CLINICAL CARE OF THE SKIN, HAIR AND NAILS Flashcards by Tim Mackey

What is an inflammation of a hair follicle that can occur anywhere on the body where hair is found?

Folliculitis

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Folliculitis is most frequently due to what bacteria?

S. aureus (+/- MRSA)

Strep species, pseudomonas also contribute

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These are what kind of causes of folliculitis ?

Dermatophytic
Pityrosporum on upper chest and back
Candida albicans

Fungal

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What are viral causes of folliculitis ?

2. Molluscum contagiosum

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What are some parasitic causes of folliculitis?

Demodex spp. Mites

2. Schistosomes

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What are the non infectious causes of Folliculitis?

2. Mechanical Folliculitis (Skinny Jeans Syndrome)

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The following are all risk factors for what?

Hair removal
Other pruritic skin conditions: eczema, scabies
Occlusive dressing or clothing
Personal carrier or contact with MRSA
DM
Immunosuppression
Use of hot tubs or saunas
Chronic antibiotic use
Tattoos
Poor hygiene

Folliculitis

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What is an abrupt onset of follicular erythematous papules or pustules, with pruritis and pain in hair areas; rash occurs on hair-bearing skin, especially the face (beard), proximal limbs, scalp, and pubis?

Folliculitis

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What form of folliculitis appears as a widespread rash, mainly on the trunk and limbs?

Pseudomonal Folliculitis

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What is the clinical hallmark of folliculitis ?

Hair emanating from the center of a pustule

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True or False

The diagnosis for folliculitis is made clinically

True

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What is the treatment of folliculitis?

Antiseptic and supportive care is usually enough.
Good hygiene practices
Wash hands
Wash towels, clothes, and linens frequently
Good hair removal practices
Use witch hazel, alcohol, or tend skin afterward

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What is the treatment for Staphylococcal folliculitis?

Mupirocin ointment applied TID for 10 days
Cephalexin: 250-500 mg PO QID (7-10 days)
Dicloxacillin: 250-500 mg PO QID (7-10 days)

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Folliculitis

What is the treatment for MRSA?

Bactrim DS: 1-2 tablets BID PO (5-10 days)
Clindamycin: 300 mg PO TID (10 to 14 days)
Doxycycline: 50-100 mg PO BID (5-10 days)

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What is the treatment for Pseudomonas folliculitis?

Ciprofloxacin: 500 to 750 mg PO BID for 7 to 14 days if lesions are
persistent
High-potency topical corticosteroids for inflammation
Antihistamines (hydroxyzine, cetirizine) to control itching

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What is the treatment for Fungal Folliculitis?

Topical antifungals: ketoconazole 2% cream or shampoo or selenium
sulfide shampoo daily
Systemic antifungals for relapses fluconazole (100 to 200 mg/day for 3 weeks) or itraconazole (200 mg/day for 1 week) or griseofulvin (500 mg/day for 2 to 4 weeks)

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What is the treatment for Parasitic folliculitis?

5% permethrin: Apply to affected area, leave on for 8 hours, and wash off.

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What is the treatment for Herpetic Folliculitis?

Valacyclovir: 500 mg PO TID for 5 to 10 days

2. Acyclovir: 200 mg PO 5 times daily for 5 to 10 days

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What is the primary complication of folliculitis?

Recurrent folliculitis

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What is a condition caused by ingrowing hairs, mostly in the beard area (neck area is typically most severe)?

Pseudofolliculitis Barbae

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What condition affects people with curly hair or those with hair follicles oriented at an oblique angle to the skin surface, a sharp, shaved, tapered hair re-enters the skins as it grows from below the skin surface and induces a foreign body reaction, producing a micro-abscess?

Pseudofolliculitis Barbae

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What condition presents with red papules or pustules that can be both painful and or pruritic, occurs in any area where the hair is shaved, scarring and hyper pigmentation may result from this condition?

Pseudofolliculitis barbae

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Keloid formation is often a problem in what condition, especially in African-American people?

Pseudofolliculitis Barbae

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PFB is found in ___% to ___% of blacks and __% to ___% of whites who shave

50%-75%

2. 3%- 5%

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What is treatment approach 1 for PFB?

Medical treatment with grooming standard modifications

What is treatment approach 1 for PFB (mild to moderate)?

Medical treatment with Grooming modifications

The treatment of what consists of the combined use of: application of medicated creams to make hairs more shaveable, shaving with gentle equipment and shaving techniques to minimize the risk of irritation and hair re-entry into the skin?

Mild to Moderate PFB

What is treatment approach 2 for PFB (moderate to severe PFB)?

Laser hair reduction with grooming modification

True or False Where available, laser hair reduction is the most reliable approach allowing a return to grooming standards. This is an appropriate treatment for moderate to severe cases of PFB or any case desiring permanent hair reduction.

True

Laser Treatment of PFB A series of at least ____ treatments is usually needed, with ___ to ___ days between treatments. This procedure is usually available at military medical treatment facilities with a dermatology department.

1. Three | 2. 30-45 days

What are the complications of PFB?

Abscess formation and scarring

What is a contagious, superficial, intra-epidermal infection occurring prominently on the exposed areas of the face and extremities?

Impetigo

What form of Impetigo is the invasion of previously healthy skin?

Primary Impetigo (pyoderma)

What form of Impetigo is an invasion at sites of minor trauma (abrasions, insect bites, underlying eczema) and can be considered to be S. aureus Impetigo of hair follicles?

Secondary Impetigo (impetiginization)

True or False Impetigo may present with S. Aureus alone or combined with Group A beta-hemolytic streptococci

True

What is known as a deeper, ulcerated impetigo infection often with lymphadenitis?

Ecthyma

What are the synonyms for Impetigo?

1. Pyoderma 2. Impetigo contagiosa 3. Impetigo vulgaris

What is the most common form of impetigo, presenting with the formation of vesiculpustules that rupture, leading to crusting with a characteristic golden appearance; some local lymphadenopathy may occur?

Nonbullous impetigo

What is a staphylococcal impetigo that progresses from small to large flaccid bullae (newborns/young children) caused by epidermolytic toxin release; ruptured bullae leaving brown crust; less lymphadenopathy; trunk is most often affected in <30% of patients?

Bullae Impetigo

These are all risk factors associated with what condition? 1. Warm humid environment 2. Tropical or subtropical climate 3. Summer or Fall season 4. Minor trauma, insect bites, breaches in skin 5. Poor hygiene, poverty, crowding, epidemics, wartime 6. Familial spread 7. Complications of pediculosis, scabies, chicken pox, eczema/atopic dermatitis 8. Contact dermatitis 9. Burns 10. Contact sports 11. Children in day care 12. Carriage of Group A Strep and S. Aureus

Impetigo

What is a cutaneous pyoderma characterized by thickly crusted erosions or ulceration, usually a consequence of neglected impetigo and classically evolves in impetigo occluded by footwear and clothing?

Ecthyma

True or False Impetigo Treatment Treatment speeds healing, improves cosmetic appearance, and avoids spread of disease. Avoidance of infection spread is the key; hand washing is vital, especially for reducing spread in children.

True

What can be used to help prevent impetigo at the sites of minor skin trauma?

Mupirocin ointment TID

Impetigo Treatment Remove crusts, clean with gentle washing ___ to ___ times daily, and clean with antibacterial soap, chlorhexidine, or Betadine

2-3 times daily

Impetigo treatment What is the treatment for Vanilla Staph? Nonbullous (minor spread, treat 7 days; widespread, treat 10 days); bullous (treat 10 days)

1. Mupirocin (Bactroban) 2% topical ointment applied TID for 5 to 7 days (nonbullous only) 2. Dicloxacillin: Adult 250 mg PO QID

Impetigo treatment What is the treatment for MRSA?

1. Clindamycin, tetracyclines, or trimethoprim-sulfamethoxazole. Oral doses given for 7 days are usually sufficient. 2. Clindamycin 300 mg q6-8h

What is the disposition for a patient with Impetigo?

1. Full duty or modified duty | 2. Dependent on location, distribution, and extent

What is an acute bacterial infection of the dermis and subcutaneous (sc) tissue and is typically caused by bacterial penetration through a break in the skin?

Cellulitis

What infection of the skin presents with these 4 classic signs of inflammation? 1. Erythema 2. Edema 3. Tenderness to palpation 4. Elevated skin temperature surrounding area of infection

Cellulitis

What skin infection typically has unilateral lower-extremity involvement with systemic symptoms usually being absent, the most common portal of entry of this for the lower leg is the toe web intertrigo with fissuring ?

Cellulitis

True or False Cellulitis typically occurs near surgical wounds and trauma sites

True

A patient presents with a wound to the lower left leg with itching and burning; he is running a fever and reports chills and malaise over the past 4 days. He has some localized pain and tenderness with erythema, induration, swelling and warmth to the site. Regional lymphadenopathy and purulent drainage is noted as well. What is the most likely diagnosis?

Cellulitis

The following is the treatment for what? 1. Demarcate area w/ sharpie to measure progress once treatment is started 2. Immobilize and elevate involved limb to reduce swelling 3. Sterile saline dressing or cool aluminum acetate compresses for pain relief 4. Compression stocking for edema 5. Tylenol +/- NSAIDS for pain relief 6. Tetanus if needed (especially if there is an open traumatic wound)

Cellulitis

What is the antimicrobial treatment for Non-purulent cellulitis? (target treatment toward beta-hemolytic streptococci and MSSA)

1. Cephalexin 500mg PO q6H | 2. Dicloxacillin 500mg PO q6H

What is the antimicrobial treatment for Purulent cellulitis? | probable CA-MRSA

1. Clindamycin 450mg PO 2. Trimethoprim-sulfamethoxazole (TMP-SMX) 1 DS tab PO BID 3. Doxycycline 100 mg PO BID

What is the antimicrobial treatment for cellulitis secondary to a human or animal bite?

Amoxicillin + clavulanic acid (Augmentin)

MEDADVICE needs to be considered when for cellulitis?

1. Elevated WBC with marked left shift 2. Failure to respond to oral antibiotics 3. Severe infection, suspicion of deep or rapidly spreading infection, tissue necrosis, or severe pain 4. Worsening symptoms that do not resolve/improve after 24 - 48 hrs of therapy

True or False Cellulitis of the hands and face my require hospitalization

TRUE TRUE TRUE

What are rare and rapidly progressing infections involving any layer of the soft tissue including the skin, subcutaneous fat, fascia, and or muscle; associated with extensive tissue destruction, systemic toxicity, limb loss and are potentially fatal; and represents a MEDICAL EMERGENCY?

Necrotizing Soft Tissue Infections (NSTI)

These can all be risk factors for what tissue infection? 1. Major penetrating trauma 2. Minor laceration or blunt trauma (muscle strain, sprain, or contusion) 3. Skin breach (varicella lesion, insect bite, injection drug use) 4. Recent surgery 5. Mucosal breach (hemorrhoids, rectal fissures, episiotomy) 6. Immunosuppression 7. Malignancy 8. Obesity 9. Alcoholism

Necrotizing Fasciitis

Where does necrotizing fasciitis most frequently occur?

extremities (predilection for the lower leg) May mimic DVT

In what skin infection will you see and initial presentation of pain, erythema, edema, cellulitis and a high fever; pain is usually progressive, relentless, and severe and is often out of proportion to the severity of the physical findings?

Necrotizing Fasciitis

The skin exam for what may be unrevealing early on, or may be even confused with cellulitis or abscess; you may see blistering, crepitus, soft tissue edema, erythema, discoloration, necrosis, bullae, vesicles, or ulceration?

Necrotizing fasciitis

An MRI for a patient with Necrotizing fasciitis may show what?

Edema along the fascial plane

Cultures for necrotizing fasciitis may show what bacteria?

Group A strep and mixed aerobic and anaerobic bacteria

What is the cornerstone of treatment for necrotizing fasciitis ?

Prompt and wide surgical debridement | **may require amputation**

What should be administered once the diagnosis of Necrotizing soft tissue infections (NSTI) is suspected?

Broad spectrum antibiotics Should cover gram positive, negative and anaerobic organisms

What is the main adjunctive therapy to surgery when a patient has Necrotizing fasciitis?

Antibiotics

What is the disposition for a patient with Necrotizing Fasciitis?

IMMEDIATE MEDEVAC

True or False Necrotizing Fasciitis Close contacts of patients and health care workers require chemoprophylaxis with antibiotics after being exposed

False Do not require chemoprophylaxis (good to brief COC on)

What is a well-circumscribed, painful, inflammatory nodule at any site that contains hair follicles, may extend into the dermis and subcutaneous tissues?

Furuncle (aka Boil)

What is a collection of pus within the dermis and deeper skin tissues and manifests as a painful, tender, fluctuant, and erythematous nodules? Typically no systemic symptoms

Skin abscess

What is a coalescence of several inflamed follicles into a single inflammatory mass with purulent drainage from multiple follicles? Typically presents with systemic symptoms and fever

Carbuncle

The following is the etiology and pathophysiology of what? 1. infection spreads away from the hair follicle into the surrounding dermis 2. pathogen strain of S. aureus or CA-MRSA

Abscess

These are risk factors associated with what? 1. Carriage of pathogenic Staphylococcus sp. in nares, skin, axilla, and perineum 2. DM, malnutrition, alcoholism, obesity, atopic dermatitis

Abscess

The following is a description of what? 1. Deep subcutaneous erythematous papules enlarge to deep seated nodules that can be stable or become fluctuant within several days 2. Most commonly occurs on the back of the neck, upper back, and lateral thighs 3. Tender perifollicular swelling, terminating in discharge of pus and necrotic plug

Carbuncle

True or False With a carbuncle, malaise, chills, and fever may precede or occur during the height of inflammation

True

Carbuncle should be handled by ____ or _____ in all situations unless the patient is unable to be transferred

dermatology or general surgery

What systemic antibiotic therapy is used to cover MSSA with a patient with an Abscess?

1. Dicloxacillin 250-500mg QID for 10 Days 2. Cephalexin 250-500mg QID for 10 Days 3. Amoxicillin and Clavulanate (Augmentin) 875 mg BID for 10 days

What systemic antibiotic therapy is used to cover MRSA with a patient with an Abscess?

1. Doxycycline 100 mg BID 2. Trimethoprim-Sulfamethoxazole DS BID 3. Clindamycin 150-300 mg BID for 10 days

Abscess What lab test is indicated if a patient has a fever or signs/symptoms of systemic disease?

CBC

What are the most common benign cutaneous cysts?

Epidermal Cysts | aka Epidermoid cysts, epidermal inclusion cysts, or improperly sebaceous cysts

What can occur anywhere on the body and the size ranges from a few millimeters to several centimeters in diameter, the wall of consists of normal stratified squamous epithelium derived from the follicular infundibulum?

Epidermal cysts

True or False Cysts can be primary (de novo) or may arise of the implantation of the follicular epithelium in the dermis as a result of trauma or from a comedone

True

What is usually a firm or fluctuant flesh-to-yellow colored solitary nodule (0.5 to 5 cm) which often connects with the surface by keratin filled pores, grow slowly over time and may remain stable for months to years, and are commonly located in the face, neck, upper back, and chest; if due to trauma, on buttocks, palms or plantar side of the feet?

Stable epidermal cyst

True or False Inflamed/Ruptured Epidermal Cyst Inflamed epidermal cysts are warm, red and boggy and TTP; sterile purulent material and keratin debris often point toward and drain to the surface

True

What lesions often mimic and present very similarly to abscesses?

Inflamed/ruptured epidermal cysts

Do asymptomatic epidermal cysts require treatment?

Nope

True or False Epidermal Cyst Disposition Duty status is based on location, severity, and control of the infection. Wound should be checked throughout treatment to ensure symptoms improvement and adequate drainage/healing

True

What is the most common benign mesenchymal neoplasm in adults and are composed of mature white adipocytes?

Lipoma

What can occur on any part of the body and usually develop superficially in the subcutaneous tissue, may often occur on the neck, trunk, and on other extremities and is composed of fat cells?

Lipoma

True or False Malignant transformation of a lipoma into a liposarcoma is common

False Rare

What should be done for rapidly growing lipomas?

Biopsy

Treatment for lipomas is usually not required, but may be excised by Dermatology for what reasons?

1. Cosmetic 2. Pain 3. Impedance of duties

True or False Classic lipomas are entirely benign and recur only rarely

True

Intramuscular/intermuscular lipomas have a recurrence rate of up to what percentage?

20%

What is an acute inflammatory process, with or without abscess formation, that involves the proximal and lateral nail folds that has been present for less than 6 weeks?

Paronychia

What is most commonly caused by S. Aureus, Streptococcus pyogenes infection in the periungual tissue by minor mechanical or chemical traumas that disrupt the nail fold barrier?

Paronychia

What are some common factors contributing to paronychia?

1. Manicuring 2. Nail biting 3. Thumb sucking 4. Picking a hangnail

What is the most common infection of the hand, representing 35% of all hand infections in the United States?

Paronychia

What usually develops along the nail margin (proximal and lateral nail folds) manifesting over hours to days with pain, warmth, redness, and swelling?

Paronychia

What is the early treatment for paronychia?

Warm compresses and soaks

What is the disposition for a patient with paronychia?

LLD may be indicated based on occupation and treatment

What is an abscess of the distal phalanx fat pad, S aureus is the most common pathogen, patient usually presents with a painful and swollen distal pulp space?

Felon

What is a pyogenic infection of the distal pulp space, with pus collecting in the spaces formed by the vertical septa anchoring the pad to the distal phalanx?

Felon nearly always follows minor finger injury

What condition is characterized by severe pain, exquisite tenderness, and tense swelling of the distal digit with erythema, may have a visible collection of pus or palpable fluctuance; underlying bone, joint or flexor tendons may become infected?

Felon

What is the treatment for a felon?

1. Prompt incision with division of the fibrous septa to ensure adequate drainage 2. Should be performed by Derm if available 3. IDC should treat with antibiotics a. MSSA- Dicloxacillin or Keflex b. MRSA- Trimethoprim/sulfamethoxazole, clindamycin, or doxy 4. Rest and immobilization 5. Elevation

What is the spectrum of cutaneous infections caused by Candida yeast?

Candidiasis

True or False Candida acts as an opportunistic pathogen when allowed to overgrow and predisposing conditions permit

True

True or False Yeast infects only the outer layers of the epithelium of the mucous membrane and skin (stratum corneum)

True

What are some synonyms for candidiasis?

1. Monilia 2. Thrush 3. Yeast 4. Intertrigo

These are all risk factors associated with what? 1. Hormonal alteration of the skin microbiome 2. Elimination of competing microorganisms 3. Physical environmental changes 4. Direct/indirect immunosuppression

Candidiasis and fungal infections

What occurs mostly in intertriginous areas such as the axillae, groin, digital web spaces, glans penis, and beneath the breasts; manifesting as pruritic, well-demarcated, erythematous patches of varying size and shape?

Candidiasis

The primary patches of what may have adjacent satellite papules and pustules; the contents of which dissect horizontally under the stratum corneum and then peel it away, resulting in a red, denuded, glistening surface with a long, cigarette paper-like, scaling and advancing border?

Candidiasis

True or False Oral candidiasis is adults can be the first sign of HIV

True

What is the treatment for candidiasis?

1. affected skin should be kept dry and exposed to air as much as possible 2. Topical Azole class antifungals 3. Allylamine class antifungals a. Terbinafine (Lamisil)

What is the treatment for Vaginal candidiasis?

1. First line (topical) a. clotrimazole vaginal cream b. miconazole nitrate vaginal cream 2. Second line (oral) a. fluconazole (Diflucan)

What kind of fungal infection involves the crural fold and gluteal cleft?

Tinea Cruris

What kind of fungal infection involves the face, trunk, and/or extremities; often presents with ring shaped lesions, hence the misnomer ringworm?

Tinea Corporis

What kind of fungal infection involves the face, trunk, and/or extremities; often presents with ring shaped lesions, hence the misnomer ringworm?

Tinea Corporis

What kind of fungal infection involves the face, trunk, and/or extremities; often presents with ring shaped lesions, hence the misnomer ringworm?

Tinea Corporis

What fungal infection involves the scalp and hair; affected areas of the scalp can show characteristic black dots resulting from broken hairs?

Tinea Capitis

What is the cause of Tinea infections that can subsist on protein, namely keratin and can cause disease in keratin-rich structures such as skin, hair, and nails?

Dermatophytes

What are anthropophilic infections?

Infections acquired from personal contact

What form of tinea will present with scaling, round or oval pruritic plaques characterized by a sharply defined annular pattern with peripheral activity and central clearing (ring shaped lesions), the papules and occasionally the pustules/vesicles present at the border, and less commonly at the center?

Tinea Corporis

How long should treatment for Tinea Corporis be continued for after the resolution of the infection?

1 week

What oral medication can be used for Tinea Corporis?

Griseofulvin (ultra-microsize) 250 po mg QD x 2 weeks or | Fluconazole 150 mg once a week for 3-4 weeks.

What form is Tinea is well-marginated, erythematous, halfmoon-shaped plaques in crural folds that spread to the medial thighs, advancing border is well defined, often with fine scaling and sometimes vesicular eruptions; lesions are often bilateral and do not include scrotum/penis (unlike candida)?

Tinea Cruris

Can tinea cruris migrate to the perineum, perianal area, and gluteal cleft and onto the buttocks in chronic/progressive cases?

Yes

What is the first line treatment of tinea cruris?

Topical antifungal creams applied 2 times a day for 10 to 14 days

For refractory or wide spread tinea cruris infections what oral medication should be used?

Itraconazole 200 mg orally once a day or terbinafine 250 mg orally once a day for 3 to 6 weeks

What is a differential of tinea cruris that fluoresces red under a wood's lamp?

Erythrasma

What is a superficial infection in the interdigital web and soles of the feet caused by dermatophytes?

Tinea Pedis

What is the most common dermatophyte infection encountered in clinical practice and is very contagious?

Tinea Pedis

What is often accompanied by tinea manuum, tinea unguium, and tinea cruris; more common in males than females?

Tinea Pedis

The following are treatments for what Tinea infection? 1. Open-toed shoes when possible 2. Shower shoes 3. Dry between toes after showering 4. Frequent sock changes 5. Antifungal powders

Tinea Pedis

What form of tinea is caused by pityrosporum orbiculare, which is part of the normal skin flora?

Tinea Versicolor

What can predispose a patient to tinea versicolor?

Excessive heat and humidity Very common, especially in tropical or semi-tropical regions Prevalence can reach 50%

Is tinea versicolor a dermatophyte infection?

Nope

The following is the presentation for what infection? 1. Velvety tan, pink or white macules that do not tan 2. Color is uniform in each person but varies between people 3. Fine scales that are not visible but are seen by scarping the lesion 4. Central upper back, chest, and proximal arms 5. Appearance is often the patients major concern

Tinea Versicolor

A wood's lamp will show faint yellow-green fluorescence/pigment changes in what?

Tinea versicolor

What is the topical treatment for tinea versicolor?

1. Selenium Sulfide 2.5% applied from neck to waist wash off after 5-15 minutes, repeat daily x 7 days. Repeat weekly x 1 month, then monthly for maintenance. 2. Ketoconazole 2% shampoo chest and back, wash off after 5 minutes. Repeat weekly.

What is the oral treatment for tinea versicolor? Cure rates may be greater than 90%

1. Ketoconazole 400 mg in a single dose with exercise to point of sweating after ingestion. Single dose is not always effective. 2. Fluconazole 300 mg (2 capsules weekly x 2 weeks) has similar efficacy.

Is oral terbinafine effective for tinea versicolor?

Noep

What is acquired through direct contact of the nail with dermatophytes, yeast or non-dermatophyte molds in the environment or through the spread of fungal infection from affected skin?

Onychomycosis

True or False Onychomycosis most often occurs in adults and the elderly, not common in younger patients

True

What is the most common presentation of Onychomycosis?

Distal subungal Onychomycosis

Common clinical manifestations of what include nail discoloration, subungal hyperkeratosis, onycholysis, splitting of the nail plate and nail plate destruction?

Onychomycosis

Is confirmation of the Onychomycosis infection required prior to treatment due to the potential for liver toxicity of treatment with oral antifungals?

Yes, confirm with KOH and fungal culture

What is considered the gold standard therapy for Onychomycosis?

Oral antifungal therapy

What is a contagious parasitic infection of the skin caused by the mite Sarcoptes scabiei, var. hominis?

Scabies

A scabies rash will appear how many weeks after exposure?

2-6 weeks

Intense pruritis that worsens at night is a cardinal feature of what?

Scabies

A burrow is a linear, curved or S-shaped slightly elevated vesicle or papule up to 1-2mm wide and is the classic lesion of what?

Scabies

Where are the common sites for burrows with scabies?

1. Finger webs 2. Wrists 3. Sides of hands and feet 4. Penis 5. Buttocks 6. Scrotum

What test can you do to confirm the burrows from scabies?

Ink test

The treatment for scabies is two fold involving killing the mites and removing the infestation and controlling the dermatitis and pruritis, what medication should be used in the treatment?

Permethrin 5% or Lindane 1% applied to entire skin surface from the neck down, including under the fingernails and toenails an in the umbilicus, patient will have this on their skin for 12 hours, repeat regimen in 1 week

After treatment of scabies all clothes and bedding must be washed in hot water or put in a hot dryer at the time of application but can also be set aside wrapped in plastic bags for how long?

14 days

Lice feed or suck blood for how many hours?

3-6 hours

How long do lice live and how many eggs can the female lay per day?

1. 1 month | 2. 7-10 per day

Phthrius Pubis causes what that is typically sexually transmitted?

Pediculosis Pubis

Pediculus humanus var corporis causes what?

Pediculosis Corporis (body lice)

Pediculus humanus var capitis causes what?

Pediculosis Capitis (head lice)

True or False Lice Diagnosis is not usually difficult, but may require repeated examinations

True

What is the treatment for head lice?

1. Permethrin rinse 1% (Nix); Permethrin 5% (Elimite); Lindane % (Kwell) 2. Removing the nits is essential (nit combs)

What is an alternative therapy for removing head lice?

1. Vaseline (Petrolatum) to the scalp overnight and covered with a shower cap, smother the lice. 2. This treatment does not kill nits, so it should be repeated for 3-4 weeks.

What is a common, acute, self limited papulosquamous skin rash that is most commonly seen in individuals aged 10-35?

Pityriasis Rosea

Prodromal symptoms such as the following are reported in as much as 69% of patients with what? 1. malaise 2. mild fever 3. fever 4. headache 5. sore throat 6. cough 7. mild URI 8. GI symptoms

Pityriasis Rosea

Classic Pityriasis Rosea begins with a solitary herald patch that appears on the trunk or proximal limbs that precedes secondary eruption by __ to ___ days

7 to 14 days

The herald patch of what is a 2-5cm round or oval, sharply delimited, pink or salmon-colored lesion on the chest, neck, or back ?

Pityriasis Rosea

Within how many days will the secondary eruption lesions of PR appear, oval lesions similar in appearance to the herald patch, but smaller, appear in crops on the trunk and proximal areas of the extremities?

7-14 days

Lesions associated with what are distributed with long axes along cleavage (langer's) lines and appear as the following: 1. "christmas tree pattern" on back 2. V-shaped pattern on the upper chest 3. Mild-moderate pruritis is common 4. rose or fawn color (not as evident in darker skin) 5. generally resolve spontaneously within 45 days

Pityriasis rosea

What is used for the symptomatic treatment of Pityriasis Rosea?

1. Non sedating antihistamines (centrizine, loratadine, fexofenadine) 2. Sedating antihistamines if sleep is interrupted (Benadryl/Atarax) 3. Topical corticosteroids

What is a contagious viral infection primarily with herpes simplex virus type 1 (HSV-1), and less often with herpes simplex virus type 2 (HSV-2), resulting in a rash of the skin and mucous membranes (usually lips)?

Herpes Labialis

Primary outbreaks of what manifest as herpetic gingivostomatitis, while recurrent episodes usually affect the vermillion borders of the lips or the mucosa of the hard palate?

Herpes simplex

True or False HSV-1 can be transmitted via mucous membranes/secretions and open or abraded skin by kissing and by sharing utensils or towels.

True

True or False Herpes Simplex Symptoms will resolve but the infection cannot be cured due to the lifelong latency of the virus.

True

Primary infection of herpes simplex usually occurs in child hood (via nonsexual contact) and what percentage are usually infected by age 6?

33%

What percentage of adults reported to have experienced oral herpes and incidence of herpes simplex virus type 2 reported to be increasing due to increased oral-genital contact?

60-90%

True or False Primary infection of Herpes simplex is defined as the initial exposure to the virus in a nonimmune person and is usually more severe and lasts longer than the recurrence

True

The recurrent infection of the herpes simplex virus is also known as what?

Herpes labialis

True or False Recurrent infection is common with HSV-2

False Recurrent infections are rare with HSV-2

What is the treatment for HSV-1 ?

1. PT education 2. Symptomatic treatment a. analgesics b. adequate hydration 3. Antivirals typically not needed because of self limited nature of the disease

When would oral antiviral therapy be indicated for patients with herpes simplex?

1. Frequent outbreaks | 2. Moderate to severe cases of primary infection in healthy persons

Herpes Simplex What is a diffuse, pox-like eruption complicating atopic dermatitis; sudden appearance of lesions in typical atopic areas (upper trunk, neck, head); high fever, localized edema, and adenopathy?

Eczema Herpeticum

Herpes Simplex What is a localized infection of an affected finger with intense itching and pain, followed by vesicles that may coalesce with swelling and erythema; mimics pyogenic paronychia; neuralgia and axillary adenopathy are possible and heals within 2-3 weeks?

Herpetic Whitlow

What is a clinical syndrome associated with reactivation of latent varicella zoster virus (VZV), typically occurs years after the primary VZV infection, and can occur at any age in persons previously infected with the varicella zoster virus (chickenpox) ?

Herpes Zoster (shingles)

What percentage of adults in the United States are seropositive for varicella?

Greater than or Equal to 95%

Herpes Zoster is most common in adults how old with age related immune decline?

Over 60

True or False Approximately one-third of people with contract herpes zoster in their lifetime, there is an estimated 1 million cases each year in the US

True

Herpes Zoster Characteristic prodrome may precede rash by __ to __ days; paresthesia with allodynia or hypesthesia described by Pt as a deep burning, throbbing, or stabbing sensation

1 to 5 days

What presents as a typically unilateral dermatomal rash without midline crossing that favors the thoracic, cranial (trigeminal), lumbar, and cervical dermatomes?

Herpes Zoster (shingles)

The rash associated with Herpes Zoster overlaps to adjacent dermatomes reported in what percentage of patients; involvement of noncontiguous dermatomes almost never occurs?

20%

What body rash begins with red macules and papules that progress to clear vesicles within 1-2 days, with new red vesicles forming 3-5 days, the vesicles evolve into pustules within 7 days; ulcerating and crusting of the pustules by day 14? Lesions heal within 2-4 weeks

Herpes Zoster (shingles)

True or False Herpes Zoster The goal of treatment is to limit the extent/duration/severity of pain and rash in the primary dermatome and to prevent the disease elsewhere

True

If a patient with herpes zoster reports in less that 72 hours after the onset what should be done?

Antiviral therapy should be initiated

If a patient with Herpes Zoster reports over 72 hours after the onset what should be done?

1. Antiviral therapy should be initiated if new lesions are still appearing at the time of presentation 2. Minimal benefits of antivirals in patients with lesions that have already encrusted

What is the occurrence of pain for months or years in the same dermatomal distribution that was affected by Herpes Zoster ?

Postherpetic Neuralgia

True or False Acute herpetic neuralgia refers to pain preceding or accompanying the eruption of a rash that persists up to 30 days from its onset

True

True or False Subacute herpetic neuralgia refers to pain that persists beyond healing of the rash but which resolves within four months of onset

True

Postherpetic Neuralgia (PHN) refers to pain persisting beyond how many months from the initial onset of the rash?

Four months

Antivirals reduce the incidence of PHN by what percentage when given within 72 hours of rash onset?

50%

Herpes Zoster Opthalmicus involves the ophthalmic division of what nerve and presents with malaise, fever, headache, and periorbital burning/itching?

Trigeminal nerve

Approximately what percentage of patients with Herpes Zoster Opthalmicus experience direct ocular involvement if antiviral therapy is not used?

50%

Vesicles on the tip/side of the nose precedes the development of HZO is known as what sign?

Hutchinson's Sign

The nasociliary branch of what nerve innervated both the cornea and the lateral dorsum of the nose as well as the tip of the nose?

Trigeminal nerve

What is the disposition for a patient with Herpes Zoster?

1. LLD-based on location, presentation, symptoms, pain management and complications 2. PTs with herpes zoster on the face should be referred to MO for further eval

Warts on the hands and or feet are caused by what?

HPV

What is a group of viruses belonging to the family Papillomaviridae ?

HPV

True or False Infection with HPV occurs by direct skin contact, with maceration or sites of trauma predisposing patients to inoculation

True

What is the incubation period for HPV?

2-6 months

Cutaneous warts caused by HPV may manifest as what?

1. Common warts (verruca vulgaris) 2. Plantar wars (verruca plantaris) 3. Plat (plane) warts (verruca plana) 4. Genital Warts

What are the common sites for common warts (verruca vulgaris) ?

1. Hands 2. Periungal skin 3. Elbows 4. Knees 5. Plantar surfaces

What warts are slightly elevated and flat topped, vary in size from 0.1-0.3 cm, may be few or numerous and often occur group or in a line as a result of spread from scratching?

Flat (plane) warts

What are the typical locations for Flat (plane) warts?

1. Forehead 2. Back of the hands 3. Chin 4. Neck 5. Legs

What warts are caused by an HPV infection on the plantar foot?

Plantar warts

A cluster of many warts is called what?

Mosaic wart

What helps discriminate plantar warts from a callus or corn?

Black dots (thrombosed capillaries)

What are the treatment options for warts?

1. PT education a. may resolve on its own, discuss this with patient 2. Salicylic acid a. terrible compliance 3. Cryotherapy a. painful 4. Duct tape application a. looks unprofessional

True or False The terms "dermatitis" and "eczema" are frequently used interchangeably

True

True or False "eczematous" also connotes some scaling, crusting, or serous oozing as opposed to mere erythema

True

What is an erythematous, pruiritic skin reaction caused by contact with exogenous agents?

Contact dermatitis

What is a non-immunologic reaction to substance or action producing direct damage to skin by chemical abrasion or physical irritation?

Irritant Contact Dermatitis

What are some causes of Irritant Contact Dermatitis?

1. Chemical agents 2. alcohol 3. creams 4. powders 5. moisture 6. friction 7. temperature extremes

What form of dermatitis is due to a delayed immunologic response (type IV hypersensitivity) to a cutaneous or systemic exposure to an allergen to which the patient has been previously sensitized; usually has a latency period of 12-48 hours between exposure and the onset of dermatitis?

Allergic contact dermatitis

What are the most common causes of allergic contact dermatitis in the US?

1. Poison ivy 2. Poison sumac 3. Poison oak

What is the most common cause of metal dermatitis and a common cause of allergic contact dermatitis?

Nickel

What form of dermatitis presents with erythema, dryness, painful cracking or fissuring and scaling with vesicles, may show juicy papules and/or vesicles on an erythematous patchy back ground with weeping and edema; hands are most often affected?

Irritant Dermatitis

What is the treatment for irritant dermatitis?

1. Medium or high potency topical steroids 2. Antihistamines 3. Frequent application of a bland emollient to affected skin is essential

What form of dermatitis is characterized by vesicles, edema, redness, and extreme pruritis, distribution is first confined to the area of direct exposure, itching and swelling are the key component of the history with the itch predominating the burning sensation?

Allergic Contact Dermatitis

What are the most common sites for Allergic Contact Dermatitis?

1. Hands 2. Forearms 3. Face

What is the treatment for Allergic Contact Dermatitis?

1. Identification and avoidance of allergenic substances 2. Topical treatment using topical corticosteroids 3. Discontinue all moisturizers, lotions, and topical products 4. Topical class I-II glucocorticoid preparations 5. Pt education

What is a chronic, superficial, recurrent inflammatory rash affecting sebum rich, hairy regions of the body, especially the scalp, eyebrows, and face?

Seborrheic Dermatitis (dandruff)

What is the prevalence of Seborrheic Dermatitis (dandruff) ?

3-5%

What form of dermatitis has Intermittent active phases with burning, scaling, and itching, alternating with inactive periods; activity is increased in winter and early spring, with remissions commonly occurring in summer?

Seborrheic Dermatitis (Dandruff)

What form of dermatitis has the following presentations? 1. Red, greasy, scaling rash in most locations consisting of patches and plaques with indistinct margins 2. Red, smooth, glazed appearance in skin folds 3. Mild pruritis 4. Chronic waxing and waning course 5. Bilateral and symmetrical

Seborrheic Dermatitis (Dandruff)

What is the treatment for Seborrheic Dermatitis (Dandruff)?

1. Control symptoms 2. can be treated with shampoos such as: a. Zinc pyrithione (head and shoulders) b. Selenium Sulfide (Selsun blue) c. Ketoconazole (Nizoral) d. Salicylic Acid (T/Sal) e. Coal tar (T/gel)

What is a chronic, inflammatory disorder most commonly characterized by cutaneous erythematous plaques with silvery scales?

Psoriasis

What is a complex immune-mediated disorder associated with flares related to systemic, psychological, infectious, and environmental factors?

Psoriasis

What is the most common variant of of Psoriasis accounting for about 80% of cases?

Plaque (vulgaris)

What percentage of patients with psoriasis have a first degree relative with the disorder?

40%

What skin disorder presents with a well-demarcated salmon pink-to-red erythematous papules and plaques, silvery scales and the distribution favors the scalp, auricular conchal bowls, post auricular areas, extensor surface of the extremities, especially the knees and elbows, the umbilicus, lower back intergluteal cleft and nails?

Plaque Psoriasis

What are some nail findings you would see with Plaque Psoriasis?

1. Pitting 2. Oil spots 3. Onycholysis

What is Auspitz sign?

Pinpoint bleeding with removal of a scale

New psoriatic lesions arising at sites of skin injury/trauma is known as what?

Koebner phenomenon

Genitals are affected in what percentage of patients with plaque psoriasis?

40%

What is the treatment for plaque psoriasis?

1. Topical a. medium potency corticosteroids daily 2. Systemic therapy a. complicated and managed by derm 3. Phototherapy (light box therapy)

Where should patients with plaque psoriasis be referred to for further evaluation and definitive treatment?

Dermatology

What is a disorder of the pilosebaceous units that is notable for open/closed comedones, papules, pustules, and nodules?

Acne

The predominant age of acne is early to late puberty, and may persist in ___% to ___% of affected individuals into the 4th decade of life

20%-40%

What percentage of adolescents are affected by acne?

80%-95%

Open comedones are known as what?

Blackheads

Closed comedones are known as what?

White heads

What is the treatment for comedonal (non-inflammatory) acne?

Topical retinoid

What is the treatment for mild comedonal + papulopustular acne?

1. Topical antimicrobial (BP alone or BP + topical antibiotic) 2. Topical retinoid OR 3. Topical antimicrobial 4. Topical antibiotics (patients who cant tolerate retinoids)

What is the treatment for moderate papulopustular and mixed acne?

1. Topical retinoid 2. Oral antibiotic 3. Topical benzoyl peroxide

What is the treatment for severe acne (nodulocystic acne)?

Oral isotretinoin monotherapy

Topical antibiotics for acne reduce the numbers of what in the sebaceous follicles?

C. acnes

What are the most common topical antibiotics used for the treatment of acne?

Erythromycin and Clindamycin

Should topical antibiotics alone be used for acne?

No, should not be used as monotherapy. Use with BP to decrease the occurrence of bacterial resistance

What is indicated for moderate to severe inflammatory acne and forms of inflammatory acne that are resistant to topical treatment?

Oral acne treatments

What are the most frequently used oral antibiotics for acne therapy?

1. Doxy 2. Minocycline 3. Oral isotretinoin (accutane)

True or False Isotretinoin is a teratogen with a very high risk for severe birth defects if taken during pregnancy in any amount, even for a short period of time.

TRUUUUUUUUUUEEEEE

True or False Isotretinoin can only be prescribed by clinicians who participate in a special restricted distribution program (iPLEDGE).

Truuuee

What is known as an abscess, or sinus tract, in the upper part of the natal (gluteal) cleft?

Pilonidal Abscess

What does the word pilonidal mean?

Nest of hair

True or False In asymptomatic pilonidal disease, there is no acute inflammation or infection

True

The following is the common clinical presentation of what? Sudden onset of mild-to-severe pain in the intergluteal region while sitting or stretching the skin overlying the natal cleft +/- swelling with mucoid, purulent, and/or bloody drainage in the area.

Acute pilonidal abscess

What is the most common cause of an acute pilonidal abscess?

Staph

The clinical hallmark for what is a tender, swollen, and fluctuant nodule located along the superior gluteal fold?

Acute pilonidal abscess

Should patients with an asymptomatic pilonidal abscess be referred to surgery?

Probably not homie

How is an acute pilonidal abscess managed?

Prompt incision and drainage at the time of presentation

What is active hair growth, 80-85% of hairs are in this stage at a given time?

Anagen (growth) phase

What phase of hair growth is when hair growth stops due to the papilla detaching (removing blood supply), 1-3% of hairs are in this stage at a given time?

Catagen (transitional) phase

What phase hair development is when its in its resting phase for 1-4 months, up to 10-15% of hairs in the normal scalp, hair is no longer connected to anything but the follicle?

Telogen (resting)

What phase of hair development is in the late telogen phase, the follicle begins to grow again and the hair base breaks free from the root and it is shed, about 2 weeks, new hair shaft begins to emerge?

Exogen (shedding)

True or False Alopecia = hair loss

True as fuck yall

____ may occur due to damage of hair cycling, inflammatory conditions that damage hair follicles, or inherited or acquired abnormalities in hair shafts

Hair loss

Alopecia is divided into what two forms?

Scarring and non-scarring

Present Follicular markings suggest what form of alopecia?

Non-scarring

Absent follicular markings suggest what form of alopecia?

Scarring

Non-scarring alopecia occurs due to something else IN the body such as?

1. Systemic diseases 2. endocrine disorders 3. Vitamin deficiencies 4. malnutrition

What is the most common form of male hair loss affecting 30-50% of men by age 50?

Androgenic alopecia (AKA male pattern baldness)

Androgenic alopecia (male pattern baldness) Familial tendency, racial variation, and heredity account for __% of predisposition, with MAA genes being inherited from both parents

80%

What form of alopecia is believed to be an immunologic process, the patches are perfectly smooth and without scarring, involvement may extend to all of the scalp hair (alopecia totalis) or to all scalp and body hair (alopecia universalis)?

Alopecia Areata

What is know as temporary hair loss that usually happens after stress, a shock, or a traumatic event, usually occurs on the top of the scalp?

Telogen Effluvium

True or False Cicitricial alopecia may occur following any type of trauma or inflammation that may scar hair follicles

True

What is an acute, delayed, and transient inflammatory response of the skin secondary to excessive exposure to Ultraviolet radiation (UVR)?

Sun burn

True or False Sun burn Depending on the frequency and exposure time, damage can be caused to melanocytes and keratinocytes

True

Sun burn Erythema is usually first noted 3 to 5 hours following sunlight exposure, peaks at ___ to ___ hours, and in most cases subsides at ___hours

1. 12-24 hours | 2. 72 hours

Sun Burn What is a rare, IgE mediated, photodermatosis characterized by pruritis, stinging, erythema, and wheal formation after exposure to sunlight?

Solar urticarial

What are some good prevention methods for sun burn?

1. Sun avoidance 2. Protective clothing (SPF 50+) 3. Broad spectrum sunscreens (UVA & UVB w/ SPF 30+) 4. Counsel patients

True or False SPF measures the UV radiation required to produce sunburn on protected skin (with sunscreen) relative to UV radiation is required to produce sunburn on unprotected skin (no sunscreen).

True

What are some symptomatic treatments of sunburn?

1. Cool compresses or soaks 2. calamine lotion 3. aloe vera 4. NSAIDS

What is causesd by lateral pressure of poorly fitting shoes, by improper or excessive trimming of the lateral nail plate or by trauma?

Ingrown nail

What is the toe that is virtually the only toe involved in ingrown nails?

Great toe

What is the treatment for an ingrown nail?

1. removal of the penetrated nail | 2. curetting granulation tissue (treated w/ silver nitrate)

What is the most common of all injuries to the upper extremities; typically results from a direct blow to the fingernail or a squeezing type injury to the distal finger?

Subungual Hematoma

The bleeding associated with a subungual hematoma may cause what?

onycholysis (separation of the nail)

True or False Subungual hematoma Treatment consists of evacuation of the hematoma via trephination of the nail

True

What is the most common acquired benign epithelial tumor of the skin and is often mistaken for Melanoma?

Seborrheic Keratoses

What is the general age that Seborrheic Keratoses develops in?

After the age of 50

The following is the clinical presentation of what? 1. Usually multiple lesions, can arise anywhere except the lips, palms and soles 2. begin as circumscribed tan brown patches or thin plaques 3. over time become more popular or verrucous with a greasy scale and a waxy stuck on appearance

Seborrheic Keratoses

True or False Because seborrheic keratoses are benign and slow-growing lesions, treatment is generally not required. However, lesions that are symptomatic or that cause cosmetic concerns can be consulted to dermatology.

True

What are some treatments for Seborrheic Keratoses?

1. Cryotherapy 2. Curettage/shave excision 3. Electrodessication

What results from the proliferation of atypical epidermal keratinocytes?

Actinic Keratosis (AKA solar keratosis)

What represents early lesions on a continuum with squamous cell carcinoma (SCC) and occasionally progresses to SCC?

Actinic Keratoses

Where does Actinic Keratoses usually occur?

Sun exposed areas

What are some risk factors for Actinic Keratoses?

1. Extensive sun exposure 2. Hx of sunburns 3. Sunscreen use 4. Fair skin

Actinic keratoses are commonly described as having what feeling and appearance?

“rough, sandpaper-like”, thicker and more yellow in color as it progresses

After referral to dermatology, what is the prescribed treatment for a patient with Actinic Keratoses?

1. Topical 5-fluorouracil 5% cream (Efudex) 2. Imiquimod 5% cream 3. Electrodessication & curettage 4. Application of liquid nitrogen (cryotherapy)

What is a malignant tumor arising from melanocytic cells and hence can occur anywhere these cells are found (anywhere on the body)?

Melanoma

What is the most fatal form of skin cancer?

Melanoma

The lesion associated with what will be the “ugly duckling”, and different than the other nevi on the body showing things such as: 1. Asymmetrical 2. Irregular borders 3. Color changes 4. Diameter >6mm 5. Evolving

Melanoma

What is the treatment for melanoma that the IDC can perform?

- NOTHING! Outside the scope of practice for the IDC - Refer all suspected lesions to MO and Biopsy - Palpate regional lymph nodes and document findings

What phase of wound healing is days 0-5 and there is no gain in wound strength?

Phase 1: initial lag phase

What phase of wound healing is days 5-14 and there is a rapid increase in wound strength, at week two the wound has achieved only 7% of its final strength?

Phase 2: Fibroplasia phase

What phase of wound healing is about day 14 until the healing is complete, further connective tissue remodeling, and up to 80% of normal skin strength is achieved?

Phase 3: Final Maturation phase

What are some contraindications for wound repair?

1. Wounds more than 12 hours old (>24hrs old on the face) 2. Animal or human bite wounds 3. Puncture wounds

What are the four principles that should be incorporated in the process of closing any wound?

1. Control all bleeding before closure 2. Eliminate “dead space” 3. Accurately approximate tissue layers 4. Approximate the wound with minimal skin tension

What sutuing technique should be as wide as it is deep, sutures with this technique need to be no closer than 2mm in a fine plastic closure, and this stitch is ideal in the scalp?

Simple interrupted sutures

True or False Suturing techniques The advantages of the simple running stich in sterile would under little or no tension are that it is quick and distributes tension evenly and provides excellent cosmetic results

True

What suturing technique is less desirable in traumatic laceration because of the increased risk for contamination?

Simple running stitch

What suturing technique promotes eversion of the skin edges, and it is useful when the natural tendency of loose skin is to create inversion of the wound margins, which is to be avoided, this suture is also appropriate when the skin is very thin and interrupted sutures have a tendency to pull through?

Vertical mattress sutures

What suturing technique is helpful in wounds under a moderate amount of tension, also promotes wound edge eversion, especially on the palms of the hands or soles of the feet and in patients who are poor candidates for deep sutures because of susceptibility to wound infections?

Horizontal mattress sutures

Skin staples provide a rapid and simple alternative to other methods of skin closure and wound repair; and are indicated for what?

1. Wounds whose edges are easily approximated and not under undue tension 2. Long, linear wound of the scalp 3. proximal extremities of the torso where cosmesis is not a

When are skin staples contraindicated?

1. facial or neck tissue 2. areas where there is an inadequate subcutaneous base 3. over small mobile joints or any other location where the staples may interfere with normal function 4. wounds that are macerated/infected or over areas of large tissue loss

CLINICAL CARE OF THE SKIN, HAIR AND NAILS Flashcards

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