SKIN/RASHES

Question 1

HSV rash

Answer 1

is characterized by grouped vesicles on an erythematous base; the mother may have active lesions or a history of the disease. HSV is diagnosed via DFA or ELISA detection of HSV antigens, and acyclovir is given for treatment.

Question 2

Transient neonatal pustular melanosis

Answer 2

vesicopustules that rupture easily and leave a halo of white scales around a central macule of hyperpigmentation,
-generally seen on the trunk, limbs, palms, and soles.
- no definitive diagnosis
- no treatment is necessary as a resolution is spontaneous.

Question 3

Henoch-Schonlein Purpura (HSP)

Answer 3

-most common vasculitis of children
- leukoclastic vasculitis of the small vessels.
-majority of children, the prognosis is excellent.
HSP can occur anytime from infancy (as early as 6 months old) to adulthood
-Caucasians having the highest incidence and African Americans the lowest incidence.
-more in males than in females -more frequently in the fall and winter months, pointing to an environmental trigger, including viral infection.
-preceded by upper respiratory infection

Question 4

Cutis marmorata

Answer 4

• Transient mottling of skin with lacy, bluish appearance
  -2/2 uneven blood flow that results from constriction of small blood vessels while others dilate
  -precipitated by cold
  -more common in preterm infants
  -found in Down syndrome
  -50% have one more more congenital conditions (glaucoma, hemangiomas, vascular malformations
  -Tx: keep stable temp, reduce cold

Question 5

Erythema Toxicum Neonatorum

Answer 5

-self limited skin rash with lesions of different morphology, erythematous macule, wheals, vesicles, pustules
-occurs in 50-60% neonates
-Yellow-white lesion on reddish pink base, seen on most of the body surface (not palms or soles)
-fade in 2-3 days, spontaneous resolution in 5-7 days
-Wright stain shows 90% eosinophils
-NO TX needed

Question 6

Milia

Answer 6

-benign, small yellow-white 1-2mm inclusion cysts
-philosebacous follicle filled with keratinous material on face (cheeks, forehead, nose)
-occurs in 50% of newborns
-epstien pearls on hard palate
-resolves spontaneously
TX- none

Question 7

Salmon Patch

Answer 7

Benign, flat light red to orange vascular birthmark on head and face
-caused by overgrowth of blood vessels in dermis
-40-50% newborns
-More common in girls
-eyelids, nape of neck, labella, occiput
-fade and disappear within 3-6 mos, nape of neck m ay persist into adulthood
-resolve completely by 7 yrs of age.

Question 8

Port-Wine Stain

Answer 8

Benign, permanent flat, dark red to purple vascular lesions on head and face (predominant)
-caused by proliferation of dilated capillaries in dermis
-lesions covering entire half of gave or bilateral–> storage-weber syndrome
-lesions on extremities–> hypertrophy of soft tissue and bone
-lesions on the back (crossing midline)–>defects in the spinal cord/vertebrae
-initially appear pink in infancy and gradually darken
-never fade- become thicker and raised in adulthood
-Tests: pediatric ophthalmologic and US at 5 mos
Refer/TX: dermatologist for pulsed dye laser tx (start in infancy before 1 yr)
-camoflauge in childhood with cosmetics
-counseling for psych

Question 9

Capillary hemangioma

Answer 9

Bright red or blue-red nodular tumors of varying sizes and shapes
-rubbery and rough surface,
-predome on hands/face
-caused by proliferation of cap endothelial cells (superficial or deep)
- more common in girls
-often not present at birth, however, area is blanched or slightly colored
- grows quickly within 2-4 weeks, most growth the first 6 months
-gradual reduction in growth starts at 9-12 mos, 50% cleared by 5, 90% by 10 years
-resolution: gray areas develop and lesions flattens from center to periphery, lesions may ulcerate as they involute
-lesions involving eye–>visual disturbances,
head and neck–>subglottic hemangiomas
-can cause CV disturbances through compression
-thrombocytopenia can occur from trapped platelets
(size does not determine risk of complication)
TX: pulse dye laser if ulcerates
oral PROPRANOLOL

Question 10

Cafe au lait spots

Answer 10

-caused by increased pigmentation activity of melanocyte cells
-higher incidence in dark skinned population
-lesions usually present at birth but can develop at any age
-present throughout life but may fade
-6+ lesions–>neurofibromatosis or Albright syndrome–if suspected refer to Derm

Question 11

Mongolian spot

Answer 11

blue-black, gray macular lesions with irregular shape and varying sized, usually in sacroccoccygeal region, buttocks, lumbar can include upper back an shoulders
-lesions consist of migrating spindle-shaped pigmented/,melanocyte cells deep within dermis layer
-occurs in 90% dark skinned infants, 5% light
-rule our child maltreatment
-lesions not seen on palms/soles
-TX: none, fade over time

Question 12

Malignant melanoma

Answer 12

Lethal form of skin cancer involving melanocyte cells, may occur on skin surface
- caused by abnormal growth within melanocyte cells, activate malignant process
-severe sunburn or excessive exposure to sun before age 10 predisposes to melanoma later in childhood/adulthood
-melanoma cells spread through lymphatic system and invade other skin surfaces and organs
-90% survival with localized
-20% with metastasis
-more common in females (birth to 40) and light skin, +family history
-DX: localized change in skin color or increase size of existing nevus, may have itching with bleeding and tenderness
-asymmetrical lesion with irregular ragged and blurred borders, uneven color with blue, black, brown, tan, red (or all in one)
-more common on arms/lower legs of females, chest of males
-single or multiple lesions may be found in distant areas with metastasis
-bleeding and ulceration is usually late sign
Dx: skin biopsy
ABCDE: Asymmetry,borders, color, diameter, evolution of lesions, check for ugly duckling that doesn’t resemble others, monthly, mole checks at home for high risk individuals

Question 13

Albinism

Answer 13

inherited congenital defect of total or partial lack of pigment
-present at birth
-two types; total (type 1): entire skin, hair, retina
type 2- confined to specific area of skin, hair, eye
-metabolic process within melanocyte cells required for melanin production is impaired- melanin is not secreted
type 2 more common in AA, type 1 ONLY in AA
-sensitivity to light, pupil red and becomes darker in adulthood
-counseling or psych, genetic counseling for inheritance factors
-Rx: ophthalmologist for vision/eye involvement

Question 14

Vitiligo

Answer 14

acquired auto-immune involving patches of depigmentation on skin, in mouth, and genitalia
-segmented: unilateral involving two dermatomes
-generalized- involved two dermatomes, often bilateral
-unknown cause- loss of destruction of melanocyte cells
-maybe assoc with autoimmune diseases
-onset usually before age 20
-condition often permentant
-Refer to Derm for tx: Topical STEROIDS, controlled ultraviolet exposure (varying degrees of success), EXIMER laser
-camouflage with cosmetics
-serious need for protection from sun 2/2 risk of cancer/sunburn

Question 15

pityriasis alba

Answer 15

acquired condition of hypopigmented, finely scaled macular lesion, indistinct borders predominantly on cheeks
-unknown cause: may be assoc with overdrying of skin causing inflammation and hypopigmentation, children 3-12 years, more apparent in dark skin
-may be pruritic, mildly erythematous
-sunlight may exacerbate making more pronounced
-TX: none, spontaneous regimentation in 3-4 mos
DX: KOH (potassium hydroxide) test to rule out tinea corporis
-protect from sunlight, SPF>30, bland moisturizers to reduce over drying!
-refer to Derm if it doesn’t improve

Question 16

pityriasis Rosea

Answer 16

acquired common mild inflammatory condition
-round/oval scaly, hypo pigmented (pink marks) and hyperpigmented (dark) lesions ( on darker skin) on trunk, upper arms and upper thighs
-unknown cause: possible viral association, more often in fall and spring, occurs more in older children
-PRODROME: malaise, low-grade fever before rash, periodic pruritic especially at onset
-“Herald” patch on trunk or buttocks occurs 5-10 days before generalized rash
-arrange in parallel fashion suggestive of CHRISTMAS TREE pattern,
-clear central to periphery
DX: KOH to rule out tinea
VDRL to rule out secondary syphils in sexually active individuals
TX: calamine lotion for pruritus, oral antipruritic (Benadryl), cool bath or compresses, low potency steroid creams
-limit sunlight exposure to shorten resolution time

Question 17

Psoriasis

Answer 17

chronic, relapsing inflammatory condition with erythematous plaques with silver-white-gray scales.
1. Psoriasis Vulgaris- large plaques on elbows and knees, often associated with rubbing or trauma (Koebner;s response), large 5-10cm paces
2. Psoriasis guttate- small patches 3-10mm, teardrop, roundon trunk, upper arms, thighs. often follows streptococcal infection
-associated with overproduction or two rapid progression of epithelial cells to skin surface, cells migrate in 3-4 days instead of usual 28.
- 20% get Psoriasiatic arthritis
-more common in light skinned
-bleeding may occur if picked
-nails dystrophic with thickening pits and ridges, “oil spots”- yellow discoloration on nail plate, oncyholysis
DX: VDRL to rule out secondary syphilis, KOH to rule out fungal
TX: topical steroids (hydrocortisone, triamcinolone_, mineral oil and moisturizers BID to decreased drying

Question 18

Atopic Derm

Answer 18

Eczema- “the itch that rashes”
ACUTE form: infants, 2weeks- 6 mos, 50% resolve by age 3. erythematous, itchy, scaly patches on face (cheeks/forehead), head, trunk, Extensor surfaces, varied morphology, can ooze and crust. more focal pruritic patches in antecubital and popliteal creases
CHRONIC: children/adolescent
-unknown cause, assoc with disorder of immunity due to elevated level of immunoglobulin E, hyperpigmentation, leathery skin, and lichenification in the FLEXOR surfaces of neck, Anticub, wrists, popliteal, ankles, fingers, toes, scratch marks
-+family history
-up to 50% develop asthma, allergic rhinoritis, hay fever
-25% have symptoms throughout adulthood
-Sx: xerosis (dry skin), allergic shiners, facial pallor, salut sign, dry scalp, Dennies creases
-pustules a sign of secondary infection, treat with oral abx, topical if localized (mupirocin/altabax)
DX: no specific testing, skin scraping to rule out scabies
TX: treat with oral antipruritics at night, nonsedating antihistamine during day, topical steroids (hydrocortisone/triamcinolone)
-rehydrate skin with lukewarm baths
-wet compresses over bland emollients, avoid harsh soaps, perfume/lotion
-cream emollients and lubricants BID
-maintain cool temp, worsens with sweating and extreme temperatures
-increase humidity during cold months

Question 19

Contact dermatitis

Answer 19

allergic response to local contact
initial contact- response delayed for several days
reexposure- response within 24h
Types: nickel, perfumes, soap, topical medications-neomycin, animal et
-varying morphology, lesions confined to area of direct contact
-pruritis, excoriation with bleeding
TX: cool compresses with Burrow, steroids, oral steroid for severe, oral antihistamine for itching
RX: dermatologist if condition doesn’t improve in 2 days
consider skin testing for hypersensitivities

Question 20

Diaper dermatitis

Answer 20

peak 9-12mos
- associated monilial rash caused by Candida albicans: oral thrush, may be pustular, nystatin, clotrimazole, ketoconazole
fiery-red rash with satellite lesions on lower abdomen/upper thigh
irritability/crying
TX: mild erythema- emollients with each diaper change
mod: erythema with papule: topical steroids
severe: erythema/edema with papule, vesicles, ulceration- wet dressings, topical antibiotics
-Prevention- expose diaper area to air several times/day, increase fluid intake, change diaper immediately, mild soap with vinegar, change diaper brand, avoid diaper wipes, lubricant on diaper area

Question 20

Seborrhea Dermatitis

Answer 20

inflammatory condition on sebum rich areas. Associated with overproduction of sebum in area with abundant sebaceous glands. May be connected with hormonal stimulation , spring and summer months
newborn: cradle cap- erythema under yellow crust and greasy scales on scalp, face, back of ears, neck folds, axilla
adolescent: dandruff- white flakes and greasy scaling on scalp, forehead, eyebrows, and face- pruritic , mild underlying erythema
TX: infants: baby shampoo and mineral oil with brushing to loosen crusts prior to washing, topical steroid lotions to reduce inflammation if severe
adolescent: antiseborrheic soaps and shampoo

Question 20

Impetigo

Answer 20

-Caused by Staph, strep invading epidermis
-children <6 increased incidence
-Bullous impetigo most common in neonates and infants, erythema with pustules vesicles that erupt resulting in smooth, shiny appearance
-non-bulbous 2-5 year olds. erythema with vesicles that erupt –>honey colored crust with erosion of epidermis
Sx: itching, erythema, edema, blister honey colored crust
TX: burrow compresses, topical abx to areas of involvement,
oral abx if severe:
staph: cephalexin, dicloxacillin
strep: amax, erythromycin,
MRSA: bactrim/clinda
-exclude from school until tx 48hr

Question 20

Cellulitis

Answer 20

• causes: streptococci, H. Flu, Staph A. invade all skin layers after break in skin
  Sx: irregular shape are of skin with redness, swelling, warm and tender, fever, chills, malaise, regional lymphadenopathy
  DX:blood culture to confirm agent
  hospitalization for severe cases and those involving face/eyes
  TX: IM/IV or oral abx
  Strep: cefazoline, Amon, nafcillin
  Staph: dicloxacillin
  H. Flu- augmenting
  mRSA: bactrim or clinda

Question 21

Burns

Answer 21

classified according to depth of injury and layers involved
First degree: epidermis only
second/partial thickness: epidermis and part of dermis
third: full thickness, epidermis, dermis, and dermal appendages
MINOR: less than 10% of bsa if superficial, less than 2% if partial or full thickness
MAJOR- 10% or More if superficial, 2% or more if partial or full thickness
Face, hands, feet, eyes, ears, perineal- regardless of extent
-Third leading cause of death in children and adolescent
SX:
superficial: red, swollen, dry with tenderness
Partial with superficial: red, swollen, moist, blistered
Partial thickness/deep: white, dry with loss of sensation, may blanch with pressure
Full thickness: white, brown, black, swollen, dry with loss of sense. pain, temperature sensitivity
TX: electrolyte studies if extensive
Inpatient hospital Mgmt: if major burns, suspected abuse, esophageal/airway and with fractures/other injuries, outpatient Mgmt if partial thickness or full <2%. , document changes daily, cool compresses. topical antimicrobial to prevent infection (silver sulfadiazine (NOT ON FACE)), mupirocin), do not excise vesicle, fluids, topical emollients to repair and maintain skin barrier
-protect from sunlight
-2nd degree burns- eval at tertiary care center recommended (ED)

Question 21

Staph scaled skin syndrom

Answer 21

toxin mediated systemic bacterial infection with skin manifestations -cased by staph A - occurs any season -presents with onset of fever, irritability, general malaise, bright red painful rash, pronounced around eyes, moth neck underarms elbow groin, knees -blistering of scaling of skin -pain with pressure and exfoliation of skin after peeling, skin appears scaled, glistening, vesicel/bullae in toxic cases, DX: blood culture to confirm staph, culture secretions to confirm staph TX: hospitalization for all infants, severe cases with IV abx, monitor F/E -outpatient if less severe, oral abx (cefazolin, dicloxacillin), oral antipyretics and analgesic for pain, increase fluids

Question 21

Furuncles

Answer 21

boil, deeper involvement of follicle and dermal appendages -superficial infection of upper follicle -most often caused by Staph A., less common Strep -localized area of erythema/edema with papular lesion - nodules present with furuncles, SX: tenderness, warmth, adenopahty, culture confirms bacteria. -TX: warm most compresses, topical abx, staph- dicloxacillin or cephalexin strep: penicillin or cephalosporin, good hygiene!

Question 21

Acne Vulgaris

Answer 21

cyclic periods of exaceration and remission - associated with breakdown of follicle wall -cells combine with sebum and plug follicle -enzymes from Corynebacterium acnes mix with trapped debris causing edema/irritation -causes: increased androgenic hormonal influence, +family history, + stress -NOT poor hygiene or food -common in females, males develop more severe SX: Open comedones (black heads-oxidized sebum), closed comedones (white heads), soreness at sites of lesions, post inflammatory hyperpigmentation and scares at previous lesions. MILD: lessons scattered and covering small area (open and closed comedones), Treat: topical benzoyl peroxide MOD: more numerous, cover more areas, all lesions of mild acne + pustules filled with follicle cells, sebum and WBC, TREAT with oral ABX (minocyclilne), TOPICAL tretinoin, topical b.p., topical abx Clinda SEVERE: larger area, more numerous, all mild and mod ones lesions with erythema with papules/pustules, nodules and CYSTS- deep dermal lesions filled with debris, often with communicating tracks to other cysts, TREAT: topical tretinoin, topical (clindamycin) or oral antibiotics (if persistent and unresponsive- Tetracycline, doxy, monocycle, tetracycline, oral clinda CONTRAINDICATED, oral tretinoin. (CONSIDER ISOTRETINOIN if unresponsive severe acne- required birth control, Pledge program mandated) -Scarring if lesions manipulated/squeezed, cysts erupted deep in dermis -condition can worsen before it gets better with treatment, tx may take month, must be consistent to be effective, monitor progress 4-6 weeks initially -refer to Derm if considering isotretinoin and condition not improving

Question 22

Folliculitis

Answer 22

-superficial infection of upper follicle -most often caused by Staph A., less common Strep -localized area of erythema/edema with pauper lesion nodules present with furuncles, tenderness, warmth, adenopahty, culture confirms bacteria. -warm most compresses, topical abx, staph- dicloxacillin or cephalexin strep: penicillin or cephalosporin, good hygiene!

Question 23

Herpes Simplez

Answer 23

-fever blisters of lips and oral mucosa - initial infectious state- more severe, lasts longer, more painful -dormant state: virus lives on ending of nerves, asymptomatic. -secondary- activated at time of increased stress, illness, fatigue, sun, menses, dental procedures Virus type !- most common virus type 2- situations of oral sex Sx: grouped vesicles and crusting on lips, erythema/edema, painful, ulcerated patches inside mouth, fever, malaise, sore throat, mild itching, tingling, burning may precede blister, halitosis -lesions last 10-14 days -staph may be secondary infection DX: Tzanck smear- multinuclear giant cells- herpes TX: burrow compresses, topical antiviral, oral antiviral with recurrent disease at first sign of prodrome (skin tingling) (acyclovir, famciclovir, valacyclovir), educate- avoid spicy food, avoid kissing, wash hands, avoid sharing cups

Question 24

Molluscum

Answer 24

waxy, firm papules -face, axilla, abdomen, arms -caused by poxvirus -common in children with HIV/AIDS, atopic derm -inculbation 2-8 weeks, up to 6 mos spread by direct contact, autoincoulation sx: itching, small firm, raised pinkish- white or skin colored lesions -rule out child maltreatment if see in genital area DX: Wright or Giemsa stain- intracytoplasmic inclusions TX: no CURE, curettage, not recommended for face, topical kertolytics (tretinoin cream, cantharidin)

Question 25

Verruca Vulgaris

Answer 25

WARTS -firm, well circumscribed, smooth to irregular singer or multiple hyperkeratotic papule -predom on fingers, palms, and soles of feet -Human papilloma virus: virus enters skin through minor injury SX: Common: raised, gray/brown to skin colored- on hands; Flat: skin colored, smooth, round, multiple lesions, slightly elevated on face and extremities Plantar: skin colored, irregular, painful, flat ingrown lesions on soles -may occur in genital area -lesions are self limited, 6-9 mos but can presist for years d/t autoinnoculation TX:none is curable; topical keratolytics and wart preparations, waterproof plastic tape treated with keratolytics -excision

Question 26

Tinea Capitis

Answer 26

Ringworm of scalp -caused by Tichophyton tonsurans (90%) -microsporum canis, microsporum audouinii, Trichophyton mentagrophytes -Dermatophytes attach to epidermis and multiply within stratum corneum, does not involve lower layers of epidermis or dermis, -spread through direct contact/indirect contact, animals (m. Canis), more often in hot humid climates, -more common in darker skin Sx: itching, varying degrees of severity, raised round or angular scaly area, yellow honeycomb crust, broken hairs and alopecia, tender erythematous areas with broken hairs (black dot appearance), Dx: Woods lamp will fluoresce M Canis only KOH scraping will confirm hyphae and spores of dermaphytes Tx: oral anti fungal medication a. Griseofulvin, ultramicrosize formulation has best absorption b. treat for 8 weeks c. topical anti fungal meds are ineffective d. shampoo 2-3 times weekly with selenium sulfide or ketoconzaole to reduce sports count and infectivity -exclusion from School not necessary -avoid sharing personal items

Question 27

Tinea Corporis

Answer 27

Ringworm of the body -LESS HAIRY surfaces of body and face -Primary source: Trichophyton rubric, Ticho. mentagrophytes, M canis. Sx: mild itching at site, slightly raised, round or angular with pink borders, scaley plaque, healing centrally while spreading peripherally, singular or multiple (but not numerous), DX: KOH scraping of borders, Dermaphyte test medium (DTM)-confirms diagnosis TX: treat with topical anti fungal medications- may require up to 8 weeks tx a. clotrimazole, miconazole, terbinafine, ketoconzazole, tolnaftate, ciclopirox Treat with oral anti fungal is extensive, recurrent, or unresponsive (griseofulvin) - dont share personal items, towels, shower after public pool, wash clothing touching affected area after each use

Question 28

Tinea Cruris

Answer 28

Jock Itch -Caused by E. Floccosum, T. Rubrum, T mentagrophytes -SX: pain and tenderness, itching, erythamtous, hyperpigmented, slightly raised scaley patch with defined borders, blisters possible, red to brown -often concurrent with tinea pedis -TX: topical antifungale, may require up to 4-6 weeks oral anti fungal if pervasive -good personal hygiene, wash garmets frequently

Question 29

How do you diagnose Tinea

Answer 29

KOH scraping of lesion borders- confirms hyphae and spores DTM-confirms diagnosis

Question 30

Tinea Pedis

Answer 30

Athletes foot -toes and feet -interdigital fissures -dystrophy of toe nails TX: topical anti fungal (clootrimazole, haloprogin, miconazole), treat 8-12 weeks possible -burros solution to fissured lesions -absorbant antifungal powder -dont wear tight shoes, use cotton socks

Question 31

Black widow bite

Answer 31

-initial pinch/sting -1 hour from bite: dull burning pain at site, two red puncture marks surrounded by white area with bluish red border, SX: muscle cramps, muscle spasm, sweating, severe- shock, coma, death, hypertension, tachycardia -can last for days -differential dx: tetanus, appendicitis TX: apply cold compress, refer to dermatologist eval and hospitalization due to potential severe reaction

Question 32

Brown recluse spider bite

Answer 32

-inital symptoms begin 2-7hrs, mild local tingling, erythema or blanching at site -delayed symptoms at 48-72hr: hemorrhagic vesicle surrounded by bluish-gray areas of necrosis, flu like symptoms -differential dx; diabetic ulcers, SJS

Question 33

anaphylactic response

Answer 33

early: dizziness, swelling of lips/throat, difficulty breathing/swallowing late: weakness collapse, confusion, coma, stridor

Question 34

Scabies

Answer 34

-caused by parasitic mite infestation -Sarcoptes scabei: gravid female mite burrows into stratum corneum to lay ova, hatch 4-14 days later -infestations occur in cyclic patters every 15-30 years - spreads through contact (indirect or direct) Sx: intense itching especially at night, irritability in infants, red bumps, blisters, pustules an small burrow marks, scratch marks -fine gray to skin colored linear curved burros with small papule at proximal end on head neck palms soles, webs of fingers, folds of wrist, axial, waist buttocks, grown, knees, ankles, abodmen -pustules mean secondary infection DX: skin scraping of burrow or-apple material culture of pustule if secondary infection - TX: Permethrin 5% (infants and children), older chidren (Crotamiton 10%, lindane, sulfur in petroleum) -topical steroids to reduce inflammation and pruritus, oral antihistamine -wash clothes with hot water and dry in dryer -store non-washable items in bag x1 week, do not use -residual itchiness for weeks after tx.

Question 35

Pediculosis

Answer 35

Lice - P. Capitits- scalp -P. humans- affects less hairy body surfaces - phthirus pubis- pubic and axilla, eyelashes, eyebrows -more common in caucasians -lice do not fly or jump -incubation of 6-10 days -Sx: pruritic, white fakes on hair, erythematous blotches -most common on back of head, behind ears, body lice most common in seams of clothing TX: Permethrin, ivermectin, pyrethrins: topical antiparasitics to destroy ova and louse (resistance is building to permethrin), TWO treatments, REMOVE ova and nits, only live 24h away from host so do not need to vacuum drapes, rugs, floors, furniture. Residual itchiness and irritation can last for weeks after successful treatment. No-nit return to school policy. -unwashable items should be sealed in plastic bags for 2-4 weeks

Question 36

Drug Eruptions(hypersensitivity)

Answer 36

morbilliform generalized rash - caused by release of histamine in reaction to immune systems response to drug allergen - most common drugs: sulfates, penicillins, barbiturates, dilantin - onset within 1st week of exposure or up to 2 weeks SX: generalized itchiness, erythematous lesions beginning on trunk and progress to extremities. Initially macular, than papular, wheals less typical DX: discontinue drug, oral steroids, oral antihistamines, refer to em if doesn't improve in 2 days or becomes severe

Question 37

Erythema Multiforme Mino

Answer 37

acute skin condition d/t hypersensitivity resulting in multimorpholoogy skin and MM eruptions, lasting 2-3 weeks with spontaneous resolution - Hypersensitivity to 1. infectious organisms- enterovirus, m. pneumonia, herpes 2. drugs- sulfa, barbiturates, penicillin 3. food -more common in adults, recurrent episodes in 1/3 Sx: itching, pain in mouth, redness/swelling with blisters (maculae, papules, vesicles, bull, petechia) on hands, elbows, knees, ankles, feet, eyes, lips, mouth -develop crops over 1-2 weeks, crop lasts 1 week, BULLS EYE lesions- necrotic center, pale middle macular ring, outer erythematous outer ring -DX: CXR- m. pneumonia, Tzanck test to rule out herpes TX: cool compresses, antihistamines, analgesic- topic/oral, determine trigger

Question 38

Erythema Multiform Major (Stevens-johnson syndrome)

Answer 38

Hypersensitivity reaction with systemic involvement - causes same as minor -can be life threatening SX: fever, fatigue, sor throat, headache, N/V/D, muscle or joint pain -rash develops 2-3 days after generalized symptoms, goes from macular to pap->vesicles->erosions/petechia; on exposed areas bilat and MM, less common on chest/trunk. -pruritis, ,pain in mouth -high fever, malaise, weakness -TARGET Lesions -can progress to resp, renal, GI symptoms DX: skin biopsy TX: immediate Derm referral and hospitalization due to life threatening situation.

Question 39

Urticaria

Answer 39

Hives -acute and chronic condition due to allergic hypersensitivity reaction causes: release of histamine to immune systems response to allergen (food, temp changes, viral, stress, scratching, insect bite, fabric) SX: last minutes to 24h, recurrence with exposure. generalized and local pruritus, mild erythema and edema, irregular shaped wheals, may have edema of lips, eyes, MM, becomes pronounced with heat, will blanch with pressure Dx: none TX: discontinue contact, topical steroid, oral steroid if sever and extensive, cool compress, oral antihistamine Rx: consider skin testing for hypersensitive after acute episode resolves