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Current Medical Dx/Tx Textbook > Dermatology > Flashcards

Dermatology Flashcards

(82 cards)

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1
Q

Ointment vs cream

A

Ointment more potent

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2
Q

How much topical steroid is needed to cover the entire body surface of an adult

A

20-30g

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3
Q

Examples of topical steroids

A

Hydrocortisone, triamcinolone, betamethasone

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4
Q

Emolients

A

Restore the epidermis by promoting keratinocyte differentiation and production of innate antimicrobials in skin
Most effective when applied to wet skin

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5
Q

Examples of emolients

A

Petrolatum, mineral oil, aquaphor, cetaphil, eucerin

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6
Q

Topical antipruritics

A

Lotions that contain 0.5% each of camphor + menthol; or pramoxine Hcl 1%

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7
Q

Typical H1 blocker for pruritus due to histamine

A

Hydroxzine 25-50mg nightly

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8
Q

Complications of topical treatment

A

Allergy (usually neomycin and bacitracin), irritations, acne like lesions/atrophic striae

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9
Q

Melanocytic nevi

A

Normal moles

Small <6mm macule or papule with well defined border and homogeneous beige or pink to dark brown pigment

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10
Q

Atypical mole

A

> 6mm, ill-defined, irregular border and irregularly distributed pigmentation

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11
Q

Blue nevi

A

Small, slightly elevated, blue-black lesions that favor the dorsal hands
Common in Asians
Malignant is rare

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12
Q

Seborrheic keratosis

A

Benign papules and plaques, beige to brown 3-20mm in diameter
Appear stuck or pasted on skin
No treatment needed
May be mistaken for melanoma

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13
Q

Malignant melanoma

A

May be flat or raised
Borders irregular
Should be suspected in any pigmented skin lesion with recent change in appearance
Leading cause of death due to skin disease

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14
Q

Ominous signs of melanoma

A

Bleeding and ulceration

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15
Q

Atopic dermatitis

A

Pruritic, xerotic, exudative, lichenified eruption on face, neck, upper trunk, wrists, hands, antecubital folds
Also known as eczema

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16
Q

How is seborrheic dermatitis different from atopic dermatitis

A

Less pruritic, frequent scalp and central face involvement, greasy and scaly lesions, quick response to therapy

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17
Q

Tx of atopic dermatitis

A

Do not bathe more than once daily, use soap sparingly, pat dry and immediately cover with emollient or steroid as needed
Begin with triamcinolone then taper to hydrocortisone
Bedtime dose of hydroxyzine or diphenhydramine may be helpful
Systemic steroids if severe

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18
Q

Lichen simplex chronicus

A

Chronic itching, lichenified lesions with exaggerated skin lines overlying a thickened, well-circumscribed, scaly plaque
Scratch-itch cycle hard to disrupt

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19
Q

Tx of lichen simplex chronicus

A

Superpotent topical steroids BID for several weeks

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20
Q

Psoriasis

A

Silvery scales on bright red, well-demarcated plaques usually on knees, elbows and scalp
May have nail pitting

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21
Q

Tx of mild psoriasis

A

NEVER use systemic steroids
High potency topical steroids for limited disease
For numerous small plaques, phototherapy is best
Vitamin D anologs BID (calcitriol)

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22
Q

Tx of generalized psoriasis

A 
>30% body surface
UVB three times weekly 
Methotrexate 25mg once weekly
Acitretin, synthetic retinoid
Cyclosporine
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23
Q

Pityriasis Rosea

A

Oval, fawn-colored, scaly eruption following cleavage lines of trunk
Herald patch precedes eruption by 1-2 weeks
Occasional pruritus
Center of lesion have cigarere paper appearance
Usually no treatment required

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24
Q

Differentials for pityriasis rosea

A

Serologic testing for syphilis, tinea corporis, seborrheic dermatitis, tinea versicolor

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25
Tinea versicolor
Multiple, small to medium sized well-demarcated hypopigmented macules on the back of a tanned individual with white skin
26
Seborrheic dermatitis
Dry scales and underlying erythema | Acute or chronic
27
Tx for seborrheic dermatitis of the scalp
Shampoos with zinc pyrithione or selenium used daily or ketoconazole shampoo 2 times weekly
28
Tx for seborrheic dermatitis of the face
Mild steroid topically; add ketoconazole cream if needed
29
Diagnostic for fungal infections
10% KOH prep
30
Tx of fungal infections
Topical unless nails or hair follicles | Itraconazole, fluconazole and terbinafine best (can all cause elevation of LFT)
31
Tinea corporis
Ring shaped lesions on exposed areas of body Trichophyton rubrum most common pathogen Advancing scaly border and central clearing
32
Tx of tinea corporis
Topical antifungal | Continue treatment for 1-2 weeks after clinical clearing
33
Tinea cruris
Jock itch | Peripherally spreading, sharply demarcated, centrally clearing erythematous lesions
34
Tinea versicolor
Velvety, tan, pink or white macules that do not tan with sun exposure Superficial yeast infection of skin
35
Tx of tinea versicolor
Selenium sulfide lotion for 7 days | 2 doses of oral fluconazole 14 days apart first line treatment
36
Cutaneous lupus erythematous
Localized violaceous red plaques, usually on face and scalp Scaling, follicular plugging, atrophy, dyspigmentation Photosensitivity If +ANA, ESR and widespread lesions, think SLE
37
Scales in DLE
Dry and thumbtack like
38
Tx of DLE
High potency steroid cream every night and covered with saran wrap Systemic if severe: antimaliarials, hydroxychloroquine, chloroquine, isotretinoin, thalidomide
39
Actinic keratoses
Small macules or papules, flesh colored, pink or slightly hyperpigmented that feel like sandpaper and are tender to palpation; occur on sun exposed body parts Pre-malignant -- may become squamous cell carcinomas
40
Rapid method of eradication of actinic keratoses
Liquid nitrogen
41
Intertrigo
due to macerating effect of heat, moisture and friction; especially likely in obese persons Body folds develop fissures, erythema, maceration, superficial denudation Keep area dry; hydrocortisone cream + clotrimazole cream effective
42
Herpetic whitlow
Large pustules superimposed on erythema and edema of the finger
43
Tx of herpes simplex
First attack: Acyclovir 400mg PO 5x daily or valacyclovir 1000mg PO 2x daily for 7-10 days Recurrent attacks: tx not necessary (only shortens the outbreak by 12-24 hours)
44
Suppressive doses for herpes prevention
Acyclovir 400mg PO BID, valacyclovir 500mg PO QD, or famciclovir 125-250mg PO BID
45
Herpes zoster
Dermatomal pain followed by grouped vesicular lesions Unilateral involvement Pain precedes eruption by 48 hours Clusters of umbilicated vesicles erupting in linear pattetn
46
Difference between poison ivy contact dermatitis and shingles
CD: Pruritic Shingles: Painful
47
Tx of shingles
Antiviral treatment within 72 hours of rash: oral acyclovir 800mg 5x a day or valacyclovir 1g TID all for 7 days Systemic steroids can be given for pain-3 week tapering course of prednisone Pain management: opioids, TCA, Gabapentin
48
Postherpetic neuralgia tx
Capsaicin ointment or lidocaine patch | TCA such as amitriptyline 25-75mg PO single nightly dose
49
Impetigo
Superficial blisters filled with purulent material that rupture easily Due to staph or strep Honey colored crusts May have bullae
50
tx of impetigo
First line: topical bacitracin, mupirocin, retapamulin If widespread: cephalexin 250mg PO 4x day, doxy 100mg BID If MRSA suspected: Doxy or Bactrim
51
Contact dermatitis
Erythema and edema, with pruritus, vesicles, bullae, weeping, crusting
52
Allergic vs irritant contact dermatitis
Irritant: only in area of direct contact Allergic: extends beyond area of direct contact
53
Most common causes of allergic contact dermatitis
Poison ivy or poison oak, bacitracin or neomycin, nickel, essential oils, adhesive tape
54
tx of allergic contact dermatitis
Calamine lotion or zinc oxide paste between wet dressings High potency topical steroids For severe: oral prednisone for 12-21 days
55
Comedones are the hallmark of
acne vulgaris | Severity varies from purely comedonal to papular or pustular inflammatory acne to cysts or nodules
56
Difference between rosacea and acne
Rosacea: papules and pustules in middle third of face but absence of truncal involvement and comedones; has flushing
57
Tx of comedonal acne
1. Topical retinoids: tretinoin; start with twice weekly (may cause irritation) 2. Benzoyl peroxide
58
Tx of papular or cystic inflammatory acne
3 week-3 month tx with topical or oral abx is mainsty - Topical Clindamycin and erythromycin + benzoyl peroxide for mild - Oral doxy (100mg BID), minocycline (50-100mg QD or BID), Bactrim DS BID, or cephalexin 500mg BID (taper the abx by 50% every 6-8 weeks once the skin is clear)
59
Tx of severe acne
Isotretinoin--vitamin A analog | -Absolutely CI in pregnancy (2 forms of contraception should be used)
60
Rosacea
Can occur due to topical steroids Flushing with papules and pustules may be present Triggers: stress, hot drinks, spicy food, sunlight, exercise, alcohol No comedones
61
Tx of rosacea
Metronidazole cream or gel Topical clindamycin If severe: oral minocycline or doxycycline
62
Folliculitis
Itching and burning in hairy areas | Pustule surrounding and including the hair follicle
63
Cause of folliculitis
Usually staph aureus | Pseudomonas if hot tub (systemic flu like sx may also occur)
64
Tx of rosacea
Metronidazole cream or gel Topical clindamycin If severe: oral minocycline or doxycycline
65
Tx of eosinophilic folliculitis
Topical potent steroids and oral antihistamines | Permtherine, azole or isotretinoin if severe
66
Cause of folliculitis
Usually staph aureus | Pseudomonas if hot tub (systemic flu like sx may also occur)
67
tx of pseudomonas folliculitis
Cipro 500mg BID 5 days
68
Tx of eosinophilic folliculitis
Topical potent steroids and oral antihistamines | Permtherine, azole or isotretinoin if severe
69
Mucocutaneous candidiasis
Superficial fungal infection More likely in pregnant women, DM, obesity or immunosuppressed Severe itching of vulva, anus or body folds Superficial, beefy red areas with or without satellite vesicopustules
70
Tx of nails candidiasis
Clotrimazole solution
71
Tx of skin candidiasis
Nystatin ointment and clotrimazole cream with hydrocortisone cream
72
Tx of urticaria/angioedema
``` H1 blockers (hydroxyzine) May add H2 blockers ```
73
Tx of balanitis candidiasis
Topical nystatin
74
Urticaria and angioedema
Acute <6 weeks or chronic >6 weeks Usually due to IgE Angioedema: swelling of lips, eyelids, palms, soles and genitalia
75
Cellulitis
Diffuse spreading infection of dermis and subcutaneous tissue on lower leg most commonly due to G+ cocci, especially group A beta hemolytic streptococci and Staph aureus Patient gets progressive chills, fever, and malaise as grows Leukocytosis present Differentials: DVT and necrotizing fasciitis
76
Erysipelas
Edematous (may pit), circumscribed, hot, erythematous area with raised advancing border; central face and lower extremities involved Superficial form of cellulitis due to beta hemolytic strep S/S: pain, malaise, chills, moderate fever Leukocytosis always present Death can occur if not treated- Tx: 7 days penicillin, dicloxacilin or first gen cephalosporin (clindamycin or erythromycin if allergic to penicillin)
77
Cellulitis
Diffuse spreading infection of dermis and subcutaneous tissue on lower leg most commonly due to G+ cocci, especially group A beta hemolytic streptococci and Staph aureus
78
Tx options for cellulitis
Cefazolin, clindamycin, dicloxacillin, cephelexin, doxycycline, bactrim
79
Molluscum contagiosum
Caused by poxvirus Single or multiple dome shaped, waxy papules 2-5mm in diameter that are umbilicated Spread by wet skin to skin Common in patients with AIDS
80
Basal cell carcinoma
Most common form of cancer Skin exposed areas Papule or nodule that may have a central scab or erosion with waxy/pearly Biopsy with shave or punch biopsy
81
Squamous cell carcinoma
Nonhealing ulcer or warty nodule May arise from actinic keratosis Preferred treatment is excision
82
Scabies tx
Permethrin 5% cream--single application from the neck down for 8-12 hours then washed off and repeated in 1 week Triamcinolone can be used for the itching

Current Medical Dx/Tx Textbook (3 decks)

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