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Clinical medicine > Dermatology 2 > Flashcards

Dermatology 2 Flashcards

1
Q

Acne

A

disease of pilosebaceous unit, appears near puberty; more sever in males, more persistent in females, dismissed as minor

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2
Q

Classification of acne

A

5 cysts, comedones >100, inflammatory> 50 or >125 total- severe

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3
Q

Etiology of acne

A

sebum is the pathogenic factor in acne, it is irritating and comedogenic, begins when sebum production inc, propionibacterium acne proliferates in sebum, and the follicular epithelial lining becomes altered and forms plugs called comedones, testosterone is a factor

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4
Q

Pathogenesis of acne

A

inc sebum production, hyperkeratosis of sebaceous duct, propionibacterium acnes, blocked or plugged pilosebaceous follicles

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5
Q

Treatment of mild acne

A

benzoyl peroxide, topical antibiotic or combo and retinoid applied on alternate evenings; oral antibiotics if no response in 6-8 weeks

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6
Q

Treatment of moderate acne

A

topical antibiotic and benzoyl peroxide, oral antibiotics, topical retinoid can be introduced if inflammation subsides, oral abx should be continued until no new lesions develop and then taper gradually

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7
Q

Treatment of severe acne

A

requires aggressive tx, reassuree about effectiveness, I&D for cysts w/ thin roofs, intra lesional injection of kenalog, oral antibiotics, oral prednisone to control inflammation, rapid introduction of accutane

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8
Q

Hormonal acne

A

increased facial oiliness, premenstrual acne, inflammatory acne on mandibular line and neck, adult acne, worsening in adult, treatment failure w/ accutane, h/o irregular menses, hirsutism, alopecia

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9
Q

Hormonal tx for acne

A

oral contraceptives, spironolactone, and prednisone/dexamethasone

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10
Q

Steroid acne

A

uniform size and symmetric distribution

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11
Q

neonatal acne

A

seb glands stimulated by maternal androgens

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12
Q

acne conglobata

A

double comedones, papules, cysts and abcesses, mainly black, no systemic symptoms

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13
Q

acne fulminans

A

ulcerative, necrotic acne w/ systemic sx, fever, wt loss, leucocytosis, arthralgia, muscle pain, elevated esr, treat w/ steroids followed by accutane, abx not effective

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14
Q

other types of acne

A

occupational, acne cosmetica, excoriated acne

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15
Q

Perioral dermatitis

A

occurs in young women, resembles acne, lesions confined to chin and nasolabial folds, pustules on cheek adjacent to nostril are characteristic, pathogenesis unknown (prolonged use of fluorinated steroids? cosmetics?)

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16
Q

Treatment of perioral dermatitis

A

abx, 2-3 weeks or oral tetracycline and erythromycin are mainstay tx, doxy also effective, long term maintenance therapy w/ oral abx may be required, tacrolimus ointment, topical abx are not effective, avoid other topicals

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17
Q

How long does treatment for perioral dermatitis take

A

2-3 months w/ proper treatment

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18
Q

Rosacea primary features

A

flushing, non-transient erythema, papules and pustules, telangiectasia

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19
Q

Rosacea secondary features

A

burning or stinging, dry appearance, edema, ocular manifestations, peripheral location, phymatous changes

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20
Q

Rosacea pearls

A

unknown etiology, EtOH may worsen, sun exposure, heat, hot drinks, a mite “demodex folliculorum”, after age 30, celtic origin,

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21
Q

Rosacea clinical features

A

erythema, edema, pappules, pustules and telangiectasia, eruptions on forehead, cheeks, nose and occasionally around the eyes, chronic deep inflammation around the nose –> irreversible hypertrophy

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22
Q

Rhinophyma

A

whisky nose, common in rosacea

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23
Q

Ocular rosacea

A

common, 58% w/ rosacea, mild conjunctivitis, soreness, foreign body sensation and lacrimation, maybe dry eyes, dec visual acuity may result from long standing disease

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24
Q

Treatment of oral antibiotics

A

doxycycline, tetracycline, minocycline or metronidazole, severe refractory cases can be treated w/ accutane, first line is metronidazole cream, sulfa prep (Sulfacet-R), mirvaso controls erythema for 12 hrs

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25
Q

Hidradenitis Suppurativa

A

chronic suppurative and scaring disease of the skin and subcutaneous tissue in axilla, anogenital regions, under breasts and body folds, mild is misdiagnosed as recurrent furunculosis

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26
Q

Pathogenesis of hidranenitis suppurtiva

A

now believed to be a disease of follicle instead of apocrine appartatus, bac infection prop a major cause of exacerbation, not appear until puberty

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27
Q

Clinical presentationof hidrandenitis suppurtiva

A

double comedone, communicating under skin, progressive and self perpetuating, extensive, deep, dermal inflammation results in large, painful abcesses, healing process permanentlly alters the dermis, cordlike bands of scar tissue criss cross

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28
Q

Management of hidradenitis suppurtiva

A

abx, long term oral, tetracycline, erythromycin, doxy, and minocycline, accutane in selected cases, large cyst should be incised and drained to intralesional injection of kenalog, get bac culture, wt loss and stop smoking

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29
Q

Psoriasis

A

1-3% pop, genetic, unknown origin, chronic, recurrent exacerbation and remission that are emotionally and physically debilitating

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30
Q

Pathology of psoriasis

A

epidermis contains a large number of mitoses, epidermal hyperplasia and scale, dermis contains enlarged and tortuous capillaries that are very close to the skin surface and impart the characteristic erythematous hue, bleeding

31
Q

Auspitz’s sign

A

bleeding when capillaries rupture as scale is removed, see pin point hemorrhages w/ scaly skin

32
Q

Variations of morphology of psoriasis

A

chronic plaque psoriasis, guttate psoriasis, pustular psoriasis, erythrodermic psoriasis, HIV induced psoriasis, light sensitive

33
Q

Variationin location of psoriasis

A

scalp, palms and soles, pustular psoriasis of palms and soles, psoriasis inversus, nail psoriasis, psoriatic arthritis

34
Q

Guttate and pustular psoriasis

A

destinctive lesions, begin as red scaling papules, coalesce to form round oval plaques, Auzpitz’s sign, scale is adherent, silvery white reveals bleeding when removed, koebner’s phenomenon, affects extensors

35
Q

Koebner’s phenomenon

A

lesions develpp at site of trauma, scratching, sunburn, surgery

36
Q

Drugs that precipitate psoriasis

A

lithium, beta blockers, antimalarials, systemic steroids

37
Q

Chronic plaque psoriasis

A

most common, evolve into erythrodermic, chronic, well-defined plaques w/ silvery white scales, enlarge to certain size and remain stable for months, temporary brown, white or red macule remains when plaque subsides

38
Q

Guttate psoriasis

A

strep pharangitis or viral URI may precede eruption by 1-2 weeks, scaling papule may appear on trunk and extremities, mm-1 cm, may resolve spontaneously in weeks to months, responds to abx

39
Q

Generalized pustular psoriasis

A

rare form, sometimes fatal, erythema suddenlly appears into flexural areas and migrates to other surfaces, numerous tiny, sterile pustules from an erythemmatous base, lakes of pus, leukocytosis, febrile, relapse common

40
Q

Treatment of generalized pustular psoriasis

A

w/drawal both topical and systemic steroids (may precipitate flares), wet dressings and group V steroids, for severe cases systemic therapy w/ acitretin methotrexate and cyclosporine

41
Q

Erythrodermic psoriasis

A

severe, unstable, highly labile disease, mainly in pt w/ chronic disease, rarely initial presentation, precepitating factors: systemic steroids, topical steroids, phototherapy, stress, infection, other topical therapies

42
Q

Treatment of erthrodermic psoriasis

A

bed rest, avoid UV light, compresses, liberal use of emollients, inc protein and fluid intake, antihistamines and hospitalization; methotrexate, cyclosporine, acitretin, biologics

43
Q

Psoriasis of the scalp

A

may be only site affected, plaques similar to skin but scales are anchored by hair, extension of plaques onto the forehead is common, even in most severe cases the hair is not permanently lost, tx topical steroids

44
Q

Psoriasis of nails

A

pitting best known abnormality, oil spot lesion, localized separation of the nail, cellular debris accumulates, brown yellow color; onycholysis- separation of nail from the nail bed in irregular manner, like fungal infection, fragmentation

45
Q

Psoriatic arthritis

A

5-8% in psoriatic pts, higher among pt w/ more severe cutaneous disease, 53% suffer from arthralgia, RF neg, 80% nail involvement, progressive arthritis

46
Q

Diagnosis of psoriatic arthritis

A

to exclude other arthritis disease: ANA, ESR, WBC, uric acid, ESR is best lab to disease activity, RF levels typically normal

47
Q

Five presentations of psoriatic arthritis

A

asymmetric arthritis, symmetric, distal interphalangeal joint disease, arthritis mutilans, ankylosing spondylitis

48
Q

Asymmetric arthritis presentation

A

most common pattern involving one or more joints, sausage finger, continued inflammation promotes soft tissue swelling on either side of the joint

49
Q

Symmetric arthritis presentation

A

polyarthritis resembling RA occurs but the RA factor is neg

50
Q

Distal interphalangeal joint disease

A

Most characteristic presentation of arthritis w/ psoriasis is involvement of DIP, chronic but mild, 5% pts

51
Q

arthritis mutilans

A

most severe form, involves osteolysis of any of the small bones of hands and feet, leads to digital telescoping producing the opera glass deformity

52
Q

ankylosing spondylitis

A

may occur as an isolated phenomenon

53
Q

Treatment of psoriatic arthritis

A

NSAIDs 1st line, intralesional injections w/ corticosteroids, methotrexate- 2nd line, biologics- embrel, humira, remicade, antimalarials, cyclosporine, acitretin, photochemotherapy, steroid creams

54
Q

When to stop treatment of psoriatic arthritis

A

when the plaque cannot be felt by drawing the finger over the skin surface

55
Q

Seborrheic dermatitis

A

common, chronic inflammatory disease w/ characteristic pattern for different age groups, pityrosporum ovale is cause, genetic and environment influence, many pt have oily complexion, remission and exacerbation common

56
Q

Infants, cradle cap

A

infants develop greasy adherent scales on vertex of the scalp, scales may accumulate and become thick and adherent and can be removed w/ shampooing, secondary infection can occur

57
Q

Treatment of cradle cap

A

serum and crust are treated w/ antistaph abx, erythema and scaling- group VI or VII steroid, dense scale removed w/ warm mineral oil or olive oil then wash detergent after sseveral hours, remission can be prolonged w/ salicylic acid and tar shampoos

58
Q

Tinea amiantacea

A

1-several patches of dense scale anywhere on scalp, persist for months before parent notices area of some hair loss and yellow white plates of scales, 2-10 cm

59
Q

Treatment of tinea amiantacea

A

warm 10% liquor carbonis detergens in nivea oil, apply over night and shampoo in morning, can use tar shampoo for maintenance, topical steroid lotion too

60
Q

Adult or classic SD

A

fine, dry, white scaling w/ minor itching, should wash hair everyday w/ antidandruff shampoo; scalp and margins, eyebrows etc, on ears could be eczema or fungus, varying degrees

61
Q

Treatment of adult SD

A

shampoos, zinc soaps, selenium, tar, salicylic acid, topical steroids, V-VII creams, anti yeast meds- ketoconazole or ciclopirox olamaine, also sulfacetamide, metrogel, protopic and elidel creams

62
Q

Pityriasis rosea

A

common, binign, asymptomatic eruption, unknown etiology, `23 yo, 2% recur, 20% have h/o acute infection w/ fatigue, HA or sore throat

63
Q

Clinical features of pityriasis rosea

A

2-10 cm round lesions~17% pt, mainly on trunk or proximal extremities, d-w enters eruptive phase, smaller lesions appear and inc in num, long axis of oval plaques oriented along skin lines “christmas tree pattern”, collarette scale

64
Q

Treatment of pityriasis rosea

A

spontaneously clears in 1-3 months, oral erythromycin, group V steroids for itching, UVB

65
Q

Lichen planus

A

unique inflammatory cutaneous and mucous membrane rxn pattern of unknown etiology, 40 yom, 46yof, 10% have fam hx, associated w/ Hep-C!

66
Q

Primary lesions

A

pruriitic, planar, polygonal, purple papules, heal w/ pigmentation, 2-10 mm papule/plaque, close inspection of surface shows lacy reticular pattern, criss-cross, whitish lines “Wickham striae” accentuated by immersion oil, focal epidermal thickening, koebner’s phenomenon

67
Q

Types of lichen planus

A

localized papules, hypertrophic lichen planus, LP of palms and soles, oral mucous membrane LP, Nail

68
Q

localized pupule LP

A

most commonly located on flexor surfaces of wrist/forearms, legs/above ankles, 20% do not itch, chronic, last >4 years

69
Q

hypertrophic LP

A

pretibial and ankles, reddish brown or violaceous plaques w/ rough or verrucose surface, heal w/ dark pigmentation, average 8 yrs, intalesional steroids

70
Q

LP of palms and soles

A

papules are larger and aggregate into semi translucent plaques w/ globular waxy surface

71
Q

Follicular LP

A

lichen planopilaris, may cause scarring alopecia

72
Q

Oral mucous membrane LP

A

asymptomatic dendritic, branching or lacy, shite network pattern seen on buccal mucosa, seen in >50% of the pts w/ cutaneous disease, twice more common in women

73
Q

Nails LP

A

proximal to distal linear grooves and depressions

74
Q

Treatment of LP

A

topical steroids I-II, intralesional steroids, systemic steroids, acitretin, azathioprine, cyclosporin, dapsone, antihistamines, steroids in orabase for mucous membranes

Clinical medicine (19 decks)

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