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Dermatology > Rashes 3 > Flashcards

Rashes 3 Flashcards

1
Q

Valtrex for lip sore dose and sig

A

500 mg BID x 5 days

Can give to pts who have 2-3 outbreaks per year to have on hand

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2
Q

For occasional pimples on forehead

A

Cleocin T gel BID to dry them up

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3
Q

Which labs to order on Accutane pt

A

CBC CMP lipids hCG monthly x 5 months

If LFT >700 stop
If > 400 talk to docs

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4
Q

Which 3 recommendations for solar purpura

A

Dermamend
RUTIN 500 BID OTC
DermaBlend foundation with spray

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5
Q

Intergluteal rash (macerated)

MC cause

A

Toilet wipes are MC cause

Could be dermatitis or Inverse psoriasis

Mometasone

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6
Q

Suppurative

A

Pus formation

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7
Q

SE of minocycline (2)

A

HA, dizziness

Lupus like : joint aches and dizzy

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8
Q

Rosacea of scalp sx

Tx

A

Follicular based papules can be itchy and painful

Is rosacea same as folliculitis acne necrotica militaris

Doxy (minocycline if doxy doesn’t work, HA dizziness)
Betameth lotion BID
T Gel (for irritation) and TSal (for flaking) every day alternate
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9
Q

T Gel and T Sal - what conditions to use in

A

T Gel for irritation and T Sal (for flakiness)

Scalp psoriasis
Rosacea of scalp (Acne Necrotica Maliaris)

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10
Q

Another name for rosacea of scalp

A

Acne Necrotica Miliaria

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11
Q

Stasis dermatitis flare

A

Was given RUTIN and fluocinonide

When retain fluid, it seeps into skin and in skin, it breaks down into hemosiderin and it is very rash and itch provoking so need Job stockings or Ted Hose daily.

If fluid just sits there - it can cause ulcers

So the only 3 options for tx:

  • hose
  • elevation
  • PCP to give you diuretics

For ITCH:
1 lbs of TAC for legs (and back - looked like ID reaction from Stasis)
Allegra could help itch!

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12
Q

Tx for intergluteal rash

A

HC 2.5 BID prn (don’t need 2 weeks on/off)

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13
Q

If nothing helps with GA, which oral tx

A

Plaquinile

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14
Q

Pityriasis amiantasia is a form of

A

Psoriasis

Inject at 90 degrees about .1 per each 1 cm area

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15
Q

Digital mucous cyst cause and tx

A

Indicative of arthritis
It sunovial joint fluid due to inflammation of joints

Tx: dont LN2 or EDC because can cause deformity of nail matrix

  • can lance it (18 G or 11 blade) and jelly comes out but will refill in couple days (sometimes doesn’t refill)
  • definitive tx - hand surgeon but even then it can refill
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16
Q

Scalp Psoriasis tx

A 
Betameth oint BID indefinitely
T Gel (to decrease redness and itch) and TSal to decrease scale

RTC 8 wks - if not better, do IL Ken 5 mg (so 10 mg 50-50)

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17
Q

Perfect distribution for Pityriasis Roses (PR)

A

Upper arms and mid thighs
Also trunk

From neck down to mid thighs

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18
Q

If recurrent BCC Or SCC, what tx

A

Always excise

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19
Q

SE of Plaquinil and what conditions for

A

Nausea
Rare risk of anemia and blindness
For interstitial GA

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20
Q

Pt edu about GA

A

In Adult - benign rash that comes and goes, no cause, may resolve over many years on its own, Tx options are plaquenil pill - SE nausea, blind, anemia
Or light therapy or topical steroid
Drugs.com

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21
Q

Tx for Grover’s

A

If itchy - TAC and Allegra

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22
Q

Pimple should resolve in how long and when to bx

A

In 2-3 weeks

If there at 4 weeks, do bx

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23
Q

For pruritic nodules ILKen, use what dose (dilute)

A

Direct Ken 10 without saline

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24
Q

How to tx GA?

A

Topical steroids then IL KEN

Plaquinil

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25
Q

What medical history question to ask pt suspected of LP

A

History of hepatitis?

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26
Q

Tab tx for LP and how long

A

Flagyl BID x 3 weeks

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27
Q

If pt with contact derm’s is not improving, what is the next step

A

TRUE allergy test

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28
Q

LPP follow up - what to look for

A

Improvement in crusting
New hair loss (pull test)
No pain or itch?
If all of the above good, continue Nizoral shampoo and RTC 8 weeks

If not better on Betameth and Nizoral shampoo, then IL Ken (5mg?)

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29
Q

Whic medication increases risk of SCC by 7 times

A

HCTZ

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30
Q

Tx for Scalp psoriasis and pityriasis amyantasia

A

Betameth lotion BID
Alternate T Gel and T sal, wash daily

If not better, IL Ken 50-50 (so 5 mg)

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31
Q

Groin intertrigo tx

A

Mometasone and ketokonazole
White boxes
Will get worse in summer so y=use above for flares and hairdryer with ZAsorb powder for maintenance

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32
Q

Which chemist drug is good for Merkel Cell

A

Ketruda

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33
Q

Asx bump on R deltoid

A

-Put on Doxy 100 BID x 1 week
-Plus Do punch Bx for H&E (neoplasm of uncertain ETIOLOGY) - came back GRANULOMATOUS DERM’S
- So do another punch for fungal culture
- Plus order labs: CBC, CMP, Cocci, Quant TB Gold
SED RATE

(Or do 2 punch bxs for H&E and for fungal culture)

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34
Q

What to do when Bx is back as GRANULOMATOUS DERM’S

A

Do another punch for fungal culture

PLUS labs: CBC, CMP, cocci, quantiferon TB Gold, SED Rate

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35
Q

Acne militaristic Necrotica is and tx

A

Extra facial rosacea on Scalp
Pain and itchy bumps
Doxy 20 BID 3 month supply (+1 rf) and Nizoral (bc rosacea and seb derm go together, anti fungal, anti yeast and anti bacterial/inflammatory)

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36
Q

How can GA present in kids

A

Pale pink plaque with rased border but without scale and with bumpy center of plaque (papules sticking out through plaque)

Tx TAC oint on rim only

The resolving lesions are flat patches and brown (will go away)

Benign rash - deep inflammation so not epidermal (no scale)

Goes away in 2 years

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37
Q

When does GA go away on its own

A

In 2 years

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38
Q

Is nummular eczema common in kids

A

No

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39
Q

OTC supplement for solar purpura

A

RUTIN 500 BID

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40
Q

If do punch for culture, how must submit specimen

A

With preservative free lido (or saline??)

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41
Q

What to ask putting pt on Flagyl and what for

SE of Flagyl

A

For LP BID x 3 weeks
Ask if any liver or health problems
SE: not a drop of alcohol, dizziness, neuropathy, (numbness/tingling in toes and fingers), upset stomach

+ cont on Betameth BID 2 weeks on/off (for body)

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42
Q

What top steroid to use for neck rash

A

Mometasone BID for itch

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43
Q

What strength of IL Kenalog for pruritic nodules

A 
10 mg (don’t dilute)
Inject .2-.3 per nodule
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44
Q

When does LP clear on its own?

A

8-10 months

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45
Q

Which rash presents with URI first?

A

Pityriasis Rosea (PR) - first URI, then 2-4 weeks later get itchy spots: tx betameth BID2 wks on/off PLUS Allegra QD. GOes away in 6 weeks!! Pink oval along skin lines

Guttate psoriasis

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46
Q

Tx for acute paronychia/ingrown toenail

A

Keflex 500 TID
Bactrian oint QD
See podiatrist

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47
Q

Ring worm tx and presentation

A 
Papules in a ring
OTC lamisil (?)
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48
Q

Onychorhexis is and tx

A

brittle nails
Nailtique #?
Biotin
Decrease hand washing

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49
Q

Bluephritis

A

Inflamm of eye lids

Tx: Allegra and aquaphor

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50
Q

Normal pimple should last how long

A

7-10 days

If doesn’t resolve in 2-3 week, must bx

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51
Q

How to select IL Ken concentration for Keloids

And RTC

A

Start with IL KEN 10 , if keloiddecreases by 50% - correct dose, if not increase dose
RTC in 4 weeks

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52
Q

Common culprit of eyelid dermatitis

A

Nails
Eye drops
Shampoo
Hair spray

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53
Q

What to ask pts when putting on Aczone

A

Sulfa allergy

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54
Q

Onychogriphosis

A

Huge nails

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55
Q

Pseudo folliculitis Barbae tx

A

Cleocin T and differin

GROW hair OUT, don’t shave

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56
Q

Wart tx

A

Best is LN2 q 4 weeks and compound W together

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57
Q

Which labs to order when starting pt on Humira
Which SE
SIG

A

Labs; CBC (infection or leukemia), CMP, Hep C, Hep B CORE Ab and antigen, HIV, QUantiferon TB GOld,

SE: cancer and infection

Q2 weeks injection

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58
Q

Which labs for Otezla

And SE
SIG

A

No labs except CMP to see kidney fx
-Ask if any kidney problems or joint pains

Tabs QD

SE: HAx 1 month, goes away, use Tylenol
DIarrhea with coffee x 1 month
Depression
Why loss

Only 60% effective, least effective and least SE

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59
Q

Humira SE

A

Increased infection and cancer

Inj q 2 weeks

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60
Q

Cosentyx

A

Strongest and newest - dont’ know all SE Q4 wks

Stronger than Stilara for severe psoriasis

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61
Q

Tx option for BSA >10% of psoriasis

A

Light tx or systemic

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62
Q

Methotrexate SIG and SE

A

Sig: 1 tab Q week
SE: Anemia, N/V, liver damage (cant drink at all) - if tx for 1-2 yrs, do liver bx

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63
Q

Which psoriasis areas are covered by insurance

A

Hands, feet, buttocks, scalp

If joint pains (but not occasional wear and tear)

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64
Q

No breast feeding on which Psoriasis med

A

Cyclosporine

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65
Q

Add Folate to which psoriasis med

A

Methotrexate

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66
Q

Anti TNF psoriasis med

A

Humira and Enbrel

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67
Q

Which one of systemic Psoriasis tx’s can’t get pregs on

A

Methotrexate

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68
Q

Nummular eczema in LE can be worsened by what condition

A

Edema so use hose during day and elevate legs

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69
Q

Which systemic med can increase sweating

A

Prednisone

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70
Q

Aldara is FDA approved for which cancer and in which distribution

A

On BCC Superficial ONly and ONLY below neck

Superficial BCC is one which has cell skipping around like pebbles and recurrence rate is higher so excision is good, EDC is good, Aldara for below neck

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71
Q

Tx for TINEA Pedis

A

Fungus
Lamisil BID x 3 weeks and spray OTC weekly
Dry well after shower and color safe bleach for socks

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72
Q

Name for xerotic dermatitis

A

Asteototic dermatitis

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73
Q

Which test to order in dermatomyocitis

Which is the #1 underlying cause of it?

A

TRANS VAGINAL US (ovarian cancer)

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74
Q

On which drugs can’t get pregs (7)

A 
Spironolactone 
Doxy
Accutane
Tazorac
Retinol (Clindamycin only for pregs?)
Class 1 steroids 
Methotrexate
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75
Q

When see something dark inside a digital mucous cyst, it’s called

A

Tindle effect

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76
Q

When there is plaque with no scale, it’s

A

Lichenified plaque

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77
Q

When does GA resolve on own

A

In 2 years

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78
Q

What to always ask a pt with acne (2 things)

A

Anything on back and chest?

How much milk?

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79
Q

Micaceous definition

A

Sparkly brilliant resemble mica

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80
Q

Use what for itch in LP

A

Antihistamines - hydroxyzine and Allegra

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81
Q

HIves started 2 days ago, took Benadryl

A

Any new meds? No

Get Allegra BID, if doesn’t work do Doxepin rx

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82
Q

How to tx Balanitis

A

Sweat leads to infection with yeast or fungus; it comes and goes with increase in sweating and heat

For flares: ketoconazole cream
For maint: ZAsorb powder daily

To decrease flares:

  • boxers instead of briefs to increase airation bc increased moisture causes increased rubbing and leads to yeast accumulation
  • keep body dry - hair dryer
  • no HOT water, use Vani soap
  • ZAsorb QD: absorbs moisture and has microconazole in it (antifungal and anti yeast)
  • worse in AZ during mansoon season
  • there is no infection or cancer - just area of accumulated moisture and irritation due to increased rubbing which causes break in skin and yeast gets in
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83
Q

OK to use TAC for face?

A

Ok only for 1 week BID (if giving pt TAC for FUDEX on arm)

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84
Q

How to explain stasis derm to pt

A

More of a a vein problem - don’t get blood back to heart, consequence of circulation and blood pulls down to LE

No hot shower, vani
Hose, elevate, PCP diuretics

Check arms

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85
Q

Cervical itch is called

A

Nostalgia parasthetica (in central upper back)

After accident

Tx: TAC, if not better - capsaycene cream (jalapeño juice)

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86
Q

White nail is

Normal white part near proximal nail fold is

A

Leukonychia

Lunula

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87
Q

What is in the compounded topical for onychomycosis and what allergy to ask pt about

A

Topical itraconazole + DMSO (tastes like rotten egg when absorbed) + ibuprofen

Check if pt has IBU allergy

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88
Q

How often to get labs checked on pt on Stilara

How often administered

Recommend what preventative steps for pt

Ask what?

What is CI in Stilara

A

Once a year: CBC CMP Cocci TB HIV

Inj q3 months

Get PNA and Flu shots (ok 18+ if immunosuppressed) AND healthy life style because risk for heart attack (and stop smoking)

Ask if any f/c/cough or site rxn?

LIVE VACCINES are CI so can’t do shingles

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89
Q

Can’t get pregs on which meds (7)

A

Tazorac
RetinA(Clindamycin ok)

Spironolactone!! Must be on OCP tubal ligation or condoms
Doxy
Methotrexate 
Class 1 steroids
Accutane
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90
Q

White nails

A

Terry nails (leukonychia)

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91
Q

Prurigo Nodules and excoriation

A

White gloves, clip nails QD, NAC
RTC 8-10 wks

Can inject with kenalog
Not warts

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92
Q

Psoriasis on nails tx before systemics

A

Betamethasone oint AM

TAZORAC PM

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93
Q

Psoriasis tx and if not better when RTC

A

Beta BID 2 on off

If not better:

Beta AM and Tazorac .1% PM (decreases scale and increases penetration)
OR
Continue Beta BID 2 on off and DOVONEX

If not better, ECZEMER laser (light tx)

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94
Q

If psoriasis pt has joint pains, do what

A

Referrals to rheumatology

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95
Q

Good starting systemic drugs for widespread psoriasis

And don’t use which systemic biologic?

A

Start with Humira or Stilara (both good starting points)

Don’t use Enbrel - not as good as Humira

If not better on above, use Cosentyx or trump is

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95
Q

Pt with psoriatic plaques tx options (BSA<10)

A 
FIrst Beta BID on/off RTC 8 weeks
NOt better :
- Beta AM and TAZORAC .1% PM (not pregs) (to decrease scale and increase penetration)
OR
-Beta AM and DOVONEX PM
NOT better on above:  IL KEN 3.3, (if 50% better, ILK 5mg)
In not better:
EXCIMER LASER
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96
Q

Which psoriasis areas does DOVONEX work well on

What other tx for those areas

A

Intergluteal and inguinal creases

Use Mometasone BID (not 2 wks on off)or Protopic (or HC 2.5 BID not 2 wks on off)

97
Q

If pt not improving on scalp psoriasis tx, ask what

A

Are you picking at it? Be gentle

98
Q

Scalp psoriasis tx

A

Beta BID (not 2 on/off) with TGEL TSAL
If not better: IL KEN
If not better: Ask if picking and EXCIMER laser

99
Q

Female psoriasis with 25% BSA and h/o breast cancer 8 years ago, tx options

A

Not otezla - not approved
Not humira bc SE cancer
Light tx only!

100
Q

Psoriasis pt with 25 BSA and h/o MM, can’t do what tx and do what biologic

A

Can’t do light rx and can’t do Humira

Can only do Otezla with h/o cancer

101
Q

what does interstitial GA look like and distribution

And what’s on DDx if in a certain distribution

A

Faint red ubiquitous papules across lower abdomen/fold (intertrigo distribution) and lateral thighs bilaterally BLANCHABLE!!!, granulomatous papules = under skin without scale (unless dry skin all over)

Looked like pink solid tapioca

DDX: TMEP if only on thighs (talengictasia macularis which is cutaneous mastocytosis)

102
Q

Name of huge BCC on nose

A

Fibroepithilioma Pinkus

103
Q

18 yo F NP with primarily comedians acne and some inflammatory,
Tx plan

A
  • Epiduo QAM for comedonal, rtc 8 wks
  • Not better at 8 wks:
    - ask if tolerating EpiDuo ok, is it too drying, DID YOU USE IT??
    - increase to Tazorac 0.1% cream PM with Efficlar or Clindamycin AM
    - OR EpiDuo BID
  • Not better in 8 wks:
    - Facials with Tina (stop tazorac 1 week BF)
    - OCP with PCP (Yaz, Yazmin or orthotricyclen)
104
Q

TMEP is

A

Talengiectasia Macularis Eruptiva Perstans (cutaneous form of mastocytosis)

105
Q

15 yo boy with very inflammatorya acne on face, chest, back with early scarring, tx plan

A

-Face: epiduo plus Doxy 100 QD

Back/chest: PanOxyl wash x 10 min (use old towels)

106
Q

Which advise to give ALL pts with rash

A

Lukewarm shower only, no hot

107
Q

Which drugs for back and chest acne

A

Spironolactone (must be on OCP, birth control, C/I pregs

108
Q

Pityriasis roses disctribution and tx

A

Upper arms, upper back, chest and neck

TAC for body and mometasone 0.1% cream BID for neck

Luckwarm shower, outside sun TIW 10-15 min

109
Q

Which topical is good for both seb derm and rosacea

A

Sulfa based

Sulfacetomide wash or lotion or ophthalmic drops (for eye lid rosacea or seb derm)

110
Q

Never undermine which excisional biopsy?

A

When suspect MM

111
Q

Uniform pink red rash on neck, do what

A

Press - dermatographism

112
Q

Rash on bottom of feet is called

A

Palmoplantar pustulosis (psoriasis form)

Beta BID 2 wks on off
On off weeks - Protopic and urea

113
Q

How often is excimer laser

A

Twice a week for 8 wks

114
Q

30 yo with jawline acne tx plan

A

Start with spironolactone 50 mg QD (can’t get pregs,hCG negative)

EpiDuo AM and Clindamycin HS

If not better, add aczone pm and cont spironolactone

If still not better in 8, increase spironolactone to 100

115
Q

20 yo F with severe comedonal and some inflammatory acne on face and back (not jaw, couple on jaw) (Tx plan)

A

Start on EpiDuo AM and Doxy 100 PM
(EpiDuo has retinol to open up pores and BP to open pores and decrease inflammation)

Clindamycin wouldn’t help as much with inflammation and don’t want to confuse pt with too much

Back: PanOxyl is good but doxy will work and don’t want to overwhelm

116
Q

What to use on back acne and pt instructions

A

PanOxyl - let sit 10 min (old towels)

Also doxy, spironolactone

117
Q

Cicatricial Pemphigoid is aka

A

Benign mucosal pemphigoid

118
Q

Name of dermatitis due to contact with plant and distribution

A

Phytophotodermatitis (usually in spring or summer when plants, fruit juice or veggies bloom): limes, lemons, celery, etc

Itchy blisters in forearms or LE, irregularly distributed or LINIAR with PIH after a few days which persists for months

Due to UVA contact with plant chemical Psoralens (contact with plant may be Brief or unnoticeable)

Vs PhotoContact Dermatitis which is when products like fragrances, sunscreens, disinfectants are hit by UVA

119
Q

Classic distribution for perioral dermatitis

A

Chin, nasolabial folds and inner or outer eyes

Can extend to neck

120
Q

NP with hair loss (20 yo F)

What questions to ask
What labs to order

A
  • does it ITCH, flake, pain, inflammation
  • how long, sudden or gradual
  • any new meds
  • PERIODS regular, acne problems?
  • any h/o of anemia, thyroid, b deficiencies, irregular periods
  • any recent surgeries, illnesses, hospitalizations
  • any family members with hair loss
  • when last checked CBC and thyroid (repeat in 1 year)
  • seen anyone before and their workup
121
Q

What type of hair loss does discoid lupus (DLE) get vs systemic lupus

A

DLE - scarring alopecia

Systemic lupus - get non scarring alopecia

122
Q

Keflex sensitivity is judged by sensitivity to which other abs

A

PCN oxacillin

123
Q

Labs to order for diffuse hair loss

A

CBC, TSH, Iron and TIBC,
testosterone, DHEA and
ANA (systemic lupus and DLE cause loss)

124
Q

Which drug to tx Lupus

And SE
Need clearance from which specialty and which labs

A

Plaquinile

SE: deaf, anemia, seizures,retinopathy, liver toxicity

Need clearance from ophthalmologist - baseline exam (and monitor?)

Need CBC, CMP, G6PD, PORPHORINS (bc if high, plaquinile makes you sick, vomit), anything else?

125
Q

Which are mast cell degranulating drugs

Avoid in which dz

Carry what with you?

A

NSAIDS, opioids (codeine,morpheme), alcohols, thiamine (B1), anesthetic (procaine)
ASA, scopolamine, BB, cough meds (Vanco/AmphoB)

Must avoid above meds in TMEP
Carry an Epi-Pen in case of anaphylaxis

TMEP is rare form of generalized cutaneous mastocytosis

126
Q

Which labs to order for TMEP

A

CBC

TRYPTASE

127
Q

Which labs to order for TMEP and why

A

CBC

TRYPTASE (bc mastocytosis)

128
Q

Name of sign when you get small bleeding after layers of scale have been scraped off psoriatic plaques or papules

A

Auspitz sign

129
Q

Distribution of dyshydrotic eczema vs palmoplantar pustulosis

A

Sides of fingers vs palms and soles (yellow pustules that turn brown when drain)

130
Q

What is the #1 question to ask a person presenting with hand dermatitis, dyshydrotic eczema or palmoplantar pustulosis

A

Do you SMOKE?

Our hands and feet have nicotine receptors and it causes flares every time you smoke. Plus, smoking makes available tx less effective - so work with PCP to stop smoking

131
Q

Which tx for hyperhydrosis

A

Drysol

Apply to hands HS for 10 min then apply lotion (or Beta oint for PPP) and gloves, wash off in am

132
Q

Name of itch on the back that causes macular amiloidosis

A

Notalgia Parasthetica

133
Q

Cause of PalmoPlantar Pustulosis (PPP)

And dz associations

A

genetic mutation or increased # of eccrine sweat glands

Can be ass’d with autoimmune dz (celiac, thyroid, DM1), chronic plaque psoriasis, strep throat, TNF meds

Form of psoriasis

134
Q

LPP tx and RTC

Risk of tx

How to describe LPP to pt

A

ILK Ken 5 mg and hold beta lotion for 6 weeks (or on spots not injected)

Risk of ILK is indentations

RTC 6 weeks for more injection

Pt edu: LPP is a scarring alopecia with itchy follicular papules

135
Q

Percent of cancer tx success with excision vs EDC vs MOHS

A

Excision is 95%
MOHS is 99%
EDC is 90%

With BCC - pebbles skipping over a creak

136
Q

If a red bump on nose, do what

A

Metro and RTC in 6 weeks to make sure gone

Pt had yellow points with blood vessels

137
Q

When pt has breast implants and you need to do a bx

A

Pull skin up with fingers (ask MA) and very superficial when injecting (just intradermal till blanch)

138
Q

Another name for dyshydrotic eczema

A

Pompholyx

139
Q

Dyshydrotic eczema distribution and other sx

Ask pt about what other parts and daily habits

A

Mostly interdigital and extends to palms (but not on dorsal fingers/hands) and severe itch

Ask if on feet, if smokes, how often washes hands, what soap uses

140
Q

MC cause of contact derm is

A

Frangrance, preservative or dye

141
Q

Descriptions of hand dermatitis

A

Fissured eczematous plaques

142
Q

What condition/rash on neck can be exacerbated by heat and sweat

Tx

A

Dermatographism (easy release of histamine with pressure, heat and sweat). Normal - 5% of ppl have it

Tx: Allegra 180

143
Q

Dyshidrotic vs hand eczema distribution

A

hand dermatitis is more dorsal

Dyshydrotic is more palms and interdigital

144
Q

How does Lichen Amyloidois look like

A

Real waxy, in eczema prone skin (also dorsal forearms and shins)

145
Q

Name of overhealing wound

And TX

A

“Proud flesh” = overgranulation tissues

TX: use topical cortisone to calm in down (Beta BID if on scalp
Don’t use cautery or silver nitrate sticks)

146
Q

How often to see pts on transplant meds vs chemo

A

On transplant meds (cyclosporine, izothiaprim):
Q 8-10 weeks if h/o many skin cancers,
Q 6 months if h/o of some cancers
Q 1 year if no skin cancers

Chemo: q 1 year

147
Q

If acne pt is not improving on Doxy 100 BID, what’s next step

A

Change to minocycline 50-100 mg QD (if >6 months - staining)

SE: HA, Dizziness, joint pains (lupus like syndrome)
If HA and dizziness - let me know: drug crosss BBB so more of it in CNS = pseudomotor cerebri cause dizziness, nausea, vision changes and HA
Papule derma of eye - HA and vision changes
[Occasional dizziness and HA is ok, but daily and bad HA means papiledema of eye)
IF JOINT PAINS - STOP!!

If not better on minocycline (or only 75% better) - discuss Accutane after 6 months of Abx)

148
Q

What dose to start Accutane on?

A

Start with 40 mg QD and stop everything else
RTC 1 month: if tolerates well and good labs, increase to 60 mg QD x 4 months

Dose: 1 mg/kg

149
Q

10 yo female with comedonal and inflamm acne 50/50: starting tx and what if not better

A

EpiDuo AM

Not better in 8 wks: comedowns better but not inflammatory: add Clindamycin

150
Q

What to always tell a female pt on Benzoyl P, retinoids and doxy for acne

A

Can’t take during pregs

151
Q

What to always ask a female pt who presents for acne

A

Periods regular?

Anything on back?

152
Q

What to ask each patient when putting on an anti biopics

A

Taking blood thinner Coumadin?

DOXY (recommend checking INR)

Keflex is least interaction with Coumadin

153
Q

What to suspect and check with recurrent mouth sores

A 
Cyclic neutropenia (check CBC)
HIV (check it)
B12, folate, zinc, riboflavin deficiency
Lupus (check ANA)
Iron levels
154
Q

Eccrine gland tumor and looks like

A

Spiradenoma adenoma

DF (deep seated)

155
Q

Name of ear drops for ear seb derm and SIG

A

DermOtic Oil 0.01%
Sig: 5 drops in each ear BID

Plus Nizoral shampoo QOD

156
Q

Itching around bra area is called (and cause)

A

Notalgia Parasthetica

Caused by arthritic changes in spine, herniated disc, back injury

157
Q

Female pt with 3 wk itchy rash DDX :
Started on legs and arms, resolved with ILK but returned on legs and chest/back so was given Prednisone
(Non scaly, excoriated pink papules on chest and polygonal on legs. JMO: non-scaly (=dermal, almost urticarial) edemnatous erythematous BLANCHEABLEj oval almost bug0bite like MONOMORPHOUS (all same) plaques (along skin lines on chest DDx and difference)

ALWAYS ASK PT WHAT when itchy rash

A

Ask if ORAL involvement

Dermal Hypersesitivity Rxn vs BP (urticarial pemphigoid) [not PRosea bc no scale and PR is epidermal (with scale)

Do 2 punch bx: H&E and DIF (results in 2 weeks when take out stitches)

158
Q

If stasis derm rash not improving on TAC and hose, do what, what could be and RTC when to do what

A

Rx Beta oint, Xyzal 5 mg for itch qHS (can be sedating, stronger than zertec)
Might also have contact derm so derm handout

RTC 6 wks: if not better, do TRUE allergy testing

159
Q

What can pts do to flatten a scar s/p EDC or excision

A

Massage it BID for 10 min

If excision, massage after 2 months bc don’t want to break deep stitches

160
Q

When pt rubs a rash a lot, the resulting skin changes are called

A

Lichen Amyloid

161
Q

If get a cyst or lipoma on back of neck or head, do what

A

Refer to ENT Dr Bassett to r/o cyst/lipoma vs LAD

162
Q

If dog bit, do what (2 things)

A 
Augmentin 875/125 BID x 10 days
Tetanus shot (go to PCP to be UTD)
163
Q

What does fixed drug eruption look like and MC meds (also what advice to pt)

A

Usually solitary: Round oval with purplish dusky center when acute and significant PIH when resolves

MC: ABX, NSAIDs, ASA, even food coloring

Keep a diary of when appears - food color or med

164
Q

Which abx for folliculitis

A

Doxy BID x 10 days

165
Q

Psoriasis severity classification by BSA

MILD MOD SEVERE

A

Mild < 3%
Moderate 3-10%
Severe >10%

Otezla approved for mod to severe

166
Q

Which immune cell releases histamine and heparin in response to an allergic reaction

A

Mast cell

167
Q

Describe mastocytosis

A

When population of mast cell accumulates in 1 tissue (eg skin, bone marrow, liver, GI, lymph node, spleen)

When mast cell is activated, it releases heparin and histamine into surrounding skin, causing inflammation that causes blood vessels to leak (resulting in localized itch, swelling,redness and at times blistering (this is a normal response in insect bites - mosquito triggers mast cell activation)

Rubbing the area of mastocytosis can also active mast cells (Darier sign: wealing following stroking of skin)

168
Q

What does H&E stand for?

A

Haemotoxylin and eosin staining

169
Q

What blood test suggest systemic involvement in mastocytosis?

A

Tryptase

170
Q

Which OTC cream to use for oral LP and regular LP

A

Aloe Vera can help

171
Q

Questions to ask when initiating Flagyl, get which labs, what dz for and Sig plus duration

A
  • Drink any alcohol so need LFTs (a sip can cause flushing, can’t drink 2 weeks after stop pills)
  • Rare SE: neuropathy and dizziness
Check CBC (for blood dyscrasia) and CMP (need LFTs) for Flagyl
Check Hep B (surface Ab and Ag), Hep C Ab for LP

Sig for LP: 500 BID x 4 wks (30 days)

C:I with Antabuse

172
Q

What labs are helpful (not critical) to check with Flagyl

A

CBC (for blood dyscrasia) and CMP for LFTs (can’t have any alcohol or Antabuse for 14 days post tx)

173
Q

What labs to check for pt with new LP

A

Heb B surface Ab and Ag, Hep C Ab

174
Q

Name of fluid filled cyst

A

Hydrocystoma

175
Q

Which labs to order for TMEP (and what is the systemic name)

A

Systemic Mastocytosis

Get TRYPTASE and CBC

176
Q

Which labs to order for cutaneous lupus (and if initiate Plaquinile)

A

CBC, CMP and Porphyrin for Plaquinile (bc causes adverse rxn if por is high)

CBC, CMP, ANA, ENA

177
Q

Which drugs trigger Subacute Cutanous Lupus Erythematosus (SCLE)

A

Lamisil, thiazides, CCB, griseofulvin, ACE inhibitors

178
Q

Which labs and test to order when starting Plaquinile

What are the side effects of Plaquinile

A

CBC, CMP and Porphorin (can’t start if high por) before starting
CBC and CMP q 1 month?? For 6 months
Also see ophthalmology for baseline exam BF tx and Qyr

SE: Anemia and blindness

179
Q

Which subtype of MM is 100% due to sun exposure

A

Lentigo Maligna (is invasive)

180
Q

What is the MC med to cause Mycosis Fungoides like rash

A

Statins (Lipitor)

181
Q

Can real MF be differentiated from drug induce MF on bx?

A

No

Drugs: Lipitor / statins
Takes months to go away after stopping

182
Q

What does Mycosis Fungoides look like

A

Ring worm (t corporis)

183
Q

Does doxy work for FFA as well as for LPP?

A

Yes

184
Q

Plaquinile is for

A

GA, LP and SCLE Lupus ( or was it for TMEP?)

185
Q

Don’t undermine which excision?

A

MM excisions bx (take 2 mm margins)

186
Q

If re-freeze a spot within 6 months, what to remember

A

Can’t charge Medicare for 2nd freeze within 6 months (they pay whistleblowers)

187
Q

If LFTs are elevated during Accutane, ask what and do what

A

Ask if was drinking alcohol (Alk Phos and ALT)

Recheck CMP in 1 week to make sure LFT down and no alc

188
Q

What is the best topical for Rosacea (and generic of it)

Also, rosacea tx

A

Soolantra (ivermectin) is best - compound is cheaper if not improving on Doxy (100 if severe, 20 BID if ok) and metro cream/gel)

189
Q

Is metro gel or cream more effective?

A

Cream is better bc less drying

190
Q

Crazy eczematous rash with desquamation all over body due to malnutrition (which nutrients)

A

Erythroderma (due to Niacin/B3 and lipid depletion)

Tx: TAC and see nutritionist

191
Q

Metro cream or gel SIG

A

BID if 0.75%

QD if 1%

192
Q

If big SCCIS, how to tx

A

Instead of EDC, do FUDEX x 3 weeks

193
Q

In pt with psoriasis, NEVER forget to look at what? (3) and ask what

A

NAILs
Elbows and knees
Palms and soles

Anything in the groin

194
Q

Doxy is for 5 conditions

A 
LPP/FFA
HS
GA
Acne
Rosacea
195
Q

LPP tx

A

Clobetasol solution or Betameth lotion BID (no need for break)

DOXY 100 qHS

Tug Test done
RTC 8 wks
ILK and bx if not improved to r/o T.E. Vs androgenetic alopecia vs LPP

196
Q

C&C

A

Curette, derm moncels, then freeze

197
Q

Stop Accutane at which triglyceride level (and bring to JMO attention at which level)

A

stop at 400

Bring to attention at 200

198
Q

Repeat LFTs when on Accutane at which numbers

A

When slightly above, recheck in 1 week to be back to normal and stop drinking

199
Q

What is better for bruising than other products

A

Arnica (can do oral or topical)

Works better than RUTIN or dermamend

200
Q

What makes HS worse

A

Smoking

201
Q

If dyshydrotic eczema or hand dermatitis not improving on tx, next step

A

TRUE allergy test

202
Q

If AK to base, do what

A

Re-bx

203
Q

What areas are considered aggressive for SCC

A

Penis, lip, ear

204
Q

Tx for moderately differentiated SCC on trunk vs face

A

Trunk - excise

Face - always MOHS

205
Q

Name of little fibrous bumps on face and associated with which dz

A

Angiofibroma (associated with tuberous sclerosis)

206
Q

If eczema is not improving on topical steroid, next step

A

Bx to r/o eczema vs TINEA vs Mycosis Fungoides (cutaneous T Cell lymphoma) and

207
Q

Workup for Humira

A

CBC CMP HEP C Ab, HEP B Surface Ag and Ab and core Ab, HIV TB Quant Gold, COCCI Serology
CXR PA LAT

208
Q

Benign tumor of follicular differentiation / cyst of follicular matrix

A

Pilotrixoma

Form due to calcification

209
Q

When can’t find prior bx spot because healed too well

A

Localization bx (“prior shave bx SCC”)

210
Q

How to tx and explain venous stasis ulcer

A

It’s a circulation problem (venous insufficiency), not a lesion. Not healing and pain due to edema or venous insufficiency or LipoDermatoSclerosis (fibrotic change in skin and subQ fat due to Venous insufficiency) (so see vascular surgeon to eval)

Tx: lymphedema clinic, vascular surgeon (Dr. D’Souza), hose and elevation
RTC 4-8 wks, add wound care and AQUAPHOR BID to soften scab if not healing

+ TRENTAL 400 TIC (Pentoxifylline): any h/o of bleeding or ulcers? Not a blood thinner, increases RBC flexibility and stimulates finrinolysis.
SE: nausea +/- v, dizziness, heartburn

NIACIN is 3rd line (also fibrinolysis)

211
Q

Champaigne bottle leg is called

A

LipoDermatoSclerosis (LDS)

212
Q

3 drug options for venous stasis ulcers

A

1st line: Stanozolol but too many SE (so hose, elevate an diuretic)
2nd line: TRENTAL 400 TID (can increase to 800 TID)

3rd line: NIACIN 100-150 TID to 5/day (helps hyperlipidemia associated with LipoDermatoSclerosis LDS)

TOC: comp and stanozolol

213
Q

How to explain to pt upset that lesion wasn’t picked up 1 month ago during regular skin check

A

It looked like an SK (inflamm. Papule or lichenoid keratosis) and it’s not standard of care to bx a benign looking lesion (portal for infection). TOday the top has been scraped and irritated and can’t tell if there is a malignant process involved (papules can change). An iSK can’t be differentiated from SCC clinically. GUarantee that we look at all suspicious lesions carefulully with dermatoscope. At that time, it looked benign but today, it’s hard to tell what’s underneath - could still be just an irritated SK due to scratching so best to bx today
A month ago could have been a smaller SK and they can grow, causing irritation and itch.

214
Q

Fitzpatrick skin type 1, 2 3 4 5 6

A

1: always burns, never tans (pale, blue/green eyes, blond/red hair)
2: burns easy, tans poorly (fair skin, blue eyes)
3: tans after initial burn (darker white skin)
4: burns minimally, tans easily (light brown skin, Hispanic??)
5: rarely burns, tans dark (brown skin)
6: never burns, always tans dark (black or dark skin)

215
Q

Chronic eczema like rash around anogenital area

A

Extramammory Paget Dz

216
Q

If painful would s/p excision persists due to edema, do what

A
  • hose and elevate
  • increase diuretics through PCP
  • pain is due to swelling/edema: lymphedema clinic to massage the fluid up
  • consult vascular surgeon (D’Souza)
  • LIDOCAINE PATCH QD but cut out center so it doesn’t touch the incision!
  • (the med that make RBCs more flexible TRENTAL (rental)
217
Q

Oral meds for GA and other tx

A

Doxy, Plaquinile 200 QD
Allopurinol has more SE than plaquinile (anti malerials)

1st line tx after topicals: Plaquinil or narrow band light

218
Q

What is oral TRENTAL for and MOA

A

Anti TNF
Can use for LIpoDermatoSclerosis and severe stasis dermatitis
Can be used also for GA (at Mayo)

219
Q

Never take which supplement with Doxy

A

ZINC (binds to doxy and decreases absorption)

220
Q

Plaquinil (anti malarial) is for

A

LP and GA

221
Q

HS tx

A

Runs in families, worse in heat and humidity
Anything in axilla? It’s recurrent boil like bumps in groin and folds called HS, - acne like process comes and goes where there is heat and sweating. There is tx but no cure. Not contagious as opposed to regular boil which can be staph infection.

To decrease flares:

  • No SMOKING
  • keep area dry: boxers> briefs
  • no hot, shower after workouts
  • ZAsorb AF powder after shower
  • ZINC gluconate = anti-inflammatory (in between flares but NEVER with DOXY)

Bacteria get involved and make things worse: PanOxyl soap - let sit 5 min (use OLD towels)

For mild flares: CLEOCIN T GEL BID
For big flares: Doxy 100 HS (1 hr bf lay down: upset stomach) [never with ZINC]

222
Q

Name of muscles for Botox

A

Globella

223
Q

Irritant contact derm on lips/mouth

A

No mints, gum
Arm and hammer toothpaste
HC 2.5% for itch and redness and aquaphor for maintenance

No metal cups, mouth washes, OTC lip balms

224
Q

Pruritic skin or rash > 2-3 months labs

A

R/o:Anemia, kidney, liver, TSH

  • BP : bx or blood
  • Contact derm
  • on exam: picking (neurotic excoriation can be confused with scabies so ask if picking at them just cause they are there?)
225
Q

Tx and recommendations for neurotic excoriation and what to ask pt

A
  • Are you picking at these just because they are there?
  • Labs: CBC, CMP, TSH, liver
  • DDx: scabies
  • white cotton gloves and CUT NAILS
  • Do labs
  • Allegra 180 QD or BID
  • NAC 600 BID - helps break the habit of picking at these
  • RTC 6 wks
226
Q

If pt comes in with itchy rash that’s all excoriated and wants the cause

A

Can’t tell you what it was bc the rash is gone (no fresh lesions) and just excoriation left. So not sure what happens but my suspicion is something internal (or external)
External: what soap, new laundry detergent? Any new meds?
Internal: had you thyroid/kidney/liver checked? Anemia?

227
Q

How to tx any recurrent skin cancer

A

MOHS (any place)

Ok to excise infiltrating aggressive BCC unless recurrent = MOHS

228
Q

Name of pimples on scalp and tx

A

Acne militarism Necrotica (extra facial rosacea)
Tx: T Gel shampoo (tar) QD and beta valerate 0.1% lotion
No hot shower and sweating makes worse

Also can do: abx and isotretinoin

229
Q

What 2 conditions present as pustules/bumps acne on scalp

A

Malassezia folliculitis (more upper forehead, chest and shoulders, less scalp): less inflamed, more comedonal like, monomorphous on chest
vs
Acne Miliaris Necrotica (rosacea of scalp) is more inflamed, acne/pustules and excoriated.

230
Q

How to tx dark liver spots

A

HQ called into walgreens ($120) (Triluma)

Laser - by Tina

231
Q

How to tx sebatious hyperplasia

A

Resurfacing Laser to flatten it (Dr. B)

Cautery if low maintenance

232
Q

Do skin tags come back? What causes them

A

Yes, they come back
Cause: friction and run in families

Can use LN2 if small or cut off after numbing

233
Q

Solitary red bump on nose that doesn’t look exactly like anything, do what

A

Cleocin T lotion to dry up (in case rosacea) and “RTC 4 weeks to ensure resolved. See picture”

234
Q

How to tx milia and what it is

A

Benign superficial cysts filled with keratin. No tx necessary. Can resolve with retinoids or extractions (Tina)

235
Q

What are the possible causes of dermal hypersensitivity reaction (back on bx)

A

Urticaria (how long do spots last if I were to draw a circle around it)
Bug bite (arthropod assaults): check feet for bug bites
Drug reaction (any new Meds or OTC in last 3 months?0
Fungal hypersensitivity reaction
Exogenous allergens

236
Q

4 high risk areas for SCC (does same count for SCCIS??)

And other SCC Mets risk factors

A

MOHS: Lip, ear, temple, penis

(Do same areas apply to SSCis??)

MOHS: Other RF for Mets of SCC: >2 cm, >2 mm deep, neural involvement, to fat

SCC on Finger always Mohs

237
Q

Never shake which bottle

A

Botox when diluting it with saline - or it will denature (only gently swirl it)

100 unit bottle Botox - add to it 2.5 cc saline to get 4 units per .1 dilution

238
Q

DIF is ordered for which skin disorders

A

Punch bx for lupus, Dermatitis Herpetiformis, lichenoid tissue rxn, vasculitis, BULLOUS PEMPHIGOID (along with blood labs of itch or urticaria without blisters)

239
Q

Cysts have what percent chance of coming back

A

40% chance of coming back (if 1 cell is left)

240
Q

Sebatious carcinoma is associated with

A

Colon/bladder cancer (refer to oncology for full work up),

Muir Torre - colon cancer etc

Dermatology (8 decks)

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