Derm disorders

Question 1

Principles of derm assessment

Answer 1

• is the pt otherwise well without systemic signs or other symptoms? likely condition limited to the skin
• is the pt miserable but not systemically ill? often uncomfortable with itch, burning, or pain (scabies, herpies zoster
• Systemically ill with constitutional s/s (fever, fatigue, loss of appetite, unintended weight loss, malaise)? dermatologic manifestation of systemic disease (varicella, transepidermal necrosis, lyme disease, SLE)
• Consider wich pts are at greatest risk for the condition
• consider transmission/contagion risk
• are there primary lesions only or primary and secondary lesions

Question 2

Primary Vs. Secondary skin lesion

Answer 2

1. Primary: results from a disease process, has not been altered by outside manipulation, treatment or natural course of disease (vesicle)
2. Secondary: lesions altered by outside manipulation, treatment, natural course of disease (crust)

Question 3

Papule

Answer 3

single uniformly brown colored, slighty raised, irregularly shapped with defined borders

6mm in diameter

Question 4

Macule

Answer 4

single non-palpable area of discoloration, irregularly shapped
5mm or less in diameter

Question 5

Purpura

Answer 5

flat, non-blanchable, confluent, purple-colored irregularly-shaped lesions on skin ranging 2-20mm

caused by low plts

Question 6

clustered

Answer 6

occuring in a group without a pattern

vessiccular lesion seen in HSV1

Question 7

Scattered

Answer 7

generalized over body without a specific pattern or distribution

viral exanthem - rash triggered by virus (rubella)

Question 8

confluent/coalescent

Answer 8

multiple lesions blending together

plaques seen in severe psoriasis

Question 9

annular

Answer 9

in a ring
characteristic bulls eye lesion with central clearing as in lyme disease

Question 10

Actininc Keratosis

Answer 10

• precancerous lesion: likely only 1:100 progress to SCC
• predominanatly found on sun-exposed skin
• microscopic to several cm
• stuck on apperance - red, brown or flesh tone, often tender but usually minimally symptomatic
• lesions can remain unchanged, spontaneously resolve, or progress to invasive SCC
• Bx not needed for Dx.
• Intervention: topical 5FU, imiqumimod cream, dicolfenac gel, phododynamic therapy, cryosurgery

Question 11

Basal cell Vs Squmous cell carcinoma

Answer 11

BCC
* sun exposed areas
* de novo - new lesion
* papule, nodule without central erosion
* pearly or waxy apperance, relatively distinct borders with or without telangiectasia
* metistatic risk low

SCC
* Sun exposed areas
* can arise from actininc keratoses or de novo
* red, conical hard lesions with or without ulceration (appears more angry)
* less distinct borders
* metastatic risk greater (3-7%) greates risk with lesion on lip, oral cavity, or genetalia

Question 12

Metastatic melanoma
ABCDEE

Answer 12

Assymetric
Borders Irregular
Color not uniform
Diameter usually greater than 6mm
Evolving new lesion or change in longstanding lesion
Elevated

Question 13

Psoriasis Vulgaris tx

Answer 13

medium potency topical coticosteroid

Question 14

Scabies treatment

Answer 14

permethrin lotion

Question 15

Verruca vulgaris tx

Answer 15

Imiquimod cream - immune modulator

Question 16

Tinea pedis tx.

Answer 16

topical ketoconazole

Question 17

Rosacea tx

Answer 17

topical metronidazole

Question 18

Phytodermatitis tx

Answer 18

Topical
* mild or high potency topical corticosteroid- triamcinolone, clobestasol
* areas of thinner skin - lower potency corticosteroid - consider oral

systemic tx
* preferred when >20% total body surface is affected, or severe rash, or is rash impacts face, genitals, hands, or rash impacts occupational function.
* prednisone 0.5 - 1 mg/kg/day for 5-7 days then half dose for additional 5-7 days.

Question 19

Impetigo - nonbullous

Answer 19

erythematous macule that rapidly evolves into vesicle or pustule, ruptures, contents dry, leaving a crusted, honey colored exudate

staphlococcus aureus, streptococcus pyogenes (gram+)

treat with topical mupirocin

Question 20

Impetigo bolus

Answer 20

bulla contain clear yellow fluid that turns cloudy, dark yellow. Bullae rupture easily within 1-3 days, leaving a rim of scale around red, moist base, followed by a brown - lacquered or scalded skin appearance.

usually requires systemic abx

Question 21

Cellulitis

Answer 21

infection of dermis and subcutaneous fat usually includes heat, redness, and discomfort

caused by streptococcus pyogenes or less commonly staphylococcus aureas (MSSA is beta-lactamese producer, MRSA resistance via altered binding sites)

TX for mild cases
* PO penicillin VK (suseptible to beta-lactamase)
* PO cephalexin (preferred)
* PO dicloxacin
* PO clindamycin (risk of c. diff)

Question 22

Abcess tx

Answer 22

Mild
* I &D
* Warm Compress

Moderate
* I &D, C&S
* TMP/SMX (bactrim) or doxycycline
* Change intherapy based on C&s results:
- MRSA continue above
- MSSA dicloxacin or cephalexin