Massapequa Dermatology Training Manual

What are the six main responsibility areas in the MA training manual?

General dermatological knowledge; daily tasks; weekly tasks; monthly tasks; MIPS; triage and exam.

What does morphology mean in dermatology?

The study of the form of lesions.

What is a macule?

A flat skin discoloration with defined borders and no elevation or depression.

What is a papule?

An elevated solid lesion typically smaller than 1 cm in diameter.

What is a plaque?

A raised, flat-topped lesion larger than 1 cm.

What is a patch?

A larger macule: flat skin discoloration with defined borders larger than 1 cm.

What is a nodule?

An elevated solid lesion larger than 1 cm; a larger and deeper papule.

What is a wheal?

A firm, swollen plaque that comes and goes and is itchy; a hive.

What is a vesicle?

A papule containing clear fluid; a blister.

What is a bulla?

A localized fluid collection larger than 0.5 cm; a large vesicle.

What must every lesion description include?

A morphology. If the provider has not stated it, ask. Never assume the default is correct or guess.

What is acne, according to the manual?

Oil glands overproduce sebum, leading to abnormal keratinization and blockage, causing redness, swelling and pus (pimples).

What causes acne according to the manual?

Hormonal changes and stress.

What treatments for acne are listed?

Oral antibiotics; topical retinoids; topical antibiotics; cosmetic procedures; phototherapy; isotretinoin; topical or oral hormonal therapies.

What is isotretinoin used for and how long is the course described as?

A systemic acne therapy taken over 5–6 months; it dries oil glands so they stop producing sebum.

Which isotretinoin brand names are listed?

Absorica, Accutane, Zenatane and Claravis.

What are actinic keratoses?

Spots on skin that has undergone prolonged sun exposure. They are not skin cancers but can develop into skin cancer, typically squamous cell carcinoma.

What treatments for actinic keratoses are listed?

Topical 5-fluorouracil cream, imiquimod, Klisyri; liquid nitrogen; photodynamic therapy using red or blue light.

What is alopecia areata?

Sudden, round, patchy hair loss; autoimmune.

What treatments for alopecia areata are listed?

Cortisone injections; oral or topical minoxidil; JAK inhibitors; vitamins such as Viviscal and biotin; PRP treatments.

What is atopic dermatitis commonly called?

Eczema; a chronic, recurring, red condition.

What causes atopic dermatitis according to the manual?

An overactive immune system and genetic susceptibility, presenting as a chronic red, scaly rash.

What treatments for atopic dermatitis are listed?

Topical corticosteroids, moisturizers, biologics, oral JAK inhibitors, Opzelura, Zoryve, Vtama, tacrolimus and pimecrolimus.

What can trigger atopic dermatitis flares?

Cold or hot weather, frequent handwashing and similar triggers.

What is bullous pemphigoid?

A skin condition that typically starts with an itchy rash that eventually becomes large, dense, fluid-filled blisters.

What causes bullous pemphigoid according to the manual?

Aging and autoimmune disorder.

What treatments for bullous pemphigoid are listed?

Topical corticosteroids, oral steroids, methotrexate, cyclosporine, Cellcept and Dupixent.

What is a cyst?

A sac-like growth.

What treatments for cysts are listed?

Excision, Kenalog injections, incision and drainage (I&D), and oral antibiotics.

What is herpes simplex (HSV)?

A viral infection that causes blisters and cold sores.

Where does HSV type 1 typically present?

Around the mouth as cold sores.

Where does HSV type 2 typically present?

In the genital area, according to the manual.

How does HSV spread according to the manual?

By direct contact.

What treatments for HSV are listed?

Antiviral medications such as acyclovir and valacyclovir.

What HSV prevention methods are listed?

Acyclovir, valacyclovir, Famvir and sunlight protection.

What causes herpes zoster (shingles) and how does it present?

Reactivation of the chickenpox virus, typically causing a one-sided painful rash or blisters.

What treatment for shingles is listed?

Antiviral medications such as acyclovir and valacyclovir.

What prevention for shingles is listed?

Vaccination helps reduce the viral load that may be experienced.

What is hidradenitis suppurativa?

Painful boil-like lumps or nodules deep under the skin, typically in the axillae or groin.

What causes of hidradenitis suppurativa are listed?

Genetics, skin friction (related to weight), hormones and smoking.

What treatments for hidradenitis suppurativa are listed?

Topical antibiotics, oral antibiotics, Humira, Cosentyx, Bimzelx and JAK inhibitors.

What is hyperhidrosis?

Excessive sweating.

What causes of hyperhidrosis are listed?

Hormonal changes, stress, anxiety or idiopathic causes.

What treatments for hyperhidrosis are listed?

Glycopyrrolate, Botox injections, Qbrexza wipes, Drysol and Sofdra.

What is impetigo?

A contagious skin infection that forms round, crusted, yellow, oozing spots.

What causes impetigo?

Staph or strep bacteria.

What treatment for impetigo is listed?

Oral antibiotics combined with topical antibiotics.

What are keloids?

Enlarged scar tissue; more common in darker skin tones.

What cause of keloids is listed?

Unknown.

What treatments for keloids are listed, and what caution is noted?

Cortisone injections and surgical excision; excision may cause more keloids.

What is molluscum contagiosum?

A contagious virus that causes small skin growths and scars; it resolves spontaneously.

What treatments for molluscum contagiosum are listed?

Liquid nitrogen, YCANTH, topical retinoids, tretinoin and Zelsuvmi.

What is pityriasis rosea?

A common, non-contagious, harmless skin disease.

What causes and treatments for pityriasis rosea are listed?

Cause is unknown. Treatments include UVB and topical steroids; it typically resolves on its own.

What is purpura?

Purple or reddish-purple discolored spots on the skin.

What causes of purpura are listed?

Small blood vessels break and bleed under the skin due to physical injury or infection, age, medications or blood disorders.

How is purpura treated?

Treatment differs based on the cause.

What is psoriasis?

An overactive immune system causes well-demarcated red, scaly plaques; it can be associated with arthritis.

What causes of psoriasis are listed?

Genetics and medications.

What treatments for psoriasis are listed?

Corticosteroids, moisturizers, phototherapy (UVB/PUVA), Excimer laser, biologic therapy, Kenalog injections and JAK inhibitors.

What MIPS-related items are associated with psoriasis in the general knowledge section?

Biologics and TB screening.

What does BSA mean and measure?

Body Surface Area; the percentage of the body affected.

What does PGA mean and measure?

Provider Global Assessment; disease severity based on the provider’s assessment, such as clear, mild, moderate or severe.

What does PEST stand for and what is it for?

Psoriasis Epidemiology Screening Tool; five questions to help evaluate whether the patient may have psoriatic arthritis.

What does NRS mean for psoriasis and what is the scale?

Itch Numeric Rating Scale; ask how itchy the patient is from 0 (no itch) to 10 (extremely itchy).

What must be entered for a psoriasis patient reporting no itch?

Enter NRS 0; do not leave the field blank.

How often should PEST be completed for psoriasis patients, and when does that stop?

At every visit until the score is positive (3/5), even if the patient uses only topical steroids. Once positive, add it to Historical Summary with the date it first became positive.

What is DLQI?

Dermatology Life Quality Index; a self-assessment questionnaire given to psoriasis patients to measure the impact on quality of life.

What psoriasis measurements are required at every visit according to the general knowledge section?

BSA, PGA, PEST as applicable per the instructions, NRS and DLQI; the manual also discusses PASI as a required measure for quality care, insurance and prescription coverage.

Does the manual define PASI in its general dermatology section?

No. It names Psoriasis Area and Severity Index (PASI) as a measure that must be documented, but does not define how it is calculated.

Does the manual define POEM in its finalization checklist?

No. POEM is listed among impression assessment details to review, but the manual does not define the acronym.

Does the manual include the referenced separate list of biologic therapies?

The psoriasis section says “biologic therapy (see list),” but no separate biologic list is included in the provided manual text.

What is psoriatic arthritis?

A chronic inflammatory disease affecting both skin and joints, closely related to psoriasis.

What treatments for psoriatic arthritis are listed?

Anti-inflammatories, steroids, immunosuppressants, biologics and JAK inhibitors.

What is rosacea?

Facial redness with mild itching or burning; sometimes presents as papules or pustules.

What triggers for rosacea are listed?

Alcohol, stress, spicy foods and sunlight exposure.

What treatments for rosacea are listed?

Oral antibiotics, topical or sulfa medications, avoiding triggers, Rhofade, ivermectin, metronidazole and azelaic acid.

What is scabies?

An intensely itchy, extremely contagious rash that typically presents in skin folds.

What causes scabies and what makes the skin itchy?

A tiny mite burrows into and multiplies in the skin; its feces cause itching.

What treatment for scabies is listed?

Topical mite-killing medication combined with oral mite-killing medication.

What are seborrheic keratoses?

Common benign skin growths that should not become cancerous or malignant; they may become inflamed and then be treated.

What causes and treatments for seborrheic keratoses are listed?

Causes: age and genetics. Treatments: liquid nitrogen and shave removal.

What is seborrheic dermatitis?

A common scaly rash on the face, chest or scalp that is sometimes itchy; on the scalp it is called dandruff.

What causes of seborrheic dermatitis are listed?

Stress, physical illness and yeast.

What treatments for seborrheic dermatitis are listed?

Medicated shampoos, sulfa products and washing more often.

What causes skin cancer according to the manual?

UV damage to skin cells.

What is basal cell carcinoma (BCC) according to the manual?

The most common form of skin cancer; described in the manual as nearly 100% curative.

What is squamous cell carcinoma (SCC) according to the manual?

A skin cancer that can become locally destructive.

What is melanoma (MM) according to the manual?

The most dangerous form of skin cancer; highly invasive and able to spread, caused by sun damage or genetics, and may lead to death if untreated.

What skin cancer treatments are listed?

Topical fluorouracil for superficial BCC/SCC; electrodessication and cautery (EDC) for BCC and SCC only; surgical excision; Mohs surgery; radiation; Erivedge.

What are skin tags and what cause is listed?

Small growths on the skin surface that look like bits of skin; cause listed is genetic.

What treatments for skin tags are listed?

Liquid nitrogen, removal with surgical scissors and electrocautery.

What is tinea pedis (athlete’s foot)?

A fungal infection of the skin.

How does tinea pedis spread and how is it treated according to the manual?

Cause: direct contact with the fungus. Treatments: topical or oral antifungals.

What is tinea versicolor?

Yeast overgrowth on the skin.

What cause and treatments for tinea versicolor are listed?

Cause listed: direct contact with fungus. Treatments: topical antifungal creams, foams and shampoos, and oral antifungals.

What are warts (verruca vulgaris)?

Contagious skin growths that are typically harmless depending on location; genital-area HPV can be called condyloma.

What causes and treatments for warts are listed?

Cause: virus. Treatments: liquid nitrogen, candida, bleomycin, biopsy and EDC.

What does QD mean?

Once a day.

What does QHS mean?

Once a day at night.