common derm problems- clin med

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  1. Involves head and body where sebaceous glands are present
    Greasy appearance
    All age groups
    Chronic or intermittent
    Scalp involvement can be minimal (dandruff) or extensive (plaques)
    In children, scalp lesions are “cradle cap”
    Often symmetrical
  2. seborrhea tx:
    • Shampoos (selenium, ketoconazole)
    • Other topicals (ketaconazole cream, terbinafine solution, corticosteroids)
  3. Thick, silvery-white scales
    Caused by rapid turnover of dermal cells
    Usually on extensor surfaces
    Nails also involved (pitting)
    Psoriatic arthritis involves hands and feet
    Guttate form has smaller lesions
    Pustular form occurs on hands and feet
    women > men
    Less frequent in highly pigmented skin
    Can be precipitated by stress
  4. psoriasis tx:
    • Control vs. cure
    • Topical corticosteroids
    • Coal tar
    • Vitamin D preparations
    • Sunshine / UVA / PUVA
    • p.o. meds (Methotrexate, cyclosporine)
  5. what is Auspitz's sign:
    punctate bleeding spots when psoriasis scales are scraped off
  6. Skin reaction to trauma (scratching)
    May occur within days or weeks
    Common in psoriasis, lichen planus
    Koebner Phnomenon
  7. Sudden raised lesions due to minor trauma to skin
    Likely histamine related
  8. Common exanthem (huge rash)
    ? Cause
    Herald patch
    Langer’s lines
    Christmas (or fir) tree pattern
    Lasts 5-8 weeks
    Easy confused with other conditions
    Pityriasis Rosea (PR)
  9. PR tx:
    • Treat pruritis
    • UV therapy use with ? Results
    • Reassurance of self-limiting nature
    • Some evidence that erythromycin may help
  10. Flat-topped papules and plaques on flexor surfaces of UE, LE, genitalia, and mucous membranes
    Often violaceous color
    Commonly ages 30 – 60 affected
    Men = Women
    Self-limiting though can last up to 5 years in mucous membranes
    Lichen planus
  11. Lichen planus tx:
    • Antihistamines
    • Topical steroids
    • Severe cases - systemic steroids
  12. Autoimmune etiology
    Can be fatal
    Men = Women
    Commonly ages 40-60
    Bullous lesions start in mucous membranes then move to body
    Painful lesions often interfering with eating
    Weight loss, fatigue, malaise frequent
    Dx made by bx
    Death due to secondary infection
  13. pemphigus tx:
    • Systemic steroids
    • Other agents – methotrexate, azathiopine     started at the same time as steroids
    • Treatment causes multiple side effects
  14. Vesicular lesions on hands, feet
    Women 2X men
    May be acute, chronic, or intermittent
    Pt c/o itching or burning
    Dyshydrotic eczema (Pompholyx)
  15. Pompholyx tx:
    • High strength topical steroids- glucocorticoids
    • Cool compresses
  16. Acute, yet self-limiting
    Can be mild or severe
    Target lesions
    All areas potentially involved (including mucous membranes)
    Categorized into Minor and Major
    Minor usually resolves in 3 weeks
    Major can last up to 6 weeks with 5% fatal
    Men slightly more frequent
    Common ages 20-40
    Multiple triggers including drug rxn and infection
    Erythema multiforme
  17. erythema multiforme tx:
    • Find trigger(s) and remove
    • Sxmatic tx (antihistamines,analgesics)
    • Topical steroids
    • Systemic steroids
    • Oral lesions may require tx
  18. –also called palpable purpura
    –triggered by drugs (penicillin), bugs (strep), tumor antigens, proteins
    cutaneous vasculitis- skin only
  19. –Henoch-Schonlein purpura, essential mixed cryoglobulinemia, connective tissue disorders, serum sickness, hypocomplementemic urticarial vasculitis
    (urticaria > 24 hours, arthritis, glomerulonephritis, gastrointestinal involvement)
    Disseminated lesions
  20. causes of vasculitits:
    • immune complexes
    • –exogenous antigens - drugs (especially sulfa), food, bugs; connective tissue disease, cancer
    • –rapidly progressive glomerulonephritis, GI bleed, angioneurotic edema
  21. testing for vasculitis:
    • depends on H & P
    • Bx most useful
  22. Tx/prognosis for vasculititis:
    • steroid
    • about half resolve in 6 months
  23. –severe febrile mucocutaneous drug reaction:
    • Toxic Epidermal Necrolysis (TEN)
    • also called: Lyell syndrome
    • –Stevens-Johnson syndrome (SJS) less severe than toxic epidermal necrolysis (TEN), but possibly part of same disease spectrum
  24. types of TEN:
    • Bulbous erythema multiforme
    • Stevens-Johnson Syndrome
    • Overlap TEN/SJS
    • TEN w/ spots
    • TEN w/o spots
  25. organ systems involved in TEN:
    • skin
    • mucous membranes
  26. causes of TEN:
    • over 100 diff drugs, including:
    • –sulfonamides
    • –aminopenicillins
    • –quinolones
    • –cephalosporins
    • –tetracyclines
    • –imidazole antifungals
    • –aromatic anticonvulsants (high risk during the first 2 months)
  27. Chief concern (CC): –skin lesions
    symptoms may precede cutaneous manifestations by 1-3 days
    –stinging eyes
    –pain upon swallowing (odynophagia due to mucosal lesions)
    skin lesion patterns:
    –often starts on trunk–progresses to neck, face, proximal extremities
    –may include entire body (including soles and palms)
  28. –initially erythematous, dusky-red, or purpuric macules of irregular size and shape
    –progresses to gray color and flaccid blisters with full-thickness necrosis
  29. what is Nikolsky sign:
    extension of blister with lateral traction
  30. wet surface (moist, glistening, exudative) characteristic of:
    pemphigus vulgaris or toxic epidermal necrolysis
  31. dry surface characteristic:
    pemphigus foliaceous or staphylococcal scalded-skin syndrome
  32. in TEN, what can be present on HEENT exam?
    • erythema and erosions of buccal, ocular, and genital mucosa
    • may have extensive involvement of mucous membranes, including:
    • –lips
    • –oral mucosa
    • –pharynx
    • –esophagus
    • –conjunctiva
    • –corneal ulcerations
    • –uveitis
  33. tx for TEN:
    • –treat as burn pt
    • – d/c all unnecessary or suspected meds
    • – bx to confirm dx
    • Prognosis based on age and comorbidities
  34. types of contact dermatitis:
    lesions are often:
    • allergic (metal, plant {Rhus})    
    • irritant    
    • photo    
    • urticaria    
    • drug rxn
    • lesions often vesicular
  35. contact derm tx:
    • Removal of irritant
    • Cool compresses (including cool baths/showers)
    • Minimize scratching
    • Antihistamines
    • Topical steroids for smaller areas
    • Systemic steroids for larger areas
  36. The itch that rashes
    Itch – scratch cycle
    Common in children (15%)
    No specific test
    -dry skin
    -feels thickened
    -red from scratching
    Atopic dermatitis (eczema)
  37. atopic derm triad:
    • asthma
    • allergic rhinitis
    • atopic dermatitis
  38. atopic (eczema) tx:
    • Reduce itching
    • Lubricants
    • Topical steroids / pimecrolimus
    • Antihistamines
    • Cool baths / showers
    • Oral steroids if severe
  39. Round shaped lesions
    Worse in dry, cold weather
    pruritis is often intense
    Nummular dermatitis
  40. Nummular dermatitis tx:
    • Mid-high strength topical steroids
    • Reduce strength as lesions improve
    • Antihistamines for itching
  41. Lower extremities
    Caused by venous insufficiency
    Reddish-brown (brawny) color
    Leg edema common
    Condition may be precursor to others
    Can become secondarily infected
    Stasis dermatitis
  42. stasis dermatitis tx:
    • Improve venous problems:    
    •       elevation of legs    
    •       support / compression hose
    • Topical steroids
    • Topical or p.o. antibiotics for infection
  43. fever, then lesions that start from head down, lasts 4-6 days, Koplik spots
    • Rubeola
    • --Viral Exanthems
  44. caused by herpes 6, rash appears after fever, often spares the face
  45. caused by parvovirus, onset with fever, then lesions (slapped cheek) after fever resolves
    Erythema Infectiosum (Fifth disease)
  46. much like rubeola but last less time
  47. Erythema infectiosum (5th disease):
    Rosey red cheeks

    • acetaminophen and supportive therapy
    • plus ibuprofen or NSAIDs
    • ongoing: immunr globulin plus RBC transfusion
  48. most cases are irritant diaper dermatitis
    –prolonged contact with feces and urine
    –alkaline pH
    –mechanical disruption of the area
    Diaper dermatitis
  49. Tx diaper dermatitis:
    • most cases should be treated conservatively
    • "diaper rash is not cured by what you put on it, but by what you take off of it"
    • reduce exposure of affected skin to urine and feces
    • –allow time out of diaper
    • –frequent diaper changes
    • –topical agents that form barrier to skin surface
    • limit antifungals to rashes typical of candida dermatitis - deep, confluent redness, geographic margins, satellite lesions
    • avoid combination clotrimazole and betamethasone propionate (Lotrisone), labeling states the product should not be used for diaper dermatitis
  50. Raised, erythematous, and edematous
    Can be acute or chronic
    Often challenging to find etiology
    Sx range from itching to anaphylaxis
    Urticaria (hives)
  51. urticarial tx:
    • Avoid known triggers
    • Oral steroids
    • IM or IV steroids
    • Antihistamines
    • H2 blockers
  52. Multi – system disease
    Lesions can be varied, but symmetrical if there are many
    More common in Irish, Scandinavian, or African descendents
  53. Sarcoidosis derm tx:
    • Evaluation for systemic disease
    • Lesions are challenging to treat
    • Systemic steroids often useful
    • Plaquenil / Methotrexate
Card Set:
common derm problems- clin med
2013-06-28 00:02:36
derm problems clin med

derm problems- clin med
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