dermatitis, systemic illnesses, derm emergencies, & viral infections

Question 1

HSV 1

Answer 1

cold sores triggered by stress

dx - viral culture

s/s - grouped vesicles on erythematous base, associated swelling often

tx - amciclovir/acyclovir/valcyclovir

Question 2

HSV 2

Answer 2

sexual skin transmission (mostly asymptomatic shedding)

dx - viral culture

s/s - grouped vesicles on erythematous base, lesions then become punched out

tx - valacyclovir/famciclovir/acyclovir

Question 3

herpes zoster (shingles)

Answer 3

reactivation of latent varicella virus

s/s - grouped vesicles on erythematous base, unilaterally along sensory nerve (does not cross midline)

can cause post-herpetic neuralgia (intense pain 4 weeks after lesions resolve)

dx - viral culture

tx - valacyclovir/famciclovir/acyclovir, mgmt of pain/postherpetic neuralgia (gabapentin, TCAs, capsaicin)

prevention via herpes zoster vaccine

Question 4

verrucae (warts)

Answer 4

infection via HPV virus

s/s - flesh colored papules evolve to dome-shaped, gray-brown hyperkeratotic growths

smooth, flat, or slightly elevated round papules

tx - widespread; liquid nitrogen cryotherapy, keratolytics, salacylic acid

Question 5

Steven-Johnson Syndrome

Answer 5

skin and mucous membrane reaction to medication (sulfa)/ infection/malignancy (hypersensitivity - minor form of TEN)

s/s - flu like symptoms -> painful red or purple rash with vesicles and bullae that spreads and blisters, causes skin to slough off (<10% TBSA)

dx - clinical or skin biopsy if needed

cx - cellulitis, eye damage, sepsis, renal injury, resp failure

tx - derm consult, treat symptoms, stop offending drug, fluids, analgesics, NO STEROIDS, cyclosporine

Question 6

toxic epidermal necrolysis

Answer 6

life threatening derm emergency (>30% skin detachment)

reaction to med/infecton/malignancy - necrosis of keratinocytes

dx - clinical

s/s - skin sloughing off with contact

tx - supportive tx, IVF, IVIG

Question 7

kaposi’s sarcoma

Answer 7

tumor caused by herpesvirus 8 (immunosuppressed individuals)

systemic disease w cutaneous lesions

s/s - erythematous patches in oral cavity, lymph site, viscera, and lower extremities

dx - tissue biopsy

tx - cryotherapy, injections, radiation, chemo, surgical excision

Question 8

psoriasis

Answer 8

inherited dermatitis triggered by stress

associated w psoriatic arthritis

s/s - well demarcated erythematous papules and plaques w silver-white scale

dx - clinical, skin biopsy or KOH

tx - topical steroids, phototherapy, methotrexate, etanercept SQ

Question 9

steroid classes

Answer 9

1-4 for trunk
5-7 for face & genitalia

Question 10

eczema

Answer 10

inflammatory rxn of dermis and epidermis

acute or chronic
acute - pruritis, erythema, vesiculation
chronic - hyperkeratosis, fissuring

Question 11

atopic dermatitis

Answer 11

genetic predisposition - asthma, allergies, eczema

acute - erythemous patches, papules, and plaques w/wo scale

chronic - lichenification (thickening of the skin) and scaling patches with skin markings that results from rubbing or scratching

tx - unscented products w moisturizers, low potency topical steroids, IL4 injectable (Dupixient), emollients, antihistamines for itching

Question 12

dyshidrotic eczema

Answer 12

eczema on hands and feet
stress trigger, or contact

s/s - pruritis followed by vesicles/papules on hands and feet

tx - topical steroids, avoid triggers

Question 13

nummular eczema

Answer 13

pruritic, chronic coin shaped plaques

worse in winter

tx - topical steroids, antihistamines for itching

Question 14

contact dermatitis

Answer 14

cell-mediated hypersensitivity rxn

erythema, progressing to pruritic papulovesicular eruptions wither serous fluid

tx - avoid irritants, topical steroids, anti-itch lotions

Question 15

urticaria (hives)

Answer 15

pruritis, reactive pattern w transient, edematous red plaques that vary in size and shape

tx - treat itch, NSAIDs or steroids, immunosuppressants if chronic