Infectious Derm - Part 2 - Exam 1 Flashcards by Johannah Crumpton

What am I? What are the 2 MC types?

Condyloma Acuminatum

HPV virus: strains 6 and 11

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What 4 HPV types are the major etiologic factors for in situ and invasive SCC?

HPV types 16, 18, 31, and 33

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How does Condyloma Acuminatum invade? What is the incubation period? When do active skin lesions develop?

Invasion of the basal cells of the epidermal layer via microabrasion

Incubation 3w-8m

skin lesions develop 2-3 months after exposure

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T/F: Condyloma Acuminatum is only spread if you have an active genital wart

FALSE!! **Active lesions are NOT required for transmission!

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Describe the pattern of condyloma acuminatum. What is the MC pt population?

generally found in clusters/groups but can be seen solo

MC in young sexually active adults

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How is condyloma acuminatum transmitted?

sexual contact either oral -> genital or genital-> anal

can pass from mother to baby during delivery

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What increases risk of expressing HPV in wart form? Do the warts always show up immediately after sexual exposure?

Immunosuppression high risk for warts if infected

NO! HPV may persist for years in a dormant state and becomes infectious intermittently

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How will a pt with condyloma acuminatum present?

usually asymptomatic, the physical appearance of skin colored/pink/red/tan/brown lesions is what bothers people the most

can cause physical obstruction if large enough

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What are the 4 types of condyloma acuminatum?

Small papular

Cauliflower-floret

Keratotic warts

Flat topped papules/plaques (most common on cervix)

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What is an important pt education point regarding Condyloma Acuminatum?

Do not shave the area!! will cause it to spread

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What am I?
What strains?
Where are they MC?

Laryngeal Papillomas of Condyloma Acuminatum

HPV 6 and 11

MC on vocal cords

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What am I?

penile pearly papules

benign condition

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How do you dx Condyloma Acuminatum?

typically a clinical dx

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If dermoscopy is done on Condyloma Acuminatum, what is the hallmark finding? What do they look like? _____ is done if refractory to tx

Dermoscopy = papillomatosis (hallmark)

Finger like knob projections

Shave Biopsy – if refractory to tx

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What is the tx for Condyloma Acuminatum?

Patient - Imiquimod, podofilox, trichloroacetic acid

Provider - cryotherapy, electrosurgery, surgical removal, laser

or may resolve spontaneously on their own

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What is the f/u recommendation for condyloma? When is it most likely to reoccur? What is the prevention?

Recommend follow up monthly until lesions gone then q3months

within the first 3 months

Gardasil vaccine and condoms

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What is the gardasil vaccine recommendations?

age 9 through 14 years -> 2-dose series 0, 6 to 12 months
OR
3-dose series at 0, 2, 6 months

if over 15-45 years old need 3 dose series at 0, 2, 6 months

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If choosing cryo therapy to tx condyloma, what is the interval? CO2 laser?

cryo: Treat every 2-4 weeks x 3 months (sometimes longer)

CO2 laser
Recurrent or resistant to treatment

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If choosing surgical therapy to tx condyloma, what is the interval? curettage? electrosurgery?

Surgical: Best option for >1cm and do a shave bx

curettage: can be done before LN or SA application

electrosurgery: Used alone or with curettage

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What is the caution with regards to using cryo therapy?

can cause permanent hypopigmentation in darker skin pts

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**_______ MOA induces immune system response to recognize and destroy lesions. What is the drug class? What are the SE?

Imiquimod 5%

Immunomodulator

Localized inflammatory reaction (redness, irritation, induration, ulceration, erosions, and vesicles)

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How do you apply imiquimod? **What is the important pt education? What type of vehicle?

Apply small amount at bedtime 3x/wk - rub cream in until no longer visible

**Wash off upon awakening with mild soap (after 6-10 h)

Cont Tx until complete clearance - maximum of 16 wks

cream

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_____ MOA prevents cell division and causes tissue necrosis. What is the drug class? What type of vehicle?

Podofilox 0.5%

Antimitotic

solution or gel

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How do you properly apply Podofilox?

Cotton tipped applicator (sol)/ finger (gel)

Apply q12h x 3 days, off 4 days, repeat therapy weekly until resolution (max 5 consecutive wks of therapy)

-Apply to normal skin between lesions (if applicable)
-avoid open wounds
-Wash medication off after 1-4 hours

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What are the surface area requirements for Podofilox?

Treatment area ≤ 10 cm₂ AND Total volume should be no more than 0.5 ml/d

What are the 3 SEs of podofilox?

mild to severe skin irritation may have HA FLAMMABLE!!!!

Is podofilox safe in pregnancy? Can they have sex?

**Preg cat C** avoid sexual activity during rx application times

_____ MOA burns, cauterizes and erodes skin lesions. How strong is it?

Trichloroacetic Acid (TCA) 80-90%

How do you apply TCA?

Apply **vaseline** around lesion to create barrier then apply TCA to area with cotton tip applicator daily x 6-10 weeks

What am I? What is it caused by? How is it transmitted? What is the MC pt?

Molluscum Contagiosum Poxvirus but it is self limiting any direct skin-skin contact including bathing together and sexual contact MC in young children but can be adults

What am I?

Molluscum Contagiosum

What am I?

Molluscum Contagiosum

What am I?

Molluscum Contagiosum

Describe molluscum contagiosum in words. What is a PE test that will help you determine dx?

small, smooth, dome shape papule central with a pit and transilluminate and will see the pit in the center

What is the common size range for molluscum contagiosum? Can anything be expressed? What 2 areas are spared?

3-6mm White, curd-like material can be expressed from the depression of the lesion. Palms and soles are spared

When will Molluscum Contagiosum typically go away? What will happen if you pick them?

6 months to 2 years picking =spread

What is the tx for molluscum contagiosum? What is the OTC option?

Cryotherapy / curettage Podofilox 0.5% SA (compound W) -> OTC option

What is a verrucae? What causes them? What is the incubation period? How is it spread?

wart HPV 2-6 months direct skin contact

What are the 3 different types of verrucae?

Verruca vulgaris - common wart Verruca plantaris - plantar wart Verruca plana - flat warts

What am I? What is the size? What is commonly seen under dermatoscope? What are they composed of?

verrucae vulgaris isolated or multiple 1-10mm in size Red and brown spots thrombosed papilla capillary loops (patient’s common call them seeds)

Where are the MC places to find verrucae vulgaris?

Trauma Hands/fingers Knees Elbows Feet

What am I? Describe it in words

verruca plantaris Shiny papules plaque with rough hyperkeratotic surface and thrombosed capillaries with DECREASED skin lines and will be uncomfortable and tender

What am I? Where are they most commonly found? Describe them in words? What size?

verruca plana face, beard area, dorsa of hands and shins sharply defined, skin colored or light brown Round, oval, polygonal or linear 1-5 mm

What will you see when you transilluminate a verruca plana?

see elevation change

How do you dx verruca?

clinical and can bx because they can be SCC

What am I?

verruca

Will verruca resolve on there own without tx?

will resolve on their own without treatment but takes months to years

When should you tx verruca? What are the tx options?

Painful /discomfort Impairment of function Cosmetic Immunosuppresion SA Cryo Imiquimod Cantharidin Electrosurgery (use caution-aerosolized virus) tx in office then cover with duct tape

_____ MOA is desquamation of hyperkeratotic epithelium. What is the drug class?

SA = Salicylic Acid Keratoylic agent

____ is considered a larger lesion with considered treating with SA. What do you need to do first before applying?

40% = larger DAILY / SAND OR FILE then apply SA Liquid, ointment, pad or patch (can also soak first before filing then topical SA)

_________ is a substance derived from the blister beetle. What does it cause? What is the pt education for application?

Canthrone Canthraridin causes a blister to form on the wart or viral lesion leave on for 4-6 hours then rinse off.

What is the proper cryotherapy technique for verruca?

Debride thick surface Cryotherapy for 3 cycles, waiting for the wart to thaw out each time before spraying again Repeat every 4 weeks (Alex does every 2-3 weeks x 3 months)

What am I? What is the pathogenesis?

herpes zoster (shingles) Pathogenesis passes from lesions in the skin and mucosa via sensory fibers to sensory ganglia = lifelong latent infection Virus multiples and spreads down the nerve fibers to the skin and mucosa produces vesicles aka lives in nerves and can become reinflammed whenever it wants

What are some triggers for herpes zoster?

immunosuppression, trauma, tumor, or irradiation

What am I? What are the 3 clinical phases?

Herpes zoster Prodrome Active infection PHN

What will the pt complain of in the prodrome phase of herpes zoster?

pain tenderness paresthesia +/- flu like constitutional symptoms

What are the 4 different types of lesion options that might be present during the active infection of herpes zoster? Give the timeframe

Papules - 24 hours Vesicles/bullae - 48 hours Pustules - 96 hours Crusts - 7-10 days

Describe the lesions of herpes zoster.

Erythematous, edematous base, clear vesicles, and sometime hemorrhagic can become crusted erosions once the vesicles erode

When does dermatome crusting resolve in HZ? **What is the location?

Dermatome crusting usually resolves in 2-4 weeks **HZ is usually unilateral and follows a dermatomal pattern!!

What is Ophthalmic zoster?

when the V1 distribution of the trigeminal nerve is involved. Hutchinson sign when the eye and tip of the nose are involved

**______ is the most sensitive dx tool for herpes zoster

PCR

What is the tx for herpes zoster? What is IC?

oral antiviral Acyclovir 800mg 5x daily for 7 days can also give NSAIDs, gabapentin, pregablin or TCAs for the associated nerve pain management Immunocompromised = extend to 10 day course

_____ may be used if pain from HZ is SEVERE

nerve block

Infectious Derm - Part 2 - Exam 1 Flashcards

(64 cards)