1. What is pyoderma gangrenosum?
    What diseases are commonly associated with it?
    • Rapidly evolving, chronic, idiopathic ulcers
    • Common associations - IBD, RA, MM
    • Biopsy not diagnostic
    • Cultures are negative
  2. Treatment of Pyoderma Gangrenosum?
    • Systemic glucocorticoids
    • Eliminate colonized bacteria
  3. Clinical and lab presentation of B12 deficiency
    • Diffuse hyperpigmentation
    • Megaloblastic anemia
    • Neuropsychiatric disturbance
  4. Clinical features of Folate deficiency
    • Diffuse hyperpigmentation
    • Megaloblastic anemia
    • Fetal neural tube defects
    • Bald tongue
  5. Clinical features of Niacin deficiency
    • Pellagra
    • Diffuse hyperpigmentation
    • Bald tongue
    • 3 D's - Dermatitis, Diarrhea, Dementia
  6. Clinical features of Zinc deficiency
    • Red, scaly patches or perioral and anogenital skin
    • Acrodermatitis enteropathica
    • Acquired zinc deficiency
  7. Clinical features of Vitamin C deficiency
    • Scurvy
    • Perifollicular hemorrhage
    • Corkscrew hairs
    • Extensive ecchymoses
    • Swollen, bleeding gingiva
    • Loose teeth
  8. Erythrasma

    Clinical presentation?
    What is the usual causative organism?
    How is this diagnosed?
    What is the treatment?
    • Sharply demarcated, brown, scaly patches
    • Corynebacterium minutissimum
    • Wood's light diagnostic - brigh red fluorescence
    • Treatment: E-mycin or clindamycin, miconazole, clotrimazole, econazole
  9. Impetigo treatment
    • Self-limited
    • Mupirocin cream or ointment -- effective against staph (including MRSA) and strep
    • Dicloxacillin or cephalexin - 5-10 day course
  10. What is echthyma?
    • Impetigo that goes deep
    • Shallow ulcers topped with crust
  11. Clinical presentation of Scarlet Fever?
    • Sandpaper-like rash accentuated at skin folds
    • "Strawberry tongue"
    • Erythema resolves with desquamation

    Toxin-mediated - erythrogenic toxin of Group A strep. Pharyngitis, tonsillitis, impetigo, wound infection
  12. Describe the rash associated with Rocky Mountain Spotted Fever
    Rash begins on wrists, pink, blanchable macules, generalizes in 6-18 hours
  13. Rash associated with Lyme Disease?
    Erythema chronicum migrans
  14. Treatment for Lyme disease?
    How about if they don't respond to treatment, what would you look for?
    • Doxycycine 100 mg PO bid or amoxicillin X 21 days
    • If non-responsive, probably HLA-DR4 allele positive
  15. What is Porphyria Cutanea Tarda?
    What induces it?
    What is it associated with?
    What is the clinical presentation?
    • Deficiency of heme synthetic enzyme uroporphyrinogen dexarboxylase (UROD)
    • Induced by estrogen or alchohol
    • Assocated with Hep C
    • Blisters on sun-exposed skin
    • Skin fragility
    • Milia
    • Hypertrichosis
    • Treatment: serial phlebotomy, antimalarials
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  16. What is Variegate Porphyria?
    • Think PCT + systemic symptoms: Abdominal pain, polyneuropathy, mental disturbance
    • Tx for acute attacks: Glucose and hematin
  17. What is Epidermolysis Bullosa Acquisita?
    • Slow onset, chronic autoimmune subepidermal blistering disease of the skin and mucous membranes
    • EBA is characterized clinically by blisters, scars, and milia primarily at the trauma-prone areas
    • Autoantibodies target Type VII collagen
  18. What is Bullous Pemphigoid?
    • Large, tense subepidermal bullae
    • May see erythematous patches and/or urticarial plaques
    • Do not spread with lateral shearing
    • Mucous membranes infrequently involved
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  19. What is Pemphigus Vulgaris?
    • Thi-walled, flaccid bullae which are easily ruptured
    • Erosion frequently present
    • Mucous membranes frequently involved
    • Nikolsky sign - lateral shearing produces blister
    • Treatment: high dose glucocorticoids +/- other immunosuppressants
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  20. How do you treat bullous pemphigoid?
    • Bullous pemphigoid is a chronic, vesiculobullous eruption that predominantly involves nonmucosal surfaces. It is characterized by subepidermal vesicles and blisters that are tense and do not rupture easily.
    • Clobetasol is effective in controlling skin lesions in elderly patients with moderate and extensive bullous pemphigoid.
    • Prednisone at a dose of 1 mg/kg/d had been standard initial therapy for bullous pemphigoid; however, its use in elderly patients is complicated by high rates of morbidity and mortality. Prednisone should be reserved for patients with severe bullous pemphigoid. The risks of systemic corticosteroid use, particularly in the elderly are significant and must be weighed against the benefits, particularly when effective alternatives are available.
  21. How do you diagnose lentigo maligna?
    A broad, shallow shave biopsy is the preferred method for diagnosis of lentigo maligna.
  22. What is Drug hypersensitivity syndrome?
    Drug hypersensitivity syndromes are classically associated with anticonvulsants, allopurinol, dapsone, and NSAIDs. They begin 3 to 6 weeks after the initiation of therapy. Angiotensin-converting enzyme inhibitors (lisinopril) are not commonly associated with hypersensitivity drug eruptions. In addition, patients with hypersensitivity drug eruptions typically present with widespread erythema that evolves over weeks rather than days and skin that is itchy more than painful, as well as facial swelling, lymphadenopathy, eosinophilia, atypical lymphocytosis, and elevated aminotransferases.
  23. Who is most commonly affected by Staphylococcal scalded skin syndrome?
    Staphylococcal scalded skin syndrome (SSSS) may be difficult to differentiate from pustular psoriasis, as it also presents with widespread erythroderma and skin pain. It is most common in children less than 6 years of age, but adults with underlying immunosuppression or renal failure may be affected.
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