Dermatology (Lecture 1)

Front 1

What is a macule?

Back 1

• circumscribed change in skin color without elevation or depression
• a flat, non-palpable lesion measuring < 1 cm
• ex. petechiae, measles, scarlet fever nevi

Front 2

What is a papule?

Back 2

• elevated, firm, circumscribed lesion < 1 cm
• solid palpable lesion

Front 3

What is a patch?

Back 3

• same as a macule but > 1 cm
• a flat, non-palpable, irregular shaped macule

Front 4

What is a nodule?

Back 4

same as a papule but > 1 cm

Front 5

What is a plaque?

Back 5

• an elevated, firm, and rough lesion with flat top > 1 cm
• a plateau-like lesion that could also be a group of confluent papules

Front 6

What is a cyst?

Back 6

• elevated, circumscribe, encapsulated lesions in the dermis or subcutaneous layer
• filled with fluid or semi-solid material

Front 7

What is an abscess?

Back 7

• a focal collection of pus resulting from necrosis of tissue
• elevated, circumscribed, encapsulated lesions in the dermis or subcutaneous layer

Front 8

How can you tell if an abscess if ready for irrigation and drainage?

Back 8

• an abscess that is fluctuant is ready for I&D
• an abscess that is indurated (hard) is not ready for I&D

Front 9

What is atopic dermatitis?

Back 9

• an immune-mediated inflammation of the skin (IgE)
• pruritic inflammation of the dermis and epidermis

Front 10

Where does atopic dermatitis usually present in children? in adults?

Back 10

• children: flexures in antecubital fossa, popliteal fossa, neck, and posterior gluteal cleft
• adults: may progress to frank diffuse eczema; localized to eyelid, retroauricular, or hands

Front 11

What are treatment options for atopic dermatitis?

Back 11

• avoid scratching
• daily bathing (but avoid long-lasting hot showers)
• topical steroids
• Emollients, cream, or ointments (less effective)
• Hydroxyzine & oral antihistamines
• oral antibiotics (for skin infections)

Front 12

What is contact dermatitis?

Back 12

• inflammatory skin reaction of the dermis and epidermis to an external agent or toxin
• produces itching, redness, discharge, desquamation, hyperpigmentation, and fissuring

Front 13

What are the 2 types of contact dermatitis?

Back 13

• irritant
• allergic

Front 14

How can you differentiate between irritant and allergic contact dermatitis?

Back 14

• irritant contact dermatitis produces symptoms within minutes of exposure
• allergic contact dermatitis needs prolonged exposure to develop an allergic response

Front 15

What is the treatment for contact dermatitis?

Back 15

• removal of irritant
• topical or systemic steroids
• cool compress, oatmeal baths

Front 16

What are characteristics of nummular eczematous?

Back 16

• chronic, pruritic inflammatory dermatitis
• common on lower legs and trunk
• coin-shaped plaques (4-5 cm in diameter) composed of small papules & vesicles on an erythematous base

Front 17

What are risk factors for nummular/discoid eczema?

Back 17

• excessive bathing
• prolonged water exposure

Front 18

What are treatment options for nummular/discoid eczema?

Back 18

• skin hydration w/ hydrated petrolatum or moisturizing cream
• topical steroids & crude coal tar

Front 19

What is the most common scalp problem for which patients seek medical attention?

Back 19

Seborrheic Dermatitis

Front 20

What are characteristics of seborrheic dermatitis?

Back 20

• chronic, inflammatory, papulosquamous disease
• more common in areas w/ numerous sebaceous glands and oily areas of the face
• hair is normal; scalp is scaly and mildly erythematous

Front 21

What is thought to be the cause of seborrheic dermatitis?

Back 21

overgrowth of fungus pityrosporum ovale

Front 22

What must you be suspicious of with an infant that presents with seborrheic dermatitis, diarrhea, and failure to thrive?q

Back 22

immunodeficiency

Front 23

What are clinical manifestations of sbeorrheic dermatitis?

Back 23

• papules are moist, transparent to pinkish-orange, greasy, and scaling with sharp margins
• may itch with scalp involvement

Front 24

What are treatment options of seborrheic dermatitis?

Back 24

• selenium sulfide or zinc pyrithione (daily dandruff shampoo)

• hydrocortisone 1% (to decrease itching and redness)

• topical antifungals
- ketoconazole (Nizoral)
- ciclopirox (Loprox 1%)

Front 25

If an infant has no response to treatment for seborrheic dermatitis, what should you be suspicious of?

Back 25

zinc deficiency

Front 26

What is stasis dermatitis?

Back 26

• eczematous dermatitis of the legs
• associated with edema, hyperpigmentation, & varicose veins
• most common in the lower legs

Front 27

What is the clinical presentation of stasis dermatitis?

Back 27

• history of DVT, surgery, or ulceration
• skin is dry, fissured, and erythematous
• pruritis, edema, and brown discoloration of the skin

Front 28

What are treatment options of stasis dermatitis?

Back 28

• elevation and compression of the legs
• cool water dressings (for acute exudative inflammation)
• topical or oral steroids
• oral antihistamine (for pruritis)
• can treat with fem-pop bypass

Front 29

What is the fungus that causes tinea/pityriasis vesicolor?

Back 29

pityrosporum orbiculare

Front 30

What are risk factors for tinea vesicolor?

Back 30

• oily skin (most common predisposing factor)
• excess heat
• humidity
• immunosuppresion (ex. stress, medications)

Front 31

What is the clinical presentation of tinea vesicolor?

Back 31

many small, circular, white, scaling papules on the upper trunk

Front 32

What would a KOH prep show in a patient with tinea vesicolor?

Back 32

hyphae and round spores "spaghetti and meatball pattern"

Front 33

What are treatment options for tinea vesicolor?

Back 33

• selenium sulfide lotion
• ketoconazole shampoo
• zinc pyrithione soap
• oral antifungal (ex. miconazole, clotrimazole, econazole)

Front 34

What is a potential side effect from oral antifungals?

Back 34

increased LFTs

Front 35

Name and describe the two clincial presentation patterns of tinea corporis

Back 35

• round annular lesions
- begin as flat, scaly papules that slowly develop a raised border
- central area becomes brown or hypopigmented
- extends in all directions

• deep inflammatory lesions
- round inflamed, elevated lesion with a red, boggy, pustular surface
- due to infection into the hair follicle

Front 36

What are treatment options fo tinea corporis?

Back 36

• antifungal cream for at least 1 week after resolution of infection

• oral antifungal (if needed): griseofulvin, itraconazole, terbinafine, fluconazole

Front 37

What is the most common area affected by dermatophytes?

Back 37

foot (Tinea pedis/Athelete's foot)

Front 38

What are predisposing factors for tinea pedis?

Back 38

• shoes creating a warm moist environment
• locker room floors
• communal baths

Front 39

Name and describe the 3 clinical presentation of tinea pedis

Back 39

• interdigital: web space is dry, scaly, and fissured; itching is profuse

• chronic scaling of the plantar surface: entire sole is covered with fine silvery white scales

• acute vesicular: itchy, sterile vesicles that are due to an allergic response to the fungus

Front 40

What are treatment options for tinea pedis?

Back 40

• oral or topical antifungal meds (ex. Terbinafine, butenafine, sertaconazole)
• Burrow's wet dressings w/ topical antifungals (for acute vesicles)

Front 41

Tinea cruris occurs in what location of the body?

Back 41

groin

Front 42

Tinea faciei occurs in what location of the body?

Back 42

face

Front 43

Tinea manuum occurs in what location of the body?

Back 43

hand

Front 44

Tinea capitis occurs in what location of the body?

Back 44

scalp

Front 45

Tinea barbae occurs in what location of the body?

Back 45

beard

Front 46

Onychomycosis occurs in what location in the body?

Back 46

nails