Derm Final Concepts

Question 1

Type of skin cancer; slow growing pink pearly papule/nodule with telangiectasis; fair skin and found on sun exposed areas (UV exposure is greatest risk); metastases RARE; Keratinocyte origin but no pre-cancer precursor like SCC; can be superficial or pigmented

Answer 1

Basal Cell Carcinoma

Question 2

Pink macule or patch or thin papule (Superficial/Pigmented)

Answer 2

Superficial BCC

Question 3

Seen in darker skin types (Superficial/Pigmented)

Answer 3

Pigmented BCC

Question 4

Treatment for BCC

Answer 4

Surgical: Mohs surgery, curettage, excision

Non-surgical: Imiquimod

Question 5

Pigmented skin cancer; Melanocyte origin; can arise de novo or from a pre-existing nevus; demonstrates any of the ABCDEs (asymmetry, borders, color, diameter and evolving); risk factors include lighter skin, hx of sunburns/tanning bed use, family hx, higher # of moles, red hair

Answer 5

Melanoma

Question 6

melanoma in the epidermis or epidermal-dermal junction only with no invasion of dermis

Answer 6

Melanoma in situ

Question 7

KEY prognostic factor for Melanomas; measurement from s. granulum to deepest point of melanoma invasion in dermis

Answer 7

Breslow depth

Question 8

Type of biopsy needed for melanoma diagnosis

Answer 8

Excision biopsy (remove the entire lesion to accurately measure Breslow depth)

Question 9

Tx for Breslow depth <0.8 mm

Answer 9

wide local excision or Mohs surgery

Question 10

Tx for Breslow depth >0.8 mm

Answer 10

wide local excision and ALSO sentinel lymph node biopsy to assess for metastatic disease

Question 11

If melanoma biopsy confirms metastatic disease, what needs to be confirmed for treatment?

Answer 11

genetic mutations to dictate the most effective immunotherapy

Question 12

What genetic mutations are the most common in melanoma?

Answer 12

BRAF & CDKN2A

Question 13

Pinpoint pink papules around nose, mouth, maybe eyes; can last up to months but not long-term like rosacea; can be triggered by aerosolized steroids and worsened by topical steroids

Answer 13

Perioral Dermatitis

Question 14

Treatment for perioral dermatitis

Answer 14

topical metronidazole + oral antibiotics (doxy or minocycline)

Question 15

a very common chronic skin disease due to inflammatory response to Malassezia (fungi); diffusely through areas of high sebum production (scalp, ears, central chest); erythema with overlying greasy yellow scale; infantile type is called “Cradle Cap”; hypopigmentation in darker skin

Answer 15

Seborrheic Dermatitis

Question 16

Severe disease of _____ can be seen in untreated HIV or parkinson disease

Answer 16

Seborrheic Dermatitis

Question 17

Treatment for Seborrheic Dermatitis

Answer 17

topical steroids (for flares) and ketoconazole (for Malassezia)

Question 18

chronic disease that presents as largely symmetric erythematous well-defined plaques with overlying silvery scale; extensors (elbows, knees) and scalp, buttocks, sacrum, umbilicus are common locations; thought to be due to cytokines triggering a hyperproliferative state resulting in thick skin and excessive scale

Answer 18

Psoriasis

Question 19

MOST COMMON type of psoriasis

Answer 19

Plaque Psoriasis (silvery scale)

Question 20

type of psoriasis commonly seen in younger people; often seen after STREPTOCOCCAL pharyngitis

Answer 20

Guttate Psoriasis

Question 21

type of psoriasis morphology; lesions located in SKIN FOLDS (axilla,groin, etc.); may lack scale due to moistness of area

Answer 21

Inverse/Flexural psoriasis

Question 22

type of psoriasis; widespread, generalized erythema covering nearly ALL (>80%) of the body surface; hospitalization is sometimes needed

Answer 22

Erythrodermic psoriasis

Question 23

type of psoriasis morphology; pustules; triggered by corticosteroid withdrawal; generalized; can be LIFE-THREATENING

Answer 23

Pustular psoriasis

Question 24

indicates higher risk of psoriatic arthritis (90% have it); can involve pitting, onycholysis (separation of nail plate from nail bed) and hyperkeratosis

Answer 24

Nail Psoriasis

Question 25

Psoriasis is complicated ____ driven disease involving cytokines (TNFa and IL-23)

Answer 25

T-cell

Question 26

What cytokine stimulates Th17 cells to release IL-17 and IL-22 leading to proliferation of keratinocytes and dermal inflammation?

Answer 26

IL-23

Question 27

High levels of ____ correlate with psoriasis severity

Answer 27

IL-22

Question 28

What gene accounts for up to 50% psoriasis?

Answer 28

PSORS1

Question 29

Histopathology of psoriasis

Answer 29

1. Regular acanthosis with elongated rete ridges 2. Vessels in dermal papillae 3. Parakeratosis and lack of s. granulosum 4. munro microabscesses (neutrophils on top of parakeratosis)

Question 30

Treatment for Psoriasis

Answer 30

1. Topical steroids first for limited disease | 2. Phototherapy, Biologic agents (TNF-a inhibitors) and Oral meds (Methotrexate) for systemic/widespread disease

Question 31

Acute red scaly rash that occurs in adolescents/young patients; starts as a HERALD patch (ring-shaped with clear center) and will progress to a CHRISTMAS TREE pattern along skin lines on trunk; unknown etiology but maybe associated with HHV6 infection; SELF-LIMITING in 6-8 weeks; no treatment needed

Answer 31

Pityriasis rosea

Question 32

Type I hypersensitivity reaction (Th2 cytokine predominance) that commonly impacts infants and young children; itchy (pruritus) rash; associated with other atopic diseases (seasonal allergy, asthma); commonly seen in flexural areas; increased serum IgE

Answer 32

Atopic Dermatitis

Question 33

Atopic dermatitis is caused by what mutation?

Answer 33

FLG (filaggrin) gene mutation --> epidermal barrier dysfunction --> transepidermal water loss

Question 34

Atopic dermatitis puts at risk for what secondary infections?

Answer 34

staph causing impetigo (crusting lesions)

Question 35

Treatment for atopic dermatitis

Answer 35

Repair epidermal barrier function (topical steroids first line tx & thick moisturizers to treat xerosis)

Question 36

What must be avoided as tx for Atopic Dermatitis?

Answer 36

systemic steroids (oral like prednisone) can cause rebound symptoms

Question 37

50-80% of children with Atopic Dermatitis will have another atopic disease, like Asthma or Allergic Rhinitis

Answer 37

Atopic Triad/March

Question 38

Eczema seen classically in lower legs in adults, very itchy and nummular (coin shaped)

Answer 38

Nummular Eczema

Question 39

Eczema described as "dry riverbed", superficial fissuring from extreme dry skin leading to dermatitis; common in lower legs in winter months

Answer 39

Asteatotic Eczema

Question 40

Tx for Eczema (nummular and asteatotic)

Answer 40

moisturizer, topical steroids

Question 41

Skin disease seen in patients with lower extremity edema who then develop overlying dermatitis; DO NOT confuse with bilater lower extremity cellulitis; no fever, chills

Answer 41

Stasis dermatitis

Question 42

Tx for Stasis dermatitis

Answer 42

compression stockings, topical steroids

Question 43

Autoimmune blistering disease; generalized tense bullae; 20% involve mouth; intensely itchy (Pruritic)

Answer 43

Bullous Pemphigoid

Question 44

Elderly (Chronic); histology shows subepidermal bullae with eosinophils; DIF shows linear IgG and C3 at the basement membrane zone

Answer 44

Bullous Pemphigoid

Question 45

TX for Bullous Pemphigoid

Answer 45

potent topical steroids if localized; prednisone (Short term); steroid-sparing agents (Maintainance)

Question 46

Autoimmune blistering disease; generalized erosion with crusting; mouth always involved; erosion rather than blisters; Positive Nikolsky sign

Answer 46

Pemphigus Vulgaris

Question 47

Histology shows intraepidermal split (no eosinophils), DIF shows fishnet IgG and C3 in the epidermis

Answer 47

Pemphigus Vulgaris

Question 48

TX for Pemphigus Vulgaris

Answer 48

potent topical steroids if localized; prednisone (Short term); steroid-sparing agents (Maintainance)

Question 49

Very itchy, red-pink edematous papules and vesicles; linear (poison ivy) or geometric shapes to the rash; Delayed-type hypersensitivity (4)

Answer 49

Allergic contact dermatitis

Question 50

The most common cause of allergic contact dermatitis is

Answer 50

Nickel * then fragrances, neomycin, poison ivy

Question 51

TX for Acute allergic contact dermatitis

Answer 51

Topical steroid or prednisone depending on the severity

Question 52

Fungal skin infection often caused by microsporum canis; causes fragility and breakage of the hair leading to multiple patchy ALOPECIA and black dot patches on scalp; reversible; 2 types

Answer 52

Tinea Capitis

Question 53

type of tinea capitis in which spores coat the hair

Answer 53

ectothrix

Question 54

type of tinea capitis in which spores are in the hair

Answer 54

endothrix

Question 55

Treatment for Tinea Capitis

Answer 55

oral antifungals since TOPICAL INEFFECTIVE

Question 56

What tinea is more common in kids than adults?

Answer 56

Tinea Capitis

Question 57

presents within minutes to hours of ingestion; transient, pruritic erythematous edematous plaques anywhere on the body: wheals

Answer 57

Acute Urticaria

Question 58

skin disorder due to mast cell degranulation and release of histamine

Answer 58

Acute Urticaria

Question 59

tx for acute urticaria

Answer 59

Stop the offending medication, H1 antihistamines, +/- second-generation H1 antihistamines, +/- prednisone taper

Question 60

flesh-colored or brown verrucous papules and plaques occurring anywhere except mucus membranes/palms/soles; Very common in late middle age/elderly; Look “stuck on”; sun exposure is a risk factor;

Answer 60

Seborrheic keratosis