Week 6: Lab Flashcards
(248 cards)
1
Q
What are the benign skin lesions?
A
Seborrheic keratosis, Dermatosis papulosis nigra, Acrochordon, Cherry angioma, Dermatofibroma, Solar lentigo, Sebaceous hyperplasia, Keloid, Epidermal inclusion cyst, Milia, Lipoma, Melasma, Pyogenic granuloma, Glomus tumor, Freckle, Melanocytic nevi. Albinism, Vitiligo
2
Q
Identify
A
Seborrheic keratosis
3
Q
Identify
A
Seborrheic keratosis
4
Q
Identify
A
Seborrheic keratosis
5
Q
Characteristics of seborrheic keratosis
A
- Sharply marginated
- Color: light tan to black
- All body surfaces expect palms or soles of feet
- Usually papules or plaques, can be macules rarely
- Round/Oval
- Dark velvety surface
- “Stuck on”
- Superficial epidermal growths
- glob of wav mushed onto skin
- if in question: scrape at it and if it crumbles, flakes or lifts off and reveals a super waxy character
6
Q
Identify
A
Seborrheic keratosis
7
Q
Identify the disease
A
Seborrheic keratosis
8
Q
Identify 1, 2, 3
A
- Keratin
- Acanthosis
- Horn cyst
9
Q
Identify this disease
A
Seborrheic keratosis
10
Q
Name the differences between nevi and seborrheic keratosis
A
SK: multiple, extensive, age of onset 40+
Nevi: first three decades of life,
11
Q
Identify this
A
Seborrheic keratosis
12
Q
Treatment for Seborrheic Keratosis
A
Curettage, cryotherapy, electrodessication, shave removal
13
Q
Identify
A
Dermatosis Papulosis Nigra (category of Seborrheic keratosis)
14
Q
Risk factors for Dermatosis Papulosis Nigra
A
Darker skin, Genetic predisposition
15
Q
Sign of Leser-Trelat
A
– Abrupt, striking increase in the # and/or size of SKs (seborrheic keratosis)
– Rare cutaneous marker of internal malignancy
16
Q
Identify
A
Acrochordons (skin tags)
17
Q
Characteristics of Acrochordons (skin tags)
A
– light tan, pink, brown
– Often pedunculated
– Eyelids, neck, axilla, groin
– Asymptomaic
18
Q
Why do skin tags appear?
A
– Genetics, obesity, friction
– More common in pregnancy
– Can be marker for insulin resistance
19
Q
Treatment for Removal of Acrochordons
A
– Snipping (pressure or aluminum chloride for bleeding)
– Cryotherapy (liquid nitrogen)
– Electrodessication
20
Q
Identify
A
Acrochordons
21
Q
Identify
A
Cherry Angioma
22
Q
Characteristics of cherry angiomas
A
– Common acquired vascular proliferations
– 4th decade, increase in # over time
– Highest concentration on trunk
23
Q
Identify
A
Traumatized Angiomas
24
Q
Identify
A
Dermatofibroma
25
Characteristics of Dermatofibroma
-- feels firm like scar tissue
--Benign
-- Often on extremities
-- Firm, hyperpigmented dome-shaped papules
-- Tan to pink
-- Periphery of darker pigment common
-- Elevated or slightly depressed. Adherent to epidermis. May be dell-like depression over the nodule
-- Pinch on either side -> dimple down due to scar-like tethering of the dermis - “the dimple sign”
-- Usually asymptomatic, no txt required
26
Identify
Dermatofibroma
27
Identify
Dermatofibroma
28
Identify
Dermatofibroma
29
Identify
Solar Lentigo
30
Characteristics of solar lentigo
-- “Sun spot”, “age spot”, or “liver spot”
-- Due to sun damage
-- No treatment required
-- Extensive solar lentigines reflect history of UV exposure
– Can identify patients at risk for skin cancer
31
Identify
Solar Lentigo
32
Identify
Sebaceous Hyperplasia
33
Characteristics of Sebaceous Hyperplasia
-- elderly
-- asymptomatic
-- slow growing bumps
-- Multiple, skin-colored or slightly yellowish, umbilicated papules
-- Sebaceous gland overgrowth (Hence yellow color, Umbilication due to gland growth around central hair follicle)
-- Removal is not medically required and is cosmetic
34
Identify
Sebaceous Hyperplasia
35
Identify
Sebaceous Hyperplasia
36
Differences between sebaceous hyperplasia and basal cell carcinoma
SH:
-- Yellow hue, gland structures surrounding a follicle, crown of vessels, multiple similar papules
BCC:
-- Pearly, arborizing vessels over the surface. Fragile, will bleed or scab easily with minimal trauma
37
Identify: Sebaceous hyperplasia vs. basal cell carcinoma
38
Characteristics of Keloid
-- itchy, firm growth
-- gradually increasing in size after surgery
-- Abnormal wound healing
-- Overgrowth of scar tissue beyond the original scar site
-- Upper trunk and earlobes
-- Genetic influence plus with some form of skin injury
-- Various colors
-- Can be itchy or tender
-- Do not regress spontaneously
-- Can be cosmetically disfiguring
39
Identify
Keloid
40
Identify
Keloid
41
Identify
Keloid
42
Treatments for Keloids
-- Difficult to treat surgically, with high recurrence rate
-- No single, reliably efficacious therapy available
-- Avoid non-essential cosmetic procedures
-- Intralesional corticosteroid injection is mainstay of treatment
43
Complete chart
44
Identify
Hypertrophic scar
45
Identify
Keloid
46
Identify
Hypertrophic scar
47
Identify
Keloid
48
Characteristics of Epidermal Inclusion Cyst (EIC)
-- Nodule
-- Mobile, dermal to subcutaneous nodule, often with overlying punctum
-- Most common cutaneous cyst
-- Not “sebaceous cysts” - EIC’s arise from hair follicles, not
oil glands
-- Cyst contains degenerating keratinocytes
49
Identify
Epidermal Inclusion Cyst (EIC)
50
Identify
Epidermal Inclusion Cyst (EIC)
51
Identify
Epidermal Inclusion Cyst (EIC)
52
Identify
Epidermal Inclusion Cyst (EIC)
53
Treatment of epidermal inclusion cysts
-- If treatment desired, surgical excision is curative
-- Cysts may recur. Removal of entire cyst wall and contents improves chances of clearance
54
Identify
Inflamed Epidermal Inclusion cyst
55
MOA of Inflamed epidermal inclusion cyst
-- Rupture in skin -> acute inflammatory response
-- Sterile, do not require antibiotics
56
Treatment of epidermal inclusion cyst
-- May require incision and drainage. Intralesional corticosteroid injections can treat inflammation.
-- Not excised b/c higher risk of infection, wound dehiscence, cyst recurrence
57
Identify
Milia
58
Characteristics of Milia
-- Tiny epidermoid cysts 1-2 mm white to yellow papules
-- Cheeks, eyelids, forehead, genitalia
-- Primary - appear spontaneously
-- Secondary - result from trauma, skin disease, medication
-- 40-50% of infants
-- Usually resolve during 1st four weeks
59
Identify
Milia
60
Identify
Milia
61
Treatment for Milia
-- Elective removal for cosmesis
-- Nick surface with 11 blade or 18 gauge needle
-- Gently express entire cyst, lining and contents
62
Characteristics of Lipoma
-- Slow growth over years
-- mobile, soft, subcutaneous nodule, lacking any overlying skin change
-- Growth usually stabilizes at few cm diameter
-- Occasionally tender
-- Often solitary
-- Trunk, proximal extremities
-- When familial (autosomal dominant), multiple and begin in early adulthood
63
Identify
Lipoma
64
Identify
Lipoma
65
Identify
Lipoma
66
Characteristics of Melasma
-- Symmetric, hyperpigmented patches with irregular outline
-- Young to middle-aged
-- Common on face
-- Darker skin types
67
ID
Melasma
68
ID
Melasma
69
Exacerbating factors of Melasma
-- Pregnancy “mask of pregnancy”
-- Oral contraceptives
-- Sun exposure
-- Genetic influences
70
MOA of Melasma
Melanocytes within involved skin produce increased amounts of melanin
71
Treatment of Melasma
-- Diligent sun protection
-- Topical hydroquinone (Competes with tyrosine as a substrate for
tyrosinase (the initial enzyme in the melanin biosynthetic pathway)
-- If bothersome, consider referral to dermatology for treatment
72
Characteristics of Pyogenic Granuloma
-- Grew rapidly over the last few weeks
-- Easily bleeds
-- Misnomer - not infectious in etiology or granulomatous histologically
-- Benign proliferation of capillaries
-- Very friable, may bleed profusely with minor trauma
-- Face, hands, mucous membranes
-- More common in children, young adults, pregnancy
-- Do not regress spontaneously
73
ID
Pyogenic Granuloma
74
ID
Pyogenic Granuloma
75
Pyogenic Granuloma
76
Treatment of pyogenic granuloma
Surgical removal, curettage, electrodesiccation, laser, cryotherapy, topicals
77
ID
Glomus Tumor
78
Characteristics of Glomus Tumor
-- Patient presents with a tender lesion at the base of the nail
-- Reddish-bluish papule
-- Originates from glomus body
-- Smooth muscle cells in dermis that regulate skin temperature
-- Concentrated in fingertips
-- Shunt blood away from surface of skin when exposed to cold
79
ID
Glomus Tumor
80
ID
Ephelides (freckles)
81
Medical term for freckles
Ephelides
82
Characteristics of ephelides
-- Brown macules
-- Sun-exposed areas
-- 1st 3 years of life
--More common and numerous in individuals with red hair and blue eyes
-- Fade without sun exposure
83
MOA of ephelides
Increased amount melanin (melanosomes), not # of melanocytes
84
Characteristics of Melanocyte Nevi
-- Increased # of melanocytes
-- Congenital or acquired
-- Arise in childhood, peak in 30s
-- Less common after the age of 50
-- Tend to disappear with increasing age
-- Indications for removal: atypical clinical appearance suspicious for melanoma, repeated irritation, cosmetic concerns
85
Define Junctional Nevi
-- Brown macule
-- Groups of melanocytes at the junction of the epidermis and dermis
86
Define type of nevi (Junctional, Compound, or Intradermal)
Junctional Nevi
87
ID
Junctional Nevi
88
Define type of nevi (Junctional, Compound, or Intradermal)
Compound Nevi
89
Characteristics of compound nevi
-- Brown papule
-- Combined histologic features of junctional and intradermal nevi
90
ID
Intradermal Nevi
91
Define type of nevi (Junctional, Compound, or Intradermal)
Intradermal
92
Characteristics of Intradermal Nevi
-- Light tan, pink, brown papule
-- Groups of melanocytes in the dermis
93
Global presence of albinism
Global prevalence, 1 in 17,000
94
MOA of albinism
-- Melanocytes and melanosomes are normal
-- Dilution or absence of melanin in skin, hair, eyes
95
Ocular characteristics of albinism
Ocular: nystagmus, foveal hypoplasia, photophobia, decreased visual acuity
96
ID
Albinism
97
MOA of Oculocutaneous Albinism
-- Mutations in genes -> proteins in melanin biosynthesis pathway (e.g., tyrosinase, P-protein) -> Low levels eumelanin (brown/black). Functions as UV absorbent, antioxidant, free radical scavenger
-- Eight subtypes of OCA
98
Management of Albinism
-- Sun protective measures
-- Sunburns, blisters, wrinkles, ephelides, lentigines, solar elastosis, actinic keratosis, skin cancers
– Lack of UV-blocking melanin -> increases skin photosensitivity & susceptibility to UV damage
– UV radiation -> DNA mutations -> generation of reactive oxygen species (ROS) -> keratinocytes undergo malignant changes
-- TBSE q 6-12 mo
-- Eye examinations q 6-12 mo
99
ID
Vitiligo
100
Characteristics of Vitiligo
-- Acquired depigmentation of skin from autoimmune destruction of melanocytes
-- Bimodal age of onset: 30% in childhood
-- Prevalence 0.5 % - 2.16%
-- More frequent: face, hands, elbows, knees, axillae, perineum
101
ID
Vitiligo
102
ID
Vitiligo
103
Most common autoimmune association with vitiligo?
Thyroid disease
104
Treatment of Vitiligo
-- Not merely cosmetic
-- Sun protection
-- Topical therapies
-- Systemic therapies: Phototherapy, Immunosuppressive
-- Camouflage
-- Surgical techniques
-- Depigmentation of non-affected skin
105
ID
Vitiligo
106
Specimens are stained with S100.
Which specimen is vitiligo? Which is albinism?
R: Vitiligo due to destruction of melanocytes
Left: Albinism due to presence of melanocytes
107
Name 4 factors contributing to acne
1 Ductal hyperkeratosis
2. Colonization by C. acnes
3. Increased sebum excretion from sebaceous gland
4. Release of inflammatory mediators
108
4 stages of acne development
1. Early Comedo
2. Later comedo
3. Inflammatory papule/pustule
4. Nodule/Cyst
109
Characteristics of the early comedo stage of acne development
Hyperkeratosis
Increased corneocyte cohesiveness
110
Characteristics of the later comedo stage of acne development
111
Characteristics of the inflammatory papule stage of acne development
112
Characteristics of the nodule stage of acne development
113
Risk factors of acne
1. Age: 12-24
2. Skin occlusion (“acne mechanica”)
3. Androgen excess (PCOS)
4. Medications (lithium, isoniazid, steroids, testerone)
114
Comedo is inflammatory or non-inflammatory acne
Non-inflammatory
115
ID
Open comedo/Blackhead
116
ID
Closed comedo/Whitehead
117
ID
MINIMALLY INFLAMED PUSTULES
118
ID
Inflamed Papules
119
ID
Inflamed nodule or cyst
120
Which level of severity of acne has some comedones and NO INFLAMMATION?
Mild
121
Which level of severity of acne has scars and some papules/pustules and NO INFLAMMATION?
Mild to moderate
122
Which level of severity of acne has some papules/pustules and NO SCARS?
Moderate
123
Which level of severity of acne has many papules, pustules, nodular cysts and severe INFLAMMATION?
Severe
124
ID
Post-Inflammatory Hyperpigmentation
125
What are the two types of acne scarring?
Boxcar and Icepick
126
ID
Boxcar Acne scarring
127
ID
Icepick scarring
128
ID
Hormonal acne
129
Characteristics of hormonal acne
- Females around menstruation
- Location: around the jaw line
130
ID
Acne Conglobata
131
ID
Acne Fulminans
132
Characteristics of Acne Conglobata
-- Severe nodulocystic acne with eruptive onset
-- No systemic manifestations
133
Characteristics of Acne Fulminans
-- Boys 13 - 16 yo. old
-- Abrupt development of nodular acne lesions
-- Systemic manifestations: Fever, arthralgias, myalgias, hepatosplenomegaly, malaise
-- Osteolytic bone lesions at the clavicle and sternum
134
Most common places to find acne on the body
Anterior face, posterior and anterior chest
135
3 medications used to treat excessive sebum production leading to acne
- Retinoids
- OPCs (oral contraceptive pills)
- Spironolactone
136
4 medications used to treat abnormal follicular keratinization leading to acne development
- Retinoids
- Benzoyl peroxide
- Azelaic acid
- Alpha and beta-hydroxy acids
137
3 medications used to treat proliferation of C. acnes
- Benzoyl peroxide
- Retinoids
- Oral and topical antibiotics
138
3 medications used to treat inflammation due to acne
- Retinoids
- Antimicrobials
- Topical dapsone
139
Patient has mild acne (some comedones) what meds do you prescribe
Topical Retinoid
+/- benzoyl peroxide
140
Patient has mild acne (some papules/pustules) what meds do you prescribe
Topical retinoid
Benzoyl peroxide
Topical antibiotic
141
Patient has moderate acne (some papules/pustules and some nodules) what meds do you prescribe
Topical retinoid
Benzoyl peroxide
Topical antibiotic
Oral antibiotics
Females: OCPs and/or Spironolactone
142
Patient has severe acne (many papules, nodules) what meds do you prescribe
Isotretinoin
Aviclear laser
143
Difference between Retinol and Retinoid
-- Three forms: retinol (alcohol), retinal (aldehyde), retinoic acid (acid)
-- Retinol: OTC
-- Retinoid: Prescription
-- Side effects: dryness and skin irritation
144
3 types of Retinoid medication
1. Adapalene (least strong)
2. Tretinoin
3. Tazarotene
145
Tretinoin medication is inactivated by what?
UV rays and oxidized by benzoyl peroxide
146
Are retinoids safe during pregnancy?
No
147
What is benzoyl peroxide?
-- Antimicrobial wash
-- Side effects are dryness and irritation
-- Topical: use on face, back and chest
148
What is the standard topical regimen for the morning and night for acne?
149
What class of medication is tetracycline?
Oral antibiotic
150
What is the MOA of tetracycline?
-- Inhibits bacterial protein synthesis
-- Binds reversibly to the 30S ribosomal subunit of bacteria
151
Does tetracycline cover MRSA? Pseudomonas?
MRSA: Yes
Pseudomonas: No
152
Side effects of doxycycline part of the tetracycline class?
GI upset and phototoxicity
153
Children should not be prescribed tetracyclines, why?
Ruins teeth, stains teeth
154
MOA of spironolactone
Potassium sparing diuretic; antagonist alderstone
155
Side effects of spironolactone
Hyponatremia, hyperkalemia, gyneclamastia
156
Which type of OCP for acne are the most effects?
Contain both estrogen and progestin
157
Can hormonal based IUDs make acne better or worse? (ie Mirena, Skyla, Liletta, Kyleena)
Worse
158
Which 3 OCPs are FDA approved for acne:
1. Ortho Tri-Cyclen (norgestimate/ethinyl estradiol)
2. Estrostep (norethindrone acetate/ethinyl estradiol)
3. YAZ (drospirenone/ethinyl estradiol)
159
Which medication is approved for severe nodulocystic acne
Isotretinoin (Accutane)
160
What is the contraindication for Isotretinoin?
Pregnancy
161
To receive Isotretinoin all patient must do what?
-- Enroll in iPledge
-- 2 forms of birth control (Abstinence can be primary method)
162
Which labs must be monitored with a prescription of Isotretinoin
ALT and triglycerides at baseline and 1 month after max dose
163
Side effects of Isotretinoin
Dryness: dry skin, lips, eyes, nose (nosebleeds)
Joint pain, muscle aches, tendonitis (Achilles)
Depression, psychosis, suicidal ideation
Pseudotumor cerebri
164
Which other treatment besides Isotretinoin can be used to treat severe acne
Aviclear Laser (3 treatments monthly)
Expensive
165
When should a PCP refer to Derm for acne
1. Recalcitrant (acne that doesn't respond to standard treatments, like over-the-counter products or common prescription medications)
2. Systemic symptoms
3. Unusual distribution
4. Potential hormonal abnormalities
166
ID
Comedos open; scattered inflamed papules
167
ID
Inflamed papules/pustules
168
Where does periorificial dermatitis affect?
-- Mouth, nose, eyes
-- Around the orifices (mouth > nose > eyes) with sparing of the vermillion border
169
What is the presentation of periorificial dermatitis?
papules, pustules, scaling, crusting, NO COMEDONES
170
Patient population affected by periorificial dermatitis
kids, women (20-45 yo)
171
ID
Periorificial Dermatitis
172
Treatment for periorificial dermatitis
1. Stop steroids
2. Start antibiotics: PO doxycycline, PO azithromycin
3. Topical calcineurin inhibitors (tacrolimus, pimecrolimus)
4. Topical metronidazole cream or gel
(May take 2-3 months to see improvement)
173
What are the 4 types of rosacea
1. Erythematotelangiectatic
2. Papulopustular
3. Rhinophymatous
4. Occular
174
Erythematotelangiectatic rosacea is characterized by which physical feature
Telangiectasias
175
Papulopustular rosacea is characterized by which features
Erythematous papules and pustules, no comedones; dry eyes
176
Rhinophymatous rosacea is characterized by which features
Bulbous deformation of the nose
Older men
Busty nose
177
Occular rosacea is characterized by which feature
Conjunctivitis
178
Triggers of rosacea
1. Anything that causes flushing or increased cutaneous vascular flow: heat (sun exposure or hot baths), spicy foods, stress, alcohol, excercise
179
Treatment of Erythemato-telangiectatic Rosacea
Topical vasoconstrictors (Oxymetalozone and Brimonidine)
Laser treatment to get rid of telangiectasis
Side effects can be rebound flushing
180
ID
Erythmatotelangiectatic rosacea
181
ID
Papulopustular rosacea
182
ID
Rhinophymatous rosacea
183
ID
Ocular Rosacea
184
Treatment for Papulopustular rosacea
-- Topical metronidazole cream or gel
-- Sodium sulfacetamide face wash
-- PO doxycycline
185
Treatment for Rhinophymatous rosacea
Electrocautery
Lasers (reshape the nose)
186
Treatment for ocular rosacea
PO doxycycline
Refer to optho
187
Causes of folliculitis
mechanical, foreign body, organisms (bacterial: staph & strep, pseudomonas); fungal (pityrosporum - Malassezia); viral: (VZV, herpes simplex)
188
What are some increased risks for a patient to have folliculitis
Immobility, immunosuppression, medications (steroids, testosterone)
189
Pathogenesis of folliculitis
inflammation of the superficial hair follicle
190
Common location of folliculitis
back, buttocks, scalp
191
Presentation of folliculitis
follicularly based papules and pustules (around the hair follicle)
192
ID
Folliculitis
193
Treatment of folliculitis
1. Workup: bacterial or fungal swab for culture/viral studies
2. Management: avoid tight clothing, shave in direction of hair growth
3. Medications
---Bacterial: Benzoyl peroxide wash, topical antibiotics, (if extensive/deep) PO doxycycline, PO Keflex
---Fungal: topical or oral antifungals (ketoconazole)
---Viral: antivirals (valacyclovir)
194
Define furuncle
painful firm or fluctuant abscess-boil
195
Define carbuncle
cluster of boils connected subcutaneously
196
ID
Furuncle
197
ID
Carbuncle
198
Furuncle vs. Carbuncle vs. Abscess
Abscess: deep under skin, no associated with a hair follicle
Carbuncle: multiple cells interconnected
Furuncle: painful firm boil
199
Example of fungal folliculitis
Pityrosporum Folliculitis
200
Example of viral folliculitis
Herpetic sycosis
201
Example of bacterial folliculitis
Pseudomonal folliculitis
202
ID
Pityrosporum Folliculitis
203
ID
Herpetic sycosis
204
ID
Pseudomonal folliculitis
205
Pityrosporum Folliculitis is characterized by
Malassezia: monomorphic pupules and pustules
206
Herpetic sycosis typically affects which location
the beard
207
Pseudomonal folliculitis is typically located
buttocks are or area covered by swimwear; ask about hot tub exposure
208
ID
Malassezia on KOH
209
Cause of pseudofolliculitis barbae
shaving (razor bumps); affects cheeks, jawline, neck
210
Risk factor for pseudofolliculitis barbae
tightly coiled hair
211
ID
pseudofolliculitis barbae
212
Pathogenesis of pseudofolliculitis barbae
Curved hair reenters the dermis -- > inflammatory response to hair keratin
213
Treatment for pseudofolliculitis barbae
-Avoid shaving (use scissors)
-Shave in direction of hair growth
214
ID
pseudofolliculitis barbae
215
ID
Acne Keloidalis Nuchae
216
Location of acne keloidalis nuchae
neck and occipital scalp
217
Risk factor for acne keloidalis nuchae
curly, coiled hair
218
Treatment for acne keloidalis nuchae
avoid sharp, razored cuts
Steroids: topical, intralesional
Antimicrobials: topical, oral
Retinoids: topical
Surgical excision, laser resurfacing, electrosurgery
219
ID
Keloidalis nuchae
220
ID
Impetigo (yellow, honey crusted shallow erosions)
221
#1 bacterial skin infection in kids
Impetigo
222
Method of transmission of impetigo
Direct skin-to-skin contact
223
Define impetigo
Common, highly contagious superficial skin infection
224
Presentation of impetigo
Honey colored crust and/or pustules
225
Most common location for impetigo
Face (around nose and mouth); occurs at site of barrier compromise (ie skin trauma, bug bites, dermatitis)
226
Bacteria causes impetigo
Staph aureus > Group A strep pyogenes
227
ID
Impetigo
228
ID
Impetigo
229
How to diagnosis impetigo
1. Clinical exam
2. Bacterial wound culture
230
Treatment for impetigo
-- Topical mupirocin (antibiotics) if locaalized
-- Oral antibiotics (penicillin, 1st gen cephalosporin) if unhealthy patient
-- Return to school/sports after 24 hours
231
ID: puffy eyes and dark colored urine. 1 month after cephalexin regimen
Post-streptococcal glomerulonephritis
232
MOA of Post-streptococcal glomerulonephritis
Immune complex deposition in glomeruli; self-resolves in children
233
Who does Post-streptococcal glomerulonephritis affect
Children
234
What is the name for the ulcerative form of impetigo
Ecthyma
235
Bacteria causing Ecthyma
Group A step and/or Staph. aureus
236
Risk factors for Ecthyma
-- Scratching/trauma
-- Poor circulation (limbs)
-- Immunosuppression
-- Malnourishment
-- Poor hygiene
-- Overcrowding (housing conditions)
237
ID
Ecthyma
238
ID
Ecthyma
239
Characteristics of ecthyma
-- initial vesiculopustule, enlarges over days, develops hemorrhagic crust
-- punched out ulcer with purulent and necrotic base
-- slow to heal and scars
240
How to diagnosis ecthyma
-- clinical exam
-- superficial wound culture vs. punch biopsy for tissue culture; aerobic
241
Treatment for ecthyma
anti-streptococcal/anti-staphylococcal oral antibiotics
Cephalexin
242
ID
Ecthyma Gangrenosum
243
Bacteria associated with ecthyma gangrenosum
pseudomonas aeruginosa
244
Pathogenesis of ecthyma gangrenosum
bacteria invade blood vessels --> occlusion and ischemic necrosis
245
Describe skin lesions of ecthyma gangrenosum
Purpuric macules --> hemorrhagic blisters --> necrotic ulcers
246
Treatment for ecthyma gangrenosum
oral antipseudomonal
247
Does ecthyma gangrenosum have systemic symptoms
Yes: hypotension, fever
248
