test 2 light related disease and pigementation disorders

Question 1

3 patterns of melasma

Answer 1

centrofacial

malar

mandibular

Question 2

texture photoaging?

Answer 2

solar elastosis: thickened wringled yellowish skin: forehead and back of the neck

artphy: thin
wrinkles: cutis rhomboidalis nuchae: sun induced wrkinlig on back of neck

Question 3

what do snow and ice do?

Answer 3

reflect UVB, ozone absorbs C

Question 4

what are the parts of natural protection?

Answer 4

stratum corneum and melanin

Question 5

patient malnourished on INH, long term 5fu, corn diet

Question 6

what is short wave germicidal, absorbed by ozone and made by germicidal lamps?

Answer 6

UVC

Question 7

tyalmost never burn, deeply pigmented; black

Answer 7

type VI, 15

Question 8

who burns easily, tans slightly, fair skinned (blond hair)? spf and type?

Answer 8

type II spf 25-30

Question 9

what are the disadvantages of sunscreen?

Answer 9

can’t put on child <6 mos

vit D

irritant and allergic: oxybenzone

systemic toxicity: titanium and zinc

Question 10

what is the treatment for photoaging?

Answer 10

prevention

retinoids (3-6 months): not good for wrinkling or telangectasia + wear sunscreen

resurfacing: peel, dermabrasion, laser: scarring/hypopig

Question 11

tingling, erythema, then burning erythema, vesicles w/in hours, then bullae, linear streaking, and finally desqumation. the hyperpigmentation may last one year. occurs after useing perfumes, celery parsnip, limes, parsley, wild carrot, fig, hogweed, meadow grass. dx treatment?

Answer 11

phototoxicity

find and avoid causative agent, sunscreen, PUVA if persists, top steroids

Question 12

what light is not filtered out by car, how does physical protection work?

Answer 12

uva, scatters and filters light

Question 13

burns rarely, tans deeply; middle east, asain, black

Answer 13

type V spf 15

Question 14

fair skinned children w/ exposure to sun can get?

Answer 14

xeroderma pigmentosum: numerous lesions

type 2 oculocutaneous albinism: large jagged lesions

Question 15

what is one of the difference in solar lentigo from ephelides (freckles)

Answer 15

freckles darkin in the sun, but solar lentigo does not

Question 16

sometimes burns then gradualy tans moderatelly, mediteranean and hispanic?

Answer 16

type III spf 15

Question 17

what is the treatment for pellagra?

Answer 17

PO niacin 50-100 mg TID/QID

premedicate w/ ASA prior to attenuate flushing

Question 18

non scarring prurutic rash that is symmetric. papules coalesce into plaques and confluent edema. Papular type is MC (small papules disseminated), and plaque is 2nd MC, butther are 6 other types. Monomorphic recurrent lesion identical to those in previous eruptoins. typcially in v of chest, legs of women, back of hangs, extensor aspect of forearms. HAS PRODROME OF MALAISE CHILLS HA NAUSEA AND HEALS W/O SCARRING

Answer 18

polymorphous light eruption

Question 19

treatment for solar lentigo?

Answer 19

none, cryo, topical retinoids, laser, combo

Question 20

what are the sun induced damages?

Answer 20

texture, vascular, pigmentation, papular

Question 21

what is the MC light induced skin disease? caused by UVA >UVB that typically occurs in first 3 decades in fair skinned females. it’s inversely related to latitude?

Answer 21

polymorphous light eruption

Question 22

what is a middle wave that produces harmful waves during summer, affects corneum and superficial layers: leads to sunburn, tan, erythema, pigmentation, and inflammation?

Answer 22

UVB

Question 23

vascular changes

Answer 23

venous lake: round pruple ectatic vessels, lower lips and ears

Question 24

pigmentation changes?

Answer 24

poikiloderma of civatte: red brown reticulated pigmenation w/ telangectaisas and prominent hair follicles, chest and neck

Question 25

what is a long wave, produced by black light, that constant, deeply penetrates dermis and subQ. Chronic exposure leads to CT degeneration and photoaging and photoallergies

Answer 25

UVA

Question 26

distribution for pellagra?

Answer 26

glove/gauntlet, casal's necklace or cravat, spares the heel, butterfly, mucous membranes

Question 27

most improant melasma factors?

Answer 27

genetic and UV, but also hormonal, thyroid cosmetic, phototoxic and antiseizure meds: phenytoin

Question 28

asymptomatic white spots on arms and legs, has seborrheic keratosis, lentigines, and xerosis in same area dx, trx

Answer 28

idiopathic guttate hypomelanosis avoid sunlight, sunscreen elective treatment: tretinoin, low potency roids, LN2, dermabrasion, make up

Question 29

always burns, never tans, celtic/irish red head? what SPF and type?

Answer 29

type I spf 25-30

Question 30

how to diagnose and treat polymorphous light eruption (areas covered in winter months vs exposed in sumer months)?

Answer 30

delayed onset, characteristic morphology, h/o disappearnace, bx and immunofluorescence studies to r/o SLE in plaque type phototesting trx: corticosteroids (topical), protection, desensitization w/ phototherapy, Psoralen UVA, antimalarial drugs (hydroxychloroquine)

Question 31

burns minimally, always tans well, darker hispanics and asians

Answer 31

type IV 15

Question 32

rules for SPF use?

Answer 32

15-30 x daily 15-30 min before going out q 2 hrs or after H2O exposure avoid 10-3 wear dark loose clothing

Question 33

CI to niacin treatment?

Answer 33

hypersensitivity, active hepatic dz, peptic ulcer disease, arterial hemorrhage, gout

Question 34

photoaging papular changes?

Answer 34

nevi seborrheic keratosis yellow papules favre racouchot: comedones and cysts around the eyes

Question 35

treatment for melasma

Answer 35

sun protection, hypopigmenting: hydroquinone, triluma cream (hydroquinone, tretinoin, fluocinolone): 8 weeks more effective than single agents: chemical peel, later tretinoin: slow, but good

Question 36

medications that can cause photoallergic reaction?

Answer 36

5-fu celecoxib, doxy, dapsone, hydrochlorothiazide, itraconazole, oral contraceptives, phenothiazines, salicylates, quinidine, sulfonylureas

Question 37

common in inuit and native americans, onset chilhood, fam hx, intensly itchy papules plaques, noduels that crust. may have actinic chelitis. mc on face. dx treatment

Answer 37

actinic prurigo corticosteroids, protection, PUVA, antimalarial, desensitization w/ therapy

Question 38

niacin deficiency, w/ dermatitis, diarrhea, dementia. begins w/ acute cutaneous phase: bilat, symmetric erythema, sunburn appearance then large bullae and brown scale and black crust. 2nd phase is late cutaneous. lesions are hard rough cracked, blackish and brittle. GOOSE SKIN, LICHENIFICATION, LESIONS HEAL CENTRIFUGALLY

Answer 38

pellagra