Flashcards in More Rashes Etc Deck (180):
Tx for scalp pruritic nodules
Betamethasone oint BID 2 wks on/off (never on face or groin - can cause thinning of skin)
NAC 600 BID
Wear cotton gloves
Protopic and Elidel are what type of drugs
Calcineurin inhibitors: immunomodulating/anti-inflammatory
Tx for LP
- Topical class 1 betameth oint BID
- PROTOPIC (never mouth) or Elidel (both calcineurin inhibitors):
IS THIS FOR WEEKS OFF STEROID?
- Sun light outside 20-30 min TIW
- Oral steroids OR
- Flagyl 500 BID x 2-4 weeks (no alcohol) with TAC
Hydroxyzine HS for itch
Where to never use Protopic and what age
Mouth (kidney peoblems)
But ok on lips
Or less than 2 yo
Which type of CD4 response is atopic derm (eczema)
Contact derm and psoriasis
Eczema is Th2:
- IL4 increases IgE
- IL5 increases Eosinophils
- IL10 decreases immunity (so pts with AD get impetigo and fungal infections, T Pedis, T corporis)
- Dupixent is anti IL4 so systemically decreases IgE (biologic for eczema)
Psoriasis/contact dermatitis is Th1:
- IF GAMMA
- TNF (TB test - feel coming down with flu): Enbrel and Humira target TNF
- IL 12 (stilara is anti)
Th1 revves yo immune system while Th2 lowers it
What is dupixent and how does it work?
Systemic biologic for eczema
Anti IL4 - so decreases IgE systemically
IL4 causes increases IgE
Vasculitis is what type of immunity
Type 4 immunity is
Delayed hypersensitivity = allergic contact dermatitis
TB rxn is type 4 (takes 3 days)
Type 1 immunity
Immediate hypersensitivity which is urticaria
Eczema tx education (percentages)
80% is topical steroids (end point is itch and lesion clear)
15% antihistamines for itch
5% is daily moisturizer
What age group can’t use antihistamines for AD eczema?
< 1 yo
What age is ok to use Protopic for eyelid eczema in kids
And what warning to give when using Protopic on eyelids?
Will burn at first for the first 1-3 days but continue using it
Protopic has which black box warning
Skin cancer increases in rats after eating tubes of it and Bathing in it
What to use on nipple ezcema
Eczema tx for <2 yo
HC 2.5 QD for face and groin
TAC .1% oint QD for rest until skin is clear and no itch daily moisturizer
Antihistamines ok >1 yo
Horrible eczema tx in kid >1 yo
Clobetasol x 5-7 days then switch to TAC right away QD
clobetasol x 4days then 10 days of Fluocinonode 0.05, then TAC QD
What to tell pt about Patch testing
And Brand name for it / how many allergens has
Put on Monday and can’t shower for 5 days bc take off Friday
Done for allergic contact dermatitis
Brand name is TRUE test has 38 allergens
Which toothpaste to use if mouth or lip rash/ soreness
Arm and Hammer
Taper prednisone for severe contact derm
And what to check when doing taper?
40 mg x 1 week (20 BID)
20 mg x 2 weeks
Not more than 3 weeks
SE: jittery, adrenal suppression, joint aches
Check BP and DM (ok if controlled)
No glaucoma (ok but see eye doc next week - meaning ok to give cortisol to someone with glaucoma but tell them to see eye doc next week?)
Can worsen infection - can’t give if cocci, PNA
Rare risk: aseptic necrosis of hip = hip fracture
What to do if give IM Kenalog for contact derm
Max number of IM Kenalog shots per year
Pull back to make sure not in artery
40 mg IM
Max 2 per year (risk osteoporosis, muscle weakness)
Tx for seb derm on face
Am: ketoconazole cream wAM
PM: 2.5 HC
Use H&Sh aids on face
Alternate shampoos from Selsum, head and shoulders and nizerol bc yeast can build up resistance
Shaving is ok bc not a fungus
Caused by yeast not fungus
Which test to order in dermatomyocitis
Which is the #1 underlying cause of it?
Order transvaginal US (ovarian cancer is #1 cause of underlying malignancy - which is cause in 26% of DM)
(Also full body cat scans???)
All age appropriate screening:
Colonoscopy at 50 yo
Mammo at 40 yo
If pt is itching during exam, what is the likely etiology of itch
Paraneoplastic or drug induced: deep itch
What to tell a pt who is lying on abdomen for excision or EDC - during electrocautery
Make sure not to touch the metal rails on the bed during electrocautery
New guidelines for MM SNL biopsy, at which depth to offer SNL bx
At 0.80 mm -
Per Dr. O - he refers to plastics for SLN bx at 0.75 depth
Which type of cancer doubles the risk of MM?
Breast cancer (BRCA) double the risk of MM
MM puts a pt at risk of which other cancers?
Onycholisis is due to
Lifting of nail plate due to overwashong - nailtique
Fever and red tender rapidly expanding nodules/plaques (sometimes with vesicles or pustules) is associated with which disorder?
2-10 cm tender plaques, edematous or indurated
Do Sweets lesions itch?
No, but they burn
Most common distribution of Sweet’s lesions
face or cheeks, neck, upper trunk, extremities (so basically sun exposed areas)
Extracutaneous symptoms of Sweets
Fever in 50-80%
Arthritis, arthralgias, myalgias in 1-2/3
Conjunctivitis and episcleritis 30% +- periodontal inflammation, dacryoadenitis (inflammation of lacrimal gland), glaucoma
Oral lesions like aphthae in 2-3% but 10% if hematologic malignancy
Cough, dysplnea, pleuritis if pulmonary involvement
Subtypes of Sweets
Associated with neoplasia 11%
Ass’d with inflammatory dz 16 %
Ass’d with pregnancy 2 %
Dusky bullous and necrotic lesions that overall with pyoderma gangrenous are ass’d with leukemia
Perioral dermatitis Tx
Start with Metro gel
If not better, add Doxy 20 BID
If not better, switch to Clindamycin Gel BID or Clind AM and Elidel 1% PM
+/- Sulfacetomide lotion 10% (Clayton lotion) IF NO SULFA ALLERGY
+/- Plesion cleanser 5% sulfa and 10% sulfacetomide (which is good for rocasea, acne, dandruff, perioral derm)
Soolantra is Ivermectin - great for demodex mites
Groin intertrigo - which steroid to use
Pt care instructions
Mometasone cream n AM
Ketoconazole cream in PM
Change to WHITE BOXERS
Hair dryer after shower then ZAsorb FA (has miconazole in it so anti fungal as well)
What to ask pt who presents with groin rash
Any other areas involved? Axilla?
Any h/o psoriasis?
Tx and pt instructions for groin rash
We have a list of recommendations to follow - not just one tx:
On good days: shower with lukewarm water only, HAIR DRY the area and apply ZAsrob AF in AM
Shower immediately after getting sweaty or work and do the same
On bad days:
Mometasone cream in AM
What does Erythema Annulare Centrifugum (EAC) look like
Red circles with scale at inner border
Central clearing and trailing inner scale behind an advancing, annular, red border
SLOW GROWING 2-3 MM/ DAY
DDx: GRANULOMA ANNULARE, TINEA, SUBACUTE CUTANEOUS LUPUS, MF
Which disease can precede malignancy by 2 years
Erythema Annulare Centrifugum EAC
Causes of EAC
Blue cheese, tomatoes
Drugs: antimalarials, cimetidine, spironolactone, gold, salicylate, piroxican, PCN, amitriptyline
Infection, cancer, sarcoidosis, other systemic illness, TB, Hodgkin Lymphoma (night sweats, fever, chills)
Tx for EAC
Resolved on its own over months to years (can be recurrent up to 34 years)
Blue cheese and tomatoes can cause what
Erythema Annulare Centrifugum
Sweet syndrome is AKA
Acute Febrile netrophilic dermatosis
If pt with Sweet has oral lesions, its a risk factor for what
10% risk of blood cancer
4 types of Sweet syndrome (associations)
Ass’d with neoplasia 11%
With inflammatory dz
With pregs 2 %
Sweet lesion - describe
Fast rapidly extending, tender red nodules/plaques can be 2-10 cm
On face neck upper trunk and extremities
Burn but don’t itch
What’s the best anti-itch and anti-hive medication on the market
Doxepin 10 mg, can increase to 50 mg qHS
WARNING: do not drive after taking, will make you tired, lasts 24 hours
Was originally an antidepressant in 150-300 mg
Which topical can use around eyes (during eczema)
Steroid taper for severe eczema that’s not responding to topicals
Also add which medication?
Prednisone 40 mg x 1 week (20 mg in AM and 20 mg in PM is stronger than 40 together)
20 mg x 2 weeks
Add Doxepin for itch (best med for itch but tired)
What history questions to ask when starting spironolactone
What is it contraindicated in
Ask about which meds they are on
Do you have a h/o ovarian or breast cancer (don’t give it of positive)? Bc this is a hormonal tx
CI in PREGS - must be on OCP or IUD (must dc drug
If on Lisinopril or losartan - check CMP even if < 40 yo
Which topical steroid is ok for groin area
For groin: Mometasone CREAM class 4
(It’s stronger that 2.5 HC, it’s same as TAC .1% ointment is class 4 but less risk of atrophy With Mometasone )
Mometasone Ointment is class 3 same as TAC 0.5% ibut less atrophy risk
HC valerate 2.5 is stronger
Aseptic necrosis of hip (hip fracture) is SE of which drug
Additional Tx for LPP
Doxy 100 qHS until decrease in pain itch and crusting and hairs regrow then 20 BID for years - helps some people
In additional to betameth lotion bid 2 weeks on/off?
Tell pts with MM to do what once per year
Make sure not to use what with perioral dermatitis?
Steroid cream makes it worse
Tx for comedonal acne only
Start wig EpiDuo qAM and Cetaphil face moisturizer
Can increase to Epiduo BID if not too drying (make sure wait and dry before bed cause can turn sheets orange)
Which one question to always ask acne patients
How much dairy are you consuming
Organic is ok
What is Necrobiosis lipoidica
What looks like
Due to which systemic dz
Cigarette paper thin flat plaques - very atrophic, some with vessels through them
Due to DM
Does it look like lipodermatosclerosis??
Post herpatic neuralgia cream
Intertrigo (under breast tx)
What advise to pt
Ketoconazole 2% cream q hs
Mometasone 0.1% cream qAM
Use hair dryer and ZAsorb AF, shower after sweating
What to make sure is done to pt with excision on lower legs
Antibiotics for 1 week
Most common areas for granuloma Annulare
Wrist and ankles
Granuloma Annulare is more common in kids or adults
What dz it’s associated with in adults
Rarely DM (and thyroid?)
Does GA leave a scar when it goes away
What color is going away Lesion vs active lesion
Brown border when going away
Pink is active leasion
GA usually resolves in what time
Goes away in 1-2 years
What is the name of condition when scalp doesn’t heal
Chronic Erosive Postulosis of scalp
What can’t do while on Accutane (2 things)
What to look for and ask pt if suspect suture infection s/p excision
Pus? (If pus - must culture)
If just red - fine
What advise to give pts with intertrigo
Use hair dryer after shower and apply ZAsorbFA once rash proves to prevent outbreaks
Rash gets worse in summer due to heat and increased sweating
What to ask pts when considering Accutane initiation? (6)
Any bowel disease?
Any cholesterol issues?
Any liver disease?
Trying to get pregs?
Acne tx for males
What to do if no improvement on standard tx
Next step - Accutane
What does it mean If no improvement in acne with Doxy or stopped improving on Doxy
Abx plateaued because bacteria became resistant to the Med
Which labs to order for Accutane and patient instructions
CMP (liver and lipids fasting)
Must be fasting and within 48 hours of next appointment
What is Muir Torre syndrome
(Associated with which other cancers)
What percent risk
It’s a subtype of Lynch syndrome (hereditary nonpolyposis colorectal cancer)
80% risk of developing colon cancer
80% risk of endometrial cancer
Also ovarian and gastric/stomach cancers, urinary
What is the yellow skin papule in Muir Torre syndrome
What oral Med to use for granuloma Annulare?
Which meds could cause granuloma Annulare
Lisinopril and statins
How to tell if granuloma Annulare is likely due to a drug?
If no improvement on plaquenil
If pts labs on plaquenil come back anemic, ask pt what?
Are you up to date on colonoscopy and age appropriate screening
Consult pcp regarding anemia
Causes of macrocytic anemia (high MCV)
B12 folate deficiency
If a lesion is tender when scratched on exam, do what?
Is there a scar when granuloma Annulare resolves?
Name of OCT urea
Exipial wrong! That’s the hand cream I like
Metro gel and doxy 100 qHS
OR Clindamycin BID (to dry out) and doxy 100 qHS
RTC 6 wks
What can be used in place of FUDEX for AKs
Solarace x 3 months (more gentle but less effective)
Aldabra (imiquimod) QD 2 wks on, 1 wk off, 2 wks on
But can cause flu sx
Blue light not effective - gets red x1 week bs 2 weeks on FUDEX
What to ask pt before giving sulfacetomide wash or lotion
Allergic to Sulfa?
Tx for inflamed cyst
Keflex 500 TID (if no allergy to PCN)
Plus warm compresses
When putting pt on Clindamycin oral, make sure to tell pt what
Can cause C Diff - call us if diarrhea
Plaquenil can cause which side effect
Itchy and red eyes - 2 no no’s
No nail polish
No make up removers
Tx for itchy and red eyelids
HC 2.5% BID but ONLY for 1 week at a time because can instigate glaucoma and cataracts
Do you have glaucoma?
Warning for HC 2.5 around eyes
Only for 1 week at a time or can cause glaucoma and cataracts
Which cream not to use for groin intertrigo
What else to advise pt
Nystatin cream - use ketoconazole instead bc its fingal (TINEA)
What advice to give male pts with groin intertrigo?
Wear WHITE boxers
Stress can cause what 2 extracutaneous events
Hair to fall out
Nails to fall out
Brand name for mupirocin is
What to ask pt presenting with groin and axilla rash or intertrigo?
Where else to look if pt present with groin rash?
H/o psoriasis? Could be inverse psoriasis - in groin, axilla, back
Look at elbows, knees, soles, mouth, scalp
Feeling ok otherwise, no joint aches?
Can’t use which acne medications when pregs
Can’t use which acne medications when pregs
What looks like nipple eczema but only on 1 side?
95% of paget’s dz is what type of cancer
Can paget’s be bilateral
Yes but rare
When pt presents with unilateral nipple eczema, what do you do?
Tx with Mometasone BID x 1 month and have pt RTC: if still there MUST BX!!
Which questions to ask when seeing a pt with nipple eczema? (2)
When was your last mammo?
Do you have a history of eczema?
What does early Paget’s look like?
Which 2 questions to ask?
Looks like eczema
When see unilateral intertrigo or unilateral TINEA on groin, what to suspect?
If see dried intertrigo on left groin approaching scrotal area, what to suspect and do?
Suspect extramammory paget’s
If on one side of groin - Bx it
25% of extramammory Paget’s have what type of cancers and should see whom?
Have rectal, ureter, rostate cancers
Need to see GI/urology/rectal surgeon to r/o cancers in those areas
What type of tx for confirmed Paget’s?
What frequency of F/U for Paget’s?
Mohs if not invasive
Plastic surgeon (wide excision) if invasive
RTC q3-4 months because often comes back
Show much does finger nail grew per month and how long odes it take to grow out?
Same for toes
Fingernail - 2 mm per month, takes 6 months to grow out a fingernail
Toe- 1 mm per month - takes 12 months to grow out
what is pathognomonic for Lichen Planus
Will PIH left by LP go away?
What is the source of fingernail fungus?
Tap Water is full of yeast
Which OTC supplement to help strengthen nails (and hair)
Who is the best expert on Merkel’s cell in Phoenix
Dr Mark Gimbel at MD Andersen in Mesa
Cause and tx of brachioradial itch
Bone spurt (arthritic changes in c spine) and SUN
Tight bra is the cause???
Guys with wallet in front pocket - causes itch on thigh
Tx: zostrix cream
If see more lines on palms, what does it mean
More prone to sensitive skin
How to ddx lichenoid keratosis from bcc
LK has skin lines through it
LPP associated pain tx
Can use gabapentin (not if breast feeding)
LPP can regrow if caught early, scars after hair falls out several times (IL kenalog is more effective)
Can use dermasmooth in breast feeding
Name of pemphigus antibodies
Desmoglien 1 and 3
If going up, ask if any new blisters
Manually depress or lance to get stuff out, keflex 500 TID X 7 day and warm compresses BID
lance it next time to get left over
If not better in 1week RTC
Any fever chills - come back
Pt with bright red rash that doesn’t itch on lower extremities (almost punctuate but papular bumps):
Check where else?
Check inside mouth (he had wickem straie)
Check feet and soles
It was LP that was originally treated as Scabies with permethrin but didn’t improve (Scabies: Apply from neck down, shower in AM then repeat same in 1 weeks)
How to describe LP to pts
It’s a benign rash that can resolve in 8-10 months
No sure what causes it, comes on and goes away mysteriously. Sometimes caused by drugs (lisinopril, BB) - taking any chronic medications?
Valtrex for shingles
What to ask pt
1 g TID X 7 days with lots of water
Any kidney problems
What has to be done when cauterizing a pt on oxygen
Turn off oxygen for a couple minutes ALWAYS
What is brittle nails
Use Biotin OTC
Nailtique #2 at Sally beauty supply store
What does Haley Haley look like and how is it different?
Looks like chronic intertrigo but with fissures that bleed and had them all their lives
Hard to tx, inherited
Which dz looks like chronic intertrigo but with fissures and bleeding
If see unilateral intertrigo, what’s on your DDx?
Inflamm of eyelids
Aquaphor for eyelids
What is the name of the benign growth on the upper palate?
Which antibodies are associated with scleroderma
Scl-70 which are bad prognosis
It’s an autoimmune disorder with no good tx. Results in skin tightening and thickening, raynaud, and visceral dz.
Avoid cold, don’t smoke, PT to increase mobility of thickened skin
What is the name of nose condition in rosacea
What is erythrasma, how looks, cause
looks like intertrigo much more Copper than TINEA cruris
Caused by corynebacterium
How to dx erythrasma
Wood lamp - coral color from porphorins
but no one uses lamp bc tx is same for all - erythrasma, TINEA cruris: ketoconazole has mild anti G+ and anti inflammatory effect. Also for all: keep area dry, white cotton boxers, ZAsorb, hairdryer, change socks/ boxes thru day
Top erythromycin or Clindamycin
Oral erythromycin and top miconazole
What is balanitis
Inflammation of glans penis
When looking at large sebatious hyperplasia, what’s on your ddx?
It’s associated with what disease?
Sebatious adenoma (benign but excise)
What is Muir Torre?
What to ask the pt?
Autosomal dominant (50% of your kids will inherit it so check/advise kids to get colonoscopy)
Any family history of colon cancer?
Have you had your colonoscopy?
Any history of bladder cancers? (Personal
Or family?) (ask PCP to check irons cytology)
Any history of breast cancer?
Also high risk of lymphoma and leukemia
What can look like stye on eyelid?
Sebatious adenoma or carcinoma
What does it mean if you have a sebaceous adenoma below the neck?
Or more than one SA?
Higher risk of Muir Torre syndrome
When pt has rash when normally covered areas are exposed to sun
Polymorphous light eruption
Lipomas around neck are called
What are 8 types of physical urticaria
What are the top 3 types of physical urticaria
Dermatograph is #1
Cholinergic #2 (increase in body temp thru exercise or hot baths)
Cold #3 (exposure to cold results in edema in those areas)
Heat (within 5 min of exp to heat >43F)
Adrenergic urticaria (by NE, within 15 min of emotional upset, coffee or chocolate, tx: propranolol (atenolol is not effective)
Solar urticaria (SS not effective, take antihistamine)
Pressure (3-12 hr after pressure, MC feet and buttocks after sitting)
Fat bump in feet
Ear dandruff drops
DermOtic oil 0.01% (fluocinolone)
Sig: 5 drops in each ear BID
Change shampoo to nizerol otc
Frontal fibrosing Alopecia is a subtype of which disorder and has what?
The other tx for scabies
Nails that grow out without being cut
White spots on toes and nails
Weathering nodule (when bump is not inflamed)
How long must be on 2 forms of OCP after stop accutane tx?
2 months after stop Accutane
Benign reactive proliferation of capillary blood vessels is called
(and not to be confused with)
(Don’t confuse with Pyoderma gangrenous - ulcers rapidly enlarging and painful (neutrophilic dermatosis, not infection), Starts suddenly as smal pimple often at site of injury then breaks down to form an ulcer)
ulcers that are rapidly enlarging and painful (neutrophilic dermatosis, not infection), Starts suddenly as smal pimple often at site of injury then breaks down to form an ulcer
Which disease is associated with Celiac?
90% of DH pts have celiac disease (but not all pts with celiac have herpetiformis)
How to ddx T. Versicolor from Progressive macular hypomelanosis
T Versi has scale
Skin discoloration/redness and swelling due to exposure to cold (2 names)
Where located: toes, ears, nose
Tx: warm socks, keep dry, heating pads
Vasodilator :nifedipine 20 TID
Nicotinamide 500 TID
Sildenafil 50 BID
Spontaneous resolution within 1-3 weeks
Name of subtype of KP that has crops of follicular papules in annular distribution or solitary, each papule with horny spine
Goes away as grow older but no good tx, 20% of people have it, normal
Ecthyma is caused by what?
Strep or staph
Shins or dorsal feet
Looks like chronic impetigo on LE, depressed wet plaque with crust
Vehicle that enlarges and gets thickly crusted in a few days, ulcer is exposed when remove crust
What is the tx of choice for dermatitis herpertiformis
Dapsone 50-200mg (only if can’t do gluten avoidance)
What to check on pt before starting Dapsone
Which other labs to order before starting Dapsone
CMP (can cause hepatitis)
AntiTTG and anti gliadin for Dermatitis Herpetiformis
SE of Dapsone
LT motor neuropathy (ask numbness tingle or can they move ok)
Is dermatits Herpetiformis itchy?
What type of medication is Dapsone (anti eosinophilic or antineutrophilic)
Vs in BP (bullous pemphigoid) - it’s eosinophils involved
What is the other oral med for Dermatitis Herpetiformis
List it’s SE
Which labs to order
Colchicine 0.6 mg BID (also anti-neutrophilic but not as strong as Dapsone)
MC SE: upset stomach/nausea (especially if take TID)
Rare SE: agranulocytosis
Check CBC first month
What is Dermatitis Herpetiformis confused for?
MC locations for DH?
What looks like?
Scabies bc comes in crops
Elbows, knees, low back, nape of neck
Itchy papules or blisters or excoriations
DDx: scabies but will be on other parts
What causes Dermatitis Herpetiformis
Gluten (celiacs dz)
Name of disease - mouth and eye ulcers (could lead to blindness)
Antigens overlap with which disorder
How many biopsies
Antigens overlap with BP 9BP 180 and BP 230)
It’s not BP if not on skin and only in mouth
For H&E (shave blister at edge)
Punch normal skin for Immunofluorescence
Another name for cicatricial pemphigoid
Tx for CP Vs BP
Benign mucosal pemphigoid
CP: celcept, steroid, detox in
BP - topical steroids and doxy
Tx for Lyme Dz and length of tx
Doxy 100 BID x 2 weeks (used to be x 3 weeks)
What is the non classic presentation of Lyme dz and how long should the tick be attached
Red plaques (cellulite like)
Classic target like expanding annular lesions (tick bite papule in center) are in 25% olnly
What to always do on a pt who is presenting with a new itchy rash
What to always ask
Pen test for dermatographism
New meds or OTC supplements
(Also new soap, shampoo)
How long for a tick to transmit Lyme dz
Tick must be attached for 24 hours to transmit Borrhelia
(Can do prophylactic Doxy BID x (1 days?))
What is SCLE and how presents?
Subacute Cutaneous Lupus Erythmatosus
What to Always document in the note of a pt with new rash (2 things)
No mucosal involvement
No new meds
(In case it turns into SJS)
Most common areas for LP
Flexor writs (inner wrists), dorsal hands
Shins (rare risk of SCC), medial things, ankles
Trunk low back
Anus, Glans penis, vulva (dispareunia) ddx:lichen sclerosis
Maybe face, palms, soles
TSH needs to be ordered in which 2 types of hair loss
AA and Telogen Effluvium
What other disorder does Rosacea commonly coexist with?
Seb Derm (caused by pitirosporum which is a yeast everyone has but not everyone get an inflammatory dandruff with it)
What oral med for LPP and FFA
Doxy 100 with dinner or 20 BID without food
Plus Betameth lotion BID
Plus IL Ken 5 mg (mix 50-50 with saline)