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136 Cards in this Set

  • Front
  • Back
this is sweat glands from axillary and groin, increased with stress
this is sweat glands all over the body
this is fatty substance secreted into hair follicles and skin
sebaceous glands
melanoma is located most commonly where and where is basal cell
melanoma - hands and feet

basal - around eyes and finger nails, webs of fingers
what is a common widespread generalized rash
systemic infection or allergic response - rubella
what is intertriginous
skin folds, in dark area

yeast - like warm moist dark places
what is a dermatomal distribution
, erythematic vesicular lesions, with macules and honey crust lesions
describe a photosensitivity pattern
bilateral sun exposed areas, will see area where sun is spared

watch bc medications cause photosensitivity
this is a web like rash, vascular changes is what makes shape and color
how is the distribution of thus dermatitis
Poison ivy – initial place where oil comes into contact with skin is linear, then will spread and become diffuse and patchy – depends on how sensitive they are to the oils

Do not have to touch the plant, carried, once shower – then not contagious to others or if ooze – will not spread
what are diseases with target lesion
syphilis - secondary
lyme disease
erythema multiforme
what do you need to rule out when there is alopecia
rheumatological disease
what is the angle greater than for clubbing
what are beu's lines
transverse depressions of the nail plates, bilaterally
seen with systemic disease
what are secondary lesions - 4
– < 1cm spot different in color; flat - neither elevated nor depressed.
Example: Freckles, flat nevi
– > 1cm spot different in color; flat - neither elevated nor depressed.
Example: Vitiligo
– circumscribed superficial solid elevation < 1cm
Example: Elevated nevi, warts, lichen planus
circumscribed, superficial firm, rough elevation > 1cm; confluence of papules with flat - topped surface.
Example: Psoriasis
palpable solid round or elevated mass/lesion > 1cm
This may be above or beneath the skin
palpable solid round or elevated mass/lesion > 2cm
VESICLE – circumscribed, superficial elevation, papule with clear fluid <.5cm
Example: Herpes Zoster
– circumscribed, superficial elevation, papule with clear fluid >.5cm; thin & translucent with serum, lymph fluid, blood or extracellular fluid within.
Example: Bullous Pemphigoid
circumscribed elevations of the skin, papule with cloudy fluid
Examples: Acne, Impetigo
rounded or flat-topped, pale-red papule or plaque characteristically evanescent, disappearing within hours; round, gyrate or irregular.
Example: Hive
Abrasion of the skin resulting in loss of epidermis; usually superficial and traumatic.
Examples: Scratched insect bites, scabies
Linear crack or break in the epidermis; may be moist or dry
Diffuse area of thickened epidermis secondary to persistent rubbing, itching, or skin irritation with resultant increase in the skin lines and markings; often involves flexor surface of extremities.
Example: Atopic dermatitis
- Irregularly shaped, elevated, progressively enlarging scar; grows beyond the boundaries of the wound; caused by excessive collagen formation during healing
Small and short or long and tortuous tunnels in the epidermis.
Example: Small and short- scabies
Long and tortuous - creeping eruptions
Plug of whitish or blackish sebaceous and keratinous material lodged in the pilosebaceous follicle usually seen on the face, the chest and/or back.
Example: Acne/ Blackhead
Whitish papules, 1-2 mm in diameter with no visible opening onto the skin surface.
Example: Whiteheads/acne, healed burns, healed bullous disease states, face of newborn babies
Dilated superficial blood vessels that appear as fine irregular red lines.
Example: Spider angiomas
used to describe inflammatory conditions of the skin, which appear erythematous and scaly with ill-defined borders.
Example: Atopic dermatitis
used to describe conditions, which manifest themselves as papules or plaques with scales.
Example: Psoriasis
what is the difference between male pattern and female pattern baldness
female - more diffuse - widening and thinning hair

male - gradual, androgenic
what are normal changes with nails that occur with age
nail become dry and brittle
flat and concave
longitudinal ridging or hyperkeratosis can develop
what is hyperkeratosis seen in
psoriasis, idiopathic, inflammatory or could be fungal, should culture to rule out
this is chronic acneform with vascular dilation on the central face
acne rosacea
red bulbous nose of rosacea; occurs mostly in men
what is the clinical presentation for acneform rosacea
age of onset
30-50 years
fair skinned
facial flushing, with increases in skin temperature, ingestion of hot or spicy food, and alcohol consumption

blepharitis and dry eye
edema with eyelids and nasolabial folds, flushing, telangacia, papules and pustules
what are differentials for acne form rosacea
Acne vulgaris; seborrheic dermatitis; contact dermatitis; lupus; photosensitivity
what is the hallmark treatment for acne form rosacea and what are other treatment choices
HALLMARK: Metronidaazole - Metrogel apply BID
others: sulfate lotion BID; clindamycin lotion BID

Oral: Tetracycline and Erythromycin 500mg PO BID for 4-6 weeks reduce to QD with significant improvement and then taper

aviod contact triggers
when do you prescribe gel vs cream medications
gel - oily skin
cream - dry skin
what does acne vulgaris result from
result of obstruction and inflammation of pilosebaceous units (hair follicles and their accompanying sebaceous gland
what are the 4 factors that contribute to acne
1. follicular epidermal hyper-proliferation plugging of the follicle
2. excess sebum (produced by androgen dependent sebaceous glands)

3. the presence and activity of Propionibacterium acnes

4. inflammation
what are common manifestations of acne in adult females
no acne until an adult,
chin/mandible peri oral areas
premenses flaring
menopause is the cure
Lesions are non-inflammatory comedones located on forehead, chin, nose, and paranasal area
what are open vs close comedomes
open - black heads
closed - white heads
usually occurs in teens after first phase of non-inflammatory acne; also occurs in women in their 20s; Scattered small papules or pustules with minimum comedones
mild inflammatory acne
more generalized eruption
can be on face and upper trunk with papules, pustules, and comedones

reflects the presence of a very destructive type of inflammation
inflammatory acne, final phase
what are general treatment options for
mild inflammatory
cystic ance
comedomal - Retin A
mild inflammatory - topical retinoid, oral antibiotics,
cystic - vitamin a analog
what is the actions of retinoids
normalizes desquamation and reduce inflammatory responce
what is the action of antibiotics
reduce microorganisms and reduce inflammation
what is the action of benzoyl peroxides
normalizes desquamation and reduce microorganisms
what is the action of hormones
reduce sebum
what is an important question when someone is coming in with acne
know if any changes in medications

OCP - start and can worsen
how long to see a change in acne
2-3 months
what are the topical antibiotics for acne
Erythromycin 2% Solution or Gel; apply BID
Clindamycin 1% solution, lotion or gel; apply BID
Sulfacetamide/Sulfur; (Sulfacet, Clenia)
Benzamycin Gel (combination of clindamycin and benzoyl peroxide; apply BID
what are oral antibiotics for acne
Doxycycline *
Minocycline *
Erythromycin (safe in pregnancy)
Typically start with BID dosing, then reduce to daily maintenance
what are anti-androgen medications for acne

what do you need to check before starting
and what are symptoms a patient has you would prescribe this for

Labs: check potassium and BP
sx: menstraul irregularities, hirsutism, mandibular and chin acne
what acne treatment is ok in pregnancy
erythromycin gel and alpha hydroxy
when do you refer out if sx not getting better for acne
3 months
how much steroid cream is needed for the whole body
how is absorption of topical steroids on the skin
site dependent = scrotom the most, soles worst
what are SE of steroids and how long should they be used on the face
<7 days
SE skin atrophy
tachyphylaxis, steriod rosacea, glaucoma, infection
where are the most commonly seen areas of atopic dermatitis
neck, chest, AC, hands, groin, knees
what is the treatment for atopic
topical steriods BID
oral antihistamines - zyrtec, allegra, claritin 10mg/d
refer after 2 weeks

what is dyshydrosis
increased water on the skin
what are symptoms of dyshydrosis
itchy vesicles on palms, after 3-4 weeks they erode then scale, and lichenifcation
what is the treatment for dyshydrosis
avoid allergy
erythro x 10 days
topical steriods
cold compresses

refer after 2 weeks
what are common causes of contact dermatitis
poison ivy
topical medications
what is the treatment for contact dermatitis
topical steriods
oral if severe or chronic
oral antihistamines
topical anti-puritic - aveeno

cool compresses
what is the cause and sx of stasis ulcers
CV insufficiency
itchy, scale, ulcer, hyperpigmented. of not treated becomes indurated and fibrotic
what is the tx for stasis ulcers
treat venous issue
elevate and compress
una boot
hydrocolloid if weeping
when do you suspect a drug eruption
anyone taking medications
what are common medications that cause drug rashes and what are the treatments
antibiotics, NSAIDS, cytokines, chemo, psycotrophic, sz, sulfa

tx: antihistamines and oral steriods
how are allergic responses related to route - IV vs topical vs Chronic use
IV - worse response, anaphylaxis
topical - delay allergy response
allergic sensitization with chronic use
what are common causes of skin reactions - meds
folic acid
what is Nikolsky sign
symptoms of SJS when slough of epidermis with lateral pressure
what is confluent erythema
angioedema, swelling, palpable purpura, fever dyspnea and hypotension
this is a reaction from a virus, will come and go
erythema multiforme
this is a rad pack with purple gray centers on arms face soles of feet and palms
erythema multiforme - HSV
what is the treatment for erythema multiform
steriods, lidocaine, acyclovir, resolve on own
this is chronic inflammation from pityrosporium oval and with environmental factors such as stress
seborrheitc dermatitis
where is seborrhatic most commonly at
hair line, and skin folds - eye brow, nasolabial folds, ears
what is the descriptions of seborrhatic
fine dry white and yellow scales, on inflamed base

if severe red plaques with white scales that are diffuse and not well cic
what is the treatment for seborrhatic
and ketoconazole shampoo

topical steroids if shampoo does not work
what is the treatment for seborrhatic on the face
hydrocortisone lotion or ketoconozole
what is the treatment for impentigo
mupirocin TID x 7-10 days
what are causes of cellulitis
after trauma and break in skin
what are symptoms of cellulitis
red hot pain
edema fever and chills
enlarged lymph
what are sx of GAS cellulitis
erysipelas - superficial with clear margins on LE face or ears with lymph enlargement - streaking seen
what is the treatment of cellulitis from an animal bite
f/u 2-4 days
what is the treatment for uncomplicated cellulitis
where are the locations of carbuncles
deep in dermis, back of neck and lateral thigh
what is the treatment for folliculitis, carbuncles and faruncles
folliculitis - benzyol peroxide or erythro or clinda

carb/faruncles - warm heat, I and D, oral dicloxacillin or cephalxen
what is the treatment for candida
nystatin x 10 days
expose to light and keep dry
F/U 2 weeks
how do you diagnose tinea vescicolor
woods lamp
what are sx of tinea vescicolor
macules of differ colors on upper trunk
worse with heat humidity and pregnancy and steroids

what is the treatment for tinea vescicolor
selsun blue leave in for 24h and wash off
can use as proph


oral diflucan or ketoconazole
what are sx of tinea capitus
erythema with scale and patchy hair loss can be boggy - Kerion
what is the treatment for capitus
grisofulven x 4-8 weeks take with food and check LFTs after 2 weeks
selenium x 2 weeks
what are sx of tinea corporus
erythema, demarcated, vescicular border, hypopignemented itchy
what are symptoms of tinea cruris
males, demarcated scales, itchy and no scotal involvement
what are sx of tinea pedis
vescicular papular scaly and itchy
in between toes
this is distal thickening and yellowing of toe nails, can occur with ring worm
what is the treatment of tinea
ketoconozole cream 2-6 weeks
lamisil 4 weeks
pedis requires longer treatment
if resistant PO lamisal or diflucan

FU 2 weeks check CBC and LFTs
these are mite burrows where larvae hatch and mature in 14 days cause itching
what is the primary vs secondary lesions of scabies
primary - burrow, gray and pinpoint serous fluid and papules

secondary scaling from scars
what is the treatment of scabies
elimite cream - 8-14 hours then bathe
safe in pregnancy
launder clothes or put in bag x 7 days
itching will last several weeks
what is the most common way lice is transmitted
inanimate objects - fomite
or direct contact
what is the most common type of lice
pubic - 90%
what is the treatment for lice
Nix cream - leave on for 10 minutes and then re treat 7-10 days after

Lindane shampoo
this is a chronic hyper proliferative inflammatory state, triggers by trauma, infection stress and meds
what are history symptoms to cue you into psoriasis
chronic dandruff
autoimmune disease
ears scale
no itching
nail pitting
DIP arthritis
what does psoriasis look like
silver white plaques
well demarcated
band together
bleeding points
elbows, knees scalp
bilateral and symmetric
what is the treatment for psoriais
>10% refer
topical steriods
daily moisturizer
dovenox NSAID cream for maintenance
Tazorac or Protopic - vitamin A

refer after 2 weeks
which medications and infections flare psoriasis

strep infection
this is a viral rash, with a herald patch first then after 7-14d have rupture of lesions on trunk - parrellel
pitryiasis rosea
what is the treatment for pityriasis rosea
will resolve on own
control itch
this is a chronic inflammation of the mucosa, seen in 30-70 year olds, immune
on flexor surfaces, reticulated patter, in mouth
lichen planus
what happens to the nails in lichen planus
loose nails
what are the 5 Ps in Lichen Planus
planar - flat
what is the treatment of lichen planus
triamicolone BID x 1-2 weeks
control itch
what is the treatment for post hepatic neuralgia
what is the treatment of shingles
wet compresses
bactroban x 10days

oral valtrex or famcyclovir if less then 72 hours or if new lesions still form >72 hours

FU 2-3 days then 7-10 days
cutaneous viral infection, burning 4-5 days before with prodrome of fever, chills, body aches, HA then clusters of vesicles form and crust
this is a benign viral rash, white or flesh colored dome papules with center divot
what is the treatment of molluscum
liquid nitrogen
this is a lesion first a macule on the trunk in the middle aged, usually brown with a stuck on appearance
seborratic keratosis - tx with cryotherapy
pedunculated fleshy tan small round polyps
skin tags
hyperpigemented pedunculated papules on blacks and asains, marker of aging
dermatosis papulosa nigra
this is a dictate mature vascular papule, marker of aging
cherry angioma
hyperpigemented macules with irregular borders to sun exposed areas
solar lentigo

liver spots - face and hands
this is tumor of sebaceous gland soft and yellow papule on face or forehead - marker of agine
senile sebacous hyperplasia