Dermatology Study Guide PDF

Dermatology Study Guide Acne Rosacea  What is Acne Rosacea? Chronic inflammatory skin disorder linked to immune-mediated inflammation and vascular dysregulation Does not involve comedones (blackheads or whiteheads)  What are subjective data for this condition? Facial flushing...

Dermatology Study Guide Acne Rosacea  What is Acne Rosacea? Chronic inflammatory skin disorder linked to immune-mediated inflammation and vascular dysregulation Does not involve comedones (blackheads or whiteheads)  What are subjective data for this condition? Facial flushing: Can occur independently of temperature changes Persistent redness and visible blood vessels (telangiectasia) Fluid-filled bumps (papules and pustules) on the face Possible history of acne or sensitivity to skincare products  What are the objective findings? Facial erythema (often in a butterfly pattern) Inflammatory papules and pustules (without comedones) Watery, irritated eyes (indicating potential ocular rosacea)  What are risk factors? Fair skin types (Fitzpatrick i-ii) Individuals of Asian descent Genetic predisposition (family hx)  What are some differential diagnoses? Adult acne vulgaris Seborrheic dermatitis Photodermatitis  How is this condition treated/managed? Goal: to reduce inflammation and manage symptoms Non-Pharm: Gentle skin care routine Avoid known triggers (spicy foods, hot beverages, sun exposure) Pharm: Topical meds: Metronidazole (0.75% gel, cream or lotion), Azelaic acid (15% gel – Finacea, 20% cream – Azelex), brimonidine (.33% gel – Mirvaso), sulfacetamide sodium/sulfur (Sulfacetamide 10% with sulfur 5–10% in creams, lotions, or washes) Oral meds: ABX: erythromycin, clindamycin, doxycycline, minocycline Accutane: *ONLY PRESCRIBED BY DERMATOLOGY*; teratogenic  Is there any preventative care, and if so, what is it? Trigger avoidance, adhere to treatment plans, routine follow-ups  FYI: Ocular rosacea: If symptoms involve the eyes (redness, irritation, blurred vision), refer patients to ophthalmology Untreated ocular rosacea can lead to vision loss Psychosocial impact: Rosacea can significantly affect self-esteem and mental health Be prepared to refer patients to mental health providers if needed Acne vulgaris  What is Acne vulgaris? an inflammatory disorder of the pilosebaceous follicles (hair follicles with associated oil glands)  What are subjective data for this condition? Bumps on the face, chest, back, and shoulders Lesions that range from blackheads and whiteheads to painful cystic nodules  What are the objective findings? Look for comedones, papules, pustules, and nodules, often on the face, back, and shoulders Scarring can occur, especially with cystic lesions  What are risk factors? Genetic predisposition Hormonal changes (puberty, menstruation)  Certain medications (steroids, lithium) Environmental factors (less sunlight exposure, stress) Facial products (comedogenic makeup, skincare)  What are some differential diagnoses? Milia (small cysts) Sebaceous hyperplasia Rosacea (note: no comedones) Folliculitis Fungal infections  How is this condition treated/managed? Topical (for mild to moderate acne): salicylic acid, benzoyl Peroxide, retinoids (Tretinoin, adapalene), abx (clinda, erythromycin), azelaic acid (finacea, Azelex) Oral (for moderate to severe acne): ABX – inflammatory acne (doxycycline, minocycline, clinda) contraceptives – hormonal acne (estrogen and progesterone combo needed because progesterone would only make symptoms worse) Isotretinoin - for severe, cystic acne (Accutane) – Teratogenic - (Prescribed by Dermatology only)  Is there any preventative care, and if so, what is it? Consistency is Crucial: Acne treatment takes time—often weeks or months Identify Triggers: Stress, diet, and product choices can impact acne severity Avoid Picking or Squeezing: This can worsen inflammation and lead to scarring Follow-up Visits: Essential to adjust treatments and prevent complications  COMPLICATIONS: Scarring and Keloids: Common in severe or untreated cases Medication Side Effects Oral antibiotics: Can cause GI issues or photosensitivity Hormonal treatments: Risk of DVT or hyperkalemia Bacterial Infection (Cellulitis)  What is cellulitis? Acute, spreading infection of dermal and subcutaneous tissues most commonly caused by Streptococcus bacteria, specifically Group A or B Hemolytic Streptococci  What are subjective data for this condition? Redness, pain, swelling, and warmth in the affected area If the infection becomes systemic, they may also experience fever, chills, and general malaise **Make sure to ask about any recent injuries, cuts, or other skin breaches that could’ve allowed bacteria to enter**  What are the objective findings? Unilateral (one-sided) involvement, most commonly on a limb. Redness (erythema), warmth, swelling, and tenderness. In some cases, there may be drainage from the area, or the skin could appear shiny and tight due to swelling. Patients may present with a fever, indicating systemic involvement. **Remember to assess for signs of a deeper infection, like abscess formation or necrotizing fasciitis.**  What are risk factors? Immunocompromised (diabetes, HIV, or on Immunosuppressive therapy) Obesity Any condition causing poor circulation (hardware in the body, like plates or screws)  What are some differential diagnoses? Deep vein thrombosis (DVT): Both conditions can cause redness, swelling, and pain, especially in the legs Superficial venous thrombosis Osteomyelitis (Bone Infection): The “go big or go home” infection that takes the infection to the bone Neoplastic disease: Skin cancers or other growths could present similarly Contact dermatitis: Sometimes confused with cellulitis due to similar erythema and swelling  How is this condition treated/managed? Systemic abx are the mainstay of therapy Cephalexin (Keflex): for mild to moderate cellulitis Clindamycin: good if you suspect an underlying MRSA abscess Augmentin Non-Pharm: Rest and elevation of the affected limb Applying compression if appropriate, to reduce swelling Patient education: Emphasizing the importance of completing the full course of antibiotics, even if symptoms improve. Otherwise, your client risks recurrence. Teach about how to recognize warning signs of worsening infection If symptoms don't improve or worsen, it’s critical to refer the patient to a specialist.  Is there any preventative care, and if so, what is it? Complete the entire course of antibiotics: Even if symptoms improve, stopping early can lead to recurrence Keep the affected area clean and elevated, which helps reduce swelling Monitor for signs of worsening infection: If the redness spreads, the swelling increases, or fever develops, they should seek immediate care Prevent future skin infections: This includes proper wound care and managing underlying conditions (e.g., diabetes, obesity) that might predispose them to cellulitis  COMPLICATIONS: Systemic sepsis: This occurs when the infection spreads to the bloodstream, leading to potentially life-threatening conditions Osteomyelitis: If the infection spreads to the bone Periorbital cellulitis: If the cellulitis occurs around the eye, it can lead to blindness or brain damage This is a medical emergency requiring immediate referral Dermatitis Allergic (Rhus dermatitis) Irritant  What is Rhus dermatitis? occurs when the skin reacts to a specific allergen—like poison ivy—resulting in a localized reaction only where the allergen contacted the skin  What are subjective data for this condition? Intense pruritus in severe reactions, also stinging and pain  What are the objective findings? Well-demarcated erythema and edema with superimposed closely spaced papules or nonumbilicated vesicles in severe reactions, bullae, confluent erosions exuding serum, and crusts Plaques of mild erythema showing small, dry scales sometimes associated with small, red, pointed, or rounded erythematous firm papules and scales  What are risk factors?  What are some differential diagnoses? Atopic dermatitis Seborrheic dermatitis psoriasis epidermal dermatophytosis (KOH) fixed drug eruption phytophotodermatitis  How is this condition treated/managed? Identify and remove the etiologic agent Topical glucocorticoid ointments/gels (classes I–III) Larger vesicles may be drained, but tops should not be removed Wet dressings with cloths soaked in Burow’s solution changed every 2 to 3 hours Glucocorticoids are indicated if severe and in airborne ACD Prednisone beginning at 1 mg/kg, tapering over a 2- to 3-week period  Is there any preventative care, and if so, what is it? Allergen avoidance Dermatitis Atopic (Eczema)  What is Eczema? Chronic inflammatory skin condition with cycles of exacerbations and remissions immune-mediated condition primarily driven by a histamine response the skin barrier is impaired, allowing allergens and irritants to penetrate more easily, leading to inflammation, itching, and rash most commonly found in areas where the skin folds, such as the elbows, knees, and under the breasts  What are subjective data for this condition? Dry itchy patches on the skin sometimes accompanied by crusting or oozing Chronically affected areas may develop thicken skin (lichenification) d/t repeated scratching Itch is often severe and can disturb sleep  What are the objective findings? Diffuse rashes Linear excoriations, and possibly scaling or crusting in affected areas, which are commonly found on the upper extremities, though it can occur anywhere on the body  What are risk factors? Asthma Food allergies Frequent exposure to irritants  What are some differential diagnoses? Fungal infections Immune deficiencies Parasitic infections like scabies  How is this condition treated/managed? Topical Steroids: Low Potency: Hydrocortisone 1% (Hydrocortisone cream/ointment) Hydrocortisone Butyrate 0.1% (Locoid) Medium Potency: Betamethasone Valerate 0.05% (Betnovate) High Potency: Mometasone Furoate 0.1% (Elocon) Triamcinolone Acetonide 0.1% (Kenalog) Oral Steroids: Prednisone: most commonly prescribed oral corticosteroid for dermatitis flare-ups (acute and severe) Methylprednisolone (Medrol): commonly used to treat severe dermatitis  Is there any preventative care, and if so, what is it? Avoid triggers Use gentle moisturizers regularly Start treatment at the first sign of a flare up Irritant Dermatitis  What is irritant dermatitis? caused by substances that break down the skin's protective barrier, like harsh detergents or frequent handwashing  What are subjective data for this condition? Burning, stinging, smarting, and itching Pain as fissures develop  What are the objective findings? Dryness, Chapping Erythema  Hyperkeratosis and scaling Fissures and crusting Sharp margination gives way to ill-defines borders, lichenification  What are risk factors? Atopy Fair skin Low temp Low humidity climate Occlusion Mechanical irritation Individuals engaged in the following occupations/activities are at risk: medical, dental, or veterinary services; housekeeping, hairdressing, cleaning, floral arranging, agriculture, horticulture, forestry, food preparation and catering, printing, painting, metal work, mechanical engineering, car maintenance, construction, and fishing  What are some differential diagnoses? Allergic Contact dermatitis Palmoplantar psoriasis Photoallergic contact dermatitis  How is this condition treated/managed? Identify and remove the etiologic agent Apply wet dressings with Burow’s solution, changed every 2 to 3 hours Topical class I–II glucocorticoid preparations In severe cases, systemic glucocorticoids may be indicated Prednisone taper over 2 to 3 weeks, starting at 1 mg/kg  Is there any preventative care, and if so, what is it? Avoid irritant or caustic chemical(s) by wearing protective clothing (i.e., goggles, shields, and gloves) If contact does occur, wash with water or weak neutralizing solution Barrier creams In occupational ICD that persists in spite of adherence to the preceding measures, a change of job may be necessary Herpes Oral  What is HSV? double-stranded DNA virus HSV-1 is most commonly responsible for oral herpes (you know, those pesky cold sores) HSV-2 is typically associated with genital herpes both types can affect either the oral or genital areas  What are subjective and objective data for this condition? patient feels that telltale burning or itching before the blisters appear painful, weepy blisters blisters crust over and form a yellow scab  What are risk factors? Women have a higher seroprevalence than men and seroprevalence is higher among black people than white HSV-2 antibodies start to develop during puberty and correlate with the onset of sexual activity  What are some differential diagnoses? Erythema multiforme Impetigo Varicella Herpes zoster  How is this condition treated/managed? If this is the first time someone is having an outbreak, antivirals like Acyclovir or Valacyclovir can help reduce the severity and duration Topical: (typically used in a primary outbreak) Acyclovir cream, Docosanol (Abreva) Oral: (for primary and recurrent/suppressive therapy)  Acyclovir (Zovirax) 400 mg 3x day 7-10 days, Valacyclovir (Valtrex)  Is there any preventative care, and if so, what is it? Start Treatment Early: As soon as they feel that burning or itching prodrome, they should start their antiviral treatment to reduce the severity of the outbreak. Avoid Contact During Outbreaks: Remind them that lesions are highly contagious, so they should avoid kissing or sharing utensils when they have active sores. Transmission Can Happen Without Visible Symptoms: Even if they don’t have a cold sore, the virus can still be spread through asymptomatic shedding. Pregnancy Considerations: For pregnant patients with a history of herpes, suppressive therapy starting at 36 weeks is important to reduce the risk of neonatal transmission. If lesions are present during delivery, a C-section may be necessary.  COMPLICATIONS: Meningitis: In rare cases, HSV can cause inflammation of the brain’s protective membranes Cutaneous Dissemination: This happens when the virus spreads beyond the original site Neonatal Transmission: If a pregnant patient has an active outbreak during delivery, the virus can be transmitted to the baby, which is why suppressive therapy is so crucial Herpes Zoster “shingles”  What is herpes zoster? dermatologic eruption caused by reactivation of the VZV that follows, sometimes by decades, a primary varicella-zoster (chickenpox) infection  What are subjective data for this condition? Painful, itchy rash with clusters of blisters Burning, stabbing, or aching pain rash is unilateral and follows a dermatome fever with initial outbreak  What are the objective findings? Clusters of clear vesicles Tender to the touch Follows the path of a single dermatome  What are risk factors? Age: Older adults are more prone to reactivation Immunosuppression: Conditions like HIV or diabetes, or treatments like chemotherapy, make reactivation more likely History of Varicella Infection: Prior chickenpox infection is necessary for VZV to be latent  What are some differential diagnoses? Allergic dermatitis Dermatitis herpetiformis Contact dermatitis Coxsackievirus infection  How is this condition treated/managed? Antiviral Medications: Acyclovir or Valacyclovir are first-line treatments ideally initiated within 72 hours of symptom onset Pain Management: This may include NSAIDs, gabapentin, pregabalin, or amitriptyline. Patient Education: Educating patients to recognize early symptoms is essential so they can seek prompt antiviral treatment. Additional Support: Moist dressings and rest can relieve some discomfort. It’s crucial for patients to avoid contact with vulnerable individuals, especially while the rash is still active.  Is there any preventative care, and if so, what is it? Shingles vaccine  COMPLICATIONS: postherpetic neuralgia: pain that persists long after the rash heals, sometimes for months or even years If the rash is on the face, refer the patient to a specialist immediately, as this can lead to severe complications like blindness or facial palsy. Human papilloma virus (Verruca)  What is HPV? infects epithelial cells in the epidermis, where it replicates, causing a localized skin overgrowth  What are subjective data for this condition? Reports of a small, raised growth resembling a skin tag Discomfort or pain, especially if the wart catches on clothing or forms a plaque  What are the objective findings? Common Warts (Verruca Vulgaris): Round, dome-shaped, rough surface Plantar Warts: Flat, painful warts on the soles of the feet; can form mosaic warts (clusters) Filiform Warts: Long, thin projections; often found on the face  What are risk factors? Skin injuries or abrasions Weakened immune system Chronic exposure to moisture (e.g., public showers, swimming pools) Close contact with an infected individual  What are some differential diagnoses? Dermatitis Corns or calluses Seborrheic keratosis Always consider ruling out malignant lesions, especially melanoma  How is this condition treated/managed? Topical Treatments: Salicylic Acid: First-line treatment; requires consistent application for weeks Duct Tape Occlusion Therapy: Can help soften and remove the wart Stronger Acids (TCA/BCA): Used for more resistant warts Advanced Treatments: Cryotherapy: Freezing the wart with liquid nitrogen Laser Ablation: Burning off the wart Surgical Removal: Reserved for large or stubborn warts  Is there any preventative care, and if so, what is it? Avoid Picking or Scratching: This can spread the virus to other areas Identify Triggers: Prevent reinfection by avoiding shared showers or wearing protective footwear Malignant Skin Lesions Melanoma (MM)  What are malignant skin lesions?  What are subjective data for this condition? Changes in mole size, shape, or color  What are the objective findings? ABCDE Rule: A: Asymmetry - Compare one side of the mole to the other B: Border irregularity - Particularly is notched, ragged, or blurred C: Color variation - If it has more than two colors, especially white, blue-black, or red D: Diameter >6 mm  size of pencil eraser E: Evolving - Changing in size, shape, or color. Be particularly wary of rapid changes  What are risk factors?  What are some differential diagnoses?  How is this condition treated/managed? Immediate referral to a dermatologist or surgeon. Early-stage excision is critical  Is there any preventative care, and if so, what is it? Annual Skin Exams: Early detection is vital Sun Protection: Sunscreen (minimum SPF 15), hats, and protective clothing Monitor for Changes: Encourage patients to seek medical attention for any persistent or evolving skin lesions Malignant Skin Lesions Basal Cell Carcinoma (BCC)  What is BCC?  What are subjective data for this condition? Sores that don’t heal Itching Crusting lesions  What are the objective findings? Pearly, shiny vesicles that may be hyperpigmented  What are risk factors? Heavy sun exposure Fair skin Aging Family history  What are some differential diagnoses?  How is this condition treated/managed? Electrodesiccation and curettage (ED&C) are common  Is there any preventative care, and if so, what is it? Annual Skin Exams: Early detection is vital Sun Protection: Sunscreen (minimum SPF 15), hats, and protective clothing Monitor for Changes: Encourage patients to seek medical attention for any persistent or evolving skin lesions Malignant Skin Lesions Squamous Cell Carcinoma (SCC)  What is SCC?  What are subjective data for this condition? Persistent, scaly lesions that may ulcerate  What are the objective findings? Scaly, volcano-shaped lesions that are non-healing  What are risk factors?  What are some differential diagnoses?  How is this condition treated/managed? Complete excision; ensure clear margins  Is there any preventative care, and if so, what is it? Annual Skin Exams: Early detection is vital Sun Protection: Sunscreen (minimum SPF 15), hats, and protective clothing Monitor for Changes: Encourage patients to seek medical attention for any persistent or evolving skin lesions Actinic keratosis  What is actinic keratosis? Precursor development of SCC  What are subjective data for this condition?  What are the objective findings? Rough, scaly patches on sun-exposed areas  What are risk factors? UV radiation Risk increases with age as the skin becomes thinner and more susceptible to UV damage Genetic predisposition Especially if there is a family history of skin cancers  What are some differential diagnoses?  How is this condition treated/managed?  Is there any preventative care, and if so, what is it? Annual Skin Exams: Early detection is vital Sun Protection: Sunscreen (minimum SPF 15), hats, and protective clothing Monitor for Changes: Encourage patients to seek medical attention for any persistent or evolving skin lesions Parasitic Infestation (Lice & Scabies)  What are Lice? small, wingless insects that survive by feeding on human blood  What are subjective data for this condition? Itching and the sensation that something is crawling  What are the objective findings? Nits and louse on the clothing or body Typically found at the back of the head, neck, and behind the ears  What are risk factors? Black children tend to be less affected than white and males less than females Most common age group affected is elementary and middle school ages  What are some differential diagnoses? Seborrheic dermatitis Scabies Eczema insect bites psoriasis  How is this condition treated/managed? Permethrin 5%: Applied to dry hair and left for about 10 minutes, this is one of the most common treatments for lice Ivermectin Lotion: An alternative that’s effective, especially in cases of resistance to permethrin It’s also important to wash all bedding, clothing, and personal items in hot water to kill any remaining lice or nits.  Is there any preventative care, and if so, what is it? Good hygiene practices complete the full course of treatment wash all clothing, bedding, and shred items in hot water Avoid close contact with infected individuals or items Notify others who may have been in close contact to prevent further spread of the infection  What is scabies? caused by mites that burrow under the skin, leading to intensely itchy rashes and papules  What are subjective data for this condition?  What are the objective findings?  What are risk factors? more common in crowded living conditions and institutional facilities such as nursing homes, prisons, long-term care facilities, and day care centers the young and elderly in resource-poor countries more prevalent in hot, humid environments as well as in poor, overcrowded areas  What are some differential diagnoses? Seborrheic dermatitis Insect bite Impetigo pediculosis  How is this condition treated/managed? Permethrin Cream 5%: Applied to the entire body from the neck down, left on overnight (8-12 hours), and repeated in one week. This second application is essential to address the scabies mites' life cycle and ensure that any newly hatched mites are eliminated. Like lice treatment, cleaning all clothing and bedding in hot water is necessary to prevent reinfestation.  Is there any preventative care, and if so, what is it? Good hygiene practices complete the full course of treatment wash all clothing, bedding, and shred items in hot water Avoid close contact with infected individuals or items Notify others who may have been in close contact to prevent further spread of the infection Pruritis  What is pruritis? commonly known as itchy skin  How does pruritis relate to diagnosis and treatment in dermatology? Presents in many dermatologic conditions: Eczema Psoriasis Contact dermatitis Allergic reactions Insect bites Irritants (soaps and detergents) Psoriasis  What is psoriasis? chronic autoimmune disorder characterized by dermal hyperproliferation—the skin cells grow and shed at an accelerated rate  What are subjective data for this condition? Scale-like patches that bleed easily when scratched (known as the Auspitz sign - the skin’s way of playing peek-a-boo) scratch a little, and you’ll see tiny droplets of blood Common sites: elbows, knees, scalp, genitals, and intergluteal folds  What are the objective findings? Well-circumscribed, erythematous macropapular lesions with a silvery white scale (a hallmark sign) Raindrop plaques (common in guttate psoriasis) Nail changes: pitting or onycholysis (nail separation)  What are risk factors? often linked to genetic predisposition A first-degree relative with psoriasis An identical twin with the condition  What are some differential diagnoses? Seborrheic dermatitis Atopic dermatitis Rosacea Gout (in cases of joint involvement)  How is this condition treated/managed? Topical steroids: Mild: hydrocortisone 1%  Moderate: Betamethasone valerate 0.1% Potent: Fluocinonide 0.05% Additional options: **Always refer to Dermatology for additional treatment options and long-term management** Vitamin D analogs: Help slow down skin cell growth Phototherapy: For moderate to severe cases Systemic treatments: For refractory cases (e.g., methotrexate or biologics)  Is there any preventative care, and if so, what is it? Emphasize the importance of long-term management—there is no cure Adherence to medication: Critical for controlling symptoms and preventing flare-ups Trigger avoidance Injuries (Koebner phenomenon) Certain medications (e.g., beta-blockers, NSAIDs) Lifestyle modifications: Stress management, healthy diet, and smoking cessation  Complications: Secondary skin infections: Due to compromised skin integrity Psoriatic arthritis: Involves joint pain and swelling—refer to a rheumatologist if joint symptoms develop Psychosocial impact: Educate patients about the potential for depression or anxiety; support resources may be necessary Tinea pedis  What is tinea pedis? “Athlete’s foot”: superficial fungal infection that usually takes root in the spaces between the toes but can also affect the soles and the sides of the feet Spreads through human-to-human contact, animal contact, or soil exposure  What are subjective and objective data for this condition? Itching Red, peeling skin (often between the toes) Foot odor Ulcerations in severe cases  What are risk factors? Male patients, post-puberty (d/t testosterone levels) Immunocompromised individuals  What are some differential diagnoses? Erythrasma Dyshidrosis Foot eczema Psoriasis, pustular psoriasis Contact dermatitis atopic dermatitis Bacterial pyodermas scabies  How is this condition treated/managed? For mild to moderate cases, topical antifungals are often 1 st line treatment Terbinafine (Lamisil) cream, Clotrimazole (lotrimin) Cream For severe, widespread, or refractory cases, oral antifungals may be prescribed Terbinafine (Lamisil) oral tabs  Is there any preventative care, and if so, what is it? Footwear should be evaluated annually for size and suitability powder toe webs and soles, not shoes avoid going barefoot in communal showers wear sweat-wicking socks alternate several pairs of shoes for daily wear that maintain a dry, roomy environment for the feet Using an antifungal spray in shoes may be helpful Tinea Unguium  What is Tinea Unguium? any infection of the nails caused by a dermatophyte, yeast, or sometimes mold most common nail condition most frequently occurs in the toenails (great toe is often first)  What are subjective and Objective data for this condition? Yellowish-brown discoloration of the nails Thickened, brittle nails  What are risk factors? Public shower use Male patients, post-puberty (d/t testosterone levels) Immunocompromised individuals  What are some differential diagnoses? Psoriasis Lichen Planus Trauma Onychogryphosis Herpetic whitlow Black nail paronychia  How is this condition treated/managed? topical treatments are largely ineffective for nail infections because they are thick, nonporous, and hard to penetrate Oral antifungal: Terbinafine (Lamisil)  Is there any preventative care, and if so, what is it? To prevent recurrences, the patient can apply ciclopirox two or three times a week, apply terbinafine cream in the nail area weekly avoid trauma to the tip of the nails from tight-fitting shoes Footwear should be evaluated annually for size and suitability Urticaria  What is Urticaria? raised, itchy welts on the skin that result from an immune system reaction immune system releases histamine and other chemicals, leading to localized swelling and itching IgE-Mediated and in most cases  What are subjective data for this condition? Sudden onset of raised, red, and intensely itchy areas on the skin **can come and go** Episodes triggered by factors like heat, stress, or certain foods Each welt may last minutes to hours before fading  What are the objective findings? Circular, confluent rashes that are red and swollen Welts that come and go, often changing locations The absence of lasting marks after the hives fade  What are risk factors?  What are some differential diagnoses?  How is this condition treated/managed? First-Line Treatment: H1 Antihistamines: Loratadine (Claritin), Cetirizine (Zyrtec) Second-Line Treatment: H2 Blockers: Cimetidine (Tagamet), Famotidine (Pepcid)  Is there any preventative care, and if so, what is it? track potential causes and avoid known allergens Topical dermatological treatment vehicles  What does “Vehicle” mean in dermatology? refers to the base of the active ingredient  What are the different levels of steroids? Class 1—Superpotent Clobetasol propionate (Temovate) 0.05% ointment/cream Betamethasone dipropionate (Diprolene) 0.05% ointment/lotion/gel Fluocinonide (Vanos) 0.1% cream Class 2—Potent Mometasone furoate (Elocon) 0.1% ointment Halcinonide (Halog) 0.1% cream Fluocinonide (Lidex) 0.05% ointment/cream Desoximetasone (Topicort) 0.25% ointment/cream Betamethasone dipropionate (Diprolene) 0.05% cream Class 3—Upper midstrength Fluticasone propionate (Cutivate) 0.005% ointment Halcinonide (Halog) 0.1% ointment Betamethasone valerate (Valisone) 0.1% ointment Class 4—Midstrength Mometasone furoate (Elocon) 0.1% cream Triamcinolone acetonide (Kenalog) 0.1% ointment/cream Fluocinolone acetonide (Synalar) 0.025% ointment Class 5—Lower midstrength Fluocinolone acetonide (Synalar) 0.025% cream Hydrocortisone valerate (Westcort) 0.2% ointment Class 6—Mild Desonide (DesOwen) 05% ointment/cream/lotion Alclometasone dipropionate (Aclovate) 0.05% ointment/cream Class 7—Least potent Hydrocortisone (Hytone) 2.5%, 1%, 0.5% ointment/cream/lotion Ointment: MOST MOISTURE!!  What does it mean to be an ointment-based medication?  When would it best be used? chronic inflammations such as lichenification, dryness, psoriasis, and pruritus  When is it not appropriate to use? Cream  What does it mean to be a cream-based medication? semisolid emulsions of oil in water that vanish when rubbed into the skin  When would it best be used?  When is it not appropriate to use? Lotion  What does it mean to be a lotion-based medication?  When would it best be used?  When is it not appropriate to use? Solution  What does it mean to be a solution-based medication?  When would it best be used?  When is it not appropriate to use? Gel  What does it mean to be a gel-based medication?  When would it best be used?  When is it not appropriate to use?