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skin Flashcards

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1
Q

skin tenderness is minimal to absent in

A

SJS

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2
Q

most common infectious cause of SJS

A

Mycoplasma pneumoniae

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3
Q

most severe disorder in the clinical spectrum of disease , extensive necrolysis of the mucous membranes, >30% if body surface area

A

TEN

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4
Q

most common etiologic agents of Cellulitis

A

Steptococcus pyogenes, S. aureus

S. aureus: more localized ; may suppurate

S. pyogenes: spread more rapidly; may be associated with lymphangitis

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5
Q

Ritter Disease

A

Staphylococcal Scalded skin syndrome

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6
Q

antitoxin of SSSS

A

exfoliative toxin A and B

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7
Q

positive Nikolsky sign

A

SSSS

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8
Q

classic lesions of scabies

A

threadlike burrows

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9
Q

Common cause of Erythema multiforme

A

HSV

May be drug related (<10%)
NSAIDS, acetaminophen, Sulfonamides, antibiotics

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10
Q

Describe lesions of erythema multiforme

A

Doughnut shaped, target-like (iris or bull’s eye) papules with an erythematous outer border and inner pale ring, dusky purple to necrotic center

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11
Q

Most common location of Erythema multiforme lesions

A

Abrupt, symmetric cutaneous eruption most commonly in extensor upper extremities, sparce on face, trunk and legs
Can be seen on palms and soles

Oral lesions: vermilion border of lips

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12
Q

Erythema multiforme minor

A

Mainly cutaneous typical or atypical targetoid lesions affecting <10% of body surface area plus no or limited mucosal involvement
Often limited to 1 site such as mouth

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13
Q

Erythema multiforme Major

A

Same cutaneous involvement such as in minor plus 2 or more mucosal sites with more severe or involvement

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14
Q

Management of Erythema multiforme

A
  • supportive
  • opioids can be used to control pain
  • diligent oral hygiene
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15
Q

Prophylaxis for erythema multiforme

A

Oral Acyclovir for 6 months mah be effective in controlling recurrent episodes

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16
Q

Most common precipitants of Stevens-Johnson syndrome and Toxic Epidermal Necrolysis (TEN)

A

Sulfonamides
NSAIDS
Antibiotics
Anticonvulsants

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17
Q

Body surface affected in SJS

A

Less than 10%

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18
Q

Body surface affected in TEN

A

More than 30%

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19
Q

Describe the lesions of SJS

A

Erythematous macules —> central necrosis —> vesicles, bullae, areas of denudation on face, trunk and extremities

2 or more mucosal surfaces:
Eyes, oral cavity, esophagus, GI tract, anogenital mucosa

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20
Q

Lesions of SJS

A

Burning sensation, edema and erythema of lips and buccal mucosa often presenting signs —> bullae, ulceration and hemorrhagic crusting

Pain from mucosal ulceration is severe but skin tenderness minimal compared to TEN

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21
Q

Management of SJS

A
  • Supportive and symptomatic
  • Ophtha consultation necessary
  • oral lesions: mouthwash and glycerin swabs
  • topical anesthetics
  • admission for IV fluids, nutritional support, sheepskin or air-fluid bedding , daily saline or Burrow solution compresses, paraffin gauze
  • systemic antibiotics for urinary or cutaneous infections and suspected bacteremia
  • use of corticosteroids discouraged due to increased morbidity and mortality
  • IVIg should be considered in early disease >2g/kg dose
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22
Q

Factors that causes TEN

A 
Sulfonamides
Amoxicillin
Phenobarbital
Hydantoin 
Allopurinol
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23
Q

TEN is defined by

A
  1. Widespread blister formation and morbilliform or confluent erythema associated with skin tenderness
  2. Absence of target lesions
  3. sudden onset and generalization within 24-48 hours
  4. Full thickness epidermal necrosis and minimal to absent dermal infiltrate
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24
Q

Full thickness epidermis lost un large sheets with Nikolsky sign but only in areas of erythema

A

TEN

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25
Long term morbidity of TEN
Healing takes place in 14 days or more Severe dehydration *alterations in skin pigmentation, eye problems and strictures of mucosal surfaces
26
Management of TEN
``` Admit to burn unit Strict reverse isolation Fluid and electrolyte therapy Air-fluid bed Daily cultures Cleansing with isotonic and Burrow solution Mouth and eye care Systemic glucocorticoids and IVIG Anti-TNF alpha inhibitors- effective use has been shown in children on limited basis (Infliximab 5mg/kg) ```
27
First line therapy for diaper dermatitis
Application of protective barrier agent (ointment or paste) containing petroleum or zinc oxide at every diaper change Topical sucralfate useful for recalcitrant cases Low potency nonhalogenated topical corticosteroids such as 2.5% hydrocortisone may be used for 3-5 days
28
Most common allergic contact dermatitis
Rhus dermatitis (Poison ivy, poison sumac, poison oak) Response to plant allergen Urushiol
29
Develops from contact with jewelry, metal closure on clothing or evern cellphones
Nickel dermatitis
30
Mainstay of managing allergic contact dermatitis
Identification and avoidance of the offending agent
31
1st line treatment for acute eruption of contact dermatitis
Mid potency topical corticosteroid oitment for 2-3weeks Symptom management with nonsensitizing wnr fragrance free emolients/moisturizers, wet dressings, and sedating antihistamines for sleep Systemic corticosteroids used when >10% of skin is involved
32
Causative agent for seborrheic dermatitis
Malassezia furfur
33
Lesion of seborrheic dermatitis
Greasy, scaly, erythematous papular dermatitis which is nonpruritic in infants and involve face, neck, retroauricular area, axillae, umbilicus and diaper area
34
Seborrheic dermatitis in adolescence
More localized and may be confined to the scalp and intertriginous areas
35
Tretment for seborrheic dermatitis in infants
Emollients Baby oil Gentle shampooing with nonmedicated baby shampoo gentle use of soft brush to remove scales Persistent lesions: low potency topical corticosteroids if inflamed Topical antifungal
36
First line of therapy for children and adolescents with scalp seborrheic dermatitis
Antifungal shampoo | Midpotency topical corticosteroids Fluocinolone
37
Second line therapy for seborrheic dermatitis
Topical calcineurin inhibitors and keratolytic agents such as urea
38
Most common subtype of Psoriasis
Plaque Psoriasis
39
Removal of scale may result to pinpoint bleeding
Auspitz sign
40
New lesions appear at sites of trauma
Koebner phenomenon
41
Valuable diagnostic sign of Psoriasis
Nail involvement
42
What are the 4 Tier process of Psoriasis management
Topical therapy Phototherapy Systmeic therapy Biologic response modifiers
43
What is the 1st Tier therapy in Psoriasis
Topical therapy Emollients Vitamin D analogs Mid to high potency corticosteroids
44
What is the second tier therapy in Psoriasis?
Phototherapy Narrow band UVB: Effective and well tolerated alternative in pedia patients
45
What is the 3rd tier therapy in Psoriasis
Systemic therapy Required rarely for children with mod to severe, recalcitrant or generalized psoriasis Methotrexate 1st line systemic agent for children
46
What is the fourth tier therapy in Psoriasis?
Biologic response modifiers TNF- alpha inhibitors: Etanercept, Infliximab, Adalimumab *etanercept only one with FDA approval
47
Which is more common bullous or nonbullous impetigo?
Nonbullous impetigo
48
Mainly an infection of infants and young children wherein there is flaccid, transparent bullae on the face, buttocks, trunk, perineum and extermities
Bullous Impetigo
49
Treatment for Impetigo
Localized:Mupirocin 2% for 10-14 days Systemic: oral antibiotics *cephalexin 25-50mkd in 3-4 divided doses for 7 days If MRSA suspected: Clindamycin, Doxycyline or Sulfamethoxazole
50
Toxins involved in Staphylococcal scalded skin syndrome
Epidermolytic toxin A heat stable | Epidermolytic toxin B heat labile
51
Onset of rash may be preceded by malaise, fever, irritability and exqusite tenderness of the skin
Staphylococcal scalded skin syndrome
52
Other name of Staphylococcal scalded skin syndrome
Ritter Disease
53
Scarlatiniform erythema develops diffusely and accentuated in flexural and periorificial areas
Staphylococcal scalded skin syndrome
54
Circumoral erythema prominent as is radial crusting and fissuring around eyes, mouth and nose. (+) Nikolsky sign
Staphylococcal Scalded Skin Syndrome
55
subcorneal, granular split on skin biopsy. Absence of inflammatory infiltrate is characteristic
Staphylococcal scalded skin syndrome
56
Treatment for staphylococcal scalded skin syndrome
Semisynthetic antistaphylococcal penicillin (eg Nafcillin) 1st gen cephalosporin (cefazolin) Clindamycin Or Vancomycin if MRSA Emolients Topical antibiotics unnecessary Neonates and infants or children, hospitalization is mandatory —> fluid and electrolyte, infection control, pain management, meticulous wound care
57
thick walled spores and myriad short, thick m, angular hyphae resembling macaroni/spaghetti and meatballs
Tinea versicolor
58
Treatment for tinea capitis
Griseofulvin 20-25mg/kg/day Absorption enhanced by fatty meal and should be recommended Minimum of 8 weeks treatment
59
treatment for candidal diaper dermatitis
Imidazole cream 2x daily Combination of corticosteroid and antifungal agent if inflammation is severe Apply thick zinc oxide paste
60
Most important factor that determines spread of scabies
Extent and duration of physical contact with an affected individual
61
classic lesion of scabies
threadlike burrows But may not be seen in infants In infants, bullae and pustules are more common Palms, soles and scalp often affected
62
Preferred sites of scabies in adolescents and adults
Interdigital spaces, wrist flexors, anterior axillary folds, ankles, buttocks, umbilicus and belt line, groin, genitals in men and areolas in women Head, neck, palms and soles are spared
63
Treatment of choice for scabies
Permethrin 5% cream tonentire body from neck down 8-12hr and reapplied in 1 week for another 8-12hr period Sulfur ointment 5-10% and crotamiton 10% lotion or cream Lindane as alternative therapy
64
What should be given to patients with severe scabies infestation or immunocompromised patients
Oral Ivermectin 2 doses, 2 weeks apart.

Dermatology (1 decks)

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