Skin Flashcards
RMSF - rash on ankles/wrists, spreadstotrunk, high fever, headache,myalgia,nausea,Think rocky and camping or Hiking NC/OK/AK/TN/MO.
Dx: PCR essay with Rickessetti Antigen
Tx: Doxycycline. EXAM
Erythema Migraines - (stage 1 Lyme) - Target bulls-eye rash, usually appears in 7-14 days POST being bitten by a deer tick. Rash is hot to touch with rough texture, flu like symptoms.
Dx: B. Burgdorferi via ELISA, then confirm with western blot. Increased ESR.
Tx: Less than 7 Amoxicillin or cefuroxime axetil. Older than 7 Doxycycline. EXAM
Melanoma
Dark Moles, uneven texture, different colors, irregular, >6mm, could be itchy.
Stevens Johnson Syndrome - Classic is target or bulls-eye. Abruptly, hives, blisters, petechiae, purpura, necrosis, sloughing of tissues. Extensive mucosal involvement. Prodrome of fevers with flu like symptoms.
Triggers: Allopurinol, anticonvulsants, pcn, sulfonamides, NSAIDS. HIV ppl have higher risk for this syndrome.
Psoriasis - Inherited. Pruritic erythematous plaques, fine silvery-white scales with pitted fingernails. Scalp, elbows, knees, sacrum, intergluteal folds.
- Koebner phenomenon- new psoriatic plaques form over skin trauma
- Auspitz sign- pinpoint bleeding when plaques are removed.
Tx: Topical steroids, Tar preps (mild). For (severe) do anti-TNF, or immunologic.
Acanthros Nigricans
velvet hyperpigmented patches most common on back of neck or skin folds- DM resistance.
Scabies - itching bedtime linear lesions, webs of fingers/toes, bikini line
Tx: Primethrin cream treat everyone wash sheets and everything else in hot water.
Atopic Dermatitis (eczema) - Inherited. Extremely itchy. On flexural folds, neck, hands. Inc. IgE. “small vesicles that rupture leaving painful, bright-red, weepy lesions” they become lichenified from itching.
Tx: First line Topical steroids. Avoid hot water/soaps. PO antihistamines. EXAM
Tinea corporis - “ring like itchy rash, slowly enlarge central clearing” on arms/legs orbody
Tx: most respond to topical antifungals, if severe do oral Lamisil. (AZOLE) EXAM
Actinic Keratosis - Precursor to squamous cell carcinoma. “numerous dry round and pink to red lesions” with a rough and scaly texture. Does not heal. Slow growing in sun exposed areas.
Dx: Punch BIOPSY Golden Standard.
Tx: Sm. (cryotherapy), Lrg.
(5-FU cream)- which causes skin to ooze, crust, scab, redness. EXAM
Seborrheic Keratosis
soft round wart light tan to black pasted on. Asymptomatic and benign.
Cellulitis
Deep dermis poor demarcated low legs. DVT risk, DM with cellulitis watch for Osteomyelitis.
Erysipelas - Group A strep, Upper dermis, clear demarcated, cheeks, shins.
Tx: Dicloxacillin QID x10d. Cephalexin, Clinda.
PCN ALLERGY? Do Azithro x5d.
D/Az
MRSA
Tx: Bactrim, clinda, doxy, mino
If sulfa allergy does not use Bactrim
(BCD)
Basal Cell Carcinoma
Pearly, waxy, skin lesions, atrophic, ulcerated center that does not heal. Most common skin disease.
Molloscum Contagiosum
White plug, dome shaped lesion. Highly contagious
If on infant in private areas, child have been molested.
Varicella Zoster Virus (chicken pox) - “contagious 48 h. before, until all lesions crusted over” low grade fever, generalized lymphadenopathy, intense itching, erythematous macules, papules develop over macules, then vesicles erupt. “initially on trunk, then scalp and face”
Tx: Supportive, antihistamines, acyclovir 20mg/kg 5xd. If given first 24 hours works best. EXAM
Acne Vulgaris (common acne) Mild - (topicals only) *open/closed comedone w/ or w/o sm. papules.
Tx: Retin-A, acne worsens 4-6 weeks if no improvement in 8-12 weeks increase dose or add erythromycin, benzoyl peroxide.
Acne Vulgaris (common acne) Moderate (topicals plus antibiotics) - papules, pustules w/ comedones. Continue with topicals combined with topical antibiotics.
Tx: Oral antibiotics tetra, mino, doxy.
Acne Vulgaris (common acne) Severe - with painful indurated nodule, cysts, abscesses, pustules.
Tx: Accutane- check LFTs, 2 forms of contraceptives, monthly prego testing, only prescribe 1 month supply. EXAM
Acne Rosacea - chronic small acne like papules/pustules around nose mouth chin.
Tx: Metrogel, Azelex. Low dose tetracycline. EXAM
Impetigo - honey-crusted exudate positive Itchy pink-red lesions, evolve into vesiculopustules that rupture. If bullous-large blisters.
Tx: Severe- Keflex, dicloxacillin. PCN Allergic-Azithro, clinda. If NO BULLAE- Bactroban. EXAM
Scarlet fever (Scarlantina)
“Sandpaper textured-pink rash with sore throat” strawberry tongue, rash starts on head and neck, spreads to trunk. The skin THEN desquamates
Lichen planus:
Small flat topped, red to purple bumps that may have white scales/flakes. whispy grey white streaks called Wickham’s striae. inner wrists forearms, and ankles. If on scalp cause hair loss. Causes hep C, medications, contact with chemicals.
Spider bite - fever chills, n/v, located arms, upper legs, or the trunk. Bitten area becomes swollen, red, and tender, and blisters appear within 24-48 hours. Necrotic in center, which kills the tissue. Ice packs to wound and cold inactivates the toxin,
Tx - like cellulitis of the skin, Abx. ointment at first, watch etc. EXAM
Pityoris rosea- itchy, herald patch, xmas tree pattern, rash hands soles/feet.
Dx: RPR then VDRL are screening, then dx FTA-ABS.
First-degree (superficial)
only epidermis – dry & erythematous
Second-degree (superficial partial thickness)
Epidermis – wet with blisters
Third-degree (full thickness)
epidermis & dermis – pale & white
9% Head, Abdomen, Arm
18% Back, Chest, Legs, 14% (child)
1% Genitals, each palm
