CH 5 Derm

Question 1

in dermatology assessment, assess..

Answer 1

assess the entire patient, not simply the skin problem

Question 2

when there is a new lesion, ask?

Answer 2

which lesion is the oldest and which lesion is the newest?

Question 3

primary skin lesion

Answer 3

the result from the disease process
ex: vesicles: fluid filled lesions, <1cm,

Question 4

secondary skin lesion

Answer 4

lesions altered by outside manipulation, treatment, the natural course of the disease
ex: crust (raised lesion from dried serum and blood remnants from vesicle rupture)

Question 5

Answer 5

Actinic Keratosis
Can be diagnosed visually

Question 6

Actinic keratosis
location:
description:

Answer 6

location: sun-exposed skin (forehead, tip of ear/nose, eyebrows)
“loosely glued on skin”
red, brown, or flesh town, scaly, often tender. unchanged, spontaneously resolve, or progress to invasive SCC

Question 7

Actinic Keratosis (AK) treatment

Answer 7

topical 5 fluorouracil (5-FU)
5% imiquimod cream
topical diclofenac gel
photodynamic therapy (PDT) with topical delta-aminolevulinic acid

Cryosurgery (liquid nitrogen)
medical grade laser or chemical peel

Question 8

basal cell carcinoma (BCC)
location:

Answer 8

sun exposed areas
arises as NEW LESION

Question 9

Squamous cell carcinoma (SCC)
location:

Answer 9

sun exposed areas
arises as NEW LESION or from AK

Question 10

BCC Description:

Answer 10

papule, nodule with or central erosion
pearly or waxy appearance, distinct borders with or w/o telangiectasia

low cancer risk but if no tx, high risk

“an open sore that doesn’t heal”

Question 11

SCC description:

Answer 11

red, conical hard lesions with or without ulceration
“more angry looking lesion”

cancer risk higher, can be anywhere but mostly on lip, oral cavity, genitalia

Question 12

Answer 12

BCC

Question 13

Answer 13

SCC

Question 14

ABCDEE for malignant melanoma

Answer 14

Asymmetric
Irregular Borders
Color not uniform (shades of brown, black, red, blue, white)
Diameter (>6mm size of a pencil eraser)
Evolving (NEW) or change in longstanding lesion or nevus or pigmented lesion
Elevated (not always)

Question 15

first line tx for Psoriasis vulgaris:

Answer 15

medium potency topical corticosteroids

Question 16

first line tx for scabies:

Answer 16

permethrin lotion

Question 17

first line for verruca vulgaris:

Answer 17

Imiquimod cream: immune modulator, cause body to create immunological action to keep wart in check)
warts caused by HPV (location of wart is a diff type)

Question 18

first line tx for tinea pedis:

Answer 18

topical ketoconazole
antifungal

Question 19

first line med for rosacea:

Answer 19

topical metronidazole

Question 20

Answer 20

eczema
-antecubital fossa, dry scale skin pruritus, crusted or weeping sores x month
-worse during cold, dry weather

Question 21

facial redness, swelling, pustular lesions over nose and cheeks with small visible blood vessels
-more common in light tone skin

Answer 21

Rosacea

Question 22

if rosacea goes untreated..

Answer 22

hyperplasia occurs and permanently thickens. blood vessels become more visible

Question 23

acute onset of pruritus, erythematous papules, and burrows on wrist or hands, between fingers

Answer 23

scabies

Question 24

solitary salmon-colored scaling patch (herald patch) on the truck or limbs, enlarges over few days with similar lesions on chest, and, back over a few weeks with “Christmas tree” distribution

Answer 24

pityriasis rosea

self limiting

Question 25

phytodermatitis

Answer 25

poison ivy, poison oak, poison sumac

Question 25

phytodermatitis

Answer 25

poison ivy, poison oak, poison sumac

Question 26

Use systemic corticosteroids for phytodermatitis (vs topical) when…

Answer 26

20% or more of total body surface area is affected, severe rash (ie lots of blisters), or have rash on face, genitals, hands and/or impacts job

Question 27

Use which topical corticosteroids for phytodermatitis such as..
for thinner skin use…

Answer 27

mid or high potency = triamcinolone (0.1% kenalog Aristocort) or clobetasol (0.05% Temovate)

thinner skin (flexural surfaces, eyelids, face, anogenital), use lower potency like desonide ointment (Desowen) or oral therapy

ointment preferred

skin atrophy risk with long (2-3 wks) higher potency use

Question 28

Which systemic corticosteroid for phytodermatitis (vs topical)?

Answer 28

prednisone 0.5 to 1 mg/kg/day PO x 5-7 days (relief after 1-2 days), then 5-7 additional days with 50% prednisone dose reduced to minimize the risk of recurrence

Total 10-14 days

Question 29

adjunct therapies for phytodermatitis

Answer 29

cool compresses to relieve sx’s
calamine lotion
colloidal oatmeal baths to help dry and soothe oozing lesions
OTC analgesics to relieve pain
Oral histamines for pruritus

Question 30

Answer 30

non bullous impetigo (non bullous= no large blisters)
erythematous macule rapidly evolves into vesicle or pustule, ruptures, dries, leaving honey colored exudates

Question 31

Answer 31

bullous impetigo
-bulla with clear, yellow fluid that turns cloudy, dark yellow
rupture easily in 1-3 days and leaves rim of scale around red, moist base then brown acquired or scalded skin appearance

Most in infants and younger children

press lesion with finger and DOESN’T hurt child *so know it’s not child abuse burn

Question 32

impetigo treatment (non bullous and bullous)

Answer 32

non bullous: topical antimicrobial (mupirocin/Bactroban)
-don’t give OTC bc not strong enough

bullous: systemic antimicrobial therapy

Question 33

Answer 33

Erysipelas cellulitis
-subcategory of cellulitis
-superficial celllulitis form, face, legs arm

Question 34

Answer 34

cellulitis
(infection of dermis & subcutaneous fat, heat, redness, discomfort

Question 35

Cellulitis most likely organism

Answer 35

strep pyogenes
less common: staph aureus
MSSA (methicillin sus S aureus)
beta lactam producing MRSA

elevate legs
warm packs
tx systemic antimicrobial therapy

Question 36

Answer 36

Cutaneous Abscess
-skin infection involving hair follicle and surrounding tissue (heat, redness, discomfort in region)

Staph Aureus

Question 37

Med Treatment of MILD Cellulitis/erysipelas impetigo

Answer 37

if systemic therapy needed:
PO penicillin, cephalexin (preferred), dicloxacillin, or clindamycin (c diff risk)

for topical therapy with non bullous impetigo only: mupiricin

Question 38

Mild Abscess treatment

Answer 38

abscess with MINIMAL redness around it
I&D and warm compresses
no antibiotics

Question 39

Moderate abscess treatment

Answer 39

lesion and cellulitis around it
1. I&D and culture and sensitivity

2. give empiric PO TMP/SMX or doxycycline (consider MRSA or MSSA)
3. once C&S results come back, if need to switch meds:
   - if MRSA: stay on PO TMP/SMX or doxy
   -if MSSA: switch to PO dicloxacillin or cephalexin

treat for 7 days!