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Derm misc- in class lecture Flashcards

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1
Q

Which derm condition?

  • Non-scarring focalized hair loss
  • Higher incidence in younger ages
  • autoimmune attack on the hair follicles by autoreactive CD8 T-cells

A

Alopecia areata

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2
Q

Clinical presentation of which derm condition?

  • Abrupt onset
  • well-demarcated bald spots on scalp/other parts of body
  • _*Exclamation point hairs*_
A

Alopecia areata

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3
Q

How do you tx Alopecia areata?

A
  • Spontaneous remission in ~6mo often occurs
  • Topical corticosteroids (superpotent- under occlusion, or potent- combo w/ minoxidil)
  • Topical Minoxidil
  • Intralesional corticosteroids (1st line in adults)
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4
Q

What is the first line tx of Alopecia areata in adults

A

Intralesional corticosteroids

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5
Q

How do you manage Alopecia areata?

A
  • Psychological support, support groups
  • Refer to derm if involvement of larger areas
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6
Q

Which derm condition?

  • Inflammation of the lateral or proximal nail folds
  • MC etiology- S. aureus
  • Risk factors: nail biting, picking at hang nails, DM, occupational risks
A

Paronychia

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7
Q

How do you tx a parnoychia WITHOUT an abscess?

A
  • Warm compresses/soaks
  • topical abx
  • more severe cases- oral Cephalexin or dicloxacillin
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8
Q

How do you tx a parnoychia WITH an abscess?

A

I&D

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9
Q

Which derm condition?

  • Hypermelanosis at sun-exposed areas of face
  • Common in pregnancy or people taking OCPs
A

Melasma

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10
Q

Clinical presentation of which derm condition?

  • Brownish macules w/ irregular borders
  • Symmetric
  • On face
  • Sun exposure intensifies lesions
A

Melasma

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11
Q

How do you tx melasma?

A
  • Sun protection and avoidance
  • Hypopigmenting agents (hydroquinone, azelaic acid, tretinoin, etc)
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12
Q

T/F: Melasma is chronic and recurrence is common

A

True

Better prognosis if pregnancy related

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13
Q

Which derm condition?

  • Progressive, autoimmune destruction of melanocytes leading to depigmentation
A

Vitiligo

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14
Q

Which derm condition?

  • Chronic inflammatory dermatosis related to chronic venous insufficiency
  • Predisposing factors- vericose veins, prolonged standing, etc
A

Stasis dermatitis

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15
Q

How do you dx and tx Stasis dermatitis?

A
  • Dx: clinical, ultrasound
  • Tx:
    • Direct tx towards venous insufficiency (leg elevation, continuous compression therapy, etc)
    • appropriate skin care and dressings
    • topical corticosteroids if pruritic
    • prevention/tx of ulcers
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16
Q

Which derm condition?

  • Localized, lichenification from repetitive rubbing/scratching
  • Highest prevalence: women, >20 years old, atopic individuals

A

Lichen Simplex chronicus

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17
Q

The following is the clinical presentation of which derm condition?

  • Well-defined plaques made by confluent papules,
  • Thickened skin - dull red color that can progress to brown or black
  • Excoriations
A

Liche Simplex Chronicus

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18
Q

What are the 2 treatments for Lichen Simplex Chronicus?

A

1. Stop scratchig/rubbing

  1. Topical Corticosteroids
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19
Q

Which derm condition?

  • MC 30-60y/o
  • 4Ps- Purple (violaceous), Polygonal, pruritic, papules/plaques
  • Koebner phenomenon (skin lesions along lines of trauma)
  • Wickman’s striae- fine white lines form network over papules
A

Lichen Planus

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20
Q

What is the 1st line treatment for Lichen Planus?

A

1st line= Topical, intralesional, or oral corticosteroids (if severe)

Can also tx w/ retinoids, photochemotherapy and cyclosporine

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21
Q

What are the 4 stages of pressure ulcers?

A

4 stages- ulcers classified by depth of soft tissue damage:

  • I: non-blancheable erythema of intact skin
  • II: partial-thickness skin loss involving epidermis, dermis, or both
  • III: full-thickness skin loss involving damage to or necrosis of subcutaneous tissue that may extend to the underlying fascia (but not through)
  • IV: full-thickness skin loss with extensive necrosis of or damage to muscle, bone, or supporting structures

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22
Q

What are the 3 complications of pressure ulcers?

A
  • Complications:
    • local infection
    • ​osteomyolitis
    • sepsis
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23
Q

Which derm condition?

  • Chronic inflammatory disorder involving hair follicle
  • MC area: intertrignous areas
  • Women 18-29y/o
  • Contributing factors: obesity, smoking, hormones, etc (also assoc. w/ DM/PCOS)
A

Hidradenitis suppurativa

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24
Q

Which derm condition?

  • Recurrent inflammed nodules
  • Draining sinus tracts
  • comedones
  • scarring
A

Hidradenitis suppurativa

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25
How do you manage Hidradenitis Suppurativa?
* Pt education, psychosocial support * Avoid skin trauma * **Hygiene**- topical antiseptic washes * **smoking cessation** * **weight management**
26
How do you treat MILD Hidradenitis Suppurativa?
1st line= **_topical Clindamycin_** adjunct treatment= intralesional corticosteroids
27
How do you tx MODERATE Hidradenitis Suppurativa?
Oral tetracyclines (e.g. Doxy)
28
What is surgical tx for Hidradenitis suppurativa?
–Punch debridement (de-roofing), wide excision
29
The following are complications of which derm condition? ## Footnote **–Fistulae** **–Strictures and contractures** –Lymphatic obstruction –Malaise, **depression**, suicide –Infectious complications
Hidradenitis Suppurativa
30
Which derm condition? * ~90% from **HSV infection** (can also be from meds) * _**\*\*Target lesion\*\***_
Erythema multiforme
31
Does Erythema multiforme major or minor have mucosal involvement?
Major= mucosal involvement Minor= NO mucosal involvement
32
What is the course of Erythema multiforme and how do you tx?
* Course- resolves in 2wks * Tx: tx cause, supportive care
33
Which derm condition? * Chronic, r**elapsing-remitting, autoimmune blistering disease** in people \>60y/o * **_Pruritic_** * **subepithelial blisters** (doesn't break easily) * **_Mucosal involvement rare_**
**Bullous pemphigoid** (bolded/underlined info is how to differentiate from Pemphigus vulgaris)
34
What is the gold standard for diagnosing Bullous pemphigoid?
Skin bx w/ direct immunofluorescence testing
35
What is 1st line tx for Bullous pemphigoid?
* **Topical Corticosteroid** (high potency)--\> Clobetasol 0.05% cream * **Systemic corticosteroid** is an alternative 1st line tx
36
Which derm condition? * **Autoimmune blistering** disease of the **skin** and **_mucous membranes_** * Blister in **_deep epidermis_** * **_Painful_** (not pruritic) flaccid blisters, occuring everwhere (NOT palms/soles) * **_Blisters fragile_** * **_Mucous membrane_** presentation MC
**_Pemphigus vulgaris_** (bold/underlined = how dif from bullous pemphigoid)
37
Which derm condition has the average age of onset of 50-70y/o is an automimmune dz and displays the **_Nikolsky sign_** (sloughing off of skin)?
Pemphigus vulgaris
38
How do you diagnose Pemphigus vulgaris?
**skin biopsy** of fresh lesion & direct immunofluourescence of perilesional skin for antibody detection
39
How do you manage pemphigus vulgaris?
* **HOSPITALIZATION** for IVF and nutrient repletion * **Systemic glucocorticoids** and **immunosuppressive therapy**
40
Which derm condition? * Velvety, **hyperpigmented**, grey-brown **plaques** * **Intertriginous sites** (neck axillae) * MC in **American indian, black and hispanics** * assoc w/ **insulin resistance (obesity, DM, PCOS)**
Acanthosis nigricans
41
How do you tx Acanthosis nigricans?
**_•treat the underlying condition_**
42
Which derm condition? * common in older adults * **bleed profusely w/ trauma** * Only tx for cosmetic reasons
Cherry angioma
43
Which derm condition? * Persistent **dilatations of small capillaries** in the **superficial dermis** * Clinical diagnosis * Tx: for cosmesis
Telangiectasia
44
How do you diagnose and tx a lipoma
* clinical diagnosis * •Tx: for pain, cosmesis, or for reassurance–-\> Surgical removal
45
What derm condition? * soft * painless subcutaneous nodule
Lipoma
46
What is the MC cutaneous cyst?
Epidermal cyst
47
Which derm condition? * Skin colored dermal nodules w/ **_central punctum_** * clinical dx
Epidermal cyst
48
How do you tx an epidermal cyst?
Intralesional triamcinolone, I&D, excision (must remove intact to decrease chance of recurrence)
49
Which derm condition occurs at or near the **upper part of the natal cleft of the buttocks**
Pilonidal cyst
50
The following is the clinical presentation of which derm condition? * **Sudden onset pain in intergluteal region** with sitting or activities that stretch the skin over the natal cleft * Intermittent swelling * Mucoid, purulent, or bloody discharge * Fever, malaise
Acute pilonidal cyst
51
How do you treat an acute pilonidal cyst?
–Acute abscess: I&D –Cellulitis without abscess: antibiotics
52
What are the sxs of a chronic pilonidal cyst and how do you tx?
Sxs: recurrent/persistent drainage and pain Tx: surgical tx to destrol all sinus tracts and skin pores
53
**Which derm condition?** * abnormal cutaneous response after **light exposure** * **often associated w/ med**s (tetracyclines, sulfonamides, FQs, NSAIDs, retinoids, etc)
Photosensitivity Reactions
54
How do you treat Vitiligo?
* **Sunscreen, cosmetic camouflage** * **psychologic support** * **Repigmentation** done by derm (topical corticosteroids, UV radiation therapy, Calcineurin inhibitors, topical Vit. D, skin grafting)
55
Which Derm condition has the following presentation? **hyperpigmented plaques** on **lower legs/ankles**, erythematous scales, edema
Stasis Dermatitis
56
What are the "4P's" of Lichen Planus?
1. Purple (violaceous) 2. Polygonal 3. Pruritic 4. Papules/plaques
57
How do you diagnose pressure ulcers?
* **Clinical diagnosis** * +/- Skin biopsy: to help with staging or to exclude other causes of skin ulcers * Imaging to evaluate for complications
58
How do you treat **pressure ulcers**?
Tx: * **PREVENTION** (reposition q2hrs, etc) * wound management (cleanse w/ normal saline) * pain management (1st line= ASA/NSAIDs, opioids for mod-severe) * Nutritional management- assess for adequate protein and caloric intake * +/- surgical tx for stage IV
59
How do you treat **_refractory moderate-severe_ Hidradenitis suppurativa**? (3)
Oral retinoids Hormonal Therapies Biologics
60
What are 3 complications of Pemphigus vulgaris?
1. Malnutrition 2. Dehydration 3. Sepsis \*\*can be life threatening!\*\*
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