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Clin med 1 > Dermatology-Peckham > Flashcards

Dermatology-Peckham Flashcards

1
Q

What is a common pediatric virus caused by the poxvirus?

A

Molluscum Contagiosum

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2
Q

Which population is commonly affected by molluscum contagiosum?

A

Young children, sexually active adults and immunosuppressed

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3
Q

Where does the molluscum contagiosum virus replicate?

A

Epithelial cells

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4
Q

Molluscum contagiosum is spread by

A

Direct contact, gym equipment, pools, and autoinoculation

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5
Q

The signs and symptoms of molluscum contagiosum include

A

Non itchy flesh colored dome shaped papule, present mostly over the face, trunk. extremities, and groin

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6
Q

What can be a differential diagnosis for molluscum contagiosum?

A

Warts and milia

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7
Q

The best way to treat molluscum contagiosum is how?

A

To avoid autoinoculation, topical cantharadin, and cryotherapy

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8
Q

What type of virus causes non genital verruca (warts)

A

HPV

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9
Q

What is another name for the common wart?

A

Veruca Vulgaris

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10
Q

A typical location for veruca vulgaris is

A

Hands, palms and periungul, nail folds

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11
Q

Clinical manifestations of veruca vulgaris include

A

Ages 5-20 most common, risk with frequent water exposure, can be >1cm, papules with GREYISH surface

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12
Q

The flat wart can also be called

A

Verruca Plana

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13
Q

Verruca plana commonly affects who?

A

Children and young adults

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14
Q

Clinical manifestations of verruca plana include

A

2-4mm flat topped FLESH COLORED papules grouped on the face, neck, wrists, hands

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15
Q

Another name for the plantar wart is what?

A

Verruca Plantaris

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16
Q

Verruca Plantaris classically appears where?

A

Soles of feet, mostly on pressure points (ball of foot or heel)

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17
Q

Which wart is known to group together and look like a “mosaic”?

A

Verruca Plantaris (plantar warts)

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18
Q

What are some common treatment options for warts (all kinds)

A

65% resolve w/in 2 years, cryotherapy, salicylic aid/cantharidin, occlusive dressing, intralesional injection of Bleomycin

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19
Q

Bleomycin

A

Last resort treatment, typically for someone who is immunocompromised and has multiple warts all over. Effective, not commonly used

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20
Q

What are dermatophyte infections?

A

Superficial fungi that germinate on the dead outer horny layer of skin

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21
Q

Demartophyte infections lead to what?

A

Epidermal scale (tinea pedis, tinea versicolor), thickened crumbly nails (onychomycosis), and hair loss (tinea capitis)

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22
Q

Where is tinea versicolor common?

A

In very humid climates

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23
Q

What can be some si/sx for tinea versicolor?

A

hypo or hyperpigmented macules that do not tan, typically asymptomatic

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24
Q

How can you diagnose tinea versicolor?

A

KOH scraping showing hyphae and spores (spaghetti and meatballs?)
Wood’s light flouresce an orange mustard color

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25
Q

What are the 3 treatment options for tinea versicolor?

A
  1. Daily Selenium sulfide shampoo for 15mins x 7days
  2. Topical Ketoconazole cream daily x 3 weeks
  3. Oral Ketoconazole 200mg qd x 2 weeks
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26
Q

Tinea Corporis is also known as?

A

Ringworm

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27
Q

What do the lesions look like in tinea corporis?

A

Annular with peripheral enlargement with central clearing. Scaly, “active border” asymmetric distribution face, trunk, extremities

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28
Q

Can tinea corporis be itchy?

A

Yes, can also be asymptomatic

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29
Q

How can you diagnose tinea corporis?

A

KOH scraping or fungal cultures. Can look similar to lyme dx

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30
Q

What is the treatment for tinea corporis (ringworm)?

A

Topical antifungals, Naftin or Ketoconazole bid x 2 weeks

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31
Q

Tinea Pedis is common in who?

A

Young men

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32
Q

What do the lesions look like in tinea pedis?

A

Scale and maceration in toe web spaces as well as “moccasin” type distribution on plantar surface. Distinct borders

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33
Q

Some si/sx for tinea pedis?

A

Itchy feet, inflammation and possibly fissures

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34
Q

Is a KOH scraping and fungal culture the proper diagnostic tools for tinea pedis?

A

Yes

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35
Q

The treatment for tinea pedis includes

A

Keep feet dry, Miconazole powder, Topical antifungals (Naftin, ketoconazole, lotrimine cream)
If severe: Lostrisone cream x1 week (steroid+antifungal)

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36
Q

What dx involves autoimmune destruction of melanocytes?

A

Vitiligo

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37
Q

What would be seen with Wood’s light when looking at Vitiligo?

A

Milky white appearance of the affected areas

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38
Q

How would you treat Vitiligo?

A

Avoid sun, Cosmetic cover-up, Tacrolimus/Pimcrolimus, Eximer laser

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39
Q

What is the incubation period for Varicella (chickenpox)

A

10-21 days

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40
Q

How can varicella be transmitted?

A

by direct contact with lesion AND respiratory droplets

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41
Q

When are individuals with varicella infectious?

A

For 4 days before and 5 days after appearance of exanthem

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42
Q

Some si/sx for varicella include

A

rash, malaise, low grade temp

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43
Q

What do the lesions look like in varicella?

A

Start as faint macules that develop into vesicular eruptions with “teardrop” vesicles on erythematous base

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44
Q

Where does chickenpox start?

A

On the scalp, face, trunk, then spreads to extremities. Can also appear or palms/soles

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45
Q

When are the lesions in varicella no longer infetious?

A

When they are crusted over

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46
Q

Which types of microbes can cause secondary complications to varicella?

A

Staph or Strep

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47
Q

Adults with chickenpox have a higher risk of what?

A

Pneumonia

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48
Q

What is an important diagnostic tool for varicella?

A

Tzank smear from the vesiles that show multinucleated giant cells

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49
Q

The treatment for varicella (children <13)

A

Oatmeal baths, calamine lotion, antihistamines

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50
Q

The treatment for varicella (Adults >13)

A

Oral acyclovir within 24 hours of onset for 5 days

Immunocompromised: IV acyclovir

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51
Q

Why should you avoid giving aspirin to children with varicella?

A

REYES SYNDROME (hepatitis and acute encephalopathy)

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52
Q

What is the reactivation of varicella zoster virus?

A

Herpes Zoster (shingles)

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53
Q

What does herpes zoster cause?

A

Inflammation in the dorsal root ganglion with hemorrhagic necrosis of nerve cells

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54
Q

The result of shingles is what?

A

Neuronal los and fibrosis

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55
Q

Is reoccurrence possible with herpes zoster?

A

Yes, 4% of cases with reoccur

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56
Q

The si/sx of herpes zoster include

A

Prodrome of pain followed by rash along the affected dermatome

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57
Q

Which dermatomes are affected themost in herpes zoster?

A

55% throacic, 20% cranial (trigeminal), 15% lumbar, 5% sacral

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58
Q

What are the lesions like in herpes zoster?

A

Classically UNILATERAL, papules and plaques of erythema that develop into vesicles, can become hemorrhagic or bullous

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59
Q

What is Hutchinson’s sign?

A

Herpes zoster lesions on the side and tip of the nose. Means opthalmic division of 5th cranial nerve is affected

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60
Q

What complications can happen when herpes zoster affects the opthalmic division of cranial nerve 5?

A

Retinal necrosis, glaucoma, optic neuritis

Send to ophthalmologist ASAP

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61
Q

The treatment for herpes zoster is

A

Antiviral therapy (w/in first 3-4 days), Valacyclovir or Famciclovir x 7 days, Prednisone, Domboro Solution, pain management

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62
Q

What is Domboro solution?

A

Can help with the “wetness” from the bursting vesicles in herpes zoster

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63
Q

How can you prevent herpes zoster?

A

Zostervax >60yo

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64
Q

What are some complications with herpes zoster?

A

Post herpetic neuralgia (pain continues past 1 mo)

Refer to neurologist for pain management

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65
Q

HSV-1 causes most cases of what?

A

Oro-labial herpes

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66
Q

HSV-2 causes most cases of what?

A

Genital herpes

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67
Q

Initial exposure of herpes is through what?

A

Direct contact with infected secretions (sexual, autoinoculation, vertical)

68
Q

Where does HSV-1 commonly reside?

A

Trigeminal ganglia

69
Q

Where does HSV-2 commonly reside?

A

Presacral ganglia

70
Q

What is the incubation period of herpes?

A

After exposed, 2-20 days

71
Q

Herpes simplex can be triggered by what?

A

Stress, menses, fever, infection, sunlight

72
Q

You have an increased risk of herpes simplex when..

A

Number of sexual partners increases, first intercourse is at a young age

73
Q

Si/sx of herpes simplex

A

Prodrome of fever, myalgias, malaise

74
Q

Orolabial herpes simplex si/sx

A

Tender grouped vesicles/blisters on an erythematous base, ulcerative, exudative “cold sore” lasting 1-2 weeks

75
Q

Genital herpes simplex si/sx

A

Grouped blisters and erosions on vagina, rectum or penis into new blisters over 1-2 weeks

76
Q

Herpetic Whitlow si/sx

A

Herpes simplex occurring on the fingers or periungually, tenderness and erythema with deep seated blisters

77
Q

What are some diagnostic tools for herpes simplex?

A

Fluorescent antibody tests/western blot to differentiate HSV-1, HSV-2, etc.
Tzanck smear for giant nucleated cells

78
Q

Primary treament for herpes simplex includes

A

Acyclovir 200mg 5x a day for 10 days

Valacyclovir 1mg bid for 10 days

79
Q

Suppressive treatment for herpes simplex includes (>9 cases a year)

A

Acyclovir 400mg bid

Valacyclovir 1gr daily

80
Q

Recurrent treatmetn for herpes simplex is

A

Acyclovir 400mg tid x 5 days

Valacyclovir 2mg bid x 1 day

81
Q

What is paronychia?

A

Inflammatory reaction involving the folds of the skin around the fingernail, can be acute or chronic

82
Q

What is the etiology of paronychia?

A

Acute and chronic begin with break in skin associated with trauma to cuticle (eponychium) or nail fold and maceration of proximal nail fold

83
Q

Acute paronychia

A

Aggressive manicure, nail biting. Usually Gram + staph aureus

84
Q

Chronic paronychia

A

Frequent handwashing. Usually pseudomonas aeruginose of candida albicans

85
Q

Acute paronychia symptoms?

A

Erythema, swelling, pain. Starts as red warm painful swelling around the nail. Can progress to formation of pus

86
Q

Chronic parynychia symptoms?

A

Swollen, erythematous tender without fluctuance. Can can become thickened with TRANSVERSE RIDGES, 6 or more weeks

87
Q

How can you diagnose paronychia?

A

KOH wet mounts may show hyphae (yeast with chronic paronychia), clinical history and exam!

88
Q

Treatment for acute paronychia includes what?

A

Warm water soaks 3-4/day. PO Augmentin 2gr x 5d, topical steroid cream

89
Q

Treament for chronic paronychia includes what?

A

Avoid moister , manicuring, etc. Warm soaks, topical steroid cream or antifungal Spectazole

90
Q

What is onychomycosis?

A

An infection of finger or toe nails by yeast or fungi

91
Q

Onychomycosis is common in who?

A

People with other nail issues (Downs syndrome, nail trauma, immunocomp., vascular insufficeincy)

92
Q

What do the lesions look like in onychomycosis?

A

Nail thickening and subungual hyperkeratosis (scale build up) nail distrophy or onycholysis (nail plate elevation form nail bed)

93
Q

What are some diagnostic tools for onychomycosis?

A

KOH + fungal/yeast culture

94
Q

Treament for onychomycosis?

A

Non treatment acceptable, topical agnets generally ineffective

95
Q

What agents can be used for onychomycosis?

A

Topcial: Ciclopirox solution, Efinaconazole solution
Oral: Lamisil (check LFTs before and after) 250qd x 6-12 weeks

96
Q

Are eczema and dermatitis the same thing?

A

Yes the terms can be used interchangeably

97
Q

What are eczematous eruptions?

A

A family of superficial, pruritic, erythematous skin lesions that can be red, blistering, oozing, scaly, or thickened skin

98
Q

What is dermatitis?

A

Inflammation of the skin

99
Q

What does the term atopic mean?

A

A lifelong tendency to allergic conditions such as asthma and allergic rhinitis

100
Q

Manifestations of dermatitis/eczema

A

Dry, flaky skin appears over red, inflamed areas causing intense itching and burning

101
Q

What is the most common type of eczema?

A

Atopic Dermatitis

102
Q

What type of sensitivity rxn is atopic dermatitis?

A

Type 1 IgE mediated hypersensitivity rxn

103
Q

Si/sx of atopic dermatitis

A

“itch that rashes” presenting on flexor surfaces, neck, eyelids, face, dorsm of hands and feet

104
Q

How can you describe the lesions in atopic dermatitis?

A

Papules or plaques, edema, erosion with or without scales or crusting

105
Q

Atopic dermatitis is characterized by

A

Flexural lichenification (thickening of skin) with a personal or family Hx of allergic rhinitis, asthma, or atopic derm

106
Q

The intense itching in atopic derm is because of what?

A

Mast cells and basophils in the dermis releasing histamines. Itching can be triggered by many things

107
Q

Hyperkeratosis, acanthosis and excoriation are all common in what skin condition?

A

Atopic dermatitis

108
Q

Infantile atopic derm commonly presents where on the body?

A

Cheeks, chest, neck, extensor/flexor extremities. Tend to by symmetric

109
Q

Adolescent/Adult atopic derm commonly presents where?

A

Same areas as childhood plus eyelids, vulvar, scrotal areas

110
Q

What is different form adolescent/adult atopic derm and psoriasis?

A

The lichenified plaques less well demarcated than psoriasis (blends into skin better in AD)

111
Q

What are Dennie-Morgan lines?

A

Hyperlinear changes under the eyes that occur in atopic dermatitis

112
Q

What are some other clinical features associated with atopic dermatitis?

A

Persisnta xerosis (dry skin) and hyperlinear palmar creases

113
Q

What can be a differential diagnosis for atopic dermatitis?

A

Contact derm, scabies, and psoriasis

114
Q

What is the mainstay of treatment for atopic derm?

A

Topical steroids (applied for short periods of time and stopped when healed)

115
Q

What do the topical steroids do for atopic derm?

A

They ahve anti-inflammatory properties and are antimitotic (reduce scale build up)

116
Q

What is the difference between cream ointment foam or gel?

A

Cream is preferred but can dry skin out
Ointment and gels are more potent but greasy
Lotions gels foams useful for hairy areas

117
Q

What are some side effects when using topical steroids?

A

Skin atrophy/telangectasis, aceneform eruptions (face)

Tolerance can be built up, loss of efficacy

118
Q

What are two examples of very high potency topical steroids?

A
  1. Betamethasone dipropionate

2. Clobetasol

119
Q

What are two examples of medium potency topical steroids?

A
  1. Mometasone

2. Traimcinolone

120
Q

What are two examples of low potency topical steroids?

A
  1. Desonide

2. Hydrocortisone

121
Q

Which antihistamines can be used for atopic dermatitis?

A

Hydroxazine (sedating) and Cetirizine (less sedating)

122
Q

Which topical immunomodulators can be used for atopic dermatitis?

A

Tacrolimus and Pimecrolimus: Used as an addition/alternative to topical steroids. Good for long term use

123
Q

What are the non-steroidal options to treat atopic dermatitis?

A

Crisaborole (PDE-4 Inhib): Doesnt work as well as steroids can be used similarly to topical immunomodulators

124
Q

What biologics can be used for atopic dermatitis?

A

Dupilumab injections

125
Q

What PO antibiotics can be used for atopic derm?

A

Only use if evidence of @ndary bacterial staph infection

Cephalexin 500mg qid x 10d

126
Q

What are the si/sx of nummular eczema?

A

COIN SHAPED pruritic patches and plaques often occurring in clusters

127
Q

What type of eczema has lesions mainly found on the legs?

A

Nummular eczema

128
Q

How can you diagnose nummular eczema?

A

Clinical appearance and negative results of KOH

129
Q

What is the course of treatment for nummular eczema?

A

Triamcinolone cream, if severe use high potency Clobetasol +/- occlusion

130
Q

What is dyshydrosis?

A

Wet eczema

131
Q

What are the vesicles in dyshydrosis caused by?

A

Inflammation and foci of intercellular edema whcih becomes loculated in skin of the palm and soles

132
Q

Si/sx of dyshydrosis

A

Small vesicles appear on hands and feet associated with pruritis

133
Q

What is the treatment for dyshydrosis?

A

Cetaphil, emollient barrier creams, gloves and avoidance of irritants, Protopic and Elidel (longterm)

134
Q

What is Burow’s solution?

A

An antibacterial astringent used to treat dyshydrosis

135
Q

Which topical corticosteroids can be used to treat dyshydrosis?

A

Clobetasol ointment for an acute flare, Triamcinolone or Fluocinonide +/- occlusion

136
Q

Contact dermatitis is

A

Acute or chronic inflammatory rxns to substances that come in contact with the skin

137
Q

An example of irritant contact dermatitis is what?

A

Diaper rash

138
Q

An example of allergic contact dermatitis is what?

A

Poison ivy, nickel

139
Q

What are the si/sx of allergic contact dermatitis?

A

Linear pruritic rash at site of contact with itching and burning of affected areas

140
Q

Differential diagnosis for allergic contact dermatitis

A

Herpes Zoster (this is usually painful and unilateral following dermatomes)

141
Q

Treatment for allergic contact dermatitis

A

Remove offending agent, cool showers, Burow’s solution, potent topical steroid, systemic steroid (if severe enough)

142
Q

What is irritant contact dermatitis?

A

A direct toxic rxn to rubbing, friction or maceration or to exposure to a chemical or thermal agent

143
Q

What are some examples of irritants?

A

Alkalis, acids, soaps, detergents

144
Q

Diaper dermatitis

A

Eruptions that occur in the area covered by a diaper. Can affect persons of any age group

145
Q

What is the patho behind diaper dermatitis?

A

Over hydration of the skin, irritated by chafing, soaps, prolonged contact with urine and feces

146
Q

The treatment for diaper dermatitis includes

A

Zinc oxide ointment and frequent diaper changes, OTC hydrocortisone

147
Q

Diaper dermatitis differential diagnosis

A

If beefy red, C. albican is suspected, a topical antifungal Ketoconazole cream with Nystatin powder

148
Q

Who does perioral dermatitis occur in mostly?

A

Young women or children

149
Q

Si/sx of perioral dermatitis

A

Clustered papulopustules on erythematous bases, may have scales. Found around mouth

150
Q

Treatment of perioral dermatitis?

A

Topical antibiotics like Metronidazole or Erythromycin. Doxy or Minocyclin if severe enough

151
Q

What should be avoided in the treatment of perioral dermatitis?

A

Topical steroids

152
Q

What is an eczematous eruption seen on lower legs as a result of venous insufficiency?

A

Stasis dermatitis

153
Q

Stasis dermatitis is commonly seen in who?

A

Women with genetic predisposition to vericosities

154
Q

What is the patho behind stasis dermatitis?

A

Incompetent valves -> dec venous return -> increased hydrostatic pressure-> edema -> tissue hypoxia

155
Q

What can stasis dermatitis develop into?

A

Hyperpigmented changes with thickened skin and “woody” appearance, ulcers

156
Q

Elastic compression stockings are the best treatment for what?

A

Stasis dermatitis

157
Q

What other things can be used to treat stasis dermatitis?

A

Burrow’s solution, Desonide and Triamcinalone cream (topical steroids), Keflex for any 2ndary infections

158
Q

Which type of dermalytitis is thought to be caused by yeast P. Ovale?

A

Seborrheic dermatitis

159
Q

Si/sx of seborrheic dermatitis

A

Pruritis yellowish gray scaley macules with greasy look mostly on body folds, face, scalp

160
Q

What is the treatment for seborrheic dermatitis?

A

Zinc shampoo and Ketoconazole shampoo for the scalp

Low potency topical steroids (Desonide or Valisone cream) for the face

161
Q

Lichen simplex chronicus is also known as?

A

Neurodermatitis

162
Q

What is chronic, solitary, pruritic ezcematous eruption caused by repetitive rubbing and scratching?

A

Neurodermatitis

163
Q

What is the distribution of lichen simplex chronicus

A

nape of neck, vulvae, scrotum, wrists, extensor forearms, ankles, pretibial areas, groin

164
Q

Possible differential diagnosis for lichen simplex chronicus?

A

Tinea cruris and candidiasis, inverse psoriasis

165
Q

Treatments for lichen simplex chronicus

A

Int. strength topical steroids (Triamcinolone), occlusion, oral antihistamines, Protopic and Elidel

Clin med 1 (9 decks)

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