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CCFP 3 > 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
Koebner’s phenomenon?
New lesions at site of injury - psoriasis
26
Management of psoriasis
Corticosteroids Vitamin D Analogues Retinoids Salicyclic Acid Tar UV Light Therapy Calcineurin Inhibitors - Tacrolimus Biologicals
27
Psoriasis nails
Stippled
28
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
29
Discoid lupus erythematosus features + treatment
Round, coin shaped lesions Scaly, lighter centre Topical/intralesional corticosteroids Antimalarials (ex: hydroxycholorquine) Tacrolimus
30
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)
31
Acne management
Topical antibiotics Topical retinoids Topical benzoyl peroxide Oral antibiotics Oral isotretinoin Anti-androgenics
32
Dermatomyositis signs
Gottron's sign/papules Heliotrope/iliac rash Shawl Sign
33
How to make dx of tinea
Fungal scraping for KOH preparation Skin biopsy Wood's Lamp
34
Bullous pemphigoid dx and treatment
Biopsy of bulla margin Direct immunofluorescence Systemic steroids
35
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
36
Granuloma annulare types
Localized (75% of cases, commonly on dorsal hand/foot surfaces) Disseminated (widespread, >10 lesions)
37
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)
38
Types of alopecia
Areata: patches Universalis: scalp + body Totalis: total scalp
39
Rx for alopecia
Corticosteroids (topical, injection) PUVA Minoxidil
40
What is Keratoacanthoma?
Variant of SCC
41
Angular Chelitis causes
Irritation (from saliva, intertriginous skin creasing) Infection (candida, staphylococcus) Nutritional deficiencies (iron, B vitamins)
42
Psoriasis rx (mild, mod, severe)
Mild: topical tar products, salicylic acid Moderate: vitamin D analogues, retinoids, steroids Severe/comorbid with generalized plaques: systemic therapy
43
Lichen planus features
Planar Purple Polygonal Pruritic Papules Plaques
44
Seborrheic keratosis features
Brown, black, tan Waxy, scaly, slightly raised
45
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
46
Dermatofibroma features
Hard, well circumscribed, non tender Dimple sign when pinches
47
Allergic dermatitis from which topical medications
Topical abx: bacitracin, neomycin, polymyxin B, corticosteroids, anesthetic, propylene glycol
48
Horner’s syndrome sx
ptosis, anhidrosis, miosis
49
Causes of Genital warts
HPV 6 + 11
50
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
51
Skin cancer prevention
Limit sun exposure Wear protective clothing Use sunscreen and lip balm Avoid indoor tanning Get vitamin D safely Self-examine skin
52
Melanoma rf
Moles Fair skin Red hair Personal/ fam hx Large congenital nevi Childhood exposure/ burns
53
Sezary syndrome sx (+ illness it is related to)
Cutaneous T cell lymphoma Widespread systemic type Red man syndrome Fatigue, fever
54
Sx of Mycosis fungoides
Patches Poikiloderma (thinning, telangectasia) Plaques
55
Management of cutaneous T cell lymphoma (mycosis + sezary)
Mycosis = topical steroids, PUVA, UVB Sezary = oral retinoids, interferon, RT
56
Sx + rx tinea
Itchy patches on trunk, neck, arms Tx w/ ketoconazole cream or oral for 10d Pedis - terbinafine 1% 1-4 weeks
57
Rx of Onychomycosis
Get lab confirmation before treatment <20% nail involvement: topical efinaconazole 20-60%: topical efinaconazole + oral terbinafine >60%: oral terbinafine
58
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
59
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
60
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
61
Management of Nail psoriasis
Vit D analogues Topical steroid + salicylic acid Topical retinoid
62
Rx of palmoplantar psoriasis
Palmoplantar psoriasis Topical coal tar + salicylic acid under occlusion Topical UVA w/ psoralen topical vit D
63
Sx of Contact dermatitis
Erythema, vesiculation, dryness, lichenification, fissuring
64
Rx of contact dermatitis
Rx: Avoidance of allergens Protection (gloves) Substitution of soaps/ detergents Topical steroids or tacrolimus
65
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
66
Sx + rx Nummular dermatitis
Annular, coin shaped, pruritic, erythematous plaques, dry scaly, lichenified Rx: emollient, topical steroids
67
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
68
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)
69
Eczema coxsackieum sx
widespread, severe, self limited 1-2 wks
70
DDx for eczema
eczema herpeticum, eczema coxsackieum, varicella-zoster, bullous impetigo coxsackievirus A6
71
Rosacea w/ papules + pustules management
topical azelaic acid, ivermectin, minocycline, metronidazole or oral dox
72
Rosacea w/ persistent erythema management
brimonidine gel, oxymetazoline
73
Rosacea w/ persistent erythema + telangiectasia management
laser
74
Prevention of eczema in kids
more frequent showers
75
Kaposi’s sarcoma appearance + cause
red/purple lesions/ nodules, human herpesvirus, consider HIV
76
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
77
Hand, foot + mouth lesion description
grey/ white vesiculo pustules
78
Venous ulcer sx
shallow, superficial, irregular margins, hemosiderin staining
79
Rx for shingles
valcyclovir
80
Roseola infantum cause
HSV 6 or 7, 6th disease
81
Drugs causing alopecia
lithium, BB, chemo, allopurinol, heparin, valproic acid, retinoids
82
What is a marjolin ulcer?
Non healing ulcer on edge of chronic wound - specific type of SCC
83
Seborrheic keratosis features
verrucous, well defined borders, brown plaque
84
Benign melanocytic nevus features
symmetry, brown, no blue, network of pigment
85
Cause of plantar warts
HPV
86
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
87
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

CCFP 3 (67 decks)

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