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Family Med EOR > Dermatitis, Hair & Nails, Dermatophyte Infections > Flashcards

Dermatitis, Hair & Nails, Dermatophyte Infections Flashcards

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1
Q

What causes atopic dermatitis (eczema)?

A

heat
perspiration
allergens
contact irritants (wool, nickel, food)

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2
Q

What is the atopic triad?

A

eczema
allergic rhinitis
asthma

*Starts in childhood

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3
Q

What are the sx of atopic dermatitis (eczema)?

A

Hallmark = pruritus

  1. Acute lesions: Erythematous blisters/papules/plaques that crust over & become scales (MC in flexor creases)
  2. Nummular eczema: sharply defined discoid/ coin-shaped lesions (MC on dorsum of hands, feet, & extensors)
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4
Q

How do you manage ACUTE atopic dermatitis (eczema)?

A

topical corticosteroids, antihistamines for itching (diphenhydramine, hydroxyzine)

Wet dressings (Burrow’s solution). Abx if infection

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5
Q

What is an alternative tx for ACUTE atopic derm (eczema)? What is the benefit?

A

Topical calcineurin inhibitors (Tacrolimus, pimecrolimus) - inhibit cytokine synthesis

No skin atrophy like steroids

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6
Q

What are S/E of topical calcineurin inhibitors (Tacrolimus, pimecrolimus)?

A

Irritation

Lymphoma/skin CA risk

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7
Q

What are forms of health maintenance for atopic derm (eczema)?

A

Avoid triggers (soaps, detergents, frequent baths)

Maintain skin hydration w/ skin emollients (eucerin, aquaphor) & tepid baths

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8
Q

What causes contact dermatitis?

A

Irritants: chemicals, detergents, cleaners, acids, prolonged H2O, metals

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9
Q

What form of contact dermatitis is caused by prolonged exposure to urine/feces in infants?

A

Diaper rash

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10
Q

What are the sx of contact dermatitis?

A 
Burning 
Itching
Erythema 
Dry skin 
Eczematous eruption
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11
Q

How do you treat contact dermatitis?

A

Avoid irritants
Protective equipment
Wet dressings (Burrow’s solution)
Topical corticosteroids

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12
Q

How do you treat diaper rash?

A

Topical petroleum or zinc oxide

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13
Q

What causes dyshidrosis?

A

Sweating
Emotional stress
Warm/humid weather
Metals

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14
Q

What are s/s of dyshidrosis?

A

Pruritic “tapioca-like” tense vesicles on the soles, palms, & fingers (lateral digits)

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15
Q

How do you treat dyshidrosis?

A

Topical steroids *Ointments preferred

Cold compresses

Burrow’s sol

Tar soaks

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16
Q

What causes lichen simplex chronicus?

A

Repetitive rubbing/scratching

“itch-scratch” cycle

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17
Q

What are the s/s of lichen simplex chronicus?

A

Scaly, well-demarcated, rough hyperkeratotic plaques w/ exaggerated skin lines

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18
Q

How do you treat lichen simplex chronicus?

A

High dose topical steroids

Antihistamines

Occlusive dressings

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19
Q

What causes perioral dermatitis? What population is it most seen in?

A

Topical corticosteroid use

MC in young women

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20
Q

What are s/s of perioral dermatitis?

A

Papulopustules on an erythematous base
May become confluent into plaques w/ scales
May have satellite lesions
Spares the vermillion border

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21
Q

How do you treat perioral dermatitis?

A

Topical metronidazole or erythromycin

Oral tetracyclines

AVOID TOPICAL CORTICOSTEROIDS

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22
Q

What causes lichen planus? What condition increases incidence?

A

Idiopathic!

Hep C

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23
Q

What are the s/s of lichen planus?

A

5 Ps: Purple, Polygonal, Planar, Pruritic Papules w/ fine scales & irregular borders

Can develop Koebner’s phenomenon (new lesions at sites of trauma)

Wickham striae: Fine white lines on the skin lesions or oral mucosa.

Nail dystrophy

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24
Q

Where does lichen planus most commonly present on the body?

A

Flexor surfaces of the extremities, skin, mouth, scalp, genitals, nails & MMs

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25
What is 1st line tx for lichen planus?
Topical corticosteroids
26
How do you treat the sx of lichen planus?
Antihistamines for pruritis, occlusive dressings
27
What is 2nd line tx for lichen planus?
PO steroids UVB therapy Retinoids (stimulate production of new cells)
28
What causes pityriasis rosea? Who is it most commonly seen in?
Uncertain etiology, a/w viral infections - HHV7 Older children & young adults
29
What can pityriasis rosea mimic? What seasons is it more commonly seen?
Syphilis! Spring & fall
30
What are the s/s of pityriasis rosea?
Herald patch on the trunk Salmon colored papules w/ white circular (collarette) scaling along cleavage lines in a Christmas tree pattern
31
What parts of the body is pityriasis rosea confined to?
Trunk & proximal extremities
32
How do you treat pityriasis rosea?
None needed PO antihistamines, topical steroids, oatmeal baths for pruritus UVB phototherapy if severe
33
What is alopecia areata? What causes it?
Nonscarring immune-mediated hair loss targeting the anagen hair follicles (scalp MC) a/w other autoimmune disorders (thyroid, addison's)
34
What are the s/s of alopecia areata?
Smooth discrete circular patches of complete hair loss that develops over weeks Exclamation point hairs (tapering near the proximal hair shaft) Nail abnormalities: pitting, fissuring, trachyonychia
35
What term is used for complete hair loss of the scalp & body (including eyelashes)?
Alopecia universalis
36
How do you treat alopecia areata?
If local --> intralesional corticosteroids If extensive --> topical corticosteroids
37
What is androgenic alopecia? What causes it?
Progressive loss of the terminal hairs on the scalp Dihydrotestosterone (DHT)
38
What are the s/s of androgenic alopecia?
Varying degrees of hair thinning & nonscarring hair loss (MC temporal/midfront/vertex of scalp)
39
How do you treat androgenic alopecia?
Minoxidil Oral finasteride (5-alpha reductase inhibitor) - androgen inhibitor (inhibits conversion of testosterone to DHT)
40
What are the S/E of finasteride?
Decreased libido, sexual or ejaculatory dysfunction
41
What is psoriasis?
immune d/o w/ genetic predisposition
42
What are the s/s of "plaque" psoriasis?
MC type, MC on extensors Raised, dark-red plaques/papules w/ thick silver/ white scales Pruritus Nail pitting. Oil spot Auspitz sign (bleeding w/ removal of plaque) Koebner's phenomenon
43
What are s/s of "pustular" psoriasis?
Deep, yellow non-infected pustules --> red macules on palms/soles
44
What are s/s of "guttate" psoriasis?
Small, erythematous papules w/ fine scales, discrete lesions & confluent plaques
45
What are s/s of "inverse" psoriasis?
erythematous (no scale) | MC seen in body folds
46
What are s/s of "erythrodermic" psoriasis?
erythematous rash involving most of skin (worst type)
47
What are s/s of psoriatic arthritis?
Joint stiffness > 30 mins, relieved w/ activity Sausage digits Pencil in cup deformity on radiograph
48
How do you treat psoriasis?
Mild-Mod --> high dose topical steroids +/- Vit D (calcipotriene), topical tar, topical retinoids/vit A (Tazarotene) Mod-severe --> phototherapy: UVB, PUVA &/or methotrexate, cyclosporine, retinoids (acitretin)
49
What causes seborrheic dermatitis? Who is this MC in?
Unclear Hypersensitivity to Malassezia furfur may play role MC in adult men
50
Where does seborrheic dermatitis occur? When does seborrheic derm worsen?
Areas of high sebaceous gland oversecretion (scalp, face, eyebrowns, body folds) Stress & winter --> worsening sx
51
What are s/s of seborrheic derm in infants?
"Cradle Cap": erythematous plaques w/ fine white scales
52
What are s/s of seborrheic derm in adults?
Erythematous plaques w/ fine white scales When on scalp = dandruff
53
How do you treat seborrheic derm?
Selenium sulfide, sodium sulfacetamide, ketoconazole or steroids. Zinc pyrithione Oral antifungals
54
How do you treat cradle cap?
Baby shampoo, ketoconazole, topical corticosteroids
55
What causes tinea versicolor?
Overgrowth of Malassezia furfur (yeast) - part of normal skin flora
56
What are the s/s of tinea versicolor?
hyper/hypopigmented, round/oval macules w/ fine scaling Often coalesce into patches on trunk, face, extremities Involved skin fails to tan w/ sun exposure
57
How do you diagnose tinea versicolor?
KOH prep: hyphae & spores "spaghetti & meatball" Woods lamp: yellow green fluorescence
58
How do you treat tinea versicolor?
Topical antifungals: selenium sulfide, sodium sulfacetamide, zinc pyrithione, "azoles" Itraconazole or fluconazole if widespread or failed topical tx *Do not shower for 8-12 hrs after bc azoles are delivered to skin via sweat
59
What are s/s of tinea corporis?
Erythematous plaques (circular rash w/ clear center & defined borders), scaling, cracking, & vesicles
60
How do you distinguish tinea corporis from erythema migrans?
Presence of scales
61
How do you treat tinea corporis & tinea pedis?
Topical antifungal PO griseofulvin if failed topical tx
62
What are the s/s of onychomycosis?
Opaque, thickened, discolored & cracked nails w/ subungual hyperkeratinization MC = big toe!
63
How do you treat onychomycosis?
Itraconazole & terbinafine
64
What causes paronychia? What is it? How does it occur?
Staph aureus MC, GABHS, Candida (if slow growing) Infection of nail margin. MC occurs after skin trauma
65
What can a paronychia progress to?
A felon (closed-space infection of the fingertip pulp)
66
What are the s/s of a paronychia?
painful, red swollen area around the nail at the cuticle site
67
How do you treat paronychia?
Warm soaks, I&D Cephalexin
68
Describe stasis dermatitis
See page 66-67 of PANCE Prep Pearls
69
Describe a Type I cutaneous drug eruption
IgE mediated Urticaria, angioedema, immediate
70
Describe a Type II cutaneous drug eruption
Cytotoxic, Ab-mediated
71
Describe a Type III cutaneous drug eruption. Provide an example.
Immune antibody-antigen complex Ex. drug-mediated vasculitis & serum sickness
72
Describe a Type IV cutaneous drug eruption
Delayed (cell-mediated) - morbiliform rxn Ex. Erythema multiforme
73
Describe a nonimmunologic cutaneous drug eruption
Due to genetic incapability to detoxify meds (anticonvulsants & sulfas)
74
What are s/s of an exanthematous/morbiliform rash?
MC skin eruption "Bright-red" macules & papules that coalesce to form plaques Begins 2-14 days after med initiation
75
What are s/s of a urticarial drug eruption?
Occurs within mins to hrs after drug administration MC triggers = abx, NSAIDs, opiates, contrast
76
What are s/s of erythema multiforme?
3rd MC drug eruption or caused by HSV Target lesions, dull "dusty violet" red, purpuric macules/vesicles or bullae surrounded by red halo MC meds: sulfas, PCNs, Phenytoin, Phenobarbital, dilantin
77
What other sx may accompany a drug eruption?
Fever, abd, or joint pain
78
How do you treat an exanthematous/morbiliform rash?
Oral antihistamines
79
How do you treat drug-induced urticaria/angioedema?
Systemic corticosteroids, antihistamines
80
How do you treat erythema multiforme minor?
Sx tx
81
How do you treat anaphylaxis?
IM epi = Tx of choice!
82
What is the difference btwn EM minor vs EM major?
Minor: No MM lesions Major: involvement of ≥ 1 MMs, no epidermal detachment
83
How do you treat erythema multiforme major?
Symptomatic Antihistamines, analgesics, skin care Oral: Steroid/lidocaine/diphenhydramine mouthwash If severe --> systemic steroids

Family Med EOR (15 decks)

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