Podcast
Questions and Answers
What is the appropriate follow-up for evaluating malignancy in patients diagnosed with DM?
What is the appropriate follow-up for evaluating malignancy in patients diagnosed with DM?
In which demographic is Systemic Sclerosis (SSc) predominantly observed?
In which demographic is Systemic Sclerosis (SSc) predominantly observed?
What distinguishes the limited form of Systemic Sclerosis from the diffuse form?
What distinguishes the limited form of Systemic Sclerosis from the diffuse form?
Which of the following is a characteristic feature of CREST syndrome?
Which of the following is a characteristic feature of CREST syndrome?
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What is a common systemic involvement seen in patients with Systemic Sclerosis?
What is a common systemic involvement seen in patients with Systemic Sclerosis?
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What is the primary risk factor for developing actinic keratosis (AK)?
What is the primary risk factor for developing actinic keratosis (AK)?
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What is the typical appearance of an actinic keratosis lesion?
What is the typical appearance of an actinic keratosis lesion?
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What is the likely consequence of Raynaud's phenomenon in Systemic Sclerosis?
What is the likely consequence of Raynaud's phenomenon in Systemic Sclerosis?
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Which mutation is commonly associated with the development of actinic keratosis?
Which mutation is commonly associated with the development of actinic keratosis?
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What is the proposed involvement of TGF-beta in the pathogenesis of Systemic Sclerosis?
What is the proposed involvement of TGF-beta in the pathogenesis of Systemic Sclerosis?
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What differentiates CREST syndrome from the typical limited form of Systemic Sclerosis?
What differentiates CREST syndrome from the typical limited form of Systemic Sclerosis?
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How often should patients with a history of actinic keratosis have skin exams?
How often should patients with a history of actinic keratosis have skin exams?
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What is the primary form of treatment for multiple actinic keratosis lesions?
What is the primary form of treatment for multiple actinic keratosis lesions?
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What is the most common clinical sign of onychomycosis?
What is the most common clinical sign of onychomycosis?
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Which of the following is NOT a common risk factor for tinea pedis?
Which of the following is NOT a common risk factor for tinea pedis?
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What does the presence of actinic keratosis indicate about a patient's risk for other skin cancers?
What does the presence of actinic keratosis indicate about a patient's risk for other skin cancers?
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What characteristic changes in the cuticles are associated with patients who have DM?
What characteristic changes in the cuticles are associated with patients who have DM?
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Which antibodies are most commonly associated with dermatomyositis (DM)?
Which antibodies are most commonly associated with dermatomyositis (DM)?
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What is the significance of checking muscle-derived enzymes in patients with DM?
What is the significance of checking muscle-derived enzymes in patients with DM?
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What should patients over age 40 presenting with DM routinely undergo?
What should patients over age 40 presenting with DM routinely undergo?
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Which of the following treatments is considered systemic for patients with DM exhibiting significant systemic disease?
Which of the following treatments is considered systemic for patients with DM exhibiting significant systemic disease?
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What is commonly seen in the capillaries of patients with DM?
What is commonly seen in the capillaries of patients with DM?
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Which systemic treatments may be used if standard immunosuppressive medications are insufficient in DM?
Which systemic treatments may be used if standard immunosuppressive medications are insufficient in DM?
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What should be expected regarding the presence of anti-nuclear antibodies in patients with DM?
What should be expected regarding the presence of anti-nuclear antibodies in patients with DM?
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What is the association of anti-centromere antibodies in systemic sclerosis?
What is the association of anti-centromere antibodies in systemic sclerosis?
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Which treatment has been shown to dramatically improve the prognosis of systemic sclerosis-related renal disease?
Which treatment has been shown to dramatically improve the prognosis of systemic sclerosis-related renal disease?
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What symptom is characteristic of cutaneous dysesthesia syndromes?
What symptom is characteristic of cutaneous dysesthesia syndromes?
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Which of the following treatments may improve skin disease in systemic sclerosis?
Which of the following treatments may improve skin disease in systemic sclerosis?
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What is a common trait of the diseases like burning vulva syndrome and burning mouth syndrome?
What is a common trait of the diseases like burning vulva syndrome and burning mouth syndrome?
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What is the proposed hypothesis regarding the pathophysiology of cutaneous dysesthesia syndromes?
What is the proposed hypothesis regarding the pathophysiology of cutaneous dysesthesia syndromes?
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What is the connection between dermatologic symptoms in cutaneous dysesthesia and mental health?
What is the connection between dermatologic symptoms in cutaneous dysesthesia and mental health?
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What is the primary immunosuppressant associated with the management of systemic sclerosis?
What is the primary immunosuppressant associated with the management of systemic sclerosis?
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Which of the following blood tests is NOT included in the standard workup for generalized pruritus?
Which of the following blood tests is NOT included in the standard workup for generalized pruritus?
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What should be considered if there is high suspicion for malignancy based on the history and physical exam?
What should be considered if there is high suspicion for malignancy based on the history and physical exam?
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Which of the following topical agents is NOT recommended for relieving pruritus?
Which of the following topical agents is NOT recommended for relieving pruritus?
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Which type of contact dermatitis is characterized by a reaction to poison ivy?
Which type of contact dermatitis is characterized by a reaction to poison ivy?
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What is the most common cause of chronic allergic contact dermatitis?
What is the most common cause of chronic allergic contact dermatitis?
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What differentiates sedating antihistamines from non-sedating antihistamines?
What differentiates sedating antihistamines from non-sedating antihistamines?
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What is a chronic exposure that can cause allergic contact dermatitis?
What is a chronic exposure that can cause allergic contact dermatitis?
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In recalcitrant cases of pruritus, which of the following agents might be useful?
In recalcitrant cases of pruritus, which of the following agents might be useful?
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What is the primary issue when a patient switches moisturizers without identifying the causative ingredient?
What is the primary issue when a patient switches moisturizers without identifying the causative ingredient?
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Which agents are most commonly associated with topical medication allergies?
Which agents are most commonly associated with topical medication allergies?
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What type of dermatitis is caused by any agent that can damage the skin?
What type of dermatitis is caused by any agent that can damage the skin?
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How do allergens typically interact with proteins in allergic contact dermatitis?
How do allergens typically interact with proteins in allergic contact dermatitis?
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What is the most challenging aspect of managing allergies to fragrances in cosmetics?
What is the most challenging aspect of managing allergies to fragrances in cosmetics?
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What occurs upon first exposure to an allergen in allergic contact dermatitis?
What occurs upon first exposure to an allergen in allergic contact dermatitis?
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Chronic irritant contact dermatitis is most commonly seen in which area of the body?
Chronic irritant contact dermatitis is most commonly seen in which area of the body?
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What is the treatment approach for allergic contact dermatitis primarily focused on?
What is the treatment approach for allergic contact dermatitis primarily focused on?
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Study Notes
Actinic Keratosis (AK)
- AKs are common skin lesions, more prevalent in those with lighter skin tones.
- Chronic sun exposure, particularly in areas with high UV radiation, is a significant risk factor.
- AKs develop as rough patches, often appearing on sun-exposed areas like the face.
- As AKs progress, they develop thick, adherent scaling and erythema beneath the scale.
- Typical AK size ranges from 0.5 to 1.5 cm in diameter.
- AKs are considered precursors to cutaneous squamous cell carcinoma (SCC).
- A small percentage (0.1-1%) of AKs progress to SCCs due to UV-induced mutations, most commonly p53 loss-of-function.
- Treatment methods include freezing (liquid nitrogen), burning (electrocautery), and topical 5-Fluorouracil.
- Multiple AKs indicate a high risk for developing skin cancers (basal cell carcinoma and melanoma).
- Annual skin exams and daily sunscreen use are crucial for patients with a history of AKs.
Onychomycosis and Tinea Pedis
- Onychomycosis is a fungal infection of the toenails, characterized by yellow or white discoloration.
- Nail separation from the nail bed, along with white, powdery material accumulation under the nail, often occurs.
- Nail thickening is a common manifestation.
- Tinea pedis (athlete's foot) is common, particularly in older adults.
- Risk factors include poor circulation in lower extremities, diabetes, and immunosuppression
- The 'moccasin' type manifests as redness and dry scaling on soles and sides of feet.
- Interdigital tinea pedis features soggy, whitish, and fissured skin between toes, often between the 4th and 5th toes.
- Bullous tinea pedis presents as groups of small blisters on soles of feet.
- The specific fungal types (e.g., Trichophyton rubrum, Trichophyton mentagrophytes) causing each form can vary.
- Treatment for onychomycosis typically involves systemic antifungal agents like terbinafine or itraconazole.
- Treating tinea pedis frequently involves topical antifungals.
- Concurrent infections of onychomycosis and tinea pedis require simultaneous treatment to prevent reinfection.
Sarcoidosis
- Sarcoidosis is a multi-system granulomatous disease, primarily affecting the lungs.
- The condition predominantly affects women between ages 20 and 60, with higher prevalence in African-American women.
- Cutaneous sarcoidosis often presents as non-inflamed skin colored papules and nodules, typically with "apple-jelly" or "waxy" appearance.
- Lesions can vary in size (0.2 cm to several centimeters).
- A wide range of clinical presentations are possible, mimicking other dermatological conditions.
- Pulmonary involvement is also common.
Dermatomyositis (DM)
- DM is a rare inflammatory myopathy, most common in women around age 50.
- Key diagnostic features are heliotrope (edema and violet-red color) on eyelids and Gottron's papules (small red scaly papules) on the dorsal aspects of fingers over knuckles.
- Other findings include shawl or V-neck erythema.
- Capillary changes, including enlarged or missing vessels in nail cuticles, can occur.
- Malignancy assessment is essential in patients over age 40 with DM due to a higher risk.
- Immunosuppressive medications (e.g., corticosteroids, azathioprine) and other treatments are used for systemic disease, if present.
- Anti-synthetase antibodies (e.g., anti-Jo-1) are often associated with DM.
Systemic Sclerosis (SSc)
- SSc is a rare disease, predominantly affecting women between the ages of 30 and 50.
- Two forms exist: limited and diffuse. The limited form affects primarily the distal extremities and face. The diffuse form affects the trunk and proximal extremities.
- Key features include skin thickening (fibrosis), microstomia, telangiectasia, and skin ulcerations/calcifications.
- Pulmonary involvement, pulmonary hypertension, renal crisis are potential complications.
Pruritus (Itching) without a Rash
- Generalized pruritus is widespread symmetrical itching without a rash.
- Initial evaluation must rule out underlying medical causes.
- Systemic causes (i.e., kidney failure, liver disease) can be associated.
- Topical treatments can include steroids, menthol, camphor, antihistamines.
- Other systemic interventions may be needed based on the etiology and severity of the itching.
Contact Dermatitis
- Contact dermatitis represents frequent consultations to dermatologists.
- Two main forms exist: allergic and irritant.
- Poison ivy is a frequent cause of allergic contact dermatitis.
- Common causes such as nickel, or preservatives and fragrances can be causes for irritant contact dermatitis.
- Diagnosis often relies on a thorough patient history and physical examination, along with potential patch testing.
- Treatment focuses on avoiding the causative agent and managing symptoms.
Topical Medications
- Neomycin and bacitracin are commonly implicated in skin allergies from topical medications.
- Irritant and allergic contact dermatitis can result from topical use of various medications.
- Avoid exposure to specific allergens, and consider treatment options such as moisturizers and topical corticosteroids.
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Description
Test your knowledge on critical aspects of dermatology, focusing on Systemic Sclerosis and actinic keratosis (AK). This quiz covers demographic information, clinical features, and pathogenesis associated with these conditions. Perfect for medical students and professionals looking to enhance their understanding in this area.