Derm Final Flashcards by Mahlet Berta

Group A beta-hemolytic streptococci.
Infection extends into dermis.
Heals with scar (because ulcerative)

Ulcerative bullous impetigo

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Chronic itch in a postmenopausal women
Negative KOH
Presents as chronic itch-scratch- cycle

lichen simplex chronicus

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Dimple sign with lateral pressure

Dermatofibroma

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Painful itchy condition
Recurrent and lasts 2-3 weeks then clears.
Starts with deep seated blisters between the fingers
no other lesions can be found.
Not infectious in its cause

Irritant contact dermatitis (clue is stand alone lesion, confined to hands & fingers, vesicular or blistering

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Pruritic inflammatory condition.
Often with a personal or Fhx of similar eruptions.
Diffuse erythema, some vesicular eruption and mild overlying scaling on the face, scalp, flexural surfaces

Atopic dermatitis

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Infected area tender, deep, red and swollen

Cellulitis

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superficial infection of the dermis

Erysipelas

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Sun exposed areas of skin
Male > Females
Pre-malignant
1 out of 1000 lesions develop into SCC annually
5-10% over a lifetime

Actinic keratosis

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Is this patient with AK amenable for surgical removal of lesions?
If not, what is the standard of care 1st line tx?

No. too many lesions
5 fluorouracil applied topically 5% cream for 4 weeks

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Acquired light or dark-brown hyperpigmentation
Age of onset - young adults
Female > male (10%)
Race - brown or black skin type
Incidence/etiology: hyperinsulinemia, pregnancy, combo hormone replacement, thyroid dysfunction, genetics, UV radiation, cosmetics, anti seizure medication

Melasma/ chloasma

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Presentation: maculopapular, urticarial, pustular and nodular eruptions
Prevention: sunblock should be used, but not always helpful
Systemic tx:
Beta-carotene, 60 mg tid 2 weeks before sun
Niacinamide, 2-3 g/day (helped 60% of pts in one study)
Vit B-6, 150-200 mg, taken 30 min before sun, or 100 mg/hr for 8-10 hrs before sun
Antimalarial drugs

Polymorphous light eruption

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Nodular mass of dilated vessels
80-90% resolves spontaneously within 5-8 years

Superficial hemangioma

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Superficial bacterial infection of the hair follicles
Most commonly S. aureus
Caused by friction blockage of follicle, shaving
Papule or pustule confined to hair follicle, often surrounded by erythematous halo
No scarring

Folliculitis

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Fair-skinned individuals with excessive sun exposure in childhood at highest risk
Location: top of the ear and crossing vermillion borders of the lips
Exposure to chemical carcinogens (pitch, tar, crude paraffin oil, creosote, lubricating oil)
Arsenic (flower’s soln. for psoriasis)
Other etiologies (HPV, immunosuppression)

SCC

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Most common areas:
lower legs, scrotum, vulva, anus pubis, wrists, ankle and elbow, upper eyelids, back and side of neck, ear-orifice and fold
Scalp-picker’s nodules

Lichen simplex chronicus

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HT for scalp-picker nodule that bleeds

Calc carb

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Caused by gram positive cocci
Bollus condition (blisters)
Ulcers
Tx with topical mupirocin

Bullous impetigo

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Single or scattered discrete lesions on sun exposed areas
Adherent hyperkeratotic scales “rough texture”
Better felt than seen
A sore that doesn’t heal

Actinic keratosis

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An acute, deep-seated, red, hot tender nodule or abscess

Furuncle

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Lesion present for 20 years
Superficial
Asymmetrical
Poorly demarcated orders
Punch biopsy was malignant

Superficial spreading melanoma

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Infection of the dermis and subcutaneous tissue
- Caused by group A Streptococcus and s. aureus in adults
- Hemophilus influenza B - kids
- Most often on legs and face
- Port of entry- crack, abrasion, bite, or other wound to skin
- Warm, tender, swollen, red area
- Possible fever, enlarged nodes, red streak

Cellulitis

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What is the HT remedy for a pt presenting with:
- woke up with bright red cheeks, super hot, red, minimally swollen, accompanied by a h/a, very dry
- Mental emotional predisposition went from normally calm individual to an extremely violently oriented person this morning due to the inconvenience of her condition.

Belladona

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Belladonna acute can appear like a ______ , Ht remedy that is chronic

Calc carb

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Painful swollen sweat glands in the axilla

hidradenitis suppurativa

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- Hutchinson's sign present - Periungual spread from nail towards the proximal finger

Acral lentiginous melanoma

- Scaling to ulcer - Elevated nodule to tumor - indurated, eroded nodule that ulcerates and bleeds easily - Common on lower lip, top of ears, tongue, head, neck, back of hands

SCC

- Maceration of toes and knees - Often malodorous - Tx - wear cotton socks (change frequently) - Consider agents to reduce moisture- powder - Topical antibiotic may be necessary

Pitted keratolysis

- Papule or nodule - Pearly or translucent - Telangiectasia - haphazard - Can be pigmented/sclerotic - Translucent when stretched

BCC

- Bacterial infection (corynebacterium minutissimum) - Gram positive rod - Diffuse brown, scaly plaque resembles tinea - 3rd and 4th toe web most common, also genital-crural region

Erythrasma

What could be identified on a wood's lamp exam with Erythrasma

A coral red fluorescence

Which pre-malignant (1 out of 1000 lesion annually) develop into SCC, 10% over lifetime?

AK (Actinic Keratosis)

- For smaller and isolated lesions- Tx includes: cryosurgery, radio surgery, hypercation or electrodes desiccation 5-Fluorouracil- 5% applied bid for 2-4 weeks- very irritating - Acetaminophen with codeine often given for pain - Petrolatum often used between applications to soothe skin

- Red, swollen, painful periorbital

Periorbital cellulitus

- Condition managed with gluten free diet, topical dapsone and sulfapyridine - Vesicular eruptions that mimics a herpes simplex but with diffuse involvement in a non contiguous pattern across the body

Dermatitis herpetiformis

- Pinpoint papules - Desquamation fo the tips and toes - Strawberry tongue- day 4-7 in untreated cases - Pastia's sign

Scarlatina/scarlet fever

- Primary-painless chancre (contagious) - Secondary (contagious) disseminated

Syphilis

- Possible association with fluoride and sodium lauryl sulfate

Perioral dermatitis?

- Locally invasive, aggressive, destructive - On the face

BCC

Associated with an acute inflammatory process at a distal site

ID reaction

- No radial growth, so early metastasis - Most common in 6th decade of life

Nodular melanoma?

Herald patch

Pityriasis rosea

- Itchy since the introduction of food 3 months ago - Both parents have asthma

Atopic dermatitis

Spilled oven cleaner

Irritant contact dermatitis

- 1 year duration - Moderate pruritus - Wickham's striae

Lichen planus

- Culture positive for pseudomonas

Folliculitis

Caused by gram positive rod from raw fish or meat contact

Cellulitis

Delayed abnormal reaction to UV radiation

Polymorphous light eruption

What is this condition?

Psoriasis

- Chronic itch rash - Remembers having a rash in cubital and popliteal fossa as a child

Atopic dermatitis

- Hyper proliferative skin disorder in generally predisposed individuals - 2% of world pop (range 0.4-4.7%)

Psoriasis

- Chronic lesion on elbow - Picking at it reveals pinpoint bleeding

Psoriasis

- No pruritus - Neg KOH - Neg ANA

seborrheic dermatitis

Oil accentuates the lacy, white Wickham's striae

Lichen planus

ID. by looking at the characteristic sites

Lichen simplex chronicus

- Chronic itchy lesions - Resistant to tx - Neg KOH - Neg culture - Biopsy-spongiosis

Nummular dermatitis

Hyperproliferative skin disorder in genetically predisposed individuals

Psoriasis

- Usually Fhx of eczema, hayfever or asthma (60-70%) - 7-15% of general population

Atopic dermatitis

End result of what condition?

Rosacea

A women had this reaction after using neomycin ointment

Allergic contact dermatitis

- Common (2-5%) - Chronic inflammatory disease - Pityrosporum ovale - Genetics, stress, and dietary factors affect onset of disease

Seborrheic dermatitis

- Sites: wrists (MC), forearm, ankles, ant legs, lumbar regions, and genitals - Up to 5% have mucous membrane and 10% nail (split ridge etc)

Lichen planus

- All skin types (10-20%) - Females > male, around age 20 first onset - Spring, early summer - 2-24 hours after 1st sun exposure - lasts 7-10 days

Polymorphous light eruption

- Lip licking - oven cleaner

Irritant contact dermatitis

ID the condition on the image

Erythema multiforme

ID the condition on the image

polymorphous light eruption?

- Like acne protocol - Loose clothing - Avoidance of heat, humidity, shaving, depilation, deodorants - Warm compresses - Zinc- 90mg/day- 2 months

Hidradenitis suppurativa?

- Centrally affects the face, forehead, cheeks, nose, and chin - May include iritis or blepharoconjunctivitis

Rosacea

- Five p's: pruritic, planar (flat-topped), polygonal, purple papules, 2-10mm in diameter

Lichen planus

- Papulopustules on an erythematous base that may have occasional itching, burning, feeling of tightness

Perioral dermatitis

- Triggers include drugs, infection or unknown

Erythema multiforme

- Acute inflammatory/immunologic rx of subcutaneous fat leading to painful, red, swollen nodules on the extensor aspec of the extremities - Prodrome: fever, malaise, later arthralgias, arthritis and hilar adenopathy

Erythema nodosum

- Pruritic, papulovesicular or scaly coin-shaped lesions - Negative KOH test

Nummular eczema

ID the condition in the image

Psoriasis

- A pt. noticed a correlation with wearing a bra and these lesions

Type lv delayed. HS- allergic dermatits

30-35% have ocular symptoms (iritis, scleritis, keratitis, chalazia, blepharoconjunctivitis)

Rosacea

Top 10 list: Nickel sulfate (10-15%), neomycin sulfate, balsam of peru, fragrance mix, thimerosal, sodium gold thiosulfate, formaldehyde, quaternium-15, cobalt chloride, bacitracin

Allergic contact dermatitis

Cradle cap

Seborrheic dermatitis

This phenomenon results from the release of cytokines that develop in a distal primary dermatitis i.e. tinea pedis, stasis derm etc

ID reaction

Tx- first try warm, moist compresses, it may resolve, if not consider incision/drainage

Boil/furuncle

Tx- Topical tx- Mupirocin (pseudomonic acid)

Bollous impetigo

Dietary recommendations may include: whole foods high in fat, low to moderate protein, high complex carbohydrates, low glycemic diet to stabilize blood glucose, dairy and wheat elimination

Acne vulgaris?

Triggers include drugs, infection or unknown

Erythema multiforme

- Recurrent - Self resolving condition of unknown etiology

Pompholyx/Dyshidrotic eczema

Caused by beta-hemolytic strep

Ecthyma

Fluoresces coral- red w/ wood's lamp

Erythrasma

Telangiectasia is commonly found in association with what condition?

Rosacea

Herald patch

Pityriasis rosacea

Chronic itch-rash-scratch cycle - Negative for fungal, bacterial or viral

Lichen simplex chronicus

- Older woman claims this scaly dry rash on her leg returns every winter. She has no other dermatitis hx, with hx yo determine she is deficient in EFA's

Asteatotic eczema

This chronic skin condition is a minor feature in what condition?

Keratosis Pilaris

ID condition in the image

Impetigo

Enlarged swollen mass with purulent material begining to exude from several points on the surface

curbuncle?

Possibly associated with fluoride and sodium lauryl sulfate, but not considered ACD.

Perioral dermatitis

- Recent sore throat - Numerous papules giving a sandpaper- like texture to the skin

Scarlet fever

- Relevant food allergies (70-80%) of cases - Major: eggs, milk, peanuts, soy, fish, wheat - Minor: citrus, tomato, strawberries, corn, chocolate, food preservatives and coloring - Inhalants: aeroallergens, animal dander, dust mites

Atopic dermatitis

- Negative KOH - Negative Hx of topical creams - Negative blood tests

Rosacea

- Streptococcal pharyngitis 1 week before rash - Resolves spontaneously in weeks to months - Teardrop shaped spots, red, small, scaly - Acute onset 1-2 days - Self resolve in 3-4 mo

Guttate psoriasis

What is the most common cause of this dermatitis?

Nickel allergy

Common condition for what condition?

Psoriasis

- Acute vesicles - linear lesion is a sign of dragged over the skin while scratching

Allergic contact dermatitis

Present in 5-20% of FST I-II

Atypical nevi

- Chronic, unchanging macular lesions - Benign on biopsy

Junctional melanocytic nevi

- Over 50 y/o,, Male:Female ratio 2:1 - Possible viral etiology - Rapid growth 2-5 cm w/in a few weeks to months - Can self-resolve in months to years (bad scar) - Removal recommended- r/o BCC, SCC, wart, AK - Single lesion-mc cheeks, nose, ears, hands (post), but can be any location

Keratoacanthoma

- Acquired loss of pigmentation - Pathogenesis is not known - Theories: autoimmune, neurogenic, self-destruct, genetic background (30%) - Age of onset any, 10-30 yrs (50%) - Incidence: common up to 1% - All skin types, equal in all sexes - lesion- white macules, sharple marginated, 5mm- 5cm - Can affect any area most common on face and extremities. Accentuated with sun exposure

Vitiligo

- Exclamation point hairs - Course: remission is common (80%) - Management: Stress reduction, topical onion juice, topical intralesional or systemic glucocorticoids, can add topical minoxidil, wig in severe cases, or refer for topical immunotherapy

Alopecia Areata

White horn cysts

Seborrheic Keratosis (sign that this may not be melanoma). But Bx still indicated.

ID this condition in the image

Stork bite lesion

- Can arrise with no known cause, or it may appear in people with a genetic - Mc in people ages 20-40 - solitary lesions that are: infrequent, inconsequential, represent spontaneous mutations - On compression, invaginate into a slit-like defect in the skin = "buttonhole" sign

Neurofibroma

Rapid growth within few weeks, can self-resolve within month-year

keratoacanthoma

- Very common, button-like dermal nodule - Pink, brown, tan, darker at center - Leg > arms > trunk - Few mm to 1 cm - 'Dimple sign' with lateral compression - Tx- leave alone, excision, cryotherapy

Dermatofibroma

Multiple benign lesions- ID

Seborrheic Keratosis (rough type)

Treated 5-FU or Curaderm - ID

BCC superficial

Benign condition - ID

Intradermal nevi

- Dilated vessels deep in dermis and subcutaneous tissue - Spontaneous resolution, surgery, interferon, propranolol, intralesional and topical corticosteroids, vincristine and cyclophosphamide

Hemangiomas of infancy (deep)

- Painful lesions - Early central crust - Apex- mc - Long standing - Dense rolled edge

Chondritis nodularis helicis

- Vascular malformation - Flat, unilateral patches - Irregular, reddish-blue color - MC face, neck - Prominent, macular hemangioma

Port-wine stain (nevus flammeus)

Filled with clear gelatinous viscous fluid

Digital mucous cyst

Asymptomatic, soft benign papule, from dilated venule

venous lake

- Develops after a minor trauma - Bleeds easily - <30 y/o

Pyogenic granuloma

ID condition in this image

Spider Angioma

- 25% remit with decrease sun exposure - Antioxidants, fruit, vegetables, green tea etc. - 5-FU - Black salve (iris, red clover, sanguinaria) - Vitamin A - Curaderm - Cryotherapy (3-10 sec max/3 w/5FU) - Sunscreen Type I &II skin - Excision for large lesions

Actinic keratosis

Black horn cyst - ID

Seborrheic Keratosis

- A reactive hypermelanosis of the skin that occurs as a sequela of cutaneous inflammation - A common disorder that can occur at any age and has an equivalent incidence in males and females - May occur regardless of skin color, but is clinically more significant with darker skin pigmentation

postinflammatory hyperpigmentation (PIH)

ID image

Milia

Painless slow growing mass in the lid Tx hot compresses 10-15 min qid/2-3 wks

Meibomian cyst

- Most common tumor of the intraepidermal eccrine sweat glands - Women > Men - Autosomal dominant - Usually symmetrical distribution

Serangioma

- Most common skin disorder in adolescents - Typical age range 12-25 years - 79 - 95% of adolescents aged 16-18

Acne?

- Filled with clear gelatinous mucin - Dorsal wrist MC

Ganglion cyst

ID image

Lipoma

- Small tumors of enlarged sebaceous glands - 1-3mm - Telangiectasia - Central umbilication - Soft - > age 30 (25%pop) - Unknown etiology

Sebaceous hyperplasia

- Very common fibrous lesion - Begin in second decade - Soft, skin-colored to slightly pigmented - Pedunculated papule-neck, axilla, groin, eye, mouth

Skin tags / Chordons

ID condition in the image

Epidermal incusion cyst

- Present in 5-20% of Northern European heritage population - Can occur anywhere - Acral and mucosal surface of other FST - Potential precursors to superficial spreading melanoma (SSM) - Increase risk for developing primary melanoma

Atypical nevi

- Usually deeper than an epidermal inclusion cyst - May feel rubbery but is usually not malleable - If lesin feels quite firm, a malignant tumor must be considered

Lipoma

- Abnormal scarring in susceptible individuals - More common in darker skin types - 1% - 6% of the population in response to trauma (acne, body piercing, tattoos, insect bites, vaccinations, surgery) - Age 10-30 years

Keloid

ID condition in the image

Skin tag / Chordon

- Wheals-transient edematous papules and plaques - Usually pruritic - 15-25% of pop will have at least one episode at during their lifetime - Duration: hours-months - Histamine is the most important mediator

Urticaria

- Autoimmune disease causing localized hair loss w/o signs of inflammation(asymptomatic) - About 2% of population have at least one episode - Etiology-autoimmune, can be assoc with Hashimoto's thyroiditis, vitiligo, myasthenia gravis

Alopecia areata

- Chronic, recurrent, intensely pruritic vesicles, papules, and urticarial plaques that are arranged in groups - Can resemble hrepes: therefore the designation of herpetiformis - Almost universally associated with celiac disease (1% of pop) - Age on onset 20-60 years - Prevalence in Caucasians, M:F 2:1, 10-39 per 100,000 persons

Dermatitis herpatiformis

- Thickened, hyperpigmented skin in the axillae and groin - Often associated with obesity and hyperinsulinemia - Can be congenital - Increased circulating insulin causes dermal fibroblast and keratinocyte

Acantosis nigricans

- Localized proliferation of melanocytes due to chronic sun exposure (esp. sunburns) - 1-3 cm macules - >40 y/o esp. Type I-III skin - Roughly 75% of FST I-III people over 60 have one or more

Solar lentigo (liver spots, senile freckles)