Hoang Derm Test Starred

Front 1

Polytrichia

Back 1

tufted or doll hair
- Loss of follicular openings; follicular pluggings
Scalp surface changes may or may not relate to alopecia:
Psoriasis: + scalp surface change; - hair loss
Male pattern baldness: - scalp surface change; + hair loss

Front 2

Lichenification criteria

Back 2

(must have all 3)
1) Palpable thickening
2) Accentuated skin markings
3) Lichen-type scale

Front 3

AGA (Androgenetic Alopecia) occurance men/women

Back 3

80% of men; 40% of women by age 70

Front 4

AGA (Androgenetic Alopecia) cause & see

Back 4

- Increased 5α reduction of T -> DHT: Lose normal ratio of Terminal:Vellus (normal 2:1) -> vellus/indeterminate will outnumber

Front 5

Alopecia Areata/Totalis/Universalis
Cause

Back 5

Smooth patches; non-scarring T-cell disorder (HLA-DQ3; HLADRB1)

Front 6

Alopecia Areata/Totalis/Universalis Bad signs

Back 6

2) BAD SIGNS:
i. Onset before puberty
ii. > 5 yr duration
iii. FHx of AA or PMHx of Atopic Derm
iv. Extensive dz like Ophiasis
v. Worsening, Persistent, Recurrent
vi. Onychodystrophy

Always potentially reversible

Front 7

2 Tests to order for DLE:

Back 7

1) ANA (lower titer; 10-20% positive
i. MAJORITY ANA Negative
2) Ro

Front 8

Approach to pt w/ Suspected Cutaneous Lupus:

Back 8

1) ANA assay on HEP-2 cells ->
i. Negative (DLE)->
1) No systemic symptoms & ongoing suspicion of anti-Ro assoc cutaneus dz? -> Ro-Ab
ii. Titer < 1:160 (DLE)
1) No systemic symptoms & ongoing suspicion of anti-Ro assoc cutaneus dz? -> Ro-Ab
2) Systemic Symptoms -> Rheumatology consult
iii. Titer 1:160 (SLE)
1) Autoab (anti-dsDNA; -Sm) if indicated by clinical findings -> anti-Ro; Cardiolipin
a) Abnormal values -> Rheumatology
2) Other tests:
a) CBC
b) Chem screen for creatinin; albumin; protein
c) ESR
d) C3/C4
Abnormal -> Rheumatology

Front 9

SCLE skin lesions have 2 types:

Back 9

1. Annular or polycyclic – no scales
DDx: Tinea infection,
Erythema annulare centrifugum.

2. Papulosquamous or psoriasiform – scales are present

Front 10

- 11 criteria (4 are derm findings) - 4 or more concurrent or serial = SLE
what are the 4

Back 10

1) Malar erythema
2) Discoid rash
3) Photosensitivity
4) Oral or Nasopharyngeal uclers (often painless)
"Photos of Malar Discoid Mouths/Noses"

Front 11

NLE cause

Back 11

Crossing of Anti-Ro ab (SSA; Sjogrens Syndrome A) across placenta

Front 12

NLE Risk

Back 12

- Congenital heart block (dmg may be permanent) (ab settle 2% of time; if do -> 54% get heart block)
- Hepatic; hematologic; neurologic dmg
- Dermatologic (50%) - analagous to SCLE (raccoon eyes; discoid)

7% (1/14) infants to anti-Ro moms

Front 13

DILE drugs (6)

Back 13

Hydralazine,
Procainamide,
Minocycline,
TNF inhibitors,
Methyldopa,
Penicinlamine.

Front 14

Dermatomyositis (DM): labs & features

Back 14

ALDOLASE is elevated (also ALT/AST; CPK; LDH)

Derm features:
§ HELIOTROPIC RASH (upper eyelids w/ violaceous edema) - pathognomonic

GOTTRONS PAPULES (red scaly papules over knuckles, ip, mp, elbow, knee) -

Front 15

Sclerodactyly

Back 15

- Sclerodactyly: no wrinkles despite old age; skin pulled tight (like collagen injection)
- Gross: salt and pepper in blacks, MAT type telangiectasia

Front 16

Acne pathophys

Back 16

- Hormonally induced disruption of infundibular keratinocyte dynamics
o Superimposed epiphenomena of immune-mediated inflammation

Front 17

Preadolescent Acne cause

Back 17

Preadolescent Acne: Androgen metabolism => acne via DHT formation

Front 18

Acne tx

Back 18

IMPORTANT TO KNOW
- Retinoid is 1st line
- Individualized
- COMBO
- BPO is cheap and highest antimicrobial activity of topicals

Front 19

Normal sebaceous follicle flora

Back 19

 Normal Sebaceous follicle flora
1. Propionibacterium acnes
2. P. granulosum, P. parvum
3. Staphylococcus epidermis
4. Demodex folliculorum (mite)
5. Liphophilic yeast
6. Malassezia furfur, M.sympodalis

Front 20

Melanoma risk factors

Back 20

Risk Factors: trauma, burn scars, albinism, X-ray radiation, pre-existing pigmented lesions

Front 21

ABCDE of nevi

Back 21

Asymmetry, Border, Color, Diameter, Evolution
Diameter > 6mm

Front 22

Ugly Duckling Sign

Back 22

unusual very darkly pigmented/ugly mole or freckle that stands out from rest

Front 23

Little Red Riding Hood Sign

Back 23

persistent scaling pink/red patch that doesn’t respond to tx

Front 24

Biopsy melanoma effect?

Back 24

3/4 of all melanomas arise de novo,
§ removal of nevi inefficient to decrease melanoma risk, manage risk instead
§ Atypical nevi = risk MARKER (not pre-cancer c/o 3/4 arise de novo)

Front 25

CUTANEOUS DRUG ERUPTIONS epidemiology

Back 25

95% of these immunological pathways are lymphocyte (T cell) mediated

Front 26

Mechanisms of Cutaneous Drug Eruption

Back 26

o Specific HLA molecules play an important role – presenting antigen to T-cells and confer a greater susceptibility to various drug eruptions

Front 27

Window of opportunity for cutaneous drug reaction

Back 27

closes after: ten weeks. >10 wks then most probably without problem

opens after:
- a week for a new drug but
- immediately for a drug the patient has previously taken.

Front 28

Drug Reaction Patterns High risk

Back 28

- Urticaria and Angioedema
- EM, Stevens-Johnson Syndrome and TEN
- Vasculitis
- The Drug Hypersensitivity Syndrome/DRESS (Drug Rxn w/ Eosinophilia & Systemic Sx)
- AGEP (Acute Generalized Exanthematous Pustulosis)
- Erythroderma

Front 29

Vascular Reactions morpho

Back 29

Lesions are typically red, without scaling lesions are typically flat-topped; often confluent

Front 30

"Fixed" erythemas morpho

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* Persistent flat erythema exanthem-like")
* Erythema multiforme (bullous and non-bullous)

Front 31

BULLOUS FIXED DRUG ERUPTIONS

Back 31

Usually a single large blister (bulla) on an erythematous base

Lesions occur within 48 hours after exposure and last 7 to 10 days; no scaring, but with HYPERpigmentation