Derm Flashcards
1
Q
Mild acne treatment
A
Benzoyl peroxide and salicylic acid cleansing
Topical retinoids for comedones (Tretinoin, Adapalene/Differin)
Antimicrobials (clindamycin, erythromycin)
2
Q
Moderate acne treatment
A
Oral abx for max 12 weeks (tetracycline/minocycline/doxycycline)
Hormones (OCP)
Spironolactone (Aldactone)
3
Q
Severe acne treatment
A
Isotretinoin (accutane, clarus, epuris)
Monotherapy
*Make sure pt is not pregnant
**Pt should be on 2 forms of birth control while on isotretinoin
4
Q
Alopecia areata
A
AI dz: T cell lymphocytes cluster around germinative zones of hair follicles –> inflammation –> hair loss
Hair follicles still alive
5
Q
Alopecia areata tx
A
Topical minoxidil = vasodilator
Topical anthralin
Cortisone or triamcinilone actonide injections
Oral steroid
6
Q
Contact dermatitis tx
A
If >20% affected –> oral prenisone
Topical corticosteroids = first line for localized allergic contact dermatitis (topical triamcinolone)
7
Q
Bulla
A
Fluid-filled blister >0.5cm in diameter
8
Q
Vesicle
A
Fluid-filled blister <0.5cm indiameter
9
Q
Furuncle
A
Purulent infected hair follicle
10
Q
Pustule
A
Visible collection of pus in skin <1cm in diameter
11
Q
Abscess
A
Localized collection of pus in a cavity >1cm in diameter
12
Q
Nodule
A
Circumscribed palpable mass >0.5cm diameter
13
Q
Plaque
A
Flat topped palpable mass which is >1cm in diameter
14
Q
Macule
A
Circumscribed area of altered skin colour without elevation <1cm in diameter
15
Q
Patch
A
Circumscribed area of altered skin colour without elevation >1cm in diameter
16
Q
Telengiectasia
A
Visible dilatation of small cutaneous blood vessels
17
Q
Petechia
A
Purpuric lesion of 2mm or less in diameter
18
Q
Ecchymosis
A
Large purpuric lesion
19
Q
Most common causes of erythematous perianal rashes in neonates
A
Irritant diaper dermatitis
Seborrheic dermatitis
Candida diaper dermatitis
20
Q
Carbuncle
A
Painful cluster of boils
21
Q
Melanoma dx
A
Excisional bx
Try to take it all if possible but if not take darkest portion
22
Q
Melanoma tx
A
Wide excision with adequate margins
Sentinel LN biopsy
Systemic therapy if stage III or IV
23
Q
Adequate margins for melanoma
A
In situ –> 0.5cm margins
= 1 mm –> 1cm margins
1.01 - 2mm –> 1-2 cm margins
>2.01 mm –> usually 2cm margin
24
Q
Acute urticaria time frame
A
<6wks
25
Chronic urticaria time frame
>/= 6 wks
26
Primary inflammatory cells of urticaria
Mast cells and basophils
27
Usual medications that can cause urticaria
Antibiotics (penicillins, cephalosporins), NSAIDs
28
Most common cause of chronic urticaria
Dermatographism
29
Bullous pemphigoid
Most common AI subepidermal blistering disorder
Common in elderly pt >60yo
Tx: Superpotent topical steroid or immunomodulators, if systemic required - tetracycline abx, systemic corticosteroid, azathioprine, MTX, mycophenolate
30
Scabies tx
Permithrin 5% from neck down with 2 treatments spaced 1 wk apart
31
Acute Urticaria tx
1st line: antihistamines (diphenhydramine, hydroxyzine, cetirizine)
32
Chronic urticaria tx
ANtihistamines (2nd generation as first line - ie. cetirizine, desloratadine, loratadine) 1 pill daily for at least a week
2nd line: omalizumab
3rd line: cyclosporin, montelukast, MTX
Avoid systemic steroids if you can
33
Corns vs warts vs calluses
Corns are painful with direct pressure, interrupt dermatoglyphics
Warts bleed with paring, black speckled apperance due to thrombosed capillaries, destory dermatoglyphics
Calluses have layers, no thrombosed capillaries or interruption of epidermal ridges
34
Corn treatment
Relieve pressure in shoes
| Topical salicylic acid
35
Junctional nevus
Flat, regular borders, demarcated
Tan-dark brown
Form from melanocytes at dermal-epidermal junction
36
Compound nevus
```
Often formed from junctional
Tan-dark brown
Domed, regularly bordered, smooth, round
NOT on palms or soles
Form from melanocytes at dermal-epidermal junction that migrate into dermis
```
37
Dermal nervus
Soft, dome-shaped, skin coloured to tan/browm
| Form from melanocytes exclusively in dermis
38
Perioral dermatitis tx
AVOID all topical steroids
Topical metronidazole 0.75% gel or 0.75-1% cream to affected area BID
Systemic tetracyline abx
39
Rosacea tx 1st line
```
Oral tetracyclines
Topical metronidazole
Oral erythromycin
Topical azelaic acid
Topical ivermectin
AVOID topical steroids
Avoid triggers
```
40
Tacrolimus and Pimecrolimus are types of...
Topical calcineurin inhibitors
Good for steroid-sparing agent
Can be used on face and neck
41
Seborrheic dermatitis tx
Possibly associated with Malassezia (yeast)
Ketonozaole or mold steroid to face
Salicylic acid in olive oil or derma-smoothe lotion to remove scales on scalp, ketoconazole shampoo, head and shoulders (zinc pyrithione), steroid lotion (betamethasone)
42
6Ps of Lichen planus
```
Purple
Pruritic
Polygonal
Peripheral
Papules
Penis (60% in mouth, vulva, glans - mucous membranes)
```
43
Pathognomonic sign of lichen planus
Wickham's striae (white/grey lines over surface)
44
Pityriasis rosea
Christmas tree pattern on back
Herald patch preceding other lesions by 1-2wks
Suspected caused by HHV-6 or HHV-7 reactivation
No tx required
Clears spontaneously in 6-12wk
45
Psoriasis tx
Topical steroids +/- topical vitamin D3 analogues (ie.Calcipotriol/Dovobet)
If severe, consider UVB or PUVA phototherapy or systemic biologic therapy
46
Guttate psoriasis often caused by...
Streptococcal pharyngitis
47
Pemphigus vulgaris vs bullous pemphigoid
```
VulgariS = Superficial, intraepidermal, flaccid lesions
PemphigoiD = Deeper, tense lesions at dermal, epidermal junction
```
48
Nibolsky's sign
Epidermal detachment with shear stress
49
Asboe-Hansen sign
Pressure applied to bulla causes it to extend laterally
50
Pemphigus vulgaris
AI blistering disease most commonly in mouth
IgG against epidermal desmoglein -1 and -3 leading to loss of intracellular adhesion in epidermis
Tx: Prednisone +/- steroid sparing agents (ie. azathioprine, cyclophosphamide, cyclopsorine)
51
Celiac disease often a/w this skin condition
Dermatitis Herpetiformis
52
Dermatitis herpetiformis
Transglutaminase IgA deposits in skin alone or in immune complexes leading to eosinophil and neutrophil infiltration
Grouped papules/vesicles/urticarai on erythematous base
Tx: Dapsone, gluten free diet for life (reduce risk of lymphoma)
53
Common causative agents for exanthematous drug reaction
Penicillin
Sulfonamides
Phenytoin
54
Drug reaction with Eosinophilia and Systemic Symptoms (DRESS)
Starts with face or periorbitally and spreads caudally
No mucosal involvement
Onset 1-6wk after first exposure to drug
Persists wks after withdrawal of drug
Common culprits: Anticonvulsants, allopurinol, sulfonamides
Tx: D/C drug, prednisone, consider cyclosporine in severe cases
55
Steven Johnson Syndrome
Epidermal detachment BSA <10%
56
Toxic epidermal Necrolysis
Epidermal detachment BSA >30%
57
Gene a/w SJS/TENS with carbamazepine
HLA-B1502
58
Gene a/w SJS/TENS with allopurinol
HLA-B5801
59
Common causative agents for SJS/TENS
```
Anticonvulsants
Sulfonamides
Allopurinol
NSAIDs
Cephalosporins
Can also be caused by viral or mycoplasma infections
```
60
Neurofibromatosis inheritance pattern
Autosomal dominant
61
AI diseases linked to vitiligo
Thyroid
Pernicious anemia
Addison's disease
Type I DM
62
Treatment of vitiligo
Sun avoidance
Topical calcineurin inhibitor or topical corticosteroids
PUVA or NB-UVB
63
Impetigo cause
GAS, S. aureus or both
64
Tx of Impetigo
```
Topical antibacterials (2% mupirocin or fusidic acid TID for 7-10d only)
Systemic abx (ie. cloxacillin or cephalexin for 7-10d)
```
65
Erysipelas tx
1st line = Penicillin, cloxacillin or cefazolin
| 2nd line = clindamycin or cephalexin
66
Common tx for DM foot infections
TMP/SMX and metronidazole
67
Tinea capitis tx
Terbinafine PO x 4wk
Oral agents required to penetrate hair root where dermatophyte resides
Adjunctive antifungal shampoos or lotions may be helpful
68
Onychomychosis tx
Terbinafine or Intraconazole PO 6wk for fingernails, 12wk for toenails for SEVERE onychomycosis (Itraconazole should not be used with statins, terbinafine should not be used with SSRI)
Mild to moderate: topical efinaconazole
69
Lice tx
Permethrin 1%, repeat in 1wk after tx
70
HSV-1
Typically cold sores
Tx during prodrome to prevent vesicle formation
Topical antiviral cream, oral antivirals are more effective
71
HSV-2
Usually sexually transmitted
| 1st episode: Acyclovir 200mg PO 5x/d x 10d, maintenance acyclovir 400mg PO BID
72
HSV smear
Tzanck smear
73
Hutchinson's sign
Shingles on tip of nose signifies ocular involvement
| Shingles in this area involves V1 (ophthalmic branch of trigeminal nerve)
74
Mollascum contagiosum tx
Topical cantharidin
75
Candidal paronychia tx
Oral antifungals recommended
76
Topical therapies for actinic keratosis
5-fluorouracil cream for 2-4wks
| Imiquimod
77
Most common oral mucosal premalignant lesion
Leukoplakia
78
Basal cell carcinoma
Rarely metastatic
Most common malignancy
Tx: Imiquimoid 5% cream, cryotherapy, fluorouracil, photodynamic t herapy for superficial
Shave excision, electrodessication for most types of BCCs
LOCAL excision (<1cm margin, wide excision not necessary)
Mohs surgery
79
Squamous cell carcinoma tx
Surgical excision with primary closure, Mohs
Lifelong follow-up
+/- radiation (higher rates of mets if >2cm in diameter, >4mm deep)
80
Melanoma treatment
Excision (full depth of dermis) + margins AFTER histologic dx
High dose IFN for stage II
Chemotherapy and high dose IFN for stage III
Node dissection if Stage IB or higher (if 0.8mm or thicker)
Increased rate of mets in melanoma
81
Growth stage of hair growth
Anagen phase
82
Transitional stage of hair growth
Catagen stage
83
Resting stage of hair growth
Telogen phase
84
Androgenetic alopecia tx
Minoxidil (Rogaine)
Spironolactone (in females)
Cyproterone acetate in females (Diane 35)
Finasteride (5-alpha-reductase inhibitor)
85
Type of hair loss from chemotherapy
Anagen effluvium
86
Type of hair loss from stress
Telogen effluvium
87
Scarring alopecia
Irreversible loss of hair follicles with fibrosis
| Always requires biopsy
88
Erythema Nodosum
```
Acute or chronic inflammation of subctuaneous fat
DDx: NODOSUMM
No cause
Drugs (sulfa, OCP)
Other infxns (GAS, TB)
Sarcoidosis
UC < CD
Malignancy (leukemia, Hodkin's lymphoma)
Many infxns
```
89
Most common type of melanoma
Superficial spreading
90
3 most important determinant of prognosis of melanoma
Tumour thickness
Histologic ulceration
Mitotic rate
91
Onychomycosis
Most commonly caused by dermatophytes (specifically Trochiphyton rubrum)
92
Paronychia
Nail fold infection
Commonly caused by Staph aureus or Strep pyogenes
Tx: Topical Gentamycin
93
Acute radiation dermatitis
Moist desquamation
Can occur acutely, late or "radiation recall"/months-years after
Improved by using intensity modulated radiation therapy (allows maximum focus on tumour while minimizing radiation to surrounding tissues)
