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97 Cards in this Set
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Molluscum contagiosum
Cause, Description, Transmission, Treatment |
cause: poxvirus (DNA virus)
Description: Bowl-shaped lesions with central depression filled with keratin. (depression contains particles called molluscum bodies) Trans: sexually (common in AIDS)- adults. Also self-inoculation by scratching the infective viral particles out of the crater. Tx: spontaneous remission in 6-9 months if immunocompetent. or cryotherapy. |
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Dx
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Molluscum contagiosum.
look for the bowl shape with a center depression. |
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Herpes Zoster
incidence, signs, description, tx for immunocompetent and immunocompromised, prevention |
incidence: increases with age and is increased in pts with cancer and AIDS.
signs: radicular pain and itching BEFORE rash occurs description: eruption characterized by groups of vesicles on an erythematous base. Rash follows sensory dermatomes. Pustules form that rupture causing crusting and weeping. tx: immunocompetent: vaccine, immunocompromised: acyclovir, valacycylovir or famiciclovir. (best before rash has erupted) prevention: zoster vaccine. |
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diagnosis
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Herpes zoster- shingles
notice the pustules following the dermatome. |
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Impetigo
cause, location, description, tx |
cause: #1 staph A; #2 Strept pyogenes
Location: usually begins on the face description: vesicles and pustules rupture to form honey-colored, crusted lesions. Bullae (fluid filled blister > 1 cm) commonly occur. Tx: mupirocin ointment + dicloxacillin (or oxacillin, amoxicillin-clavalanate, azithromycin) |
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diagnose
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Impetigo
clue: honey-colored crusted lesions |
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Acne Vulgaris
what is it, when it begins,clinical lesions, 2 types of comedones and their causes, tx |
WIT: chronic inflammation of the pilosebaceous unit.
WIB: Begins at an early age (9-11 YO), getting worse once puberty Clinical lesions: inflammatory papules, pustules, nodules, cysts 2 types of comedones: a) noninflamed comedones: plugging of the outlet of a hair follicle by keratin debris. b) inflammatory type: abnormal keratinization of the follicular epithelium. Increased sebum production. caused by bacterial lipase which produces irritating fatty acids producing this inflammatory reaction. Tx: Topical agents (topical retinoid + benzoyl peroxide) systemic antibiotics (tetracycline, erythromycine) systemic retinoids (isotretinoin- decreases follicular keratinization, sebum production, bacterial count) Hormonal therapy: oral contraceptives and antiandrogens (spironolactone). |
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what is a whitehead? a blackhead?
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whitehead: closed comedone
blackhead: open comedone. |
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diagnose
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acne vulgairs
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dermatophytoses
confined to, incidence, present with what, list the infections from most common to least |
confined to: fungi are confined to the stratum corneum or its adnexal structures
incidence: increases in warm, humid climates present with what: scaling rash most common to least: Tinea pedis, tinea ungium, tinea versicolor, tinea cruris. |
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Tinea capitis
define. Name the three pathogens, say where they infect, if there is a race preference, if there are an associations, and +/- wood's lamp. result of infection and tx |
define: superficial fungal infection of the scalp
pathogens : 1) Trichophyton tonsurans (most common). - infects inner hair shaft - negative wood's lamp - race pref: blacks 2) Microsporum canis and microsporum audouinii - both infect outer hair shaft - positive wood's lamp - race: white - Microsporum canis - associated with exposure to dogs. result: circular or ring-shaped alopecia. black dot is present where hair breaks off. Tx: oral terbinafine |
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diagnose
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Tinea Capitis
clue: black dots where the hair broke off + alopecia. |
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Tinea Corporis
cause, generic name, exposure, describe, Tx |
cause: trichophyton
GN: ring worm exposure: cat or dog describe: annular with an elevated red, scaly border. Tendency for central clearing tx: topical agents (miconazole, clotrimazole). |
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diagnose
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Tinea corporis
clue: a ring with central clearance |
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Tinea pedis
most common in certain types of pts, description, eldery differences, Tx |
common: Pts with sweaty feet
description: macerated scaling rash between the toes elderly: diffuse plantar scaling- moccasin appearance tx: topical agents (miconazole, clotrimazole). |
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Tinea cruris
associated w/, description, body parts involved, tx |
associated w/ : tinea pedis; excessively sweaty areas
description: rash is NOT annular, but has elevated scaly borders body parts: groin and scrotum tx: topical agents (miconazole, clotrimazole) |
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Tinea unguium
2 most common pathogens, description, tx |
pathogens: 1) Trichophyton rubrum (most common) and Trichophyton mentagrophytes
descrption: nail is raised and nail plate in white, thick, and crumbly. Nail is frequently discolored. tx: Oral therapy + terbinafine (best) or itraconazole. Topical agents do NOT work. |
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diagnose
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Tenia pedis
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diagnose
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Tinea Unguium
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diagnose
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Tinea cruris
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Seborrheic dermatitis
cause, common associations (diseases), description, locations, different name in newborns, tx |
common: dandruff
cause: M. Furfur common assoc: AIDS and AIDS related complex, parkinson's disease description: scaly, yellowish, greasy dermatitis locations: 1) scalp, eyebrows and nasal creases. newborns: cradle cap tx: shampoo- selenium sulfide, zinc pyrithione |
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diagnose
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seborrheic dermatitis
newborns: cradle cap |
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Scabies
cause, description, adult scabies vs infant scabies |
cause: adult females bore into the stratum corneum. The females lay eggs at the end of the tunnel and those eggs are responsible for the pruritic lesion.
description: burrows are visible as dark lines between the fingers, at the wrists, on the nipples, or on scrotum adults scabies: disease limited to webs between the fingers, intertrigionous areas. spares oles, palms, face and head. infant scabies: NO BURROWS ARE PRESENT. Pruritic rash occurs on the palms, soles, face or head |
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diagnose
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scabies- infant
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Nevocellular nevus
common name, define, origin, 4 types of nevus and describe them, |
common name: mole
define: neoplastic melanocytic disorder. Modified melanocytes. Origin: neural crest-derived nevus cells 4 types: 1) junctional nevus - develops in early childhood, pigmented macular lesion (nevus cells along basal cell layer). most common in children 2) compound nevus- jxnal turns into compound which is when the nevus cells extend into the superficial dermis. Pigmented lesion with papillomatous surface. Occurs in children- adolescents. 3) Intradermal nevus: compound nevus loses its junctional component 4) dysplastic nevus (atypical mole): may arise sporadiacally. Usually >6mm, varied in color, irregular borders indicating a malignancy. |
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diagnose
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nevocellular nevus
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what is the epidemiology of malignant melanoma?
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-malignant tumor of melanocytes, most rapidly increasing cancer worldwide. More common in whites than blacks.
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what are the risk factors associated with malignant melanoma?
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1) exposure to excessive sunlight (UVA and UVB) at an early age (MOST IMPORTANT)
2) FHx of melanoma 3) use of tanning booths 4) dysplastic nevus syndrome 5) Hx of melanoma in 1st and 2nd degree relative 6) Xeroderma pigmentosum. |
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what are the 2 growth phases of malignant melanoma?
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1) radial growth- initial phase of invasion, melanocytes proliferate laterally within the epidermis, along the dermoepidermal jxn, and within the papillary dermis.
2) vertical growth phase- final phase of invasion, malignant cells penetrate the underlying reticular dermis with a potential for metastasis. |
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what are the four subtypes of malignant melanoma? describe them
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1) superficial spreading melanoma: most common, develops on lower extremities, arms and upper back
2) lentigo laigna melanoma: common in elderly pop, extension of lentigo (intraepidermal lesion) into the dermis. Occurs on parts of the face most exposure to the sun (least likely to have a vertical phase) 3) nodular: NO RADIAL growth phase only vertical, found in any sun-exposed area (most popular = trunk), poor prognosis 4) acral lentiginous: NOT related to sun exposure, located on palm, sole, or beneath the nail, popular in asians and blacks, poor prognosis |
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what is the ABCD criteria for malignancy?
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Asymmetry of shape
Border of irregularity Color varition Diameter >6mm |
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how do you prevent melanoma?
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spf > 15 and protective clothing
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diagnose
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spreading malignant melanoma- most common type of malignant melanoma
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Seborrheic keratosis
epidemiology, describe, locations, associated sign for cancer, tx |
epidemiology: most common benign tumor in older people. >50 YO
Describe: benign pigmented epidermal tumor which is coin-like, macular to raised varrucoid lesion with "stuck-on" appearance. locations: extremities and shoulders most common, but common on the face in elderly patients associated sign: Leser-Trelat sign which is a rapid increase in number of keratosis. Marker for stomach adenocarcinoma. tx: cryotherapy, curettage, shave biopsy/ excision. |
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diagnose
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seborrheic keratosis
- "stuck on" appearance |
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keratoacanthoma
sex predominance, describe, growth, regression, recommendation |
sex: males
describe: benign crateriform tumor with central keratin plug. develops in sun-exposed areas. growth: rapid: within 4-6 weeks regression: spontaneously with scarring usually within 6 months recommendation: excision |
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diagnose
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Keratoacanthoma
Looks a lot thicker and nastier that mollusca contagiosum |
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epidermal inclusion cysts
derivation, location, composition, tx |
derivation: from epidermis of the hair follicle- benign
locations: face, base of ears, and trunk composition: cyst wall composed of normal epidermis that produces keratin intermixed with lipid-rich debris. tx: none required; surgical excision if necessary. |
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Actinic (solar) keratosis
cause, precursor of, description, location, tx |
cause: prolonged UV light exposure
precursor of: squamous cell dysplasia ---> squamous cell carcinoma description: hyperkeratotic, pearly gray-white appearance. location: on face, back of neck, dorsum of hands/ forearms. tx: protection of skin with sunscreen, topical therapy- 5-fluorouracil, cryotherapy. |
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diagnose
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epidermal inclusion cysts
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diagnose
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actinic keratosis
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Basal cell carcinoma
cause, description, type of cancer, location, histologically, diagnosis, tx |
cause: chronic exposure to UV light
description: raised papule or nodule with a central crater- sides of the crater are surface by telangiectatic vessels location: sun-exposured area--> inner canthus (corner of the eye), upper lip. type of cancer: locally aggressive infiltrating cancer, but does NOT metastasize. Stromal dependent arising from the basal cell layer of the epidermis. Multifocal in origin. histologically: cords of basophilic-staining basal cells infiltrate the underlying dermis diag: punch biopsy or shave biopsy tx: varies with location and size of cancer. options include topical 5-fluorouracil, cryotherapy, curettage and electrodesiccation, surgical excision, radiation (usu. elderly). |
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diagnose
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Basal cell carcinoma
hint: look for the telangiectatic vessels. |
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Squamous cell carcinoma
Risk factors, description, location, risk for metastasis, tx |
RF: a) excessive exposure to UV (most common), b) actinic keratosis, c) arsenic exposure, d) scar tissue in a 3rd degree burn, e) orifice of chronically draining sinus tract, f) immunosuppressive therapy
description: scaly to nodular lesions, often ulcerated locations: majority occur in sun-exposure areas of the bottom. Ears, dorsum of hands, LOWER LIP. risk for m: minimal due to its very well differentiated cells tx: varies; options include topical 5-fluorouracil, cryotherapy, curettage and electrodesiccation, surgical excision, radiation (usu. elderly). |
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diagnose
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squamous cell carcinoma
hint: lower lip |
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Atopic dermatitis
hypersensitivity type, sx in children, sx in adults |
HSN: type 1 (IgE)
children: dry skin and eczema on cheeks and extensor and flexural surfaces adults: dry skin and eczame on hands, eyelids, elbows and knees |
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contact dermatitis
overall hypersensitivity, 3 types: for each type name the examples. |
HSN: type 4
3 types: allergic contact dermatitis (poison ivy), irritant contact dermatitis (laundry detergent), and contact photodermatitis (UV light reacts with drugs that have a photosensitizing effect-- tetracycline) |
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diagnose
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atopic dermatitis
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diagnose
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allergic contact dermatitis
-poison ivy |
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Pemphigus vulgaris
immune response, HSN, description, histologically, signs associated, tx |
immune: IgG antibodies against desmosomes between keratinocytes.
HSN: type 2 description: vesicles and bullae dev on skin and oral mucosa histologically: intraepithelial vesicles are located ABOVE basal layer. Basal cells resemble a row of tombstones. acantholysis of keratinocytes in the vesicle fluid. signs: Nikolsky sign + which means that the outer epidermis separates from the basal layer with minimal pressure tx: corticosteroids and other immunosuppressive agents ( ie methotrexate, azathioprine) |
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Bullous pemphigoid
immune response, HSN, description, histologically, signs associated, time frame, tx |
immune: IgG antibodies against the basement membrane
HSN: type 2 Description: vesicles are subepidermal. they develop on the skin and oral mucosa. histologically: NO acantholytic cells in vesicle fluid signs: Nikolsky sign time frame: disease usually subsides after months or years tx: maybe corticosteroids |
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Dermatitis herpetiformis
immune response, description, associated disease, tx |
immune: IgA - anti-IgA complexes deposit at the tips of the dermal papillae
description: subepidermal vesicles with neutrophils. assoc disease: strongly correlated with celiac disease (increase in antireticulin and endomysial antibodies) tx: gluten-free diet and dapsone or sulfapyridine |
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diagnose
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pemphigus vulgaris
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diagnose
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Bullous pemphigoid
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diagnose
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dermatitis herpetiformis
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diagnose
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bullous pemphigoid
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diagnose
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pemphigus vulgaris
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Lichen Planus
describe, locations, koebner's phenomenon, sex preference, risk of cancer, association with another disease, tx |
describe: intensely pruritic, scaly, violaceous, flat-topped papules. Fine white reticular pattern on the surface (wickham's striae)
locations: wrists and ankles, nails are commonly dystrophic and oral mucose is involved in 50% cases koebner's phen: lesions developing in areas of scratching sex: females risk: slight risk of developing squamous cell carcinoma association: Hep C Tx: topical high potency corticosteroids, antihistamines (for pruritus), systemic corticosteroids, retinoids, cyclosporine in resistant cases |
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diagnose
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lichen planus
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what is the epidemiology of psoriasis?
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afflicts 1-3% of pop, strong human leukocyte antigen (HLA) relationship. Peak age at onset has two peaks: adolescent and 60. No gender difference
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what is the pathogenesis of psoriasis?
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unregulated proliferation of keratinocytes: A) genetic factors (30% of cases),
B) aggravating factors like: 1) streptococcal pharyngitis, 2) HIV 3) drugs (lithium, B-blockers, NSAIDS) 4)scratching the skin (Koebner's phen) -also some microcirculatory changes in superficial papillary dermis |
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what does a sudden onset of psoriasis suggest?
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HIV
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Psoriasis
describe gross and microscopic findings including locations |
gross: well demarcated, flat, elevated salmon colored plaques, covered by adherent white to silver-colored scales. Pinpoint areas of bleeding occur when scales are scraped off- (auspitz sign). Rash commonly develops in areas of trauma (elbows, lower back). also might have pitting of the nails.
microscopic: hyperkeratosis and parakeratosis (retention of nucleus in the stratum corneum). Elongation of rete pegs (downward extensions of basal layer). Extension of papillary dermis close to the surface epithelium. Neutrophil collections in the stratum corneum--- munro microabcesses. |
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how do you treat psoriasis?
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topical high potency corticosteroids, topical calcipotriene, UVA light + psoralen applied to plaque, UVB light + coal tar applied to plaques, retinoids, systemic tx (methotrexate, cyclosporine).
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diagnose
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psoriasis
hint: silver scales |
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erythema multiforme
define, triggers, describe, syndrome associated with EM, tx |
define: immunologic rxn of skin
trigger: 1) infection: mycoplasma pneumoniae, HSV (if recurrent EM, then this is the primary agent), drugs (sulfonamides, penicillin, barbiturates, phenytoin) describe: vesicles and bullae have a "targetoid" appearance. located on the palms soles and extensor surfaces. syndrome: Steven Johnson syndrome: EM that involves the kin and mucous membranes which can be fatal TX: systemic corticosteroids, treat the triggering infection, discontinue drug |
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diagnose
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erythema multiforme
hint: "targetoid" appearance. |
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erythema nodosum
define, sex preference, describe, associations, tx |
define: inflammatory lesion of subcutaneous fat (panniculitis)
sex; women describe: raised, erythematous, painful nodules located on the anterior portion of the shins. assoc: 1) coccidioidomycosis, histoplsmosis, 2) Tb, leprosy, 3) streptococcal pharyngitis, 4) Yersinia enterocolitis, 5) sarcoidosis, Ulcerative colitis, 6) Pregnancy, OCPs tx: identify and treat precipitating causes, NSAIDs, systemic corticosteroids if severe |
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diagnose
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Erthema nodosum
hint: location---- shins |
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Urticaria
define, cause, triggers, determatographism, tx |
define: pruritic elevations of the skin
cause: Most often due to mast cell release of Histamine triggers: 1) foods, 2) insect bites, 3) drugs, 4) emotional stress, 5) Hep B (type 3 hsn) Dermatographism: urticaria develops in areas of mechanical pressure on skin. tx: 1) discontinue offending drug, b) avoid aspirin and other NSAIDs, c) antihistamines, d) tricyclic drugs, e) systemic steroids |
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Acne rosacea
define, describe, exacerbated by, results in, tx |
define: inflammatory rxn of the pilosebaceous units of facial skin.
describe: pustules and flushing of the cheeks exacerbated by: drinking alcohol, stress, eating spicy foods results in: sebaceous gland hyerplasia--- enlargement of the nose (rhinophyma) tx: topical metronidazole gel, systemic treatment (isotretinoin and tetracycline) |
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diagnose
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dermatographism
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diagnose
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acne rosacea
hint: rhinopyma |
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blue nevus
location, describe |
face, neck, hands, trunk, feet
describe: flat to slightly elevated, smooth surfaced macule, papule, or plaque; gray-blue to bluish black |
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dermatofibroma
location, description, what is it |
location: extremities
describe: LE - red nodule that umbilicates when squeezed WIS: benign, nonencapsulated proliferation of spindle cells confined to dermis |
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Discoid lupus erythematosus (chronic cutaneous)
location, description, histologically, |
location: face
description: butterfly rash; erythematous maculopapular eruption; photosensitive histologically: positive IF band test - immunocomplexes along basement membrane; atrophy of epidermis |
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Disseminated Intravascular Coagulation
what is it? most common cause? how does it work? |
WIS: diffuse oozing of blood from all breaks in skin and mucous membranes; petechiae and ecchymoses
Common: sepsis works: fibrin thrombi cosume coagulation factors; thrombohemorrhagic disorder |
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Drug Eruption (dermatitis medicamentosa)
describe |
myriad; morbilliform (most common), urticarial, papulosquamous, pustular, bullous. suddenly develop symmetric, cutaneous eruption
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Hemangioma (capillary)
location, time frame |
location: face - in newborns, regresses w/ age
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Mycosis Fungoides
what is it? location, travels to, syndrome association, age range, immune response |
WIS: rash to plaque to nodular masses
location: (often abdomen, hips, buttocks, breasts. also on medial sides of proximal extremities travels to : lymph nodes, lung, liver, spleen syndrome: sezary- mycosis fungoids in leukemic phase age: adults 40-60 YO immune: involves neoplastic peripheral CD4 T cells |
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Verruca vulgaris
cause, locations, describe, tx |
cause: HPV; DNA virus
location: fingers and soles describe: verrucous papular lesions covered by scales tx: PT (cryotherapy with liquid nitrogen), chemotherapy (salicylic acid, trichloroacetic acid), biologic theapuetic agent (imiquimod inducing cytokines) |
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dew drop on a rose petal
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Varicella
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circular "punched out" appearance
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ecthyma
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lesion has a clear demarcation with a slightly elevated border. Hot, tense, indurated skin with non-pitting edema. Tends to be painful.
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Erysipelas
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skin infection that involves the deep dermis and subcutaneous tissue. Lesion usually has an ill-defined, non-palpable border. warmth and pain to palpation.
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Cellulitis
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localized to the beard, follicular pustules with a surrounding halo of erythema.
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sycosis barbae
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whirpool. Papules/ pustules 1-3 days later.
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Hot Tub folliculitis
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black males, ingrown hairs
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pseudofolliculitis barbae
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gently sloping sides and a central depression (anthill). "black spots/ dots" on surface.
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Palmar and plantar warts/ verrucae palmares et plantares
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Painful vesicles/ erosions on tongue; covered with characteristic gray membrane
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primary gingivostomatitis
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prodrome + vermillion border of lip (skin-mucosa junction)
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recurrent herpes labialis
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multiple grouped vesicles and erosions. Painful inguinal lymphadenopathy.
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primary genital herpes
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itch is intense, intractable, widespready and always worse at night.
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scabies
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pruritic red oviod papules/ nodules on penis and scrotum
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nodular scabies
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crusted and thick hyperkeratotis psorasiorm plaques on hands, feet, palms, subungual areas, wrists, elbows, knees. Immunosuppressed individual.
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crusted scabies.
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poor hygiene or homeless. Pruritis- numerous linear exoriation on trunk and neck d/t scratching.
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body lice
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pruritis. pts are aware of something "crawling" . gray-blue macules make form.
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crabs- pubic lice.
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