Lectures 1-3 Flashcards
1
Q
Are the red scaling patches of atopic dermatitis well defined or ill defined?
A
Ill defined
2
Q
What are some long term complications from SJS/TEN?
A
Scarring/contracture of skin
Vision loss/eye problems
Pulmonary complications
3
Q
What is onychomycosis?
A
Infection of the nail by:
Fungus
Yeast
Non-dermatophyte molds
4
Q
What color is tinea versicolor
A
Variety of colors!
Hypopigmented
Hyperpigmented
Erythematous
5
Q
Clinical manifestation of melanoma?
A
Most de novo, with some arising from pre-existing nevus
Usually asymptomatic
Pigmented papule, plaque or nodule
6
Q
DDx for BCC?
A
Sebaceous Hyperplasia- enlarged oil gland with central clearing.
Fibrous Papule-benign angiofibroma. Skin colored/pink papule on nose. No telangiectasia and lacks pearly texture.
7
Q
On infants, is atopic dermatitis on the flexor surfaces or extensor surfaces?
A
Starts on extensor surfaces then moves to flexor surfaces once they start crawling/walking
8
Q
Burning stinging pain on hands is associated with which skin condition
A
Irritant contact dermatitis
9
Q
Presentation of proximal subungual onychomycosis
A
Starts near cuticle and progresses out
Uncommon
Usually seen in VERY immunocompromised ppl (like AIDS)
10
Q
Is sweat isotonic or hypotonic?
A
It starts isotonic with plasma, but due to electrolyte reabsorption in duct, it becomes hypotonic
11
Q
What is intertrigo
A
Any inflammatory condition of two closely opposed (intertriginous) skin surfaces
-often due to candida species
12
Q
What might a patient report before a drug eruption?
A
A prodrome involving fever, malaise, flu-like symptoms
13
Q
Which is more common, distal or proximal subungual onychomycosis?
A
Distal, by far
14
Q
Why does tylenol get blamed for SJS/TEN?
A
Because people take tylenol for the prodrome they feel for 1-3 days before rash erupts and they blame it on that.
15
Q
Which layer of epidermis has keratinization?
A
Stratum granulosum
Some cancers start here
16
Q
Tx of nondermatophyte onychomycosis
A
Oral itraconazole
6wks for fingernails
12 wks for toes
17
Q
What skin condition is associated with occupations like bartenders, hairdressers, cleaning ladies?
A
Irritant contact dermatitis
18
Q
What does SJS/TEN look like before skin starts sloughing off?
A
TENDER red and purple macules with blisters
19
Q
Clinical presentation of tinea corporis
A
Pruritic, annular, erythematous plaque
(Itchy, red, round plaque)
Central clearing **
RAISED advancing border (touch it)
20
Q
What does a drug eruption look like
A
Erythematous macules and papules
Measles-like
21
Q
Diagnosis of tinea versicolor
A
KOH prep Woods lamp (1/3 of them glow yellow-green) not very useful
22
Q
What is Leser-Trelat sign?
A
Sudden onset of multiple SKs with inflammatory base
+skin tags
+acanthosis nigricans
=possible association with GI and lung cancers
23
Q
What is the dominant symptom of allergic contact dermatitis?
A
Itch
24
Q
Difference between acute and chronic tinea pedis?
A
Acute-self limited, intermittent, recurrent infection. Itchy painful blisters following sweating with 2* staph infections common.
Chronic- slowly progressive infx that persists indefinitely. Interdigital fissures and erosions/scales between toes (especially 3rd and 4th)
25
Clinical presentation of tinea capitis?
Scaly patches with hair loss
Hair loss with black dots
Widespread scaling w. Minimal hair loss
Kerion (boggy, edematous, painful plaque)
Favus (multiple cup shaped yellow crusts aka scutula)
26
Who is at risk for scabies infection
EVERYONE
27
Most common cell in epidermis?
Keratinocytes
28
Risk factors for Malignant melanoma?
```
Genetic predispostion
Prolonged UV exposure
Fair skin/hair/eyes
Immunosuppressed
6+ atypical nevi
26+ regular nevi
```
29
How long after taking a drug will a drug eruption occur
5-14 days
30
What are 5 common drugs that can cause drug eruptions?
```
Penicillins
Cephalosporins
Sulfonamides
Carbamazepine
Phenytoin
```
31
What types of cells are in the hypodermis (subcutis)
Fibroblasts, adipose, and macrophages
32
What is distinctly different about SJS/TEN vs drug hypersensitivity syndrome?
SJS/TEN involves mucous membranes
33
Where is it NOT OK to use high potency steroids?
Face
Skin folds
Genitalia
34
Risk factors for tinea versicolor
Tropical climate
Adolescents
Hyperhidrosis
Immunosuppression
35
What are the 2 types of severe cutaneous adverse reactions?
- drug hypersensitivity syndrome
| - Stevens-Johnson/Toxic Epidermal Necrolysis
36
Where does tinea cruris begin?
Inguinal fold
37
What area is usually spared by atopic dermatitis in children?
DIAPER AREA
38
Treatment for solar lentigo?
No treatment required
39
Treatment of tinea versicolor
```
Topical:
Clotrimazole x 2 weeks
Selenium sulfide x 1 week (shampoo, lotion, foam)
Zinc pyrithione shampoo x 2 weeks
Systemic:
Itraconazole
```
40
Appearance of tinea versicolor
Macules, patches, plaques on trunk & arms
Often have a fine scale
Can coalesce into a big patch
Might itch
41
What is the gold standard treatment for atopic dermatitis?
Petroleum (Vaseline) applied twice a day and right after bathing
Goal is to hydrate the skin with emollients
42
What are important features (not essential) of atopic dermatitis that would add support to your diagnosis?
Atopy (predisposition to developing allergic hypersensitivity rxns)
Early age of onset
Xerosis (dry skin)
43
What is a solar lentigo
“Age spot”
Flat, brown macule
Often in groups
Well circumscribed
44
What does nummular eczema look like?
Coin shaped red lesions
45
Features of nodular melanoma
AGGRESSIVE
Nodule is INFLAMED AND FRIABLE
Rapid vertical growth
46
Who should get systemic treatment for tinea corporis
- immunocompromised
- failed topical tx
- tinea corporis gladiatorum (no participation for 10-15 days) (athletes are eager to get back)
47
What does irritant contact dermatitis look like?
Dry, red chapped skin with fissuring
48
Keratosis Pilaris is a disorder of what
Keratinization
| Keratinocytes don’t slough off right
49
Associated signs of tinea capitis?
1. Swollen cervical nodes
2. Dermatophytid rxn-eczema like rxn after starting tx
3. Erythema nodosum- leg lesions (rare)
50
From where does BCC arise?
Basal layer of epidermis (least concerning)
51
What will happen if you treat tinea corporis with a steroid?
It gets worse (mojocchi’s granuloma)
| +you waste money
52
What is a positive Nikolsky sign?
Skin blisters and separates as a result of gentle mechanical pressure on the skin
53
Features of superficial spreading melanoma?
```
Most common subtype (70%)
Confined to epidermis
Grows out not up
Younger people
Men:back
Women: back and legs
```
54
Where is atopic dermatitis usually found in infants?
CHEEKS
Trunk
Extremities
55
What skin condition is an example of a DELAYED hypersensitivity reaction
Allergic contact dermatitis
56
How is SJS/TEN diagnosed?
Clinically initially: blisters in mouth, been feeling feverish, has the rash...
Then,
biopsy looking for 2* infections
Culture blood, wound, mucosal lesions
57
Diagnosis of actinic keratoses?
Typically based on appearance and texture.
If over 1cm, rapidly growing, ulcerated or painful, you should biopsy.
If over 6mm, consider SCC in situ.
58
Clinical presentation of tinea cruris
- WELL MARGINATED, scaly round plaque with a RAISED border
- extends from inguinal fold to inner thigh
- scrotum typically spared
59
Presentation of white superficial onychomycosis
- starts w dull white spots on nail
- spreads OUT over entire nail
- soft lesions that can be scraped for sampling
60
Poison ivy, oak, and sumac contain what oil that causes allergic contact dermatitis 12-24hrs later?
Urushiol oil
61
Is irritant contact dermatitis an immune response?
No
62
Most common type of skin cancer?
Basal cell carcinoma
63
What effect does more melanin have on skin tone and vitamin D production?
Darker skin tone
| Difficulty synthesizing vitamin d
64
Where is the Basement Membrane Zone
Between the epidermis and dermis.
| It is a barrier for malignant cells.
65
What distinguishes SJS from TEN?
SJS is less than 10% surface area
TEN is more than 30% surface area
(SJS/TEN overlap if 10-30%)
66
Where is dyshidrotic eczema found
Hands, sides of fingers, palms/soles
67
Treatment of Tinea capitis
Systemic anti fungal therapy- Griseofulvin x 6-12 weeks
| Tx of choice for Microsporum genus or EMPIRIC tx
68
Treatment of tinea pedis
Clotrimazole x 4 wks (topical)
itraconazole (oral) for chronic/extensive disease.
+Burow’s wet dressings for vesiculation/maceration 20 min 2-3x/day
+foot powder/better shoes etc
(SIMILAR to tinea corporis but typically requires longer tx bc its stubborn)
69
4 layers of epidermis
```
Stratum corneum
Stratum lucidum *palms/soles
Stratum granulosum
Stratum spinosum
Stratum basale
```
“Come lets get sun burned”
70
Dermatitis and Eczema are used interchangeably, but dermatitis is most often used to describe ____ causes
Exogenous.
| Ex: irritant contact dermatitis, allergic contact dermatitis, seborrheic dermatitis etc
71
How do you treat pubic lice?
Permethrin 1%, repeat in 10 days (same stuff as for scabies but less potent)
Treat sex partners
Take detailed sexual history because they have another STI 30% of the time
72
Management of multiple actinic keratoses?
Field treatment:
- photodynamic therapy
- Topical 5-FU
- Imiquimod (Aldara)
73
Can sarcoptes scabei mites live away from a host
Yes for 3 days
74
What is the treatment for dyshidrotic eczema?
- Reassurance (2-3 wks spontaneous remission)
- topical steroids
- wet dressings (Burows soaks)
75
Concern with actinic keratoses?
Precancerous. 8% progress to SCC.
76
What is the treatment for eczema herpeticum?
Prompt treatment with an antiviral (acyclovir/valacyclovir)
| **its herpes**
77
Hallmark of Actinic Keratosis
Feels like sandpaper
78
Where is atopic dermatitis usually found on older children/adults?
Flexor surfaces and backs of hands/feet
| Neck
79
How do you treat lichen simplex?
You have to stop the itch-scratch cycle!
- high potency topical steroids (thick skin)
- moisturizers
- SSRI’s (histamine effect)
- hydroxyzine or doxepin for sedative effect that prevents nighttime scratching
80
Colloquial name for tinea pedis?
Athletes foot
81
What does Keratoacanthoma look like?
RAPID GROWTH over 6-8 was
| Round, flesh colored nodule with CENTRAL KERATIN PLUG
82
Treatment of tinea corporis
Clotrimazole x 2 wks (at least)
Systemic tx for special cases: Itraconazole
83
What is a Type IV pathogenetic mechanism?
Delayed sensitivity
24-48 hrs after exposure. Cell mediated immunity
84
What is the concern with a lesion that never heals?
SCC
85
What causes tinea versicolor
Overgrowth of NORMAL fungal skin flora that transforms into the mycelial form
86
What kind of cell gives rise to Squamous cell carcinoma?
keratinocytes
87
How is atopic dermatitis diagnosed?
Clinical diagnosis based on history, morphology and distribution
88
What percentage of Rxs written for a new medication cause a drug eruption
2%
89
What drugs do you treat candidal intertrigo with
Topical nystatin
| Itraconazole (oral) for resistant/severe cases
90
What is the pathognomic sign of scabies?
Burrow
91
Other treatments for tinea cruris?
- treat concomitant tinea pedis and/or onychomycosis
- daily talcum powder
- avoid tight clothing
- weight loss
- avoid hot baths? (Hot water might irritate skin)
92
Clinical presentation of BCC
Pearly, shiny
Telangiectasia
Rolled border
93
Where does sweat from apocrine glands go?
Into hair follicles. it is odorless at first. Becomes smelly when bacteria eats it.
94
Management of isolated actinic keratosis?
- Isolated lesion: CRYOTHERAPY or surgical intervention
| - May resolve spontaneously, but could reoccur
95
3 main layers of skin
Epidermis
Dermis
Hypodermis
96
What medications commonly cause SJS/TEN?
Allopurinol
Anticonvulsants (phenobarbital, phenytoin, carbamazepine, lamotrigine)
Sulfonamides (Bactrim)
NSAIDs
97
Presentation of distal subungual onychomycosis?
- white/brown/yellow starts at distal corner and spreads toward the cuticle
- usually starts with big toe
- end of nail breaks, exposing nail bed
98
How is scabies transmitted?
Direct contact
99
What is included in the atopic triad?
| Group of 3 diseases that all come together
Atopic dermatitis
Allergic rhinitis
Asthma
(In this order known as atopic march)
100
Features of acral lentiginous melanoma
```
AFRICAN/ASIAN ancestry (dark skin)
Spreads out, then grows up
Usually males
Large due to delay in dx
Often palmar, plantar, or subungual
```
BOB MARLEY
101
When is atopic dermatitis usually diagnosed?
before age 5
| 60% are in the first year of life!
102
What two things make dyshidrotic eczema worse?
Emotional stress and hot weather
103
Features of Lentigo maligna
Common in OLD PEOPLE
Slowly grows out, but rapidly grows UP
Usually remains more superficial
104
What is the main prescribed treatment for atopic dermatitis?
Topical steroids, increasing the potency accordingly based on the severity of the eczema
105
What condition is associated with a positive nikolsky sign?
SJS/TEN
106
What does dishydrotic eczema look like?
Tapioca.
| Deep seated vesicles that coalesce and rupture.
107
Considerations for tx of onychomycosis
Topical medications usually don’t work
HIGH RATES of failure/recoccurence
108
What type of reaction is allergic contact dermatitis?
Delayed-type hypersensitivity reaction. CELL MEDIATED.
109
```
TBSA of:
Head:
1 arm:
1 leg:
Back:
Torso:
Genitals:
```
```
Head: 9%
1 arm: 9%
1 leg: 18%
Back: 18%
Torso: 18%
Genitals: 1%
```
110
Reasons to treat onychomycosis
- history of cellulitis
- diabetic
- cosmetic
- pain/discomfort
111
What are the essential features that must be present in order to make a diagnosis of atopic dermatitis
1. Pruritus
| 2. Eczema with typical morphology and age specific patterns, as well as a chronic or relapsing history.
112
What complication of atopic dermatitis involves thickening/deepening of skin lines?
Flexural lichenification
113
Pharmacological treatment of tinea cruris
Topical: clotrimazole
| Resistant cases: oral itraconazole
114
What are important questions to ask the pt in the evaluation of any rash?
```
Who
What
When
Where
Why
Associated symptoms (itch, pain,fever)
STI risk
```
115
What can you prescribe for contact dermatitis?
Topical steroids for 1-2 wks
| But you should consider prednisone if it involves the face or more than 20% body surface area (.5-1mg/kg)
116
What is a Type III pathogenetic mechanism?
Immune Complex
| Antigen-antibody complexes cause tissue inflammation. IgG or IgM.
117
Topical steroids are grouped based on potency. Which group is the most potent?
Group 1 is super high potency
| Group 7 is least
118
What does seborrheic keratosis look like?
“Barnacle of aging”
-Tan to black, Warty, waxy, “stuck on” appearance
- Well demarcated, oval/round/irregular shape
- Common on chest back head and neck
119
Dermatitis and eczema can be used interchangeably, but eczema is more often used to describe _____
Endogenous disease
| Ex: atopic eczema, nummular eczema, etc
120
Presentation of candidal intertrigo?
- erythematous, macerated plaques and erosions
- Satellite papules/pustules
- fine peripheral scaling
121
So if you can’t put steroids on face or in skin folds, what topical treatment can you prescribe for atopic dermatitis?
Topical calcineurin inhibitors
Which is a cream/ointment that ends in “-crolimus”
(Trade names: Elidel or Protopic)
122
What group of people has a 100-fold increase of SJS/TEN incidence?
HIV+
123
Pharm treatments of scabies
Topical or systemic tx:
Permethrin 5%-slather all over once and then again 10-14 days later
OR
Oral ivermectin-single dose repeated two weeks later
124
What type of antibodies are associated with atopic dermatitis?
IgE (the ones attached to mast cells)
125
What causes lichen simplex chronicus/neurodermatitis?
excessive scratching or rubbing
126
Who is most at risk for getting tinea capitis?
Children,
African-Americans
Decreased personal hygiene
Overcrowding
127
What should pt education about scabies involve?
- postscabetic itch can persist for 2 wks
- close contacts and housemates must be treated as well
- wash linens in hot water and dry under high heat
- oral antihistamines and emollients can provide relief
128
ABCDEs of melanoma?
```
A-asymmetry
B-border (uneven borders bad)
C-color (multiple colors bad)
D-Diameter (bigger than .25 inch bad)
E-evolving
```
129
Other name for tinea versicolor
Pityriasis versicolor
130
Who is more likely to get tinea corporis?
Caregivers for children with tinea capitis
Athletes w. Skin to skin contact (tinea corporis gladiatorum)
Immunocompromised ppl
131
What are the most common types of drug eruptions (appearance-wise)?
Morbilliform (measles like)
Exanthematous
-basically a widespread measles-like rash
132
Management of keratoacanthoma?
Majority resolve spontaneously in 6-9 months
| BUT you are too stupid to differentiate from SCC so you will biopsy these.
133
What is Norwegian scabies
Crusty, fissured, extreme scabies in the immunocompromised
| Fissures provide route for bacterial infection too
134
What causes scabies
Sarcoptes scabei mite
135
Tx of dermatophyte onychomycosis
Oral terbinafine
6wks for fingernails
12wks for toes
136
What skin condition causes a dry, leathery appearance with exaggerated skin markings and pigmentation?
Lichen simplex chronicus
137
If a kid has a rash all around their lips cause they lick them all day, what condiiton is that’/
Irritant contact dermatitis
138
What are the fatal complications of SJS/TEN?
Infection of skin, lungs, mucus membranes, septicemia **
```
Dehydration & malnutrition
GI ulceration/perforation
Shock/organ failure
Thromboembolism
Acute respiratory distress syndrome
```
139
Most common cause of onychomycosis in fingernails
Yeast, usually Candida albicans
| May cause chronic paronychia-infection of nail margin/cuticle
140
Nickel, latex, cosmetics, preservatives, and neomycin can cause what skin condition?
Allergic contact dermatitis
141
What is the most common dermatophytosis in the world?
Tinea pedis
142
Side effects of topical steroids
```
Pigment changes
Atrophy
Striae
Bruising
Tenlangiectasias
```
143
Clinical presentation of SCC?
```
Scaly
Exophytic (grows out)
Indurated (hardened)
Friable
Often appears warty
```
144
What are some other presentations of chronic tinea pedis?
Moccasin ringworm-sharp demarcation around whole foot w/accumulated scale in skin creases.
Tinea manuum-two feet, one hand
145
What type of reaction is drug eruptions
TYPE IV DELAYED TYPE IMMUNE REACTIONS
| **CELL MEDIATED**
146
With SJS/TEN, should the pt keep taking the offending medication?
No lol
147
4 types of melanoma?
Superficial spreading
Nodular
Lentigo maligna
Acral lentiginous
148
Is tinea versicolor contagious
No
149
Where are Merkel cells and what do they do?
They are in the epidermis and are for perception of light touch. Abundant in fingertips.
150
What is a dermatophyte?
Fungus that causes infection
| Tinea capitis, tinea corporis, tinea cruris, tinea pedis
151
What type of reaction is atopic dermatitis?
Type 1 Hypersensitivity
| IgE Mediated
152
How do you know if you have SCC in situ?
Only from biopsy
153
What is a Type I pathogenetic Mechanism?
Immediate/anaphylaxis
| Allergic reaction involving IgE, Mast cells, basophils, hives, laryngeal spasm, edema
154
What are the 2 types of contact dermatitis?
Allergic Contact Dermatitis
Irritant contact dermatitis
155
Which type of contact dermatitis is associated with papules, blisters and edema?
Allergic contact dermatitis
156
Treatment of melanoma
WIDE SURGICAL EXCISION IS GOLD STANDARD with 2cm of clear margins
-lymph node biopsy,
Chemotherapy, immunotherapy, gene therapy, follow up every 3 months
157
What is the colloquial name for tinea cruris
Jock itch
158
What is the most common type of contact dermatitis
irritant contact dermatitis (80%)
159
How is tinea capitis acquired?
Direct contact with infected person, animal, or fomite
160
How does Mohs surgery affect recurrence rates?
Lowers recurrence rates
| Higher cure rates than excisional biopsy
161
What two bacteria can cause fatal SJS/TEN complications like septicemia and pneumonia?
S. Aureus
| P. Aeruginosa
162
How to diagnose scabies?
- visualization of the burrow w naked eye
- microscopic identification of the mite, eggs, or poop pellets
- dermatoscope can be used to actually visualize mites
163
What is a Type II pathogenetic mechanism?
Cytotoxic
Involves IgG or IgM
Reaction to surface antigen and activate complement
164
How would you empirically treat fingernail vs toenail onychomycosis?
Toes are USUALLY dermatophyte, so you would go with terbinafine x 12 wks
Fingers are USUALLY yeast (nondermatophyte), so you would go with itraconazole x 6wks
(Both are oral)
165
What oral meds can be taken for atopic dermatitis?
Oral antihistamines for itching
Antibiotics for 2* infection
Oral steroids for BAD cases
166
```
Scalp
Back of neck
Wrists
Forearms
Lower legs
Genitals esp scrotum
Are common areas for which skin condition?
```
Lichen simplex chronicus
167
What are the symptoms of drug hypersensitivity syndrome?
High Fever
Rash (morbilliform)
Internal organ involvement
```
Hematological weirdness (labs)
Lymphadenopathy
```
168
To what disease does the phrase “The itch that rashes” refer to?
Atopic dermatitis
-vicious cycle of scratching that makes it worse
169
Where are apocrine sweat glands
Axillary and Anogenital regions
170
Concerns with onychomycosis?
- primarily cosmetic
- can be painful
- increases risk of other infections, esp in immunocompromised
171
Management of Seborrheic Keratoses?
Biopsy if ISK looks really nasty
Reassure pt it is benign
Consider removal for cosmetic reasons, or if irritated (under bra strap, etc)
(Usually cryotherapy, but can be shaved off or curettage and electrodessication
172
In what skin layer does the female scabies mite burrow and lay eggs
Stratum corneum
173
From where are Langerhans cells derived?
Bone marrow
-“macrophages of skin”
174
SCC treatment?
Usually surgical. Either wide excision or Mohs.
| C&D or cryotherapy on an AK may reveal it was SCC in situ.
175
Usual areas affected by candidal intertrigo
Groin, mammary/abdominal folds, web spaces, axilla
