Derm

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Man with vague upperabdominal discomfort. Present for 3 months. Not associated with meals oractivity. Oblong shaped firm and deeply seated mass in the epigastric area. Notenderness on direct palpation. He says he had similar thing in the past.

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Desmoid tumor, locallyaggressive bening with high recurrence even after removal.CT or MRI to evaluatethe size.

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Onychomycosis treatment

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Terbinafine, itraconazoleSecond line: griseofulvin,fluconazole

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54 yo male with flaky anditchy scalp. He has red oily skin with inflammation and scaling of the scalp,eyebrows and ears.

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Seborrheic dermatitis“dandruff” Treatment is selenium shampoo

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Atopic dermatitis (eczema)presentation in infants and adults

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Infants: Itchy, red, scaly,crusted lesions on extensor surfaces, trunk, cheeks, scalpAdults: Lichenified plaquesin flexural creases

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Treatment of atopicdermatitis (eczema)

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Topical steroids

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Porphyria cutanea tardainvolves deficiency of

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Uroporphyrinogendecarboxylase an enzyme in the heme synthesis pathway

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Porphyria cutanea tardamanifests as

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Painless blisters andincreased fragility of the skin on the dorsal surfaces of the hands, facialhypertrichosis (excessive hair growth) and hyperpigmentation

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Whats the treatment ofporphyria cutanea tarda

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Phlebotomy or hydroxychloroquine,interferon alpha if infected with Hep C.

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Pruritic papules and vesicleson elbows, knees, buttocks, posterior neck and scalp. Usually associated withgluten allergy

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Dermatitis herpetiformis

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Tinea versicolor treated with

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Topical ketoconazole

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Diaper rash treated with

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Topical zinc oxide paste

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Self limiting condition thatfirst manifests as primary plaque (herald patch) with a fine collarette scale.A generalized eruption develops 1 to 2weeks later with fine scaling papules and plaques in the Christmas treedistribution

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Pityriasis rosea

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Whats the treatment forphotoaging?

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Tretinoin

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Single or multiple lesions,well demarcated, pigmented, round or oval with dull or verrucous surface with astuck on appearance.

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Seborrheick keratosis usually bening no treatment needed.

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Explosive onset of multiplepruritic seborrheic keratosis has been associated with

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Lung and Gi cancer

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Tinea capitis is treated with

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Oral griseofulvin

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Treament for mild to moderateplaque psoriasis

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Topical high potency steroids(betamethasone) and topical vitamin D derivatives

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Severe plaque psoriasistreatment

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Phototherapy, methotrexate

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Facial and intertriginous(axillae) psoriasis

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Topical tacrolimus Low potency steroids

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Guttate (salmon pink spots)psoriasis

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Observation, or phototherapy

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Erythema in the central faceoften associated with flushing, telangiectasias and pustules.

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Rosacea, topicalmetronidazole if popular or pustular lesions.

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If rosacea ony has erythemaand telangiectasias, treatment is

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Topical brimonidine

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Whats the common complicationwith rosacea

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Eye problems like blepharitis, keratitis,conjunctivitis, corneal ulcers and recurrent chalazion

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When scabies is suspectedwhat to do?

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Skin scrappings and examinationunder the microscope

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Whats the treatment ofscabies

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Topical 5% permethrin

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The most commonly used treatment for actinic keratosis is

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Topical 5 fluorouracil

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Herpes zoster treatment

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Oral valacyclovir 7-10 days

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Pain management for herpeszoster

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Amitriptyline, capsaicin,gabapentin

Front 29

Shiny, discrete intensely pruritic polygonalshaped violaceous plaques and papules most frequent on flexural surfaces of theextremities

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Lichen planus

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What should be checked forafter diagnosis of linchen planus?

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Anti hep C antibioides

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Photosensitivity that appearsafter treatment of acne is likely due to which antibiotic

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Doxycycline. Treated withNSADs

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Methods to prevent acneinclude

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Water based skin products, pHneutral detergent cleansers, low sugar diet. Avoid saturated fats, dairyproducts and refined carbohydrates.

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Bullous phemphigoid should bediagnosed by

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Skin biopsy from the edge ofan intact blister

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Tense bullae, itching,erythema and urticarial

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Bullous pemphigoid

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Phemphigus vulgaris

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Flaccid bullaeSloughing of skinOral lesions

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Severe itching, crusting andvesicles Elbows, knees, buttAssociated with celiacdisease

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Dermatitis herpetiformis

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Grouped lesions linear orannular pattern

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Linear bullous dermatosis

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Psoriatic arthritis requires

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Systemic treatment withmethotrexate

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8 year olf with vesicularrash at the level of the seventh left intercostal space involving the anteriorand posterior walls of the chest. What is it?

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Nothing. This is herpeszoster infection. No further testing needed.

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Which diuretic is associatedwith photosensitivy when exposed to the sun?

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Hydrochlorothiazide. Which isa sulfa

Front 41

White kid when to summercamp, developed a rash 2 days later. Intense itchy lesion in right arm. Red,irregular, linear with papules and vesicles with oozing of a serous fluid.Small popular lesions on the lateral part of the left hand. What is it?

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Poison ivy dermatitis.

Front 42

65 yo male with scaly pink,white and gray spots on his hands for several years but now increasing in size.He has small papules and plaques on the dorsum of the hand with a rough scale

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Actinic keratosis which is apremalignant condition associate with scc.

Front 43

Female sexually active with anew partner. Small skin colored papules with indented centers that may occuranywhere except the palms and soles

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Molluscum contagiosum causedby poxvirus. HIV testing should be considered.

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Molluscum contagiosumtreatment

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Curettage/cryotherapyPodophyllotoxin for chemicalremoval

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Closed or open comedones onforehead nose and chin, what is it? Tx?

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Comedonal acne, topicalretinoids, salicylic, azelaic or glycolic acid

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Inflammed papules (less than5mm) and pustules with erythema. What is it, whats the tx?

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Inflammatory acne. If mildtopical retinoids + benzoyl peroxideModerate: add topicalantibiotics erythromycin, clindaSevere: ORAL ANTIBIOTICS

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Large (greater than 5mm)nodules that can appear cystic. What is it? Whats the treatment

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Nodular cystic acne. Moderate: topical retinoid +benzoyl peroxide+topical antibioitcsSevere: add oral antibioticsUnresponsive: oralisotretinoin

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Clinical feats of melanoma

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Asymmetry: when bisected, the2 sides are not identical

Border: uneven edges, pigmentfading off

ColorDiameter >6mm,

Evolving.

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When are topical antibiotics useful?

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Full thickness burns and partial thickness burns with loss of epithelium

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47 yo man with 2 month leftplantar surface of his left great toe enlarging painful and thickened papule.What is it? Treatment?

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Plantar warts by hpv. Usuallyhappens to people that work with meat, poultry, fish. Topical salicylic acid.Effects are seen in 2-3 weeks

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Characteristics of alopeciaareata in terms of recurrence and treatment

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Intralesional steroids. Hairgrowth in 4-6 weeksThere is high chance ofrecurrence of hair loss even after successful treatment

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What is the treatment ofatopic dermatitis

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1-oral antihistamines2-regular use of emollientsto maintain skin hydration and avoidance of hot or dry environments3-topical steroidstriamcinolone

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in which areas are topicalsteroids contraindicated? Can be used instead

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face, eyelid, flexural areas.Tacrolimus can be used instead

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Biopsy for actinic keratosisis indicate for

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Diagnosis is unclearLesions > 1cm in diameterLesions are induratedUlceration is present There is tendernessLesions are growing rapidlyLesions fail to respond toappropriate therapy

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Patients with low risk sccrefusing surgery the best course of action is

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Radiation therapy

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Whats the best treatment forkeloid

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Intralesional steroids

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Treatment of mild tineapedis. And treatment of extensive disease or failure of topicals

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For mild topical terbinafine,miconazole, clotrimazoleSevere oral terbinafine,itraconazole, fluconazole

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What skin condition isassociated with insulin resistance, GI malignancy

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Acanthosis nigricans

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Multiple skin tags areassociated with which disease

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Insulin resistance, pregnancy, chrons (perianal

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Porphyria cutanea tarda.Cutaneous leukocytoclastic vasculitis (palpable purpura) secondary tocryoglobulinemia is associated with which disease

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Hep c

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Dermatitis herpetiformis isassociated with

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Celiac disease

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Sudden onset severepsoriasis, recurrent herpes zoster, disseminated molluscum contagiosum areassociated with what

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HIV

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Severe seborrheic dermatitisis associated with

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HIV and Parkinson

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Explosive onset of multipleitchy seborrheic keratosis is associated with

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GI malignancies

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Pyoderma gangrenosum isassociated with

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Inflammatory bowel disease

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Initial solitary painful andinflamed nodule in intertriginois area. May have abscess formation withpurulent or seroanguineous drainage. Multiple recurrent nodules with sinustracts, comedones and scarring

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Hydradenitis suppurativa

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What is the management ofhidradenitis suppurativa

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Weight loss, smokingcessation, cleansing of the area.

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Treatment of mildhidradenitis suppurativa

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Topical clindaIntralesional steroids ororal antibiotics

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Treatment of moderatehidradenitis suppurative-nodules sinus tracts and scarring

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Oral doxy (tetracyclines)Oral clinda + rifampin

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Treatment of severehidradenitis suppurativa-diffuse involvement and extensive sinus tract

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Infliximab (TNF alphainhibitor)Oral retinoidsSurgical

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For women who may becomepregnant the preferred medications are

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Topical erythroClindamycinAzelaic acid.

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Tomato red plaques andsatellite papules with involvement of crural folds

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Candidal intertrigo andperineal infection. Clotrimazole cream

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Which are is spared in diaperdermatitis

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Crural folds.

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Sun protection factor 15recommended for

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Regular daily use

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Sun protection factor 30 recommended for

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Outdoor work or recreation