Chapter 11- Inflammatory Papules Flashcards
Characterized by discrete, small, erythematous papules that do NOT become confluent (run together/become one) =
inflammatory papules
comedones and pustules accompany papules in ______.
acne
**comedones - primary sign of acne ; dilated hair follicle with bacteria
______ coalesce into plaques in atopic dermatitis.
eczematous papules
T/F Plaques and papules are present in psoriasis.
true
Acute skin reactions appear as _____, and more chronic reactions appear as ______ .
hives ; inflammatory papules
Bees, waspas, and fire ants _____.
sting
Mosquitoes, fleas, flies, bedbugs, and lice _____
bite
What is the leading caue of allergic insect sting reactions in the USA? What about tin the southern USA?
yellow jackets
southern - fire ants
This insect bites in groups of three, infest bats and birds, hides in cracks and crevices, and attacks a sleeping victim.
Bed Bug
What do fleas, spiders, bedbugs, and lice have in common?
all indoor insects
Papules occur only in people who are _____ and ____ the insects.
allergic and attract
The reaction to a ______ is usually an immediate hive, often with a central punctum, that resolves in a few hours
sting
What produces multiple itching hives, that quickly progress to painful papulovesicles and pustules?
fire ants
What produces a severe local necrotic reaction with ulceration?
recluse spider
what favors the legs and areas of tight fitting clothing, where they produce inflammatory papules an vesicles, and occasionally even bullae?
Chiggers
______ attach to the hair and are called “crabs”
Pubic lice - Pediculosis pubis
What should be suspected in the presence of itching of the scalp, particularly the occiput or peripheral scalp?
Head lice - Pediculosis capitis
body lice =
Pediculosis corporis
T/F Flea bites and bedbugs usually occur in streaks of tree: “breakfast, lunch, dinner”.
true
urticarial reaction =
hives
when a hive has a central punctum, its cause is ____
an insect bite
When only excoriations are found, ______ is in the PA’s differential diagnosis of inflammatory papules
Dermatitis herpetiformis
Excoriations may also lead to secondary infection and a diagnosis of _____.
impetigo
An uncommon idiopathic disorder, _________ , presents with scattered necrotic papules and vesicles that can resemble insect bites but are usually more generalized and symmetric.
Mucha-Habermann disease
The diagnosis of an inflammatory papule is performing a biopsy, which shows a wedge- shaped superficial and deep cellular infiltrate, so dense tha tit may be mistaken for what???
malignant lymphoma
What gent do you use to chemically kill lice?
NIX - permethrin creme rinse
Adult lice can live on human host for ____ days. Nits (eggs) can live for ____ days.
3; 10
T/F Most treatments for lice are pediculicidal, but not ovoidal (kills the lice but not the eggs). Therefore treatment usually requires 7-10 days.
true
T/F Successful treatment of flea bites includes fumigation of the home.
true - smoke or fumes
Permethrin and DEET is effective in deterrent of insect bites, especially _____.
ticks
What form of symptomatic therapy is used for itching?
topical steroids and antihistimines
Lice and Tecks both use what for initial therapy?
permethrin
Fleas and bedbugs both use what for initial therapy?
house fumigation
An alternative for lice treatment is topical ________ and _____.
topical benzyl alcohol and malathion
what immunoglobulin mediates an anaphylactic reaction to stings?
igE
Patients with anaphylactic reactions require promo therapy with what?
epinephrine, antihistimines, systemic steroids
A persistant local reaction to the bite of an infected deer tick is a characteristic of what?
Lyme disease and is called erythema migrans
The primary mechanism for insect bite reactions is _____.
allergic
What is characterized by monomorphic, follicle based papules with a central horny spine and are located predominantly on the extensor upper arms and thighs, with the face less commonly affected?
Keratosis Pilaris
Almost one half of the population is affected by keratosis pillars, but it is most common in _______, especially people with _____ skin. Also a positive family history is usually present
adolescents; dry skin
A patient presents with rough bumps along the extensor of upper arms and thighs that will not go away with washing, especially scrubbing. It is not pruiritic or painful. You then examine the patent and see individual, small, follicular papules with a central horny spine. What do you suspect?
Keratosis Pilaris
A PA should inform patient being diagnosed with Keratosis Pilaris that the disease will become worsen during what time of the year? They should be relieved that the disease will eventually improve when?
worsens in the winter; improves with age.
T/F Keratosis pilaris is polymorphic.
false. monomorphic
What are the most common areas infected with Keratosis pillaris?
extensors of arms and thighs & face (but uncommon)
When Keratosis pillaris affects the face of a patient, what else would you expect to see that differs from when the extensor surfaces of arms and thighs are affected?
there will be a background erythema commonly seen
T/F Laboratory work up and biopsy are not necessary in diagnosis of Keratosis pillars.
true - straightforward
How do you distinguish acne from keratosis pillars involving the cheek?
Look for pustules and comedones that are diagnostic of acne
How does Lichen spinulosus differ from keratosis pillaris?
Lochen spinulosius is located mostly on the abdomen, but it can be seen on extensor of arms, knees, and neck
How do you differ between lichen nitridus and Keratosis pillars?
Lichen nitrides are flat topped papules and not as rough as keratosis pillaris ; also … koebnerization (linear streaks of papules) is seen in lichen nitrides not keratosis pilaris
Therapy for Keratosis pillars would be what?
- reassurance and education
- emollient cream - urea 20%, salicylic acid 6%, ammonium lactate 12%
- tretinoin cream .05% - alternative therapy
what are the 4 P’s that characterize Lichen planus?
- Purplish
- Planar
- Pruritus
- Polygonal
- Papule
idiopathic inflammatory disorder of the skin. papules are flat with white dots and lines. purplish papules that favor flexor wrists and distal lower extremities
Lichen Planus
T/F Lichen Planus can affect hair, skin, nails, and mucous membranes.
true
What will confirm Lichen Planus in a patient?
biopsy
T/F Lichen Planus disorder is both uncommon and rare.
false. it is uncommon but not rare
What would be the most important / careful history of a patient to take if a PA suspects Lichen Planus?
drug history - lichen planus-like eruptions can be induced by drugs
What is a patients main complaint when coming in with Lichen Planus?
itching - which is usually severe
**mucous membrane involvement can result in painful erosions
The primary lesion of Lichen Planus is purple, polygonal, flat topped papule. The surface has a fine reticulate pattern of white dots and lines called ______.
Wickham’s striae
How can you view Wickham’s striae in a patient presenting with Lichen Planus?
closely- drop of oil on the papule and use a hand held lens
where are the favored locations for lichen plans?
wrists and ankles - but palms, soles, and genitalia can be affected
The papules of Lichen Planus are sometimes arranged in streaks, resulting from the trauma of scratching called _______.
Koebner’s phenomenon
T/F Mucous membrane involvement is common in Lichen Planus and is the sole manifestation of the disease
true
T/F tThe hair and nail follicles are occasionally involved with dystrophic changes and even scarring in Lichen Planus.
true
What is most commonly confused with Lichen Planus?
Discoid Lupus
When Lichen Planus presents with only a FEW scattered papules, it can be confused with _____.
insect bites
_____ can mimic Lichen Planus
Drug Eruptions
Thiazides, Phenothaizines, Gold, Quinidine, Quinacrine, Chloroquine all causes ______ .
lichen planus-like eruptions
The course of Lichen Planus can be months to years. BUT 2/3 of patients experience _______.
spontaneous resolutions within 1 year
Patients with ______ involvement in Lichen Planus usually have a longer course.
mucous memebrane involvement
T/F Recurrences are almost absolute in patients with Lichen Planus.
false - very uncommon - in less than 20%
What are two complications of mucous membrane lichen planus?
- candidiasis
2. squamous cell carcinoma
T/F Patients who have undergone bone marrow transplantation have showed occurrences of lichen planus-like eruptions. But the cause of Lichen Planus is still unknown
true
Because of the intense pruritus in some patients with scabies, only excoriations are seen. A misdiagnosis of ________ could easily be made.
neurotic excoriations
A widespread disease of scabies may be misdiagnosed as ______.
essential dermatitis
What is diagnostic of scabies?
mits or eggs; and black dot at the burrow
What laboratory method would be used to diagnose scabies?
skin scaling with no.15 blade. biopsy usually not necessary
What is the drug of choice for scabies?
Elimite = a permethrin cream
**it has to be applied over the ENTIRE body surface, including under the finger nails
T/F An infant patient is diagnosed with scabies, the PA should tell the parents not to bother treating themselves, an infant isn’t as contagious as an adult.
FALSE!! all family members who live in the same house hold as the patient being treated with scabies should also apply the cream. Highly contagious.
Which drug is recommended when scabies breaks out in a nursing home?
Ivermectin (oral dose)
How long does itching persist after treatment of scabies?
1-2 weeks
_______ is found in immunocompromised patients such as patients with AIDS
crusted scabies - Norwegian scabies
**easily misdiagnosed as eczema or psoriasis but when you look close burrows and mites are usually numerous and confirms scabies diagnosis
Is it easier to transmit scabies form human to human contact or from bedding and clothing to human?
human to human is easier ; a stuy during 2nd World War confirmed that it was difficult to transmit scabies from bedding to human
Also in the study during 2nd World War, the incubation time from inoculation to itching was _______ long.
1 month
Also in the study during 2nd World War, they found that if Scabies is left untreated, ______ occurs.
progressive itching
T/F In the study during 2nd World War, they found that the hypersensitivity to the reaction of scabies provided protection in a way that made it difficult to reinfest previously infested patients.
true
heat rash, represents an inflammatory reaction around a sweat duct
miliaria
clinically how does miliaria appear?
as multiple small papules
what is the main presenting complaint of patients with miliaria?
pruirtus
Who is miliaria commonly found in?
infants
WHERE is miliara more commonly found?
warm, humid environments particularly in skin that has ben occluded
What is the most common form of miliaria ?
mililaria ruba
multiple discrete small red papules that occur most often on the trunk, particularly the back
miliaria ruba
Clinically how does miliiaria tuba present?
multiple small, discrete uniform size papules not associated with hair follicles.
What is th eless common variant of miliaria?
miliara crystallina
superficial non inflamed vesicles containing crystal-clear fluid (dewdrops) commonly seen in infants
miliaria crystallina
How can you tell the difference between miliaria rubra and contact dermatitis?
papules tend to be confluent rather than discrete and itching is often more pronounced in contact dermatitis
How can you tell the difference between miliaria and folliculitis?
in miliaria the pustules are usually smaller and more numerous, and do NOT have a centrally placed hair, although, sometimes the two conditions co-exist because they may share the same predisposing factor
small non-inflamed superficial epidermal duration cysts often found on the face of young infants
milia
Gram staining and culture will rule out ____ when forming a differential diagnosis of miliaria?
folliculitis
Candida is identified using ____
hydroxde prep
T/F Therapy for a patient with miliaria would include cooling measures, air exposure, and topical steroid, but avoid overuse of the steroid because it can cause more occlusion.
true
What will cause miliaria to resolve spontaneously within days?
decreasing heat and increasing air exposure
Heather has hydrated herself to a point where there has been swelling of the stratum corneum and compromise of the ductal lumina. After occlusion, sweat extravastes into the epidermis, where it produces an irritant reaction. This occurs within the epidermis at the level of the granular cell layer. This is the pathogenesis of _______.
miliaria ruba
Where does the sweat duct obstruction occur in miliaria crystalline?
in the stratum corneum
an infestation of th epidermis with the “itch” mite. Burrows are usually found. The “WORST ITCH OF THE PATIENTS LIFE”
scabies
what is characteristic of scabies.
burrows are usually found and are diagnostic. Inflammatory papules resulting from host hypersensitivity however constitute the more frequent and obvious finding
T/F Scabies is a very uncommon disease.
FALSE! very common - school age children, hyper endemic among rural populations of less developed countries. Immobilized geriatric patients in nursing homes, patients with HIV/AIDS, and medically compromised patients (DOWN SYNDROME) are predisposed to infestation with high mite counts.
what is the major complain of patients with scabies?
generalized pruritus
What is the incubation time from inoculation to onset of pruritus in scabies?
1 month
T/F Scabies is often severe enough to interrupt sleep.
true
What history should be taken when a patient is suspected of scabies?
usually family members and friends often also itch - pet history
Itching papules and small nodules on the penis should be considered _______ . unless otherwise proven.
scabies
What is the predominant condition of scabies?
small inflammatory papules
______ is usually generalized but favor locations included the finger webs, wrists, elbows, axillae, girdle area, and feet.
scabies
Where are nodules of scabies most commonly found? If you look closely what do you see?
hands ; black dot which represents the adult mite
