Dermatology pt2

The itch that rashes

atopic dermatitis (eczema)

Atopic dermatitis is associated with skin barrier dysfunction leading to

Dehydration and IgE reactivity

Diagnostic criteria for atopic dermitis

Pruritus

Onset in childhood

What is a baseline treatment for eczema

Emollients (Cerave, Vaseline)

Treatment for mile AD

Topical pimecrolimus or tacrolimus

Treatment of severe AD flares

Topical glucocorticoids (trimcinolone 0.1)

Steroid ointment

Most potent, most occlusive

Which class of steroids is super potent

Class 1

What should be avoided in AD?

Systemic glucocorticoids

Most common spot for irritant contact dermatitis

Hands

Allergic contact dermatitis is involvement

Beyond contact area

Example of irritant contact dermitis

Soaps

example of allergic contact dermatitis

poison ivy

After removing the causative agent and apply wet dressings, what treatment can be given for contact dermitis

Topical glucocorticoids

In severe cases of contact dermatitis, what oral steroid is given daily, tapering off 2-3 wks

Prednisone (60mg)

What is used to validate a diagnosis of allergic contact sensistization and to ID the causative agent

Patch test

Four Ps of lichen planus

Pruritic

Purple

Polygonal

Paplules or plaques

What are the fine white streaks in the papules of lichen planus called

Wickham striae

Cardinal findings of lichen planus

Mucosal lesions

Lymphocytes in upper dermis

What phenomenon commonly occurs in lichen planus

Koebner

Explain the Koebner phenomenon

Appearance of lesions in areas of trauma such as scratching

What is the associated risk of lichen planus

Squamous cell carcinoma (oral and genital 5% of patients)

Treatment for lichen planus

-lesions resolve in 1-2 years

-localized and systemic treatments

Localized treatment for lichen planus

High potency topical steroids

Oral and vaginal: topical tacrolimus

Systemic treatment for LP

PUVA photochemotherapy + oral retinoid

What disorder stems from habitual rubbing and scratching

Lichen simplex chronicus

Signs of lichen simplex chronicus

Solid plaque of lichenification

Palpably thickened

Treatment for lichen simplex chronicus

Occlusive bandages

Topical glucocorticoids

Intralesional glucocorticoids

What is the presumed cause for the common, mild, acute inflammatory disease Pityriasis Rosea

Herpesvirus 7 & 6

What young adult is more likely to have Pityriasis Rosea?

Women

In the spring and fall

Clinical findings of Pityriasis Rosea

Herald patch

Oval salmon red or fawn color plaques

Christmas tree pattern

describe the herald patch of pityriasis rosea?

Initial lesion is larger than later lesions

What kind of scales is in Pityriasis Rosea

Collarette

-scale attached at the periphery, loose towards center of the lesion

Cause of psoriasis

Genetics and environmental triggers

What phenomenon is present in psoriasis

Koebner

Which -psoriasis is usually bilateral and symmetrical

Chronic stable (plaque)

Plaque psoriasis is sharply marginated, dull red plaques with loosely adherent

Silvery white scales

Common sites of plaque psoriasis

Elbows

Knees

Scalp

Palm/soles

Sacral gluteal

Describe the scales of acute guttate psoriasis

Salmon pink papules, 2mm to 1cm with or without scale

What can trigger acute guttate psoriasis?

Streptococcal infection

Acute guttate psoriasis usually present on

Trunk

Auspitz sign is present in acute guttate psoriasis, which is

Removal of scale results in appearance of minute blood droplets

Inverse psoriasis usually in

Warm moist environments and is bright red

What labs are ordered for psoriasis

Biopsy if needed to confirm

ANA usually +

What are the differentials for psoriasis?

Eczema

Lichen simplex chronicus

Seborrheic dermatitis

Treatment for localized psoriasis

High potency topical steroid +/- Vitamin D analog

What therapy is helpful in guttate psoriasis

Photo

What is recommended treatment for psoriasis on the face/genitals

Tacrolimus or pimecrolimus

Treatment of severe psoriasis

Narrowband UVB phototherapy three times weekly +/- crude coal tar application

Medications one preferred for severe psoriasis

IL23 and IL17 cytokines inhibitors: Stelara and Cosentyx

Otezla

When does Seborrheic dermitis occur

Where sebaceous glands are most active : face, scalp, body folds

Seborrheic dermatitis is associated with proliferation of

Malassezia furfur

Seborrheic dermatitis is more common in patients with

Parkinson's/immunosupression illness

Treatment of seborrheic dermatitis on the scalp

Shampoo containing selenium sulfide, zinc pyrite ions, 2% ketoconazole

Treatment for Seborrheic dermatitis on face and body

Ketaconazole 2% cream (or Clotrimazole 1% cream)

Add low potency glucocorticoid if not improving

Prognosis for Seborrheic dermatitis

Tendency for lifelong reoccurrences

Telangiectasias are ____

Blanchable

Cherry angiomas are

Asymptomatic, bright red to purple tiny papules

Age for cherry angiomas

Age 30

Prognosis if infantile hemangioma

Present few months after birth

Peak around 1 yr

Regress in childhood

Stabalized by 10 yrs

Diagnosis of infantile hemangioma

Clinical and MRI

Vascular bleeding < 2mm

Petechiae

Vascular bleeding 2-10 mm

Purpura

Vascular bleeding > 10mm

Eccymosis

Purpura simplex is increased bruising from vascular fragility that usually effects women, what are the risk factors

ASA or anticoagulant

Low body weight

Corticosteroid use

Senile purpura is characteristically on

Extensor hands and forearms

Skin findings in chronic venous insuffiency

Edema

Stasis dermatitis

Hyperpigmentation

Fibrosis of skin

Ulceration

What is the most chronic common wound in humans

Venous ulcers

What is heaviness/achiness of legs reported in

Chronic venous insuffuency

Management of CVI

Compression stockings (20-30 mmHg)

Management of stasis dermatitis

Topical steroids

Ulcer from CVI will not heal until

Edema is controlled and pressure is applied

Benign, autoimmune, pruritic disease characterized by tense blisters

Bullous pemphigoid

Age range for Bullous pemphigoid

>60 yrs

Clinical findings of Bullous pemphigoid

Tense blisters

Treatment for Bullous pemphigoid

Ultrapotent topical corticosteroid for mild cases but SYSTEMIC STEROIDS USUALLY NEEDED

What is orally given for Bullous Pemphigoid

Prednisone 1mg/kg daily

Patient with Bullous pemphigoid can't use corticosteroids so you give ___ instead

Doxycycline 100 mg twice daily

If mucous membranes are involved in Bullous pemphigoid, prescribe

Dapsone 50-200 mg daily

What disorder has lesions that appear first in the oral mucosa?

Pemphigus Vulgaris

In pemphigus vulgaris, skin lesions appear _____ months later

6-12

Nikolsky sign in pemphigus vulgaris

Positive

Treatment for pemphigus vulgaris

2 mg/kg body weight of Prednisone until cessation of new blister formation and disappearance of the Nikolsky sign

Immunosuppressive therapy

Treatment for melasma for cosmetic reasons

Hydroquinone 4% cream, Azelaic Acid20% cream

Treatment for localized vitiligo

Topical calcineurin inhibitors (tacrolimus or pimecrolimus)

Treatment for generalized vitiligo

Pulse therapy with oral steroids for three months

Narrowband UVB

Erythema Multiforme typically involves the

Palms and soles

Mucous membranes

Most cases of erythema multiforme are related to

HSV (mild)

Drug induced (severe)

Clinical presentation of erythema multiforme

Iris or target shaped

Treatment of erythema multiforme

Control of HSV using oral antiviral (valaciclovir) may prevent recurrent EM

Systemic steroids

Acute life threatening mucocutaneous reactions characterized by extensive necrosis and detachment of the epidermis

SJS TEN

<10% epidermal detachment

SJS

>30% epidermal detachment

TEN

Leading causative factor of SJS and TEN

Drug induced

What is one drug that is high risk of TEN?

Allopurinol

Clinical presentation of SJS/TEN

Resembles 2nd degree burn

+ Nikolsky sign

Prodrome

Lab findings of SJS/TEN

Acute renal failure may occur

Neutropenia = poor prognosis

Mortality for TEN and SJS

30%

5-12%

Management of SJS/TEN

ICU

IV fluid

Consult with all doctors

Treatment of urticaria

Antihistamines: H1 blockers is first line of defense