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MJ- F2 E6- Derm and ID > Derm 2 > Flashcards

Derm 2 Flashcards

1
Q

Which benign skin lesion?

  • Superficial epidermal growth
  • Stuck on quality
  • Appear >40y/o
  • All body surfaces (NOT palms/soles)
  • Usually papules/plaques- can be macular
  • Velvety–> verrucous (wart like)
A

Seborrhic Keratosis

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2
Q

What do you see on microscopy for seborrhic keratosis?

A

keratin pseudocysts

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3
Q

How do you tx Seborrhic Keratosis? (4 options)

A

currettage, cryotherapy, electrodessication or shave removal

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4
Q

Which benign skin lesion?

  • Variant of a seborrhic keratosis
  • Multiple, small, hyperpigmented, sessile to filliform, smooth-surfaced papules
  • Common in dark skin- cheeks and temples
A

Dermatosis Papulosa nigra

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5
Q

How do you treat Dermatosis Papulosa nigra? What do you NOT treat with?

A
  • Tx w/ very light electrodessication
  • NO LIQUID NITROGEN- could cause pigmentation changes
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6
Q

Which benign skin lesion?

  • Variant of Seborrhic keratosis
  • small white gray SKs on dorsal feet/ankles
  • older, light-skinned individuals
A

Stucco keratoses

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7
Q

How do you tx stucco keratoses? (4 options)

A
  1. Cryotherapy
  2. Curettage
  3. Electrodessication
  4. OTC ammonium lactate lotion/cream
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8
Q

Which benign lesion?

  • Often pedunculated, fleshy papules
  • Eyelids, neck, axillae, groin
  • Asymptomatic
  • Risk factors- genetics, obesity, friction, pregnancy
  • Can be marker of insulin resistance
A

Acrochordons (skin tags)

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9
Q

What is the treatment for Acrochordons?

A

Elective removal:

  • Snipping
  • Liquid nitrogen
  • Electrodessication
  • Can fall off on own
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10
Q

Which benign lesion?

  • Round to oval, red, dome shaped papule
  • Arises in 40s
  • increases in # over time
    *
A

Cherry angioma

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11
Q

Which benign lesion?

  • Extremities
  • Firm, hyperpigmented dome shaped papule
  • “dimple sign”–> dimples if pinched
  • Asymptomatic, doesn’t require tx
A

Dermatofibroma

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12
Q

Which benign skin lesion is due to sun damage?

A

Solar lentigines

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13
Q

How do you prevent and treat solar lentigines?

A
  • prevention- sun protection
  • No tx required, but can do cosmetic tx- bleaching creams, liquid nitrogen, chemical peels, lasers
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14
Q

Which benign skin lesion?

  • Sebaceous gland enlargement
  • Yellow
  • Umbilicated
  • Removal is cosmetic
  • Biopsy/referral may be necessary
A

Sebaceous hyperplasia

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15
Q

Which benign skin lesion

  • African American + skin lesion
  • Overgrowth of scar tissue
  • Difficult to tx (intralesional corticosteroid injection)- high recurrence rate
A

Keloids

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16
Q

What is the mainstay tx for keloids?

A
  • Intralesional corticosteroid injection
  • Difficult to tx and has a high recurrence rate
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17
Q

Which benign lesion?

  • Tiny epidermoid cysts
  • 1-2mm white to yellow subepidermal papules
  • Fixed and persistent
  • All ages
  • Cheeks, eyelids, forehead, genitals
  • Spontaneous or secondary from trauma/skin dz/rx
A

Milium

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18
Q

How do you tx a Milium?

A
  • Easily extracted w/o scarring
  • Nick surface w/ 11 blade or 18 gauge needle, express entire cyst lining and contents
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19
Q

What causes Verucca Vulgaris?

A

HPV

(this is a wart)

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20
Q

Which type of wart?

  • Flat
  • Skin colored or pink
  • Smooth-surfaced, slightly elevated, flat topped papule
  • Dorsal hands, arms, face
A

Verrucae Planae

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21
Q

Which type of wart?

  • Thick, endophytic papules (depressed into skin of sole)
  • Can accumulate a thick callus over and around wart
  • Plantar warts may be painful when walking
A

Palmoplantar Verruca

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22
Q

What is a mosaic wart?

A

Plantar warts coalescing into large plaques

23
Q

Which type of warts?

  • External genitalia, perineum, perianal, inguinal fold
  • NOT hard or hyperkeratotic
  • Sessile (broad based) papules
  • On physical exam- papillomatous exophytic papules and plaques
A

Papillomatous, sessile papules (genital warts)

24
Q

Which HPV type causes Verruca vulgaris (common warts)?

A

HPV 2, 4

25
Q

Which type of HPV causes Verrucae plana (flat warts)?

A

HPV 3, 10

26
Q

Which types of HPV causes palmoplantar warts?

A

HPV 1

27
Q

Which Types of HPV causes Condylomata acuminata (external genital warts)?

A

HPV 6, 11, 16, 18, etc

28
Q

What is the initial tx plan for a pt with warts?

A
  • Observation: >75% chance of spont. resolution at 2 yrs
  • Multiple txs almost always needed (laser, acids, cryotherapy)
    • start with: Cryotherapy and salicylic acid
29
Q

How do you tx genital warts?

A
  • Imiquimod
  • Surgical methods- laser, electrocautery, scissor or shave debulking

*most favored at top, least favored at bottom*

30
Q

How do you tx a patient with a few warts on the hands and feet?

A
  • Salicylic acid
  • Adhesive tape
  • Cryotherapy
  • laser

*most favored at top, least favored at bottom*

31
Q

How do you tx a patient with a MANY warts on the hands and feet?

A
  • Salicylic acid
  • Cryotherapy
  • Squaric acid or DCNB
  • laser

*most favored at top, least favored at bottom*

32
Q

How do you tx a patient with a few warts on the face?

A
  • Cryotherapy
  • Shave (surgical removal)

*most favored at top, least favored at bottom*

33
Q

How do you tx a patient with a MANY warts on the face?

A
  • Cryotherapy
  • Tretinoin cream

*most favored at top, least favored at bottom*

34
Q

How do you tx a patient with a few warts at other sites than the hands, feet or face?

A
  • Cryotherapy
  • salicylic acid

*most favored at top, least favored at bottom*

35
Q

How do you tx a patient with a MANY warts at other sites than the hands, feet or face?

A
  • Imiquimod
  • Tretinoin cream
  • Squaric acid or DCNB

*most favored at top, least favored at bottom*

36
Q

What should you consider in tx of warts in kids?

A

Consider observation

37
Q

When should you use cryogenic therapy?

A
  • Benign lesions (warts, seborrheic keratoses)
  • Premalignant lesions (actinic keratoses)
38
Q

What vaccine can be given to prevent warts?

A
  • HPV vaccine to prevent genital warts
  • Gardasil and Cervarix
  • ***FOR PREVENTION of genital warts and genital cancers not treatment–> not for common warts***
39
Q

What age is the Gardasil vaccine approved for (prevention of HPV)? Cervarix?

A
  • Gardasil- Females and males 9-26y/o
  • Cervarix- Females 10-25y/o
40
Q

What are open comedones also known as? Closed comedones?

A
  • Open= blackheads
  • Closed= whiteheads
41
Q

What are the 5 tx options for acne vulgaris?

A
  1. Topical retinoids (tretinoin)
  2. Benzoyl peroxide
  3. Topical antibiotics (Erythromycin 2% or Clindamycin 1%)
  4. Oral abx (for moderate-severe inflammatory acne, often combined w/ BP)
  5. Oral Isotreitinoin (Accutane- for severe nodulocystic acne failing other tx)
42
Q

T/F: Isotreitinoin (Accutane) is contraindicated in pregnancy

A

TRUE

Females must be on 2 forms of contraception during and 1 month after, iPLEDGE)

43
Q

What do you do if a patient has no response to acne therapy after 3 months?

A

Increase dose, change tx or refer to derm

44
Q

What are the 4 SEs of oral Isotreitnoin (Accutane)?

A
  1. Dry skin
  2. Chelitis
  3. Elevated liver enzymes
  4. Hypertriglyceridemia
45
Q

How do you tx severe acne?

A
  • Can require combo of oral abx, topical retinoids, benzoyl peroxide, +/- topical abx
  • Refer to derm for tx w/ isotretinoin (Accutane) if acne failing other therapies
  • Consider hormonal therapy in pubertal females
46
Q

What is initial tx of mild acne?

A
  • topical retinoid or benzoyl peroxide
  • alternative- topical retinoid and BP +/- topical abx
47
Q

How do you tx moderate acne?

(moderate= comedones w/ marked number of inflammatory lesions)

A
  • Initial: Topical retinoid and benzoyl peroxide +/- topical abx
    • if inadequate response- consider oral abx, derm referral and hormonal therapy for females
48
Q

What is the initial tx for severe acne (extensive inflammatory lesions w/ diffuse scarring)? What do you do if there is inadequate response to initial tx?

A
  • Initial: Oral abx + topical retinoid + Benzoyl peroxide +/- topical abx
  • Inadequate response: Consider oral isotretinoin, derm referral, hormonal therapy for females
49
Q
  • How long does it take before a patient sees the effects of acne treatment?
  • How long should a therapy be continued before a tx response can be accurately evaluated?
A
  • 2-3 months before see a response
  • Therapy should be continued for at least 8 weeks before a tx response can be accurately evaluated
50
Q

How is Acne Rosacea different than acne vulgaris?

A

Acne Rosacea has:

  • absence of comedones
  • Presents w/ easy flushing, erythema, telangietasias
  • Triggers= alcohol, sun, heat, spicy food, emotional stress
  • Not related to hormones
  • Treated topically and orally
51
Q

When do you refer a patient with acne to derm?

A

Pt w/ difficult to control acne or the presence of scarring

52
Q

When is oral abx contraindicated in the tx of acne (eg: Minocycline, Doxycycine)?

A
  • Pregnancy
  • pt <8y/o (damages tooth enamel and bones)
53
Q

T/F: Tetracyclines interfere with birth control pills

A

FALSE

54
Q

What are the common adverse effects of oral abx used to tx acne (eg: minocycline, doxycycline, etc)?

A
  • GI upset
  • photosensitivity
  • Minocycline- vertigo, dizziness, hyperpigmentation

MJ- F2 E6- Derm and ID (11 decks)

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