Dermatology Flashcards by katie gazda

Why use a wet compress?

Use to decrease inflammation, mild wound debridement, anti-bacterial benefits
Antibacterial: aluminum acetate, acetic acid, silver nitrate

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topical steroid groups

1-7

Group 1: strongest

Group 7: weakest

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Disorder of the pilosebaceous follicles → increased sebum production, altered keratinization, inflammation, bacterial colonization

Acne Vulgaris

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What is considered mild acne?
moderate acne?
Severe?

Mild → less than ¼ of face without scarring or nodules, moderate → ½ of face, severe → ¾ face

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characterized by comedones, erythematous papules, pustules and nodules

Acne Vulgaris

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Acne differentials

Milia
Rosacea
Perioral Dermatitis
Sebaceous Hyperplasia

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How long does it take for acne medicine to take effect

6-12 weeks

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First-line tx for acne

Topicals are first line: tretinoin (retin-a), adapalene (differin), tazarotene, azelaic acid, benzoyl peroxide, salicylic acid

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Oral Antibiotics for Acne

Oral abx: for inflammatory acne and used for severe cases, unresponsive to topicals, scarring prone pts, lesions on trunk and back

Minimum 6 weeks; once improvement is achieved, d/c and stick to retinol

Most used: minocycline (most effective), doxycycline, erythromycin, tetracycline

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Hormone Therapy to Tx Acne

ombined oral contraceptives, spironolactone, drosperidone

Antiandrogen meds that cause sebaceous gland suppression

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What to know about Isotretinoin

Severe acne ONLY; monitored by derm, monthly triglyceride and hepatic function monitoring, 2 forms of birth control for women

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Best way to differ rosacea from acne

rosacea does NOT have comedones

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Rosacea that coexists with acne; most often seen between 30-50 y/o women, men are more severely affected if they have it

Acne Rosacea

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…end up having psoriasis arthritis, autoimmune disorder, T cells have a key role, environmental triggers can bring a flare, immune stimulation of epidermal keratinocytes that builds up the layers and creates the plaques/ lesions

Psoriasis

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5 types of Psoriasis

Plaque (most common)- \_\_\_\_
Guttate-\_\_\_\_\_\_
Inverse- \_\_\_\_\_\_
Pustular-\_\_\_\_\_\_\_
Erythrodermic - \_\_\_\_\_\_\_

5 types:
Plaque (most common)- grey, crusty
Guttate- young adults and children, water droplet scaly
Inverse- mistake it for fungal
Pustular- looks dry and mistake for tines pedis
Erythrodermic - broad and hot

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when to use Emollient creams and lotions

Dry lesions
Loss of cutaneous moisture, epidermal lipids and proteins
Best if you applied to damp skin
Creams with urea and lactic acid work best
Thicker is better

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Warnings for topical steroid level I (psoriasis, hand eczema)
ex. Clobetasol

not for face, axillae, groin or under breasts! Limit use to 14 days

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Warnings for topical steroid levels II and III (atopic dermatitis adults)
ex. Difloorasone, Desoximetasone

not for face, axillae, groin or under breasts!

Limit use to 21 days

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Warnings for topical steroid levels IV and V (atopic dermatitis in children)
ex. Triamcinolone
Hydrocortisone valerate

Limit use in children to 7-21 days, limit in intertriginous areas

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Warnings for topical steroid levels VI & VII
ex. Desonide, Hydrocortisone
(eyelid dermatitis, diaper dermatitis)

reevaluate if not responded in 28 days - avoid long term use continuous in any areas

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benign Dilated venules, <0.5cm, mostly found on trunk

After the age of 30 y.o
Red and are 3-5mm
Not associated with disease process
Tx = cosmetic- electrodessication, laser

cherry angioma

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Small skin flaps, attached by a stalk

can occur anywhere on the body, increase with weight gain, increase the frequency with age

Skin Tags

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Autoimmune disorder; causes chronic inflammatory response at bulbs of hair and breaks easily (cycles of growth and loss) → stress, Addison dx, lupus, thyroid dx causes

Alopecia areata

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Common tx for Alopecia Areata

Topical Minoxidil

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Most common type of hair loss : heredity thinning of hair, effects anagen (growth) phase, polygenetic tx? Men: receding hairline at temples, thinning frontal and vertex; women: diffuse thinning, frontal-parietal areas most affected

Androgenic alopecia

Other name for atopic dermatitis

eczema

Patho: We see it on cheeks in children, AC Risk Factors: Children Environmental triggers (soy, fish, dust mites, molds, staph)

Atopic Dermatitis / EZCEMA

2 phases of Atopic Dermatitis / EZCEMA

Acute phase: weep, red, scales Chronic: Lichenified skin due to scratching- dry - > Risk for infection

Form of eczema, allergies response Resolutions takes 3 weeks Remains sensitive to offending substance Treatment Avoid triggers, topical creams, lotions, corticosteroids

Contact Dermatitis

Patho: Benign but if untreated -> squamous cell carcinoma Risk Factors: Sun exposure, tanning beds, fair skin, blue/ green eyes

Actinic Keratosis

How to manage Actinic Keratosis

``` Refer for tx Liquid nitrogen (freeze-thaw technique) ``` Topical 5-fluorouracil (Efudex, Carac) or imiquimod (Aldara)

hair prematurely enters telogen (shedding of mature hair) phase → sudden hair loss Women, men, infants affected; causes: childbirth, high fevers, medications, endocrine abnormalities, anemia, malnutrition

Telogen Effluvium

Patches of hair loss on scalp, eyebrows, eyelashes, beard (men)

Alopecia areata

How to tx alopecia in women? men?

Minoxidil (rogaine) only FDA approved for women, finasteride (Propecia) preg cat X

Important to ask about with alopecia?

History! | Ask about sx (scalp itching, pain, flaking) → differentials

Diagnostics for bites?

C-reactive protein, sed rate for tx response | Radiographs for fractures, foreign bodies, soft tissue injury, subq gas, osteomyelitis

How to manage a bite?

DO NOT CLOSE IT Irrigate wound with sterile NS, pack if necessary Bites to face → debride, preemptive abx, primary closure, then ED/plastics referral Cat and human bites, puncture wounds, infected wounds, wounds >6-12 hours old should be left open r/t infection risk hand/foot wounds: immobilization 1-3 days Qday outpatient monitoring

Abx tx for bites?

Prophylaxis only for high-risk bites or patients; cat/hand 5-7 days prophylactic abx amox/clav (augmentin) 5-7 days; clindamycin + doxy for pcn allergy Older infected bites → IV abx in hospital

What to do if possibly rabies bite?

wash immediately with soap and water OR 1% iodine solution Watchful waiting for most bites If animal becomes ill, patient should be treated; high risk bites should be treated If bite is on head/neck, do not do watchful waiting for tx → TX IMMEDIATELY Tx: immunization of human rabies immune globulin (HRIG) or purified chick embryo vaccine (PCEV); active immunization with human diploid cell vaccine (HDCV) or PCEV days 0,3,7,14

Firm, intradermal nodules in skin; mostly found in women on the legs -Typically asymptomatic, but pruritic/tender if sx occur, Variable color Fitzpatrick sign Cosmetic or discomfort purposes → deep excision necessary, inform pt scar may be more unattractive than lesion itself

dermatofibroma

What is Fitzpatrick sign?

(dimple sign) Squeeze lesion with thumb and forefinger → lesion will dimple -> dermatofibroma

Skin lesion varying size from 2mm-3cm (Present as waxy or verrucous appearing papules or plaques that have a “stuck on” appearance; variable color) Family members, advancing age, anywhere on body (frequently trunk, no palms or soles)

seborrheic keratosis

Most common benign non-melanocytic skin lesion on body

seborrheic keratosis

how to tx seborrheic keratosis? when to be concerned?

Bx or referral to derm for atypical lesion Cryotherapy, shave biopsy or curettage Worried if Change in SK, irregular borders, color changes, unusual black or blue

First line abx. med mgmt for insect/ spider bites?

Amox-clav first line Allergies: Cephalosporin or Bactrim + clindamycin Cleansing. IRRIGATION

Autoimmune disorder: large, tense, subepidermal blisters occurring on normal or erythematous skin -> presence of circulating IgG antibodies for hemidesmosomal BP against proteins of dermal-epidermal junction

Bullous Pemphigoid

What phase of Bullous Pemphigoid? mild to severe pruritis with erythematous, eczematous papules or urticarial lesions lasting several weeks to months; early sign of dx, delays diagnosis

Prodromal phase

What phase of Bullous Pemphigoid? presents suddenly intense pruritus, widespread blister formation Lower abd, flexor aspects of arms and legs including axillae, groin and thighs, oral lesions common

Bullous phase

Risk factors/ triggers for Bullous Pemphigoid lesions

>60 y/o | Triggers for lesions: trauma (burn, UVR, radiotherapy), drugs (lasix, enalapril, ibuprofen, abx), herpes virus, EBV

(ability to split dermis from epidermis with pressure) negative in BP(Bullous Pemphigoid) pt

Nikolsky sign

Gold standard diagnostic for Bullous Pemphigoid?

direct immunofluorescence (DIF) microscopy of skin bx;

goals with tx eczema

PREVENT ITCH/ hydrate =goal | moisturizer/ rehydration - after bath

3 months of age, SUPER itchy Acute phase: weep, red, scales Chronic: Lichenified skin due to scratching- dry Risk for infection Turns to this if untreated and continuous scratching

Atopic Dermatitis

1st line tx for chronic atopic dermatitis/ eczema if infected with staph or strep?

first line cephalosporins - cephalexin

Rash 24-72 hours from contact - oils, so SHOWER Vesicles Does Not follow dermatome Itchy

Plant Dermatitis ... Domeboro- compress wet dressing, dries it up

Greasy, white or yellow scales, itchy Ear or around nose (nasal folds) Redness Cradle cap→ baby shampoo to keep it clean Can be mistaken for yeast if in diaper area PE: looks and flakes like dandruff

Seborrheic (dermatitis)

Inflammation or infection of hair follicles, typically result of an infection Occurs in regions with hair that is thick, long, and dark; area under occlusion → head, neck, axillae, groin, buttocks - Topical benzoyl peroxide Abx if needed Superficial should resolve on own

Folliculitis

Candida is resistant to ____

Nystatin

how to manage candida?

Treat the mother and the baby BOTH Clotrimazole 10 mg dissolve in mouth 5x/day for 14 days Nystatin- 4-6ml swish and spit 3-4x/day 7-14 days CONTINUE AFTER symptoms resolved Fluconazole 200mg by mouth first day, 100mg for 2-3 weeks

Cutaneous dermatophyte infection -> Circular ring and central clearing CONTAGIOUS- athletes (wrestlers)

Cruris Corporis - ringworm

How to tx Cruris Corporis - ringworm

Oral (more severe/widespread): itraconazole 200 mg 1x/day or terbinafine 250mg 1x/day for 2-3 weeks (watch the liver) topical anti-fungal: mild to moderate lesions BID 7-10 days after lesions resolve Use clean towel

4 types of Pedis- Athlete's foot (fungal)

Chronic hyperkeratotic- pattern of lesions, scale and thick Chronic intertriginous- the skin breaks between the toes Acute ulcerative- Vesiculobullous -

Crusty, red ring with central clearing on foot

Pedis- Athlete's foot

how to tx Pedis- Athlete's foot

K+ hydroxide Drying agents: anti-fungal powders (miconazole), gentian violet Keep feet dry, dont use corn starch (hold moisture and promotes growth of dermatophytes) Oral (more severe /widespread): itraconazole 200 mg 1x/day for month or terbinafine 250mg 1x/day for 2-6 weeks

Brought on by autoimmune disease... blackheads in small pitted areas of the skin.. Often occur in pairs Red tender bumps Painful, pea-sized under skin , Itching and burning, Occurs where skin rubs against skin or hair follicle… can occur anywhere there is hair but often in axilla Women, obese, smoker, ance, family hx, 20-29 y.o, may resolve after menopause

Hidradenitis suppurative & hyperhidrosis (autoimmune)

superficial/partial thickness: epidermis only, glossy, red, painful

1st degree burn

partial-thickness: dermis involved, dull or glossy with pink, red or white pigmentation; may blister → very painful

2nd degree burn

full thickness to sq fat: matte, white, brown, red or black; insensate is hallmark

3rd degree burn

what labs to check with serious burns?

cbc, glucose, electrolytes (high K+-cell breakdown), BUN, creat- rhabdo, renal fxn, tissue perfusion, , UA-myoglobin=ATN,; chest xray (inhalation), culture of site if delayed healing

Periungal tissue induated with infectious matter Antibiotics appropriate for likely causative organisms Nail may need to be removed if nail has separated from the bed

paronchial Infections

Caused by trauma to the nail May result in loss of nail… usually grows back If no hx of trauma, consider Proteus or Pseudomonas infection

subungal hematomas

inflammatory dermatitis, co-exist with acne Later in life 30-50 y.o Spicy foods, ETOH Clinical Manifestations: On the face, looks like flushing, burns manage w/ Topical metronidazole 3-4 months

Pityriasis Rosacea (rash)

T cells have a key role, environmental triggers can bring a flare, immune stimulation of epidermal keratinocytes that builds up the layers and creates the plaques/ lesions

Psoriasis (rash) - Autoimmune

(most common Psoriasis)- grey, crusty, over bigger areas of skin

Plaque

type of psoriasis- young adults and children, water droplet scaly

Guttate

type of psoriasis ... broad and hot

Erythrodermic

How to manage autoimmune psoriasis

Severe (>20%- refer to dermatology); if joint swelling/ joint pain refer to rheumatology High potency topical steroid - hard to be absorbed because of the plaque UV light therapy Immunosuppressive drugs- biologics

skin cancer warning signs

Open sore that does not heal for 3 weeks A spot or sore that burns, itches, stings, crusts, or bleeds Any mole or spot that changes in size or texture, develops irregular borders, appears pearly, translucent, or multicolored Changes that occur over a month or more should be evaluated

Most common skin cancer-> sun exposure Lesions vary from normal, flesh-colored lesions to slightly pigmented Typically have raised, shiny appearance with pearly borders >3 weeks- think BCC They can spread

Basal Cell Carcinoma: rise up a little more

Lesion is typically roughened, scaling area that does not heal and readily bleeds when scraped Keratinization can lead to heaped-up, flaky appearance Don’t spread ... needs total excision

Squamous Cell Carcinoma

Most fatal skin cancer; heavy sun exposure UV radiation → DNA damage, gene mutation, immunosuppression, oxidative stress, inflammatory response Surgical cure- IF CAUGHT EARLY, if spread- deadly Immunotherapy

melanoma

ABCDE of melanoma

Asymmetry of the border; Border irregularities; Color variability within lesion; Diameter >6mm (¼ in); Elevation

common MM sites in African Americans, Asian Americans, and dark-skinned individuals

nails, hands and feet

primary skin lesion vs secondary?

Primary skin lesions are present at the onset of a disease secondary skin lesions result from changes over time caused by disease progression, manipulation (scratching, picking, rubbing), or treatment.

elevation in the skin with smooth surface and sloping borders (usually) light pink ranges from 3mm- 20 cm ex. mosquito bite

Wheal

raised lesion up to 1cm in diameter filled with clear fluid | ex: herpes simplex (early stages)

Vesicle

Raised lesion > 1cm in diameter, filled with clear fluid | ex:

bulla

raised lesion filled with pus | ex: acne

pustule

a spot, circumcised, up to 1 cm; not palpable; not elevated above or depressed below surrounding skin surface; hypopigmented, hyperpigmented, or erythematous ex. freckle

Macule

a spot, circumcised, greater than 1 cm; not palpable; not elevated above or depressed below surrounding skin surface; hypopigmented, hyperpigmented, or erythematous ex. Cafe au lait spots, Mongolian spots

Patch

A bump, palpable and circumcised, elevated and less than 5 mm in diameter, might be pigmented, erythematous, or flesh-toned ex. elevated nevus

Papule

similar to papule, diameter of 5mm- 2cm, may have significant palpable dermal component ex. fibroma, xanthoma, intradermal nevi

nodule

usually well-circumcised lesion with large surface area and slight elevation ex. psoriasis, lichen planus

plaque

painful burning, usually unilateral, lesions last about 7-10 days

Herpes Zoster

Pustules on the skin, recently in hot tub

Folliculitis

How to dx and tx herpes zoster?

dx with Tzank smear | Tx: with an antiviral (acyclovir, valacyclovir)

Folliculitis tx?

benzol peroxide | if necessary: penicillins (others work too)

Dermatology Flashcards

(97 cards)