Skin Lesions/Skin Conditions

Question 1

Treatment of mild comedonal acne vulgaris

Answer 1

Topical retinoid or benzoyl peroxide

Question 2

Treatment of mild to moderate inflammatory acne

Answer 2

Topical retinoid, benzoyl peroxide, or antibiotic

Question 3

Treatment of moderate to severe inflammatory acne

Answer 3

Topical retinoid or benzoyl peroxide or oral antibiotics

Question 4

Treatment of severe nodulocystic acne

Answer 4

Oral retinoid (derm referral), topical benzoyl peroxide, or oral antibiotic

Question 5

If limited response after 3 months antibiotic therapy….

Answer 5

Increase does, change medication, or refer to derm

Question 6

Follicular plug

Answer 6

Excessive keratin in an inactive hair follicle»resulting in rough, cone-shaped elevated papules

Question 7

Teratogenic

Answer 7

Can disturb the development of the fetus; increased risk of spontaneous abortion, birth defects

Question 8

Adverse effects of oral isotetinoin

Answer 8

dry skin, lips, nose, mouth, pruritus, epitaxis, conjunctivitis; increased intracranial pressure, pancreatitis, IBS, premature epiphyseal closure, hyperlipidemia

Question 9

Telangiectasia

Answer 9

Condition in which widened venules cause threadlike red lines or patterns on the skin (spider veins)

Question 10

Differential diagnoses of acne

Answer 10

Peri-oral dermatitis, keratosis pilaris, rosacea, steroid folliculitis

Question 11

Rosacea clinical presentation

Answer 11

Skin: papules and pustules, erythema, telangiectasia
Nonskin: mild conjunctivitis, redness of sclrea, blepharitis, telangiectasia of lid

Question 12

Differential diagnoses of rosacea

Answer 12

Staphylococcal folliculitis, pustular tinea, systemic lupus erythematous, perioral dermatitis

Question 13

Classification of rosacea

Answer 13

Erythematotelangiectatic (erythema and telangiectasia on nose and cheeks)
Papulopustular (erythema with papules and pustules on nose and chin, erythematous patches on cheeks)
Phymatous (facial erythema, scattered pustules and papules on forehead, nose, cheeks, chin; thick, oily skin; rhinophyma)

Question 14

Stage 1 pressure ulcer

Answer 14

Nonblanchable erythema

Question 15

Stage 2 pressure ulcer

Answer 15

Loss of epidermis w/ or w/o true ulceration; ulcer shallow with a pink to red wound be without slough

Question 16

Stage 3 pressure ulcer

Answer 16

Full-thickness (into subcutaneous or beyond) loss w/o underlying muscle, tendon, or bone exposure

Question 17

Stage 4 pressure ulcer

Answer 17

Full thickness with underlying bone, tendon, or muscle exposure

Question 18

Unstageable pressure ulcer

Answer 18

Covered with debris or eschar which does not allow depth assessment

Question 19

Diffuse hair loss (telogen effluvium)

Answer 19

Reversible; caused by chemo or other meds (lithium, warfarin, beta-blockers, retinoids, interferon, amphetamine); initial labs - TSH, hemoglobin/hematocrit, iron

Question 20

Patterened hair loss

Answer 20

Miniaturization of individual hair follicles/shaft due to effects of dihydrotestosterone, hyperandrogenism; topical minoxidil, oral finasteride, hair transplant

Question 21

Circumscribed (non-scarring) alopecia

Answer 21

Autoimmune process in which T-lymphocytes surround hair bulb deep in dermis; no inflammation

Question 22

Scarring alopecia

Answer 22

Irreversible; active lesions with scalp inflammation and eventually scalp scarring; lichen planus and discoid lupus cause

Question 23

Characteristics of psoriasis

Answer 23

• Occurs at any age
• chronic relapsing skin disease
• sharply demarcated plaques
• silvery scales
• • Auspitz sign
• extensor surfaces (may be on palms and soles)

Question 24

Symptoms and associated disease with psoriasis

Answer 24

• Guttate psoriasis can be triggered by streptococcal infection
• onycholysis and pitting of nails
• Koebner
• psoriatic arthritis

Question 25

Pathogenesis of psoriasis

Answer 25

Increased proliferation and shedding of keratinocytes

Question 26

Treatment of psoriasis

Answer 26

Topical retinoids and steroids | UV light

Question 27

Characteristics of lichen planus

Answer 27

- skin, hair, nails and mucous membranes (especially oral mucosa) may be affected - insatiable itching - can occur abruptly or secondary to drug - flexor surfaces

Question 28

Symptoms and associated disease of lichen planus

Answer 28

- violaceous and hyperpigmented polygonal papules and plaques - Wickham striae (thick hyperkeratotic plaque with white lacelike pattern) - Koebner - oral squamous carcinoma rare

Question 29

5 Ps of lichen planus

Answer 29

``` Pruritic Planar Polygonal Purple Papules/plaques ```

Question 30

Treatment for lichen planus

Answer 30

- Self-limited resolves in 8-12 months | - first line is topical steroids

Question 31

Seborrheic dermatitis characteristics

Answer 31

- Common, chronic inflammatory papulosquamous disease - any age; peaks in adolescence - linked to Pityrosporun(Malassezia) yeast - favors areas with sebaceous glands (scalp margins, central face, presternal areas)

Question 32

Seborrheic dermatits symptoms and associated diseases

Answer 32

- moist, transparent to yellow, greasy and scaling with coalescing red patches and plaques - locations: eyebrows, base of eyelashes, nasolabial folds and paranasal skin, external ear canals - flexural skin (skin on skin) - seborrheic blepharitis - cradle cap

Question 33

Seborrheic dermatitis treatment

Answer 33

- topical antifungals | - antidandruff shampoo or soaps containing zinc pyrithione (ZNP)

Question 34

Acute atopic dermatitis

Answer 34

Poorly defined erythematous patches, papules, and plaques with or without scale. Skin may be extremely dry, cracked, and scaly.

Question 35

Chronic atopic dermatitis

Answer 35

Lichenification results from repeated rubbing or scratching; Fissures

Question 36

Atopic dermatitis characteristics

Answer 36

- Usually begins in infancy - Characterized by dry skin and pruritus; consequent rubbing leads to increased inflammation and lichenification and to further itching and scratching: itch-scratch cycle - skin barrier dysfunction - Often associated with a family history of AD, allergic rhinitis, and asthma - Most experts believe there is a genetic basis for AD (80% concordance in monozygotic twins), influenced by environmental factors - Staph aureus exotoxins may trigger

Question 37

Location of atopic dermatitis

Answer 37

Predilection for the flexures, front and sides of the neck, eyelids, forehead, face, wrists, and dorsa of the feet and hands. Generalized in severe disease.

Question 38

Exacerbations of atopic dermatitis

Answer 38

- Skin Barrier Disruption: decrease of barrier function and increased transepidermal water loss. - Infections: S. aureus secondary infection is often present in severe case

Question 39

Special populations of atopic dermatitis

Answer 39

- Children: affects the cubital and popliteal fossae, neck, and face - Adults: lichenification and exoriations

Question 40

Atopic dermatitis management

Answer 40

- optimal skin care (hydration, topical, unscented moisturizers) - NO ANTIHISTAMINES - Antibiotics if secondary infection suspected - wet-wrap therapy