Skin Disorder Flashcards
What is SJS + what are the sx
Rare immune-mediated skin reaction, usually triggered by medications
Prodromal flu-like illness: Fever >39C, sore throat, rhinorrhea, cough, aches
Sudden onset tender/painful skin rash on face/limbs, 90% with involvement of mucous membranes (mouth, eyes, genital)
Tender red/purple macules, diffuse erythema, targetoid lesions, bullae and/or vesicles (may have positive Nikolsky)
Melanoma sx, dx, rx, types (in order of commonness)
ABCDE (Asymmetry, Border, Colour, Diameter >6mm, Evolving/elevation)
Subtype frequency: superficial spreading > nodular > lentigo maligna > acral lentiginous
Diagnosis and treatment: full-thickness excisional biopsy with 0.5-2cm safety margin (according to Breslow thickness)
Prognosis highly dependent on Breslow thickness, 5-year survival drops with depth > 1-2 mm
Sx, dx, rx of BCC
Basal Cell Carcinoma
Nodular BCC (most common) - raised pearly white nodule with telangiectasia >6mm
Superficial BCC - red scaling plaques with thready border
Diagnosis and treatment: full or partial-thickness biopsy (at edge of lesion to contain normal tissue)
SCC sx, dx + rx
Persistent ulceration, crusting, hyperkeratosis, erythema
Treatment: Surgical excision + biopsy (e.g., punch biopsy, Mohs micrographic)
SCC In Situ: Bowen’s disease
Pre-malignancy: Actinic keratosis (AK), Leukoplakia (oral)
Treat local AK with cryotherapy (eg. two freeze thaw cycles of 5s)
Treat widespread AK with fluorouracil 5% cream BID x 2-6 weeks
Sx of Cutaneous T-cell lymphoma (Mycosis Fungoides)
Lymphocyte infiltration in progressive stages (slow course over years)
Pruritus → oval or annular patches → thickened plaque → tumors
Types + sx of pemphigus
Refers to a group of life-threatening autoimmune blistering and erosive diseases affecting the skin and mucosa (
Complications include infection, fluid loss, electrolyte disturbances
Types: Vulgaris (most common; 70% of all pemphigus), Foliaceus, IgA, Paraneoplastic
Rx for pemphigus
Systemic steroids (1-2mg/kg prednisone daily or 0.5-1mg/kg in combination with rituximab)
Azathioprine or mycophenolate mofetil are often used to attempt to reduce steroids
Consider adjunctive high potency topical steroid (e.g., clobetasol propionate) for larger erosions
Cover erosions with antibiotic ointment or a bland emollient (eg, petroleum jelly) +/- non-adhesive wound dressings
What is the rash associated with celiac?
Dermatitis Herpetiformis (“Celiac of the skin”)
Pruritic papulovesicular rash on extensor
Can biopsy to confirm celiac
Recurrent aphthous stomatitis
What skin conditions are associated with DM?
Acanthosis nigricans (seen in most patients with childhood diabetes)
Diabetic dermopathy (30% of patients with diabetes)
Light brown/red oval/round scaly patches usually in pretibial area
What is Kaposi’s sarcoma?
Common in AIDS and following organ transplant
Purple/black papular lesions, most commonly affecting lower limbs, back, face, mouth, genitalia
Cause of folliculitis
Pseudomonas aeruginosa
Management of folliculitis
Reassurance - resolves spontaneously
If immunocompromised: Ciprofloxacin 500mg po bid x 7-14 days
Dishydrotic Eczema?
(Pompholyx)
Associated with Atopy and Palmoplantar Hyperhidrosis
Keratosis Pilaris?
Hyperkeratinization of pillar follicles
Sebaceous Hyperplasia rx
Reassurance (cosmetic concern, no malignant potential)
Tretinoins
Anti-androgens (for female patients)
Where do you find Angioma Serpiginosum?
Buttocks
Lower Extremities
Paronychia rx?
Infection around nail
Trimethoprim/Sulfamethoxazole
Doxycycline
Clindamycin
Erythema migrans rx + complications
First sign of Lyme disease
Doxycycline
Amoxicillin
Cefuroxime
Complications:
Fever
Arthritis
Myalgias
Headaches
Fatigue
Cranial Nerve Palsies (CN VII)
Peripheral Neuropathy
Pericarditis
Heart Blocks
Encephalopathy
Meningitis
Solar lentigo
Hyperpigmentation caused by the proliferation of melanocytes and keratinocytes from UV exposure
What is Erythema toxicum neonatorum?
Occurs in 50% term babies, occurs day 2-5
Eyelid Dermatitis rx
Corticosteroids
Calcineurin Inhibitors
Macrolide Immunosuppressant
Rosacea aggravating factors
Alcohol
Heat
Cold
Stress
Caffeine
Treatment:
Doxycycline
Erythromycin
What to avoid in rosacea
Topical steroids
Auspitz sign?
Pinpoint bleeding with scale removal - psoriasis
Koebner’s phenomenon?
New lesions at site of injury - psoriasis
Management of psoriasis
Corticosteroids
Vitamin D Analogues
Retinoids
Salicyclic Acid
Tar
UV Light Therapy
Calcineurin Inhibitors - Tacrolimus
Biologicals
Psoriasis nails
Stippled
BCC features
History of UV exposure
Non-healing lesion
Easy/recurrent bleeding
Ulceration
Telangiectasia
Pearly Appearance
Raised Border
Central Depression
Previous history of BCC/SCC
Discoid lupus erythematosus features + treatment
Round, coin shaped lesions
Scaly, lighter centre
Topical/intralesional corticosteroids
Antimalarials (ex: hydroxycholorquine)
Tacrolimus
Pityriasis Rosea features and treatment
Initial “Herald Patch” followed by diffuse papulosquamous eruption in “Christmas Tree” distribution. May last 6-8 weeks.
Conservative management (control pruritic symptoms as needed; topical zinc oxide, calamine, corticosteroids or antihistamines)
Acne management
Topical antibiotics
Topical retinoids
Topical benzoyl peroxide
Oral antibiotics
Oral isotretinoin
Anti-androgenics
Dermatomyositis signs
Gottron’s sign/papules
Heliotrope/iliac rash
Shawl Sign
How to make dx of tinea
Fungal scraping for KOH preparation
Skin biopsy
Wood’s Lamp
Bullous pemphigoid dx and treatment
Biopsy of bulla margin
Direct immunofluorescence
Systemic steroids
What is Nikoslky’s sign?
Epidermis is easily detached from skin, elicited through lateral pressure to bullae leading to their lateral extension. Seen in Bullous pemphigoid
Granuloma annulare types
Localized (75% of cases, commonly on dorsal hand/foot surfaces)
Disseminated (widespread, >10 lesions)
Pityrosporum folliculitis - pathophysiology, RF + treatment
Overgrowth and follicle occlusion by Malassezia furfur.
RF:
Increased sebaceous gland activity (ex: adolescents)
Antibiotic use
Immunosuppression
Humid climates
Rx: Antifungals (systemic)
Types of alopecia
Areata: patches
Universalis: scalp + body
Totalis: total scalp
Rx for alopecia
Corticosteroids (topical, injection)
PUVA
Minoxidil
What is Keratoacanthoma?
Variant of SCC
Angular Chelitis causes
Irritation (from saliva, intertriginous skin creasing)
Infection (candida, staphylococcus)
Nutritional deficiencies (iron, B vitamins)
Psoriasis rx (mild, mod, severe)
Mild: topical tar products, salicylic acid
Moderate: vitamin D analogues, retinoids, steroids
Severe/comorbid with generalized plaques: systemic therapy
Lichen planus features
Planar
Purple
Polygonal
Pruritic
Papules
Plaques
Seborrheic keratosis features
Brown, black, tan
Waxy, scaly, slightly raised
Melasma - sx, RF + rx
Darkened pigmented skin
RF
darker skin types (Fitzpatrick 3 and 4)
pregnancy (cholasma)
hormone treatments
sun exposure
hypothyroidism
certain cosmetics
Rx
Discontinue hormonal therapies
Sun protection
Topical lightening creams
Dermatofibroma features
Hard, well circumscribed, non tender
Dimple sign when pinches
Allergic dermatitis from which topical medications
Topical abx: bacitracin, neomycin, polymyxin B, corticosteroids, anesthetic, propylene glycol
Horner’s syndrome sx
ptosis, anhidrosis, miosis
Causes of Genital warts
HPV 6 + 11
Difference between plantar wart and callus
Skin lines: callus go over lesion, wart goes around lesion
Plantar warts can bleed
Callus are usually on pressure point
Callus are yellow, warts are skin colour or with vessels
Callus cause pain with direct pressure, warts are painful with side pressure
Skin cancer prevention
Limit sun exposure
Wear protective clothing
Use sunscreen and lip balm
Avoid indoor tanning
Get vitamin D safely
Self-examine skin
Melanoma rf
Moles
Fair skin
Red hair
Personal/ fam hx
Large congenital nevi
Childhood exposure/ burns
Sezary syndrome sx (+ illness it is related to)
Cutaneous T cell lymphoma
Widespread systemic type
Red man syndrome
Fatigue, fever
Sx of Mycosis fungoides
Patches
Poikiloderma (thinning, telangectasia)
Plaques
Management of cutaneous T cell lymphoma (mycosis + sezary)
Mycosis = topical steroids, PUVA, UVB
Sezary = oral retinoids, interferon, RT
Sx + rx tinea
Itchy patches on trunk, neck, arms
Tx w/ ketoconazole cream or oral for 10d
Pedis - terbinafine 1% 1-4 weeks
Rx of Onychomycosis
Get lab confirmation before treatment
<20% nail involvement: topical efinaconazole
20-60%: topical efinaconazole + oral terbinafine
>60%: oral terbinafine
Types of psoriasis
Plaque psoriasis
Young adults, most common
Symmetric plaques on scalp, extensor elbows, knees, back, trunk, buttocks
Erythematous, raised, thick silver flaking scale, sharply demarcated
Can be painful, can be itchy
Guttate psoriasis
Abrupt appearance of multiple small lesions (dew drop), salmon pink, fine-scaled, small papules on trunk/ limbs
Strong association w/ recent strep infection
Inverse psoriasis
Red, smooth, shiny lesions in body folds
Pustular psoriasis
Severe
Acute onset widespread erythema, scaling, sheets of superficial pustules w/ erosions on painful/ inflamed skin
Usually palms and soles
Erythroderma
Erythema covering >90% of body, hypothermia, low albumin, electrolyte abnormality, cardiac failure
Annular
Well demarcated scaling plaques w/ central clearing
Complications of psoriasis
Psoriatic arthritis
Seronegative arthropathy
Can develop dactylitis
Malignancy (non Hodgkin lymphoma + cutaneous T cell lymphoma)
RF for MI + CAD
IBD
Depression
Obesity
Management of psoriasis
Lifestyle: avoid sunburn, avoid exacerbating meds (BB, lithium)
Emollients
Vit D analogues (calcitriol, Dovonex, Dovobet (Vit D + betamethasone)
Topical steroids (mod to strong)
Topical retinoids (Tazarotene) - good for nail psoriasis
Coal tar
Salicylic acid
Anthralin
Phototherapy
Cyclosporine
Methotrexate
Oral retinoid
Biologics
Management of Nail psoriasis
Vit D analogues
Topical steroid + salicylic acid
Topical retinoid
Rx of palmoplantar psoriasis
Palmoplantar psoriasis
Topical coal tar + salicylic acid under occlusion
Topical UVA w/ psoralen
topical vit D
Sx of Contact dermatitis
Erythema, vesiculation, dryness, lichenification, fissuring
Rx of contact dermatitis
Rx:
Avoidance of allergens
Protection (gloves)
Substitution of soaps/ detergents
Topical steroids or tacrolimus
What is Dyshidrotic eczema, precipitated by + rx?
Papulovesicular dermatitis of hands and feet, followed by painful cracking/ fissuring
Precipitated by stress
Rx:
Emollients
High potency topical steroids for up to 2 weeks
Systemic prednisone for severe cases
Sx + rx Nummular dermatitis
Annular, coin shaped, pruritic, erythematous plaques, dry scaly, lichenified
Rx: emollient, topical steroids
Sx + rx of Seborrheic dermatitis
Greasy, erythematous, yellow, non-pruritic
Infants (cradle cap), children (scalp, flexural), adults (scalp, eyebrows, beard, face, trunk, body folds)
Rx:
Ketoconazole cream for face
Ketoconazole shampoo for scalp, Head + Shoulders shampoo
Rx for alopecia: <50% hairloss vs >50%
<50% = steroids (topical or injection), minoxidil.
> 50% hairloss = steroids, minoxidil, refer to derm, hair piece, wig, camouflage, immunotherapy (diphenylcyclopropenone), JAK inhibitors (Olumiant)
Eczema coxsackieum sx
widespread, severe, self limited 1-2 wks
DDx for eczema
eczema herpeticum, eczema coxsackieum, varicella-zoster, bullous impetigo
coxsackievirus A6
Rosacea w/ papules + pustules management
topical azelaic acid, ivermectin, minocycline, metronidazole or oral dox
Rosacea w/ persistent erythema management
brimonidine gel, oxymetazoline
Rosacea w/ persistent erythema + telangiectasia management
laser
Prevention of eczema in kids
more frequent showers
Kaposi’s sarcoma appearance + cause
red/purple lesions/ nodules, human herpesvirus, consider HIV
Arterial ulcer sx + cause
punched out full thickness ulcer w/ smooth wound edges, often on lateral ankle or distal digits, surrounding skin hairless, pale - caused by PAD
Hand, foot + mouth lesion description
grey/ white vesiculo pustules
Venous ulcer sx
shallow, superficial, irregular margins, hemosiderin staining
Rx for shingles
valcyclovir
Roseola infantum cause
HSV 6 or 7, 6th disease
Drugs causing alopecia
lithium, BB, chemo, allopurinol, heparin, valproic acid, retinoids
What is a marjolin ulcer?
Non healing ulcer on edge of chronic wound - specific type of SCC
Seborrheic keratosis features
verrucous, well defined borders, brown plaque
Benign melanocytic nevus features
symmetry, brown, no blue, network of pigment
Cause of plantar warts
HPV
How to treat plantar warts w/ duct tape
apply directly to wart, leave for 1 wk, remove tape, remove dead skin w/ emery board, re-apply tape 12hrs later, repeat for 6 wks
What is a Jarisch-Herxheimer reaction?
Abrupt onset of fever, myalgias, HA, flushing following antibiotic treatment for syphilis, leptospirosis, Lyme dz. Lasts 24hrs, treat w/ Tylenol
