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Older Adult Exam 1 > Derm > Flashcards

Derm Flashcards

1
Q

what is the structure and function of the skin?

A
  • barrier against fluid loss
  • protection from UV radiation
  • thermoregulation
  • cushioning
  • immunologic protection
  • appearance
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2
Q

what is a flat, nonpalpable, <1cm in size lesion called?

A

macule

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3
Q

what is a flat, nonpalpable, >1cm in size lesion called?

A

patch

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4
Q

what is a raised, <1cm in size lesion called?

A

papule

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5
Q

what is a raised, >1cm in size lesion called?

A

plaque

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6
Q

what is a raised, >1cm in size lesion located in the dermis or subcutaneous fat called?

A

nodule

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7
Q

what is a fluid-filled, <1cm in size lesion called?

A

vesicle

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8
Q

what is a fluid-filled, >1cm in size lesion called?

A

bulla

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9
Q

what is an edematous papule or plaque than lasts < 24 hrs called?

A

wheal or hive

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10
Q

what is a dry or greasy laminated mass of keratin called?

A

scale

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11
Q

what is a lesion of dried serum, pus, or blood called?

A

crust

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12
Q

what is a linear cleft through the epidermis or into the dermis called?

A

fissure

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13
Q

what is a loss of all or portions of the epidermis alone that heals without scarring called?

A

erosion

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14
Q

what is a complete loss of the epidermis and some portion of the dermis that heals with scarring called?

A

ulcer

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15
Q

what is the etiology of nummular “coin-shaped” dermatitis?

A
  • unknown

- classified as a form of atopic derm

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16
Q

at what age(s) is nummular “coin-shaped” dermatitis most common?

A
  • 6th to 7th decade of life w/ M>F

- 2nd to 3rd decade of life F>M

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17
Q

how does nummular “coin-shaped” dermatitis present?

A

round-to-oval crusted or scaly erythematous plaques

  • most common on arms and legs
  • start as papules which coalesce into plaques with scale
  • early lesions may be studded with vesicles containing serous exudate
  • usually very pruritic
  • often recurs in the same location as old lesions
  • lesions often symmetrically distributed
  • waxes and wanes with winter
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18
Q

what are some d/dx of nummular “coin-shaped” dermatitis?

A
  • contact derm
  • psoriasis
  • CTCL
  • pityriasis rosea
  • tinea corporis
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19
Q

what is the tx for nummular “coin-shaped” dermatitis?

A

topical steroids
- may alternate high potency with mid-potency to reduce risk or use on weekends only

topical calcineurin inhibitors (steroid sparing agents)

  • tacrolimus (protopic) ointment
  • pimecrolimus (elidel) cream
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20
Q

what are some risks of overuse of topical steroids?

A
  • atrophy
  • striae
  • telangiectasis
  • hypopigmentation (temporary)
  • can have systemic absorption if using long-term on a large body surface
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21
Q

how should you recommend application of topical steriods to prevent side effects of overuse?

A
  • use <14/28 days
  • use 2-3x/week
  • Sat/Sun use
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22
Q

on what properties are the 7 classes of topical steroids based?

A

vasoconstrictive properties

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23
Q

how are the 7 classes of steroids stratified?

A
  • Class 1 = superpotent
  • Classes 3 and 4 = mid-strength
  • Classes 6 and 7 = low potency
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24
Q

what are some topical steroids that are considered superpotent?

A
  • clobetasol proprionate

- bethamethasone diproprionate

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25
Q

on what body parts are the superpotent steroids best used?

A
  • scalp
  • palms
  • soles
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26
Q

what are some topical steroids that are considered mid-strength?

A
  • fluocinonide
  • betamethasone valerate
  • triamcinolone
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27
Q

on what body parts are the mid-strength steroids best used?

A
  • trunk

- extremities

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28
Q

what are some topical steroids that are considered low potency?

A
  • fluocinolone
  • desonide
  • hydrocortisone
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29
Q

on what body parts are the low potency steroids best used?

A
  • face
  • genitals
  • intertriginous areas
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30
Q

what are some interventions for nummular “coin-shaped” dermatitis that address hygiene changes and lubrication of skin?

A

avoid barrier disruption

  • harsh soaps
  • washcloths
  • bathing too frequently

moisturize!

  • them more the better
  • soak and smear technique - soak in tub of luke warm water for 20 min, pat dry, and liberally apply topical medication or lubricant
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31
Q

what is the etiology of allergic contact dermatitis?

A
  • delayed type of induced sensitivity
  • cutaneous contact with a specific allergen to which the patient has developed a specific sensitivity
    ~25 chemicals are responsible for as many as 1/2 of all cases
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32
Q

what are some common culprits of allergic contact dermatitis?

A
  • poison ivy
  • topical abx (neosporin, neomycin, bacitracin)
  • nickel
  • rubber gloves
  • hair dye
  • textiles
  • preservatives
  • fragrances
  • benzocaine
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33
Q

how does allergic contact dermatitis present?

A

pruritic papules and vesicles on an erythematous base

  • acute onset
  • geometric morphology (circles, lines, etc.)
  • lichenified pruritic plaques may indicate chronic ACD
  • inital site of dermatitis often provides best clue regarding the potential cause
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34
Q

what are some d/dx of allergic contact dermatitis?

A
  • drug rash
  • nummular dermatitis
  • seb derm
  • tinea
  • urticaria
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35
Q

what is the tx for allergic contact dermatitis?

A
  • avoid offending agent
  • topical steroids or calcineurin inhibitors
  • antihistamines for itching
  • cool soaks
  • emollients
  • oral prednisone in severe cases, but need to tx for 14-21 days
  • can refer to patch testing to help determine allergen
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36
Q

when should a drug-induced eruption be considered when evaluating a skin lesion?

A

in any patient who is taking meds and suddnely develops a symmetric cutaneous eruption (usually occurs w/in 1st 2 wks of tx)

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37
Q

what are some common culprits of drug-induced eruptions?

A
  • antimicrobial agents
  • NSAIDs
  • cytokines
  • chemotherapeutic agents
  • anticonvulsants
  • psychotropic agents
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38
Q

how do drug-induced eruptions present?

A

lesions usually appear proximally and generalize w/in 1-2 days

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39
Q

what are some d/dx for drug-induced eruptions?

A
  • contact dermatitis
  • erythroderma
  • leukocytoclastic vasculitis
  • measles
  • pityriasis rosea, lichen planus, psoriasis (pustular), urticaria, syphilis
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40
Q

what are the tx for drug-induced eruptions?

A

d/c offending agent

  • can tx w/ antihistamines and topical steroids
  • most drug eruptions are mild, self-limited, and usually resolve w/in 2 wks of stopping the offending agent
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41
Q

what are some life threatening drug-induced eruptions?

A
  • SJS

- TEN

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42
Q

what is the most common form of drug-induced eruption?

A

morbilliform drug rxn

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43
Q

what is the primary lesion(s) of a morbilliform drug rxn?

A
  • macules

- papules

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44
Q

what are the secondary lesion(s) of a morbilliform drug rxn?

A

none

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45
Q

what is the configuration of a morbilliform drug rxn?

A

coalescing

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46
Q

what is the distribution of a morbilliform drug rxn?

A

generalized

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47
Q

what color is a morbilliform drug rxn?

A

red

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48
Q

what is the etiology of urticaria (hives)?

A

release of histamines & otherwise vasoactive substances from mast cells and basophils

  • 15-20% of general population is affected at some point during their lifetime
  • may be acute (lasting < 6 weeks) or chronic (lasting > 6 weeks)
  • can occur at any age, but chronic urticaria is more common in 40s and 50s
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49
Q

what are some causes of acute urticaria (hives)?

A

cause is unknown in > 60% of cases

common causes:

  • infections (ask about recent illness and travel)
  • caterpillars/moths
  • foods (shellfish, nuts)
  • drugs (PCN, sulfonamides, salicylates, NSAIDs)
  • environmental factors (pollens, plants, danders, dust, mold)
  • latex
  • exposure to undue skin pressure, cold, heat
  • emotional stress, exercise
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50
Q

what are some causes of chronic urticaria (hives)?

A

cause is unknown in 80-90% of cases

common causes:
same causes as in acute urticaria, plus
- autoimmune disorders
- chronic medical illness
- cold urticaria
- cryoglobulinemia
- syphilis
- mastocytosis
- inherited autoinflammatory syndromes
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51
Q

how does urticaria present?

A

blanching, raised, palpable wheals

  • occur on any skin area and are usually transient (last < 24 hours) and migratory
  • dermatographism may occur (urticaria resulting from light scratching)
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52
Q

with what PE findings should you refer or send to ED?

A
  • angioedema of lips, tongue, or larynx
  • urticarial lesions that are painful, long lasting (> 36-48 hrs), ecchymotic, or leave residual hyperpigmentation upon resolution (suggests urticarial vasculitis)
  • systemic s/sx: arthralgias, arthritis, weight changes, lymphadenopathy, bone pain
  • scleral icterus, hepatic enlargement, or tenderness that suggests hepatitis or cholestatic liver disease
  • evidence on skin of bacterial or fungal infection
  • listen to lungs for signs of asthma or PNA
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53
Q

what are some d/dx of urticaria?

A
  • contact or atopic dermatitis
  • pityriasis rosea
  • drug rxn
  • mastocytosis
  • urticarial vasculitis
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54
Q

what is the tx for urticaria?

A

H1 antihistamines (benadryl, hydroxyzine, zyrtec)

  • may add H2 antihistamines (ranitidine) for severe or persistent urticaria
  • glucocorticosteroids for refractory cases
  • zyrtec should be dosed BID
  • doxepin, TCAs with potent antihistamine properties, or Xolair may be useful in chronic urticaria
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55
Q

what is the etiology of seborrheic dermatitis?

A
  • related to a pathologic overproduction of sebum

- may involve an inflammatory rxn to the yeast Malassezia

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56
Q

how does seborrheic dermatitis present?

A

erythema with greasy, yellowish scale

  • on T-zone of face, scalp, behind ears, central chest, intertrigo
  • dandruff
  • can affect intertriginous areas
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57
Q

when is the onset of seborrheic dermatitis typically?

A

puberty

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58
Q

what factors worsen seborrheic dermatitis?

A
  • changes in seasons
  • trauma
  • stress
  • Parkinson’s disease
  • AIDS
  • certain meds
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59
Q

what are some d/dx of seborrheic dermatitis?

A
  • atopic or contact dermatitis
  • rosacea
  • perioral dermatitis
  • tinea
  • impetigo
60
Q

what is the tx for seborrheic dermatitis?

A
  • shampoo at least every other day (shampoos that contain salicylic acid, tar, selenium, sulfur, or zinc are especially helpful) - leave on for 5 min before washing off
  • clobetasol 0.05% solution or derma-smoothe/FS (mineral/peanut oil + flucinolone 0.1%) for severe flaking on the scalp
  • ketoconazole 2% cream BID (for face, ears, chest)
  • hydrocortisone 2.5% cream - short term use during flares
  • tacrolimus ointment or pimecrolimus cream as steroid sparing agents
61
Q

what is the etiology of psoriasis?

A

multifactorial disease that appears to be influenced by genetic and immune-mediated components

62
Q

how does psoriasis present?

A

red papules and plaques with adherent silvery scale

63
Q

what are some triggers for psoriasis?

A
  • physical trauma
  • stress
  • infection (strep, HIV)
  • pregnancy
  • meds
64
Q

what drugs can trigger psoriasis?

A
  • NSAIDs
  • abx
  • steroids
  • antimalarials
  • lithium
  • ACE-Is
  • BBs
  • CCBs
  • interferon
  • tetanus
  • antihistamines
65
Q

what is an important ROS questions to ask those with psoriasis?

A

ask about joint pain - 10% of patients have psoriatic arthritis (refer to derm or rheum)

66
Q

how do you estimate body surface area (BSA) of a skin lesion?

A

avg palm = 1%

disease severity:

  • mild = <5%
  • moderate = 5-10% BSA (refer to derm)
  • severe = >10% BSA (refer to derm)
67
Q

with what conditions is psoriasis associated?

A
  • CVD
  • smoking
  • ETOH
  • metabolic syndrome
  • lymphoma
  • depression
  • suicide
68
Q

describethe characteristics and distribution of psoriasis vulgaris

A

chronic and stationary - lesions can persist for years

distribution

  • elbows
  • knees
  • scalp
  • lumbosacral
  • umbilicus

nail pitting and other nail changes common

69
Q

describe Koebner’s phenomenon

A
  • occurs in 20% of psoriasis patients

- non-specific trauma can lead to formation of psoriasis in the area of irritation

70
Q

describe inverse psoriasis

A
  • involvement limited to skin fold regions
  • usually associated with minimal scaling
  • distribution: axilla, inframammary region, genitocrural region, neck
  • often confused with intertrigo
71
Q

what are some topical tx for psoriasis?

A
  1. topical steroids
    - hydrocortisone 2.5% ointment (low strength) - good for short term use on face, penis, and intertriginous areas
    - triamcinolone 0.1% ointment (medium strength)
    - clobetasol 0.05% ointment (high strength)
  2. synthetic vitamin D
    - dovonex (calcipotriene) cream - helps reduce scale
  3. topical calcineurin inhibitors -steroid sparing agents (good for face, penis, intertriginous areas)
    - protopic ointment
    - elidel cream
72
Q

what is a common tx regimen for psoriasis?

A
  • calcipotriene BID Mon-Fri
  • clobetasol oint BID Sat-Sun for lesions on trunk and extremities
  • hydrocortisone or calcineurin inhibitor for face, penis, and intertriginous areas
73
Q

what is the etiology of tinea pedis?

A

dermatophyte infection of the soles of the feet and interdigital spaces, commonly caused by trichophyton rubrum

74
Q

in what population does tinea pedis typically present?

A
  • increases with age

- M>F

75
Q

how and where does tinea pedis present?

A

pruritic, scaling in a moccasin distribution, often with painful fissures between toes

76
Q

what is one way to dx tinea pedis?

A

KOK prep

77
Q

what are some d/dx of tinea pedis?

A
  • contact dermatitis
  • dyshidrotic eczema
  • psoriasis
78
Q

what is the tx for tinea pedis?

A
  • topical -azoles (ketoconazole)
  • topical allylamines (terbinafine)
  • Castellani’s paint, which is esp good for interdigital webspaces
  • apply to bottoms, sides, and interdigital areas of the feet once or twice/day for at least 2 weeks, depending on which agent is used
79
Q

what is the etiology of onychomycosis?

A

a fungal infection of the toenails or fingernails

80
Q

how does onychomycosis present?

A

asymptomatic subungal hyperkeratosis and onycholysis, usually yellow-white in color

81
Q

how can you confirm dx of onychomycosis?

A

clip nail to send for PAS or put in dermatophyte medium

82
Q

what are some d/dx of onychomycosis?

A
  • lichen planus
  • psoriasis
  • trauma
83
Q

how do you tx onychomycosis?

A
  • oral terbinafine, itraconazole
84
Q

how long should you tx w/ oral antifungals for onychomycosis?

A
  • 6 weeks for fingernails

- 12 weeks for toenails

85
Q

what diagnostics should you check before tx w/ oral antifungals for onychomycosis? when should you recheck these?

A
  • Cr
  • LFTs
  • CBC
  • recheck if tx > 6 weeks
86
Q

what tx can you try for onychomycosis when orals are contraindicated 2/2 liver disease?

A
  • ciclopirox lacquer OR
  • urea 40% w/ topical terbinafine

these are often not effective

  • Jublia is new topical solution on the market, but tx is 48 weeks!
87
Q

what is some education you should provide patients about how long it takes to tx onychomycosis, recurrence, and maintenance?

A
  • inform pts that it can take a year for entire nail to grow out and appear normal
  • recurrence is common even after systemic tx
  • clean shoes and used topicals as maintenance
88
Q

what is the etiology of intertrigo?

A

an inflammatory condition of skin folds resulting from heat, moisture, and friction

  • often colonized by infection - usually candida but can also be bacterial, fungal, or viral
  • a common complication of obesity and diabetes
89
Q

how and where does intertrigo present?

A

erythema, cracking, and maceration with burning and itching at sites in which skin surfaces are in close proximity (axillae, perineum, inframammary creases, abdominal folds, inguinal creases)

90
Q

what are some d/dx of intertrigo?

A
  • contact dermatits
  • seborrheic dermatitis
  • cellulitis
  • inverse psoriasis
  • acanthuses nigrans
91
Q

what is the tx for intertrigo?

A
  • barrier creams such as zinc oxide paste
  • compresses with Burow solution 1:40 or dilute vinegar
  • absorbent powders and moisture-wicking undergarments
  • exposing the skin folds to air
  • topical antifungal agents for secondary infections (i.e. clotrimazole, econazole, ciclopirox, miconazole, ketoconazole, nystatin)
92
Q

what is the etiology of scabies?

A

sarcoptes scabiei
- in developed countries, scabies occur primarily in institutional settings and LTC facilities; also common among children

93
Q

how and where do scabies present?

A
  • extremely itchy, especially at night
  • often involves armpits, groin, umbilicus, wrists, fingerwebs, nipples
  • primary lesions typically include small papules, vesicles, and burrows
94
Q

what are some d/dx for scabies?

A
  • atopic dermatitis
  • bug bites
  • psoriasis
95
Q

what is the tx for scabies?

A
  • topical antiscabietic agents (Permethrin 5%) are applied from the neck down w/ repeat application in 7 days
  • oral ivermectin is also effective
96
Q

how long will itching last and how can we help relieve it?

A
  • pruritis may continue for up to 2 weeks after successful tx
  • antipruritic agents (i.e. sedating antihistamines) and/or antimicrobial agents (for secondary infection) may be needed
97
Q

what is important patient and family education regarding scabies?

A

all family members and close contacts must be evaluated and tx for scabies, even if they do not have symptoms

98
Q

by what are itchy papules on the penis most commonly caused?

A

scabies

99
Q

what is the etiology of zoster aka “shingles”?

A

reactivation of varicella-zoster virus (VZV) in a dermatome

100
Q

what age does zoster aka “shingles” typically present?

A

a person of any age with a prior hx of varicella infection may develop zoster, but incidence increases with age 2/2 declining immunity

101
Q

what are the 2 phases of zoster aka “shingles” presentation?

A
  • pre-eruptive phase

- active eruptive phase

102
Q

how does each phase of zoster aka “shingles” present?

A
  • pre-eruptive phase: characterized by unusual skin sensations or pain w/in the affected dermatome that heralds the onset of lesions by 48-72 hours
  • active eruptive phase: marked by lesions that begin as erythematous macules and quickly develop into vesicles; new lesions form over 3-5 days
  • lesions in the eruptive phase tend to resolve over 10-15 days
  • can be very painful and cause chronic neuralgia
103
Q

what are some d/dx for zoster aka “shingles”?

A
  • poison ivy

- atopic dermatitis

104
Q

what is the tx for zoster aka “shingles”?

A

antivirals (i.e. acyclovir, valacyclovir, and famciclovir)

  • patients are infections until the lesions have dried
  • zostavax for people ages 50+ can help prevent zoster
105
Q

what is an important form of zoster not to miss?

A
  • herpes zoster ophthalmicus
  • involves trigeminal (5th cranial) nerve
  • vescicles may appear on the tip or inside nose (Hutchinson sign)
  • urgent referral to ophthalmology is required
106
Q

what is the etiology of folliculitis?

A
  • primary inflammation of the hair follicle resulting from infections, follicular trauma, or occlusion
  • superficial folliculitis is common and often self-limited
107
Q

who does folliculitis most commonly affect?

A

affects all races, ages, and sexes equally

108
Q

how does folliculitis present?

A

erythematous, folliculocentric papules and pustules associated with pruritis or mild discomfort

109
Q

what are some d/dx of folliculitis?

A
  • acne
  • contact dermatitis
  • milia
  • miliaria
  • insect bites
110
Q

what is the tx for folliculitis?

A
  • uncomplicated superficial folliculitis can be treated w/ abx soap and good hand washing technique
    = refractory or deep lesions w/ a suspected infectious etiology may need empiric tx w/ topical and/or oral abx that cover gram-positive organisms (choose a drug that covers MRSA in areas of high prevalence or in predisposed patients)
  • mupirocin ointment in the nasal vestibule BID for 5 days may eliminate S. aureus carrier state in recurrent folliculitis
111
Q

what is the prevalence of MSSA and MRSA colonization/infection?

A
  • ~25-30% of population is colonized w/ MSSA (usually found on skin in nasal passages)
  • half of patients presenting for eval of skin infection has MRSA+ cx
112
Q

how does community acquired MRSA (CA-MRSA) present?

A
  • infections usually manifest as folliculitis or a similar skin infection
  • patients often present with a “spider bite” or “infected pimple”
113
Q

how is community acquired MRSA (CA-MRSA) transmitted?

A

through an open wound or from contact w/ a community acquired MRSA (CA-MRSA) carrier

114
Q

what is tx for community acquired MRSA (CA-MRSA)?

A

I&D of the abscess and tx w/ appropriate abx when indicated
- wound exudates should be cultures to determine the causative organism and appropriate abx

115
Q

what oral abx are best for community acquired MRSA (CA-MRSA), when indicated?

A 
- trimethoprim-sulfamethoxazole DS BID
W/ OR W/O
- rifampin 600 mg/day
- doxycycline 100 mg BID
- clindamycin 450 mg TID
116
Q

what is rosacea?

A

CHRONIC inflammatory disease of the central face

117
Q

what are the 4 types of rosacea?

A
  • erythematotelangiectatic
  • papulopustular
  • phymatous (glandular rosacea)
  • ocular
118
Q

what is the etiology of rosacea?

A

unknown, but the following may play a role:

  • vasculature
  • climatic exposures
  • chemicals and ingested agents
  • pilosebaceous unit abnormalities
  • microbial organisms
  • increased neoangiogenesis
119
Q

in what populations is rosacea more common?

A

fair-skinned people of European and Celtic origin

120
Q

what are some d/dx of rosacea?

A
  • lupus
  • seborrheic dermatitis
  • perioral dermatitis
121
Q

what are some characteristics of erythematotelangiectatic rosacea?

A
  • hx flushing
  • central facial erythema
  • telangiectasis not essential
122
Q

what are some characteristics of papulopustular rosacea?

A
  • central facial erythema
  • papules or pustules
  • edema
123
Q

what are some characteristics of phymatous rosacea?

A
  • thickened, edematous skin
  • nose most commonly affected
  • sebaceous hyperplasia
124
Q

what are some characteristics of ocular rosacea?

A
  • ocular sx occur prior to cutaneous manifestations in ~20% of patients
  • blepharitis and conjunctivitis
  • staph infectious common
125
Q

what are some topical tx for rosacea?

A
  • sunscreen!!! daily broad spectrum sunscreen is recommended for all pts w/ rosacea
  • metronidazole
  • azelaic acid
  • sodium sulfacetamide/sulfur
  • protopic
  • erythromycin
  • clindamycin
  • tretinoin
  • benzoyl peroxide
126
Q

what are some systemic tx for rosacea?

A
  • tetracyclines (DCN and MCN > TCN)
  • azithromycin
  • metronidazole
  • isotretinoin
127
Q

what is a typical tx regimen for rosacea?

A

tretinoin at night bc reacts to sunlight and benzoyl peroxide in AM - spread out so they don’t cancel each other out

128
Q

what are some ROS questions to ask someone presenting with alopecia?

A
  • detailed hx
  • onset
  • stress
  • meds
  • diet
  • grooming
  • family hx
129
Q

2 types of alopecia pattern

A
  • patchy

- diffuse

130
Q

2 types of alopecia sequelae

A
  • scarring (loss of hair follicle openings - requires biopsy)
  • non-scarring
131
Q

what are some characteristics of telogen effluvium? (contributing factors, scarring vs. not, pattern, etc.)

A
  • caused by stress
    • hair pull test
  • > 25% telogen hair
  • non-scarring
    diffuse
  • consider: thyroid dysfunction, drugs, nutrition
  • check labs: CBC, TSH, iron, ferritin
132
Q

what are some characteristics of androgenic alopecia? (contributing factors, scarring vs. not, pattern, etc.)

A
  • family hx
  • non-scarring
  • male pattern
  • consider androgen excess in females
133
Q

what are some characteristics of trichotillomania? (contributing factors, scarring vs. not, pattern, etc.)

A
  • cause is emotional
  • broken hairs
  • non-scarring
  • patchy
  • d/dx: areata, fungal
134
Q

what are some characteristics of alopecia areata? (contributing factors, scarring vs. not, pattern, etc.)

A
  • acute onset
  • smooth patches
  • autoimmune (consider DM, thyroid, vitiligo)
  • exclamation point hairs
  • non-scarring
  • d/dx: tricho, fungal
  • tx: topical steroids, ILK, PUVA
135
Q

what are some characteristics of lupus erythematosus? (contributing factors, scarring vs. not, pattern, etc.)

A
  • scarring or non-scarring

- tx: steroids, hydroxychloroquine

136
Q

what are some characteristics of tinea capitis? (contributing factors, scarring vs. not, pattern, etc.)

A
  • seborrea-like
  • patchy
  • broken hair
  • occipital lymph nodes
  • tx: requires systemic: griseofulvin, terbinafine, or itraconazole for 1-3 months
  • follow LFTs on meds
137
Q

what are some examples of scarring types of alopecia?

A
  • lichen planopilaris: F>M, pustular, erythema, localized
  • folliculitis decalvans: expanding patch w/ pustules to periphery
  • acne keloidalis nuchae: nape of neck
138
Q

what is bullous pemphigoid?

A

autoimmune blistering disease

139
Q

how is bullous pemphigoid detected/diagnosed?

A

presence of circulating IgG autoantibodies (BP230, BP180)

140
Q

what are the 2 phases of bullous pemphigoid and how does each present?

A
  • prodromal period: pruritic eczematous/urticarial lesions for weeks - months
  • bullous phase: abrupt onset widespread blister formation- tense, oval, and round
141
Q

what parts of the body does bullous pemphigoid most commonly present?

A
  • abdomen

- flexor sufaces

142
Q

what are some PE components to include when assessing someone who possibly has bullous pemphigoid?

A
  • ocular involvement
  • mucosal involvement
  • genitalia involvement
  • negative Nilolsky
143
Q

what are some common triggers of bullous pemphigoid?

A
  1. pharmacologic
    - lasix
    - phenacetin
    - enalapril
    - NSAIDs
    - vaccines
    - ampicillin
    - penicillin
    - cephalexin
  2. traumatic
    - burns
    - radiation
  3. infections
    - human herpes virus
    - Epstein barr
    - CMV
    - Hep B and C
144
Q

what are some d/dx of bullous pemphigoid?

A
  • contact dermatitis
  • urticaria
  • bites
145
Q

what are the goals of tx of bullous pemphigoid?

A
  • promote healing
  • reduce itching
  • preventing secondary infections
146
Q

what is the tx for bullous pemphigoid?

A
  • topical steroids
  • systemic oral steroids
  • referral for biologic tx: methotrexate, rituximab, cellcept, azathioprine

Older Adult Exam 1 (7 decks)

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