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skin Flashcards

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1
Q

common causes of rash

A

allergens, infections, collagen vascular disease, toxic, drugs, metabolic

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2
Q

life threatening rashes

A

anaphylaxis, angioedema, bacterial endocarditis, meningococcal meningitis, severe thrombocytopenia, Kawasaki syndrome, TSS, toxic epidermal necrolysis (TEN)

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3
Q

flat, non-palpable skin lesion

A

macule–>patch(>1cm)

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4
Q

elevated, firm circumscribed skin lesion

A

papule–>nodule(1-2cm)

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5
Q

elevated firm rough skin lesion (>1cm) flat top

A

plaque

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6
Q

elevated, irreg. shaped cutaneous edema

A

wheal

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7
Q

elevated, circumscribed, superficial, not into dermis, filled with serous fluid

A

vesicle–>bulla (>1cm)

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8
Q

like vesicle but pus

A

pustule

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9
Q

superficial dilated blood vessels

A

telangiectasia

1 cause: chronic etOH

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10
Q

allergic skin reaction

A

urticaria, hives

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11
Q

suspect bacterial endocarditis

A

Oslar nodes and Janeway lesions

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12
Q

if wet purpura in mouth worry about

A 
severe thrombocytopenia (as low as 2000)
infectious etiology
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13
Q

peds

A

Kawasaki

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14
Q

skin sloughs off, typ. medication related, tachy

A

toxic epidermal necrolysis (TEN)

also SJS w/ sulfa drugs

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15
Q

present w. purpura, fever, altered, neck stiffness

A

meningitis

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16
Q

K-OH prep

A

highlights fungal infection

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17
Q

basal cell carcinoma

A
  • caucasians
  • pearly white lesion, pt may scratch–>bleed
  • slow growing tumor
  • 30% lifetime risk M>F
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18
Q

BCC risk factors

A

-UV sunlight, tanning, chronic arsenic exposure, radiation, long term immunosuppr. tx (transplants)

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19
Q

BCC dx

A
  • pearly/waxy translucent in light papule
  • best obs. w/ stretched skin
  • erythematous patch >6mm or non-healing ulcer in sun exposed areas
  • shave or punch biopsy: bests of basaloid cells in dermis, sep. from adj stroma by thin clefts
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20
Q

BCC tx

A
  • electrodessication and curettage: not able to histologically confirm complete removal
  • surgical excision
  • Mohs surgery: take out one slide at a time til histologically confirm no more BCC (imp. on face, lips, nose, etc)
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21
Q

BCC topical/non-surg tx

A
  • 5-fluorouracil: pyrimidine antimetabolite, interferes w. DNA synthesis
  • Imiquimod (Aldara): unknown mechanism, TLR7 agonist, induces cytokines (INF-a)
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22
Q

radiation therapy for BCC

A

typically avoided
used in pt. who are nonsurgical candidates
-admin. in 4+ fractions, limits side effects, gives normal skin time to heal while cancerous cells cannot repair themselves as quickly

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23
Q

benefits of radiation tx

A

-cosmetically sparing, noninvasive, painless, nonsurg. candidates

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24
Q

BCC follow up

A

monitor pt annually

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25
metastatic basal cell
deeply invasive/large lesions >10cm2 - missed w. poor examination, altered elderly pts - reg. lymph nodes, lungs, bones, skin, liver * Vismodegib (Erivedge): Hedgehog pathway inhibitor
26
squamous cell carcinoma
non-healing ulcer/wart nodule recurring, bleeding lesion, dry, scaly dorsum of hand, arm, nose -sun damage, fair skinned ind., transplant recipients
27
SCC risks
2nd most common UV radiation, tanning, arsenic exposure, smoking, high fat/meat diet, immunesuppr (transplant >5 yrs, HIV, long term glucocorticoid use)
28
genetic risk factors for SCC
xeroderma pigmentosum, v. rare epidermolysis bullosa albinism Fanconi's anemia
29
other SCC risk factors
Chronic lymphocytic leukemia (CLL) meds: Voriconazole(longterm anti fungal) BRAF inhibitors (Vemurafenib and Dabrafenib) used to tx metastatic melanoma, but do not stop, cut out SCC
30
Actinic Keratosis
-develops into SCC -chronic sunlight exposure-->excess keratin buildup -
31
SCC dx
complete skin and regional exam -lymph node exam biopsy
32
SCC tx
surgical excision Mohs electrodesiccation and curettage radiation therapy: for non surg candidates, if extensive perineural or large nerve involvement, LN involvement
33
SCC follow up
every 3 mos w/ LN exam for 1 year, then every 6 mos thereafter
34
malignant melanoma
``` UV radiation exposure cutaneous acral: palms, soles mucosal ocular/uveal ```
35
inc. risk for malignant melanoma
- Irish/European, fair - more freckles - Fam Hx
36
ABCDE of malig mel
``` Asymmetric Borders-irregular Color-variations Diameter->pencil eraser Evolution-take pic to monitor changes ```
37
staging of malig mel
>4 mm deep: systemic chemo (T4, metastatic) - thickness, ulcerated or not - regional LN
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stage 1A-1B
wide excision
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stage 1B (0.76-1mm)
wide excision +/- INF
40
stage III
LN dissection and INF
41
stage IV
systemic therapy (chemo)
42
wider margins do not have added benefit with tumor thickness
>4mm (grow deeper)
43
sentinel LN biopsy if..
>1mm depth | -less if high risk features: ulceration, elevated MR, regression signs, BT>=0.75 mm
44
complete LN dissection
radiation after
45
stereotactic radiosurgery
for brain metastases: hottest around lesions to spare rest of brain tissue
46
chemotherapy meds
Ipilimumab Dabrafenib + trametinib Pembrolizumab Nivolumab
47
other chemo meds
``` Vemurafenib Dabrafenib Trametinib Imatinib Dacarbazine Temozolomide Alb-bound palitaxel IL-2 Dacarbazine or temozolomide-based combo Pacliltaxel Pacliltaxel/carboplatin ```
48
BRAF inhibitors
Vemurafenib, dabrafenib -MAP kinase pathway inhib. (inhib. *BRAF V600E*) SE: edema, HA, rash **SCC of skin! arthralgia
49
MEK inhibitors
Trametinib -rev. and sel. inhib. mitogen-act EC kinase (MEK) downstream from BRAF (combine with BRAF inhibs.) SE: *cardiomyopathy, rash, anemia, hemorrahge, liver inflamm.
50
CTLA-4 inhibitors
Ipilimumab blocks CTLA-4, allows for enhanced T-cell activation and prolif SE: (hyperactivates Imm. sys) colitis, dermatitis, hepatitis, hypophysitis, thyroiditis
51
Anti-PD-1 Monoclonal Ab
Nivolumab Pembrolizumab inhib. PD-1 activity by binding PD-1 rec. to block ligands PD-L1/2, releases PD-1 pathway med inhib of IR (anti tumor response) SE: e-lyte abnormalities, cytopenia, rash
52
Ipilimumab
enables prolif of T cells thru CD28 or CTLA-4-->inc. signalling-->T-cell activation - works in 10-15% pts - takes 1-4 mos (diff. to monitor) - may look worse on CAT scan after tx before gets better
53
50% BRAF mutations in
skin lesions, not as common in others
54
BRAF inhibitors (vemurafenib)
shuts down cascade of DNA replication
55
combine BRAF and MEK
to inc. survival
56
largest challenge w/ BRAF/MEK combo w/ PD1 inhibitors
poor side effects w/ PD1 inhibs.
57
PD1 inhibitors
releases shut down of CTL, allows immune response
58
scaly
psoriasis, xerosis, pityriasis
59
vesicular
shingles, herpes simplex
60
weepy/crusted
impetigo
61
pustular
acne, folliculitis
62
figurate
erythema mulitform
63
bullous
bullous pemphigoid, pemphigus vulgaris
64
nodular
erythema nodosum
65
morbilliform
drug rash, viral exanthema
66
erosive (umbilicated)
vesicular dermatitis
67
ulcerative
decubiti, herpes simplex, cancers
68
biliform rash
chest and neck (drug reaction)
69
honeycombing rash
face and chin-impetigo rash
70
impetigo
chin, crusty, weepy lesion
71
melanocytic nevi (normal moles)
72
atypical/dysplastic nevi
>6mm, irreg borders, irreg. pigment | -5-10% adults
73
separated keratosis
"stuck on" lesion, waxy not worrisome could transition into something worse
74
malig mel
flat or raised, suspected in any lesion w/ appear. change, varying colors ABCDE
75
most common malig mel etiology
"superficial spreading" comes from dysplastic nevi | -acral lentinginous in all skin types (palms/soles)
76
malig. mel tx
excision and re-excision (Mohs) margins depend on size/thickness LN biopsy for high risk/thick lesions (sys. chemo)
77
atopic dermatitis
pruritis, exudative eruptions on face, neck, wrists, hands, skin folds - hx of allergies, rhinitis - tendency to recur - typ. childhood (
78
atopic dermatitis
wet: dry it dry: moisten acute weeping: oatmeal astringent soaks, high pot. corticosteroids
79
tx for subacute or scaly lesions
(dry, red and pruritic) | mid-high pot. steroids, wean to emollients
80
tx for chronic dry lichenified lesions
nightly occlusion to hold in moisture (silvadene, vaseline) high pot corticosteroids aquaphor
81
atopic dermatitis maintenance tx
constant appl. of moisturizers, sparing used of corticosteroids
82
lichen simplex chronicus
itching, scratching, dry, leathery lesions -trauma, exposure *exaggerated skin creases -well circum. scaly plaque neck, wrists, forearms, lower legs, scrotum, vulva (vulva: biopsy) -often appear psoriatic -risk of invasive superinfection
83
lichen simplex chronicus tx
high dose topical corticosteroid +/- occlusion antihistamins to prevent itching (dis. may remit to other sites)
84
psoriasis
-AI, may have no sympts or itching -scalp, elbows, knees, palms, soles, nails -"silver scales" on erythematous plaque, occurs in creases limited (10% BSA)-->moderate-->generalized (>30%) disease continuum w/ rheumatoid arthritis
85
psoriasis tx
numerous sm. plaques (mild-mod disease): phototherapy, home UV lights lg plaques: v. high pot steroids 2-3 wks BID then pulse -vit. D analogs -scalp: tar shampoo, salicylic acid gel *never use SYSTEMIC (ORAL) corticosteroids (lead to severe rebound)
86
severe psoriasis tx
``` UVB tx 3x week psoralen plus UVA (PUVA) methotrexate acitretin (pustular) cyclosporin anti-TNF agents, DMARDs ```
87
pityriasis rosea
``` oval scaly eruption on trunk Herald path-->then eruptions "christmas tree" distribution occasional pruritus resolves in 6 wks ```
88
seborrheic dermatitis and dandruff
dry scales w/ underly. erythema -face, scalp, eyelids, ears, presternal inter scapular areas acute or chronic -pruritis is inconsistent mild-->severe
89
tx for seborrhea
scalp: shampoos w. zinc pyrithione, selenium, ketoconazole tar shampoo facial: mild c.steroids, ketoconazole cream 2x daily intertrig. : low pot. c.steroids 5-7 days eyelids: baby shampoo
90
fungal inf. of skin
``` tinea corporis (body) tinea circinata (body) tinea cruris (groin) tinea manuum (foot) tinea pedis (foot) tinea versicolor (pityriasis versicolor) (cent. up. trunk) -dx with 10% KOH prep, Cx, skin biopsy ```
91
tinea corporis/circinata
ring-shaped, exposed areas, +/- itching (often) can be severe in HIV pts tx: topical antifungals (PO griseofulvin if severe)
92
tinea cruris ("jock itch")
- groin, sparing scrotum peri. spread, sharply demarcated, central clearing - assoc. pedis, onychomycosis - reoccurs after tx tx: antifungal powder, top. antifung. cream, oral griseofulvin/itraconazole if severe
93
lyme disease should not..
ITCH -think fungal- tinea ringworm
94
tinea manuum/pedis
``` scaling, itching btw toes along foot -can prog. to moist macerated areas -common in LE cellulitis pts tx: macerated: aluminum subacetate soaks, br.spec antifungal creams dry/scaly: OTC topical anti fungal ```
95
tinea versicolor (pityriasis versicolor)
velvety pink, tan macules (also white, tanning resist.) fine scales upp trunk/chest yeast on microscopic exam (Malassezia-"spaghetti and meatballs") tx: selenium sulfide lotion, Ketoconazole PO if severe
96
cutaneous lupus
chronic cut. lupus and discoid lupus - scaling, atrophy, dyspigmentation, telangiectasia, photosensitive - head, scalp, face, ears tx: avoid sun, photosens. drugs, radiation therapy - high pot. steroid creams
97
cutaneous T-cell lymphoma (Mycosis fungoides)
loc/gen erythematous patches/plaques >5 cm -trunk severe pruritis tx: diff. PUVA, retinoids, other skin. dir tx
98
vesicular dermatoses
HSV 1 & 2 herpes zoster (shingles) vesiculobullous eczema porphyria cutanea tarda
99
HSV
recurrent sm. vesicles on an erythematous base (orolabial/genital distribution) -post-stress, trauma, sun -viral cx, abx test + -1st episodes may present as gingivostomatitis or sev. genital outbreak w/ flu sumps and lymphadenopathy (ppl test + for HSV) -shingles should not typ. recur
100
herpes zoster
pain along dermatome distribution-->grouped vesicular lesions (occ. fall outside if >20 lesions), typ. not dissem unless pt. is IC -face, trunk varicella zoster virus tx: zostavax >50yo
101
Hutchinson's sign
shingles on nose | must consider optic nerve is involved
102
Ramsay-Hunt syndrome
shingles in ear, must consider ear drum is involved, Bell's palsy can lead to systemic infection
103
Herpetic whitlow
lesion on finger/thumb (HC workers, sexual activity(autoinoculatoin) finger/thumb suckers) HSV 1* or 2
104
herpes/shingles tx
oral antiviral: acyclovier, valacyclovir w/in 72 hours -abx if secondary cellulitis tx only shortens duration by 1-2 days BUT **dec. risk of post-herpetic neuralgia!!* (esp. elderly)
105
vesiculobullous eczema
"tapioca" vesicles on palms, soles, sides of fingers multiloculated large blisters recurs over lifetime tx: topical & systemic steroids, chronic prob--> steroids abort the flares
106
porphyria cutanea tarda
non-inf./inflamm. blisters on sun-exp. sites - assoc. liver disease dx: PE, abn. LFTs, elev. ur porphyrins tx: phlebotomy, eliminate etOH,
107
impetigo
superficial blisters w. some opaque/purulent material - rupture easily, weep-->crusted superfic. erosions dx: Gs often + for GPC in clusters/pairs (staph or strep, MRSA) tx: top. bacitracin or mupirocin(bactroban) chlorhexidine/bleach baths, occasional oral coverage
108
contact dermatitis poison ivy
erythema, intense pruritus-->dev. of blisters: weeping, crusting autoinoculation, spread by scratching, look for exposure hx tx: was oil w/ dish soap severe: mid-pot steroid creams m. severe: tapering prednisone
109
acne vulgaris
``` onset of puberty op/closed comedones (white/black heads) most common severe: papular, pustular, cysts, nodules, scarring -face, upper trunk ```
110
tx of acne vulgarism: comedones
face wash, topical retinoids, benzoly peroxide, top. abx
111
tx of acne: mild papular/cystic
top. clindamycin/eryth w/ benz peroxide, poss. tretinoin cream
112
tx of acne: mod pap/cystic
oral tetra, doxy, minocycline, OCTs, topical
113
tx of sev. acne
isotrentinoin, intralesional injection, laser dermabrasion, oral and topical agents
114
rosacea
chronic, neurovasc. component, telangiectasias, flush glandular as well exacerb. by hot foods, etOH, emotions, sun tx: avoid triggers, also tetra/doxy/mino
115
folliculitis
hairy areas typ. itching, burning, pustular formation staph, strep, MRSA "hot tub": diffuse pruitis, rash in exposed areas, pseudomonas, clears spontaneous (no abx)
116
candida tx
topical: miconazol, nystatin powders clotrimazole, ketoconazole creams/lotions oral: flucanazole, voriconazole nystatin swish and swallow
117
MRSA
v. indurated w/ min. purulence may req. drainage, some spont. drain tx: trimethoprim/sulfa, doxy, clindamycin -->rarely causes sys. inf.
118
steven johnson syndrome
dry, cracked bleeding lips, red rash, stinging sensation, skin peeling **stop offending medication!!**
119
erythema multiforme
sudden onset of syst. erythematous skin rxn target lesions having clear centers mild, self-lim post-viral inf. or med rxn OR major, life threatening: SJS, TEN
120
erythema multiform tx:
stop offending agent! TEN: burn unit for massive skin exfoliation steroids, IVIG
121
erythema migrans
bullseye, *with Lyme disease*
122
bullous pemphigoid
tense blisters in flexural areas, subepiderm. blisters, gen >60 yo
123
pemphigus vulgaris
flaccid blisters, crusts, erosions, acantholysis | any age
124
BCC
pearly papule >6mm, non healing, sunexp. area, "rat bite" lesion, bleeding tx: Mohs, removal
125
SCC
nonhealing ulcer, long term sun exposure, often begins as actinic keratosis tx: Mohs, excisional, top. retinoid acid
126
Kaposi's sarcoma
brown/black flecks, classically on chest *HIV+, males* (anal sex) can be in bowels-->bleed to death
127
Pediculosis
(lice!) pruritus w/ excoriations, nits(eggs) on hair shafts, lice on skin, clothing direct contact needed (can't jump) tx: permethrin cream rinse (Nix), high temp laundering
128
erythema nodosum
painful, erythematous nodules on ant. aspects of shins, below knees mostly women (10:1) -recent viral proc., drug rxn, underly. IBD -lasts about 6 wks, can reflare
129
erythema nodosum tx
NSAIDS, time
130
cellulitis
``` may come in w. flu-like symptoms: fever, chills, body aches, nausea typically GAS (redness, blisters) (staph causes pus, boils, abscesses) ```
131
cellulitis tx
cephalosporins: cefalexin, (4x day, low compliance), cephadroxil, cefuroxine clindamycin not her favs: bactim, amoxicillin vs IV: ancef (ceph) or vancomycin
132
cellulitis vs decubitis ulcer
the latter needs wound care, typ. IV abx, doppler to ensure perfusion
133
scabies
``` *extremely itchy* ask about bugs extremely contagious chest, classically on fingers topical permetherin oral ivermectin ```
134
what can cause low grade fever/fatigue for weeks
``` CMV Coxsackie Parvovirus Mono (*viruses*!) or smoldering diverticulitis, abscess ```
135
non infectious causes of low grade fever/fatigh for weeks
malignance (>50) joint pains: rheumatoid arthritis AI diseases LPE
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