derm conditions week 1 Flashcards
1
Q
pruritis (Desc)
A
itching from internal or external stimulus of cutaneous nerve endings…… mediators: histamine, kallikrein (vasodilation), peptidases
2
Q
pruritis (Etiology)
A
dry skin
3
Q
pruritis (Hx)
A
drug/occ/hobby exposures
4
Q
pruritis (Testing)
A
biopsy, CBC, liver/kidney/thyroid fx test
5
Q
urticaria (Desc)
A
migratory, erythematous, pruritic plaques….. mediators: histamine
6
Q
urticaria (Etiology)
A
viral,bact infx; IgE allergy; NSAIDs; rare autoimmune dz
7
Q
urticaria (Hx)
A
duration, triggers, freq, concomitatnts (GI esp), resp. system, drug use, travel, FHx
8
Q
urticaria (Testing)
A
CBC, Ig to foods, thyroid, ANA
9
Q
acne vulgaris (Desc)
A
obstruction of pilosebaceous unit…. Presents with: comedones (black/whiteheads), pustules, papules, inflamed nodules, superficial pus sacs and sometimes deep purulent sacs
10
Q
acne vulgaris (Etiology)
A
androgen stim, food sensitivities, sebum, stress
11
Q
acne vulgaris (Distribution)
A
face, chest, back, upper arms
12
Q
acne vulgaris (Hx)
A
age puberty~35, M>F.
13
Q
acne vulgaris (S/Sx)
A
comedones, papules, pustules, nodules
14
Q
acne vulgaris (Dx)
A
H&P….comedones and several stages of lesions
15
Q
acne vulgaris (Testing)
A
total/free testosterone w/ other sex hormones (FSH, LH, progesterone, estrogen)
16
Q
acne vulgaris (Ddx)
A
rosacea (no comedones); folliculitis; perioral dermatitis; keratosis pilaris
17
Q
rosacea (Desc)
A
chronic inflamx d/o featuring facial fushing, telangiectasia, erythema, papules, and pustules
18
Q
rosacea (Etiology)
A
idiopathic (GI issues more common)
19
Q
rosacea (Distribution)
A
central face and scalp
20
Q
rosacea (Hx)
A
Recurrent flushing (from spicy food, alcohol, emotional rxn); eye involvement (foreign body sensation, telangiectasia of lids, keratitis, conjunctivitis, episcleritis); age 30-60
21
Q
rosacea (S/Sx)
A
Stages: pre-rosacea; vascular phase; inflamx phase (papules, pustules, etc presen); late-stage/rhinophyma
22
Q
rosacea (Dx)
A
one primary: flushing, nontransient erythema, papules & pustules, telangiectasia AND one secondary: burning, plaque, dry appearance, edema, ocular manifestation, peripheral loc
23
Q
rosacea (Ddx)
A
acne vulgaris; SLE; discoid lupus
24
Q
bullous pemphigoid (Desc)
A
chronic pruritic bullous eruptions. uncommon.
25
bullous pemphigoid (Etiology)
autoimmune; drug induced (furosemide, NSAIDs)
26
bullous pemphigoid (Distribution)
trunk, lower legs, extremity flexures, axillary & inguinal folds
27
bullous pemphigoid (Hx)
assoc. w/ dementia, Parkinson's, unipolar/bipolar; age >60
28
bullous pemphigoid (Dx)
H&P….must biopsy. Shows: subepidermal bulla w/ eosinophil infiltrate (direct immunofluresence), skin with IgG and/or C3 in linear band in basement membrane
29
bullous pemphigoid (Testing)
biopsy
30
bullous pemphigoid (Ddx)
pemphigus vulgaris, dermatitis herpatiformis, erythema multiforme, drg eruption
31
dermatitis herpetiformis (Desc)
autoimmune, chronic recurring, intensely pruritic skin with symmetrical groups of inflamed vesicles, papules and hives
32
dermatitis herpetiformis (Etiology)
autimmune, celiac dz (asx)
33
dermatitis herpetiformis (Distribution)
symmetrical over extensor aspects, sacrum, and/or base of head
34
dermatitis herpetiformis (Hx)
assoc. w/ celiac/thyroid d/os; age 20-50, M:F 2:1
35
dermatitis herpetiformis (S/Sx)
burning, severe stinging and itching, freqquently transient…lasts weeks to years
36
dermatitis herpetiformis (Dx)
H&P, skin biopsy of lesion and adjacent normal skin (immunofluoresence); will see pinpoint bleeding from shave biopsy, subepidermal clefting and papillary dermal tips w/ PMNs and eosinophils; IgA deposition
37
dermatitis herpetiformis (Testing)
biopsy, TTG, anti-endomysial Ab, jejunal bx for celiac
38
dermatitis herpetiformis (Ddx)
pemphigus, bullous pemphigoid, (contact) dermatitis, herpes (vesicular rashes)
39
pemphigus vulgaris (Desc)
potentially fatal blistering dz. Rare.
40
pemphigus vulgaris (Etiology)
autoimmune
41
pemphigus vulgaris (Distribution)
oral lesions often precede skin lesions. Groin, scalp, abd, back, upper legs, axilla
42
pemphigus vulgaris (Hx)
age>60, F>M; highest incidence amongst ashkenazi
43
pemphigus vulgaris (Dx)
H&P and punch biopsy of lesion and normal skin (immunofluoresence); biopsy shows intraepidermal bulla, eosinophil infiltration, IgG, nikolsky's sign positive.
44
pemphigus vulgaris (Ddx)
HS1, HZ, bullous pemphigoid, canker sores, paraneoplastic pemphigus (must do bx to exclude)
45
callouses and corns (Desc)
epidermal thickening from pressure/friction …. Callouses: usu asx, intact skin lines …. Corns: pain from pressure, yellow core, interrupts skin lines
46
callouses and corns (Distribution)
feet and toes
47
callouses and corns (Dx)
H&P
48
ichthyosis (Desc)
scaling and flaking of skin. 'fish scale skin.' resembles cracked pavement
49
ichthyosis (Etiology)
autosomal dominant x-linked
50
ichthyosis (Distribution)
shins and outer arms
51
ichthyosis (Hx)
infx or systemic dz (acquired ichthyosis has sudden onset)
52
ichthyosis (Dx)
H&P
53
ichthyosis (Ddx)
dry skin (which is less severe)
54
keratosis pilaris (Desc)
keratinization d/o where horny plugs fill the openings of hair follicles
55
keratosis pilaris (Etiology)
nutritional deficiency (omega-3, Zn, biotin)
56
keratosis pilaris (Distribution)
lateral aspects of upper arms, thighs, buttocks. Kids may have on face (confusion w/acne)
57
keratosis pilaris (Hx)
eczema, asthma, hayfever triad through the family
58
keratosis pilaris (S/Sx)
keratotic follicular papules, skin feels rough like sandpaper
59
keratosis pilaris (Dx)
H&P
60
atopic dermatitis (Desc)
aka eczema…. Immune-mediated skin inflamx. Very common. Aggravated by: dry skin, wool sweating, allergens, tight clothing, emotional stress, notritional def., SIBO
61
atopic dermatitis (Etiology)
genetic (atopy), food & envt allergies
62
atopic dermatitis (Distribution)
face, neck, extremities, abd, flexor surfaces, hands, buttocks
63
atopic dermatitis (S/Sx)
variation in colors; weeping crusted lesions, intensely pruritic, lichenification
64
atopic dermatitis (Dx)
H&P
65
atopic dermatitis (Testing)
food/allergy testing; vit D and GI assessment
66
atopic dermatitis (Ddx)
seborrhic dermatitis, contact derm, nummular derm, candida, tinea
67
contact dermatitis (Desc)
acute inflamx caused by irritants/allergens…..hypersensitivity rxn w/ initial exposure and rxn on re-exposure
68
contact dermatitis (Etiology)
exposure (chemicals, metals, woods, dust, soaps, cosmetics, poison oak, drugs - neomycin, bacitracin, hydrocortisone)
69
contact dermatitis (Distribution)
hands (both dorsal and palmer), around the mouths of chronic lip lickers
70
contact dermatitis (Hx)
occupation, hobbies, household duties, travel, topical exposure)
71
contact dermatitis (S/Sx)
erythema, dryness, cracking….acute: weeping papules w/edema; chronic: lichenification, excoriation, scaling
72
contact dermatitis (Dx)
H&P
73
contact dermatitis (Ddx)
seborrhic dermatitis, atopic derm, nummular derm, candida, tinea
74
neurodermatitis (Desc)
chronic pruritis w/o demonstrable external cause (nervous system is getting queued up)
75
neurodermatitis (Distribution)
back of neck, wrists, ankles, pubic … usu NOT seen on back, abd, face, upper legs
76
neurodermatitis (S/Sx)
dry scaling skin; hyperpigmentation (won't be seen w/ eczema); eryhthematous lichenified plaques in irregular shapes
77
neurodermatitis (Dx)
H&P …. KOH to exclude tinea
78
neurodermatitis (Testing)
patch test to identify allergens, biopsy
79
neurodermatitis (Ddx)
tinea, lichen planus, psoriasis
80
nummular dermatitis (Desc)
coin-shaped skin inflamx
81
nummular dermatitis (Etiology)
idiopathic
82
nummular dermatitis (Distribution)
extensor surfaces, buttocks, trunk; usu begins on legs
83
nummular dermatitis (S/Sx)
1-50 excessively pruritic, coin-shaped, vesicular lesions; crusting and scaling.
84
nummular dermatitis (Dx)
H & P
85
nummular dermatitis (Testing)
patch test to identify allergens, biopsy, KOH, culture (Staph Aureus)
86
nummular dermatitis (Ddx)
psoriasis, tinea, T cell lymphoma
87
seborrheic dermatitis (Desc)
inflamx of skin in high-density area of sebaceous glands (like face dandruff)
88
seborrheic dermatitis (Etiology)
nutritional deficiency; possibly fungal
89
seborrheic dermatitis (Distribution)
scalp, eyelids, eyebrows, face
90
seborrheic dermatitis (Hx)
increased susceptibility w/ HIV+, parkinson's, neuroleptic medication use
91
seborrheic dermatitis (S/Sx)
gradual onset; erythematous plaques with yellowish greasy scales; no hair loss (fungi can cause hair loss); cradle cap in newborns
92
seborrheic dermatitis (Dx)
H&P
93
seborrheic dermatitis (Testing)
KOH and fungal culture
94
seborrheic dermatitis (Ddx)
atopic dermatitis, rosacea, contact dermatitis, psoriasis
95
stasis dermatitis (Desc)
persistent dermatitis of lower legs, especially ankle
96
stasis dermatitis (Etiology)
secondary to chronic venous insufficiency (poor circulation) - skin is starving for oxygen
97
stasis dermatitis (Distribution)
low legs…ankle
98
stasis dermatitis (Hx)
Pt complaint of heaviness in the leg that is aggravated by standing/walking; legs swollen at end of the day. Hx of DVT, ulceration
99
stasis dermatitis (S/Sx)
bronzing pigment over time; edema nd petechiae (blood stuck outside the vessels); erythema; fissuring; dry or weeping crusting; stasis ulcers that don't heal;
100
stasis dermatitis (Dx)
H&P; ankle brachial index
101
stasis dermatitis (Ddx)
cellulitis, contact dermatitis, tinea
102
polymorphous light eruption (Desc)
acute recurrent photodermatitis following sun exposure
103
polymorphous light eruption (Etiology)
sun exposure
104
polymorphous light eruption (Hx)
all ages, races, genders
105
polymorphous light eruption (S/Sx)
lesions appear 2 hrs to 5 days after exposure and last 7-10 days. Burning, itching, erythema…..three types: plaque, papular, papulovesicular
106
polymorphous light eruption (Dx)
H&P
107
polymorphous light eruption (Testing)
ANA, anti-SSA/B to distinguish from SLE
108
polymorphous light eruption (Ddx)
SLE, photodrug rxn, solar urticaria
109
actinic keratosis (Desc)
chronic…. Precancerous neoplasm from UV exposure
110
actinic keratosis (Etiology)
chronic UV exposure
111
actinic keratosis (Distribution)
face, lips, back of hand, shoulders, legs (wherever sun can get to)
112
actinic keratosis (Hx)
increases with age, fair-skinned blondes/gingers
113
actinic keratosis (S/Sx)
rough scaling macule, papule, or plaque; develops a thin-transparent scale that becomes thicker and yellow over time….horny lesion
114
actinic keratosis (Dx)
bx to differentiate SCC
115
actinic keratosis (Ddx)
seborrheic keratoses; SCC (will be more thick)
116
psoriasis (Desc)
immune-mediated chronic recurring inflamx of epidermis with increased epidermal proliferation resulting in scaling
117
psoriasis (Etiology)
genetics, env't triggers, stress, medication
118
psoriasis (Distribution)
scalp, extensor surfaces, buttocks and back
119
psoriasis (Hx)
smoking, obesity, and HIV predispose
120
psoriasis (S/Sx)
dry, sharply demarcated, erythematous plaques and papules topped with silvery scales (seven subtypes)
121
psoriasis (Dx)
H&P, auspitz' sign
122
psoriasis (Ddx)
seborrheic dermatitis, eczema, tinea, SCC
123
pityriasis rosea (Desc)
acute, self-limited, mild-inflamx, scaling skin dz
124
pityriasis rosea (Etiology)
reactivation of HH7, primary infx HH6
125
pityriasis rosea (Distribution)
trunk (usu back)
126
pityriasis rosea (S/Sx)
usu asx; oval, minimally elevated papules and plaques….starts with 'herald patch' followed by xmas tree distribution
127
pityriasis rosea (Dx)
PE
128
pityriasis rosea (Ddx)
tinea, drug eruptions, psoriasis, syphilis
129
lichen planus (Desc)
recurrent itching/inflamx w/ small, discrete angular papules. Uncommon.
130
lichen planus (Etiology)
idiopathic, maybe Hep C
131
lichen planus (Distribution)
ankles, wrists, pubic region, lips, mouth
132
lichen planus (S/Sx)
2-4 mm papules w/ angular border - PPPP: purple polygonal pruritic papules
133
lichen planus (Dx)
PE and bx
134
lichen planus (Testing)
biopsy (accumulation of PMNs and t-cell mediated cytotoxic rxn against basal cell keratinocytes)
135
lichen planus (Ddx)
leukoplakia, candida, herpes stomatitis, aphthous ulcers, erythema multiforme
136
drug eruptions (Desc)
immune mediated
137
drug eruptions (Etiology)
penicillin, sulfonamides, qunidine
138
drug eruptions (S/Sx)
exanthems (from Abx - pruritic rash, symmetric distribution on trunk/extremities); urticaria (from abx/NSAIDs - pruritis on palms/soles); pigmentation (melasma from birth control)
139
drug eruptions (Dx)
H&P
140
drug eruptions (Testing)
CBC - eosinophils
141
erythema multiforme (Desc)
inflamx reaction w/ target lesions
142
erythema multiforme (Etiology)
drugs, infx, immunization, autoimmune, idiopathic
143
erythema multiforme (Distribution)
dorsal/palmar hands, soles, forearms, feet, face, elbows, knees, genitals, mucus membranes
144
erythema multiforme (Hx)
M>F; more than half
145
erythema multiforme (S/Sx)
3-5 day onset, resolves in 2 wks; erythema, edema, bullous lesions on face and extremities; pruritic, painful; sometimes with systemic sxs (fever, weakness, malaise)
146
erythema multiforme (Dx)
H&P
147
erythema multiforme (Ddx)
urticaria, drug eruptions, bullous pemphigoid, pemphigus, dermatitis herpetiformis, herpes stomatitis
148
erythema nodosum (Desc)
inflamx of skin and subQ tissue - characterized by tender, red, swollen shins
149
erythema nodosum (Etiology)
infx, drug, malignancy, sarcoidosis
150
erythema nodosum (S/Sx)
indurated nodules that look like bruises; painful; systemic sxs (fever, malaise, joint pain); spontaneous resolution ~6 wks
151
erythema nodosum (Dx)
H&P …. But must look for underlying d/o
152
erythema nodosum (Testing)
blood work
153
erythema nodosum (Ddx)
vasculitis, lymphoma, pretibial myxedema
154
miliara (Desc)
heat rash
155
miliara (Etiology)
sweat accumulates beneath ducts b/c of keratin obstruction at level of corneum
156
miliara (Hx)
common in babies/kids
157
miliara (S/Sx)
pruritis; small red papules (occasional pustules)
158
miliara (Dx)
H&P
159
miliara (Ddx)
baby acne
