Skin Disorders

What is pruritus the most common symptom of?

Patients with dermatologic disorders.

What are the manifestations of pruritus?

Generalized itching; perineal/perianal itching may be from fecal particles, scratching, moisture, corticosteroid/antibiotic therapy, hemorrhoids, fungal/yeast infections, pinworm, or no cause.

What systemic disorders are associated with generalized pruritus?

Allergic reactions, immune disorders, liver disease, kidney disease.

What should be included in assessment of pruritus?

Evaluate skin, bathing/hygiene habits, medications/home remedies, inspect perineal area, determine triggers (heat, alcohol, caffeine, irritants, clothing).

How is pruritus managed?

Reinforce therapeutic regimen, educate on self-care (tepid baths, gentle drying, lubrication, avoid heat/alcohol/hot foods, avoid bubble baths/detergent soaps, wear cotton/natural fabrics).

What medications are used for pruritus?

Menthol creams, zinc oxide calamine, anti-itch creams (crotamiton, capsaicin), mild steroid ointments (hydrocortisone), antihistamines, lightweight lotions.

What is recommended perineal/perianal care for pruritus?

Rinse with lukewarm water, blot dry, use premoistened tissues, maintain fiber intake.

What is dermatitis?

Inflammation/irritation of skin, noncontagious.

What are risk factors for dermatitis?

Contact with allergens, stress, family history/genetics, sometimes unknown.

What are the signs and symptoms of dermatitis?

Itchy, painful skin; dry, cracked, or scaly skin; rash with swelling and color variation; blisters that may ooze or crust.

What are the three types of dermatitis?

Nonspecific eczematous (dry/moist, itchy, bilateral), contact (site-specific inflammation, acute vs chronic changes), atopic (chronic allergic, red papules, lichenification, common on hands, elbows, knees, face, neck).

What is assessed in contact dermatitis?

History (onset, exposures), physical exam (location, distribution), patch testing, environmental exposure.

What is assessed in atopic dermatitis?

History (triggers, atopic conditions), physical exam (lesion morphology/distribution), labs/biopsy if needed.

How is dermatitis managed?

Identify/avoid cause, prevent scratching, use fragrance-free products, wash skin after irritants, cool compresses, oatmeal baths.

What specific management is used for contact dermatitis?

Avoid irritant, acute cool compresses (Burow solution), topical/systemic corticosteroids, oral antihistamines, hydrophilic cream, antibiotics if infected.

What specific management is used for atopic dermatitis?

Avoid triggers, hydrate skin with emollients, topical corticosteroids, topical calcineurin inhibitors, short systemic steroids, dupilumab, antibiotics for infection, antihistamines for itching.

What medications are used for dermatitis?

Steroids (hydrocortisone, betamethasone, prednisone), antihistamines (diphenhydramine), topical immunosuppressants (tacrolimus).

What causes impetigo?

Staphylococcus aureus, Streptococcus pyogenes, MRSA.

What are manifestations of impetigo?

Small red macules → vesicles → honey-yellow crusts, usually on face, hands, neck, extremities; contagious.

How is impetigo assessed?

History of skin trauma/hygiene, physical exam of lesions.

How is impetigo managed?

Topical antibiotics (mupirocin, retapamulin), systemic antibiotics if widespread, wash/soak lesions, monitor complications.

What patient education is given for impetigo?

Bathe daily with bactericidal soap, hand hygiene, separate towels/washcloths, avoid contact until healed.

What causes folliculitis, furuncles, carbuncles?

Staphylococcus aureus.

What are manifestations?

Folliculitis = pustules at follicles; furuncle = deep boil, painful/tender; carbuncle = multiple furuncles, systemic symptoms possible.

How are they assessed?

Exam lesions, risk factors (shaving, clothing, diabetes, immunocompromise).

How are they managed?

Warm compresses, systemic antibiotics (based on culture, MRSA coverage), incision/drainage if needed.

What education is given for furuncles/carbuncles?

Maintain hygiene, avoid squeezing, wash linens, seek care for facial boils.

What causes herpes zoster?

Reactivation of varicella-zoster virus.

What are manifestations of herpes zoster?

Preeruptive pain/itching, acute unilateral vesicular rash with pain, postherpetic neuralgia, ophthalmic involvement.

How is herpes zoster assessed?

History of chickenpox, exam of dermatomal rash.

How is herpes zoster managed?

Antivirals (acyclovir, valacyclovir, famciclovir), pain meds, pregabalin/gabapentin for neuralgia, ophthalmology referral if ocular.

What patient education is given for herpes zoster?

Take antivirals as prescribed, hygiene, calamine/Burow's for comfort, rest.

What causes herpes simplex?

HSV-1 (oral), HSV-2 (genital).

What are manifestations of herpes simplex?

Painful vesicles, erythema, ulcers, recurrent outbreaks.

How is it assessed?

History of outbreaks, lesion exam.

How is it managed?

Antivirals (acyclovir, valacyclovir, famciclovir).

What education is given for herpes simplex?

Avoid direct contact, good hygiene, medication adherence.

What causes fungal infections of skin?

Dermatophytes (Trichophyton, Microsporum, Epidermophyton).

What are common types of tinea?

Pedis (athlete's foot), corporis (ringworm), capitis (scalp), cruris (jock itch), unguium (nails).

How are fungal infections assessed?

Inspect lesions, KOH prep, culture if needed.

How are fungal infections managed?

Topical antifungals (clotrimazole, terbinafine, ketoconazole); oral antifungals for severe/nail/scalp infections.

What patient education is given for fungal infections?

Keep area clean/dry, don't share items, complete meds, wear breathable clothing.

What is pediculosis?

Infestation by lice.

What are the types of pediculosis?

Capitis (head), corporis (body), pubis (crabs).

What is scabies?

Infestation by mite Sarcoptes scabiei.

What are manifestations of scabies?

Intense itching (worse at night), burrows, vesicles/papules, crusts, crusted scabies in elderly.

How are pediculosis and scabies assessed?

Look for nits/lice/burrows, secondary infection, microscopic scraping.

How are they managed?

Permethrin or pyrethrin shampoos/lotions, treat all contacts, wash clothing/bedding hot, antibiotics if secondary infection, symptomatic antihistamines/corticosteroids.

What patient education is given for lice/scabies?

Not a sign of poor hygiene, avoid sharing items, treat all contacts, wash/disinfect fabrics, avoid repeat scabicide.

What is psoriasis?

Chronic autoimmune inflammatory skin disease with rapid keratinocyte turnover.

What are risk factors for psoriasis?

Obesity, lithium, beta-blockers, hormones, infections, stress, trauma, cold weather.

What are common sites of psoriasis?

Elbows, knees, scalp, sacrum, extremities, joints.

What are manifestations of psoriasis?

Red plaques with silvery scales, Auspitz sign, nail pitting, arthritis, emotional distress.

How is psoriasis classified by BSA?

Mild <5%, moderate 5-10%, severe >10%.

How is psoriasis managed?

Topicals (steroids, vitamin D analogs, retinoids, tar), phototherapy, systemic (methotrexate, cyclosporine, biologics), adjunctive emollients.

What education is given for psoriasis?

Maintain skin care, avoid scratching, warm water baths, moisturize, know triggers, adhere to therapy, support groups.

What are blistering diseases caused by?

Autoimmune IgG/IgA reactions, infections, burns, contact reactions.

What is the pathophysiology of blistering diseases?

Autoantibodies attack skin antigens → epidermal separation (acantholysis) → bullae.

What are key blistering disorders?

Pemphigus vulgaris (IgG, mucous membranes, Nikolsky sign), bullous pemphigoid (tense bullae), dermatitis herpetiformis (IgA, gluten sensitivity).

What complications can occur in blistering diseases?

Secondary infection, sepsis, fluid/electrolyte imbalance, hypovolemia.

How are blistering diseases managed?

Corticosteroids, immunosuppressants, biologics, dapsone + gluten-free diet, supportive care (oral/skin, infection prevention, pain control, nutrition).

What education is given for blistering diseases?

Long-term management, infection prevention, oral hygiene, diet (gluten-free if DH), avoid scratching, monitor for complications, emotional support.

What is Stevens-Johnson syndrome/TEN?

Severe skin reaction often drug-induced, with epidermal sloughing.

What are manifestations?

Widespread erythema, blisters, mucosal erosions, pain, fever, respiratory risk, ocular damage.

How is it managed?

Stop causative drug, burn-unit level care, wound/oral care, IV fluids, prevent hypothermia, pain control, monitor for infection/sepsis, possible IVIG/cyclosporine.

What education is given for SJS/TEN?

Wound/eye/oral care, infection signs, nutrition, pain control, psychosocial support, rehab follow-up.

What are the main types of skin cancer?

Basal cell carcinoma, squamous cell carcinoma, melanoma.

What are key features of basal cell carcinoma?

Waxy nodule with rolled border, may crust, rarely lethal, recurrence common.

What are key features of squamous cell carcinoma?

Rough, thick, scaly tumor, 4-8% metastasis, \~4000 deaths/year.

What are key features of melanoma?

Most lethal, irregular nevus with color changes, rapid growth/bleeding/ulceration, more common in women (legs) and men (head/neck/trunk).

What are the ABCDEs of melanoma?

Asymmetry, border irregularity, color variation, diameter >6 mm, evolving.

What are risk factors for skin cancer?

Sun exposure, tanning beds, burns, family history, age, smoking, immunosuppression, chemicals.

How is skin cancer managed?

Early excision, wide excision, lymph node biopsy, targeted therapy (BRAF/MEK), checkpoint inhibitors, radiation, topical chemo.

What education is given for skin cancer?

Sun safety, self-exam, ABCDEs, wound care, recurrence monitoring, psychological support.

What is Kaposi sarcoma?

Malignancy of endothelial cells lining blood vessels.

What are manifestations of Kaposi sarcoma?

Reddish-purple to dark blue lesions on skin, oral cavity, GI, lungs.

What are subtypes of Kaposi sarcoma?

Classic (older Mediterranean/Jewish men), endemic (African), iatrogenic (immunosuppression), AIDS-related (aggressive, visceral involvement).

What are risk factors for Kaposi sarcoma?

Older Mediterranean/Jewish men, African origin, immunosuppression, HIV/AIDS.

How is Kaposi sarcoma managed?

Classic = monitor/local, endemic = local/systemic if severe, iatrogenic = reduce immunosuppression, AIDS-related = ART + local/systemic.