Dermatology Flashcards
(224 cards)
1
Q
6 functions of skin
A
protection, absorption, excretion, secretion, regulation, sensation
2
Q
6 morphological things to describe
A
- palpability (indicated by shadow)
- Color
- Shape
- Texture
- Size
- Location
3
Q
circumscribed; non-palpable discoloration of the skin; less than 1 cm
A
Macule
Primary lesion
ex: freckles and rubella
4
Q
non palpable discoloration; irregular border; greater than 1 cm
A
Patch
Primary lesion
ex: vitiligo
5
Q
well-circumscribed; solid lesion; flat topped, plateau-like; greater than 1 cm
In Epidermis
A
Plaque
Primary lesion
ex: psoriasis, discoid lupus, erythematosus
6
Q
solid elevation; less than 1 cm
A
Papule
Primary lesion
ex: acne, warts, insect bites
7
Q
solid, palpable; circumscribed lesion; larger than a papule (> 1 cm)
smaller than a tumor; originates in dermal or subcutaneous tissue
A
Nodule
Primary lesion
ex: erythema nodosum, gouty tophi
8
Q
solid, palpable, circumscribed lesion
> 2 cm
can be above, level or beneath skin surface
A
Tumor
Primary lesion
ex: lipoma
9
Q
superficial, well-circumscribed, raised, fluid-filled lesion
contains serous fluid
less than 0.5 cm
A
Vesicle
Primary lesion
ex: herpes simplex, varicella (chickenpox)
10
Q
superficial, well-circumscribed, raised, fluid filled lesion
> 0.5 cm
Epidermis
A
Bulla (blister)
Primary lesion
ex: bullous pemphigoid, pemphigus, dermatitis herpetiformis
11
Q
a vesicle filled with PURULENT fluid small, circumscribed
A
Pustule
Primary lesion
ex: acne, impetigo
12
Q
slightly raised, red, irregular, transient lesions,
secondary to edema of the skin
erythematous borders with pale centers epidermis
A
Wheal
Primary lesion
ex: urticarial (hives), allergic rxn to injections or insect bites
13
Q
flat, non-blanching, red-purple lesions; caused by a hemorrhage to the skin
2 non-palpable types
A
Purpura
Primary lesion
- Petechia: less than 5 mm
- Ecchymosis (bruise): greater than 5 mm
14
Q
SECONDARY LESION
visible shedding of stratum corneum
epidermal origin
A
Scale
ex: often seen with psoriasis
15
Q
SECONDARY LESION
slightly raised; irregular border; variable color
resulting from dried blood, serum or other exudate
epidermis origin
A
Crust
ex: scab
16
Q
SECONDARY LESION
depressed lesion; resulting from loss of epidermis due to rupture of vesicles or bullae; often caused by friction or pressure
heals WITHOUT scar confined to epidermis
A
Erosion
ex: rupture of herpes simplex blister
17
Q
SECONDARY LESION
depressed lesion resulting from loss epidermis and part of dermis
HEALS WITH SCAR irregular size and shape
A
Ulcer
ex: decubitus ulcers, primary lesion of syphilis
18
Q
SECONDARY LESION
deep linear lesion into the dermis; wedge-shaped in epidermis with abrupt walls
can extend into dermis
A
Fissure
ex: cracks in athlete’s foot
19
Q
SECONDARY LESION
linear superficial lesion, may be covered with dried blood due to scratching of skin
*specific to itching
A
Excoriation
20
Q
SECONDARY LESION
Thickening of epidermis, resulting in accentuation of skin lines results from chronic irritation and rubbing
A
Lichenification
ex: atopic dermatitis
21
Q
SECONDARY LESION
replacement of normal skin with fibrous tissue; often resulting from injury involved in deeper dermis
A
Scar
22
Q
SECONDARY LESION
thinning or depression of the skin surface due to reduction of underlying tissue depression in epidermis
A
Atrophy
ex: aging, stretch marks
23
Q
SECONDARY LESION
hardening of the skin caused by an increase in collagen, mucin, edema or cellular infiltration
A
Sclerosis
24
Q
SECONDARY LESION
tissue death
A
Necrosis
25
Hypertrophic scar
heals above layer of epidermis; confined to edges of wound
26
Keloidal scar
scar tissue goes beyond the edges of original wound
27
darkened plug of sebum and keratin that occludes the pilosebaceous follicle
some open; some closed
Comedone
ex: blackhead (open)
28
NODULE; encapsulated containing fluid or semi-fluid substance; fluctuant
Cyst
29
linear or serpinginous tunnels within the epidermis
Burrow
ex: scabies
30
small, superficial blood vessels that become visible because they are dilated;
disappear with pressure (blanch)
Telangiectasia
31
Poikiloderma
combination of: cutaneous pigmentation (hyper- & hypo-), atrophy, and telangiectasia
32
Distribution
location on the body
33
Configuration
the lesions are arranged or relate to each other
34
each lesion is easily separated from others
discrete configuration
35
edges of the lesions blend into one another
Confluent configuration
36
Isolated/solitary configuration
one lesion in an area
37
lesions are discrete; multiple and distributed in no pattern
scattered configuration
38
lesions are close together WITH normal skin between groups
grouped configuration
39
configuration
linear configuration
40
configuration
dermatomal
distributed in one spinal nerve or equivalent branch
41
shape
annular
ring-like shape
42
shape
polycyclic
shape made up of tangential rings
43
shape
arcuate
arc/crescent-shaped
44
shape
serpinginous
shaped like a snake
45
shape
iris/targetoid
shaped like a bulls-eye
46
net-like pattern
reticulate
47
shape
glaborous
shiny and smooth surface; bald
48
Atopic triad
asthma
allergies
atopic dermatitis (eczema)
49
Instruments for Elliptical excision
Anesthesia, 15 blade, forceps and suture
50
Instruments for shave/biopsy excision
anesthesia, 11-blade/curved razor, forceps and scissors
51
Instruments for punch biopsy
Anesthsia, punch, forceps, scissors/scalpel
52
Instruments for KOH preparation
15-blade, glass slide, 10-20% KOH, +/- petri dish test for fungal infections
53
Instruments for tzanck smear
11 blade-, glass slide OR herpes culture swab, collecting fluid to see if multinucleated giant cells ; confirms HSV/VZV
54
Wood's light: Coral/pink
Erythrasma (corynebacterium)
55
Wood's light: Pale blue
Pseudomonas
56
Wood's light: Yellow
Microsporum (tinea capitis)
\*Fungal infection of scalp
57
Wood's light: Green/gold
tinea versicolor
\*Fungal infection causing HYPOpigmentation
58
# describe this!
Macule
Primary lesion
ex: freckles and rubella
circumscribed; non-palpable discoloration of the skin; less than 1 cm
59
# describe this!
Patch
Primary lesion
ex: vitiligo
non palpable discoloration; irregular border; greater than 1 cm
60
# describe this!
Plaque
Primary lesion
ex: psoriasis, discoid lupus, erythematosus
well-circumscribed; solid lesion; flat topped, plateau-like; greater than 1 cm
In Epidermis
61
# describe this!
Papule
Primary lesion
ex: acne, warts, insect bites
solid elevation; less than 1 cm
62
# describe this!
Nodule
Primary lesion
ex: erythema nodosum, gouty tophi
solid, palpable; circumscribed lesion; larger than a papule (\> 1 cm)
smaller than a tumor; originates in dermal or subcutaneous tissue
63
# describe this!
Tumor
Primary lesion
ex: lipoma
solid, palpable, circumscribed lesion
\> 2 cm
can be above, level or beneath skin surface
64
# describe this!
Vesicle
Primary lesion
ex: herpes simplex, varicella (chickenpox)
superficial, well-circumscribed, raised, fluid-filled lesion
contains serous fluid
less than 0.5 cm
65
# describe this!
Bulla (blister)
Primary lesion
ex: bullous pemphigoid, pemphigus, dermatitis herpetiformis
superficial, well-circumscribed, raised, fluid filled lesion
\> 0.5 cm
Epidermis
66
# describe this!
Pustule
Primary lesion
ex: acne, impetigo
a vesicle filled with PURULENT fluid small, circumscribed
67
# describe this!
Wheal
Primary lesion
ex: urticarial (hives), allergic rxn to injections or insect bites
slightly raised, red, irregular, transient lesions,
secondary to edema of the skin
erythematous borders with pale centers epidermis
68
# describe this!
Purpura
Primary lesion
1. Petechia: less than 5 mm
2. Ecchymosis (bruise): greater than 5 mm
flat, non-blanching, red-purple lesions; caused by a hemorrhage to the skin
2 non-palpable types
69
# describe this!
Scale
ex: often seen with psoriasis
SECONDARY LESION
visible shedding of stratum corneum
epidermal origin
70
# describe this!
Crust
ex: scab
SECONDARY LESION
slightly raised; irregular border; variable color
resulting from dried blood, serum or other exudate
epidermis origin
71
# describe this!
Erosion
ex: rupture of herpes simplex blister
SECONDARY LESION
depressed lesion; resulting from loss of epidermis due to rupture of vesicles or bullae; often caused by friction or pressure
heals WITHOUT scar confined to epidermis
72
# describe this!
Ulcer
ex: decubitus ulcers, primary lesion of syphilis
SECONDARY LESION
depressed lesion resulting from loss epidermis and part of dermis
HEALS WITH SCAR irregular size and shape
73
# describe this!
Fissure
ex: cracks in athlete's foot
SECONDARY LESION
deep linear lesion into the dermis; wedge-shaped in epidermis with abrupt walls
can extend into dermis
74
# describe this!
Excoriation
SECONDARY LESION
linear superficial lesion, may be covered with dried blood due to scratching of skin
\*specific to itching
75
# describe this!
Lichenification
ex: atopic dermatitis
SECONDARY LESION
Thickening of epidermis, resulting in accentuation of skin lines results from chronic irritation and rubbing
76
# describe this!
Scar
SECONDARY LESION
replacement of normal skin with fibrous tissue; often resulting from injury involved in deeper dermis
77
# describe this!
Atrophy
ex: aging, stretch marks
SECONDARY LESION
thinning or depression of the skin surface due to reduction of underlying tissue depression in epidermis
78
# describe this!
Sclerosis
SECONDARY LESION
hardening of the skin caused by an increase in collagen, mucin, edema or cellular infiltration
79
# describe this!
Necrosis
SECONDARY LESION
tissue death
80
# describe this!
heals above layer of epidermis; confined to edges of wound
Hypertrophic scar
81
# describe this!
scar tissue goes beyond the edges of original wound
Keloidal scar
82
# describe this!
Comedone
ex: blackhead (open)
darkened plug of sebum and keratin that occludes the pilosebaceous follicle
some open; some closed
83
# describe this!
Cyst
NODULE; encapsulated containing fluid or semi-fluid substance; fluctuant
84
# describe this!
Burrow
ex: scabies
linear or serpinginous tunnels within the epidermis
85
# describe this!
Telangiectasia
small, superficial blood vessels that become visible because they are dilated;
disappear with pressure (blanch)
86
Location, incidence, treatment, Ddx
Acrochordon (skin tag)
Commonly found in skin folds
Females \> males
Treated: snip excision & reassurance; few need biopsy
Ddx: wart & nevus
87
Location, incidence, treatment
Cafe au'Lait Spot
Usually inherited
6+ may indicate neurofibromatosis type 1
No treatment required
88
Description, location, treatment, Ddx
MOST COMMON VASCULAR GROWTH ON SKIN
Cherry Angioma
Round-dome shape, slightly raised, red/purple
Mostly on trunk
Treatment: reassurance or cosmetic removal via cauterization
89
Description, incidence,location, treatment, Ddx
Cutaneous horm
Skin colored, horny growth
Can arise from benign, pre-CA, malignant lesions
mostly on face/scalp
Treatment: excisional biopsy; MUST INCLUDE BASE
90
Description, incidence, location, treatment, Ddx
Dermatofibroma
Firm, dense, dermal **papule or nodule;** 0.5-1 cm
Female \> male
Lower extremities or UE above elbow
DIMPLE SIGN
Treatment: reassurance; eliptical excision; **excisional biopsy if \> 2cm**
Ddx: amelanotic melanoma, neurofibroma, DFSP
91
Description, treatment, Ddx
Epidermal (Inclusion) Cyst
Benign, firm, mobile nodule filled w/ keratin; central plug; usually asymptomatic; grow slowly and persist indefinitely
Treatment: reassurance; drain content; excision -**must remove wall**
92
Description, incidence, location, treatment, Ddx
\* Most common tumor of infancy
Infantile "strawberry" hemangioma
Red/purple benign vascular neoplasm ; occcurs during first year and involutes around 6
Usually head/neck
Treated if interferes with function/development
93
**Port Wine Stain "Nevus Flammeus"**
Description, location, Associations
Occurs during fetal development; begins as red/pink lesion; becomes blue/purple with age/ nodules may develop in adulthood; **does not involute**
Mostly on head/neck
Associations: Sturge-Weber syndrome and Klippel-Ternaunay Syndrome
94
**Nervus Simplex (Salmon's patch)**
Stork bite: nape of neck
Angel's kiss forehead between eyebrows
Almost always fades
95
Soft, dense, often compressible papule or nodule
Skin-colored to brown
Neurofibroma
Excision if symptomatic
Neurofibratosis if \> 6 care au'lait spots
96
Neurofibromatosis
autosomal dominant disorder
affects bone, NS, soft tissue and skin
97
Pigmented, tan, dark, brown
ABCDE?
Nevi (Mole)
Assymetry, border, color, diameter, evolution
98
Halo Nevus
Most common in adolescence
Surrounding hypopigmentation
99
Dysplastic Nevus
Tan, brown, pink discoloration
Irregular borders/atypical mole
Various grades (mild, moderate, severe)
BIOPSY and total body scan annually
100
101
Usually fades during childhood
Mongolian Spot
Deeper in skin so it hasd a blue-ish look
2-8 cm
Commonly in sacral
102
Most people have at least one in lifetime
ddx?
Seborrheic Keratosis
"Stuck-on" appearance; crumbles; **flat or raised;** 0.2-2 cm
Less common under 30
ddx: skin tags, wart, melanocytic nevus, melanoma
103
Solar Lentigo "Sun Spots"
2-20 mm; oval often irregular macules; sharp borders
Treatment: sun avoidance; creams; chemical peels
104
Ass. with sun exposure
Usually on face, lips, ears, neck, forearms
Venous Lake
Common, soft, compressible venous papule; blue-purple in color
**BLANCHES**
Reassurance and cautery if desired
105
Actinic Keratosis
**Pre Malignant SCC;** face, ears, balding scalp, dorsal hands/forearms
Multiple, discrete; flat OR elevated; red pigmented skin; may feel rough like sandpaper
Treatment: topical therapy, cyrotherapy, 5-fluorouracil (5-FU) or imiquimod, laser resurfacing, chem peel
106
Most common form of skin cancer
## Footnote
" pearly papule "; doesn't have skin lines within it; Rolled borders; (for **nodular)**
"dry skin patch that doesn't heal"; for **superficial**
Basal Cell Carcinoma
Intermittent; intense sun exposre
Face, scalp, ears, neck; RARE ON DORSAL HANDS
**Slow growing**
SHAVE BIOPSY usually is sufficient
107
Chronic, long term sun exposure (not intermittent)
Red base with hyperkeratoic white adherent scale; over times becomes nodular and ulcerated
Squamous Cell Carcinoma
Frequently develop on site of AK
Face,scalp, neck, dorsal hands
**Faster growing**
Excision with borders; **DO LYMPH EXAM**
108
Used to be pseudomalignant, **but now "malignant"**
Rare before age 40; peaks 50-59
Solitary **nodule**; central keratotic plug; often tender
Keratoacanthoma (SCC, "KA" Type)
Rapid growth over weeks to months; can resolve spontaneously OR BECOME MALIGNANT
**Men**: dorsal hands; **Women**: lower legs
Treatment: BIOPSY with DEPTH; Moh's
109
Melanoma
Rapid increase in deadly melanocytes
**Men**: upper back; **Women**; lower legs and upper back
Check ABCDEs
**Complete excision with margin;** if too large, punch biopsy (ex: lentigo maligna); **send to dermapathologist; follow up by dentist/ophthalmologist**
110
Amelanomic melanoma
111
Breslow thickness
Vertical mm of tumor to the base
112
Hutchinson's sign - Melanoma
113
114
Keratinization of hair follicle
Keratosis Pilaris
F\>M
MC: posterolateral upper arms
115
Keratosis pilaris treatment
Acne cleanser (mild) followed by exfoliant
**Keratolytic (ex: 12% ammonium lactate)** breaks down dead skin
116
Xerosis "dry skin"
extensor surfaces
erythema, horizontal linear splits
117
Xerosis treatment
Avoid triggers; use "sensitive skin stuff" ; frequent hand washing/drying = BAD
Topical therapies = WET dressings; emolients IMMEDIATELY after bathing (oils \> ointments \> creams \> lotions)
118
fine, white, adherent, polygonal scale with central tacking ("pasted on")
ichthyosis vulgaris
Autosomal dominant (95% heredity)
FLEXORS; LE \> UE
119
ichthyosis vulgaris treatment
Emollient use
Lactid acid, urea, or alpha-hydroxy acids for severe scaling
AVOID DRY ENVIROMENTS
120
Koebner phenomena
likely to get some sort of lesion on top of trauma such as a skin or a burn
121
chronic plauqe psoriasis
SYMMETRICAL
EXTENSORS
"silvery-white scale" = always psoriasis
122
Auspitz sign
pinpoint bleeding when scale removed
123
guttate psoriasis
1/3 BEFORE 20 y.o.; often preceeded by strep
resolves spontaneously
SUDDEN appearance (\*\*plaques are more gradual); TRUNK!
124
Pustular psoriasis
small sterile pustules
**on palms and soles!**
Von Zumbach's syndrome; when pustules coalesce into one big area
125
interiginous areas
Inverse psoriasis
UNCOMMON; usually lack scales
126
erythodermic psoriasis
entire skin surface is involved
127
Pityriasis rosea
**75% = 10-35**
MC in F slightly; SEASONAL (cooler months)
**Herald patch**: initial primary plaque; then generalized rash 1-2 weeks later; SYMMETRICAL; usually trunk
"Christmas tree distribution"; "Collarette scale"
128
5 P's: Pruritic (80%); Planar (flat-topped); Polyangular (not round); Purple; Papules
Lichen planus
**F \> M; rare in kids**
\*may be associated with chronic active Hep C
Wickham striae: "net-like"
Papular (localized) pattern = MC (then hypertrophic)
129
Mucosal Lichen Planus
in oral mucosa
F\>M ; onset \> 60 y.o.
EROSIVE FORM: ~3% can become SCC
130
"Tenting" nail
LIchen planus nail disease
131
Lichen planus treatment
REFER TO DERM
Topical corticosteroids (Class I-II) for localized
Intralesional corticosteroids for hypertrophic pattern
Oral 'mouthwash' for mucosal
132
**smooth; "non-scaling"**
## Footnote
Localized = MC
Generalized
Granuloma Anulare
2F: M ; **dorsal hands; extensors**
duration = weeks to decades; spontenous involution
**central depression; arcuate/annular plaques**
**\***Associated with diabetes
133
H1 Receptors
Triple response of lewis: Vasodilation (erythema); axon reflex (itchiness); and wheal
134
H2 receptors
vasodilation; increased gastric secretion (nausea)
135
Urticaria
**sudden onset; each lesion lasts**
can be acute ( 6 weeks)
TREAT WITH **ANTIHISTAMINES** initially
136
5 "I"s with urticaria
Infections, ingestants, inhalants, injectants, internal disease
137
1st generation antihistamine
SEDATING
hydroxyzine (atarax)
diphenhydramine (benadryl)
138
2nd generation antihistamine
LOW SEDATING
fexofenadine (allegra)
cetirizine (zyrtec)
loratadine (claratin)
139
"non-pitted swelling"
angioedema
F\>M; needs to be dealt with immediately
140
Angioedema treatment
severe: epinephrine and antihistamines (maybe IV)
**always refer to derm/allergist**
ID bracelets; epi-pen
if HAE: replacement with C1 inhibitor concentrate; fresh frozen plasma
141
Erythema Multiforme etiology and causes
M \> F
20-40; 20 % adolescents
142
Erythema multiforme clinical features
**prodrome:** malaise, fever, itching, burning, cough
primary lesion small red macule or papule with central papule that flattens and clears
TARGETOID LESION; PALMS / SOLES
143
lesions start as poorly defined, red, **firm , tender subcutaneous nodules**; 2-6 cm; fade over 1-3 weeks
similar to bruise; do not scar
Erythema nodosum
**5F : 1 M;** extensor surcaces; BILATERAL
**MC cause = strep**
144
145
Tissue involved and etiology?
Cellulitis
dermis **AND** subcutaneous tissue
*streptococci* and *staphylococcus aureus*
146
Major clinical features?
irregular, ILL-DEFINED MARGINS
unilateral; generally lower extremity
147
treatment?
Antibiotics PO ; (IV if very ill)
Wet dressings, rest and elevation
148
definition, etiology?
Erysipelas
"superficial cellulitis" - infection of upper dermis
Etiology: ONLY *streptococcus* (pyogenes)
149
Major clinical features?
(erysipylas)
peau d' orange appearance
UNILATERAL; raised
sharp elevated margins
150
treatment?
(erysipylas)
antibiotics PO
(bacterial infection)
151
etiology
(Impetigo)
*staphylococcus aureus* and *streptococcus*
VERY CONTAGIOUS
152
major clinical features?
Impetigo
"honey colored crust" ; stuck on appearance
putsule/vesicles with yellow purulent fluid
153
Treatment?
| (local, widespread & recurrent)
(impetigo)
**Local**: vinegar/bleach wet dressings; topical cream (mupirocin) ; antibacterial soap
**Widespread:** antibiotics PO
**Recurrent:** swab for colonization of strep; nasal/fingernail ointment reginen
154
TSS:defintion, etiology
(Toxic Shock Syndrome)
"emergency toxin-mediated bacterial infection"
staphylococcal and streptococcal
FEMALE \> MALE
155
TSS: major clinical features?
treatment?
(Toxic Shock Syndrome)
sudden onset of fever; STRAWBERRY TONGUE; hypotension; diffuse macular rash
REMOVE FB; early IV antibiotics
156
Exanthems
term used for a generalized rash; (most commonly by a virus)
accompanied by systemic systems (fever, malaise, headach)
**Reaction** to toxin from organism; **damage** to the skin by the organism; OR **immune response**
157
definition? etiology? predisposing factors?
Erythema infectiosum
"5ths disease" ; **slapped-cheek** ; childhood
Parvovirus B19
Spread via droplets/blood; late winter-early spring
158
clinical presentation
course?
(Erythema infectiosum)
~2 days prior ; prodrome
Rash = 'slapped-cheek' then lacy reticular rash
**Incubates** 4-14 days; **prodrome**; 1-4 days '**slapped** **cheeks**' ; 1-6 weeks extremities/trunk **rash** ; 1-3 possible recurrence
159
treatment?
(Erythema infectiosum)
symptomatic/supportive
avoid heat, sun, stress
160
Etiology? Predisposing conditions?
Hand, foot, and mouth disease
Etiology: Coxsackie A16 virus; Enterovirus 71
Conditions: seasonal (late summer/autumn) ; household contacts ; children
161
clinical features?
(hand, foot and mouth disease) **CONTAGIOUS**
nose/throat discharge; small vesicles initially form in mouth (appear as chancre sores)
ovals/square, YELLOW, vesicles appear on hands, feet, buttocks
**vesicles --\> bulla --\> ulcers** (if blisters open)
lasts 7-10 days
162
treatment?
(hand, foot and mouth disease)
Symptomatic ; isolate children 3-7 days
163
etiology? predisposing?
(herpes simplex)
often involves mucous membrane
HSV 1: oral ; HSV 2: genital
Conditions: direct contact; droplet infection; open skin
164
Herpes primary infection
grouped vesicles; eroding to crusts
(possible prodrome)
NUMEROUS, scattered or soliatry
resolve within **2-6 weeks**; WITHOUT scarring
can be sympomatic or PAINFUl
lies dorman in dorsal root ganglia
165
Herpes simplex secondary infection
less significant; shorter period
travels through peripheral nerves
PREDISPOSE BY: menses, fatigue, stress, trauma to area , infections
166
diagnosis?
Treatment?
(herpes simplex)
Presentation, PCR, culture, serum assay OR tzank smear
Treat symtomatically; topical or PO antivirals
\*best to start within 24 hours
167
definition/etiology?
(Varicella) "Chicken pox" ; HIGHLY contagious ; lifelong immunity
Varicella zoster virus (VSV) aka: human herpesvirus type 3
168
clinical features? course?
(Varicella)
14-16 day incubation after exposure; 1-2 prodrome
**VARIED STAGES at same time**; macules to crusts; become vesicles; SURROUNDING ERYTHEMA
\* contagious 2 days before rash appears until ALL lesions are crusted
169
diagnosis?
treatment?
complications?
(Varicella)
Clinical presentation, PCR, culture, tzank smear
symtomatic treatment; antiviral agents
\*SCRATCHING can cause secondary infections; can spread in utero during pregnancy
170
definition? etiology?
(herpes zoster ; shingles)
UNILATERAL localized infection ; usually involving a SINGLE DERMATOME
Reactivation of varicella-zoster virus
171
clinical features?
(herpes zoster ; shingles )
3-5 days of localizes symptoms (PAIN, discomfort, itchy)
Red **macule** rapidly becomes a **papule** then a **vesicle**; surrounded by **erythema**
Vesicles group over 2-3 weeks; become pustular; then scab over; WHITE SCAR
172
diagnosis? treatments? common complications?
(herpes zoster ; shingles )
clinical presentation, PCR, tzank smear
treatment: **antiviral agents**; rest; topical analgesics, narcotics steroids
AV agents prevent **post-herpetic neuralgia**
**HZ opthalmicus** : can cause blindness; dentrite appearance in eye
173
HZ opthalmicus
\*distinct on central axis; vesicles on the side or tip of nose
174
definition? etiology? predisposing?
(Molluscum contagiosum)
self-limiting mucocutaneous viral infection; can last **months to years**
Poxvirus
Swimming pools; communal bathing
175
clinical features?
(Molluscum contagiosum)
skin-colored papule ; dome shaped with **central punctum** (umbilicated)
**white molloscum bodies** at center of papules
176
diagnosis? treatment?
(Molluscum contagiosum)
presentation, biopsy, **microscopic eval of core**
Treat: supportive; topical treatment **(tretinoin, aldara, cantharidin, salicylic acid)**; NO COMMUNAL BATHING
Remove if in genital area\*\*\*
177
etiology; predisposing?
( Measles (rubeola) )
Parmyxovirus group
Predisposing: densley populated regions; lack of immunizations
178
clincial features?
three C's?!
( Measles (rubeola) )
10-12 day **incubation**; HIGH FEVER
**3 C's**: cough, coryza (runny nose), conjuctivitis
**Koplick spots** on buccal mucosa (blue-white spots on a red base
_Exanmthem_: "Morbilliform rash" starts on face, hairline & behind ears**;** MOVES DOWNWARD; clears in **3-4 days**; leaves coppery stain
179
diagnosis? treament?
( Measles (rubeola) )
Antibody titers; presentation; QUARANTINE if positive
Treat: symptomatic; antibiotics with secondary infections
180
definition? etiology?
(Rubella - German measles)
common viral infection affecting skin, lymph nodes and joints
Etiology: togavirus
181
clinical features?
(Rubella - German measles)
(Incubation: 14-21 days)
**prodrome** -malaise, tender lymphadenophathy, fever
2-3 mm pink macules appear with prodrome; begin on face/scalp & move downward
Become **papular** and then desquamate - fade within 3 days
**Forchheimer spots:** red petechiae on soft palate
182
diagnosis? treatment?
(Rubella - German measles)
serology; presentation
Treat symptomatically
\*THREAT TO UNBORN CHILD
183
definition; etiology; predisposing
(Roseola infantum) - "Childhood exanthem"
sudden rash after fever; "6th disease"
Etiology: HHV-6 or HHV-7
6-35 mo. ; spring time ; trans by droplets
184
clinical features?
(Roseola infantum)
High fever each **night x3** (goes away in morning)
After 3rd night fever breaks; **subtle pink maculopapular rash;** mostly NECK AND TRUNK
otherwise asymtomatic
185
diagnosis; treatment
(Roseola infantum)
clinical presentation, cultures, serology
treating: supportive
186
etiology; predisposing
(warts)
Human papilloma virus
Predispos: localized trauma, immunosuppresion, communal bathing
MOST COMMON ON HANDS
187
clinical features; 4 types;
(warts)
common, plantar, mosaic, planar (flat)
Confined to the epidermis; **interrupt normal skin lines**
188
diagnosis; treatment; prevention
(warts)
clinical presentation (disrupts skin lines; thrombosed capillaries (little black dots))
Treat: spontaneously involute OR physical, chemical, immunotherapy
Prevent: dry, clean surfaces; sandals in common areas
189
Candidiasis description
yeast type of infection
*candida albicans*; causes majority of **fungal**
affects skin and MUCOUS membranes
lives within normal fluora of the mouth, vaginal tract and gut
EXTREME AGES
190
candidiasis clinical presentation
superficial infection; outer layers of ep
PRIMARY LESION = **erythematous papule or pustule**
Scaling, advancing borders - stops when it reaches dry skin
Satellite lesions
191
candidiasis diagnosis
clinical presentation; KOH
192
definition; risk factors; clinical presentation
(Candida balantis)
inflammation of the glans penis
Risks: uncircumcised males; diabetics/immunosupressed
Tenderness/pain; inability to retract foreskin; **pin-point papules**
193
diagnosis; treatment; prevention
(Candida balantis)
clinical presentation, location, KOH, cultures
topical antifungal; FINISH ALL; retract gently/wash
Prevent: keep areas dry, cleanliness, powders
194
definition: predisposing; common sites
(candida intertrigo)
superficial yeast infection of intertriginous areas
obesity, diabetes, pendulous breasts, humid weather
sites: groin/gluteal folds/ under breasts/ allilae
195
clinical presentation
(Candida intertrigo)
erythematous macerated folds; **satellite papules/pustules**
Glistening plaques
SYMMETRIC
196
diagnosis; treatment; prevent
(Candida intertrigo)
clinical presentation; KOH; culture
treat: topical antifungal, vinegar wet dressings, burrows solution, DRY
Prevent: powders, ointments, weight loss
197
definition; predisposing
(oral candidiasis (thrush) )
yeast infection of the mucous membranes of the mouth (palata, esophagus, pharynx)
neonate, diabetes, antibiotic use, extreme ages
198
clinical presentation
oral candidiasis (thrush)
burning/pain with spicy food; diminished taste
**creamy white exudates/ plaque like lesions of mucus membranes**
199
diagnosis; treatment
oral candidiasis (thrush)
presentation; KOH
Treat: topical antifungal (**nystatin**) - tablet OR gentian violet (stain)
200
definition; predisposing
angular chelitis
inflammation of the angles of hte mouth; secondary to saliva maceration
eldery, poor fitting dentures, ACCUTANE use
201
clinical presentation; diagnosis; treatment
angular chelitis
sore, raw, macerated at the angles of the mouth; erythematous
presentation; culture
treat: **aquaphor**; topical anti-fungal; topical steroid sparingly
202
definition; etiology
(tinea/ptiyriasis versicolor)
chronic asymptomatic superficial fungal infection of the torso
**Malassezia furfur,** M. globosa
May or may not be contagious
203
predisposing; clinical presentation
tinea/ptiyriasis versicolor
factors: oily skin, heat, moisture warm climates
fungus gets into melanin and causes them not to tan as much; asymptomatic
sharply marginated, **fawn colored/brown/pink** oval macule with fine powdery scale
204
diagnosis ; treatment
tinea/ptiyriasis versicolor
KOH; wood's lamp (irregular pale yellow to white or green fluorescence)
treat: topical - **selenium sulfide** (selsum blue shampoo); oral antifungal - hypopigmented areas may not disappear immediately
205
tinea
**Dermatophyte**
Group of fungi capable of infecting skin, hair and nails
Most common of all mucocutaneous infections\*
Predisposition: wrestlers, day cares, pets, etc
206
definition; etiology
tinea capitis
Invasion of the stratum corneum and the hair shaft with fungal hyphae
etiology: 90% **trichophyton**
207
Clinical - 4 types
tinea capitis
## Footnote
1: inflammatory
2: seborrheic: (patchy fine adherent scales; MOST COMMON
3: non-inflammatory : black dots, alopesia
4: pustular: pustules; NO SCALING OR ALOPESIA
208
diagnosis; treatment
tinea capitis
KOH; woods lamp (BRIGHT GREEN); culture
treat: both oral and topical preps (griseofulvin and antifungal shampoo)
treat pets too!
209
definition; clinical presentation; diagnosis
inflammatory tinea capitis
boggy tender areas of alopecia; scarring; painful
KOH - REFER!
210
definition; predisposing; etiology
tinea corporis - "ring worm"
dermatophyte of the trunk
warm climates, close contact (wrestlers)
T. rubrum; M. canis; T tonsurans
211
clinical presentation; diagnosis; treat
tinea corporis - "ring worm"
papules/macules; **raised red border** with **central clearing** or brownish discoloration
pustules, vesicles, bullous
asymptomatic or itchy
Clinical presentation; KOH; culture
treat: topical antifungal; extensive use oral
212
definition; etiology
tinea cruris "jock itch"
tinea of the groin; almost exclusively in post-pubertal boys (**M\>F)**
**T. rubrum; T. mentagrophytes**
213
clinical presentation; diagnosis
tinea cruris "jock itch"
itching (increases with moisture); usually BILATERAL; can migrate to buttocks
**plaques with scale; spares penis/scrotum**
clinical presentation; KOH; culture
214
definition; predisposing
tinea manus
"tinea of the hand"
Pre: tinea pedis/cruris
\*UNILATERAL commonly
215
clinical presentation; diagnosis
tinea manus
**scaling/hyperkeratosis**; palmar creases, fissures pronounced
progresses slowly
papules, vesicles, bullae
Clinical presentation; KOH
216
treatment
tinea manus
topical antifungals -often fails
oral often used
KEEP HANDS DRY; can recur if nails are not clear
217
definition; etiology; predisposing
tinea pedis " athletes foot "
DERMATOPHYTS: T. rubrum, T. mentagrophytes, E. floccosum
Pre: dark, warm, moist enviroment; locker rooms
218
clinical presentation; treatment; diagnosis
tinea pedis " athletes foot "
lessions may be annular; between digits; **moccasin distribution**
scaling, macerated, erythema, bulla formation
Clinical; KOH; culture; NEG wood's lamp
Treat: PO or topical antifungal; change socks freq. dry well
219
# describe this!
heals above layer of epidermis; confined to edges of wound
Hypertrophic scar
219
# describe this!
scar tissue goes beyond the edges of original wound
Keloidal scar
219
# describe this!
Comedone
ex: blackhead (open)
darkened plug of sebum and keratin that occludes the pilosebaceous follicle
some open; some closed
219
# describe this!
Cyst
NODULE; encapsulated containing fluid or semi-fluid substance; fluctuant
219
# describe this!
Burrow
ex: scabies
linear or serpinginous tunnels within the epidermis
219
# describe this!
Telangiectasia
small, superficial blood vessels that become visible because they are dilated;
disappear with pressure (blanch)
