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Flashcards in Rashes 3 Deck (121):
1

Valtrex for lip sore dose and sig

500 mg BID x 5 days
(Can give to pts who have 2-3 outbreaks per year to have on hand)

2

For occasional pimples on forehead

Cleocin T gel BID to dry them up

3

Which labs to order on Accutane pt

CBC CMP lipids hCG monthly x 5 months

4

Which 3 recommendations for solar purpura

Dermamend
RUTIN 500 BID OTC
DermaBlend foundation with spray

5

Intergluteal rash (macerated)

MC cause

Toilet wipes are MC cause

Could be dermatitis or Inverse psoriasis

Mometasone

6

Suppurative

Pus formation

7

SE of minocycline (2)

HA, dizziness

8

Rosacea of scalp sx

Tx

Follicular based papules can be itchy and painful

Doxy (minocycline if doxy doesn’t work, HA dizziness)
Betameth lotion BID
T Gel (for irritation) and TSal (for flaking) every day alternate

9

T Gel and T Sal - what conditions to use in

T Gel for irritation and T Sal (for flakiness)

Scalp psoriasis
Rosacea of scalp (Acne Necrotica Maliaris)

10

Another name for rosacea of scalp

Acne Necrotica Miliaria

11

Status dermatitis flare

Was given RUTIN and fluocinonide

When retain fluid, it seeps into skin and in skin, it breaks down into hemosiderin and it is very rash and itch provoking so need Job stockings or Ted Hose daily.

If fluid just sits there - it can cause ulcers

So the only 3 options for tx:
-hose
-elevation
-PCP to give you diuretics

For ITCH:
1 lbs of TAC for legs (and back - looked like ID reaction from Stasis)
Allegra could help itch!

12

Tx for intergluteal rash

HC 2.5 BID prn (don’t need 2 weeks on/off)

13

If nothing helps with GA, which oral tx

Plaquinile

14

Pityriasis amiantasia is a form of

Psoriasis

Inject at 90 degrees about .1 per each 1 cm area

15

Digital mucous cyst cause and tx

Indicative of arthritis
It sunovial joint fluid due to inflammation of joints

Tx: dont LN2 or EDC because can cause deformity of nail matrix
-can lance it (18 G or 11 blade) and jelly comes out but will refill in couple days (sometimes doesn’t refill)
-definitive tx - hand surgeon but even then it can refill

16

Scalp Psoriasis tx

Betameth oint BID indefinitely
T Gel (to decrease redness and itch) and TSal to decrease scale

RTC 8 wks - if not better, do IL Ken 5 mg (so 10 mg 50-50)

17

Perfect distribution for Pityriasis Roses (PR)

Upper arms and mid thighs
Also trunk

From neck down to mid thighs

18

If recurrent BCC Or SCC, what tx

Always excise

19

SE of Plaquinil and what conditions for

Nausea
Rare risk of anemia and blindness
For interstitial GA

20

Pt edu about GA

In Adult - benign rash that comes and goes, no cause, may resolve over many years on its own, Tx options are plaquenil pill - SE nausea, blind, anemia
Or light therapy
Drugs.com

21

Tx for Grover’s

If itchy - TAC and Allegra

22

Pimple should resolve in how long and when to bx

In 2-3 weeks
If there at 4 weeks, do bx

23

For pruritic nodules ILKen, use what dose (dilute)

Direct Ken 10 without saline

24

How to tx GA?

Topical steroids then IL KEN

25

What medical history question to ask pt suspected of LP

History of hepatitis?

26

Tab tx for LP and how long

Flagyl BID x 3 weeks

27

If pt with contact derm’s is not improving, what is the next step

TRUE allergy test

28

LPP follow up - what to look for

Improvement in crusting
New hair loss (pull test)
No pain or itch?
If all of the above good, continue Nizoral shampoo and RTC 8 weeks

If not better on Betameth and Nizoral shampoo, then IL Ken (5mg?)

29

Whic medication increases risk of SCC by 7 times

HCTZ

30

Tx for Scalp psoriasis and pityriasis amyantasia

Betameth lotion BID
Alternate T Gel and T sal, wash daily

If not better, IL Ken 50-50 (so 5 mg)

31

Groin intertrigo tx

Mometasone and ketokonazole
White boxes
Will get worse in summer so y=use above for flares and hairdryer with ZAsorb powder for maintenance

32

Which chemist drug is good for Merkel Cell

Ketruda

33

Asx bump on R deltoid

-Put on Doxy 100 BID x 1 week
-Plus Do punch Bx for H&E (neoplasm of uncertain ETIOLOGY) - came back GRANULOMATOUS DERM’S
- So do another punch for fungal culture
- Plus order labs: CBC, CMP, Cocci, Quant TB Gold
SED RATE




(Or do 2 punch bxs for H&E and for fungal culture)

34

What to do when Bx is back as GRANULOMATOUS DERM’S

Do another punch for fungal culture
PLUS labs: CBC, CMP, cocci, quantiferon TB Gold, SED Rate

35

Acne militaristic Necrotica is and tx

Extra facial rosacea on Scalp
Pain and itchy bumps
Doxy 20 BID 3 month supply (+1 rf) and Nizoral (bc rosacea and seb derm go together, anti fungal, anti yeast and anti bacterial/inflammatory)

36

How can GA present in kids

Pale pink plaque with rased border but without scale and with bumpy center of plaque (papules sticking out through plaque)

Tx TAC oint on rim only

The resolving lesions are flat patches and brown (will go away)

Benign rash - deep inflammation so not epidermal (no scale)

Goes away in 2 years

37

When does GA go away on its own

In 2 years

38

Is nummular eczema common in kids

No

39

OTC supplement for solar purpura

RUTIN 500 BID

40

If do punch for culture, how must submit specimen

With preservative free lido (or saline??)

41

What to ask putting pt on Flagyl and what for

SE of Flagyl

For LP BID x 3 weeks
Ask if any liver or health problems
SE: not a drop of alcohol, dizziness, neuropathy, (numbness/tingling in toes and fingers), upset stomach

+ cont on Betameth BID 2 weeks on/off (for body)


42

What top steroid to use for neck rash

Mometasone BID for itch

43

What strength of IL Kenalog for pruritic nodules

10 mg (don’t dilute)
Inject .2-.3 per nodule

44

When does LP clear on its own?

8-10 months

45

Which rash presents with URI first?

Pityriasis Roses (PR) - first URI, then 2-4 weeks later get itchy spots: tx betameth BID2 wks on/off PLUS Allegra QD. GOes away in 6 weeks!! Pink oval along skin lines

Guttate psoriasis

46

Tx for acute paronychia/ingrown toenail

Keflex 500 TID
Bactrian oint QD
See podiatrist

47

Ring worm tx and presentation

Papules in a ring
OTC lamisil (?)

48

Onychorhexis is and tx

brittle nails
Nailtique #?
Biotin
Decrease hand washing

49

Bluephritis

Inflamm of eye lids
Tx: Allegra and aquaphor

50

Normal pimple should last how long

7-10 days
If doesn’t resolve in 2-3 week, must bx

51

How to select IL Ken concentration for Keloids
And RTC

Start with IL KEN 10 , if keloiddecreases by 50% - correct dose, if not increase dose
RTC in 4 weeks

52

Common culprit of eyelid dermatitis

Nails

53

What to ask pts when putting on Aczone

Sulfa allergy

54

Onychogriphosis

Huge nails

55

Pseudo folliculitis Barbae tx

Cleocin T and differin
GROW hair OUT, don’t shave

56

Watt tx

Best is LN2 q 4 weeks and compound W together

57

Which labs to order when starting pt on Humira
Which SE
SIG

Labs; CBC (infection or leukemia), CMP, Hep C, Hep B CORE Ab and antigen, HIV, QUantiferon TB GOld,

SE: cancer and infection

Q2 weeks injection

58

Which labs for Otezla

And SE
SIG

No labs except CMP to see kidney fx
-Ask if any kidney problems or joint pains

Tabs QD

SE: HAx 1 month, goes away, use Tylenol
DIarrhea with coffee x 1 month
Depression
Why loss

Only 60% effective, least effective and least SE

59

Humira SE

Increased infection and cancer

Inj q 2 weeks

60

Cosentyx

Strongest and newest - dont’ know all SE Q4 wks

Stronger than Stilara for severe psoriasis

61

Tx option for BSA >10% of psoriasis

Light tx or systemic

62

Methotrexate SIG and SE

Sig: 1 tab Q week
SE: Anemia, N/V, liver damage (cant drink at all) - if tx for 1-2 yrs, do liver bx

63

Which psoriasis areas are covered by insurance

Hands, feet, buttocks, scalp
If joint pains (but not occasional wear and tear)

64

No breast feeding on which Psoriasis med

Cyclosporine

65

Add Folate to which psoriasis med

Methotrexate

66

Anti TNF psoriasis med

Humira and Enbrel

67

Which one of systemic Psoriasis tx’s can’t get pregs on

Methotrexate

68

Nummular eczema in LE can be worsened by what condition

Edema so use hose during day and elevate legs

69

Which systemic med can increase sweating

Prednisone

70

Aldara is FDA approved for which cancer and in which distribution

On BCC Superficial ONly and ONLY below neck

Superficial BCC is one which has cell skipping around like pebbles and recurrence rate is higher so excision is good, EDC is good, Aldara for below neck

71

Tx for TINEA Pedis

Fungus
Lamisil BID x 3 weeks and spray OTC weekly
Dry well after shower and color safe bleach for socks

72

Name for xerotic dermatitis

Asteototic dermatitis

73

Which test to order in dermatomyocitis

Which is the #1 underlying cause of it?

TRANS VAGINAL US (ovarian cancer)

74

On which drugs can’t get pregs (7)

Spironolactone
Doxy
Accutane
Tazorac
Retinol (Clindamycin only for pregs?)
Class 1 steroids
Methotrexate

75

When see something dark inside a digital mucous cyst, it’s called

Tindle effect

76

When there is plaque with no scale, it’s

Lichenified plaque

77

When does GA resolve on own

In 2 years

78

What to always ask a pt with acne (2 things)

Anything on back and chest?
How much milk?

79

Micaceous definition

Sparkly brilliant resemble mica

80

Use what for itch in LP

Antihistamines - hydroxyzine and Allegra

81

HIves started 2 days ago, took Benadryl

Any new meds? No

Get Allegra BID, if doesn’t work do Doxepin rx

82

How to tx Balanitis

Sweat leads to infection with yeast or fungus; it comes and goes with increase in sweating and heat

For flares: ketoconazole cream
For maint: ZAsorb powder daily

To decrease flares:
-boxers instead of briefs to increase airation bc increased moisture causes increased rubbing and leads to yeast accumulation
-keep body dry - hair dryer
-no HOT water, use Vani soap
-ZAsorb QD: absorbs moisture and has microconazole in it (antifungal and anti yeast)
-worse in AZ during mansoon season
-there is no infection or cancer - just area of accumulated moisture and irritation due to increased rubbing which causes break in skin and yeast gets in

83

OK to use TAC for face?

Ok only for 1 week BID (if giving pt TAC for FUDEX on arm)

84

How to explain stasis derm to pt

More of a a vein problem - don’t get blood back to heart, consequence of circulation and blood pulls down to LE

No hot shower, vani
Hose, elevate, PCP diuretics

Check arms

85

Cervical itch is called

Nostalgia parasthetica (in central upper back)

After accident?

Tx: TAC, if not better - capsaycene cream (jalapeño juice)

86

White nail is

Normal white part near proximal nail fold is

Leukonychia

Lunula

87

What is in the compounded topical for onychomycosis and what allergy to ask pt about

Topical itraconazole + DMSO (tastes like rotten egg when absorbed) + ibuprofen

Check if pt has IBU allergy

88

How often to get labs checked on pt on Stilara

How often administered

Recommend what preventative steps for pt

Ask what?

What is CI in Stilara

Once a year: CBC CMP Cocci TB HIV

Inj q3 months

Get PNA and Flu shots (ok 18+ if immunosuppressed) AND healthy life style because risk for heart attack (and stop smoking)

Ask if any f/c/cough or site rxn?

LIVE VACCINES are CI so can’t do shingles



89

Can’t get pregs on which meds (7)

Tazorac
RetinA(Clindamycin ok)

Spironolactone
Doxy
Methotrexate
Class 1 steroids
Accutane

90

White nails

Terry nails (leukonychia)

91

Prurigo Nodules and excoriation

White gloves, clip nails QD, NAC
RTC 8-10 wks

Can inject with kenalog
Not warts

92

Psoriasis on nails tx before systemics

Betamethasone oint AM
TAZORAC PM

93

Psoriasis tx and if not better when RTC

Beta BID 2 on off

If not better:

Beta AM and Tazorac .1% PM (decreases scale and increases penetration)
OR
Continue Beta BID 2 on off and DOVONEX

If not better, ECZEMER laser (light tx)

94

If psoriasis pt has joint pains, do what

Referrals to rheumatology

95

Good starting systemic drugs for widespread psoriasis

And don’t use which systemic biologic?

Start with Humira or Stilara (both good starting points)

Don’t use Enbrel - not as good as Humira

If not better on above, use Cosentyx or trump is

95

Pt with psoriatic plaques tx options (BSA<10)

FIrst Beta BID on/off RTC 8 weeks
NOt better :
- Beta AM and TAZORAC .1% PM (not pregs) (to decrease scale and increase penetration)
OR
-Beta AM and DOVONEX PM
NOT better on above: IL KEN 3.3, (if 50% better, ILK 5mg)
In not better:
EXCIMER LASER

96

Which psoriasis areas does DOVONEX work well on

What other tx for those areas

Intergluteal and inguinal creases

Use Mometasone BID (not 2 wks on off)or Protopic (or HC 2.5 BID not 2 wks on off)

97

If pt not improving on scalp psoriasis tx, ask what

Are you picking at it? Be gentle

98

Scalp psoriasis tx

Beta BID (not 2 on/off) with TGEL TSAL
If not better: IL KEN
If not better: Ask if picking and EXCIMER laser

99

Female psoriasis with 25% BSA and h/o breast cancer 8 years ago, tx options

Not otezla - not approved
Not humira bc SE cancer
Light tx only!

100

Psoriasis pt with 25 BSA and h/o MM, can’t do what tx and do what biologic

Can’t do light rx and can’t do Humira

Can only do Otezla with h/o cancer

101

what does interstitial GA look like and distribution

And what’s on DDx if in a certain distribution

Faint red ubiquitous papules across lower abdomen/fold (intertrigo distribution) and lateral thighs bilaterally BLANCHABLE!!!, granulomatous papules = under skin without scale (unless dry skin all over)

Looked like pink solid tapioca

DDX: TMEP if only on thighs (talengictasia macularis which is cutaneous mastocytosis)

102

Name of huge BCC on nose

Fibroepithilioma Pinkus

103

18 yo F NP with primarily comedians acne and some inflammatory,
Tx plan

-Epiduo QAM for comedonal, rtc 8 wks
-Not better at 8 wks:
- ask if tolerating EpiDuo ok, is it too drying, DID YOU USE IT??
- increase to Tazorac 0.1% cream PM with Efficlar or Clindamycin AM
-OR EpiDuo BID

-Not better in 8 wks:
- Facials with Tina (stop tazorac 1 week BF)
- OCP with PCP (Yaz, Yazmin or orthotricyclen)

104

TMEP is

Talengiectasia Macularis Eruptiva Perstans (cutaneous form of mastocytosis)

105

15 yo boy with very inflammatorya acne on face, chest, back with early scarring, tx plan

-Face: epiduo plus Doxy 100 QD
Back/chest: PanOxyl wash x 10 min (use old towels)

106

Which advise to give ALL pts with rash

Lukewarm shower only, no hot

107

Which drugs for back and chest acne

Spironolactone (must be on OCP, birth control, C/I pregs

108

Pityriasis roses disctribution and tx

Upper arms, upper back, chest and neck

TAC for body and mometasone 0.1% cream BID for neck

Luckwarm shower, outside sun TIW 10-15 min

109

Which topical is good for both seb derm and rosacea

Sulfa based
Sulfacetomide wash or lotion or ophthalmic drops (for eye lid rosacea or seb derm)

110

Never undermine which excisional biopsy?

When suspect MM

111

Uniform pink red rash on neck, do what

Press - dermatographism

112

Rash on bottom of feet is called

Palmoplantar pustulosis (psoriasis form)

Beta BID 2 wks on off
On off weeks - Protopic and urea

113

How often is excimer laser

Twice a week for 8 wks

114

30 yo with jawline acne tx plan

Start with spironolactone 50 mg QD (can’t get pregs,hCG negative)

EpiDuo AM and Clindamycin HS

If not better, add aczone pm and cont spironolactone

If still not better in 8, increase spironolactone to 100

115

20 yo F with severe comedonal and some inflammatory acne on face and back (not jaw, couple on jaw) (Tx plan)

Start on EpiDuo AM and Doxy 100 PM
(EpiDuo has retinol to open up pores and BP to open pores and decrease inflammation)

Clindamycin wouldn’t help as much with inflammation and don’t want to confuse pt with too much

Back: PanOxyl is good but doxy will work and don’t want to overwhelm

116

What to use on back acne and pt instructions

PanOxyl - let sit 10 min (old towels)

Also doxy, spironolactone

117

Cicatricial Pemphigoid is aka

Benign mucosal pemphigoid

118

Name of dermatitis due to contact with plant and distribution

Phytophotodermatitis (usually in spring or summer when plants, fruit juice or veggies bloom): limes, lemons, celery, etc

Itchy blisters in forearms or LE, irregularly distributed or LINIAR with PIH after a few days which persists for months

Due to UVA contact with plant chemical Psoralens (contact with plant may be Brief or unnoticeable)

Vs PhotoContact Dermatitis which is when products like fragrances, sunscreens, disinfectants are hit by UVA

119

Classic distribution for perioral dermatitis

Chin, nasolabial folds and inner or outer eyes

(Can extend to neck)

120

NP with hair loss (20 yo F)

What questions to ask
What labs to order

-does it ITCH, flake, pain, inflammation
-how long, sudden or gradual
-any new meds
-PERIODS regular, acne problems?
-any h/o of anemia, thyroid, b deficiencies, irregular periods
-any recent surgeries, illnesses, hospitalizations
-any family members with hair loss
-when last checked CBC and thyroid (repeat in 1 year)
-seen anyone before and their workup