Derm Flashcards
Ddx of rash on palms? 4-5 things
EM minor vs EM major
Major involves mucous membranes
Description of EM rash
Erythematous papuls, often become target lesion , on palms and dorsal surface forearms (but also anywhere)
EM triggers
Most commonly HSV, but can be any virus, bacterial infection, fungal infection or meds
TX of EM
Topical steroids and oral prednisone (short course) for EM major (aka mucous membrane involvement)
What the 5 “dangerous rashes”
Painful and tender symmetric erythematous rash, think… (2 things)
SJS/TEN
SSSS
SJS vs TEN
SJS= <10% tbsa
tEN = > 30% t sa
10-30= SJS/ten overlap syndrome
Rash description SJS/TEN
Tender symmetric erythema, can be bullae, can be target lesions. Will have + Nikolsky sign and involvement of two or more mucous membranes
most common age for SSSS?
<6, very uncommon in adults
description of rash for SSSS?
very similar to TEN (however mucous membranes not involved), will have + Nikolsky, tender erythema and will have “sand-paper” like feel
mgmt of SSSS
admit, +/- ICU if severe. need abx that cover MRSA and correction of fluids/electrolytes
when do exanthematous (aka morbiliform) drug eruptions occur?
how to manage them?
1-2 weeks after starting, type 4 immune reaction (instead of anaphylactic type reactions which is within minutes to hours)
mgmt = cetrizine, topical steroids and stopping offending agent
triggers of urticaria?
meds, infection, food allergies, emotional stress, cold/heat, exercise
mgmt of urticaria?
-if any concern for anaphylaxis –> epi
-otherwise H1 blocker (eg cetirizine) and avoid trigger if ID’d
what is DRESS
drug eruption with eosinophilic and systemic symptoms
morbiliform drug eruption that becomes confluent and is associated with fever, malaise and multiorgan involvement.
happens 2-8 weeks after exposure.
what is exfoliative dermatitis aka erythroderma?
can be life threatening (mortality up to 30%) , diffuse epidermal cell turnover
causes: exacerbation of existing dermatitis, psoriasis, or drug reaction.
it is leathery, tight, scaly skin invoving >90 tbsa and is very itchy.
exfoliative dermatitis aka erythroderma mgmt?
emergent derm consult, admission, topical steroids and correct andy temperature or electrolyte abns
What does erysipelas look like
Signs and symptoms of nec fasciitis
Pain out of proportion
Rapidly progressive erythema (derm exam can be normal initially)
Bullae or crepitus
Systemic toxicity
Mgmt of nec fasc
Broad spectrum
Resuscitation
Emergent surgical consult
when is oral treatment indicated for VZV?
if pt presents within 72 hours of symptom onset or if new lesions still appearing
3 types of lice that infest humans?
head, body and pubic
how is lice diagnosed? and treated?
visualization of lice (size of sesame seed) or their eggs.
tx= permethrin shampoo, cream or rinse
how long can lice live on inanimate objects?
2 days
how long can scabies live no inanimate objects?
2-3 days
pathognomonic skin finding with scabies?
burrows, waxy, up to 1 cm long, gray white and threadlike, not always present though
2 treatment options for scabies?
permethrin cream or ivermectin oral
Causes of erythema nodosum
What is erythema nodosum, what does it look like, how is is treated
-Delayed hypersensitivity rxn to a trigger
-Tender erythematous subq nodules (usually on legs)
- mgmt is treatment of underlying cause and symptomatic mgmt (resolves in 6 wks to 6 months)
3 disease (all serious) with + nikolsky sign
Staph scale red skin syndrome
SJS/TEN
Pemphigus vulgaris
Pemphigus vulgaris vs bullous pemphigoid
Pt ages, lesions, nikolsky sign and mgmt
