Skin conditions 3 and 4 Flashcards

(118 cards)

1
Q

molluscum contagiosum

A
  • common pediatric virus
  • replicates in epithelial cells
  • usually affects young kids, sexually active adults and immunosuppressed
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2
Q

what causes molluscum contagiosum

A
  • poxvirus MCV 1-4
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3
Q

how is molluscum contagiosum spread

A
  • direct skin to skin contact
  • gym equipment
  • autoinnoculation
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4
Q

si/sx of molluscum contagiosum

A
  • non pruritic
  • flesh colored dome shaped papules
  • has punctum in middle
  • curd like material
  • usually on face, trunk, extremities, groin
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5
Q

differential dx for molluscum contagiosum

A
  • warts

- milia- epidermal like cyst

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6
Q

treatment of molluscum contagiosum

A
  • usually not necessary
  • self limited
  • take months- yr to recover
  • contagious the entire time there is a lesion
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7
Q

non genital verruca

A
  • aka warts
  • more than 100 human papillomaviruses
  • can occur anywhere
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8
Q

verruca vulgaris

A
  • aka common wart
  • usually ages 5-20
  • risk with frequent exposure to water
  • hands and palms, periungunal, nail folds
  • papules with rough gray surface
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9
Q

verruca planta

A
  • aka flat wart
  • usually kids and young adults
  • flat topped flesh colored papules
  • grouped together on face, neck, wrist, hands
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10
Q

verruca plantaris

A
  • aka plantar wart
  • appear on sole of feet
  • usually at pressure points on ball of foot or heel
  • can be grouped together- “mosaic wart”
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11
Q

diagnosis of verruca

A
  • clinical exam

- punch biopsy

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12
Q

treatment for verruca

A
  • no treatment
  • 65% regress spontaneously in 2 yrs
  • tx recommended for pts with extensive, spreading or symptomatic warts
  • cryotherapy
  • salicylic acid/ cantharidin
  • occlusive dressing
  • intralesional inj of bleomycin
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13
Q

what causes tinea versicolor

A
  • malassezia furfur (yeast)

- more common in humid climates

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14
Q

si/sx of tinea versicolor

A
  • hypo or hyperpigmented macules that do not tan
  • asymptomatic
  • usually noticed in summer bc of tan
  • well defined round macules with scaling on trunk, arms, face
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15
Q

dx of tinea versicolor

A
  • KOH scraping -> hyphae and sports “spaghetti and meatballs”
  • woods light -> orange mustard color
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16
Q

differential dx for tinea versicolor

A
  • vitiligo

- difference= vitiligo is complete depigmentation with no scaling

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17
Q

treatment for tinea versicolor

A
  • selenium sulfide shampoo daily
  • topical ketoconazole cream
  • PO ketoconazole- caution LFTs
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18
Q

tinea corporis

A
  • aka ring worm
  • aquired by contact with organism
  • increased risk with wrestlers
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19
Q

si/sx of tinea corporis

A
  • annular lesions with peripheral enlargement
  • central clearing
  • scaly active boarder
  • asymmetrical distribution
  • usually on face, trunk, extremities
  • pruritic or asymptomatic
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20
Q

differential dx of tinea corporis

A
  • acute lyme disease

- difference= no scaling

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21
Q

treatment for tinea corporis

A
  • topical naftin or ketoconazole
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22
Q

tinea pedis

A
  • common in young men d/t sweaty work boots

- moccasin distribution

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23
Q

si/sx of tinea pedis

A
  • scale and maceration in toe web spaces
  • moccasin distribution on plantar surface
  • distinct boarder
  • pruritic feet
  • inflammation and fissures possible
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24
Q

diagnosis of tinea pedis

A
  • KOH or fungal culture
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25
treatment of tinea pedis
- keep feet dry - zeasorb-AF powder- miconzaole - topical antifungals - if severe lostrisone cream
26
vitiligo
- autoimmune disease - destruction of melanocytes - mostly idiopathic - can affect any age/race
27
si/sx of vitiligo
- hypopigmentation macules - may occur focally or generalized in a pattern - hair can also become white - NO scales - often occurs at places where trauma occurs like knuckles and knees
28
dx of vitiligo
- clinical - punch biopsy - woods light= milky white appearance
29
treatment for vitiligo
- sunscreens - avoid sun exposure - cosmetic cover up - protopic/elidel - eximer laser
30
varicella
- aka chickenpox - 90% in kids <10 - incubation pd= 10-21 days - usually self limiting in healthy kids - adults= increased risk of pneumonia
31
how is varicella transmitted
- direct contact with lesion - respiratory droplets - infectious 4 days before and 5 days after rash
32
si/sx of varicella
- rash, malaise, low grade temp - macules -> teardrop vesicles on erythematous base - descending presentation - scalp -> face -> trunk -> extremities - can be on palms and soles
33
changes of varicella lesions
- vesicles are pruritic -> pustular -> crusted - crusted = not infectious - can dev secondary staph or strep infection d/t itching
34
dx of varicella
- clinical | - tzank smear
35
treatment of varicella
- kids <13 = supportive - oatmeal baths - calamine lotion - antihistamines - **AVOID ASPIRIN**-> reyes syndrome - in adults give PO acyclovir within 1st 24 hrs
36
what is reye syndrome
- acute encephalopathy - hepatitis - possible with ASA and chickenpox/ shingles
37
immunization for varicella
- single dose for kids 1-12 | - over 13 should receive two vaccines 4-8 weeks apart
38
herpes zoster
- aka shingles - reactivation of varicella zoster virus - remains latent in sensory dorsal root ganglion - increased risk > 50 - possible to have a reoccurance
39
how is damage caused by VZV
- inflammation on dorsal root ganglion -> hemorrhagic necrosis of nerve cell - result = neuronal loss and fibrosis - rash distribution is associated with infected neurons in that specific ganglion
40
si/sx of VZV
- prodrome of pain -> rash - burning, throbbing, electrical pain - severity varies - almost always unilateral (unless immunocompromised) - papules/plaques of erythema -> vesicles -> hemorrhagic or bullous - rare but can have pain and no lesions
41
how long does VZV last
- usually 2-3 weeks - in elderly can last up to 6 weeks - new lesions seen for 1-5 days
42
where is VZV typically found?
- 55% thoracic - cranial (trigeminal) - lumbar - sacral - if opthalmic division of trigeminal N must see opthalmologist
43
hutchinson's sign
- VZV lesions on side and tip of nose - MUST get opthalmologist consult - tetinal necrosis - glaucoma - optic neuritis
44
differential dx for VZV
- angina pectoris - plant dermatitis - impetigo - biliary or renal colic - appendicitis
45
diagnosis of VZV
- clinical once lesions appear | - tzank smear
46
treatment for VZV
- antivirals for 1 week within first 3-4 days - helps limit severity - prednisone - domboro solution - pain mgmnt= APAP, NSAIDs, narcotics, lidoderm patch - NO ASA** reye sydrome
47
what is the name of the VZV vaccine
- zostervax
48
complications of VZV
- post herpetic neuralgia - refer to neurologist for pain mgmt if pain continues after infection - neurtontin, TCAs, gabapentin
49
herpes simplex virus
- most prevalent infection worldwide - HSV-1 orolabial usually - HSV-2 gential usually - produces life long chronic latent infections
50
how are you initially exposed to HSV?
- direct contact with infected secretions - sexual - autoinnoculation -> herpetic whitlow - vertical- mother -> baby
51
where does the HSV reside
- neurons - HSV-1 trigeminal ganglia - HSV-2 presacral ganglia
52
replication and shedding of HSV
- may be asymptomatic - begins before lesions appear and until they heal - incubation pd= 2-20 days after initial exposure - recurrence may correlate with number of neurons infected
53
what increases risk for HSV?
- increased number of sexual partners | - first intercourse at young age
54
si/sx of orolabial HSV
- tender grouped vesicles on erythematous base - ulcerative - exudative - last 1-2 weeks - recurrence has itching/tingling
55
si/sx of gential HSV
- grouped blisters and erosions - usually on vagina, rectum, or penis - blisters over in 1-2 weeks
56
si/sx of herpetic whitlow
- occurs on fingers or periungually - tenderness - erythema with deep seated blisters
57
dx of HSV
- fluorescent antibody test/ western blot to differentiate (not clinically necessary) - tzank smear - usually just clinical presentation
58
treatment of HSV
- doesnt cure - decrease duration of sx, viral shedding, time to heal - acyclovir/ valacyclovir
59
paryonychia
- inflammatory rxn in folds of skin around fingernails - acute or chronic - begin with break in eponychium or nail fold -> maceration of proximal nail fold
60
eponychium
cuticle
61
acte paronychia
- usually d/t aggressive manicure or nail biting | - usually staph aureus
62
chronic paronychia
- usually d/t frequent hand washing or water contact - food handlers, dishwashers - pseudomonas aerugionosa or candida albicans
63
si/sx of acute paronychia
- erythema - swelling - pain - can extend into proximal nail fold - can progress to pus that separates skin from nail
64
si/sx of chronic paronychia
- swollen - erythematous - tender without fluctuance - nail may become thickened - transverse ridges - lasts 6 or more weeks
65
dx of paronychia
- r/o herpetic whitlow - fluctuant paronychia usually bacterial - KOH wet mount for chronic - clinical hx and exam
66
treatment of acute paronychia
- warm water soaks 3-4 x a day - PO abx for staph aureus (augmentin) - topical steroid cream - incision and drain if abscessed
67
treatment of chronic paronychia
- avoid inciting factors - warm soaks - topical steroid cream or antifungal
68
onychomycosis
- infection of finer or toe nail by yeast or fungi | - most common in people with other nail problems
69
causes of onychomycosis in hands
- t. mentagraphytes
70
cause of onychomycosis in feet
c albicans
71
si/sx of onychomycosis
- nail thickening and subungual hyperkeratosis - nail distrophy or onycholysis - usually asymptomatic
72
dx of onychomycosis
- KOH or fungal/ yeast culture
73
treatment of onychomycosis
- non-treatment is accetable - topical agents usually ineffective (penlac and jublia) - oral cure rate <40% - monitor LFTs before and after PO tx with lamisil
74
eczema
- interchangable with dermatitis - superficial - pruritic - erythematous - red, blistering, oozing, or scaling/thickened skin
75
atopic dermatitis
- aka eczema - atopic- lifelong tendency to allergic conditions like asthma and allergic rhinitis - chronic and relapsing - most common type - IgE mediated hypersensitivity rxn
76
si/sx of atopic dermatitis
- "itch that rashes" secondary to scratching - flexor surfaces - neck - eyelides and face - dorsum of hands and feet - papules or plaques, edema, erosion - +/- scales or crusting - persistant xerosis - dennie morgan lines - hyperlinear palmar creases
77
classic charatcteristics of atopic dermatitis
- pruritis - flexural lichenification (less demarcated than psoriasis) - personal/family hx of allergic rhinitis, asthma, or atopic dermatitis - post inflammatory hyper/o pigmented changes
78
pathogenesis of atopic dermatitis
- IgE hypersensitivity rxn - intense itching produced by mast cells and basophils - is inflamed skin! not "fancy dry skin"
79
triggers for atopic dermatitis
- mites - food - alcohol - hot/ cold/ humid weather
80
histology of atopic dermatitis
- varies with stage of lesion - hyperkeratosis, acanthosis - excoriation - staph colonization is possible - eosinophil deposition
81
infantile atopic dermatitis
- usually presents in 1st yr of life (after 2 mo) - cheeks, chest, neck, flexor/extensor extremities - red scaly and occasionally ooze - usually symmetrical
82
dennie morgan lines
- infra-orbital folds | - associated with atopic dermatitis
83
differential dx for atopic dermatitis
- contact dermatitis - scabies - psoriasis- usually on extensor surfaces and less pruritic
84
treatment of atopic dermatitis
- topical steroids (short pd of time)= mainstay - antihistamines - topical immunomodulators- tacrolimus and pimecrolimus - crisaborole (eucrisa) - PO abx if secondary infection - avoid triggers - bath with moisturizing soaps and use emolients
85
considerations for topical steroid use
- use for short term - skin atrophy - telangectasis - acneform eruptions on the face - can lead to tolerance (tachyphylaxis) - consider cycled dosing
86
nummular eczema
- coin shaped pruritic patches and plaques - occurs in clusters - usually in atopic pts - mainly seen on legs - may clear centrally like tinea corporis
87
dx of nummular eczema
- clinical appearance | - negative KOH results
88
differential diagnosis for nummular eczema
- tinnea corporis
89
treatment for nummular eczema
- acute- intermediate strength topical steroids - if severe can use high potency +/- occlusion - long term- treat with less potent steroid
90
dyshydrosis
- inflammation and foci of intercellular edema in palms and soles
91
si/sx of dyshydrosis
- small vesicles on hands and feet | - very itchy
92
treatment for dyshydrosis
- mild cleansers - emollient barrier creams - protective gloves - avoid irritants - burows solution - topical steroids** - protopic and elidel for long term mgmt
93
contact dermatitis
- acute or chronic inflammatory reactions to substance that contacts skin - irritant or allergic contact dermatitis
94
allergic contact dermatitis
- type IV delayed hypersensitivity rxn | - exposed to poison ivy, nickel, or chemicals
95
si/sx of allergic contact dermatitis
- well demarcated linear pruritic rash at site of contact - itching, burning - poison ivy- classic linear streaks of juicy papules and vesicles
96
differential dx for allergic contact dermatitis
- herpes zoster (usually painful and follows dermatome)
97
treatment of allergic contact dermatitis
- remove offending agent - cool showers - burow's solution - potent or super potent topical steroids - severe cases- systemic steroids
98
irritant contact dermatitis
- direct toxic reaction to rubbing, friction, or maceration | - exposure to chem or thermal agent
99
irritants that cause irritant contact dermatitis
- alkalis - acid - soaps - detergents - diaper rash*
100
si/sx of irritant contact dermatitis
- erythematous - scaly - eczematous eruptions - not caused by allergen
101
diagnosis of irritant contact dermatitis
- history | - rule out of allergic dermatitis
102
diaper dermatitis
- eruptions in area covered by diaper - result of hydration of skin - irritated by chafing, soaps, prolonged contact
103
si/sx of diaper dermatitis
- erythema - scale papules and plaques - can erode and ulcerate - spares the creases
104
treatment of diaper dermatitis
- zinc oxide ointment - frequent diaper changes - OTC hydrocortisone - if beefy red, c albicans is suspected -> topical ketoconazle with nystatin powder
105
perioral dermatitis
- usually in young women and children | - can be induced by topical steroids, hormone changes, cosmetics
106
si/sx of perioral dermatitis
- clustered papulopustules - erythematous base - can scale - found around mouth
107
treatment of perioral dermatitis
- topical antibiotics - metronidazole or erythromycin - severe cases- minocyclin or doxycycline - avoid topical steroids**
108
stasis dermatitis
- eczematous eruption - lower legs - d/t venous insufficiency - usually in women with genetic predispostion to vericosities
109
pathogenesis of stasis dermatitis
- incompetent valves -> decreased venous return -> increased hydrostatic pressure -> edema -> tissue hypoxia
110
si/sx of stasis dermatitis
- erythematous scale - edema - erosions - crusts - secondary infection possible - chronic- hyperpigmented changes, thickened skin, "woody" appearance - can dev ulcers
111
treatment for stasis dermatitis
- elastic compression stockings - burrows solution - mod topical steroids - treat any secondary infections with abx
112
seborrheic dermatitis
- caused by yeast p.. ovale - found in areas with high concentration of sebaceous glands - scalp, face, body folds
113
si/sx of seborrheic dermatitis
- pruritic - yellow gray scaley macules - greasy - cradle cap in infants - dandruff in adults - erythema and scaling on face
114
treatment for seborrheic dermatitis
- scalp- zinc shampoos, ketoconazole shampoo | - face/intertriginous areas- low pot topical steroids
115
lichen simplex chronicus
- aka neurodermatitis - chronic - solitary pruritic eruption - d/t repetitive rubbing and scratching - focal lichenified plaque or multiple plaques
116
distribution of lichen simplex chronicus
- found in areas easily reachable - nape of neck - vulvae - scrotum - wrists - extensor forearms - ankles - pretibial areas - groin
117
differential dx for lichen simplex chronicus
- tinea cruris - candidiasis - inverse psoriasis if in inguinal creases and perianal area
118
treatment for lichen simplex chronicus
- intermed strength topical steroid - occlusion when able - oral antihistamines - protopic - elidel