Week 5

Question 1

What are the two classifications of contact dermatitis?

Answer 1

Allergic

Irritant

Question 2

Allergic contact dermatitis is a ______ type hypersensitivity reaction

Answer 2

Delayed (cell-mediated)

Examples: poison ivy, nickel

Question 3

80% of all contact dermatitis is what type?

Answer 3

Irritant

Question 4

What can predispose you to irritant contact derm?

Answer 4

Household duties or occupational exposures (hair dressers, bar tenders, janitors)

Ie - hands in water, detergents, solvents

Most common occupational skin disease

Question 5

What is the dominant symptom for allergic contact derm?

Answer 5

Itchiness, localized to skin areas that came in contact with the allergen

Question 6

What does allergic contact derm look like?

Answer 6

Erythematous, popular dermatitis with indistinct margins

Often blisters and edema

Can take 1-2 days to appear

Question 7

What is the dominant symptom of irritant contact derm?

Answer 7

Burning, stinging pain

Hands most common

Question 8

What does irritant contact derm look like?

Answer 8

Erythema, chapped skin, dryness, and fissuring

More immediate onset

Hands most common

Question 9

Common allergens that can cause allergic contact derm

Answer 9

Poison ivy, oak, and sumac (urushiol oil)

Nickel

Rubber/latex

Preservatives/cosmetics

Neomycin

Question 10

Lip licker’s dermatitis is a type of …

Answer 10

Irritant contact derm

Question 11

Treatment options for contact derm

Answer 11

D/c exposure to allergen/irritant

Decrease frequency of hand-washing (if that’s the cause)

Wear gloves/protective clothing

Apply bland emollient (Vaseline)

Topical steroids 1-2x daily for 7-14 days

Consider oral corticosteroid for ACD involving face or >20% BSA

Question 12

When should you consider oral corticosteroids for allergic contact derm?

Answer 12

If it involves face or >20% BSA

Prednisone 0.5-1mg/kg/day (max 60 mg/day) x 7 days

Question 13

Infection of the nail by fungus, yeast, or non-dermatophyte mold

Answer 13

Onychomycosis

Question 14

Risk factors for onychomycosis

Answer 14

Advanced age

Tinea pedis

Genetics

Immunodeficiency

Household infection

Question 15

Most common subtype of onychomycosis

Answer 15

Distal subungual

Typically starts with great toe

Question 16

Proximal subungual onychomycosis is usually seen in…

Answer 16

Severally immunocompromised patients (ie AIDS)

Starts near the cuticle and progresses distally

Question 17

Yeast onychomycosis is usually due to…

Answer 17

Candida Albicans

Can also cause chronic paronychia

Question 18

How do you diagnosis onychomycosis and differentiate from other nail dystrophies?

Answer 18

KOH prep of nail scrapings

Culture

Histopathology

Question 19

When should you consider treatment of onychomycosis?

Answer 19

Hx of cellulitis

DM

Patient desires cosmetic improvement

Patient complains of discomfort/pain

Question 20

What are the treatment options for onychomycosis?

Answer 20

Dermatophyte onychomycosis:
• Oral terbinafine x 6 weeks for fingernails or 12 weeks for toenails
• Fluconazole
• Itraconazole

Non-dermatophyte onychomycosis:
• Oral itraconazole x 6 weeks for fingernails or 12 weeks for toenails

Question 21

Risk factors for candidal intertrigo

Answer 21

Moisture

Skin friction (obesity, sumo wrestlers)

Immunocompromised

Question 22

Candidal intertrigo typically affects…

Answer 22

Groin

Mammary/abd folds

Web spaces

Axilla

Question 23

How do you diagnose candidal intertrigo

Answer 23

Primarily a clinical dx

PE

KOH prep

Culture

Question 24

Treatment of candidal intertrigo

Answer 24

Preventative measures (drying agents, weight loss, address underlying conditions)

Topical Nystatin or azole

Systemic meds in resistant/severe cases (Itraconazole)

Question 25

Tinea versicolor is a fungal infection caused by...

Answer 25

Malassezia furfur or M. globosa

Question 26

What populations are most at risk for tinea versicolor?

Answer 26

Tropical climate Adolescents/young adults Hyperhidrosis Genetics Immunosuppression ***IT’S NOT CONTAGIOUS***

Question 27

How is tinea versicolor diagnosed?

Answer 27

Like other tinea infections PE KOH prep Wood’s lamp —> yellow to yellow-green fluorescence

Question 28

How do you treat tinea versicolor?

Answer 28

Topical tx: • Azole antifungals (clotrimazole) x 2 weeks • Selenium sulfide x 1 week • Zinc Pyrithione shampoo x 2 weeks Systemic tx: • Oral azole (itraconazole) Recurrence common

Question 29

Where does stasis dermatitis most commonly occur?

Answer 29

Medial ankle (can also be circumferential)

Question 30

What skin changes do you see with stasis dermatitis?

Answer 30

Erythema, inflammation, pruritis, scaling, and vesicle formation

Question 31

How do you treat stasis dermatitis?

Answer 31

Emollients Barrier creams Topical corticosteroids (triamcinolone, betamethasone)

Question 32

Arterial or venous ulcer: Location = toe joints, malleoli, anterior shin, base of heel, other pressure points

Answer 32

Arterial

Question 33

Arterial or venous ulcer: Location = malleoli above bony prominence, posterior calf, may be large/circumferential

Answer 33

Venous

Question 34

Arterial or venous ulcer: Dry, often pale/necrotic (brown/black fibrous tissue)

Answer 34

Arterial

Question 35

Arterial or venous ulcer: Pink/red with yellow fibrinous tissue, exudate common

Answer 35

Venous

Question 36

Arterial or venous ulcer: Absent pulses

Answer 36

Arterial

Question 37

Arterial or venous ulcer: Pulses present

Answer 37

Venous

Question 38

Arterial or venous ulcer: Skin atrophy, shiny, taut, loss of hair

Answer 38

Arterial

Question 39

Arterial or venous ulcer: Skin erythematous, hyperpigmented, edema, dry skin, varicosities

Answer 39

Venous

Question 40

Arterial or venous ulcer: Foot becomes pale with leg elevation

Answer 40

Arterial