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Flashcards in Rashes 2 Deck (144):
1

What is erythema multiforme caused by?

Herpes virus

2

What to always ask pt before stating Benadryl or doxepin HS

Any balance issues?

3

What tx for eyelid dermatitis

Aquaphor at night

If itches - give Protopic 0.03?

4

Tachyphylaxis

Diminishing response to drug

5

Diminishing response to drug

Tachyphylaxis

6

Which drug not to use for Hair Loss in male with prostate cancer

Propecia (finasteride)

7

LPP tx

Can try topical Betamethasone lotion on scalp

If not improvement, start Doxy 100 qHS with dinner and sunscreen
PLUS
IL Kenalog (half Ken, half saline) - inject at 90 degrees 1 cm apart

RTC in 8 weeks

8

Which oral med for Bullous Pemphigoid (BP)>

Standard tx:
Doxy 100 BID with SS and food
Plus
Topical Clobetasol compounded in aquaphor (wrap bad areas in seran wrap)

If no improvement/refractory:
Prednisone


9

What is chilblains

Redness and swelling of toes hands feet nose ears and face due to cold
Especially in kids

10

Ask about which recreational activity in pt presenting with itch?

Do you smoke? (Cancer)

11

If SCCis and BBC superficial to edge in the same location (dorsal hand) - how to tx

Aldabra

12

Can’t do bx when pt just finished FUDEX or Aldara for how long?

For 2 weeks (till skin calms down)

13

If SCCis to base, how to tx

Always excise or MOHS (because could be deeper than SCCis)

14

SCCis to edge, how to tx

EDC

15

Aldara is indicated for

BCC (SUPERFICIAL Only)
And AKs

16

Angular cheilitis is also called

Perleche

17

How long is Aldara tx

For BCC: M-F x 6 weeks
For AK: 2 weeks on/2 weeks off/2 weeks on

Only 80% of ppl respond and flu like sx in 1 %

18

Can FUDEX be used on SSCis

Yes, x 3-4 weeks, but not FDA approved

19

Besides FUDEX, what other tx for AKs

Solarace (3% diclofenac) BID x 12 weeks

Picato qHS x 3 days

PDT blue light

Aldara

20

Which SCC requires URGENT MOHS?

MODERATELY differentiated AND immunocompromised pt

21

Tx of MM to base

Any depth to BASE is going to plastics

22

Furfuraceous meaning

Fluffy scales

23

Oral tx for TINEA versicolor and directions

Intraconaze 200 mg QD x 5 days and.
And tell pt to sweat 30 min after taking pill
Maintenance: same BID once per month

Or FLUCONASOLE 400 once and repeated monthly

24

What recreational activity makes dyshydrotic eczema worse?

Smoking

(Also stress and sweating)

25

Tx of Nodular BCC to base and edge

EDC ok if small

Excise if big

26

Oral tabs for scabies

Ivermectin

If not responding to permethrin?

27

Which labs to order for itchy rash, when ddx BP

BP 180 (IgG antibodies) (more sensitive)
BP 230

CBC CMP
ANA

28

Cicatricial meaning

Scarring

29

What strength of Kenalog for face pimple

2.5 Kenalog: mix .1 Kenalog with .3 saline (total .4)
At 30 degree angle till blanches
Less than 0.1 cc

30

Pt presents with hand rash, where else to always check

Feet - TINEA pedis can cause ID reaction on hands (as dyshydrotic eczema or degeralized dermatitis)

31

What to always tell pts with psoriasis of scalp - pt education

Be gentle when washing hair and when cloning hair

32

Scalp psoriasis tx

Betamethasone lotion BID x 2 weeks
PLUS
TGel ((t odecrease redness and itch) and T SAL (helps with crusting)
Alternate shampos - wash hair every day!

If not better, IL Ken, if not better, ECZEMER laser(scalp, hands, feet)

33

Pt presents with thick, well demarcated plaques, where else to look

Elbows, knees, butt

34

Doxy is used for

LPP
Hydradenitis Supporativa
Bullous Pemphigoid

35

Oral med for LPP

Doxy

36

Oral med for LP not responding to regular tx

Flagyl (can’t drink)

37

Does frontal fibrosing alopecia (FFA) ever go away

FFA cause

Yes but not sure when

Cause is unknown. It;s inflammation of hair follicles which eventually leads to permanent hair loss (so best to tx it on)

38

Best tx for FFA and LPP

IL kenalog to prevent permanent hair loss but it’s not a cure - have to come back every 6 weeks?
IL kenalog lasts couple of mounths

For LPP - DOxy
But not for FFA?

39

Another tx option for scalp psoriasis

Eczemer laser

Start tx with Beta lotion BID, TGEL and TSAL, RTC in 6-8 wks
If not better, IL Ken and RTC 6-8 wks
In not better, then make sure NOT picking and Eczemer laser
If not better, compound betameth in olive oil, shower cap overnight, and compound TSAL with 6 % SA

40

How to tx benign angiomas?

Vascular laser
There is chance they will come back

41

Scalp sores that won’t heal after procedures

Chronic erosive pustulosis of scalp

42

Why people get skin cancer

Due to sun damage - DNA mutations accumulate in skin
And due to senescence - our immune system weakens as we become older (we don’t need a PNA vaccine at 30, but at 60)

43

When pt with h/o of aggressive skin cancer presents with a new lipoma like bump on body - do what

Send to oncology for PET scan and fine needle aspiration (of what - lymph node?)

Pt who had a lipoma on right posterior scalp With ho of invasive SCC

44

Tx for TINEA pedis

Common name for t pedis

Lamisil (terbinafine) otc

Athletes foot

45

Hand dermatitis that’s not improving on topical steroids and histamines - what to do next

Patch testing: nickel and balsam of Peru
If allergic to nickel, may be ingesting nickel through legumes
If allergic to balsam of Peru, ingesting cinnamon, baked goods

RTC 6 weeks

46

Pt presenting with lipoma or a skin cyst/bump, ask what?

Any history of cancer or skin cancer?

47

Dolls eye
Toothbrush bristles

Folliculitis Decalvins

48

Is folliculaitos decalvins scarring Alopecia

Yes inflammation of hair follicles leads to permanent hair loss

Folloculitis and crusts around Hair

49

Grey skin due to hydroquinone

Ochronosis

50

What may bleach clothing

EpiDuo forte
PanOxyl soap

51

Warning to pts on EpiDuo forte or
PanOxyl soap

May bleach clothing

52

TINEA versicolor causes

Looks like

Aka

Aka pityriasis versicolor
Caused by yeast called pitirosporum (basically body dandruff)

Pink or hypopigmented scaly patches/plaques on upper back and chest, armpits

Normal skin yeast grows out of control so not contagious

Causes: oily skin, hot climate, sweating, low immunity

53

Is ringworm (tinea) contagious

Yes, dermatophyte fungus, get from people, pets, objects, floors, soil. Common where you sweat

T versicolor is not bc natural skin flora out of control

54

Ramsey hunt happens in what disease

In shingles

Sx: dead, vertigo, face drip, taste changes

ER: send to ENT?

55

Herpes rash often appears where

Low back at t bone

56

Most common areas for LP

Flexor writs (inner wrists), dorsal hands

Shins (rare risk of SCC), medial things, ankles

Axialla

Trunk low back

Anus, Glans penis, vulva (dispareunia) ddx:lichen sclerosis

Maybe face, palms, soles

57

What s aspartame broken down into and what disease important to ask in?

Breaks down into formaldehyde

Ask pts with allergic contact dermif taking Montelukast(has aspartame) or if drink diet soda see

58

Yellow orange flat or veruccous lesion on face neck or scalp of child (or adultt?) is called

Nevus sebatious

59

Intertrigo that never goes away

Haley Haley

Genetic
Fissures and bleeding of stretch skin

60

How to ddx intertrigo from Haley Haley

Intertrigo is seasonal, worse with heat and in heat area

61

Benign growth on upper palate

Torus palantines

62

Very thick yellow flakes on scalp that come off easily

Pityriasis amiantacia

63

Ear bumps - inflamed cartilage

Chondrodermatitis Nodularis
CNCH

64

3 common nail conditions

Paronychia infection or inflamm
Trachyonychia (washboard rough nails)
Onycholysis

65

Pt presenting with nummular rash on legs, check what else?
And do what to rule out what?

Feet for TINEA pedis and do KOH to r/o TINEA

66

Does 2 weeks on off apply to scalp Betamethasone lotion?

No
Can’t use QD,doesn’t thin skin on scalp

67

What type of rosacea is soolantra best suited for

Rosacea due to demodex mites (red bumps with telangectasia on cheeks)

Soolantra am
Nizoral pm (for associated den derm and pitirosporum folliculitis)
Doxy 20 BID without food

68

MC yeast to cause folliculitis

Pitirosporum (aka Malassezia)
Usually itch but can be asx

69

Pitirosporum yeast is aka

Malassezia

(Cause of scalp folliculitis )

70

Which blood work to order in AA

TSH

71

Micropustules on scalp are caused most likely by which organism?

Pitirosporum (Malassezia) yeast which is found in san derm

72

Cause of regular rosacea

Demodex mites

Soolantra is best

73

What makes HS worse? (2 things)

Smoking and rubbing so avoid tight clothing

74

Tx for HS

Doxy 100 BID with food and SS x 12 weeks
PanOxyl body soap but make sure use only old towels because can bleach towels
Cleocin T Gel
Warm compresses but don’t squeeze
eMedicine.com

75

Can’t use Aldara on which pts

Never on pt with organ transplant bc can systemically rev up immune system against transplant

76

What to tell pt about HS

1% of people get it, it runs in families, comes and goes almost like acne (boils)
NO SMOKING
No tight clothing worse with rubbing

77

What to ask pt if doing a bx on LIP

Any joint replacement, heart dz, artificial valves because it’s a dirty biopsy

78

Lichen mitosis

Flesh colored bumps in kids
Feloxor, dorsal hans, penis, buttocks, chest and

79

Ear anatomy

Scapha, then antihelix then fossa then
Concha

80

Difference between scabies and bed bugs

Scabies can get under clothes
Bed bugs affect areas exposed to air, can’t get under clothes

81

What does dermal hypersensitivity reaction looks like on BX

Tumid Lupus

82

When bx comes back as Dermal Hypersensitivity reaction, what dx are you concerned with

Urticarial phase of BP (do punch DIF for BP)

83

Painful bump or ulcer on leg

Pyoderma Gangrenosum

84

Tx for bad TINEA versicolor

Oral itraconazole 200 mg QD X 1 week with ACIDIC DRINK
also go wxcercise for 1 hour and sweat so Med goes through sweat

Maintain with head and shoulder or z bar

85

Pt instructions for oral itrakonazole

With acidic drink and exceeds x1 he and sweat

86

Lichenidied papules or plaques

Rubbed at

87

Yellow plaque on eyelids

Xantholasma

High LDL

88

Pt edu for FUDEX follow up

Maintain results with SS And hat

HC 2.5 Bid x 1 week, redness will go away and then it will peel

89

Rash that occurs in the same spot after taking a Med

Fixed drug eruption

90

Name of dry chapped lips in kids and cause of it
Tx

Lip lick dermatitis

Due to pursing lips all together

Tx HC 2.5 OINTMENT QD prn (ok longer that 1 week)

91

Infection or inflamm of nailfold

Paronychia

92

Washboard nails

Trachyonychia

93

Topical for off weeks for Psoriasis?

Dovonex (calcipotriene)

94

Phenomenon in prosiasis

Kebnarization (psoriasis spreads to areas of precious trauma - froze a wart and psoriasis spread to the area)

95

Name of response when after shingles resolve you get granuloma Annulare

Isotopic response (each spot gets GA)

96

Each spot gets GA in unilateral dermatomal distribution after which dz?
Name of response

After shingles can get GA, call isotopic response

97

If metro cream doesn’t help rosacea, what’s next tx options

Doxy 20 bid without food
And compound Ivermectin 1% with Clindamycin 1% BID

Once gets better: dc doxy and do cream QD

98

When to never use comp hose

What to test

When suspect arterial insufficiency (lateral side) in stasis pt - don’t use hose: just elevate in recliner and send to vein surgeon

Test dorsal foot pulses bilaterally

99

Lady with venous and arterial insufficiency with some small leg sores (her edema wasn’t florid)

Tx plan

Tx: medicines for sores to dry them up and elevate

100

Tx for molluscum

Cantharidin

101

What other disorder does Rosacea commonly coexist with?

With Seb derm

102

=Oral med tx for LPP and FFA

Doxy 100 with dinner or 20 BID without food
Plus betameth lotion BID indefinitely
Plus IL Ken 5 mg (mix 50-50)

103

Tx for pruritic nodules and excoriation

NAC 600 BID
White gloves
Clip nails to no white
MediHoney !!!

104

Circinate

Circular

105

Sx of LPP and FFA and tx

Itchy scaly - betameth lotion BID for itch

Perfollicular crusting and inflamm - Doxy 100 with dinner or 20 BID without food

IL Ken 5 mg

106

What angle to inject IL Ken for LPP and FFA

At 70-90 degree angle

107

Pt education when starting rogaine

Change pillow cases often so that medication doesn’t get on skin (causes hair growth)

108

Odd rash on abdomen - pale pink circular patches all over abdomen and chest, non itchy, non scaly, BX back - viral hives drug rxn

How to describe

Somewhat circinate surpigenous pale erythematous BLANCHEABLE non-scaly patches (don’t use macular popular description)

109

Only Abx proven to interfere with OCP

Rifampin

110

1% of BSA is equivalent to

1 palm

111

Questions to ask for work up for Biologic

H/o of cancer, lupus, MS, TB, CONGESTIVE heart disease, chronic infections like Hepatitis, HIV

112

How to ddx Granuloma Annulare from interstitial granulomatous dermatitis

GA can also present with papules and plaques but normally on dorsal hands and feet. Less associated with autoimmune dz

IGD is more trunk and arms/hands - plus more associated with autoimmune disorders

113

Interstitial granulomatous drug reaction lesion description and distribution

Erythematous annular plaques with indurated border (woman had pink papules closely grouped in annular configuration), sometimes with central clearing

Favor creases (groin, axilla, popliteal) but also trunk, proximal extremities, palms and soles (woman had bilateral inner writs, ventral mid forearm, anticubital fossa, upper back, both trunk sides resolving, a little on ankles)

Itch is minimal or none
No mucosal involvement

114

CNCH is

Chondrodermatitis Nodularis (chronicus?) Helicus

115

A thick firm white bump on palm

Dupuytren’s contracture

Fascial fibromatosis

116

Fascial palmer fibromatosis

Dupuytren’s contracture

Fibrous overgrowth of dermal and subq CT develop tumors called fibromas. Benign

Runs in families

Arises from fascia

117

Lichenoid means and looks

Flat topped instead of dome shaped, kebranization, confluence, PIH when resolves (almost cayenne pepper look like pigmented purpura)

Band sheet like of inflammation under the dermis (or in papillary dermis - band like infiltrate of lymphocytes

118

C&C

Curettage and cryo

119

Dupuytren’s contracture

Progressive shortening and thickening of Palmer fascia leading to digital contractures. Use 4 and 5th digits

120

On path Lichenoid vs Dermatits vs granulomatous on path

Lichenoid: always has a band-like infiltrate of lymphocytes under SK or AK or in LP

Dermatitis: spongiotic, edema

Granulomatous: chronic inflammation with nests of macrophages, giant cells or neutros, eos, histiocytes

121

Warts on penis are called
Anogenital warts

Condylomata

122

Why does acne look worse when starting Accutane

BC it’s bringing acne from deep below to the surface

123

Tx options for SSCis with negative margins

EDC or FUDEX BID for 3 weeks and RTC in 3 weeks (can give pt option for cosmetic results)

124

Med for FFA?

Dudasteride 0.5 mg QD (anti testosterone med used for men with enlarged prostate) (but it doesn’t work for LPP even though FFA is a type of LPP)

Also Betameth and IL KEn 5 mg

125

Some pacemaker are not resistant to magnet - must do what with pt who has pacemaker 6 cm from cautery

Call cardiologist to confirm that pace is resistant to magnet

126

Central Centrifugum Cicatricial Apopecia CCCA

In black women, same thing as LPP but in blacks. Tx IL Ken and rogaine

127

Which face soap for acne pts

Cetaphil soap

128

Which soap for background rosacea

sulfacetomide 10%/ sulfur 5% wash (can compound if too expensive )

129

LPP tx

Start with steroids, then IL Ken, if not better (looking for decrease in crusting and inflammation/redness) - then start Doxy100 with dinner and sun screen

130

Always ask pt on Accutane what questions (4)

Any depression, HA, any JOINT/muscle aches, any nausea/blood in urine or stool, back pain, blurred vision

131

Which labs to order when suspecting LP

Hep panel

Ask what meds on and check mouth

132

Another name for xerotic dermatitis is

Asteototic dermatitis

133

Which rashes are super itchy

LP (Allegra)
BP
DYSHYDROTIC eczema

134

LP tx

Betameth oint 2 wks on/off
Sun
Flagyl ( not a sip of alcohol) BID x 3 wks

135

Flagyl SE

No alcohol!!!!!!!!!!!
Dizziness
Upset stomach

136

How long Flagyl for LP

BID X 3 wks

137

Toothbrush like Hairs on scalp is what?

Folliculitis decalvons

Tx doxy

138

Glabella is

Between eyebrows

139

Stop Accutane at which triglyceride level and why

Stop when >400 (at 700-800 get pancreatitis)

If >300, watch and let Dr. O know

140

If Flagyl fails for LP or lichenoid drug rxn

Use excimer laser

141

What else to order besides blood work when initiating biologic for Psoriasis

CXR PA and lat

142

Order ovarian transvaginal US in which dz?

Dermatomyocitis

143

Don’t undermine which excision?

Excisions bx of MM (take 2 mm margins)

144

What disorder are angiofibromas associated with and what are the other cutaneous/ systemic findings

Tuberous Sclerosis