Dermatology 4 Flashcards

vocabulary
Terms Definitions
Lichen planus
Melanocytes
Pigment producing cells
Melasma
Malara Hyperpigmentation associated with pregnancy ("mask of pregancy") or OCP use
Vesicle
circumscribed, elevated lesion containing serous fluid, less than 5mm in diameter (ex: chicken pox)
lupus
systemic lupus erythmatosus (SLE)
chronic cutataneus LE
subaccute cutaneus LE 
 
 
Pemphigus
autoimmune blistering skin disease
Pearly pink papule:
Basal cell carcinoma
Tinea Versicolor
 Presentation: Papulosquamous or maculosquamous, tan and irregularly shaped lesions on upper back, neck, chest and arms.  Areas may depigment.

Diagnosis?
Lichen planus: Tx
-Topical steroids-Intralesional steroids: injection that can take down surface of lesion but too much: can take skin away. -topical Tretinoin is for severe lesions-cyclosporine mouthwash-system therapy : severe cases-Psoralens + UVA radiation : generalized eruptions
Eumelanin
Brown/black common form of melanin
Spongiosis
odema fluid between squamous cells
Do petechiae blanch with pressure?
Nope
Psoriasis
Th1 cytokines (autoimmunity): TNFa, IFNgamma, IL-2
HLA subtype Cw13 confers increased RR.
White, silvery scales.
Treat with topical treatments, phototherapy, immunosuppressives.
intradermal injection
injection into the skin.....wtf....used for diagnostic purposes
Erythema Multiforme pathogenesis:
Circulating immune complexesAntigen from the drug or infectious agentIgM Immune complexesPossible also cellular immune mechanism
Localized erythema in plaques and nodules may indicate subcutaneous fat necrosis indicative of __ cancer.
pancreatic
In _______ folliculitis, multiple monomorphic pustules and red papules appear w/i 2 wks of systemic ______ tx.
Steroid, steroid
Physical Urticaria
Rare condition acquired during adolescence which is self-limiting. Wheals are reproducible using an ice pack, irradiation, or test tube of warm water
Urticaria: chronic
-6+ wks-wax/wane lesions-maybe by stress-females 2x more affected than males-rxn to cold, water, infection, exercise, sun
 
What virus can cause rash, encephalopathy, and retinitis in immunocompromised patients?
Varicella
Dermo-epidermal junction
Interface between epidermis and dermis
How is dandruff tx?
1)Frequent washings 2)Antiproliferative shampoos (T-Gel - Tar), Selsun - Se, Head and Shoulders - Zn) 3)Antifungal shampoos (ketoconazole, ciclopirox)
Cellulitis
similar to erysipelas but involves subcutis. not reaised lesions though, poorly demarcated from uninvolved skin. cuase is GABHS/staph but can also be wide variety of other bacteria
Syphilis SSX
Clinical manifestations: Primary - chancreSecondary - Condylomata lata (watery lesions), rash, mucocutaneous lesions and adenopathyTertiary - has cardiac, nuerologic, opthamic, or auditory manifestations; Gumma (deep skin lesions- often necrotic)Test via - darkfield examination of lesion, RPR, VDRL, FTA-ABSTTX - Penecillin G
Occult
hidden or unable to observe directly.
varicella is also known as?
chicken pox
Acatholysis
Separation of epidermal cells or Loss of cohesion between keratinocytes
Ex: Pemphigus Vulgaris
grouped vesicles on an erythematous base, may become necrotic:
Herpes Simplex
Permanent loss of follicular opening and PERIFOLLICULAR ERYTHEMA AND SCALE. Can be localized or widespread. Associated with other skin surfaces/mucus membranes in 50% of cases.
Lichen Planopilaris
epidermal growths occur due to proliferation of ___ or __ cells.
keratinocytesbasal cells
Moles commonly change or one can acquire more during pregnancy and puberty.
A common, benign condition of sebaceous glands in adults of middle age or older. Lesions can be single or multiple and manifest as yellowish, soft, small papules on the face (particularly nose, cheeks, and forehead).
Sebaceous hyperplasia
Erysipelas
What skin infection commonly follows a streptococcal URI?
young children
What age group is Molluscum Contagiosum usually found?
Koilonychia
 
*spoon nails
A concavity of the nail plate.
Psoriatic Vulgaris
-most common type of psoriasis-chronic recurring scaling papules and plaques
 
 
Where does pus accumulate in skin abscesses?
 
 
Subcutaneous tissue
Hirsutism
excess of terminal hair growth in women in a typical male patern
BurningIrritationContact allergic dermatitisLocal or systemic toxicity
Side effects of topical therapies
Sites of staph carriage
nares, axilla, toe webs
MRSA
can be spread by fomites: gym equipment, personal items, etc.  often presents in otherwis healthy patients as folliculitis, abcess, cellulitis
Management of Acne?
Topical - antibiotics, Benzoyl peroxide, and retinoids (tretinoin).Systemic - Isotretinoin and Accutane.
PE with Stevens-johnson
-Prodromal Rash - Morbilliform, erythema multiforme like, diffuse erythema- Early - Necrotic epidermis first as macular areas - enlarge and coalesce.Late- sheet like loss of epidermis. Raised flaccid blisters (+ Nickolsky’s Sign) on erythematous areas.-Any trauma leads to full thickness epidermal detachment-Lesions are pink red early then dusky cyanotic later lesions are tender-Usually occur on face, extremities then becoming confluent over hours or days.-widely distributed mostly trunk and face TEN- generalized 90% of patient have mucousmembrane involvement85% have conjunctival leasions
Edema
an accumulation of fluid in the interstitial tissue.
this dermatophyte presents as ring shaped lesions with an advancing scaly border and central clearing?
tinea corporis
Pathogenesis of Erythema Multiforme
Associated with infections (Mycoplasma pneumoniae, HSV), drugs (sulfa drugs, β-lactams, phenytoin), cancers, & autoimmune dz
If you see a white hue around urticaria, it likely ___.
allergic
SCC arising in an AK has ___ metastatic potential.
low
Therapy for nevus:
- elliptical excision- shave excision- ALL REMOVED NEVI MUST BE EXAMINED BY A PATHOLOGIST
When being treated for syphilis, many patients experience a febrile reaction called ___ ___ __ that occurs with onset of therapy. This lasts for about 1 day.
Jarisch-Herxheimer reaction
Sebaceous glands
Which glands are stimulated by sex hormones and secrete sebum to the skin through hair follicles?
Lanula
What is the half moon on the fingernails called?
Elidel 1% and Protopic
Which nonsteroidal treatments for atopic dermatitis can only be used in children above 2 y/o?
Superficial
What type of BCC is erythematous scaly macule or patch with an elevated threadlike (nodular) border?
Nikolsky's Sign
This sign presents with dislodging the epidermis adjacent to the bulla with light finger pressure causing an ulcerated area. Pressure directly on the bulla Leads to Lateral extension of the blister.
Molluscum contagiosum: Pathophys
-virus replicates in cytoplasm of epothelial cells: cytoplasmic inclusions= lots of infected cells
Diaper rash/dermatitis: Labs
-KOH scrapings from fresh lesion -finding mites, ova, feces on mineral oil prep can confirm dx of scabies instead
Lunula
White part at the base of the nail
SWEAT GLANDS
HEAT REGULATION AND WATER AND SALT EXCRETION
TX of Guttate Psoriasis
oral antibiotics, topical steriods, narrow band uvb and natural sunlight. time (spontaneously resolve bw 4 & 6 weeks.)
 
*be ready to explain that Guttate can develop into chronic stable plaque 
Group VI VII
Use for  eyelid dermatitis, diaper dermatitis, mild dermatitis•  Warnings: re-evaluate if no response in 28 days. Avoid long term continuous use.
Fissure
a linear lesion or break in the surface of the skin
pityriasis rosacea most often appears when?
spring and fall
patients over 60 years old with herpes zoster have a risk of developing what?
neuralgia
Herpes zoster diagnosis is usually ___, though __ ___ smears are the most sensitive test.
- clinical- direct immunofluorescence
What vascular study is the best to rule out PVD?
Ankle:brachial index
Fungal causes of fever and rash of purpura.
Candidal septicemia
Melasma tmt for cosmetic purposes:
Hydroquinone cream 4% twice dailySunscreen SPF 30Tretinoin cream 0.1% daily or every other dayFluocinolone 0.01% + hydroquinone 4% + tretinoin 0.05% solution (Tri-Luma) twice dailyAzelaic acid cream 20%Chemical peels
After clearance of chronic tinea pedis, for suppressive therapy use antifungal ___ such as __ ___. This can be used indefinitely.
- powders- Zeasorb AF
Tx for corns?
1)Pare and core w/ #15 blade 2)Keratolytics (urea, salicylic or glycolic acid) 3)Orthotics 4)Refer to podiatry
Group A Strep
What is the common organism for Lymphangitis?
Wide excision
What kind of treatment is required for a Malignant melanoma?
Alopecia Areata
Localized loss of hair in round or oval areas without skin inflammation. Most commonly in the scalp.
Hidradenitis suppurativa: General characteristics
-disease of apocrine gland areas: axilla, anogenital, scalp-females btw puberty and menopause more than males (anogenital)-predisposing factors: obesity, hx of acne, apocrine duct obstruction, bacterial infection, genetics
What are the "three symptoms of the skin"?
 
Pain
Itching
"Strange" (neuralgia)
Name 3 tx for nummular eczema.
Topical steroid (ointment), moisturization, light tx. Very difficult to tx - variable and unpredictable outbreaks.
ICD  (non contact dermatitis)
exposure to any irritating substance. mediated by substance direct toxicity to skin cells. can occur immediately after first exposure or take months after repeated.
mid-early: pink mildly erythematous patches or slightly raised papules and plaques. scaley or vesicular
severe-late: eroded, crusted, fissured freaqently bleed and get secondary infection
:a skin defect in which there has been loss of epidermis and upper papillary layer of the dermis, it may extend into the SQ and always occurs within pathologically altered tissue. It always heals with a scar.
Ulcer
Stevens-Johnson Syndrome. - often due to which drugs
Sulfa drugs, Allopurinol, amino-penicillins, Certain NSAIDS, Cephalosporins,  Floroquinolones
a reaction pattern of blood vessels in the dermis with secondary epidermal changes that manifest clinically as characteristic erythematous iris shaped popular & vesiculobullous lesions?
erythema multiforme
Intraepidermal blisters suggest __ __ or __ __.
- contact dermatitis- pemphigus vulgaris
__ and __ lupus can often cause alopecia.
Systemic and Discoid
what is interleukin 2?
protein that occurs naturally in your body and plays an important role in activating your immune system. PROLEUKIN therapy is a genetically engineered or recombinant version of IL-2. PROLEUKIN therapy possesses the same properties as naturally occurring IL-2 and helps activate the immune system to recognize and eliminate certain kinds of cancer cells.
Describe the re-exposure in allergic contact dermatitis.
After 1-14d initiates sensitized lymphocytes to release cytokines that lead to inflammation w/i 12-48hrs
face, genitals,  mucous membranes, broken skin, & under occlusive dressings
Where are the highest absorption areas?
Squamous Cell Carcinoma
What type of skin infection is more prominent in areas with previous burns?
What factor best predicts prognosis in melanoma?
 
What is the biggest risk that someone has melanoma?
Lesion thickness
 
Recent changes in a mole's appearance
Nature of skin - thickness/hydrationDrug conc/properties
Factors influenciing Topical route of drug administration
clincial presentation of PPP
non rupturing pustules on palms and soles.  emerging over time at skin surface to form a scale or crust.  slowly heal.  sterile. only infected secondarily.
Stage II pressure ulcer
Tissue damage limited to epidermis or dermis - may present as a blister
Triggers for recurrences of HSV:
- fever- UV light- physical trauma- menstruation- emotional stress
Ulcer healing requires intact __ _, __, proliferation of __, __ __, and __.
- vascular supply- inflammation- proliferation of fibroblasts, endothelial cells, and keratinocytes
Normal distribution for atopic dermatitis in children:
- face/head- hands- groin- front of knees- feet
Describe the primary sensitization in allergic contact dermatitis?
Hypersensitivity rxn begins 14-21d /p initial exposure to allergen
Lymph node syndrome
 
*ex. cat scratch disease
What is a collection of infectious diseases where the org is innoculated at one site, but later will manifest itself at the region of lymph nodes?
 
What is Chalazion?
How do you treat it?
From obstruction of the meibomian gland
 
can be due to meibomian gland carcinoma - do histology
 
rx: steroids or Incision/Curettage
Nam4 4 tx for chronic paronychia.
1)Avoid irritants 2)Keep hands dry 3)topical steroids 4)Oral diflucan
:a plateau-like elevation that has a surface area greater than its heightWhat usually forms these?What is it called if the surface is rough and the skin is thickened?
PlaqueFrequently formed by a confluence of papulesIf the surface is rough and the skin is thickened, it is called a lichenification
Group I topical steroids
Super potent (of I through VII)- for psoriasis, hand eczema, use on palms, soles where thick- Not for face, groin, under breasts --> atrophy- 45-60 per week- limit 14 days
Herpes opthamalicus affects the __ branch of the ___ division of the __ nerve. It involves the __ of the __ and scarring of the __ may occur.
- nasociliary branch of the opthalmic division of the trigeminal nerve- tip of the nose- conjuctiva
With Darier's disease, the skin biopsy would show __ ___ __ with __ ___.
- epidermal suprabasalar clefts - acantholytic keratinocytes
What is most commonly affected in irritant contact dermatitis?
Hands MC, also eyelids and lips
pitting of the nails
What nail disease is seen in pts with psoriasis or alopecia areata?
Name 3 oral tx for onchomycosis. Which one works best for candida?
1)Terbinaine (Lamisil) 2)Itraconazole (Sporanox) 3)Fluconazole (Diflucan) - Candida
What 3 hereditary predispositions make someone more likely to have Atopic Dermatitis?
Over two-thirds of patients have a personal or family history of allergic rhinitis, hay fever, or asthma.
Pyoderma Gangreosum is NOT an __ __. You will culture it over and over and it will come back with no organisms. Treat with ___ to slow down over-inflammatory process and allow for wound healing.
- NOT an infectious process- steroids
A junctional nevus is acquired in ___ and is a mole at the junction of __ and ___ . These have a high risk of developing into ___ ____.
- childhood- dermis and epidermis- malignant melanoma
 results will occur within 6 months
If a pt tries repigmentation to treat their vitiligo, within how long should the treatment be working?
What happens in a FDE if the offending drug continues?
the inflammation intensifies, turns dusky red, violaceous or brown, may crust, desquamate or blister
Lesions of those with Herpes Simplex: In HIV pop
 active lesions are mostly the result of reactivation of latent infection; recurrences can be progressive and persistant.
a.      Clinical manifestations: pain, acute vesicular eruption rapidly evolves into a chronic, non-healing ulcer; most common sites are perianal, genital, & orofacialb.      DX: mostly clinical, viral culture/ Tzanck smearc.       TX: anti-virals such as acyclovir d.      Complications: lesions can extend from oropharnynx to esophagus; secondary infections (esp. of perianal ulcers)
Guidelines for management and follow up of patients with multiple atypical moles (6):
- biopsy at least 2 lesions to confirm diagnosis- skin photographs, including close ups of suspicious lesions- sun protection- patient self examination periodically- screen blood relatives for atypical nevi and melanoma- frequency of follow up: yearly for patients with no FHx of melanoma, every 6 months for pts with personal or FHx of melanoma for 2 years and then yearly
Describe the distribution of skin areas affected by adult AD.
Can be flexural as in children or more localized (hands, periorbital, or anogenital)
What is Keras?Xero or Sicca?Ichthyo or Piscis?Onycho or Ungual?Aktinos or Solaris?Senilis?Myco or Tinea?
Keras = hornXero = Sicca = DryIchthyo = Piscis = FishOnycho = Ungual = NailAktinos = Solaris = SunSenilis = OldMyco = Tinea = Fungus
Describe a spider angioma. Does it blanch with pressure? What is the central body called?
It has a central body and radiating spider-like legs. The central body blanches with pressure and the central body is called the punctum.
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