1
Q
Which benign skin lesion?
- Superficial epidermal growth
- Stuck on quality
- Appear >40y/o
- All body surfaces (NOT palms/soles)
- Usually papules/plaques- can be macular
- Velvety–> verrucous (wart like)
A
Seborrhic Keratosis
2
Q
What do you see on microscopy for seborrhic keratosis?
A
keratin pseudocysts
3
Q
How do you tx Seborrhic Keratosis? (4 options)
A
currettage, cryotherapy, electrodessication or shave removal
4
Q
Which benign skin lesion?
- Variant of a seborrhic keratosis
- Multiple, small, hyperpigmented, sessile to filliform, smooth-surfaced papules
- Common in dark skin- cheeks and temples
A
Dermatosis Papulosa nigra
5
Q
How do you treat Dermatosis Papulosa nigra? What do you NOT treat with?
A
- Tx w/ very light electrodessication
- NO LIQUID NITROGEN- could cause pigmentation changes
6
Q
Which benign skin lesion?
- Variant of Seborrhic keratosis
- small white gray SKs on dorsal feet/ankles
- older, light-skinned individuals
A
Stucco keratoses
7
Q
How do you tx stucco keratoses? (4 options)
A
- Cryotherapy
- Curettage
- Electrodessication
- OTC ammonium lactate lotion/cream
8
Q
Which benign lesion?
- Often pedunculated, fleshy papules
- Eyelids, neck, axillae, groin
- Asymptomatic
- Risk factors- genetics, obesity, friction, pregnancy
- Can be marker of insulin resistance
A
Acrochordons (skin tags)
9
Q
What is the treatment for Acrochordons?
A
Elective removal:
- Snipping
- Liquid nitrogen
- Electrodessication
- Can fall off on own
10
Q
Which benign lesion?
- Round to oval, red, dome shaped papule
- Arises in 40s
- increases in # over time
*
A
Cherry angioma
11
Q
Which benign lesion?
- Extremities
- Firm, hyperpigmented dome shaped papule
- “dimple sign”–> dimples if pinched
- Asymptomatic, doesn’t require tx
A
Dermatofibroma
12
Q
Which benign skin lesion is due to sun damage?
A
Solar lentigines
13
Q
How do you prevent and treat solar lentigines?
A
- prevention- sun protection
- No tx required, but can do cosmetic tx- bleaching creams, liquid nitrogen, chemical peels, lasers
14
Q
Which benign skin lesion?
- Sebaceous gland enlargement
- Yellow
- Umbilicated
- Removal is cosmetic
- Biopsy/referral may be necessary
A
Sebaceous hyperplasia
15
Q
Which benign skin lesion
- African American + skin lesion
- Overgrowth of scar tissue
- Difficult to tx (intralesional corticosteroid injection)- high recurrence rate
A
Keloids
16
Q
What is the mainstay tx for keloids?
A
- Intralesional corticosteroid injection
- Difficult to tx and has a high recurrence rate
17
Q
Which benign lesion?
- Tiny epidermoid cysts
- 1-2mm white to yellow subepidermal papules
- Fixed and persistent
- All ages
- Cheeks, eyelids, forehead, genitals
- Spontaneous or secondary from trauma/skin dz/rx
A
Milium
18
Q
How do you tx a Milium?
A
- Easily extracted w/o scarring
- Nick surface w/ 11 blade or 18 gauge needle, express entire cyst lining and contents
19
Q
What causes Verucca Vulgaris?
A
HPV
(this is a wart)
20
Q
Which type of wart?
- Flat
- Skin colored or pink
- Smooth-surfaced, slightly elevated, flat topped papule
- Dorsal hands, arms, face
A
Verrucae Planae
21
Q
Which type of wart?
- Thick, endophytic papules (depressed into skin of sole)
- Can accumulate a thick callus over and around wart
- Plantar warts may be painful when walking
A
Palmoplantar Verruca
22
Q
What is a mosaic wart?
A
Plantar warts coalescing into large plaques
23
Q
Which type of warts?
- External genitalia, perineum, perianal, inguinal fold
- NOT hard or hyperkeratotic
- Sessile (broad based) papules
- On physical exam- papillomatous exophytic papules and plaques
A
Papillomatous, sessile papules (genital warts)
24
Q
Which HPV type causes Verruca vulgaris (common warts)?
A
HPV 2, 4
25
Which type of HPV causes **Verrucae plana** (flat warts)?
HPV 3, 10
26
Which types of HPV causes **palmoplantar wart**s?
HPV 1
27
Which Types of HPV causes **Condylomata acuminata** (external genital warts)?
HPV 6, 11, 16, 18, etc
28
What is the initial tx plan for a pt with warts?
* **Observation:** \>75% chance of spont. resolution at 2 yrs
* Multiple txs almost always needed (laser, acids, cryotherapy)
* start with: **_Cryotherapy and salicylic acid_**
29
How do you tx genital warts?
* **Imiquimod**
* Surgical methods- laser, electrocautery, scissor or shave debulking
\*most favored at top, least favored at bottom\*
30
How do you tx a patient with a **few warts** on the **hands and feet**?
* **Salicylic acid**
* Adhesive tape
* Cryotherapy
* laser
\*most favored at top, least favored at bottom\*
31
How do you tx a patient with a **MANY warts** on the **hands and feet**?
* **Salicylic acid**
* Cryotherapy
* Squaric acid or DCNB
* laser
\*most favored at top, least favored at bottom\*
32
How do you tx a patient with a **few warts** on the **face**?
* **Cryotherapy**
* Shave (surgical removal)
\*most favored at top, least favored at bottom\*
33
How do you tx a patient with a **MANY** warts on the **face**?
* **Cryotherapy**
* Tretinoin cream
\*most favored at top, least favored at bottom\*
34
How do you tx a patient with a **few** warts at **other sites** than the hands, feet or face?
* **Cryotherapy**
* salicylic acid
\*most favored at top, least favored at bottom\*
35
How do you tx a patient with a **MANY** warts at **other sites** than the hands, feet or face?
* **Imiquimod**
* Tretinoin cream
* Squaric acid or DCNB
\*most favored at top, least favored at bottom\*
36
What should you consider in tx of warts in kids?
Consider **observation**
37
When should you use **cryogenic therapy?**
* Benign lesions (**warts, seborrheic keratoses**)
* Premalignant lesions (**actinic keratoses**)
38
What vaccine can be given to prevent warts?
* HPV vaccine to prevent genital warts
* Gardasil and Cervarix
* \*\*\*FOR PREVENTION of genital warts and genital cancers not treatment--\> not for common warts\*\*\*
39
What age is the Gardasil vaccine approved for (prevention of HPV)? Cervarix?
* Gardasil- Females and **males** 9-26y/o
* Cervarix- Females 10-25y/o
40
What are **open comedones** also known as? **Closed comedones**?
* Open= blackheads
* Closed= whiteheads
41
What are the 5 tx options for acne vulgaris?
1. **Topical retinoids (**tretinoin)
2. **Benzoyl peroxide**
3. **Topical antibiotics** (Erythromycin 2% or Clindamycin 1%)
4. **Oral abx** (for _moderate-severe inflammatory acne_, often combined w/ BP)
5. **Oral Isotreitinoin** (Accutane- for _severe nodulocystic acne_ failing other tx)
42
T/F: Isotreitinoin (Accutane) is contraindicated in pregnancy
TRUE
Females must be on 2 forms of contraception during and 1 month after, iPLEDGE)
43
What do you do if a patient has **no response to acne therapy after 3 months**?
Increase dose, change tx or refer to derm
44
What are the 4 SEs of oral Isotreitnoin (Accutane)?
1. Dry skin
2. Chelitis
3. Elevated liver enzymes
4. Hypertriglyceridemia
45
How do you tx severe acne?
* Can require combo of oral abx, topical retinoids, benzoyl peroxide, +/- topical abx
* Refer to derm for tx w/ isotretinoin (Accutane) if acne failing other therapies
* Consider hormonal therapy in pubertal females
46
What is initial tx of mild acne?
* **_topical retinoid or benzoyl peroxide_**
* alternative- topical retinoid and BP +/- topical abx
47
**How do you tx moderate acne?**
(moderate= comedones w/ marked number of inflammatory lesions)
* Initial: **Topical retinoid _and_ benzoyl peroxide +/- topical abx**
* if inadequate response- consider oral abx, derm referral and hormonal therapy for females
48
What is the **initial tx for severe acne** (extensive inflammatory lesions w/ diffuse scarring)? What do you do if there is **inadequate response** to initial tx?
* Initial: **Oral abx + topical retinoid + Benzoyl peroxide +/- topical abx**
* Inadequate response: Consider oral isotretinoin, derm referral, hormonal therapy for females
49
* How long does it take before a patient sees the effects of acne treatment?
* How long should a therapy be continued before a tx response can be accurately evaluated?
* **2-3 months** before see a response
* Therapy should be continued for at least **8 weeks** before a tx response can be accurately evaluated
50
**How is Acne Rosacea** different than acne vulgaris?
Acne Rosacea has:
* **absence of comedones**
* Presents w/ easy **flushing,** erythema, telangietasias
* Triggers= **_alcohol, sun, heat, spicy food, emotional stress_**
* Not related to hormones
* Treated topically and orally
51
When do you refer a patient with acne to derm?
Pt w/ difficult to control acne or the presence of scarring
52
When is oral abx contraindicated in the tx of acne (eg: Minocycline, Doxycycine)?
* **Pregnancy**
* **pt \<8y/o** (damages tooth enamel and bones)
53
T/F: Tetracyclines interfere with birth control pills
FALSE
54
What are the common adverse effects of oral abx used to tx acne (eg: minocycline, doxycycline, etc)?
* GI upset
* **photosensitivity**
* Minocycline- vertigo, dizziness, hyperpigmentation
