derm exam 2

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  1. what type of warts evolve into dome-shaped, gray-brown, hyperkeratotic papules with black dots on surface
    Common warts (Verruca Vulgaris)
  2. what is the MC site for common warts (verruca vulgaris)
    Hands most common site
  3. what is the tx for common warts (verruca vulgaris)
    • Liquid nitrogen, repeated in 2-4 wks
    • Light electrocautery
    • Topical salicylic acid (may take months)
    • Topical Imiquimod 5% (Aldara)
    • Blunt dissection (large, resistant lesions)
  4. Image Upload 1
    what type of wart is this
    common wart (verruca vulgaris)
  5. Image Upload 2
    which type of wart is this
    filiform warts
  6. which type of wart has fingerlike, flesh-colored projections, and is most common found on the face
    filiform warts
  7. what are filiform warts tx
    • Curettage
    • Light electrocautery
    • Light cryosurgery
  8. Image Upload 3
    what type of warts are these
    flat warts (verruca plana)
  9. which type of warts are flat-topped papules, often grouped, usually found on the forehead, around mouth, backs of hands and shaved areas (beard, legs)
    flat warts (verruca plana)
  10. how are flat warts (verruca plana) tx
    • Imiquimod 5% cream (Aldara)
    • Careful cryosurgery or electrosurgery
    • 5-fluorouracil cream (Efudex)
    • Tretinoin cream (Retin-A)
  11. Image Upload 4
    which type of warts are these
    plantar warts
  12. these types of warts are found on the soles of feet, may be painful, they are frequently at points of maximum pressure, such as over metatarsal heads or heels and are assoc with callus formation
    plantar warts
  13. how are plantar warts tx
    • Regular debridement
    • Hot soaks
    • Duct tape
    • Salicylic acid (Occlusal-HP, Duoplant)
    • 40% salicylic acid plasters
    • Blunt dissection
    • Imiquimod 5% cream (Aldara)
    • Cryosurgery
    • Laser
    • Electrodessication and curettage
    • Cantharidin, with occlusion
    • Chemotherapy (bichloracetic acid)
    • Intralesional beomycin sulfate–Expensive…if all else fails
  14. Image Upload 5
    which type of wart is this
    subungual and periungual warts
  15. what spreads subungual and periungual warts
    cuticle biting
  16. how are subungual/periungual warts tx
    • Cryosurgery
    • Cantharidin
    • Duct tape
    • Blunt dissection
    • Salicylic acid
  17. Image Upload 6
    which type of warts are these
    genital warts
  18. these are also known as condyloma acuminate or veneral warts, they are MC assoc with HPV 6,11, and 16.
    genital warts
  19. what is the most common viral STI
    genital warts
  20. These lesions are pink with numerous, discrete, narrow-to-wide projections on a broad base. Surface is moist and lacks hyperkeratosis of warts found elsewhere. May coalesce to form large, cauliflower-like mass
    genital warts
  21. what are some tx considerations for genital warts
    • Cryosurgery
    • Scissors excision, curettage, or electrosurgery
    • Trichloroacetic acid (TCA)
    • Podophyllum resin
    • Imiquimod 5% cream (Aldara)
    • Podofilox gel (Condylox)
    • 5-Fluorouracil cream (Efudex)
    • Carbon dioxide laser
  22. Image Upload 7
    what is this
    bowenoid papule
  23. these are small, brown or pink, flat or slightly irregular, discrete grouped papules, they resemble flat or genital warts
    bowenoid papules
  24. what is the tx for bowenoid papules
    • Cryosurgery
    • Electrosurgery
    • Excision
    • CO2 laser
    • 5-FU cream (Efudex)
    • Imiquimod 5% (Aldara)
    • Abstinence
    • Condom use
    • Check sexual partner
  25. Image Upload 8
    what is this
    molluscum contagiosum
  26. this is most common in kids, usually affects the arms and face, it is spread thru self-inoculation. If found in adults, it is spread thru sexual contact and is found in the groin, pubis, and thighs
    molluscum contagiosum
  27. these are small discrete 1-2mm skin colored or slight pink smooth shiny papules, they have central umbilication with a curette small white bead, and if they are large lesions (1cm) they will be inflamed and crusted
    molluscum contagiosum
  28. what is the etiology of molluscum contagiosum
    DNA poxvirus
  29. how is molluscum contagiosum tx in babies, small children
    • Retin-A .025-.05% cream qd-tid
    • Titrate to response
    • Lesion irritated-rub off with cloth
    • Wash area to prevent spread
  30. how is molluscum contagiosum tx if found in older kids or adults
    • Curette (best)–Use anesthesia –Control bleeding
    • LN2 –May need multiple applications
    • Multiple lesions–Retin-A or TCA
  31. Image Upload 9
    what is this
    herpes simplex
  32. what is the primary mode of herpes virus transmission
    asymptomatic viral shedding
  33. this has grouped vesicles on an erythematous base
    herpes simplex
  34. what will you see on a Tzanck prep if a pt has herpes simplex
    multinucleated giant cells
  35. how is herpes simplex tx
    • oral: zovirax, valtrex, famvir
    • herpes labialis: penciclovir or abreva
  36. what are some suggested regimens for recurrent HSV
    –Acyclovir (Zovirax) 400 mg TID x 5 days–Valacyclovir (Valtrex) 500 mg BID x 3 days–Famciclovir (Famvir) 125 mg BID x 3-5 days
  37. Image Upload 10
    what is this
  38. what is the tx for varicella
    • Cool bathes (Aveeno)
    • Antihistamine PRN
    • Tylenol, avoid ASA due to Reye’s Syndrome
  39. when would you use acyclovir for a pt with varicella
    • If can start within 24 hrs
    • Non-pregnant over age 13
    • Chronic skin disease
    • Children on steroids or immunocompromised
  40. Image Upload 11
    what is this
    herpes zoster
  41. what is the tx for herpes zoster
    • Acyclovir/Valtrex/Famvir
    • -- To prevent postherpetic neuralgia…the major cause of morbidity.
    • -- Treat within first 72 hrs
  42. what are the suggested regimens for Herpes Zoster
    • Valacyclovir (Valtrex) 1 gram TID
    • Famciclovir (Famvir) 500 mg TID
    • Acyclovir (Zovirax) 800 mg 5x/day
    • Tx for 7-10 days
  43. how can Zoster be prevented
    • Zostavax
    • --Single dose, subcutaneous, live attenuated vaccine
    • --For pts age 60 and older
  44. why would you do a shave bx
    • To obtain tissue for diagnostic purposes
    • To remove benign surface neoplasms
    • For raised lesions, when full-thickness tissue specimen is not necessary
  45. why would you use a punch bx
    • For full thickness specimen
    • For flat lesions
    • *Sizes range from 2 to 8 mm
  46. what are some important things to consider when doing an excisional bx
    • Biopsy should include 2-mm of margin of normal skin
    • Length should be 3 times the width when drawing ellipse
  47. when should scalp sutures be removed
  48. when should eyelid sx be removed
    3-4 days
  49. when should facial sx be removed
    5-7 days
  50. when should neck sx be removed
  51. when should trunk sx be removed
    10-14 d
  52. Image Upload 12
    what is this
    linear epidermal nevus
  53. this is a benign proliferation of epidermal cells, it is hyperpigmented due to a thickened epidermis
    linear epidermal nevus
  54. how is linear epidermal nevus tx
    decrease discomfort and improve cosmetic appearance

    • Cryosurgery
    • Partial thickness excision
    • Topical agents (5-FU, retiniods)
    • Laser
    • Dermabrasion
  55. Image Upload 13
    what is this
    melanocytic nevus
  56. what will a bx show for a melanocytic nevus
    nest of nevus cells
  57. what is the treatment for melanocytic nevus
    • follow up for ABCS changes
    • if >100 mole f/u at 6-12 mo intervals
    • sx excision for suspected lesions with bx
  58. when would you suspect a melanocytic nevus to have an increase for malignant melanoma
    if they are large
  59. Image Upload 14
    is this a congenital or acquired melanocytic nevus
  60. acquired melanocytic nevus is affected by what
    hormones and sun
  61. which melanocytic nevus has the nevus with nest that goes into the upper dermis, it is raised and often papular
    compound melanocytic nevus
  62. which melanocytic nevus has all nests in the dermis, it is domed shaped and is skin colored with hair
    intradermal melanocytic nevus
  63. Image Upload 15
    which type of melanocytic nevus is this
  64. Image Upload 16
    which type of melanocytic nevus is this
  65. Image Upload 17
    which type of melanocytic nevus is this
  66. Image Upload 18
    which type of melanocytic nevus is this
  67. Image Upload 19
    what is this
    Mongolian spot
  68. this have blue-black lesions of dermal melanocytes, this is MC in the scalp, presacral, backs of hands, face/trunk in a dermatomal pattern
    mongolian spot/nevus of Ota/ blue nevus
  69. why does the mongolian spot/ nevus of ota/ blue nevus apprear blue-black
    it is due to the Tyndall effect of melanin deeper in the skin
  70. Image Upload 20
    what is this
    nevus of Ota
  71. this is a blue-black pigmentation in the 1st-2nd branch of the trigeminal nerve. It affects the sclera, conjunctiva and skin around the eye. It is common in orientals, females
    nevus of Ota
  72. how is the nevus of Ota tx
    • laser to lighten lesions
    • monitor pt for glaucoma
  73. Image Upload 21
    what is this
    halo nevus
  74. this is most common in adolescence, may herald onset of vitiligo, this has one or more hypopigmented to white lesions that contain a central red, brown or black nevus. The nevus regresses and pigment returns
    halo nevus
  75. where is the halo nevus most commonly found
    on the trunk
  76. what is the tx for a halo nevus
    • teens- none needed
    • adults- woods lamp looking for vitiligo
    •         - bx if suspect MM
  77. Image Upload 22
    what is this
    dysplastic nevus
  78. how is a dysplastic nevus dx
    bx-- if it is raised, has any variation in pigment and borders or alteration of skin markings require bx
  79. how is dysplastic nevus tx
    • excision bx with margins
    • pt educated on self-exam and sun avoidance
    • consider baseline pix
    • f/u at least annually (at risk for MM)
  80. Image Upload 23
    what is this
    tinea/ pityriasis versicolor
  81. this is due to overgrowth of yeasts, highly sebaceous areas and hot, humid climates
    Tinea/Pityriasis Versicolor
  82. these are scattered round to confluent color change/superficial flaking and are usually distributed to the mid chest, back, antecubital fossa, neck, extensive upper arms and lower face
    Tinea/Pityriasis Versicolor
  83. how is Tinea/Pityriasis Versicolor dx
    • KOH
    • --Numerous short, broad hyphae and clusters of budding cells
    • --“spaghetti and meatballs” or “bats and balls”
    • Wood’s light
    • --Pale white/yellow fluorescence
  84. how is Tinea/Pityriasis Versicolor tx
    • –Limited dz:
    • Tx of choice is ketaconazole (Nizoral) 2% shampoo–Apply x 5 minutes, then wash off –Use for 3 days
    • –Oral agents (more extensive dz):
    • --Ketoconazole (Nizoral)–Single dose of 400 mg–Exercise afterwards…no shower x 12 hrs
    • --Itraconazole (Sporanox)–200 mg QD x 7 days
    • --Fluconazole (Diflucan)–Single dose of 300 or 400 mg
  85. how do u tx a pt with recurrent Tinea/Pityriasis Versicolor
    • Ketaconazole (Nizoral) 2% shampoo AAA x 5-10 minutes once weekly
    • Ketaconazole 400 mg once monthly
  86. this starts as a stratum corneum vesicle or pustule, it classically presents as a honey crusted weeping lesion.
    impetigo contagiosum (nonbullous impetigo)
  87. how is impetigo contagiosum (nonbullous impetigo) tx
    • Cool or warm soaks to remove crust
    • Control infection–topical mupirocin 2% (Bactroban)
    • Systemic antibiotics–Dicloxacillin, Cephalexin –prevent acute glomerulonephritis
    • Dressing to prevent spread
    • Culture - 2nd infection
  88. Image Upload 24
    what is this
    impetigo contagiosum (nonbullous impetigo)
  89. this type of impetigo is common in any age, usually is from staph only (no secondary strep), and has less exudative crusting
    bullous impetigo
  90. how is bullous impetigo tx
    • Strict hand washing
    • Warm or cool soaks, to remove crusts
    • Mupirocin ointment (Bactroban)
    • Systemic antibiotics after culture to r/o resistance»Dicloxacillin, Cephalexin, Erythromycin
  91. Image Upload 25
    what is this
    bullous impetigo
  92. this is caused by water that is not hot enough or chemically treated well enough to prevent growth of pseudomonas. It is usually found in areas that are occluded by a bathing suit. The pt presents with pruritis, malaise with low grade fever, and may develop follicular pustules with surrounding erythema
    hot tub folliculitis
  93. what is the tx for pseudomonas folliculitis (hot tub folliculitis)
    • Showering after exposure will not help
    • usually self-limiting, may take up to 3 mo
    • Antihistamine, such as Atarax PRN
    • Localized dz - Vinegar soaks (acetic acid 5%), Domeboro’s, or Burrow’s
    • More involved/severe - Ciprofloxacin 500mg BID x 5 days for more toxic cases
  94. Image Upload 26
    what is this
    pseudomonas folliculitis (hot tub folliculitis)
  95. Image Upload 27
    what is this
  96. where is the most common site for erythrasma
    4th interdigital space (also located in bilateral inguinal area, axillae, inframmary folds)
  97. how is erythrasma dx
    • Need to do KOH
    • woods light- coral red fluorescence due to prophyrins produced by organism
  98. what is the tx for erythrasm
    • Keep area clean, dry
    • Systemic: Erythromycin 250mg QID up to 2 wks or Clarithromycin 1 gram x 1 dose
    • Topical: Erythromycin, Miconazole, Clotrimazole
  99. Image Upload 28
    what is this
  100. this is found in infrequent shavers, this is staph impetigo of the beard. The razor spreads the infection from follicle to follicle. It involves the entire depth of hair follicle
    sycosis barbae
  101. how is sycosis barbae tx
    • if mild: mupirocin (bactroban ointment)
    • if severe: oral abx x 2 weeks
  102. Image Upload 29
    what is this
    sycosis barbae
  103. this type of scabies is highly contagious, it is scaly packed with mites, affects the hands and/or face and HIV is highly suspicious with this
    crusted Norwegian scabies
  104. Image Upload 30Image Upload 31
    what is this
    crusted Norwegian scabies
  105. this is suspected if you see red papules on the neck, see eggs on hairs, these live on seams of clothing, and can cause adenopathy and secondary infx
    pediculosis capitis
  106. how do you get rid of pediculosis capitus
    • elimite or RID shampoo (put in 10 min, don't shave head, comb out knits after vinegar soak)
    • coat eyelashes with Vaseline, wash with baby shampoo TID x 5 d
  107. Image Upload 32
    whats this
    pediculosis capitus
  108. Image Upload 33
    what is this
    cutaneous larva migrans
  109. this is commonly found in on the back of workers that work under porches, can be found on the back, buttock and foot/hand of sunbathers on a beach. it is caused by an accidental invasion by dog and cat hookworm. On PE you will see a long serpiginous lesion
    cutaneous larva migrans
  110. what is the tx for cutaneous larva migrans
    • None–Larva dies eventually
    • Topical–Thiabendazole qid x 1 week –Topical steroid decrease inflammation
    • Oral–Severe cases:Thiabendazole –Albendazole
  111. this is the loss of resting hairs that are ready to be shed. It can be due to severe physical or emotional stressors, delivery of a child, discontinuing OCPs, high fevers or sx, and serious weight loss
    telogen effluvium
  112. what is the tx for telogen effluvium
    • Reassurance hair will regrow
    • Cosmetic ways to make hair look thicker
    • Full recovery expected
  113. Image Upload 34
    what is this
    telogen effluvium
  114. what are the 2 follicle types of male androgenic balding
    • top- androgen sensitive
    • sides- androgen independent
  115. what is the tx for male androgenic balding
    • Minoxidil (Rogaine)
    • Finasteride (Propecia)
    • transplants
    • advancement flaps-small areas
    • hair weave
    • toupee
    • anything advertised on TV or in health food store!!!
  116. this type of androgenic balding is due to a loss on the vertx, begins at menopause when there is a drop in estrogens and a relative increase in androgens
    female androgenic balding
  117. what labs should be considered for female androgenic balding
    • DHEA
    • prolactin
    • testosterone
  118. what is the tx for female androgenic balding
    OTC minoxidil
  119. the presence of terminal hairs in females in a male-like pattern is known as what
  120. what are some possible causes of hirsutism
    • PCOS
    • cushing syndrome
    • androgen-secreting tumors
    • corticosteroid use
    • obesity
  121. this type of carcinoma is red and scaly, it is persistent, it can be a hypertrophic lesion with ulcer or hyperkeratosis (cutaneous horn). If on the lip it will look like an ulcer with induration and it is malignant
  122. how can someone acquire SCC
    • Up to 60% of SCC lesions develop from AKKeratinocytes/spinous layer of epidermis
    • Bowen’s
    • Thermal/radiation burns
    • Chronic irritation
    • Infection (HPV)
    • Inflammation
  123. what is the management for SCC
    • excision with margins
    • examine for nodes
    • f/u q6 mo for life
    • photoprotection
  124. this type of cancer is slow growing, pts are asymptomatic, and nodular is the MOST COMMON form (can be skin or pink colored and is firm)
  125. if you see a pt with a shiny, pearly papule with telangiectasis and central ulceration with rolled borders, what type of CA are you thinking
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derm exam 2
derm exam 2
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