Dermatology

Question 1

________________ is the standard form of phototherapy used in the treatment of extensive psoriasis.

Answer 1

Narrowband ultraviolet B (UVB)

Question 2

_____________ can cause allergic contact dermatitis that mimics a wound infection; the most appropriate initial management is to discontinue its use.

Answer 2

Neomycin and bacitracin

Question 3

Common treatments for psioriasis

Answer 3

MTX, UV B, topical steroid, aciretin (retinoids)

Question 4

lichen planus associated with_____________________

Answer 4

Hep C

Potent topical glucocorticoids are effective in most patients. Systemic glucocorticoids, oral retinoids, sulfasalazine, and phototherapy are reserved for severe cutaneous or persistent oral disease.

Question 4

___________ is an interferon inducer, and it can treat actinic keratosis by producing an immunologic reaction against the lesion. It is also used to treat some basal cell carcinomas; it is an effective treatment and approved only for the superficial pathologic subtype of basal cell carcinoma

Answer 4

Topical imiquimod

Question 4

Seborrheic dermatitis associated with _____________

Answer 4

HIV, Downs, Parkinsons

Question 4

Melasma, which results in patchy hyperpigmentation on the face during pregnancy or with oral contraceptive use, is treated with strict sun protection, avoidance or discontinuation of causative factors, and bleaching agents such as hydroquinone.

Question 4

Medications that cause pruritis _____________________

Answer 4

many medications such as hydrochlorothiazide, calcium channel blockers, opiates, or NSAIDs can also cause generalized pruritus without skin findings, bactrim, SSRI

Question 5

Skin biopsies should be performed to evaluate for urticarial vasculitis when individual urticarial lesions are present for longer than 24 hours

Question 5

Dapsone should be used in conjunction with a gluten-free diet as first-line treatment of dermatitis herpetiformis.

Question 6

Pemphigus vulgaris is the most common intraepidermal ABD, and its incidence increases with age. It presents with oral or vaginal erosions and flaccid vesicles that rupture easily and leave erosions (Figure 95). Pemphigus vulgaris has a positive Nikolsky sign whereby light lateral friction on perilesional skin induces a blister

Question 7

Subacute cutaneous lupus erythematosus is frequently diagnosed as a drug-induced photosensitive rash characterized by erythematous annular scaly patches, such as someone recently started on Humira

Question 8

Therapy for cutaneous lupus includes antimalarial agents such as hydroxychloroquine, methotrexate, mycophenolate mofetil, cyclosporine, dapsone, and combination therapy

Question 9

Amyopathic dermatomyositis presents with skin findings characteristic of dermatomyositis, but without clinical or laboratory evidence of muscle disease; it carries risks for underlying malignancy

Question 10

_________________ is a constellation of findings including dermatomyositis, hyperkeratotic, fissured skin on the palmar and lateral aspects of fingers (mechanic’s hands), fevers, Raynaud phenomenon, elevated titers of anti-synthetase antibodies, and often interstitial lung disease. Anti-Jo1 is the prototypical antisynthetase antibody

Answer 10

The antisynthetase syndrome

Reynauds with dermatomyositis = anti-synthetase syndrome

Question 11

ESRD derm conditions
1) Calciphylaxis : sodium thiosulfate
2) Kyrle disease: firm keratin plugs, emollients

Question 12

____________ is seen most frequently in association with alcoholic liver disease, hepatitis C infection, or hemochromatosis.

Answer 12

Porphyria cutanea tarda

Tx: In addition to treating the underlying condition, phlebotomy is the mainstay of therapy. Low-dose hydroxychloroquine is an effective second option for those who do not have significant iron overload. It is dosed at 200 mg once or twice weekly.

Question 13

Treatment of pyoderma gangrenosum

Answer 13

Pyoderma gangrenosum usually responds well to systemic glucocorticoids; trauma and surgical debridement should be avoided to prevent pathergy.

avoid surgery

Question 14

Sweet syndrome, or acute febrile neutrophilic dermatosis, is characterized by fever, neutrophilia, a dense dermal infiltrate on histology, and characteristic skin lesions

Answer 14

Post infection , heme malignancy, autoimmune (IBD)

setting of hematologic abnormalities, particularly myelodysplastic syndrome and myelodysplastic syndrome evolving into acute myeloid leukemia (Table 25). Sweet syndrome has also been associated with solid malignancies and medications (particularly neutrophil-stimulating medications such as granulocyte-colony stimulating factor and all-trans retinoic acid. In addition to the skin eruption, patients typically have high fevers, leukocytosis with a left shift, elevated inflammatory markers, and often muscle or joint pain.

Question 15

Acanthosis nigricans treatment________

Answer 15

It is mainly of cosmetic concern and resolves when the underlying condition is treated. Topical salicylic acid, retinoids, and ammonium lactate have modest benefit.

Send for DM2 testing

Question 16

__________ is recommended in the evaluation of erythema nodosum to assess for the presence of lymphoma, sarcoidosis, tuberculosis, and fungal infection such as coccidioidomycosis.

Answer 16

A chest radiograph

Question 17

___________ consists of erythema nodosum, arthritis, and hilar lymphadenopathy; this is so specific for sarcoidosis that a biopsy is not needed to confirm the diagnosis.

Answer 17

Löfgren syndrome

Question 18

Most cases of erythema multiforme are caused by herpes simplex virus or Mycoplasma pneumoniae; drug-induced cases of erythema multiforme minor are less frequent and typically result from NSAIDs, antiepileptic agents, or sulfonamides.

Answer 18

Not the same as erythema migrans, but also target looking

The presence of extensive epidermal sloughing and a positive Nikolsky sign further differentiate SJS/TEN from EM major

Tx: Intravenous glucocorticoids or intravenous immune globulins are probably the most commonly used treatments, but neither is supported by strong evidence. Supportive care in an ICU with experienced nursing staff is critical for wound care, and many patients are transferred to a burn center

Question 19

SJS refers to patients with less than 10% BSA affected. Greater than 30% BSA affected is the criterion for TEN. Patients with BSA between 10% and 30% are referred to as SJS/TEN overlap syndrome.

Answer 19

Common medications associated with TEN/SJS

Allopurinol

Ampicillin/amoxicillin

Carbamazepine, Lamotrigine, Phenytoin

Sulfasalazine

Nevirapine

Question 20

DRESS syndrome: Patients typically develop a morbilliform exanthem that starts on the face and upper trunk and spreads distally (Figure 131). Eventually the patients develop striking facial edema and redness, a hallmark of this condition. Oral mucosal involvement is common but is less severe than SJS/TEN or EM major + Eosinophillia

Answer 20

Associated medications: PPI, sulfasalazine, minocycline, carbamazepine, phenytoin, allopurinol, abacavir

Question 21

______________ is defined as diffuse erythema covering 80% to 90% body surface area and is commonly associated with pruritus, peripheral edema, erosions, scaling, and lymphadenopathy.

Answer 21

Erythroderma

Question 22

Oral therapy with terbinafine or itraconazole is the preferred treatment for onychomycosis; confirmation of infection should be done before treatment.

Answer 22

Confirmation of infection with potassium hydroxide preparation, staining with periodic acid-Schiff, or fungal culture should be done before treatment

Question 23

Oral hairy leukoplakia (Epstein-Barr virus induced) occurs in patients with HIV infection and presents as adherent linear white plaques on the lateral surface of the tongue. Erythroplakia, appearing as red mucosal patches, has a high risk of malignant transformation. Both leukoplakia and erythroplakia require biopsy to rule out dysplasia. These conditions are seen most frequently in tobacco users.

Question 24

Apthous ulcers: Severe, recurrent oral ulcers suggest the possibility of infection or a systemic disease such as Behçet syndrome, Crohn disease, HIV infection, or erythema multiforme.

Question 25

lichen planus is usually not known, although possible causes include: _____________

Answer 25

Hepatitis C

Question 26

Lichen schlerosis confers risk of ___________

Answer 26

SCC