Dermatology

Question 1

What is cellulitis? Treat or refer?

Answer 1

Cellulitis is an infection near a break in skin. You must refer to PCP so it can be treated with oral antibiotics.

Question 2

How does cellulitis present?

Answer 2

red, swollen, warm area of skin likely near a break

Question 3

This topical skin disorder is common in kids, spread by direct contact, and requires PCP referral for oral antibiotics.

Answer 3

impetigo (topical staph skin infection)

Question 4

How is pediculosis treated? (5 different options)

Answer 4

permethrin 1%, oral ivermectin, spinosad, topical ivermectin, malathion

Question 5

Describe the presentation of scabies.

Answer 5

raised, red areas of skin that cause extreme pruritus – refer to PCP

Question 6

What are the treatment options for scabies?

Answer 6

permethrin 5%, crotamiton cream, oral ivermectin

Question 7

Herpes zoster most often present in patients who are > _____ y.o. with a history of ____________.

Answer 7

40, chicken pox infection

Question 8

Describe the presentation of herpes zoster and what can trigger it.

Answer 8

presents as tender red papules that progress to scabs – can be triggered by stress, old age, immunosuppression

Question 9

How is herpes zoster treated?

Answer 9

oral antivirals (valacyclovir) and some tx for acute postherpetic pain (opioids, gabapentin)

Question 10

Of the three kinds of skin cancer, which is the most common? the most deadly?

Answer 10

most common - BCC

most deadly - melanoma

Question 11

Which kinds of patients are most at risk for developing skin cancer?

Answer 11

fair skinned, light eyes, light hair (red or blonde)

Question 12

Where does xerosis most often present?

Answer 12

feet and lower extremities, hands, elbows, face

Question 13

What is first-line treatment for xerosis?

Answer 13

emollients (help with itching and restoration of skin)

if ineffective, recommend alteration of bathing habits

Question 14

What are Dr. Martin’s rules of 3’s?

Answer 14

(1) bathe NMT 3x/week
(2) use tepid water 3-5 degrees above body temperature
(3) bathe for 3-5 minutes
(4) apply emollients w/in 3 minutes of showering
(5) apply emollients 3x daily

Question 15

What are some agents a patient can use to reduce itching if emollients are ineffective?

Answer 15

methol/camphor
pramoxine (anesthetic)
hydrocortisone (anti-inflamm)
aluminum acetate 0.2%

Question 16

Differentiate between acute, subacute, and chronic dermatitis.

Answer 16

ACUTE: red patches or plaques that may blister, itchiness
SUBACUTE: more dry than red, crusting, oozing, skin beginning to thicken
CHRONIC: thickening, lichenification, scaling, less itching

Question 17

Differentiate between allergic and irritant acute contact dermatitis.

Answer 17

allergic: immunologic response to some antigen
irritant: non-immunologic reaction from frequent contact with everyday substances

Question 18

Topical therapy is okay for poison ivy treatment if NMT ___% of BSA is involved.

Answer 18

10

Question 19

What factors must be taken into account when determining whether to treat or refer a poison ivy patient?

Answer 19

extent of damage, amount of body area affected

Question 20

What are the benefits of soaks in treatment of acute dermatitis?

Answer 20

In oozing, weeping, crusting lesions, soaks not only help control symptoms, but can help dry out the area as well. Use wet dressings in acutely inflamed/wet areas.

Question 21

What directions should you give patients for wet dressing use?

Answer 21

apply to linen or cheese cloth and put on until dry BID-QID, take off and replace with dry dressing

Question 22

What method can be used to enhance penetration of topical corticosteroids?

Answer 22

occlusion: apply then cover with plastic wrap and a bandage or shirt, leave on for 6 hours

Question 23

Which grades of topical steroids are safest for long-term maintenance use?

Answer 23

grades 5-7 (hydrocortisone, desonide)

Question 24

Give some examples of mid-potency (grade 3-5) steroids.

Answer 24

betamethasone, triamcinolone, mometasone

Question 25

What are some examples of high potency (grades 1-2) steroids?

Answer 25

clobetasol, halobetasol, fluocinolide

Question 26

What are the advantages and disadvantages of using topical calcineurin inhibitors for dermatitis?

Answer 26

adv: no risk of atrophy, equivalent to mid-potency steroids, fewer side effects
disadv: very high cost, only indicated for short-term use due to malignancy risk

Question 27

Why are steroid dose packs not useful in treatment of dermatitis?

Answer 27

do not provide treatment for long enough – will need at least 10-14 days of treatment

Question 28

What is the atopic triad?

Answer 28

atopic dermatitis, asthma, allergic rhinitis

Question 29

What is the clinical presentation of atopic dermatitis?

Answer 29

pruritus (most common sx)
red papules or plaques
scaling/redness/inflammation
dryness

Question 30

What are common triggers of atopic dermatitis?

Answer 30

detergents, linens, allergens, smoke, dust, infections, frequent bathing

Question 31

What are the non-pharmacological methods for treating atopic dermatitis?

Answer 31

lukewarm/tepid baths
elimination of triggers
emollients
bleach baths if extreme

Question 32

What are the pharmacological treatments of atopic dermatitis?

Answer 32

topical CS/calcineurin inhibitors, phototherapy, immunosuppressants

Question 33

Poor circulation is the most common cause of _______ ________ is patients greater than 50 y.o.

Answer 33

stasis dermatitis

Question 34

How does stasis dermatitis typically present?

Answer 34

red, scaly, crusting swellings, discomfort, hyperpigmentation

Question 35

How is stasis dermatitis treated? (think of the sx)

Answer 35

emollients for dryness/itching, topical CS, compression legwear for edema, oral abx for local infection

Question 36

treatment of chronic dermatitis

Answer 36

same as subacute (emollients, topical CS), UV light

Question 37

Most topical fungal infections are treated with OTC antifungals, but what conditions would warrant a PCP referral?

Answer 37

systemic symptoms, immunocompromisation

Question 38

Treatment of diaper rashes

Answer 38

remove irritant, air dry, keep clean, topical antifungals, protectants (apply over anti fungal)

Question 39

treatment options for seborrheic dermatitis

Answer 39

medicated shampoo (selsun blue, head&shoulders), low strength topical CS