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Flashcards in Dermatology 2 Deck (23):
0

Pemphigus vulgaris – causes?

#drug induced (ACE inhibitors, penicillamine, phebobarbitol, penicillin)
#autoimmune

1

Pemphigus vulgaris – clinical features? Clinical sign?

#Easily ruptured bullae
#Mouth involvement
#Fluid loss infection widespread (like a burn)

Nikolsky sign

2

Pemphigus vulgaris - diagnosis and management?

Biopsy showing antibodies on a immunofluroescent studies

#Systemic steroids
#Azathioprine or mycophenolate to wean patient off steroids
#Rituximab
#IVIg in refractory cases

3

Bullous Pemphgoid vs Pemphigus vulgaris - bullae? Mouth involvement? Infection rates?

Intact versus rupture easily

Uncommon versus common

Less lots of fluid and infection vs more

4

Patient presents with intact bullae and negative Nikolaky sign – suspected diagnosis? Most accurate test? Best initial therapy? (Subsequent therapy?)

If mild, can treat with?

Bulbous pemphigoid

Biopsy with immunofluorescence stains

Prednisone (later steroid alternatives)

#Dapsone
#Nicotinamide

5

Patient presents with blistering skin disease on the backs of hands and face – suspected diagnosis? Specific history to get?

Porphyria cutanea tarda (rash on sun exposed areas)

#Hepatitis C, or liver disease from alcohol
#Estrogen use
#Hemachromatosis

6

Patient presents with blisters on sun exposed areas – diagnosis? Deficiency? most accurate diagnostic test? Treatment?

Porphyria cutanea tarda

Uroporphyrin decarboxylase

24-urine for uroporphyrins

#stop EtOH and estrogens
#phlebotomy

7

Oral vs IV medications for cellulitis, folliculitis, furuncles, carbuncles?

If penicillin allergic?

If MRSA?

Mild disease (oral meds)
#dicloxacillin, cephalexin, cefadroxyl
#Penicillin allergic – erythromycin, clarithromycin, clindamycin
#MRSA – doxycycline, clindamycin, Bactrim

Severe disease (IV)
#Oxacillin, nafcillin, cefazolin
#Penicillin allergy – clindamycin, vancomycin
#MRSA – vancomycin, daptomycin, tigecycline, ceftaroline

8

Anti-staph penicillins?

OX-CLOX-DICLOX-NAF

9

Staph infection - Switch to these if patient develops penicillin induced rash? Anaphylactic reaction?

Switch to cephalosporins

If mild infection: macrolides, clindamycin, doxycycline, Bactrim

If severe infection: vancomycin, linezolid, daptomycin, tigecycline, ceftaroline

10

Location of body:
1. Tinea corporis
2. Tinea manus
3. Tinea pedis
4. Tinea cruris
5. Tinea unguium

1. Body
2. Hand
3. Foot
4. Groin
5. Nail

11

Fungal skin infection – best initial test? Most accurate test? Best initial therapy if hair/nails not involved?

Best initial therapy if hair and nails involved?

KOH prep

Fungal culture

Topical Antifungal

Terbinafine Or itraconazole

12

Topical antifungals?

#Clotrimazole
#Ketoconazole
#Econazole
#Miconazole
#Nystatin
#Ciclopirox

13

Side effect of oral ketoconazole?

Gynecomastia (anti-androgenic)

14

Patient with oral/vaginal candidiasis best initial test? Most accurate test? Best initial treatment?

KOH prep

Fungal culture

Topical antifungal

15

Drugs that cause hypersensitivity skin reactions?

#Penicillins
#Sulfa drugs (including thiazides, furosemide, sulfonylureas)
#Allopurinol
#Phenytoin
#Lamotrigene
#NSAIDs

16

Drugs that cause hypersensitivity skin reactions also cause?

#Hemolysis
#Interstitial nephritis
#Drug induced thrombocytopenia

17

Hypersensitivity skin reactions in order of the severity? Therapies?

#Morbilliform rash (skin intact without mucous membrane involvement – no therapy)

#Erythema multiforme (small target lesions without mucous membrane involvement – prednisone)

#Stevens-Johnson syndrome (rash involves mucous membranes and sloughing off of respiratory epithelium leading to respiratory failure – IVIg)

#Toxic epidermal necrolysis (rash with mucous membrane involvement and Nikolsky sign – IVIg)

18

In addition to drug reactions, erythema multiforme also seen with?

Herpes or Mycoplasma

19

Staphylococcal scalded skin syndrome findings vs Toxic shock syndrome?

#Like TEN, including Nikolsky sign


Versus
#Same skin findings AND:
#Hypotension
#Renal dysfunction (elevated BUN and creatinine)
#Liver dysfunction
#Delirium (CNS involvement)

20

Treatment of staphylococcal scalded skin syndrome him and toxic shock syndrome?

Oxacillin or Nafcillin or cefazolin



21

Side effect of isotretinoin?

Hyperlipidemia

22

Before placing person on vitamin A derivative, must?

If female, pregnancy test and place on hormonal and barrier birth control

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