Flashcards in Dermatolgy Deck (261):
Deep infection if the hair follicles
Access, furuncle, boil
Fluid filled or puss filled <0.5cm
Bulls or blister
Flat change in skin with a color change (brown, blue, red, or hypo pigmented
Solid lesion >0.5-2.0cm
(Greater than 2.0 is tumor)
Raised, solid lesion <=0.5cm, varies in color
Raised solid lesion >0.5cm
<=0.5cm elevated lesion that contains fluid
Transient rounded or flat top plaque
Wheal or hive
What skin pathogen/infection presents with purulent (pus) cellulitis
When there is puss about, let it out!
Patient needs I&D
At what age does a patient get a shingles immunization?
60 yo. Patient must be immunocompetent
What serological test if positive makes lupus highly suspicious
Positive antinuclear antibodies
What diseases present with a palmar rash
Rocky Mountain spotted fever
What skin condition is a precursor to skin cancer (SCC)
How many days of antibiotics should be given for prophylaxis
How many days should antibiotics be given to treat infection
What is the gentlest vehicle of topical medication
What is the most potent vehicle for topical medication
What skin condition causes honey colored crusts and how is it treated?
Topical antibiotic Muripicin
What skin condition causes a herald patch
What skin condition causes burrows
Treated with scabacide prometharin
What skin condition causes a sandpaper textured rash?
Treated with penicillin
What skin condition causes a pearly domed module?
What skin condition causes a Christmas tree pattern rash
What skin condition causes a bright beefy red rash
Topical anti fungal
What skin condition causes silvery scales
Treated with topical & systemic agent
What skin condition causes a bulls eye lesion
What skin condition causes nits?
Treated with scabacide
What skin condition causes a dermatomal rash?
Treated with antiviral
What skin condition causes a butterfly malar rash
What skin condition causes recurrent highly pruitic rash and/on flexor and extensor surfaces
Treated with topical steroid
What skin condition causes HSV infection of the finger
Treasured with oral antiviral
With phytodermatitis or poison ivy, how do you treat it when >=20% of total body surface area is affected?
Infection if the upper dermis of skin
TBSA % of head and neck
TBSA % of upper limbs
TBSA % of trunk
TBSA % of palmar aspect of hand
TBSA % of genitalia
TBSA %of lower limbs
The classic rash looks like small red spots or petechiae and starts to abrupt on both of the hands and feet including the palms and soles. Rapidly progressing toward the trunk until it becomes generalized. The rashes appear on the third day after the abrupt onset of high fever accompanied by a severe headache, myalgia, conjunctival infection, nausea/vomiting, and Arthralgia. It can be fatal and the highest incidence is in South Eastern/South central areas of the country. Most cases occur during the spring and early summer season.
Rocky Mountain spotted fever
Precursor to skin cancer
Risk factors for this condition include chronic sun exposure, fair skin, aging, occasionally progresses to squamous cell carcinoma, serves as a marker of chronic skin damage, so need to follow up with dermatology and self inspection monthly.
Symptoms include sudden onset of sore throat, cough, fever, headache,stiff neck, photophobia, and changes in level of consciousness. The appearance could be toxic. In some cases, there is an abrupt onset of petechial to hemorrhagic rashes in the axilla, Flanks, wrists, and ankles. Rapid progression in fulfillment cases results in death within 48 hours. The risk is higher for college students residing in dormitories. It is spread by aerosol droplets. Rifampin prophylaxis is recommended for close contacts.
The classic lesion is an expanding red rash with central clearing that resembles a target. The bull’s-eye rash appears within 7 to 14 days after a deer tick bites. The rash feels hot to the touch and has a rough texture. Common locations are the beltline, axillary area, behind the knees, and in the groin area. It is accompanied by flu like symptoms. The lesion spontaneously resolved within a few weeks. It is most common in the north east region of the US. Use of DEET containing repellent on clothes in skin can Repel deer ticks
Erythema migrans or early Lyme disease
A reactivation of the varicella zoster i.e. chickenpox virus that has laid dormant in nerve cells. This involves the skin of a single dermatome or less commonly several dermatones
Herpes zoster or shingles
What is the pharmacological management for herpes zoster or shingles
NSAIDs or narcotic analgesics for pain. Antiviral agents if patient presents within 72 hours of symptoms. Antiviral agents to all immunocompromise patients.
What is a complication of herpes zoster or shingles
Post herpetic neuralgia; consider TCAs, gabapentin, pre-Gabalin, capsaicin cream
When is the herpes zoster vaccine given
All immunocompetent patients greater than or equal to 60 years old
A sight threatening condition caused by the activation of the herpes zoster virus that is located on the ophthalmic branch of the trigeminal nerve five. Patient reports sudden eruption of multiple vesicular lesions that are located on one side of the scalp, forehead, and the sides and tip of the nose. The eye lid on the same side is swollen and red. The patient complains of photophobia, eye pain, and blurred vision. This is more common in elderly patients . Refer to ophthalmologist or the ED as soon as possible
Shingles infection of the trigeminal nerve i.e. herpes zoster opthalmicus
How do you diagnose melanoma
B border is irregular
C different colors within the same region
D diameter >6mm ( in whites primarily on lower legs and back; in blacks on hands, feet & Nails
Common in the 50 and 60 years old patients. Most common sites are head and neck. Usual appearance is pearly domed nodule with overlying tell telangiectatic vessels, later, central ulceration and crusting. Occurs 40 times more common than squamous cell. Particularly common in Caucasians and uncommon in dark skin populations. Most important risk factor is sun exposure. Definitive diagnosis always with biopsy or excision of specimen. Presentations: nodular, superficial, other presentations. 70% occur on face. Typically present on face as a pink or flesh colored papule.
Crusts and bleeds over and over again. Sore that does not heal.
This is the most common type of melanoma in African-Americans and Asians, and is a subtype of melanoma. These dark brown to black lesions are located on the nailbeds i.e. sub ungua, Palmar and plantar surfaces, and rarely the mucous membranes. Sub ungual melanomas look like longitudinal black to brown band is on the nail bed.
Acral lentiginous melanoma
Direct trauma to the nailbed resulting in pain and bleeding that is trapped between the nailbed and the finger/toenail. If the hematoma involves greater than 25% of the area of the nail, there is a high risk of permanent is Ischemic damage to the nail matrix if the blood is not drained. One method of training i.e. trephination a sub ungual hematoma is to straighten one end of a steel paper clip or to use An 18 gauge needle and heat it with a flame until it is very hot. The hot end is pushed down gently until a 3 to 4 mm hole is burned on the nail. The nail is pressed down gently until most or all of the blood is drained or suctioned with the smaller needle. Blood may continue draining for 24 to 36 hours.
Sub ungual hematoma
This condition creates target like lesions. It is an immune mediated reaction usually caused by infection such as herpes Symplex virus or mycoplasma pneumonia, sometimes meds. These medications include NSAIDs, sulfonamide, antibiotics, antiepileptics. These lesions may also occur in lupus. These lesions are usually on extremities, Self limited and results in 2 to 4 weeks, Common is a targetoid or Iris appearance. Also papules, macules, plaques, vesicles
What drug classes are associated with Stevens Johnson syndrome
Penicillin, sulfa’s, barbiturates, and phenytoin (Dilantin)
Patients with what disease have a 40 fold increased risk of Steven Johnson syndrome due to sulfa drugs
A deficiency in vitamin D in pregnancy results in
Infantile rickets i.e. brittle bones, skeletal abnormalities
Lesions in impetigo, 2nd° burn with blisters, and Steven Johnson syndrome are
Hepatic lesions are
Acne lesions are
Freckles and small cherry angiomas are what kind of lesions
Nevi and nine cystic acne what type of lesions
Psoriatic lesions are what kind of lesions
Deep infection of the hair follicles
Abscess, furuncle , boil
Common benign neoplasm, 10 to dark brown, common in older adults
Soft and round wart like flashy growth in the trunk that are located mostly on the back. Lesions on the same person can range in color from like tan to black. It is asymptomatic.
Raise and yellow colored soft plaques that are located under the brow or upper and or lower lids of the eyes on the nasal side. It may be a sign of hyperlipidemia if present in person is younger than 40 years of age.
An increase in estrogen can cause what condition in women
These lesions are due to a nest of malformed arterioles . It is asymptomatic.
When should you avoid prescribing topical steroids
Avoid steroids in case of suspected fungal ideology because it can worsen the infection. Also avoid in infants, children, and adults with thin facial skin. With topical steroids hypothalamus – pituitary – adrenal axis suppression may occur with excessive or prolonged use. It can cause straie, skin atrophy, telangiectasia. And acne and hypopigmentation
What is the pharmacological management for psoriasis
Emolients to hydrate skin i.e. Lubriderm, Aquaphor, Eucetin. Topical steroids at the lowest strength due to skin pigment changes. Methotrexate. Systemic agents prescribed by dermatology such as Humira
New psoriatic plaques forming over lesions and areas of skin trauma
Pinpoint areas of bleeding remain in the skin when a psoriasis plaque is removed
Does psoriasis cause pitted fingernails and toenails
Can psoriasis cause psoriatic arthritis
When prescribing a patient Hugmira, Enbrel, and Remicade, what labs should be gotten
Baseline PPD, CBC with differential. This is due to an associated higher risk of serious fatal infections, malignancy, TB, fungal infections, and sepsis
What is Goeckerman regimen for psoriasis
UVB light and tar derived topicals
What is a complication of psoriasis resulting from a beta hemolytic streptococci’s group infection usually due to strep throat
Pre-cancerous precursors to squamous cell carcinoma
What cream can be prescribed for actinic keratosis
Fluorouracil cream 5% used over several weeks
What is the pharmacologic management for antifungal therapy
Apply 1-2 inches beyond the rash
Treat 1-2 weeks
Then treat 1-2 weeks after resolution to prevent recurrence
When a patient has repeat fungal infection what must also be considered
Immunocompromised states such as HIV and diabetes with extensive infection, failure to respond to treatment.
What are the most common pathogens for fungal infections
Epidermophyton, trichophyton, microsporum
What treatment is the most effective for toenail fungus
Oral terbinafine (lamasil)
Takes six months for fingernail and 12 months for toenail to grow out regardless of treatment
How do you get a sample of a fungal infected nail plate for diagnosis
Trim away distal nail plate to expose affected nail. Use a small curette to obtain Nail fragments. Place on slide and drop of KOH. Microscopic visualization
This is a fungal nail infection and terbinafine 73 to 79% cure rate if treated for 6 to 12 weeks. Others are less effective. Watch for hepatotoxicity and drug interactions i.e. statins. Topical or poorly effective.
A superficial infection caused by yeasts Pityrosporum orbiculare and pityrosporum ovale.
Patient complains of multiple hypopigmented round macules on the chest, shoulders, and or back that appear after skin becomes tan from sun exposure. Asymptomatic.
If the KOH slide shows hyphae and spores what condition would this be
This condition is diagnosed due to clinical symptoms with pruritus being the predominant symptom. Clues are chronic and the recurring. Family history of allergic disease.
Atopic dermatitis or eczema
What is the first line treatment for a topic dermatitis or eczema
Topical steroids or first line. Mild will get hydrocortisone 1% to 2.5%. Medium will get Triamcinolone
Medium to high potency steroid use for 10 days and then taper off to weaker steroids and then stop. Systemic oral antihistamines for itching i.e. Benadryl or hydroxyzine. Skin lubricants such as Eucerin. Avoid drying skin/xerosis since it will exacerbate eczema. No hot bath, harsh soaps, chemicals, wool clothing. Hydrating baths avoid hot water and follow immediately with skin lubricants.
This skin condition is due to direct exposure to a substance. Trigger induces an immune response via T cell mediated response. Maybe allergic or irritant induced. Example would be poison ivy.
Do you treat contact dermatitis with a topical steroid
Should a topical steroid be used on broken skin
How do you treat contact dermatitis
Stop exposure to substance. Calamine lotion, topical steroids, oatmeal bath i.e. Aveeno. If severe rash, oral prednisone for 12 to 14 days and then wean. Avoid reexposure.
And Obese adult complains of bright red and shiny lesions that itch or burn, located on the intertriginous areas i.e. under the breast in females, axillae, abdomen, groin, the web spaces between the toes. The rash may have satellite lesions which are small red rashes around the main rash.
Patient complains of a severe sore throat with white adherent plaques with a red base that are hard to dislodge on the pharynx. In healthy adults, this condition may signal an immunodeficient condition.
How do you treat the intertriginous areas of a patient with superficial candidiasis
Nystatin powder and or cream. BID. Over-the-counter topical antifungal’s can also be used. Keep skin dry and aerated
What can be used for oral thrush
Nystatin oral suspension QID swish and swallow
How should HIV esophageal cancer infections be treated
Systemic antifungal’s i.e. flucanazole
A non-purulent Cellulitis is most appropriately treated with what medication
Should cellulitis be treated with a systemic agent
When a patient presents with cellulitis that is purulent i.e. MRSA what should be done
When there is a purulent cellulitis what bacteria is the culprit
A purulent cellulitis is most appropriately treated with a systemic agent. What might be used
Bactrim, clindamycin, or
Follow up 48 hours after initial treatment and then as patient condition dictates
Acute cellulitis is a skin infection of the deep dermis and underlying tissue usually caused by what type of bacteria
What are common points of entry for acute cellulitis
Skin breaks, insect bites, abrasions, and surgical wounds.
Community acquired type MRSA strain is also called
Purulent form of cellulitis is usually due to what type of bacteria
Staph which is gram-positive. Community acquired MRSA is now common with most cases located on the lower leg
What type of bacteria is responsible for nonpurulent form of cellulitis
Usually due to streptococci but may also be staph
What bacteria is due to dog and cat bites
Pasturella multicida which is gram negative
What kind of bacteria is responsible for erysipelas
Group B streptococcus
When a patient presents with puncture wounds in the foot what must be ruled out as far as bacteria
What type of bacteria should be considered with a cellulitis infection due to salt water contamination
Higher risk of liver disease or immunocompromised
Acute onset of diffuse pink to red colored skin on the traumatized site with poorly demarcated margin that grows larger. Usually on the legs or feet. The lesion feels hot and does not have a distinct border. There may be an abscess or draining of purulent green discharge. Deeper infection of the skin is manifested by red streaks radiating from infected area under the skin and regional lymphadenopathy. Patients may have systemic symptoms.
What fungal infection Increases the risk of lower extremity cellulitis
If a patient comes in with a clenched fist injury what must be done
Refer to the ED for treatment. There may be a foreign body in bedded such as a tooth so an x-ray is needed. Can cause necrotizing fasciitis which is usually group a strep or poly microbial. It is a reddish to purple collar lesion that increases rapidly in size. Infected area appears indurated with complaints of severe pain on affected side.
The patient was bitten by a dog about two hours ago. There are puncture marks and a small laceration on the right anterior thigh. What should be done at this time.
Clean and flush the bike thoroughly. Prescribed Augmentin for 3 to 5 days for prophylaxis. Order tetanus, rabies prophylaxis if needed.
Infected hair follicle that fills with pus. It looks like a round red bump that is hot and tender to touch. What it is fluctuant, it can rupture and drain purulent green colored discharge. What is this and how do you treat it
Boil or Furuncle
Apply antibiotic ointment BID and cover with dressing until healed.
Several boils that coalesce to form a large boil or abscess. Sometimes they may form several heads. They are usually treated with systemic antibiotics
Carbuncles or coalesced boils
What labs are indicated for carbuncles
Culture and sensitivity advancing edge of the lesion if the fluid has pus, vesicles, or drainage. If lower extremity cellulitis, fungal culture for tinea pedis by swabbing interdigital spaces. CBC if febrile or toxic or suspect necrotizing fasciitis and refer to the ED
What is the treatment plan for non-MRSA nonpurulent cellulitis
Dicloxacillin PO QID x 10 days. Keflex or clindamycin TID x 10 days
If PCs allergic, erythromycins macrolides, second generation cephalosporins, or clindamycin 3-4x day for 10 days
What is this treatment if MRSA is suspected
Bactrim DS 1 tablet BID x 10 days, doxycycline PO BID x 10 days or clindamycin 3-4x day for 10 days
Should a TD booster be given for a patient with carbuncles
Yes, but only if the last dose was more than 5 years ago.
What should be prescribed for recurrent cellulitis
Consider decolonization. Muciprocinn BID on nares times 5 to 10 days. Elevate affected limb.
When should the patient follow up with carbuncles
Have the patient follow up within 48 hours. Refer cellulitis cases if systemic symptoms develop or worsen i.e. fever or toxicity. The cellulitis is not responding to treatment within 48 hours. Cellulitis is spreading quickly or is a small lesion with gangrenous center associated with large amount of pain (necrotizing fasciitis). Patient is a diabetic, immunocompromise, or taking anti-TNF medication (rheumatoid arthritis).
What are potential complications of carbuncles
Osteomyelitis, septic arthritis, or sepsis. Tendon and fascial extension.
Rarely, death 💀 (V. Vulnificus infections have high fatality rates.)
A subtype of cellulitis involving the upper Dermis and superficial lymphatics that is usually caused by group a strep
Sudden onset of one large and indurated red skin lesion that has clear demarcated margins. It is usually located on the lower legs i.e. the shins or on the cheeks. It is accompanied by fever and chills. Hospitalization maybe needed for severe cases, infants, the elderly, and the immunocompromised.
P. Multicoda is a bacteria associated with
Dog 🐕 and cat 🐈 bites
What is the treatment plan for both human and animal bites
Augmentin PO for 10 days. If penicillin allergy, use clindamycin plus flouroquinolone. All bites and infected wounds need wound cultures with sensitivity testing. Do not suture wounds at high-risk for infection i.e. puncture wounds, wounds greater than 12 hours old or 24 hours on the face, cat bites, bites wounds on compromised hosts. Cartilage injury’s referred to plastic surgeon. Tetanus prophylaxis if last booster is Greater than five years, needs booster. Follow up with patient within 24 to 48 hours after treatment.
When is a referral for a wound needed
Closed fist injuries or crush injuries. Cartilage damage or wounds with cosmetic affects refer to plastic surgeons. Compromised hosts i.e. diabetics, absent/dysfunction of the spleen, immunocompromised.
What is needed if a patient is expected to have rabies
Rabies immunoglobulin plus rabies vaccine maybe required. Call a local health department for advice.
A bacterial infection of the sebaceous Glands of the axilla or groin by staff that frequently becomes chronic. It is marked by flareups and resolution. Usually both axilla are involved. Chronic episodic infection eventually leaves sinus tracts and heavy scarring.
What labs are needed for Hidradenitis Suppurativa
Culture and sensitivity of purulent discharge.
What is the treatment plan for hidradenitis Suppurativa
Augmentin PO be ID or dicloxacillin TID times 10 days.
Mupirocin ointment to lower third of nares and under fingernails BID x 2 weeks
Use antibacterial soap i.e. Dial especially on axilla and groin areas.
Avoid underarm deodorants during acute phase
Acute superficial skin infection caused by gram-positive bacteria such as streptococcus pyogenes i.e. beta strep or staph aureus. It is very contagious and pruitic, and is more common in warm and humid weather. Two types are bullous and nonbullous forms.
More common in children and teens. There may be acute onset of itchy pink to red lesions that become bullous, then crusty and maculopapular. The bullae are thin roofed and easily ruptured. After rupture, lesions are covered with honey colored crusts i.e. dried serous fluid.
What labs are indicated for impetigo
Culture and sensitivity of the crusts and wound
What is the treatment plan for impetigo
Cephalexin or Keflex QID, dicloxacillin Q ID times 10 days. If penicillin allergic, azithromycin 250 mg times five days or clindamycin times 10 days. If very few lesions with no Bulla, may use topical 2% mupirocin (Bacitracin) ointment times 10 days. Frequent handwashing, shower/bathe daily to remove crusts
A serious life-threatening infection caused by Neisseria meningitides (gram -) that are spread via respiratory droplets. Medical emergency
Who is most at risk for meningococcemia
College students living in dormitories are at higher risk. If treated early, mortality is less than 5%. The bodily damage is due to the endotoxins effects on the endothelium of blood cells.
What is the prophylaxis for close contacts of a patient with meningococcemia
Rifampin PO q12 hours x 2 days.
Meningococcal vaccination recommendation for all college students living in dormatories
What labs are indicated for meningococcemia
Lumbar punctures for a culture of cerebrospinal fluid. Blood cultures, throat cultures. CT or MRI of the brain.
What is the treatment plan for meningococcemia
Ceftriaxone (Rocephin) 2g IV every 12 hours plus vancomycin IV every 8-12 hours. Hospitalization with isolation precautions and supportive treatment
What are possible complications of meningococcemia
Tissue infarction and necrosis i.e. gangrene of the toes, foot, fingers etc. causing amputation. Death.
Erythema migrants is a skin lesion caused by the bite of a tick infected with Borrelia burgdorferi. If untreated, becomes systemic and affects multiple organ systems
Early Lyme disease
What lab tests are indicated for early Lyme disease
Serum anti-body titers I GM early and I GG late
What is the treatment plan for early Lyme disease
Doxycycline BID twice daily or tetracycline times 14 days. Give amoxicillin if pregnant.
Guillain-Barré syndrome is a neurological system problem that is a complication of
Early Lyme disease
Migratory arthritis, chronic fatigue are complications of
Early Lyme disease
Which diseases can present with the Palmar rashes
Rocky Mountain spotted fever, syphilis, erythema multiforme
Caused by a bite of a dog 🐕 tick or wood tick that is infected with the parasite Rickettsia rickettsii. If high index of suspicion, do not delay treatment. Treatment most effective if started within first 5 days of symptoms. Doxycycline is the first-line treatment for all age groups. Most cases occur during spring and early summer
Rocky Mountain spotted fever
What labs are indicated for Rocky Mountain spotted fever
Diagnostic antibody titers to R. Ricketsii (by indirect flourescent antibodies)
Biopsy of skin lesion (3mm punch biopsy). CBC, LFTs, CSF, others.
What medications should be prescribed for Rocky Mountain spotted fever
Doxycycline b.i.d. or tetracycline QID times 21 days. Refer stat
What are possible complications of rocky Mountain spotted fever
Death. Neurological sequela i.e. hearing loss, para paresis, neuropathy.
Superficial infections of the skin like impetigo are most appropriately treated with what medication
If infection is extensive what medication might be used
The primary infection of chickenpox is called
The reactivation of the chickenpox infection is called
Shingles or herpes zoster
When is chickenpox contagious
It is contagious from 1 to 2 days before the onset of the rash and until all of the lesions have crusted over i.e. chickenpox and shingles. Duration of illness is one or two weeks.
When is shingles contagious
It is contagious with the onset of the rashes until all the lesions have crusted over.
Who is most at risk for post herpetic neuralgia
Immunocompromised and elderly patients. Early treatment reduces risk. Treat within 48 to 72 hours after onset of break out if patient is above 50 years of age and is immunocompromise with shingles
What labs are indicated for shingles
The gold standard is viral culture, polymerase chain reaction (PCR) for ZDV
What medications are given for shingles
Acyclovir (Zovirax) 5x per day or valacyclovir (Valtrex) BId x 10 days for initial breakouts and 7 days for flare ups. Most effective when started within 48-72 hours of when rash appears
How is post herpetic neuralgia treated
Try cyclic antidepressants such as low-dose amitriptyline, anticonvulsants such as Depakote, or gabapentin TID. Lidocaine 5% Patch to intact skin
What is herpes zoster opthalmicus
It is a complication of herpes zoster that affects the cranial nerve number five and can result in corneal blindness. Refer immediately to ophthalmologist or ED.
What is Ramsay Hunt syndrome
A complication of herpes Zoster that affects cranial nerve eight. Refer to neurologist.
If the varicella vaccine is given to a reproductive aged woman what must be considered
The woman cannot get pregnant within the next three months
What is a contraindication to shingles and varicella vaccine
AIDS, chronic high doses steroids, radiation, chemo, immunocompromised
Can a person without chickenpox get shingles
A virus skin infection of the fingers that is caused by herpes Symplex virus infection from direct contact with either a cold sore or genital herpes lesion
Patient complains of the acute onset of extremely painful red bumps and small blisters on the sides of the finger or the cuticle area around the terminal phalanx of one or more fingers; may have recurrent outbreaks. Ask patient about coexisting Symptoms of oral herpes or genital herpes
What is the treatment plan for herpetic whitlow
Usually symptomatic treatment. Analgesics or NSAIDs for pain as needed. If severe, treat with acyclovir
Patient education for herpetic whitlow
Avoid sharing personal items, gloves, towels. Cover skin lesion completely with large Band-Aid/bandage until the lesions heal.
An acute local bacterial skin infection of the proximal or lateral nail fold’s (cuticle) that resolves after the abscess drain’s. Causative bacteria are staph, strep, or Pseudomonas (gram-negative). Chronic cases are associated with coexisting onychomycosis.
How do you manage paronychia
Soak affected finger in warm water for 20 minutes three times a day. Apply topical antibiotic such as triple antibiotic or mupirocin to infected finger after soaking. For abscess, incision and drainage using number 11 scalpel or use the beveled edge of a large gauge needle to gently separate the cuticle margin from the nailbed to drain the abscess.
Cause is unknown. Self limiting illness (4-8 weeks) And asymptomatic. Patient complains of overall lesions with fine scales that follow skin lines of the trunk or a Christmas tree pattern. Salmon pink color in whites. Maybe pruritus
First lesion to appear and largest in size and appears two weeks before fall break out of pityriasis rosea
What is the treatment plan for pityriasis rosea
No medications. Advise patient that lesions will take about four weeks to resolve. If high-risk of STDs, check RPR to rule out secondary syphilis.
An infestation of the skin by Sarcoptes scabiei mite. The female mite burrows under the skin to lay her eggs, transmitted by close contact. May be asymptomatic for the first 2 to 6 weeks. Even after treatment, the pruritis may persist for 2 to 4 weeks.
Lesions covered with find scales that look like white plaques and Crusts, involves the Nails (dystrophic nails), scalp, body; absent to mild pruritus; very contagious
Patient complains of pruitic rashes located in the interdigital webs of the hands, axilla, breasts, buttock folds, waist, scrotum and penis. Severe itching that is worse at night time and interferes with sleep. Other family members may also have the same symptoms.
The rash appears as serpinginous (snakelike) or linear burrows. Lesions can be papillae, vesicular, or crusted. Higher incidence in crowded conditions (nursing homes) and among the homeless.
What labs are indicated for scabies
Scrape burrow or scales with glass slide, use coverslip (wet mount). Look for mites or eggs.
What medications are indicated for scabies
Permethrin 5%, apply cream to entire body head to soles and wash off at 8 to 14 hours. Treat everyone in the same household at the same time. Any clothes, bedding used three days before and during treatment should be washed and dried using the hot settings. Pruritus usually improves in 48 hours, but can last up to 2 to 4 weeks even if mites are dead. Do not retreat. Do wet mount to check for live mites. Treat itch with Benadryl and topical steroids. In a long-term care facility, treat all patients, staff, family members, and frequent visitors for scabies.
An infection of superficial keratinized tissue i.e. skin, hair, nails by tinea yeast organisms.
Dermatophytosis tinea infections
Tinea yeast organisms are classified as
What are the labs for tinea infections
Gold standard is fungal culture of scales, hair, nails, or skin lesions. KOH slide microscopy on low to medium power reveals pseudohyphae and spores
What is tinea capitis
Ringworm of the scalp
What is the most common type of tinea capitis in the United States
Black dot tinea capitis is the most common type in the United States. African-American children are at higher risk. Spread by close contact, fomites via Shared hats and combs.
School-age child with asymptomatic scaly patch that gradually enlarges. The hair is inside the patch break off easily by the roots and look like black dots causing patchy alopecia. Black dot sign is broken hair shaft that leave a dot like pattern on scalp.
What medications are indicated for tinea capitis
Baseline LFTs and repeat two weeks after initiating systemic antifungal treatment. Monitor. Gold standard treatment is griseofulvin (microsize/ultramicrosize) Daily to BID x 6-12 weeks.
Avoid hepato-toxic substances such as alcohol, statins, acetaminophen
Connie colored crusts. Fragile bullae. Pruitic.
Kolpick’s spots are small round white spots on the base of the buccal mucosa by the rear molars
Very pruritic, especially at night. Serpenginous rash on interdigital webs, waist, axilla, penis
Sandpaper rash with sore throat (strep throat)
Hypo pigmented round to oval macular rashes. Most lesions on upper shoulders/back. Not pruritc
Christmas tree pattern rash on cleavage lines. Herald patch is the largest lesion that appears initially
Smooth papules 5 mm size that are dome shaped with central umbilication with a white plug
Red target like lesions that grow in size. Some central clearing. Early stage of Lyme disease.
Purple color to dark red painful skin lesions all over the body. Acute onset high fever. Level of consciousness changes. Rifampin prophylaxis for close contacts. Headache
Red spot like rashes that first break out on the hand/palm/wrist and on the feet/sole/ankles. Acute onset high fever. Severe headache. Myalgias.
Rocky Mountain spotted fever
How do you treat impetigo
Topical antibiotic such as mupirocin
Is there a treatment for pityriasis rosea
How do you treat scabies
Scabicide such as Prometharin
How do you treat scarlet fever
Pearly domed Nodule
Bright beefy red rash and how is it treated
Candida. Topical antifungal.
Recurrent highly pruitic rash and/on flexor and extensor surfaces and how to treat
Eczema. Topical steroid.
What is a complication of tinea capitis
Kerion: inflammatory and indurated lesions that permanently damage hair follicles causing patchy alopecia.
Pruitic round rashes with fine scales on the hands. Usually infected from chronic scratching of foot that is infected with tinea.
Tinea Manuum (hands)
How was onychomycosis treated
Oral flucanazole or turbinafine (Lamasil) weekly for several weeks. Must get baseline LFTs and monitor periodically. For mild cases, Penlac nail lacquer can be used for several weeks. Works best in mild cases of the fingernails.
How do you treat mild acne which is open comedones or blackheads, closed comedones, small papules, small pustules.
Topicals such as Retin-A, benzyl peroxide with erythromycin cream or clindamycin topical.
How do you prescribe a retinal to a patient with mild acne
Start at the lowest dose. Retin-A 0.25% cream every other day at that time for 2 to 3 weeks, then daily application at bedtime. Photosensitivity reaction possible so use sunscreen.
How do you treat moderate acne which is the same number of acne as mild acne plus large numbers of papules and pustules
Use topicals plus oral tetracycline which is category D for pregnancy. Minicycline or doxycycline. Tetracyclines can be given for acne starting at about age 13. Growth of permanent teeth is finished except wisdom teeth which are wrapped between the ages of 17 and 25. Tetracycline can cause permanent discoloration of growing tooth enamel. It can also decrease the effectiveness of oral contraceptives. Not given during pregnancy or two children under the age of 13. Certain oral contraceptives are indicated for acne (Desogen)
What medications are given for severe cystic acne. All of the preceding findings of mild to moderate acne plus painful indurated nodules and cysts over face, shoulders, and chest.
Isotretinoin or Accutane is category X and extremely to Teratogenic. Need to sign special consent forms. Females must enroll in approved pregnancy prevention program called I pledge. Use two forms of reliable contraception. Prescribe one month supply only. Monthly pregnancy testing and show results to pharmacist before refills. pregnancy test one month after discontinued.
When should Accutane be discontinued
Severe depression, visual disturbance, hearing loss, tinnitus, G.I. pain, rectal bleeding, uncontrolled hypertriglyceridemia, pancreatitis, hepatitis.
Chronic and relapsing skin inflammatory disorder that is common. There is no cure. Management is aimed at symptom control and avoidance of triggers that cause exacerbations.
What medications are indicated for rosacea
Metronidazole topical gel, Azelaic acid topical gel, low-dose oral tetracycline or Minocycline given over several weeks.
What are some complications of rosacea
Rhinophyma which is hyperplasia of tissue at the tip of the nose from chronic severe disease. Ocular rosacea which is a blepharitis, conjunctival injection, lid margin telangiectasia
Describe a superficial think this war 1st° burn
Erythema only. No blisters. Painful such as sunburns or mild scalds. Cleanse with mild soap and water or Saline. Cold packs for 24 to 48 hours. Topical over-the-counter anesthetics such as benzocaine if desired.
Describe a partial thickness or 2nd° burn
Red colored skin with superficial blisters. Painful such as hot water/oil scalds, fire. Use water with mild soap or normal Saline to clean broken skin. Do not rupture blisters. Treat with silver sulfadiazine cream i.e. Silvadene and apply dressings.
Describe a full thickness burn or 3rd° burn
Rule out airway and breathing compromise. Smoke inhalation injury is a medical emergency. Painless. Entire skin layer, subcutaneous area, and soft tissue fascia may be destroyed. Refer all facial Burns, electrical burns, third-degree burns, cartilaginous areas such as the nose and ears as cartilage will not regenerate. Burns on greater than 10% of the body need to be referred.
What is the body surface percentage for each arm and the head for the rule of nines
What is the total percentage of body surface area for the rule of nines for each leg, anterior trunk, or posterior trunk
What bacteria causes anthrax
Bacillus anthracis (gram +)
What is the post exposure prophylaxis for anthrax
Ciprofloxacin 500 mg PO BID times 60 days (doxycycline alternative PO)
What kind of dermatitis presents with the uni lateral location
Rashes that are very pruritic at night and located on the interdigital webs and or penis is
Scabies. Treated entire family. Wash linens/cloth in hot water.
What is the preferred antibiotic for human, dog, and cat bites.
If a patient is covered with fine scales they probably have
Are tar derived topicals used to treat psoriasis
Yes. Psoralens they are called and antimetabolites are also used, such as methotrexate
If a patient is walking barefoot, what condition are they susceptible to
What kind of steroids should be used on the facial and intertriginous areas of the body i.e. skin folds
Low potency such as hydrocortisone 1%
What kind of steroids should be used on the scalp back or soles
Higher potency steroid due to the fact that there is thicker skin in these areas
If group B strep to caucus infection is found in cellulitis what is the patient at risk for developing
Post glomerular nephritis as seen in strep throat. Treat for 10 days.
Put gel, cream, Ointment, and lotion in order of weakest to strongest.
What common disease may be associated with seborrheic dermatitis
What type of skin cancer presents as papules, planks, nodules, smooth, hyperkeratotic, or ulcerative lesions. May bleed easily. Definitive diagnosis always with biopsy or excision of specimen.
Squamous cell carcinoma
What is the most common complaints of elderly people on their skin
Itching or xerosis
What serologic test if positive makes lupus highly suspicious
Positive antinuclear antibody’s
Keratoconjunctivitis sicca is associated with what condition
What antibiotics can be used to treat purulent cellulitis
Clindamycin, Bactrim, doxycycline. Antibiotic must treat MRSA
When there is Purulent cellulitis what must be considered
Needs I&D first line treatment
Can amoxicillin be used to treat cellulitis
What are the three basic questions to ask with every rash
Where did the rash start? (Face, torso, extremities, genitals)
How long have you had it? (Acute or chronic)
Does the rash it itch? (Rule in or out many diagnoses)
The most excepted recommendation regarding skin cancer prevention is
Avoidance of excessive sun exposure
To reduce skin cancer risk associated with ultraviolet light and ionizing radiation, sun exposure should be avoided between the hours of
10 and 3 PM
What does an annular skin rash look like
A six-year-old African-American child has a round alopecic patch on his scalp. There is scaling of the lesion and broken hair shafts. What is this child’s diagnosis and what is the most appropriate action
The child should be started on an oral antifungal daily for 6 weeks
How is molluscum contagiosum spread
Skin to skin contact
Complications of carbuncles include
Septic arthritis, osteomyelitis, death, sepsis, tendon/fascial extension
In the anatomy of the skin which layer consists of keratinized cells or dead squamous epithelial cells
Top layer of the epidermis