Dermatology #1 Flashcards by Tyler Cichowski

What are the four main pathophysiology factors of acne vulgaris?

1) follicular hyperkeratinization
2) increased sebum production
3) Propionibacterium acne overgrowth (bacteria)
4) inflammatory response

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What stimulates sebum production with acne vulgaris?

Androgens

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Clinical manifestations of acne vulgaris

Often occur in areas with sebaceous glands (chest, back, face, upper arms)
Open comedones: blackheads (incomplete blockage)
Closed comedones: whiteheads (complete blockage)
Inflammatory: papules or pustules surrounded by inflammation
Nodular or cystic: often heals with scarring

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Explain the different severity levels of acne vulgaris (mild, moderate, and severe)

Mild: comedones, small amounts of papules/pustules
Moderate: comedones, larger amount of papules/pustules
Severe: nodular or cystic acne

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Management of the three severities of acne vulgaris

Mild: Topical (Azelaic acid, salicylic acid, benzoyl peroxide, retinoids. Tretinoin or topical ABX such as Clindamycin or Erythromycin)
Moderate: As above + Oral ABX (Minocycline or Doxycycline). Spironolactone
Severe: Oral Isotretinoin

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What is the most effective medication for acne vulgaris and why?

Isotretinoin

-Affects all 4 pathophysiologic mechanisms of acne

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Name 5 side effects of isotretinoin

Dry skin and lips
Highly teratogenic: must obtain at least 2 pregnancy tests prior to starting treatment and commit to 2 forms of contraception. Must sign up for iPledge. Monthly pregnancy tests before refills.
Increased triglycerides and cholesterol
Photosensitivity
Worsening of Diabetes Mellitus
Headache
Fatigue
Visual Changes
Premature closure of long bones

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Risk factors for acne rosacea

Women

- 30-50 years old

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What is acne rosacea?

Disease of pilosebaceous units associated with increased activity of capillaries, leading to telangiectasias and flushing secondary to vasodilation

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Triggers of acne rosacea

Alcohol
Hot or cold weather
Hot drinks
Hot baths
Spicy foods
Sun exposure
Medications

(HEAT RELATED)

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Symptoms of acne rosacea

Acne-like rash (papulopustules)
Centrofacial erythema
Facial flushing
Telangiectasias
Skin coarsening with burning and stinging
Red eyes
Later, lymphedema, hyperplasia, and telangiectasias develop
Rhinophyma (red, enlarged nose), otophyma (ear), gnathophyma (chin), metophyma (forehead), and blearophyma (eyelid)

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Although a ______ is the definitive diagnostic for acne rosacea, it is rarely done.

Biopsy

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Treatment for acne rosacea

Lifestyle modifications: limit triggers, avoid irritants
Topical metronidazole (first-line), Sodium sulfacetamide, erythromycin
Oral ABX (Tetracycline, Minocycline, or Doxycycline if fail topical treatments)
Oral isotretinoin if failed other treatments or severe

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For the facial erythema of acne rosacea, what is a specific treatment/medication that can be given?

Topical Brimonidine

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Risk factors for folliculitis

Men
Prolonged use of ABX
Topical corticosteroids

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MCC of folliculitis

Staph Aureus

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MCC of hot tub-related folliculitis

Pseudomonas aeruginosa

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Noninfectious folliculitis is common in what types of jobs?

People working hot, oil environments such as engine workers, on ships, machinists, or working in a hot, dirty environment
-Occlusion, perspiration, skin rubbing against tight clothing

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Symptoms of folliculitis

Singular or clusters of erythematous papules or pustules on hair bearing skin
Not painful, but pruritic
Abscesses may form at the site of severe folliculitis

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Treatment for folliculitis

Gentle cleansing with antibacterial soap and mild compresses
Topical Mupirocin, Clindamycin, Erythromycin, or Benzoyl peroxide
Oral ABX for severe: Cephalexin or Dicloxacillin

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Treatment for hot tub folliculitis

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usually resolves without treatment (severe cases may be treated with an oral fluoroquinolone such as Ciprofloxacin, Moxifloxacin)

What is Erythema Multiforme?

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-Type IV hypersensitivity reaction of the skin following infections of medication exposure

MC infection that causes Erythema Multiforme

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Herpes Simplex Virus

- Mycoplasma sp is another common cause in children

Medications that cause Erythema Multiforme

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-Sulfa drugs, beta-lactams, Phenytoin, Phenobarbital, Allupurinol

Explain the lesions in Erythema Multiforme

Target lesions that have 1) a dusky central area or blister, 2) surrounded by a pale ring of edema and 3) an erythematous halo on the extreme periphery -Most common on extremities and trunk

Other symptoms of Erythema Multiforme

- Negative Nikolsky sign: no epidermal detachment. Often febrile. - Minor: target lesions with no mucosal involvement - Major: target lesions head --> centrally + mucosal membrane involvement (oral, genital, ocular). No epidermal detachment still.

What are the two types of Erythema Multiforme and how do they differ?

- Minor: no mucosal involvement | - Major: mucosal involvement

Treatment for Erythema Multiforme

- Symptomatic: discontinue offending agent, antihistamines, skin care. Diphenhydramine + Lidocaine mouth wash for oral lesions - Systemic corticosteroids if severe. Oral Acyclovir if HSV related.

What are Steven-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN)?

Severe mucocutaneous reactions characterized by detachment of the epidermis and extensive necrosis

What is the difference between SJS and TEN?

SJS: sloughing involving < 10% of body surface involvement TEN: sloughing involving > 30% of body surface involvement

Risk Factors/Causes of SJS/TEN

- Medications (MCC): Sulfa drugs, Anticonvulsants, Lamotrigine, Allopurinol, NSAIDS, antipsychotics, antibiotics - Sulfa drugs: Bactrim, Glyburides

Symptoms of SJS and TEN

- Prodrome of fever, URI followed by widespread flaccid bullae beginning at trunk/face - Pruritic target lesions (erythematous macule with purpuric centers) and involvement of at least 1 mucous membrane - Positive Nikolsky sign (epidermal detachment) - Ocular involvement common (uveitis, corneal ulceration)

Treatment for SJS/TEN

- Prompt discontinuation of causative agent - Supportive therapy: treat like severe burns (burn unit admission, pain control, prompt withdrawal of offending medications, fluid and electrolyte replacement, wound care)

Alopecia Areata is commonly associated with

Other autoimmune disorders: thyroid disease, Addison's disease, etc.

Exam findings of Alopecia Areata

- Exclamation point hairs: short hairs broken off a few mm from the scalp. Tapering near the proximal hair shaft. - Nail abnormalities: pitting, trachyonychia (roughening of the nail plate) - Smooth, discrete, circular patches of complete hair loss that develop over a few weeks

What gives a definitive diagnosis of alopecia areata?

-Punch biopsy

Treatment for alopecia areata

- Local: intralesional corticosteroids | - Extenstive: topical corticosteroids

What is alopecia totalis and alopecia universalis?

Totalis: complete scalp hair loss Universalis: complete hair loss on scalp and body, including eyelashes

What is androgenetic alopecia?

Genetically predetermined loss of terminal hairs on scalp in a pattern. Most common type of hair loss in men and women.

What is the key androgen that leads to hair loss in androgenetic alopecia

Dihydrotestosterone (DHT)

Activation of DHT does what in androgenetic alopecia?

Shortens the anagen (growth phase) in the normal hair growth cycle -Pathologic specimen show decreased anagen to telogen ratio

Symptoms of androgenetic alopecia

- Hair thinning and non scarring hair loss - -In males, it begins as bitemporal thinning of frontal scalp then involves vertex - -In females, thinning of hair between frontal and vertex of scalp without affecting frontal hairline

Treatment for androgenetic alopecia

- Topical Minoxidil: Requires 4-6 month trial and must be used indefinitely - Oral Finasteride - Hair transplant

Mechanism of action of Minoxidil

-Widens blood vessels, allowing more blood, oxygen, and nutrients to promote the anagen (growth phase)

Finasteride, a 5-alpha reductase type 2 inhibitor, has a MOA of

-androgen inhibitor (inhibits the conversion of testosterone to dihydrotestosterone)

What are some adverse effects of Finasteride?

Decreased libido, sexual or ejaculatory dysfunction, increased risk of prostate cancer -Category X

Explain the Rule of 9's (Anterior/Posterior)

Anterior - Head: 4.5% - Torso: 9% - Belly: 9% - Genital: 1% - Arm: 4.5% - Leg: 9% Posterior: - Head: 4.5% - Torso: 9% - Lower Back: 9% - Arm: 4.5% - Leg: 9%

What is considered a "minor burn" in adults and children/old?

Adults: < 10% TBSA Children/Old: < 5% TBSA --Must be isolated injury --Must NOT involve face, hands, perineum, feet -Must NOT cross major joints or circumferential.

What is considered a MAJOR burn in adults and children/old?

Adults: > 25% TBSA Children/Old: > 20% TBSA -Burns involving: face, perineum, hands, feet -Burns crossing major joints, circumferential

What is the rule of 9's chart that is used (the specific name of it)?

Lund-Browder Chart (most specific)

Dermatology #1 Flashcards

(50 cards)