Session 4 Flashcards

Question

Macules and Patches

Answer 1

Macules are nonpalpable lesions <1 cm that vary in pigmentation from the surrounding skin. Patches are nonpalpable lesions >1 cm. These lesions are flush with the surrounding skin.

Answer 2

Papules are palpable, discrete lesions measuring <1 cm in diameter. They may be isolated or grouped

Answer 3

Plaques are elevated lesions that are >1 cm in diameter. Plaques may be formed by a confluence of papules

Answer 4

Nodules are palpable, solid or cystic, discrete lesions measuring 1-2cm in diameter.

Answer 5

Pustules are small, circumscribed skin papules containing purulent material

Answer 6

Vesicles are small (<1 cm in diameter), circumscribed skin papules containing clear serous or hemorrhagic fluid Bullae are large (>1 cm in diameter) vesicles.

Answer 7

Wheals are irregularly shaped, elevated, edematous skin areas that may be erythematous or paler than surrounding skin. The borders of a wheal are well demarcated but not stable; they may move to adjacent, uninvolved areas over periods of hours.

Answer 8

GENERALISED SYMMETRICAL rash, consisting of WELL DEFINED, ERYTHEMATOUS, URTICATED PAPULES AND PLAQUES Note: if we know they are transient (<24 hours) we can call them WHEALS • Erythematous, pruritic ‘swellings’ (wheals) • Transient (<24 hours) +/-angioedema • Acute vs chronic (urticarial persisting for over 6 weeks) • Mast cell degranulation and histamine release leading to increased capillary permeability and leakage of fluid into surrounding tissue • Clinical diagnosis • Eliminate underlying cause (eg drug related) • High dose anti-histamines –second generation H1 anti histamines eg fexofenadine, cetirizine, loratadine • Acute course of oral steroids, ciclosporin, montelukast, H2 antihistamine, omaluzimab Urticarial lesions may be rounded (F) or irregular (A) in shape and uniform or mixed (G) in morphology. Individual lesions may be small (H) or large (D). Urticaria are raised plaques, although they may appear flattened in patients taking antihistamines (C). Although lesions are consistently erythematous, this may be difficult to appreciate on darkly pigmented skin (I). Some urticaria show central clearing (E).

Answer 9

LOCALISED, UNILATERAL skin condition consisting of MULTIPLE WELL DEFINED*, SHINY, DOME- SHAPED, UMBILICATED PAPULEs *(DISCRETE can be accepted) •Pox virus infection •2-6 week incubation period •More common in atopic and immunocompromised patients •Most self resolve within 6-9 months •No treatment required

Answer 10

BODY- SOLITARY, WELL DEFINED, ERYTHEMA, SCALY, ANNULAR (with central clearing, as opposed to circular/discoid), PLAQUE SCALP- LOCALISED, SOLITARY, ERYTHEMA, SCALE with accompanying HAIR LOSS (PATCH of ALOPECIA)

Answer 11

GENERALIZED, MACULAR, PAPULAR, ERYTHEMATOUS (blanching) rash •Often appear after a latent period required for induction. •Cell mediated immune reaction •Most common reaction is macular-papular (morbilliform) rash •Culprit drug avoidance important • Penicillins • Cephalosporins • Allopurinol • NSAIDs

Answer 12

Insert table

Answer 13

LOCALISED, DERMATOMAL rash consisting of PAPULE, VESICULE, BULLA, EROSION, CRUST (some due to dry blood and exudate from vesicle content, some with yellow discoloration GOLDEN suggesting infection) •Herpes virus varicella zoster-dermatomal(unilateral) •Attack usually result of re-activation of virus which has remained dormant in a sensory root ganglion since an earlier episode of chicken pox (varicella) •Elderly and immuno-compromised are at higher risk •Associated with burning pain •Duration is around 2-3 weeks •Complications include secondary bacterial infection, paralysis (if motor nerve involvement), corneal ulcers and scarring if ophthalmic division of trigeminal nerve involved), neuralgic pain •Systemic acyclovir within 2 days of episode and analgesics

Answer 14

The oral mucosa and the vermilion border are involved, with painful hemorrhagic erosions covered with a grayish-white membrane Multiple bullae and areas of denuded epidermis are present. Dermatologic emergency! • Severe mucocutaneous reactions, most commonly triggered by medications, characterized by extensive necrosis and detachment of the epidermis. • Mucous membranes are affected in >90% of patients, usually at >2 distinct sites (ocular, oral, and genital) • SJS is the less severe condition, in which skin detachment is <10% of the body surface • TEN involves detachment of >30% of the body surface area • The incidence is much higher in patients with HIV or active cancer • SJS/TEN can occur in patients of any age. Female > Male 2:1 • The overall mortality rate among patients with SJS/TEN is approximately 30% (up to 50% for TEN) • Treatment is mainly supportive +/- steroids, immunosuppressive drugs insert table

Session 4 Flashcards

(39 cards)