Dermatology - ulcers, burns, hair and nails

irregular

Venous ulcers typically have ___ borders

3 multiple choice options

Venous insufficiency

M/C cause of venous ulcers?

eczematous changes

Often venous ulcers will be accompanied by ___ around the border

medial

Venous ulcers are more likely to be on the ___ side of the calf

- treat underlying contrition = swelling

- leg elevation

- unna boots

- topical steroid for underlying stasis dermatitis

- occlusive dressings (moist environment + mupirocin)

- skin grafts if necessary

Tx of venous ulcer?

Arterial

Which of the ulcers is most painful?

Arterial ulcer

What is the diagnosis?

Venous ulcer

What is the diagnosis?

Venous ulcer

What is the diagnosis?

arterial ulcer

What is the diagnosis?

arterial ulcer

Symptoms of claudication are indicative of an ___

Arterial ulcer

Painful, sharply demarcated, and round ulcer

Venous ulcer

Which ulcer has granulation tissue?

- reperfusion

- vascular surgeon

- wound care similar to venous ulcer

Tx of arterial ulcer?

Neuropathic

___ ulcers favor the soles of the feet

Neuropathic

___ ulcers are surrounded by thick caluses

secondary infection

Neuropathic ulcers are prone to ___

- protect ulcer from pressure with brace

- moist environment in dressing

- order imaging if concern for osteomylitis

Tx of neuropathic ulcer?

Decubitus

Which type of ulcer is most common in non-ambulatory patients?

- frequent rotation

- keep clean and dry, barrier creams

- debride necrotic tissue

- negative pressure bandage

- skin graft if necessary

Tx for decubitus ulcers?

Neuropathic ulcer

What is the diagnosis?

Decubitus ulcer

What is the diagnosis?

Decubitus ulcer

What is the diagnosis?

Neurogenic ulcer

What is the diagnosis?

Pyoderma gangrenosum

Auto-inflammatory ulcerative process that begins as a small pustule/nodule and rapidly breaks down

Pyoderma gangrenosum

Which of the diagnoses is a neutrophilic dermatitis?

3 multiple choice options

Pyoderma gangrenosum

Which skin disease is associated with IBD, RA and malignancy?

Pyoderma gangrenosum

Which disease has characteristic violaceous undermined borders?

- topical/intralesional steroid injections

- oral steroids

- cyclosporine

- adalimumab, infliximab

Tx of pyoderma gangrenosum?

Partial thickness (2nd)

Which type of burn has blisters?

Presence of hair

Difference b/w superficial partial thickness and deep partial thickness?

Full

___ thickness burns are typically not painful due to loss of nerve endings

- ABC

- smoke inhalation

- fluid resuscitation

- high voltage burn = cardiac monitoring

- look out for compartment syndrome

- local wound care (antimicrobials)

- debridement, escharotomy, fasciotomy, skin grafts

Tx of burns?

anagen

Longest stage of hair growth?

- sudden vs gradual

- focal vs diffuse

- non-scarring vs scaring

Categories of hair loss to differentiate

Alopecia areata

What is the diagnosis?

Alopecia areata

What is the diagnosis?

Ophiasis

What pattern of hair loss is this?

3 multiple choice options

autoimmune - lymphocytes attack hair follicles

Etiology of alopecia areata?

Alopecia areata

Exclamation point hairs are indicative of

Thyroid

Which disorders are commonly associate with alopecia areata?

6 months

Alopecia areata usually resolves on its own in ___

- topical steroids +/- minoxidil

- intralesional kenalog (4-6 wks)

Tx for alopecia areata

totalis

Alopecia ___ is hair loss on entire scalp

3 multiple choice options

universalis

Alopecia ___ is hair loss on the entire body

- poor prognosis

- PUVA

- methotrexate

- prednisone

- topical steroids + minoxidil

- JAK inhibitors

Tx of alopecia totalis/universalis

Tinea capitis

fungal infection of the scalp

Tinea capitis

___ is associated with cervical and occipital lymphadenopathy

Black dot presentation of tinea capitis

What is the diagnosis?

Gray patch presentation of tinea capitis

What is the diagnosis?

Tinea capitis

What is the diagnosis?

Kerion

A ___ is a form of inflammatory tinea capitis with a boggy mass and broken hair follicles

- ORAL

- griseofulvin

- terbinafine

- alt. fluconazole or itraconazole

Tx for tinea capitis?

faster cycling of the hair

Telogen effulvium is caused by a stressful event that leads to ___

Telogen effulvium

Widening part and a positive hair pull test indicates

iron deficiency

___ is the most common cause of treatable hair shedding

genetic predisposition and action of androgens

Which two factors cause androgenic alopecia?

weeks to months

DHT shortens the hair cycle from 2-6 years to ___

- topical minoxidil

- men = finasteride

- women = spironolactone or cyproterone acetate

- oral minoxidil (hair growth everywhere)

Androgenetic alopecia tx?

Androgenic alopecia

What is the diagnosis?

Traction

___ alopecia causes hair loss around the hair line and a (+) fringe sign

Traction alopecia

What is the diagnosis?

Tricotillomania

___ can be differentiated from alopecia based on differing hair lengths within a bald patch

Trichotillomania

What is the diagnosis?

- psych eval

- clomipramine

- SSRI

- N-acetylcysteine

Tx of trichotillomania?

hair loss

Alopecia with inflammation and scarring causes permanent ___

scarring alopecia

A shiny scalp in a bald spot is indicative of ___

Discoid lupus

Oval areas of scarring alopecia with white atrophic center?

Discoid lupus

What is the diagnosis?

Discoid lupus

What is the diagnosis?

- biopsy

- CBC

- ANA

- Urinalysis

diagnosing discoid lupus requires:

- topical/intralesional steroids

- hydroxychloroquine

Tx of discoid lupus?

patients of color

Central centrifugal cicatricial alopecia is more common in ___

Central centrifugal cicatricial alopecia

Scalp symptoms including itching, burning, and tenderness

genetic predisposition

Central centrifugal cicatricial alopecia is caused by ___

Central centrifugal cicatricial alopecia

What is the diagnosis?

- prevention of further hair loss

- topical and intralesional steroid injections

- tetracyclines (anti-inflammatory properties)

- minoxidil

Tx of Central centrifugal cicatricial alopecia?

Onychorrhexis and melanoychia striata

What are the normal changes associated with the nail?

Dry brittle nails

What is onychorrhexis?

multiple fingers

Melanonychia striata should be present on ___ or it could be melanoma

Fungal

Onychomycosis is a ___ infection of the tails (most commonly toe nails)

Mealnoychia striata

What is the diagnosis?

Onychorrhexis

What is the diagnosis?

Onychomycosis

What is the diagnosis?

Onychomyosis

What is the diagnosis?

- KOH and PAS

- fungal culture for specific fungus

Dx of onychomycosis?

- oral terbinafine (6 wks fingers, 12 wks toes)

- oral itraconazole (pulsed doses)

- topical antifungals prophylactically

Tx of onychomycosis?

50

up to ___% of patients with psoriasis have nail involvement

pitting and oil stains

What are two characteristics of psoriatic nails?

Psoriatic nails

What is the diagnosis?

Psoriatic nails

What is the diagnosis?

bacteria (usually staph)

Acute paronychia is caused by ___

fungal (candida)

Chronić paronychia is a ___ issue

Wet work, finger sucking, manicures

Risk factors for chronic paronychia?

Acute bacterial paronychia

What is the diagnosis?

Chronic paronychia

What is the diagnosis?

- cephalexin

- erythromycin

- dicloxacillin

Acute paronychia tx?

- avoid trauma and water

- lotrisone

Chronic paronychia tx?

Ingrown toenail

Lateral portion of nail plate grows into the lateral nail fold causing inflammation

- nail trimming

- topical antiseptics

- severe cases: avulsion with matrix destruction

Tx for ingrown toenail?