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Derm Tingz

Terms in this set (41)

Plaque psoriasis
Dx: Pruritic, Erythematous papules w/ thick, sliver white scales & well-demarcated, extensor extremities. Nails: pitted, onycholysis, oil spots. Auspitz sign.
Tx: <10% Topical CS: Flucinoide, Clobetasol, Desomethasone
>30% UVB, Topical CS: Flucinoide, Clobetasol, Desomethasone
PO: Acintretin (retinoid), Methotrexate/Cyclosporine (immunomodulator)
Face/Genital: Tacrolimus/Pimecrolimus
Guttate psoriasis
Dx: Small "tear drop" thin pink to salmon-colored papules and plaques surmounted by a fine, white scale. Trunk, abdomen, upper thighs mostly.
Tx: Fluocinonide, Triamcinolone, Clobetasol, Betamethasone dipropionate
*often occurs after streptococcal pharyngitis
Inverse psoriasis
Dx: Thin pink plaques, sharp well-demarcated, with minimal scale in the axillae, inguinal and inframammary area and in body folds of the trunk, they are moist.
Tx: <10% Topical CS: Flucinoide, Clobetasol, Desomethasone
>30% UVB, Topical CS: Flucinoide, Clobetasol, Desomethasone
PO: Acintretin (retinoid), Methotrexate/Cyclosporine (immunomodulator)
Face/Genital: Tacrolimus/Pimecrolimus/ Hydrocortisone
Erythrodermic psoriasis
Dx: Skin reaction pattern of total body redness and desquamation of the skin. Massive shedding of skin, can result in infection, hypothermia, protein loss, hypoalbuminemia, dehydration, and electrolyte disturbances.
Tx: UVA treatment, Cyclosporine (Neoral) and Remicade (infliximab), oral retinoids (Acitretin), MTX
Pustular psoriasis
Dx: Erythematous w/ pustules, deep yellow superficial, this can be isolated to the palms/soles or generalized. Acute associated with fevers, diarrhea, hypocalcemia and leukocytosis.
Tx: Oral antihistamines
Steroids if pruritic: Clobetasol, Fluocinonide, Tacrolimus /Pimecrolimus for face, genitalia, Cyclosporin (severe)
Pityriasis Rosea
Dx: Initial single lesions: Hearlds patch (solitary salmon colored, red/brown macule), Christmas tree pattern of dark pink, oval scattered plaques/papules. Trunk/proximal extremities.
Tx: Topical: Triamcinolone/Fluocinonide, Emollients
PO: Antihistamines
Self-limited: resolves in 6-12 wks
Lichen Planus
Dx: Purple (violaceous) ,Plaques, Papules, Pruritic (or not), Polygonal,Planar (flat topped).Wickham's striae: Fine, grey white lines on oral mucosa. Scalp involvement = scarring alopecia.
Tx: TC: Clobetasol (HP), Desonide/ Triamcinolone (MP), Tacrolimus (oral/vaginal)
Seborrheic Dermatitis "cradle cap"
Dx: Erythematous plaques/scales covered w/ fine white-yellow greasy scales. Can be pruritic/burn. Scalp major player! Malassezia furfur yeast.
Tx: Scalp: selenium sulfide, ketoconazole shampoo, Fluocinolone, Triamcinolone (TC)
Face: hydrocortisone (MP TC), miconazole, ketoconazole (antifungal)
Onycgomycosis
Dx: White/yellow or orange/brown streaks or macules under the nail plate, subungual hyperkeratosis, onycholysis and thicken nail plate. KOH/PAS
Tx: 1st PO (AF): Terbinafine
2nd: Efinaconazole (azoles) *only if the liver is a concern
Tinea Pedis
Dx: Interdigital (maserated), pruritic, erythematous erosions, scales. Hyperkeratotic, Vesiculobullous. KOH
Tx: 1st (TAF) terbinafine, Naftifine (Allyamines), Clotrimazole, Ketoconazole (Imid"azoles")
2nd PO (AF): terbinafine / griseofulvin
Tinea Curis
Dx: Pruritus!!! Annular hyper-pigmented patches/plaques, diffuse erythema, sharply demarcated raised borders. KOH,
Woodlamp: PINK
Tx: 1st topical: Terbinafine, Ketoconazole
2nd PO: Terbinafine/Griseofulvin
Tinea Corporis
Dx: Single/multiple pruritic circular plaques/patches w/ central clearing + well defined borders. KOH
Tx: 1st topical: Terbinafine, Clortimazole/Econazole "azoles"
2nd if Oral refractor PO: Itraconazole, Terbinafine 2nd line PO: Griseofulvin
Body: Head and Shoulders, Selsun Blue as body wash
Tinea Capitis
Dx: Alopecia (black dots), scaly patches w/ alopecia, Kerion "boggy" edematous plaques w/pustules. Favus perifollicular erythema -> cup shaped, yellow crusts (scutula). KOH
Woodslamp: (+) microsporum , (-) tricophyton spp.
Tx: 1st PO: Griseofulvin
2nd PO: Terbinafine
Tinea Versicolor
Dx: Hyper/Hypo pigmented/ erythematous, well demarcated round/oval macules w/fine scaling (shoulders, trunk, back). KOH
Woodslamp: yellow green fluorescence
Tx: Selenium or Ketoconazole shampoo
2nd PO: Itraconazole/Fluconazole
Cutaneous Candidiasis
Dx: Moist, pruritic, erythematous plaques with satellite pustules usually in a body fold area (Intertriginous areas), Mouth: thrush. KOH
Tx: (TAF) Ecinazole, Ketoconazole, Nystatin
Thrust: Nystatin mouth wash
Cellulitis
Dx: Localized, sharply defined erythematous, warm, edematous plaque, usually on face or legs. Fever, chills, pain. (Strep A. most common)
Tx: PO: Cephalexin, Dicloxacillin (pcn. A: Clinda/Erthto)
IV: Cefazolin, Ceftriaxone, MRSA: Vancomycin, Linezolid, Clindamycin, Daptomycin, Doxycycline, Bacterium
Cat/Human bite: Amoxicillin-clavulanate (augmentin)
Necrotizing fasciitis
Dx: Painful erythema with bullae, quickly progressing into a large black eschar and necrosis of the skin, fascia or muscle.
Tx: Surgery early to debridement!
IV: Ampicillin or ampicillin-sulbactam combined with metronidazole or clindamycin
Erysipelas
Dx: Edematous, circumscribed, hot, erythematous area, with sharpe, raised advancing border. Face typically. Pain, malaise, chills, fever.
Tx: PO: Dicloxacillin, Chepaphlexin, Clindamycin (pcn A)
IV: PCN, Clindamycinm, Ceftriaxone
Abscess
Dx: Swelling, painful/tender
region of tissue with central fluctuance.
Tx: I & D, packing
G+: PCN, Cloxacillin, Erythomycin, Vancomycin
G-: Amikacin, Imipenem, Cefepime
Folliculitis
Dx: Single/cluster of perifollicular papules/pustules, surrounding erythema.
Tx: Topical Mupirocin PO: Ciprofloxacin
Carbuncle
Dx: Red, indurated, tender with central fluctuance, multiple fruncles. Staph/Strep
Tx: I&D w/ fluctuance
PO: Clindamycin, Dicloxacllin/Cephalexin, Doxycycline
MRSA: Doxy, Rifampin
Furuncle
Dx: "boils" DEEP infection of hair follicle, erythematous, tender lesion. Staph/Strep
Tx: I&D w/ fluctuance
PO: Clindamycin, Dicloxacllin/Cephalexin, Doxycycline
MRSA: Doxy, Rifampin
Paronychia
Dx: Acute, painful swelling of lateral/proximal nail folds, +/- fluctuant, visible pus.
Tx: Mild: Warm soaks, topical Bacitracin, Mupirocin
Moderate: I&D
Felon
Dx: Severe, throbbing pain,Erythema, swelling, fluctuance at pad of fingertip.
Tx: Fluc (+): I&D, Fluc (-): warm soaks, compress, PO abx.
Type I Rx reactions
IgE mediated : Immediate
Urticaria
Angioedema
Anaphylaxis
Type II Rx reactions
Cytotoxic, body-mediated :cause cell lysis
Pemphigus Vulgaris (POTENTIALLY LIFE THREATENING)
Bullous Pemphigoid (NON LIFE THREATING)
Type III Rx reactions
Immune antibody-antigen complex
Serum sickness/vasculitis
Type IV Rx reactions
Delayed (cell mediated)
DIHS/DRESS
Erythema Multiforme
SJS: Stevens-Johnson Syndrome
Dx: <10% epidermal detachment, Nikolsky (+)
Tx: Supportive therapy, Pain control, electrolyte replacement, wound care (like burn pt) Corticosteroids, Immunoglobulins,
,Cyclosporin, Etanercept
Type IV
SJS/TEN
Involves 10-30% of body surface (over 30% is just TEN)
Cause: Rx reaction to sulfonamides, anticonvulsants and Lamotrigine, Allopurional.
Type IV
TEN:Toxic Epidermal Necrolysis
Dx: >30% detachment of the epidermis and extensive necrosis. Nikolsky (+)
Tx: Supportive therapy, BURN unit
Cause: Rx reaction to sulfonamides, anticonvulsants and Lamotrigine, Allopurional.
Type IV
Erythema Multiforme
Dx: Target Lesions, most common on the extremities, Nikolsky (-). Minor: no mucosal/Major: mucosal
Tx: Removal of causing agent, Anithistmines (H1 blocker) Topical corticosteroids ( clobetasone, hydrocortisone, beclometason, fluticasone)
Type IV
Angioedema
Dx: Effects mucosal tissues causing swelling to face, lips, tongue, larynx.
Tx: Mast-cell (histamine) mediated: allergic reaction. Gulcocrticoids IV/PO, H1 antihistamines.
Bradykinin-mediated (WITHOUT allergic reaction sx):
Angiotensin converting enzyme inhibitor-induced. [Fresh frozen plasma, C1 inhibitor concentrate, Ecallantide, Ictibant]
Type IV
Urticaria
Dx: circumscibed hives/wheals, blanchable, raised, erythemdous plaques, PRURITIC.
Tx: Antihistamines (H1 blockers), systemic corticosteroids if sever, Epi only if airway concern.
Type 1
DIHS/DRESS
Dx: Fever, Chills, lymphadenopathy (LAD) exathem, myocarditis
Tx: Oral corticosteroids Dexamethasone, Cortisone Acetate, Prednisone
Type IV
Anaphylaxis Criterion 1
Dx: "lump in my throat", hoarse voice, Skin/mucosa, w/respiratory compromise, low BP, end organ dysfunction.
Tx: IM EPI, airway management, IV fluids, antihistamines, bronchodilators, corticosteroid's
Anaphylaxis Criterion 2
Dx: LIKELY cause (<2) Skin/mucosa, Respiratory compromise, Low BP, GI symptoms.
Tx: IM EPI, airway management, IV fluids, antihistamines, bronchodilators, corticosteroid's
Anaphylaxis Criterion 3
Dx: KNOWN cause, Low BP
Tx: IM EPI/IV fluids, antihistamines, bronchodilators, corticosteroid's
Pemphigus vulgaris
Dx: Mucosal membrane erosion/ulceration, painful flaccid skin bullae, Nikolsky (+), ELISA( anti-epithelial autoantibodies). Potentially life threating
Tx: Corticosteroids, immmunomodulators
Type II
Bullous pemphigoid
Dx: Prodrome of pruritic hives, then tense, large bullae. Nikolski (-), Immunoflorescence "gold standard" , NOT LIFE THREATING
Tx: Topical Corticosteroids limited, PO if extensive,
Squamous cell carcinoma (SCC)
Dx: Bowen disease (SCC in situ), small red, conical, hard nodules that occasionally ulcerate non-healing center. May bleed if picked. ENT: runny nose
Tx: Excision with clear margins or imiquimod or 5-fluorouracil.
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