Dermatology Flashcards
(156 cards)
1
Q
What are the functions of the skin
A
Protects internal tissues and organs from bacteria and viruses foreign substances/chemicals ultraviolet light fluid loss
Regulates temperature
Sensation: hot, cold, touch, pain, vibration
2
Q
Examples of Primary Skin Lesions
A
Macule Patch Papule Plaque Nodule Pustule Vesicle Bulla Tumor Cyst Wheal (Hive) Nevi
3
Q
Macule
A
flat discoloration 0.5 cm or smaller
4
Q
Patch
A
flat discoloration larger than 0.5 cm
5
Q
Papule
A
palpable lesion up to 0.5 cm in diameter
6
Q
Plaque
A
palpable solid lesion more than 0.5 cm in diameter
7
Q
Nodule
A
usually round, solid lesion more than 0.5 cm in diameter
8
Q
Pustule
A
a collection of leukocytes and free fluid that varies in size
9
Q
Vesicle
A
collection of free fluid up to 0.5 cm in diameter
10
Q
Bulla
A
a collection of free fluid more than 0.5 cm in diameter
11
Q
Cyst
A
encapsulated, expressible liquid or semisolid material in dermis or subcutaneous region
12
Q
Pilonidal Cyst/Abscess
A
Infected cyst at upper gluteal cleft above the anus/coccyx. Treat with surgical I&D or excision.
13
Q
Tumor
A
elevated solid lesion larger than 2 cm (Lipoma – benign adipose tissue tumor)
14
Q
Wheal (aka Hive)
A
a firm edematous papule or plaque, resulting from infiltration of the dermis with fluid
15
Q
Types of Nevi
A
Junctional: macule or patch. You can see this but you can’t fell it.
Compound: You can feel this and see this
Intradermal: You can feel this, but it is hard to see due to lack of pigmentation
16
Q
Examples of Secondary Skin Lesions
A
Scales Crust Erosion Excoriation Lichenification Ulcer Fissure Atrophy Scar
17
Q
Scales
A
excess dead epidermal cells
18
Q
Crust
A
collection of dried serum and cellular debris (scab)
19
Q
Erosion
A
a focal loss of epidermis (heals without scarring)
20
Q
Excoriation
A
linear erosions of the epidermis caused by scratching
21
Q
Lichenification
A
thickened epidermis secondary to prolonged rubbing or scratching
22
Q
Ulcer
A
a focal loss of epidermis and dermis (heals with scarring)
23
Q
Fissure
A
a linear loss of epidermis and dermis with sharply defined walls
24
Q
Atrophy
A
depression in the skin from thinning of the epidermis or dermis
25
Scar
abnormal formation of connective tissue from dermal damage
26
Examples of Treatment Vehicles
```
Cream
Lotion
Ointment
Gel
Solution
Foam
Pads
Patch/Tape
Bar/Cleanser
```
27
Topical Corticosteroids
High potency = more vasoconstriction and increased risk of atrophy.
Class 1 – HIGH potency
Class 7 – LOW potency
OTC hydrocortisone cream
28
Atopic Dermatitis (eczema)
Erythematous, patches of eczematous change with excoriation to the malar cheeks, bilateral antecubital and popliteal fossa (flexural surfaces)
- Very Common in children
- Possibly family history of asthma
- Commonly flares in winder with dry environment
29
Atopic Dermatitis (eczema) Treatment
Oral antihistamines
(Stops the itch)
Topical corticosteroid BID for 10-21 days
(Puts the “fire” out)
Topical immune modulators for long term control (Elidel, Protopic)
(Prevents the “fire” from coming back )
Moisturizing cleansers, emollients, humidifier
30
Rhus Contact Dermatitis
Linear, erythematous streaking with vesicles to the anterior neck, upper and lower extremities
- Most commonly referenced with poison Ivy
- Antigen remains contagious until it is washed. The skin itself is not contagious after washing.
31
Rhus Contact Dermatitis Treatment
Tapering dose of systemic corticosteroids (Prednisone) for 3-4 weeks.
(A 7-day pack does not work because the itch can last up to a month)
Medium to high potency topical corticosteroid BID
Oral antihistamines
Antigen causing itch can remain in skin up to 1 month
32
Contact Dermatitis
Dermatitis due to contact with something
-Often children react to nickel
33
Contact Dermatitis Treatment
Prednisone
34
Dyshidrotic dermatitis (pompholyx
Excoriated erythema with multiple 1-3 mm vesicles, worse on the lateral aspect of the fingers
- worse when warm and moist
- Often seen in people that wear gloves
35
Dyshidrotic dermatitis treatment
Medium to high potency topical corticosteroid BID
Oral antihistamines
Rule out tinea and contact dermatitis**
36
Nummular Dermatitis
Multiple round, dry erythematous patches to the back and dorsal hands. There is no white scale and no central clearing
-Common in winter when skin dries out
37
Nummular Dermatitis Treatment
Medium to high potency topical corticosteroid BID
Oral antihistamines
Rule out tinea
Moisturizing cleansers, emollients, humidifier
38
Seborrheic Dermatitis
Erythema with mild scale to the central face, eyebrows and nasolabial folds. There is also diffuse flaking to the scalp and ears.
-This is a build up of yeast on the skin
39
Seborrheic Dermatitis Treatment
Sulfa based cleanser (Plexion, Clenia) BID
and/or antidandruff shampoo
Topical ketoconazole cream or cicloprox lotion BID
Low potency topical steroid for 3-4 days only
CAUTION: STEROIDS ARE FOOD FOR FUNGUS
40
Stasis Dermatitis
Multiple varicosities to the lower extremities. 2+ pretibial edema. Lichenified eczematous changes with excoriation to the pretibial region
- Swelling, redness, itching to lower extremities
- Worse when standing
- Found in patients with HTN and CHF
- Iron from the blood leaks out on skin to cause pigment change
41
Stasis Dermatitis Treatment
```
High potency topical steroids
Oral antihistamines
Compression stockings
Systemic corticosteroids for flares
Oral antibiotics for infection
Venous ultrasound
```
42
Stasis Ulcer
Often occurs suddenly, even with minor trauma – usually not infected
Tx: elevation, compression, treatment of surrounding stasis, Duoderm dressing (wet dressing to keep area moist), Unna boots (gauze with calamine lotion to help dry out wound)
PRN culture and antibiotics
43
Decubitus Ulcer
Occurs in areas of constant pressure - often infected with mixed bowel flora
Relieve pressure point, debriedment, Duoderm dressing, culture and antibiotics
Often seen in nursing home patients sitting in wheelchair or bed all day
44
Lichen Simplex Chronicus
Excoriated eczematous changes to the trunk and extremities with large areas of lichenification
-Secondary to a long history of eczema (uncontrolled atopic dermatitis)
45
Lichen Simplex Chronicus Treatment
Treatment of underlying condition
Oral antihistamines
High potency topical steroids
46
Tinea Pedis
Excoriated scaling erythema to the web spaces of foot with involvement of the plantar surface. Toenails are normal with no discoloration or subungal debris. KOH +
-Fungi like to begin in creases or webbed spaces
47
Tinea Pedis Treatment
Topical “cidal” antifungal cream – Naftin, Lamisil, Ertaczo, Loprox,
Mentax, Luzu
Oral antihistamines
Check for toenail involvement
48
Tinea Corporis
Two 2-3 cm well demarcated, circular areas of erythema with central clearing and follicular involvement on the arm.
- Red Circular Rash
- Central Clearing
49
Tinea Corporis Treatment
Stop hydrocortisone cream because steroids "feed" fungus and will cause it to grow
Contine Naftin cream BID
Terbinafine (Lamisil) 250 mg qd for 7 days
Oral antihistamines for itch
50
Onychomycosis
Yellow, hypertrophic (Thick) toenails with subungal debris and spiking to the left foot. Nail biopsy PAS +
51
Onychomycosis Treatment
terbinafine (Lamisil) 250 mg qd x 3 months (do baseline and 6 week LFT) liver function tests
Commonly comes back
(other oral tx: Sporanox or Diflucan)
(Penlac or Jublia for single nail involvement
52
Tinea Versicolor
Multiple pink macules on the chest, back and shoulders. Woods light exam is + for a yellow/green fluorescence.
53
Tinea Versicolor Treatment
Ketoconazole 2% (Nizoral) shampoo qd to body
Itraconazole 200 mg (Sproanox) po in am & pm today, repeat in 1 week – exercise after taking to get meds into pores
Oral terbinafine (Lamisil) is not effective for this condition
54
Lichen Planus
Planar, polygonal, purple papules on the volar surface of the wrist. Oral exam reveals a white lacy plaque to the buccal mucosa and tongue (Wickam’s striae).
- Scratching is painful
- Associated with HEP C
55
Lichen Planus
High potency topical corticosteroid
Oral antihistamine
Lab test for Hepatitis C
56
Pityriasis Rosea
: Multiple salmon colored broad-based papules with thin collarette scale (in a Christmas tree pattern). There is a single larger lesion to the right posterior shoulder (Herald patch). Woods light exam is negative
- See more in Spring or Fall
- Develops from a SINGLE SPOT
57
Pityriasis Rosea Treatment
Oral antihistamines
Low potency topical corticosteroids
This will resolve itself over a few weeks
58
Cutaneous Drug Eruption
Maculopapular erythematous eruption to the trunk and extremities.
- Itchy red rash
- No drainage, warmth, or induration
- May present in many forms
59
Cutaneous Drug Eruption Treatment
Stop Keflex
Oral antihistamines
Cooling lotions – Sarna, Eucerin Calming Anti-itch lotion
60
Fixed Drug Eruption
Single well demarcated erythematous macular lesion to the left lower abdomen. There are no blisters, pustules, scaling or tenderness
*To treat... stop the drug causing the reaction
61
Urticaria (Hives)
Multiple erythematous, edematous plaques to the trunk and extremities. + dermatographism (it leaves a line when you scratch the skin)
62
Urticaria Treatment
```
Acute Urticaria
Desloratadine (Clarinex) 5 mg q am
Hydroxyzine 10-25 mg @ hs
Labs: ASO titer
Avoid hot showers
```
Chronic-More than 6 weeks
63
Vasculitis
Patches of palpable purpura (bruising that you can feel) to the bilateral calves and pretibial region.
-Inflammation/damage to blood vessels
64
Vasculitis Treatment
: CXR, CBC, CMP, ESR, ANA, UA, (rarely LP)
Punch biopsy
Topical mid-potency corticosteroids
Oral antihistamines
Slow prednisone taper over 6 weeks (start with 60-80 mg qd)
65
Stevens-Johnson syndrome
Dusky vesicles with desquamation to the trunk and extremitites. There are some bullae and erosions to the oral and genital mucosa.
- Type of Cutaneous Drug Eruption
- Sudden, rapid onset
- Less then 10% of the skin surface is effected
- Smaller risk of mortality than TEN <5%
66
Stevens-Johnson syndrome Treatment
Stop Drug
Ophthalmology consult
Supportive care (burn treatment)
67
Toxic Epidermal Necrolysis
- Painful erosions to mucus membranes.
- Skin is diffusely erythematous with multiple bullae and desquamation (peeling)
- gentle pressure easily produces epidermal detachment. -Nakolski’s sign
- More than 30% of body surface area
- More gradual progression
- More systemic effects
- More fatal than SJS 25-50%
68
Toxic Epidermal Necrolysis Treatment
Stop Drug
IV immunoglobulin G
-may block immune signal causing apoptosis
Supportive care
Ophthalmology consult
69
Bullous Pemphigoid
Multiple erythematous fluid filled bulla (blisters) to the trunk and upper extremities, worse in the axilla and groin.
- Typical happens in the elderly (over 80s)
- Itching is normally the worst part for the patient
70
Bullous Pemphigoid Treatment
Oral antihistamines
Tapering dose of prednisone over several months
Dapsone 100 mg qd – (Oral antibacterial agent used to tx Leprosy. Acts as an anti-inflammatory by inhibiting neutrophil activity. Check for G6PD deficiency prior to starting tx).
Topical high potency corticosteroids
71
Perioral Dermatitis
Multiple erythematous papules to the perioral and perinasal areas. There are no pustules or honey colored crusting.
-More common in women
72
Perioral Dermatitis Treatment
Oral antibiotics BID for 2-4 weeks - TCN, Minocycline, Doxycycline
Topical antibiotics – Clindamycin
Do not use topical corticosteroids.
73
Acne Vulgaris
Multiple inflammatory papules and multiple open comedones with moderate oil to the central face.
Open comedones:
(Black heads, where oil has been oxidized and hardened)
Closed comedones:
(White heads not exposed to air)
P. acnes-bacteria associated with acne
74
Acne Vulgaris Treatment
Drying wash - Benzoyl Peroxide 10% wash BID
Bleaches towels
Oral antibiotic - Minocycline 100 mg BID
Topical antibiotic – Clindamycin solution BID
Topical retinoid – Tazorac 0.1% cream @ hs (at bedtime)
Helps white heads and black heads
Accutane (isotretinoin) – for nodulocystic acne
20 week treatment, requires monthly labs including pregnancy test in females, IPledge
75
Rosacea
Background erythema to the central face with scattered inflammatory papules. There are no comedones. (whitehead/blackhead)
Flushing due to vasodilation
Rhinophyma-enlargement of the nose
-Happens in response to hot temperatures and spicy foods
76
Rosacea Treatments
Avoid trigger factors
Sulfa based cleanser (Plexion, Clenia) BID
Topical antibiotic – Metronidazole or Sulfa based gel BID
Oral antibiotics – Doxycycline or Minocycline
Mirvaso gel – brimonidine gel
Causes vasoconstriction
Soolantra – ivermectin cream
77
Folliculitis
Muliple areas of follicular erythema and inflammation. There are no obvious pustules.
Folliculitis (Pseudomonas)
inflamation of the hair follicle
Caused from the pseudomonas in the hot tub
78
Folliculitis Treatment
levofloxacin (Levaquin) 500 mg BID x 10 days
Oral antihistamines
Culture any new pustules
Drain and disinfect hot tub
79
Pseudofolliculitis Barbae
Ingrown, inflamed hair
Tx:
avoid close shaving – Bump Fighter razor
Topical antibiotics (clindamycin)
Laser hair removal
80
Seborrheic Keratosis
Multiple brown waxy stuck-on lesions with sharply demarcated borders to the trunk.
More as you get older
-Normally are not painful or itchy, patients just do not like how they look
No treatment needed unless a lesion becomes inflamed or has grossly atypical pigment.
Cryosurgery can be performed but is considered a cosmetic procedure by insurance
81
Pediculosis Capitis-lice
Multiple white flakes attached firmly to the hair shaft – more prominent at the base of the scalp. There is excoriation to the occipital scalp and upper neck. No obvious lice.
-look for lice in the back of the head
82
Pediculosis Capitis Treatment
OTC RID shampoo (Pyrethrin)
Lindane lotion or shampoo – use if OTC treatment not effective
Leave on for 5 minutes then wash out, repeat in 1 week
Nit comb
(topical Benzyl Alcohol 5% or Ivermectin lotion)
Treat close family members
83
Scabies
Multiple punctate areas of excoriation to the trunk and extremities that involves the palms, soles and web spaces.
- Skin scraping + for microscopic ova.
- Pain and itching more at night
84
Scabies Treatment
Permethrin cream (Elimite) apply from neck down, including umbilicus, hands, feet and nails – leave on for 12 hours and then wash off.
Wash clothing and bedding in hot water and dry in dryer.
Oral antihistamines for itch
Topical lotion and mild corticosteroid cream
Persons in close contact with pt must also be treated.
85
Actinic Keratosis
Multiple areas of dry erythema, some lesions have a yellow or transparent adherent scale. Some areas are easier to palpate than observe
- In sun exposed areas
- Can develop into Squamous Cell Carcinoma
86
Actinic Keratosis Treatment
Topical 5-Fluorouracil cream BID for 2-3 weeks or Aldara qd
Cryosurgery to hypertrophic lesions
Sunscreen – prevention
87
Squamous Cell Carcinoma
8 x 8 mm hypertrophic scaling lesion to the left dorsal hand.
-Person with Actinic Keratosis comes back a few months later
Have metastatic potential
Usually in sun exposed areas or patients that have radiation treatment
88
Squamous Cell Carcinoma Treatment
Shave biopsy with ED&C
Electric desiccation and curettage
After wound heals, treat scar and surrounding area with topical 5-Fluorouracil
Recheck area q 3 months for 1 year – if reoccurs may need MOHS
Microscopically oriented histologic surgery
89
Basal Cell Carcinoma
8 x 7 mm erythematous pearly papule to the frontal scalp.
-Often friable with central ulceration.
delicate
-Normal mole randomly begins to grow
-Most common skin
malignancy but rarely
metastasizes.
-Usually in sun exposed
areas.
90
Basal Cell Carcinoma Treatment
P: Shave biopsy with ED&C
Superficial lesions can be treated with imiquimod 5% cream (Aldara)
If biopsy shows Morpheaform BCC than MOHS is indicated.
Recheck area q 3 months for 1 year – then yearly.
91
Malignant Melanoma
A few superficial, uninflamed stuck-on lesions to the chest and midback.
There is a 6 x 7 mm grossly irregular lesion with jet black border to the scapula
ABCDE's
92
ABCDE's of a Malignant Melanoma
```
A-asymmetrical
B-border irregularity
C-color change
D-diameter increasing
E-evolution
```
93
Malignant Melanoma Treatment
Refer to dermatology
Excisional biopsy to determine depth
If malignant you do not want a shave biopsy, you need to be deeper
Surgical excision, possible sentinel node biopsy
Full skin and lymph node exam
Baseline liver function test, chest x-ray
(CT scan of head, chest & abdomen)
30% of MM develop within a pre-existing nevus while the remaining 70% develop de novo.
94
Psoriasis Vulgaris
- Well demarcated erythematous plaques with thick white scale to the scalp, trunk, elbows, knees and hands.
- There is pitting to the nails.
- Found on the extension areas
- Overactive immune system
- Can lead to Psoratic Arthritis
95
Psoriasis Vulgaris Treatment
```
Topical treatments:
Emollients
Corticosteroids
Tazorac – (Vit. A)
Dovonex, Vectical – (Vit. D) ** help prevent return
```
Phototherapy
Methotrexate, Cyclosporine, Soriatane, Otezla
Immunosupressives
```
Biologic therapy
Enbrel
Humira
Remicade
Stelara
Cosentyx
Simponi
Cimzia
taltz
```
96
Alopecia Areata
4 x 5 cm well demarcated area of hair loss to the right scalp. There is no evidence of excoriation, pustules, scaring, flaking or hair breakage.
-Immune condition attacking hair follicles
97
Alopecia Areata Treatment
TSH - Thyroid lab workup
Topical anthralin or high potency corticosteroid
98
Vitiligo
Large macular, hypopigmented patches to the bilateral hands.
-Large white patches on hands
99
Vitiligo Treatment
Sunscreens
Tacrolimus ointment 0.1% BID (Protopic)
Thyroid workup
100
Acute paronychia
Flourid erythema with accumulated exudate to the lateral nail fold.
-infection of the lateral nail fold
101
Acute Paronchia Treatment
Simple I & D, culture
Cephalexin (Keflex) 500 mg BID x 10 days
102
Erythema Multiforme
Multiple erythematous target lesions to the dorsal hands, palms and soles. There is a fever blister to the right upper lip.
-Usually a response to a hepetic lesion elsewhere in the body
103
Erythema Multiform Treatment
Oral antiviral treatment for
Herpes Simplex Virus
EM usually resolves within one month
104
Herpes Simplex Virus
Small, erythematous vesicles to the distal shaft of the penis.
- Red painful blisters
- Burning sensation before outbreak
105
Herpes Simplex Virus Treatment
Take at onset of symptoms:
Valacyclovir (Valtrex) 500 mg BID x 3 days OR
Famciclovir (Famvir) 125 mg BID x 5 days
Patient education on asymptomatic viral shedding
Chronic suppressive therapy – indicated for more than 5 outbreaks per year.
Valacyclovir 1 g QD x 1 year
Famciclovir 250 mg BID x 1 year
Tzanck smear=multinucleated giant cells
106
Herpes Zoster-Shingles
```
Erythematous macular rash with small vesicles to the right flank in a dermatomal pattern.
- Lesions do not pass the midline.
Disease of skin and
nerve. Reactivation of
varicella virus in nerve.
```
- happens when you get older
- often associated with stress
- Follows the dermatome of a nerve.
- On ONE side
- Radiating nerve pain in the back
107
Herpes Zoster (shingles) Treatment
: Valacyclovir (Valtrex) 1 g TID for 7 days
OR
Famciclovir (Famvir) 500 mg TID for 7 days
Amitriptyline 10-25 mg @ hs for PHN
Helps with nerve pain
Pain control
108
Huntington's Sign
-Affiliated with Herpes Zoster
Vesicles on the side or tip of the nose are associated with the most serious ocular complications.
Pts with ophthalmic zoster should be referred to an ophthalmologist.
CN V – ophthalmic division of trigeminal nerve
109
Condyloma acuminata
-AKA Genital Warts
Multiple filliform lesions to the anus.
-types 16 & 18 linked to carcinoma/cervical cancer
110
Condyloma Acuminate Treatment
Imiquimod 5% cream (Aldara) qod @ hs, OR Condylox gel BID for 3 days followed by no treatment for 4 days (repeat prn)
Cryosurgery
Refer to GI for sigmoidoscopy and treatment of internal lesions
111
Molluscum Contagiosum
Multiple flesh colored umbilicated papules to the popliteal fossae
-no itching or burning in these skin colored bumps.
(Pox virus)
- common in kids
- immune system can progressively fight this off
112
Molluscum Contagiomsum Treatment
Imiquimod 5% cream (Aldara) qod for 12 weeks
Cryosurgery or topical cantharidin
113
Verrucae Vulgaris
Multiple hypertrophic verrucous lesions to the fingers.
- warts on fingers and toes
- Caused by HPV
114
Verrucae Vulgaris Treatment
Topical OTC salicyclic acid (Occlusal HP/Compound W) with duct tape occlusion
This helps to soften the wart, which makes it easier to freeze
Debridment
Freeze
Cryosurgery
HPV – can spread by
autoinoculation
115
Cellulitis
Confluent erythema with significant edema to the entire hand that extends to the wrist. Affected area is very warm on palpation. Patient has limited range of motion – he cannot make a fist or bend his fingers 90*. There is no red streaking to the forearm.
116
Cellulitis Treatment
Rest and elevate limb
Augmentin 500 mg TID OR
Keflex 500 mg QID
X-Ray
Obtain culture if skin is weeping
117
Erysipelas
Sudden onset cellulitis with lymphatic involvement (red streaking)
Prodrome of high fever, chills, myalgia and vomiting
Group A strep – Rx: Pen VK 500 QID x 14 days (Zithromax, Biaxin)
118
Acanthosis Nigricans
Velvety brown hyperpigment to the neck and axilla
-Patient Complains of dirty neck
- Often in obese patients
- Sign of insulin resistance so test for diabetes
119
Acanthosis Nigerians Treatment
Labs: Fasting Glucose, Hgb A1C, insulin antibodies
Retin-A cream @ hs to affected area
Weight Loss
Diabetes management if applicable
120
Hidradenitis Suppurativa
Multiple areas of post inflammatory pigment, scaring, dilated pores with communicating cysts.
- Double comedones
- Painful abscesses
- Cord-like bands of scar tissue
-Often under arms and or between legs
121
Hidraentitis Suppurativa Treatment
Minocycline 100 mg BID –
OR Bactrim DS BID
OR Clindamycin 150 mg BID
Humira
Weight loss may improve condition
122
Melasma
Macular hyperpigmented patches to the forehead and cheeks.
-"mask of pregnancy"
123
Melasma Treatment
Daily sunscreen use
Hydroquinone 4% + retinoid
Do not use during pregnancy
124
Candidiasis – Intertrigo
Confluent, bright erythema with multiple satellite lesions
125
Candidiasis-Intertrigo treatment
Topical “cidal” antifungal –
Naftin, Lamisil, Ertaczo, Loprox, Mentax
Fluconazole (Diflucan) 100 mg qd x 7 days
Prevention – absorbent powder (Zeasorb)
126
Erythrasma
Confluent, mild erythema to groin. Woods light exam reveals a coral red fluorescence.
-Corynebacterium
infection
-Treat with Erythromycin
127
Fifth Disease - Erythema Infectiosum
Bright erythema to the malar cheeks - the forehead and perioral area are clear. There is macular, lacy erythema to the trunk and extremities. '
- Parvovirus B19
- Slapped Cheek
- Treat with NSAID
- Rash goes away in 2 weeks
128
Roseola
Small, pink macules diffusely spread over the trunk and extremities. Posterior cervical and occipital lymphadenopathy. Patient is alert and in no distress.
-High fever goes away, THEN rash appears
(Herpes Virus 6 & 7)
Patient has a high fever.. Fever breaks, and then “blooms like a rose”
-Treat with Acetometaphin
129
Impetigo
Denuded erythema to the perioral area with honey colored crusting
-Staph aureus or group A strep
130
Impetigo Treatment
Mupirocin (Bactroban) Ointment TID
Oral Cephalexin (Keflex)
R/O MRSA
131
Hand, Foot, and Mouth dz
Total of 5, 3-4 mm ulcerations to the tongue and buccal mucosa. Scattered 4mm, square vesicles on the palms and soles. No lymphadenopathy.
-(Coxsackie A16 virus)
- "tongue hurting"
- blisters on hands and feet
132
Hand, Foot, and Mouth dz Treatment
Acetaminophen
Cool fluids, prevent dehydration
Avoid acidic foods
133
Herpes Varicella (Chicken Pox)
Multiple 2-4 mm clear vesicles, crusts and pustules on an erythmatous base (dew drop on rose petal / teardrop) to the trunk and extremities. Several ulcers to oral cavity. Patient is scratching
134
Herpes Varicella Treatment
Antihistamines (claritin, zyrtec, atarax, etc)
Calamine lotion
Antivirals (acyclovir 20mg/kg QID po x 5 days or 10mg/kg q 8 hrs x 7 days) in adults and immunocompromised children.
Culture for secondary bacterial infection.
Chicken pox is spread by respiratory droplets or direct contact with vesicles. Patient is contagious from 2 days prior to onset of rash and until all lesions have crusted.
Maternal infection during first 20 weeks of gestation may result in congenital malformations.
135
Measles – Rubeola
Spread by respiratory droplets.
Prodrome: Cough, fever, conjunctivitis, rhinitis (1-7 days).
Erythematous maculopapular rash that becomes confluent. Starts in hairline, spreads to face and neck, then to trunk and extremities (6-7 days).
```
-Koplik spots on buccal mucosa
White spots .
-Complications: otitis media, pneumonia, encephalitis. Infection during pregnancy may cause fetal death.
Treatment: high dose vitamin A
Prevention: live virus vaccine
```
136
Rubella – German Measles
Spread by respiratory droplets.
Prodrome: Mild fever, malaise, headache, URI symptoms (1-5 days).
Maculopapular rash becomes pinpoint. Begins on face and spreads to trunk and extremities in 24 hours and resolves in 3 days.
Posterior cervical, suboccipital and postauricular lymphadenopathy.
Complications: arthralgia/arthritis especially in women, may last 1 month or longer. Infection during 1st trimester may cause congenital defects.
Prevention: live vaccine
137
Kawasaki Disease
Acute multisystem vasculitis of unknown origin in infants and young children. Major cause of acquired heart disease in US children
138
Kawasaki Dz Treatment
Diagnosis based on 5 of 6 clinical signs:
Fever of unknown origin for more than 5 days
Bilateral conjunctiva injection
Oral cavity erythema, strawberry tongue, dry/fissured lips
Cervical lymphadenopathy
Polymorphous exanthema with vesicles or crusts
Peripheral extremity edema and desquamation
139
Rocky Mountain Spotted Fever
Tick borne, potentially fatal illness
Rickettsia reckettsii
Onset is 6-8 days after tick bite.
Most common in south central and south eastern US and Brazil.
Acute fever, severe headache, myalgia, vomiting and petechial rash.
Rash typically starts on the wrists and ankles, then spreads to palms and soles.
Tx: Doxycycline 100 mg BID for at least 7 days.
Habif pg. 322-323
140
Lyme Dz
Tick borne, affects many organ systems
Borrellia burgdorferi
Onset 3-28 days after tick bite.
Stage 1: erythema migrans – “bull’s eye” lesion at site of tick bite, flu symptoms.
Stage 2: cardiac and neurological problems
Stage 3: arthritis and chronic neurological problems
Tx: Doxycycline 100 mg BID & Amoxicillin 500 mg TID x 21 days.
Habif 320-321
141
Kaposi’s Sarcoma
Malignancy of lymphatic endothelial cells associated with Human Herpes Virus 8 (HHV-8)
Subtypes: Classic, Endemic, Immunosuppressed
142
Classical Kaposi Sarcoma
Men of Eastern European or Mediterranean descent, ages 50-70
Violaceous patches and plaques involving the lower extremities.
Tx: Excision of solitary lesions or radiation for multiple lesions.
Course: Progresses slowly, rarely fatal from lymph node or GI/lung involvement.
143
Endemic Kaposi Sarcoma
In regions of Africa seen in men ages 20-50 and in children under the age of 10
Men: Locally aggressive, nodular infiltrating lesions on extremities
Children: Aggressive lymph node involvement with or without skin lesions
Tx: Radiation or chemotherapy
Course: Aggressive with poor prognosis
144
Immunocompromised Kaposi Sarcoma due to AIDS
AIDS:
CD4 count often < 200. Violaceous macules, plaques and nodules commonly involving the head, neck and upper trunk, lymphadenopathy common.
Tx: Radiation/chemotherapy
Course: Rarely fatal as patient usually dies of other infection
145
Immunocompromised Kaposi Sarcoma secondary to medication
Immunosuppressed secondary to medication (i.e. organ transplant patients)
Presentation is similar to Classic Kaposi’s Sarcoma
Tx: Lesions often improve or resolve when immunosuppressive therapy discontinued.
146
Black Widow Spider Bite
Black spider with red hour glass on abdomen.
Systemic disease due to neurotoxin causes abdominal pain, muscle cramping, hypertension, nausea/vomiting, weakness, tremors and potential paralysis.
Site DOESN’T LOOK BAD , but they feel awful
Mild erythema or swelling at site of bite.
Tx: Antivenin, muscle relaxants, pain control
147
Brown Recluse Spider Bite
Yellow, tan or brown spider with violin shaped marking on back.
Localized pain, burning and stinging and possible local tissue ischemia.
Site LOOKS bad, but they don’t feel as bad
Uncommon systemic symptoms: fever, chills, nausea/vomiting, weakness, joint pain.
Tx: Supportive care – cool dressings.
148
Androgenetic Alopecia - Male
Begins with receding hairline
Tx: Rogaine, Propecia, hair transplant
149
Androgenetic Alopecia - Female
Loose hair from the scalp
Tx: Rogaine, hair transplant
150
Rule of 9's
```
Head and Neck=9%
Arm= 9% each
Trunk=back, 18% front, 18%
Genital=1%
Legs=18% each
```
151
Superficial Burn (1st degree)
Damage is limited to the epidermis, causing erythema and pain.
152
Superficial Partial Burn (2nd degree)
The epidermis and part of the dermis are damaged, producing blisters and mild to moderate edema and pain.
153
Deep Burn (3rd degree)
The epidermis and dermis are damaged. No blisters appear, but white, brown, or black tissue and thrombosed vessels are visible without muscle and/or bone involvement.
154
Full Thickness Burn (4th degree)
Damage extends through deeply charred subcutaneous tissue to muscle and bone.
155
Subungal Hematoma Evacuation
Used to alleviate hematoma under nail
156
Port Wine Stain
Congenital "blood vessel birth mark"
| -treated with laser therapy
