Derm 2 Flashcards
1
Q
Acute Skin Wounds: Referral
A
- Foreign matter post irrigation
- Chronic wounds
- Animal/human bites
- Infected
- Face, mm’s (mucous membrane), genitalia
- Deep (closure needed)
- Tetanus status(?)
Don’t suture in wild, close in bacteria
2
Q
What would you treat these wounds with and why?
- H2O2, 3% - efferescent cleansing action, strong bactericidal effect
- Neosporin ointment (Triple antibotic) – prevent wound infections
- Iodine treated lake/creek water-irrigation removal of debris, antisepsis
- Betadine solution-safe i.e., not absorbed systemically.
A
- H202: weakly bactericidal, releases oxygen to have weak bactericidal effect, bubble and get gunk out
- Neosporin: prevent infection, won’t treat infection, barrier (can use Vaseline), don’t like because resistance issues, out in the woods might be good
- Irrigating to get the big chunk out. 1 tab per liter for clean water. 2 tab per liter of dirty water. Iodine very effective at cleaning water. Iodine not cause probably
- Betadine: bactericidal, well tolerated, probably won’t be carrying when hiking
3
Q
Ferral Cat Wound
A
- Pasteurella multocida
- The hot water most important part, but not Epsom salt
- Refer for antibiotics
- Cats have dirty mouths
- P. multocida sensitive to augmentin
- Little cut can streak up arm because of tendon sheath, infection all up arm, infection on hands really risky
- Cut on leg not as risky, no “highway” tendon sheath
4
Q
Acute Skin Wounds: Treatment
A
- Cleanse with irrigation (saline)
- saline better than water because less irritating
- Antiseptics
- hydrogen peroxide
- enzymatic release of oxygen, effervscent cleansing action, short acting (O2 release), not in abcess, limited cidal effect, risk of tissue toxicity – little benefit over soapy water
- ETOH
- Good cidal activity in 20-70% range; tissue irritation; flammable;
- isopropyl alcohol
- 70% stronger cidal; cytotoxic effects; drying; flammable
- iodine
- broad spectrum; oxidizes microbial protoplasm; Water base preferable to alcohol base – less irritating; stains, irritates tissue, allergic sensitization (used with chlorhexidine allergy)
- povidone-iodine
- Better than iodine
- AKA: Betadine
- nonirritating; absorbed sysemically;
- hydrogen peroxide
- Antibiotics
- neomycin, Gm+/-
- bacitracin, Gm-
- polymyxin B, Gm-
- tetracycline, DON’T USE
- Use one Gm+ and -, don’t need to double up, so triple antibiotic ointment is bad, can cause sensitization
5
Q
Insect Bites
A
- Mosquito: West Nile, malaria
- Malaria: fever, malaise, swollen spleen, from typical area
- West Nile: same sort of symptoms, horses
- Fleas: annoying, bubonic plague, endemic typhus, itching problem
- Scabies: “the itch”
- Takes physical contact
- Common reaction sites: interdigital spaces, flexor wrists, external male genitalia, buttocks, anterior axillary folds
- Don’t jump across pharmacy counter
- Spiders: black widow, brown recluse, hobo
- Chiggers: (red bugs) brushy areas
- DEET: Sunscreen first, then DEET
- Bees, YJ’s, wasps: Local to allergy/anaphylaxis; infections 3-5 days, cold, prednisone, NSAID, H1RB, top steroids
- Anaphylactic shock: red, swollen, lightheaded, dizziness have already developed antibodies
- Benadryl too slow, only block reaction, but reaction still going. Need epinephrine.
- Remove stinger immediately (if wait, already empty) get off with credit card
- They have dirty mouths too, infection
- Slower, 3-5 days, redness, swelling
- Anaphylactic shock: red, swollen, lightheaded, dizziness have already developed antibodies
- How deal with local inflammatory reaction
- 1 dose prednisone
- Topical steroid
- NSAID
- H1RB
- Cold compress
6
Q
Inset Bites: Treatment
A
- LAs: Pramoxine less cross sensitivity; temporary blockade of transmission of nerve impulses
- Phenol conc >2% irritating, avoid in Pg, children depresses sensory receptors
- Topical antihistamines: use systemic
- Camphor, menthol: Depresses cutaneous receptors; camphor – dangerous if ingested.
- Hydrocortisone:
- Spider Bites: big red blob, necrosis in the middle, normally don’t see spider that bit you
- Local anesthetics: only last short time, sensitizer
-
Counterirritants:
- **Sarna **lotion, camphor, menthol
-
Systemic antihistamine, need to be sedating
- cetirazine might be okay
7
Q
Ticks
A
- RM spotted fever
- HA, fever, fatigue, palmar rash
- Remove intact
- tweezers at base
- Not w/ mineral oil, vaseline – induces salivation
- Lyme’s
- skin rash, flu
- Untreated: neurological, HA, stiff neck, cardiac, rhem BAD
- If treat quickly, okay
- treatment effective, chronic if not treated
- Target rash 2-3 weeks after bite
- See picture
8
Q
Pediculosis
A
- AKA: Lice (head, body, pubic)
- Kids share hats, have sleepovers, put heads together, lay together
- Nurses tend to go overkill and see it as the “black-mark”
- Don’t keep kids out of school
- Leads to overtreatment, leads to expense, resistance, toxicity
- Only treat Sam, not the other kids
- Seizure not caused by pyrethrins
- Seizure caused by Quell, Lindane, neurotoxic to humans, keep away from children, tendency to overtreat
- BE CAREFULL with refills
- Side note: Febrile fits, fever, treat kid for fever because more serious
- Mayo and dippity-doo to get the nits (“empty treehouses”) off hair shaft. Don’t comb obsessively
- # 4: Permethrin is a cream rinse, not a shampoo
- Shampoo doesn’t stay on hair, let sit on hair for 10 minutes with cap.
- Pass on instructions to patients
9
Q
Pediculosis: Treatment
A
- Physical (comb)
- Pediculicides
- Pyrethrins
- Shampoo
- Permethrin
- Nix
- cream rinse
- Lindane
- Malathion
- Spinosad
- Benzoyl alcohol
- Ivermectin
- Last chance drug
- Pyrethrins
- Tea tree oil
- mayo, Dippity-Do, Vaseline
10
Q
Fungal Skin Infections:
- Tinea pedis
- Tinea corporis
- Tinea cruris
- Tinea capitus
A
- Common
- Yeast fungal infections, under breast, vagina, mouth
- Dermatophite causes majority of infection
- Named by where it occurs
- Pedis: Athletes foot
- Corporis: Ringworm
- Cruris: Jock’s Itch
- Capitus: Head
11
Q
What is this?
A
- Tinea corporis
- Vesicular on borders and clearing in middle
- Hydrocortisone making fungi worse
- Tinea incognito, when doesn’t look like “typical” ringworm
- Steroids putting a mask on it
12
Q
Fungal Skin Infections: Treatments
A
- Antifungals
- Treat it long enough
- Apply sparingly
- Generous area
- Put it on until done, and then a couple days longer
- Clotrimazole
- Turbinafine
- Butenafine
- Miconazole
- Not as good against microsporin
- Microsporin found in kids and hair
- If kids and hair, think about using something different
- Tolnaftate
- Dermatophites ONLY
- Undecylenic acid
- Dermatophites ONLY
- Very weak
- Only good use as prophylactic in boots
13
Q
Tinea unguium
onychomycosis
A
- Get after dose of athlete’s foot first
- Get between toes 4 and 5 first
- Big toes always get infected at nail base
- 6-12 months to treat
-
Cannot treat nails topically
- Lousy cure rates topically
- Potential liver toxicity with systemic
- Try to not get it in first place
- Diabetes with fissures with athletes foot, entrance for bacteria
- Not feel toes
- Diabetic, careful to treat feet
- Only if can’t feel feet, normal feet treat like everybody else
- Soak in hot water, burn foot example
14
Q
Tinea Capitis
A
- Patch of hairloss
- Patch, circumferential, spreading out, broken hair shafts
- Cannot treat OTC
- Cannot self treat because on head
- Use turbenafine oral, flucanzol oral, grinesefol oral
15
Q
Don’t treat hair and nails with topical products!
A
Only treat systemically
16
Q
What is this?
A
- ID reaction
- Looks like eczema of hands
- New cosmetics, handling soaps, ask those questions
- Rashes anywhere else, no
- Athletes foot between 4-5
- Treat it and hand rash go away
- Id reaction means reacting to herself
20
Q
Diagnose
A
- Really bad, probably 3 or 4, needs to go to doctor
- Antibiotics
21
Q
(Acne) Rosacea
Adult Acne
A
- Disorder of blood vessels
- Vascular, not sebaceous
- No endocrine relationships
- Differs from acne
- Sensitive to touch
- reddening of the face
- enlarged blood vessels (telangiectasias)
- solid papules
- central face
- no comedones
- Worsened by alcohol, spicy foods, steroids
- Treatment:
- Oral antibiotics
- Topical metronidazole, clindamycin (gels), mosturizing gels
22
Q
Diagnose and Treat
A
- Planter Warts
- Corn and calluses tell you that shoes don’t fit
- Corn and calluses don’t lie
- Retain footprint
- Corn on top of foot and calluses on the bottom
- He has way too many warts for salicylic acid
- Apply patch directly to wart, eats away at wart until crater left
- Can’t put on whole heel because will form a red ulcerated square on foot
- Volatile, painted on salicylic acid
- 4 drops on wart each night
- Take a long time and the guy is already limping
- Can freeze at home, but can only treat a little wart, this guy would need like 40 bottles
- Referal needed because of extense/quantity
26
Q
What is this?
A
-
Androgenetic Alopecia
- male pattern baldness
-
finesteride
- inhibits the 5-alpha-reductase type 2, inhibits conversion of testosterone to DHT
-
minoxidal
- 5% vs 2%; Foam – no propylene glycol irritant
- have to do continious
- take months to work
27
Q
What is this?
A
- Alopecia areata
- treated with injectable steroids
- smooth, discrete
- explanation point hairs at margins
- nail involvement
- thyroid, rheum, autoimmune
- Rx: intralesional steroids
28
Q
What is this?
A
- Telogen effluvium
- diffuse, nonscarring, noninflammatory hair loss post trauma
- Regrows, reassure patient
- diffuse hair loss (all over), no spots, no broken hairs, usually emotional or medical problems
