DERMATOLOGY BOARD PREP 1 EXAM QUESTIONS WITH VERIFIED CORRECT ANSWERS.

What characterizes eczema? -Inflamed, dry, red, itchy skin -Vesicles typical in acute -Lichenification defines chronic Some common types of eczema are... -Atopic dermatitis -Contact Dermatitis -Dyshidrotic -Asteatotic What should you look for if considering atopic dermatitis? -Waxing and waning course -Pruritic, erythematous papules and plaques that may be vesicular and weeping -Chronic lesions that may be lichenified and hyperkeratotic -Involvement of the periocular areas and flexural surfaces including posterior neck, antecubital and popliteal fossae, wrists, and ankles -Complicating staph infection evidenced by pustules, crusting and erosions Why type of hypersensitivity reaction is allergic contact dermatitis? -Type 4 Hypersensitivity Reaction What is irritant contact dermatitis? -Direct toxic effect from exposure to chemical such as cleaning agent or other caustic substance -Non-immune mediated Describe dyshidrotic eczema -Extremely itchy eruption of small vesicles on the sides of fingers and palms -Can occur from wetting and drying, sweating or allergies -Occurs as a reaction pattern to tinea pedis Describe xerotic eczema -Usually occurs on the anterior shins of older persons with dry skin -Affected skin is red, dry and cracked w/multiple fine fissures that resemble cracks in porcelain -More common in winter or in dry conditions Should potent glucocorticoids be used on the face? Why or why not? -NO -Risk of steroid-induced acne and cutaneous atrophy What are the typical findings of chronic plaque psoriasis? -Erythema -Scaling -Induration on the extensor surfaces, scalp, ears, intertriginous folds and genitalia What can exacerbate psoriasis? -Systemic glucocorticoids -Lithium -Antimalarial drugs -Tetracyclines -B-blockers -NSAIDs -ACE inhibitors Describe Chronic Plaque Psoriasis -Thick, erythematous lesions w/silvery, adherent scale anywhere on the body Describe Guttate psoriasis -Many small drop-like papules and plaques on the drunk often developing after infection with B-hemolytic Strep Describe Erythrodermic psoriasis -Generalized erythema and scaling involving most of the body -Often occurring after abrupt discontinuation of systemic glucocorticoids -Potentially life-threatening Describe Inverse Psoriasis -Red, thin plaques with variable amount of scale in the axillae, under the breasts or pannus, intergluteal cleft and perineum Describe Nail Psoriasis -Indentations, pits and oil spots often involving multiple nails How do you treat psoriasis? -Limited, Localized Plaques: Topical glucocorticoids then rotate with topical Vit D analogues (Calcipotriene, Tacalcitol), retinoids, anthralin or tar preps -Pts with >10% BSA or with psoriatic arthritis, recalcitrant palmoplantar psoriasis, pustular psoriasis or psoriasis in groin or scalp: Systemic therapy with phototherapy, systemic agents (retinoids, methotrexate, cyclosporine) or TNF inhibitors and interleukin-inhibitors Which pts with psoriasis are considered for systemic therapy? -Pts with >10% BSA or with psoriatic arthritis, recalcitrant palmoplantar psoriasis, pustular psoriasis or psoriasis in groin or scalp What does systemic therapy for psoriasis consist of? -Systemic therapy with phototherapy, systemic agents (retinoids, methotrexate, cyclosporine) or TNF inhibitors and interleukin-inhibitors Sudden cessation of glucocorticoids or cyclosporine in a pt with psoriasis puts them at risk for.... -Erythrodermi psoriasis, a dermatologic emergency b/c the pts are at high risk for infection and electrolyte abnormalities 2/2 fluid loss True or False? Systemic glucocorticoids should NEVER be selected for the treatment of psoriasis? -True What can pityriasis rosea mimic? -Secondary Syphillis BUT it does NOT involve the palms and soles -Get RPR in high-risk individuals How does Lichen Planus present? How is it treated? -Acute eruption of purple, pruritic, polygonal papules most commonly on the wrists and ankles -Can also present in the mouth, vaginal vault, penis and in the nails -Treat with topical glucocorticoids How does seborrheic dermatitis present? How is it treated? -Typically involves areas w/sebaceous glands, especially scalp, eyebrows, paranasal area, external auditory canal -Yellow, greasy scale overlying erythematous patches or plaques -Treat w/selenium sulfide or zinc pyrithione shampoos, ketoconazole shampoo Describe pityriasis rosea -Pruritic eruption that begins with herald patch (75% of the time) -Erythematous, salmon-colored -Looks like secondary syphilis (spares palms and soles though) -Distinctive ring of scale at the periphery -Christmas tree pattern -Rash resolves spontaneously, topical glucocorticoids or oral antihistamines for itching What viruses are associated with pityriasis rosea? -Herpes Virus 6 or 7 What is acne like in women with hyperandrogenism? -Acne is severe, cyclical and unresponsive to conventional therapy -Associated with menstrual irregularities, virilizations, hirsutism or rapid onset of severe disease How can you differentiate rosacea from acne vulgaris? -Rosacea can have telangiectasias and will NOT have comedones -Acne vulgaris will have comedones but will NOT have telangiectasias How can you differentiate rosacea from SLE malar rash? -The rash of SLE SPARES the nasolabial folds Which inflammatory scarring disease affects the axilla, groin and perianal areas? Hidradenitis How do you treat acne? -Mild noninflammatory (comedones): Comedolytic agent (topical retinoid) -Mild inflammatory acne (papules and pustules): Topical retinoid and topical antibiotic (erythromycin or clindamycin) -Mod noninflammatory: topical retinoid and benzoyl peroxide or azelaic acid -Mod to sev inflammatory: Topical retinoid, topical antibiotic, and oral antibiotic (tetracycline or others) -Women with hyperandrogenism: Oral contraceptive -Severe recalitrant nodular: Oral isoretinoin -Iatrogenic perioral: Stop topical glucocorticoid How do you treat rosacea? -Metronidazole gel and low-dose oral tetracycline How do you treat hidradenitis suppurativa? -Clindamycin-Rifampin combination antibiotics -Infliximab -Surgical excision Tinea pedis -Presents as chronic fissuring and scaling btwn toes -Some pts have a chronic "moccasin-type" form of infxn w/fine, silvery scale extending from sole to heel and sides of feet Tinea corporis -Typically presents as an annular lesion w/active erythematous border of small vesicles and scales often w/central clearing Tinea cruris -Jock itch -Inguinal folds presenting as erythematous patches with a rim of scale that does NOT involve the scrotum