STEP 2: DERM DECK 1

Question 1

Answer 1

Actinic keratosis of the scalp

**Frontal and parietal scalp of a male older adult

Multiple, partially confluent, hyperpigmented and hypopigmented macules of different size are visible. Some of these lesions have scaling, and some are covered in yellow to black-brown crusts.

These findings are characteristic of actinic keratosis.**
Lesions may either regress, persist, or progress to cutaneous squamous cell carcinoma (SCC).
The degree of epithelial dysplasia determines the risk of cutaneous squamous cell carcinoma.

Question 2

Answer 2

Actinic keratosis

Multiple scaly lesions on erythematous s

Right hand of an older patient

Lesions may either regress, persist, or progress to cutaneous squamous cell carcinoma (SCC).
The degree of epithelial dysplasia determines the risk of cutaneous squamous cell carcinoma.

Question 3

Answer 3

Actinic cheilitis
Four photographs of the lips of different patients (A. B, C, D)

In all patients, there is a loss of distinction of the vermillion border either focally (lower lip in C) or circumorally.
The angles of mouth (oral commissures) are characteristically spared.

A - A brown scaly lesion is visible on the lower lip.
B - The lower vermillion border is edematous. A grayish-white macule can be seen on the lower lip. Superficial ulceration with crusting is visible on the mid-upper and lower lips. Scaling and fissuring are also visible.
C - The lower vermillion border is edematous. The lower lip appears dry and brownish scales are visible laterally.
D - Multiple brown macules can be seen.

These features depict the various presentations of actinic cheilitis, a precancerous lesion of the skin caused by chronic sun damage.

Question 4

Actinic keratoses are caused by

Answer 4

exposure to UV light.

Question 5

Colonization of the yeast Malassezia furfur (previously known as Pityrosporum ovale) in areas with sebaceous glands

Answer 5

Seborrheic dermatitis

Question 7

What is seborrheic dermatitis?

Answer 7

A common chronic inflammatory skin condition affecting areas with high sebaceous glands.

Affects the scalp and face primarily.

Question 8

What are the common symptoms of seborrheic dermatitis?

Answer 8

Burning and/or itching.

Symptoms also include erythematous patches, scaling, and greasy yellow crusts.

Question 9

What is the typical treatment for seborrheic dermatitis?

Answer 9

Topical antifungal agents, with possible use of anti-inflammatory agents based on severity.

Ongoing management may include pharmacotherapy to prevent flares.

Question 10

What is infantile seborrheic dermatitis also known as?

Answer 10

Cradle cap.

It usually appears within the first 3 months after birth.

Question 11

What is the prognosis for seborrheic dermatitis?

Answer 11

Chronic, recurrent course with flares requiring intermittent treatment.

Most cases can be managed effectively.

Question 12

What is the prevalence of seborrheic dermatitis in the general population?

Answer 12

Approximately 2–5% worldwide.

Epidemiological data primarily refers to the US.

Question 13

Which factors are associated with the etiology of seborrheic dermatitis?

Answer 13

Malassezia species, hormonal and immunological factors, climate.

The exact etiology remains unknown.

Question 14

What are the endogenous precipitants of seborrheic dermatitis?

Answer 14

Psychological stress, fatigue, sleep deprivation, hormonal changes.

These factors can exacerbate the condition.

Question 15

What are the exogenous precipitants of seborrheic dermatitis?

Answer 15

Climate, trauma, medication.

Symptoms may improve in summer and worsen in winter.

Question 16

What is the typical appearance of seborrheic dermatitis in adults and adolescents?

Answer 16

Erythematous patches or plaques with scaling and greasy yellow crusts.

Can also include flaking and hyperpigmentation/hypopigmentation.

Question 17

How is the diagnosis of seborrheic dermatitis made?

Answer 17

Diagnosis is clinical.

Skin biopsy may be needed for diagnostic uncertainty.

Question 18

What are the differential diagnoses for seborrheic dermatitis?

Answer 18

Atopic dermatitis, contact dermatitis, dermatophyte infections, rosacea, candidiasis.

Each has distinct clinical features.

Question 19

What is the recommended management approach for seborrheic dermatitis?

Answer 19

Avoid precipitating factors, initiate treatment with topical antifungals, consider corticosteroids for moderate to severe cases.

Systemic therapy may be needed for widespread disease.

Question 20

What are potential complications of seborrheic dermatitis?

Answer 20

Exacerbation leading to generalized erythroderma and secondary bacterial infection.

Complications are not exhaustive.

Question 21

When does infantile seborrheic dermatitis typically resolve?

Answer 21

Usually resolves without intervention by 12 months of age.

It is a benign condition.

Question 22

What advice can be given to parents regarding infantile seborrheic dermatitis?

Answer 22

The condition is benign and often resolves spontaneously.

Parents can remove scales with gentle washing and softeners.

Question 23

What is a severe form of infantile seborrheic dermatitis?

Answer 23

Desquamative erythroderma (Leiner disease).

It includes symptoms like recurrent diarrhea and failure to thrive.

Question 24

Fill in the blank: The pathophysiology of seborrheic dermatitis is not yet fully _______.

Answer 24

understood.

Question 25

Answer 25

Atopic dermatitis Ill-defined, erythematous macules with excoriation (due to scratching) can be seen on the flexural surface of the knee.

Question 26

Answer 26

Seborrheic dermatitis Chest of a male patient Erythema with fine scaling is visible between and underneath the breasts. These findings are consistent with seborrheic dermatitis.

Question 27

Answer 27

Dyshidrotic eczema Multiple vesicles with an erythematous base are visible on the finger. These findings are suggestive of dyshidrotic eczema. | Herpetic whitlow, NOT dishyrotic eczema:

Question 28

Answer 28

Plaque psoriasis Multiple sharply demarcated confluent plaques covered with hard, coarse, silver-white scaling are visible over the extensor surface of the knee. This is the characteristic appearance of plaque psoriasis.

Question 29

Answer 29

Interdigital skin lesions in scabies Multiple erythematous papules can be seen in the interdigital folds between the index and middle finger. Interdigital folds are a common site for scabies, as the scabies mite prefers warmer skin regions with a thin keratinous layer.

Question 30

Answer 30

Tinea pedis (athlete's foot) Plantar view of the left foot There is skin peeling in the region of the forefoot with a blistered appearance. The erythematous base appears dry and scaly. These findings are characteristic of tinea pedis.

Question 31

Answer 31

Dermatitis herpetiformis Grouped, erythematous, papulovesicular lesions that are partially excoriated (presumably due to pruritus) can be seen on the dorsal forearm. These findings, especially in combination with pruritus, suggest dermatitis herpetiformis.

Question 32

Answer 32

Cutaneous T-cell lymphoma Multiple partially confluent, sharply demarcated, erythematous, scaling plaques are visible on this patient's flank. This appearance is suggestive of cutaneous lymphoma.

Question 33

herpetic whitlow v dyshidrotic eczema

Answer 33

Question 34

First line tx for papulopustular rosacea

Answer 34

Topical metronidazole, azeaic acid, ivermectin

Question 35

Tx for erythematotelangiectasiatic rosacea

Answer 35

topical bromonidine

Question 36

First line for comedonal acne

Answer 36

topical retinoids

Question 37

Tx for scabies

Answer 37

Topical permethrin

Question 38

First line tx:

Question 39

Firstline tx: new roomate w/same presentation, severely itchy

Answer 39

Topical permethrin

Question 40

What further work up woould you do for a pt w/ the following rash. No other symptoms, intermittent intensely pruritic, somewhat decreases w/antihistamines.

Answer 40

Acute urticaria, uncomplicated--> no fruther workup necessary

Question 41

Actinic keratoses are treated with...

Answer 41

cryotherapy, topical flurouracil, and topical imiquimod