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NURP 532 > Week 6 Dermatology > Flashcards

Week 6 Dermatology Flashcards

1
Q

class 1-7 topical corticosteroid potency

A

class 1: superpotent

class 2: very high potency

class 3: high potency

class 4: medium-high potency

class 5: medium potency

class 6: low potency

class 7: very low potency

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2
Q

irritant diaper dermatitis

A
  • spares the skin folds
  • tx: no scented wipes, freq diaper changes, barrier cream, air exposure
  • hydrocortisone 0.5% cream
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3
Q

candiasis rash

A
  • candida doesn’t spare skin/intertriginous areas (neck, axillae, groin)
  • clotrimazole 1% cream (anti fungal)
  • mouth: white plaques on erythematous base (thrush)
  • diaper: beefy, red satellite lesions
  • vulvogainal area: thick cheesy, yellow discharge
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4
Q

seborrheic dermatitis

A
  • greasy scaling in area of lots of sebaceous glands (scalp, face, post auricular or intertriginous areas)
  • treatment:
    • infant: mineral oil 5-10 mins before washing
    • adolescent/adults: salicyclic acid, keoconzaole, selenium sulfide
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5
Q

atopic dermatitis (eczema)

A
  • Scaly, red, plaques or patches
  • Raised areas and bumps
  • Flexor surfaces
    • Behind knees, flexor of elbow, ankles, wrist, neck
    • Children: cheeks, knees
    • Adults: eyelids, elbows, knees
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6
Q

what is atopic dermatitis associated with?

A
  • Family or personal hx of atopy (genetic disposition of developing allergic diseases)
  • Xerosis or dysfunction of skin barrier
  • IgE reactivity (elevated IgE levels)
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7
Q

how long can you use topical steroids?

A

max 2 weeks

  • causes atrophy, striae
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8
Q

perioral dermatitis sx’s and tx

A
  • Triggers: pregnancy, stress, cosmetics, unknown
  • Papules on erythematous base around mouth and nasolabial folds
  • Sparing above lips and lips
  • Itch, burn
  • Tx: similar to acne
    • Oral Doxy or minocycline in non pregnant women
    • Or oral erythromycin
    • 6-8 weeks to resolve
    • NO topical steroids (worsens)
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9
Q

acneiform disorders

A
  • comedonal (open and closed comedones)
  • inflammatory (papule and pustules)
  • cystic/nodular
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10
Q

acne treatment

A

Benzoyl peroxide (BP)

  • Use first line for mild inflammatory or mixed (comedonal and inflammatory) acne
  • Drying
  • Topicals
    • clindamycin or erythromycin
    • Combinations of 5% BP + topical antibiotic may be more efficacious than either alone
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11
Q

topical retinoids (tretinoin, adapalene, tazarotene)

A
  • For comedonal acne
  • Normalize keratinization and reduce obstruction
  • Creams, gels (0.01%, 0.025%, and 0.05%)
  • May cause irritation, dryness, redness, hypo- or hyperpigmentation
  • Use a pea-sized amount for the whole face
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12
Q

Caution with BP and tretinoin

A

*Tretinoin is inactivated by BP, so apply BP in the morning and topical retinoid at night (to avoid sun exposure)

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13
Q

red, itchy rash, hands, torso, burrows sites (interdigital spaces of the hands, flexures of the wrists and arms, genitals, feet, buttocks, and axillae)

A

scabies

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14
Q

scabies diagnosis

A

based on clinical findings

dermoscopy shows burrows as ‘jet planes’

scabies prep confirms - mineral oil and lesion scraped

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15
Q

scabies tx and education

A
  • Permethrin 5% cream applied neck down for 8-12 hrs then washed off; repeat in 1 week
  • Tx house members
  • Oral antihistamine and emollients as needed
  • Oral ivermectin
    • If topicals don’t work
    • NO children < 15 kg or preg/ac
  • Education
    • clothing and bedding washed, very hot dry clean
    • treat past 30 days household contacts
    • residual itching for 4 weeks even if mites are gone
    • not infectious 24 hrs after treatment, can go back to school
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16
Q

pediculosis capitis (head lice)

A
  • Spread by physical contact (pillows, brush, etc)
    • Common behind ear and back of scalp
  • itching, scratching, irritability
  • crawling sensation in scalp
  • dandruff like substance in hair
  • hx infatuation in family or day care
17
Q

Pediculosis Pubis (crab lice)

A
  • Pubic, facial hair, eyelashes, scalp hair
  • Transmission: sexual, close contact, fomites
  • if pubis found in chid, consider sexual abuse
  • excoriation, small bluish macule, papule
18
Q

pediculosis corporis

A

uncommon in childhood

not on body but on clothes, and intermittently pierces skin

can carry disease

belt line, collar, underwear common sites

19
Q

treatment for head lice and pubic lice

A
  • Head lice:
    • Permethrin 1% cream rinse
    • shampoo hair then dry/damp hair, apply, leave 10 mins, rinse
    • don’t wash for at least 24-48 hrs
    • repeat
    • remove nits w fine tooth comb
    • clean environment, contacts, clothing, vacuum seal items x 2 days
  • > 6 months old or older can use:
    • Spinosad
    • Ivermectin topical single dose, 10 min to dry hair
20
Q

actinic keratosis aka solar keratosis

A
  • Premalignant lesions
  • persistent or recurrent reddened, roughened area that scales or crusts
  • Risk factor to SCC
  • On sun exposed area of body (neck, face, scalp)
  • Tx: cryotherapy
21
Q

basal cell carincoma

A

most common form of skin cancer

slow growing cancer in sun exposed areas (auricles)

least likely to be malignant but can rarely be invasive

slow growing, auricle

shiny, irregular, painless lesion

22
Q

squamous cell carcinoma

A

auricle, fair skin, hx of sun exposure

can sting, itch, bleed

open sore that doesn’t heal

more serious form of skin cancer = can metastasize to regional lymph nodes and death

23
Q

pyogenic granuloma

A

benign, small, raised, red bumps

triggered by pregnancy, meds

results from injury

bleeds easily, refer to Derm for excision or electrocautery

24
Q

dermatofibroma

A

dome shaped nodule on extremities

indent with palpation (Fitzpatrick sign)

benign

25
Q

measles, rubella

A

measles:

  1. URI x 4-5 days, >101 F, cough, coryza (nasal discharge), conjunctivitis (3 C’s of measles)
  2. enanthem (koplik spots) oral mucosa (small, irregular, white granules)
  3. rash, 105F, maculopapular rash (behind ears, forehead) spreading to back, abdomen, thighs

rubella: German measles, maculopapular rash from face to neck trunk over 24 hrs

26
Q

erythema infectiosum

A

aka 5th disease

by parvovirus B19

mostly in 5-15 yr olds slapped cheek

high fever, rash 7-10 days in face with circumoral pallor, then maculopapular eruption on trunk to arms, thighs, buttock x 1 month

27
Q

roseola infantum

A
  • 6th disease; 6 months - 2 yr old
  • erythema infectiosum in older children
  • rash begins on TRUNK, spares face
  • sudden 101F-103F x 3-7 days
  • URI, cervical/posterior occipital lymphadenopathy, lethargy, eyelid edema
28
Q

pityriasis rosea hallmark clinical presentation

A

herald patch*

  • 2-5cm slightly erythematous lesion finely scaled slightly elevated border that enlarges quickly with central clearing (starts on back, trunk, upper arm, neck, thigh)
  • secondary lesions: small, macular to papular, thin, round to oval
  • Christmas tree rash along dermatome
29
Q

pityriasis rosea management & education

A
  • calamine lotion, tepid baths, antihistamines, emollients
  • NO topical steroids (worsens)
  • minimal sun exposure
  • educate: benign, self limited, non contagious w 3 cycles, resolves in 6-12 wks
30
Q

mononucleosis syndrome

A
  • affects lymphoid tissue and peripheral blood
  • infancy/early childhood
  • personal contact (deep kissing), sex, exchange of saliva among children
  • hepatomegaly, splenomegaly
  • rash trunk, arms, palms
    • mono spot if > 4 yrs old
  • avoid contact sports x 4 weeks (hepatiplenomagly)
  • sx’s resolve 2-4 wks, 95% recover w/o tx
31
Q

atopic dermatitis treatment

A
  • Skin hydration
    • daily emollient/moisturizer esp after shower
    • no fragrances/dyes
  • Control pruritis
  • Control inflammation
    • Mild to moderate topical corticosteroid
    • Topical calcineurin inhibitors
      • tacrolimus or pimecrolimus
  • Education
  • Treat superinfection if needed
    • give oral antibiotic for staph infection
32
Q

types of psoriasis

A

bilateral, extensor surfaces

red, scaly inflamed rash, plaque [refer if on scalp or large % of body]

guttate: tear drop 1-10mm body
inverse: in folds/flexor
erythodermic: severe, redness entire body
pustular: pustules on soles, palms, no plaques

33
Q

koebner phenomenon

A

isomorphic response

lesions in areas of local injury like scratches, surgical scars or sunburns

34
Q

varicella / chicken pox

A
  • rash begins abdomen > face > extremities
  • pinpoint vesicles
  • highly pruritic lesions, scabs from 5-20 days, 105F
  • self limiting (Tylenol, hydration, emollients)
  • acyclovir only if >12 yrs, immunocompromised, comorbidities
  • prevention with vaccine (2 doses: 12-15mo then 4-6 yrs old)
35
Q

candidiasis rashes areas

A
  • mouth: white plaques on erythematous base (thrush)
  • diaper: beefy, red satellite lesions
    • includes skin folds /intertriginous areas (neck, axillae, groin)
  • vulvogainal area: thick cheesy, yellow discharge
36
Q

acute infection of dermis or subcutaneous tissue

irregular borders, fever, chills, malaise

A

cellulitis

group A strep or S aureus

37
Q

cellulitis management

A
  • Consider extent of injury
    • Derm and subcutaneous tissue
    • osteomyelitis?
  • Ask about fever, malaise, swollen lymph nodes = more serious infection, close f/u
  • No imaging, no culture really needed if non purulent
  • amoxicillin clavulanate (1st line)
    • or cephalexin

NURP 532 (13 decks)

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