops prices: 5 drops q each ear prn
Fluocinolone - steroid
What to use for rash/psoriasis behind ears
Mometasone 0.1 % (prn, not 2 on/off, even if groin area)
Directions for mometasone cream vs ointment
Cream prn even in groin
Ointment - break 2 weeks in groin
What to always ask and tell a pt when putting on Doxy
Are you using OCP? Must use at least condoms if child bearing age. Both partners commit to using condom ms before proceeding with Doxy
Still gettin periods? LMP?
What 2 oral med for LP
Metronidazole (can’t drink, good LFTs)
If not improved on above, start Plaquinil:
Get baseline eye exam! Before initiating
Also order: CBC (anemia, agranulocytosis), CMP (liver toxicity), hep C Ab, Hep B Ag (antigen)
Plaquinil SE: Baseline eye exam and every year, angranulcytosis, aplastic ANEMIA, seizures, rashes, retinopathy, LIVER TOXICITY
If ketoconazole is not working for ring worm or jock itch cruris, use what cream
Lamisil OTC
What baseline testing needs to be done for Plaquinil initiation and what it’s used for
- Baseline eye exam and q1 year
- CBC, CMP (liver)Hep B surface Ag, Hep C Ab
- SE: anemia, agranulocytosis, retinopathy, SEIZURE, liver toxicity
DOse and sig of Metronidizole for LP
500 mg BID x ??
How to tx angular cheilitis, what types there are
Ketoconazole 2% in case it’s yeast and mometasone 0.1% for irritant contact (due to saliva)
Perlesh can be unilateral from saliva, (superficial bacteria and yeast), some from vitamin deficiency (B12 and folate)
Take OTC multivitamin, Arm and Hammer toothpaste
Discontinue: mints and gum, mouthwash
What is perlesh
Angular cheilitis
Palmoplantar pustulosis is part of what disease and what’s important to avoid
Psoriasis
Smoking makes worse (talk to PCP to quit smoking)
Pt on spironolactone for acne, must stop it in which case
If stops OCP, must stop spironolactone
Ask what if puttin got on acyclovir
Kidney problems
Zoster - 1 g TID X 7 days (or 10 days?)
Ask what when starting spironolactone
OCP? Condoms?
Ace inhibitors? Blood pressure issues?
Which meds to ask if on ocp or planning to get pregs
Spironolactone Doxy Methotrexate Retinols BP Valtrex (ok you use acyclovir in PREGS)
Name if Nodular elastosis with comedones and cutest
FAVRE Racouchot
Doxy is tx for what
HS (hidtadenitis supp) BP Bullous Pemphigoid LPP/FFA ROSACEA ACNE Erythema chronicum Migrans (expanding annular rash/solid plaques)
Which med for GA (generalized)?
Plaquinile (can try Doxy first butnot as good as Plaquinil)
Name of large venous papules
Pyogenic granumloma
“Gran”ma’s pie
Which abx for dog bites
Augmentin 875 - 125 unless allergy to PCN
Oral tx for LP
Flagyl / no drinking and no liver problems
When rx’g valcyclovir, ask what
Any kidney issues
Pregs
Which oral meds for FFA
doxy (if a lot of crusting) or dudasteride if no crusting and looks more like androgenetic alopecia
Graying/yellowing is the skin
Ochronisis
Groin intertrigo tx and can turn into what
Also what’s on ddx and how to tell difference
Nystatin or
Ketokonazole
Can turn into lichen amyloid (from rubbing area)
Ddx: inverse psoriasis but will have inverse ps in all intertrigo iOS areas plus family history
Bump filled with fluid
Hydrocystoma
T pedis tx
Lamisil bid x 3 wks
Or ketoconazole 2%
What does pyogenic granuloma look like and what it is
Looks like huge blood proliferation/ “blood wart”
It’s a capillary hemangioma
What is Osler Weber Rendu
Hereditory hemorrhagic telangectasia
Increased risk for bleeding
What does sebatious Nevis look like?
Warty to Smooh yellow orange growth (can be liniar) - birthmark (epidermal Nevus)
When can you not use Epi when
Never in pregs!!!
Not penis or digits
Which body areas are suspicious for Mycosis Fungoides?
Low back
Intergluteal/ inner thigh
Which rashes are on ddx for MF?
TINEA corporis (ring worm) Nummular eczema Any rash that’s not itchy and doesn’t resolve after 1 month of topical steroid
Which bacteria causes smelly feet and name of condition plus tx
Pitted keratolysis causes by keranobacterium (?)
Tx: Clindamycin or BP
add detail if sweats a lot
What to always ask pt presenting with hives?
Any recent illness - cough sore throat prwsents with viruses like valley fever etc
Name for freckles
Ephelides
Things to ID in psoriasis and tx options to match
ID BSA % (<3 mild, 3-10 moderate, >10 severe start biologic=Humira) or if sensitive area and 5% = mod to severe
ID Sensitive areas (eyes, groin) vs non sensitive because different TX!!!
Sensitive:
ears and deep intergluteal/groin: Mometasone
EYES: Protopic ONLY!!! 0.03% (or otezla once topicals fail)
What is good for back acne
Doxy 100 qHS
And PanOxyl soap x 10 min, white towels
Tx for severe psoriasis plus what to always ask
Compound Clobetasol in oil ($50-60)
Compound T Gel with 6% SA
Ask:
What shampoo using? How often wash? Do you pick? FH?
What is the name of cheilitis in corner of mouth and tx for it
Angular cheilitis
Check B12 levels (PCP)
HC 2.5 in AM and ketoconazole 2% PM
Also take a multivitamin
Which rash is caused most often by herpes virus
Erythema Multiforme
Caused by infection 90% and 10% by drugs (nsaids, anticonvulsants)
TX: topical steroids??
What questions to ask when contact derm around lips?
Toothpaste, mouthwash, gums (are loaded with balsam of Peru - cinnamon like product)
CHAPSTICKs (have fragrances)
NEOSPORIN?
SMOKER??????
Cough drops
Drinking out of what cup? - try glass or plastic (metals have nickle and cobalt in them)
Toothpicks - wood has preservatives
ALways check their med list for lip sores etc
MC causes of lip contact allergies: preservatives, fragrance or flavoring
What did I forget to add to seb derm on face tx
Nizoral (or Head and shoulders?) shampoo suds
Pay presenting with eczematous scaly patches, check where?
Belly button - common sight for Psoriasis (silvery scale). Can use TAC
What is keratosis pilaris?
Form of dry skin, Hair follicle plugged by dry skin
Tx: hard, use amlactin or cerave SATURDAY
What to do if Patch testing is back negative
Patch tests only for 36% of what people are allergic to. For more extensive testing of allergens - Mayo (doesn’t take medicare) or Phoenix Contact Dermatitis Institute (takes medicare)
What is Eczemer laser approved for
Hand dermatitis/psoriasis
Vitiligo
Rare cause of generalized hyperhydrosis
Pheochromocytosis
What to ask when pt presents with hyperhydrosis
Is it flushing or sweating? Is it localized or generalized How long Night sweats? DM, thyroid, pheo, Meds (CTA and SSRIs), menopause
Part of ear that goes into ear canal
incisura
Tx for CNCH
Inject ILK 5 or bx to r/o CNCH v SCC
At what age can start OCP or spironolactone in female
- can start OCP at 13 yo
- can start spironolactone at 15 yo (start with OCP and can add spironolactone if no improvement)
Compound topical for hyperhydrosis on face, scalp and intertrigo areas
Face: 0.5% GlycoPirolate cream
Scalp: 1% GlycoPirolate in foam
Body: cream
Contact derm on Face/eyelids causes and tx
-nails, perfumes
Granuloma Annulare can be associated with which 2 diseases
DM and thyroid
Tx for GA and pt education
- can be associated with DM and thyroid
-Benign rash that can resolve on its own over months or years (if one spot, goes away faster, if more generalized - can take years) - good news if not raised (donut like) - means on its way out
- most people are not bothered by itch or pain, just looks
- usually no tx but depends on how aggressive you want to be with it - can apply topical steroid, ILK, LIGHT TX (TIW x 8 weeks: 50% success) or
Plaquenil (anti-malarial med for lupus that can help with this 50% of time (takes 1 month) - SE: can cause anemia, nausea and liver fx, very rare is blindness: baseline eye exams (if on it for 3-5 years, not for a few months)
Use of topical steroid in newborns (clobetasol, TAC, Protopic, HC and antihistamines)
- HC 2.5 and TAC ok > 0 yo
- Clobetasol and antihistamines ok >1
- Protopic ok >2 yo
What can look like Acne Miliaris and how to ddx
What systemic dz associated with?
Eosinophilic folliculitis can look like Acne Miliaris but EF is more itchy (while AM is more painful and some itch)
EF can look like face GA, acne-like or a bug bite
Commonly associated with HIV
Do bx
HIV is commonly associated with which scalp dz?
Eosinophilic folliculitis
Raised, mod firm, slightly pedunctulated nodules covered by smooth red skin (looks like a giant basal cell)
Fibroepithelioma Pinkus
Resembles fibroma, MC is back
It’s an uncommon variant of BCC
Single or multiple dome shaped sessile papules to large pedunculated tumors. Shades of pink, yellow, brown, skin colored
Tx as BCC
Hives are which type of hypersensitivity reaction
Urticaria/asthma/angioedema is type 1 hypersensitivity. Labs show high Eos and TRYPTASE
(Includes anaphylaxis = IgE)
Tx: antihistamines, avoidance, desensitisation
Milia can result from what
Excoriations and in scarring areas from shingles
NP with rash
- any new meds
- any new products
- any illness or infection???
- itch on scale of 1 to 10
- what used in past/now?
- tried an antihistamine
- mouth, groin, buttocks, face, scalp?
Milia outside the face is a sign of what
Scarring
What oral meds can’t be given to pts with heart failure/arrhythmia and in kidney failure
No atorax
And no Allegra
Which type of virus/number for plantar, common, flat, butchers and condylomata
1- plantar
Pt with hives: what to ask and what to rx
- an recent viruses/illness
- new meds or foods
- more or less than 6 weeks
- type 1 hypersensitivity rxn
- tx: antihistamines, steroid plus EPIPEN (epinephrine auto-injector)
Pt presenting with new rash that doesn’t look like eczema, look for what
Look for distribution along clothing lines (bra straps, hooks, cups, belts) and symmetry - if symmetric, could be allergic contact derm
Grovers on chest and upper back that doesn’t respond to TAC, suspect which ddx
And what tx
Pytirosporum folliculitis
Tx: Nizoral 2% shampoo rx - suds on body
Infection of toe nail - what abx if allergic to Keflex and what to do during exam plus recommendation
Use cipro (tendon rupture) 500 BID x 7 days if allergy to Keflex Cx it (lance with 11 blade if pustul/blister) Dr. Ezbar - podiatrist to eval ingrown toenail
If SCC (well or moderately differentiated) in an immunocompromised pt, tx on face vs body
If on face - urgent MOHS (if well or moderately diff)
If body - can excise
Tx for genital warts
LN2 is just fine!
Imiquimod 5% cream (aldara)
Podofilox 0.5% solution or gel BID for 3 days, the no tx for 4 days (do 4-6 cycles)
LN2
Surgery,lasers, EDC, TCA peel
Do DIF culture only when suspect what dz
Bullous disease only
No Epi in which conditions
Mastocytosis
Pregs
Penis or finger
Prosiasis eval and tx
Ask:
- Where (groin, face, ears, scalp, NAILS, palms/soles)
- FH
- Joint aches
- Picking?
Tx:
-Beta BID (RTC 8wks) —> Beta BID plus Dovonex (good for intergluteal and penis) or plus Tazorac PM
-ILK
- Eczemer laser (BIW x8 wks, works 2 months)
Penis: Mometasone BID or Protopic + Dovonex
NAILS: Beta and Tazorac PM
Ears: Mometasone BID (no break), Protopic or HC 2.5
> 10% BSA
- Humira: no h/o ca or infection (TB, Hep C/B, HIV)
Labs: CBC, CMP, TB, Cocci, Hep C B HIV
C/I: h/o MM and breast cancer
-Otezla pills: ok with cancer or infection. Not in breast cancer
-MM: use Otezla, not Humira, not light tx
-Breast cancer: not Otezla, not Humira, must use light tx
Do you need 2 weeks break when using TAC ointment (vs cream)
No
Humira initiation questions and labs
- CONGESTIVE HEART FAILURE (pacemaker OK)
- LUPUS, MS, internal cancer or Lymphoma
Labs: CBC, CMP, TB, Cocci, Hep C/B, HIV
Several leomyomas in the same spot in dermatomal distribution is sing of what
Kidney cancer
Eczema education in kids (can be associated with what condition in darker skins kids)
Associated with Pityriasis Alba
It’s always sensitive skin, a genetic condition - a defect in profilagrin: when it’s not made right, we lose water —> need to be careful about several things: everything hypoallergenic and moisturize daily Eczema waxes and wanes -Lube up after shower -All fragrance free detergents -No dryer sheets
It’s a genetic condition that creates chronically skin due to a defect in profilagrin protein in the skin: when it’s not make right, our skin loses our ability to retain water and stay hydratited. So you need to be extra careful about several things: must moisturize daily and use only hypoallergenic soaps and products, laundry detergent. it WAXES and wanes
Generalized GA in adult associated with what and advise what
Malignancy lung ca lymphoma etc
Make sure get annual screenings
Acne Miliaris Necrotica tx
Doxy q HS 100 with dinner
Plus CLEOCIN T GEL to spots
T Sal shampoo
BLADE #4 when cutting hair
What is good for toe nail infections and what abx and topical for toe nail infections
Vinegar soaks are good for G- bacteria (like klebsiella)
MC is staph but need both G+ and G- so Cipro is best
Gentamicin cream
Haley Haley is caused by what
Genetics
Blistering dz - chronic fissures in skin open to Infection worse with heat and friction
Tx steroid cream
What to use if TINEA corporis (ring worm) is not responding to ketoconazole cream?
OTC lamisil is better than ketoconazole
How to describe allergic dermatitis to pt
Let’s go through your normal routine: dermatitis is almost an eczema like rash. You are allergic to something that you are using. They are constantly changing ingredients in body soaps, detergents.
Any new meds?
If you take oral prednisone: lots of SE
So TAC cream jar
Hydroxyzine - change to Allegra (less sedating) without decongestant
No polysporin/neosporin
Tx for palmar plantar pustulosis and what to tell pt
Tx: Beta oint BID with SERAN WRAP!!!
2 weeks off, till clears
ITCH: ALLERGRA
(No sure tazorac will help on feet)
RTC 6 weeks
If not better: Eczemer laser BIW x 8 weeks, then consider non-biologic systemics like DOXY and COLCHISINE (anti-neutros, pustules have neutros on bx)
NO SMOKING, no pumice stones, no rubbing
SHOES and SOCKS, no Sandals (bc doesn’t support the sole and too much rubbing )
Can be aggravated by allergens - so hypoallergenic soap and moisturizer
NO sandals bc allergens in RUBBER and leather so need socks to create a barrier like SOCK
Form of psoriasis that forms pustules. It’s a genetic hereditary condition and 3% of population in US gets. It’s more stubborn to treat. THere is no cure. Starts with redness which is inflammation then forms crops of pustules that turn brown.
What 2 interesting oral meds for palmoplantar pustulosis (non responsive to topical steroid and Eczemer)
Doxy and Colchisine
Both anti-neutrophilic, pustules have neutros on bx
What else to ask HS pts and what to add to pt edu
No Smoking Loose clothing, Wgt loss!!!! Form of boils in areas of rubbing 1% of population, genetic condition Doxy x 2 weeks for flares, PanOxyl 10 min soap Cleocin T gel
Cause of brachioradial pruritus?
Spinal/neck injury or arthritis?
Nerve that’s being impinged on so have PCP look at neck
TINGLING IN HANDS
Worse with sun - SS and clothing
Tx: TAC BID, ice, SARNA, Vanicream daily
(On left arm only: started in writs, then elbow area, then upper forearm)
What to use for inflammatory intertrigo rash under arms
Mometasone cream
Explain nummular eczema
It’s basically adult eczema with coin shaped patches that come and go and can be itchy. Due to dry mature skin. There are 2 things that make it worse: dry skin and hot water.
It’s not an allergy, not environmental - just dry and mature skin.
Our ability to retain water is not as good as it was 20 years ago so skin is not as hydrated
End point is itch free and clear
There is no cure, only ways to manage it
TAC BID for flares, Allegra if itch
Will Allegra help BrachioRadial pruritus?
No, bc it’s a nerve condition, neck injury/arthritis
3 tx options for androgenetic alopecia and pt edu
It’s recession of frontal hairline, hereditary, 40% has it
- made worse by testosterone supplements
RTC 6 months
Tx:
- rogaine (but comes back when stops),
- PROPECIA (finasteride) for BPH (SE: decreased libido and ejaculation - can continue after DC med)
- PRP - take your blood, spin it and take plasma out and inject it, not covered by insurance
Wart education
It’s harmless virus but a nuecense. that’s easy to get by shaking hands, video games, in gym lockers. Kids get it more than adults bc immune system is not as mature as adults and doesn’t recognize the virus. Good news is that eventually all warts go away by themselves but we don’t know when. If type in wart tx on internet, will come up with many options because what works for 1 person may not work for another.
What is different for potential treatments are SE
- LN2 otc is 20 vs 196, blisters and can leave a white scar (hands won’t free)
-OTC comp W is 40% SA and is as effective as LN2 - it revs up imm says to see the wart. The advantage is doesn’t hurt and no scar but takes 12 WEEKS to work (but can’t use on face)
-FUDEX cream can help with DUCK tape
-Aldara qHS 3-5 nights per week with duct tape, wash off in am
- Candida injection
-Versipulse laser (insurance PA)
- Start with comp W and LN2
Sweat feed warts
Sand warts down every night and apply FUDEX and bandaid, wash off qAM
Wart on nose - cantharidin blister beetle juice, no shower
If not improvement, Dr. B does candida injections
What wierd questions to ask when initiating biological like humira
Congestive HF? Lupus, MS, internal cancers, lymphoma, hep CB HIV TB
MC cause of dermatitis
Preservatives and fragrance
Several leomyomas in same distribution is a sign of what
Sign of kidney cancer
Fibromas (smooth muscle tumor benign), can be on skin??
What is another cause for HS
Hormonal, worse with period: start doxy 1 weeks before period for flares
Atopic eczema education
It’s a genetic condition that creates chronically skin due to a defect in profilagrin protein in the skin: when it’s not make right, our skin loses our ability to retain water and stay hydratited. So you need to be extra careful about several things: must moisturize daily and use only hypoallergenic soaps and products, laundry detergent. it WAXES and wanes
