Dermatology -Jones Flashcards
(166 cards)
1
Q
Erysipelas effects which layers of the skin?
A
Upper dermis and superficial lymphatics
2
Q
Cellulitis effects which layers of the skin?
A
Deeper dermis and subcutaneous fat
3
Q
Abscesses effect which layers of the skin?
A
Upper and deeper dermis
4
Q
Which skin/soft tissue infection is observed in middle-aged and older adults?
A
Cellulitis
5
Q
Which microbe commonly causes erysipelas?
A
Beta-hemolytic streptococci
6
Q
Which microbe commonly causes cellulitis?
A
Beta-hemolytic strep and staphylococcus aureus including MRSA
7
Q
Which microbe commonly causes a skin abscess?
A
Staph aureus
8
Q
Acute onset of sx, clear demarcation-butterfly involvement of face are manifestations of what?
A
Erysipelas
9
Q
Localized sx developing over days, indolent course with less distinct borders is what?
A
Cellulitis
10
Q
Cellulitis can present with or without
A
Purulence (pus)
11
Q
Erysipelas is what
A
Nonpurulent (no pus)
12
Q
A skin abscess is a collection of
A
Pus within the dermis of subq space
13
Q
Furuncle
A
Skin abscess can develop via infection of hair follicle
14
Q
Carbuncle
A
Multiple hair follicle infection-leading to skin abscess
15
Q
Regional adenopathy and surrounding induration happen with what?
A
Skin abscess
16
Q
Diagnosis of erysipelas
A
Raised above level of surrounding skin, clear demarcations
17
Q
LRINEC Score
A
Laboratory Risk Indicator for Necrotizing Fasciitis
18
Q
A LRINEC score above what can rule in NF
A
6
19
Q
Some complications of soft tissue infections include
A
NF, Bacteremia and sepsis, osteomyelitis, septic joint
20
Q
What empiric therapy is used in a moderate purulent soft tissue infection? (Furuncle, carbuncle, abscess)
A
TMP/SMX (Bactrim) or Doxycycline
21
Q
What empiric therapy can be used for a severe purulent soft tissue infection?
A
Vancomycin, daptomycin, linezolid, televancin, or ceftaroline
22
Q
What is the proper treatment of a mild nonpurulent soft tissue infection? (Cellulitis, erysipelas)
A
Oral Rx! Like penicillin, cephalosporin, dicloxacillin, or clindamycin
23
Q
What is the treatment for a moderate nonpurulent soft tissue infection?
A
IV Rx! Penicillin, Ceftriaxone, cefazolin, or clindamycin
24
Q
How do you treat a severe nonpurulent soft tissue infection?
A
Surgical inspection/debriedment along with empiric Rx (Vanco plus piperacillin/tazobactam)
25
What is found most frequently in children ages 2-5?
Impetigo
26
What is primary impetigo?
Direct bacterial invasion of normal skin
27
What is secondary impetigo?
Infection is at the site of skin trauma
28
The most common form of impetigo
Non-bullous
29
Papules progress to vesicles surrounded by erythema in what?
Non-bullous impetigo
30
The papules in non-bullous impetigo form into what?
They breakdown and form thick golden crusts
31
Bullous impetigo
Vesicles enlarge to form flaccid bullae with clear fluid, leaves brown crust
32
What is ecthyma?
Ulcerative form of impetigo
33
"Punched-out" ulcers covered with yellow crusts are from what?
Ecthyma
34
What microbe causes impetigo?
Staph aureus, occasionally beta-hemolytic strep A
35
Microbe causing bullous impetigo
S.aureus strain that cleaves the superficial skin layer
36
Microbe causing ecthyma?
Group A beta-hemolytic strep pyogenes
37
What topical therapy is used for limited non-bullous and bullous impetigo?
Mupirocin and Retapamulin
38
What oral therapy is used for extensive impetigo and ecthyma?
Dicloxacillin and Cephalexin
39
What are hives, welts, and wheals?
Urticaria
40
Urticaria can also be accompanied by what?
Angioedema
41
What is the duration of acute urticaria?
Less than 6 weeks
42
Chronic urticaria
Recurrent, with signs an symptoms recurring most days of the week for more than 6 weeks
43
Round oval vary in size 1 cm up to several
Urticaria
44
The angioedema in urticaria effects what parts of the body?
Lips, extremities, genitals
45
What mediates the reaction in urticaria?
Cutaneous mast cells in the superficial dermis
46
What is released by cutaneous mast cells in urticaria?
Histamine (itching) and vasodilator mediators (swelling)
47
What are some medications used to treat urticaria?
```
H1 antihistamines (Diphenhydramine, chlopheniramine, hydroxyzine, cetirizine, loratadine, fexofenadine)
H2 antihistamines (Ranitidine, nizatidine, all end in -tidine)
Glucocorticoids (Prednisone)
```
48
A common benign soft-tissue neoplasm
Lipoma
49
What do lipomas consist of?
Mature fat cells, enclosed by a thin fibrous capsule
50
What is a benign soft tissue neoplasm that occurs mainly on the upper extremities and trunk?
Lipoma
51
A cutaneous cyst with a visible central punctum
Epidermal inclusion cyst
52
Skin colored dermal nodule
Epidermal inclusion cyst
53
Where are epidermal inclusion cysts commonly located
Face, scalp, neck, and trunk
54
What syndrome are epidermal inclusion cysts seen in?
Gardener Syndrome (hereditary condition)
55
Treatment of epidermal inclusion cyst?
Excision of cyst or incision and drainage
56
What's the most common cutaneous disorder affecting adolescents and young adults
Acne
57
Acne is a disease of
Pilosebaceous follicles
58
What are the 4 factors of acne?
1. Follicular hyperkeratinization
2. Increased sebum production
3. Cutibacterium acnes within the follicle
4. Inflammation
59
What happens in prepuberty to the sebaceous glands?
They enlarge and sebum production increases
60
Sebum provides a growth medium for?
C.acnes
61
What provides an anaerobic lipid-rich environment for bacteria in acne?
Microcomedones
62
What is another name for a white-head?
Closed comedone
63
What is another name for a black-head?
Open comedone
64
What leads to inflammatory papules and nodules in acne?
Proinflammatory lipids and keratin
65
What can cause infantile acne?
Elevated levels of androgens produced by immature adrenal glands in girls and immature adrenal glands and testes in boys
66
What serum level rises as puberty approaches?
DHEA-S levels
67
DHEA-S is related to acne how?
Onset of acne correlates with high levels of DHEA-S, high levels found in prepubertal girls with acne
68
What are some conditions where hyperandrogenism is seen?
PCOS, congenital adrenal hyperplasia, adrenal or ovarian tumors
69
What can worsen acne?
Repetitive mechanical trauma like scrubbing; ruptures comedones and promotes inflammatory lesions
70
Occlusion of pilosebaceous follicles leads to what?
Comedone formation
71
What are some drug-induced causes of acne?
Glucocorticoids, phenytoin, lithium, isoniazid, iodides, bromides, androgens
72
Can milk worsen acne?
Yes, increased levels of IGF are associated with consumption of milk. Hormones seem to exacerbate acne
73
Is insulin resistance related to acne?
It can stimulate increased androgen production and is associated with increased serum levels of IGF
74
What are the three classifications of acne?
1. Comedones acne (noninflammatory)
2. Inflammatory acne
3. Modular acne
75
What are some diagnostic tools for acne?
Endocrine fx, DHEA-S, total testosterone and free testosterone
76
What can the rapid onset of acne suggest?
An adrenal or ovarian tumor
77
What is the treatment for follicular hyperkeratinization? (5)
1. Topical retinoids
2. Oral retinoids
3. Azelaic acid
4. Salicylic acid
5. Hormonal therapies
78
What is the treatment for increased sebum production? (2)
1. Oral isotretinoin
| 2. Hormonal therapies
79
What is the treatment for c. Acnes proliferation? (3)
1. Benzoyl peroxide
2. Topical and oral antibiotics
3. Azelaic acid
80
What is the treament for inflammation in acne? (4)
1. Oral isotretinoin
2. Oral tetracyclines
3. Topical retinoids
4. Azelaic acid
81
Which acne symptoms can be treated with topical retinoids?
Follicular hyperkeratinization and inflammation
82
What are some examples of topical retinoids?
Retin-A, Tretin-X, Atralin, Avita, Refissa, REnova, Adapalene, Tazaotene
83
Which topical retinoid will you have to be careful of fish allergies?
Atralin
84
When should topical retinoids be taken?
Once daily at bedtime, watch for sun sensitivity!!!
85
What are some topical antimicrobials used to treat acne?
Benzoyl peroxide, Clindamycin, Erythromycin, Dapsone
86
What is important to note about topical combination products (used for acne)?
Used once daily, may bleach hair or clothing
87
What are some oral antibiotics used for acne?
Tetracycline, Doxycyline, Minocycline, Erythromycin, Trimethoprim-sulfamethoxazole, Azithromycin int. Dosing
88
What hormonal agents are used to control acne?
Combination oral contraceptives and Spironolactone
89
What oral retinoids are used to treat acne?
Isotretinoin, Accutane
90
What acne symptoms can be treated with oral retinoid?
Follicular hyperkeratinization, increased sebum production, and inflammation
91
How long can treatment take to work for acne?
4-6 weeks, may get worse before it gets better
92
What is a common skin disorder localized primarily to the central face?
Rosacea
93
What are the 4 main subtypes of rosacea?
1. Erythematotelangiectatic
2. Papulopustular
3. Phymatous
4. Ocular rosacea
94
Who is most likely to get rosacea?
Celtic and Northern European origin, adults over 30, and females (except for phymatous form)
95
What are some factors contributing to rosacea?
Vascular dysfx, UV damage, inflammatory rxns to cutaneous organisms, abnormalities in innate immunity
96
What are clinical features of erythematotelangiectatic rosacea?
Persistent central erythema, flushing, enlarged cutaneous blood vessels, roughness and scaling
97
Erythema congestivum
After an exacerbation of facial redness, return to baseline is slow (erythematotelangiectatic rosacea)
98
What are the clinical features of papulopustular rosacea?
Papules and pustules present in central face, can be mistaken for acne although there are no comedones
99
What are the clinical features of phymatous rosacea?
Exhibits tissue hypertrophy (thickened skin with irregular contours)
Commonly occurs in men, and involves the nose, chin, cheeks and forehead
100
What are the clinical features of ocular rosacea?
Occurs in more than 50% of patients with rosacea
| Conjunctival hyperemia, blepharitis, keratitis, lid margin teleangiectasias, abnormal tearing, chalazion, hordeolum
101
What are some exacerbating factors to rosacea?
Extreme temps, sun, hot beverages, spicy food, alcohol, exercise, irritation from topical patterns, emotions (anger, rage, embarrassment), drugs (nicotinic acid, vasodilators), skin barrier disruption
102
How do you diagnose rosacea?
Assessment is key, biopsies rarely indicated, no serologic studies useful
103
How to manage erythematotelangiectatic rosacea?
First line: behavioral changes, sun protection, decrease alcohol
Second line: laser and light-base therapy
Rx: Topical Brimonidine and Oxymetazoline
104
How to manage papulopustular rosacea?
Topical: metronidazole, azelaic acid, ivermectin
Oral: tetracycline, doxycycline, minocycline, isotretinoin
105
How to manage ocular rosacea?
Lid scrubs, warm compresses, topical antibiotics (Ilotycin ointment), referral to ophthalmologist
106
How to manage phymatous rosacea?
Oral isotretinoin in early disease and laser ablation/surgery in advanced disease
107
Which skin disease is characterized by well-demarcated erythematous plaques with silver scales?
Psoriasis
108
Prevalence of psoriasis tends to increase when?
When farther away from the equator
109
What are the two peaks of age onset for psoriasis?
20-39 and 50-69 years
110
What role does genetics play in psoriasis?
40% with family history have it, concordat among monozygotic twins
111
Predisposing risk factors to psoriasis include
Smoking, obesity (increased proinflammatory cytokines), drugs, infections, alcohol, vitamind D deficiency
112
Which drugs can be risk factors for psoriasis?
Beta blockers, lithium, antimalarials
113
What types of infections can be risk factors for psoriasis?
Poststrep flares and HIV
114
What is the pathophysiology behind psoriasis?
Complex immune-mediated disease
115
Typical clinical findings of psoriasis
Scaling, induration and erythema, hyperproliferation and abnormal differentiation of the epidermis, inflammatory cell infiltrates, vascular dilitation
116
What are the 6 clinical categories of psoriasis?
1. Chronic plaque
2. Guttate
3. Pustular
4. Erythrodermic
5. Inverse
6. Nail
117
What is the most common variant of psoriasis?
Chronic plaque
118
Chronic plaque manifestations
Symmetrically distributed, found on scalp, extensor elbows, knees, and gluteal cleft
May be asymptomatic but pruritis is common
119
Guttate psoriasis manifestations
Abrupt appearance of multiple small psoriatic papules and plaques (usually less than 1 cm)
Strong association with recent infection (strep)
120
Guttate psoriasis is most commonly found on what parts of the body?
Trunk and proximal extremities
121
Which type of psoriasis can have life-threatening complications?
Pustular psoriasis
122
What are the manifestations of pustular psoriasis?
Most severe variant (von Zumbusch type), acute onset wide-spread erythema, scaling and sheets of superficial pustules
123
What is pustular psoriasis associated with?
Malaise, fever, diarrhea, leukocytosis, hypocalcemia
124
Some possible causes of pustular psoriasis
Pregnancy, infection and withdrawal of glucocorticoids
125
Which type of psoriasis is characterized by generalized erythema and scaling from head to toe?
Erythrodermic psoriasis
126
Complications arising from erythrodermic psoriasis include
Related to loss of adequate barrier; electrolyte abnormalities
127
Which areas of the body are affected by inverse psoriasis?
Inguinal, perineal, genital, intergluteal, axillary, inframammary
128
Inverse psoriasis can sometimes be misdiagnosed as what?
Fungal or bacterial infection
129
Patients with psoriatic arthritis are more likely to have
Nail psoriasis
130
How to diagnose psoriasis
Family history, clinical exam, skin biopsy, no lab tests
131
What is the management for mild to moderate psoriasis?
Emollients, topical corticosteroids, vitamin D analogs, topical retinoids, anthralin, tacrolimus or pimecrolimus (for face)
132
Which topical corticosteroids can be used to treat mild to moderate psoriasis?
hydrocortisone, triamcinolone, fluocinonide, betamethasone diproprionate, clobetasol
133
Which vitamin D analogs can be used for mild to moderate psoriasis?
Calcipotriol, calcitrol, tacalcitol, tar-t
134
What is the management for moderate to severe psoriasis?
Phototherapy, systemic therapy, and biologics
135
What are the options of phototherapy to treat psoriasis?
UVB alone or in combo with topical tar
Narrow band UVB in suberythemogenic doses
Home phototherapy machines ($$$)
136
What systemic therapies are used to treat moderate to severe disease?
Methotrexate (folic acid antagonist)
Cyclosporine (t cell suppressor)
Apremilast (phosphodiesterase 4 inhibitor)
137
What biologics are used to treat moderate to severe psoriasis?
Entanercept, Infliximab, Adalimumab, Ustekinumab (-umab)
138
What is a chronic immune-mediated disorder that targets active hair follicles causing hair loss?
Alopecia
139
Commonly presents with discrete patches on the scalp
Alopecia
140
What is alopecia areata?
Discrete patches of hair loss
141
What is Alopecia totalis?
Hair loss of the entire scalp
142
What is alopecia universalis?
Hair loss of hate entire body
143
What is the pathophysiology behind alopecia?
T-cell mediated inflammation, inappropriate trigger of immune response against follicular antigens
144
Does alopecia lead to the destruction of the hair follicle?
No
145
What are some risk factors for alopecia?
Stress, drugs, infections, vitamin D definciency, genetics
146
Alopecia develops over a period of what?
2-3 weeks
147
What else can develop in patients with alopecia?
Nail abnormalities- onychorrhexis (longitudinal fissuring of nail plate)
148
What are some associated diseases with alopecia?
Lupus, vitiligo, atopic dermatitis, thyroid disease, allergic rhinitis, psoriasis, Down syndrome, polyglandular autoimmune syndrome type 1
149
50% of patients with alopecia will what?
Recover spontaneously in a year
150
What can be a diagnostic tool when looking for alopecia?
Exclamation point hair at margins, skin biopsy, and peribulbar lymphatic inflammatory infiltrates surrounding the follicles
151
For limited patchy hair loss what is the treatment?
Topical or intralesional corticosteroids (triamcinolone, betamethasone dipropionate)
152
For extensive alopecia, what is the treatment?
Topical immunotherapy (DPCP, SADBE, DNCB)
153
How is the topical immunotherapy dosed when treating extensive alopecia?
2% solution is applied first to desensitize the pt, 1-2 weeks later 0.01% applied to affected area 1/week titration get up to 2%
*DC after 6 mo if no improvement*
154
What can be some second-line treatment for alopecia?
Minoxidil, Anthralin, and phototherapy
155
Some examples of systemic therapies for alopecia
Oral glucocorticoids, sulfasalazine, methotrexate, cyclosporine, biologics
156
What is hidradenitis suppurativa?
Hidros: sweat, Aden: glands
| Chronic inflammatory skin condition, also known as acne inversa
157
What population tend have hidradenitis suppurativa more?
African American women
158
What is the patho behind hidradenitis suppurativa?
Plugging, rupture, and inflammation of follicle. Stimulates an immune response and leads to sinus tracts in the skin
159
What are the most common sites of HS?
Axillae, inguinal, inner thigh, perianal, inframammary, buttocks, scrotum, vulva
160
Hidradenitis suppurativa can be misdiagnosed as what?
Furunculosis or abscess
161
What are the 3 stages of hidradenitis suppurativa?
1: abscess formation
2: recurrent abscess formation with sinus tract formation and scarring
3: diffuse involvement multiple interconnected sinus tracts
162
What will be important to find in a clinical exam for a pt with hidradenitis suppurativa?
```
Typical lesions (inflamed nodules, sinus tracts) in the typical locations (axillae, groin) with relapse and chronicity
Skin biopsy not necessary
```
163
How can a pt prevent hidradenitis suppurativa?
Avoidance of skin trauma, stop smoking, weight management, chlorhexidine 1/week, emollients
164
How can a pt in Hurley stage 1 (stage 1 of HS) manage it?
Topical clindamycin, intralesional corticosteroid (triamcinolone), punch debridement to evacuate inflammation, topical resorcinol (peel)
165
What is the management for Hurley stage 2 of HS?
Oral tetracycline (many months), clindamycin and rifampin, oral retinoids, antiadrenergic therapies, punch biopsy of lesions
166
What is the management of Hurley stage 3 of HS?
TNF-alpha inhibitors once weekly, systemic glucocorticoids (prednisone), cyclosporine, surgery
