Cutaneous Flashcards
(43 cards)
What is the Parkland Formula?
Dx and Tx of Erythema
Multiforme
Hallmark = TARGET lesions, SYMMETRIC on palms & soles (± trunk, face), minimal to no mucosal involvement, -Nikolsky; Rx: remove trigger, supportive
What is the most common cause
of Erythema Multiforme?
Infections: HSV (most common viral cause) > Mycoplasma (most
common bacterial cause)
What drugs are most commonly
associated with Erythema
Multiforme?
SOAPS: Sulfa, Oral hypoglycemics, Anticonvulsants, Penicillin, NSAIDS
What is the difference between
Stevens Johnson Syndrome and
Toxic Epidermal Necrolysis?
BOTH: mucosal involvement, drugs = most common cause, flu-like prodrome, painful target lesions, +Nicholsky’s; SJS: <10% TBSA, most common in children; TEN: >30% TBSA, more common in elderly, fluid /lyte problems common; Rx (both): supportive, remove trigger
What distinguishes Staph
Scalded Skin Syndrome (SSSS)
from SJS/TEN?
SSSS: NO mucosal involvement, younger children/infants/newborns, caused by infection (Staph exotoxin) & treated with antibiotics (Nafcillin/Dicloxacillin), NO STEROIDS; BOTH: painful rash, bullae, + Nikolsky
Dx and Tx of Necrotizing
Fasciitis?
Type 1: polymicrobial (most common), abdomen/perineum, DM2 = risk factor.
Type 2: monomicrobial (GAS), extremities.
SSx: severe pain out of proportion to exam, rapid progression, erythema (most common finding), crepitus, necrosis, cellulitis turns dusky blue with bullae/vesicles, dirty dishwater discharge, La Belle Indifference (pt unconcerned); XR: SQ emphyesma; Rx: broad sepctrum IV abx (Clinda halts toxin production) AND surgical debridement (definitive tx)
Dx and Tx of Urticaria
Transient pruritic edematous plaques, red border with central clearing, NOT symmetric; Rx: remove trigger, benadryl/steroids/epi prn
Dx and Tx of Rocky Mountain
Spotted Fever?
Rickettsia rickettsii.
Transmission: wood tick (must be attached for 6 hours to transmit, eastern US (Carolinas, Oklahoma).
SSx: fever (MC sx), centripetal (wrists/ankles → trunk) maculopapular rash (palms + soles), calf tenderness.
Labs: low platelets, hypoNa.
Rx: Doxycycline
College kid with petechiae →
purpura presents in shock
Meningococcemia; seen in college kids, military barracks (close
quarters), caused by N. meningitidis (requires airborne precautions);
Rx: ceftriaxone, supportive,
Note: tx high-risk contacts with Rifampin, CTX or Cipro
What is the difference between
Pemphigus Vulgaris and Bullous
Pemphigoid?
PemphiguS: Superficial, flaccid bullae → break easily & crust, +mucosal involvement, +Nikolsky; Associations: Myasthenia, thymoma; Rx: steroids;
PemphgoiD: Deeper, elderly, pruritic papules → tense bullae,
NO mucosa, -Nikolsky, Tx: steroids, tetracylcine or dapsone
Shock + Erythroderma and
possible foreign body
Toxic Shock Syndrome. Bacteria that produce toxins. Staph (TSS):
more common; erythematous rash w/ desquamation + hypotension + high fever ≥3 organ systems, assoc. w/ foreign body; Strep (STSS): fever, but less rash often with existing wound, not associated with foreign bodies. Rx: remove foreign bodies FIRST, supportive care, and antibiotics (clinda first to reduce protein production, then empiric broadspectrum
for sepsis coverage), IVIG for refractory cases
Gunmetal gray pustules on
palms
Disseminated Gonococcemia (arthritis-dermatitis syndrome).
SSx: fever + migratory arthritis + rash (papules → pustules with gray necrotic or hemorrhagic center);
Dx: genital + throat culture;
Rx: ceftriaxone.
Complications: tenosynovitis, septic arthritis
Dx and Tx of Impetigo
Most often in kids, facial vesicles rupture and become “honey-crusted”, + contagious, Staph more common cause than strep, Tx topical mupirocin (if small area) vs systemic keflex (more extensive or bullous)
What is the characteristic rash
and cause of Erysipelas?
Well demarcated, slightly raised, beefy red plaque. Group A Strep = most common cause
Obese woman with red macular
rash under breasts, noted
satellite lesions
Candida; also associated with immunocompromised state; Rx: PO
nystatin for thrush, Topical azoles for rashes, dry skin care
What is the difference between
Candida and Tinea rashes?
Candida: seen in babies, immunocompromised, DM, fat adults
(intertriginous), rash: red + macular with characteristic satellite lesions,
Rx PO nystatin for thrush, Topical azoles for rashes, dry skin care;
Tinea: sharply marginated, annular lesion with raised or vesicular
margins with central clearing, Rx: topical azoles for everything except scalp and nails (griseofulvin)
What are the names for Tinea
infections in the following areas:
groin, foot, scalp, nail
Groin: Crura (jock itch),
Foot: Pedis,
Scalp: Capitis,
Nail: Unguium
Compare the rashes of HSV and
HPV
HSV: vesicular clusters with painful erosions (T1- mouth, T2- genitals,Rx: acyclovir);
HPV: cauliflower-like and painless (anogenital warts) = most common STD in US (> Chlamydia)
Vesicle or ulcer noted on tip of
nose or ear?
Herpes Zoster (shingles), tip of nose (Hutchinson sign) for herpes
ophthalmicus (V1), ear (Ramsay-Hunt) if CN 7/8;
Rx: acyclovir, steroids
What is the characteristic rash
Molluscum Contagiosum?
Dome-shaped fleshy papule with central umbilication on face/torso/ext; most common in kids in daycare or adults with HIV; caused by MCV (pox virus),
Rx: self-limited, cryotherapy
Compare the rashes of Scabies
and Pediculosis
Scabies: linear burrows in interdigital web space and intertriginous areas with expreme pruritis;
Pediculosis (lice): erythematous macules/wheals,
extreme pruritis, nits visible; Rx (BOTH): decontamination, Permethrin cream (often repeat 1wk, esp lice)
Compare atopic dermatitis and
psoriasis
Atopic dermatitis (eczema): usually kids <5, allergy/asthma history, winter months, dry pruritis skin with lichenification
(hyperpigmentation/thickening) in flexural areas,
Psoriasis: welldemarcated erythematous plaques/papules with silvery white scales in extensor areas, +Auspitz sign (small bleeding points after successive layers of scale have been removed from the surface of psoriatic papules or plaques),
Rx (BOTH): emollients, topical steroids
Dx and Tx of Seborrheic
Dermatitis
Cradle cap. Occurs in infants. Yellowish, greasy scales on scalp, ±
diaper area & axillae; Rx: emollients, topical antifungals, steroids
