Dermatology High-Yield: Skin Conditions Every FNP Student Must Know
Clinical High-Yield · 9 min read · April 16, 2026
Acne Vulgaris
Pathophysiology: Sebum overproduction + follicular plugging + P. acnes colonization + inflammation
Classification:
- Comedonal (non-inflammatory): Blackheads, whiteheads
- Inflammatory: Papules, pustules
- Nodular/cystic: Severe, scarring
Treatment (stepwise):
- Mild comedonal: Topical retinoids (tretinoin, adapalene)
- Mild-moderate inflammatory: Topical benzoyl peroxide ± topical antibiotics
- Moderate: Add oral antibiotics (doxycycline, minocycline) — limit to 3 months
- Severe/cystic: Isotretinoin (requires iPLEDGE program due to teratogenicity)
- Women: Oral contraceptives or spironolactone as adjuncts
Atopic Dermatitis (Eczema)
Presentation: Pruritic, erythematous, scaly patches; flexural surfaces in adults; cheeks and extensor surfaces in infants
Treatment:
- Moisturizers: Foundation of treatment — apply immediately after bathing
- Topical corticosteroids: First-line for flares; use lowest potency effective
- Topical calcineurin inhibitors (tacrolimus, pimecrolimus): Steroid-sparing, safe for face
- Dupilumab: Biologic for moderate-severe disease
- Antihistamines: For sleep disruption from pruritus
Psoriasis
Presentation: Well-demarcated, erythematous plaques with silvery scale; extensor surfaces (elbows, knees), scalp, nails (pitting, onycholysis)
Auspitz sign: Pinpoint bleeding when scale is removed
Treatment:
- Mild-moderate: Topical corticosteroids, vitamin D analogues (calcipotriene), topical retinoids
- Moderate-severe: Phototherapy (UVB), methotrexate, biologics (TNF inhibitors, IL-17 inhibitors)
Skin Infections
Impetigo: Honey-crusted lesions; S. aureus or Strep; topical mupirocin for localized, oral antibiotics for widespread
Cellulitis: Spreading erythema, warmth, tenderness; usually S. aureus or Strep; cephalexin or dicloxacillin; TMP-SMX if MRSA suspected
Tinea (ringworm): Annular, scaly plaques; topical antifungals (clotrimazole, terbinafine); oral terbinafine for tinea capitis and onychomycosis
Herpes zoster (shingles): Dermatomal vesicular rash; treat with valacyclovir within 72 hours of rash onset; postherpetic neuralgia treated with gabapentin, TCAs
Skin Cancer Recognition
Basal cell carcinoma (BCC): Most common; pearly papule with rolled borders, telangiectasias; rarely metastasizes
Squamous cell carcinoma (SCC): Scaly, ulcerated plaque; can metastasize; associated with actinic keratoses (precursor)
Melanoma (ABCDE rule):
- Asymmetry
- Border irregularity
- Color variation
- Diameter >6mm
- Evolution (changing)
Board pearl: Any suspicious lesion should be referred for biopsy. Do not attempt to diagnose melanoma clinically — refer.