CLIPP 32 Flashcards
wheals vs petichiae/purpura, and purpura vs petichiae
wheals blanch and purpura/petechiae don’t..
purpora are larger than petchiae
what is a wheal
blanching, edematous, thin erythematous papule or plaque, often with a rim of hypopigmentation
May be white to pale red and often appear and disappear over a period of hours
atopic triad
asthma, eczema (atopic dermatitis), allergies (allergic rhinitis/hay fever)
Roseola
A viral exanthem that classically follows 3-5 days of a febrile illness.
As the fever resolves, patients develop a pink, maculopapular rash that starts on the trunk and may spread to the face and extremities.
Caused by human herpes virus-6 (HHV-6
Erythema infectiosum (Fifth Disease)
another viral exanthem - Rash starts on the face with a “slapped”-cheek appearance followed by a reticular (lacy) erythematous rash on the trunk and extremities.
Caused by parvovirus B19.
erythema migrans
Lesion associated with early localized Lyme disease.
Starts as a red papule at the site of a tick bite.
Expands to form a large erythematous, annular patch.
urticaria is due to
type 1 hypersensitvity
classic urticaria lesion
very pruritic (bc histamine release from mast cells), erythematous, edematous wheal often w/ central pallor/hypopig. these lesions continually change with new ones appearing as old ones disappear and individual lesions don’t last more than 12- 24 hours. trigger sometime can be ID’d. usually asymmetric
papular urticaria
common pediatric condition due to insect bites (i.e. kid will likely be outdoors a lot in hx) and is pruruitic, can be recurrent/chronic. lesions are 3-10mm
rash in streptococcal infection
often scarlet fever, which is fine red sandpapery rash worst at creases; can cause ~ to uriticarial rash
Erythema multiforme
symmetric, acute hypersensitivity reaction. dusky red macules become wheals become target lesions. lesions stay for 1-3 weeks and does not come and go. typically assoc w/ herpes.
drug eruption
often urticarial, can be type 1 HS but could also be non-immuno triggers
hives aka
acute urticaria, often caused by histamine release triggered by food etc or other common allergens
tx acute urticaria/hives
anti histamines, cool and calm patient (not hot bath).
-oral pred rarely used if anti histamines don’t work. topical steroids not used bc area is typically large
“cradle cap”
seborrheic dermatitis - eryhtematous plaques w/ red/yellow scale, typically on scalp but also on diaper area, ears or neck.
3 clues pointing to eczema
atopic diathesis, posterior scalp, extensor surfaces
candidal rash
7-10months old, diaper dermatitis, eryhtematous plaques w/ SATELLITE LESIONS
psoriasis of scalp
thicker and less waxy scale than seborrheic dermatitis and more defined. may or may nor be pruriitc. may have family hx of this, may have other areas on body affected too.
what causes seborrheic dermatitis in older people
malazzeia
tx of seborrheic dermatitis in infants and adults
adults = ketoconazole cream
infants =baby oil, baby shampoo or maybe ketoconazole shampoo, and / or mild topical steroid
blackheads vs whiteheads
blackheads = open comedones, whiteheads = closed comedones
staph folliculitis, furunculitis
often waist or groin area, can be similar to cystic or nodular acne
hidrenitis suppuritiva
pustular lesion causing occlusion of apocrine (vs pilosebascious in acne) and often co-infected w/ staph or strep. often affects axilla/groin areas unlike acne.
rosacea
often in adults tho early form seen in adol. no comedones. worse w/ stress, spicy food, alcohol. impacts malar and nasal areas. tx w/ metro topically
perioral dermaitits
adolescent variant of roscea w/ erhema, papules pustules but still NO comedones. not just perioral, also around eyes/nose
psueodfollicutusi
papules, not pustules thus distinct from acne due to this. often in beard area w/ papules near hair follicles and occurs when hair shaved close grows back into folilcle
eryhtema nodosum
Hypersensitivity reaction presenting as red, tender, nodular lesions on pretibial surface of the legs.
Many possible etiologies, a few of which include infections, drugs, and inflammatory bowel disease.
Primary lesions are nodules, not pustules.
3 things known to exacerbate acne
mechanical (manipulation, or occlusion i.e. from helmet), make up, overzealous cleaning
tx for mild vs mod vs severe acne
mild: BPO, retinoids
mod: abx topically or orally, bcp
severe: derm referral, isotretinoin
4 key facts about retinoid timing
Retinoids need to be used at night, because they can cause photosensitization and lead to a significant sunburn.
Tretinoin is also inactivated by oxidation of BPO (so the BPO cream should be applied in the morning).
Tretinoin also must be applied to bone-dry skin or it may be significantly irritating.
It is important to make sure teens know that retinoids can make acne transiently look worse.
doxycycline side effects (5)
photosensitivity, dental staining in children under age 9, teratogenicity, esophagitis i.e. stay upright for 30 min after taking, and pseudotumor cerebri
dimethylglyoxime test
home test for nickel
chronic contant dermatitis type of rxn
is delayed t4 hypersensitivity, takes 24-72h from start of contact and can occur even w prior tolerance. resolves w/i days to weeks of avoidance
tx contact dermaitits
emollient lkike vaseline, aquaphor. remoev offending agent. can try medium potency topical steroid
chronic vs acute contact dermaitist
acute will have vesicles, edema and erythema w/ itching
toxicodendron/rhus genus
poison ivy, oak, sumac contain urshiol which is active in all seasons and on pets/objects
is urshiol tranfersed by blister fluid?
NO
tx urshiol exposure
wash hands w/i 30 min w/ soap/water or detergent, topical steroids/oral antihistamines if severe rash and itching. use oral steroids if widespread or increasing in size, for 10-14d
impetigo
weeping honey colored crusts often below the nares, due to strep or staph
tx impetigo
mupircoin. but b/c of mrsa, watch for abscess formation
4 key steroid side effects
hypopig, telangiectasia, suppression HPA axis, skin breakdown/atrophy
classes of steroids and their potency, and an example of each
mild - class 7,6 (hydrocortisone acetate) med - class 5,4 (triamcinolone acetonide) potent - class 3,2 (betamethasone propionate) super potent - class 1 (clobetazol) -1000x diff between mild and super potent
a reason infants absorb more steroid
bc of occlusive dressings like diapers
pediculosis capitis
head lice
tx of lice prophyalctically and missing school
can’t tx proph.
otherwise healthy child shouldn’t miss school due to nits (i.e. lice ova)
current rx for lice
permethrin - repeated applications 2-3x in weekly intervals
benzyl alcohol if kid is older than 6 mos
malthion - if kid is older than 2y. use malthion or benzyl alcohol if failed permethrin/pyrethin or if resistance to it. also should wet comb w/ fine comb regardless.
Lindane
former lice tx but can –> neurotoxicity
scabies sx
itching, wosrt at night, often fingers toes wrists and elbows. often see linear lesions, can ultimately –>impetigo or even cellulitis
scabies tx and after its gone
two applications of permethrin 5% cream, one week apart, for all affected household members. (oral ivermectin if allergic to permethrin)
can get post scabetic itch due to inflammation of infestation for a few weeks
ringworm aka
tinea corporis, a superficial fungal infxn
classic ringworm lesion and its dx
annular w/ raised borders and scaly, pururitc, w hypo pig in middle or brown.
dx w/ koh, see branches and rod shaped septated hyphae
tinea versicolor - what iti s, predispose by, tx
aka malazeia.
predispose by sweat, sun, humidity
tx = selium sulfide shampoo
which type of tine requires systemic tx, and w what
tine capitis - griseofulvin 6-8weeks - i.e. any involvement of scalp w/ tines –>systemic tx
kerion
allergic response occurring in tine capitits - weepy boggy lesion requring oral steroids that goes away once fungus infection is controlled
what can make tine worse
if misdiag as eczema and tx w/ steroid
nummular eczema
coin shaped lesions on butt and legs
pityriasis alba vs roesa
alba: hypo pig (due to fewer melanocytes/emlanosomes) on face, neck, upper trunk, prox extremities and assoc w/ sun exposure. don’t confuse w/ versicolor!
rosea: crhistmas tree distinction on back and trunk, upper thighs and groin. has herald patch
christmass tree skin lesion
pityriasis rosea
herald patch
pityriasis roesa
home tx of warts and molluscum that works best
salicylic acid
3 causes diaper rash
irritant is most common and spares intertrigenous creases and tx w/ barrier cream like zinc oxide, bactieral (strep perianal group a) may sees bloody streaks in stool, tx w/ oral abx, candida has satellite lesions and tx w/ nystatins, maybe azoles
certain __ conditions can present w diaper rash
infalmmatory conditions - all have alarm sx of irritability, poor growth, fever etc
-examples include zinc/nutrition deficiency, malabsorption, langerhans histiocytosis (crusty weepy bloody diaper reash lesions)
key sx that can be seen in atopic dermatitis
licehnification in skin flexures
psoriaris pathophys
hyperprolif of keratinocytes
type of virus that is the molluscum virus
poxviurs
