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Didactic Year > Clin Med Derm > Flashcards

Clin Med Derm Flashcards

1
Q

Excoriation

A

Picking or scratching

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2
Q

Skin components (superficial to deep)

A

Epidermis,
dermis (appendages: sweat glands, oil glands, hair, nails)
subcutaneous fat

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3
Q

Layers of epidermis

A

From bottom to top- basal cell, stratum spinosum, stratum granulosum, stratum corneum
(also contains melanocytes and Langerhans cells)

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4
Q

Basal cell layer

A

Basement layer, undifferentiated proliferating cells takes 4 weeks to go from basement to roof
Skin cells divide in this layer

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5
Q

Stratum spinosum

A

Layer above basal cells, contains keratinocytes.

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6
Q

Stratum granulosum

A

Differentiated cells, have more keratin and become flatter, cells begin to stick together. Polysaccharides, glycoproteins, and lipids may also be found here

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7
Q

Stratum corneum

A

Roof layer, stacked in layers. 15-25 most surfaces, 100 on palms/soles
Major physical barrier, cells are large, flat, filled with keratin
Cells die and shed in this layer

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8
Q

Melanocytes

A

Pigment producing cells in basal cell layer, rise to surface when stimulated by sunlight
Provide protection from UV rays

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9
Q

Langerhans cells

A

From bone marrow (found in epidermis) like macrophages and present antigens to lymphocytes (immune cells)

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10
Q

Dermis

A

Tough, elastic support. Contains nerves, blood vessels and appendages. 1-4 mm thick (thinner in face, thicker in soles)

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11
Q

Skin appendages

A

Eccrine sweat glands, apocrine sweat glands, hair follicles, sebaceous glands, nails

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12
Q

Eccrine sweat glands

A

Sweat only, triggered by emotion and thermal stimuli(regulates body temp) , transported by duct in dermis to epidermis

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13
Q

Apocrine sweat glands

A

No useful purpose, body odor only (caused by surface bacteria), glands in axillae and anogenital areas, located deep in dermis and reach surface by hair follicle

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14
Q

Hair follicle

A

Protective and decorative
2 types: vellus (fine, light colored “peach fuzz”) and terminal (coarse, dark, most of the hair on our bodies)

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15
Q

Hair growth

A

Occurs in cycles:
Anagen: active growth
Catagen: transition
Telogen: resting, when hair easily falls out

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16
Q

Sebaceous glands

A

Produce sebum, located with hair follicles, size and activity controlled by androgen- full size at puberty

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17
Q

Nails

A

Made of keratin,formed from matrix of dividing cells, grow at 0.1 mm/day
3 months for finger nails to grow out
6-12 months for toe nails to grow out

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18
Q

Nail components

A

Proximal fold: protects matrix, contains cuticle
Matrix: produces nail plate (if damaged, can never be repaired and nail will always grow abnormally)
Hyponychium: distal edge of the nail

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19
Q

Subcutaneous fat

A

Lies between dermis and fascia
Insulation, cushion, and energy reserve

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20
Q

Macule

A

Flat Skin lesion, different color
Ex- freckle

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21
Q

Papule

A

Small raised skin lesions, no fluid
ex-pimple

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22
Q

Alopecia

A

Partial or complete hair loss. Can scar or not, determines if hair can grow back
Affects children and adults
Possible causes: Autoimmune and genetic

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23
Q

Comedones

A

Blackheads (open), whiteheads (closed)

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24
Q

Vesicle

A

Blister filled with clear fluid, less than .5 cm diameter

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25
Q

Bullae

A

Blister filled with clear fluid, greater than .5 cm diameter

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26
Q

Pustule

A

Raised fluid filled lesion, filled with pus or cloudy fluid

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27
Q

Wheal

A

Lesion of dermal edema, speed bump in skin (slightly raised) (Ex. Urticaria (hives))

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28
Q

Nodule

A

Raised marble like, diameter and depth greater than .5 cm

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29
Q

Ulcer

A

Epidermis is gone and part of dermis affected, from pressure (being in bed for a long time)

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30
Q

Lichenification

A

Thickening of epidermis, alligator skin, exaggerated skin lines visible. During inflammatory process, person scratches (intense excoriation), skin thickens

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31
Q

Polyp

A

Soft fleshy growth, skin tag

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32
Q

Fissure

A

Linear cracks and tears in epidermis, seen with swelling

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33
Q

Scale

A

Thickened stratum corneum, dry, easily flakes off
dandruff, eczema, psoriasis

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34
Q

Crust

A

Dried liquid (blood, serum, pus) on surface of skin, scab

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35
Q

Atrophy

A

Loss of skin tissue
Epidermal -skin looks thin/shiny (saran wrap)
Dermal- detectable depression (divot) “sunken in appearance”

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36
Q

Plaque

A

Elevated skin lesion but lacks depth, diameter greater than .5cm

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37
Q

Telangectasia

A

Squiggly, broken, enlarged superficial blood vessels

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38
Q

Depigmentation

A

Complete loss of pigment in an area (Vitiligo)

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39
Q

Hypopigmentation

A

Partial loss of pigment (Tinea versicolor)

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40
Q

Hyperpigmentation

A

Excessive pigment, darker than surrounding skin
Macule is considered a hyperpigmented lesion

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41
Q

Langer’s lines

A

Skin tension lines, guide for strongest scar and better cosmetic outcome

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42
Q

Pruritis

A

the sensation of itching

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43
Q

Papulosquamous diseases

A

Psoriasis, pityriasis rosea, drug eruptions, lichen planus

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44
Q

Psoriasis

A

Well demarcated erythematous plaque with silvery scale on extensor surfaces
No cure, epidermal cells produced 7x normal rate (thickened stratum corneum), “too many shingles on roof”
Elbow, knees, and scalp most common
May be autoimmune disease, comorbid disease
Chronic

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45
Q

Koebner phenomenon

A

Psoriasis can occur where there is trauma to the skin ex-where surgical incision occurs

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46
Q

Nail psoriasis

A

Pitting of nail bed, subungal discoloration, difficult to treat, differentiate from nail fungus

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47
Q

Guttate psoriasis

A

Many small red plaques peppered throughout body
associated with strep/upper respiratory infection

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48
Q

Pustular psoriasis

A

Small pustules, common on hands and feet

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49
Q

Palmar/plantar psoriasis

A

Confined to palms and soles

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50
Q

Inverse psoriasis

A

Occurs in skin folds, often mistaken for Tinea infections, under breasts, between buttocks, in axillae

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51
Q

Systemic effects of psoriasis

A

Psoriatic arthritis (30%), risk for cv disease, cancer, obesity, depression/alcoholism

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52
Q

Psoriasis treatment

A

No cure, goal of tx is control
Tx depends on severity, location, symptoms, insurance, pt preference
Can be topical, phototherapy, or systemic treatment

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53
Q

Topical steroids (psoriasis)

A

Decrease inflammation, use class appropriate for location
ointments work better than creams or lotions

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54
Q

Phototherapy (psoriasis)

A

Good for widespread disease
light causes a photochemical rxn that is anti-inflammatory
Never treat back-back days
2-3x/wk, build time then taper back
Average “clear” time= 3 months

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55
Q

Systemic medications (psoriasis)

A

Methotrexate: inhibits cell proliferation, labs needed to monitor liver regularly, hepatotoxic
Soriatane: no blood donation/pregnancy for three years after d/c (teratogenic), labs for cholesterol/triglycerides. Best used for palmar/plantar psoriasis.
Otezla (Apremilast): reduces production of cytokines, $

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56
Q

Pityriasis rosea (PR)

A

Unknown cause
Peaks in spring and fall in younger population
Possible Viral etiology
Herald patch (salmon pink, 1st to show up)
followed by red/pink/brown scaly patches at trunk and proximal extremeties (like Christmas tree)
Acute
Pruritis is usually intense

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57
Q

Treatment for PR

A

Topical steroids, oral antihistamines, phototherapy
TX won’t stop eruption, will only control itch, Will last 6-12 weeks (resolve on its own), not contagious

NOT COMMON AND NOT RECURRENT

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58
Q

Lichen planus

A

Pruritic flat top violaceous (purple) papule (degree of pruritis varies)
Can affect skin, scalp, nails, and mucous membranes
test for Hepatitis C, may be associated with this
If oral only, monitor for cancer in mouth
Mostly seen in adults
4 P’s Purple, pruritic, polygonal, papules
Clinical features: Wickham’s Striae
Can lead to scarring alopecia and nail deformity

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59
Q

Wickham’s striae

A

Fine white lines or grey streaks within lesions, can be in mouth

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60
Q

Lichen planus Tx

A

Diagnose with biopsy (punch), test for hepatitis
Can tx with intralesional steroids (IL)
Topical, systemic, photo tx
Spontaneously resolves between 6 months -2 years
Can flare up with stress or recur at any time

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61
Q

Drug eruptions

A

Systemic sudden onset, hives or bright papular rash
starts proximally and moves distally
usually seen within 1 week of new med
Caused by antibiotics(bactrim/sulfa,penicillins,cephalosporins), diuretics(furesomide-lasix), NSAIDs, blood products
IF IT HAPPENS TO ONE SIDE IT WILL HAPPEN TO THE OTHER (bilateral)

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62
Q

Drug eruptions treatment

A

Biopsy to diagnose (won’t tell you what medication the pt is allergic to)
D/C suspected drug, talk to PCP about replacing drug, may take 4 weeks for drug to clear system

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63
Q

Fixed drug eruption

A

Usually develop 1 annular or oval erythematous patch
More common with PRN meds
May see 2 week delay between drug intro and lesion
May recur at same site with reexposure (lighting up of the hyper-pigmented lesion)
Seen on lip, hip, sacrum, or genitalia
Nickel to quarter in size
May have itching, burning, and pain

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64
Q

Causes of acne

A

Clogged pores due to the epidermis not shedding dead skin cells fast enough coupled with the overproduction of oil in sebaceous glands.
Naturally occurring C. acnes can infect the clogged pore causing inflammation and lesions on the skin.

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65
Q

Acne

A

Chronic inflammatory condition affecting both genders mainly in face, chest, and back.
It consists of comedones, papules, pustules, and nodules
It can start as early as 8 years and last through adulthood

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66
Q

Mild acne

A

Classification of acne characterized by few papules, pustules, and comedones; small number of lesions; limited in location

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67
Q

Moderate acne

A

Classification of acne characterized by many papules, pustules, and comedones; can cause scarring; usually in more than one location

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68
Q

Severe acne

A

Classification of acne characterized by extensive papules, pustules, and nodules; will cause scarring; usually in more than one location

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69
Q

Papulopustular acne

A

Type of acne characterized by papules and pustules

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70
Q

Comedonal acne

A

Type of acne characterized by “whiteheads” if comedones closed, “blackheads” if comedones open

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71
Q

Nodulocystic acne

A

Type of acne characterized by nodules; feels like a hard or firm ball under the skin
Scarring will likely happen

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72
Q

Topical treatments for acne

A

Benzoyl peroxide, topical antibiotics (ex. Clindamycin), retinoids (Retin-A,differin,tazorac), witch hazel

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73
Q

Systemic treatments for acne

A

Oral antibiotics, birth control pills, spironolactone, isotretinoin (accutane)

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74
Q

Patient education points for acne

A

No cure for acne, treatment response can take up to 6 weeks, don’t pick, cleanse face 2x daily with warm water and hands, makeup and moisturizer should be oil free, avoid toners/scrubs/masks
Pitted acne scars are permanent
Topical tx may bleach fabrics
Avoid sun exposure while on most acne tx

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75
Q

Tx considerations for isotretinoin

A

Last resort tx for nodulocystic acne
Standard course is 6 months
Side effects include dry lips/skin, sun sensitivity, muscle/joint pain, alopecia, nose bleeds, depression, pseudocerebri tumor,
Frequent lab tests throughout tx to check liver
Must be seen by prescriber every 30 days throughout tx
Teratogenic
Females must choose 2 forms of birth control and must compete monthly quizzes about pregnancy prevention in order to refill monthly rx

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76
Q

Rosacea

A

Chronic inflammatory/neurovascular condition
Mainly affects face
Characterized by flares and remissions
No cure
Primarily adult disease

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77
Q

Symptoms of rosacea

A

Affects nose and medial aspect of cheeks; flat redness (flushing)
May have papules and pustules, telangiectasia, burning sensation, tenderness, blepharitis, keratitis(inflammation of the cornea)
C/o of dry eye or feeling of sand in eye

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78
Q

Common triggers of Rosacea

A

Temperature extremes, wind, stress, spicy food, alcohol (especially red wine), sun exposure, emotions

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79
Q

Topical Tx for rosacea

A

Gentle cleansers, sunscreen, topical antibiotics(metronidazole,clindamycin,sodium sulfacetamide)
topical retinoids (azaleic acid-can burn first few times), Mirvaso (vasoconstrictor) = for use episodically but rebound flaring: purple appearance can occur
AVOID BENZOYL PEROXIDE

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80
Q

Systemic Tx for Rosacea

A

Low dose doxycycline for its anti inflammatory properties

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81
Q

Verrucous lesion

A

Warty looking lesion
2 types:
-Seborrheic keratosis
-actinic keratosis

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82
Q

Seborrheic Keratosis (SK)

A

Benign warty stuck on growth
Adults only
May have hereditary factor
Appearance: Sharply defined, raised, stuck on, tan to black in color, biopsy if not clear
cut SK
Sx: asymptomatic, maybe itchy or tender if irritated
Tx: not necessary, only remove if irritated or hx of breast cx
Remove with cryotherapy for small lesion or surgery for large
Sign of Lester-Trelat = malignancy

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83
Q

Actinic (sun related) Keratosis

A

Premalignant (25% will develop into squamous cell)
Caused by excess sun exposure
Seen on face, ears, scalp, forearms, chest, upper back, hands
Initially may come and go, then stays
Appearance: Scaly, flaky, rough, red, pink, sensitive
Tx: destroy with liquid nitrogen freezing, topical chemotherapy, or photodynamic
therapy (depends on location, number, size)

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84
Q

Neoplasm

A

New and abnormal growth of tissue

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85
Q

Skin cancer facts

A

Risk of melanoma doubles after 1 burn as child
Risk of skin cancer doubles after 3-5 burns
1 person dies every hour from melanoma
Melanoma is more common form in age 25-29
1/5 develop

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86
Q

Skin cancer risk factors

A

Fair skin, light hair/eyes
Geographic location
Hx of UV exposure and radiation tx
Family hx of melanoma
50 or more moles on body
Chronically suppressed immune system (transplant pt)
More deadly in non-Caucasian due to delayed dx

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87
Q

Basal cell skin cancer

A

Most common skin cancer
Not life threatening
Caused by increase sun exposure
Sx: sore that doesn’t heal, pearly shiny bump, scar like appearance, red scaly crusted patch, lesion may bleed
Dx: made by biopsy
Tx: Cryotherapy, topical chemo, ED&C, MOHS Surgery, excision
Excellent cure rate

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88
Q

ED&C

A

Burn an scrape method for treatment
Blind test, not retesting to make sure cancer is gone

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89
Q

MOHS Surgery

A

Highest cure rate
Cut around skin cancer, put on a slide, and look under microscope to see if any left, continue until none is left
Better cosmetic outcome

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90
Q

Squamous cell skin cancer

A

Second most common skin cancer
700,000 dx/year
If untreated, can metastasize
Caused by excess sun exposure/radiation, lips often affected, can develop with immunodeficiency
Sx: Thick round horn like lesion, wart-like sore, may bleed, irregular rough red patch persists
Dx: made by biopsy
Tx: Cryotherapy, topical chemo, ED&C, MOHS surgery
Good prognosis

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91
Q

Facts about malignant melanoma

A

Most serious skin cancer- 4%
Causes most skin cancer related deaths
If dx and tx early, cure rate near 100%
Can be hereditary- 1st degree relative has it, 50% greater chance of developing

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92
Q

Signs of Malignant Melanoma

A

ABCD’s (EF)
A- Asymmetry
B- Borders (jagged edge)
C- Color (multi-colored, not good)
D- Diameter (6mm or less, pencil eraser)
E- evolving (changes)
F- failure to respond to tx

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93
Q

Diagnosis of Malignant Melanoma

A

Done by biopsy
Should use excision biopsy- gives a deeper test
and better plan for tx

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94
Q

4 types of Malignant Melanoma

A
  1. Superficial spreading (in situ)
  2. Lentigo Maligna- Elderly (in situ)
  3. Acral Lentiginous (in situ)
  4. Nodular (starts invasive)
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95
Q

Superficial Spreading

A

Most commonly
Trunk in men
Legs in women
upper back in both

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96
Q

Lentigo Maligna- Elderly

A

Chronically damaged skin
Common in face, ears, arms, upper trunk
*big freckle turns cancer from sun exposure

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97
Q

Acral lentiginous

A

Seen under nails or palms of hands/soles of feet
Common in African Americans and Asians, can advance quickly

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98
Q

Nodular

A

Most aggressive, starts invasive, presents with raised lesions
Seen on trunk, legs, scalp of men
Worse prognosis of the 4

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99
Q

Breslow’s Thickness

A

Measures the deepest point of tumor penetration in mm
In situ- confined to the epidermis, best prognosis
Thin tumor- <1 mm
Intermediate tumor- 1mm-4mm
thick tumor- >4mm

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100
Q

Staging of Melanoma

A

Stage 0- in situ
Stage 1- Up to 1mm thick, no spread
Stage 2- 1.01 mm-4mm thick, no spread
Stage 3- MM has spread to nearby lymph nodes or skin
Stage 4- MM has spread to internal organs, far away skin, and far away lymph nodes

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101
Q

After treatment for malignant melanoma

A

See ophthalmologist 1x/ year
See gynecologist 1x/year
See dermatologist every 3 months for first year, every 6 months for 2-5 years, and 1x/year after 5 years

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102
Q

Who does psoriasis affect?

A

Affects all ages
Most common onset is around the third decade of life
Strep infection, emotional stress, skin trauma, drugs and obesity can contribute to the onset

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103
Q

Onset of psoriasis

A

-Usually gradual, can be sudden
-strep can cause another form of this
-emotional stress/obesity/medications can aggravate

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104
Q

Atopic Dermatitis

A

Condition characterized by chronic, itchy, eczematous eruptions
It affects the face, neck, antecubital and popliteal spaces, and flexor surfaces
It is common in childhood

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105
Q

Symptoms of Atopic dermatitis

A

Pruritis, burning, erythema, scaling, crusting, lichenification

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106
Q

Basic treatments for atopic dermatitis

A

Moisturizer cream
Decrease bathing frequency
Gentle cleansers, humidifiers, sensitive skin laundry detergents
trim nails

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107
Q

Topical treatments for Atopic dermatitis

A

Topical steroids, calcineurin inhibitors-Immunomodulators; Rx moisturizers; phototherapy

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108
Q

Systemic treatments for Atopic dermatitis

A

Oral steroids, antihistamines, antibiotics

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109
Q

Irritant contact dermatitis

A

Condition caused by a substance that produces a direct toxic effect to the skin
It only affects the skin in contact with the substance (ex. nickel in a watch)

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110
Q

Allergic contact dermatitis

A

Condition caused by an immunologic reaction that triggers inflammation
It can be systemic and cause anaphylaxis (ex. Poison ivy)

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111
Q

Seborrheic dermatitis

A

Condition characterized by a superficial inflammatory response
It can be chronic and occurs in hairy areas of body
Organism causing this is Malassezia

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112
Q

Symptoms of Seborrheic dermatitis

A

On face: white or yellow skin, flaky, erythema, may be pruritic
On scalp: dandruff with no itch, erythema, or adherent scale

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113
Q

Shampoo treatments for Seborrheic dermatitis

A

3x per week: selenium sulfide, zinc pyrithione
(Head and Shoulders), or Ketaconazole (Nizoral)

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114
Q

Topical treatments for Seborrheic Dermatitis

A

Low potency topical steroids PRN, immunomodulators (elides and protopic), topical antifungals, and keratolytics for thick scale
For eyelids, baby shampoo

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115
Q

Treatment for Lichen Simplex Chronicus

A

Potent topical steroid (ointment or cordran tape),
Interlesional steroids, oral and topical anti pruritics, behavior modification

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116
Q

Name 3 functions of the skin

A

Temperature regulation
Insulation
Sensation
Protection

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117
Q

Where are Melanocytes and Langerhans cells located?

A

Epidermis

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118
Q

What is the possible explanation for why topical treatments take time and why patients should be given realistic expectations?

A

Takes 4 weeks for cells to migrate up

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119
Q

What epidermal layer does cell differentiation occur?

A

Stratum granulosum

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120
Q

What epidermal layer contains a lot of keratin?

A

Stratum corneum

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121
Q

Why might treatment of palmar/plantar pathology be more aggressive than other locations?

A

Thicker skin layers, need to penetrate deeper to treat the cause

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122
Q

T/F: People with darker skin have more melanocytes than someone with fairer skin

A

False
Same number of melanocytes, more melanin

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123
Q

Collagen and elastic fibers are contained within the

A

Dermis

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124
Q

How much sweat can the body produce per day?

A

10 liters

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125
Q

What locations will we not find any hair?

A

Palmar and plantar surfaces

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126
Q

What does the pilosebaceous unit consist of?

A

Hair follicle and sebaceous gland (amongst other things)

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127
Q

Why might toenail pathology be treated different than fingernail?

A

More distal, blood flow

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128
Q

What is one possible cause of skin atrophy?

A

Chronic topical steroid use

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129
Q

Name a skin condition where Telangiectasia can be seen

A

Rosacea
Basal cell carcinoma (BCC)

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130
Q

What is a dermatome?

A

An area of skin supplied by branches of a single spinal sensory nerve root

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131
Q

Name a condition where dermatomes can be clinically important

A

Herpes Zoster (shingles) Has a dermatomal pattern

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132
Q

How many dermatome groups are there? What are they divided into (general)?

A

5
-cervical (7)
-thoracic (12)
-lumbar (5)
-sacral (5)
-coccygeal (1)

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133
Q

What is the Fitzpatrick scale used for?

A

Classifies skin in reaction to sun exposure

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134
Q

A Fitzpatrick score of 1 is

A

Very little melanin, the fairest skin possible

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135
Q

A Fitzpatrick score of 6 is

A

The most melanin, dark skin

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136
Q

What is a possible etiology for psoriasis?

A

Possibly T-cell (immune) mediated

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137
Q

Is there a genetic predisposition for psoriasis?

A

Yes 30-50%

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138
Q

What is the most common type of psoriasis?

A

Plaque psoriasis

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139
Q

What age does psoriasis mostly affect?

A

3rd decade of life

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140
Q

What kinds of drugs can cause psoriasis flaring?

A

Lithium
Beta blockers
NSAIDS

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141
Q

What are some other predisposing factors for psoriasis?

A

Obesity

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142
Q

Symptoms of psoriasis can include

A

Pruritis
Pain
Arthralgias (**need to ask about joint symptoms)

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143
Q

Guttate psoriasis can be mistaken for

A

Tinea (fungal) infection

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144
Q

Ddx of Psoriasis

A

Candidiasis (inverse)
Atopic dermatitis (eczema)
Tinea (fungal, ringworm)
Pityriasis rosea
Seb. Dermatitis
Nummular eczema

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145
Q

Name 2 topical medications that we can use for treatment of psoriasis

A

Calcipotriene: topical steroid, alters keratinocyte proliferation
Tazarotene: topical retinoid, alters epidermal proliferation

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146
Q

Name alternative topical treatment we can use for psoriasis

A

Tar: anti inflammatory

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147
Q

What are some downsides of phototherapy?

A

Expensive, time-consuming, not widely available
Associated risks (photo aging, risk of skin cancer)

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148
Q

What labs do we monitor for when Methotrexate is used?

A

CBC, BUN, HFP, CREAT.

Not a good option for pts with alcoholic cirrhosis

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149
Q

Common symptom of Methotrexate

A

Nausea

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150
Q

What is an indication for starting systemic treatment for psoriasis?

A

Large BSA or presence of joint symptoms (indicating possible psoriatic arthritis)

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151
Q

Major symptom of soriatane?

A

Dryness (lips)

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152
Q

What is the preferred treatment for moderate to severe psoriasis?

A

Biologics- SQ injection/IV infusion
Immunosuppression causes inflammation interference
However increased risk of infection
Needs PPD

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153
Q

Herald patch

A

One 2-6 cm patch that shows up before rest of the rash blossoms

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154
Q

Pityriasis rosea DDx

A

Guttate psoriasis
Tinea
Secondary syphilis
Nummular eczema

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155
Q

What differentiates secondary syphilis from Pityriasis rosea?

A

Palmar/plantar rash seen in secondary syphilis, not in PR

156
Q

What does lichen planopilaris refer to?

A

Lichen planus affecting the scalp, causing alopecia

157
Q

Why is a thorough history so important in diagnosing a drug eruption?

A

Need to figure out the offending drug! Ask about all medications, not just prescription (otc, homeopathic, topicals)

158
Q

What is onychomycosis?

A

A fungal infection of the nails

159
Q

3 acneiform disorders

A

Acne
Rosacea
Folliculitis

160
Q

You see a 6 year old with diffuse acne lesions. Why is this concerning?

A

Red flag
There could be an underlying endocrine issue

161
Q

Frontline topical treatment for mild to moderate acne?

A

Benzoyl peroxide - bacteriostatic that reduces C. acne

162
Q

Aczone Gel is used for_________ ___________ acne

A

Adult female

163
Q

What are some ABx to treat mod to severe acne?

A

Tetracycline class
Ex. Minocycline, doxycycline

164
Q

Why should minocycline be avoided in pregnant women?

A

Risks for tooth staining

165
Q

What is the idea for using combination birth control pills for acne?

A

Lowering the estrogen levels can decrease oil production and therefore acne formation

166
Q

What do we need to ask about in patients we are considering starting on combo birth control pills for acne?

A

Smoking history

167
Q

What labs should we consider monitoring in acne patients being treated with spironolactone?

A

Potassium

168
Q

What is iPLEDGE?

A

single pregnancy risk management program for prescribing and dispensing of all isotretinoin products

169
Q

How can lupus be distinguished from rosacea

A

Lupus has a more purple appearance, constant and consistent (“doesn’t relent”)
Rule out lupus from our rosacea diagnosis by checking ANA (anti-nuclear antibody)

170
Q

What is a complication associated with rosacea?

A

Rhinophyma - hyperplasia of the soft tissues of the nose

171
Q

We may need a ______referral for rosacea patients

A

Ophthalmology

172
Q

Clinical features of folliculitis

A

Follicular pustules
Follicular erythematous papules or nodules

173
Q

What bacteria most commonly causes folliculitis?

A

S. aureus

174
Q

For most cases of folliculitis, we could use the topical ABXs _______ or _________

A

Mupirocin, Clindamycin

175
Q

What oral ABx could we use for extensive folliculitis?

A

Cephalexin
TMP sulfa

176
Q

Two subtypes of folliculitis are

A

Hot tub folliculitis (pseudomonas)
Folliculitis barbae (shaving distribution)

177
Q

What are the types of eczematous disorders we discussed?

A

Atopic dermatitis
Contact dermatitis
Seborrheic dermatitis
Dyshidrotic eczema
Lichen simplex chronicus

178
Q

The atopic triad is composed of

A

Allergies, asthma, atopic dermatitis

179
Q

Secondary bacterial infection in atopic dermatitis

A

Fever, chills, and purulent discharge could be a sign

180
Q

Atopic dermatitis DDx

A

Contact dermatitis
Cellulitis
Seborrheic dermatitis

181
Q

Contact dermatitis DDx

A

Atopic dermatitis
Psoriasis
Herpes zoster

182
Q

What is patch testing and what is it used for?

A

Exposing skin to irritants to identify a possible cause for contact dermatitis

183
Q

Treatment for contact dermatitis

A

Remove offender
Treat symptoms (topical and oral steroids)
Antihistamines
Prevention and avoidance

184
Q

Seborrheic dermatitis DDx

A

Psoriasis
Rosacea
Contact dermatitis

185
Q

There is a high rate of occurrence of seborrheic dermatitis in what special populations

A

HIV/AIDS
Parkinson’s

186
Q

Dyshidrotic eczema (all ages) is also known as
and the cause?

A

Acute palmoplantar eczema
Caused by overexposure to moisture

187
Q

Hallmark sign of dyshidrotic eczema

A

Small tapioca vesicles in high moisture area

188
Q

Dyshidrotic eczema DDx

A

MRSA
Cellulitis
HSV
Pustular psoriasis

189
Q

Treatment of dyshidrotic eczema is

A

Prevention
Topical or systemic steroids
phototherapy

190
Q

Nummular eczema presents with

A

Erythematous, round patches that are very diffuse,
More prevalent in the winter time

191
Q

How is nummular eczema different than a tinea infection?

A

More widespread/diffuse and solid red

192
Q

Stasis dermatitis is secondarily caused by

A

Vascular disease

193
Q

Skin in stasis dermatitis will have a __________ color

A

Brown-red

Extra info: texture may be shiny, edematous, may ulcerate

194
Q

Neurodermatitis cause

A

Patients picking,
Real or perceived

195
Q

What disease is described as a “chronic itch scratch cycle?”

A

Lichen simplex chronicus

196
Q

What population does nummular eczema typically affect?

A

Older

197
Q

Lichen simplex chronicus DDx

A

Psoriasis

198
Q

What age does bullous pemphigoid usually affect?

A

65+ y/o, usually with comorbidities

199
Q

Bullous pemphigoid is _______ mediated

A

Autoimmune

200
Q

“Tense bullae arise on any part of the skin surface, with a predilection for the flexural areas of the skin”

A

Bullous pemphigoid

201
Q

Symptoms of bullous pemphigoid

A

Prodrome
Intense pruritis
Lesions may occur intra-orally
Lesions heal without scarring

202
Q

Diagnostic studies of choice for bullous pemphigoid

A

Skin biopsy (need 2 samples: one regular specimen from edge of blister and one normal appearing sample from peri-lesion skin for direct immunofluorescence)
Blood testing

203
Q

Frontline treatment for bullous pemphigoid? Other treatments?

A

Oral steroids (prednisone) #1
STEROID WORKS FASTER but not for diabetics
Topical steroids (given in conjunction with systemic tx)
Oral ABx - tetracyclines (also first line)
Immunosuppressives (second line) - Methotrexate, dapsone, imuran

204
Q

What is different about pemphigus vulgaris?

A

Blisters occur on skin and mucous membranes
Usually in younger population
Rare
Can be associated with cancer

205
Q

Erythema multiforme has 2 types

A

Minor, major

206
Q

Is erythema multiforme self-limiting?

A

Yes

207
Q

What causes erythema multiforme?

A

HSV

208
Q

Target lesions-clear center with erythematous ring indicative of

A

Erythema multiforme

209
Q

Supportive measures for erythema multiforme

A

Topical steroids
Viscous lidocaine

210
Q

What is the main difference between SJS and TEN?

A

SJS <10% BSA affected
TEN >30% BSA

211
Q

Causes of SJS/TEN

A

Infection (HIV)
Medication- ABx, NSAIDS, Anti-gout
Psychoepileptics
Malignancy
Idiopathic

212
Q

What is a clinical key to note about SJS/TEN in terms of onset of symptoms?

A

Prodromal symptoms (1-3 days before)
Including productive cough
Headache
Malaise
Arthalgias

213
Q

What other body system (outside of the skin) can be affected in SJS/TEN?

A

Ocular symptoms: red eye, dry eye, pain, grittiness, decreased vision, diplopia

214
Q

Why can SJS/TEN be considered life-threatening?

A

Risk of systemic infection

215
Q

Treatment of patients with SJS/TEN should be in a ___________

A

burn unit/icu

216
Q

1 priority for SJS/TEN treatment is to

A

Remove the offending drug

217
Q

What is cause of death attributed to in sjs/ten patients?

A

Sepsis and multi organ failure

218
Q

Other considerations for SJS/TEN treatment

A

Fluid resuscitation
O2, intubation if can’t protect airway
Pain control
Treat secondary infections
Parenteral nutrition

219
Q

What is a positive nikolsky sign?

A

Application of slight lateral pressure on the epidermal surface results in epidermis easily separating from its underlying surface
In SJS/TEN

220
Q

Explain the rule of 9’s

A

Head - 9
Anterior trunk - 18
Posterior trunk - 18
Legs - 18 each
Genitalia- 1
Palm - 1
Arms - 9 each

221
Q

A female pt with lesions on the entire anterior trunk, anterior left arm, and anterior left leg has approximately __________ % BSA affected

A

32%
Anterior trunk was 18 plus ANTERIOR arm (9/2 = 4.5) plus ANTERIOR leg (18/2 = 9)

222
Q

What is the sign of Leser-Trelat? What is it associated with?

A

Sudden onset of numerous SKs. Associated with various malignancies

223
Q

What are two long term effects of freezing with liquid nitrogen?

A
  1. Depression
  2. White color
224
Q

A nevi is another word for a

A

Mole

225
Q

T/F An atypical mole should be excised.

A

True

226
Q

T/F Melanoma results in more deaths per year than SCC

A

False
SCC results in more deaths because prevalence is also greater
Melanoma is still deadlier

227
Q

Skin cancer capital of the world?

A

Australia

228
Q

Commonly affected areas for SCC include

A

The lips, especially the bottom

229
Q

“Meaty craterform lesion”

A

Warning sign for SCC

230
Q

Lice is most commonly caused by _________parasite

A

Pediculus

231
Q

What causes the irritation in a lice infestation?

A

Saliva of lice produces an irritant reaction

232
Q

Nit

A

Empty egg shell

233
Q

How can nits be differentiated from dandruff?

A

Nits don’t come out easily, dandruff does

234
Q

Severe lice infestation can cause

A

Local lymphadenopathy

235
Q

Treatment for lice

A

Topical pediculicides

236
Q

What should not be used for lice treatment?

A

Lindane

237
Q

What can be used for lice with eyelash involvement?

A

Petroleum jelly

238
Q

T/F the presence of nits doesn’t necessarily mean an active lice infestation

A

True

239
Q

Scabies is caused by

A

Sarcoptes species

240
Q

Scabies spread by

A

Prolonged skin to skin contact
Frequently sexually acquired
Common in crowded conditions (nursing homes, jail)
Exposure to clothing, bedding, furniture used by infested person

241
Q

Scabies may take ________ months to start itching

A

2

242
Q

Pruritis in scabies is usually worse at

A

Night

243
Q

Areas of predilection for scabies

A

Finger web spaces
Wrist
Elbows
Axillae
Penis
Nipples
Buttocks

244
Q

What is always a concern with the intense scratching asociated with scabies?

A

Secondary infection

245
Q

Diagnosis for scabies is made by

A

Skin scrapings

246
Q

Treatment for scabies

A

Permetherin 5% cream (elimite)

247
Q

Post scabetic pruritis

A

Can last up to 4 weeks after tx
Should become less dramatic with time
Tx with topical steroids and oral anti histamines

248
Q

T/F most spider bites are minor

A

True

249
Q

Brown recluse bite

A

Minimal pain initially
Symptoms usually delayed 2-8 hours,
fevers/chills, nausea/vomiting, joint pain, local tissue necrosis
Halo of red then white then red in the center

250
Q

A black widow spider bite contains potent

A

Neurotoxins

251
Q

Black widow bite

A

Usually no reaction, little or no redness or pain
Symptoms delayed 1/2 to 2 hours, systemic muscle pain, extreme abdominal pain, muscle cramping, chest tightness, dyspnea, abdominal rigidity, may develop hypertensive crisis, seizures

252
Q

Complications to black widow bites usually more in what populations?

A

Elderly, young, sick

253
Q

Treatment for black widow bite

A

Tetanus
Analgesics
Antispasmodic
Anti-venom (call medical toxicologist ~ may take awhile)

254
Q

Impetigo is a common bacterial infection in

A

Children

255
Q

Impetigo is highly

A

Contagious and autoinocuable

256
Q

Offending organisms of impetigo

A

S. pyogenes or S. aureus

257
Q

“Superficial pustule that ruptures and forms a yellow brown honey colored crust” classic of

A

Impetigo

258
Q

Treatment for impetigo

A

Topical-mupirocin
Systemic-cephalexin
If MRSA, TMP Sulfa (bactrim) or clindamycin

259
Q

Erysipelas

A

Bacterial skin infection caused by strep. pyogenes

260
Q

Difference between erysipelas and cellulitis

A

Borders much more defined, sharply demarcated from heathy skin. Cellulitis is more diffuse

261
Q

Treatment for erysipelas

A

5-14 day course of oral ABx
Penicillin mild
IV ceftriaxone for significant

262
Q

Causative agents for cellulitis

A

S. aureus and S. pyogenes
MRSA on the rise

263
Q

Predisposing factors for cellulitis

A

Tinea pedis
Vascular insufficiency
Diabetes

264
Q

Pt’s with cellulitis are at risk for becoming

A

Septic

265
Q

Workup for cellulitis includes

A

Labs - CBC with diff
Blood cultures if systemic illness is present

266
Q

Cellulitis DDx

A

DVT
Stasis dermatitis

267
Q

Treatment for cellulitis

A

Oral or IV ABx depending on severity

268
Q

Tinea corporis

A

Ringworm

269
Q

Tinea capitis

A

Ringworm of the scalp

270
Q

Tinea faciei

A

Ringworm of the face

271
Q

Tinea pedis

A

A ringworm fungus of the foot

272
Q

Tinea mannum

A

Tinea on hands

273
Q

Tinea ungium

A

Ringworm of the nail associated with onychomycosis

274
Q

Tinea Cruris

A

Jock itch
Tinea of the groin

275
Q

Treatment for tinea infection

A

Topical antifungal (azole) (not for nails or scalp)
Oral lamisil or griseofulvin
Treat scalp for 6 weeks at least

276
Q

Tinea versicolor is caused by

A

Malassezia furfur

277
Q

Tinea versicolor usually occurs in

A

Young adults
Neck, trunk, and upper arms
Summer recurrent

278
Q

KOH of tinea versicolor will show

A

Spaghetti and meatballs

279
Q

Tinea versicolor treatment

A

Topical antifungal (ketaconazole)
Oral fluconazole
Prevention: Selenium sulfide shampoo as a body wash

280
Q

Causative organism for candidiasis?

A

Candida albicans

281
Q

High risk patients for candidiasis

A

Diabetics
HIV/aids
Pregnancy
Obese

282
Q

“ Denuded, beefy red skin with white curd like collections on mucosa, usually in the creases (inframammary, IG crease, axillae, groin)”

A

Candidiasis

283
Q

Treatment for candidiasis

A

Keep skin dry
Azole topicals or nystatin powder
Oral fluconazole

284
Q

HSV is commonly known as

A

Cold sores, fever blisters

285
Q

What type of HSV most commonly causes oral lesions?

A

HSV 1 (80%)

286
Q

Incubation period for HSV? Average?

A

HSV is highly contagious
2-12 days
4 days average

287
Q

Duration of HSV infection?

A

5-8 days

288
Q

HSV lesions are most contagious when they are in what form

A

Intact vesicles

289
Q

Testing for HSV

A

PCR testing
Viral culture
Throat culture
HSV 1/2 serology
Tzanck smear

290
Q

A positive Tzanck smear will show what under microscope

A

Giant multinucleate cells

291
Q

Treatment for HSV

A

Oral acyclovir (famcyclovir, valacyclovir)

292
Q

Recurrent HSV patients may get a __________ prior to onset

A

Prodromal of pain, tingling, burning

293
Q

Acyclovir/valocycliovir prophylaxis has been shown to

A

Reduce number of HSV episodes

294
Q

Herpes zoster also known as

A

Shingles

295
Q

Lesions in herpes shingles occur in ________ pattern

A

Dermatomal
-unilateral

296
Q

Shingles caused by

A

Reactivation of latent varicella zoster virus (chickenpox)

297
Q

Shingles seen mostly after age

A

50

298
Q

T/F shingles vaccine can cause shingles in someone without latent varicella zoster virus

A

True! Vaccine has live virus

299
Q

Prodromal pain or burning in dermatome
Grouped, linear vesicles in unilateral dermatomal distribution

A

Classic sign of shingles infection

300
Q

Herpes zoster patients with periorbital involvement require

A

Ophthalmology consult

301
Q

Shingles treatment

A

Valtrez 1gm TID x 1 week
Pain meds (depending)

302
Q

PHN

A

Post herpetic neuralgia, can persist beyond 4 months of initial eruption
Increased age increases risk for PHN (in Herpes Zoster)
Neurontin or Elavil may be helpful

303
Q

Name of shingles vaccine
Indicated for?

A

Shingrex
50 yo+ or 19 yo+ immunocompromised

304
Q

Molluscum contagiosum

A

Verrucous growths caused by poxvirus

305
Q

Molluscum commonly seen in age

A

3-10

306
Q

“Umbilicated dome shaped pink papules” hallmark of

A

Molluscum contagiosum

307
Q

Tx for molluscum

A

Observation!
(Self-limiting)

308
Q

Verruca vulgaris

A

Common wart

309
Q

Condyloma acuminata

A

Genital warts

310
Q

Verrucae are caused by

A

HPV (human papilloma virus)

311
Q

Verrucae DDx

A

SCC ( biopsy if questioning)

312
Q

Tx for verrucae

A

Liquid nitrogen
Laser therapy
Immunotherapy

313
Q

Acanthosis nigricans

A

The presence of dark velvety patches of skin around the armpit, back, neck, and groin

Patients with this may complain of “dirty skin”

314
Q

Acanthosis nigricans has been linked to

A

Insulin resistance and diabetes

These patients should be screened for diabetes: check plasma insulin level

315
Q

Tx for Acanthosis nigricans

A

Treat underlying disease
Improve appearance with topical keratolytics, retinoids

316
Q

Malignancy associated AN can be linked to

A

GI malignancy
Do a cancer workup

317
Q

Hidradentis suppurativa

A

Apocrine duct obstruction in axilla or anogenital region
Dominant in females
Abscess formation
Will cause dermal contractures

318
Q

There is an association with hidradentis suppurativa and

A

IBD
metabolic syndrome
Acne

319
Q

Clinical features of Hidradentis suppurativa

A

Erythema, painful papules/nodules, abscess formation, discharge, scarring
Recurrence is a classic feature

320
Q

Hurley staging system

A

Correlates mild, moderate, or severe HS
Stage 1 - Abscess, no sinus tracts
Stage 2 - Recurrent abscesses with sinus tracts/scar
Stage 3 - Diffuse involvement

321
Q

Tx for HS

A

No cure!
Topical or oral ABx first line
IL steroids
Humira-TNF alpha inhibitor

322
Q

Comorbidities for HS

A

Smoking
Overweight

323
Q

Lipomas

A

A benign, slow-growing fatty tumor located between the skin and the muscle layer
More commonly seen in adults

324
Q

Tx for lipomas

A

None needed
Surgical excision (purely cosmetic)

325
Q

Epidermal inclusion cyst

A

Benign cyst developing from proliferation of epidermal cells within a circumscribed space in the dermis

326
Q

Tx for epidermal inclusion cyst

A

Not necessary
Excision

327
Q

The cyst lining of an epidermal inclusion cyst resembles the

A

Inner lining of an egg

328
Q

Melasma

A

Hyperpigmentation triggered by hormonal changes, often during pregnancy or with birth control use

329
Q

Tx for melasma

A

1 sun avoidance

High SPF sunscreen
Hydroquinone- bleaching
Topical retinoids

330
Q

Vitiligo

A

Autoimmune condition caused by the destruction of melanin that results in the appearance of white patches on the skin (commonly the face, hands, legs, and genital areas)

331
Q

Woods lamp

A

illuminates skin conditions
Can Dx vitiligo

332
Q

Consider ________________ evaluation in patients with vitiligo

A

Thyroid lab evaluation

333
Q

Tx for vitiligo

A

High SPF sunscreen (45+ spf 100 is for them)
Phototherapy
Topical steroids, immunomodulators (calcineurin inhibitors)
Oral steroids
Surgical - skin grafting
Mental health referral

334
Q

“Raised well circumscribed lesion of erythema and edema” (wheal)

A

Urticaria ~ hives

335
Q

Dermographism

A

Development of urticaria with scratching

336
Q

Angioedema

A

Localized areas of swelling beneath the skin, often around the eyes and lips, but it can also involve other body areas as well
Clinical feature of urticaria

337
Q

Labs for chronic urticaria

A

CBC, TSH, ANA

338
Q

Tx for urticaria

A

Front line: Antihistamines
Reserve systemic steroids for angioedema
Epipen Rx (go to ER after using)

339
Q

Pressure ulcer

A

Any lesion caused by unrelieved pressure that results in damage to underlying tissue

340
Q

Factors for pressure ulcers

A

Incontinence
Immobility (bed bound)
Malignancy
Nutritional status

341
Q

Ulcer staging

A
  1. Redness
  2. Partial thickness loss of skin involving epidermis and maybe dermis
  3. Subcutaneous damage that may go down to fascia
  4. Through fascia
    Unstageable - bad
342
Q

Work up for pressure ulcer

A

Wound cultures, blood cultures (r/o sepsis)
CBC, UA, protein, albumin
X-ray,bone scan, MRI (r/o osteomyelitis)

343
Q

Complications of pressure ulcers

A

Osteomyelitis
Pyarthrosis
Sepsis
Malignant transformation

344
Q

How many deaths per year caused by pressure ulcer complications?

A

60,000

345
Q

For patients with the same underlying illness,
patient with pressure ulcer has __________ higher risk of death

A

4.5

346
Q

Pilonidal disease

A

Chronic infection in skin in the crease above the buttocks
More common in males (more hair)

347
Q

Risk factors for pilonidal disease

A

Obesity
Sedentary lifestyle
Excess body hair
Poor hygiene

348
Q

Tx for pilonidal disease

A

I&D
ABx in presence of cellulitis
Complete excision for recurrent lesion

349
Q

What are the clinical manifestations of onychomycosis?

A

Usually asymptomatic at first
Can progress to pain, numbness
Sublingual hyperkeratosis

350
Q

What is oncholysis?

A

Separation of the nail from the nail bed, usually with a white/yellow color

351
Q

Onychomycosis DDx

A

Nail trauma
Nail psoriasis
Aging toenail

352
Q

Main diagnostic tool in onychomycosis

A

KOH scrape (sublingual debris)
Nail clip for PAS stain

353
Q

Treatment regimen for onychomycosis

A

Combo of topical and oral

354
Q

Why are topical treatments typically ineffective with onychomycosis?

A

Unable to penetrate the thick nail plate

355
Q

The first line TX for onychomycosis

A

Lamisil (terbinafine)
1x/day for 6 weeks in fingernails
1x/day for 3 months in toenails

356
Q

What labs should we monitor with terbinafine (lamisil) and how often

A

LFT at baseline and 6 weeks at least

357
Q

Paronychia

A

Soft tissue infection, usually of the lateral and proximal nail folds

358
Q

Characteristics of acute paronychia?

A

Purulent and painful
Caused by staph infection

359
Q

Characteristics of chronic paronychia?

A

Swelling
Non-purulent
Candida is often isolated, but not causative

360
Q

Diagnostic evaluation for paronychia

A

Bacterial culture
KOH smear

361
Q

What systemic problem should we consider with paronychia?

A

Osteomyelitis- imaging if needed

362
Q

Primary treatment for acute paronychia includes

A

Soaks, I&D, Topical or oral ABx

363
Q

Primary treatment for chronic paronychia includes

A

Topical or oral steroid and skin protection

364
Q

Risk factors for paronychia

A

Nail biting
Educate - Trim hang nails and trim nails flush to tip

365
Q

Alopecia areata presents with

A

Discrete patches of hair loss

366
Q

Alopecia totalis presents with

A

Complete baldness of the scalp

367
Q

Alopecia universalis presents with

A

Baldness of all hair-bearing areas

368
Q

Exclamation hairs

A

Pathognomic hairs that can be located in or around affected areas of alopecia, shaped like an exclamation point, pull out easy in a pull test

369
Q

What is important to note about the bald skin seen in Alopecia?

A

It is non-inflamed

370
Q

Alopecia could have a possible association with

A

Thyroid diseases
Consider checking TSH

371
Q

Tx of alopecia

A

Topical or IL steroids
Immunotherapy (second line)
Psychosocial support

372
Q

Is androgenetic alopecia progressive?

A

Yes

373
Q

What does male pattern baldness usually look like?

A

Thinning in the temporal area w/ gradual frontal recession

374
Q

Female pattern baldness

A

Thinning at the crown

375
Q

Hamilton-Norwood scale?

A

Used to classify severity of androgenetic alopecia

376
Q

What labs should be performed in females with androgenetic alopecia?

A

DHEAS and testosterone

377
Q

Medications we can use for androgenetic alopecia

A

Minoxidil (Rogaine) - Topical soln, both 2% and 5% strengths
Finasteride (propecia) - oral
Spironalactone in females

378
Q

What is a risk associated with finasteride for androgenetic alopecia?

A

Teratogenic

379
Q

Telogen effluvium

A

A prolonged resting phase of the hair cycle
(Non-scarring alopecia)
Self resolving but could take 6-12 months

380
Q

Inciting factors for Telogen effluvium

A

General anesthesia
Pregnancy
Significant stress
Significant weight loss
Febrile illness
Dietary restrictions

381
Q

Lab workup for Telogen effluvium

A

CBC, thyroid, iron

382
Q

Topical therapy treatment for Atopic dermatitis

A

Topical steroids
Calcineurin inhibitors-immunomodulators (not for acute episodes- black box warning, not for under 2 year olds)
Eucrisa - non-steroidal topical
Phototherapy

383
Q

Systemic treatment for atopic dermatitis

A

Steroids - acute episodes only
Antihistamines
ABx for infection
Dupixent - SQ injection for moderate to severe uncontrolled AD
JAK inhibitors- oral or topical, newer class

384
Q

“White or yellow scale, flaky, background erythema, greasy appearance”

A

Hallmark of Seborrheic dermatitis

385
Q

Systemic complications of brown recluse spider bite

A

Fevers, chills, weakness, HA, n/v, arthalgia, rash, leukocytosis

386
Q

Testing for tinea includes

A

KOH, fungal culture, PAS stain on biopsy

387
Q

Central Centrifugal Cicatrical Alopecia

A

Permanent hair loss starting at the crown and progressing outward
Almost exclusive to black women 30 yo+
Scarring alopecia
Skin is also affected
Clinical dx
Early intervention is vital - regrowth is possible

Didactic Year (24 decks)

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