Foundations- ID/Derm > Derm 2 > Flashcards

Derm 2 Flashcards

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1
Q

What are the verrucous lesions?

A

Actinic keratosis

Seborrheic keratosis

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2
Q

What is actinic keratosis?

A

Most common pre-cancerous skin lesion resulting from chronic, cumulative sun exposure in susceptible individuals

Squamous cell carcinoma can arise from pre-existing AK

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3
Q

Presentation of actinic keratosis? dx?

A

single or multiple, discreet, 3mm-1cm erythematous or brown rough, scaly papules and plaques found on sun exposed skin; scale is coarse, sandpaper-like

Diagnosis: clinical, biopsy

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4
Q

Tx for actinic keratosis?

A 
Cryotherapy – most common treatment
Topical fluorouracil (Efudex)
Topical imiquimod (Aldara)

prevention: good sun protection

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5
Q

What is seborrheic keratosis?

A

Common benign growths

onset 40-50 y/o

Oval, slightly raised, tan/light brown to black well-demarcated papules or plaques <3cm in size, “stuck-on” waxy greasy verrucous appearance on trunk, scalp, face, neck, extremities; usually multiples

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6
Q

Tx for seborrheic keratosis?

A

none necessary

Cryotherapy or curettage if irritating or bleeding
Biopsy to r/o malignant lesion if suspicious

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7
Q

What is the MC skin malignancy?

A

basal cell carcinoma

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8
Q

Epidemiology of basal cell carcinoma?

A

Occurs mostly in fair-skinned ind. 20-40 y/o

Heavy, cumulative sun exposure is a predisposing factor

Limited potential for metastasis

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9
Q

Clinical findings of basal cell carcinoma?

A

translucent, telangiectatic pearly papule/nodule with rolled border and sometimes ulcerated center; 85% on head and neck

“sock donut” with necrotic center

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10
Q

Tx for basal cell carcinoma?

A

bx for dx

Surgical – excision, curettage, MOHS surgery

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11
Q

Epidemiology of squamous cell carcinoma?

A

2nd MC skin CA

usually in pts >55

usually arises from AKs

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12
Q

Risk factors for squamous cell carcinoma?

A

Long-term sun exposure is major risk factor; exposure to industrial carcinogens, HPV, immunosuppression are predisposing factors

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13
Q

Clinical findings in squamous cell carcinoma?

A

solitary, slowly evolving keratotic or eroded erythematous, yellowish, or skin-colored papule or plaque found on sun exposed areas

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14
Q

Tx for squamous cell carcinoma?

A

biopsy for dx –>

excision, MOHS surgery

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15
Q

Any isolated keratotic or eroded papule or plaque present >1 month should be considered a…… until proven otherwise by biopsy

A

SCC

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16
Q

Epidemiology of malignant melanoma? Etiology?

A

MC CA among women aged 25-29

cumulative UV exposure

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17
Q

Risk factors for malignant melanoma?

A

age, fair skin, blue eyes, red or blonde hair, freckles, multiple nevi, atypical nevi, FHx, blistering sunburns before puberty, tanning bed use

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18
Q

What are the 5 types of malignant melanoma?

A

Superficial spreading- MC (men-back, women-back and legs)

Nodular – grows fast, more aggressive, grows vertically
-Breslow’s depth

Lentigo maligna

Acral lentiginous – MC in darker skin

Subungual

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19
Q

Presentation for malignant melanoma?

A

usually no symptoms, typically a pigmented papule, plaque, or nodule

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20
Q

What to look for with malignant melanoma?

A 
Asymmetry 
Border- irregular/jagged 
Color-multi-colored 
Diameter >6mm (pencil eraser) 
Evolving
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21
Q

What type of melanoma can be seen freq. on the hands and feet and is more common in darker skin individuals?

A

Acral lentiginous

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22
Q

Dx for malignant melanoma?

A

need to do an excisional biopsy!!

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23
Q

Management for malignant melanoma?

A

high cure rate if dx early

thickness of lesion most important px factor

lymph node involvement has worse px

skin exam Q6 months x 2yrs

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24
Q

What is kaposi sarcoma? Presentation?

A

Vascular neoplastic condition linked to HHV-8

red, brown, or purple macules, plaques and nodules on trunk, extremities, face

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25
Dx of kaposi sarcoma?
biopsy Test for HIV if status unknown AIDS associated type is more aggressive
26
Tx for kaposi sarcoma?
AIDS associated – treat with HAART, refer to oncologist/HIV specialist Non-AIDS associated – cryotherapy, radiation, chemotherapy
27
What are dematophytoses?
Group of fungal infections affecting keratinized cutaneous structures; transmitted by humans, animals, soil - Epidermal i.e. tinea pedia, (tinea corporis) - Trichomycosis-dermatophytosis of hair and hair and hair follicles (tinea capitus) - Onychomycosis-nail apparatus
28
Dx and tx for tinea pedis, tinea corporis, or tinea cruris?
KOH-hyphae Clotrimazole, miconazole, terbinafine cream 4-6 wks
29
Dx and tx for tinea capitis?
Fungal culture-hair w/ whole follicle Griseofulvin x 8 weeks or terbinafine 4-8 weeks (oral therapy!)
30
Dx and tx for onychomycosis?
Fungal culture, KOH of subungual debris Oral terbenafine x 12 weeks, cure in 50%
31
What is tinea versicolor?
actually a yeast, not a dermatophyte SF yeast infection caused by Malessezia furfur colonization in humid environment, recurs in summer
32
Clinical findings in tinea versicolor?
hypo- or hyperpigmented coalescing scaly macules of varying color on trunk, upper extremities (tan, salmon) Post-inflammatory hypomelanosis- after resolution, pigmentation doesn't go away
33
How do we dx tinea versicolor?
scrap scales, KOH- spaghetti and meatballs wood's lamp exam: blue/green fluorescence
34
Tx for tinea versicolor?
Shampoo- selenium sulfide, ketoconazole- let it sit on skin x 10 min Creams: ketoconazole, clotrimazole Oral: Fluconazole, Itraconazole
35
ADEs of antifungals?
Hepatotoxicity, GI side effects, drug interactions, monitor LFTs
36
What is candidiasis? Predisposing factors?
(Candidia albicans) Inflammation of skin folds = intertrigo Predisposing factors: moisture, warmth, breaks in skin barrier, antibiotics, glucocorticoids
37
Clinical findings in candidiasis?
papules and pustules on erythematous base -> confluence and erosion ->beefy red patches with satellite lesions; burning>pruritis
38
How do we dx candidiasis?
KOH – pseudohyphae, spores; fungal culture may be more sensitive
39
How do we tx candidiasis?
Keep area dry, clean, cool Loose clothing Topical antifungals – miconazole, clotrimazole; nystatin Topical steroids – helps burning; use low potency (1% hydrocortisone ointment)
40
What is condyloma acuminata?
A viral disease genital warts
41
Etiology of condyloma acuminata? assoc. with?
caused by HPV 6, 11, 16, 18, 31 ++ Associated with neoplasia (16 & 18 cause most cervical CA)
42
Clinical findings in condyloma acuminata?
fleshy, broad-based papules
43
Tx for condyloma acuminata?
surg removal electrocautery laser Imiquimod (cream also used for AK) Prevention: HPV vaccine
44
What is verruca vulgaris?
viral: common wart caused by HPV (types 2, 4)
45
clinical findings in verruca vulgaris?
Hyperkeratotic, exophytic papules on fingers, hands, knees (can occur anywhere) Punctate black dots – thrombosed capillaries Koebner rxn -spreads with skin trauma
46
Epidemiology of verruca vulgaris?
common in all age groups, skin to skin contact, contaminated objects
47
What are verruca plana?
viral: flat warts caused by HPV (type 3, 10)
48
Clinical findings of verruca plana?
Skin colored or pink smooth slightly elevated flat-topped papules on dorsal hands, arms, face
49
What are palmoplantar warts?
viral: caused by HPV Thick, endophytic papules on palms or soles of feet Can form a callus Pain with walking
50
What is a variated of palmoplantar warts?
mosaic warts (smaller warts coalesce into a large wart plaque)
51
Tx for palmoplantar warts?
Can spontaneously resolve Acids, cryotherapy, retinoid cream, surgical removal, duct tape, laser – all irritating or destructive Imiquimod, Candida antigen - Immune-stimulating
52
What is herpes zoster?
Reactivation of varicella-zoster virus latent in the nerve ganglia (same virus that causes chicken pox) 75% occur in patients >50 y old
53
Clinical findings of herpes zoster?
Prodrome of stinging/pain Clinical findings: grouped vesicles on erythematous base, unilateral, in dermatomal distribution
54
Tx for herpes virus?
to prevent post-herpetic neuralgia Valacyclovir or famciclovir PO within 48-72 hrs of eruption Pain control
55
What will you see if you have ocular involvement in herpes zoster? What should you include in tx plan?
Hutchinson’s sign: vesicles on the side and tip of nose- nasociliary branch of trigeminal nerve affected ophthalmology consult ASAP
56
What is molluscum contagiosum?
viral disease Well demarcated small 2-6mm smooth, firm, shiny dome-shaped flesh-colored papules with central UMBILICATION caused by DNA poxvirus
57
What two skin abnormalities can you seen umbilical lesions in?
molluscan contagiosum basal cell carcinoma
58
How is molluscum contagiosum transmitted?
spread by skin to skin contact genitalia in adults - considered STI
59
Tx for molluscum contagiosum?
spontaneous resolution cryotherapy, curettage, acids, cantharidin topical therapy- retinoids
60
What is impetigo?
Superficial infection of the epidermis by S. aureus and GAS (S. pyogenes) arising from superficial breaks in the skin or as a secondary infection of pre-existing dermatoses.
61
Clinical findings of impetigo?
small vesicles or pustules rupture ->erosions with yellow honey colored crusts usually peri-nasal or intertriginous sites (bullous form)
62
How can we dx impetigo?
gram stain or culture but usually clinical dx
63
Tx for impetigo?
topical mupirocin (Bactroban) or retapamulin
64
How can we prevent impetigo?
proper hygiene, very contagious daily bath with antibacterial soap, frequent hand washing; check for other family or household members
65
What is erysipelas?
Upper dermis infection, more superficial than cellulitis Group A strep
66
Clinical findings of erysipelas?
Raised, well demarcated Enlarges rapidly Face, arms, fingers, legs, toes
67
Tx for erysipelas?
IV antibiotics if systemic symptoms, otherwise oral PCN or amoxicillin
68
What is cellulitis?
Erythema, edema, warmth of skin Infection in deep dermis and subcutaneous fat Disruption of skin barrier predisposes to this GAS and Strep pyogenes most common pathogens
69
Tx for cellulitis?
abx covering beta hemolytic strep and MRSA -Cefazolin IV or cephalexin oral
70
What is scabies?
Infestation of the mite Sarcoptes scabiei spread by skin-skin contact; intensely pruritic especially worse at night
71
Clinical findings of scabies?
papules with excoriations and gray or skin-colored burrows in s-shape diagnostic especially in finger webs, wrists, ankles, feet, genitalia
72
Tx for scabies?
permethrin 5% topical lotion/cream or Lindane or oral ivermectin tx all household contacts antipruritics (can be itchy for 6 wks after tx)
73
What is pediculosis?
lice Capitis (head lice) and pubis (pubic lice) are most common Pruritus in the affected area, nits (oval grayish-white egg capsules) may be visible
74
Tx for pediculosis?
permethrin 1% OTC or 5% overnight for resistance - Malathion (ovide) - 5% benzyl alcohol (Ulesfia) - Treat all contacts - Heat sensitive
75
What is the MC presentation from non-poisonous spider bites?
papular urticaria
76
Presentation for brown recluse spider?
venom is necrotizing Mild urticaria to full-thickness necrosis Spider has yellow-brown body with violin-shaped dark brown mark on abdomen
77
Tx for brown recluse spider bit?
ice/elevated? abx: erythromycin, cephalosporins update tetanus
78
Presentation for black widow spider?
venom is neurotoxic Bite is non-painful; within minutes or hours, severe muscle cramping leg, back, generalized abdominal pain Spider has red hourglass abdominal markings
79
Tx for black widow spider bit?
antivenom muscle relaxants supportive care
80
What is alopecia aerta?
Focalized hair loss Autoimmune attack on hair follicles on head, beard, any hair-bearing body location Can have associated autoimmune disorders
81
Clinical findings in alopecia aerata?
discrete, smooth round or oval areas of hair loss without visible inflammation of scalp, face, body May have nail pits Exclamation point hairs
82
Tx for alopecia aerata?
reassurance-spontaneous resolution in 6 months Topical steroid – potent Topical minoxidil Intralesional steroids Refer to dermatology - especially if larger areas of hair loss
83
What is paronychia?
Acute infection of lateral or proximal nail fold usually caused by S. aureus occuring from a break in the epidermal skin Pt will c/o throbbing pain
84
Clinical findings in paronychia?
tenderness, erythema, swelling, +/- abscess formation and purulent drainage
85
Tx for paronychia?
warm compresses- sufficient in mild cases I&D-Bacterial culture Oral antibiotics based on organism sensitivity (cephalexin, dicloxacillin)
86
What is vitiligo?
Autoimmune process of melanocyte destruction leading to depigmentation; cause unknown
87
What are the predisposing factors to vitiligo?
genetic factors, stress, illness, trauma, severe sunburn
88
clinical findings in vitiligo?
bilateral, symmetric sharply defined depigmented “chalky”-white macules on hands, face, elbows, knees, skin folds, genitals
89
Tx for vitiligo?
sunscreens, cosmetic cover-up Repigmentation – topical glucocorticoids and tacrolimus, PUVA, grafting
90
What does vitiligo look like on wood's lamp?
chalky white- full depigmentation
91
What is melasma?
Common disorder; melanocytes produce a large amount of pigment when stimulated by UV light or increase in hormone levels (pregnancy, OCP’s), “mask of pregnancy” unknown pathogenesis
92
Epidemiology of melasma?
darker skinned ind/ susceptible, women > men
93
Clinical findings of melasma?
sharply demarcated brown patches on the forehead and malar prominences
94
Tx for melasma?
sunscreen Hydroquinone, tretinoin Chemical peels, laser treatments
95
What is acanthosis nigricans?
Localized skin disorder manifested by hyperpigmented, symmetrical velvety plaques that are grayish, black, or brown commonly found on the neck, skinfolds Can occur in obese persons with or without endocrine disorders
96
What are some conditions assoc. with acanthosis nigricans?
obesity, diabetes, PCOS atypical presentations and acute onset - malignancy
97
acanthosis nigricans MCly affects...
Native American, African American, and Hispanic populations
98
Tx for acanthosis nigricans?
treat underlying condition Fasting plasma insulin and glucose, weight loss counseling Topical therapy for cosmetic purposes: lactic acid 12% cream, urea cream, retinoids, salicylic acid 6%
99
What are pressure ulcers? (Decubitus ulcers)
Bedsores; produced anywhere on the body by prolonged pressure especially bony sites- below the waist (95%)
100
Clinical findings of pressure ulcers?
“punched-out” ulcer -> necrosis with grayish pseudomembrane
101
Tx for pressure ulcers?
prevention – minimize pressure, change positions q 2 hours, foam products Ulcer care- debridement, cleansing, wet-dry dressings, occlusive dressings Bacterial culture if secondary infection is suspected
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