Derm Flashcards by Hailey Baldwin

Condyloma acuminata

are soft, fleshy warts that are caused by the HPV. Cervical dysplasia and carcinoma in situ are likely caused by types 16, 18, 31, 33, and 34

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erythematous, scaly, nontender nodule on his left lower lip. There are no surrounding telangiectasias. The nodule is firm, ill-defined, and fixed to the underlying tissue

Squamous cell carcinoma

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If you push on a Hemangiomata if will?

blanch under pressure

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___________ are precursors to squamous cell carcinoma

Actinic keratoses (AK)

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difference between tinea capitis and alopecia areata

alopecia areata has round sharply demarcated patches of hair loss. Tinea Capitis is scaly and painful, less demarcated.

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Secondary syphilis hair findings

moth eaten

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What type of ulcer is associated with DM?

Neurotropic

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Name the rule of 9s for burn victims

9(neck/head)9(upper anterior torso)9(lower posterior torso)9(lower anterior torso)9(upper anterior torso)9(each arm)9(anterior leg) 9(posterior leg) 1(genital)

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bites from what spider can cause bites can lead to necrosis of the skin, destruction of red blood cells, blood clot formation, acute renal failure, coma, and death.

Brown recluse

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2 most common bugs of cellulitis

strep A and staph A

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Neonates: cellulitis most common bug

Group B Strep

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US finding of cellulitis

cobblestone

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Erysipelas

Superficial bacterial skin infection that involves lymphatics
● Classically on face, common on leg

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most common bug of Erysipelas

strep progenies, treat for strep. raise border

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Impetigo bugs

Staph aureus predominantly, also strep pyogenes

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tx Impetigo

Mupirocin ointment
● Avoid scratching (can self inoculate)
● Oral abx: for more severe cases (dicloxacillin, cephalexin (MSSA), TMP/SMX, clindamycin (MRSA)

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tx of acne

Tx: topical retinoids, benzoyl peroxide, oral abx (tetracyclines), OCPs (decreased
androgen levels), oral isotretinoin (teratogenic).

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When on isotretinoin, MUST be on

OCPs simultaneously due to potential teratogenic effects.

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tx for rosacea

Tx: avoid triggers (hot beverages, Ethanol, sunlight)
○ Hydrocortisone topical
○ Metronidazole topical

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which one is worse and has oral lesions? Bullous pemphigoid or Pemphigus vulgarism

Pemphigus vulgarismtx

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low down on Bullous pemphigoid

● Low mortality (“not so bad”)
● Elderly
● Negative Nikolsky sign
● Tense bullae
● Rarely oral lesions
● Treatment: stop offending drug, topical/oral steroids

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name 3 disorder with positive Nikolsky sign

Pemphigus vulgaris, SSSS, Toxic epidermal necrolysis

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tx of Pemphigus vulgaris

Treatment: treatment similar to burns, systemic steroids, immunomodulators

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● High mortality (“bad”)
● Younger
● Positive Nikolsky sign
● Flaccid bullae
● Oral lesions
●

of Pemphigus vulgaris

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Desquamation (AKA: skin sloughing) 3 disorders

Erythema multiforme “minor, Stevens-Johnson syndrome, | Toxic epidermal necrolysis.

Target lesions, Palms and soles, then moves centrally ● Causes: Herpes simplex and Mycoplasma pneumonia ONLY ON SKIN

Erythema multiforme “minor

tx of Erythema multiforme “minor

acyclovir,

Severe immune-complex mediated hypersensitivity ● MUCOUS membranes ● Systemic symptoms ●

Stevens-Johnson syndrome

causes of Stevens-Johnson syndrome

o Antibiotics (PCN, Sulpha) o Antiepileptics o NSAIDs

Tx of steven johnson syndrome

● Treatment: remove cause, treat similar to burns

● Severe form of Stevens-Johnson syndrome ● Histology: dermal-epidermal cleavage ● >30% body surface area ( larger involvement than Steven john sons syndrome) dermal cleavage (external vs.. internal layers of the skin

Toxic epidermal necrolysis

● Treatment of toxic epidermal necrolysis

Burns ICU, supportive, IV immunoglobulin

steven johnson of the eye

can go blind must see ophthalmologist (acute care)

Lichen simplex chronicus

Firm, thick plaques ● Secondary to pruritis ● Lichenification ● Treatment: topical steroids

Pityriasis rosea is from what herpes family

Human herpesvirus 7

Symptom progression: 1-Viral prodrome, 2-Herald patch, 3-“Christmas Tree” ● Round, oval salmon-colored maculopapular rash

Pityriasis rosea

raised scaly rashes: Papulosquamous diseases

Psoriasis, Pityriasis rosea, Psoriatic arthritis,Lichen planus, Fixed drug eruption, Dermatophyte (fungal) infection & secondary syphilis

``` Distal IP polyarthritis ● Pitting of finger nails ● Pathology: HLA B27 positive (iritis, sacroiliitis, inflammatory bowel disease) ● Treatment: o systemic steroids ```

Psoriatic arthritis

``` Pruritic o Planar o Purple o Polygonal o Papules (“violaceous papules”) ```

``` Lichen planus (this is immune related) Wrist, ankles, legs and MOUTH (white linear line inside cheek) ```

Actinic keratosis or Seborrheic keratosis can cause CA?

ACTINIC KERATOSIS

horrible DIP joints and skin issues (pencil cup)

psoratic arthritis (give strong immunosuppressant drugs)

Seborrheic keratosis describe

flat warty brown

androgenic alopecia

male patterned baldness

Paronychia tx

I & D

treatment for lice

``` Primarily topical o Permethrin (Elimite®, Nix®) o Pyrethroids (A200®, RID®) o Malathion (Ovide®) o Lindane (Kwell®) ⇒ too toxic ⇒ seizure ● Oral Ivermectin - for severe cases ```

dx scabies

Light microscopy of skin scrapings | ● CBC

tx for bed bugs

Treatment is supportive ○ Antipyretics, antibiotics if infection ● Eradication with insecticides ● New mattresses, etc

Africanized Bees | ● “Killer” bees may result in?

May result in: ○ Hemolysis ○ Rhabdomyolysis ○ Acute renal failure

localized, Most common, Death rare because usually, pearly, rolled edges

BCC

Exanthems think

viral or drug rash

Primarily head, neck, and oral ● Actinic keratosis is a precancerous lesion that can precede this ● Clinically: scaling, crusting, telangiectasia, raised nodule or shallow ulcer, firm, slow growing, may bleed

SCC

``` A: B: C: D: how many mm E: of skin cancer ```

``` asymmetry (irregular) borders (variation in) coloration diameter >6mm evolution in lesions ```

Connective tissue tumor, predominantly in HIV and immunosuppressed ● HHV-8 causative ● Usually cutaneous but also in other organs ● Clinically: on skin it is purple-red-blue papules, painless, non-pruritic

Kaposi sarcoma

Common viral disease of the skin ● Poxvirus ● Discrete, flesh colored, waxy, dome shaped umbilicated papules

Molluscum contagiosum

Molluscum contagiosum tx

self limiting

Verrucae (bad HPV numbers)

warts 16,18

Vitiligo

Associated with autoimmune endocrine disease destruction of melanocytes

what are worse Alkali or acid burns

Alkali more severe than acid

urticara is _____ mediated by

IgE

stage I-IV pressure ulcers

Stage I: non-blanching erythema Stage II: necrosis, superficial, partial thickness Stage III: deep necrosis, crater ulcer with full thickness skin loss Stage IV: FULL thickness

chloasma / Melasma

sun damage

Hidradenitis suppurativa

Disease of apocrine sweat glands

Tinea Versicolor / Pityriasis versicolor bug

Malassezia furfur

Tinea Versicolor tx

selenium sulfide shampoo

Dermatophyte tx

Itraconazole – careful with liver dz | o Terbinafine

Which of the following is the most common complication associated with Herpes Zoster infection?

Post-herpetic neuralgia

Where is Atopic Dermatitis usually found in infants and young children?

Antecubital and popliteal fossa

A 7 year old girl is brought to your clinic because for the last 5 days she has had a slight fever, sore throat, and abdominal pain. This morning, however, she developed a rash on her cheeks. Physical exam shows a brightly erythematous rash across both cheeks, and a lacy rash on both arms. Given this patient’s most likely diagnosis, what is the causative organisms?

This patient most likely has Erythema infectiosum, for which the most common causative agent is Parvovirus B19.

A 23 year old female with history of anxiety and depression presents to your office because of an itchy rash on her abdomen that she has had for years some evidence of excoriation, but no telangiectasias, or signs of infection. Which of the following is the most likely diagnosis

Lichenified plaques due to chronic scratching, especially in someone with a nervous habit (due to anxiety) leads to lichen simplex chronicus.

what is hydoxyzine

Hydroxyzine or another H1 receptor blocking agent is the treatment of choice in Urticaria. Other agents may be added if the patient is still having symptoms (corticosteroids, H2 receptor blockers, doxepin, etc)

What is the different between diagnosis of Hansen’s disease instead of vitiligo?

The loss of sensation at the areas of depigmentation should increase your suspicion of leprosy (Hansen’s disease).

What is the most common location affected by erysipelas?

the legs

A 63 year old man presents complaining of discoloration and scaling on the top of his head. Physical exam reveals a bald male with various erythematous papules and scaly plaques covering the majority of the scalp. Lesions are rough to palpation. Which of the following is the treatment of choice in this condition?

Topical 5-Fluorouracil cream would be the treatment of choice in this patient with Actinic Keratosis. Since his lesions are widespread over the scalp, cryotherapy or excision are unreasonable treatment options at this time.

What is the most common location affected by erysipelas?

legs

what is potassium hydroxide preparation?

KOH prep