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Dermatology > Derm ClinMed > Flashcards

Derm ClinMed Flashcards

Dermatology

1
Q

Overproduction of skin cells and sebum (natural oil) greasy scales on scalp, face, mid upper chest, dandruff is a mild case of this

A

Seborrheic Dermatitis (slide 43)

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2
Q

What are the causes for seborrheic dermatitis?

A

Not completely clear There is an overgrowth of skin fungus, yeast. Fungus causing redness and flaking or flaking allowing overgrowth of fungus

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3
Q

Seborrheic dermatitis, where is it seen? what is the treatment in infants (cradle cap)?

A

Most commonly scalp. Seen face, ears, neck and diaper area Usually resolves without treatment Can treat with shampooing frequently with baby shampoo and soft toothbrush. White petroleum or mineral oil overnight to loosen scales then toothbrush

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4
Q

Treatment for sebhorrheic dermatitis in adults?

A

Low potency corticosteroids and/or 2% ketoconazole cream Sulfa-based products, less acceptable cosmetically Shampoos containing tar, selenium sulfide, pyrithone or ketoconazole Off label use of tacrolimus or pimecrolimus for recalcitrant disease

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5
Q

Diaper dermatitis that involves skin folds?

A

Candidal

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6
Q

Diaper dermatitis typically surfaces in direct contact with diaper (buttock, lower abdomen and genitalia) is called what?

A

Irritant

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7
Q

Diaper dermatitis can manifest because of allergies, true or false?

A

True

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8
Q

What are some non-diaper associated dermatitis?

A

Scabies, herpes virus, psoriasis, bacterial, plus

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9
Q

How do you treat diaper dermatitis? Also, what is a controversial treatment?

A

Eliminate direct contact with urine and feces Topical barrier Anti-fungal (make sure it is below the barrier ointment) Corticosteroids Antibiotics Powders are controversial.

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10
Q

What is refractory diaper dermatitis? Why might it occur?

A

It is recurring diaper dermatitis. It may occur because of: Immunodeficiency Nutritional deficiency Child abuse or neglect Type I diabetes

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11
Q

How do you prevent diaper dermatitis?

A

frequent diaper changes and barriers

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12
Q

What is Dyshidrotic eczema? What does it look like?

A

Intensely pruritic, chronic, recurrent, vesicular Unknown eitology Palms, soles and lateral aspects of fingers Vesicles desquamate leaving cracking DD: tinea, and contact dermatitis

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13
Q

How do you treat dyshidrotic eczema?

A

Rx medium to potent topical corticosteroids

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14
Q

What is Venous Stasis Dermatitis often confused with?

A

Cellulitis

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15
Q

What are the 3 contributing factors to Venous Stasis Dermatitis?

A

Venous Hypertension Chronic inflammation Microangiopathy

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16
Q

How do you treat venous stasis dermatitis?

A

Low to mild potency topical corticosteroid Topical antibiotics avoided Leg elevation and compression

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17
Q

How do you prevent venous stasis dermatitis?

A

Unna boots for acute dermatitis and knee-high compression 20-40mmHg for prevention Review medication ie Edema will exacerbate

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18
Q

What does lichen planus look like? Where is it commonly seen?

A

Pruritic, shiny, purple, polygonal papules Symmetrical on wrists, flexural aspect of arms, legs, lower back, genitalia

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19
Q

What causes lichen planus and who does it affect? Where does it affect the body?

A

Unknown cause Most commonly affects middle aged adults Inflammatory disorder Can affect skin, mucous membranes, scalp &/or nails ↑ frequency in patients with liver disease Drugs can cause lichenoid rxns

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20
Q

People with lichen planus can exhbit what?

A

The koebner reaction, which develops in areas of trauma.

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21
Q

What is Wickhams Striae?

A

Oral lichen planus. Oral lesions present a white, lacy (webbed) pattern and an erythematous lesion are present on the buccal mucosa.

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22
Q

What biopsies do you use for Lichen Planus?

A

deep shave or punch

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23
Q

How often does lichen planus remit?

A

1-2 years, exception is oral. Oral is usually chronic.

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24
Q

How do you treat lichen planus?

A

Topical and or systemic corticosteroids Retinoids Immunosuppressants Phototherapy

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25
Q

What is lichen planus associated with?

A

Hep C

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26
Q

On who and where on the body would you find lichen planus?

A

Middle aged Skin, nails, mucous membranes and scalp

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27
Q

Lichen Simplex Chronicus (circumscribed neurodermatitis)- What are the symptoms and why does it happen?

A

Chronic disorder Probably precipitated by emotions Endogenous vs exogenous (irritant vs allergen) Localized Intense pruritis Very thickened lichenfied areas. Lichenified areas become pruritic

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28
Q

What is the treatment for lichen simplex chronicus?

A

Soaking in warm water, then seal in moisture with topical corticosteroid ointment. Consider antihistamine Potency based on severity. Recalcitrant: Intralesional triamcinolone Tacrolimus

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29
Q

What are the symptoms of nummular dermatitis and where can you find it?

A

Common Intensely pruritic patches (circular 2-10 cm) Usually trunk and lower extremities Usually spontaneous

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30
Q

What is the treatment and differential diagnosis for nummular dermatitis?

A

DD tinea Rx Potent topical steroid, and emollient post bathing

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31
Q

What are the symptoms of Dermatitis Herpetiformis and what does it look like?

A

Uncommon Highest prevalence in Scandinavia Not herpetic Chronic recurrent pruritic vesicular eruption often on erythematous base and symmetrical pattern Autoimmune blistering disorder associated with a Gluten sensitive enteropathy Exquisitely pruritic Increased risk for gastrointestional lymphoma

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32
Q

What causes Dermatitis Herpetiformis? How do you treat it?

A

Usually associated with gluten-sensitive enteropathy. Majority sub-clinical IgA deposits in dermal papillae 90% of individuals have circulating antibodies to tissue transglutaminase Dapsone and gluten-free diet is treatment

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33
Q

Psoriasis- Who is affected and what are the risk factors?

A

1-3% worlds population Men and woman affected equally, all races. Onset any age. Peak age is bimodal ( 20 and 60) Genetic, environmental and behavioral risks

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34
Q

What are the genetic factors of psoriasis?

A

Appx 40% of patients with psoriasis or psoriatic arthritis have first degree family member affected. Psoriasis tends to be concordant among monozygotic twins more commonly than dizygotic twins.

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35
Q

What are the exacerbating factors of psoriasis?

A

Stress Infection Medications (Lithium, B-Blockers)

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36
Q

What does psoriasis look like and where is it usually found?

A

Sharply marginated ,scaly plaque Elbows, knees, presacral and scalp Clinical types Plaque, Guttate, Inverse, Nail, and Pustular

37
Q

Where is plaque psoriasis found, what does it look like and on whom?

A

Typically young adult Symmetrically distributed plaques involving scalp, elbows, knees and back Erythematous, sharply defined, and raised. Thick silvery scale (usually asymptomatic) 1cm-10cm Look for nail pitting, check umbilicus and intergluteal cleft

38
Q

Where is guttate psoriasis found, what does it look like and on whom?

A

Abrupt appearing Characterized by small, droplike, scaly plaques Most often children and adolescents Frequently triggered by prior infection, ie streptococcal Less commonly seen as flare of pre-existing Usually less than 1cm

39
Q

What is inverse psoriasis and where is It found?

A

Reverse of typical presentation on extensor surfaces Presentation involving intertriginous areas. Easily misdiagnosed as fungal or bacterial infection due to lack of scaling

40
Q

What can nail psoriasis be confused with?

A

onchomycosis

41
Q

What does nail psoriasis look like?

A

Up to half of patients with psoriasis will have nail changes. Usually not isolated Pitting (psoriatic involvement of nail matrix) Localized color change “oil drop sign”

42
Q

Why does pustular psoriasis happen and what are some of its qualities?

A

Severe form Life threatening complications von Zumbusch varient Has been seen with withdrawal of systemic corticosteroids, pregnancy and infection

43
Q

What is the von Zumbusch variant?

A

This form of pustular psoriasis may be lethal if proper supportive measures are not taken during the acute phase. The acute, generalized type is accompanied by fever and toxicity.

44
Q

What are some psoriasis comorbidities?

A

Metabolic syndrome Cardiovascular disease Inflammatory bowel disease Patients with moderate to severe psoriasis should be informed of increased risk for myocardial infarction and appropriately screened

45
Q

What do you do to diagnose psoriasis? What are some differential diagnoses?

A

History and Physical exam Rarely skin biopsy to rule out other conditions Differential diagnosis seborrheic dermatitis, atopic dermatitis and lichen simplex chronicus

46
Q

Psoriatic Arthritis qualities?

A

Most have coincidental skin involvement Arthritis can precede skin involvement Nail involvement is often severe Distal interphalangeal joints Spondyloarthropathies

47
Q

What do you base treatment of psoriasis on?

A

Disease severity Relevant comorbities ***psychosocial Patient preference (cost and convenience) Evaluation of response.

48
Q

What are the treatments for mid-moderate psoriasis?

A

Topical corticosteroids and emollients Topical tar or topical retinoids (tazarotene) Tacrolimus or pimecrolimus for facial or intertriginous areas Methotrexate Phototherapy Biologics

49
Q

What are the treatments for severe psoriasis?

A

Know to refer Phototherapy (Ultraviolet light) Systemic Retinoids (derivatives of vitamin A) Methotrexate (folic acid antagonist) Cyclosporin ( T-cell suppressor) Biologics or immunomodulatory drugs (alefacept,etanercept ,infiximab)

50
Q

What is the treatment for nail psoriasis?

A

Physical maneuvers Systemic more effective Treatment remains difficult

51
Q

What is the intertriginous treatment for psoriasis?

A

Class VI or Class VII (low potency corticosteroids) tacrolimus (ointment) or pimecrolimus (cream)

52
Q

What are the 4 types of acne lesions?

A

Acne Rosacea Folliculitis Perioral Dermatitis

53
Q

Who is affected by acne?

A

Prevalence in adolescents ranges from 35-95% Activated by androgens More common and severe in males Tends to resolve in 3rd decade Post adolescent predominately affects women

54
Q

How does an acne lesion develop?

A

A disease of pilosebaceous follicles Degree of follicular hyperkeratinization Sebum production Propionbacterium acnes (P. acnes) growth Inflammation

55
Q

What are the severity levels of acne?

A

a) Solely comedonal to b) Papular or pustular inflammatory to c) Cysts or nodules Scaring may be a sequela

56
Q

Where is acne found? What are closed and open comedones?

A

Lesions mainly face, neck, chest, upper back, shoulders Closed comedone: tiny flesh colored non-inflamed bumps Open comedones: slightly larger, black material Usual presentation in pre-teens is comedones

57
Q

How do you diagnostically evaluate and examine acne?

A

Endocrine function Medication history Examine skin for type and location Type Location Scarring Post-inflammatory pigment changes Hirsutism or virilizism prompts further lab/imaging/potential referral Psychological

58
Q

What are other external factors that can cause acne?

A

Cosmetics Oil vs water based products Scrubbing promotes inflammation Soaps ,astringents etc. remove sebum but do not decrease production Diet controversial Stress Possibly due to corticotropin releasing hormone CRH

59
Q

Treatment for acne?

A

Global market Rx 2 billion Non Rx 2-4 times Rx Not physically disabling Can have psychological impact Topical retinoids Topical antimicrobials Azelaic acid Oral antibiotics Hormonal therapies OTC Oral isotretinoin (Accutane)

60
Q

What do topical retinoids do for comedonal acne?

A

As a monotherapy: Normalize follicular hyperkeratosis (to prevent formation of microcomedo) Decrease inflammation (intrinsic anti-inflammatory properties) Adjunct to more severe with a comedonal component: Example: tretinoin Limited by irritation

61
Q

What is the treatment for comedonal acne?

A

Topical retinoids (tretinoin) Benzoyl Peroxide- less irritating (also acts an antimicrobial for pustular) Topical antibiotics-decrease pustular and comedonal lesions Comedo extraction

62
Q

What is the treatment for papular or cystic inflammatory acne?

A

Antibiotics mainstay of Rx for inflammatory Topical formulations (with addition of benzoyl peroxide to reduce resistance) Systemic:Tetracycline or doxycycline plus others Isotretinoin Intralesional injection Laser

63
Q

What are the treatment plans for mild, moderate and severe papular or cystic acne?

A

Mild=Topical antibiotic with benzoyl peroxide (could add tretinoin at HS) Moderate=Oral antibiotic Severe=Isotretinoin Providing other Rx has failed and start before scarring.

64
Q

What does azelaic acid do for acne? How is it taken?

A

Antimicrobial properties Comedolytic properties Anti-inflammatory properties Can improve post-inflammatory hyperpigmentation Used in treating rosacea It is used topically.

65
Q

What do you use with complications of post- inflammatory pigmentation in acne?

A

Significant problem in darker complexions Topical retinoids and azelaic acid Hydroquinone inhibits melanin production Avail OTC 2% and 3%-4% as Rx

66
Q

What are basic acne home care treatments?

A

Cleanser with pH close to skin . Cetaphil or Dove pH 5.5-7less peeling/dry Warm not hot water Don’t scrub, promotes inflammation Water based cosmetics Don’t pick, promotes scarring

67
Q

What are some differential diagnoses for resistant acne?

A

Rosacea Gram negative folliculitits Staph. folliculitis or eosinophilic folliculitis Steroid use Polycystic Ovarian Syndrome

68
Q

What does Perioral dermatitis look like? Where is it found on the body? Most commonly on who?

A

Small papules, vesicles +/or vesicles Erythema and scaling around mouth Most common in young women Exact cause unknown

69
Q

Who typically gets rosacea? What does it look like?

A

Onset typically occurs between 30-50 years More often light skinned females Men more severely affected (rhinophyma) Telangiectasias , pink papules, sm pustules Possibly ocular disease Flushing lasting more than ten minutes

70
Q

What are some differential diagnoses for rosacea?

A

Systemic Lupus Erythematosus (SLE) SLE usually spares nasolabial folds Acne Perioral dermatitis

71
Q

What is the treatment for rosacea?

A

Sun avoidance to limit photodamage Topical metronidazole , clindamycin, sodium sulfacetamide or azelaic acid PO antibiotic after 4-6 weeks or ocular symptoms Lazar for telangiectasias

72
Q

How does folliculitis occur?

A

Superficial bacterial infection Infection of the hair follicle Purulent material in the epidermis

73
Q

What are the symptoms of folliculitis and what does it look like?

A

Clusters of Small Raised Pruritic Erythematous lesions Less than 5mm diameter Pustules may be present at center of lesion

74
Q

What are some examples of folliculitis?

A

Folliculitis barbae Hot tub folliculitis

75
Q

Follicular pathology- What is a carbuncle? What is a furuncle?

A

Carbuncle Coalescence of several inflamed follicles into a single inflammatory mass Purulent drainage from multiple follicles involving epidermis Furuncle or boil Infection of hair follicle where purulent material extends through the dermis into the subcutaneous tissue, forming an abscess.

76
Q

How are cellulitis and erysipelas similar, and how are they different? In whom are they both found?

A

They are both: Skin erythema, edema and warmth Erysipelas – Upper dermis and superficial lymphatics. (sharply defined) (found in young children and elderly) Cellulitis- Deeper dermis and subcutaneous fat (more frequently found in elderly and middle aged)

77
Q

What are the 4 groups corticosteroids can be divided into?

A

Super potent (Class I) Potent (Classes II to III) Intermediate (Classes IV to V) Mild (Classes VI to VII)

78
Q

What are the different types of eczemas? (eczema and dermatitis are used interchangeably)

A

Winters Itch Contact Dermatitis Atopic dermatitis Dyshidrotic Eczema Venous stasis dermatitis

79
Q

What is Winter’s Itch?

A

Red dry cracked skin with multiple fine fissures More common in the winter or dry conditions Aggravated or precipitated by hot water/drying soaps

80
Q

How do you treat winter’s itch?

A

Treatment is emollients and consider mild to low potency topical corticosteroids

81
Q

What is contact dermatitis and what are the different types?

A

Any dermatitis arising from direct skin exposure to a substance Irritant (trigger itself directly damages the skin) Allergic ( trigger induces an immune response)

82
Q

What are the qualities of allergic contact dermatitis, what does it look like and what is the treatment?

A

Delayed-type hypersensitivity Requires initial sensitization Become more intense with repeated exposure. Usually intensely itchy Acute rxn. Erythema, edema, weepy and vesicles Chronic rxn. Lichenification, scaly and hyperpigmentation

83
Q

What are the risk factors for atopic dermatitis and who is affected by it typically?

A

Primarily affects children Interaction of both genetic and environmental Personal or family hx of allergies, asthma and/or allergic rhinitis Diagnosed clinically

84
Q

What is the treatment for atopic dermatitis?

A

Eliminate exacerbating factors that disrupt epidermal barrier Gentle skin care ( bland emollients, low water content ) Once daily topical corticosteroids (1st line), then maintain Topical macrolide immunomodulators (risks and benefits) 2nd line for moderate-severe Control pruritis (evidence is weak) sedating reaction is more effective

85
Q

What are some factors to consider when treating a patient with a topical corticosteroid?

A

Pregnancy Potency Vehicle Amount Refills

86
Q

What are some therapies for atopic dermatitis?

A

Phototherapy Oral calcineurin inhibitors (cyclosporin) Immunosuppressants ie MTX methotrexate Probiotics (Lactobacillus), oral essential fatty acids, Chinese herbal meds all probably not of significant benefit

87
Q

What should you consider to happen secondary to atopic dermatitis?

A

Community acquired MRSA methicillin resistant staphylococcus and Herpes Simplex infections widespread known as eczema herpeticum

88
Q

How does staph aureus affect the skin?

A

It is a frequent skin colonizer and it creates a honey crust with folliculitis and pyoderma. Rx warrented

Dermatology (1 decks)

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