Dermatology Flashcards
(175 cards)
1
Q
Describe what transient neonatal pustular melanosis looks like.
A
surrounding erythema everywhere but hands/feet, vesicles rupture leaving collarete scale –> hyperpigmentation –> lasts for months
2
Q
Which neonatal lesion is seen at birth, which is later (when)?
A
TNPM - at birth ET - day 1; goes away 2/3 wks SubQ fat necrosis - 1-6 weeks Neonatal acne/neonatal cephalic pustulosis -2wks to 3mo Seborrheic derm - 2wks to 1yr Infantile acne 3mo --> 3/4 yrs
3
Q
Which neonatal rash has eosinophils? which has neutrophils?
A
Eos erythema toxicum
Neuts TNPM
4
Q
What is causing agent for neonatal cephalic pustulosis?
A
malassezia furfur
P. ovale
5
Q
What causes neonatal acne?
A
excessive maternal androgen
6
Q
Cause of seborrheic dermatitis
A
P. ovale
7
Q
Pattern: pustules at day 1
A
erythema toxicum
8
Q
Pattern: Papules and pustules on cheek and skin with comedones
A
neonatal acne
9
Q
Pattern: Pattern papules and pustules on face and neck without comedones at 3weeks age
A
neonatal cephalic pustulosis
10
Q
Pattern: If infantile acne is so severe what do you think of?
A
abnormal Androgen source such as congenital adrenal
11
Q
Pattern: bad peeling, mouth, butt, extensor of extremities and fingers/toes, irritable, FTT, diarrhea, alopecia
A
acrodermatitis enteropathica
12
Q
Pattern: at 1-6 weeks, firm, indurated, non-tender plaque with cellulitic erythema
A
Sub Q fat necrosis
13
Q
What is a cause of subQ fat necrosis?
A
hypercalcemia, irritability, constipation, FTT, seizures
14
Q
Pattern: at 3 weeks, greasy, yellow scale on scalp, midface, groin, trunk
A
seborrheic dermatitis
15
Q
How do you treat neonatal acne?
A
benzo peroxide, antibiotics
16
Q
How do you treat neonatal cephalic pustulosis?
A
topical antifungals
17
Q
How do you treat acrodermatitis enteropathica
A
give zn
18
Q
How do you treat seborrheic dermatitis
A
zinc or selenium to kill p. ovale and hydrocortisone
19
Q
How do you treat subQ fat necrosis
A
diuretics to decrease Ca2+ , decr Ca2+ in diet, corticosteroids
20
Q
What is time course of regular hemangioma
A
present in 1st few months of life, grows rapidly first 6 months, starts involuting after 1st yr by 10%/yr
21
Q
Periorbital hemangioma can cause what?
A
amblyopia
22
Q
Beard hemangioma can cause what?
A
recurrent croup, upper airway problem
23
Q
Lumbosacral hemangioma can be a sign of what?
A
tethered cord, spinal fusion
24
Q
Sacral/perineal hemangioma can be a sign of what?
A
renal and GU abnormalities
25
Liver hemangioma can cause what?
CHF, anemia, thrombocytopenia (trapping)
26
Large segmental or liver hemangioma can be associated with what?
hypothyroidism
27
What is first line treatment for hemangiomas?
beta blockers
28
What are SE of beta blockers?
Hypoglycemia, hypotension, bradycardia, bronchospasm
29
Besides the generic barrier cream, steroids/propanolol, analgesics, and abx for ulcerated hemangioma, what is the distinct treatment that can be given for this?
Platelet derived growth factors
30
Patter: tufted angioma at 3 weeks of life, thrombocytopenia, coagulopathy, microangiopathic hemolytic anemia
Kasaback-Meritt
31
What must you do if you see multiple hemagiomas of skin?
Get MRI and liver US
32
Pattern: posterior fossa syndrome, aortic arch, micro-ophthalmia, sternal clefting, arterial anomalies such as internal carotid problems leading to stroke, hemangiomas (V1)
PHACES
33
Suspicious for PHACES, what must you do?
MRI/MRA, ECHO, optho, neuro consult
34
Pattern: Unilateral large purple stain at birth that darkens and thickens causing plaque
port-wine stain
35
What is a Rx for port-wine stain
pulse dye laser
36
What eye problem do you worry about with Sturge Weber?
glaucoma, need MRI w/ contrast and ophtho consult
37
What are some calcineurin inhibitor?
tacrolimus, pimocrolimus
38
What is severe SE of calcineurin inhibitor?
can cause cancer if used for long time
39
If patient presents with lots of and prolonged seborrheic dermatitis and eczema, what should you also think about?
Langerhan, immunodeficiencies, biotin deficiency and organic acidemia, psoriasis, tinea capitas, atopic dermatitis and eczema
40
Steroid dose for lesions on face, groin, axillae, trunk, extremities
low potency 1%
41
Steroid dose for lesion that are severe on palms and soles
high potency
42
What is the risk factor for atopic dermatitis?
Hx, FHx of atopy (asthma or allergic rhinitis)
43
Pattern: pruritic, chornic or relapsing skin skin in infant everywhere but groin and axillae.
Atopic dermatitis
44
What does atopic dermatitis predispose you too?
Staph, HSV, warts, molluscum
45
What should you consider if atopic dermatitis is severe and early onset?
Food allergy, associated atopy
46
Pattern: school aged children, hypopigmented plaques with indistinct borders on cheeks and chin
Pityriasis alba
47
Pattern: firm, skin-colored or erythematous papules on lateral upper arms, anterior upper thighs, cheeks
Mechanical removal, salicyclic/lactic acid topical, RA
48
Pattern: coined shape lesions on leg that itches, can get excoriated.
Nummular eczema
49
Rx for nummular eczema
antifungal
50
What happens if you put steroids on nummular eczema?
fungus will proliferate
51
Difference between irritant and allergic contact dermatitis
Irritant - lip licker, diaper
| Allergic Type IV poison oak/ivy
52
Pattern: edema, papules, vesicles, oozing, crusting, scaling, thickened skin, chronic lichenification, fissuring
Allergic contact dermatitis
53
Rx for allergic contact dermatitis
avoidance, topical CS, topical calcineurin inhibitor for 1-4 weeks, oral CS if severe
54
What test can be done for allergic contact dermatitis?
patch testing
55
Pattern: redness, cracking, peeling of weight-bearing surface
juvenile plantar dermatosis
56
What is cause of juvenile plantar dermatosis?
secondary to repeated maceration and dry
57
Rx for juvenile plantar dermatosis.
emollient, topical steroids
58
Name 4 types of tinea capitis
1) scale with alopecia + auricular lymph nodes
2) black-dot tinea - spores in hair shaft (hair falls off)
3) Seborrheic w/out hair loss
4) Kerion - inflammatory, hair loss, fever, increased WBC, flu-like, with fever, adenopathy
59
Pattern: abscess with hair loss
Tinea capitis kerion
60
Rx for tinea capitis kerios
Systemic antifungal +/- oral CS
61
Cause of tinea capitis
90% trich tonsurans, 10% microsporum canis
| Fomites or contact person
62
What is woods lamp useful in detecting with tinea?
Microsporum canis, not useful for T. tonsurans
63
Main Rx for tinea capitis
1) Griseofulvin which is fungistatic
2) Topical selenium or ketoconazole
3) Terbinafine, itraconazole, fluconazole (all reservoir meds), last two can cause drug interactions
64
What does griseofulvin have to be given with?
fatty meal
65
SE of griseofulvin
hepatitis, fatty liver, decrease OCP
66
Pattern: foot dermatitis on weight bearing surface
Juvenile plantar dermatosis
67
Pattern: foot dermatitis in interdigital, arch
tinea pedis
68
Pattern: foot dermatitis on dorsum of foot
contact derm
69
Pattern: scaly, raised erythematous margin +/- central clearing on body
Tinea corporis
70
Dx for tinea corporis
KOH will how hyphae with spores
71
Rx for tinea corporis
antifungals for 2-4 weeks, topical steroids may mask dx
72
Rx for tinea pedis
topical antifungals, oral antifungals if widespread or resistant, keratolytics for moccasin type infections
73
Pattern: Adolescents, has white patches almost liquified on superficial nail and the some nails lift off
onychomycosis - tinea unguium
74
Rx for onychomycosis
oral terbinafine and itraconzaole
75
Pattern: adolescent, warm humid weather, confluent macules with sharp borders and varying levels of hypopigmented patches with mild scale
Pityriasis versicolor
76
Pattern: sphagettic and meatballs under KOH, fluoresce yellow-orange with Wood's lamp
Pityriasis versicolor
77
Infectious agent for pityriasis versicolor
skin yeast (malasezzia, pityrosporum)
78
Rx for pityriasis versicolor
Topical selenium, ketoconazole shampoos; topical antifugnals, systemic keto, itra, fluco
Griseo NOT EFFECTIVE
79
Incubation period for scabies
2-4 wks
80
Pattern: papules, vesicles, burrows with other lesions around that look eczematous, impetigo, nodules can be intertriginous
Scabies
81
Dx for scabies
scrapings under minearl oil
82
Rx for scabies
Permethrin, topical ivermectin is 2nd line, in resistant cases, can be used oral
83
Why lindane is bad
CNS and lung toxicity
84
What are "black" lice and what are the white ones?
Nits and white are hatched eggs
85
Rx for head lice
permethrin or pyrethrin, malathion, 5% benzoyl alcohol; no need to treat fomites
86
Pattern: 2-7 year old in summer and sprint with small wheal with central punctum, develops firm nodules
papular urticaria
87
Rx for papular urticaria
Antipruritics
88
Pattern: papules coalesce into plaque, SPARES TRUNK, low grade fever, itching, lasts 3-8 weeks
Papular acrodermatitis of childhood
89
What is Gianotti Crosti?
id rxn to preceding infection, can be secondary to EBV and enterovirus
90
Cause of warts
human papillomavirus
91
Rx for warts
topical RA, light freezing, imiquimod; flat warts that are numerous are hard to treat so wait for spontaneous resolution 2/3 over 2 years
92
Cause of molluscum contagiosum
Poxvirus
93
Pattern: 3 or 4 yro with superficial fragile blisters, perioral fissuring or peeling, blister extends when pushed, red skin peels
staph scalded skin
94
Cause of staph scalded skin?
epi staph toxins A/B
95
Rx for staph scalded skin
antibiotics, emollients
96
Pattern: persistent redness in perianal region, can blister or ulcerate + papules
Perianal infectious dermatitis
97
Cause of perianal infectious dermatitis
group A strep and staph
98
Rx for perianal infectious dermatitis
antibiotics
99
What are drugs associated with acne?
INH, phenytoin, corticosteroids, lithium, sunscreens, cosmetics, OCP
100
Rx for comedomal acne
Topical tretinon or benzoyl peroxide
101
Rx for mild acne
benzoyl peroxide
102
Rx for moderate acne
benzoyl peroxide, topical tretinoin, topical or oral antibiotics
103
Rx for severe acne
isotretinoin, OCPs for females
104
Pattern: hair loss, scalp looks good, very rapid loss, exclamation hair, fhx of autoimmune (TH, IBD, DM)
alopecia areata
105
Rx for alopecia areata
mid-high potency topical or injected corticosteroids, topical minoxidil, anthralin, calneurin inhibitors
106
Pattern: Diffuse thinning of hair 6wk to 4mo after a stressful event
Telogen effluvium
107
What workup should be considered for telogen effluvium
CBC, Fe, TSH, T4 (could also be zinc, FA/biotin deficiency
108
Decreased production of hair by chemotherapy
Anagen effluvium
109
Pattern: oval or linear lesions of incomplete hair loss and perifollicular inflammation
Traction alopecia
110
What is cause of vitiligo?
auto-immune against melanocytes
111
Rx and workup of vitiligo
Biopsy shows absence of melanocytes, w/u other immune disorders
112
Pattern: erythema, streaky like juice stain 24hrs after exposure to UA, limes, lemons, celery/grass
phytophotodermatitis
113
Pattern: small papule that coalesce into silver-grey scale, pinpoint bloody when scale removed
Psoriasis
114
Pattern: small droplets of red papules with silver-grey scale on top.
Guttate psoriasis
115
Causes of guttate psoriasis and associated symptoms that precede it.
Group A strep; perianal cellulitis, URI, arthritis, uveitis
116
Pattern: large patch then 10 days later, smaller macules/papules along the skin creases, scale lifts from center, lasts 4 to 8 weeks
Pityriasis rosea
117
Rx for guttate psoriasis
Avoid skin/sun exposure/injury. topical steroid 1st line, calciprotriene or tacrolimus, narrow UVB, cyclosporine, anti-TNF
118
Pattern: papules on extremities, target lesion for 10 days, disappear in 2 wks. Central area of epidermal damage (blister, ulcer, crusting)
erythema multiforme
119
What are causes of erythema multiforme?
HSV, mycoplasma, drugs
120
Urticaria or EM:
| Truncal, prox extremity; central clearing, new lesions over 7-10d, lesions transient, swelling hands/feet
Urticaria
121
Urticaria or EM:
Acral distribution, central blister, ucler, or crust; all lesions come up at same time, fixed lesions for 7 to 10d, no edema
EM
122
Can acyclovir be used for EM?
no
123
Pattern: small droplets of red papules with silver-grey scale on top.
Guttate psoriasis
124
Causes of guttate psoriasis and associated symptoms that precede it.
Group A strep; perianal cellulitis, URI, arthritis, uveitis
125
Pattern: large patch then 10 days later, smaller macules/papules along the skin creases, scale lifts from center, lasts 4 to 8 weeks
Pityriasis rosea
126
What is the typical cause of SJS?
Mycoplasma/drugs (50/50)
127
Pattern: papules on extremities, target lesion for 10 days, disappear in 2 wks. Central area of epidermal damage (blister, ulcer, crusting)
erythema multiforme
128
What are causes of erythema multiforme?
HSV, mycoplasma, drugs
129
Urticaria or EM:
| Truncal, prox extremity; central clearing, new lesions over 7-10d, lesions transient, swelling hands/feet
Urticaria
130
Urticaria or EM:
Acral distribution, central blister, ucler, or crust; all lesions come up at same time, fixed lesions for 7 to 10d, no edema
EM
131
Can acyclovir be used for EM?
no
132
Pattern: pruritic, edematous lesion that clears centrally (may be blue or brown in the middle) associated with swelling hands/feet, pinpoint or 10-12 ring, each lesion last 24hrs.
Urticaria
133
Causes of urticaria
IgE mediated or secondary mast cell degranulation, respiratory virus, GAS, coccidiomycosis, histoplasmosis, EBV
134
Rx for urticaria
antihistamine, steroids, doxepin
135
What is the typical cause of TEN?
90% Drugs 1-12 weeks after initiation
136
What drugs can cause TEN?
Abx, AED, allopurinol, NSAIDs
137
SJS or TEN
| Prodrome of fever, HA, sore throat, cough, arthralgias, vomiting or diarrhea
SJS
138
SJS or TEN
| High fever/tender skin or erythroderma
TEN
139
SJS or TEN
| Severe mucous membrane involvement, stomatitis, conjunctiva, GU/GI tracts
SJS
140
What determines terminology used SJS vs TEN
Extent of blistering
141
Mortality rate for SJS and TEN
10 and 30%
142
SJS/TEN
| Multi-organ dysfuntion
GI tract and lungs
143
Should relatives of pts with SJS/TEN from drug avoid that drug?
yes
144
Pattern rash starts with mucous membrane involvement
SJS/TEN
145
Pattern: red macules start centrally, develop into papular or mrobilliform eruption
SJS/TEN
146
Can congential melanocytic nevi and neurocutaneous melanosis and acquired melanocytic nevi lead to melanoma
All can, larger lesion or if axial lesion, more likely to have higher change of melanoma
147
What should you worry about when you see large congenital melanocytic nevi on head, neck, and back
increased ICP, Sz, spinal cord compression
148
UVA or B: absorbed by dermis
UVA
149
UVA or B: absorbed by epidermis
UVB
150
UVA or B: causes aging
UVA
151
UVA or B: causes cancer, sunburn
UVB
152
UVA or B: SPF measures protection again this
UVB
153
Pattern: at birth, yellow/orange/tan hairless lesion on scalp, face or neck, orange peel texture
nevus sebaceous
154
Is there risk for malignancy with nevus sebaceous?
no
155
Pattern: subQ non-tender nodule found over later brow or midline nasal region
dermoids - should MRI to delineate extent of lesion
156
Pattern: slow growing, irregular, rock hard mass in head and neck that is bluish
pilonatricoma
157
What is pilonatricoma
benign tumors of hair shaft that calcifies
158
Pattern: yellow/orangish lesion that when you scratch can blister, looks like orange peel
mastocytosis
159
What two skin lesion looks like orange peel texture?
nevus sebaceous and mastocytosis
160
What is the difference in two lesions that has orange peel texture?
Nevus sebaceous - hairless lesion
| Mastocytosis - urticaria when you scratch it
161
Pattern: brownish lesion that can lead to eruptionand affect other organs to cause abdominal pain, diarrhea, vomiting
urticaria pigmentosa
162
Pattern: ring-shpaed, not scaly, skin colored or violaceous occurs in skin creases
Granuloma annulare; self-resolves
163
Rx for mastocytosis
oral cromolyn, topical or systemic CS, epi injection, avoid triggers: exercise, heat, cold, stress
164
What is cause of mastocytosis
mass cell accumulation in skin or other organs
165
Coal tar preparations are useful in treatment of what?
psoriasis and chronic dermatoses
166
Topical selenium sulfide shampoo is helpful to what?
tinea versicolor and seborrheic dermatitis
167
What factors can worsen eczema?
drying, chemical irritants, heat, and physical trauma
168
Children with atopic dermatitis are prone to skin infections from what?
Staphylococcus aureus and HSV
169
Pattern: umbilicated vesicles, forming ulcers that have a "punched-out" appearnace
HSV - eczema herpeticum
170
Pattern: erythematous or violaceous nodules
sporotrichosis
171
Pattern: Individual vesicles that rupture leaving shallow erosions
VZV
172
Two most common bacterial agents for cellulitis
streptococcus pyogenes and staphylococcus aureus
173
Difference in way cellulitis by S pyogenes and S aureus present
S pyogenes red, tightness in skin
| S aureus localized and purulent
174
What is agent? Cellulitis in pt who had a cut on the leg from a stick in a creek +/- immunocompromised or has DM
pseudomonas aeruginosa
175
What is agent? necrotizing fasciitis from fish or objects in salt water in an immunocompromised patient.
vibrio vulnificans
