Derm Week Flashcards
(231 cards)
1
Q
What are the four layers of the epidermis?
A
stratum corneum, stratum granulosum, statum spinosum, stratum basale
2
Q
How long does it take for a basal cell to reach the stratum corneum and how long does it stay there?
A
two weeks each (four weeks total)
3
Q
What is the function of the stratum basale?
A
epidermal stem cells
4
Q
What is the function of the stratum spinosum?
A
bulk of epidermis, contains desmosomes
5
Q
What is the function of the stratum granulosum?
A
lipid granules for water-tight barrier
6
Q
What is the function of the stratum corneum?
A
barrier of anucleated cells
7
Q
What 2 important proteins are found in corneal cells?
A
keratin and filaggrin
8
Q
What are the three types of epidermal cells and their function?
A
keratinocytes - main epidermal/barrier cells
melanocytes - secrete melanin to keratinocytes
Langerhans - APC
9
Q
What is found in the dermis?
A
blood/lymphatic vessels hair follicles sebaceous & eccrine glands fibroblasts mast cells
10
Q
What is a small, flat lesion?
A
macule
11
Q
What is a large, flat lesion?
A
patch
12
Q
What is a large, raised lesion?
A
plaque
13
Q
What is a small, raised lesion without fluid?
A
papule
14
Q
What is a small, raised lesion with fluid?
A
vesicle
15
Q
What is a large, deep papule?
A
nodule
16
Q
What is a vesicle filled with pus?
A
pustule
17
Q
What is the highest potency topical steroid?
A
clobetasol
18
Q
What is the high potency topical steroid?
A
fluicinonide
19
Q
What is the medium potency topical steroid?
A
triamcinolone
20
Q
What are the two low potency topical steroids?
A
desonide, hydrocortisone
21
Q
What are the 6 side effects of topical steroids?
A
skin atrophy telangiectasias striae acne steroid rosacea hypopigmentation
22
Q
What are the 6 types of psoriasis?
A
plaque inverse/flexural guttate erythodermic pustular
23
Q
What is characteristic of guttate psoriasis?
A
raindrop-sized lesions after strep infection
24
Q
What is characteristic of inverse psoriasis?
A
erythematous plaques in the flexural folds, without scaling
25
What is characteristic of pustular psoriasis?
clustered pustules, often after corticosteroid withdrawal
26
What is characteristic of psoriatic erythoderma?
erythematous skin, often the entire body
27
What are the extra-dermal manifestations of psoriasis?
nail pitting, arthritis
28
What should never be used to treat psoriasis?
oral steroids
29
What are the three systemic treatments for psoriasis?
phototherapy
methotrexate
biologics
30
What is the first step in management for red scaly rashes?
KOH exam
31
What are the hallmarks of pityriasis rosea?
herald patch, then Christmas tree rash, due to HHV6
32
What is the hallmark of secondary syphilis?
rash with palm and sole involvement
33
What are the hallmarks of nummular dermatitis?
multiple coin-shaped plaques, pruritic, weeping, crusting
34
What are the hallmarks of asteatotic dermatitis?
papular rash on arms, legs, or flank
| looks like cellulitits
35
What are the hallmarks of pediculosis?
adult lice or nits attached to hair
visible to naked eye
treatment by removing nits or 1% permethrin lotion
36
What are the hallmarks of Sarcoptes (scabies)?
papules with burrows, often in the webs of fingers
| treat with 5% permethrin cream or oral ivermectin
37
What are the hallmarks of seborrheic keratosis?
multiple pigmented, stuck-on growths, can't be on palms/soles
38
What predisposes to acrochordons?
genetics, obesity, friction, marker for insulin resistance
39
What are small red moles?
cherry angiomas
40
What causes dermatofibroma formation?
minor trauma enduces spindle cell proliferation
41
What is important about solar lentigo?
sun exposure means higher risk for melanoma
42
What are the hallmarks of sebaceous hyperplasia?
multiple yellor or skin-colored papules
| looks similar to basal cell carcinoma
43
What is a keloid?
overgrowth of scar tissue
44
What is treatment for a keloid?
steroid injection into the lesion
45
What is an epidermal inclusion cyst?
collections of debris (cells and oil) that smells bad
46
What are pilar cysts?
subcutaneous nodules, always on scalp
47
What are lipomas?
collections of fat under the skin, usually solitary, sometines tender
48
What is verruca vulgaris?
hyperkeratotic fungating papules and nodules, caused by HPV infecting basal cells
49
what is verrucae planae?
flat warts, often on dorsal hands, arms, or face
50
What are treatment options for warts?
cryotherapy, salicylic acid, waiting
51
What are the hallmarks of molluscum contagiosum?
dome-shaped, umbilicated papules, spread through direct contact
52
What is urticaria?
hives, caused by vascular reaction in the skin
53
What kind of hypersensitivity is urticaria?
Type 1
54
What is the most common cause of acute urticaria?
idiopathic
55
At what level of the skin does urticaria occur?
dermis
56
What is dermatographism?
urticaria from physical pressure
57
How does immunologic urticaria occur?
antigen binds IgE on mast cells
58
How does non-immunologic urticaria occur?
direct mast cell degranulation due to pressure or drugs
59
What is the treatment for urticaria?
high dose anti-histamines (4x dose on bottle of multiple drugs)
60
What is angioedema?
swelling in the subcutis, similar to urticaria but deeper
61
At what point should urticaria be biopsied?
6 weeks (can indicate systemic disease)
62
What is the most severe form of type 1 hypersensitivity?
anaphylaxis
63
What does atopic dermatitis affect?
usually cheeks, then extensor, then flexural, never nose
64
When does atopic dermatitis develop?
before age 5
65
How does atopic dermatitis start?
erythematous papules, can be weeping, crusting, or scaling
66
What is the atopic triad?
asthma, atopic dermatitis, allergic rhinitis
67
What is lichenification?
thickening of the skin that accentuates skin lines
68
What does eczema mean?
red and scaly
69
What causes atopic dermatitis?
multifactorial, including filaggrin mutation, impaired immune response, skin barrier dysfunction
70
What is the treatment for atopic dermatitis?
topical steroids and moisturization/skin care, especially vasoline
71
What is the second line therapy for atopic dermatitis?
topical calcineurin inhibitor
72
Is cream or ointment stronger?
ointment
73
How many kids with atopic dermatitis will develop allergic rhinitis or asthma?
more than half
74
What bacteria commonly infects atopic dermatitis?
staph aureus or GA strep
75
What is pityriasis alba?
patches with loss of pigment and scale, inflammatory cause
76
What fungi infect the skin?
```
Malassezia
Candida
Trichophyton
Microsporum
Epidermophyton
```
77
What is tinea pedis?
athlete's foot
78
What causes tinea pedis?
Trichophyton rubrum growing in food/showers
79
Where does tinea pedis occur?
between the toes (interdigital) or along the heel/bottom of foot (mocassin)
80
How does moccasin-type tinea pedis present?
one hand, two feel
81
What causes vesiculobullous type tinea pedis?
type 4 immune response to fungal antigen
82
What are the three classes of topical antifungals?
imidazoles (static)
allylamines (cidal)
ciclopirox (both)
83
What is onychomycosis?
chronic fungal nail infection
84
How is onychomycosis treated?
oral antifungals for three months
85
How does tinea corpis present?
erythematous ring with scale and central clearing
86
How is tinea corpis treated?
topical antifungals (oral if hair follicles are involved)
87
How does T tonsurans grow?
inside hair follicle, causing hair to break off
88
What are the two main causes of tinea capitis?
Microsporum canis
| Trichophyton tinsurans
89
What is a complication of tinea corpus treatment
kerion - inflammatory response that discharges pus, can become infected
90
How is tinea capitis treated?
oral griseofulvin or terbinafine
91
What are the hallmarks of diaper candidiasis?
erythematous plaques in skin creases with satellite papules, not responsive to rash cream
92
What predisposes to diaper candidiasis?
not changing diapers regularly (daycare)
93
How is diaper candidiasis treated?
nystatin or imidazole cream/ointment, avoid steroids
94
How does irritant dermatitis present?
erythema on srufaces that touch diaper, spares folds
95
How is irritant dermatitis treated?
zinc oxide paste
96
What is candidal intertrigo?
candida infection of skin folds
97
What are predisposing factors for candidal intertrigo?
DM
hot/humid
limited mobility
obesity
98
How is candidal intertrigo treated?
topical nystatin or imidazoles
99
What is a large blister called?
bulla
100
What is a small blister called?
vesicle
101
What are the three common etiologies of blisters?
trauma, infection, inflammation
102
What does HSV1 tend to infect?
mouth and nose
103
What does HSV 2 tend to infect?
genitalie, buttocks, thighs
104
What is herpetic whitlow and who tends to get it?
herpes infection on the fingers, common in dentists
105
What is the best test for HSV1, HSV2, and VZV?
PCR from fluid swab
106
What are three treatments for HSV?
acyclovir, famciclovir, valacyclovir
107
What is dyshidrotic eczema?
vesiculopapular rash on palms, soles, and fingers
108
What is the treatment for dyshidrotic eczema?
high strength topical steroids
109
What kinds of vesicular rash present on the dorsal foot?
contact dermatitis, insect bites
110
What kind of vesicular rash presents on the sides of feet and toes?
dyshidrotic eczema
111
What kinds of vesicular rash present on the soles of the feet?
tinea pedis, dyshidrotic eczema
112
What kind of vesicular rash presents on the balls and heels?
friction blisters
113
What is the ddx for facial vesicles?
HSV, bullous impetigo
114
What is the ddx for chest/back vesicles?
VZV
115
What is the ddx for finger vesicles?
dyshidrotic eczema, contact dermatitis, herpetic whitlow
116
What is the ddx for arm/leg vesicles?
contact dermatitis
117
What is the ddx for genitalia vesicles?
HSV
118
What is the ddx for foot vesicles?
dyshidrotic eczema, tinea pedis, contact dermatitis
119
What are 4 causes of extensive blisters?
VZV (chicken pox)
pemphigus vulgaris
bullous pemphigoid
drug eruptions
120
What causes seborrheic dermatitis?
Malassezia yeast
121
Where does seborrheic dermatitis present?
scalp, hairline, eyebrows, eyelids, face, nosolabial folds, ears, central chest
122
How is seborrheic dermatitis treated?
anti-dandruff shampoo and topical anti-fungal or steroids
123
Where does rosacea present?
cheeks, nose, brow, chin, eyelids, eyes
124
What is a complication of rosacea?
rhinophyma (hyperplasia of nasal sebaceous glands)
125
How is rosacea treated?
chronic low-dose antibiotics, avoid triggers, lasers
126
How is rhinophyma treated?
isotretinoin or surgery
127
What are the two most common causes of allergic contact dermatitis?
poison ivy and nickel
128
What is the most common facial rash in infants?
atopic dermatitis
129
What is the most common facial rash in adolescents?
acne vulgaris
130
What is an open comedo?
blackhead
131
What is a closed comedo?
whitehead, turns into a pustule
132
What are the three types of acne?
comedonal
inflammatory
nodulocystic
133
What 4 factors lead to acne?
hormones
sebaceous gland activity
hair follicle plugging
P. acnes bacteria
134
How is mild comedonal acne treated?
topical retinoid
135
How is mild inflammatory acne treated?
topical retinoid and topical clindamycin
136
How is moderate inflammatory and mild nodular acne treated?
topical retinoid
topical clindamycin
oral antibiotic
137
How is severe acne treated?
isotretinoin
138
What are the cutaneous manifestations of AL amyloid?
pinch purpura
macroglossia
infilrated periorbital nodules and plaques
139
What are the cutaneous manifestations of sarcoid?
symmetric red-brown papules and plaques
| non-caseating granulomas on biopsy
140
What is necrobiosis lipoidica?
necrotizing skin condition in diabetics
141
What is Sweet's syndrome?
Acute febrile neutrophilic dermatosis
142
How is Sweet's syndrome treated?
systemic steroids
143
What is calcific uremic arteriolopathy?
subcutaneous nodules that form ulcers, associated with ESRD
144
What are the 4 possible skin findings in neurofibromatosis?
neurofibromas
cafe-au-lait macules
axillary/inguinal freckles
plexiform neurofibroma
145
What are the 4 possible skin findings in tuberous sclerosis?
facial angiofibromas
hypomelaotic macules
shagreen patch
periungual fibromas
146
What is pyoderma gangrenosum?
chronic ulcerative skin disease, associated with IBD, heme malignancies
147
How is pyoderma gangrenosum treated?
topical and systemic steroids
148
What is lichen sclerosus?
inflammatory disease that leads to scarring, often on genitals
149
How is lichen sclerosus treated?
high strength topical steroids
150
What causes port wine stain? Treatment?
congenital capillary malformation
| treat with laser
151
How does Kaposi Sarcoma present and what is the cause?
dark, violaceous plaques/nodules, often in HIV pts
| Caused by HHV-8
152
What is hidradenitis suppurativa?
inflammation of the hair follicles causing abscesses, nodules, and sinuses, often in the axilla
153
What defines an immediate drug reaction?
within 1 hour
154
What defines a delayed drug reaction?
after 1 hour, usually after 6 hours
155
What disease leads to signigicantly increased risk of drug reactions?
HIV
156
What is the most common cutaneous drug reaction?
exanthematous
157
What is an exanthematous reaction?
erythematous macules/papules, usually a week after starting a drug
158
What is the treatment for exanthematous reactions?
antihistamines and topical steroids
159
What is a fixed drug eruption?
solitary erythematous patch with central bulla, often recurs in the same spot
160
What is Drug-Induced Hypersensitivity Syndrome?
diffuse skin eruption with fever, internal organ involvement, and facial swelling
161
What CBC abnormality is common in DIHS?
eosinophilia
162
What is the timing for DIHS?
presents 3wks - 3mo
163
What medications are common in DIHS?
allopurinol, sulfa, penicillin, anticonvulsants, abacavir
164
What is the treatment for DIHS?
stop meds
| prolonged systemic steroids
165
What is Stevens-Johnson Syndrome?
erythematous erosions and macules with extensive necrosis and detachment of epidermis and mucosa
166
What is the difference between SJS and toxic epidermal necrolysis?
SJS involves <10% of BSA
| TEN involves >30%
167
What drugs are associated with SJS/TEN?
```
Sulfa
Allopurinol
Tetracyclines
Anticonvulsants
NSAIDs
```
168
What is diascopy?
checking purpura for blanching
169
What defines petechiae?
<3mm
170
What defines ecchymoses?
>5mm
171
What is the cause and cutaneous findings in scurvy?
vitamin C deficinecy
| petechiae and hemmorhagic gums
172
What is purpura fulminans?
large ecchymotic patches on extremeties, seen in sepsis/DIC
173
What is seen in Rocky Mountain Spotted Fever?
faint macules on wrists and ankles with petechiae on the trunk and extremeties
174
What causes palpable purpura?
vasculitis
175
What is Henoch-Schonlein Purpura?
small vessel vasculitis in the skin, characterized by IgA deposition
Presents with nonblanching macules/papules on legs
176
How does polyarteritis nodosa present?
erythematous nodules in skin, proteinuria, anemia
177
What is tinea versicolor?
fulgal rash with hypo or hyperpigmented macules on back and chest
178
What is the treatment for tinea versicolor?
dandruff shampoo, azole creams, oral fluconazole
179
What is melasma?
brown pigmented patches on the face, usually in women
180
What makes melasma worse?
UV light
181
What is the treatment for melasma?
suncreen, hydroquinone (bleaching agent)
182
What is minocycline pigmentation?
blue-grey discoloration of the skin from minocycline
183
Where does minocycline pigmentation occur?
mouth and eye
| can be in bones, thyroid, scars, shins
184
What medications cause hyperpigmentation?
minocycline
amiodarone
hydroxychloroquine
185
What is stasis dermatitis?
eczematous eruption overlying venous stasis and edema
186
What is the treatment for stasis dermatitis?
compression and topical steroids
| avoid topical antibiotics
187
What is postinflammatory hyperpigmentation?
darkening of the skin around sites of inflammation, especially in those with darker skin
188
What can be seen with Wood's light?
de-pigmentation
189
How does vitiligo present?
areas of depigmentation, often on the face, hands, or area of trauma
190
What causes vitiligo?
autoimmune, anti-melanocytes
191
What is the treatment for vitiligo?
topical steroids
topical tacrolimus
phototherapy
192
What are the three questions to ask about a pigmented lesion?
remained the same for a year?
symmetric with distinct borders and one color?
similar to other moles?
193
What is the risk of melanoma in congenital nevi?
no increased risk in small/med.
| 5-10% in large
194
At what age is an acquired nevus worrisome?
after 50
195
What makes an atypical nevus?
macular base with raised center
196
What are the two most common mutations in familial melanoma?
CDKN2A
| CDK4
197
Where does melanoma occur?
usually in sun-exposed areas, but can be anywhere
198
What is the most important prognostic factor for melanoma?
Breslow depth
199
What is the most common subtype of melanoma?
superficial spreading
200
What are the five subtypes of melanoma?
```
superficial spreading
nodular
lentigo maligna
acral lentiginous
amelanotic
```
201
What causes squamous cell carcinoma of the skin?
UV light-induced mutation of p53
202
What is actinic keratosis?
premalignant SCC, presents as a rough, scaly plaque
203
What are actinic purpura?
easy bruising and perivascular inflammation, common in elderly
204
What is the most common skin cancer?
basal cell carcinoma
205
What is the etiology of basal cell carcinoma?
PTCH mutation
206
What are the 2 subtypes of basal cell carcinoma?
nodular
| superficial
207
What are the possible variations of basal cell carcinoma?
ulcerated
pigmented
morpheaform
208
When is Mohs Micrographic Surgery indicated?
need to spare tissue
aggressive subtypes
large or recurrent tumors
209
What is Mohs Micrographic Surgery?
precise treatment for skin cancer that maximizes conservation of tissue
210
What is the major species of bacteria in the skin?
Staph epidermidis
211
What is a common cause of impetigo?
Group A Strep
212
What immune factors do keratinocytes have?
TLRs, cytokines, antimicrobial peptides
213
What are antimicrobial peptides?
b-defensins, irregularly congregate in bacterial membranes and form pores
214
What response does S. epidermidis invoke in immune function?
stimulates enhanced barrier function
215
What bacteria have superantigens?
Staph aureus and Strep pyogenes
216
What response do superantigens cause?
toxic shock syndrome
217
What is the predominant symptom of cellulitis?
pain
218
What are cellulitis risk factors?
trauma
inflammation
edema
systemic infection
219
What is the outpatient treatment for cellulitis?
cephalosporin
220
What is erysipelas?
a type of cellulitis with dermal lymphatic involvement and edema
221
What is the treatment for abscess?
I&D, sometimes with antibiotics
222
What is a furuncle?
a perifollicular abscess (boil)
223
What is a carbuncle?
a site where multiple furuncles have ruptured and coalesced
224
What is folliculitis?
pustules of infection within hair follicles
225
What is the most common cause of folliculitis?
staph
226
What is the cause of hot tub folliculitis?
pseudomonas
227
What causes honey-colored crust?
impetigo
228
What causes bullous impetigo?
staph exotoxin that ruptures hemidesmosomes
229
Why does strep scalded skin syndrome happen?
kidneys aren't able to clear the strep toxin
230
What is necrotizing fasciitis?
quickly spreading infection of the fascia, high mortality
231
What is the treatment for necrotizing fasciitis?
surgical debridement and antibiotics
