Nur 732 Derm

Front 1

Candida occurs in?

Back 1

mucous membranes and intertriginous surfaces.

Front 2

Increased incidence of candida in pts with what other dx states?

Back 2

1 DM
2 on broad-spectrum antibiotics
3 on OCPs
4 immunosuppressed.

Front 3

How do you diagnose candida?

Back 3

via wet prep with KOH.

Front 4

Oral (thrush)?

Back 4

underlying erythema with white plaques on tongue/mucosa.

Front 5

Rx for oral thrush?

Back 5

Nystatin swish and swallow or troches.

Front 6

Balanitis?

Back 6

under uncircumcised foreskin.

Front 7

Tx for balanitis?

Back 7

Topical Rx or PO, prn

Front 8

Paronychia?

Back 8

candida that invades nail bed, inducing a nail fold infection with bacteria or fungus (candidia), slowly starts and induces redness, tenderness, swelling.

Front 9

Rx for Paronychia?

Back 9

PO antibiotic for bacterial paronychia which has a more acute onset, or tree tea oil. I & D when “ripe”

Front 10

Intertrigo?

Back 10

Candida that invades skin folds.

Front 11

Tx for candida?

Back 11

Clotrimazole (lotrimin) or ketoconazole (nizoral)

Front 12

Diaper derm induces?

Back 12

dark red “beefy” red with satellite lesions, clearly demarcated from surrounding skin.

Front 13

Rx for diaper derm?

Back 13

more frequent diaper changes, careful cleansing, possible change in laundry soap or personal soap, mycostatin.

Front 14

Tinea versicolor?

Back 14

hypopigmented patches in warm months, these areas don’t tan, are often hypopigmented in winter. Some scaling, +/- itching.

Front 15

For tinea versicolor, with KOH, see?

Back 15

spaghetti and meatballs pattern.
the main symptom is patches of discolored skin with sharp borders (edges) and fine scales. The patches are often dark reddish-tan in color. The most common sites are the back, underarms, upper arms, chest, and neck. Affected areas do not darken in the sun (skin may appear lighter than surrounding healthy skin); African Americans, there may be loss of skin color (hypopigmentation) or an increase in skin color (hyperpigmentation).

Front 16

Rx for tinea versicolor takes time. Tx?

Back 16

Initially selenium sulfide daily first week (Selsun 1% or Exsel 2%) then weekly for 6 weeks. May consider PO ketoconazole.

Front 17

Malassezia furfur can cause?

Back 17

tinea versicolor

Front 18

Tinea capitis?

Back 18

small patches alopecia, scalp scale, + green fluorescence with Wood’s light.

Front 19

Rx for tinea capitis?

Back 19

griseofulvin (Grisactin) adults 500 mg qD microsize for 4-6 weeks

Front 20

Tinea barbae?

Back 20

affects beard and mustache areas in men

Front 21

Tinea barbae is due to?

Back 21

trichophyton or Microsporum fungi

Front 22

How do you tx tinea barbae?

Back 22

Assess for superinfection, if +, use antibiotics. Resolution takes weeks. PO Griseofulvin as above.

Front 23

Tinea corporis?

Back 23

“ringworm” induces single or multiple round to oval lesions with erythematous borders, with central clearing. Scaly.

Front 24

How do you diagnose tinea corporis?

Back 24

with KOH see hyphae.

Front 25

Tx for tinea corporis?

Back 25

Lotimin for 2 weeks to see initial improvement, then 4 weeks to resolution.

Front 26

Tinea cruris?

Back 26

“jock itch” large plaques of erythema with scaly borders.

Front 27

Rx for tinea cruris?

Back 27

Lamisil for one week (terbinafine cream daily)

Front 28

Tinea pedis?

Back 28

“athlete’s foot” maceration or cracking between toes or along lateral foot edge or occas on plantar surface.
Diagnose tinea pedis?

Front 29

Rx for tinea pedis?

Back 29

terbinafine (Lamisil) topical or PO griseofulvin. Prevention important: dry socks, tinactin powder.

Front 30

Tinea unguum?

Back 30

fungal infection of nail plate. Presents with change over time: nails become thick, ridged, yellowed, or white with ridged edge.

Front 31

Rx for tinea unguum?

Back 31

sporonox or topical Penlac (preferred, less toxic) applied weekly for one year.

Front 32

Sporotrichosis?

Back 32

is associated with thorn and plant materials insertion into skin, with individual indurated papules along lymphatic lines with central ulceration.

Front 33

Rx for sporotrichosis?

Back 33

potassium iodide TID

Front 34

Sunlight: sunburn: induces erythema when which degree?

Back 34

first degree

Front 35

2nd degree burns are accompanied by?

Back 35

vesicle development.

Front 36

Initial sun exposure leads to continuing erythema for how long?

Back 36

6-24 hours later. Avoidance recommended.

Front 37

Photosensitivity occurs with many drugs, primarily?

Back 37

thiazides, sulfonamides, tetracycline, doxy, quinolones.

Front 38

Chronic sun exposure may incite skin?

Back 38

CA and accelerate aging/wrinkling of skin.

Front 39

AIDS associated derm conditions include?

Back 39

Kaposi’s sarcoma: vascular skin tumors, onset as violet or red macules, which progress to nodule or tumor 1-3 cm, multiples on face, or trunk may ulcerate. Occurs on extremities less frequently. Not limited to pts with HIV. Requires biopsy.

Front 40

Dermatoses such as severe seborrheic derm occur.Which derm derm conditions tend to be most extensive?

Back 40

Fungal overgrowth tends to be more extensive.

Front 41

Staph and strep skin infections are?

Back 41

more common derm infections.

Front 42

Urticaria induces wheal and flare reaction in response to allergic triggers. These can include?

Back 42

food, pollen, drugs, contrast agents, heat, cold, stress, infection. Best approach is to identify trigger to avoid in future, though this not always straightforward. Use H1 blocker such as Benadryl, though sedating.

Front 43

Erythema multiforme ?

Back 43

is an immune-mediated recurrent rash, especially with HSV, Mycoplasma infection, sulfa drug reaction. Milder cases present with some itching, burning

Front 44

Rx for Erythema multiforme?

Back 44

symptomatic, resolves in 2-3 weeks, may recur.

Front 45

More severe Erythema multiforme is?

Back 45

above with vesicles, bulla in pre-existing lesions.

Front 46

Most severe form is Stevens-Johnson syndrome?

Back 46

occurs with increased number of inflammatory bulla on mucus membranes.

Front 47

Rx for steven johnson's syndrome?

Back 47

admit, supportive.

Front 48

Alopecia?

Back 48

Male pattern (androgenic) induces recession in parietal areas and on crown. In women, occurs as diffuse crown loss.

Front 49

Rx for alopecia?

Back 49

rogaine, transplantation.

Front 50

Hair loss that occurs 2-4 months after pregnancy or stressful event is known as?

Back 50

telogen effluvium.

Front 51

Trauma induced hair loss or abuse may occur via?

Back 51

patient or others.

Front 52

Alopecia areata?

Back 52

is a single or multiple area of hair loss.
Alopecia universalis?

Front 53

Alopecia generally occurs between the ages of?

Back 53

40-60 in men and women. R/O ?

Front 54

Parasites?

Back 54

scabies, lice

Front 55

Scabies ?

Back 55

is a contagious parasitic infection characterized by intense itching at night. Burrows 2-3 mm in length often noted in finger webs, axillae, forearms, lower abdomen, genitalia with secondary red papules and excoriations.

Front 56

Rx for scabies?

Back 56

permethrin (Elimite) 5% cream applied to entire body left on overnight then washed off. All bed linens, clothing need to be laundered and dried on hot.

Front 57

Lice?

Back 57

(pediculosis capitis = head lice). Dx: presence of nits, adherent white spots on hair shaft that don’t brush off like dandruff. + Wood’s light fluorescence as gray color.

Front 58

Rx for lice?

Back 58

. OTC Nix or similar product, or possibly prescription lindane (Kwell). May be necessary to repeat application in one week, though treatments are very drying and induce itching.

Front 59

Teaching re garments for lice?

Back 59

Careful laundering of all contact products and surfaces necessary to prevent re-infection. Any items not able to be laundered in hot water and hot dryer can be double bagged for 2 weeks or dry cleaned.
Nit?

Front 60

Body lice? name

Back 60

(pediculosis corporis) induces itching. Lice or ova noted on skin, hair, or on clothing, especially seams.
Rx for body lice?

Front 61

Genital lice are Phthiriasis pubis =?

Back 61

crab louse.

Front 62

Crab louse are spread via?

Back 62

shared clothing or intimate contact.

Front 63

Crab louse induces?

Back 63

itching and ornage color “dust” visible on underclothing.

Front 64

Rx for crab louse?

Back 64

Kwell.

Front 65

pedunculated ?

Back 65

referring to a lesion attached with a narrow, stalklike base.

Front 66

intertriginous?

Back 66

An area where opposing skin surfaces touch and may rub, such as skin folds of the groin, axilla and breasts.

Front 67

Malassezia furfur?

Back 67

Pityriasis versicolor – most often due to the subspecies M. globosa, M. sympodialis and M./is a genus of related fungi, classified as yeasts, naturally found on the skin surfaces of many animals including humans. It can cause hypopigmentation on the trunk and other locations in humans if it becomes an opportunistic infection.

Front 68

Benign lesions include skin tags, which appear during middle or late adulthood. These are?

Back 68

pedunculated flesh colored, lesions which occasionally require removal when in areas where they are frequently irritated or for cosmetic concerns.

Front 69

Cherry angiomas?

Back 69

are benign red, raised papules on the trunk that occur in some numbers with aging.

Front 70

Pyogenic granuloma?

Back 70

are pedunculated red or purple lesions with highly vascular granulation tissue which occur at the site of trauma. They require surgical removal.

Front 71

A lipoma?

Back 71

a a soft, rubbery mass of mature adipose cells. They are often removed due to cosmetic concerns.

Front 72

Sebaceous cysts?

Back 72

are firm nodules often located on the back, face, neck, or scalp. They may become infected. I & D performed after initiation of antibiotic therapy. Cyst capsule must be removed, may require packing and careful follow up.

Front 73

Antibiotic regimens for skin infections include?

Back 73

Cephalexin 250 mg one PO QID for 10 days (often prescribed as 500 mg BID, Augmentin 875 mg one PO BID for 10 days, take with food, Biaxin 500 mg one BID for 10 days with food
Cipro 500 mg PO BID for 10 days, Azithromycin as a Z-pac, Bactroban topical may be indicated for some

Front 74

Dermatofibroma?

Back 74

is a leg lesion seen mostly in women: it is a firm, round, pink, red or purple lesion that often occurs subsequent to scar formation.

Front 75

Most common malignant lesions are?

Back 75

basal cell CA, the most common of the skin cancers. It sometimes metastasizes, and can be destructive. It appears as a white or pink papule with later development of telangiectasis (raised, translucent, red border with ulceration and crusting).

Front 76

Type of ca that grows fast and is most likely to metastisize?

Back 76

Squamous cell CA grows faster than basal cell and is more likely to metastasize.

Front 77

Squamouns cell ca occurs in?

Back 77

sun exposed areas most commonly in fair skinned persons, especially in organ transplant recipients.

Front 78

Squamous cell lesions appear as?

Back 78

warty nodules or non-healing ulcers. They sometimes arise from actinic keratoses, and if so, are less likely to metastasize.

Front 79

Rx for squamous cell ca/ lesions?

Back 79

excision and frequent follow up.

Front 80

Actinic keratosis?

Back 80

is a common lesion with a low malignancy potential that appears most commonly in the elderly on the side of the face as a crusty “sore” of relatively long duration that bleeds easily when scratched and fails to heal. These occur on sun exposed areas of the body, especially in fair skinned individuals.

Front 81

Malignant melanoma has an increased incidence in?
Rx?

Back 81

persons of northern European descent, those who burn easily, are fair skinned, and have light color irises.
-
Rx: wide excision, and possibly chemo, radiation.

Front 82

This is the occurring more commonly in persons under 40 years. In males it tends to appear ?

Back 82

on the trunk

With Malignant melanoma, there is often a history of at least one blistering sunburn prior to the age of 18 years (for both genders)

Front 83

On females, malignant melanoma tends to appear?

Back 83

on the extremities of females.

Front 84

Removal or alteration for biopsy for malignant melanoma should only be performed by a ?

Back 84

dermatologist. Poor biopsy technique destroys the ability to adequately stage the tumor and provide some prognostic indication. Tumor thickness provides survival expectation data: if less than 1 mm thick, 10 year survival rate is 95%

Front 85

Survival rate for malignant melonomas?

Back 85

Less than 2 mm, 10 year survival rate about 80%,At 2-4 mm, expect 55% and over 4mm, about 30%.,When distant nodes are + and survival generally up to 6 months.

Front 86

Diagnostic clues malignant melonomas?

Back 86

: changes in existing nevi, varied shades of brown, black, red, white, blue, irregular border, size over 6 mm in diameter. Remember that simply being flat does not rule out melanoma.

Front 87

Psoriasis?

Back 87

appears as irregular plaques with red base and silvery scale. There is often a + family history of same, increased occurrence on extensor surfaces. Examine nails for evidence of pitting.

Front 88

Which months are psoriasis worse? What causes it to improve?

Back 88

-Increases in winter months, improves with some sun exposure.
-Topical steroids are used 1st line. If patient starts methotrexate via dermatologist, must monitor blood work.

Front 89

Pityriasis alba?

Back 89

induces hypopigmented patches on the face of especially teens and younger children.

Front 90

Rx for pityriasis alba?

Back 90

mild hydrocortisone and some sun exposure.

Front 91

Pityriasis rosea is most common in young adults, initially appears with ?

Back 91

a solitary “herald” patch which is a salmon colored patch usually on the trunk for days to weeks prior to appearance of other lesions.

Front 92

Pityriasis is usually self-limited and resolves in? most common in which gender and in which seasons?

Back 92

6 weeks. More common in girls, in fall or winter. Only mildly contagious.

Front 93

Lichen planus is another self-limited, benign condition. It induces?

Back 93

pruritic, small, flat topped often purplish papules on flexor surfaces, mucus membranes (lacey white lesions) and the genitalia.

Front 94

Seborrheic keratoses?

Back 94

appears in mid life and beyond as flat, tan lesions which elevate and exhibit a velvety brown surface.

Front 95

History as pertains to skin disorders?

Back 95

1) Location? At onset, and at
presentation
2) Timing?
3) Setting? New skin care
products, soaps, etc.
4) Quality? Itchy? Painful?
Appearance at onset vs.
current
5) Quantity? How itchy or
painful?
6) Aggrav/allev Use OTC or Rx
meds?
7) Assoc factors? Any
systemic symptoms? New
unwashed linens or
clothing?

Front 96

Evaluate the arrangement of lesions?

Back 96

solitary or grouped

Front 97

Distribution/location on body of lesions of the body…clues can be provided by?

Back 97

dermatomal distributions, occurrence only on flexor or extensor surfaces, contact reactions

Front 98

Primary lesions include?

Back 98

Macules, Patches, Papules, Nodules, Tumors, Vesicles, Pustules, Bulla, Wheals, Petechiae, Purpura, Cysts

Front 99

Secondary lesions include?

Back 99

Crusts, Scale, Excavations, Ulcers, Fissures, Excoriations

Front 100

keliod?

Back 100

Scars when hypertrophic are called keloid (name means clawlike)

Front 101

Signs of systemic disease are?

Back 101

Interal malignancy (acanthosis nigricans, hyperkeratosis of the palms and soles), Nutritional dx, (perleche, pellegra), Metabolic dx (hypercholesterolemia, ochronosis), Rheumatologic disease, (connective tissue dx dermatomyositis, lupus), Endocrine dx, Psyche disorders

Front 102

A sudden increase in seborrheic keratoses may represent?

Back 102

a paraneoplastic process.

Front 103

Acanthosis nigricans?

Back 103

is seen in the axillae and neck or antecubital fossa as skin becomes darker, elevated, papillatomous and eventually appears wartlike.

Front 104

Leser Trelat sign?

Back 104

An increase in the number of skin tags may accompany internal malignancy or may not indicate malignancy, such as familial tendencies, with endocrinopathies, or with obesity. When associated with malignancy, forms are usually gastric or colonic CA which won’t emerge for 12 months or so before the appearance of the acanthosis.

Front 105

-hyperkeratosis of palms and soles (hyperkeratosis palmaris et plantaris) is associated ?

Back 105

with adenocarcinoma.

Front 106

perleche (angular stomatitis) is no longer associated with?

Back 106

Vitamin B deficiency and Likely this represents a fungal overgrowth, or associated with constant drooling due to ill-fitting dentures.

Front 107

Treat perleche with?

Back 107

Lotrisone, or antifungal.-eating disorders, such as anorexia or bulemia

Front 108

Pellegra sometimes develops in pts?

Back 108

on INH therapy but not using Vit B6 (pyridoxine) 50 mg daily. May also be associated with carcinoid syndrome, alcoholism.

Front 109

Signs of pellegra include?

Back 109

erythematous, blistered lesions on neck as on wrists, ankles, upper torso with very distinct demarcation from normal skin. Dermatitis is often preceded by diarrhea, dementia may ensue.

Front 110

Treatment for pellegra is?

Back 110

via nicotinamide supplementation.

Front 111

Watson Schwartz test?

Back 111

is used to diagnose porphyria cutanea tarda is made by measuring porphyrins in stool during asymptomatic phase

Front 112

Outward symptoms of hypercholesterolemia may induce?

Back 112

xanthelasmas around eyes, or on skin or tendinous form, over knee and Achilles tendon. Those which develop in people before age 40 should have lipid profile checked (fasting).

Front 113

Porphyria cutanea tarda occurs with what illness? How does it present?

Back 113

alcoholism inducing painful, reddened hands and facial and hand blisters that occur with sun exposure (the combination of sunlight and oxygen with deposited skin toxins lead to the development of ulcerative and vesiculobullous photosensitive rash).

Front 114

Diagnosis of Porphyria cutanea tarda is made by?

Back 114

measuring porphyrins in stool during asymptomatic phase

Front 115

ochronosis ?

Back 115

(=alkaptonuria) = deficiency homogentisic acid oxidase which leads to an increase in homogentisic acid which turns into a brown or black substance that binds to collagen or cartilage.

Front 116

How do you diagnose ochronosis?

Back 116

with UA, add NaOH, sample turns black. Carried as an autosomal recessive trait and manifestations appear after age 20.

Front 117

Heliotrope sign?

Back 117

a purple hue that appears on the upper eyelids or on dorsum of hands, indicates diagnosis dermatomyositis.

Front 118

Symptoms of lupus are?

Back 118

a malar rash, fever, malaise, arthralgia, and severe weakness. May also note severe photosensitive dermatitis: the entire upper body is affected with the exception of the small area shaded by pinna and eyebrows.

Front 119

Lab to obtain for Lupus is?

Back 119

the ANA titer, which increases substantially.

Front 120

Treatment for lupus is?

Back 120

prednisone

Front 121

Thyroid disease such as pretibial myxedema presents as?

Back 121

lumps occur in skin of lower extremities with pretibial pain

Front 122

Lumps represent?

Back 122

an accumulation of polysaccarides of unknown origin. May occur before Graves disease or after pt has been treated and becomes euthyroid.

Front 123

Cushing’s = ?

Back 123

(hyperadenocorticism) is associated with the development of a “buffalo hump” secondary to increase in adipose depostion

Front 124

trichotillomania?

Back 124

symptoms usually begin before the age of 17. The hair may come out in round patches or across the scalp. The effect is an uneven appearance. The person may pluck other hairy areas, such as the eyebrows, eyelashes, or body hair.

Front 125

neurodermatitis?

Back 125

lichen simplex chronicus or scratch dermatitis Neurodermatitis is a skin condition characterized by chronic itching or scaling. Neurodermatitis starts with a patch of itchy skin, but scratching makes the area even itchier, so you keep scratching. Eventually you may scratch simply out of habit. This cycle of chronic itching and scratching can cause the affected skin to become thick and leathery.

Front 126

Pt's with bulemia may present with?

Back 126

tooth erosion, and callus formation on dorsum of hand used to induce gagging.

Front 127

General management?

Back 127

Biopsy for suspicous lesions Hydration Pruritis control using PO Benadryl Corticosteroid

Front 128

Biopsy for suspicous lesions?

Back 128

(shave for elevated lesions, or punch)

Front 129

Pruritis control using ?

Back 129

PO Benadryl perhaps every 4-6 hours, though it is quire sedating (so caution pts not to drive under the influence or operate heavy machinery)

Front 130

Corticosteroid use, NEVER use with?

Back 130

occlusive dressings since skin will atrophy. There should be notable improvement within 2-3 days, usually these items are not used over one week for contact derm treatment: if no improvement, re-evaluate or refer to derm.

Front 131

Dermatomyositis?

Back 131

(DM) is a connective-tissue disease related to polymyositis (PM) that is characterized by inflammation of the muscles and the skin.

Front 132

Other signs of Dermatomyositis?

Back 132

include helitrope sign, arm weakness, and a pruritic rash on face and hands. Lab: increased serum creatinine kinase.

Front 133

Suitable for treatment of contact derm, eczema, psoriasis, seborrhiec derm, pruritis ani. Use least potent required for clinical efficacy

Back 133

in general, use ?

Front 134

Eczema?

Back 134

in an umbrella term for lesions that are characterized by pruritic, weepy, erythematous papules and plaques accompanied by superficial yellow scale. Frequently associated with serous D/C. Occurs as a type IV delayed hypersensitivity reaction, therefore expect a delay from hours to days after exposure to onset of skin reaction.

Front 135

Contact derm: examine ?

Back 135

distribution and question precipitating factors

Front 136

Common OTC products for contact derm?

Back 136

such as neomycin, diphenhydramine

Front 137

Over 200 industrial products have been implicated in contact derm reactions, name some?

Back 137

Propylene glycol in EKG electrode paste, nickel, hair dyes, latex, some other synthetic, especially rubber products can also stimulate reactions

Front 138

Treatment for eczema and contact derm?

Back 138

aims at first identifying the offending agent, so that avoidance may ensue.Topical steroids are appropriate for small localized outbreaks

Front 139

Extensive outbreaks for eczema and contact derm would be in which anatomical locations?

Back 139

which include the eyes and hands significantly

Front 140

Dose for extensive outbreaks for eczema and contact derm would?

Back 140

10 mg, 4 tabs x 2 days

Front 141

IM agents for outbreaks for eczema and contact derm are?

Back 141

such as triamcinolone acetonide may be used, though benefit may be delayed up to 36-72 hours.

Front 142

For pruritis control, recommend?

Back 142

diphenhydramine for pruruitis control, hydration, follow up prn and caution pt to monitor for signs of skin infection and return for evaluation and probable antibiotics.

Front 143

Exercise caution using steroids in pts with what comorbidities?

Back 143

DM, infection, PUD, HTN.

Front 144

Atopic derm usually presents when?

Back 144

in childhood, between ages 2 months and 2 years

Front 145

Atopic derm usually presents with? and where?

Back 145

increase in pruritic, erythematous, exudative, crusting papules and plaques on scalp, face, cheeks, forehead, flexor surfaces. Later in adolescence and adulthood, more often affects popliteal fossa, antecubital fossa, neck, back, dorsum of hands and feet.

Front 146

Usually + FH, increased eos and IgE levels. Atopic derm is usually associated with problems with ?

Back 146

sweat retention, food allergy, chronic and common progression to staph infection secondary to itch and scratch cycle and resulting lichenification.

Front 147

Treatment of atopic derm?

Back 147

avoid irritants, after identification

Front 148

Atopic derm often resolves spontaneously, but recurrent condition may be in response to?

Back 148

stress, or other triggers, including nickel-containing foods such as asparagus, rhubarb, spinach, tomatoes, peas, mushrooms, and onions.

Front 149

Treatment for atopic derm?

Back 149

local steroids as appropriate, stress management

Front 150

Seborrheic derm?

Back 150

-very common, chronic, involves scalp, eyebrows, external ear, nose, presternal region.

Front 151

Seborrheic derm affects which gender more?

Back 151

men more often

Front 152

Seborrheic derm is worse in which time of the yr?

Back 152

and during winter months. Pt with Seborrheic derm affects which type of pt's most?

Front 153

Seborrheic derm may indicate which diagnosis?

Back 153

HIV if appearance is sudden and widespread, especially in presence of risk factors.

Front 154

Treatment for seborrheic derm?

Back 154

antidandruff shampoo OTC, reserve ketoconazole for difficult cases.

Front 155

Sweat gland or follicular disease?

Back 155

Roseaca Acne vulgaris Hyperhidrosis Folliculitis

Front 156

Acne vulgaris =?

Back 156

obstruction of sebaceous follicles.Genetic predisposition

Front 157

Clinical expression of Acne vulgaris?

Back 157

noninflammatory open and closed comedones (blackheads and whiteheads) to inflammatory papules, pustules, and nodules.

Front 158

Sebum production in unrelated to?

Back 158

diet, or cleansing regimens (including use of astringents)

Front 159

Which systemic drugs influence sebum production?

Back 159

include estrogen, antiandrogens (spironolactone or retinoid isotretinon)

Front 160

Estrogen dose and time for tx of Acne vulgaris?

Back 160

given to treat is most effective at higher doses than used for contraception, e.g. 50 mcg and needed for 2-4 months to begin to see improvement. Treatment usually required for years. Combination (OCP estrogen and progesterone) is used.

Front 161

Retin A is teratogenic, when can women using it become pregnant?

Back 161

not at all or for one month after D/C drug.

Front 162

Which antibiotics for systemic treatment of Acne vulgaris exert an indirect effect on comedogensis?

Back 162

-TCN, Erythromycin, Doxycycline, Minocin, Accutane, Retin A/

Front 163

TCN freq and SE?

Back 163

BID or QID not with food, is inexpensive,

Front 164

Erythromycin freq and SE?

Back 164

QID tapered to qD often induces GI upset

Front 165

Doxycycline freq and SE?

Back 165

causes photosensitivity

Front 166

Minocin freq and SE?

Back 166

is rather expensive and is associated with abnormal pigmentation of oral mucosa and vertigo-like symptoms.

Front 167

Bactrim and Clindamycin are of limited value since they?

Back 167

are capable of inducing severe erythema multiforme and pseudomembranous colitis, respectively.

Front 168

Isotretinoin (Accutane) and tretinoin (Retin A) both?

Back 168

influence comedogenesis.

Front 169

Benzoyl peroxide can be?

Back 169

successful in limiting growth of Propionibacterium acnes, but can be irritating and elicits and allergic response in 1% of pts.

Front 170

Benzoyl peroxide is available combined with?

Back 170

erythromycin as Benzomycin gel (in 23.3 or 46.6 gm tubs, which must be refrigerated)

Front 171

Roseaca often occurs with?

Back 171

seborrheic derm

Front 172

With roseaca, it is helpful to avoid?

Back 172

heat, stress, etc.

Front 173

Treat roseaca with?

Back 173

topical metronidazole and topical steroids.

Front 174

Hyperhidrosis ?

Back 174

excessive sweating

Front 175

Folliculitis is usually caused by?

Back 175

Staph aureus

Front 176

Treatment for folliculitis?

Back 176

includes cooler invironment, less occlusive clothing

Front 177

Bacterial infections in derm?

Back 177

1 Impetigo
2 Ersipelas

Front 178

Impetigo is caused by?

Back 178

staph or strep

Front 179

Normally impetigo presents?

Back 179

on skin surface

Front 180

Impetigo Treatment is?

Back 180

topical Bactroban ointment applied TID to lesions after soaking to remove crusts

Front 181

When several impetigo lesions are present, add?

Back 181

PO antibiotic such as PCN or eryth.

Front 182

Ersipelas?

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can induce sepsis or acute febrile illness. It causes superficial cellulitis with lymphatic involvement. Increased incidence in very young and the elderly

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ErsipelasTreatment is?

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PCN or eryth if allergic

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Viral infections in derm?

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Warts (verruca) Molluscum Herpes or herpes simplex virus (HPV) HSV II Zoster Varicella

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Warts (verruca) are of several types?

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filiform flat common warts condyloma plantar

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Filiform warts?

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involve the face and neck

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Treatment for filiform warts?

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shave off

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Flat warts?

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are flesh-colored, occur on face, arms, and knees.

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Common warts occur on?

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hands as rough, scaly papules

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Remove common warts via?

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cryotherapy or TCA

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-condyloma warts?

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involve the external genitalia or perineal area

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plantar warts?

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hyperkeratotic on soles of feet: cryo to remove.

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Molluscum?

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2-4 months, usually in children as multiple, umbilicated, discrete, flesh-colored papules

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How is Molluscum diagnosed?

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Can biopsy or stain smears of central material to diagnose.

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Molluscum usually disappear spontaneously

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may recur

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Herpes or herpes simplex virus (HPV) is responsible for?

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skin and mucus membrane involvement, keratoconjunctivitis, encephalitis.

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In general, HSV I occurs above the belt. After primary infection, lies dormant in nerve cells and may be reactivated by?

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stress, sunlight, fever, illness, or menstruation.

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HSV lesions are contagious via?

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direct mucocutaneous contact.

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HSV I causes ?

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“cold sores”

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HSV I is nicely treated by?

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Denavir topically or PO Famvir 250 mg BID x 5 days for adult. Must be started at first sign of prodrome of tingling or burning.

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HSV II after innoculation induces vesicle formation with prodrome of tingling or burning or pain. Initial episode induces?

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systemic illness with fever, malaise, dysuria, inguinal lymphadenopathy.

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Treatment for HSV II is ?

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PO acyclovir, Famvir 250 mg BID or Valtrex 500 mg BID. Vaginal delivery is contraindicated in pregnant women, so OB must be aware. Virus sheds while asymptomatic.

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It is estimated that 25-30% of the US population is infected with this virus. Suspect it and do serologic testing to identify especially in cases with?

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recurrent pain syndromes that affect the same place repeatedly, without the usual signs of disease, e.g. women C/O “UTI” whose urine C & S is negative

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Herpetic whitlow?

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is herpes infection of hand or finger, commonly affects health care workers. Wear gloves.

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Identification of HSV may be made using ?

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serum testing or by scraping or unroofing a vesicle (very painful for pt) and sending to lab for ID type. Microscopic ID made using Tzanck prep, where multinucleated giant cells are identified.

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Zoster?

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is reactivated varicella virus. Does not cross midline in immunocompetent
Shingles

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Treatment for zoster?

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via acyclovir 800 mg five times a day for 10 days

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Varicella ?onset in children is usually abdomen rather than face

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spread is rapid and lesions are intensely itchy

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Various stages of varicella occur over?

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3-5 days, pt no longer contagious once all lesions have crusted over. Initially occurs with fever, malaise, coryza.

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Tx varicella?

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use acetaminofen for fever, NO ASA in children < 18 to reduce possiblity of development of Reyes’s syndrome.

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Comfort measures for varicella include?

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Aveeno bath or ¼ c baking soda in tub of tepid water

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Tx for hyperhidrosis?

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For hyperhidrosis, prescription Drysol applies qHS to axilla, palms, soles helps

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: Roseaca affects adults, (ages? Gender?)

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Roseaca affects adults ages 30-50, women > men, but men are more severely affected.

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Hyperhidrosis?

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Hyperhidrosis or excessive sweating is a common disorder affecting many people. Hyperhidrosis can cause excessive hand, foot, underarm and facial sweating.