Y2S1B1 - Cs - Actinic Keratosis, Atopic Dermatitis, & Derm Manifestations Of Systemic Dz

Front 1

Actinic Keratosis typically present as...

Back 1

-Macule or papule w/ dry adherent scale
-On fair-skinned patient
-on head, dorsum of hands, neck

-pleomorphism and starts as inflammatory infiltrate in lower epidermis/upper dermis

Front 2

What are some possible treatments for Actinic Keratosis?

Back 2

Liquid Nitrogen - kills superficial layer of skin, used for smaller lesions

Excision w/ biopsy if hypertrophic/thicker

Fluorouracil products for widespread lesions

Imiquimod - increases immune response (cytokines) locally

Front 3

What's the most likely population for Squamous Cell Carcinoma?

Back 3

White males over 40

Front 4

SCC involves what pathologic changes?

Back 4

Pathologic changes moving into the dermis

Front 5

Basal Cell Carcinoma is more common in what age group?

Back 5

Over 40

Front 6

What disorder usually starts as a "pearly" papule?

Back 6

BCC

Front 7

What is an important treatment for BCC?

Back 7

Electrodessication and Curettage

(burn, scrape, burn, scrape; finished when base feels hard)

Front 8

What is the most common cancer in ages 25-29??

Back 8

Malignant Melanoma!

Front 9

T/F

Lesions with ANY of the ABCDE's are malignant

Back 9

False!

Many benign lesions may also have these characteristics*

Front 10

What are the ABCDE's used to diagnose malignant melanomas?

Back 10

A - asymmetry
B - border irregularity
C - color variability
D - large diameter (>6mm)
E - evolving

Front 11

Who should have a thorough head-to-toe skin exam?

Back 11

If patient has had one of the 3 skin cancers, should have it documented at least once a year, often 2x a year

Front 12

When does atopic dermatitis usually began?

Back 12

Infancy

Front 13

The skin lesions of atopic dermatitis are...

Back 13

pruritic and erythematous

Front 14

What are some eliciting factors of atopic dermatitis?

Back 14

dryness, stress, and allergens

-Inhalants (aeroallergens)
-Microbial agents (s aureus)
-Autoallergens (sera IgE antibodies)
-Food
-Skin barrier disruption (a/w reduced ceramide levels -> inflammatory cascade (cytokines); dehydration)
-Infections
-Seasons (improves in summer, flares in winter)
-Clothing
-Emotional distress

Front 15

Who should have a thorough head-to-toe skin exam?

Back 15

If patient has had one of the 3 skin cancers, should have it documented at least once a year, often 2x a year

Front 16

What is the ESSENTIAL element of atopic dermatitis?

Back 16

Pruritus!

"eczema is the itch that rashes"

Front 17

When does atopic dermatitis usually began?

Back 17

Infancy

Front 18

The skin lesions of atopic dermatitis are...

Back 18

pruritic and erythematous

Front 19

What are some eliciting factors of atopic dermatitis?

Back 19

dryness, stress, and allergens

-Inhalants (aeroallergens)
-Microbial agents (s aureus)
-Autoallergens (sera IgE antibodies)
-Food
-Skin barrier disruption (a/w reduced ceramide levels -> inflammatory cascade (cytokines); dehydration)
-Infections
-Seasons (improves in summer, flares in winter)
-Clothing
-Emotional distress

Front 20

What is the ESSENTIAL element of atopic dermatitis?

Back 20

Pruritus!

"eczema is the itch that rashes"

Front 21

How do acute skin lesions compare to chronic skin lesions of atopic dermatitis?

Back 21

Acute:
erythematous papules, patches, plaques

Chronic:
more lichenified
painful fissures
alopecia of lateral 1/3 of eyebrow
periorbital pigmentation
characteristic infra-orbital fold in eyelids (Dennie-Morgan sign)

Front 22

What is the latest theory of treatment for atopic dermatitis?

Back 22

Restore skin ceramides to normal ratio (thereby reducing tendency for abnormal inflammation processes)

Front 23

What special features of atopic dermatitis are related to:

a) Infants?
b) Childhood?
c) Adults?

Back 23

a) on face, tiny vesicles on puffy surface

b) flexor surfaces; lichenified plaques, erosions, crusts

c) similar distribution as childhood w/ lichenification and excoriations being most conspicuous symptoms

Front 24

How can you diagnose Atopic Dermatitis?

Back 24

History in infancy

also clinical findings and lab results (increased serum IgE, eosinophilia)

Front 25

How do you manage atopic dermatitis?

a) Acute

b) Subacute and Chronic

Back 25

a) Cera-V replaces ceramides

b) Hydration, NSAIDs (Atopiclair w/ glycyrrhetinic acid from licorice root and vitis venera from grapevine)

Front 26

How does glycyrrhetinic acid help with treating atopic dermatitis?

Back 26

Its major active metabolite, 18-beta-GrA, inhibits 11-beta-hydroxysteroid hydrogenase and classical complement cascade

Front 27

How does vitis vinera help with treating atopic dermatitis?

Back 27

Contains OPC (proanthocyanidines) which belong to bioflavonoid group and have antioxidant activity. OPC decreases pro-inflammatory IL-8

Front 28

In relationship to atopic dermatitis, what can herpes simplex infection lead to?

Back 28

Eczema herpeticum

which can be life-threatening (in children)

Front 29

What systemic dz is Acanthosis Nigricans a/w?

Back 29

Diabetes (specifically insulin resistance, so can exist in pre-diabetic stage of type 2)

*Treating the underlying disease can clear up skin

Front 30

Kaposi's sarcoma is a defining illness of what?

Back 30

AIDS

*Treatment of retrovirals decreases incidence of AIDS and therefore Kaposi's

Front 31

What disorder has white vertical corrugations on the tongue, but cannot be scraped with a tongue blade (unlike candidiasis/thrush)?

Back 31

Oral Hairy Leukoplakia

Usually in HIV or immusuppressed, a/w EBV

Front 32

Intraoral lesions and biopsies of Lichen Planus are automatically referred to who?

Back 32

Oral surgeon or ENT

Front 33

What is the disease when pts develop sebaceous adenomas and sometimes keratoacanthomas and are prone to develop cancers of the colon, breast and genitourinary tract?

Back 33

Muirr-Torre Syndrome

Front 34

Which skin disorder is characterized by dusky red target lesions?

Back 34

Erythema Multiforme

Front 35

What should you ask a patient with Erythema Multiforme?

Back 35

If they get cold sores

b/c a/w preceding Herpes Simplex infection, mycoplasma pneumoniae infection, and acute URI

Front 36

What is the work-up for Erythema Multiforme?

Back 36

PPD, throat culture, CXR, basic blood tests

Front 37

Does Alopecia Areata scar?

Back 37

Noooooo

Also, considered cosmetic and often not covered by insurance

Front 38

What is the name for a non-scarring, non-inflammatory alopecia usually occurring 3-5 months following systemic stress?

Back 38

Telogen Effluvium

Associated systemic stressors include pregnancy, on or off OCP, crash dieting, physical illness or emotional stress. Check for overprocessed hair or family history

Front 39

What other things should you check in a patient who presents with Telogen Effluvium?

Back 39

thyroid, CBC and vitamin B12 (pernicious anemia) folate, testosterone, DHEA, FSH, LH

Front 40

How can you treat Telogen Effluvium?

Back 40

Topical steroid at bedtime

Minoxidil may be helpful in chronic cases

Front 41

If someone has Pyoderma Gangrenosum, you should refer them where?

Back 41

Wound care

Front 42

Digital clubbing is often an incidental finding and should be referred where?

Back 42

FP, IM, or Peds

Front 43

Why is Mycosis Fungoides a misnomer?

Back 43

"fungus fungus" but is actually a T cell lymphoma. can take a long time to make correct diagnosis

Front 44

What systemic disease is dermatitis herpetiformis a/w?

Back 44

Celiac disease! Treat with gluten-free diet

Front 45

What skin disorder do you do a 24 hour test for porphyrins?

Back 45

Porphyria Cutanea Tarda

Front 46

What tests do you need in someone with Erythema Nodosum?

Back 46

CXR, throat culture, PPD, lab work

Front 47

T/F

Serious medical problems can be a/w itching.

Back 47

True!