COMMON SKIN DISORDERS & INFECTIONS Flashcards
- inflammation of pilosebaceous units of certain body parts
acne vulgaris
sebaceous glands - help hydrate the skin - also aid in __________________
thermoregulation
allows sweat to stick to us instead of rolling off - to help us cool down when too hot
acne occurs more often in ___________ during adolescence
males
o Age of onset = boys/girls going through puberty (starts around 12)
o Occurs more in males than females during adolescence
o Adult acne more prevalent in women
o acne should start “burning out” by late 20’s into 30’s
4 factors involved in the pathogenesis of acne
follicular hyperkeratinization
increased sebum production
Propionibacterium acnes within the follicle
inflammation
bacteria that causes acne
Propionibacterium acnes
normal bacteria on our skin, but with excess sebum –> plugged up follicle with bacteria –> acne
___________ are what kick off the sebaceous glands -> increased sebum production
androgens (DHEA)
precursor to testosterone
DHEA = what increases sebum production
___________ in the sebum is what bacteria thrives on
triglycerides
PATHOGENESIS OF ACNE
Androgens cause increased sebum production & abnormal follicular desquamation
o seborrhea
o follicular desquamation
- which lead to altered follicular milieu –>
Propionibacterium acnes colonization & proliferation –> inflammation
hormones & p. acnes bacteria present
1) accumulation of dead skin cells filled with keratin & sebum from sebaceous gland
2) bacteria colonizes and eats excess sebum; chemicals released into bloodstream
3) bacteria proliferation / WBCs accumulate
4) marked inflammation & scarring
clinical presentation & skin lesions of acne
CLINICAL PRESENTATION
lesions on the skin - inflammation
pain
SKIN LESIONS INCLUDE
- comedones (open / closed)
- papules & papulopustules
- nodules
open comedone = _____________
closed comedone = __________
open = blackhead closed = whitehead
diagnosis of acne
- clinical
- for female patients who have dysmenorrhea or hirsutism o free / total testosterone o DHEA - S o FSH o LH
diagnosis of acne for female patients who have dysmenorrhea or hirsutism
o free / total testosterone
o DHEA - S
o FSH
o LH
1st line treatment for acne
retinoids
Adapalene (Differin): best tolerated –OTC now
Tretinoin (Retin-A)
Tazarotene (Tazorac)
2nd line treatment for acne
topical antibiotics
clindamycin
erythromycin
treatment for acne
OTC
benzoyl peroxide
salicylic acid
1st line = Topical retinoids: Adapalene (Differin) = best tolerated; Tretinoin (Retin-A), Tazarotene (Tazorac)
2nd line = topical antibiotics: Clindamycin, Erythromycin
- for moderate to severe acne = Doxycycline or Minocycline (Minocin)
For severe acne and/or treatment failure = Isotretinoin (accutane) - must go through IPLEDGE
After individual treatment goals have been met, oral antibiotics can be discontinued and replaced with ________________
topical retinoids for maintenance therapy
retinoids help to ALTER THE PILOSEBACEOUS GLANDS
The use of isotretinoin has been suggested to worsen _________ and increase the risk of ________
depression
suicide
Laboratory monitoring during isotretinoin therapy includes:
CBC
Lipids
LFTs
- increased reactivity of capillaries to heat
Chronic acneiform disorder of facial pilosebaceous units
rosacea
rosacea onset:
predominantly affects
- onset: 30-50 years old
- predominantly affects females
exacerbating rosacea factors
hot liquids spicy foods alcohol exposure to sun & heat exercise
clinical presentation of rosacea
- redness to cheeks, nose and chin
- burning or stinging with episodes
- skin dryness, edema
4 subtypes of rosacea
erythematotelangiectatic rosacea
papulopustular rosacea
phymatous rosacea (large nose)
ocular rosacea
1st line therapy for mild to moderate patient with rosacea
topical antibiotics
rosacea treatment
- minimize precipitating factors
- TOPICAL ANTIBIOTICS = 1st line therapy for mild to moderate patient
use gel or creams
Azelaic acid
Metronidazole - most common
Erythromycin
Clindamycin
Brimonidine = best for facial flushing / persistent redness
Topical Ivermectin cream = for ppl who get rosacea due to being immunologically sensitive to mites
SYSTEMIC ANTIBIOTICS = for mod/severe rosacea
⦁ Tetracycline
⦁ Doxycycline / Minocycline
⦁ Erythromycin
most common treatment for rosacea
metronidazole (cream or gel)
other treatment considerations for rosacea
⦁ laser tx - can be helpful for telangiectasias
⦁ pulsed light therapy for facial erythema
⦁ cleansers
⦁ photodynamic therapy
complications of rosacea
⦁ eye involvement
⦁ gram negative folliculitis
⦁ permanent telangiectasias
⦁ rhinophyma
MOST COMMON PATHOGEN FOR FOLLICULITIS
STAPH AUREUS
“hot tub” folliculitis caused by
pseudomonas
folliculitis symptoms
⦁ looks like red pimples with hair in the center
⦁ may itch or burn
⦁ “hot tub” folliculitis appears about 72hrs after
recurrent folliculitis is associated with nasal carriage of
staph
try mupirocin in nares
Antibiotic therapy, corticosteroid therapy, and immunosuppression may predispose a patient to
candida folliculitis
- “razor bumps”
pseudofolliculitis
- very common in african americans
- occurs when free ends of tightly coiled hairs re-enter skin and cause foreign body inflammatory response
- firm papules with embedded hair
extrafollicular vs intrafollicular penetration
⦁ extrafollicular penetration = curly hair coming out and coming back into the hair = more common
⦁ intrafollicular penetration = hair grows out of a different spot - out of the follicle
1st line treatment for pseudofolliculitis
stop shaving
treatment for pseudofolliculitis
⦁ Most effective and safe is stop shaving (first line)
⦁ Laser hair removal
⦁ Adjunctive medical therapy
- Topical retinoids (Tretinoin)
- Low potency topical corticosteroids (treat only for 3-4 weeks)
- Topical antimicrobials (benzoyl peroxide 5% or clindamycin 1%)
boils or skin abscesses
furuncles
furuncles = boils or skin abscesses caused by _______ infection of hair follicle
STAPH
cluster of furuncles
carbuncles
common areas of furuncles / carbuncles
⦁ buttocks ⦁ axillae ⦁ neck ⦁ face ⦁ waist
furuncle / carbuncle treatment
< 5 cm
- hot compresses to enhance drainage
- fluctuant lesions = I&D (may have to pack wound)
> 5cm = systemic antibiotics of constitutional symptoms or concomitant cellulitis
- Bactrim
- Clinda + Keflex
impetigo most common pathogens
strep or staph
impetigo tx
mupirocin (Bactroban)
IMPETIGO
- red lesions that can break open/ooze –> develop YELLOW-BROWN CRUST = HONEY COLORED
- sores = usually appear around mouth & nose
- can spread to others through close contact or by sharing items like towels and toys
- scratching can also spread it to other parts of the body
MOLES
- well defined borders
- uniform in color
- usually brown or black
- can be anywhere on the body, alone or in groups
- generally appear before age 20
Some moles change slowly over the years: become raised, develop hair, change color, etc.
- Most are non-cancerous, but some moles have a higher risk of becoming cancerous
Biopsy the mole if does not meet ABCDE criteria, or if mole becomes itchy, bleeds or ulcerates
Treatment = remove with shave biopsy or excision
1st line treatment for SLs
cryotherapy
solar lentigo treatment
⦁ cryotherapy = 1st line
⦁ laser treatments
⦁ tretinoin cream or hydroquinone cream (lightens)
⦁ modified Kligman (fluocinolone / hydroquinone / tretinoin)
⦁ bleaching solutions / chemical peels
appearance of SKs
Well-circumscribed gray-brown-to-black plaques with a “stuck-on” appearance
Warty
often scaly
hyperpigmented lesion
SK treatment
- don’t require treatment unless causing discomfort or for cosmetic reasons
⦁ cryotherapy
⦁ curettage & cautery
⦁ laser surgery
⦁ shave biopsy
⦁ send any suspicious looking lesions for pathology
AKs
- Rough, dry, scaly patch or growth that forms on the skin
- Extremely common, occurs in sun exposed areas
- More common in fair-skinned individuals
SYMPTOMS ⦁ Rough feeling patch on skin ⦁ Rough patch that feels painful when rubbed ⦁ Itching or burning ⦁ Lips feel constantly dry
causes of AKs
sun exposure
tanning beds
AK treatment
o nonhypertrophic = LN2
o Hypertrophic = surgical curettage (send these to pathology)
o multiple AKs = Efudex or Imiquimod (aldara)
triggers for melasma
⦁ Sun exposure
⦁ Change in hormones
⦁ Cosmetics
MELASMA
- Tan or brown patches on the cheeks, nose, forehead, and chin.
- Melasma occurs in half of all women during pregnancy.
- Usually called “pregnancy mask,” men can also develop it.
- More often in women and people with darker skin
diagnosis of melasma
- clinical
- biopsy
1st line melasma treatment
hydroquinone
melasma treatment
⦁ Will usually go away on own
⦁ Hydroquinone (first line)
⦁ Tretinoin and corticosteroids (second line)
2nd line melasma treatment
tretinoin & corticosteroids
superficial fungal infection caused by DERMATOPHYTES - most commonly the TRICHOPHYTON TYPE
TINEA
TINEA = superficial fungal infection caused by ___________- most commonly the ________TYPE
DERMATOPHYTES
TRICHOPHYTON
TINEA TYPES
Capitis Corporis Pedis Cruris Versicolor
Gradual appearance of round patches of dry scale, alopecia, or both on scalp
tinea capitis
tinea capitis diagnosis
- clinical
- wet mount - KOH
- woods lamp
tinea capitis treatment
- griseofulvin (kids)
- terbinafine (adults)
- selenium sulfide shampoo
cause of tinea corporis
trichophyton rubrum
tinea corporis
“ringworm”
Dermatophytosis that causes pink-to-red O-shaped patches and plaques.
Crusty ring with central clearing.
tinea corporis treatment
- clotrimazole
- miconazole
- ketoconazole
for extensive or resistant lesions = Oral Itraconazole or Terbinafine
most common dermatophytosis
tinea pedis
4 forms of tinea pedis
Chronic hyperkeratotic = most common
Chronic intertriginous
Acute ulcerative
Vesiculobullous
treatment for tinea pedis
⦁ topical / oral antifungals - Itraconazole (sporanox)
- moisture reduction & drying agents
⦁ miconazole powder
⦁ burrow solution soaks - aluminum acetate - dries it out
risk factors for tinea cruris
⦁ Warm weather
⦁ Wet restrictive clothing
⦁ Obesity
tinea cruris & treatment
Lesions are pruritic ringed lesions that extend from crural fold over adjacent upper thigh
Treatment
⦁ Clotrimazole
⦁ Ketoconazole
Skin infection from Malassezia furfur
Manifest as multiple asymptomatic scaly patches varying in color
tinea versicolor
tinea versicolor is due to the overgrowth of the yeast _______________
Malassezia furfur
risk factors for tinea versicolor
Heat & humidity
Pregnancy
Diabetes
undernutrition
fifth’s disease caused by
parvovirus
“slapped cheek” disease
fifth’s disease rash
Bright red raised rash on the face, then arms, legs and trunk
Flu-like symptoms
Rash usually goes away within 2 weeks, fades from the center outward causing a blotchy or “lacy” look
5ths disease treatment
NSAIDS for symptomatic relief
5ths disease complications
pregnancy: Can cause the baby to develop severe anemia and miscarriage or stillbirth
hand-foot-mouth disease caused by
Coxsackie virus A16
hand-foot-mouth disease
This common, contagious childhood illness starts with a
⦁ Fever
⦁ Painful mouth sores
⦁ Non-pruritic rash with blisters on hands, feet, and sometimes buttocks and legs that follow
It spreads through coughing, sneezing, so wash hands often when dealing with coxsackie.
treatment for hand/foot/mouth
Home treatment includes ibuprofen or acetaminophen (do not give aspirin to children) and fluids. It will typically resolve in 7-10 days
SCARLATINA CAUSED BY
GROUP A STREP (like erysipelas)
strawberry tongue
scarlatina
scarlatina rash
fine, red, and rough-textured appears 12–48 hours after the fever generally starts on the chest, armpits, and behind the ears spares the face Swollen red tongue (strawberry tongue)
if scarletina is left untreated, may develop into
⦁ rheumatic fever
⦁ glomerulonephritis
⦁ meningitis
⦁ pneumonia
treatment for scarletina
1st line = PCN
2nd line = 1st gen cephalosporin
ROSEOLA SYMPTOMS
⦁ respiratory illness, followed by a HIGH FEVER x 3-5 days (which can trigger seizures)
⦁ fever abruptly ends, and is followed by a rash on the trunk which then spreads to extremities
this rash blanches!
cause of roseola
HH6
roseola treatment
supportive
HEAT RASH (MILIARIA)
- occurs as a result of blocked sweat ducts
- looks like small red or pink pimples
TX = benign & does NOT require treatment
often caused when parents dress babies too warmly, but can happen to any infant in very hot weather. A baby should be dressed as lightly as an adult who is resting
miliaria treatment
benign & does NOT require treatment ⦁ Keep skin cool and dry ⦁ Cool down ⦁ Dry off ⦁ Reduce friction ⦁ Treat fever
heat rash more likely to occur in which locations
⦁ Neck ⦁ Groin ⦁ Underneath the breasts ⦁ In creases of elbows ⦁ Armpits
small flap of flesh-colored or slightly darker tissue that hangs off the skin by a connecting stalk
skin tag
