Derm cumulative

this is definitely too long srry

_____ blanches with pressure because the lesion is due to vascular dilatation.

erythema

Which is thinning of the skin due to loss of connective tissue, associated w/ hypopigmentation, and most commonly secondary to overuse of steroids?

dermal atrophy

Which is thinning of the skin that becomes transparent, reveals papillary and sub papillary vessels, loses skin texture, and is common in older patients w/ cigarette paper like wrinkling?

epidermal atrophy

what is an exudate that involves the entire epidermis and is accompanied by necrosis of deeper tissues?

ecthyma

Which is a superficial, focal loss of part of the epidermis where the basement membrane remains intact and heals without a scar?

erosion

which is a focal loss of epidermis extending into dermis or SC tissue, typically heals w/ a scar, and is associated with pathologic tissue?

ulceration

What is a plug of sebaceous and keratinous material w/in the opening of a hair follicle; may be dilated (blackhead) or narrowed (whitehead)?

comedone

What is a small, 1-2mm sub epidermal keratin cyst that arises from pilosebaceous units or eccrine sweat ducts?

milia

what is a circumscribed lesion with a wall and lumen that may contain liquid, solid, or semisolid material and may be superficial or deep?

cyst

Which are extensor surfaces?

elbow, knee

Which are flexor surfaces?

antecubital fossa, popliteal fossa

Dermatophytosis of a hair follicle will illuminate as _____ under a wood’s lamp.

yellow/green

Erythrasma will illuminate _____ under a wood’s lamp.

coral

Urine from a patient with porphyria will illuminate ____ under a wood’s lamp.

red/pink

______ will not blanch under pressure because it is an extravasation of blood.

purpura

What would multinucleate giant cells on a tzanck smear indicate?

herpes simplex or zoster

what would Henderson-patterson bodies on a tzanck smear indicate?

molluscum contagiosum

What is performed w/ colposcopy to detect subclinical HPV lesions?

acetowhitening (positive result = blanching/whitening of lesion)

The appearance of new skin lesions on previously unaffected skin secondary trauma is known as _______, and indicates psoriasis.

koebner phenomenon

Slight scratching or curetting of a scaly lesion that reveals punctate bleeding points is known as ______, and is seen in psoriasis.

auspitz sign

When the epidermis is dislodged from the dermis by shearing pressure with a finger, this is known as _____ and commonly associated w/ SSS or pemphigus vulgaris.

nikolsky phenomenon

Rubbing or scratching of skin affected by mastocytosis that results in redness, swelling, itching, and a palpable wheal is known as _____ and may indicate atopic dermatitis.

darier sign

What is the atopic triad?

atopic dermatitis, asthma, allergies

What is the strongest risk factor for atopic dermatitis?

FHx of atopic triad

What condition has the clinical presentation of pruritic, dry skin, the itch scratch cycle, lichenification and is most commonly on the flexor surfaces (expect in children under 2- extensor)?

atopic dermatitis

Diagnosis of atopic dermatitis?

• clinical based on H&P

• labs: CBC → eosinophilia

• skin bx: spongiosis

what is the treatment for mild to moderate atopic dermatitis?

• TCS and emollients

  • low potency (group 5/6- desonide, hydrocortisone)

• Alt: topical calcineurin inhibitors

  • tacrolimus or pimecrolimus

what is the treatment for moderate-severe atopic dermatitis?

• TCS

  • medium-high potency (group 3-5, triamcinolone, etc)

• systemic immunosuppressants

  • dupilumab/dupixent

• alt: narrowband UVB phototherapy 2-3x/wk

What is non-pharmacologic management of atopic dermatitis?

• oral antihistamine for pruritus

• lukewarm baths, wet dressings

• daily emollients and creams w/ ceramides

• avoid fragrances, wool clothing, chemicals, etc

• manage stress/anxiety

What condition?

• sebum-rich areas of scalp, face, trunk, intertriginous

• well demarcated, pruritic erythematous plaques w/ greasy appearing yellow scales

• ranges from scalp dandruff (pityriasis sicca) to widespread

• biphasic: infants 2-12 wks (cradle cap) and 4th decade

• unknown cause but has been linked to malassezia furfur colonization

seborrheic dermatitis

what is the treatment for seborrheic dermatitis?

• OTC scalp: selenium sulfide (selsun blue) or coal tar shampoo

• cradle cap: mineral oil or baby shampoo

• 1st line:

  • topical antifungals (ketoconazole 2%)

  • TCS low potency (alt- tacrolimus)

• severe/generalized: oral anti fungal (itraconazole)

What condition occurs when contact with a substance elicits a delayed type IV hypersensitivity reaction with a rash appearing w/in 48hrs?

allergic contact dermatitis

what is the treatment for allergic contact dermatitis?

• 1st line: TCS

• alt: tacrolimus

• if severe / involving >20% body: oral steroids, medrol dose pack

• 2nd line: UVA/UVB or immunomodulators (MTX, cyclosporine)

• calamine lotion and oatmeal baths may help pruritus

why should you NOT perform a patch test on an individual w/ poison oak/ivy dermatitis?

can sensitize the individual

Exposure to what substance causes poison ivy/oak dermatitis?

olioresin- urushiol

Which is ALWAYS sharply marginated and NEVER spreads?

irritant contact dermatitis

what is the treatment for stasis dermatitis?

• tx underlying → leg elevation, walking, exercise, weight reduction, compression socks

• emollients

• acute dz

  • TCS group 3-4 (long term use can cause ulceration)

what condition?

• intense pruritus

• tapioca like vesicles that may coalesce to form bullae

• lesions usually sterile

• affects palms, soles, lateral aspects of digits

dyshidrotic eczema

what is the treatment for dyshidrotic eczema?

• spontaneous remission occurs 2-3 wks

• mild-mod: high potency TCS

• severe: oral glucocorticoids

what condition?

• highly pruritic round, coin shaped lesions (grouped small papules/vesicles on erythematous base)

• excoriations/lichenification from scratching

• acute: exudative, crusting; over time dry, scaly, w/ central clearing

• M > F

• extremities > trunk

nummular / discoid dermatitis

what is the treatment for nummular eczema?

• 1st line: high potency TCS

• alt: PUVA/UVB

• severe/refractory: systemic immunosuppressants (MTX, cyclosporine, dupixent)

what is the most potent topical corticosteroid (TCS)?

class 1- clobetasol propionate, halobetasol propionate

what is the least potent topical corticosteroid (TCS)?

class 7- hydrocortisone

what condition?

• chronic inflammatory skin dz that involves hyperproliferation of keratinocytes in the epidermis

• peaks 30-39 and 50-69

• T lymphocytes, dendritic cells, cytokines play central roll; increased cell turnover

psoriasis

what subtype of psoriasis?

• erythematous plaques w. silver scales

• sharply defined well demarcated

• ± pruritus

• positive auspitz, koebner

• extensor surfaces, scalp, palms/soles (painful fissures)

chronic plaque psoriasis

what is the treatment for chronic plaque psoriasis?

limited:

• high potency (1-3) TCS and emollients ± UVB

• vit d analog- calcipotriene

• topical retinoids- tazarotene

mod/severe:

• phototherapy

• retinoids

• DMARDS- MTX, cyclosporine

• anti-TNF- infliximab (Remicade), adalimumab (Humira)

what subtype of psoriasis?

• abrupt onset multiple small psoriatic papules and scales w/ raindrop appearance

• may spontaneously remit

• trunk, back, proximal extremities

• children/young adult w/ recent strep infx

guttate psoriasis

what is the treatment for guttate psoriasis?

• 1st line: UV phototherapy

• alt: TCS and vit D analogs (not ideal due to widespread nature)

what subtype of psoriasis?

• caused by pregnancy, infx, stress, withdrawal of steroids

• acute onset of erythematous pustules, localized or generalized

• assoc w/ malaise, fever, diarrhea, leukocytosis, hypocalcemia

• can be life threatening

• Von zumbusch (most severe), acrodermatitis continue of hallopeau (distal digits), palmoplantar pustulosis variants

pustular psoriasis

What would labs look like in pustular psoriasis?

• elevated WBC

• inc ESR

• hypocalcemnia

• hypoalbuminemia

what is the treatment for pustular psoriasis?

mild: acitretin and MTX

severe/acute: cyclosporine, infliximab

which subtype of psoriasis?

• generalized erythema and exfoliation of ≥75% BSA

• painful, pruritic scales

• results from exacerbation of unstable plaque psoriasis

• assoc w/ fevers, chills, malaise, arthralgias, LAD

• leukocytosis w/ eosinophilia, anemia

erythrodermic psoriasis

what is the treatment for erythrodermic psoriasis?

• stable: outpt, supportive care

  • TCS

  • systemic- cyclosporine or infliximab

• unstable: admit ICU or inpt

  • fluid/elyte replacement

  • nutritional support

  • tx assoc infx

  • TCS and/or systemic immunomodulators

what manifestation of psoriasis?

• well demarcated, smooth, shiny plaque w/ absent or minimal scale

• often misdiagnosed as fungal or bacterial infx

• intertriginous areas, inguinal, perianal, etc

inverse / intertriginous psoriasis

what is the tx for intertriginous psoriasis?

• TCS class 6, 7

• topical vit D analog- calcitriol

• tacrolimus, pimecrolimus

what condition?

• pitting leukonychia, nail dystrophy, red spots on lunula and crumbling of nail plate; splinter hemorrhages

• subungual hyperkeratosis

• oil drop sign- changes in nailed to tan/brown

• common w/ psoriatic arthritis

nail psoriasis

what is the treatment for nail psoriasis?

high potency TCS (betamethasone) and topical vit D analog (calipotriol)

what are clinical features of psoriatic arthritis?

• joint pain, stiffness (morning), asymmetric back pain

• dactylitis (sausage digits), tenosynovitis

• nail involvement is common

• arthritis mutilans- destruction of IP joints; “pencil in cup” deformity

• asymmetric peripheral joint involvement of upper extremities; smaller joints

what is the treatment for psoriatic arthritis?

• mild axial dz → NSAIDS (naproxen, celecoxib)

• mod-severe axial dz → TNF inhibitors

  • 1st line: adalimumab (Humira)

  • etanercept, infliximab

• dactylitis: DMARDs (MTX + folic acid)

whitehead is _____, blackhead is _____

closed; open

acne vulgaris diagnosis?

• comedones- required

• labs- required if prescribing isotretinoin

  • LFTs, lipid panel, beta HCG

what is the treatment for mild acne vulgaris (few scattered comedones or small inflammatory papules w/o scarring)?

• topical monotherapy of

  • benzoyl peroxide

  • tretinoin (Retin A)

  • salicylic acid

  • azelaic acid

• resistant → topical dapsone (**Don’t apply w/ benzoyl peroxide)

what is the treatment for moderate acne (prominent comedones, large inflammatory pustules/papules)?

• topical combo:

  • benzoyl peroxide + tretinoin + topical abx (erythromycin/clindamycin)

• topical/oral combo:

  • benzoyl peroxide + tretinoin + oral abx (doxy, minocycline)

• alt: intralesional triamcinolone (kenalog)

what is the treatment for severe acne (addition of nodules w/ scarring affecting multiple areas)?

• oral abx + topical retinoid + benzoyl peroxide +/- topical abx

• if refractory → oral isotretinoin (accutane)

what condition?

• inflammatory acneiform disorder of facial pilosebaceous units

• facial flushing

• papules/pustules localized to central face

• telangiectasias

• no comedones

• + /- burning, phymatous changes (tissue hypertrophy, nodules), ocular manifestations

rosacea

what is the treatment for rosacea?

• mild-mod:

  • topical abx- metronidazole gel

  • alt: azelaic acid gel

  • oral abx: tetracyclines (DO NOT use w/ isotretinoin- risk pseudo tumor cerebri)

• refractory: oral isotretinoin

• non pharm: pulse dye laser

what condition?

• discrete erythematous micropapules and microvesicles around mouth/nose/eyes

• no comedones

• assoc w/ atopy

• spares narrow area around vermillion border

• risk: F, age 16-45, TCS use

perioral dermatitis

what is the treatment for perioral dermatitis?

• non pharm: stop/taper TCS usage; gentle cleanser

• pharm:

  • topical erythromycin/clindamycin, metronidazole gel

  • tacrolimus

  • mod-severe: oral tetracyclines

what condition?

• recurrent inflamed, painful nodules/abscesses

• malodorous draining sinus tracts/fistulas

• follicular occlusion

• progressive severe scars

• open comadones

• intertriginous areas

• uses Hurley staging

hidradenitis suppurativa

what is the treatment for hidradenitis suppurativa?

that’s a lot to type lol

what is the most common type of cutaneous cyst that may result from trauma of follicular epithelium or comedones?

epidermoid cyst / epidermal inclusion cyst

what condition?

• skin colored benign dermal nodule often w/ visible central punctum

• cyst wall made of normal stratified squamous epithelium

• nontender, freely moveable

• filled w/ thick malodorous keratin material

epidermal inclusion cyst

what is the treatment for milia?

asx- no tx necessary

neonatal- will spontaneously resolve

definitive tx- incision and expression of contents

what condition?

• derived from root sheath of hair follicle

• firm, slow growing SC nodule filled w/ keratin

• lacks central punctum

• not connected to epidermis

• can be painful

pilar / trichilemmal cyst

what condition?

• translucent papule on dorsum of digit bt DIP and proximal nail fold

• no capsule (pseudocyst)

• caused by degeneration of connective tissue and/or joint fluid leaking from osteoarthritic DIP joint

• mc > 60

digital myxoid cyst

what is the treatment for a digital myxoid cyst?

• surgical excision; I&D

• injection of sclerosis agent or triamcinolone

• recurrence is high

what condition?

• painful, fluctuant mass in sacrococcygeal region

• pain and purulent dc from sinus tract

• person bends → damages hair follicle & opens pore/pit → collects debris, hair embeds → constant friction leads to sinus → infection & abscess develops

pilonidal cyst

what are risk factors for pilonidal cyst?

• age 15-30

• obesity

• sedentary lifestyle

• trauma/irritation

• deep natal cleft

• family hx

what is the tx for pilonidal cyst?

surgery

acute: I&D and curettage

chronic: excision w/ primary closure vs secondary closure or marsupialization

what condition?

• asx, well circumscribed pigmented macule/papule/nodule

• begin to appear after first 6 mos of life, can disappear w/ age

• can itch w/ growth; can appear anywhere

acquired melanocytes nevi (mole)

what condition?

• precursor of malignant melanoma

• benign AMN w/ asymmetric irregular borders,

• variegated colors- pink, tan, brown

• diameter > 5mm

• macular component w/ papular center → fried egg appearance

atypical / dysplastic nevi

what is the rule of thumb for referring an atypical nevi to derm?

asymmetry + > 6 mm + irregular borders + abnormal color

what condition?

• melanocytic nevus surrounded by round/oval usually symmetric halo of depigmentation

• common on back and trunk

• occurs in 4 stages

• common in children and young adults w/ FHx vitiligo

halo melanocytic nevus / Sutton’s nevus

what condition?

• <1 cm firm, blue-black sharply defined papule or nodule

• benign proliferation of dendritic dermal melanocytes that actively produce melanin

• arise in adolescence

• found on dorsal hands and feet

• benign and can be observed

common blue nevi

what condition?

• > 1cm congenital or acquired elevated blue-black nodule or plaque

• benign proliferation of dendritic dermal melanocytes that actively produce melanin

• smooth or slightly irregular surface

• found on scalp, buttocks, sacrum, face

• can transform into melanoma, should be excised

cellular blue nevi

what condition?

• uncommon melanocytic lesion of large epithelioid or spindled cells

• rapid initial growth phase

• dome shaped, red-brown or tan-brown papule/nodule

• symmetric and sharply circumscribed

• face, extremities

• MC in children, adolescents, young adults

spitz nevus

what lesion has this appearance under a dermatoscope?

• starburst / globular pattern of pigment

• prominent punctate or rounded blood vessels

• regularly distributed dottiest vascular pattern

spitz nevus

what condition?

• common cutaneous hamartoma w/ epidermal or dermal elements

• overgrowth of epidermis, melanocytes, and hair follicles

• well-defined unilateral brown patch w/ sharply demarcated borders

• macular w/ papular/verrucous surface

• hypertrichosis in 50%

• tx: laser therapy (q switch, pulse dye, fractional resurfacing)

Becker nevus

what condition?

• benign vascular tumor of skin/mucus membranes

• small, red papule that grows rapidly over wks-mos → pedunculated/sessil

• friable + bleeds easily

• + /- collared scale at base

• peaks in 6-10 y/o and 2-3rd decades

• adults: trunk+extremities

• children: head+neck

• M > F

pyogenic granuloma (aka lobular capillary hemangioma)

what lesion has this appearance under a dermatoscope?

pink, homogenous papule w/ white septa

pyogenic granuloma

what is the treatment for pyogenic granulomas?

• topical: imiquimod cream or timolol gel

• procedural: elliptical excision w/ cautery, cryotherapy, pulse dye laser, CO2 laser

what is the most common vascular tumor characterized by proliferative phase (3-9 mos rapid growth) and involution phase (2-6 yrs regresses and resolves)?

infantile hemangioma

what condition?

• superficial type: soft bright red papule or nodule

• deep type: not visible to naked eye, may case proptosis, strabismus, dec VA if compressing optic nerve

• mixed: combo of superficial and deep

• located head and neck

• risk: infants, low birth wt, advanced maternal age, placenta previa

Infantile Hemangioma

what is the treatment for infantile hemangiomas?

• 1st line:

  • uncomplicated lesion: topical timolol gel

  • complicated: oral propranolol

• 2nd line:

  • pulsed dye laser

  • excisional surgery

what condition?

• dome shaped 1-4 mm red/purple/blue/black papule

• can bleed w/ trauma

• located on trunk

• MC in middle age-older pts

cherry angioma / campbell de morgan spots

what lesion appears as red, purple, blue, or black lagoons under a dermatoscope?

cherry angioma

what are treatment options for cherry angiomas?

electrocautery, laser, shave excision, cryotherapy

what condition?

• irregularly shaped, painless red or violaceous patches that are present at birth and never disappear spontaneously

• congenital low flow vascular malformation

• blanchable

• follows CN V and does not cross midline

• assoc w/ sturge weber, klippel-trenaunay, CLOVES

• treated w/ pulse dye laser

port wine stain

what lesion has this appearance under dermatoscope?

• radiating telangiectasias

• blanch

• central arteriole may pulsate

spider angioma

what lesion is an acquired vascular malformation of anomalous dilatation caused by failure of muscles involved in arteriole vasoconstriction? appear as:

• central red papule w/ fine red lines that extend radially

• face, forearms, hands

• children, pregnancy, OCPs, cirrhosis

spider angionma / naevus / telangiectasia