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CCFP Version 1 > Skin Disorder > Flashcards

Skin Disorder Flashcards

1
Q

What is SJS + what are the sx

A

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)

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2
Q

Melanoma sx, dx, rx, types (in order of commonness)

A

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

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3
Q

Sx, dx, rx of BCC

A

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)

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4
Q

SCC sx, dx + rx

A

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

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5
Q

Sx of Cutaneous T-cell lymphoma (Mycosis Fungoides)

A

Lymphocyte infiltration in progressive stages (slow course over years)
Pruritus → oval or annular patches → thickened plaque → tumors

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6
Q

Types + sx of pemphigus

A

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

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7
Q

Rx for pemphigus

A

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

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8
Q

What is the rash associated with celiac?

A

Dermatitis Herpetiformis (“Celiac of the skin”)
Pruritic papulovesicular rash on extensor
Can biopsy to confirm celiac
Recurrent aphthous stomatitis

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9
Q

What skin conditions are associated with DM?

A

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

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10
Q

What is Kaposi’s sarcoma?

A

Common in AIDS and following organ transplant
Purple/black papular lesions, most commonly affecting lower limbs, back, face, mouth, genitalia

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11
Q

Cause of folliculitis

A

Pseudomonas aeruginosa

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12
Q

Management of folliculitis

A

Reassurance - resolves spontaneously
If immunocompromised: Ciprofloxacin 500mg po bid x 7-14 days

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13
Q

Dishydrotic Eczema?

A

(Pompholyx)
Associated with Atopy and Palmoplantar Hyperhidrosis

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14
Q

Keratosis Pilaris?

A

Hyperkeratinization of pillar follicles

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15
Q

Sebaceous Hyperplasia rx

A

Reassurance (cosmetic concern, no malignant potential)
Tretinoins
Anti-androgens (for female patients)

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16
Q

Where do you find Angioma Serpiginosum?

A

Buttocks
Lower Extremities

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17
Q

Paronychia rx?

A

Infection around nail
Trimethoprim/Sulfamethoxazole
Doxycycline
Clindamycin

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18
Q

Erythema migrans rx + complications

A

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

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19
Q

Solar lentigo

A

Hyperpigmentation caused by the proliferation of melanocytes and keratinocytes from UV exposure

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20
Q

What is Erythema toxicum neonatorum?

A

Occurs in 50% term babies, occurs day 2-5

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21
Q

Eyelid Dermatitis rx

A

Corticosteroids
Calcineurin Inhibitors
Macrolide Immunosuppressant

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22
Q

Rosacea aggravating factors

A

Alcohol
Heat
Cold
Stress
Caffeine
Treatment:
Doxycycline
Erythromycin

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23
Q

What to avoid in rosacea

A

Topical steroids

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24
Q

Auspitz sign?

A

Pinpoint bleeding with scale removal - psoriasis

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25
Q

Koebner’s phenomenon?

A

New lesions at site of injury - psoriasis

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26
Q

Management of psoriasis

A

Corticosteroids
Vitamin D Analogues
Retinoids
Salicyclic Acid
Tar
UV Light Therapy
Calcineurin Inhibitors - Tacrolimus
Biologicals

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27
Q

Psoriasis nails

A

Stippled

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28
Q

BCC features

A

History of UV exposure
Non-healing lesion
Easy/recurrent bleeding
Ulceration
Telangiectasia
Pearly Appearance
Raised Border
Central Depression
Previous history of BCC/SCC

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29
Q

Discoid lupus erythematosus features + treatment

A

Round, coin shaped lesions
Scaly, lighter centre
Topical/intralesional corticosteroids
Antimalarials (ex: hydroxycholorquine)
Tacrolimus

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30
Q

Pityriasis Rosea features and treatment

A

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)

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31
Q

Acne management

A

Topical antibiotics
Topical retinoids
Topical benzoyl peroxide
Oral antibiotics
Oral isotretinoin
Anti-androgenics

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32
Q

Dermatomyositis signs

A

Gottron’s sign/papules
Heliotrope/iliac rash
Shawl Sign

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33
Q

How to make dx of tinea

A

Fungal scraping for KOH preparation
Skin biopsy
Wood’s Lamp

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34
Q

Bullous pemphigoid dx and treatment

A

Biopsy of bulla margin
Direct immunofluorescence
Systemic steroids

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35
Q

What is Nikoslky’s sign?

A

Epidermis is easily detached from skin, elicited through lateral pressure to bullae leading to their lateral extension. Seen in Bullous pemphigoid

36
Q

Granuloma annulare types

A

Localized (75% of cases, commonly on dorsal hand/foot surfaces)
Disseminated (widespread, >10 lesions)

37
Q

Pityrosporum folliculitis - pathophysiology, RF + treatment

A

Overgrowth and follicle occlusion by Malassezia furfur.
RF:
Increased sebaceous gland activity (ex: adolescents)
Antibiotic use
Immunosuppression
Humid climates
Rx: Antifungals (systemic)

38
Q

Types of alopecia

A

Areata: patches
Universalis: scalp + body
Totalis: total scalp

39
Q

Rx for alopecia

A

Corticosteroids (topical, injection)
PUVA
Minoxidil

40
Q

What is Keratoacanthoma?

A

Variant of SCC

41
Q

Angular Chelitis causes

A

Irritation (from saliva, intertriginous skin creasing)
Infection (candida, staphylococcus)
Nutritional deficiencies (iron, B vitamins)

42
Q

Psoriasis rx (mild, mod, severe)

A

Mild: topical tar products, salicylic acid
Moderate: vitamin D analogues, retinoids, steroids
Severe/comorbid with generalized plaques: systemic therapy

43
Q

Lichen planus features

A

Planar
Purple
Polygonal
Pruritic
Papules
Plaques

44
Q

Seborrheic keratosis features

A

Brown, black, tan
Waxy, scaly, slightly raised

45
Q

Melasma - sx, RF + rx

A

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

46
Q

Dermatofibroma features

A

Hard, well circumscribed, non tender
Dimple sign when pinches

47
Q

Allergic dermatitis from which topical medications

A

Topical abx: bacitracin, neomycin, polymyxin B, corticosteroids, anesthetic, propylene glycol

48
Q

Horner’s syndrome sx

A

ptosis, anhidrosis, miosis

49
Q

Causes of Genital warts

A

HPV 6 + 11

50
Q

Difference between plantar wart and callus

A

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

51
Q

Skin cancer prevention

A

Limit sun exposure
Wear protective clothing
Use sunscreen and lip balm
Avoid indoor tanning
Get vitamin D safely
Self-examine skin

52
Q

Melanoma rf

A

Moles
Fair skin
Red hair
Personal/ fam hx
Large congenital nevi
Childhood exposure/ burns

53
Q

Sezary syndrome sx (+ illness it is related to)

A

Cutaneous T cell lymphoma

Widespread systemic type
Red man syndrome
Fatigue, fever

54
Q

Sx of Mycosis fungoides

A

Patches
Poikiloderma (thinning, telangectasia)
Plaques

55
Q

Management of cutaneous T cell lymphoma (mycosis + sezary)

A

Mycosis = topical steroids, PUVA, UVB
Sezary = oral retinoids, interferon, RT

56
Q

Sx + rx tinea

A

Itchy patches on trunk, neck, arms
Tx w/ ketoconazole cream or oral for 10d
Pedis - terbinafine 1% 1-4 weeks

57
Q

Rx of Onychomycosis

A

Get lab confirmation before treatment
<20% nail involvement: topical efinaconazole
20-60%: topical efinaconazole + oral terbinafine
>60%: oral terbinafine

58
Q

Types of psoriasis

A

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

59
Q

Complications of psoriasis

A

Psoriatic arthritis
Seronegative arthropathy
Can develop dactylitis
Malignancy (non Hodgkin lymphoma + cutaneous T cell lymphoma)
RF for MI + CAD
IBD
Depression
Obesity

60
Q

Management of psoriasis

A

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

61
Q

Management of Nail psoriasis

A

Vit D analogues
Topical steroid + salicylic acid
Topical retinoid

62
Q

Rx of palmoplantar psoriasis

A

Palmoplantar psoriasis
Topical coal tar + salicylic acid under occlusion
Topical UVA w/ psoralen
topical vit D

63
Q

Sx of Contact dermatitis

A

Erythema, vesiculation, dryness, lichenification, fissuring

64
Q

Rx of contact dermatitis

A

Rx:
Avoidance of allergens
Protection (gloves)
Substitution of soaps/ detergents
Topical steroids or tacrolimus

65
Q

What is Dyshidrotic eczema, precipitated by + rx?

A

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

66
Q

Sx + rx Nummular dermatitis

A

Annular, coin shaped, pruritic, erythematous plaques, dry scaly, lichenified
Rx: emollient, topical steroids

67
Q

Sx + rx of Seborrheic dermatitis

A

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

68
Q

Rx for alopecia: <50% hairloss vs >50%

A

<50% = steroids (topical or injection), minoxidil.

> 50% hairloss = steroids, minoxidil, refer to derm, hair piece, wig, camouflage, immunotherapy (diphenylcyclopropenone), JAK inhibitors (Olumiant)

69
Q

Eczema coxsackieum sx

A

widespread, severe, self limited 1-2 wks

70
Q

DDx for eczema

A

eczema herpeticum, eczema coxsackieum, varicella-zoster, bullous impetigo
coxsackievirus A6

71
Q

Rosacea w/ papules + pustules management

A

topical azelaic acid, ivermectin, minocycline, metronidazole or oral dox

72
Q

Rosacea w/ persistent erythema management

A

brimonidine gel, oxymetazoline

73
Q

Rosacea w/ persistent erythema + telangiectasia management

A

laser

74
Q

Prevention of eczema in kids

A

more frequent showers

75
Q

Kaposi’s sarcoma appearance + cause

A

red/purple lesions/ nodules, human herpesvirus, consider HIV

76
Q

Arterial ulcer sx + cause

A

punched out full thickness ulcer w/ smooth wound edges, often on lateral ankle or distal digits, surrounding skin hairless, pale - caused by PAD

77
Q

Hand, foot + mouth lesion description

A

grey/ white vesiculo pustules

78
Q

Venous ulcer sx

A

shallow, superficial, irregular margins, hemosiderin staining

79
Q

Rx for shingles

A

valcyclovir

80
Q

Roseola infantum cause

A

HSV 6 or 7, 6th disease

81
Q

Drugs causing alopecia

A

lithium, BB, chemo, allopurinol, heparin, valproic acid, retinoids

82
Q

What is a marjolin ulcer?

A

Non healing ulcer on edge of chronic wound - specific type of SCC

83
Q

Seborrheic keratosis features

A

verrucous, well defined borders, brown plaque

84
Q

Benign melanocytic nevus features

A

symmetry, brown, no blue, network of pigment

85
Q

Cause of plantar warts

A

HPV

86
Q

How to treat plantar warts w/ duct tape

A

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

87
Q

What is a Jarisch-Herxheimer reaction?

A

Abrupt onset of fever, myalgias, HA, flushing following antibiotic treatment for syphilis, leptospirosis, Lyme dz. Lasts 24hrs, treat w/ Tylenol

CCFP Version 1 (67 decks)

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