Week 11 derm Flashcards
ABCDE for melanoma screening
Asymmetry Border (irregular) Colour (variation) Diameter (>6 mm) Evolving
what are the four steps in 4-point derm description?
- anatomic distribution
- lesion configuration
- primary lesion and colour
- secondary change
SCALDA for derm
size colour arrangement lesion morphology distribution always check hair, nails, mouth, toes
what lesion is….
waxy, stuck on, wart-like
seborrheic keratosis
what is lesar trelat sign?
sudden multiple eruptions of SK
-?associated with internal malignancy
what lesion is:
solitary pink-brown dome-shaped firm papule and has dimple sign when squeezed?
location: common to legs
dermatofibroma
what lesion is….
initially poorly defined redness
then becomes pink-brown papule/patch with yellow scale or gritty texture
location: sun-exposed areas
actinic keratosis
actinic keratosis is precursor to…..
SCC or BCC
IDRBEU is a mnemonic that helps to determine if lesionis more likely to be SCC vs AK
Inflammation/induration Diameter > 1 cm Rapidly enlarging Bleeding Erythema Ulceration
common locations affected by squamous cell carcinoma?
face, head, neck, hands
what lesion is….
indurated, pink-red, scaly plaque/nodule
OR
non-healing ulcer
squamous cell carcinoma
what are risk factors for squamous cell carcinoma?
sun exposure radiation exposure chronic infections (osteomyelitis) burns immunosuppression fair skin
what is bowen’s disease?
SCC in situ
what is keratoacanthoma?
firm nodule with central necrosis
*low grade variant of invasive SCC
what lesion is….
shiny/pearly papule or nodule with smooth surface, central depression, rolled edges and telangiectasia?
location: sun-exposed skin: face, scalp, ears, neck
nodular BCC
what lesion is….
scaly, irregular plaque, thin and translucent with rolled border?
location: trunk and extremities (shoulders)
superficial BCC
what are the four subtypes of melanoma?
- superficial spreading melanoma
- nodular melanoma
- lentigo maligna melanoma (growing brown patch with irregular edges and pigmentation)
- acral lentiginous melanoma (palms, soles, nail)
secondary causes of pruritis without a rash in older adults?
- CKD
- med side effect
- metabolic (anemia, cholestasis, hypercalcemia, thyroid)
- neuropathy
- paraneoplastic (lymphoma, leukemia, myeloma)
- psychogenic (dx of exclusion)
what are some medications that can cause pruritis?
statins CCB HCTZ ACE-I opioids
- discontinue
- allow 1-2 month drug holiday before assessing
- chronically prescribed anti-HTN can be cause of pruritis with eczematous changes
what derm condition is….
dry, scaly, lichenified plaques with fissures?
chronic eczema
what derm condition is….
itchy red/blistered/crusted plaques or dry fissured and scaly plaques to one/both lower legs?
venous stasis dersmtaitis
*often mis-diagnosed as bilateral leg cellulitis
WORSENED by amlodipine
what derm condition is….
solitary or multiple coin-shaped plaques
-can be crusted, weeping or blistered
location: lower legs, back of hands, trunk
nummular eczema
treatment for nummular eczema?
one of most difficult forms of ezema to treat
*chronic and relapsing
medium to high potency steroid BID for 3-4 weeks (treat for one extra week)
- occlusion with plastic wrap
- non-fragranced emollients
what is autoeczematization aka id reaction?
eruption of eczema DISTANT to primary site of chronic skin inflammation
(eg eczema to upper torso with chronic tinea pedis)
differential diagnoses for eczema?
- cutaneous T-cell lymphoma
- scabies
- SCC or BCC
- Paget’s disease
- dermatophytosis
what is Grover’s disease?
aka transient acantholytic dermatosis
- intensely pruritic pink papules and vesicles with scale to torso
- most common in middle aged white men
- worse with cold weather, sweating, heat, friction
what organism is linked to seborrheic dermatitis?
malassezia furfur
what chronic conditions are associated with seborrheic dermatitis?
- neurological (Parkinson’s, CVA, head trauma)
- HIV
triggers for rosacea
- UV/sunlight
- exercise
- heat (including hot food and drinks)
- embarrassment
- spicy foods
- chocolate
- alcohol
what derm condition is…..
papulopustular eruptions to nose, cheeks, around eyes
rosacea
what are ocular symptoms of rosacea?
-mild conjunctivitis: sore eyes, gritty, teary
- photophobia, itching, burning
- conjunctival hyperemia, telangiectasia of eyelid, blepharitis, chalazion, crusting along lash line
DDX for rosacea
acne
perioral dermatitis
lupus
sarcoidosis
rosacea first line treatment
- systemic
- topical
doxycycline 100 mg BID for 2-4 weeks
*systemic abx needed if ocular involvement
metrogel (no difference between 0.75 and 1%) BID
patient teaching rosacea
- avoid triggers
- avoid irritating cleansers and anti-aging creams
- may worsen for 1-2 weeks before noticing improvement with treatment
what is Hutchinson’s sign?
vesicle to nasal tip, redness to eye –> signals ocular involvement of herpes zoster
what is Ramsay Hunt Syndrome?
facial nerve palsy with herpes zoster vesicles to ear (canal or on pinna) or mouth
may involve hearing loss/tinnitus/otalgia, lacrimation, vertigo
optimal vehicle of topical rx for hair-bearing skin?
gel, lotion, shampoo, oil, foam
easier than ointment and cream
pityriasis rosea is caused by….
herpesvirus 6 and 7
pityriasis rosea timeline:
herald patch 1-20 days before generalized rash
duration: 6-12 weeks
self-limiting
what derm condition is this?
oval pink plaque 2-5 cm, collarette scale
pityriasis rosea
what does the secondary rash of pityriasis look like?
location?
itch?
scaly patch or plaques to chest and back, Christmas tree pattern
25% itchy
what derm condition is this?
primary lesion: purple, planar (flat topped), papule/plaque, polygonal, pruritic
- surface: lacy reticulated white lines: Wickham’s striae
location: wrists, ankles, vulva, mucous membranes
lichen planus
cause of lichen planus?
?T-cell driven autoimmune
can be associated with hep C
can be drug induced (esp antihypertensives: ACE-I, BB, thiazides)
what is potential sequelae of lichen sclerosus?
increased risk VIN and vulvar SCC
vulvar pruritis, dyspareunia, dysuria
DDx:
lichen sclerosus
lichen planus
first line treatment of lichen sclerosus
• 1st line- super potent topical corticosteroid (group 1) • Clobetasol propionate 0.05% • Initially: 0.5 FTU ○ Weeks 1-4: once nightly ○ Weeks 5-8: every other night ○ Weeks 9-12: twice weekly • Maintenance: ○ Mometasone 0.1% twice weekly Long term maintenance needed to maintain skin colour and reduce risk of VIN, vulvar cancer
symptoms of notalgia paresthetica?
unilateral infrascapular itching T2-T6
unilateral hyperpigmented patch to infrascapular region (3-10 cm)
may have pain, paresthesia, hyperalgesia, hyperesth
what derm condition is this?
dome shaped cherry red/purple papule, 0.1-0.5 cm
location: trunk
may have many
cherry angiomas
onychomycosis
most common organism
trichophyton rubrum
onychomycosis
what to do before treatment?
confirm fungal infection (scraping)
check CBC and LFT at baseline
onychomycosis
pulse treatment with terbinafine?
terbinafine 250 mg BID for 1 week, repeat every 3 months for 4 cycles
first line treatment for bullous pemphigoid?
- high potency topical steroid (clobetasol)
- prednisone
- doxycycline
Risk factors for intertrigo
obesity immunodeficiency DM meds: prednisone hot weather poor hygiene incontinence
what derm condition is this?
Red moist, glistening plaques w/satellite pustules and papules w/fringe of white scale
intertrigo
DDx of intertrigo?
inverse psoriasis
seborrheic dermatitis
erythasma
irritant contact dermatitis
Treatment of intertrigo?
- wet dressings for 20 min, then dry
- nystatin for anti-yeast or econazole (antifungal) BID
- light moisturizer (lubriderm) to decrease friction, create barrier
- weight loss
- avoid tight clothing
what are consequences of ocular rosacea?
mild to severe corneal involvement in up to 1/3 of patients (keratitis)
which cranial nerve is involved in herpes zoster ophthalmicus or keratitis?
ophthalmic branch of trigeminal nerve (CN V)
what is the difference between acute neuritis and postherpetic neuralgia?
acute neuritis: acute pain lasting for 30 days
PNH: 3/10 pain persisting for 90 days after rash onset
what is consequence of herpes ophthalmicus?
- threat to vision loss
- acute keratitis involves all layers of cornea
- acute retinal necrosis: iritis, viritis, retinal vasculitis, retinal detachment
- blurred vision and pain
which cranial nerve is involved in Ramsay Hunt syndrome?
CN VIII
when should antivirals be started for max benefit with herpes zoster?
<72 hours
Valtrex 1 g TID x 7 days
what is Auspitz sign?
psoriasis - removal of scale causes bleeding
risk factors for psoriasis?
- Age
- Family history (genetic)
- Medications
- Stress
- Localized trauma
- Streptococcal infection
- HIV
- ETOH, Tobacco
patho of psoriasis?
abnormal T-lymphocyte function
inflammatory cascade causing hyperproliferation, decreased turnover time for epidermal shedding (from normal 14-20 days to 3-4 days)
what is the cause of guttate psoriasis?
beta-hemolytic strep stimulates T-cell proliferation
timeline of guttate psoriasis?
- time after strep infection
- duration of rash?
1-2 weeks post-strep
resolves in 6-12 months
25% develop chronic plaque psoriasis
what derm condition is this?
- red sharply defined papules and plaques with scale
location: extensor surfaces
psoriasis
lesions for guttate psoriasis appear commonly in what location?
torso, extremities
changes to nails seen in psoriasis?
- pitting onycholysis
- subungual hyperkeratosis
- nail plate dystrophy
allergic contact dermatitis is what type of hypersensitivity?
type IV (delayed cell-mediated)
what category of topical corticosteroid should be used for lichenified plaque psoriasis?
group I
*eg clobetasol propionate 0.05%
what category of topical corticosteroid should be used for seborrheic dermatitis?
- mild to moderate?
- mild
if moderate: group V
*betamethasone 0.1%
if mild: VI or VII
- tiamcinolonce acetonide 0.025%
- hydrocortisone 0.5-2.5%
what category of topical corticosteroid should be used for
nummular eczema?
group I or II
- group I: clobetasol propionate 0.05%
- group II: betamethasone diproprionate 0.05%
what category of topical corticosteroid should be used for
moderate or severe chronic eczema?
group IV
*mometasone furoate 0.1%
what vehicle is best for corticosteroids to soles or palms?
ointment
what vehicle is best for corticosteroids to scalp?
lotions or foams
what vehicle is best for corticosteroids to face?
cream, lotion, gel
what vehicle is best for corticosteroids to eyelids and genitalia? (42x absorption)
creams, lotions, paste
rank in order of potency:
cream
lotion
ointment
ointment»_space; cream»_space; lotion
dosing schedule of topical corticosteroids?
- group I
- group II to VII
group I:
- avoid > 2 weeks
- once daily
- cyclic dosing: 2 weeks on, 1 week off
group II
- BID
- response in 2-6 weeks
- limit use for 1-2 weeks if face, genital or intertriginous areas
describe the four stages of a pressure ulcer
stage 1: red, no open areas
stage 2: open ulcer/blister
stage 3: ulcer extends –> fat
stage 4: extends to muscle/bone
IDIPAMOP
mnemonic about management of pressure ulcer
- Infection (eliminate)
- Debride necrotic tissue
- Insulate the wound
- Protect the periwound tissue
- Absorb excess exudate
- Maintain a constant moisture level
- Obliterate dead space
- Prevent future injury
what medications can trigger psoriasis?
Lithium beta-blockers NSAIDs antimalarials sudden withdrawal of systemic/topical corticosteroids
psoriasis is linked to an increased risk of……
anxiety, depression obesity DM HTN lymphoma, non-melanoma skin cancer, cutaneous T-cell lymphoma, and solid organ cancer MI, stroke
