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Flashcards in Pance pearls Deck (126)
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1

Triggers of Dishydrosis

Sweating, emotional stress, warm weather, metals

2

Pruritus "tapioca pudding" tense vesicles on palms, soles and fingers

Dishydrosis

3

Management of Dishydrosis

Topical steroids (high strength)- ointments preferred

4

What is atopic dermatitis linked with?

Hay fever, allergy, allergic rhinitis, asthma, & other atopic dx

5

Altered immune reaction in genetically susceptible population when exposed to triggers --> T-cell mediated immune activation with increase in IgE production

Atopic dermatitis

6

Triggers of atopic dermatitis?

heat, perspiration, allergens, and contact irritants

7

What is the hallmark clinical manifestation of atopic dermatitis?

Pruritus- "itch-scratch cycle"

8

Tiny, erythematous, edematous ill-defined blisters --> dries/crusts over and scales. MC in flexor creases (anticubital & popliteal folds)

atopic dermatitis

9

Sharply defined coin-shaped lesions on dorsal hand, feet extensor surface

Nummular eczema

10

Management of atopic dermatitis

High strength topical steroids & antihistamines for itching

11

Skin thickening in patients with eczema secondary to repetitive rubbing/scratching

Lichen simplex chronicus

12

Scaly, well-demarcated rough plaques with exaggerated skin lines

Lichen simplex chronicus

13

Management of LSC?

Topical steroids (high strength) and avoid scratching

14

Where does lichen planus develop?

Flexor surfaces of extremities, mucous membranes on skin mouth, scalp, genitals, or nails

15

In which disease do you see lichen planus more often?

HCV infection

16

What are the 5 P's for lichen planus?

Purple, polygonal, planar, pruritic papules with fine scales

17

What type of lesions can be seen in the oral mucosa with lichen planus?

Lacy lesions (Wickham striae)

18

Management of lichen planus?

Topical steroid ointment and antihistamines

19

Herald patch (solitary salmon-colored macule) on trunk --> general exanthem 1-2 weeks later with smaller, round/oval salmon-colored papules with white circular (collarette) scaling along cleavage lines. VERY PRURITIC

Pityriasis rosea

20

What rash pattern is seen with Pityriasis rosea?

Christmas tree

21

Management for Pityriasis rosea

None needed

22

What is the pathophysiology of psoriasis?

Keratin hyperplasia (proliferating cells in the stratum basale and stratum spinosum due to T-cell activation & cytokine release). Leads to epidermal thickening and continuous turnover of the dermis

23

Plaques seen in Psoriasis?

  • MC type
  • raised dark red plaques/papules with thick silver/white scales
  • found on extensor surfaces and scalp
  • Nail pitting in 25%

24

What signs/phenomenon are seen with Psoriasis?

Auspitz sigmn and Koebner's phenomenon 

25

Clinical manifestations of Pustular psoriasis?

Deep, yellow non-infected pustules --> red macules on palms/soles

26

Clinical manifestations of Guttate psoriasis?

  • small, erythematous papules with fine scales, discrete lesions, and confluent plaques

27

What inflammatory condition is seen with psoriasis?

Psoriatic arthritis 

28

Sx of psoriatic arthritis?

  • Stiffness >30mins relived with activity 
  • Sausage digits
  • X-ray: pencil in cup deformity 

29

Management of psoriasis?

  • Topical steroids, tar-based anthralin, Vit. D analnogs & retinoid
  • UBV light therapy , immune agents 

30

Occurs in areas of high sebaceous glands over secretion (scalp, face, eyebrows, body folds)

Seborrheic dermatitis

31

What do you have a hypersensitivity too in seborrheic dermatitis?

Pityrosporum ovale

32

What does seborrheic dermatitis present as in infants?

Cradle cap

33

Erythematous plaques with fine white scales common on the scalp (dandruff)

Seborrheic dermatitis

34

Management of seborrheic dermatitis?

Selenium sulfide, sodium sulfacetamide, ketoconazole (shampoo or cream), steroids, zinc pyrithione 

35

Type I HSN (IgE) reaction of dermis or SQ tissues

Urticaria (Hives)

36

Triggers of Urticaria (Hives)?

  • foods
  • meds
  • infections
  • insect bites
  • drugs
  • environmental 

37

What is the pathophys of Urticaria (Hives)?

Mast cells release histamine causing vasodilation of venules --> edema of dermis and SQ tissues 

38

Blanchable, edematous pink papules, wheals, or plaques that are oval, linear, or irregular

Urticaria (Hives)

39

What is Darier's sign?

Localized urticaria appearing where skin is rubbed (histamine induced)

40

What is the tx of choice for Urticaria (Hives)?

oral antihistamines

41

Acute, self-limiting type IV HSN rxn most common in adults 20-40 y/o

Erythema multiforme

42

What infections are assoicated with erythema multiforme?

  • HSV most common
  • mycoplasma 
  • s. pneumo 

43

What meds are associated with erythema multiforme?

  • sulfa drugs
  • beta-lactams
  • phenytoin
  • phenobarbital

44

What type of lesion is pathognomonic of erythema multiforme?

TARGET (iris) lesions

45

Dull, "dusty-violet" red, purpuric macule/vesicle or bullae in center surrounded by pale edematous rim & peropheral halo. Patient often FEBRILE 

Erythema multiforme 

46

What are the guidelines for erythema multiforme minor?

  • target lesions distributed acrally
  • no mucosal membrane lesions

47

What are the guidelines for erythema multiforme major?

  • target lesions with involvement of >1 mucous membranes (oral, genital, ocular mucosa)
  • <10% BSA acrally --> centrally
  • no epidermal detachment

48

Management of erythema multiforme?

  • Symptomatic: discontinue drug causing rash
  • can also use steroid mouthwashes for oral lesions 

49

What most commonly causes SJS and TEN?

Drug eruptions esp. Sulfa and antioconvulsant meds and infections like Mycoplasma, HSV, HIV, malignancy

50

What % of sloughing of BSA is seen in SJS and TEN?

  • SJS: <10%
  • TEN: >30%

51

What sign is positive in SJS and TEN?

Nikolsky sign: pushing a blister causes further separation of the dermis

52

What are the clinical manifestations of SJS and TEN?

  • Fever & URI sx
  • Widespread blisters begin on trunk/face
  • erythematous/pruritic macules >1 mucous membrane with epidermal detachment

53

Management of SJS and TEN?

treat like severe burns 

54

4 main pathophysiologic factors of acne vulgarus

  • Increased sebum production: MC due to puberty (increased androgens)
  • Clogged sebaceous glands
  • Propionibacterium acne overgrowth in blocked pores
  • Inflammatory response 

55

Clinical manifestations of acne vulgaris?

  • Comedones
  • Inflammatory papules or pustules
  • Nodular or cystic acne --> often heals with scarring

56

What is an open comedone?

Blackhead --> due to incomplete blockage 

57

What is a closed comedone?

Whitehead --> complete blockage 

58

What is seen in mild acne?

Comedones w or w/o small amounts of papules or pustules 

59

What is seen in moderate acne?

Comedones with larger amounts of papules and/or pustules 

60

What is seen in severe acne?

Nodular or cystic acne 

61

What is the management for mild acne?

  • topical retinoids
  • benzyl peroxide
  • topical abx
  • OCPs

62

What is the management for moderate acne?

Same as mild acne but can add oral abx like doxy or minocycline and spironolactone (anti-androgen agent)

63

What is the management for severe acne?

Isotretinoins

64

What are the side effects of Isotretinoins?

  • Highly teratogenic
  • psych side effects
  • hepatits
  • increased triglycerides/cholesterol
  • MUST obtain 2 pregnancy tests prior to starting & monthly while on it 

65

What is considered "adult acne"?

Rosacea

66

Triggers of Rosacea?

  • EtOH
  • increased temperature 
  • hot drinks
  • hot/cold weather
  • hot baths
  • spicy foods

67

Acne-like rash with erythema, facial flushing, telangiectasia, skin coarsening, papulopustules with burning/stinging 

Rosacea

68

What distinguishes rosacea from acne?

Absence of comedones 

69

What is first line treatment for rosacea?

Topical metronidazole and clonidine may be used for flushing 

70

Lifestyle modifications for rosacea?

  • sunscreen
  • avoid toners
  • astringent menthols
  • camphor 

71

What population is actinic keratosis most commonly seen in?

fair-skinned elderly with prolonged sun exposure 

72

What is actinic keratosis a premalignant condition to?

squamous cell carcinoma 

73

Dry, rough, scaly "sandpaper" skin lesions or edematous, hyperkeratotic plaques

Actinic keratosis 

74

How do you diagnose actinic keratosis?

epidermal/dermal cells with large hyper chromatic nuclei 

75

Management of actinic keratosis?

  • Observation
  • Surgical: cryotherapy or dermabrasion
  • medical: 5FU or imiquimod

76

What is the pathophysiology of vitiligo?

Autoimmune destruction of melanocytes that leads to skin depigmentation 

77

Irregular macules & patches of total depigmentation 

vitiligo 

78

Management of vitiligo?

  • Systemic phototherapy (may aid in repigmentation)
  • laser therapy (effective on limited areas)

79

What is the most common benign skin tumor that is seen in fair-skinned elderly with prolonged sun exposure?

Seborrheic keratosis

80

Small papule/plaque velvety warty lesion with "greasy/stuck on appearance"

varied colors: flesh-colored, brown, black, grey

Seborrheic keratosis 

81

Management of seborrheic keratosis?

Benign= NO TREATMENT NEEDED! :)

Can use cryotherapy for cosmetic reasons 

82

Most common type of skin cancer in the US

Basal cell carcinoma 

83

Where is basal cell carcinoma most commonly seen?

Fair-skinned with prolonged sun expsoure and xeroderma

84

Slow growing 

Locally invasive but very low incidence of metastasis 

Basal cell carcinoma 

85

Flat, firm area with small, raised, translucent/pearly/waxy papule with central ulceration & raised, rolled borders

MC on face/nose/trunk

Often friable (bleeds easily)

Basal cell carcinoma 

86

How do you dx basal cell carcinoma?

Punch or shave biopsy 

87

What is the tx of choice for basal cell carcinoma?

Electric desiccation/curettage 

88

2nd MC skin cancer

Squamous cell carcinoma 

89

What often preceeds squamous cell carcinoma?

  • Actinic keratosis 
  • HPV infection
  • Sun/envrio exposure
  • Xeroderma pigmentosum

 

90

Where on the body is SCC most commonly found?

Lips, hands, neck & head 

91

Pathophysiology of SCC?

Malignancy pf keratinocytes of skin/mucous membranes: hyperkeratosis & ulceration 

92

What is Bowen's disease?

SCC in situ --> slow growing 

93

Red, elevated nodule with white scaly or crusted bloody margins

Squamous cell carcinoma 

94

How do you dx SCC?

Biopsy: epidermal & dermal cells with large, pleomorphic, hyperchromatic nuclei 

95

Tx of choice for SCC?

Excision!!

96

What % of cases of malignant melanoma are associated with UV radiation?

80%

97

Agressive with high METS potential

Malignant melanoma 

98

In which population is malignant melanoma most commonly seen?

Caucasian patient with light hair/eye color

Also pt's with Xeroderma pigmentosum

99

"ABCDE" of malignant melanoma 

  • Asymmetry
  • Borders: irregular
  • Color: variation (dark blue, black)
  • Diameter: >6mm
  • Evolution (suspect in a lesion with recent/rapid change in appearance)

100

What is the most important prognostic factor for METS in malignant melanoma?

Thickness

101

What is the MC skin cancer death?

Malignant melanoma 

102

How do you dx malignant melanoma?

Full-thickness wide excisional bx with LN biopsy

103

Management of malignant melanoma?

Excision (lymph node bx or dissection)

104

What is the MC neoplasm seen in HIV/immunocompromised?

Kaposi sarcoma 

105

Connective tissue cancer caused by HHV-8

Kaposi sarcoma 

106

Macular, popular, nodule, plaque-like brown/pink/red or violaceous lesions

Kaposi sarcoma 

107

Management for Kaposi sarcoma?

HAART therapy 

108

Highly contagious superficial vesiculopustular skin infection primarily on exposed surface of face and extremities 

Usually multiple lesions

Impetigo

109

Risk factors of impetigo?

  • warm, humid conditions
  • poor personal hygeine 

110

Where does impetigo most often occur?

@ sites of superficial skin trauma (eg insect bites)

111

What is nonbullous impetigo?

  • Impetigo contagiosa: vesicles, pustules 
  • characteristic "honey-colored crusts"
  • MC type!

112

What is the MC and 2nd MC cause of nonbullous impetigo?

1st: S. aureus

2nd: GABHS

113

What is bullous impetigo?

Vesicles form large bullae (rapidly) --> rupture --> thin "varnish like crusts"

114

What is the MC cause of bullous impetigo?

S. aureus 

115

Is bullous impetigo common?

NO, but usually seen in newborn/young children

116

What is ecthyma impetigo?

Ulcerative pyoderma caused by GABHS (heals with scarring)

Not common

117

What is the DOC for impetigo?

Mupirocin (Bactroban)

118

What tx is used for extensive impetigo dx?

Systemic abx (Cephalexin, Dicloxacillin)

119

What is cellulitis?

Acute, spreading superficial infection of dermal, subcutaneous tissues 

120

What bacterias cause cellulitis?

S. aureus and group A strep

H. influenza/S. pneumonia in children

121

How does cellulitis usually occur?

Break in the skin 

122

Local manifestations of cellulitis?

macular erythema (margins flat, not sharply dermarcated), swelling, warmth, and tenderness

123

Tx for cellulitis?

Abx for 7-10 days: Cephalexin or Dicloxacillin

124

Systemic manifestations of cellulitis?

Fever, chills, +/- tender lymphadenopathy, +/- lymphangitis (erythematous streaking), myalgias 

vesicles, bullae, hemorrhage, and necrosis may form 

125

What abx should you use for cellulitis caused by a cat bite? :)

Augmentin for Pasteurella multocida

126