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Symptoms > 043015 rash > Flashcards

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
Q

eczema herpeticum is also named

A

Kaposi varicelliform eruption

26
Q

eczema herpeticum

A

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
Q

tx for eczema herpeticum

A

IV acyclovir

28
Q

how to tx AD

A

topical emollients, gentle skin care
topical anti-inflam meds (corticosteroids, calcineurin inhibitors)

antihistamines (for sleep)

widespread disease: phototherapy, immunosuppresives

29
Q

bulla

A

greater than 5 mm

30
Q

vesicles in dermatomal distribution with erythematous base with pain as prodrome-differential?

A

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
Q

Tzank smear

A

positive for HSV and VZV

has multiple nuclei molded together

32
Q

what tests can be used to confirm shingles diagnosis

A 
tzanck smear
molecular test (direct fluorescent antigen, PCR)
33
Q

tx for shingles

A

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
Q

Ramsay Hunt syndrome

A

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
Q

Herpes zoster ophthalmicus

A

reactivation of VZV in V1 of trigeminal nerve

vesicles on tip of nose may raise suspicion–poses risk for corneal damage

36
Q

dewdrops on rose petal

A

chicken pox

37
Q

herpes-genetic composition, enveloped or not?

A

double stranded DNA, icosahedral, enveloped

38
Q

how is VZV different from HSV in terms of pathogenesis

A

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
Q

impetigo

A

small vesicles or pustules that rupture and become honey colored crust with erythematous base

40
Q

tx for impetigo

A

local wound care
mupirocin or retpamulin topically
first line oral antibiotics: penicillin, cephalosporin, beta lactamse inhibitor combo with beta lactam

41
Q

who’s at risk for SSSS

A

kids under 2

adults w renal disease (can’t excrete toxin)

42
Q

how does SSSS occur

A

exfoliative toxins A, B target desmoglein 1 (component of desmosomes)–in bullous impetigo and SSSS

Symptoms (18 decks)

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