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Clinical Prep > derm wk 5 > Flashcards

derm wk 5 Flashcards

1
Q

erythematous brown hyperpigmented plaque

w fine fissuring and scale located above the medial malleolus

A

Stasis dermatitis

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2
Q

Stasis Dermatitis

A

Presents with redness, scale, itchy, erosions, exudate, and crust

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3
Q

Stasis Dermatitis

A

Common on lower 1/3 of legs
Lichenification may develop
Pitting edema

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4
Q

Scaly and erythema

A

Stasis Dermatitis

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5
Q

What is causing Stasis Dermatitis?

A

Venous insufficiency

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6
Q

What is causing Venous insuff

A

When the valves in the deep or perforating veins are not working, so there is BLOOD REFLUX/ backup into the superficial system

“Venous hypertension”

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7
Q

Risk factors for venous insuff

A 
Genes
Older
Female
Pregnant
Obese
Prolonged standing
Prior injury or surgery
Prior DDVT
Sedentary life
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8
Q

What is Lipodermatosclerosis?

A

Stasis dermatitis can –> lead to this

fat necrosis looking like “inverted champagne bottle”

can have acute inflammatory episodes with pain and redness

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9
Q

Lipodermatosclersosi

A

Chronic inflammation and Fat necrosis

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10
Q

Complication of venous insuff

A

Recurrent ulcer
Cellulitis
Contact dermatitis
Venous clot

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11
Q

Tx of Stasis Dermatitis

A

Super high and High potency STEROIDS
Elevate
Compression
Change wraps at least weekly

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12
Q

Ulcers from venous insuff generally look like

A

Tender, shallow, irregular ulcer with fibrinous base

always below the knee

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13
Q

What to do if you diagnose a Venous insuff ulcer?

A

Measure the blood pressure in the Left arm and Left ankle

to make sure there is not also arterial disease goin’ on

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14
Q

Compression therapy is CONTRA if

A

ABI is <0.5
OR
Absolute ankle pressure is <60 mmHg

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15
Q

Normal ABI

A

> 0.8

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16
Q

What should you perform with all pts with Venous insuff?

A

Pulse exam
Venous duplex US
ABI

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17
Q

Should you use Abx on Venous ulcers?

A

NO

can lead to contact dermatitis

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18
Q

arterial ulcers

A

“punched out”
well-demarcated
pale base

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19
Q

Arterial ischemia

A

loss of hair

Shiny atrophic skin

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20
Q

Arterial insuff

A

leg elevation does not help!

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21
Q

Pain and claud at rest

A

Arterial insuff

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22
Q

PG is often mistaken for a spider bite

A

If you think someone has spider bite, consider PG or MRSA

PG= pyoderma gangrenosum

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23
Q

PG= Pyoderma Gangrenosum

A

Auto-inflammatory process
Ulcerative

Starts small pustule, breaks down and rapidly expands forming an ulcer with an UNDERMINED (can probe underneath) violaceous border

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24
Q

Pyoderma Gangrenosum

A

Rapid progression
Usually happens on lower legs

Can be V painful

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25
Q

What do patients experiencing PG (pyoderma gangrenosum) often have also?

A

ARTHRITIS!!

or IBD, RA, Hematologic pathy, or CA

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26
Q

Pyoderma Gangrenosum is triggered by

A

TRAUMA

i.e. insect bite, surgical debridement, grafting

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27
Q

Pyoderma Gangrenosum

A

DERM EMERGENCY

Tx:
Topical therapy- superpotent Steroid, Tacrolimus

Systemic- Steroid, Cyclosporine, Tacrolimus, Cellcept, Thalidomide, TNF- inhibitor

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28
Q

Dermatitis in general

ACUTE vs
CHRONIC

A

Acute: red, vesicles, itching

Chronic: dry, scaly, lichenification, fissure, itching (still)

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29
Q

Two types of Contact Dermatitis

A

Irritant

Allergic

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30
Q

How does Allergic Contact Derm work?

A

Sensitization process: 10-14 days

Upon re-exposure: 12-48 hours

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31
Q

Most common type of Allergic Contact Derm

A

Rhus dermatitis

  • poison ivy
  • poison oak
  • poison sumac
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32
Q

How long does poison ivy last?

A

10-21 days

about 1-3 weeks

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33
Q

How long is the first episode of poison ivy?

A

Up to 6 weeks

the first one is the longest

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34
Q

What can you use to treat poison ivy if Clobetasol ointment doesn’t work?

A

2 week taper of Oral prednisone

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35
Q

What to consider when treating poison ivy with oral steroids

A

If given for a short amt of time, pt may relapse. avoid short bursts of steroids

GIVE LONGER DURATION

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36
Q

Tx of Allergic Contact Derm

like poison ivy

A

Mild- mod: topical steroids, maybe systemic steroids short course

Oatmeal bath, soothing lotion

If extensive oozing: wet dressing

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37
Q

Chronic case or if Allergic Contact derm is taking up >10% BSA

A

Refer to Derm

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38
Q

Scaling and redness b/w the toes with associated maceration

A

Tinea Pedis- Interdigital type

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39
Q

Tinea Pedis- Moccasin type

aka

Hyperkeratotic type

A

Sharply marginated scale

Lateral borders of feet, heels, and soles

Often a/w fungal infection of nails

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40
Q

Moccasin Type/ Hyperkeratotic often presents with

A

ONE HAND involvement

“One hand, two feet” syndrome

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41
Q

Tinea pedis- Vesicular type

A

Grouped vesicles or bullae, often on medial foot

Itchy or painful

42
Q

Tinea pedis- Ulcerative

A

Worsening of interdigital

Ulcer and erosion in web space

43
Q

Tinea pedis- ulcerative

A

Seen in:
Immunocompromised
Diabetic

44
Q

Best diagnostic exam w fungal infections

A

KOH

dissolves keratinocytes making it easier to see Fungal hyphae

45
Q

Tinea Versicolor

A

“Spaghetti and Meatballs”

46
Q

Tinea capitis

A

Spores

can be inside or outside hair shaft

47
Q

KOH exam prep

A 
Clean skin w alc
Collect sample
Put on glass slide
Add 1-2 drops KOH
Let sit for 10 min
Examine at low power, then --> 10X to study Hyphae
48
Q

Moccasin foot Tx

A

Terbinifine cream BID for 2 weeks

49
Q

1st line Tx for Tinea Pedis

A

Terbinafine
Naftifine
Butenafine

cream or gel BID for 1-2 wks

All are Allylamines

50
Q

2nd line tx for Tinea Pedis

A

Clortimazole
Miconazole

BID for 4-6 wks

51
Q

How many grams to Rx for Tinea Pedis tx?

A

30-45 g to cover both soles BID for 1 month

52
Q

1st line tx for Tinea Pedis

A

Terbinafine BID for 1-2 wks

53
Q

Sharply marginated, Erythematous annular plaque w central clearing and scaling at edges

A

Ringworm

tinea corporis

54
Q

Tinea corporis

A

Annular lesion with central clearing

55
Q

Tinea Corporis tx duration

A

4-6 wks total

Until resolution, then 2 more weeks after that

56
Q

Tinea corporis “ringworm” 1st line tx

A

Terbinafine
Butenafine
Naftifene

(more expensive)

57
Q

Tinea corporis

“ringworm” 1nd line (less expensive)

A

Clotrimazole
Miconazole

(Imidazoles)

58
Q

When to use ORAL tx for ringworm?

A

Poor response to topical
Animal is source
Large surface area

59
Q

ORAL tx for “ringworm”

A

Terbinafine daily 7-14 days

60
Q

Oral Terbinafine SE

A

Taste loss or disturbance in 3% people taking this

61
Q

How to describe toe fungus

A

Nail thickening and Subungual debris

62
Q

Most common type of Onychomycosis

A

Distal subungual onychomycosis

thickened nail bed
subungual debris
separation from nail plate

63
Q

1st line tx for Onychomycosis

A

Terbinafine 250 mg daily for 90 days

64
Q

Risk of Onychomycosis oral tx

A

Liver toxic
Taste disturbance (reversible)
Drug intxns
Skin rxn

Failure to cure. only 50%.

To help this, also add Topical Antifungal therapy

65
Q

Tinea corporis “ringworm” 1st line tx

A

Terbinafine
Butenafine
Naftifene

(more expensive)

66
Q

Tinea corporis

“ringworm” 1nd line (less expensive)

A

Clotrimazole
Miconazole

(Imidazoles)

67
Q

When to use ORAL tx for ringworm?

A

Poor response to topical
Animal is source
Large surface area

68
Q

2nd line tx for Onychomycosis

A

Fluconazole
Itraconazole

(IF)

69
Q

Oral Terbinafine SE

A

Taste loss or disturbance in 3% people taking this

70
Q

Tinea Versicolor is different from other tinea, how?

A

NOT caused by dermatophyte, but rather my a YEAST

Malassezia furfur

71
Q

Most common type of Onychomycosis

A

Distal subungual onychomycosis

thickened nail bed
subungual debris
separation from nail plate

72
Q

1st line tx for Onychomycosis

A

Terbinafine 250 mg daily for 90 days

73
Q

Option for pts concerned about long term liver issues

A

PULSE THERAPY

short bursts of oral tx given (either until nail is healthy or for a total of 3 bursts)

74
Q

1st line for mostly all fungal infections: Tinea and Onychomycocis

A

Terbinafine

onychomycosis is Oral

75
Q

Maintenance therapy for tinea versicolor

A

Topical shampoo 1-2x per week

Selenium sulfide
Ketoconazole
Zinc

leave on 10 min b4 rinsing off

76
Q

2nd line tx for Onychomycosis

A

Fluconazole
Itraconazole

(IF)

77
Q

How to describe Tinea Versicolor

A

Well-demarcated, hyperpigmented macules and patches across the back

78
Q

More about Malassezia (Tinea versicolor)

A

Lipophilic yeast that’s actually a normal resident in the keratin of skin and hair follicles of those at puberty and beyond

79
Q

Diagnostic feature of Tinea Versicolor

A

Visible scale not present until rubbed with finger or scalpel

Evoked scale dissappears after tx

80
Q

Tx for Tinea Versicolor

topical is 1st line

A

SHAMPOOS-
Selenium sulfide
Ketoconazole
Zinc pyrithione

IMIDAZOLE cream-
Ketoconazole
Clotrimazole
(for limited areas, more $)

81
Q

Two tx classes for Intertrigo

A

Imidazoles-
Clotrimazole, Miconazole, Econazole
(more effective but may burn)

OR

Polyene-
Nystatin (not as affective but benefit is can be powder and ointment)

82
Q

What can you apply to Candidal Intertrigo to improve the burning and itching?

A

Low strength steroid

Desonide or Hydrocortisone
ointment, BID x 1-2 wks

83
Q

Intertrigo

A

inflammation of large skin folds

84
Q

Classic signs of Intertrigo complicated by Candida yeast

A

Burns

Satellite macules, papules, pustules around the redness in the fold

85
Q

Satellite papules

A

Candidal intertrigo

86
Q

Best tx for Intertrigo

A

Clotrimazole cream

87
Q

Prevention of Intertrigo

A

Dry area after bathing
Weight loss
Loose clothing made of cotton

88
Q

Tx options for Seborrheic derm

A

Topical Ketoconazole
Low potency steroid (Desonide, Hydrocort)
Antidandruff shampoo

89
Q

Chronic conditions req maintenance tx

A

Tinea versicolor

Seborrheic derm

90
Q

Seborrheic dermatitis

A

Common, inflammatory rxn to Malassezia yeast that thrives on Seborrheic oil producing skin

91
Q

Seborrheic derm

A

Inflammatory rxn to normal flora

chronic condition, can be controlled (but not cured)

92
Q

Red scaling patches on scalp, hairline, eyebrow, eyelids, central face, nasolabial folds, central chest

A

Seborrheic derm

worse in HIV pts

93
Q

Central chest

Red and scaly

A

Seborrheic derm

94
Q

Tx for Seborrheic derm

A

Desonide cream

95
Q

Chronic conditions req maintenance tx

A

Tinea versicolor

Seborrheic derm

96
Q

Tx for Candidal Intertrigo

A 
Clotrimazole cream (preferred)
Nystatin powder (may be easier tolerated)
97
Q

Is Intertrigo usually caused by fungus?

A

No, usually just from irritation to skin by warmth, moisture, etc

98
Q

Tx for PVD - veins

A

Exercise, Leg elevation

Compression stockings

99
Q

Tx for PAD - arteries

A

Fixed distance walking/ exercise
Stop smoking
Cilostazol (pharm)
Angioplasty Revascularization (surgery)

100
Q

PAD tx

A

exercise
meds- cilostazol
surgery- revascularization

Clinical Prep (41 decks)

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