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CMN 572 Module 5 > Dermatology - Turnham Zoom > Flashcards

Dermatology - Turnham Zoom Flashcards

1
Q

ABCDE of skin moles/cancer

A 
A - Asymmetry
B - Borders (outer edges uneven)
C - Color (dark black/multiple colors)
D - Diameter (> 6mm)
E - Evolving (change in size, shape, color)
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2
Q

Benign Mole

A
  • < 6 mm
  • Macule/Papule
  • Well-defined border
  • Homogenous Color (brown or pink)
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3
Q

Atypical Nevi

A
  • > 6 mm
  • ill-defined border
  • Irregular Pigmentation
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4
Q

Blue Nevi

A
  • Asian ethnicity
  • “Old & Unchanged” = Benign
  • “New or Changed” = Eval IMMEDIATELY
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5
Q

Freckles

A
  • Hereditary
  • Increase with sun exposure
  • Fade without sun exposure
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6
Q

Lentigines

A
  • AKA Sun Spots

- Tx with topical agents/laser/cryotherapy

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7
Q

Seborrheic Keratosis

A
  • Benign
  • Beige/Brown
  • 3-20 mm in size
  • Velvety or thick/scaly papules/plaques
  • “Stuck-on” Appearance
  • Tx: Cryotherapy if irritated
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8
Q

Malignant Melanoma

A
  • Flat/Raised
  • Red, White, Blue, Black
  • Pigmented lesion w/recent change in appearance, suspect malignancy
  • Tumor thickness = Prognostic factor
  • Bleeding and ulceration are ominous signs
  • Larger # of moles, higher risk of Melanoma
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9
Q

Malignant Melanoma

Tumor Thickness Survival Rate %

A
  • < 1 mm = 95%
  • 1-2 mm = 80%
  • 2-4 mm = 55%
  • > 4 mm = 30%
  • Lymph node involvement: 62% @ 5 years, but if distant metastasis = 16%
  • Moh’s surgical excision, CLOSE F/U
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10
Q

Atopic Dermatitis

Characteristics

A
  • Involves face, neck, upper trunk, wrists, hands, antecubital/popliteal folds
  • Recurrent
  • Onset usually in childhood, rare when > 30 yo
  • Fam Hx of asthma, allergic rhinitis, or atopic dermatitis (Triangle of A)
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11
Q

Atopic Dermatitis

Diagnosis

A
  • Must have pruritis
  • Typically morphology and distribution (flexural lichenification (thickening), hand eczema, nipple eczema, eyelid eczema in adults)
  • Itching is key clinical feature
  • Scaly red plaques (no thickening like with Psoriasis)
  • If long-term with weeping, consider staph infection
  • INFRA-AURICULAR FISSURE is a caridnal sign of secondary infection
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12
Q

Atopic Dermatitis

Prevention

A
  • Avoid triggers or anything that irritates the skin
  • Limit baths when possible
  • Pat skin dry, no rubbing with towel
  • Use emollient creams/lotions
  • Cotton fabrics or synthetic wool may exacerbate s/s
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13
Q

Seborrheic Dermatitis

Characteristics

A
  • Less pruritic
  • More scalp/central face involvement
  • Greasy, scaly lesions that respond quickly to tx
  • Often co-exist with Psoriasis, but not always
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14
Q

Seborrheic Dermatitis

Treatment

A
  • Zinc Pyrithione or Selenium shampoos used daily
  • Ketoconazole shampoo (1% or 2%) used 2x weekly
  • Tar shampoo may be effective on scalp
  • Low potency corticosteroid creams (1-2.5%) can be used, BUT NOT ON FACE
  • If eyelids are involved (blepharitis) consider washing eyelids w/J&J baby shampoo daily
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15
Q

Psoriasis

Characteristics

A
  • Silvery scales on bright red well-demarcated plaque
  • Most common on knees, elbows, scalp
  • Pitting and Onycholysis (painless detachment of nail from nail bed)
  • May have associated joint pain (psoriatic arthritis)
    • These pts have higher risk for CV events, metabolic syndrome, and lymphoma
  • Limited disease if < 10% body surface area affected
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16
Q

Psoriasis

Treatment

A
  • High-ultra potent topical steroids 2-3x week MAX

- Numerous small plaques would respond best to photo therapy

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17
Q

Psoriasis

Complications - Koebner Phenomenon

A
  • Injury or irritation of normal skin results in plaque forming
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18
Q

Psoriasis

Complications - Flare/Exacerbation

A
  • Can be due to beta blocker, antimalarial medication, statins, or lithium
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19
Q

Psoriasis

Complications - Auspitz sign

A
  • Appearance of small bleeding pt after layers of scale are removed (pinpoint bleeding)
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20
Q

Pityriasis Rosea

Characteristics

A
  • Oval, fawn colored, scaly eruption that follows cleavage lines of the trunk “christmas tree pattern”
    • Up to 2cm diameter, crinkled/cigarette paper appearance, tiny scale on edged w/central clearing
  • Herald Patch (erythematous, 2 to 10 centimeter, round to oval scaly patch or plaque with a depressed center and raised border) occurs 1-2 wk prior to lesions
  • Occasional pruritus
  • 50% more common in females than males
  • Usually clears in 6-8 wks
  • If plantar, palmar, or mucous membrane lesions present screen for secondary syphillis
  • Treat symptoms only, UV therapy if necessary
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21
Q

Mycotic Infections of the Skin

A
  • Superficial
  • Tinea corporis/Tinea cruris
  • Dermatophytosis of the feet/hands
  • Tinea Unguium (Onychomycosis - Nail fungus causing thickened, brittle, crumbly, or ragged nails)
  • Tinea Versicolor
  • Confirmed by KOH prep, culture, biopsy
  • Corn starch can exacerbate s/s
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22
Q 
Tinea Corporis (Ringworm)
Characteristics
A
  • Ring shaped lesion
  • Scaly border
  • Central clearing
  • ANYWHERE on body
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23
Q 
Tinea Corporis (Ringworm)
Treatment
A
  • Topical antifungal (OTC 7-14 days after clearing)
  • Griseofulvin 350-500mg BID x4-6 weeks
  • NO CORTISONE
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24
Q 
Tinea Cruris (Jock Itch)
Characteristics
A
  • SIGNIFICANT ITCHING intertriginous areas + peripherally spreading, sharply demarcated, centrally clearing, erythematous lesion
  • Candidiasis bright red + satellite papules outside main border
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25
Q 
Tinea Cruris (Jock Itch)
Treatment
A
  • Miconazole (drying powder)
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26
Q 
Tinea Pedis (Athlete's Foot)
Characteristics
A
  • Asymptomatic scaling
  • Fissures or maceration between toes
  • Moccasin distribution
  • Itching, burning, stinging
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27
Q 
Tinea Pedis (Athlete's Foot)
Treatment
A
  • Miconazole (drying powder)

- Severe cases: Griseofulvin, Itraconazole, Terbinafine

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28
Q

Tinea Versicolor

Characteristics

A
  • VELVETY TAN or pink macules that DON’T TAN
  • Located on central upper trunk
  • High recurrence due to yeast
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29
Q

Tinea Versicolor

Treatment

A
  • Selenium Sulfide lotion: use on neck to waist daily then wash off after 5-15 mins
  • Use daily x7 days, then weekly x1 month, then 1x monthly
  • Ketoconazole shampoo: leave on for 5 mins then rinse
  • Ketoconazole PO: daily
  • SWEAT! No shower for 8-12 hrs
  • Fluconazole 300mg x1 dose then repeat in 14 days
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30
Q

Lupus

Characteristics

A
  • Localized violaceous (violet color) red plaques usually on face/scalp
  • Atrophy dyspigmentation & telangiectasia (small, widened blood vessels on the skin)
  • Photosensitivity (use > 50 SPF)
  • Butterfly (Malar) rash
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31
Q

Lupus

Triggers

A
  • HCTZ
  • CCB
  • H2 blockers
  • PPI
  • ACE-I
  • Terbinafine
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32
Q

Lupus

Treatment

A
  • High-potency corticosteroid cream EVERY PM with occlusive dressing (saran wrap)
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33
Q

Actinic Keratosis

Characteristics

A
  • Small (0.2-0.6mm), flesh colored
  • Pink macule/papule
  • Feels rough like sandpaper
  • TENDER WHEN FINGER BRUSHES OVER
  • CONSIDERED PRE-MALIGNANT
  • May progress to SCC
  • Sun exposed areas on fair skinned pt
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34
Q

Actinic Keratosis

Treatment

A
  • Cryotherapy

- May require more than 1 tx

35
Q

Pagets Disease

A
  • Scaling, red plaque on breast that resembles eczema

- Intraductal mammary carcinoma

36
Q

Bowen Disease

A
  • Abnormal growth of cells in epidermis (SCC in situ)
  • 0.5-3 cm slightly raised pink-red plaque
  • Rare to develop into SCC (3-5%)

Tx: Excision

37
Q

Herpes Simplex

HSV 1 vs HSV 2

A
  • HSV 1 = oral lesions
  • > 85% of adults will test +
  • Can be provoked by sun exp, surgery, stress, fever, infections
  • HSV 2 = genital herpes
38
Q

Herpes Simplex

Characteristics

A
  • Cluster of vesicles on erythematous base

- Usually near mouth (HSV1): stinging, burning before…then crusts over and heals x 1 week

39
Q

Herpes Simplex

Treatment

A
  • Acyclovir 400mg PO 5x/day x 7-10 days
  • Recurrent: Valtrex 500mg PO BID x3 days (initiate within 12-24 hours of first sign)
  • Genital: Valtrex 500mg PO BID x7-10 days
  • Suppressive tx: Valtrex 500mg QD x 1 year (up to 5-7 years) and wear condoms
40
Q

Herpes Zoster
(Shingles)
Characteristics

A
  • Follows a dermatome, pain along that nerve
  • Cluster/group of lesions
  • Unilateral - very unusual to have bilateral
  • Face or trunk
  • Immunosuppressed = more common
  • Pain precedes eruption by 48 hrs or more, and may persist after lesions clear (Post-herpetic Neuralgia)
  • Different from poison ivy/oak - those are pruritic, herpes is PAINFUL
  • HSV 1/2 does not usually follow dermatome
  • Refer to ophthalmology if lesions on the face
41
Q

Herpes Zoster

Treatment

A
  • Zostavax approved for > 50yo, but recommended > 60yo
    • Effective in preventing zoster even if hx of zoster/PHN present
  • Shingrix Vaccine
    • 2 doses: 1 now and repeat in 2-6 months
42
Q

Pompholyx Vesiculobullous

Hand Eczema, aka Dyshidrosis

A
  • Pruritic “tapioca” vesicles on palms, soles, and sides of fingers
  • Increase w/stress or allergy (nickel)
43
Q

Pompholyx Vesiculobullous
(Hand Eczema, aka Dyshidrosis)
Treatment

A
  • Topical Corticosteroids

- Avoid irritants and use emollient after washing hands

44
Q

Impetigo

Characteristics

A
  • Macules, vesicles, bullae, pustules, and HONEY COLORED CRUSTS
  • Contagious - staph or strep
  • Face and other “exposed” body parts
  • Soaks/scrubbing can be helpful
45
Q

Impetigo

Treatment

A
  • Topical agents
    • Bacitracin
    • Mupirocin (Bactroban)
  • Systemic abx for widespread infection
    • Keflex, Doxy
    • Bactrim for possible MRSA
46
Q

Contact Dermatitis

Characteristics

A
  • Contact w/allergen or chemical (soap, detergent, solvent, metal, antimicrobial, adhesive, latex, etc.)
  • Poison Ivy/Oak - Linear pattern
  • Tiny vesicles w/weepy to crusted lesions
  • Erythematous macules, papules, and vesicles
    • Look for patches where something may have rubbed against skin
47
Q

Contact Dermatitis

Treatment

A
  • Prompt and thorough washing of affected area with liquid dishwashing soap to remove oils (must be w/in 30 mins to decrease effects of irritant)
  • Barrier creams (Stokogard, Hydropel) - applied prior to exposure
  • Symptomatic tx w/monitoring for subsequent cellilitis
  • Treat itching w/Calamine, Benadryl, Vistaril
  • Zanfel (10 year half-life)
48
Q

Primary Irritant CD
(Diaper Dermatitis)
Characteristics

A
  • Caused by prolonged contact of skin with urine/feces
  • Beefy red
  • Sharply demarcated w/satellite lesions
49
Q

Primary Irritant CD
(Diaper Dermatitis)
Treatment

A
  • Zinc Oxide

- > 3 days = Nystatin

50
Q

Acne Vulgaris

Characteristics

A
  • From premenstrual to menopause (possible)

- Comedones are hallmark although papular, pustular, cysts, or nodules may be present

51
Q

Acne Vulgaris

Treatment

A
  • Educate pt that tx can take 6-8 wks to make difference
  • Avoid topical oils found in cosmetics & hair products
  • Retin A
  • Benzoyl Peroxide 2.5%, may be combined w/abx for topical application (Benzaclin, Bezamycin)
  • Papular/Cystic acne: if no response to 1st line, then consider oral abx such as Doxy or Minocycline
52
Q

Severe Acne

A
  • Accutane
    • Only for those who don’t respond to conv therapy
    • NEVER IN PREGNANCY - 2 serum neg pregnancy tests before tx, another neg test before each month prescription renewed
    • Only allowed to give one month at a time
    • 2 forms of effective birth control must be used, abstinence can be 1 of them
    • Informed consent form must be signed
53
Q

Rosacea

Characteristics

A
  • Common chronic disorder, affects the face
  • Erythema and telangiectasia (small red/purple clusters) w/tendency to flush easily
  • Hyperplasia of soft tissue of nose (rhinophyma)
  • Triggered by heat, hot/spicy foods, sunlight, exercise, alcohol, emotions, or hormones
  • Burning/stinging may accompany flushes
54
Q

Rosacea

Treatment

A
  • Broad spectrum sunscreen
  • Metronidazole gel 0.75% BID or 1% QD
  • Clindamycin gel
  • Oral meds if topicals are ineffective
  • Avoid harsh chemicals, find good moisturizer and gentle cleanser
  • Laser therapy if necessary to treat veins in the face
55
Q

Folliculitis

Characteristics

A
  • Itching/burning in hair follicles
  • Typically staph infections, may be more frequent in DM pt
  • Pseudofolliculitis - beard area (ingrown hair from shaving)
  • Hot tub folliculitis appears 1-4 days after being in hot tub/swimming pool from pseudomonas
    • Tender, pruritic pustular lesions
    • Fatigue/malaise, low grade fever
56
Q

Mucocutaneous Candidiasis
(Thrush)
Characteristics

A
  • Itching
  • Beefy red areas with or without satellite vesicopustules
  • White curd-like concretions on mucosa
  • Keep dry and open to air as much as possible
57
Q

Mucocutaneous Candidiasis
(Thrush)
Treatment

A
  • Diflucan (Fluconazole) 150mg PO X1 for perineal infections
  • Skin - Nystatin ointment or powder BID for at least 7 days
  • Balanitis - topical Nystatin
  • Mastitis - Nystatin or Clotrimazole cream
  • Oral - Nystatin swish and swallow or Diflucan
58
Q

Urticaria
(Hives)
Characteristics

A
  • Eruptions of wheals or hives

- Intense itching

59
Q

Urticaria
(Hives)
Treatment

A
  • Avoid alcohol, ASA, NSAIDs
  • Anti-histamine and consider adding H2 receptor agonist (Cimetidine), both BID X 7-14 days
  • Consider using Singular as well
60
Q

Angioedema

Characteristics

A
  • Non-pitting subcutaneous edema
  • Well demarcated
  • May be associated w/anaphylaxis if on face, hands, buttocks, genitalia, abdomen, laryngeal
  • Triggers: ACE-I, NSAIDs, ASA
  • ACE-I angioedema is NOT an allergic reaction, but is an accumulation of bradykinin and doesn’t respond to typical angioedema tx
  • ACE-I induces angioedema in AA 2-4X more often
61
Q

Erythema Multi-Forme (EMF)

Stevens Johnson Syndrome

A
  • Abrupt onset symmetrical erythematous skin lesions
  • Macular, papular, urticarial, bullous, or purpuric
  • “Target” lesions with central clearing, concentric erythematous rings (iris) lesions - RARE in drug associated erythema multiforme
  • Erythema Multiforme major is more likely found on trunk, Minor more likely on hands, palms, soles, mucous membranes
  • HSV is most common form of EMF
  • Meds are most common form of EMF
    • Sulfonamides, NSAIDs, Allopurinol, Anti-convulsants
62
Q

Erythema Multi-Forme (EMF)
Stevens Johnson Syndrome
Treatment

A
  • Stop offending drug
  • If > 30% of BSA is affected, consider burn unit/hospitalization
  • Monitor hydration and nutrition
63
Q

Erythema Migrans

A
  • Early stage of Lyme disease
  • Flat or slightly raised red lesion that expands with central clearing
  • “Bulls Eye”
  • Appears 3-30 days after tick bite
  • Accompanied by HA, stiff neck, joint pain, malaise, fatigue
64
Q

Cellulitis

Characteristics

A
  • Diffuse spreading erythema of localized tissue w/accompanying edema, warmth, and tenderness
  • Frequently in LE, may have pain, chills, and fever
  • Typically from group A beta-hemolytic strep and staph aureus.
65
Q

Cellulitis

Treatment

A
  • Oral antibiotics may be sufficient…
    HOWEVER
  • IV abx may be necessary
  • Be aware of possible MRSA risks including previous infections, personal hx of MRSA, or exposure to MRSA
66
Q

Warts

Characteristics

A
  • Plantar and genital are common, caused by HPVs

- Plantar warts will have tenderness when pressure is applied, anogenital warts itchy

67
Q

Warts

Prevention and Treatment

A
  • Prevention:
    • HPV vaccine between age 9-22 in both male/female
    • Girls may have Gardasil up to age 27, boys to age 22
    • If male having sex with male (MSM) or immunocompromised, they may have vaccine up to age 27
    • SE of vaccine are fever, pain, site reaction, fainting - Pt should be monitored for 15 mins post vaccine
  • Tx:
    • Cryotherapy
    • Keratolytic agents (40% salicyclic and occlusion)
    • Podophyllum resin for genital warts
68
Q

Molloscum Contagiosum

Characteristics

A
  • Single or multiple dome shaped, waxy papules, 2-5mm with umbilication
  • Initially firm, solid, flesh colored but change to soft, white, pearly gray and may have suppuration
  • Spread by wet skin to skin contact
  • Approx 13 months for remission

Tx:

  • Cryotherapy
  • Curretage
  • Light electrocautery
  • Should spontaneously resolve w/o treatment
69
Q

Mongolian Spot

A
  • Blue black macule found over lumbrosacral area in 90% of NA, AA, Asian descent infants
  • May be found over shoulder and back, may extend over buttocks
  • Lesions often fade as skin darkens
70
Q

Cafe au Lait Macule

A
  • Light brown oval macule (dark brown on brown/black skin)
  • May be found anywhere on body
  • Remains throughout lifetime, may develop more as pt ages
  • Presence of 6 or more over 1.5cm is major dx tool for neurofibromatosis type 1 (NF-1)
71
Q

NF-1 may develop:

A
  • Intracranial low-grade gliomas and hamartomas
  • Learning disabilities
  • Speech abnormalities
  • Seizure disorder
  • Macrocephaly
  • Cerebrovascular disease (Moyamoya Disease, rare)
  • HTN associated w/renal artery stenosis
  • Pheocromocytoma
  • Malignancies: Leukemia, Wilms’ Tumor
  • CNS Tumors: meningiomas, astrocytomas
72
Q

Hemangiomas

A
  • Red rubbery vascular plaque or nodule w/characteristic growth pattern
  • Max regression occurs by 9 yo
  • Immediate tx required for visual/airway obstruction or cardiac decompensation

Tx:

  • Propranolol PO tx of choice
  • Pulsed dye laser therapy is an option as well
73
Q

Basal Cell Carcinoma

A
  • Most common form of skin cancer
  • Sun exposed skin, more often in fair skinned pt
  • Papule or nodule that may have central scab or erosion
  • Slow growing, only 1-2 cm diameter after years of growth
  • Waxy, “pearly” appearance with vessels visible
  • Mostly on back/chest
74
Q

Basal Cell Carcinoma

Treatment

A
  • Punch or shave biopsy to confirm dx
  • Moh’s surgical excision has highest cure rate
  • BCC has high recurrence rate and pts should be evaluated annually
75
Q

Squamous Cell Carcinoma

A
  • Mostly on sun exposed areas of skin in fair skinned pt who sunburn easily and/or tan poorly
  • Small red, conical, hard nodule that occasionally ulcerate
  • Excision is tx of choice
  • F/U should be at least 2X/year
76
Q

Scabies

A
  • Generalized, severe itching accompanied by burrows, vesicles, and pustules (finger webs and wrist creases)
  • burrows are short, irregular marks, 2-3mm long and width of a hair
  • Head and neck are typically not affected
  • May be acquired through close physical contact for 15-20 min or contact w/infected bedding
  • Dx through skin/lesion scraping
77
Q

Scabies

Treatment

A
  • Pt, family, roommates, and BEDDING must be treated
  • Bedding/clothes placed in plastic bags for 14 days or laundered in high heat (>60*C)
  • Permethrin 5% cream is highly effective and safe, single application from neck down, leave in place for 8-12 hrs then rinse off and REPEAT IN 1 WEEK
  • Itching may continue for weeks after tx, Triamcinolone may help reduce itching
78
Q

Pediculosis (lice)

A
  • Itching, presence of nits or lice on skin or in hair
  • Head/body lice similar in appearance, 3-4mm long
  • Body lice may be found in seams of clothing

Tx:
- Permethrin 5% cream can be used as with scabies but this time to scalp - may use 1% for scalp alone if preferred

79
Q

Furuncle (Boil)

A
  • Deep seated infection/abscess that involves hair follicle as well as adjacent tissue
  • Usually staph aureus
  • Carbuncle - several furuncles that coalesce to form a deep mass or pocket w/multiple draining points
  • WBCs are seldom elevated w/localized infections, can culture the drainage for sensitivities
  • I&D recommended for all lesions
  • Oral abx often given
80
Q

Epidermal Inclusion Cyst

A
  • Firm, benign growth of upper portion of hair follicle
  • Overlying black comedone or punctum
  • May express foul smelling cheesy material
  • Inflamed lesions = I&D
81
Q

Leg Ulcer d/t Venous Insufficiency

A
  • Hx of venous insufficiency/immobility

- Irregular shape on lower leg, typicall above malleolus

82
Q

Leg Ulcers r/t Venous Insufficiency

Treatment

A
  • Check ABI, if < 0.7 = Venous sx
  • Compression TED hose + wound care
  • Pentoxifyline 400mg TID to accel healing
83
Q

Vitiligo

A
  • Unpigmented white macules 0.5-5 cm
  • Men/women affected equally
  • Generalized > 10% BSA involvement
84
Q

Vitiligo

Treatment

A
  • Topical corticosteroids
  • Phototherapy
  • > 40% body surface affected = skin graft or permanent depigmentation

CMN 572 Module 5 (2 decks)

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