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Derm
dc
72
Medical
Graduate
02/08/2010
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Term
Kerion, description and RX
 Definition
Red boggy mass with pustules on children. RX: Terbinafine & Prednisone
Term
Tinea capitis, description and RX
 Definition
Red scaly scalp with broken hairs. RX: Terbinafine
Term
Tinea faceii, corporis, cruris, manus, pedis, description and RX
 Definition
red and scaly sometimes perifollicular pustules or vesicles. RX: Topical miconazole or oral terbinafine if follicular involvement
Term
Erythrasma
 Definition
Red/brown area that is coral pink under UVA light, topical clindamycin or erythromycin
Term
Candidiasis
 Definition
beefy red, may have satellite papules or pustules in usually warm moist areas. Topical miconazole or oral flucanazole for mucous membranes
Term
Onychomycosis
 Definition
yellow/white/brown thickening and scaling of nails. oral terbinafine or topical cyclopirox
Term
Molluscum contagiosum
 Definition
Caused by pox virus. common, lesions are flesh-colored, dome-shaped, and pearly in appearance. They are often 1–5 millimeters in diameter, with a dimpled center. They are generally not painful, but they may itch or become irritated. Picking or scratching the bumps may lead to further infection or scarring. Will resolve spontaneously but it takes months to years. RX: Liquid nitrogen spray 2 sec. Extract central core w needle, Curettage, Imiquimod 5% cream (off label), Podophylin (off label)
Term
Erythema infectiosum
 Definition
one of several possible manifestations of infection by erythrovirus previously called parvovirus B19.[1] The disease is also referred to as slapped cheek syndrome, slapcheek, slap face or slapped face. Once rash appears they are no longer contagious. Danger to pregnant women
Term
HOW MANY SECONDS DOES ONE TYPICALLY FREEZE WARTS?
 Definition
10
Term
TREATMENT OF PERIORIFICIAL DERMATITIS
 Definition
Topical Tacrolimus or oral doxycycline
Term
Secondary syphilis treatments
 Definition
Benzathine penicillin 2.4 million U
intramuscular (‘2.4 and out the door’)
Term
When would you use a high or super potent steroid on the face?
 Definition
To calm down disoid lupus
Term
Recessive Epidermolysis bullosa
 Definition
lack of collagen 7 which connects epidermis to dermis “No 7 goes to heaven”
Term
Bullous pemphigoid oral ulcers
 Definition
antibodies against components of basement membrane (desmoglein)
Often present with sores in the mouth with impetigo
Term
Meissner’s Corpuscle
 Definition
dynamic fine touch, low frequency vibration, adapt quickly
Term
Pacini’s Corpuscle
 Definition
vibration, pressure
Term
Netherton’s Syndrome
 Definition
rapid turnover of epidermis and the epidermal fissures
Eat ½ a chicken each day to replace protein
Term
What type of collagen is in the dermis and about what % of the dermis does it make up?
 Definition
o 85% collagen I
Term
Epinephrine administation
 Definition
 Dosage: *0.01 cc/kg injected IM (dilution of 1:1,000) dilute to 1:10,000 for IV
 Give every 10-15 minutes
 Don’t give in bum because vasoconstriction promotes anaerobe growth
 Can give in the tummy or lateral thigh
 Can cause immediate relief of hives
Term
Other than epi, what else can be given in the case of an anaphylactic shock
 Definition
o Glucagon – 1-5 mg given IV or IM
 Give in addition to epinephrine or if EPI isn’t working (patient is on beta blockers)
 Can induce vomiting
o Hydrocortisone, antihistamines, etc.
Term
Toxic epidermal necrolysis (TEN)
 Definition
 *Skin sloughs off, separation of epidermis from dermis, needs to be treated in burn unit
• Immune attack on epidermis
 Skin is exquisitely tender and painful
 Seen in case example of vancomycin
Term
petechiae on soft pallet
 Definition
 EBV can manifest as petechiae on soft pallet
Term
o Necrotizing fasciitis
 Definition
 Aggressive organism (MRSA), tissue can appear black for dermal tissue death
 Must remove brown or black tissue – includes epidermis, dermis, subcutaneous fat
 Dead tissue provides food for bacteria – emergency to remove it
Term
Treatment for sunburn
 Definition
• Cool water, topical aloe vera
• Potent topical corticosteroids, oral corticosteroids (prednisone – for severe)
• Oral antihistamines
• Oral opiates (severe)
Term
Incision size for melanoma
 Definition
o *< 2 mm depth = 1 cm radius margin
o *> 2 mm depth = 2 cm radius margin
o Still in epidermis = 5 mm radius margin
Term
immunosupression predisposes to what type of skin cancer
 Definition
Squamous. Also, more common in blacks
Term
% of squamous cancer that metastisizes
 Definition
3% from non-mucosal skin can metastasize, 11% from mucosal skin can metastasize
Term
- Basal cell carcinoma
 Definition
o *75% of all skin cancer
o Causes: ultraviolet radiation (#1), X-rays, arsenic (contaminated water, semiconductors),
o Appears pearly and simple ulcer, elevated border, firm and translucent
o Main gene found on chromosome 7
Term
Treatment of basal cell carcinoma
 Definition
 Scrape and burn: if tumor is < 1cm, 95% cure rate, but 5% is too high in risky locations
 Excision: 5 mm margin
 Excision with frozen sections (MOH’s surgery): critical anatomical areas – eyelids, lips, nose, ears
• With making an incision below the eyelid, cut vertically so the eyelid isn’t retracted when sealing
• When removing tumors from nasal area, cut right down to bone/cartilage
 Imiquimod: superficial tumors
 X-radiation
Term
What kind of stain would you do if you suspected herpes
 Definition
Wrights stain (tzanck) used to stain epidermis (scrape sample) – when there is fluid
 Wright Stain: doesn’t need as high a magnification as gram stain (40X)
 Fluid: do a gram and tzanck (wright’s) stain – shows cellular details better for herpetic infection
 *Herpetic infection – Causes multinucleate giant cells
Term
Ecthyma
 Definition
thick crusting & deep erosions – super impetigo
• Treatment includes removing crust and oral anti-staph drugs
Term
 Erysipelas
 Definition
red skin, infection at level of dermis, *sharp borders, very painful (tender)
• Central ecthyma with surround erysipelas
• Doesn’t cause scaling
• Has to be treated with oral antibiotics – amoxicillin/clavulanate
Term
 Lymphangitis
 Definition
red streaking, apparent impetigo
Term
 Cellulitis
 Definition
: inflammation of little cells, ill-defined borders
• Stratum corneum is also lifting off and filling with purulent material
• Can easily penetrate the blood stream
• Doesn’t involve epidermis unless impetigo is also involved
o Doesn’t itch, much more painful
• Txt: IV nafcillin
Term
If it looks like a wart but is smooth, think...
 Definition
foreign body
Term
o Molluscum Contagiosum
 Definition
 Cause – pox virus
 Treat similarly to warts (freezing common)
 *Pearly red bumps on the skin with central umbilication
 Slightly translucent vesicles (may look like bullous impetigo & BCC)
Term
o Roseola
 Definition
 High fever, fever breaks and then it breaks out with red macules and papules on the trunk
• Rash after 3-5 days of fever
 Occurs in infants 6 months – 2 years of age
 Small red/pink papules
 Face much more than the trunk or extremities
Term
o Scarlatina
 Definition
 Rash secondary to group A strep
 2-10 years, rarely adults
 Sandpaper rash, accent, folds
 Kids hate to be touched, very sick kids
 Skin is rough caused by toxin produced by staph/strep
 Tender skin, caused by staph or strep
 Txt: oral penicillin or erythromycin
Term
o Rubeola / Measles
 Definition
 Child is very miserable with cough, fever, etc
Term
o Rubella
 Definition
 Enlarged postauricular and occipital nodes
 Feel like you have a cold
 Moves down in three days
Term
o Erythema Infectiosusm
 Definition
 Can present asymptomatic
 Slapped cheeks, reticulated erythema on arms and legs, smooth skin
 *Infects bone marrow and can cause anemia – can be deadly to fetus in pregnant women
 Getting hot can cause rash to come back for 6 months after
 By the time they get the rash they are no longer infectious
Term
spaghetti and meatballs on the KOH prep
 Definition
 Tinea Versicolor
Term
Eczema / Dermatitis
 Definition
- Pathogenesis
o Defective stratum corneum allows leakage of water out of epidermis
 Ceramides are absent or abnormal
o Stimulates lymphocytes to invade
 Th2 Response (IL4, IL13, CD4 T-Cells)
o *Hereditary – runs with asthma and hay fever
o Sloughing doesn’t occur normally and scaling occurs from retention of dead skin from stratum corneum
- Microbiology
o *Staph aureus loves to grow on skin with eczema
- Epidemiology
o Highest prevalence in northern Europe
o Usually starts before age 5 (post-adolescence 16.8%)
o Timeline – acute: red papules, blistering
o Aggravating factors: stress, dry weather, tight clothing, rough fabrics (wool), infections, animal allergens, sweating, soap
o Clinically: the itch that rashes
o Lab: IgE elevated in 80%
Term
- Atopic Dermatitis
 Definition
o Atopy: means strange in Greek, rash associated with hay fever or asthma
o Triad: eczema, asthma, allergic rhinitis
o Time scale: atopic dermatitis and food allergies both start early, the dermatitis persists longer
 Asthma then rhinitis come on 5 & 10 years later respectively
o Th2 Blues:
o Cradle cap – childhood beginning, also accompanied by diaper rash
 Diaper rash for longer than 3 days is probably yeast
 Foot infection/scaling & redness is almost never fungal – likely eczema
o Bad: tight clothing, wool, fragrances
Term
Treatment of eczema/atopic dermatitis
 Definition
o Low potency steroids: kids and sensitive areas in adults (genitalia, face, armpits, nipples)
o Mid potency steroids: trunk of adolescents and adults
o High potency steroids: palms and soles of adults
o Procedure
 Soak: 5-10 minutes in water
 Apply topical anti-inflammatory agents: steroids or calcineurin inhibitors
 Anti-staph agents (oral or topical)
 Lubricant – grease twice a day (lubricant – cream or ointment)
• Cera Ve cream contains ceramides and sphingosines
• *Twice a day keeps the doctor away, Grease for peace
o Severe: prednisone
Term
- Nummular Dermatitis
 Definition
o Means “coin shaped” – round areas of redness and scaling or with vesiculation, itchy
o Scrape because it could be a fungal infection
o Acute vesicular presentation?
o Same treatment as atopic dermatitis
o Course: waxes and wanes – episodic
o Differential: bullous impetigo – look for gram + cocci
Term
- Lichen simplex chronicus
 Definition
common on shins and perianal area, genital area, forearms – standard pattern
o Baseball player’s disease – itching disease
o Induce by scratching – epidermis would return to normal after stopping scratching one month
o Epidermis thickens as a protective response to the scratching
o Treatment: same as atopic dermatitis
o Often associated with anxiety and depression
Term
- Seborrheic Dermatitis – Dandruff
 Definition
o Pathogenesis
 Defective scalp epidermal barrier function
 Intrafollicular yeast that breakdown sebum into free fatty acids – induce inflammation
 Hereditary component of inflammation susceptibility
o Treatments
 Shampoos – leave in there for 5-10 minutes (anti yeast)
 Ears – use liquid hydrochlorothiazide drops twice a day
Term
- Irritant Dermatitis
 Definition
o Example: erythema secondary to shaving
o Treatment: soap-free cleanser as a lubricant (Cera Ve)
o Use Gillette blade, apply Cera Ve cream, apply 1% hydrocortisone if obvious inflammation
o Avoid alcohol based aftershaves
Term
- Allergic Contact Dermatitis
 Definition
o Causes: poison ivy, neomycin, benzacaine
o Not common on palms and soles because stratum corneum is so thick
o First exposure – one week, subsequent exposure – usually hours
Term
Acne treatment
 Definition
o Goal
 Men: open plugs and kill bacteria
 Women: same as men + lower serum androgen levels
o *Comedones: use retinoids – takes at least *2 months to see improvement
 All retinoids are apparently equal
o *Comedones & < 15 red papules/pustules – topical retinoid and topical benzoyl peroxide/clindamycin
o *Comedones & > 15 red papules/pustules – add oral tetracycline
 Can given oral contraceptive in women but preferably not
 Tetracycline – only 50% is absorbed if taken with food
o Other
 Isotretinoid – teratogenic, usually has birth control pills accompany
• AKA Accutane: 1mg/kg/day – often treats
 Benzoyl peroxide – free radical oxygen kills bacteria
 Abrasion stuff/biorays doesn’t help
o Most antibiotics work agains P. Acne
Term
- Pariorificial dermatitis
 Definition
o *Treatment: topical tacrolimus and oral doxycycline (not topical steroid or retinoid)
o Oral tetracycline – reduces inflammation
Term
- Rosacea
 Definition
o Onset is usually adulthood
o Facial erythema, sometimes with red papules superimposed
o No comedones
o Lifelong
o Treatment: oral tetracycline or topical metronidazole gel
Term
Scabies treatment
 Definition
Ivermectin
Term
Head Lice
 Definition
Malathione lotion for 8-12 hrs on dry hair; comb with fine tooth comb. Clothes: wash or dry clean form past month
Term
Tick
 Definition
Back flip removal; max incubation period is 7 days. can cause:
1. Rocky mtn spotted fever
2. Lyme disease
3. Colorado tick fever
4. Ascending tick paralysis
Term
Fleas
 Definition
Cause of plague and typhus. Vacuum and fumigate home. Animals: apply fipronil to animals back monthly.
Term
Scabies
 Definition
Apply permethryn to body from neck down overnight. Repeat in 5 days. Oral ivermectin may be used. Clothing/bedding: Wash or set aside all contacted within the past week.
Term
Bed Bugs
 Definition
Fumigate bed bedroom or house if necessary.
Term
Pubic lice
 Definition
Lindane 1% shampoo for 10 minutes. Clothing/bedding: Wash/dry clean from the past month
Term
Chiggers
 Definition
Ultrapotent topical steroids 2X/day, oral antihistamines
Term
Optimal treatment for poison Ivy
 Definition
Prednisone. So long as they're not diabetic or have TB
Term
Diaper dermatitis present over 3
days is assumed to have
 Definition
Candida infection
Term
Lichens planus can be associated with what other diseases. Has what prognosis?
 Definition
Hep C. Oral and skin involvement 1.5 yrs. Oral only 5yrs.
Term
Treatment for androgentic alopecia
 Definition
minoxodil
Term
epidermal inclusion cysts
 Definition
Firm, mobile subcutaneous nodules often with a small opening, punctum, to the surface. Or pilar cysts, most common on the scalp.
Epidermal inclusion cysts have a granular cell layer and laminated keratin that resembles stratum corneum.
Term
Keratinocytes differentiate normally but appear in reticulated chords around pseudo-horn cysts (look like cysts but communicate with epidermal surface).
 Definition
Seborrheic keratosis
Term
What layer of the epidermis does squamous cell carcinoma originate from?
 Definition
Stratum spinosum
Term
Different treatments for different forms of basal cell carcinoma
 Definition
Superficial and nodular types may be successfully treated with electrodessication and curettage, other are more aggressive and may be best treated with Mohs surgery
Term
Panniculitis
 Definition
tender, smooth nodules without scaling – inflammation in subcutaneous fat.
Term
- parakeratosis (nuclei in stratum corneum), thick epidermis, neutrophils in dermal papillae.
 Definition
Psoriasis
Term
Granuloma annulare
 Definition
ring-shaped with raised edges – vaguely palisaded histiocytes in dermis. More common in children & young adults. Papular form can be seen with diabetes.
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