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Dermatology 1 > Various Derm Dz (Brooks) > Flashcards

Various Derm Dz (Brooks) Flashcards

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Dermatology Board Prep flashcards
1
Q

two types of sweat glands

A
  • apocrine: larger; only in axillae, inframammary, groin and genital; release secretion into hair follicles
  • eccrine: all over body; palms, soles, forehead;release sweat directly onto the skin
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2
Q

hidradenitis suppurative

A
  • Chronic, suppurative, inflammatory condition of the aprocine gland.
  • Common in intertriginous skin regions: axillae, groin, perianal, perineal, inframammary skin
  • Characterized by recurrent “boils” and draining sinus tracts with subsequent scarring.
  • Pain, fluctuance, discharge and sinus tract formation are characteristic.
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3
Q

epidemiology of hidradenitis suppurativa

A
  • F>M
  • MC in AA
  • 2nd and 3rd decades of life
  • males: anogenital
  • females: axillary
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4
Q

general pathophys behind HS

A
  • follicular plugging within apocrine gland bearing skin –> mechanical stress in intertriginous regions –> immune response
  • secondary bacterial involvement
  • rupture and reepithelialization cause sinus tracts to form
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5
Q

risk factors for HS

A
  • obesity and smoking***
  • hyperandrogenism
  • OCPs
  • Acne
  • PCOS
  • lithium
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6
Q

S/S of HS

A
  • initially painful, inflammatory nodules and abscesses
  • 0.5 - 3cm in size
  • may drain
  • eventually form scars
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7
Q

if there is infection in chronic HS, what are the common pathogens?

A
  • staph aureus

- staph epidermidis

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8
Q

Hurley clinical staging system for HS

A

I: abscess formation w/o sinus tracts or scarring
II: widely separated, recurrent abscesses w/ tract formation and scarring
III: diffuse, multiple interconnected tracts and abscesses

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9
Q

HS increases the risk for what other disease?

A
  • squamous cell carcinoma

- if concerned, bx

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10
Q

HS prognosis

A
  • individual lesions heal 10-30 days

- can recur for years

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11
Q

complications of HS

A
  • SCC
  • lymphedema
  • psychosocial issues
  • anemia
  • amyloidosis
  • lumbosacral epidural abscess
  • disseminated infection
  • fistulas
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12
Q

what is the MC soft tissue tumor?

A

lipoma

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13
Q

what is a lipoma

A
  • slow growing benign fatty tumor that form soft lobulated masses enclosed by a thin capsule
  • often found in shoulders, back, neck, and head
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14
Q

what type of tumors are lipomas?

A

mesenchymal (they can develop in almost all organs)

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15
Q

lipomas in the GI tract

A
  • submucosal fatty tumors
  • MC location: esophagus, stomach, SI
  • can cause luminal obstruction and bleeding
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16
Q

typical pt. presenting w/ a lipoma

A
  • 40-60 yo group
  • rare in children
  • no clear gender predilection
  • F: chondroid, myolipoma, adiposis dolorosa
  • M: spindle cell, speomorphic, intramuscular, lipoblastoma, multiple symmetric lipomatosis
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17
Q

RF for lipoma

A
  • obesity
  • ETOH
  • liver dz
  • glucose intolerance
  • soft tissue trauma
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18
Q

S/S of lipoma

A
  • often asx
  • slow growing (if fast, suspect other dx)
  • sx will vary depending on location
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19
Q

PE of lipoma

A
  • subQ, nontender, rubbery feel
  • “slippage sign”
  • overlying skin is nl
  • commonly <5cm
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20
Q

what should you consider if a lipoma is over 5 cm?

A

-liposarcoma

but regular lipomas can be > 10 cm

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21
Q

indications for imaging a lipoma

A
  • larger lesions w/ irregular shape

- suggestive of myofacial involvement

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22
Q

imaging modalities for lipoma

A
  • start w/ US but MRI is most sensitive

- MRI helpful in differentiating lipoma from sarcoma

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23
Q

gold standard for histological dx of lipoma

A
  • open surgical bx

- although core-needle bx is preferred

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24
Q

tx of lipoma

A
  • observation is an option
  • tx is usually surgical excision
  • if it’s superficial, can try steroid injection or liposuction
  • kybella injections have been successful
25
Q

indications for removal of lipoma

A
  • diagnostic uncertainty
  • cosmetic concerns
  • nerve impingement
  • pain
  • increase in size
  • irregular characteristics
  • > 5 cm
  • core needle bx w/ atypical features
  • features consistent w/ sarcoma
26
Q

complications of a lipoma

A
  • hematoma and seroma MC
  • infections rare but possible
  • high risk of recurrence
27
Q

what kind of lipomas have the highest rate of recurrence?

A
  • intramuscular
  • lipomas w/ infiltrating tendencies
  • bilobar lipomas
28
Q

what is the MC cutaneous cyst?

A

-epidermoid cysts (EC)

29
Q

epidermoid cysts are aka

A
  • sebaceous cysts

- epidermoid inclusion cysts

30
Q

what are ECs?

A
  • benign cysts that can form anywhere on the body
  • MC on face, scalp, neck and trunk
  • very rarely can become malignant
31
Q

patho of EC

A
  • derived from epidermis or epithelium of hair follicle
  • epithelium encloses w/i the dermis and becomes filled w/ keratin and lipid
  • walls are thin and rupture is common
32
Q

epidemiology of ECs

A
  • no racial predilection
  • M>F
  • 3rd-4th decade of life
33
Q

what are pilar cysts?

A
  • appear identical to epidermal inclusion cysts but 90% are on the scalp
  • usually have fam hx
34
Q

S/S of ECs

A
  • usually asx
  • discharge of malodorous “cheeselike” material
  • can get inflammed/infected
35
Q

PE of EC

A
  • dermal or SQ nodule
  • firm and usually solitary
  • 0.5-5 cm
  • may have central pore or punctum
36
Q

diagnostics of an EC

A
  • labs typically unnecessary
  • if recurrent infection, C&S indicated
  • if in unusual location (breast, bone, intracranial), imaging indicated or FNA
37
Q

general measures in tx of EC

A
  • asx ECs need no tx

- oral abx if infected

38
Q

surgical care of EC

A
  • simple excision or incision w/ removal of cyst and cyst wall (or will recur)
  • if inflamed, I&D
39
Q

complications of EC

A
  • rare; infection, scarring

- malignancy is rare

40
Q

pilonidal dz

A

-spectrum of clinical presentations ranging from asx hair containing cysts and sinuses to large sx abscesses of the sacrococcygeal region w/ tendency to recur

41
Q

synonym for pilonidal dz

A

jeep dz

42
Q

epidemiology of pilonidal dz

A
  • M>F
  • late teens - early 20s
  • decreases after 25
  • rare > 45
  • Caucasians > AA > Asians
43
Q

patho of pilonidal dz

A
  • hair in natal cleft draws into deeper tissues via movement of buttocks
  • follicle is occluded from stretching and pore blocking from debris
  • inflammation w/ secondary infection occurs
  • polymicrobial d/t proximity to anorectal region
44
Q

genetic component in pilonidal dz

A
  • congenital dimple in natal cleft
  • spina bifida occulta
  • follicular occluding tetrad
45
Q

what is the follicular occluding tetrad (there are actually 4)?

A
  • ance conglobata
  • dissecting cellulitis
  • hidradenitis supperativa
  • pilonidal dz
46
Q

RFs for pilonidal dz

A
  • sedentary/prolonged sitting
  • excessive body hair
  • obesity / increase sacrococcygeal fold thickness
  • congenital natal dimple
  • trauma to coccyx
47
Q

asx presentation of pilonidal dz

A

-painless cyst or sinus at top of gluteal cleft

48
Q

acute presentation of pilonidal dz

A

-acute abscess: severe pain, swelling, discharge from top of gluteal cleft that may or may not have drained spontaneously

49
Q

chronic presentation of pilonidal dz

A

-chronic abscess w/ persistent drainage from a sinus tract at the top of the gluteal cleft

50
Q

which presentation of pilonidal dz is MC?

A

acute abscess

51
Q

PE in pilonidal dz

A
  • pt is usually afebrible and nontoxic
  • inflamed cystic mass at top of gluteal cleft w/ limited surrounding erythema
  • +/- drainage or sinus tract
  • less common presentation: significant cellulitis of surrounding tissue
52
Q

diagnostic tests for pilonidal dz

A
  • it’s a clinical diagnosis
  • consider CBC and wound culture if severe infection
  • consider MRI to differentiate perirectal abscess and pilonidal
53
Q

tx of pilonidal dz

A
  • I&D is primary tx for recurrent dz

- meds: abx not indicated unless significant cellulitis

54
Q

if pilonidal dz needs abx (cellulitis suspected), what is used empirically?

A

-cefazolin + metronidazole
or
-amoxicillin-clavulanate

55
Q

criteria for admission for pilonidal dz

A
  • severe celluitis

- large area excision

56
Q

F/u recommendations for pilonidal dz

A
  • frequent dressing changes after I&D
  • f/u wound checks
  • monitor for fever, more extensive celluitits
57
Q

pt education in pilonidal dz

A
  • wash area briskly w/ washcloth daily
  • remove hair from crypts weekly
  • avoid prolonged sitting
  • neg. pressure wound therapy
  • laser epilation of hair in gluteal fold
58
Q

prognosis of pilonidal dz

A

-simple I&D has 55% failure rate
-median time to healing is 5 weeks
more extensive surgical excisions involve hospital stays and longer healing time

59
Q

complications of pilonidal dz

A

malignant degeneration is a rare complication if untreated

Dermatology 1 (19 decks)

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