Derm Amanda

Front 1

hyperirritable skin, rough, red plaques, pruritic, exudative or lichenified eruptions, w/o thick scale, hx of allergies, onset in childhood

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atopic dermatitis

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treatment of atopic dermatitis

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gentls skin care, avoid drying, always emollient after bathing, topical steroids sparingly to taper, tacrolimus or pimecrolimus cream, systemic steroids only for most severe cases

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erythema, edema, pruritis, often e/ vesicles and bullae, followed by weeping/crusting, secondary to contact with chemical or allergic irritant

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contact dermatitis

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tx of contact dermatitis

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topical steroid may be sufficient, systemic steroid usually required, protect from irritant

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erythema, edema, papular and pustular lesions, erosions, oozing, involving perigenital and perianal inner aspects of thighs and buttocks

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diaper dermatitis

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tx of diaper dermatitis

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prevention by keeping intertiginous areas dry, powder with miconazole, castellani's pain for sx relief, topical antifungals, judicious short term use of topical glucocorticoids

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chronic, pruritic, inflammatory, coin shaped plaques, grouped small papules and vesicles on erythematous base, commonly on the lower legs of males during the winter months

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nummular eczematous dermatitis

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tx of nummular eczematous dermatitis

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moisturize skin after bath or shower, topical glucocorticoids, crude coal tar, PUVA or UVB 311-nm therapy

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mainly young women, unknown etiology, aggravated by topical glucocorticoids, erythematous papules on erythematous background around mouth

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perioral dermatitis

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acute or chronic paulosquamous dermatitis, often coexists with psoriasis, dry scales, oily yellow scrugg, usually face, scalp, sternum

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seborrheic dermatitis

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tx of seborrheic dermatitis

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mild topical corticosteroid, shampoo with zine pyrithione or selenium, tar shampoo for mild cases

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secondary to chronic venous insufficiency in the lower extremities, inflammatory papules, scaly, crusted erosions, pigmentation, stippled with recent and old hemmorrhages

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stasis dermatitis

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tx of stasis dermatitis

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compression stockings, avoid trauma to area, intralesional triamcinolone if painful, consider venous sclerotherapy

Front 14

tapioca vesicles, may coalesce, scalinga and fissuring may follow, palms and sides of fingers, associated with pruritis, appearance in the third decade, lifelong recurrences

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dyshidrosis

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tx of dyshidrosis

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topical and systemic corticosteroids, avoid anything that irritates the skin especially wet chores

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self perpetuating scratch/itch cycle, exaggerated skin lines overlying a thick well circumscribed scaly plaque, hyperpigmented, prediliction for nape of neck, wrists, external surfaces of forearms, lower legs, scrotum, vulva

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lichen simplex chronicus

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tx of lichen simplex chronicus

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superpotent topical steroids, w/ or w/o occlusive dressing to avoid scratching

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localized hair loss in round or oval areas, no visible inflammation of the sknin in hair bearing areas, scalp most common presenting site, autoimmune disease, spontaneous remission common

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alopecia areata

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tx of alopecia areata

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psychological support, intralesional steroid injection, systemic steroid

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common progressive balding, occurs through comined effect of genetic predisposition and action of androgen on scalp hair follicles

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androgenic alopecia

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androgenic alopeica tx

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oral finasteride, topical minoxidil, antiandrogens (in women), hairpiece, surgical implantation or scalp reduction

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caused by tinea unguium, more common in immunocompromised and diabetics,

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onycomycosis

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treamtent of onycomycosis

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debridment, topical antifungals, prophylaxis, systemic (terbinafine, itraconazole)

Front 24

erythema and swelling with retraction of periungual tissue

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paronychia

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agent of infection for tinea versicolor

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malassezia

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hypopigmented, light brown, or salmon colored macules, confirmed by direct microscope examination of hyphae and spores

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tinea versicolor

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tinea versicolor tx

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topical antifungals

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infectious agent of tinea corporis/pedis

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t rubrum

Front 29

acute or chronic inflammatory dermatosis characterized by flat-topped pink violaceous, shiny, pruritic papules (4 p's papule, purple, polygonal, pruritic)

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lichen planus

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lichen planus tx

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topical steroids, systemic steroids, PUVA photochemotherapy

Front 31

acute self limited exanthematous, characterized by slightly inflammatory, oval papulosquamous lesions on the trunk and proximal areas of the extremities

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pityriasis rosea

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pityriasis rosea tx

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often nothing, steroids for itching

Front 33

common chronic skin d/o, typically characterized by erythematous papules and plaques with a silver scale, m=w, all races and ages equal

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psoriasis

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two peaks of age of onset for psoriasis

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20-30 and 50-60

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etiology of psoriasis

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complex immune mediated disease in which t-lymphocytes play a central role

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psoriasis tx (mild to moderate dz)

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topical glucocorticoids and emollients, alternatives (tar, retinoids-tazarotene, calcipotriene)

Front 37

tx for mild to moderate psoriasis of facial/intertriginous areas

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tacrolimus or pimecrolimus

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tx of severe psoriasis

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phototherapy or systemic retinoids, methotrexate, cyclosporine, or bilogical immune modifiers (alefacept, efalizumab, etanercept, or infliximab)

Front 39

acute inflammatory skin disease, <10% bsa loss, usually caused by drug, often targets mucosal surfaces

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stevens johnson syndrome

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tx for stevens johnson

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stop drug, nutritional and fluid support, high dose steroid?

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acute inflammatory skin disease, >30% bsa loss, usually caused by drug

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toxic epidermal necrolysis

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mortality % of toxic epidermal necrolysis

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30%

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tx of toxic epidermal necrolysis

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stop drug, >25% bsa requires burn unit, nutritional and fluid support, high dose steroid?, IvIg

Front 44

sudden onset symmetric erythematous skin lesions, may be macular, papular, urticarial, bullous, purpuric, target lesions with clear centers and concentric rings or "iris" lesions

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erythema multiforme (minor)

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most common cause of erythema multiforme minor

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herpes simplex

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tx of erythema multiforme minor

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topicals not very effective, benadryl/kaopectate for oral lesions, usually resolves in 2-6 weeks

Front 47

tx of bullous pemphigoid

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systemic prednisone wither alone or combo with azathiprine, mild cases(dapsone), very mild cases (topical steroid)

Front 48

benign neoplasms

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epidermoid cyst, seborrheic keratosis, actinic keratosis, keratoacanthoma, lipoma, dermatofibroma, skin tag

Front 49

occurs secondary to traumatic implantation of epidermis into the dermis, accumulation of keratin withing the cyst cavity, appears as dermal nodule most often in the palms, soles and fingers

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epidermal inclusion cyst

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tx of epidermal inclusion cyst

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excision

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most common of the benign epithelial tumors, hereditary, appear after age 30

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seborrheic keratoses

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discrete, dry, rough, adherent scaly lesions, occur on areas of habitual sun exposure

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actinic keratoses

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actinic keratoses tx

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cryo, 5-flourouricil cream, imiquimod, retinoids, facial peels, laser surgery photodynamic therapy,

Front 54

pseudocancer, isolated nodule usually on the face, mimics scc, uniquely rapid growth, spontaneous remission over several month

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keratoacanthoma

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keratoacanthoma tx

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surgical excision, rule out scc, systemic retinoids/methotrexate

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soft, rounded, lobulated, composed of fat cells, movable against the overlying skin, especially on the neck, trunk, and extremities

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lipoma

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button like dermal nodule, usually on the extremities, may be tender, if pigmented may mimic melanoma

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dermatofibroma

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tx of dermatofibroma

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surgical removal not usually indicated, resulting scar less cosmetically acceptable, cryosurgery often effective

Front 59

sof, skin colored, tan or brown, round or oval dedunculated papilloam,

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acrochordon aka skin tag

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tx of acrochordon

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snip, electrodessication, cryosurgery

Front 61

most common skin d/o in america, disease of pilosebaceous follicles, retention hyperkeratosis, increased sebum production

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acne vulgaris

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organism responsible for acne vulgaris

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propionibacterium acnes

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acne vulgaris tx

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topical retinoids, benzoyl peroxide, topical antibiotics, oral antibiotics, oral isotretinoin, hormonal and corticosteroid therapy

Front 64

chronic facial disorder, neurovascular component (telangiectasias), actiniform component (inflammatory papules), glandular component (rhinophyma)

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rosacea

Front 65

flushin exacerbated by temp, hot drinks, spicy food, sunlight, exercise, alcohol, emotions and hormonal flux, rosy hue to cheeks, forhead, chin or entire face, pt may complain of burning or stinging

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rosacea

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rosacea tx

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topical metronidazole, systemic tetracycline/minocycline/doxycycline, refractory w/ metronidazole or amoxicillin

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most common pathogen for folliculitis

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s. aureus

Front 68

tx for persistant folliculitis

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warm compresses 3x daily, topical mupirocin

Front 69

pearly papule, erythematous patch, nonhealing ulcer in sun exposed area, usually fair skinned pts with hx of sun exposure, often hx of bleeding, most common form of cancer

Back 69

basal cell carcinoma

Front 70

nonhealing ucler or warty nodule, skin damage due to long term sun exposure, may arise from an actinic keratoses, common on skin of organ transplant recipients

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squamous cell carcinoma

Front 71

most malignant tumor of the skin

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melanoma

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what is one of the most important diagnostic factors for malignant melanoma

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enlargment

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tx for melanoma

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total excisional biopsy, sentinal node biopsy, lymphadenectomy as indicated, adjuvant therapy with IFN-alpha-2Bb

Front 74

velvety thickening, hyperpigmentation, chiefly in axillae and other folds, often associated with endocrine d/o, obesity, drug admin, or malignancy

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acanthosis nigricans

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acquired light or dark brown hyperpigmentation, occurs in exposed areas, most often face, results from exposure to sun, may be associated with pregnancy or hormonal contraceptives

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melasm

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melasma tx

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hydroquinone, azelaic acid, flucinolone, tretinoin

Front 77

wheals, superficial, well defined, transient edematous papules and plaques, angioedema involves dermis and subq tissue, acute, recurrent or chronic

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urticaria

Front 78

tx of urticaria

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prevent exposure, antihistamines, prednisone if angioedema, danazol for long term use if hereditary

Front 79

development of totally white macules completely absent of melanocytes, may be associated with thyroid disease

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vitiligo

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vitiligo tx

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sunscreens, cosmetic coverup, topical steroids, topical photochemotherapy, PUVA, narrow band uvb, tacrolimus or pimecrolimus

Front 81

barely visible papules to nodules to confluent masses, anogenital or oral mucosa or skin, caused by hpv, if present in birth canal may be transmitted to newborn

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condyloma accuminata

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tx of condyloma accuminata

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cannot eradicate hpv, iniquimoid cream, pdofilox solution, cryosurgery, podophyllin, tca, surgery, electrocautery, laser

Front 83

grouped vesicles on an erythematous base

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herpes simplex

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herpes simplex tx

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prevent by avoiding skin to skin during outbreakes, topical acyclovir, oral antiviral, foscarnet for severe cases, imiquimod cream

Front 85

self limiting epidermal viral infection, skin colored papules, umbilicated,

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molluscum contagiosum

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tx of molluscum contagiosum

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resolves spontaneously w/o scarring in up to 2 years

Front 87

hpv infected keratinized skin, discrete benign epithelial hyperplasia

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verrucae

Front 88

verrucae tx

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spontaneous resolution in months to years, salicylic acid, imiquimod cream, cryosurgery, electrosurgery, laser, curretage

Front 89

90% of cases occur in children, 98% of adults have been infected, disseminated pruritic vesicles

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varicella zoster

Front 90

mortality rate of varicella zoster

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1/50,000 cases (100 deathsa annually)

Front 91

acute, diffuse, spreading, edematous, suppurative inflammation, systemic symptoms

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cellulitis

Front 92

hypersensitivity to antigens from infectious agents/drugs, postcapillary venules, inflammation, fibrinoid necrosis, palpable purpura

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vasculitis

Front 93

tx of vasculitis

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antibiotics, prednisone, cytotoxic immunosupressives

Front 94

distinct type of superficial cutaneous cellulitis, marked dermal lyphatic vessle involvment, painful, bright red, raised, edematous, indurated plaque, advancing raised boders, sharply marginated

Back 94

erysipelas

Front 95

erysipelas usually cause by what infectious agent

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group a beta-hemolytic strep

Front 96

crusted erosions or ulcers, most common in children, superficial infection of the epidermis

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impetigo

Front 97

impetigo is most commonly caused by what infectious agent

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staph aureus, and staph pyogenes

Front 98

tx of impetigo

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mupirocin, systemic antibiotics

Front 99

painful red nodules (no ulceration), anterior aspect of legs most common site, slow regression over several weeks, women more than men,

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erythema nodosum

Front 100

erythema nodosum tx

Back 100

identify underlying cause, nsaid, topical potassium iodide, bedrest if extremely painful, systemic steroids select cases

Front 101

consist of multiple furuncles in adjoining follicles

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carbuncles

Front 102

abscesses mostly caused by what infectious agent

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staph aureus

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tx for padiculosis

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pyrethrins, malathion, lindane

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tx of scabies

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permethrin cream, lindane

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spider bite tx

Back 105

glucocorticoids, antimicrobial agents