derm Flashcards
Satellite lesions present in diaper dermatitis are associated with
Candida The term is commonly used to describe a portion of the rash of cutaneous candidiasis in which a beefy red plaque may be found surrounded by numerous, smaller red macules located adjacent to the body of the main lesions.
what is the most common type of diaper dermatitis
yeast
What type of diaper dermatitis consists of pustules?
strep/staph think MRSA
If child has thrush in mouth, check the _______
diaper area
Mild redness to erosion of the outermost layer of the skin and rarely involving skin folds is called
Irritant diaper dermatitis
Allergic dermatitis is described as
well demarcated, superficial areas of vesicles erythema and erosion
If vesicles are present on diaper dermatitis think
allergic dermatitis
If pustules, erythema, blisters are present in diaper dermatitis, think….
staph strep diaper dermatitis
zones of erythema with sattelite lesions, the zones of irritated skin are confluent and noted in skin folds, the diagnosis that should be considered is
diaper dermatitis; BEEFRY RED WITH SATTELITES IN SKIN FOLDS
RX for staph/strep dermatitis
bactrim cephalosporin, augmentin
RX for candida diaper derm
anti fungal cream/cortisone cream
Atopic dermatitis is described as
scaley, vesicles, erythema and peeling
What does Atopic dermatitis stem from?
immune system disorder: IgE mediated type 1 reactions
cell mediated type 4 reactions
Th1 subtype of T cells
What are triggers of atopic dermatitis
food allergies-milk, nuts eggs
environmental allergies: dust dancer pollen
stres
What is the major criteria for atopic dermatitis
pruritis
typical distribution and morphology-
1. extensor surfaces during infancy and early childhood, 2.flexor lichenfication and linearity by adolescence
3.recurrent or chromic dermatitis
What is the minor criteria for dermatitis
- child or hx of atopy (allergy)
2.+ skin test reactivity
3.white dermographism or delayed blach to cholinergic agents - anterior subcapsular cataracts
Dermographism is an exaggerated wealing tendency when the skin is stroked. It is the commonest form of physical urticaria. It is also called dermatographism, dermatographia and dermatographic urticaria.
When a patient has atopic dermatitis don’t forget to check for
CATARACTS
What are associated conditions with atopic dermatitis
hyperlinear palms, xerosis, ichtyosis pityriasis alba keratosis ilaris facial pallor, infraorbital darkening dennie-morgan fold elevated serum igE karatoconus no specific dermatitis of the hands recurrent skin infections
What are the lab tests for atopic derm
1immune testing w recurrent infections
2cultures of lesions of staph or strep is suspected
3allergy testing
4skin biopsy to confirm diagnosis
management of AD
1emollient creams and ointments 2limit baths 3 mild soaps/detergents 4topical coeticosteroids 5 protopic/elidil 6 abx for super-infections 7 minumize exposure to allergens
pilar keratosis
Keratosis pilaris is a common skin condition, which appears as tiny bumps on the skin. Some people say these bumps look like goosebumps or the skin of a plucked chicken. Others mistake the bumps for small pimples
what is causative agent for impetigo
usually staph aureus; some strep
what does impetigo present as?
- yellow honey crusted lesions with pink glistening base when crust is removed
- bullous-clear fluid denuded (stripped) skin with thin brown crust
- most commonly found on face
What is impetigo most commonly mistake for?
HSV
A patient presents with honey crusted lesions and pink glistening base on face after crusting is removed, and bullous denuded skin with think brown crust can be diagnosed as
impetigo
what is management of impetigo
management -bactroban -clindamycin preMRSA agents; -Emycin -keflex -augmentin
molluscum contagiosum is a ____ virus
pox
80% of cases of Molluscum Contagiosum is found in children under
8 years old
fomites
objects or materials that are likely to carry infection, such as clothes, utensils, and furniture.
how is molluscum cantagiosum spread
skin to skin contact fomites heated public pools and baths increased incidence with concomitant HIV atopy immunosuppresion therapy
clinical presentation of MC
discrete and dome shaped <5 mm
waxy papules (pink white and skin colored)
umbilicated
distribution on axilla trunk lower abd, thighs and face
a 5 year old child presents with dome shaped papules
and umbilicated appearance on axilla trunk and face. what can be the diagnosis?
MC
umbilicated
A pit or navellike depression. Formation of a depression at the apex of a papule, vesicle, or pustule.
when a dimple is seen on small <5mm papule on thigh andomen axilla or face think…
MC
management for MC
watch and wait-can take 5 years trenotin duct tape cryotherapy tagamet podophyllin dye laser
how is tinea Corporus Spread
Dermatophyte infection that is spread through: skin to skin contact (Pet for person) fomite rarely through soil auto innoculation from feet or scalp
clinical presentation of tinea corporus
scaley sharply marginated plaques
with or without pustules at the margin
peripheral enlargement with central clearing
what is the management of tinea coporus
topical antifungals
a patient presents with scaley sharp marginated plaques with pustules at margins. has peripheral enlargement with central clearing. diagnosis can be
tinea corporis
central clearing of marginated red plaques
tinea corporis or tinea capitis
tinea capitis is a _____ infection
fungal
An African American child has recurrent tinea capitis and has just developed a new area of alopecia after successful treatment several months prior. When prescribing treatment with griseofulvin and selenium shampoo, what else will the primary care pediatric nurse practitioner do
Perform fungal cultures on family members and pets.
A child is diagnosed with tinea versicolor. What is the correct management of this disorder?
Application of selenium sulfide 2.5% lotion twice weekly for 2 to 4 weeks
patients presents with small erythematous papule around a hair shaft on the scalp eyebrows or lashes. a few days later red papules become paler and scaley and surrounding hair becomes brittle and breaks off
lesion spreads forming numerous papules that are pruritic in a typical ring form that coalesce. Inflammation was mild but becomes severe.Then some pustules develop. Some alopecia is present what is the diagnosis?
Tinea capitis
tinea capitis presents as?
starts out as erythemous papule around hair shaft-eyebrows lashes or scalp may or may not have alopecia later it it becomes scaly and hair becomes brittle and breaks off forms numerous papules can be itchy but not always typical ring may coalesce alopecia is common inflammation may be mild or severe pustules (kerions) may develop
Kerions are associated with
tinea capitus
Tinea capitis can be mistaken for
Lymes disease because of ring.
presentation of ringwork
The classic presentation of tinea infection, known as “ringworm,” is a lesion with central clearing surrounded by an advancing, red, scaly, elevated border. One or more lesions may appear. Inflammation assists in colonization and may result in vesicles on the border of the affected area. Atopic (denoting a form of allergy) persons and those infected with zoophilic fungi tend to have more inflammation.
Tinea definition
Dermatophyte infections are classified according to the affected body site, such as tinea capitis (scalp), tinea bar-bae (beard area), tinea corporis (skin other than bearded area, scalp, groin, hands or feet), tinea cruris (groin, perineum and perineal areas), tinea pedis (feet), tinea manuum (hands)
Tinea capitis-description
lesions begin as red papules with progession to grayish ring-formed patches containing perifollicular papules
pustules with inflammed crusts, exudate, matted infected hairs, and debris may be seen
small black dot refers to an infection with fracture of the hair, leaving the infected dark subs visible in the follicular orifices
kerion celsi may progress to a patchy or diffuse distribution and to severe hair loss with scarring alopecia
management of Tinea Capitis
grisofulvin provided the first effective oral therapy for tinea capitus
tpical treatment alone is not effective and not recommended
ketoconazole, intrconazole
terninafine and fluconazole have been reported as effective therapeutic agents
intraconazole and terninafine are used commonly
selenium sulfide shampoo-selsum blue can reduce risk of spreading bu reducint number of viable spored that are shed
Pityriasis: most common presentation
herald patch- oval or round with central, wrinkled, salmon colored area. 1-2 cm in diameter, xmas tree, on trunk usually but can also be on neck and extremities
A secondary eruption in about 10 days: symmetric and localized, predominatly on trunk and adjacent areas of neck and extremities
involvement is maximal over the abdomen and surface of the thorax
The secondary lesions appear as the primary match in miniatrure. They are distrinuted in a christmas tree pattern with their long axis
Pityriasis can be mistaken for:
Tinea corporus
how does Pityriasis present
Usually starts on trunk: pruritis usually acute exanthem occurs in clusters spreads inwards or outwards no defined causative agent patients with acne, seborrhea, dandruff atopy are more likely to develop pityriasis
Podromal symptoms of pityriasis?
malaise, nausea, anorexia, fever joint pain, lymph node swelling, headache that may precede the appearance of the herald patch
- pruritis which may be intense is present in 73% of cases
- ask patient if this is the first episode
management of pityriasis?
claritin, benadryl, sun helps
physical presentation of pityriasis from power point
In atypical pityriasis rosea (20% of patients), the herald patch may be missing or confluent with other lesions.
The distribution of the rash may be peripheral, and facial involvement may be seen in children. Involvement of the axilla and groin (inverse variant) can also be seen.
The lesions of pityriasis rosea may be large (pityriasis rosea gigantea), urticarial (pityriasis rosea urticata), vesicular, pustular, purpuric, and erythema multiforme –like.
Hypopigmentary and hyperpigmentary skin changes may follow the inflammatory stage. In patients with black skin, hyperpigmentation is more common.
Black children have been shown to have more facial involvement (30%) and scalp involvement (8%) than white children. Approximately one third of black children have papular lesions, and 48% have residual hyperpigmentation.2
Oral lesions of various types have been reported with pityriasis rosea, including erythematous plaques, hemorrhagic puncta, and ulcers.
Varicella-how spread?
droplet and or fluid from vesicles
how much before and after rash develops is Varicella communicable?
1-2 daysbefore and 5 days til after the rash or until all lesions have crusted over
what is the incubation period for Varicella
10-21 days
what is podrome of varicella?
no podrome or can have mild malaise/low grade fever
describe chicken pox rash
macular rash that becomes papular, vesicular and itchy
Crops of vesicules that become pustular and crust over
fever is common
what are the complications of varicella
pneumonia
reyes syndrome (encelopathy, fatty liver egen
thrombocytopenia
hepatitis
neuro:encephalitis, seizures, meningitis, myelitis, cerebellar ataxia
management of varicella
fever control
antihistamines
calamine, cetaphil
acyclovir
Scarletina causitive agent is erythrotoxin caused by
strep or staph
describe scarletina rash
fine papular eruption with an erythematous base-sandpaper like found on trunk and upperextremeties
lips palms and soles may be erythematous
how can scarletina be passed?
from breathing on you!
Scarletina presentation:
pastia lines in the antecubes
can be located on trunk and arms
prominent papillaw on a red base-strawberry tongue
desquamation occurs in the recovery phase
treat underlying cause
scarletina can be mistake for:
atopic dermatitis
Scarletina presentation:
pastia lines in the antecubes
can be located on trunk and arms
prominent papilla on a red base-strawberry tongue
desquamation occurs in the recovery phase
treat underlying cause
how is hand foot and mouth disease transmitted
fecal/oral
droplet
contact w fluid from vesicles
what is the usual age to contract hand foot and mouth
generally under 10 years old
how long is incubation for hand foot and mouth
one week
what are the presenting symptoms of hand foot and mouth disease
malaise and sore mouth and throat
Physical presentation of hand foot and mouth disease
Initially, macular lesions appear on the buccal mucosa, tongue, and/or hard palate. These mucosal lesions rapidly progress to vesicles that erode and become surrounded by an erythematous halo.
Skin lesions, which present as tender macules or vesicles on an erythematous base, develop in approximately 75% of patients with HFMD.
A fever may be present for 24-48 hours.
Atypical clinical features
HFMD caused by coxsackievirus strains rarely presents with concomitant aseptic meningitis.1
HFMD caused by EV-71 has a higher incidence of neurologic involvement, including a poliolike syndrome, aseptic meningitis, encephalitis, encephalomyelitis, acute cerebellar ataxia, acute transverse myelitis, Guillain-Barré syndrome, opsomyoclonus syndrome, and benign intracranial hypertension.4
Roseola is caused by
herpesvirus-6
how is roseola tramsitted?
secretions
how does roseola present?
3-4 days hi fever
after hi fever breaks, a pink maculo-papular rash develops
starts on neck and spreads to the trunk and extremeties. no facial onvolvement
rash lasts 1-2 days
a 2 year old patient presents with hi fever two days ago, then had pink maculopapular rash on neck that started to spread to trunk. No rash on face. Diagnosis?
roseola
Disease that spares face and has high fever?
roseola
What disease can roseola can be mistaken for and whats the difference?
mistaken for scarletina but no sandpaper texture
child presents with sandpaper rash on trunks and arms, pastia lines on antecues, and strawberry tongue. whats the possible diagnosis?
scarletina
MRSA prsentation
small pustule that can develop into abcess
hemoch schonlein purpura affects
gi tract, joints, kidbeys, lungs and in some cases the CNS
ages of hemoch schonlein purpura
3-10 years old
what is HSP?
Iga mediated acute systemic vasculitis
etiology of hsp
allergens, foods, horse serum, insect bites, exposure to cold
medications:ampicillin, pcn, emycin quinidine
infections, mycoplasma legionella haemophilis, shigella, salmonella
viruses, EBG, parovirus, varicella, zoster
vaccines: measles, paratyphoid, yellow fever, cholera
symptoms of HSP
podrome followed by rash vomiting/abd pain arthralgia, especially ankles and knees SC edema scrotal edema bloody stools
what can children develop from HSP
intussusception bowel infarction ileus with gi hemorrhage acute appendicitis renal complications may not present for 3 months after the onset and may persist for 6 months; glomerular lesions endocapillary proliferation necrosis hypercellularity leukocyte infiltration
what are the rash features of HSP
erythematous macular or urticarial lesions then blanching papules progressing to palpable purpura
lesions are commonly symmetrical and area especially dominant over the ankles and lower legs in older children
in younger children the lesions are found on the back , buttocks , upper extremities and upper thighs
diagnostics for HSP
no specific laboratory study CBC CMP U/A ABD CT/US Renal biopsy
management of hsp
hydration
monitoring for abdominal and renal complications
symptomatic relief of arthritis, edema, fever
healthy diet
discontinuance of any drugs syspected of playing a causative role
Erythema multiforme-hypersensitivity reaction linked to _____ virus
herpes
EM is most commonly linked to
mycooplasma infection,
medications, sulfonamides, tetracycline, amoxil, ampicillin, NSAIDS, anticonvulsants
symtpoms of EM
prodrome
rash: starts on extremities
target lesions
common lesions associated with EM
a target lesion or bull’s-eye lesion, named for its resemblance to the bull’s-eye of a shooting target, is the typical lesion of erythema multiforme (EM) in which a vesicle is surrounded by an often hemorrhagic maculopapule.
Describe EM major lesions
painful blister at center of target lesions. lesions noted to trunk eyes, inside mouth and genitals
child presents with painful blisters on trunk, genitals and inside mouth with a target lesions. previously had taken amoxycillin. what is the possible diagnosis?
EMM
difference between erythema multiforme minor and erythema multiforme major?
EM major has mucous membrane association. always check mouth when you see a target lesions.
testing for EM
no specific. treatment is geared towards symptomatic relief. corticosteroid use is controversial. antivirals may shorten course of illness
scabies
Scabies is a skin condition caused by an infestation of the human itch mite called Sarcoptes scabiei. These microscopic mites burrow into the skin and cause symptoms of itching and rash.
lice
The common head louse is an insect which attaches itself to the scalp and feeds off of human blood. A louse is tiny and mobile and can be hard to spot, especially in individuals with thick hair. Lice lay eggs on the shafts of hair, and often it is these small white “nits” that are the first indication of an infestationYoung school-aged children and their caregivers are at highest risk for developing head lice. Sharing of hats, hair brushes, and other hair-related items are often integral to spreading the infestation.
Lice spread through direct contact. They cannot jump or fly and therefore depend upon direct or indirect “head to head” contact. Lice can survive for short periods on clothing, hats, and hairbrushes, so these are often involved in the spread of infestationsAlthough itching may be a sign of a lice infestation, most often individuals are asymptomatic. Keep in mind that although the only reliable sign of an infestation is the presence of a live louse or nymph (juvenile louse), the presence of nits may be a sign that there is or has been an active infestation. Some people develop an allergic response to the lice, and it is not uncommon to see evidence of inflammation on the neck or scalpFor individuals who develop an allergic reaction to the lice, there is a risk for developing a bacterial infection due to skin breakdown and over-scratching. In these cases, antibiotics may be required to treat the skin infection. It’s important to call the doctor if there is increased swelling, redness, and pain.
check household membersMost topical lice treatments are available without a prescription; however, since some of the ingredients may not be recommended for small children, always discuss the options with a health-care professional. Generally, the topical shampoos have little effect on the nits, so these should be removed manually using a fine-toothed comb. Often, more than one application is needed to ensure complete eradicationTry to wash all bedding and clothing possibly exposed to head lice. Though lice cannot survive long without feeding, it serves as another level of security that the lice have been eradicated. Though it is unnecessary to clean and bag all stuffed animals, it is probably wise to focus on the “favorite” bedtime companionThere are a number of nonmedical remedies that have been used over the ages to treat lice infestations. Although there is little evidence that these are effective, many pediatricians recognize that there is no harm in trying them out. These include using barrier remedies, such as oil or mayonnaise, and vinegar. The mainstay of treatment remains those permethrin- or pyrethrin-based medical therapies such as Nix or Rid. Always discuss treatment options with a health-care professional.
scabies
Scabies is a skin condition caused by an infestation of the human itch mite called Sarcoptes scabiei. These microscopic mites burrow into the skin and cause symptoms of itching and rash.Anyone can get scabies. It is found all over the world and the mite is transmitted by direct and prolonged skin-to-skin contact with a person who has scabies. Sexual contact is the most common way scabies is transmitted. Transmission can also happen from parents to children, particularly mother-to-infant. The mite can only survive about 48 to 72 hours without human contact, so it is uncommon, though possible, for scabies to spread through infested bedding or furnitureScabies mites can only live about 72 hours without human contact, but once on a person, the mites can live up to two months. Mites survive longer in colder conditions with higher humidity. Once on a person, mites can burrow into the skin, and symptoms usually begin three to six weeks after infestationSymptoms of scabies are usually itching (which tends to be more intense at night), and a pimple-like rash. Scabies rash can appear on any part of the body, but the most common sites are wrists, elbows, armpits, the skin between the fingers and toes and around the nails, and skin usually covered by clothing such as the buttocks, belt line, nipples, and penis. Infants and young children may have scabies rash on their head, face, neck, palms, and soles.
In some patients with weakened immune systems, scabies rash may become crustedScabies causes intense itching, often worst at night. The itching starts as a minor nuisance and progresses to a point where the infested person cannot sleepScabies is usually diagnosed by the patient’s history and a physical examination of the lesions (bumps). Other tests that may be done include:
Skin scraping to identify the mites or eggs
Dermoscopy, which uses a handheld dermoscope to allow closer visual examination of the skin to look for mites
Adhesive tape test in which a doctor uses strong adhesive tape applied to the skin lesions and then pulled off and viewed under a microscope to check for mites
There are no over-the-counter approved treatments for scabies. A doctor must prescribe treatment. A first-line treatment for scabies may involve a topical cream, such as permethrin (Elimite), which is applied directly to the skin, from the neck to the soles of the feet. It should be left on overnight and then washed off 8 to 14 hours later. Usually a second application after 1 to 2 weeks is recommended.
Other topical scabies treatments include crotamiton (Crotan, Eurax) cream or lotion, lindane (not usually used as a first-line treatment due to risk of seizures), sulfur ointment, and benzyl benzoate (not available in the United States).
In some cases, oral ivermectin may be used, particularly in cases where scabies covers a large part of the body and is crusted. It is also often used in settings such as nursing homes where there may be widespread outbreaks. The Centers for Disease Control (CDC) recommends a dose of 200 mcg/kg as a single dose, repeated in two weeks. The advantages of oral ivermectin are that it is easy to use and it does not cause related skin problems. However, oral ivermectin can cause unwanted side effects so it is not always the first choice treatmentTo get relief from the symptom of itching, some over-the-counter antihistamines such as diphenhydramine (Benadryl) may help control the itch and allow sleepScabies mites do not survive more than 72 hours without human contact. It is usually sufficient to machine wash bed linens and clothing in hot water and dry on high heat, or have the items dry-cleaned. It is not necessary to have furniture or carpets cleaned as the mites will die off on their own in a few days without human contactMake sure everyone who is in contact with the infested person is treated, particularly those who come in frequent, close contact with that person (i.e., sexual partners, people who live with the infested person, small children and infants cared for by an infested parent).
Keep fingernails and toenails well trimmed and clean of any mites or eggs.
Thoroughly vacuum carpets, furniture, and car interiors. Use extra caution vacuuming after someone who has crusted mites, as these are more contagious. Discard the vacuum cleaner bags or clear out the dirt receptacle when done.
Avoid scratching bumps or lesions.
Keep open sores clean.
Remember that once treatment starts it may still take a few days for itching and other symptoms to subside. If it does not go away, see a doctor.
Scabies can often resemble other skin conditions. It may look like small pimples, or mosquito bites. It may also look like eczema or tinea (ringworm, athlete’s foot, and jock itch). It is important to see a doctor to receive the correct diagnosis and treatment.
What are “Norwegian scabies”
another name for crusted scabies, which tends to occur more often in patients with compromised immune systems due to conditions such as HIV/AIDS or cancer, or in the elderly, and in patients with Down syndrome. Patients with crusted scabies have large numbers of scabies mites and are very contagious. It can affect any area of the body but the scalp, hands, and feet are most commonly affected. The scales become warty, with crusts and fissures. Lesions may have an unpleasant odor. Nails may be thick and discolored, and patients may or may not have symptoms of itching.
