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Dermatologic Flashcards

1
Q

Atopic dermatitis

A

Epi

  • h/o atopy
  • infants: face, scalp, ext surfaces
  • children: flexures
  • adults: hands, eyelids, nipples, flexures
  • d/t irritants, allergens, psych, envr, microbial

Sxs

  • chronic, itchy skin; rough red patch; scaling
  • acute flare - may have weeping area

Mgmt

  • topical steroids
  • PO anti-histamine (sedative)
  • secondary infection: abx
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2
Q

Contact dermatitis

A

Epi
- common allergens: plants, nickel, neomycin, terpentine, procaine

Allergic:

  • acute onset, pruritic, vesicles, weeping, crusts, erythema
  • sensitization after first contact; future contact results in allergic response

Irritant:

  • first exposure
  • chronic in nature; erythema w/scale and excoriations; burning/stinging

Mgmt:
- avoid irritants, wear gloves, barrier creams, topical steroids

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3
Q

Nummular eczematous dermatitis

A
  • groups of coin shaped plaques of papules and vesicles
  • plaques may be dry and scaly or exudative and crusty
  • lower legs of older men
  • consider ring worm but nummular is solidly scaly throughout
  • winter flares

Mgmt: topical steroids (can use higher potency on older men on lower legs)

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4
Q

Perioral dermatitis

A
  • often in adults who say they have never had acne before
  • superficial inflammatory papules in clusters on patches of erythema
  • itchy or asx

Mgmt:

  • PO abx + topical metronidazole or azelaic acid gel BID
  • abx: doxy, mino, erythro, ttc

come back in 6wk, if better, can reduce to daily

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5
Q

Seborrheic dermatitis

A
  • D/t: sebum production, overgrowth of Malassezia and immunologic abnormalities

Sx:

  • scalp, eyebrows, nasolabial fold, groin, chest
  • skin inflamed w/yellow or white greasy scale; mildly pruritic
  • worse in winter

adults: dandruff
peds: cradle cap

Mgmt:
- scalp: anti-seb shampoo* (zinc, selenium); ketoconazole shampoo twice weekly; tar shampoo mild case; topical corticosteroid solution

  • skin: low potency corticosteroid*
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6
Q

Stasis dermatitis

A
  • d/t chronic venous insufficiency

Sx:

  • itchy, eczematous, scaly rash on lower legs
  • fissures, ulcers
  • hyperpigmentation (hemosiderin) - “brawny”

Mgmt:

  • topical steroids
  • lubrication
  • elevation, compression stockings
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7
Q

Dyshidrotic eczema

A

Epi: atopy; outbreaks during hot, humid weather

Sx

  • pruritic, clear “tapioca-like” vesicles that progress to papules, scaling, lichenification
  • fingers, palms, soles

Mgmt: topical steroid

If concern for athletes foot, treat w/antifungal first and then switch to steroid for eczema

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8
Q

Lichen simplex chronicus

A

D/t habitual scratching –> leathery and lichenification [neck, wrists, extensor surfaces of forearms, legs, scrotum, vulva]

Sx

  • well circumscribed plaque of Lichenification arising from confluence of small papules*
  • pruritic

Mgmt: stop itch-scratch cycle

  • mid/high potency topical steroid x 3wk to thick lesion (less potency for thinner skin)
  • PO antianxiety/sedating meds may be beneficial to stop scratch at night
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9
Q

Drug eruptions

A

Type I: classic immediate hypersensitivity [urticaria, angioedema, anaphylaxis]

Type II: cytotoxic [hemolysis, purpura]

Type III: immune complex [vasculitis, serum sickness, urticaria, angioedema]

Type IV: delayed hypersensitivity [contact dermatitis, exanthematous rxn, photoallergic rxn]

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10
Q

Morbilliform eruptions

A

MC cutaneous drug reaction (Type IV) - 7-10d after starting drug

Sx: maculopapular eruption, itching, polycyclic erythema; symmetrical on trunk, extremities

Common drugs: PCN, NSAIDs, TMP-SMX, thiazides

Mgmt: D/c drug; antihistamine

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11
Q

Urticarial drug reactions

A

Onset depends on governing mechanism

Sx: hives/wheals; angioedema; anaphylaxis; pruritus; burning of palms/soles

Common drugs: ASA, PCN, blood products, radiographic dye, morphine

Mgmt: d/c drug, antihistamine, +/- systemic steroid

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12
Q

Fixed drug eruption

A

Presents soon after drug exposure (30min to 8hr); reappears same site each time drug is taken

Sx: dusky red, round, plaques/bullae

MC: glans of penis (location)

Common drugs: ASA, NSAIDs, sulfonamides, TTC, TMP-SMX

Mgmt: d/c drug, topical steroid
- eroded lesion: use bactroban (abx ointment)

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13
Q

Lichenoid drug reaction

A

Onset 3wk - 3yr from drug exposure

Sx: multiple purple, flat topped, itchy papules

  • heal w/brown post-inflammatory hyperpigmentation
  • oral mucosa can be affected

Common drugs: gold salts, antimalarials, TTC, ketoconazole, sulfonylureas, NSAIDs, BB, ACE, CCB, furosemide, thiazide

Mgmt: d/c drug +/- steroid; antihistamine

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14
Q

Drug hypersensitivity syndrome

A

W/in first 2mo of drug exposure

Dx criteria: hematologic abnormality, cutaneous eruption, systemic involvement

Sx: fever, facial edema; exfoliative dermatitis; erythematous papules; LAD; eosinophilia, leukocytosis, atypical lymphocytes

Common drugs: sulfonamides, AEDs, allopurinol, minocycline, CCBs, ranitidine

Mgmt: d/c drug, prednisone, topical steroids, PO antihistamine

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15
Q

Acute Generalized Exanthematous Pustulosis (AGEP)

A

5d after drug ingested

Sx: superficial inflammatory pustules all over; fever, chills, ill; leukocytosis

Common drugs: macrolides, PCN, diltiazem

Mgmt: d/c drug; refer to derm

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16
Q

Stevens-Johnson Syndrome

A

MC: AEDs, sulfa, PCN, cold/cough OTC, NSAIDs, analgesics

Sx: erythematous macules w/darker purpuric centers (2 zones of color)

  • extensive mucous membrane involvement
  • fever, malaise, myalgias

Mgmt:

  • ICU/burn unit
  • tx infection
  • d/c drug
  • +/- steroids
  • supportive treatment
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17
Q

Toxic epidermal necrolysis

A

Sx:

  • prodrome: flu-like sxs, fever, prior to mucus membrane lesions
  • mild/mod tenderness of skin to pain, burning, paresthesias
  • skin peels off, glistening
  • mouth lesions, conjunctival burning

Nikolsky sign: push on skin and it peels away

Mgmt: d/c drug

  • supportive, pain relief
  • IVIG
  • tx infection
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18
Q

Lichen planus

A

Epi: MC in women

Sx: 1-10mm flat-topped pink-purple pruritic, polygonal, papules (4Ps)

Wickman’s Striae: fine white lines

Dx confirmed w/bx

Mgmt:
- steroids, retinoids, immunosuppressive agents

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19
Q

Pityriasis rosea

A

Et: viral

  • older children, young adults
  • spring, fall

Herald patch: single 2-5cm Oval lesion, red with collarette of scale

Progress to exanthem (smaller, salmon patch)

“Christmas tree” distribution

Initially look like ring worm but widespread distribution w/in a few days

Mgmt: spontaneous resolution 6-12wk

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20
Q

Psoriasis

A

MC elbows, knees, scalp

Sx: silvery, dry scales on bright red well-demarcated plaques

  • mild pruritus
  • nail pitting or onycholysis
  • Koebner phenomenon: lesions at trauma site
  • Auspitz sign: pinpoint bleeding after removal of scale
  • Woronoff ring: blanching around healing plaque

Mgmt:

  • > 5% BSA = derm referral
  • do NOT use PO steroid
  • topical steroid: high/ultra high x 2-3wk then pulse
  • Pluse: calcipoteriene, retinoids, coal tar, salicylic acid
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21
Q

Types of Psoriasis

A

Plaque: localized area w/thick scale (MC on extensor surfaces)

Guttate: small red papules w/scale

Inverse: shiny red areas in flexures

Pustular: pustules on palms and soles

Erythrodermic: generalized redness, may require admit

Psoriatic arthritis: hand joints MC, nail involvement, requires systemic therapy

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22
Q

Erythema multiforme

A

Et: HSV (MC)

Sx: targetoid pink, dark red, purple macules

  • papules/plaques +/- vesicles and bullae on palms, soles, forearms, legs
  • 3 zones of color**

Mgmt:

  • d/c drug
  • tx infection; control HSV w/acyclovir
  • topical abx for eroded vesicles
  • prednisone taper
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23
Q

Acne vulgaris

A

Bacteria: propionibacterium acnes

Sx: inflammatory papules/pustules, cysts/nodules

  • open: blackheads
  • closed: whiteheads
  • ice pick/pock mark scars, keloids

Mgmt:

  • inflammatory: benzoyl peroxide cream +/- topical Abx
  • comedome: topical retinoid [tretinoin, adapalene, tazarotene]

can add: PO abx (doxy or other ttc)

wear sunscreen!

refer to derm

24
Q

Rosacea

A

Erythematous telangiectasia - fixed erythema w telangiectasia, intermittent flushing
Tx: metronidazole gel*

Papulopustular type
Tx: topical metronidazole gel + oral abx (doxy or mino)

25
Actinic keratosis
Premalignant - BCC or SCC* dt sun exposure Fair skin, older than 40 Sx: red brown scaly Papule without underlying induration, 1-6mm, usually asx Skin checks q 6mo Sun protection Mgmt Derm referral Cryotherapy <15 lesions Tx: topical 5fu, imiquimod, aminolevulinic acid pulse light therapy*
26
Seborrheic keratosis
Mc after age 30 Sx: warty stuck on appearance anywhere except lips, palms, soles Any color and variable size Mgmt Don’t have to treat unless cosmetics Cryo, E&D
27
Seborrheic keratosis subtypes
Dermatosis papulosa nigra- African descent smaller darker papules on cheek Stucco keratosis: white papules on legs Sign of leser trelat: can indicate internal malignancy
28
Lice
Children Hair shaft Nits behind ears or near neck Itching OTC: permethrin 1% repeat in 9d Rx: benzyl alcohol lotion 5% ivermectin and malathion lotion Nit comb
29
Scabies
Infants, I/c head and neck Extremely pruritic papules and burrows seen abdomen hands feet axilla and genitals Scabies prep: scrape lesion w 15 blade Mgmt 5% permetherin cream repeat in 1 wk, ivermectin (not under 5y or pregnant females); tx family and close contacts
30
Alopecia areata
Immunologic phenomenon - emotional physical mental stress Sx: sudden hair loss, skin is NORMAL (no scarring erythema or scale) Can regrow but lose hair in another area Indicator: missing medial brows and eyelashes Labs: thyroid, cbc, ana, cmp Mgmt Steroids w immunomodulator, control autoimmune condition
31
Androgenic alopecia
Mc type of hair loss in men Progressive loss of terminal hairs on scalp - anterior scalp, mid scalp, temporal and vertex Mgmt: minoxidil, po finasteride
32
Onychomychosis
Fungal infection of the nail, increased with age and immunosuppression
33
Paronychia
Bacterial infection of lateral nail fold Skin red, inflamed, warm, tender +/- pus Mgmt I&D Bacterial infection: pcn or cph Antifungal cream bid
34
Condyloma accuminatum
Anogenital warts Soft, single or multiple, flat, dome shaped, cauliflower, filiform, fungating, pedunculated, smooth, verruceous w variable color Typically asx but sometimes pruritic Mgmt Pt applied: topical imiquimod, podophyllotoxin, sinecatechins Clinician applied: cryo, trichloroacetic acid, surgery
35
Measles (rubeola)
Prodrome: coryza, cough, Koplik spots (1-3mm grayish elevations w erythematous base, typically buccal mucosa) Brick red erythematous maculopapular blanching rash beginning on face spreading down body Supportive care
36
Rubella (German measles)
Pink pinpoint maculopapules appearing on face and spreading cephalocaudal; generalized in 24hr Anterior, posterior, and occipital LAD SUPPORTIVE CARE
37
Roseola infantum
Kids <2y High fever for several days, followed by blanching maculopapular rash Neck and trunk then spreads to face and extremities Supportive care
38
Erythema infectiosum
Parvovirus b19* Slapped cheek rash Followed by “lace-like” rash (reticulated blanching erythema) on trunk and extremities Supportive care
39
Scarlet fever
GAS (pyogenes) Pastia lines - confluent petechiae in antecubital fossa Diffuse erythematous sandpaper rash Occurs w or preceded by pharyngitis Mgmt Resolute followed by desquamation or frank peeling Tx strep
40
HSV 1 Primary
Asx Primary gingivostomatitis - lips oral mucosa involved, swollen bleeding gums Vesicles become erosion
41
HSV 1 recurrent
Trigger - uv exposure, abrasions, chapping, stress, hormones, illness Prodrome- tingling, burning, itching Eruption of tender vesicles on erythematous base (dew drop on rose petal) A/w Bell’s palsy
42
HSV 1 dx tx
Clinical dx Viral culture or pcr Thank smear Mgmt Mild - topical penciclovir or doconosol Extensive, frequent - po antivirals
43
HSV 2
Genitalia herpes | Tx po antiviral on hand
44
VZV
Reactivation of varicella virus most over 60 Prodrome: burning, tingling, itching Red patch - vesicles - rupture - crust Dermatomal dist Herpes zoster ophthalmicus- Hutchinson sign (tip of nose) risk for corneal involvement Postherpetic neuralgia Dx- tzanck and culture Tx - po abx Zostavax vaccine >50; one dose live vaccine
45
Verrucae (warts) info and tx
Hpv infecting epidermis and mucous membranes Direct contact and auto inoculation * Rf- young age, sexual activity, I/c ``` Most resolve on their own Exfoliative - salicylic acid; retinoid Ablative - cryo, cantharidin, laser Cytotoxic - bleomycin, 5fu, interferon Immunomod - imiquinod, candida antigen Other - duct tape, pads, apple cider vinegar ```
46
Types of warts
``` 1. Common 1-10mm hyperkeratotic outgrowth Disruption of palmar crease Red brown dot might bleed w scraping Filiform - small base w elongated cap and digital projections ``` 2. Plantar Small shiny sharp marginated papule then plaque w rough hyperkeratotic surface studded w brown black dots Disrupt skin lines 3. Flat 1-5mm sharp defined flat papule Skin colored to light brown on dorsal hand face or shin Linear distribution 4. Corn (not wart) Friction pressure - progress to tenderness w pressure Skin lines travel through lesion Shaved = glassy core w no cap bleed points
47
Molluscum contagiosum
Child and sexually active adult Smooth, pearly, dome shaped, umbilicated papule* often multiple lesions Resolve on own, may use cryo, curettage, cantharidin, imiquimod
48
Candidiasis
Sweaty area, skin fold Red moist glistening papule with “satellite lesions”* Dx KOH and culture Manage - dry w powder, topical nystatin and azole
49
Tinea versicolor
Superficial skin infection of trunk, neck, and upper arm Velvety tan, pink, or white macules that may coalesce Asx or mild itch Likely to recur Manage: Topical - selenium sulfide or ketoconazole shampoo, antifungal azole cream PO - itraconazole or fluconazole
50
Tinea corporis/pedis
Pedis - athletes foot: erythema, scaling, maceration, itch Capitis- head: black dot, scaling and broken hairs (require PO therapy) Sx- ring shaped lesion w advanced scaly border and central clearing, mild pruritus Dx - skin scraping for KOH Mgmt Local - topical therapy Extensive or follicular - Po therapy
51
Acanthosis nigricans
DM*, hypothyroid, obesity, drug, malignancy Velvety thickening and hyperpigmentation of skin* may have skin tags super imposed on top Axilla, posterior neck Dx - FBG, TSH, imaging if suspicious for malignancy Tx- underlying; DM; sxs
52
Hiradenitis suppurativa
Apocrine gland, more common w F Inflammatory papules/pustules, cysts, comedones, sinus tracts ``` Mgmt Acne meds - Po abx, topical or Po retinoids Steroid injections I&d Adalimumab ```
53
Lipoma
SQ tissue neoplasm Soft mobile, solitary or multiple round, lobulated, yellow masses Well circumscribed, no overlying skin changes Mgmt Excision
54
Epithelial inclusion cysts
Epidermis/epithelium of hair follicle Soft, mobile nodule (may have overlying puncta) Mgmt Excision - white and shiny after extraction I&d not effective
55
Melasma
Harmless pigmentary seen on malar region of darker skin women commonly during pregnancy Brown tan patches Mc on face Irregular patches w well demarcated borders ``` Dx — HCG; TSH, cortisol (addisons), woods lamp Mgmt Gone after pregnancy Hydroquinone Limit sunlight exposure Topical retinoid ```

Family Medicine (17 decks)

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