Dermatology

Question 1

Psoriasis

Answer 1

Chronic inflammatory pruritic skin disorder characterized by rapid proliferation of epidermal cells
* Patients may have frequent exacerbations or remissions
May have significant impact on social behavior and self-esteem

Question 2

Psoriasis Signs and symptoms

Answer 2

Hallmark signs:
 *Plaque-type lesions, with silvery white scales on erythematous base
 *May distribute on scalp, elbows, palms, soles, fingernails, nail pitting
 *Auspitz Sign: pinpoint bleeding under the skin’s surface
 *Gluteal pinking: where the gluteal folds are pink and smooth

Question 3

Psoriasis treatment

Answer 3

Treatment
 Topical steroids with plastic occlusion
* *Start with lowest dose possible
o *Especially on face and sensitive skin areas
* May cause thinning of the skin
* May get rebound after steroids are withdrawn

Question 4

Psoriasis Education:

Answer 4

Education:
o striae can develop with overuse
o only use low doses on the face
* F/U in 2 weeks
 UV light

Question 5

• Cellulitis signs, symptoms,

Answer 5

S/S: swelling, warmth, tenderness of site; fever/chills/malaise

Question 6

• Acne Vulgaris

Answer 6

Inflammation and infection of the pilosebaceous units
* Causes: genetic, hormonal changes, bacterial infections, PCOS
* Most common during puberty
* Girls > boys, however, boys are worse when it does occur
* Locations: commonly seen on the face, shoulders, chest and back

Question 7

Mild Acne Vulgaris treatment plan

Answer 7

-generally treated with topical only
 1st line: Topical retinoid and antimicrobial (mycins) combo
* Ex-adapalene, alitretinoin, tazarotene, tretinoin
* Pharm: retinoids accelerate the turnover of keratin plugs and decrease comedome formation
* Start at the lowest dose
* *Side effects: redness, drying, scaling of the skin, photosensitivity especially in the first 2-4 weeks (acne may seem to worsen at first) after about 6 weeks the acne will improve
o F/u in 8 weeks after initiation of treatment
o If no improvement, consider adding:
 Benzyl peroxide and antimicrobial(mycins)

Question 8

• Moderate Acne treatment

Answer 8

Presence of papules and pustules (infected comedomes)
 Treatment
* Continue with prescription topicals (retinol/benzyl/antimicrobial-mycins)
* *Now add oral abx (TCN) ”-clines” for up to 6 months
o *Do NOT given < age 13 y/o (d/t teeth discoloration)
o *Do NOT give to anyone pregnant or breastfeeding
o Can get photosensitivity
o Take with a full glass of water d/t esophageal ulceration/irritation
o IF allergies to TCN, give macrolide for 3 months
 -“mycins”

Question 9

• Severe nodulocystic acne

Answer 9

Painful indurated nodules (cysts, abscess, nodules)
 *Consider referral to derm
 Treatment:
* Accutane (Category X)
o *Can only be prescribed by providers with special cert (iPledge program)
o PT must be on 2 forms of contraception
o *Pregnancy test must be performed before and after treatment
o *Can only be prescribed 1 month at a time
o *Requires monthly pregnancy tests (PhD must see results)
o Side effects: abd pain(pancreatitis/hepatitis), depression
o *Good documentation is a MUST

Question 10

Lyme Disease

Answer 10

A multisystemic disease transmitted by a specific tick

Question 11

lyme disease signs, symptoms,

Answer 11

S/S: flu-like, weakness, joint pain, unique rash (erythema migrans/’bullseye”)*
* Rash/lesion may come within 7-14 days, but may last 3-30 days after bite
* Lesion will usually spontaneously resolve
* Common areas: belt line, axilla, behind knees, groin
* Common in the NE of the US
*

Question 12

lyme disease diagnosis

Answer 12

Diagnostics
* 1st: Elisa test (blood or CSF)
 If Elisa is negative, no other tests needed
 If Elisa is positive, or indeterminate, move onto Western Blot
* 2nd: Western Blot
 Looking for IgG or IgM antibodies

Question 13

lyme disease treatment plan

Answer 13

• Treatment
• For prophylaxis -initiate within 72 hours of tick removal
   Single dose: Doxy 200mg
• For positive tests or noted bullseye lesion
   Doxy-14-21 days
   Do NOT give during pregnancy or breastfeeding
• If pregnant, will need IV abx
• Also educate that OCP are less effective while on Doxy
   DO NOT use in children < 7 years old
• Use amoxicillin instead
• F/U depends on stage and severity

Question 14

Seborrheic Dermatitis

Answer 14

• Chronic superficial disorder that affects the hairy areas of the body where sebaceous glands are present (caused by genetics and/or environment)
  
  *

Question 15

Seborrheic Dermatitis signs, symptoms,

Answer 15

Scalp, face, eyebrows
* Ex: Cradle cap (in babies)
 Fine, white, yellow greasy scales on erythematous base
 Usually resolves by 8-12 months
* In Adults : yellow greasy scale on face, nasolabial folds, scalp, ear canals
 Usually symmetrical and itchy

Question 16

Seborrheic Dermatitis treatment plan

Answer 16

Treatment
 Sunlight
 Shampoo frequently
 Warm olive oil in the evening and letting it sit overnight
 RX shampoos
 Hydrocortisone (be cautious)
* Education:
o striae can develop with overuse
o only use low doses on the face

Question 17

Atopic Dermatitis

Answer 17

Eczema
Chronic inherited skin disorder marked by extremely pruritic rashes
* Found on hands, Flex folds, neck
* Exacerbated by stress and environmental (seasons/winter), allergies/asthma/allergic rhinitis
* Itching can cause scaling and lichenification (thick, leathery skin)

Question 18

Atopic Dermatitis signs, symptoms,

Answer 18

Presentation
* Can reappear in adulthood after occurrence during childhood
* pruritis, erythema, dry skin, erythema on infraorbital folds, antecubital fossa, posterior patella, scalp
* on infants lesions are erythematous and papular, vesicles may ooze
can be on cheeks
lichenification

Question 19

Atopic Dermatitis treatment plan

Answer 19

Treatment
* Topical steroids (hydrocortisone) and emollients
 Eucerin, baby Oil, antihistamine for itching
 RX-Vistaril/hydroxyzine for itching
 Contraindicated in patients with infected lesions or rosacea
* Avoid using harsh soaps or chemicals
* Use cold water when bathing
* Use education when using topical cortisones
* Education:
 striae can develop with overuse
 only use low doses on the face

Question 20

Melanoma

Answer 20

Malignancies arising from melanocytes (pigment-producing cells)
* Usually diagnosed in the early 40’s
* Risk factors: UV exposure
*

Question 21

Melanoma signs, symptoms,

Answer 21

*Major: Change in size, change in color, change in shape
* *Minor: presence of inflammation, bleeding, sensation, diameter > 6mm
* Prevention: avoid sun exposure; use sunscreen
* Remember ABCDE

Question 22

ABCDE

Answer 22

common characteristics of melanoma: think alphabetically – the ABCDEs of melanoma.
asymmetry,
border,
color,
diameter
evolving

Question 23

Shingles treatment

Answer 23

• Virus from Herpes Zoster
• Treatment
• Early treatment can limit the post-herpetic neuralgia
   Begin treatment 48-72 hours after onset of pain/breakout
• Antiviral
   Acyclovir (5x day), valcyclovir (2 x day, but $$$$)
• TCA (for post-herpetic neur.)
   Amytriptaline
• Anticonvulsants (for post-herpetic neur.)
   Gabapentin
• Lidocaine patch
• *Immediate referral for lesions near the eye

Question 24

• Shingles signs, symptoms,

Answer 24

Papules or vesicles on a red base that rupture and become crusted
* *Along a dermatome/unilateral (Dermatomes are areas of skin on your body that rely on specific nerve connections on your spine. In this way, dermatomes are much like a map.)
* More common in elderly, especially immunocompromised
* *Prodromal pain, or pain with lesions
* Can last 2-4 weeks or longer
* Post-herpetic neuralgia can last for months or longer

Question 25

Shingles treatment plan

Answer 25

* Treatment * Early treatment can limit the post-herpetic neuralgia  Begin treatment 48-72 hours after onset of pain/breakout * Antiviral  Acyclovir (5x day), valcyclovir (2 x day, but $$$$) * TCA (for post-herpetic neur.)  Amytriptaline * Anticonvulsants (for post-herpetic neur.)  Gabapentin Lidocaine patch * *Immediate referral for lesions near the eye *

Question 26

Dermatomes

Answer 26

Dermatomes are areas of skin on your body that rely on specific nerve connections on your spine. In this way, dermatomes are much like a map. The nature of that connection means that dermatomes can help a healthcare provider detect and diagnose conditions or problems affecting your spine, spinal cord or spinal nerves.

Question 27

shingles vaccine

Answer 27

Vaccine for > age 50 y/o * Even if they have had shingles * *Efficacy wanes after 5 years * *Repeat if the vaccine was received before age 60, or if it has been > 10 years

Question 28

Rosacea

Answer 28

Chronic and relapsing inflammatory skin disorder * More common in people who are lighter color (Irish, Scottish, English…) * Also more common in blond or red hair people * 4 subtypes

Question 29

Rosacea signs, symptoms,

Answer 29

Hallmark signs: * light skinned adult c/o red cheeks * small papules around mouth, nose, chin * telangiectasia on cheeks * pt blushes easily * c/o dry eyes or chronic blepharitis (ocular rosacea)

Question 30

Rosacea treatment plan

Answer 30

Treatment * Aimed at symptom control and avoidance of triggers that cause exacerbations  Spicy foods, alcohol, sunlight  Avoid irritating skin products  Apply moisture frequently * Topical gels  Metronidazole * Oral TCN over several weeks * Patient education if using topical steroids  striae can develop with overuse  only use low doses on the face

Question 31

* Mongolian Spots signs, symptoms, treatment plan *

Answer 31

The most common type of pigmented skin lesion in newborns * Blue to black colored patches * Usually located in the lumbosacral area, but can be anywhere * More common in darker-skinned babies * Usually, fade by 2-3 years * No need to be concerned

Question 32

Hemangiomas signs, symptoms

Answer 32

“strawberry” * Raised vascular lesion * Can be between <0.5cm-4 cm * Red color, soft to palpation * Usually on head and neck * Grow in the first 12 months of life *

Question 33

Hemangiomas treatment plan

Answer 33

Treatment * Watchful waiting * Can be referred to derm  PDL therapy (pulse, dye, laser) * Reassurance

Question 34

* Café Au Lait Spots signs, symptoms, treatment plan *

Answer 34

Flat light or dark brown spots that are > 5mm * Risk factors are unknown (may be genetic) * *If 6 or more spots are > 5mm, r/o neuro causes * May see sz or learning disorders * Neurofibromatosis

Question 35

* Herpes Simplex Virus Type 1

Answer 35

“cold sores” * Blisters mostly on the face, lips, eyes * Usually have prodromal pain, burning, tingling before lesion erupts * Treatment  Antivirals: Acyclovir, valacyclovir during the prodromal phase

Question 36

* Herpes simplex virus type 2

Answer 36

* “genital warts” or oral * Painful lesions that are recurrent * Viral shedding is greatest on the initial outbreak, then lessens with each additional outbreak * Prevention  Condoms may help * Best to treat during prodromal phase * Treatment  Antiviral: acyclovir, valacyclovir

Question 37

HPV

Answer 37

May exist without signs * Can be asymptomatic for many years * Increases incidence of cervical cancer, * And Laryngeal or esophageal cancers * Risk factors: multiple sexual partners, prior STD, circumcised, men with men

Question 38

HPV Warts treatment plan

Answer 38

Treatment destroys wart tissue (~45-90% will clear but can return) * Aldera (Imiquimod) cream * Podophyllin cream * May also try laser treatment for external warts * For cervical warts, refer for biopsy before treatment * During pregnancy/lactation, warts will grow rapidly, then will regress * Cryotherapy can be used or TCA; other creams are contraindicated * F/u in 1-2 weeks * Screen for other STDs * Gardisil vaccine is important prior to age of sexual activity

Question 39

most important for exzema

Answer 39

Implement a daily bathing and moisturizing routine; skin hydration is imperative emollients after bathing

Question 40

Emollients

Answer 40

Emollients are ingredients in skin creams, lotions, moisturizers or ointments that form a film on your skin. These ingredients can relieve dryness, itching and scaling. Emollients can help your skin feel more comfortable if you have eczema, psoriasis, dry or sensitive skin.

Question 41

when is shingles not infectious?

Answer 41

after lesions have crusted over

Question 42

Retinoids

Answer 42

Retinoids are a class of medications that are chemically derived from vitamin A

Question 43

demarcated

Answer 43

set the boundaries or limits of.

Question 44

Basal Cell Carcinoma

Answer 44

Tumors that arise from the basal cell layer of the skin * Most common in 40-60 y/o * *Sites: head and neck (80%) * Men>women

Question 45

Basal Cell Carcinoma Presentation

Answer 45

* Presentation Pearly dome nodule with telegenetic vessels

Question 46

Squamous Cell Carcinoma

Answer 46

Tumors arising from the epidermis * Sites: face, nose, lower lip (smokers) * Indistinct borders, firm surface, scaly, irregular, bleed easily  Red, tan, brown, grey * Metastasis in 10%

Question 47

difference between squamous cell and basal cell

Answer 47

Basal cell carcinoma most commonly appears as a pearly white, dome-shaped papule with prominent telangiectatic surface vessels. Squamous cell carcinoma most commonly appears as a firm, smooth, or hyperkeratotic papule or plaque, often with central ulceration.