Derm USMLE
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| describe pityriasis rosea symptoms, orgnaism | HHV7; herald patch (often ring shaped or oval, scaly), then 1 wk later many itchy lesions on back that follow Langerhan's skin lines (Christmas tree appearance)
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| describe molloscum contagiosum, organism, bx, tx | waxy papules w central depression (umbilicated), organism: poxvirus, bx: inclusion bodies; tx: freezing or currettage
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| seborrheic dermatits describe skin findings | hyperpigment, lichenification, scaling in areas of oily skin, ie eyebrows, nasolabial fold, midchest, scalp **can be severe in AIDs pts
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| what can cause large regions of skin desquamation? | TEN, SSSS, graft v host
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| differentiate TEN and SSSS | TEN (toxic epidermyl necrolysis): usu adults and result of Rx (sulfonamides, allopurinol, phenytoin, carbamazepine); SSSS (Staph scalded-skin syndrome)=children, infxs; use bx to know for sure
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| Rx that can cause TEN | sulfonamides, allopurinol, phenytoin, carbamazepine
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| bx TEN v SSSS | TEN: full thickness epidermis damage (SSSS: superficial)
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| tx TEN | same as for burns, skin coverage, maintain fluids and electrolytes
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| MC cause erythema multiforme | HSV infx of lip (also Rx and mycoplasma)
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| erythema marginatum | Rheum F
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| erythema nodosum | pretibial, painful, assoc UC, sarcoid
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| erythema multiforme | target lesion seen in HSV and Rx reaction (ie sulfa, PCN)
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| erythema migrans | bull's eye w central clearing, seen in Lymes
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| list some causes of rash (incl 4 erythemas) | erythema infectiosum ( slapped-cheek parvovirus B19); Roseola (HHV6) hi F, stops then rash; Rheum F (erythema marginum); erythema nodosum; typhus (trunk rash); RMSF, syph, coxsackie, eryth multiform (palm/sole rash); vasculitides (HSP); Lyme,
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| erythema infectiosum | slapped-cheek --starts on cheek and proceeds to trunk and extremities ((caused by parvovirus B19))
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| dzs w blisters | pemphigous, dermatitis herpetiformism, graft v host
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| compare pemphigus vulgaris and bullous pemphigoid blisters, dz severity | pemphigus vulgaris: intraepidermal, blisters tear-severe dz; bullous pemphigoid: blisters below epidermis, don't tear
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| Abs in 2 pemphigus dzs | pemphigus vulgaris: Ab to desmoglein so intraepidermal blisters that tear-severe dz ( acantholysis on bx); bullous pemphigoid: Ab to hemidesmosomes, blisters below epidermis, don't tear
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| compare pemphigus vulgaris and bullous pemphigoid involvement mucous mem | pemphigus vulgaris: yes; bullous pemphigoid: no
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| which HPV assoc with squamous malignancies | HPV 16, 18
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| appearance genital warts, tx | cauliflower papule or nodule; tx: podophyllin, trichloroacetic acid, imiquimod, 5FU **on cervix monitor cytology/histology for malignancy
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| Rx for acne | start with benzoyl peroxide, then topical clindamycin or oral tetracycline or erthromycin (tx Propionibacterium acnes); then topical tretinoin (retin-A), LAST isotretinoin (Accutane)
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| SE Isotretinoin (Accutane) | teratogen, transient incrsd chol, TGA, LFTs and maybe depression
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| tinea versicolor, organism, tx | small scaly patches of difft colors that can be hypopigment (don't confuse w vitliigo); organism: pityrosporum orbiculare; tx: topical selenium sulfide or topical imidazoles
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| vitiligo, describe, assoc | unknown origin, depigmented patches of skin, assoc: autoimmune dzs like pernicious anemia, Addison, often have Abs to melanin and decrsd melanocytes
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| aka warts | verrucae
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| aka mole | nevocellular nevus
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| herpetitiformis dermatitis, describe, assoc | intensely pruritc vesicles on extensors of elbows and knees, assoc celiac sprue (tx: avoid gluten)
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| describe lichen planus; assoc, tx | 4Ps: pruritic, purple polygonal papules; assoc: Rx and Hep C; tx: topical steroids and anti his
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| tx lice: head, body, pubic, | head: pyrethrin (RID) and remove nits, body: wash clothes&bedding, pubic: pyrethrin
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| scabies describe presentation, organism, tx | intensely pruritic (esp at night), sarcoptes scabiei, mites burrow can see track and excoriated papules; tx permethrin or oral ivermectin (but pruritis will remain 2 wks after tx) **treat contacts
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| 3 types of gangrene and causes | dry: ischemia, wet: bacterial usu skin flora, gas: C perfringens
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| tx gas gangrene | hyperbaric oxygen (since C perfringens is anaerobic) **this is an emergency
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| acanthosis nigricans, describe, assoc, tx | hyperpigment, hyperkeratotic velvety in intertriginous zones (incl axillary), assoc with insulin resistance, obesity, and underlying adenocarcinoma (often GI); tx: topical steroid or retinoid, lose weight
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| rosacea, describe, tx | looks like acne in middle aged ppl, often w rhinophyma (bulbous red nose), tx: topical metronidazole
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| seborrheic keratosis | **if appear suddenly could be paraneoplastic; brown, warty papules appear stuck on, bx: hyperplasia of benign, basaloid epidermal cells
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| actinic keratosis, tx | precursor of squamous cell carcinoma; caused by light; tx cryosurgery or 5FU
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| squamos cell carcinoma, cause, px, grading, tx | 2nd most common (basal cell MC), can metastasize, arise from actinic keratoses; graded histologically; tx: excise
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| basal cell carcinoma, describe, px, grading, tx | most common, slow growing but won't met, appear in sun-exposed areas; tx options excision, incl Moh's surgery, superficial radiation (cure >95%)
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| melanoma, cause, px, grading, tx | cause: short intense sun, congenital dysplastic nevi, px most determined by depth of lesion, may met; grading by Clark's levels; tx: excision
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| lesion characteristics suggestive of melanoma | irregular color, contour/border, nodule and ulcer formation, diam >6mm, changes in these charact noted by pt or Dr., and pruritis
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| classic progression of melanoma lesion | start as shiny papule, enlarges and develops umbilicated center that gets peripheral telangiectasias
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| type of skin cancer seen in African Americans | acrolentiginous
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| Kaposi's sarcoma | vascular prolifer HHV8, **most common HIV associated malignancy, tx palliative
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| mycosis fungoides, aka, suspect when, stages | cutaneous T-Cell lymphoma, slow progression of T cells, stage I: patchy, plaque like, stage II: skin tumors, multicentric, reddish
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| cerebriform nuclei | characteristic of mycosis fungoides
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| common Rx that can cause Steven-Johnson syndrome | sulfa, PCN, Phenytoin, phenobarb, allopurinol, carbamzepine, cephalo, quinolones
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| describe S-J syndrome | morbillform rash that coalesces full thickness blistering, can have skin detach and involves eye/mouth
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| differentiate bw TEN and S-J syndrome | if <10%BSA=S-J, if >30%=TEN
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| tx bullous pemphigoid and pemphigous vulgaris | systemic steroids +/- other immunosuppress (ie azathioprine)
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| what are the dermatophytes? | microsporum, trichophyton, epidemiophyton
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| what dzs do dermatophytes cause? | tineas pedis and cruris (athlete's foot and jock's itch), tinea corporis, tinea capitis (ringworm, scalp caling)
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| how identify dermatophytes? | KOH preparation
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| what organism causes tinea versicolor? | pityrosporum orbiculare (yeast)
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| subtypes of basal cell cancer | nodular (MC, pearly nodule w telangiectasia), ulcerated, sclerosing (scarred area), superficial, pigmented (melanocytes), nevus syndrome (AD dz mltpl BCC from childhood, jaw cysts, CNS tumors)
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| subtypes of SCC | nodular (often w central ulceration), exophytic (friable, bleeds easily from Bowen's dz--intraepithelial form SCC), verrucous (resembles wart on mucus mem and plantar), SCC w cutaneous horn
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| MC cause of death from skin cancer is which type | melanoma
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| what % of melanoma arise from nevi | 50%
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| Staging clark's levels and TMN for skin cancer | Staging: I=epidermis, II=into derm, III=fill derm, IV=into reticular derm, V=into subQ fat; TMN: 1=no local/regional met, II=local/regional met; III=distant met
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| types of melanoma | superficial spreading (70%), nodular 15-30%, lentigo maligna, acral lentiginous
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| describe superficial spreading melanoma | mostly flat, variegated color w indistinct border, often back on men and legs of women, middle aged
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| describe nodular melanoma | discrete nodule, uniform, blueberry like, arises rapidly, no radial growth phase
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| describe lentigo maligna melanoma | arises in a lentigo maligna (melanoma in situ, blue/black color, usu pretty large, flat geographic shape) that develops a nodule, usus elderly face/neck/scalp
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| describe acral lentiginous melanoma | MC in dark skinned (Asian, AA), variegation of brown/black; often sole of foot
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| stages of decubitus ulcers | 1=nonblanching erythema, 2=partial thick loss, 3=into subQ, 4=into mscl, jt
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| Auspitz sign | bldg capillary when scale of psoriasis is removed
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| types of psoriasis | chronic/guttate (MC), pustular (intraepithelial PMN)
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| tx psoriasis (3) | topical steroids, calciopotriene (vit D derivative), tars (Smelly)
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| % of pts w psoriasis that get arthritis | 10%
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| mechanism of psoriasis | hyperproliferation of epidermal cells so they don't have time to keratinize properly **note: NOT pruritic
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| characteristics of psoriasis | non pruritic plaques on extensors, nail pitting and lifting of nailbed,
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| cause of leprosy | Mycobac leprae
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| tx leprosy | rifampacine + dapsone 6mos if 1-5 lesions, if >5lesion rifampicine, clofazimine,& dapson for 12 mos
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