Dermatology

Front 1

Eczema

Back 1

pruritic inflammation of the epidermis and dermis, 2mos-2years on cheeks and extensor surfaces, eyelids and flexor surfaces for 2 and up, erythema, papules, scaling, excoriations, crusting, lichenification, keratosis pilaris, ichthyosis vulgaris, Dennie-Morgan sign, pityriasis alba

Front 2

Keratosis pilaris

Back 2

follicular keratosis, chicken skin, red bumps on the dorsum of the skin and the back, this is a type of eczema

Front 3

Ichthyosis vulgaris

Back 3

dry, scaly skin, can treat with lotion containing alpha-hydoroxy acids

Front 4

Dennie-Morgan sign

Back 4

extra fold or line under the eyes due to edema from atopic dermatitis(type of eczema), steroid creams, corticosteroids, antibiotics if caused by bacterial infections, sedating antihistamines to help with itching and sleep at night

Front 5

Pityriasis alba

Back 5

hypopigmented patches of skin secondary to inflammation due to atopic dermatitis, treat the rash and repigmentation will occur

Front 6

Dyhidrotic eczema

Back 6

occurs on the hands and feet with noted peeling and small tapioca pudding blisters on the palms or lateral borders of the fingers (referred to as pomphylox), Usually an associated hyperhidrosis or excess sweating, Treat with class I or II steroid and a drying agent such as 20% aluminum chloride, erythema and scale of dyshidrosis, erythema and pustules, both hands are affected which is typical in eczema

Front 7

nummular eczema

Back 7

coin shaped lesions usually on the dorsum of the hands and arms,seen in older patients it is often secondary to an underlying tinea infection referred to as a dermatophytid reaction, treating the underlying fungal infection(clotrimazole) will help clear the nummular eczema but quicker resolution will occur with the use of a topical steroid on the eczematoid lesions

Front 8

asteatotic eczema

Back 8

eczema craquele,appearance of cracked porcelain, seen in older patients,essentially excessively dry skin, treated with keratolytic agents such as 12% lactic acid, 10% or 20% urea cream or glycolic acids, emollient use, the greasier the better, H1 antihistamines help patients fall asleep but generally do not stop the itching

Front 9

lichen simplex chronicus (still eczema)

Back 9

secondary to rubbing or scratching, skin thickens in response to the insult, commonly seen in areas where patients have easy access(medial ankles and forearms), treated with potent topical steroids under occlusion and keratolytic agents, avoiding scratching or rubbing by use of distraction methods or cooling emollients such as those with menthol, avoiding allergic triggers and scratchy clothing such as wool, frequent emollients, topical steroids – using the lowest potency to clear the lesions, tars (however they will stain clothes, towels and porcelain tubs), the keratolytic agents such as the alpha-hydroxy acids, the immunomodulators such as tacrolimus and pimecrolimus and in extensive cases phototherapy

Front 10

contact dermatitis

Back 10

Caused by external agents, toxicity, or allergic reaction; pruiritis or burning of skin, irregular well demarcated patches of erythema and edema, non-umbilicated vescicles, punctuate erosions exuding serum and crusts, often linear arrangement, clinical findings and patch test, remove agent causing reaction, topical or systemic corticosteroids

Front 11

Seborrheic dermatitis

Back 11

“cradle cap” in infants and dandruff in adults, Infants usually grow out of the rash by 9 months, the scalp, eyebrows, eyelashes, beard and mustache area, behind the ears the v of the chest and the groins, can also go to the forehead and in the ears, treatment for infants is to use mineral oil and a soft baby brush instead of seborrhea shampoos because of the risk of contact dermatitis, Salicylic acid, selenium sulfide, zinc pyrithrone, tar preparations, ketoconazole, topical steroids, sodium sulfacetamide with sulfur, cicloprox

Front 12

psoriasis

Back 12

sharply marginated papules and plaques, hereditary disorder, presents in the 20's and 50's, +auspitz sign(white scale when scraped off causes bleeding), elbows, knees, sacral area, nails, biopsy, "pepperoni" appearance, Topical steroids, Emollients, Tars, Dovonex, Phototherapy (UVB, PUVA), Anthralin, topical retinoids Methotrexate, Acitretin, Cyclosporine, Biologics

Front 13

Pityriasis Rosea

Back 13

maculopapular, red, scaling, eruption, herald patch(bigger than the others and erupts first), fine scaling, oval maculates w/marginal collaterette, "christmas tree" pattern, mimics syphillis so run RPR, palliative care with topical steroids and antihistamines

Front 14

Lichen planus

Back 14

acute or chronic inflammation of the skin and mucous membranes, pruiritic, purple, papules, planar, polygonal, wrist, lumbar area, shins, scalp, eyelids, groin, nails, 40% papules w/white reticulate lesions on the buccal mucosa, usually resolves on its own, Topical corticosteroids with occlusion (not on lids), tacrolimus, pimecrolimus, PUVA, Oral corticosteroids, Cyclosporine A in resistant cases

Front 15

Rosacea

Back 15

stage 1-intermittent flushing w/few talangiectasis
stage 2-persitent flushing, telangiectasis, papules, pustules, abscence of comedones
stage 3-persistent erythema, numerous talangiectasis, papules, pustules, nodules, rhinophyma formation
stop using the things that trigger flushing, sunscreen daily, metronidazole 0.75%, clindamycin 1%, erythromycin 2%, azelic acid cream 20%, tetracyclines, accutane 0.5-1mg/kg/day
rhinophyma-dermabrasion, telangiectasias-electrocautery

Front 16

Folliculitis

Back 16

follicular-based pustule, frequently grouped
face/legs-staph aureus due to shaving, mupriocin, dicloxicillin, macrolide antibiotics
trunk-psuedomonas aeruginosa(hot tub), quinolones
back-candida albicans in febrile hospitalized pts

Front 17

Perioral dermatitis

Back 17

females age 16-45, erythematous, micropapular, fine scaling eruption, nasolabial folds, chin and upper lip, etiology unknown(maybe toothpaste?)
tetracycline/erythromycin

Front 18

Hidradenitis suppurative

Back 18

chronic inflammatory scarring disease related to apocrine sweat glands, axilla, inguinal, perianal and inframammary areas, intralesional triamcinolone 5-10mg/ml, I&D, minocycline, ciproflaxican, cephalosporins, clindamycin, accutane 1mg/kg, surgical excision of area aprocrine glands

Front 19

paronychia

Back 19

red, painful area proximal/lateral to nail fold, post trauma, usually staph, I&D, penicillinase resistant antibiotics (acute)
redness, edema of nail fold of several fingers, long term dystrophy of the nail, people who work with hands in moist enviroment, class 5 steroid, miconazole, thymol, fluconazole if canididal overgrowth

Front 20

impetigo

Back 20

transient thin roofed vesicles, then golden-yellow stuck on crusts, face, arms, legs, buttocks
mupirocin, fusidic acid, oral antibiotics w/good staph/streptococci coverage
*can occasionally cause glomerulonephritis

Front 21

cellulitis

Back 21

adults-strep and staph children- H. influenza, strep, staph
breaks in skin, ulcers, chronic dermatosis
red, hot, tender,edema, sharply defined, irregular borders
analgesia and oral antibiotics
IV antibiotics if severe

Front 22

erysipelas

Back 22

variant of cellulitis caused by group A streptococci, lymphatics involved, sharply demarcated from normal skin, spreads centrally, painful, face, lower legs, areas w/preexisting lymphedema, umbilical stump
analgesia and oral antibiotics
IV antibiotics if severe

Front 23

diaper dermatitis

Back 23

nystatin or imidazole cream bid
oral nystatin
diluted Castellani's paint
addition of topical steroids speed up healing

Front 24

onychomycosis

Back 24

yellow, white hyperkeratotic ddebris, crumbly toenails, generally due to trichophyton rubrum, KOH and culture
itraconazole 200mg, 2 PO qd for one week on and 3 weeks off for 3 months
terbenifine 250mg qd 3 mos
ciclopirox nail lacquer as added agent
surgical removal

Front 25

dermatophytes

Back 25

superficial infections on non-viable keratinzied tissue, caused by trichophyton, microsporum, epidermophytan, broken off hair on th scalp(black dots), kerion(exudative follicles), Wood's lamp, KOH prep, culture
terbenifine, griseofulvin, ketoconazole, itroconazole, PO or IM steroids if kerion present

Front 26

Tinea Corporis/pedis

Back 26

sharply marginated plaque, scaling, enlarges from periphery
maceration between toes or moccasin-like scale
Wood’s lamp, KOH prep, Culture
Topical imidazoles, Terbenifine, Griseofulvin, Ketoconazole, Itraconazole

Front 27

tinea versicolor

Back 27

Malassezia furfur, sharply marginated off-white to brown “velvety” macule, fine scaling, round to oval on chest and back, occasionally pruritic, worse in hot humid weather, topical imidazoles, oral or topical ketoconazole, itraconazole, Selenium sulfide

Front 28

Verruca Vulgaris

Back 28

Human Papilloma Virus, school age children, decreases after 25, firm papules, hyperkeratotic, clefted surface, vegetations, site of trauma, biopsy, HPV subtyping, : Salicylic acid and/or lactic acid in collodion, curettage, surgical or laser excision, cryosurgery, electrocautery, tagamet, hyperthermia, intralesional bleomycin/interferon, Imiquimod, topical retinoids, cantharone

Front 29

Verruca Plana

Back 29

HPV, biopsy, HPV subtyping, mesa-like flat-topped papules, linear (self inoculation from scratching), Topical retinoids, cryosurgery, electrosurgery

Front 30

Condyloma acuminata

Back 30

Subtypes 6 and 11 are the most common (90% of all genital warts), however 16 & 18 are associated with 70% of cervical cancer,
Imiquimod (Aldara), 20% podophyllin, 0.5% podofilox, 5-fluorouracil, Trichloroacetic acid, Pulsed dye laser, Cryotherapy
Electrocautery
Gardasil, the HPV vaccine, covers subtypes 6, 11, 16, 18

Front 31

Molluscum Conatagiosum

Back 31

caused by poxvirus
Discrete, umbilicated, dome-shaped, pearly-white, waxy papules, Adults (often STD or in HIV infected individual), Neck, trunk, anogenital area, eyelids,
Children - spontaneous remission, but can use cryosurgery and curettage
Adults - curettage, cryosurgery, electrocautery, Topical retinoids

Front 32

Scabies

Back 32

intense, generalized, intractable pruritis, burrows, vesicles, nodules, excoriations, Pruritis can continue up to 2-3 weeks, Topical steroids, Antihistamines (Atarax, Benadryl), Elimite (5% Permethrin), Ivermectin, Clothes, sheets, etc. wash normally the next morning; bedspread, coats, put in plastic bag for 4-7 days

Front 33

Pediculosis (lice)

Back 33

Over-the-counter treatment:
topical pyrethrin with piperonyl butoxide (Rid)
Prescription treatments:
permethrin (5% Elimite, 1% Nix)
topical sulfur
lindane (Kwell)
malathion (Ovide)
crotamiton (Eurax)
Remove nits using a special comb
Sanitize clothing and bedding
Examine close contacts, especially children

Front 34

Brown Recluse Bite

Back 34

RICE, aspirin, antihistamine, tetanus prn, antibiotics, analgesics, dapsone, surgical debridement

Front 35

black widow bite

Back 35

Neurotoxin – muscle cramps, spasm, nausea, vomiting, hypertension, weakness, malaise, tremors, lasting days to a week
Ice, antivenin alone or in combination with IV opioids and muscle relaxants

Front 36

Bullous Pemphigoid

Back 36

Onset >60 years of age
Pruritic skin lesions
Tense blisters
Oral mucous membrane lesions in 10-35%
Self-limited in many cases
Treatment with oral glucocorticoids alone or with azathioprine, also dapsone, tetracycline, niacinamide

Front 37

Vitiligo

Back 37

Symmetric white macules, periorificial locations, sites of trauma, early lesions can be pink or tan
Review of systems - halo nevi, Alopecia areata
H/O thyroid disease, diabetes mellitus, pernicious anemia, Addison’s disease
Any age - peak 10-30 years
Etiology: Autoimmune destruction of melanocytes
Labs: TSH, FBS, ANA
Psoralen plus UVA (PUVA), Topical corticosteroids, Minigrafting, Sunscreens, Cosmetics, Depigmenting (MBEH)

Front 38

Melasma

Back 38

Common acquired hypermelanosis
Occurs in sun-exposed areas,
Worse with sun exposure, pregnancy, oral contraceptives and anti-epileptic medications
Only 10% of cases reported in males
Most common in the central face, may be epidermal (brown), dermal (blue-gray) or mixed (brown-gray)
Treatment: sunblock (>SPF 30, Parsol 1789, Mexoryl) , bleach (2 to 4% hydroquinone, adapalene, tretinoin, +/- hydrocortisone and time (may take 2 to 6 months to see a response), also azelaic acid, chemical peels, laser
Do not use MBEH because of risk of irreversible leukoderma/induction of vitiligo in distant sites
Discontinue OCP’s if possible

Front 39

Acanthosis nigricans

Back 39

Hyperpigmentation and thickening of the skin of the neck and in body folds; appears “velvety”
Skin markings are accentuated
Paraneoplastic AN can involve palms/soles and vermillion border of the lips
Classification:
Type 1 - hereditary, benign
Type 2 - insulin resistant states
Type 3 - Pseudo-AN, seen with obesity
Type 4 - Drug-induced (nicotinic acid, oral contraceptives)
Type 5 - Malignant - Paraneoplastic

Front 40

Moles

Back 40

A - Asymmetry in shape, one half unlike the other
B - Borders are irregular with irregular, scalloped edges
C - Color is mottled, with a haphazard display of colors - shades of brown, black, gray, red and white
D - Diameter is usually large, greater than the tip of a pencil eraser (6.0mm)
E - Enlargement (history of an increase in the size of a lesion) is perhaps one of the most important signs of malignant melanoma

Front 41

Superficial spreading melanomas

Back 41

Account for 70% of all melanomas, 30 - 50 years, Slightly higher in females, Evolves over a period of 1 - 5 years, excisional biopsy is treatment

Front 42

Nodular melanoma

Back 42

Account for 16% of all melanomas, Median 50 years, Evolves over 6 - 18 months, Rarely associated with a nevus remnant, worse prognosis than superficial spreading bc of vertical growth and thickness

Front 43

Lentigo maligna

Back 43

Synonymous with Hutchinson’s nevus, Hutchinson’s freckle, melanoma in situ, Flat, macular, intraepidermal neoplasm and the precursor or evolving lesion of Lentigo Maligna Melanoma (LMM), median age 65, Older population with increased sun exposure

Front 44

Lentigo maligna melanoma

Back 44

Accounts for 5% of all melanomas,Seventh decade, predominantly occur on the head and neck, May take up to 20 years to evolve from a Lentigo Maligna

Front 45

acral lentiginous melanoma

Back 45

Account for 2 to 8% of all melanomas; evolves over 2.5 years, Median is 65 years, Male:Female ratio - 3:1, ALM is the principal melanoma in American and African Blacks; accounts for 50 - 70% of melanomas in Japanese population, Survival rates for the volar(on palms and soles) type are less than 50%, Subungual(under the nails) type has a 5-year survival rate of 80%

Front 46

Acitinic Keratosis

Back 46

Single or multiple, discrete, dry, rough, adherent, scaly lesions on habitually sun-exposed skin, Usually middle age, More common in males, skin phototypes I, II, III, Rare in IV , Almost never in V or VI, Outdoor workers, sportspersons and sun worshipers

Front 47

Basal Cell carcinoma

Back 47

Mole like,papule, nodules, ulcer-like, most common type of skin cancer, does not have ability to metastisize, Excision with primary closure, skin flaps or grafts, Cryosurgery, curettage and electrosurgery are options, but have higher recurrence rates, Imiquimod, For lesions in the danger zones (around eyes, in the ear canal, posterior auricular sulcus and in sclerosing BCC) Moh’s surgery is the best approach

Front 48

Bowen's Disease
(squamous cell carcinoma in situ)

Back 48

Usually a solitary lesion on exposed skin, Slowly enlarging, erythematous macule, sharp border, little or no infiltration, usually slight scaling, some crusting, excision, Moh’s surgery in difficult sites, Cryotherapy, Efudex, Imiquimod, Mortality rate is very low

Front 49

Invasive Squamous Cell Carcinoma

Back 49

Fleshy, granulating, friable, crusted nodules, Has the capacity to metastasize, Any persistent nodule, plaque or ulcer, especially in areas of sun-exposure, radiation dermatitis, old burn scars or on the genitalia must be biopsied, Excision, SCC has an overall remission rate after therapy of 90%

Front 50

Seborrheic Keratosis

Back 50

skin colored to brown to black, discrete, raised, rough or hyperkeratotic, papules to plaques, often verrucous,
greasy “stuck on” appearance, sebaceous areas: face, back, chest, groin, Completely benign, Common, middle age-elderly, higher in whites, hereditary, liquid N2,"", curettage, treatment not necessary,R/O malignant melanoma in dark lesions

Front 51

Dermatosis Papulosis Nigra

Back 51

2-3mm, brown to black, hyperkeratotic, pedunculated or verrucous papules, cheeks, around eyes bilaterally, Completely benign, teens to middle age, hereditary, more common in Blacks and Hispanics, Origin
equivalent to seborrheic keratosis, Liquid nitrogen – do test patch for hypopigmentation, small lesion electrocautery and curette, large lesion-anesthetize, excise, will normally recur

Front 52

Lipoma

Back 52

soft, pillowy, SQ lesions, normal, mobile overlying skin, 1-10+cm, trunk, extremities, Benign, fast growing, consider malignant transformation, any age, more common mid 20’s, asymptomatic, may be tender if large component of blood vessels, excision, once removed, they normally do not recur

Front 53

Erythema Nodosum

Back 53

Acute inflammatory/immunologic reaction caused by a number of etiologies, Painful, tender nodules on the lower legs, fever, malaise, 50% with arthralgias, F:M 3:1, Infection - Group A ß-hemolytic Strep and others, Drugs - Sulfa, OCP, Sarcoidosis, Ulcerative colitis, Behçet’s, Idiopathic in 40%, Spontaneous resolution in 6 weeks depending on etiology, Bed rest, symptomatic treatment

Front 54

Erythema multiforme

Back 54

acute, self-limited skin eruption with symmetric, pruritic or painful, acral target lesions, EM Minor, No mucosal lesions, No prodromal symptoms, Tends to be recurrent,
EM Major (SJS/TEN), At least one mucosal surface involved,
Acral and facial lesions early, Trunk is frequently spared,
Often see prodrome of fever, headache, myalgias, cough, Infection - HSV infections are the most common cause, preceding the EM outbreak by 10-14 days, bacterial, mycotic, viral, e.g. influenza, EBV, Mycoplasma pneumoniae, Drugs - Antibiotics - PCN, tetracycline, sulfa, Anticonvulsants - hydantoins, carbamazepine, barbiturates, Other - antihypertensives, NSAID’s, allopurinol; Stop medication, Resolution of virus, Topical or systemic steroids

Front 55

Stevens-Johnson Syndrome

Back 55

1-6 week duration, Usually symmetric distribution, fixed
> 7 days, Severe mucosal involvement in 2 or more areas, Prodrome of fever, malaise, sore throat, headache, cough, Secondary infection, Fluid and electrolyte loss,
Sloughing of upper and lower respiratory tract, Blindness due to corneal lesions, Death
Attempt to identify underlying infection or drug source
Specific treatment or removal of offending drug, Systemic corticosteroids *,IViG *, Support measures, Burn unit support, Fluid/electrolyte & nutrition support, Treat secondary infection specifically, Care of skin