- medications - insect bites - foods - emotions - latex

Dermatology Flashcards by Deleted Deleted

30-40 yoa
AI disease of unclear etiology
Abs produced against Ags in intercellular spaces of epidermal cells
possible causes are idiopathic, ACEI, penicillamine
bullae are relatively thin and fragile
POSITIVE Nikolsky’s sign
PAINFUL
not pruritic
fluid loss and risk of infection d/t loss of skin integrity
life-threatening
mouth involvement

pemphigus vulgaris

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MOST ACCURATE test for pemphigus vulgaris

skin biopsy

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treatment for pemphigus vulgaris

steroids

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treatment for pemphigus vulgaris if steroids are ineffective

azathioprine
mycophenolate
cyclophosphamide

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70-80 yoa
can be sulfa drug-induced
deep blisters
thicker bullae much less likely to rupture
oral lesions are RARE

bullous pemphigoid

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test for bullous pemphigoid

skin biopsy w/ immunofluorescent Abs

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treatment for bullous pemphigoid

steroids

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alternative treatment to steroids for bullous pemphigoid

tetracycline

- erythromycin w/ nicotinamide

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associated w/ other AI diseases
can be drug-induced by ACEIs or NSAIDs
very superficial
NO oral lesions

pemphigus foliaceus

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diagnosis for pemphigus foliaceus

skin biopsy

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treatment for pemphigus foliaceus

steroids

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d/o of porphyrin metabolism
photosensitivity reaction to abnormally high accumulation of porphyrins
NONHEALING blisters on sun-exposed parts of body
hyperpigmentation of skin
hypertrichosis of face

porphyria cutanea tarda

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are associated w/ porphyria cutanea tarda

alcoholism
liver disease
chronic hepatitis C
OCPs
hemochromatosis
DM

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test for porphyria cutanea tarda

urinary uroporphyrins

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treatment for porphyria cutanea tarda

stop drinking alcohol
stop all estrogen use
barrier sun protection
phlebotomy/deferoxamine
chloroquine (increases porphyrin excretion)

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hypersensitivity reaction, most often mediated by IgE and mast cell activation
evanescent wheals and hives (onset w/i 30 minutes, and lasts

urticaria

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MCC of urticaria

medications
insect bites
foods
emotions
latex

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chronic urticaria is associated w/

pressure on skin
cold
vibration

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treatment for severe, acute urticaria

H1 antihistamines

- steroids if life-threatening

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treatment for chronic urticaria

H2 antihistamines

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treatment for urticaria when trigger cannot be avoided

desensitization

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milder version of hypersensitivity reaction than urticaria
“typical” drug reaction
rash resembles MEASLES (hence the name)
can appear days after exposure, and even after medication has been stopped
lymphocyte mediated

morbilliform rash

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treatment for morbilliform rash

antihistamines

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erythema multiforme causes

penicillins
phenytoin
NSAIDs
sulfa drugs
HSV, or mycoplasma infection

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- target-like lesions especially on PALMS and SOLES | - can be described as "iris-like"

erythema multiforme

treatment for erythema multiforme

antihistamines and treat underlying infection

- hypersensitivity response to medications (penicillins, sulfa drugs, NSAIDs, phenytoin, phenobarbital) - involves

Stevens-Johnson syndrome (SJS)

treatment for Stevens-Johnson syndrome (SJS)

- should be managed in burn unit | - IVIG, cyclophosphamide, cyclosporine, or thalidomide

- most serious version of cutaneous hypersensitivity reaction - 30-100% BSA involvement - positive Nikolsky's sign - drug-induced

toxic epidermal necrolysis

MCC of death in toxic epidermal necrolysis

sepsis

are prophylactic systemic antibiotics indicated in toxic epidermal necrolysis?

causes of death in Stevens-Johnson syndrome (SJS)

infection, dehydration, and malnutrition

diagnosis of toxic epidermal necrolysis

skin biopsy

what effect do steroids have in toxic epidermal necrolysis?

decrease chances of survival

- LOCALIZED allergic drug reaction w/ repeated drug exposure | - round, sharply demarcated lesions that leave a hyperpigmented spot at the site after they resolve

fixed drug reaction

treatment for fixed drug reaction

topical steroids

- painful, red, raised nodules on anterior surface of LE's - nodules are TTP - do not ulcerate - ast about 6 weeks - 2/2 recent infections or inflammatory conditions

erythema nodosum

inflammatory conditions associated w/ erythema nodosum

- pregnancy - recent Streptococcal infection - coccidioidomycosis - histoplasmosis - sarcoidosis - IBD - syphilis - hepatitis - enteric infections

treatment for erythema nodosum

- analgesics and NSAIDs | - treat underlying cause

best INITIAL test for: - tinea pedis - tinea cruris - tinea corporis - tinea versicolor - tinea capitis - onychomycosis

KOH test of skin

MOST ACCURATE test for: - tinea pedis - tinea cruris - tinea corporis - tinea versicolor - tinea capitis - onychomycosis

fungal culture

- superficial bacterial infection - described as "weeping," "oozing," "honey-colored," or "draining" - occurs in warm, humid conditions - more often caused by Staphylococcus, but sometimes Streptococcus pyogenes

impetigo

complication of impetigo

glomerulonephritis

treatment for impetigo

- topical mupirocin | - PO antistaphylococcal abx if topical isn't enough (dicloxacillin, cephalexin, or cefadroxil (PO))

- involves both dermis and epidermis - MCC by group A Streptococcus (pyogenes) - fever, chills, bacteremia - bright red, angry, swollen appearance to face

erysipelas

treatment for erysipelas

- dicloxacillin, cephalexin, or cefadroxil (PO) | - oxacillin, nafcillin, cefazolin (IV)

if a pt is allergic to PCN w/ reaction being a RASH ONLY, can cephalosporins be used?

YES

if a pt is allergic to PCN w/ reaction being ANAPHYLAXIS, can cephalosporins be used?

treatment for erysipelas if culture confirms Streptococcus

PCN G, or ampicillin (IV)

- involves dermis, and subcutaneous tissue - caused by Staphylococcus, or Streptococcus - +/- fever, hypotension, signs of sepsis

cellulitis

empiric treatment for cellulitis

oxacillin, nafcillin, cefazolin (IV)

treatment for mild cellulitis w/ MRSA

TMP/SMX, doxycycline, or clindamycin

- extremely severe, life-threatening skin infection - starts as cellulitis that dissects into fascial planes - Streptococcus and Clostridium are MC organisms - increased risk with DM pts

necrotizing fasciitis

necrotizing fasciitis presentation:

- very high fever - portal of entry into skin - pain out of proportion to superficial appearance - bullae - palpable crepitus

diagnostic tests for necrotizing fasciitis

- CPK | - XR, CT, or MRI to show air in tissue, or necrosis

best way to confirm diagnosis and mainstay treatment for necrotizing fasciitis

surgical debridement

antibiotic treatment for necrotizing fasciitis

- ampicillin/sulbactam - ticarcillin/clavulanate - piperacillin/tazobactam

treatment for necrotizing fasciitis if there is definite diagnosis of group A Streptococcus (pyogenes)

clindamycin and PCN

mortality rate of necrotizing fasciitis w/o adequate treatment

80%

infection loculated under skin surrounding a nail

paronychia

treatment for paronychia

- small incision to drain - antistaphylococcal abx (dicloxacillin, cephalexin, or cefadroxil (PO))

multiple, painful vesicles of genitals

herpes simplex

best INITIAL test for genital herpes simplex

Tzanck smear

MOST ACCURATE test for genital herpes simplex

viral culture

treatment for genital herpes simplex

PO acyclovir, famciclovir, or valacyclovir

when should you treat a child for chickenpox?

if immunocompromised | same meds: PO acyclovir, famciclovir, or valacyclovir

complications of varicella

- PNA - hepatitis - dissemination

treatment for severe pain in elderly pts w/ dermatomal herpes zoster

steroids

best efficacy for decreasing risk of postherpetic neuralgia in dermatomal herpes zoster

acyclovir

nonimmune adults exposed to chickenpox should receive what?

varicella zoster immune globulin w/i 96 hours of exposure

- warts (condylomata acuminata) [heaped up, translucent, white or flesh-colored lesions on mucous surfaces]

human papillomavirus (HPV)

treatment for human papillomavirus (HPV)

- mechanical removal | - imiquimod

- ulceration w/ heaped-up indurated edges | - painLESS

primary syphilis

best INITIAL test for primary syphilis

darkfield microscopy

treatment for primary syphilis

IM PCN single dose

treatment for primary syphilis if PCN allergic

PO doxycycline x 2 weeks

- generalized copper-colored, maculopapular rash especially on PALMS and SOLES - mucous patch - alopecia areata - condylomata lata

secondary syphilis

diagnostic tests for secondary syphilis

VDRL, or RPR (nearly 100% sensitive)

treatment for secondary syphilis

IM PCN single dose

treatment for secondary syphilis if PCN allergic

PO doxycycline x 2 weeks

- skin infection involving web spaces of hands and feet - can also cause pruritic lesions around penis and breast - burrows and excoriations around small pruritic vesicles - often spares the head

scabies

scabies is confirmed by

scraping out organism after mineral oil is applied to burrow

best INITIAL treatment for scabies

permethrin

treatment for Norwegian scabies (severe crusting)

PO ivermectin

- includes the head - easily transmitted - extremely high rate of transmission - sometimes rust colored from ingestion of blood

pediculosis (lice and crabs)

diagnosis of pediculosis (lice and crabs)

can be seen attached to hair-bearing areas

treatment for pediculosis (lice and crabs)

permethrin

- target lesion (> 85%) = rash must be erythematous w/ central clearing and be at least 5cm in diameter - usually occurs 7-10 days after tick bite

lyme disease

treatment for lyme disease

doxycycline, amoxicillin, or cefuroxime (PO)

- caused by Staphylococcus attached to a foreign body (nasal packing, retained sutures, surgical material retained in the body) - fever > 102 - SBP

toxic shock syndrome (TSS)

treatment for toxic shock syndrome (TSS)

- vigorous fluid resuscitation - vasopressors - antistaphylococcal abx (oxacillin, nafcillin, cefazolin (IV))

treatment for toxic shock syndrome (TSS) if MRSA

vancomycin, or linezolid

- mediated by toxin from Staphylococcus - loss of superficial layers of epidermis - Nikolsky's sign - presents w/ NORMAL BP - NO involvement of liver, kidney, BM, or CNS

Staphylococcal scalded skin syndrome (SSSS)

treatment for Staphylococcal scalded skin syndrome (SSSS)

IV oxacillin, or nafcillin

- cutaneous infection acquired from contact w/ infected livestock - occupational hazard of wool sorters - can be used for bioterrorism - papule w/ central necrosis (eschar) - 20% fatality if untreated

anthrax | Bacillus anthracis

how is the diagnosis of anthrax confirmed?

gram stain and culutre

treatment for anthrax

ciprofloxacin, or doxycycline

MOST ACCURATE test for melanoma

full thickness biopsy of lesion

most important prognostic factor for melanoma

tumor thickness

treatment for melanoma

excision

reduces recurrence rates of melanoma

interferon

- BENIGN | - hyperpigmented lesions in elderly pts ("stuck on" appearance)

seborrheic keratosis

- PRECANCEROUS (increases risk of SCC) - occur on sun-exposed areas in older pts - can be TTP

actinic keratosis

treatment for actinic keratosis

- cryotherapy - topical 5-FU - imiquimod - topical retinoic acid - curettage

- sun-exposed areas in elderly pts - commonly on the lip - ULCERATION is common - metastasis is rare

squamous cell carcinoma

diagnosis of squamous cell carcinoma

biopsy

treatment for squamous cell carcinoma

surgical removal

- shiny, or "pearly" appearance | - accounts for 65-80% of skin cancer

basal cell carcinoma

how is diagnosis of basal cell carcinoma confirmed?

shave or punch biopsy

treatment for basal cell carcinoma

surgical removal (Mohs microsurgery)

- purplish lesions | - HIV-positive w/ CD4 count

kaposi's sarcoma

treatment for kaposi's sarcoma

- ART to raise CD4 count | - liposomal doxorubicin and vinblastine if HIV-negative

- silvery scales on EXTENSOR surfaces - nail pitting - Koebner phenomenon (lesions that develop at site of epidermal injury)

psoriasis

treatment for psoriasis

- emollients (moisturizer) | - salicylic acid

treatment for xerosis/asteatotic dermatitis

humidifiers and emollients

- high IgE levels | - red, itchy plaques on FLEXOR surfaces

atopic dermatitis

preventive treatment for atopic dermatitis

emollients

treatment for active disease of atopic dermatitis

- AVOID SCRATCHING - topical steroids - antihistamines

- oversecretion of sebaceous material - hypersensitivity reaction to superficial fungal organism (Pityrosporum ovale) - scaly, greasy, flaky skin found on red base of scalp, eyebrows, and nasolabial fold

seborrheic dermatitis

treatment for seborrheic dermatitis

- topical steroids - topical antifungal - zinc pyrithione

- hyperpigmentation built up from hemosiderin | - occurs over long period from VENOUS incompetence of LE's

stasis dermatitis

prevention of stasis dermatitis

elevation of LE's

- hypersensitivity reaction to soaps, detergents, latex, sunscreen, or neomycin - jewelry is a common cause - can present as linear streaked vesicles (especially when caused by poison ivy)

contact dermatitis

definitive testing for contact dermatitis

patch testing

treatment for contact dermatitis

- identifying causative agent | - antihistamines and topical steroids

- pruritic eruption that begins w/ "herald patch" - erythematous and salmon colored - mild and self-limited, resolves in 8 weeks

pityriasis rosea

- pustules and cysts occur and rupture - caused by Propionibacterium acnes - discharge is odorless

acne

treatment for acne: mild disease

- topical antibiotics: clindamycin, erythromycin, or sulfacetamide - topical retinoids

treatment for acne: moderate disease

benzoyl peroxide and retinoids

treatment for acne: severe cystic acne

- PO antibiotics | - PO retinoic acid derivatives

definition of stage 1 pressure ulcer

nonblanchable erythema of INTACT skin

definition of stage 2 pressure ulcer

superficial ulcers causing PARTIAL thickness loss of epidermis, dermis, or both

definition of stage 3 pressure ulcer

deeper ulcers causing FULL thickness loss w/ damage to subcutaneous tissue that may extend to, but NOT through, any underlying fascia

definition of stage 4 pressure ulcer

VERY deep ulcers causing FULL thickness loss w/ EXTENSIVE tissue destruction that may damage adjacent muscle, bone, or supporting structures

Dermatology Flashcards

(134 cards)