DERM Flashcards
What causes rhinophyma if left untreated?
Rosacea
Patho- chronic inflam, acneiform, of pilosebacceosu units. w/ increased reactivity of caps to heat resulting in flushing and telangectasia. Who?- 30-50yr olds, > F, light skin.
CP- Worse w/ alcohol, stress, hot foods Sym-pattern on cheeks, nose, forehead, paulopustules on cheeks, nose, forehead. comps: rhinophyma- large, thicken nose-M untreated
TX- metronidazole topical 0.75% AVOID EtOH, hot bevs
What is T-cell activated and has rapid cell turnover of 3-4d?
PSORAISIS WHO-2% by 20. M=F, PATH- immune mediated hereditary
CP-graudal mild itch, ‘SALMON PINK” lesions, wax and wan, chronic red scaling papules circular plaques. silvery white Red border thick d/t neutrophils well defined borders sym BiL scalp, pitting nails, Extensor surface of limbs SACRUM-MC oil slicks and pits on nails. Plaque psoriasis MC MC-scalp, elbows, knee, groin, ears Comps- CV, DM, HTN, metabolic, IBD, flu-like sx
TX- Pt education no scrath ITch -topical steroids/antihist Topical corticosteroids- RISK-skin atrophy, abosrbs Saran wrap w/ steroid then emollient Wks-months Sun 15min
What has a “christmas tree” pattern that is viral?
PITYRIASIS ROSEA
Who? 10-35Y, 2%
PATH? viral w or w/o pruritis.
CP-maculopapular, red scaling eruption TRUNK. HERALD patch=larger first lesion. Lesions w/ fine scaling oval shapes macules and papules on erythematous base. ***Christmas Tree.
TX- viral, so self-limiting. pruritis- doxepin 5% cream, or Calamine lotion. 2 MONTHS
If a patient never had chicken pox or vaccinatin, what MAY they get in older age?
VARICELLA
WHO- KIDS, vaccin 12-18mo, 4-5
PATH- varicela zoster virus, !!contagious
CP- dew drop on a rose petal crusty
TX- RARE treatment oatmeal baths antihistamine 24 hr after crusty return to school
DANGER Elderly PT NO HX OF VARICELLA/VAC- HIGH RISK >AGE. MUST HAVE 1ST B4 SHINGLES ALL IF VAC- RISK OF SHINGLES
What do you scrape off with little bit of bleeding/Pt discomfort then treat with cryotherapy?
VERRUCA VULGARIS (warts)
WHO: F. kids, rare > 25 adults have immunity PATH: HPV. Contagious!!!No itchy. No Pain.
CP- raised firm papules/plaques, lesions: 1-10mm, hyperkeratonic, skin colored. **Cauliflower appearance. Reddish brown dots.
TX-topical: 3-6 TX Q3WKS 1. scrape off dead tissue 2. salicylic acid, or liquid nitrogen, 4-duct tape 3. Laser treatment for resistant warts.
What grows on bottom of feet?
Verruca plantaris
WHO- 5-25, F
PATH-soles of feet ONLY
CP- skin flushed
TX-resolve spontaneously. Shave and salicylic acid. Cryotherapy
What is umbilicated not itching firm papules related to poxvirus?
MOLLUSCUM CONTAGIOSUM TANA FAV
WHO: M, KIDS /ADULTS-SEX/
PATHO: Poxvirus, sex
CP: discrete FIRM umbilicated(BELLY BUTTON, pit/depression in middle) pearly-white papules. isolated or generalized. Neck, anogenital region, eyelids. TRUNK and extremities NO itching
TX: Self Limiting. AVOID KIDS BC LESS SCAR liquid nitrogen, electrocautery, curettage SCAR lesions last 2-3 mos
Pt has very painful finger. What is the sign and TX?
HSV 1
WHO young adults
PATH-HSV type 1 or 2 genital. Virus in CV trigenimal nerve ganglia. V1-3Ophthalmic, maxillary, mandibular.
CP: **grouped vesicles on an erythematous base**, malaise, lymphadenopathy, fever.
KIDS: gingivostomatitis MC primary sx.
Lesions do not cross midline.
COMPS: herpetic whitlow: painful infection of finger w/ herpes.
TX- acyclovir topical or oral, supportive treatment. Anelgelsic. Key-treat early before tingling and rash
primary lesions are self-limiting,
What is tingling and itching before onset of lesions?
PRODROME of HSV
CP-prodrome of tingling, itching or burning
24 hr later vesicles in groups
Maybe umbilicated, papules, bleed and crust.
TX- cold sores are self-limiting.
topical acyclovir
oral outbreaks-suppress oral antivirals.
What is difference btwn HSV and HZV?
Herpes zoster virus
WHO? >50.
PATH? Immunosuppression, compromise, stress. Contageous!
VZV CP-VERY PAINFUL!!! prodrome 3-5 days, burning, numb, tingling. Pain w/ eruption, wanes over time. malaise, fever, lymphadenopathy acute, bullous eruption dermatome.
Herpeteform lesions- beefy red base, crusts, w w/out pustules and bleeding. 50% on thorax, 10-20% trigenimal (eye)
TX-Narcotics
Oral acyclovir: high dose asap.
antiviral IV. lesions: 2-3 weeks.
COMPS-50% postherpetic neuralgia,
GABA meds
Urgent referral to opth if eye/ tip of nose HUTCHINGSON SIGN
What has no distinct margins, mergining to macular erythema. Warm, tender. 2nd to impetigo, follulitis? What is treatment?
Cellulitis
PATH-Disruption of cutaneous barrier, venous/lymphatic compromise, h/o, S. aureus/B-hemolytic strep.
Continuum of skin infxns: impetigo, folliculitis, carbuncles, and abscesses.
CP-
- NO distinct margins.
- Confluent macular erythema,
- swelling, warmth, tenderness,
- LAD, systemically–fever, chills, myalgias (more in sick and elderly)
- abscess
- LABS-blood and skin culture Deeper
TX- slow.
- Oral: Cephalexin x10-14d.
- Alt’s: Clindamycin or levofloxacin.
- IV: vanco, OR cefazolin or nafcillin**
What is treated with Vanco in the hospital?
WHO: sports teams, jails, day cares
PATHO- NOT spider bites, know local resist. Poor hygiene. Recurrent
CP: compromised skin integrity
TX=
- Culture a wound DOC=Vacomycin IV, *not oral -c.diff
- Bactrim (+rifampin to dec resistanc)
- clindamycin (+/- rifampin or linezolid)
- tetracyclin (mino, doxy) + rifampin,
- Never use rifampin or linezolid alone-d/t inc. resistance
What leads to crusty vesiculpapular skin infx of face the crust?
WHO: varies PATH: S. aureus, B-hemolytic strep. poststrep glomerulonephritis or rhematic fever
CP-Superficial **vesiculopapular skin infxn on face and extremities–> rupture and “honey crust”.
TX:Topical Mupirocin for small, non-bullous lesions. Oral: Erythro, Dicloxacillin, cephalexin, or clindamycin x 7d
Folliculitis
PATH:Nasal carriage of S. aureus, exposure to whirlpools, hot tubs, abx use-flora, use of steroids, P. aeruginosa hot tub
CP- multiple, red, pruritic, <5mm, cluster NO systemic. Purulent
TX-WARM COMPRESS topical antibiotics no shaving
Furuncles
PATH-Inflam nodule of hair follicle. Follows episode of folliculitis. Caused by Staph
TX- w/ warm compresses; surgical I/D;
systemic sx’s req abx’s: dicloxacillin or cephalexin
How to prevent Recurrent Furunculosis?
Nasal Mupirocin ointment.
Vitamin C.
Low dose clindamycin supressive therapy for patients who really continue to get infections (usually immunocomp pts)
Carbuncles
PATH-Series of abscesses in the subcutaneous tissue that drain via hair follicles.
CP-Swollen lump under skin: White/yellow center, weep, ooze, or crust. May have systemic sx’s
Tx w/ warm compresses to promote drainage; surgical Incision; Drainage;
systemic sx’s req abx’s: dicloxacillin or cephalexin
What is polymicriobial and my have complications?
Abscess
WHO: DM or immunosuppressed, VDU, nasal colony of staph,
PATH: Minor local skin trauma (insect bite, abrasion); IDeeper than carbuncles. May be polymicrobial. MC S. aurues. Localized accumulation of PMN leukocytes with tissue necrosis involving the dermis and subcutaneous tissue. NOT associated with hair follicles. Infxn tracks in from skin to deep skin layers. Localized accumulation of PMN leukocytes w/ tissue necrosis
CP
- Local pain, swelling, erythema, fluctuance, warmth;
- cellultis around the abscess;
- regional adenopathy;
- spont drainage of purulent material;
- UNUSUAL to have systemic sx’s (fever, chills) indicates necrotizing fasciatis.
- LABS-Large numbers of microorg’s present. Celluitis surrouding the abcess is normal.
TX:
- I/D: fluctuance or “pointed”,
- send purulence for C/S testing. I/D at the Point. ID to open even more.
- If theres no point, do NOT I/D, tell patient to put warm compress erryday till point forms.
- Pack after Oral abx: Dixcloxacillin
- -secondary, cephalexin, clindamycin,
- NOT AN INGROWN HAIR.
