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NURS783 Exam 4 > Derm > Flashcards

Derm Flashcards

1
Q

What are defining characteristics of polymorphic eruption of pregnancy (PEP)/pruritic urticarial papule and placques of pregnancy (PUPPP)?

A
  • excoriated papules that starts along abdominal striae
  • spreads to thighs, buttocks, arms, legs
  • spares periumbilical area (halo), face, palms, soles, mucous membranes
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2
Q

What does PEP/PUP typically present?

A

third tri or immediately postpartum

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3
Q

How is PEP/PUPPP treated?

A
  • emollients
  • topical corticosteroids
  • PO antihistamine
  • menthol
  • typically resolves 1-6wks PP*
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4
Q

What are risks associated w/ PEP/PUPPP?

A

none

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5
Q

What are risk factors for PEP/PUPPP?

A
  • atopic constitution (e.g. asthma, allergies, eczema)
  • multiple gestation
  • excessive weight gain
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6
Q

How is PEP/PUPPP dx’ed?

A

no dx testing

R/O PG, cholestasis

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7
Q

What are defining characteristics of prurigo of pregnancy (PP)?

A
  • grouped, crusted, erythematous papules, patches, plaques; often excoriated
  • extensor surface of arms, legs, abdomen
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8
Q

When does PP present?

A

b/w 25-30wks

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9
Q

What are PP differentials?

A
  • pre-existing atopic s/sx
  • scabies
  • insect bites
  • eczema
  • drug-related rash
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10
Q

How is PP managed?

A
  • topical corticosteroid cream
  • PO antihistamine
  • 3-10% urea emollient
  • narrow band UVB tx
  • typically resolves several weeks PP but may last for 12wks*
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11
Q

What are defining characteristics of pruritic folliculitis of pregnancy (PFP)?

A
  • papules, pustules around hair follicles
  • start on abdomen/trunk –> extremities
  • +/- pruritus
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12
Q

When does PFP present?

A

rare

2nd or 3rd tri

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13
Q

What are differentials for PFP?

A

R/O

  • PEP: no urticaria, lesions in striae
  • PG: no bullous lesions
  • acne: no lesions on face
  • drug rxn
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14
Q

How is PFP managed?

A
  • no pruritis = no tx
  • symptomatic: topical steroid or UVB light
  • resolves late in pregnancy or by 2wk PP*
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15
Q

What skin conditions does atopic dermatitis include?

A
  • acne
  • psoriasis
  • eczema
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16
Q

What are defining characteristics of atopic dermatitis?

A
  • lesions on UE/LE on flexor surfaces, trunk, hands, feet, nipples
  • more widespread than in PP
  • no primary lesions
  • secondarily: erythema, scaling, lichenification, papules
  • excoriation: oozing, weeping, secondary bacterial infection
17
Q

When does atopic dermatitis present?

A

early in pregnancy - typically becomes worse during pregnancy in pts w/ pre-existing condition

18
Q

What are risk factors for actopic dermatitis?

A
  • hx of atopy
  • family hx of atopy
  • children w/ infantile atopic dermatitis
  • African-American
  • Asian
  • smoking
19
Q

How is atopic dermatitis managed?

A
  • emollients
  • PO antihistamines
  • UV light
  • mild topical steroids; PO steroids use sparingly, esp in 1st tri
20
Q

What are defining characteristics of pemphigoid gestationis (PG)?

A
  • severe pruritus
  • urticarial, erythematous papules in periumbilical region and extremities
  • not on face, palms, soles, mucous membranes
  • papules change to placques –> form tense blisters (“bullous lesions”)
  • blisters erupt –> yellow or hemorrhagic crust forms
21
Q

What is the pathophysiology of PG?

A

autoimmune

IgG attacks transmembrane glycoprotein
begins in placenta; impacts skin

22
Q

How is PG dx’ed?

A
  • biopsy
  • direct immunofluorescence (DIF) to detect C3 protein deposits –> r/o drug eruptions, contact dermatitis, bullous pemphigoid, erythema multiforme
  • IgG presence
  • ELISA to detect PG Abs
23
Q

When does PG present?

A

rare

2nd and 3rd tri
usually in first pregnancy

*typically recurs in subsequent pregnancies - begins earlier, lasts longer *

24
Q

How is PG managed?

A
  • pre-blistering stage: emollients, high-potency topical steroids, PO steroid (prednisone)
  • blisters: PO prednisone to reduce pruritus and new blister formation; PO 1st gen antihistamine in 1st tri
  • eruptions resolve w/in 4wks PP*
  • urticaria may last up to 14wks PP*
25
Q

How should tx w/ prednisone be managed in PG?

A
  • start at 0.5-1mg/kg/day
  • titrate up
  • taper w/ relief (about 2wks)
  • remain on low dose until just prior to EDD
  • increase dose around EDD d/t increased risk of flares
26
Q

What are risk factors for PG?

A
  • Causasian
  • multiparity
  • PO contraception can cause flares
27
Q

What are risks associated with PG?

A
  • no long-term morbidity or mortality
  • increased risk of LBW
  • prematurity
  • IgG crosses placenta –> 10% newborns born w/ lesions; fade w/in a few weeks
28
Q

What are defining characteristics of intrahepatic cholestasis of pregnancy (ICP)?

A
  • intense, generalized pruritus
  • starts on soles and palms –> spreads to arms, shins, abdomen
  • pruritus worse at night
  • no rash or lesions*

secondary:

  • skin infection
  • jaundice
29
Q

What are risk factors for ICP?

A
  • twin pregnancies

- hx ICP

30
Q

How is ICP dx’ed?

A

dx of exclusion

  • bile acids ~47mcmol/L (normal = 6.6-11)
  • increased ALT
  • vitamin K deficiency and coagulopathy in severe cases
31
Q

How is ICP treated?

A
  • emollient
  • anti-pruretic topical
  • evening primrose oil
  • antihistamine to help w/ sleep
  • off-label ursodeoxycholic acid (Ursodiol) 13-15mg/kg/day single dose or divided 2-3x/day
32
Q

What are risks associated w/ ICP?

A

no long-term complications for gestational carrier

SEVERE complications for fetus d/t build up of toxic bile acids in fetus

  • prematurity
  • fetal distress
  • fetal demise, usually >36wks GA
  • stillbirth
  • sudden fetal death (w/in hrs)
33
Q

How is ICP managed?

A
  • NSTs at 34-35wks
  • uterine artery doppler studies
  • BPP
  • deliver at 37-39wks
34
Q

What txs should be avoided in acne management?

A
  • isotreninoin
  • tazarotene
  • sprinolactone
35
Q

What txs can be used to manage acne?

A
  • discuss w/ provider*
  • topical abx (e.g. clindamycin)
  • PO abx (e.g. cefadroxil for severe acne)
  • azelaic acid
  • benzoyl peroxide (small amounts)
  • laser therapy
  • salicyclic acid (limited)
36
Q

How should fungal infections be treated?

A
  • topical imidazole (miconazole) for 7 days

- NO! PO -azole –> birth defects, miscarriage

NURS783 Exam 4 (11 decks)

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