Derm Flashcards
the itch that rashes
atopic dermatitis
presentation of atopic dermaitis
xerosis (dry skin)
papular or papulovesicular pruritic lesions
excoriations
common locations for atopic dermatitis
kids: face and extensor surfaces
adults: flexor surfaces
nasal and diaper areas usually spared
triggers for atopic dermatitis
frequent bathing
hot weather
sweating
contact irritant
food
environmental allergens
management of atopic dermatitis
id and limit triggers
moisturize w/in min of bathing or swimming
topical corticosteroids
- mild: 1% hydrocortisone ointment
- mod: 0.1% triamcinolone ointment
- severe: clobetasol ointment
oral anthistamines for pruritus
oral abx for 2nd infections
irritant contact dermatitis presentation
skin lesions occur rapidly (min to 24hrs)
sharply demarcated erythema with superficial edema
lesions do not spread beyond site of exposure
management of irritant contact dermatitis
Id and avoid irritants
antihistamine creams for pruritus relief
allergic contact dermatitis pathophys
delayed cell mediated
type IV hypersensitivity rxn
presentation of allergic contact dermaitits
12-72hrs after exposures
well demarcated erythema
edema with vesicles and/or papules
lesions initially confined but later spread
poison ivy /poison oak present with
linear lesions that then involve into papules
management of allergic dermatitis
id and avoid irritants
cool compresses
antihistamine creams (calamine lotion or hydrocortisone)
corticosteroids for severe cases (21 day course)
psoriasis background
T cell driven dz
keratinocyte cell kinetic alteration that leads to overproduction of epidermal cells
triggers for psoriasis
stress
alcohol
steroid withdrawal
physical trauma
infection (strepto)
presentation of psoriasis
salmon colored, well demarcated erythematous plaques w/ scales
koebner phenomenon (physical trauma causes new lesions to form)
symptoms worse in winter
strepto precipitates onset of disseminated patches
polyarthritis
ausptiz sign
removal of scale causes bleeding
seen in psoriasis
management of psoriasis
petroleum jelly
topical steroids
- long term use can cause skin atrophy
- dont use systemic steroids for risk of pustular psoriasis
seborrheic dermatitis
scaling in regions where sebaceous glands are active
associated with malassezia furfur
greasy scaling macules and papules
MC - face and scalp
may be severe in HIV pts
management of seborrheic dermatitis
antidandruff shampoo (contains zinc pyrithione, selenium sulfide 2.5%, salicylic acid or tar
ketoconazole shampoo for scalp
hydrocortisone 2.5% or desonide 0.05% for face
decubitus ulcer stages
1) affects superficial layer of skin, skin is intact and nonblanchable erythema is present
2) partial thickness skin loss involving epidermis and/or dermis, serum filled blister
3) full thickness skin loss w/ tissue necrosis, malodorous crateriform ulceration
4) full thickness tissue loss w. exposed tendon, muscle, bone, visible bones and eschar w/in ulcer
management of decubitis ulcers
stage I and II
- clean and dry
- topical abx
stage III and IV
- oral abx
- sx intervention
prevention of decubitus ulcers
- change positions Q2hrs
- use pillows or foam pads to relieve pressure
- clean and dry
complications of decubitus ulcers
cellulitis
osteomyelitis
sepsis
nec fas
endocarditis
meningitis
septic arthritis
venous stasis presentations
bilateral “cellulitis”
dependent edema
orange brown hyperpigmentation
erythema
weeping eruptions (chronic) honey colored crustings (suggest 2nd bacterial infection)
MC - medial or lateral malleolus and medial aspect of calf
management of venous stasis
obtain pulses
leg elevation
compression stockings
oral antihistamines for pruritus relief
diabetic foot ulcers presentation
peripheral neuropathy
deformity + trauma
MC - plantar surface of foot underlying 1st and 5th metatarsal
- great toe, heel
ulcer is punched out surrounded by rim of callous
management of diabetic foot ulcer
redistributing pressure off wound
therapeutic footwear
daily dressings for moisture
abx for 2nd inf (vanc, pip/tazo, or cefepime)
consult vasc/pod
complications of diabetic foot ulcer
cellulitis
osteomyelitis
sepsis
nec fas
systemic abx for an abscess
bactrim
clindamycin
doxycycline
cellulitis background
lymphedema is MC risk factor
severe in diabetics and immunocompromised pts
usually bacterial inculation through break in skin
presentation of cellulitis
typically unilateral
erythematous, hot
tender area of skin
skin is NOT raised
systemic symptoms
dx of cellulitis
PE
wound culture
^WBC and ESR
cobblestoning on US
management of cellulitis
oral or IV abx
(cephalexin +/- bactrim if MRSA suspected)
elevation
pain control
erysipelas
superifical cutaneous cellulitis with dermal lymphatic vessel involvement
MC etiology = Group A streptococcus
MRSA prevalence increasing
presentation of erysipelas
Face and legs MC
erythematous, hot
tender, edematous
sharp demarcation of borders
skin raised
systemic symptoms
management of erysipelas
oral or IV abx
cephalexin +/- bactrim if MRSA suspected
impetigo
mcc B hemolytic strepto also caused by staph aureus
skin to skin contact transmission (highly contagious)
commonly at the site of cutaneous trauma
presentation of impetigo
erythematous macules that develop thin walled vesicles
honey colored cruts appear when vesicles rupture
mc site is between philtrum
management of impetigo
mupirocin 2% ointment
nec fasc background
caused by gas producing organisms
I: polymicrobial predilection for perineum (gram (-) e coli, gram (+), anaerobes, clos, bact fragi)
II: group A strep
III: vibrio vulnificus
IV: fungals (immunocompromised)
risk factors for nec fas
advanced age diabetes IVDA / alcoholism PVD HIV immunocompromised
presentation of nec fas
cutaneous erythema
edema, crepitus
hemorrhagic blisters
black eschar
malodorous serosanguineous discharge
tenderness beyond erythema (on passive ROM)
systemic sxs
