Derm disorders Flashcards

1
Q

Principles of derm assessment

A
  • is the pt otherwise well without systemic signs or other symptoms? likely condition limited to the skin
  • is the pt miserable but not systemically ill? often uncomfortable with itch, burning, or pain (scabies, herpies zoster
  • Systemically ill with constitutional s/s (fever, fatigue, loss of appetite, unintended weight loss, malaise)? dermatologic manifestation of systemic disease (varicella, transepidermal necrosis, lyme disease, SLE)
  • Consider wich pts are at greatest risk for the condition
  • consider transmission/contagion risk
  • are there primary lesions only or primary and secondary lesions
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2
Q

Primary Vs. Secondary skin lesion

A
  1. Primary: results from a disease process, has not been altered by outside manipulation, treatment or natural course of disease (vesicle)
  2. Secondary: lesions altered by outside manipulation, treatment, natural course of disease (crust)
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3
Q

Papule

A

single uniformly brown colored, slighty raised, irregularly shapped with defined borders

6mm in diameter

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4
Q

Macule

A

single non-palpable area of discoloration, irregularly shapped
5mm or less in diameter

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5
Q

Purpura

A

flat, non-blanchable, confluent, purple-colored irregularly-shaped lesions on skin ranging 2-20mm

caused by low plts

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6
Q

clustered

A

occuring in a group without a pattern

vessiccular lesion seen in HSV1

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7
Q

Scattered

A

generalized over body without a specific pattern or distribution

viral exanthem - rash triggered by virus (rubella)

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8
Q

confluent/coalescent

A

multiple lesions blending together

plaques seen in severe psoriasis

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9
Q

annular

A

in a ring
characteristic bulls eye lesion with central clearing as in lyme disease

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10
Q

Actininc Keratosis

A
  • precancerous lesion: likely only 1:100 progress to SCC
  • predominanatly found on sun-exposed skin
  • microscopic to several cm
  • stuck on apperance - red, brown or flesh tone, often tender but usually minimally symptomatic
  • lesions can remain unchanged, spontaneously resolve, or progress to invasive SCC
  • Bx not needed for Dx.
  • Intervention: topical 5FU, imiqumimod cream, dicolfenac gel, phododynamic therapy, cryosurgery
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11
Q

Basal cell Vs Squmous cell carcinoma

A

BCC
* sun exposed areas
* de novo - new lesion
* papule, nodule without central erosion
* pearly or waxy apperance, relatively distinct borders with or without telangiectasia
* metistatic risk low

SCC
* Sun exposed areas
* can arise from actininc keratoses or de novo
* red, conical hard lesions with or without ulceration (appears more angry)
* less distinct borders
* metastatic risk greater (3-7%) greates risk with lesion on lip, oral cavity, or genetalia

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12
Q

Metastatic melanoma
ABCDEE

A

Assymetric
Borders Irregular
Color not uniform
Diameter usually greater than 6mm
Evolving new lesion or change in longstanding lesion
Elevated

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13
Q

Psoriasis Vulgaris tx

A

medium potency topical coticosteroid

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14
Q

Scabies treatment

A

permethrin lotion

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15
Q

Verruca vulgaris tx

A

Imiquimod cream - immune modulator

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16
Q

Tinea pedis tx.

A

topical ketoconazole

17
Q

Rosacea tx

A

topical metronidazole

18
Q

Phytodermatitis tx

A

Topical
* mild or high potency topical corticosteroid- triamcinolone, clobestasol
* areas of thinner skin - lower potency corticosteroid - consider oral

systemic tx
* preferred when >20% total body surface is affected, or severe rash, or is rash impacts face, genitals, hands, or rash impacts occupational function.
* prednisone 0.5 - 1 mg/kg/day for 5-7 days then half dose for additional 5-7 days.

19
Q

Impetigo - nonbullous

A

erythematous macule that rapidly evolves into vesicle or pustule, ruptures, contents dry, leaving a crusted, honey colored exudate

staphlococcus aureus, streptococcus pyogenes (gram+)

treat with topical mupirocin

20
Q

Impetigo bolus

A

bulla contain clear yellow fluid that turns cloudy, dark yellow. Bullae rupture easily within 1-3 days, leaving a rim of scale around red, moist base, followed by a brown - lacquered or scalded skin appearance.

usually requires systemic abx

21
Q

Cellulitis

A

infection of dermis and subcutaneous fat usually includes heat, redness, and discomfort

caused by streptococcus pyogenes or less commonly staphylococcus aureas (MSSA is beta-lactamese producer, MRSA resistance via altered binding sites)

TX for mild cases
* PO penicillin VK (suseptible to beta-lactamase)
* PO cephalexin (preferred)
* PO dicloxacin
* PO clindamycin (risk of c. diff)

22
Q

Abcess tx

A

Mild
* I &D
* Warm Compress

Moderate
* I &D, C&S
* TMP/SMX (bactrim) or doxycycline
* Change intherapy based on C&s results:
- MRSA continue above
- MSSA dicloxacin or cephalexin