Chapter 49: Maculopapular Skin Disorders

Buttaro: Primary Care: A Collaborative Practice, 6th Edition

Multiple Choice

1. A patient with chronic seborrheic dermatitis reports having difficulty remembering to use the twice daily ketoconazole cream prescribed by the provider. What will the provider order for this patient?

a. Burrow’s solution soaks once daily b. Oral corticosteroids c. Oral itraconazole (Sporanox) d. Selenium sulfide shampoo 2.5% as a daily rinse

ANS: C a. Atopic dermatitis b. Guttate psoriasis c. Psoriasis d. Seborrhea

Itraconazole is effective for moderate to severe symptoms and is an alternative for those who do not wish to use topical treatment. Burrow’s solution and selenium shampoo rinses are not indicated. Oral corticosteroids are usually not given.

2. A child has plaques on the extensor surfaces of both elbows and on the face with minimal scaling and pruritis. What is the likely cause of these lesions?

ANS: C

Children with psoriasis often have lesions on the face and have less scaling than adults. Psoriasis tends to present on extensor surfaces, while atopic dermatitis occurs on flexor surfaces. Guttate psoriasis appears as teardrop-shaped lesions that appear on the trunk and spread to the extremities and are occasionally seen after streptococcal infections in adolescents. Seborrhea usually occurs on the scalp.

NURSINGTB.COM a. High-potency topical steroids b. Oral corticosteroid injections c. Topical steroids with vitamin D d. Topical, low-potency steroids

3. A patient diagnosed with psoriasis develops lesions on the intertriginous areas of the skin. Which treatment is recommended?

ANS: D a. Cyclosporine b. Etanercept c. Methotrexate d. Oral retinoids

Patients with intertriginous psoriasis should be treated with low-potency topical steroids. High-potency steroids usually produce maximum benefit in 2 to 3 weeks and research suggests combining high-potency steroids with vitamin D analog is best. Oral corticosteroids are used for recalcitrant symptoms.

4. A patient with severe, recalcitrant psoriasis has tried topical medications, intralesional steroid injections, and phototherapy with ultraviolet B light without consistent improvement in symptoms. What is the next step in treating this patient?

ANS: C

Methotrexate has shown good efficacy in treating recalcitrant psoriasis. Cyclosporine and oral retinoids are effective but have serious side effects. Etanercept and other biologic agents are effective but expensive and should be tried after all other treatments have failed.

Multiple Response

1. An adult patient has greasy, scaling patches on the forehead and eyebrows suggestive of seborrheic dermatitis. What is included in assessment and management of this condition? (Select all that apply.)

a. Begin first-line treatment with a topical antifungal medication.

b. Evaluate the scalp for dry, flaky scales and treat with selenium sulfide shampoo.

c. Teach the patient that proper treatment is curative in most instances.

d. Topical antibacterial medications may be used to prevent Malassezia proliferation.

e. Use topical steroids for several weeks to prevent recurrence of symptoms.

ANS: A, B

First-line therapy may include topical antifungals or corticosteroids. Adults with symptoms on the face or eyebrows are likely to have scalp lesions, since this is usually a “top-down” disorder. The condition is chronic and recurrent. Antibacterial medications are used for secondary bacterial infections but do not treat Malassezia, which is a fungus. Topical steroids should be used on a short-term basis.

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