Dermatology Flashcards

Question

Answer 1

Atopic Dermatitis (aka Eczema) * Erythematous patches * Papules * Plaques w or wo scales * Erosions * Excoriation/lichenification * Patho: * acute, subacute chronic * "itch that rashes" - IgE antibodies * associated w/ asthma & allergic rhinitis * Etiology: * unknow- genetics? common in AD * foods, inhalants, microbials, seasonal, stress... * Epidemiology: * early childhood: 15-20% (2mo-3y ~60%) * S/s: * puritis, xerosis (dry skin), rhinitis, "allergic shiners" * prurigo nodularis, keratosis pilaris, pityriasis alba * skin lesions: * erythematous patches, papules, plaques, erosions, excoriation/lichenification * on flexor surfaces, neck, eyelids, forehead, face, wrists, feet, hands * Tests: * cultures to rule out bacterial, viral, fungal * serum IgE to check for allergic rxn * Tx (AVOID systemic steroids): * luke-warm bath w/ mild cleanser * bid application of ointments/creams best on damp skin * active:topical corticosteroids * hydrocortisone * metamethasone * triamcinolog * +/- antihistamine: hydroxyzine; diphenhydramine * +/- abx (superinfection) * chronic (calcineurin inhibitors): * tacrolimus .1% (protopic); pimecrolimus 1% (Elidel) * phototherapy: UVA-UVB * maintenance: * corticosteroids and emollients for hot spots * basic skin care * stress management

Answer 2

Atopic Dermatitis - Prurigo Nodularis * S/s: * **dome-shaped nodules** * various stages of erosions and excoriation * seen in multiple extremeties * Tx: * topical, oral or interlesional corticosteroids * occlusive dressings * anti-psychotic meds

Answer 3

Atopic Dermatitis - Kertosis Pilaris * common BENIGN condition (40% of AD patients) * more common in adolescents * keratinization of **hair follicles** - feels like sandpaper (goosebumps) * worse in winter and with dry skin * distribution: * lateral arms, highs, lateral cheeks * lesions: * papules +/- erythema * Tx: * lubrication- lotions, emollients (Eucerine) * keratolytic agents/topical retinoids: Tretinoin (Retin-A) * intermittent topical corticosteroids

Answer 4

Atopic Dermatitis - Pityiasis Alba * "low-grade" eczematous dermatitis w/ post-antinflammatory **hypopigmented macules or patches** +/- fine scaling * usually on face * Tx: * emolliants * topical steroids

Answer 5

Seborrheic Dematitis * S/s: * gradual onset * variable pruritis * **"greasy", yellow, white-gray scales** * macules, paules, or patches * better in summer/worse in winter * recurrences & remissions- watch for alopecia * Tx: * shampoos * Selenium sulfide; zinc pyrithione; tar (Selsun Blue) * cradle cap- remove crust w/ olive oil compresses * Ketocanazole 2% shampoo (Nizoral Rx) * topical corticosteroid cream (body areas) * betametasone

Answer 6

Periorbital Dermatitis * S/s: * chronic, papulo**_pustular_** dermatitis (resembles rosacea) * stinging/burning +/- itching * 1-2mm irregular erythematous papules and papulopustules * **NO comedones, spares vermillion border** * Etiology: * unknown * **topical steroids for other conditions worsens this** * fluorinated toothpaste * UV light, heat or wind * Epidemiology: * .5-1%, W \> M, 20-45 y/o * Tx: * topical * metronidazole 0.75% gel bid * erythromycin 2% gel bid * systemic * minocycline or doxycycline 100mg/d until clear * maintenance 50mg d x 2mo * tetracycline 500 mg bid until clear * 500 mg/d x 1mo then 250mg/d 1mo

Answer 7

Lichen Simplex Chronicus * S/s: * thickening skin from scratching/rubbing * w/ AD, anxiety, depression or OCD * anywhere a pt can reach * Etiology: * \> F, \>20 y/o, \> Asians * Tests: * serum IgE * KOH to check for secondary infection * Tx: * education: stop rubbing/scratching * occlusive dressings * steroids: * topical or injectible * antihistamines * diphenhydramine 25-50mg tid (Benadryl) * hydroxyzine 25mg tid * anti-anxiety * clonazepam (Klonopin) .25m q 12hr * derm/psych referral

Answer 8

Psoriasis Vulgaris * Patho: * inflammatory T-cell driven disease * chronic hyperproliferation of keratinocytes- incr. cell turnover leads to flaking and scaling w/ plaques * superficial vessel dilation * Etiology: * multifactorial: * environmental- stress, infection, truama, alcohol * genetic- HLA-B13, B37, B57, HLA-Cw6 * immunologic? * Epidemiology * all ages: peak @ 22.5 y/o * M=F * S/s: * well-demarcated, erythematous plaques w/ silver scale * dystrophic nails * pruritis, joint pain * common sites: inverse pattern- warm/moist environments, **flexural surfaces**, axilla, groin, skin folds, under breasts

Answer 9

Guttate Psoriasis * S/s: * hands & feet: sterile pustules w/ erythematous base mixed yellow/brown macules * general acute: systemic symptoms (fever, malaise) * Epidemiology: * more common in children * post strep infection * self limiting * can be recurrent, can develop psoriasis vulgaris

Answer 10

Psoriatic Arthritis * S/s: * cutaneous symtoms first then joint disease * progressive degeneration of joints * **Hands & Feet- pitting of nails**

Answer 11

Pityriasis Rosea * salmon colored Herald patch w/ trailing collarette of scale (oval scaling patches) * "Christmas tree" pattern on back * Tests: none * Tx: * antihistamines * antipruritic lotions * UVB therapy (severe cases) * +/- short course systemic steroids

Answer 12

Lichen Planus * S/s: * insidisous onset * 4 P's: papule, purple, polygonal, pruritic * sites: wrists (flexor), lumbar, scalp, glans penis, mouth * flat topped lesions, vary in size, sharply defined, shiny, polygonal w/ 3+ sides, Wickham Striae * Etiology: * idiopathic: metals, drugs, infection * UC, vitiligo, myasthenia gravis, hep C * Epidemiology: * F \> M, 30-60, \<1% all races * Tests: * biopsy w/ histology confirmationl * Tx: * remove offending agent * topical glucocorticoids * antihistamine * systemic cyclosporine, glucoccoriticoids, retinoids * UVA light therapy

Answer 13

Lichens Planus * atrophic: white-bluish, well demarcated lesions w/ central clearing * follicular: keratotic-follicular papules and plaques- can lead to allopecia * erosive * hypertrophic- large thick plaques

Answer 14

* clinical diagnosis * perform tests to r/o other disorders * psoriatic arthritis: r/o gout, RA * lifelong remissions and exacerbations * Tx: * corticosteroids * Vitamin D analogs - inhibits epidermal proliferation * calcitriol ointment (Vectical) * calcipotriene (Dovonex) * anthralin (Dithranol) - inhibits epidermal proliferation and T lymphocyte proliferation * retinoids - tazarotene (Tazorac) * phototherapy * coal tar * immunomodulators * methorexate * cyclosporine * Moncional abx * TNF-alpha

Answer 15

* anagen - active growth 3-6yrs, 90% of hairs * catagen - transition (2-3wks) * telogen - rest period (3-4mo) * return to anagen (anagen cycle slows w/ aging) * normal loss 50-100 hairs per day

Answer 16

Androgenic Alopecia * S/s: * gradually thinning hair * Norwood scale (men) / Ludwig scale (women) * Patho: * dihydrotestosterone increase due to increase 5 alpha reductase in hair follicle- increase telogen phase and decrease anagen phase * Dx: * trichogram- count anagen vs telogen hairs * hormone: testosterone, DHEAS, prolactin (primarily women) * thyroid and iron studies (anemic- pica) * Tx: * Finasteride (Propecia) 1mg PO qd- MEN ONLY * type II 5a-reductase inhibitor (loss * TERATOGEN * Minoxidil topical 2% and 5% (Rogaine) bid * hair transplants

Answer 17

Alopecia Areata * S/s: * localized hair loss w/o inflammatory process * lymphatic infiltrate around hair bulbs * spontaneous remission and recurrence * Patho: * unknown: autoimmune, stress, illness, drugs, trauma; genetics * M=F, peak 15-29 y/o * Patterns: * reticular- extensive and patchy * opiasis- localized on sides and lower back scalp * sisapho- spares sides and back * totalis- entire scalp * universalis- entire body

Answer 18

Alopecia Areata * S/s: * nail pitting w/ hammered brass longitudinal striation * 20% of alopecia pts * Dx * thyroid studies * serum iron- r/o anemia, ANA- r/o SLE * rapid plasma regain (RPR)- r/o syphilis, KOH- r/o tinea

Answer 19

* topical steroids * **tacrolimus (Protopic) / pimecrolimus (Elidel)** * shortens t-lymphocyte activation * SHORT term use only- risk of malignancy * Minoxidil (Rogaine) * Glucocorticoids * Clobetasol (Temovate)- potent topical steroid * Prednisone (Deltasone)- oral to halt progression * **Tiamcinolone (Kenalog)**- intralesion injection * Immunomodulators * Cyclosporine (Sandimmune, Neoral)- topical/systemic * Methoxsalen (8-MOP, Oxsoralen) * Anthraline (Dritho-Scalp 0.5% cream) * no cure- tx inadequate (wigs, therapy)

Answer 20

Telogen Effluvium * S/s: * +/- Beau lines (horizontal lines on nails – telltale sign of past illness) * acute onset of diffuse shedding * Dx: * metabolic stress (illness, hospitalization), diet, endocrine, drugs (birth control, anticoagulants, ace inhibitors, b-blockers, cholesterol) * hair pull test * CBC (anemia), TSH (hypo/hyperthyroid), serology (ANA- lupus), RPR * Tx: * reassurance- spontaneous regrowth * diet

Answer 21

Anagen Effluvium * Dx: * choemo, radiation, _protein malnutrition_ * Tx: * reassurance- revesible with time

Answer 22

Traction Alopiecia (TA) * Dx: * corn rows, pulling, hair extensions * Tx: * change hair style * early TA- revesible w/ topical steroids (Clobetasol (Temovate)- superpotent topical) * late TA- permanent loss, no tx

Answer 23

Scarring Alopecia * S/s: * damage/destruction to hair folicles * beard & scalp * Patho: * inflammatory conditions (lupus), infections (folliculitis), surgical scars * Tx: * Clobetasol (Temovate)- superpotent topical steroid * Tiamcinolone (Kenalog)- intralesional injection

Answer 24

Trichotillomania * S/s: * diffuse alopecia- hair different lengths * scalp or eyebrows * Dx: * self induced- twirling, pulling, breaking hair * Tx: * counseling

Answer 25

Onychomycosis Tinea Unguium * S/s: * nail discolor/disfiguration * pain, parethesia, loss of dexterity * presentation varies by infection * Patho: * 3 fungi: _dermatophyes_, yeasts, molds * Dx: * KOH * fungal cultures * Tx: * Topical: * Ciclopirox (Penlac) 8% lacquer qhs \<48w * Efinaconazole (Jublia) 10% * Systemic: * Itraconazole (Sporanox) 200mg bid 7d, repeat 21d later (toes: qd 12w) * Terinafine (Lamisil) 250mg po 6w (toes: 12w)

Answer 26

Onycholysis * S/s: * spontaneous nail detachment from bed- increase risk of infection * discoloration * Patho: * idiopathic, dermatitis, psoriasis, onychomycosis * Tx: * treat underlying disease * avoid trauma

Answer 27

Psoriasis * S/s: * Nail Pitting / Oil Spot * Patho: * psoriasis * MELANOMA

Answer 28

Acute Paronychia * S/s: * infection of lateral or proximal nail fold * Patho: * S. aureus * Tx: * Abx * amoxicillin-clavulanic acid (Augmentin) 875mg bid 10d * Bactrim DXD 10d (MRSA) * Clindamycin / Doxycyclin bid 10d (sulfa allergry)

Answer 29

Subungual Hematoma * Tx: * 18ga needle puncture * cautery tool * drainage does not accelerate healing or prevent infection

Answer 30

Unguis Incarnatus (Ingrown Toenail) * S/s: * infection of medial or lateral toe (great toe most common) * Tx: * nail removal with cauterization (phenol or 10% sodium hydroxide) * Abx 1w to avoid infection

Answer 31

Terry's Nails * S/s: * proximal nail bed 2/3 white, distal 1/3 red * don't blanch * Patho: * systemic disease * CHF, hepatic cirrhosis

Answer 32

Splinter Hemorrhage * S/s: * tiny blood clots under nail * Patho: * systemic disease * bacterial endocarditis, SLE, RA, nail trauma

Answer 33

Beau's Lines * Patho: * systemic disease * high fever, cytotoxic drugs, drug rxn, eczema, peripheral ischemia * temporary growth arrest, trauma

Answer 34

Blue Nails (Copper Accumulation) * S/s: * accumulation of copper * Patho: * systemic disease * Wilson's disease; minocycline quinacrine

Answer 35

Koilonychia (Spoon Nails) * Patho: * systemic disease * iron deficiency anemia

Answer 36

Clubbed Fingers * Patho: * systemic disease * cardio-pulmonary disease (COPD, emphysema)

Answer 37

Pediculosis Capitus (head lice) * S/s: * nits (eggs) and lice * excoriation, pruritis scalp, posterior neck and auricle * secondary infection * Tx: * **Permethrin topical 1% lotion, 5% cream 1x repeat in 7-9d** * Malathion topical .5% lotion 1x repeat 7-9d * Invermectin topical .5% lotion 1x no combing * Lindane topical 1% 30ml shampoo (not for children) * Benzyl alcohol 5% lotion * Spinosad topical .9% suspension age 4+ * hot laundry 131 deg+, items sealed 2w, vacuuming, discard combs/brushes

Answer 38

Pediculosis Corporis (body lice) * S/s: * nits (eggs) and lice * excoriation, pruritis axillary, naval, trunk and groin * secondary infection * Tx: * NO Permethrin- louse lives on clothing * hot laundry 131 deg+, items sealed 2w, vacuuming, discard combs/brushes * spray room w/ RID

Answer 39

Pediculosis Pubis (pubic lice) * S/s: * nits (eggs) and lice * excoriation, pruritis groin, axillae, eyelashes, eyebrows * secondary infection * Tx: * Permethrin topical 1% lotion, 5% cream 1x repeat in 7-10d * Malathion topical .5% lotion 1x repeat 7-10d * Lindane topical 1% 30ml shampoo (not for children) * Qwell shampoo * STD: inform/treat all partners

Answer 40

Scabies * S/s * INTENSE PRURITIS * burrows * erythematous macules, papules, plaques * adults: flexor wrists, interdigital web, dorsal feet, waist, buttocks, genitalia * children: face, scalp, neck, palms and soles * Patho: * Sarcoptes scabiei hominis * Crusted scabies (Norwegian scabies)- large areas, crusted lesions * Nodular scabies- pinkish brown nodules * Tx: * infested person, household, sexual contacts * **Permethrin (Acticin) 5%** * benzyl benzoate * antimicrobial if secondary infection * crusted: multiple meds- permethrin AND keratolytic acid (topical urea) * nodules: intranodular steroid injection

Answer 41

Bed Bugs ("breakfast, lunch, and dinner") * S/s: * papules, utricaria (groups of 3) * secondary infections * Patho: * blood-sucking ectoparasite (cimex) * Tx: * prevention/education * corticosteroids for allergic rxn * Abx for secondary infection: Augmentin, Cephalexin, Cipro (tendon rupture, growth)

Answer 42

Brown Recluse "Fiddle Back" Spider Bite * S/s: * erythema (maybe bulla) * vasoconstriction * **necrosis** * Patho: * *Loxoscele reclusa*- most common species in US * Tx: * ice, rest, elevation * debridement, surgery * antihistamines, corticosteroids * no prophylactic abx

Answer 43

Black Widow (red-orange hour glass) Spider Bite * S/s: * pain/rxn at site * muscle spasms or cramping * +/- NAV, HA, anxiety, weakness, abdominal rigidity * Patho: * *Latrodectus mactans* * Tx: * antivenom * risk of anaphylaxis- skin test first

Answer 44

Acne Vulgaris - Open Comedone (black head) * S/s: * Patho: * Propionibacterium acnes (P. acnes)- G+ rod shaped anaerobe * follicular hyperkeratinization- formation of hard plugs in follicle * genetics * chronic inflammation of pilosebaceous unit (hair, follicle, erector pili m.) * Dx: * androgens, stress, meds, mechanical * Tx: * Mild * topical abx * Erythromycin 2% sol, gel, ointment * Clindamycin 1% sol, gel, lotion * Tretinoin (Retin-A, Avita) * topical benzoyl peroxide (2.5, 5, 10%) gel * benzoyl peroxide & topical abx combo (Benzamycin, Benzaclin) * topical retinoids * Tretinoin (Retin A) sol, cream, gel * Tazarotene (Tazorac) cream, gel * Adapalene (Differin) cream, gel * Azalaic Acid (Finacea) gel * Moderate * po abx * Minocycline 50-100mg po bid * Doxycycline 100mg po bid * Tetracycline 250-500mg po bid * Erythromycin 250-500mg po bid * oral contraceptives * ortho tri-cyclen * estrostep * YAZ * Recalcitrant acne * Isotretinoin (Accutane) 13-cis-retinoic acid 1mg/kg/d po divided bid 15-20wk * s/e: pseudotumor cerebri w/ concurrent tetracycline use (increased intercranial pressure)

Answer 45

Acne Vulgaris - Closed Comedone (white head) non-inflammatory

Answer 46

Acne Vulgaris - Papule

Answer 47

Acne Vulgaris - Pustule greenish appearance w/ nodule

Answer 48

Acne Vulgaris - Cysts and Nodules

Answer 49

Acne Scars - Pitted

Answer 50

Acne Scars - Hypertrophic

Answer 51

Acne Excorièe (excessive picking - crusted erosions and potential scarring) teen girls & young women

Answer 52

Acne Fulminans (sudden onset w/ cystic coalescing lesions with system symptoms) teen boys

Answer 53

Rosacea Erythematotelangiectatic (no comedones) * S/s: * persistent erythema (central portion of face), \>3mo, flushing, papules/pustules, telangiectasias (spider veins) * ocular manifestations (dry eyes) * burning, stinging * Patho: * stress, hot drinks, alcohol, exercise, cold/hot weather, hot baths/showers

Answer 54

Rosacea Papulopustular * S/s: * classic presentation of rosacea * telangiectasia likely but difficult to distinguish * Dx: * middle age women

Answer 55

Phymatous Rosacea: Rhinophyma * S/s: * chronic nasal inflammation * **irreversible** hyperplasia of nasal tissue * progressive * Tx: * Isotretinoin topial * surgery

Answer 56

Hidradenitis Suppurativa (abscess of apocrine sweat gland) * Patho: * keratin plug of follicle -\> apocrine duct occlusion -\> inflammation -\> abscess -\> rupture -\> ulceration / firbrosis / draining sinus tract formation -\> bilateral develop * Staph aureus, streptococci, E. coli, preteus mirabilis, Pseudomonas aeruginosa * Dx: * labs for inflammation: CBC w/ diff, ESR, CRP * bacterial cultures * US * Tx: * po abx: * tetracycline * doxycycline * erythromycin * minocycline * Triamcinalone intralesional injections * Accutane * surgery: marsupialization, excision, grafting

Answer 57

Ocular Rosacea * blepharitis * conjuntivitis * episcleritis * rosacea keratitis -\> corneal ulcers * Tx: * opthalmology referral

Answer 58

* avoid precipitating factors * topical Metronidazole .75% or 1% (MetroGel, Metrocream, Metrolotion) * topical Azelaic Acid 15% gel or foam (Finacea), 20% cream (Azelex) * topical Brimonidine gel .5% (Mirvaso) * alpha-2 agonist reduces redness * topical & po abx (acne) * Isotretinoin (13 cis-reinoic acid) * Invermectin anti-inflammatory 1% pea size app daily

Answer 59

Impetigo * S/s: * "honey-crusted" lesions * Patho: * mix of S aureus and S pyogenes (Group A Strep) * confined to epidermis

Answer 60

Bullous Impetigo * S/s: * blisters w/ yellowish fluid * erythematous halo around blister * Patho: * toxin from S aureus * Dx: * bacterial culture * Tx: * very contageous- good hygiene; wash clothing, towels, linen * systemic * Cephalosporins: Cephalexin (Keflex) 250-500mg bid/tid * Amoxicillin-clavulanate (Augmentin) * Dicloxacillin * MRSA: Clindamycin (Cleocin) or Trimethoprim-sulfamethoxazole (Bactrim DSD) bid * topical abx: * Mupirocin 2% (Bactroban) tid 5-10d * Retapamulin (Altabax) bid 5d- not on mucous membranes

Answer 61

Ecthyma * S/s: * (ulcer w/ hemorrhagic crust) * Patho: * Strep. pyogenes * extends to superficial dermis * Tx: * dependent on causitive agent

Answer 62

Folliculitis w/ Scarring Alopecia Complication * S/s: * hair follicle infection creating follicula-based pustule * Patho: * Staph aureus (MRSA & MSSA) * shaving/plucking or occlusion (acne) * Tx: * good hygiene, hand washing, antibacterial soaps * abx: * Mupirocin (Bactroban) * Dicloxacillin 500mg po qid 7d * Cephalexin (Keflex) 250-500mg po qid 7d * MRSA: * Clindamycin * TMP/SMX (Bactrim DX)

Answer 63

Pseudofolliculitis Barbae * S/s: * chronic pustular staph infection of beard * Dx: * AA males * curly hair * Tx: * limit shaving trauma * abx: * Tetracycline 500mg po q6h 7-10d * Erythromycin topical 2% bid * Tretinoin topical * topical Hydrocortisone 1%

Answer 64

Pseudomonas aeruginosa folliculitis * S/s: * "hot tub" folliculitis * bathing suit lines * Tx: * self-limiting * Cipro 500 bid 1w if persistent

Answer 65

Furuncle (Boils), Carbuncle, Abscess * S/s: * furuncle- single hair follicle * carbuncle- collection of furuncle * Patho: * S. aureus * Tx: * I&D

Answer 66

Cutaneous Abscess * S/s: * red, hot/warm, swelling, tenderness * +/- associated cellulitis * Patho: * S. aureus * autoinoculation, immunosuppression, alcohol/IV drug abuse, malnutrition * Dx: * culture * imaging: US, CT, MRI * Tx: * warm compress * I&D +/- abx (immunocompromised, systemic infection) * empiric antimicrobial (MRSA, pseudomonas- Cipro) * IP: * Vancomycin 15mg/kg IV q12h * Clindamycin 600mg po or IV q8h * OP: * Clindamycin 300-400mg po q8h 5-7d * Cephalexin 250-500mg po q6h 5-7d * Dicloxacillin 250-500m po q6h 5-7d * Trimethoprim-sulfamethoxazole DS 1-2 tab po q12h 5-7d

Answer 67

Cellulitis * S/s: * irregular borders that merge smoothly with adjacent skin * pinkish to reddish * Patho: * Group A Streptococci * Staph aureus * Tx: * mild-mod: Dicloxacillin 500mg po q6h * pcn allergy: Cephalexin 500mg po q6h * severe: Nafcillin 1-2g IV q4h * pcn allergy: Cefazolin 1g IV q8h

Answer 68

Erysipelas * S/s: * elevated and sharply demarcated border * fiery-red appearance * Patho: * Group A streptococci (S. pyogenes- face) * Dx: * ASO titer- streptococcal infection * WBC- left shift bacterial, right shift viral * Tx: * mild-mod: Penicillin VK 500mg po q6h * pcn allergy: Cephalexin 500mg po q6h * severe: Pen G 1-2 million U q6h * pcn allergy: Cefazolin 1g IV q8h

Answer 69

Necrotizing Fasciitis * S/s: * local redness, edema, warmth * **pain out of proportion** * necrosis, dusky tissue, bullae w/in 36-72h * Patho: * polymicrobial: clostridium, E. coli, klebiella, GAS * Tx: * surgical debridement * empric abx for anaerobes, G-, strep, staph aureus (\>3 weeks): * metronidazole + clindamycin + ceftriaxone * ancomycin + piperacillin/tazobactam * imipenem/cilastatin; clindamycin * ampicillin/sulbactam + clindamycin + ciprofloxin

Answer 70

Fournier’s Gangrene * S/s: * perineal, perianal, genital * Patho: * polymicrobial * Tx: * Vancomycin * Ampicillin-sulbactam sodium (Unasyn) * Piperacillin + tazobactam (Zosyn) * Gentamycin * Metronidazole (Flagyl) * Clindamycin (Cleocin)

Answer 71

Ecthyma Gangrenosum * S/s: * grouped hemorrhagic vesicle or pustules that evolve into necrotic ulcers w/ tender border * Tx: * piperacillin + aminoglycoside (Gentamicin)

Answer 72

Stapholococcal Scalded Skin Syndrome * S/s: * severe exfoliation affecting entire body (**Nikolsky sign**) * macular erythema - sloughing * Patho: * S. aureus toxins * Tx: * Penicillin * 1st gen cephalosporin * Macrolides * Aminoglycosides

Answer 73

Toxic Shock Syndrome * S/s: * sudden onset flu symptoms * hypotension, mulit-system failures * Erythematous rash followed by dequamation (hands) * mucous membrane erythema and ulcers * Tx: * Clindamycin; Pen G; Nafcillin; Vanco * newer abx: * Tedizolid (Sivextro); Oritavancin (Obrativ); Dalbavancin (Dalvance)

Answer 74

Myonecrosis (Gas Gangrene) * S/s: * localized swelling & severe pain * discoloration * skin blebs/bullae * crepitus * serosanguinous, dirty, foul smelling discharge * Patho: * Clostridium perfringens (infects muscle) * Tx: * aggressive surgical debridement * Pen G + Clindamycin + metronidazole

Answer 75

Tinea (Pityriasis) Versicolor * S/s: * +/- pruritis * **hypo or hyperpigmented lesions**- pink * well-demarcated scaling **patches** * Patho: * Malassezia furfur (normal skin flora) * Dx: * KOH- spaghetti and meatballs * Wood's light: yellow to coppery-orange flourescence * Tx: * Shampoo: * Selenium sulfide 1% (OTC) or 2.5% * Ketaconazole 1% (OTC) or 2% * Ketaconazole cream 2% bid 2w * Itraconazole (Sporanox) 200mg po qd 5d * Fluconazole (Diflucan) 300mg qw 2w

Answer 76

Tinea Capitus * S/s: * Non-inflammatory patches of alopecia and scaling * "Black dot"- broken hair shaft at scalp * Kerion- boggy, purulent, indurated mass; heals with scarring alopecia * Favus- "honeycomb"; perifollicular erythema and matting of hair * Patho: * Trichophyton tonsuransk * Dx: * KOH, culture, Wood lamp * Tx: * Griseofulvin (Fulvicin) 20-25mg/kg/d 6-8w * Itraconazole (Sporanox) 3-5mg/kg/d w/ FULL MEAL 4-6w * Terbinafine (Lamisil) 3-6kg/mg/d 2-4w * Selenium sulfide shampoo

Answer 77

Tinea Corporis * S/s: * Annular lesions- raised red sharp borders w/ shallow center * scaly ring-like plaques, elevated border w/ central clearing * Patho: * Trichophyton, Microsporum, Epidermophyton * Dx: * KOH, fungal culture * Tx * Topical (2cm beyond area \>2w): * Naftifine (Naftin) 1% cream/gel * Terbinafine (Lamisil) topical * Ketoconazole (Nizoral) topial * Clotrimazole (Mycelex, Lotrimin) 1% cream * Systemic * Griseofluvin (Fulvicin) 10mg/kg/d 4w * Fluconazole (Diflucan) 50-100mg/150mg 1xw 2-4w * Itraconazole (Sporanox): **BLACK BOX** CHF and drug interactions * Ketoconazole (Nizoral): **BLACK BOX** hepatotoxicity, QT prolongation, drug interactions

Answer 78

Tinea Cruris * S/s: * pruritic fungal infection of groin * Patho: * Trichophyton rubrum * tight-fitting, wet clothes * Tx: * break "warm, moist, dark" triangle, socks before pants * topical: * Naftifine (Naftin) 1% cream/gel * Terbinafine (Lamisil) * Ketoconazole (Nizoral) * Clotrimazole (Mycelex, Lotrimin) 1%

Answer 79

Tinea Pedis * S/s: * "athletes foot" * pruritic, scaly soles and painful fissures between toes * types: interdigital type, moccasin type, inflammatory/bullous type, ulcerative type * Patho: * Trichophyton rubrum * Dx: * hot/humid/tropical environments, swimming * Tx: * Naftifine (Naftin) 1% cream/gel bid 4w * Terbinafine (Lamisil) 1% 2-3w * Oral: Griseofluvin (Fulvicin); Fluconazole (Diflucan); Itraconazole (Sporanox); Itraconazole (Sproanox)

Answer 80

Cutaneous Candidiasis * S/s: * intertrigo, interdigital (3rd-4th), diaper dermatitis, occluded skin (casts, wraps) , follicular candidiasis * Tx: * topical: * Nystatin cream/ointment * oral * Nystatin * Fluconazole * Itraconazole * Ketoconazole

Answer 81

Oropharyngeal Candidiasis * S/s: * burning/pain w/ eating * diminished taste * odynophagia (pain w/ swallowing) * pseudomembranous candidiasis ("thrush") * erythematous/atrophic candidiasis (smooth, red tongue) * candidal leukoplakia- can't wipe off but resolves w/ tx * angular chelitis * Tx: * topical: * Nystatin (Mycostatin)- oral swish & spit/swallow * oral: * Fluconazole (Diflucan) * Itraconazole (Sporanox) * Ketoconazole (Nizoral) * Amphotericin B (Fungizone, Amphocin)- severe/systemic

Answer 82

Genital Candidiasis * S/s: * sudden onset pruritis, vaginal discharge, soreness * vulval burning * dyspareunia * dysurea * erosions, edema, curd-like white discharge * Patho: * Candida albicans * Tx: * topical azole at bedtime: * Clortrimazole (Mycelex, Femizole) * Butoconazole (Femstat) * Miconazole (Monistat) * oral: * Fluconazole (Diflucan) 150mg 1 dose (may need to repeat)

Answer 83

Disseminated Candidiasis * S/s: * erythematous cutaneous papules * Patho: * C. albicans & C. tropicalis * enters blood via catheters, intestinal mucosa

Answer 84

Venous Insufficiency - Edema * S/s: * venous stasis ulcers, **vericose veins** * burning, swelling, throbbing, cramping, aching, heaviness, restless leg, leg fatigue * **pitting edema**, hyperpigmentation, chronic cellulitis, * **atrophie blache** * **lipodermatosiclerosis** * Patho: * incompetent venous valves (thrombus formation, conginital abnormalities * Dx: * W: 40-49; M: 70-79

Answer 85

Venous Insufficiency - Vericose Veins * valvular incompetance- back flow of blood causing veins to enlarge * cosmetic and painful

Answer 86

Venous Insufficiency * Atrophie blanche * scarring that occurs after skin injury in the area of poor blood supply * small ivory-white depressed patches * stellate, irregular coalescing, stippled pigmentation, hemosiderin-pigmented border * often seen with stasis dermatitis * Lipodermatosclerosis * inverted "champagne bottle" caused by extravasation of fibrinogen or WBCs into dermal tissue due to capillary HTN * chronic inflammation/fibrosis of subcutaneous tissue

Answer 87

Stasis Dermatitis * S/s: * pruritis, brownish discoloration (hemosiderin deposition) * medial ankle * eczema (scaly patches), erythema * signs of venous insufficiencies: edema, vericosities, **red-brown discoloration** * Patho: * direct consequence of venous insufficiency * hypoxia/stasis theory- insufficient oxygen perfusion leads to hypoxic damage to skin * fibrin cuffs- increased venous hydrostatic pressure leads to leaking fibrinogen converted to fibrin cuffs * Tx: * control insufficiency and edema- compression/elevation * ligation of vessels * abx: * topical for erosions * oral/systemic for cellulitis * corticosteroids * Triamcinolone .1% ointment * topical imollients to maximize moisture

Answer 88

Venous Ulcers * S/s: * most common lower extremity ulcer * mid calf to media malleoli * **moist grannular base with irregular border** * **more shoallow than other ulcers** * Patho: * at least 1 symtom of venous insufficiency * increased venous pressure and leukocyte activation * fibrin cuff formation * Dx: * ankle-brachial index: ratio BP ankle to arm (**lower in leg than arm**) * color of duplex US * venography * Tx: * treat underlying cause: HTN, peripheral edema, weight reduction * compreassion theray: elastic (greaded compression); inelastic (zinc oxide hardening wrap) * leg elevation * dressings * topical negative pressure * meds: * Pentoxifylline (Trental) 400 mg q8h \>8w - inhibits platelet aggregation, improves circulation * Iloprost (Ventavis) - vasodilator that inhibits platelet aggregation * hyperbaric oxygen therapy * surgery: ablation, phelbectomy, ligation & stripping

Answer 89

Arterial Insufficiency * S/s: * intermittent claudication (limping) * pallor, cyanosis * loss of hair * decreased pulses * mottled vascular pattern * Patho: * arthrosclerosis (atheroembolism- acute pain at site of embolization)

Answer 90

Arterial Ulcers * S/s: * pain * punched out (irregular borders progressing to well-defined edges) * **necrotic base** * pressure sites: distal toes, pretibial, supramalleolar * Patho: * atherosclerosis * Dx: * ABIs, duplex US, CT angiography, MR angiography * Tx: * underlying cause, by-pass surgery, endarterectomy * meds: Heparin, Warfarin, Analgesics

Answer 91

Neuropathic Ulcers * S/s: * punched out * surrounding callused skin * @ pressure points and bony prominences * decreased sensation * foot deformities * Patho: * diabetic neuropathy (MCC), sensory neuropathy (unknown trauma), motor neuropathy (increased mechanical stress), autonomic neuropathy (AV shunting, decreased sweating, increase dryness/fissuring) * Dx: * nerve conduction study (NCS) / electromyelogram (EMG) * labs to rule out infection: CBC, ESR, CRP, wound culture * Tx: * treat underlying problem * education: proper foot care * would care * surgery * hyperbaric oxygen treatment * meds: * Pentoxifylline (Trental)- improved blood flow/tissue oxygenation * Cilostazol (Pletal) 100mg q12h- dilation of vascular beds * Clopidogrel (Plavix)- antiplatelet * Becaplermin (Regranex) gel- topical recombinant human PDGF

Answer 92

Pressure Ulcers (decubitus ulcers, bed sores) * S/s: * non-blanchable erythema- sign of impending skin ulceration-\>superficial lesion-\>crater-\>full thickness * pain, odor, fever, chills * Patho: * continuous pressure, shearing forces/friction of sheets etc, moisture * Dx: * CBC, CRP, ESR, blood/wound culture * nutrition status * UA and culture (incontinence) * stool exam (fecal incontinence0 * imaging * Tx: * pressure reduction, position change * nutrition supplements * wound care * surgical debridement

Answer 93

1st Degree Burn

Answer 94

2nd Degree Burn

Answer 95

3rd Degree Burn

Answer 96

4th Degree Burn

Answer 97

Junctional Nevi * flat or minimally elevated * tan to brown * usually 1-4mm * uniform shape

Answer 98

Compound Nevi * uniformly pigmented papules to small domed nodules * heavily pigmented: light tan to black * Cobblestone appearance with regular and sharply defined borders * can be firm or soft and sometimes contain hair

Answer 99

Dermal Malanocytic * Sharply defined dome-shaped papule or nodule with smooth surface * skin colored, tan or flecks of brown * lighter color since has less melanocytes

Answer 100

Halo Nevus * inflammatory infiltrate * sually autoimmune mechanism that leads to cell death of the melanocyte surrounding the central nevus * repigmentation can occur, but not always

Answer 101

Blue Nevus * 3 types * common * cellular- can become malignant (should be excised) * combined mole and nevus * color due to depth of melanin in epidermis

Answer 102

Nevus Spilus * light brown pigmented macule and contain smaller dark macules * appears this way due to distribution of melanocytes * rarely becomes malignant- biopsy atypical areas

Answer 103

* Spitz Nevus * usually solitary - often mistaken for melanoma * light brown pigmented macule and contain smaller dark macules * appears this way due to distribution of melanocytes * rarely becomes malignant - excise atypical lesions

Answer 104

Mongolian Spots * collection of spindle melanocytes * LS, scalp, single lesion common * blue-gray macular lesions * 99-100% of asains and native americans

Answer 105

Nevus of Ota/Ito * Ota: 1st & 2nd trigeminal n.; sometimes bilateral * Ito: shoulder, upper arm, back; usually unilateral * mixture of blue/brown hyperpigmentation * asians * rarely deveop to melanoma

Answer 106

Hemangioma * proliferation of the endothelial lining of the blood vessels * proliferation in early months- 3 to 9 months, regression 2-6 years with resolution by 10. * soft, bright red to purple and compressible; can occur anywhere- more common on the head and neck * can also be seen on other organs including the liver, GI tract, spleen, lung, etc * early proliferation w/ spontaneous involution * Tx: * propanolol topical (beta-blocker) * steroids * laser therapy

Answer 107

Pyogenic Granuloma * S/s: * also called lobular capillary hemangioma * can be bright red or violaceous * smooth surface without erosions or crusts * lesions form after minor injury, in pregnancy and sometimes with viral infections triggers angiogenesis * Tx: * surgical excision vs electrodesiccation

Answer 108

Glomus Tumor * S/s: * tender smooth muscle found in nail beds, volar aspects of hands/feet, skin of ears, center of face * painful attack in cold * Patho: * arises from glomulus body- in dermal layer of skin and helps control body temp through AV shunting * Tx: * excision

Answer 109

Port-Wine Stain * S/s: * red, violaceous irregularly shaped macule * usually follow a dermatomal pattern and are unilateral * trigeminal distribution is common * as the patient ages, will develop disfiguring papules or nodules * Patho: * capillary malformation * Sturge–Weber syndrome: (neurological face) * Klippel–Trénaunay–Weber syndrome: blood vessel abnormality * Tx: * laser therapy

Answer 110

Spider Angioma * S/s: * dilated capiallaries * Dx: * face, forearms, hands * Tx: * laser

Answer 111

Cherry Angioma * S/s: * dilated capillaries * Patho: * benign * Dx: * common by age 30 * location- trunk * Tx: * laser if symtomatic

Answer 112

Epidermoid Cyst * S/s: * resembles a blackhead * cyst is filled with keratin and lipid-rich debris (most common cutaneous cyst) * might report cream-colored, foul smelling, cheese-like discharge * Patho: * forms in epithelium of hair follicle * Tx: * excision if symtomatic

Answer 113

Milium (Milia) * Epidermal cysts (more superficial than epidermoid cysts * Patho: * Contain keratin * Dx: * Occurs at any age * Common in infants * Eyelids, cheeks, and forehead * Tx: * Incision and expression

Answer 114

Seborrheic Keratosis * S/s: * macular, papular, verrucous * white to brown to black * "stuck on" appearance * Tx: * excise if symtomatic

Answer 115

Lipoma * S/s: * "fatty tumor" * round, soft, mobile, lobulated * Tx: * excision if symtomatic

Answer 116

Dermatofibroma * S/s: * dome shaped, 3-10 mm in diameter * sometimes can see depression * color ranges from skin tone to brown or black * Patho: * usually on extremeties * Tx: * not indicated

Answer 117

Neurofibromatosis * S/s: * papules to nodules * flesh colored to brown * cafe-au-lait spots * Type-1 skin lesions; bony abnormalities; occasional brain or cranial nerve tumors * Patho: * Neurofibromatosis- genetic disorder of the nervous system affecting the growth and development of nerve cell tissue * autosomal dominant * Von Recklinghausen disease

Answer 118

Cafe-au-lait Spots * S/s: * light brown to dark brown- name comes from :coffee with milk” * tan to dark brown irregular macules/patches and uniformly pigmented * Patho: * disease affects melanocytes- increased melanin content * Dx: * \>90% present in 1st year of life * Fanconi anemia- bone marrow failure syndrom * Tuberous sclerosis- genetic disorder affecting cellular differentiation, proliferation and migration in early development

Answer 119

Hypertrophic Scars and Keloids * S/s: * excessive scar formation * hypertrophic scars- elevated and confined to site of injury * keloid- clawlike and nodular * Tx: * surgical excision * intralesional cortisone injections (if small) * silicone cream or gel * prevention- avoid ear piercing, tight clothing

Answer 120

Skin Tags * S/s: * lesions can be round or oval and vary in color from flesh colored and pink to brown or black; pedunculated; can get a large as 10cm * intertriginous areas- axillae, below the breasts, groin, neck, eyelids, Acanthosis Nigricans (AN) * Tx: * snip w/ scissors * electrodesiccation * cryosurgery

Answer 121

Acanthosis Nigricans (AN) * S/s: * velvety thickening hyperpigmentation of skin * Classification/Types: * Hereditary Benign AN- no evidence of endocrine disorder * Benign AN- Insulin resistance endocrine disorders * Pseudo- AN- Associated with obesity * Drug-induced AN- nicotinic acid Malignant AN- adenocarcinoma GI or GU tract * Dx: * **Type II DM**, hyperandreogenic states, acromegaly / gigantism, Cushing disease, Addison disease * Tx: * treat underlying disease * topical keratolytics: Tretinoin, ammonium lactate, hydroquinone

Answer 122

Melasma * S/s: * symmetrical, hyperpigmented patches * punctate or pinpoint areas within the patches * irregular borders * face: cheeks, upper lid, chin, forehead; mid-upper chest; extensor forearms * Patho: * increased melanin production * Tx: * sunscreen, limit sun exposure * meds: * Hydroxyquinone (HQ)- affects pathway in melanin synthesis * Azelaic acid * topical retinoids

Answer 123

Vitiligo * S/s: * macules ranging in size and distribution: focal, generalized, segmental * white or gray hair * Patho: * destruction of melanocytes (autoimmune, neurogenic, self-destruction) * Tx: * no treatment, just management

Answer 124

Albinism * S/s: * snow white, cream white, light tan * purple eyes * Tx: * none, just management

Answer 125

* S/s: * moles * melanocytic nevus cells: epidermis, dermis and rarely subcutaneous * Patho: * common * caucasians * sun exposure, genetic * \># NMN = \> risk melanoma * early childhood -\> plateau in young adult -\> most disappear after 60

Answer 126

* Asymmetry - folded in half, sides are not similar * Border- irregular * Color - varied * Diameter - \>6mm suspicious * Evolution - how long present and how quickly changing

Answer 127

Actinic Keratosis (precursor to squamos cell CA) * S/s: * "solar keratosis" * small crusty bump * colors vary, can be itchy and bleed * scaling with erythematous base * Dx: * skin biopsy * Tx: * cryosurgery * curettage vs shave excision * meds: * 5-FU, 5-fluorouracil (Efudex) .5% cream @ bedtime 4w * Imiquimod (Aldara) 5% cream @ bedtime 2w, break then repeat * Diclofenac (Solaraze) topical 3% gel bid 90d * facial peels; photodynamic therapy; ablative laser techniques

Answer 128

Squamous Cell Carcinoma - *in situ* (Bowden disease) * S/s: * sharply demarcated; scaling; macule, papule, or plaque; red or pink * soliary or multiple * non-steroid resonsive dermatitis * glans penis/labia minora * Patho: * within intraepidermal layer * UV, HPV, ionizing radiation * Tx: * 5-Fluorouracil cream BID 4w * Imiquimod 5% cream qd 6w * cryosurgery * surgical excision - Mohs surgery

Answer 129

Squamous Cell Carcinoma * S/s: * "non-healing ulcer" * head and neck: lower lip, external ear, forehead and scalp * Patho: * 2nd most common skin cancer * malignant transformation of epidermal keratinocytes- tumor suppressor gene TP53 loses function * UVR exposure, radiation, chemicals, immuno, HPV? * Dx: * biopsy * staging: TNM- tumor size/location, node involvement, metastasis * Tx: * surgical excision +/- radiation/chemo

Answer 130

Nodual BCC * most common * papule or module * translucent or pearly * skin colored or reddish * smooth with telangiectasia (spider veins)

Answer 131

Ulcerating BCC * ulcer with rolled border * translucent, pearly * smooth w/ telangiectasia * **looks like moluskum (pearl on red center)**

Answer 132

Sclerosing BCC * small patch (morpheaform) * ill defined * skin-colored or whitish * infiltrating- can progress to nodular or ulcerating

Answer 133

Superficial BCC * thin plaques * pink or red * threadlike border * telangiectasia

Answer 134

Pigmented BCC * brown to blue or black * smooth, glistening surface * hard or firm * round or oval shape w/ central depression

Answer 135

Melanoma (Dysplastic Nevi- mole that changes) * S/s: * atypical moles (ABC's) * Patho: * melanocyte neoplasm * genetics, UV, sunburn * radial then vertical growth * Dx: * family history * gene markers (CDKN2a), BRAF, Mc1R * Tx: * surgical excision **+/- sentinal lymph node biopsy** * must do TOTAL BODY exam * chemo if advanced

Answer 136

Dysplastic Nevi ("fried egg") * atypical nodes (ABC's) * central papule could be the beginning of the transformation to melanoma

Answer 137

Superficial Spreading Melanoma * S/s: * color changes, enlargement, ulceration * many arise from dysplastic nevus

Answer 138

Nodular Melanoma * S/s: * DO NOT follow ABC's- usually symmetrical w/ regular borders and one color * firm to touch * dark brown or black * can be amelanotic (do not make melanin) * Patho: * quick growing- anything growing over 1m should be biopsied

Answer 139

Lentigo Maligna Melanoma (melanoma *in situ*) * S/s: * flat macule, varying in size, uniform shape * speckled brown and black hues * Patho: * **slow growing**

Answer 140

Acral Lentinginous Melanoma * S/s: * **Hutchinson sign**- pigment spread to the proximal or lateral nail folds * palms, soles, subungal * Tx: * surgical excision +/- sentinal lymph node biopsy * chemo for advanced disease

Answer 141

* Characteristics * most common skin cancer * no known precursor lesions * multiple variants and presentations * sun-exposed areas * slow growing * _rarely metastasize_ * isolated lesions, **waxy papules w/ central depression**, pearly appearance, erosion/ulceration, bleeding, crusting, rolled border * Tx: * excision- Mohs for danger spots * topical meds * 5-fluorouracil bid 6w * Imiquimod 5% 5x/w for 6w

Answer 142

Verruca Vulgaris (Common Warts - HPV 1,2,4) "dome/mushroom-shaped" * S/s: * firm papules 1-10mm * hyperderatotic- vegetation/cauliflower like * red, brown, black punctate dots (thrombosed capillaries) * Patho: * central papule could be the beginning of the transformation to melanoma

Answer 143

Verruca Plantaris ("seed warts") * can see warts "kissing"

Answer 144

Verruca Planae ("flat warts") * flesh or skin colored to light brown * smooth or slightly elevated, flat topped papules * common on the face, beard area, dorsum of the hands and shins

Answer 145

Periungual Warts

Answer 146

Condyloma Accuminatum (genital warts) * Presentation can vary from sessile, flesh colored papules to cauliflower-floret lesions which is really condyloma accuminatum

Answer 147

Verrucae: Molluscum Contagiosum (umbilicated papules) * S/s: * 2-5mm flesh colored dome-shaped papules w/ central umbilication * +/- pruritis * Patho: * sexually transmitted * Tx: * supportive * Imiquimod (Aldara) 5% cream * curettage- scrape to remove * cryotherapy (liquid nitrogen) * laser

Answer 148

Viral Exanthem ("sandpaper rash") includes roseola, erythema infectionsum, hand-foot-mouth, rubeola, rubella * rash appears suddenly and affects several areas of skin simultaneously * exanthema Greek for "a breaking out" * erythematous macules and papules

Answer 149

Roseola * S/s: * high fever +/- febrile seizures * pinkish/red macules or papules * **Nagayama spots** (on soft palate) * cough, diarrhea, meningitis, encphalitis * Patho: * human herpes virus 6 (HHV-6) * "sixth disease" * illness 3-7 days

Answer 150

Erythema Infectiosum ("slapped cheek") * S/s: * lacy or reticulated rash * low-grade fever * adenopathy * Patho: * human parvovirus * fifth disease

Answer 151

Hand-Foot-Mouth Disease * S/s: * painful mouth sores, **rash on hands & feet** * prodrome fever, malaise, sore throat * DDX: * syphilis in adults * Tx" * "magic mouthwash" - steroid, malox (malox + benedryl OTC)

Answer 152

Rubeola * S/s: * fever, cough, coryza, conjuntivis, coryza, conjunctivitis * Koplik spots- bluish white spots on mucusal surface of mouth * Patho: * RNA virus: morbillivirus * self limited

Answer 153

Rubella (German measles) * S/s: * prodrome: anorexia, malaise, conjunctivitis, HA, low fever, upper respiratory infection * **Forchheimer spots**- petechiae on soft palate * pink or red macules and papules * occipital, postauricular lymphadenopathy * Patho: * _teratogenic_

Answer 154

Herpes Labialis * S/s: * papules to vesicles * erythema * lymphadenopathy * pain, burning, tingling * trigeminal neuralgia * Tx (oral and topical antivirals): * topical: * Acyclovir (Zovirax) 5% ointment 6x/d * Penciclovir (Denavir) 1% cream * oral: * Valacyclovir (Valtrex) * Famciclovir (Famvir) * Acyclovir (Zovirax)

Answer 155

Herpetic Gingivostomatitis * S/s: * children 6m - 5y * abrupt onset * high temp \>102 * anorexis * gingivitis * vesicular lesions: oral mucosa, tongue, lips * lymphadenopathy

Answer 156

Varicella ("dew drops on a rose petal") * S/s: * vesicle w/ surrounding erythema * Patho: * self limited * Acyclovir 800mg q6h 5d

Answer 157

Herpes Zoster * S/s: * prodrome: pain, tenderness, paresthesia * active: erythema, vesicles * postherpetic neuralgia * flu-like symptoms

Answer 158

Herpes Zoster Ophthamic * nasocilliary involvement * V-1 opthalmic branch of trigeminal nerve * Hutchinson sign- vesicles on tip of nose * uveitis, keratitis, retinitis * Tx: * Valacyclovir (Valtrex) 1g po q8h 7d * Famciclovir (Famvir) * Acyclovir (Zovirax) * **must be given withing 48-72h of first symptom**

Answer 159

Morbilliform (Exanthematous) Drug Reaction ("head-to-toe" rash)

Answer 160

Pustular Eruptions

Answer 161

Fixed Drug Reaction

Answer 162

Drug Hypersensitivity Syndrome

Answer 163

Adverse Cutaneous Drug Reaction Related Necrosis

Answer 164

Uticaria (Hives)

Answer 165

Physical Causes * Dermatographism- wheals from scratching * Delayed pressure ulcer- 30m to 12hr * Cold urticaria- within minutes of exposure

Answer 166

Angioedema

Answer 167

Erythema Multiforme ("Targe lesions")

Answer 168

Erythema Multiforme MINOR * 1st herpes rash, then target rash

Answer 169

Erythema Multiforme MAJOR * bulla followed by peeling skin- tx as burn patient

Answer 170

Steven-Johnsons Syndrome / Toxic Epidermal Necrolysis

Answer 171

Stevens-Johnson Syndrome (affects MUCOSA)

Answer 172

Toxic Epidermal Necrolysis (affects SKIN)

Answer 173

Bullous Pemphigoid

Answer 174

Pemphigus ## Footnote (Nikolsky sign - disruption of normal appearing epidermis by rubbing skin = painful erosions)

Answer 175

Vegetating Pemphigus Vulgaris

Answer 176

Pemphigus Foliaceus

Answer 177

Dermatitis Herpetiformis | (Gluten-sensitive enteropathy)

Answer 178

Topicals * Benzoyl peroxide * Topical abx (anti-inflammatory): * Clindamycin * Erythromycin - resistance issues * Retinoids: * Tretinoin (Retin A) * Adapalene (OTC) * Tazarotene (CAT X pregnancy) * Addt'l * Azelaic Acid- abx P. acnes and S. epidermidis, antiinflam * Dapsone * Salicyclic Acid (not first-line tx)

Answer 179

Oral Abx in conjunction with Topicals * Tetracyclines * tetracycline * doxycycline * minocycline * contraindicated * under age 8 * pregnant women

Answer 180

Isotretinoin * vitamin A derivative * s/e: * depression * dryness * inflammation of lips * hypertriglyceridemia * alopecia * muscle & joint pain * photosensitivity

Answer 181

* combined oral contraceptives * Ethinyl estadiol + * norgestimate * norethindrone acetate + ferrous fumarate * drosperinone +/- levomefolate * Spironolactone * women w/ androgenic acne * corticosteroids * prednisone .5 1mg/kg/d tapered for ance fulminans

Answer 182

* mild to moderate: * Metronidazole (Metrogel) topical facial (not vaginal) **drug of choice** * others: * Azelaic acid (Azelex): 1st line, s/e, $$$ * Sulfacetamide 10% sulfur 5% (Sulfacet): limited, odor, no sulfas * Ivermectin (Soolantra): kills mites, $$$ * moderate to severe: * topical metronidazole + doxycycline ld (Oracea 40mg qd/20mg bid) * Phymatuos- Isotretinoin * Ocular- topical metronidazole on eyelids only

Answer 183

immunologic disease of keatinocyte hyperproliferation * Topicals: * corticosteroids (most to least potent): NOT LONG TERM * Betamethasone dipropionate .05% ointment * Betamethasone dipropionate .05% cream/gel * Betamethasone valerate .1% ointment * Betamethasone dipropionate .05% lotion * Betamethasone valerate .05% ceam and ointment * Hydrocortisone .5, 1, 2, 2.5% cream, lotion, spray, ointment * Vitamin D analogs (slower onset, longer remission) * Calcipotriene (Dovonex) * Calcipotriene/betamethasone dip (Enstilar, Taclonex) * Coal tar * Goeckerman regimen: coal tar + UV light * Others: * Tazarotene (best with topical steroid) * Salicyclic acid (assists in penetration) NO PEDS, salicylism if \>20% body * Systemics: * Methotrexate- immunosuppressant * Cyclosporine (Gengraf, Neoral, Sandimmune)- immunosuppressant * Acetretin (Soriatane)- no immune suppress, retinoid-like, TERATOGEN, NO ALCOHOL * Biologics: * monoclone abx that downregulate immune system (serious s/e) * adalimumab (Humira) * -umab's

Dermatology Flashcards

(209 cards)