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41 Cards in this Set

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Name the layers of the epidermis
stratum basalis
stratum spinosum
stratum granulosum
stratum corneum
dark, thick, velvety plaques under arms, breasts, in groin and on neck. Associated w/ insulin resistance and a predictor of DMII.
Dx?
Rx?
Acanthosis Nigricans
Rx. treat underlying disorder (obesity, malignancy, diabetes, cushings, etc.)
Enlarging pink or browm macular patches on flexor surfaces. Asymptommatic. Caused by corynebacterium. prevalent in diabetics and warm climates.
Dx?
Rx?
Erythrasma diagnosed by Wood's light causing lesions to fluoresce pink.
Rx: topical or oral erythromycin
Scaly, pruritic patches and plaques on flexor surfaces and neck. Associated with asthma and allergies and/or a family history.
Dx?
Rx?
Eczema
Rx: avoid triggers, use mild soaps, add steroids, tacrolimus, phototherapy or methotrexate as needed
presensitized mast cells and basophils bind to antigen and reaction develops rapidly. examples include anaphylaxis, asthma, and local wheal and flare. Type of Reaction?
Type I
(anaphylactic and atopic)
IgM or IgG bind to antigen leading to lysis by complement or phagocytosis. examples include Rh disease, Goodpasture's syndrome and rheumatic fever. Type of Reaction?
Type II (cytotoxic)
sensitized T cells encounter antigen and release lymphokines. examples included TB skin test, transplant rejection, contact dermatitis. Type of Reaction?
Type IV (delayed,
cell-mediated)
antigen antibody complexes activate complement. Examples include serum sickness, SLE, RA, or the arthus reaction. Type of Reaction?
Type III
large, pruritic, non-painful bullae filled with serous/bloody fluid. rarely involves mucous membranes. negative nikolsky. fluorescence at dermal-epidermal junction. autoantibodies to BP1 and BP2.
Dx?
Rx?
Bullous Pemphigoid
Rx: topical or oral steroid
shallow, painful blisters on epidermal and mucosal surfaces. autoantibodies to desmocollins and desmogleins. positive nikolsky. intercellular fluorescence and acantholysis. Dx?
Rx?
Pemphigus
Rx: oral steroids, plasmaphoresis for severe cases, lesions should be cared for as burns
cutaneous disorder d/t drugs, infection, vaccinations, or malignancy. mild myalgias/malaise. raised erythematous plaques on extremities. biopsy shows perivascular lymphocytes and necrotic keratinocytes. Dx?
Rx?
Erythema multiforme
Rx: mild cases resolve spontaneously, discontinue inciting agent, acyclovir for HSV
painful, erythematous pretibial nodules d/t drug hypersensitivity, infection, sarcoid, rheumatic fever, or IBD. accompanied by fever, rash, and malaise. elevated ESR, positive ASO titer, false positive VRDL. Dx?
Rx?
Erythema Nodosum
Rx: treat underlying cause, elevate leg, KI, NSAIDS, corticosteroids
polygonal, purple, pruritic papules on inner wrists and lower legs with overlying network of white lines (wickham's striae). induced by drugs and strong association w/ HCV. Bx shows hyperkeratosis.
Dx?
Rx?
Lichen Planus
Rx: topical steroids and oral antihistamines, for serious cases can use UV, cyclosporine, oral steroids
dark red plaques with scales over extensor surfaces d/t epidermal proliferation. non-pruritic. also nail pitting, and onycholysis. can have joint stiffness in DIP joints. increased ESR & uric acid. Dx?
Rx?
Psoriasis
Rx: topical steroids and calcipotriol for mild cases, immunosuppressants and phototherapy for severe dz
pruritic, yellowish, greasy, scaling patches seen on scalp, ears and face. Dx?
Rx?
seborrheic dermatitis
Rx: hydrocorisone and topical antifungals for face, body and interitriginous areas, medicated shampoos for scalp
coalescing red macules and flaccid blisters with full-thickness epidermal loss d/t drug reaction. oral lesions present. + Nikolsky. Dx?
Rx?
Dx: SJS <10% Body surface and perivascular mononuclear infiltrate with degeneration of basal layer on bx
TEN >30% BSA, full-thickness epidermal necrosis with macrophages and dendrocytes and reactivity to TNF-alpha
Rx: discontinue offending agent, pain control, IVIG, admit to burn unit
areas of depigmentation d/t loss of melanocytes. associated with thyroid disease, pernicious anemia, addison's dz, and DMI. Dx?
Rx?
Vitiligo
Rx: artificial tanning creams, steriods, or phototherapy.
comedones on face,neck, arms, back, butt. associated with change in androgen levels. Dx?
Rx?
Acne Vulgaris
Rx: topical clinda or erythro, benzoyl peroxide and topical retinoids for mild cases, add tetracycline for moderate cases. Isotretinoin for most severe cases.
red, hot, swollen, skin lesions d/t infection of subcutaneous tissue. Dx?
Rx?
Cellulitis, or folliculitis if hair follicle involved
Rx: oral antibiotics for mild cases. hospitalize cases w/ systemic, hand, or orbital involvement.
small, scaling, hyper or hypopigmented macules on chest and back. can be pruritic. spaghetti and meatballs on KOH prep. Dx?
Rx?
tinea versicolor caused by Malassezia furfur
Rx: topical antifungal and selenium sulfide shampoo
pruritic ring shaped scaling plaques with central clearing and raised borders. hyphae seen on KOH prep. Dx?
Rx?
tinea corporis (ringworm)
Rx: topical antifungal. oral antifungals for tinea capitis
painful, recurrent vesicular eruptions on erythematous mucocutaneous surfaces. multinucleated giant cells on Tzank smear. Dx? Rx?
Herpes Simplex
Rx: acyclovir reduces viral shedding and frequency and severity of recurrences
a common, contagious, childhood infection with pruritic facial lesions and yellowish crusts. Dx? Rx?
impetigo
Rx: wash with mild soap, topical mupirocin for coag(+) S.aureus, systemic abx for other staph/strep species
2-5mm dome shaped papules with central umbilication. asymptommatic. seen on face trunk and extremities in kids and genitals and perianal area in adults. inclusion bodies on wrights and giemsa stain. Dx? Rx?
Molluscum contagiosum d/t poxvirus infx.
Rx: resolve spontaneously over months to years. can be removed by cryotherapy, curettage, or TCA application
rapidly developing skin and fascia infection with swelling, tenderness, induration or bullae with pain and fever. Dx? Rx?
necrotizing faciitis caused by Group A Strep, C.perfringens, or mixed bacteria
Rx: emergent surgery to remove necrotic tissue, culture tissue and treat w/ abx.
mild childhood dz presents with diffuse pruritic round/oval erythematous papules convered w/ "cigarette paper" white scale. Christmas tree pattern on trunk and a solitary patch precedes the rash(herald patch). Dx? Rx?
Pityriasis Rosea associated with HHV-6 infx
Rx: self limited dz, can treat pruritis
itching worse at night and after hot showers, papules and vesicles can be seen. skin scraping reveals mites or eggs with KOH. Dx? Rx?
Scabies (Sarcoptes scabiei)
Rx: permethrin cream, treat close contacts as well.
painful, unilateral, vesicular eruptions in a dermatomal distribution. Dx? Rx?
varicella zoster
Rx: antivirals w/in 72 hours of lesions
white, sharply demarcated confluent macules, papules, and plaques usually in anogenital area of postmenopausal women. may be pruritic and painful. Bx shows hyperkeratotic epidermis. Dx? Rx?
lichen sclerosus
Rx: short term high potency glucocorticoids or hydrochloroquine
thickened areas of skin(shagreen patches), hypopigmentation(ash leaf spots), red papules around nose(angiofibromas), seizures, mental retardation, periventricular tubers.
Dx?
Tuberous sclerosis
Cafe-au-lait spots, neurofibromas, axillary freckling, acoustic neuromas, lisch nodules, optic nerve glioma, meningiomas. Dx?
neurofibromatosis
Port wine stain on face (over distribution of V1), seizures, mental retardation, visual impairment. Dx?
Sturge-Weber syndrome
hemangiomas, retinal hamartomas, renal cell cancer, pheo, polycythemia. Dx?
von Hippel-Lindau
brown, stuck on appearance on face, trunk, upper extremity. uniform appearance over entire surface. Dx? Rx?
Seborrheic keratosis
Rx: no treatment necessary, but can be removed for cosmetic purposes
bleeding or scabbing sore on head or neck or pearly papules of variable size. associated with sun exposure. Bx shows basophilic cells palisading. Dx? Rx?
Basal Cell Carcinoma
Rx: dependent upon location curettage, surgical excision, Moh's, cryosurgery or radiation
asymptommatic, rough papule with poorly demarcated base and white superficial scaling. premalignant. caused by sun exposure. Bx dysplastic squamous epithelium. Dx? Rx?
Actinic keratosis
Rx: cryosurgery, 5-FU, curettage or chemical peel.
red-purple thin plaques on skin and mucosa. almost always seen in AIDS pts. Dx? Rx?
Kaposi's Sarcoma (d/t HHV-8)
Rx: Antiretrovirals for HIV, chemotherapy for lesions
changing pigmented skin lesion found on sun-exposed areas and soles of feet that can be itchy. Characterized by asymmetry, irregular borders, various colors, and >6mm diameter. Bx shows melanocytes with atypia, and melanocytic invasion into the dermis. Dx? Rx?
Melanoma
Rx: surgical excision and lymph node dissection may be necessary. Stage determined by depth of invasion (Breslow stage)
thin scaling patches in sun-protected areas that progress to plaques to nodules to tumors. associated with "lion-like" facies and intractable pruritis.
Bx shows infiltrate of atypical T-lymphocytes in the dermis. Dx? Rx?
Mycosis Fungoides
Rx: PUVA, topical nitrogen mustard, high potency topical steroids, total electron beam irradiation
small papules, erythema, and telangiectasias in a symmetric distribution on cheeks chin and forehead. Flushing worsened by heat, spicy food, alcohol, caffeine, and sun. Dx? Rx?
Rosacea
Rx: avoid precipitating factors, topical metronidazole, sulfur lotions, or oral tetracycline are options
What is rhinophyma?
large porous lobulated nose that can develop in men with Rosacea