Step2 Derm

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Author:
gm1147
ID:
163109
Filename:
Step2 Derm
Updated:
2012-07-19 12:37:40
Tags:
Step2 Derm
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Description:
Kaplan
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  1. Mole diameter indicating malignancy
    >6mm
  2. Melanoma dx and tx
    • Full thickness biopsy, not shave
    • Removal, interferon injections for widespread
  3. Squamous cell cancer risks
    Sunlight and immunosuppressive drugs such as with organ transplant
  4. Basal cell carcinoma
    dx
    tx
    recurrence rate
    • Shave bx
    • Mohs micrographic surgery - immediate frozen section with no wide margin
    • <5%
  5. Kaposi
    locals
    pts
    tx
    • Skin, GI, lung
    • In pts with AIDS via sex, not IVDU
    • Tx AIDS, intralesional vincristine or interferon, chemo with liposomal doxorubicin
  6. Actinic keratoses
    risk
    tx
    • Premalignant to squamous
    • Remove with curettage, cryo, laser, 5FU, or imiquimod
  7. Atopic dermatitis tx
    • Moisture
    • Avoid irritants including soaps and washcloths
    • Topical corticosteroids for flares - oral if severe
    • Tacrolimus and pimecrolimus - Tcell inh for tapering off steroids and long term, topical
    • Antihistamines- if severe, doxepine
    • Antibiotics - cephalexin, mupirocin, repatamulin for secondary imetigo
    • UV light
  8. Psoriasis tx
    • Local:
    • Topical steroids
    • Vit A and D (calcipotriene) ointment to taper off roids to prevent atrophy
    • Coal tar
    • Pimecrolimus and tacrolimus for delicate areas

    • Extensive:
    • UV
    • TNF inh - etanercept, adalimumab, infliximab
    • Methotrexate - liver and lung sides
  9. Rash which looks like secondary syphilis but spares palms
    its tx if severe
    • Pityriasis rosea
    • Steroids and UV
  10. Mech of seborrheic dermatitis
    Inc risk in what diseases
    Tx
    • Hypersensitivity rxn to dermal infection of dermatophyte
    • AIDs, Parkinson
    • Steroids, ketoconazole
  11. Pemphigus Vulgaris
    -Cause
    -Differentiate from bullous pemphigoid
    -tx
    • -idiopathic or drugs:
    • ACEi,
    • penicillamine,
    • phenobarbital,
    • penicillin

    • -Nikolsky sign
    • mouth involved
    • More fluid loss
    • More infections

    • -Prednisone
    • azathioprine or mycophenolate to wean off
    • Rituximab (anti-CD20) or IVIG for refractory
  12. Bullous pemphigoid tx
    • Prednisone
    • Taper with azathioprine, cyclophosphamide or mycophenolate
    • Mild: erythromycin, dapsone, nicotinamide
  13. porphyria Cutanea Tarda
    -what
    -mech
    -dx
    -tx
    Blistering of sun exposed with involvement of backs of hands and face in pts with HepC, etoh, estrogen, or iron overload

    hypersensitivity to abnormal porphyrins when they are exposed to light due to deficiency in uroporphyrin decarboxylase activity

    dx with inc uroporphyrins in a 24hr Ur

    Correct underlying
  14. Impetigo tx
    • Mupirocin
    • Bacitracin
    • Repatamulin
    • Severe: oral dicoxacillin or cephalexin
    • Comm MRSA: Doxy, Clinda, bactrim
  15. Epysipelas bugs, symptoms
    • Strep>staph
    • Red, hot, lesion on face, bacteremia, leukocytosis, F/C. Can lead to glomerulonephritis if GAS (not rheumatic fever)
  16. Tx for skin infections
    • Mild: oral
    • Dicloxacillin, cephalexin, cefadroxyl
    • Pen all- erythromycin, clarithro, clinda
    • MRSA- doxy, clinda, bactrim

    • Severe: fever - IV
    • Oxacillin, nafcillin, cefazolin
    • Penn all - clina, vanc
    • MRSA - vanc, linezolid, dapto, tigecycline
  17. Hair follicle infections
    • Folliculitis is small
    • Furuncle is small abscess
    • Carbuncle is collection of furuncles
  18. Tinea:
    best initial test
    most accurate test
    best initial tx
    • KOH prep
    • Fungal cx
    • Topical antifungal. If hair or nail - terbinafine or itraconazole
  19. Topical antifungals
    • Clotrimazole
    • Ketoconazole - antiandrogenic, oral leads to gynecomastia
    • Econazole
    • Miconazole
    • Nystatin - only for yeasts
    • Ciclopirox
  20. Major Sulfa drugs
    • Thiazides
    • Furosemide
    • Sulfonylureas
  21. Common drugs causing hypersensitivity
    • Pen
    • Sulfa
    • Allopurinol
    • Phenytoin
    • Lamotrigine
    • NSAIDs
  22. Range of derm drug hypersensitivity
    • Morbilliform rash: no tx, no mucous memb
    • Erythema multiforme: widespread, no mucous, prednisone
    • Stevens-Johnsons: mucous involved, can lead to resp failure. IVIG
    • Toxic epidermal necrolysis: mucous, Nikolsky. IVIG
  23. Staph Scalded Skin Syndrome
    -presentation
    -organs at risk
    • Looks like TEN
    • Hypotension, Renal, Liver, Delirium
  24. Acne tx
    • Mild: Benzoyl peroxide
    • Topical clinda or erythro

    • Mod: Topical Vit A - tretinoin, adapalene, tazarotene
    • Oral abx - minocycline, doxycycline

    Severe: oral vit A - isotretinoin (side: hyperlipidemia)

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