Derm disorders Flashcards
Cellulitis - patho, s/s, things to look for
diffuse infiltration of bacteria
red, warm skin
important to determine if lymphadenopathy or streaking is present
Erysipelas - what is it and treatment
Type of cellulitis on the face
gram + strep
usually occurs on the middle 3rd of the face and drains downwards into regional lymph nodes –> meningitis
need IV antibiotics - linezolid
Carbuncle - description, management
multiple deep seeded furuncles, does not have a central location for I & D
Management - needs OR I&D with washout and IV abx
Paronychia - description, management
abscess of the nail bed, requires I&D + oral abx
Treatment for minor skin infections
bacitracin or mupirocin
Treatment for severe skin infections (systemic s/s)
First-generation cephalosporins (FA/PHA) - cefazolin, cephalexin or beta-lactamase resistant PCNs (pipercillin)
Herpes Zoster (shingles) general information
c/b varicella-zoster virus –> acute vesicular eruptions along a dermatomal pattern
in immunocompromised adults, this can be life-threatening
Herpes Zoster Assessment
painful, grouped vesicular eruption across a dermatomal pattern
typically on the trunk, if it goes beyond midline consider immunocompromised
regional lymphadenopathy may be present
typically presents in steps - discomfort/tingling prodromal syndrome, vesicular eruption
Herpes Zoster labs/diagnostics
typically not indicated
you can consider Tznack smear, viral serology for viral IgM
Appropriate treatment for herpes zoster
oral valacyclovir for 7 days
start within 72hrs of presentation
- can use other -clovir drugs
immunocompromised patients - severe - acyclovir IV 7-14 days
ocular involvement - urgent referral to optho
Lyme disease - general information
spirochetal disease c/b Borrelia burgdorferi
most common vector-born disease in the US
c/b deer ticks - tick becomes infected with the bacteria after feeding on mice and/or birds.
Must attach to person > 24hrs
Lyme disease Assessment
Stage 1 (local) - erythema migrans rash, 50% of patients develop flu-like symptoms (bull’s eye rash)
Stage 2 (systemic) - HA, joint stiffness, migratory pain, complications - cardiac symptoms, aseptic meningitis, Bell’s palsy, and peripheral neuropathy
Stage 3 - joint and periarticular pain, sub-acute encephalopathy, acrodermatitis chornicum atrophicans (bluish/red discoloration of the distal extremity with edema)
Lyme disease lab/diagnostics
ELISA screening - detects B. Burgdorferi antibody
Western blot - for confirmation
can also consider PCR, ESR, LFTs
Lyme disease diagnostic criteria
- exposure to tick habitat within the last 30 days with erythema migrans
- exposure to tick habitat within the last 30 days with one late manifestation and laboratory confirmation
Lyme disease treatment
primary regimen - doxycycline 100mg PO bid 10 days
can also consider amoxicillin or cefuroxime
azithromycin 500mg PO 1x daily for 10 days (if unable to take doxy or beta-lactams)
if they have systemic complications - 30 days
neuro manifestations - PCN or cephalosporin IV
Actinic keratosis general information
small patches occurring on sun-exposed parts of the body
typical in individuals with a fair complexion
considered premalignant and can progress to SCC
AK Assessment
small (typically painless) patches
flesh colored, pink, or slight pigmentation
feel like sandpaper
AK labs and diagnostics
not typically needed, biopsy if unresponsive to treatment
AK treatment
LN
flouracin cream bid two weeks
Masoprocol 10% cream
Seborrheic keratosis general information & assessment
benign plaques, with a stuck-on appearance
3-30mm in diameter
no labs or diagnostic studies
SK treatment
no treatment necessary
can be frozen with LN or surgically removed
cosmetic
BCC general information
slow-growing carcinoma starting as a papule or nodule - central scab or erosion
commonly presents on the face, occurs mostly in fair-skinned individuals in 20-30s
no mets, can lead to deformity
BCC assessment
papule or nodule with central scab or erosion
waxy or pearly appearance can also present shiny red
BCC labs & diagnostics
shave or punch bx
if left untreated it can really cause deformity
