Derm Exam 1 Flashcards
(295 cards)
1
Q
epidermis
A
outer layer of skin
has sub layers (stratum basale, spinosum, granulosum, lucidum, corneum)
2
Q
epidermis cell types
A
keratinocytes
melanocytes
langerhans cells
merkel cells
3
Q
keratinocytes
A
predominant epidermal cell
produce keratin and structural strength/integrity of skin
begin as basal cell in dermal epidermal junct, migrate to surface, slough off in 30 days
pink cytoplasm, intercellular bridges
4
Q
melanocytes
A
normally in basal layer of epidermis
produce melanin in pigment granules (melanosomes) that transfer into cytoplasm of keratinocytes
melanosomes determine skin color
stain with S100, MART1, HMB45
5
Q
langerhans cells
A
dendritic immunologic cells that resemble melanocytes
migrate to and from epidermis
process antigens for presentation
damaged by UV light
stain S100, CD1a, CD207
have birbeck granules
6
Q
merkel cells
A
dendritic cells located in epidermal base layer
associated with sensory nerve fibers and act as mechanoreceptors, higher number in areas of high tactile touch
stain CK20
7
Q
dermis
A
highly vascular
fibrocytes, muscle cells, mast cells
role in temperature regulation
2 layers (outer papillary dermis interdigitates with epidermis, inner reticular dermis with horizontal collagen and elastin fibers)
8
Q
skin appendages
A
eccrine sweat glands (widely distributed, open onto skin)
apocrine sweat glands (open into hair follicle, axilla/anogenital)
sebaceous glands (widespread, produce sebum, empty into hair follicle)
hair follicles
8
Q
hypodermis
A
contains fat mixed with CT fibers
attach skin to the fascia of muscles
aka subq
9
Q
macule
A
flat area of discoloration
up to 1 cam
10
Q
patch
A
flat area of discoloration
over 1 cm
11
Q
papule
A
elevated dome shaped or flat topped lesion up to 1 cm
12
Q
plaque
A
flat topped elevated lesion over 1 cm
13
Q
nodule
A
dome shaped elevated lesion over 1 cm
14
Q
vesicle
A
fluid filled raised lesions up to 1 cm
15
Q
pustule
A
vesicle with cloudy fluid containing inflammatory cells
16
Q
bulla
A
single fluid filled lesion greater than 1 cm
17
Q
scale
A
flaky keratin fragments of superficial sloughed epidermis
18
Q
crust
A
hard layer of dried exudate or secretion
19
Q
erosion
A
focal area of loss of part of or all of epidermis (intact basement membrane)
20
Q
ulcer
A
focal area of loss of all of epidermis and at least part of dermis (basement membrane not intact)
21
Q
purpura
A
red purple skin lesion caused by extravasation of blood into skin
palpable or nonpalpable
22
Q
petechia
A
non palpable purpura less than 3 mm
23
Q
echymosis
A
no palpable purpura over 5 mm
24
skin function
protect from injuries
act as barrier and regulate what enters/leaves
regulate body temp
synthesize and store vitamins
sensory functions
25
cutaneous membrane
dermis and epidermis (not hypodermis)
26
epidermis
avascular stratified squamous epithelium
functional cells are keratinocytes
arranged in layers
27
keratinocytes
most of cells in epidermis
keratin production
all derived from stem cells at dermal epidermal junction
migrate toward surface and shed -30 days
28
stratum basale (germinativum)
single layer of columnar or cuboid stem cells
mainly keratinocytes, also melanocytes and merkel cells
situated directly on dermis
desmosomes - upper and lateral surfaces
intense mitotic activity
contain intermediate filaments (keratin) and melanin granules
29
stratum spinosum
contain several layers of daughter cells from keratinocytes of basale and some still divide
abundant desmosomes - tonofilaments (bundles of fibrils give rise to fibrous component of keratin)
lemellar granule appear
langerhans cells
30
malphigan layer
epidermal stem cells
mitotically active layers of stratum spinosum and basale
31
stratum granulosum
cells displaced from stratum spinosum
produce basophilic keratohyalin granules (cause amorphous component of keratin)
accumulate keratin forming tonofilaments
lamellar granule release into intercellular spaces (making impermeable to water)
cells start to die, dehydration interlocks layers of keratin/keratohyalin/PL
32
stratum lucidum
palms and soles of feel
33
stratum corneum
many layers of flattened dead cells
filled with soft keratin
thicker in thicker skin
34
pemphigus vulgaris
type of blistering
autoimmune damage to intercellular junctions between keratinocytes
space forms between layers of epidermis
middle age and older adults
35
skin pigmentation
carotene in epidermal cells (yellow)
blood in vessels (pink)
melanin by melanocytes (yellow to black)
melanin shield epidermal nuclei from UV radiation
36
melanocytes
produce melanin
in basal layer and hair follicles
derived from neural crest cells that migrate to stratum basale
melanin production influenced by melanocyte simulating hormone (MSH)
37
albinism
congenital disorder that produces hypopigmentation
defect in melanin producing pathway
38
vitiligo
skin depigmentation often in patches
autoimmune disorder causing destruction of melanocytes
39
malignant melanoma
malignant transformed melanocytes can penetrate basal lamina to enter dermis (metastasize to blood and lymph)
proliferating melanocytes forms moles
40
langerhans cells
antigen presenting cells
derived from monocytes
cytoplasmic extensions form network in epidermis
microorganism in epidermis trigger immune response
41
merkel cells
epithelial tactile cells
abundant in sensitive skin
similar appearance to keratinocytes
contain granules concentrated near basolateral surface
42
dermis papillary layer
fine collagenous fibers
dermal papillae contain nerves and blood vessels
papillae interlock dermis and epidermis
43
dermis reticular layer
deep to papillary layer
dense irregular CT
larger blood vessels and nerves
smooth and skeletal muscle
extensive distribution of elastic fibers among eosinophilic collagen bundles
deeper has thicker elastic fibers
44
dermis function
tensile strength
contributes to elasticity
healing
thermoregulation
provide nutrients to epidermal cells
45
deep touch/pressure
lamellated (pacinian) corpuscles
deep dermis and hypodermis
46
light touch/pressure
meisners corpuscles
dermal papillae
47
warm/cold/pain
free nerve endings
epidermis
48
subcutaneous layer/hypodermis/superficial fascia
loose connective tissue with lots of fat
secretory portion of sweat glands
nerves
pacinian corpuscles
roots of hair
stabilize skin while allowing individual movement
49
hair
shaft projects above surface
root enclosed by follicle
epidermal cells that are keratinized (hard keratin), many contain melanin granules
50
hair follicle and matrix
follicle - tubular invagination partly epidermal partly dermal
matrix - consists of cells at base of hai bulb that cause hair growth
on layer rests on dermal papillae (highly cellular with cells/capillaries/nerves/melanocytes) and it is inductive on hair matrix
51
sebaceous glands
in dermis, associated w hair follicles
secretory portion - solid mass of cells, centrally located cells degenerating and rich in lipids
excretory duct - short wide unbranches and lined by stratified squamous
secrete sebum by holocrine secretion (whole cell lost)
lubricate skin
52
eccrine sweat glands
long and highly coiled
upper end opens on skin as pore
part that passes through epidermis has no lining of its own
duct in dermis and subq have stratified cuboidal
gland - simple cuboid/columbar
myoepithelial cells help with merocrine secretion (dont lose cell)
clear watery secretion, responds to temp
53
apocrine sweat glands
merocrine mechanism
empty into hair follicle
viscous cloudy secretions
may contain pheromones
stimulated during emotional distress
-modified examples are mammary and ceruminous glands
54
nail matrix
where growth occurs
55
eponychium
stratum corneum that overlies nail rooth (cuticle)
56
hyponychium
stratum corneum of underlying nail bed
57
immunobullous diseases
autoimmune diseases where patients frequently develop blisters
pemphigus vulgaris
pemphigus foliaceus
bullous pemphigoid
dermatitis herpetiformis
linear IgA bullous dermatosis
epidermolysis bullosa acquisita
58
immunobullous treatment principles
control phase - intensive therapy given until no new lesions appear
consolidation phase - treatment continues until lesions completely clear
maintenance phase - lowest dose of drug given to prevent appearance of new lesions
59
locations of bullae/vesicles
subcorneal - stratum corneum is rool
suprabasal - portion of epidermis forms roof
subepidermal - entire epidermis separates from dermis
60
hemidesmosomes
anchor stratum basale to basement membrane
61
desmoglein 1
highest in superficial layers and taper in basal layers
62
desmoglein 3
highest in basal layers and taper in superficial layers
63
pemphigus vulgaris
autoimmune destruction of desmosomes
often painful
oral mucosa almost always involved
+ nikolskys sign
IgG antibodies against desmoglein 3 (against desmoglein 1 common with oral and skin involvement)
IgG and C3 in intercellular spaces in epidermis
suprabasal intraepidermal vesicel/bulla
row of tombstones
lymphocytes and eosinophils
tx - prednisone + rituximab
64
pemphigus foliaceus
autoimmune disease, often painful
no mouth lesions
superficial intraepidermal vesicles/bulla that easily rupture
common face/scalp/chest/upper back
+ nikolsky sign
IgG agains desmoglein 1
IgG and C3 in intercellular spaces in superficial epidermis
lymphocytes, neutrophils, eosinophils
tx - topical steroid or prednisone + rituximab for widespread
65
bullous pemphigoid
autoimmune disease with destruction of hemidesmosomes
large tense vesicles and bullae on erythematous base that dont rupture easy
common groin, axillae, flexor forearms
- nikolskys sign
IgG against 2 hemidesmosome proteins
IgG and C3 in linear band along basement membrane
rapid spread
tx - topical high potency steroid, oral steroid, oral tetracycline
66
dermatitis herpetiformis
autoimmune disease affects anchoring fibrils in basement membrane
genetic predisposition (HLA A1/B3/DR3/DQ2)
most have celiac sprue
intensely pruritic, occasional bullae
excoriates papules/erosions
common extensor sites, butt, scapular and sacral areas
IgA deposition at tips of dermal papillae
granular IgA deposits at tips of dermal papillae
subepidermal vesicles with neutrophils
tx - gluten free and oral dapsone
67
linear IgA dermatosis
autoimmune
may be drug induced (vancomycin) or idiopathic
may be asymptomatic or cause pruritis or burning
pruritic vesiculobullous disease, not as pruritic as dermatitis herpetiformis
IgA binds antigens in hemidesmosomes in basement membrane
linear deposition IgA along basement membrane (may have some IgG as well)
subepidermal blister with neutrophils
tx - withdrawal offending agent, oral dapsone, oral prednisone, topical steroid
68
vitiligo
depigmented macules and patches
usually asymptomatic, sometimes pruritic
autoimmune - circulating antibodies and melanocyte specific T cells
hair in areas may be white
commonly generalized and symmetric
MART1 stain to confirm absence of melanocytes
tx- repigmentation (steroids, calcineurin inhibitors, UV therapy, laser, topical prostoglandin) or depigmentation
69
streptococcus
gram + cocci
catalase negative
cause hemolysis
70
hemolysis types
beta - clear zone of complete hemolysis (glow)
alpha - partial hemolysis (green)
gamma - no hemolysis
71
group A strep
hyaluronic acid capsule
group A carbohydrate
M protein - major virulence factor, antiphagocytic, prevents complement C3b deposition, also act as superantigen
streptolysins S (SLS) - beta hemolysis
streptolysin ) (SLO) - oxygen labile, beta hemolysis, antigenic
hyaluronidase - spreading factor (breakdown CT), increase Ab titers
DNase - solubilize DNA, antibodies BEST SEROLOGICAL TEST FOR DX SKIN INFECT
streptococcus C5a peptidase - prevent C5a from acting as chemoattractant for PMNs
pyrogenic exotoxins - responsible for rash and toxicity of scarlet fecer and TSS
72
streptococcal pharyngitis
group A strep (tonsillitis)
cannot be diagnosed based on clinical symptoms
diagnosis important to prevent rheumatic fever
primary disease 4-10 days and remits spontaneously - exudative pharyngitis, constitutional symps, infalmmatory response and tissue damage
tx - penicillin
73
strep A skin infections (pyoderma)
simple skin infections - secondary invasion of existing lesions (penicillins)
impetigo - superficial skin infections with crusting amber lesions, may develop acute glomerulonephritis (first gen cephalosporin, topical mupirocin)
erysipelas - acute lymphangitis of skin, rare, fever/headache/chills/comiting, bright red lesion (IM penicillin G)
74
scarlet fever
group A strep
disease begins as rash on neck 24-48 hours after onset of pharyngitis
punctate rash on trunk to inner arms and legs
tx - penicillin
75
acute streptococcal glomerulonephritis
complication of group A streptococcal pharyngitis
common in children
acute onset of edema, oligouria (decreased urine output), HTN, renal failure
present 1-2 weeks post pharyngitis
tx - sodium restriction, diuretics, anticonvulsants
76
acute rheumatic fever
2-3 weeks after onset of Group A strep
caditis/arthritis, chorea
jones criteria - 2 major or 2 minor and 1 major
lead to tissue injury of heat, joints, CNS
M protein cross react with glycoprotein in human heart valves
tx - penicillin, long term prophylaxis
77
necrotizing fasciitis
group a strep
underlying predisposition that compromises immune system
some cases in those who appear healthy (access via trauma, destroy fat and fascia not skin)
M protein strains are associated
pyrogenic exotoxins contribute
symps of shock bc action of superantigen
very rapid
nerves destroyed
tx - debridement/amputation, parenteral combo (ampicillin, gentamicin, clindamycin, or metronidazole)
78
vibrio parahaemolyticus
acute gastroenteritis (especially near coastal areas/eating shellfish)
79
vibrio vulnificus
fulminating septicemia (enter GI tract, often preexisting liver disease)
OR
cellulitis w marked necrosis and edema (not as serious, saltwater associated wounds)
key is raw shellfish
80
vibrio alginolyticus
not associated with GI
skin and ear infections
cellulitis in wound infects
usually self limiting
81
vibrio fluvalis
isolated from diarrheic stools of infants/children/young adults
82
vibrio damsela
human wound infections
mild to devastating
edema and necrotizing process
83
normal body temp
35.5-37.7 celsius (96-99.9 F)
84
slight temp variations reversible how
behavior changes/physiologic response
85
normal variation in temp
metabolic changes
sleep/wake cycle
hormone variability
changing activity level
86
diurnal variation
4 am lowest body temp
3-6 pm highest body temp
87
105.8 or higher
hyperthermia (heat stroke)/hyperpyrexia cause multiple organ failure/brain lesions
88
100.6 to 105.8
moderate to high fever
89
34-36 C
mild hypothermia
90
30 - 34 C
impairment of temp regulation
91
27-29 C
cardiac fibrillation
92
determinants of internal heat production
basal rate of metabolism of cells
increased rate of metabolism bc muscle activity
increased metabolism bc increased thyroid hormone and others
increased metabolism because epinephrine/norepinephrine (sympathetic)
increased metabolism for digestion, absorption, and storage
93
heat loss
radiation
conduction
convection
evaporation
94
infrared radiation
produced by anything over absolute 0
60% total heat loss, radiates in all directions
high metabolic organs produce more
can identify tumors
95
heat loss by conduction
heat lost by contact of body to objects
some lost to air but there is an insular zone
conductivity to water much greater than that to air
96
heat loss by convection currents
heat conducted to air/water and carried away by convection current
effect of using fan or windy day
97
heat loss by evaporation
sweating (2/3) and respiratory tract (1/3)
if temp of surroundings is greater than skin the body gains heat
humidity decreases evaporation and heat loss through sweating
98
thermal sensors
skin (environment changes)
core (internal changes)
99
skin free nerve endings
distinct warm and cold receptors
provide hypothalmic thermoregulatory center with info about ambient temp
100
deep body temp receptors
in spinal cord and abdominal viscera
changes in core temp elicit thermoregulatory response to maintain core temp within narrow limits
101
hypothalmic thermal sensors
anterior hypothalamus preoptic area (heat and cold neurons)
more heat sensing neurons
OVLT lacks BBB
102
integrating thermal signals
signals from skin, core, and anterior hypothalamus sent to posterior hypothalamus (thermostat)
signals integrated and then response sent to autonomic and somatic effectors to raise or lower temp
103
regulation when temp too high
vasodilation of vessels in skin (adrenergic sympathetic centers in posterior hypothalamus inhibited, increased cholinergic parasympathetic stimulation)
sweating (cholinergic parasympathetic output to eccrine sweat glands)
decrease heat production (stop shivering)
104
regulation when temp too low
shivering to increase heat production (sympathetic stimulation, thyroxine synthesis and release) and nonshivering thermogenesis
inhibit sweating
promote vasoconstriction (alpha 1 receptors of adrenergic sympathetic system)
105
increase shivering thermogenesis
primary motor center in dorsomedial posterior hypothalamus
increase tone fo skeletal muscles via increase activity of motor neurons
106
nonshivering thermogenesis
increase sympathetic stimulation (or circulating epi/norepi)
increase rate of cellular metabolism
proportional to brow fat deposits (rich in sympathetic nerves, stimulates thermogenin)
infants have some brown fat
107
increased thyroxine output
hypothalmic preoptic area increases thyroid releasing hormone
TRH increases TSH which increases secretion thyroid hormone which increases rate of cellular metabolism
108
piloerections (goosebumps)
transfer heat to surroundings lessened
adrenergic sympathetic control (alpha 1 receptor)
other factors cause it (fear/excitation)
109
fever
body temp above normal range
pyrogen - antigen that causes fever (resets set point)
-gram - bacteria, lipopolysaccharides release cytokines, bacterial endotoxins, prostoglandin E2
110
resetting set point
antipyretics (aspirin/acetominophen) through inhibiting COX
growth inhibition on microbial agents
enhance immune function
111
heat stroke
body temp above critical temp into 105-108 range
proteins denatured and affects enzymatic processes (organ damage/dysfunction)
there is limit body can lose heat even w maximal sweating
excessive heating of hypothalamus causes depression of heat regulation (decreased sweating)
112
severe hypothermia
body temp below 77 F is fatal
below 85 F hypothalamus loses control - sleepiness/coma, decreased enzymatic rxns
113
principles of topical therapy
efficacy depends on potency and ability to penetrate skin
penetration effected by concentration of med, thickness/integrity of stratium corneum, frequency of application, occlusiveness of vehicle
compliance
topical formations with vehicles and additives enhance benefits of drug (enhance absorption)
vehicle or active ingredients can cause local toxicity
topical meds can cause systemic toxicity
114
penetration enhancers
oitments best
then creams
then lotions
115
what is the biggest barrier for penetration
skin (mainly stratium corneum)
diffusion through epidermis faster at some anatomic sites
116
integrity of stratum corneum
abraded/eczematized presents less of barrier
solvents/surfactants/alcohols denature stratum corneum to increase penetration
hydration enhances absorption
117
tachyphylaxis
decrease in response when used over prolonged period of time
118
rebound effect
worsening or preexisting dermatoses
119
other things affecting penetration
hair follicles enhance drug delivery
120
more permeable areas of epidermis
due to variation in stratum corneum thickness, number of sebaceous glands, hydration
scrotum/face/axilla/scalp more permeable
121
chemical enhancers
water
alcohol
sulphoxides
decylmethylsulphoxide/DCMS
azones
urea
propylene glycol
surfactants
fatty acids
esters
122
physical enhancers
ionophoresis (small electric current)
ultrasound energy (phono or sonophoresis)
use of microneedles
123
stabulizers
nontherapeutic ingredients (preservatives, antioxidants, chelating agents)
preservatives protect formulation from microbial growth - parabens (against molg/fungi/yeast) others (phenols, benzoic acid, sodium benzolate, formaldehyde, thiomerosal)
124
thickening agents
bees wax
carbomers
125
vehicles
help drug penetrate skin and important therepeutic effects (moisten)
other properties (cooling, protective, emollient, occlusive, astringent properties)
126
powders
absorb moisture and decrease friction
limited to cosmetic/hygienic
can be inhaled
most have 3 ingredients (zinc oxide, talc, stearate)
calamine and antifungal powders
127
local toxicity
usually minor and reversable
irritation, allergenicity, atrophy, comedogenicity, formation of telangiectasis, pruritis, stinging, pain
128
most common side effect of topical meds
contact dermatitis
20% allergic, 80% irritant
129
irritant contact dermatitis
usually confined to where trigger touched skin
immediately after contact
nonimmune mediated
more driven by drug conc
-bc solvents/surfactant in topical meds
130
allergic contact dermatitis
depends on local penetration
rash more widespread
appear 1-2 days after exposure
type IV delayed hypersensitivity
prior immune sensitization required
presents as rash
-ivy, nickle, fragrences, hair dye
-tx: topical/oral corticosteroids, topical tacrolimus
131
photosensitivity/toxicity/irritation
electron clouds absorb UV radiation
phototoxic caused by direct damage to tissue by light activaiton/photosensitizing agent
usually bc sulfonamide component, tetracyclines, fluoroquinones, phenothiazines
tx - avoid sunlight, use sunscreen/protective clothing
132
photoallergic contact dermatitis
type IV delayed hypersensitivity
photoantigen applied to skin + UVA
prior immune sensitization required
eczema like and confined to areas in contact with chemical and sun exposure
133
urticaria
histamine release
usually rapid onset
itchy w angioedema
alergy can be virtually anything
tx - oral antihistamines
134
immunologic contact urticaria
IgE mediated, spread beyond point of contact and progress to general urticaria/angioedema.possibly anaphylactic shock
prior immune sensitization required
-rubber latex, raw meat and fish, potatoes, phenylmercuric propionate
135
nonimmunologic contact urticaria
direct release of vasoactive substances from cells or other granulocytes
immediate contact reaction without prior sensitization
-benzoic acid, dimethylsulfoxide, cinnamic aldehyde, sorbic acid, cobalt chloride, trafuril
136
treatment of local/anaphylactic reaction
remove irritant w damp cloth
weak acid solutions counteract weak basic irritants
cold moist compress for blisters
calamine lotion/oatmeal baths for itching
barrier creams like zinc oxide to protect skin and keep moist
mild to moderate use oral antihistamine/topical corticosteroid
severe use oral antihistamine/oral steroid/tacrolimus
anyphalaxis - IV/IM epinephrine
137
systemic toxicity
result of drug, metabolites, or vehicle
range from CNS/cariac/renal/teratogenic/carcinogenic
tx - remove source, systemic treament, treat symptoms
138
elderly
decreased absorption and penetration
thinner stratum corneum - better
skin poorly hydrated - worse
fewer hair particles - worse
139
children
greater risk percutaneous toxicity
greater surface area volume ratio
140
acute imflammation with oozing/vesiculations/crusting
use drying preparations
tinctures, wet dressing, lotion (usually contain alcohol)
141
chronic inflammation with xerosis/scaling/lichenification
treat with lubricating preparations
creams and ointments
142
creams vs ointments
ointment more occlusive
143
SPF
sun protective factor
measure of effectiveness in absorbing erythrogenic ultraviolet light
ratio of minimal erythema dose with sunscreen to minimal erythema dse w/o sunscreen
maximum SPF value 50
water resistant 40 min
very water resistant 80 min
15 or higher prevent sunburn and cancer
144
sunscreens
absorb ultraviolet light
-UVB blocks burn (para aminobenzoic acid and esters)
-UVA blocks aging (dibenzoylmethanes)
-benzophenones broader spectrum but not as effective as PABAs
most absorb UVB (cause sunburn and photocarcinogenesis)
145
sunshade
opaque material that reflect UV light
titanium oxide
146
antiinflammatory agents
topical corticosteroids - clobetasol, halobetasole, hydrocortisone, dexamethasone, beclomethasone, fluocinolone, fluticasone, triamcinolone, methylprednisone, betamethasone, prednisone, mometasone
-depress chemical mediators of inflammation by inducing phospholipase A2 inhibitory proteins and inhibition of release of arachidonic acid
-antimitotic effects
-may suppress pituitary adrenal axis, iatrogenic cushings syndrome, skin atrophy, cataracts/increased periorbital pressure
147
drug induced skin reactions
exanthematous drug eruptions
vasculitis
angioedema
exfoliative dermatitis
steven johnson syndrome/toxic epidermal necrolysis
erythema multiorme
purple toe
systemic lupus erythematous like syndrome
148
exanthematous drug eruptions
drug rash/maculopapular eruption
erythematous macules/patches/papules
onset 7-14 days
starts centrally and spreads outwards
-cause - allopurinol, antibiotics, carbamazepine, sulfonamide, gold salts
-tx - stop offending agent, antihistamines, topical/oral steroids, topical antipruritic
149
vasculitis
raised purpuric lesion on leg
fever/urticaria/lymphadenopathy, maculopapular rash
-cause - allopurinol, antibiotics, carbamazepine, NSAIDs, sulfonamide, gold salts, propithiouracil
-tx - systemic steroids or NSAIDs
150
angioedema
swelling of lips, tongue, eyes, genitalia bc increased permeability and fluid leakage
-cause - Ace inhibitors, NSAIDs, contrast media
-tx - systemic, oral antihistmine and/or steroid
151
exfoliative dermatitis
severe
exfoliation, fever, lymphadenopathy, edema
-cause - penicillins, isonaizid, gold salts, phenytoin, sulfonamides
-tx - antipyretics and fluids
152
stevens johnson syndrome
toxic epidermal necrolysis
SJS and TEN
EMERGENCY
TEN more severe
-cause - allopurinol, isonaizid, antiepiletics, gold salts, sulfonamides, tetracyclines
-tx - oral steroids, fluids, immunisuppresives, IVIG
153
erythema multiforme
cause - penicillin, barbs, NSAID
tx - stop drug, systemic steroid
154
purple toe
skin necrosis caused by warfarin
155
systemic lupus erythematous like syndrome
drugs that undergo n acetylation
more common in slow acetylators
isoniazid, hydralazine, procainamide
156
keratinolytic and destructive agents
therapy to remove warts, calluses, lesions where epidermis produces excess skin
soften keratin and assist in exfoliation of cells
bind moisture and treat dry skin conditions
salicyic acid
propylene glycol
urea
podophyllum resin
podofilox
sinecatechins
fluoruracil
NSAIDs (diclofenac gel)
aminolevulinic acid
157
salysilic acid
desquamination of kerotic debris
adverse - urticaria, anaphylactic rxns, erythema multiforme, local irritation.inflammation, ulceration with high conc
-can get toxicity in children more easily, toxicity when serum levels around 30-50mg/dL
158
propylene glycol
excellent vehicle for organic compounds (increase penetration)
remove hyperkeratotic debris, increase water conc of stratum corneum
used w polyethylene occlusion or w salycilic acid
adverse - irritant, allergic contact dermatitis
159
urea
vehicle in creams/ointment bc softens and moistens stratum corneum
160
podophyllum resin
treat condyloma acuminatum
cytotoxic agent for microtubule protein and arrest in metaphase
can distribute to CNS
adverse - N/V, altered mental status, muscle weakness, neuropathy, conjunctivitis
161
podofilox
treat genital condyloma
self administered cycle
adverse - irritation, inflammation, erosions, burning, itching
162
sinecatechins
treat external genital and perianal warts in immunocompetent pts
adverse - burning, discomfort, pruritis, erythema, skin erosion
163
topical 5 FU
inhibit thymidine synthetase interfering w synthesis of DNA
treat - actinic and solar keratoses, basal cell carcinoma
adverse - pain, pruritis, burning, tenderness, residual postinflammatory hyperpigmentation
164
diclofenac gel
for actinic keratosis
caution for hypersensitivity to aspirin
165
aminolevulinic acids
precursor of photosensitizing porphyrin metabolites, protoprophyrin IX accumulates
treat actinic keratosis
adverse - stingins and burning, redness and swelling, allergic contact dermatitis
only applied by medical professionals
166
pigmentation meds
for hyperpigmentation (causes hypopigmentation) - hydroquinone, monobenzone, mequinol
for hypopigmentation (causes hyerpigmentation) - trioxsalen/methoxsalen must be photoactivated or doxycycline/minocycline
167
hydroquinone/monobenzone/mequinol
inhibit tyrosinase which interferes with the biosynthesis of melanin
cause depigmentation
adverse - irritation, allergic contact dermatitis
168
trioxsalen/methoxsalen
must be photoactivated
intercalate w DNA and adducts formed which cause interstrand cross links
cause repigmentation
adverse - cataracts and skin cancer
169
trichogenic
produce hair
minoxidil, finasteride, bimatoprost
170
antitrichogenic
reduce hair
eflornithine
171
minoxidil
treat androgenic alopecia
effects not permanent
adverse - must monitor blood pressure (hypotension)
172
finasteride
5 alpha reductase inhibitor block conversion testosterone to dihydrotestosterone which causes androgenic alopecia
oral
adverse - decreased libido, ED
173
bimatoprost
prostoglandin analog
topically treat hypotrichosis of eye lashes
adverse - pruritis, conjunctival hyperemia, skin pigmentation, erythema, increased brown iris pigmentation
174
eflornithine
irreversible inhibitor of ornithin decarboxylase which inhibits polyamines
adverse - stinging, burning, folliculitis
175
acne treatments
topical retinoic acid and derivatives
oral isotretinoin
topical benzoyl peroxide
topical azelaic acid
topical and oral antibiotics
176
mild comedonal acne
1st choice - topical retinoid
alternate - alt. topical retinoid, azelaic acid, salicylic acid
female alternate - 1st choice
maintenance - topical retinoid
177
mild pustular acne
1st choice - topical retinoid and topical antimicrobial
alternate - alt. topical antimicrobial agent and alt topical retinoid or azelaic acid
femal alternate - 1st choice
maintenance - topical retinoid
178
moderate papular acne
1st choice - oral antibiotic and topical retinoid w or w/o BPO
alternate - alt oral abx and alt topical retinoid w or w/o BPO
female alternate - oral antiandrogen with topical retinoid/azelaic acid w or /o topical antimicrobial
maintenance - topical retinoid w or w/o BPO
179
moderate nodular acne
1st choice - oral antibiotic with topical retinoid with BPO
alternate - oral isotretinoin or alt oral antibiotic w alt topical retinoid w or w/o BOP/azelaic acid
female alternate - oral antiandrogen with topical retinoid w or w/o oral antibiotic/alt antimicrobial
maintenance - topical retinoid w or w/o BPO
180
severe nodular/conglobate acne
1st choice - oral isotretinoin
alternate - high dose oral antibiotic with topical retinoid and BPO
female alternate - high dose oral antibiotic with topical retinoid w or w/o alt topical antimicrobial
maintenance - topical retinoid w or w/o BPO
181
retinoic acid and derivatives
acid form af vitamin A
tretinoin and all trans retinoic acid
treats acne vulgaris
decreases cohesion between epidermal cells and increased epidermal cell turnover
adverse - erythema, dryness
adapalene - photochemically stable, less irritating, fixed preparation w BPO
tazarotene - mild/moderate facial acne, contraceptive counseling
isotretinoin - severe cystic acne, hypervitaminosis A/lipid abnormalities/teratogen
182
benzoyl peroxide
topical agent for acne vulgaris
OTC by itself
adverse - potent contact sensitizer, may bleach hair/colored fabric
183
azelaic acid
treat acne vulgaris and acne rosacea
adverse - irritant, redness, drying
184
brimonidine
alpha 2 adrenergic agonist
topical treatment of rosacea
adverse - lower BP
185
oxymetazoline
selective alpha 1 adrenergic receptor agonist
topical treatment of rosacea
adverse - blood pressure bc causes vasoconstriction
186
antibiotics to treat acne
oral - clindamycin, erythromycin, minocycline, tetracycline
topical - clindamycin, erythromycin, metronidazole, dapsone, sulfactamide
187
topical metronidazole
acne rosacea
188
topical dapsone
acne vulgaris
189
psoriasis approach
limited - use topical steroid and emolients
moderate to severe - phototherapy
moderate to severe and CI or failed phototherapy - retinoids, apremilast, biologics
190
psoriasis drugs
acitretin
tazarotene
calcipotriene
calcitrol
biologics - alefacept, etanercept, infliximab, adalimumab, ustekinumab
191
acitretin
retinoid like compound (bind retinoid X and retinoid acid recepptors)
oral treatment of psoriasis
adverse - hypervitaminosis A, increase cholesterole, hepatotoxicity, teratogenic
192
tazarotene
topical only
bind retinoic acid receptor
adverse - burning, peeling, erythema, edema, potentiate photosensitivity
193
calcipotriene
topical synthetic vitamin d derivative
bind vit d receptor and inhibit keratinocytes
treat plaque psoriasis
adverse - hypercalcemia, burning, itching, irritation, dyrness, ocular irritation
194
calcitriol
active vitamin d derivative
bind vit d receptor and inhibit keratinocytes
adverse - hypercalcemia, dermatologic
195
biologics
treat moderate to severe plaque psoriasis
196
TNF alpha inhibitors
adalimumab
certolizumab
etanercept
infliximab
197
IL 17 inhibitors
brodalumab
ixekizumab
secukinumab
198
IL23 inhibitors
guselkumab
risankizumab
tildrakizumab
199
IS 12 and IL 23 inhibitor
ustekinumab
200
cytokine inhibitors
interleukin receptor antagonists
adverse - serious infections, screen for TB
201
apremilast
oral phosphodiesterase 4 inhibitor
adverse - mild GI complaints, depresion, weight loss
202
immunomodulators
imiquimod
tacrolimus and pimecrolimus
dupilumab
203
imiquimod
stimulate mononuclear cells
treat external genital and perianal warts, actinic keratoses, basal cell carcinoma
adverse - inflammation, pruritis, erythema, erosions
204
tacrolimus and pimecrolimus
tacrolimus oral and topical
pimecrolimus topical only
suppress cellular immunity
for mild to moderate atopic dermatitis
adverse - burning, unsure long term safety
205
dupilumab
IL 4 receptor alpha antagonist reduces cytokine activity
treat moderate to severe atopic dermatitis
adverse - injection site reaction, conjunctivitis, keratitis
206
anti inflammatory agents
corticosteroids
crisaborole
tar compounds
207
crisaborole
PDE4 inhibitor
for mild to moderate atopic dermatitis over 2 yrs
adverse - burning
208
tar compounds
treat psoriasis, dermatitis, licken simplex chronicus
adverse - irritant folliculitis, photoirritation
209
antipruritic
doxepin and pramoxine
diphenhydramine
210
doxepin
topically treat pruritis w atopic dermatitis of lichen simplex chronicus
anticholinergic so avoid in narrow angle glaucoma
adverse - burning, allergic contact dermatitis
211
pramoxine
topical anesthetic with temporary relief from pruritis with mild eczematous dermatoses
usually combine w hydrocortisone
adverse - burning, avoid contact w eyes
212
sporothrix schenckii
rose gardners disease
dimorphic fungus
on plants as hyphae w rosettes and sleeves of conidia
traumatic implantation
in tissue as cigar shaped yeast
213
sporotrichosis
subq or lymphocutaneous lesions
tx - itraconazole
214
pulmonary spporotrichosis
alcoholics/homeless
tx - itraconazole/amphotericin B for severe
215
parvovirus B19
transmitted via respiratory droplets
cause erythema infectiosum
highly contagious before symptoms
cause impairment of erythrocyte development (anemia)
produce strong antibody response to end viremia
rash in children
polyarthritis in adults
mother to fetus (hyrops fatalis)
216
varicella zoster chicken pox
maculopapular lesions on scalp that spread to trunk and then extremities
217
varicella zoster shingles
reactivation of VZV
correlates w decrease VZV specific t cells
affect 1 dermatome
if spread will develop chicken pox
218
coxsackievirus and echovirus
mouth entry
replicate in oropharynx and intestine
spread to variety of organs
A - vesicular lesions
B - body
mostly asymptomatic disease
causes herpangia - lesions in soft palate, hand foot and mouth with lesions in all these areas, aseptic meningitis, pleurodynia (abdominal and chest pain), pericarditis and myocarditis
fecal oral transmission
219
mycobacterium leprae
hansens bacillus
mouse footpads and armadillos
HLA linked predisposition
primarily attacks cooler regions of body
several forms related to different levels of cell mediated immunity
220
tuberculoid leprosy
least severe
red cutaneous nodules that resemble tubercles and contain granulomas
lesions are anesthetic
221
borderline leprosy
suffer from clawin hands, footdrop, facial palsy
lesions flat red or white
nerve damage and anesthesia, few granulomas
222
lepromatous leprosy
most severe
huge numbers of bacilli
lesions contain histocytes filled w lipids
lesions hypoesthetic then anesthetic
erythema nodosum
very dismembering
dx - acid fast bacilli, enlarged peripheral nerves, anesthetic lesions
tx - rifampin and dapsone
223
mitsuda skin test
analogous to tuberculin test
evaluate immune status of leprosy patients
224
mycobacteria other than tuberculosis
atypical mycobacteria
noncontagious
found in surface waters/soil
M. marinum - cutaneous granulomas in fish enthusiasts
225
rickettsia
gram negative pleomorphic rod
obligate intracellular parasite
insect is vector
enter through bite or abrasion
produce phospholipase A (hemolytic) and destroy vascular system
weil felix test - identifies anti rickettsial antibodies
rocky mountain spotted fever - prodromal illness then maculopapular rash that starts on extremities and moves to trunk, treat with doxycyline
226
western USA
dermacentor andersonii
wood tick
227
eastern USA
dercamentor variabilis
dog tick
228
leishmania
transmitted by sandflies
promastigote in insects
amastigote in humans
spread person to person via cutaneous or mucocutaneous contact
cutaneous - primary localized infection, multiply in tissue macrophages, eventually nodules ulcerate
mucocutaneous - organisms disseminate, hypertrophy of spleen and liverm glomerulonephrits, hypertrophy of upper lip and nose
visceral - blackening skin, hypertrophy of liver and spleen, most asymptomatic/mild
229
folliculitis
inflammed hair follicle
S. aureus, pseudomonas, other gram - organisms
topical/oral antibiotics
230
acne vulgaris
disorder of pilosebaceous units
231
comedo
hair follicle infundibulum that is dilated and plugged by keratin
open comedo = black head
closed comedo = white head
232
rosacea
facial flushing, erythema, papules, pustules, telangiectasia
1. erythemotelangiectatic
2. papulopustular
3. phymatous
tx - brimonidine
233
impetigo
superficial intraepidermal infections
most S. aureus or S. pyrogenes
echthyma. - non treated and severe (ulceration)
tx - dicloxacillin/cephalexin, if MRSA TMP/SMX doxycycline or clindamycin
234
pustular psoriasis
pustules on erythematous background
idiopathic in many
235
acanthosis`
thickening of stratum spinosum
236
acantholysis
spearation of keratinocytes in epidermis
237
hyperkeratosis
thickened stratum corneum
238
parakeratosis
abnormal nuclei in stratum corneum
239
dyskeratosis
abnormal keratinization of cells in epidermis
240
spongiosis
edema in epidermis (desmosomes stretch)
241
hypergranulosis
increased thickness of stratum granulosum
242
pediculosis
lice
head/body louse
pubic louse
tx - permethrine
243
scabies
contagious parasitic infection by sarcoptes scabiei
see lesions/burrows
test w mineral oil mounts
tx - permethrine
244
cimex lectularius
bed bug
seet oder, bites in a line
tx - good hygeine, antibiotics/antihistamines/steroids
245
lichen planus
idiopathic inflammatory disorder
t cell mediated
pruritic eruption with papules or hypertrophic plaque of hair skin or mucosa
tx - high potency topical steroid, oral steroid, topical tacrolimus
histology - band like infiltrate of t lymphocytes at dermal epidermal junction
246
urticaria
hives
vascular reaction of skin with wheals surrounded by red halo
mast cell degranulation
tx - antihistamines
247
angioedema
swelling of eyes, lips, tongue
248
scomboid food poisoning
ingestion of spoiled fish
erythema of face/neck.trunk
249
impetigo treatment
non bullous (staph) - mupirocin/retapamulin ointment
severe bullous (staph +/- strep) = dicloxacillin or cephalexin or doxyxycline/clindamycin/TMPSMX for MRSA
250
ecthyma
dicloxacillin or cephalexin
clindamycin, doxyxycline, TMP/SMX for MRSA
251
folliculitis
hygeine - chlorhexidine wash
topical - mupirocin, clindamycin
252
furuncle
usually staph
I&D
systemic TMP/SMX or clindamycin
253
carbuncle
progression further
oral TMP/SMX or clindamycin
254
erysipelas
superficial derm lymphatic vessel infection
group A strep or staph
non diabetic on extremities - penicillin G or cefazolin inpatient, penicillin VK outpatient
facial infection - IV vancomycin
diabetics - mild TMP/SMX plus vancomycin/cephalexin, severe PENEM plus linezolid/vancomycin/daptomycin
255
cellulitis
empiric therapy same as above
256
necrotizing fasciitis
strep pyrogenes or clostridium
if only 1 - penicillin G and clindamycin
if polymicrobial - PENEM
if MRSA - add vancomycin or daptomycin
empiric - PENEM and vancomycin
257
MRSA
CA - mild topical mupirocin/clindamycin, moderate TMP/SMX/clindamycin/doxyxyxline, severe vancomycin
HA - vancomycin
258
MSSA
cillins or cef (cephalexin)
259
tinea pedis
topical clotrimazole, terbinafine
oral terbinafen, griseofulvin
260
tine cruris
topical clotrimazole, terbinafine, miconazole
oral terbinafine, fluconazole, griseofulvin
261
tinea corporis
topical clotrimazole, terbinafine, miconazole
oral terbinafine, fluconazole, griseofulvin
262
tinea capitis
oral terbinafine or griseofulvin
263
tinea versicolor
not dermatophyte
selenium sulfide or topical zinc pyrithio
264
azole antifungal meds
inhibit synthesis of ergosterol by inhibiting CYP 450 enzymes
265
nystatin
candida
binds sterols in membrane to allow leakage of cellular components
266
tine unguium
oral tebinafine, itraconazole, or fluconazole
-tavaborole
267
terbinafine
inhibit squalene epoxidase
268
griseofulvin
inhibit assembly of microtubules
269
tavaborole
inhibit fungal protein synthesis
270
efinaconazole
solution for topical use of onychomycosis
271
sporotrichosis
rose gardners disease
itraconazole
272
pediculosis
permethrine
273
scabies
permethrine
oral ivermectin
274
permethrine
inhibit sodium influx in nerve cell of parasite
275
ivermectine
bind glutamate gated chloride channels and hyperpolarize the cells
276
verruca
salysilic acid, cryo, podophylin, imiquimod
277
anthrax
oral ciprofoxacin or doxycycline
278
rocky mountain spotted fever
doxycycline in adults and children
279
mycobacterium marinum
clarithromycin and ethambutol or rifampin and ethambutol
280
staph aureus
most pathogenic
catalase positive, coagulase positive, ferments mannitol and sensitive to novobiocin, beta hemolysis
protein A
281
staph epidermidis
normal flora
infections of implanted devices (biofilm)
catalase positive, coagulase negative, addition of biotin on mannitol agar and sensitive to novobiocin
282
staph saprophyticus
UTIs
catalase positive, coagulase negative, grow on mannitol agar and resistant to novobiocin
283
staph haemolyticus
prosthetic associated infections (biofilms)
catalase positive, coagulase negative
284
staph virulence factors
adherence to endothelial cells - fibronectin, fibrinogen, lamanin, collagen
protein A - antiphagocytic, anti complementary, chemotactic
techoic acid - activate complement away from bacterium, protect from opsonization, induce CMI
hydrolytic - catalase, hyaluronidase, coagulase, staphylokinase, alpha hemolysin, beta hemolysin, panton valentine leukocidin
exfoliative toxins - scalded skin syndrome
enterotoxins - food poisoning and superantigen
toxic shock syndrome toxin 1
285
superficial fungal infections
tinea versicolor, tinea nigra, white piedra, black piedra
286
cutaneous fungal infections
tinea corporis, tinea cruris, tinea manuum, tinea pedis, tine capitis, tinea barbae, tinea unguium
287
tinea versicolor
malassezia furfur
small hypo/hyperpigmented macules
spaghetti and meatballs on sourbrouds agar
yellow under woodlamp
288
tinea nigra
solitary irregular pigmented macule
hortaea werneckii
traumatic inocculation
KOH mount with 2 celled oval yeast and short hyphae
289
white piedra
white brown swellin around hair shaft
trichosporon
290
black piedra
small dark nodules surrounding hair shaft
piedraia hortae
291
epidermophyton floccosum
yellow colored colony cultures
thick bifurcated hyphae with multiple smooth club shaped macronidia
skin and nails
292
microsporum
skin and hair
many rough thick waled macroconidia
green under wood lamp
293
trichophyton
skin, hair, nails
numerous microconidia
294
candidiasis
most common opportunistic mycoses
budding yeast and pseudohyphae
mucocutaneous - oropharyngeal/esophageal/vaginal
cutaneous - intertriginous (skin rubs), diaper rash, onychomycosis
