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Family Med EOR > Desquamation, Acneiform Lesions, & Other Dermatologic Conditions > Flashcards

Desquamation, Acneiform Lesions, & Other Dermatologic Conditions Flashcards

(53 cards)

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1
Q

What causes Steven-Johnson Syndrome (SJS) & Toxic Epidermal Necrolysis (TEN)?

A

MC after drug eruptions, esp. sulfa & anticonvulsant meds*, NSAIDs, allopurinol, abx

Less common: mycoplasma, HIV, HSV, malignancy

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2
Q

What is the difference btwn SJS & TEN?

A

SJS = sloughing < 10% of BSA

TEN = sloughing > 30%, may develop skin necrosis

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3
Q

What are s/s of SJS & TEN?

A

Fever & URI sx –> widespread blisters begin on trunk/face, erythematous/pruritic macules ≥ 1 MM involvement w/ epidermal detachment* (+ Nikolsky sign)

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4
Q

How do you treat SJS & TEN?

A

Treat like severe burns

Burn unit admission, pain control, withdrawal of offending meds, fluid/electrolyte replacement, wound care

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5
Q

What causes pemphigus vulgaris?

A

Autoimmune d/o 2ndary to desmosome disruption

*Desmosomes hold the skin together

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6
Q

What are s/s of pemphigus vulgaris?

A

Oral MM erosions & ulcerations –> painful flaccid skin bullae (rupture & bleed easily)

Nikolsky sign: SF detachment of skin under pressure/trauma

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7
Q

How do you diagnose pemphigus vulgaris?

A

Skin biopsy, direct immunofluorescence (IgG throughout the epidermis)

ELISA

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8
Q

How do you treat pemphigus vulgaris?

A

High dose corticosteroids 1st line

Methotrexate, azathioprine, cyclophosphamide

Local wound care, abx

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9
Q

What is bullous pemphigoid?

A

Chronic widespread autoimmune blistering skin disease primarily of the elderly

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10
Q

What are s/s of bullous pemphigoid?

A

Urticarial plaques –> tense bullae (don’t rupture easily)

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11
Q

What distinguishes bullous pemphigoid from pemphigus vulgaris?

A

Subepidermal involvement

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12
Q

How do you treat bullous pemphigoid?

A

Systemic corticosteroids, antihistamines

Immunosuppressants

If mild –> topical corticosteroids

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13
Q

What is melasma? What causes it?

A

Hypermelanosis of sun exposed areas

Increased estrogen (OCPs, pregnancy), sun exposure

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14
Q

What does melasma look like?

A

Hypermelanotic symmetrical macules esp on face/neck

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15
Q

How do you diagnose melasma?

A

Wood’s lamp: appearance is unchanged

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16
Q

How do you treat melasma?

A

Sunscreen

Topical bleachers: Hydroquinone, azelaic acid

Topical retinoids, chemical peels

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17
Q

What is vitiligo?

A

Autoimmune destruction of melanocytes –> skin depigmentation

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18
Q

What are s/s of vitiligo?

A

Irregular discrete macules & patches of total depigmentation

Dorsum of hands, axilla, face, fingers, folds, genitals

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19
Q

How do you treat vitiligo?

A

Localized: topical corticosteroids
Facial: Calcineurin inhibitors
Disseminated: Systemic phototherapy
Laser, grafts

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20
Q

What type of hsn reaction leads to urticaria (hives)? What are triggers?

A

Type I (IgE) or complement-mediated. Mast cells release histamine.

Foods, meds, infections, insect bites, environment, stress, heat/cold

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21
Q

What does urticaria look like?

A

Blanchable, edematous pink papules, wheals or plaques that may coalesce

Often disappear after 24 hrs

Dermatographism: local pressure –> wheals to that area

Darier’s sign: urticaria appearing where skin is rubbed

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22
Q

How do you treat urticaria?

Study These Flashcards
A

Oral antihistamines = tx of choice!

Corticosteroids, H2 blockers

23
Q

What are the 4 main pathophysiologic factors of acne vulgaris?

Study These Flashcards
A
  1. Increased sebum production due to increased androgens
  2. Clogged sebaceous glands
  3. Propionibacterium acne overgrowth
  4. Inflammatory response
24
Q

What are the s/s of acne vulgaris?

Study These Flashcards
A
  1. Comedones (open/incomplete blockage = blackheads, closed/complete blockage = whiteheads)
  2. Inflammatory: papules or pustules
  3. Nodular or cystic acne: often heals w/ scarring
25
How do you diagnose acne vulgaris?
Mild: comedones (+/- small amt of papules/pustules) Mod: comedones, larger amt of papules/pustules Severe: nodular (> 5mm) or cystic
26
How do you treat mild acne vulgaris?
Topical retinoids, benzoyl peroxide, topical abx, OCPs
27
How do you treat moderate acne vulgaris?
Same as mild + oral abx (doxycycline or minocycline, macrolides) +/- anti-androgen agents (spironolactone)
28
How do you treat severe acne vulgaris?
Isotretinoin
29
What causes rosacea? What are triggers?
Unclear, MC in males. Demodex mite? Etoh, increased temp, hot drinks, hot/cold weather, hot baths, spicy food, meds
30
What are s/s of rosacea?
Acne-like rash + erythema, facial flushing, telangiectasia, skin coarsening, papulopustules w/ burning, stinging
31
How do you treat rosacea?
Topical metronidazole = 1st line Azelaic acid, ivermectin cream Sulfacetamide, abx
32
How do you treat mod-severe rosacea?
Oral abx, laser, isotretinoin
33
What are lifestyle modifications for rosacea?
Sunscreen Avoid toners, astringents, camphor
34
What is folliculitis? What bacteria causes it?
SF hair follicle infection w/ singular or clusters of small papules or pustules w/ surrounding erythema S. aureus MC
35
How do you treat folliculitis?
Topical mupirocin, clinda, erythromycin If severe/refractory --> oral cephalexin, dicloxacillin
36
What is acanthosis nigricans?
Dark, velvety discoloration in body folds & creases
37
What causes acanthosis nigricans?
Insulin resistance Hormone d/o Drugs/supplements CA
38
What is the criteria for minor burns?
< 10% of TBSA in adults < 5% of TBSA in young/elderly < 2% full thickness
39
What is the criteria for major burns?
``` > 25% of TBSA in adults > 20% TBSA in young/old > 10% full thickness Involving face, hands, perineum, feet Crossing major joints, circumferential ```
40
How do you treat burns?
Cleansing (For chemical burns, irrigate profusely for at least 20 mins) Debridement Pain management: acetaminophen, NSAIDs, opioids Topical abx: silver sulfadiazine, silvadene CI if sulfa allergic/pregnant/<2 months (avoid face due to discoloration) Honey, aloe vera Dressings Lactated ringers x 1st 24hrs (1/2 in 1st 8hrs, other 1/2 over remaining 16 hrs)
41
Describe a stage I pressure ulcer
SF, nonblanchable redness that doesn't dissipate after pressure is relieved
42
Describe a stage II pressure ulcer
Epidermal damage --> dermis. Resembles blister or abrasion
43
Describe a stage III pressure ulcer
Full thickness of skin, may extend into SQ layer
44
Describe a stage IV pressure ulcer
Deepest. Extends beyond fascia --> muscle, tendon, bone
45
How do you treat pressure ulcers?
Wet to dry dressings, hydrogels I, II: wound care, pain management III, IV: IV +/- surgical debridement
46
What are lipomas? Where on the body are they MC?
SQ benign tumor of adipose tissue MC on trunk & extremities
47
What do lipomas look like?
Soft, symmetric, painless easily mobile, palpable mass
48
How do you treat lipomas?
No tx needed Cosmetic: surgical removal
49
Describe venous stasis ulcers & ulcers a/w arterial insufficiency
See pg 66 of PANCE Prep Pearls
50
What is hidradenitis suppurativa?
Chronic abscess of apocrine sweat glands or sebaceous cysts w/ tract formation
51
What does hidradenitis suppurativa look like? Who is it MC in?
Red tender inflammatory nodules/abscesses MC in obese women (axilla, groin, under breasts, anogenital)
52
How do you treat hidradenitis suppurativa?
Mild --> clinda, intralesional injections of triamcinolone Deep, recurrent --> punch debridement, unroofing w/ washout Abscess --> I&D Oral tetracycline, cephalosporin, clinda, cipro
53
What are lifestyle changes for hidradenitis suppurativa?
Avoid high glycemic foods Smoking cessation Local skin care

Family Med EOR (15 decks)

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