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Dermatology > Lecture 4: Infections Part 2 > Flashcards

Lecture 4: Infections Part 2 Flashcards

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1
Q

What is condyloma acuminatum?

A

Genital warts

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2
Q

What is the cause of condyloma acuminatum and the transmission?

A
  • Cause: HPV, mainly 6 & 11
  • 16, 18, 31, 33 are most dangerous
  • Transmission via microabrasion, does not require active lesions

MC in sexually active young adults

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3
Q

What are the RFs for condyloma acuminatum?

A
  • Number of partners
  • Frequency of sex
  • Partner with HPV
  • Other STIs

Lots of sex with lots of people

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4
Q

Is conyloma acuminatum transmissible to a baby?

A

Yes, an infected mother can transmit it.

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5
Q

How does low risk and high risk condyloma acuminatum appear?

A
  • Both appear with warts.
  • However, if immunosuppressed, there is a higher risk for warts if infected.
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6
Q

Clinical manifestations of condyloma acuminatum?

Warts

A
  • Asymptomatic is the MC presentation
  • Anxiety
  • Obstruction if large mucocutaneous lesions
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7
Q

What are the 4 types of mucocutaneous lesions seen in condyloma acuminatum?

A
  • Small papular
  • Cauliflower-floret
  • Keratotic warts
  • Flat topped papules/plaques (MC on cervix)
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8
Q

What is a red flag on condyloma acuminatum presentation that may suggest an immunocompromised state?

A

Large and multiple lesions

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9
Q

Where are the MC sites for lesions on a male with condyloma acuminatum? Female?

A
  • Male: Frenulum, corona, glans penis, prepuce, shaft, and scrotum
  • Female: labia, clitoris, periurethral, perineum, vagina, and cervix
  • Both: perineal, perianal, anal canal, rectal, urethral meatus, urethra, and bladder
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10
Q

Features of laryngeal papillomas

A
  • Uncommon with HPV 6 & 11
  • MC on the vocal cords
  • age: < 5 or > 20 = risk of SCCis and invasive SCC
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11
Q

What tests help diagnose condyloma acuminatum?

A
  • Pap smear
  • Dermatopathology
  • Typically clinical diagnosis
  • Dermoscopy showing papillomatosis = hallmark
  • Shave biopsy if wart was refractive to tx

Finger like knob projections.

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12
Q

Tx for condyloma acuminatum

A
  • Patient: imiquimod, podofilox, trichloroacetic acid
  • Provider: Cryotherapy, electrosurgery, surgical removal, laser

Also can be self-resolving

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13
Q

Follow-up for condyloma

A
  • Monthly until lesions are gone, then Q3months
  • Routine PAP in females
  • Prevention via Gardasil (6, 11, 16, 18)

Highest chance of recurrence is within 3 months

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14
Q

When is condyloma MC to recur within?

A

3 months

Hence why you still check within 3 months if lesions gone

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15
Q

Gardasil vaccine schedule

A

Starting at age 9 or 15

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16
Q

Summary of condyloma tx specifics

Non pharmaceuticals

A

Surgical is best for > 1 cm

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17
Q

MOA of imiquimod

Condyloma

A

Induction of immune system to recognize and destroy lesions

Anti-tumor topical; ImIquImod Induces Immune

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18
Q

How to use imiquimod?

A
  • Small amount at bedtime 3x/wk.
  • Wash off upon awakening
  • Don’t have sex
  • continue tx until complete clearance
  • may need holidays due to strong SEs.
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19
Q

MOA of podofilox

A

Prevention of cell division and causes tissue necrosis

must know antimitotic

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20
Q

How do you apply podofilox?

Schedule and pt education

Study These Flashcards
A
  • Cotton tipped applicaiton
  • Q12h x 3 days on, 4 days off
  • You want to also put it on normal skin around lesion
  • Wash med off after 1-4 hrs
  • Tx area must be <= 10cm2 and total volume < 0.5ml/d

I guess it is very potent

21
Q

MC SEs of podofilox

Study These Flashcards
A
  • Local mild systemic skin irritation
  • HA
  • it is flammable

CI in pregnancy

22
Q

What is the MOA of trichloroacetic acid (TCA)?

Study These Flashcards
A

Burns, cauterizes, and erodes skin lesions

Triple action; literal acid

23
Q

How should TCA be applied?

Study These Flashcards
A
  1. Apply vaseline AROUND the lesion first
  2. Apply TCA to wart for 6-10 wks
  3. Very effective!
24
Q

What is molluscum contagiosum?

Study These Flashcards
A

Water warts, caused by poxvirus

25
How is molluscum contagiosum spread?
**Direct skin-skin contact** * Bathing together * Sexual encounter (2-6 weeks to incubate)
26
Who is molluscum contagiosum MC in?
Young children
27
What are the RFs for molluscum contagiosum?
* Childcare/daycare * School * Sports * Risky sexual behavior | Based on MC demographics
28
How does molluscum contagiosum present?
* **small, smooth, dome shaped papule with umbilicated center** * If adults: groin/lower abdomen area * 3-6mm * **White, curd-like material can be expressed** * Usually **no palm or sole involvement** * High risk for immunocomped or atopic patients
29
What are the reasons to tx molluscum contagiosum?
* **Prevent spreading** * Cosmetic * Recurrent dermatitis * Stress | It typically regresses on its own after 6m-2y
30
What are the tx options for molluscum contagiosum?
* Cryotherapy/curettage * **Podofilox** * SA (compound W) | Don't pick at it or it will spread. ## Footnote Primarily containing the spread, so no imiquimod i guess
31
What is the cause of verrucae/warts?
**HPV** via direct skin contact
32
What are the 3 common types of verrucae seen in kids?
* Verruca vulgaris: common wart * Verruca plantaris: plantar wart * Verruca plana: flat wart (plain wart)
33
How does verruca vulgaris present?
* 1-10mm papules * Isolated or multiple * **MCC: trauma, hands/fingers/knees** * Red and brown spots: thrombosed papilla capillary loops (seen on dermatoscope)
34
How does verruca plantaris present?
* **Shiny plaques with a rough, hyperkeratotic surface** * Thrombosed capillaries * Skin lines decrease * Usually uncomfortable * Tender | reminds me of a cigarette butt
35
How does verruca plana present?
* Sharply defined * 1-5mm * **Flat surface** * Skin colored or light brown * Round, oval, polygonal, or linear * MC on **face, beard, dorsa of hands and shins**
36
Management options for verrucae
* **Salicyclic acid** * Cryotherapy * **Imiquimod** * **Cantharidin (blister beetle)** * Electrosurgery + vacuum to prevent aerosolization | Podofilox not mentioned, maybe cause it doesn't really spread?
37
What does SA do?
* **Desquamation of hyperkeratotic epithelium** * 10-30% conc for small * 40% conc for big lesions
38
What else should you do when applying SA?
Sanding/filing
39
What is cantharidin?
Blister beetle substance, which causes a blister on the wart.
40
How does HZV present?
**Dermatomal** infection with immense **pain** | Prior hx of chickenpox as child
41
What are the 3 clinical phases of HZV?
1. Prodrome 2. Active 3. PHN
42
How does the prodrome phase present in HZV?
* **Pain** (angina/acute abdomen) * Tenderness * Paresthesia (FLS)
43
How does the active phase in HZV present?
* Papules at 24h * Vesicles/bullae at 48h * Pustules at 96h * Crusts at 7-10d
44
How do later lesions appear in HZV?
* Erythematous and edematous base * Clear vesicles or hemorrhagic * Erosion => crusted erosions * Dermatome crusting normally resolves after 2-4weeks
45
When is HZV a big concern?
**Ophthalmic involvement**, affecting V1 (hutchinson sign)
46
How do we diagnose the active phase of HZV?
* Clinically * Tzanck smear * DFA * Viral culture * PCR (**most sensitive**) ## Footnote DFA = direct fluorescent antibody
47
Antiviral therapy for HZV
* Valcyclovir 1000mg TID x 1 week * Famciclovir 500mg q8 x 1 week * Acyclovir 800mg x5 a day for x1 week (up to 10d for immunocompromised) | FAV antivirals
48
What can help with PHN?
* NSAIDs * Gabapentin * Pregabalin * TCAs * Nerve block (**Severe**)
49
Most sensitive test for HZV?
PCR

Dermatology (12 decks)

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