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043015 rash Flashcards

1
Q

morbiliform

A

blanching macules and papules

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2
Q

plaque

A

raised and larger than 1 cm

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3
Q

morbiliform rash over trunk and extremities-differential?

A

drug eruption:

  • morbilliform drug eruption
  • drug induced hypersensitivity syndrome/DRESS (has mobiliform and systemic symptoms)
  • SJS/TEN (would have blisters)

viral exanthem

graft vs host disease (red palms)

secondary syphilis

irritant or allergic contact dermatitis (more scales)

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4
Q

what is thought to be the mechanism behind exanthematous drug eruption

A

type IV hypersensitivity reaction

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5
Q

what do you do for pt with exanthematous drug eruption

A

it will resolve on its own in 1-2 wks (even if continue the offending agent)

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6
Q

what is exanthematous drug eruption commonly caused by

A

aminopenicillins, sulfonamides, cephalosporins, anticonvulsants

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7
Q

in pt w morbilliform rash that’s drug induced, what symptoms, labs, or PE findings may indicate more serious diagnosis

A 
mucous membrane involvement (SJS TEN)
temp above 38.5
blisters
confluent erythema
facial edema and erythema (DRESS)
angioedema or tongue swelling (type I hypersen/anaphylaxis)

LAD (SJS/TEN, drug hypersensitivity)
painful skin lesions or necrosis
marked peripheral blood eosinophilia
elevated liver enzymes

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8
Q

typical lesions of SJS/TEN

A

tender dusky red or purpuric macules that progress to flaccid bullae and erosions

involves buccal, ocular, genital mucosae in over 90%

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9
Q

typical symptoms of SJS/TEN

A

rash, fever, LAD, hepatitis, cytopenias

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10
Q

Nicholsky’s sign positive

A

SJS/TEN
Staph aureus
pemphigus vulgaris

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11
Q

mechanism of type III hypersensitivity rxn

A

antigen-antibody complexes deposit in various tissues (esp kidney and lung). they induce complement activation and ensuing inflam response mediated by neutrophils

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12
Q

ex of type III hypersen rxn

A

PSGN
SLE
serum sickness reaction (to antiserum that’s from an animal)

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13
Q

what is the time course of type III hypersen

A

immune complexes prominent in 8-14 days after exposure (after this time, becomes free Ig)

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14
Q

ex of type II hypersensitivity rxn

A 
autoimmune hemolytic anemia
blood transfusion rxns 
Grave's dis
myasthenia gravis
Goodpasture dis
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15
Q

ex to type IV hypersen rxn

A

contact dermatitis
chronic transplant rejection
exanthematous drug eruption
tuberculin skin test

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16
Q

pink, lichenified papules and plaques with mild scale and excoriations in bilateral antecubital and popliteal fossae

differential?

A

inflammatory:

  • atopic dermatitis
  • seborrheic dermatitis (not as scaly or lichenified)
  • allergic contact dermatitis
  • psorasis

infectious:

  • scabies
  • tinea corporis

drug exanthem (but would be more widespread)

nutritional deficiency (would be around mouth, groin)
-zinc

immunodeficiency (wiskott-Aldrich)

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17
Q

how does lichenification develop

A

itchy then scratch

18
Q

infantile stage of atopic dermatitis

A

face, scalp, extensor surfaces of extremities, diaper area spared, secondary impetiginization common

19
Q

childhood stage of atopic dermatitis

A

flexural folds and extremities, more lichenification

20
Q

adult stage of atopic dermatitis

A

hand dermatitis common
variable course
ill-defined

21
Q

immunology of AD

A

type 2 helper T cell disease
defects in epidermal skin barrier (decreased essential fatty acids, fillagrin mutations, increased susceptiblity to allergns, increased water loss)

defects in cell mediated immunity (increased susceptibility to viral, bac, fungal infec of skin. majority of pts colonized w staph aureus)

22
Q

molluscum contagiosum is most common in

A

children

spread by contact with infected skin, clothing

23
Q

appearance of molluscum contagiosum

A

flesh colored dome shaped papules with central umbilication

24
Q

what unique feature does molluscum contag have

A

replicates exclusively in cyto of infected cell (unique for a DNA virus)

25
eczema herpeticum is also named
Kaposi varicelliform eruption
26
eczema herpeticum
viral infec of preexisting dermatosis PAINFUL, edematous, crusted vesicles, pustules, erosions may hv high temp, malaise, LAD most commonly caused by disseminated HSV infec in pts with atopic dermatitis
27
tx for eczema herpeticum
IV acyclovir
28
how to tx AD
topical emollients, gentle skin care topical anti-inflam meds (corticosteroids, calcineurin inhibitors) antihistamines (for sleep) widespread disease: phototherapy, immunosuppresives
29
bulla
greater than 5 mm
30
vesicles in dermatomal distribution with erythematous base with pain as prodrome-differential?
infections: - HSV - herpes zoster - bullous impetigo inflammatory: - acute allergic contact dermatitis (could be dermatomal) - bullous insect bites (no prodrome) autoimmune bullous: -bullous pemphigoid (larger bulla, all over) drug eruption -SJS
31
Tzank smear
positive for HSV and VZV has multiple nuclei molded together
32
what tests can be used to confirm shingles diagnosis
``` tzanck smear molecular test (direct fluorescent antigen, PCR) ```
33
tx for shingles
self-limited for immunocompetent antivirals may be used within 72 hrs (acyclovir, etc): - may reduce duration - may reduce risk of post-herpetic neuralgia symptomatic care -pain meds, topical corticosteroids, soaks
34
Ramsay Hunt syndrome
complication of herpes zoster reactivation of VZV in geniculate ganglion causes facial paralysis and ear pain can visualized vesicles in ear canal assoc w vestibular and hearing disturbances
35
Herpes zoster ophthalmicus
reactivation of VZV in V1 of trigeminal nerve | vesicles on tip of nose may raise suspicion--poses risk for corneal damage
36
dewdrops on rose petal
chicken pox
37
herpes-genetic composition, enveloped or not?
double stranded DNA, icosahedral, enveloped
38
how is VZV different from HSV in terms of pathogenesis
VZV has primary viremia, replicates throughout body, then has secondary viremia which brings VZV to the skin where it causes the vesicular rash HSV goes from skin to neuron viral latency is supported by many ganglia for VZV as opposed to one of a few for HSV
39
impetigo
small vesicles or pustules that rupture and become honey colored crust with erythematous base
40
tx for impetigo
local wound care mupirocin or retpamulin topically first line oral antibiotics: penicillin, cephalosporin, beta lactamse inhibitor combo with beta lactam
41
who's at risk for SSSS
kids under 2 | adults w renal disease (can't excrete toxin)
42
how does SSSS occur
exfoliative toxins A, B target desmoglein 1 (component of desmosomes)--in bullous impetigo and SSSS

Symptoms (18 decks)

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