test 1 deck 6 Flashcards
woman presents in mid 20s to late 30’s flares w/ very inflamed red papules and comedones on chin and jawline. dx__ trx__
adult female acne, oral contraceptives, tretinoin, erythromycin if all fails
pt. presents w/ complaint of tiny pea shaped cyst above eyelids. they look like epidermial cyst, but have no openings. You suspect they are from sun damage. dx__ trx__
milia
solitary: excision
multiple: tretinoin .025%
what is inflammatory acne?
one or more of
- papules
- pustules
- nodules/cysts
pt presents w/ pruritic follicular papules and pustules on chest, neck and back. They were recently prescribed PO corticosteroids. The patient is worried about scarring and wonder’s if they are allowed to take it again. dx__ trx__
steroid acne, d/c leads to fairly rapid clearing, no scarring should occur, they can take in the future, diphenhydramine/hydroxyzine for itch
treatment for mild inflammatory acne?
start w/ retinoid and or benzoyl peroxide or top abx. -> f/u adujst dose ->consider adding oral abx if pustules remain at f/u: doxycycline/tetracycline min. 3 month trial
baby presents 1 week after birth w/ red diffusely scattered 1 mm papules/vesicles on forehead, cheeks, and trunk. it’s august in san antonio and hot as heck and the baby is wearing winter clothing. The peds doctor says it looks like prickly heat from sweat retention and occlusion of eccrine gland. dx__ trx__
miliaria
red= miliaria rubra, skin= miliaria crystallina
self limited, cool compress, antihistamine, remove from heat
pt. presents w/ small non-inflamed papules and comedones near hair line w/ application of oils/creams. dx__ trx
pomade acne/acne cosmetica, try to change ingrained habits, stop oil 1 month, add tretinoin .025%, if inflamed topical abx
what is the MC infectious folliculitis?
staphyloccus folliculitis
when do you have to stop isotrentinoin?
HA not relieved by tyelenol, HA w/ visual changes, mood swings w/ Suicidal ideation
pt presents w/ grouped small pustules around the nares. They have a tenderness, low grade fever, and recently used occlusive topical steroid therapy. DX__ trx___
isolated: erythromycin, diclox 10 days
recurrent: cephalexin, rifmapin, bactroban to nares, wash w/ hibiclens TID, change pillow case and towel
african american male presents w/ complaint of post-inflammatory hyperpigmentation, scarring and keloids in his beard, axilla, and groin. dx__ trx__
pseudofolliculitis barbae
modify shaving technique by hydrating beard and brushing beard w/ toothbrush or warm wash cloth. wash w/ benzoyl peroxide and use glycolic acid/shaving cream
topical abx, retin A, po abx for pustules
temproary profile <=3 months/ lifetime no greater than 1/4 inch
acne vulgaris is an issue w/ what?
pilosebaceous unit
pt. presents w/ complaint of round, smooth surfaced, soft, mobile mass w/ visible pore. the patient has oily sebaceous skin which makes sense because the upper pore is most likely filled w/ sebum. dx__ trx__
epidermal inclusion cyst,
removal w/ 11 blade, if inflamed intralesional injection
what is the treatment for comedonal acne (non-inflammatory)?
retinoid @ bedtime->4-8 wks benzoly peroxide or top abx, patience closed comedones respond slowly
treatment for nodulocystic acne?
derm referral: isotretinoin
pt presents w/ transient erythema, telangectasia, rhinophyma, and swelling of cheeks and forhead. you suspect this may be caused by demodex folliculorum (a mite). The patient says they become easily flushed w/ ETOH, spicy food, hot drinks, hot climate, emotions/sun. DX__ trx__
acne rosacea,
mild to mod: metronidazole, doxy, sunscreen, avoid triggers
persistent/severe: accutane, rhinophyma (specialty surgery)
african american pt. complaining of keloid on nape of neck. you know it’s of UNK etiology. dx__ trx__
acne keloidalis nuchae
no shaved haircuts/putualr or exudative= abx
3 step control
- topical clindamycin 12 months
- fluocinonide 12 months
- tretinoin 3-6 onths
steroids, laser therapy, surgery
pt. presents w/ multiple, firm, smooth movable 1-3 cm subQ cysts on scalp. it has a tough lining and isnt an EIC. dx__ trx__
pilar cyst (wen), trx excision
treatment for mod-severe inflammatory acne vulagaris?
top abx and benzoyl peroxide, >10 pustules start oral abx, later consider topical retinoid -> difficult nodules get steroid injection (triamcinolone) -> if treatment failing then culture for amipicillin refer to derm for isotretinoin and for women OCP/spironolactone
pt. presents w/ scarring in armpits, anogenital, and under breasts. They say they have a hx of fam. acne scarring. You know that this can be caused by hyperkaratosis over apocrine glands w/ a secondary infection. the patients is an overweight female that has finished puberty. the patient appears to have a double comedone morphology (blackheads w/ two or more communicating surface openings). DX__ trx__
d/c smoking,
mild: long term abx- mainstay, hot compress, I & D, intralesional steroid inj
extensive: surgical graft, isotretinoin
what is non-inflammatory acne vulgaris?
closed comedones (white heads), open comedones (black heads)
young woman w/ fair/delicate skin and hx or habitual use of moisturizing creams and topical steroid use presents w/ small red papules and pustules on chin and nasolabial fold. She has pustules on her cheeks adjacent to the nasolabial fold and a clear zone around the vermililion border. DX__ trx__
perioral dermatitis, doxy 2-4 weeks, 1% HC cream for inflammatin and if steroid induced pimecrolimus cream. d/c moisturizers and cosemetics
