Dermatology Flashcards by Jonathan Walker

Associated with asthma and allergic rhinitis
Erythema, crusts, fissures, pruritis, excoriations, lichenification
Chronic pruritic skin condition
Infants: Blisters, crusts, exfoliation (face, scalp, extremities),1st few months. Resolves by age 2
Adults: Dryness and thickening in antecubital and popliteal fossae, neck
Positive family history, worse in winter (dry weather)

Eczema (Atopic Dermatitis)

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Delayed type hypersensitivity
Poison ivy, poison oak, poison sumac (linear extension)
Contact with metal jewelry (nickel)
Hair dyes, detergents
Erythema, pruritus, vesicles, bullae
Blister fluid contains no antigen
Corticosteroids for severe cases

Allergic Contact Dermatitis

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Generalized dermatitis, diffuse, scaly, warm, erythematous, non-tender, pruritic
Leads to exfoliation
Most are secondary to underlying disease
Involves most or all of skin
Flares of pre-existing skin disease (psoriasis, atopic dermatitis etc.)

Differential: SSSS, EM, TEN ,TSS

Exfoliative Dermatitis

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Response to drugs, chemicals, systemic disease or malignancy (lymphoma, leukemia)
May be acute, subacute or chronic
Typically males over 40
Complications are 2° to disruption of epidermis
Hypothermia, volume loss, electrolyte abnormalities, 2° skin infection
Important to diagnose underlying cause
Admit, IV, steroids for severe cases

Exfoliative Dermatitis

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Chronic papulosquamous eruption
Due to more rapid cell cycle
Erythematous plaques with white (silver) scales
Extensor surfaces of elbows, knees, scalp, palms, soles
Pitting of the nails
May be accompanied by psoriatic arthritis
Treatment: steroids, tar, UV light, methotrexate

Psoriasis

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White, yellow, waxy scales with erythema
Localized to hairy skin areas
Scalp, eyebrow, ear, axilla, groin (wherever
there are sebaceous glands)
Malassezia (a fungus) is associated
Not contagious
Frequent recurrences, worse in cold weather
May be severe or generalized in HIV positive patients
Treatment: Rotating antidandruff shampoos,
ketoconazole shampoo or cream; steroids are discouraged

Seborrheic Dermatitis (Dandruff)

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Children, young adults, spring and fall
Etiology unknown
No epidemics, not contagious
Rash evolves over weeks
Herald patch: Single salmon-colored lesion with raised boarder on trunk, 1–5 cm
1-2 weeks after herald patch: Widespread eruption, pink maculopapular oval patches that follow the ribs (“Christmas tree” pattern)
Rule out syphilis (if clinically indicated), drug reaction
Treatment: Symptomatic, antihistamines
Resolution in 2-10 weeks

Pityriasis Rosea

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Deposits of blood under skin
Non-blanching
Petechiae <3 mm, purpura >3 mm
Non-palpable: Platelet disorder, thrombocytopenia
Palpable purpura = Vasculitis
Treatment: Antibiotics, steroids, 
   plasmapheresis (depends on etiology)

Petechiae / Purpura

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Diffuse pruritus, wheals, hives (superficial dermis)
Lesions move around within 24 hours
Etiology is unknown most of time
IgE → mast cells → histamine release
Usually self-limited
Treatment: Antihistamines, steroids, antipruritics, H2 blockers, epinephrine

Urticaria

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Bradykinin-mediated
↑ Vasodilation
↑ Vascular permeability 
Edema of the deeper dermis
Common cause: ACE inhibitors
ACE inhibitors decrease metabolism of bradykinins
Can occur early or late
2/3 occur in hours
1/3 in months to years

Angioedema (1)

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Familial - associated with C1 esterase inhibitor deficiency
C1 esterase inhibitor inhibits complement cascade
Deficiency leads to increased bradykinin
Edema of face, extremities, bowel wall
Responds to fresh frozen plasma and C1 esterase inhibitor concentrate
Autosomal dominant (positive family history)

Angioedema

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Infants, toddlers, elderly
Usually Group A Strep, occasionally Staph
Superficial cellulitis, lymphangitis
Localized (face, legs, ear)
Butterfly facial rash (warm and tender)
Raised, well demarcated border
Treatment: PCN, dicloxacillin, erythromycin

Erysipelas

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Painful, non-ulcerative, violaceous nodules (localized vasculitis) on anterior tibia, arms, trunk
Looks like erythema, feels like nodes
EN is often a marker for systemic disease
Drug reaction (oral contraceptives, sulfa, PCN)
Systemic infection (TB, fungal)
Sarcoid
Inflammatory bowel disease (ulcerative colitis)
Malignancy (leukemia, lymphoma)
Most common in women 30-50
Resolves in 3-6 weeks
Treatment is directed at underlying disease

Erythema Nodosum (EN)

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Consider in any acute, symmetrical eruption
Common: PCN, cephalosporins, sulfa
Usually disappears within 1-2 weeks
Immediate hypersensitivity: IgE (urticaria)
Delayed hypersensitivity: IgM (serum sickness)
Urticaria, morbilliform rash (discreet red-brown papules coalesce to erythema), erythema multiforme
Treatment: Discontinue drug, antihistamines, steroids
Complications: Stevens-Johnson syndrome (mucosal and cutaneous), Severe bullous (form can be fatal)

Drug Eruption

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Minor (erythema multiforme)  EM major (Stevens-Johnson)  EM maximum (TEN)
Hypersensitivity reaction
Infection (Mycoplasma, Herpes), malignancy, drugs
Sulfa, oral hypoglycemics, anticonvulsants, PCN (memory aid: “SOAP”)
Palms, soles, extensor surfaces
“Bull’s eye” or “target” lesions
Treatment: Remove offending agents; symptomatic for minor forms; major forms may need resuscitation, ICU admission

Erythema Multiforme

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Severe bullous form of EM, 10-30% of BSA, mucosal involvement, can be fatal
Bullous cutaneous lesions, mucositis, stomatitis, conjunctivitis, crusted nares
Children, adolescents, males
Serious, potentially fatal form of E. multiforme
Hypersensitivity reaction
Severe reaction to medication: Sulfonamides PCN, barbiturates, phenytoin, tetracycline, thiazides

Stevens-Johnson Syndrome

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Erythema multiforme, Stevens-Johnson syndrome and TEN
Probably variants of the same disease process. The difference is in severity and body surface area affected
TEN affects >30% of BSA
Exposure to drugs, chemical agents, infections
Sulfa, PCN, barbiturates, phenytoin, allopurinol, NSAIDs
Mycoplasma, HSV
Toxic patient, large bullae, mucous membranes, widespread systemic manifestations

Toxic Epidermal Necrolysis (TEN) 1

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Separation of dermal-epidermal junction
Nikolsky’s sign: Skin peels off with light pressure
Older age group has high mortality
Increased mortality from dehydration and 2° infection
Primary causes of death: Sepsis, pneumonia
Treatment: Admit to ICU

Toxic Epidermal Necrolysis (TEN)

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Usually children <2 years old
Staph aureus exotoxin
Fever, scarlatiniform rash followed by exfoliation
Nikolsky’s sign: Skin peels off with light pressure
Antibiotics (vancomycin) indicated, but do not alter cutaneous disease
More favorable prognosis than TEN
Steroids are contraindicated

Staphylococcal Scalded Skin Syndrome

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Painful intradermal bullae, 40-60 years old, possible autoimmune etiology
Associated with penicillamine, captopril, phenobarbital
Bullae on normal skin, often start in mouth
Mucus membranes are frequently involved
Blisters are fragile, break easily, leave red or crusted erosions
Small flaccid bullae  erosions, ulcerations
Nikolsky sign positive (like TEN)
Can be lethal: Mortality due to secondary infection, dehydration
Treatment: Steroids, admission, biopsy

Pemphigus Vulgaris

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Chronic benign bullous eruption. Autoimmune disease
Risk factors: Age > 60, female, malignancy, furosemide (Lasix)
Begins with urticarial lesions, then tense blisters up to 10 cm
Large bullae (2-5 cm) arise from erythematous skin
Mucus membranes infrequently involved
Nikolsky sign negative
IgE deposited on basement membrane
Course is usually benign. Mortality much less than in pemphigus

Bullous Pemphigoid

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Most common skin malignancy
Pearly, rolled border with central ulceration
Not a metastasizing tumor
Slow growing, usually head and neck
Seen only where hair follicles exist
Cure rate 100% if found early

Basal Cell Carcinoma

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Increasing incidence
Ages 30-50
Risk factors: Adulthood, dysplastic nevi, family history of melanoma, fair skin, UV exposure, congenital nevi
Account for majority of skin cancer deaths
Sun exposed areas (head, neck, trunk)
The greater the depth, the worse the prognosis
Metastases are common

Malignant Melanoma

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Second most common cutaneous malignancy
Common in elderly males, fair skin, sun 
    exposure
Face, lips, ears, tongue, hands
Rapid growth, central ulcer, raised and indurated  border
Metastases occur early
Treatment: Excisional surgery, radiation

Squamous Cell Carcinoma

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Tinea capitis (scalp) and tinea barbae (beard) Bald, broken hair Scaly patch Edematous nodules and pustules (kerion) Tinea corporis (ringworm) Non-hairy parts of the body, outward spreading, annular lesion, clear center Tinea pedis (athlete’s foot) Tinea cruris (jock itch) Groin and inner thigh (sharp demarcation) Scrotum not involved Causes: Trichophyton, Microsporum, Epidermophyton Treatment: Antifungal (topical or oral)

Tinea (Dermatophytosis

Hypopigmented or hyperpigmented circular, scaly patches Poor hygiene, moisture Malassezia fungus Treatment: Selenium shampoo, ketoconazole shampoo or cream

Pityriasis (Tinea) Versicolor

Pathogenic spirochete Reservoirs: Rats, cattle, pigs, dogs Skin contact with urine of infected animal Contaminated water Hepatitis, nephritis, meningitis, coagulopathy Weil’s disease (severe form): Jaundice, subconjunctival hemorrhage, hepatitis, DIC Risk of death from hepatorenal failure Diagnosis by serology Treatment: Pen G, tetracycline, doxycycline

Leptospirosis

``` Borrelia burgdorferi (spirochete) Transmitted by bites of Ixodes ticks Tick reservoirs: Rodents, rabbits, deer Most do not recall tick bite Fever, myalgias, arthralgias, headache 3 stages Localized (rash) Disseminated (neurologic and cardiac) Persistent (arthritis) ```

Lyme Disease

Erythema migrans: Annular, expanding erythematous lesion with central clearing (spares palms, soles) Neuro: CN VII palsy, meningitis, peripheral neuropathy Cardiac: Myocarditis, pericarditis, heart block Diagnosis: ELISA (screening); Western blot Treatment: Doxycycline, amoxicillin, cefuroxime; macrolides if others not tolerated Probable risk = Test Probable disease = Treat

Lyme Disease

N. meningitidis (encapsulated Gram negative diplococcus) Broad spectrum of disease Bacteremia, sepsis, meningitis Fever, myalgias, headache, rash 1-2 mm petechiae  purpura Poor prognosis if petechiae, hypotension, T> 40 °C, decreased platelets, no meningismus or leukocytosis

Meningococcemia

Prophylaxis: Close contacts, nursing home, dormitory, family Prophylaxis is not indicated for brief hospital encounter (ER patient, no close contact) Rifampin, Cipro for prophylaxis Diagnosis: CSF and blood serology, cultures Treatment: PCN, chloramphenicol, isolation

Meningococcemia

shock, petechiae, adrenal infarction

Waterhouse-Friderichsen syndrome | associated with meningococcemia

Virulent, toxin-producing bacteria Often seen with IVDU Widespread fascial and muscle necrosis, sparing of skin Crepitant anaerobic cellulitis (necrotic soft tissues, subcutaneous gas) Myonecrosis (clostridial, non-clostridial) Necrotizing fasciitis (rapid dissection and necrosis in superficial and deep fascial planes)

Necrotizing Soft Tissue Infections

``` Flesh-eating” bacteria Strep, clostridia, polymicrobial “Pain out of proportion” is hallmark Surgical emergency Pen G + imipenem, or amp + gent + clinda Fournier's gangrene: Necrotizing fasciitis involving scrotum, vulvar or perianal skin ```

Necrotizing fasciitis

Hospital acquired MRSA Hospitalized, dialysis, IVDU, nursing home Community acquired MRSA Skin and soft tissue infections High prevalence in many areas Resistant to beta-lactam antibiotics Milder infections: clindamycin, doxycycline or trimethoprim/sulfamethoxazole Serious infections: vancomycin or linezolid

Methicillin ResistantStaph aureus (MRSA)

Staph aureus exotoxin Prolonged tampon use, packed surgical wounds, nasal packing Menstruating females, postpartum, also in males Fever, hypotension Rash: Diffuse, erythematous, nonpruritic, macular Involvement of at least three systems Renal, hepatic, hematologic, GI, musculoskeletal, mucosal, CNS Treatment: Fluids, remove source, antibiotics Group A Strep variant (higher mortality)

Toxic Shock Syndrome

Rickettsia rickettsii (obligate intracellular bacterium) Bite from infected tick Most cases seen in April-September (tick season) Commonly seen in children <15 Endemic in Southeastern US Fever, headache, myalgias Small pink macules  petechiae, purpura (from a vasculitis) / (wrists, ankles)

Rocky Mountain Spotted Fever (RMSF)(

Rash begins on extremities, wrists, ankles, palms and soles Spreads up trunk, spares face Lab: WBC count normal, left shift, mild anemia, moderate thrombocytopenia, hyponatremia Diagnosis: Clinical (don’t wait for serology tests) Treatment: Doxycycline preferred, chloramphenicol Complications (due to vasculitis) DIC Loss of limbs CNS Lungs Kidneys

Rocky Mountain Spotted Fever (RMSF)(

Clinical presentation similar to rocky mountain spotted fever Transmission through tick bite Two types HME: human monocytic HGE: human granulocytic Fever, headache, myalgias Maculopapular rash Leukopenia, thrombocytopenia, hyponatremia, anemia, LFTs Diagnosis: Clinical suspicion Treatment: Doxycycline, tetracycline, chloramphenicol Complications: DIC, renal failure, coma, death

Ehrlichiosis

Tick-borne hemolytic disease, blood transfusions Intra-erythrocyte protozoan parasite Endemic to northeastern USA Fever, chills, fatigue, malaise Hepatosplenomegaly, jaundice Peripheral blood smear -- parasites in RBCs Usually mild unless asplenic, elderly, or immunosuppressed Treatment: Quinine plus clindamycin; Atovaquone plus azithromycin

Babesiosis

A member of the herpes virus group (dormant until reactivated) The most common of the TORCH infections Congenital: Chorioretinitis, jaundice, hepatosplenomegaly, deafness, rash Acquired: Asymptomatic or mono-like illness Immunocompromised: CMV retinitis, nephritis, pneumonitis, colitis. Carries high mortality Diagnosis: Atypical lymphocytosis, ELISA Treatment: IV ganciclovir or foscarnet

Cytomegalovirus

Toxoplasmosis, Other (Syphilis), Rubella, CMV, Herpes simplex Organisms associated with congenital transmission

TORCH Infections

HSV-1: Stomatitis, fever, decreased fluid intake, oral lesions, corneal ulcers (steroids are contraindicated) Herpetic whitlow: Vesicles grouped on digits, non-surgical treatment, often misdiagnosed HSV-2: Painful vesicles of genitalia and anus Diagnosis: Viral culture, PCR Complications: Congenital transmission (TORCH), encephalitis Treatment: Acyclovir and analogs, vidarabine

Herpes Simplex

Varicella-zoster virus reactivation Painful vesicles in dermatome distribution Cranial nerve involvement HZ ophthalmicus: Opthalmic branch of CN V, lesion seen on tip of nose (Hutchinson’s sign), vision- threatening Ramsay Hunt: CN VII, zoster presenting with facial nerve palsy, ear pain Complications: Pneumonia, meningitis, post-herpetic neuralgia, 2° infection, dissemination Treatment: Acyclovir and analogs, prednisone

Herpes Zoster (Shingles)

HIV types 1, 2 (RNA retroviruses) | Virus multiplication in CD4 lymphocytes

Acquired Immune Deficiency

``` Pneumocystis jiroveci pneumonia (PJP) is the most frequent infection CXR: bilateral infiltrates, hypoxemia Treatment: TMP/SMX, steroids Cryptococcal meningitis Most common CNS fungal infection Diagnosis: CSF (India ink, cryptococcal antigen) Treatment: amphotericin B Toxoplasmosis Most common cause of encephalitis Diagnosis: CT (ring-enhancing lesions) Treatment: pyrimethamine, sulfadiazine Oral candida is most common GI tract infection ```

Acquired Immune Deficiency

Second most common AIDS manifestation Seen in men who have sex with men (MSM) Not a cause of significant morbidity or mortality Purple, painless, non-pruritic areas, flush with skin or raised strawberry-like plaques Persist, enlarge, coalesce, may bleed Extracutaneous involvement: GI tract, liver, spleen, lungs, CNS

Kaposi’s Sarcoma

Viral infection of skin (poxvirus) 2-5 mm umbilicated, pink, dome-shaped papules Autoinoculation: Common locations are face, trunk, extremities (children), groin and genitalia (adults). Usually self-limited Transmission: Close personal contact, swimming pools. Sexual transmission is common in adults HIV/AIDS: Not uncommon, lesions can be extensive and atypical

Molluscum Contagiosum

Epstein-Barr virus (EBV) Common in adolescents. Usually asymptomatic in infants and children Fever, exudative pharyngitis, splenomegaly, lymphadenopathy, atypical lymphocytosis Complications: Splenic rupture, thrombocytopenia Diagnosis: Monospot, serology Amoxicillin almost always causes a maculopapular rash (may be diagnostic) Treatment: Rest, supportive, no contact sports

Infectious Mononucleosis

A collection of congenital infections that can cause severe fetal abnormalities that are associated with a variety of dermatologic manifestations T = Toxoplamosis O = Other (syphilis, EBV, VZV, HBV, Parvo B19) R = Rubella C = Cytomegalovirus (most common) H = Herpes simplex

TORCH Infections

Human Parvovirus B19 Fever, myalgias, diarrhea, URI symptoms, flu symptoms Rash: Abrupt onset, bright red cheeks (slapped cheeks), tiny papules on erythematous base, eyelids and chin spared “Lace-like” erythematous rash on limbs, trunk Complications: Arthritis, aplastic crisis (especially in sicklers) Can cause fetal anemia if acquired during pregnancy Treatment: NSAIDs

Erythema Infectiosum (Fifth Disease)

Coxsackie virus (enterovirus) Occurs in outbreak Fecal-oral transmission Fever, sore throat, malaise, URI Oral lesions: Painful vesicles on anterior mouth (buccal mucosa, tongue, soft palate, gingiva) Skin lesions: Red papules (change to gray vesicles) on palms, soles, buttocks Vesicles on hands, feet, soles Avoid viscous lidocaine in young children because of risk of seizures

Hand-Foot-Mouth Disease

Coxsackie virus Fecal-oral transmission, preschool age, spreads to siblings Fever, dysphagia, drooling, vomiting, headache Ulcerative lesions (vesicles rupture, leaving painful ulcers on posterior pharynx, soft palate, uvula) Complications are rare Resolves in 1 week Anterior mouth spared

Herpangina

Most common acute vasculitis affecting children Preceding Strep or GI infection (Salmonella, Shigella) Ages 2-10, abdominal pain, GI bleeding, hematuria Palpable purpura (legs, buttocks) Thrombocytopenia is absent Complications: Arthritis, glomerulonephritis, hematuria, GI bleeding, intussusception Renal consult Usually resolves spontaneously

Henoch-Schönlein Purpura

Mucocutaneous lymph node syndrome About 2,000 cases/yr in the U.S. Acute, febrile, exanthematous disease of children (age 2-5, males, Asian) Self-limited vasculitis with predilection for coronary arteries Cause unknown Possibly an immune response to bacterial infection, since it occurs in outbreaks

Kawasaki's Disease

Major criteria: Fever >5 days PLUS 4 of the following Conjunctival injection (bilateral) Strawberry tongue, fissures, lips cracked Desquamation or swelling of fingers and toes Erythematous rash (starts on palms and soles) Enlarged (15mm or greater) cervical lymph nodes ↑ WBC, ↑ ESR, ↑ platelets Coronary artery aneurysms Treatment: Aspirin, IV immunoglobulin

Kawasaki's Disease

Staph. aureus, Strep. pyogenes Superficial epidermis, no fever, highly contagious Preschool, young adults, poor hygiene Red, moist vesicles Painless, honey-crusted lesions Rarely causes glomerulonephritis (antibiotics do not prevent this) Treatment: Dicloxacillin, cephalosporin, erythromycin, mupirocin ointment Bullous impetigo suggests Staph infection

Impetigo

Acute viral illness (fever, sore throat, headache) “Three day measles” Rash (pink macules spread from head to feet) Complications Arthritis (immune complex) Encephalitis 1st trimester pregnancy (congenital defects) Prominent lymphadenopathy: posterior auricular, cervical, occipital

Rubella (German Measles)

Fever, cough, conjunctivitis, coryza (3 “C”s) Koplik spots: Buccal mucosa (before rash), non-tender, tiny white spots (“grains of salt”) Maculopapular, red-brown “morbilliform” rash spreads from head to feet Complications: Encephalitis, pneumonia, otitis media, conjunctivitis

Rubeola (Measles)

``` Exanthem subitum Human herpes viruses (HHV) 6 Common at ages 6-18 months High fever (3-4 days), then rash with defervescence Febrile seizures are common Pink macules and papules on trunk May spread to neck, face, extremities ```

Roseola Infantum

Head lice Scalp and neck (erythema, scaling) Nits (eggs) attached to the hair shaft Body lice Linear excoriations, nits in seams of clothing Pubic lice (crabs) Sexually transmitted Intense pruritus, papular urticaria on thighs and abdomen Treatment: Extensive cleaning of clothing and bedding, pediculicide creams and shampoos (pyrethrin, permethrin, malathion)

Pediculosis (Lice)

Severe pruritus (due to hypersensitivity reaction to scabies mite) Web spaces, elbow, axilla, groin (favors thin skin) Red papules, vesicles, crusts, linear burrows Treatment: Permethrin cream, ivermectin; lindane lotion (not first line, age >2 yrs) “Norwegian scabies” (severe disease) seen in immunocompromised

Scabies

Group A beta hemolytic Strep toxin Sore throat, fever, headache, vomiting Sandpaper rash starts on flexor creases and moves to trunk and extremities; circumoral sparing “Strawberry” tongue Groin, axilla, antecubital areas (Pastia’s lines) Skin peeling (palms and soles) Diagnosis: Throat swab, increasing ASO titer Treatment: Pen G

Scarlet Fever

Varicella zoster virus Fever, malaise, URI Macules, papules  vesicles (“dewdrop on a rose petal”) that come in crops  crusts Complications (mostly adults): Pneumonia, encephalitis, otitis media, 2° infection Treatment: Acyclovir or analogues Avoid salicylates (Reye syndrome) Prevention: Immune globulin if immunocompromised or pregnant, vaccine in kids and non-immune adults

Varicella (Chicken Pox)

Hepatitis B HB Surface antigen = Infectious HB Surface antibody = Protective HB e antigen = Highly infectious Per the CDC, a needle stick or cut exposure if not successfully vaccinated = 6-30% Risk is at the high end of the range (25-30%) if source is HBeAg-positive

``` Hepatitis B vaccination Very safe vaccine Three-dose series (0, 1, 6 months) Test for seroconversion (desired antibody level >10 mIU/mL) Repeat series if non-responder No boosters if responder ``` Hepatitis B Immune Globulin (HBIG) Passive immunization (pooled antibodies) Effective within 1 week of exposure

Management of possible hepatitis B exposure Test source for HB surface antigen Test exposed patient for HB surface antibody Exposure to HBsAg-positive source If the healthcare worker is unvaccinated, give HBIG and start the vaccine series If the healthcare worker has protective levels of antibody (>10 mIU/mL), no treatment is needed Special circumstances (known non-responders, partially vaccinated) -- look it up!

Percutaneous transmission is common Sexual transmission is rare Per the CDC, after a cut or needle stick exposure the seroconversion risk about 2% Test source for anti-HCV No effective post-exposure prophylaxis If positive do serial tests of the healthcare worker for anti-HCV and liver enzymes

Hepatitis C

HIV exposure Transmission by percutaneous exposure 0.3% Risk of transmission is increased when Contaminating device is visibly contaminated with blood A needle is placed directly into a blood vessel Injury is deep Contamination is with a hollow bore needle Source is likely to have a heavy viral load (as occurs in terminal HIV) Post-exposure prophylaxis recommended for significant HIV exposures

``` HIV Post-Exposure Prophylaxis For HIV-positive exposures HIV test source and healthcare worker Start meds within 1-2 hours of exposure Multi-drug protocols are standard Reverse transcriptase inhibitors (e.g., tenofovir-emtricitabine) and integrase inhibitors (e.g., raltegravir) are used Side effects often limit treatment PEP is continued for 4 weeks Consult ID for most cases CDC PEP hotline: 888-HIV-4911 ```

Dermatology Flashcards

(68 cards)