Derm II Flashcards
Molluscum Contagoisum is described as ?
How does it transmit?
Common pediatric virus caused by poxvirus, MCV-1 to 4
direct skin to contact (most easily spread in pools), gym equipment, and spread by autoinoculation
-Virus replicates in epithelial cells
Molluscum Contagoisum primarily affects what age demographic?
young children and sexually active adults and immunosuppressed
What are the signs and symptoms of Molluscum Contagoisum?
Where does this condition usually appear?
- non pruritic flesh colored dome shaped papules 3-6mm
- curd like material can be expressed (if you try to pop it )
Distribution: present anywhere, but classically over the face, trunk, and extremities, groin
How do you diagnose Molluscum Contagoisum?
What are the differential diagnosis of Molluscum Contagoisum?
Diagnosis:
- Clinical exam/history
- Punch biopsy
Differential Dx:
- Warts
- Milia
How do you treat Molluscum Contagoisum?
- usually not necessary (resolves after a few months up to a few years)
- avoid autoinoculation or transmission to close contact, therapy may be beneficial
NOT FDA APPROVED TREATMENTS
→ topical cantharadin
→ cryotherapy
(these treatments promotes low amount of irritation to encourage body to produce antibodies)
Veruca Vulgaris (common wart)
→ Most common in ages?
→ Risk factor?
→ Distribution?
→ Size of lesions?
→ ages 5-20
→ risk w/ frequent exposure to water
→ distribution to hands and palm and peringuinal, nail folds
→ Size is pinpoint to > 1cm, papules with a rough grayish surface
Verruca Plana (flat wart)
→ Most common in what population?
→ Size of lesions?
→ Distribution?
→ children and young adults
→ 2-4 mm flat topped flesh colored papules
→ grouped together on face, neck, wrists, hands
Verruca Plantaris (plantar wart) → where does it distribute to?
appear anywhere on the sole(plantar surface), but classically at pressure points on ball of the foot or heal
How do you diagnose and treat Non Genital Verruca (Warts)
Diagnose→ clinical exam, punch biopsy
Treatment→ No treatment at all is an option since 65% of warts regress spontaneously w/n 2 years. However, patients risk warts that may enlarge or spread to other areas. Treatment is recommended for patients with extensive spreading, or symptomatic warts or warts that have been present for more than 2 years
- cryotherapy
- salicycle acid/cantharidin
- occlusive dressing
- intralesional injection of bleomycin (can cause necrosis so be careful)
Tinea Versicolor:
Signs and symptoms?
Treatment?
Signs and symptoms?
- hypo or hyperpigmented round macules (with scaling) that do not tan; located on trunk and arms or face
- Pt is asymptomatic and notices during summer
Treatment?
-Daily Selenium sulfide shampoo for 15 min x 7 days
-Topical ketoconazole cream daily x 3 weeks
-Oral Ketoconazole 200 mg qd x 2 weeks (careful of LFT’s)
→ (Will get rid of scales but not light spots)
Tinea Versicolor:
How to Diagnose it?
What are the diff dx ?
How to Diagnose it?
→ KOH scraping show hyphae and spores (Spaghetti and meatballs)
→ Wood’s light (black light) (orange mustard color)
What are the diff dx ?
-Vitiligo: complete depigmentation (no scale)
Tinea Pedis is common in what population?
Lesions of Tinea Pedis can be described as ?
common in young men
Lesions:
- scale and maceration in toe web spaces
- moccasin type distribution on plantar surface (distinct borders)
Si/sx of Tinea pedis?
Diagnosis of TP?
Treatment of TP?
Si/sx of Tinea pedis?
→ pruritic feet(may hav inflammation and fissures)
Diagnosis of TP?
→ KOH+ or fungal culture
Treatment of TP?
→ Keep feet dry
→ Zeabsorb-AF (miconazole) powder
→ Topical antifungals:
Naftin, ketoconazole, Lotrimine cream BID
→ If severe, Lostrisone creak x 1 wk (steroid+ anti-fungal)
Vitiligo:
si/sx?
dx?
tx?
Vitiligo:
si/sx?
→ can occur to anyone
→ hypo pigmentation macules may occur focally or generalized in pattern
dx?
→ clinical or punch biopsy
→ woods light
tx? → sunscreen (avoid sun exposure) → cosmetic cover up → protonic/elidel (Tacrolimus/Pimcrolimus) -Eximer laser
Varicella (zoster virus) Chicken pox
Epidemology ?
Incubation period?
Epidemology ?
-90% occur in children < 10 yo. However tropical countries it tends to be a disease of teenagers
Incubation period?
-10-21 days
-Individuals are infections for 4 days before and 5 days after appearance of exanthem
→ transmitted via direct contact with lesion or respiratory route
Si/Sx of Varicella (zoster virus) Chicken pox ?
- Rash, malaise, low grade temp,
- Start as faint macules that develop into vesicular eruptions w/ tear drop vesicles on erythematous base (teardrop on a rose petal)
- Starts on scalp, face, trunk, then spreads to extremities. May appear on palms and soles
- vesicles are pruritic and become pustular then crusted (lesion no contagious when crusted)
- can have 2ndary staph infection
- *adults pt’s tend to have ↑ risk of pneumonia
How to diagnose Varicella (zoster virus) Chicken pox?
How to treat Chicken pox?
Diagnosis:
- Clinical
- Tzank smear from vesicle show multinucleate giant cells**
Tx:
Healthy children (<13)
-supportive: oatmeal baths, calamine lotion, antihistamines
-avoid aspirin due to Eye syndrome→ hepatitis and acute encephalopathy
Immunocompetent Adults:
-Oral Acylovir w/n 24 hrs of onset (↓ severity/duration) for 5 days
Immunocompromised: IV acyclovir
IMMUNIZATION: single dose for children 1-12 (over 13 yo should relieve two vacinations 4-8 wks apart. )
Herpes Zoster (shingles) signs and symptoms?
-Prodrome of pain(burning, electrical, throbbing) followed by rash → 55% thoracic → 20% cranial →15 % lumbar → 5% sacral
- Lesions are classically unilateral but may disseminate in immunocompromised pt’s
- Papules and plaques of erythema develop into vesicles may become hemorrhagic or bullous
→ new lesions for 1-5 days (last 2-3 weeks; 6 weeks in elderly pt’s)
→ rarely have pain but no lesions but is possible (4% of pts have shingles reoccur)
What does it mean if you see a “Hutchinson’s sign”
“Hutchinson’s sign”→ lesions on the side and tip of nose during infection of zoster virus
-ophthalmic division of 5th CN must be seen by ophthalmologist due to complicating concerns of tetinal necrosis, glaucoma, optic neuritis
Diff Dx for shingles?
How do you diagnose condition?
- angina pectoris
- plant dermatitis
- impetigo (crusty and scabby)
- biliary or renal colic
- appendicitis
Diagnosis: clinical once lesions appear→ Tzanck smear
How do you prevent and treat shingles?
Tx:
- Antiviral therapy (w/n 3-4 days there will be a resolution of pain and lesions)
- Valacyclovir or famiciclovir x 7 days
- prednisone (for more severe situations)
- Domboro solution (for weepy- advanced version of burrows solution) to relieve itchy and inflammation
- Pain management→ acetaminophen, NSAIDS, Narcotics, lidoderm patch
Prevention:
-Zostervax >60yo
What are some complications of shingles that can occur?
Post herpetic neuralgia
→ if pain continues past one month refer to neurologist for pain management (TCA’s, Neurtontin, Gabapentin)
HSV-1 and HSV-2 are the cause of herpes in what areas?
1: oro-labial herpes
2: genital herpes
> 30% of adults are seropositive for HSV-1
How is HSV-1&2 spread?
How long does the infection last for?
Initial exposure is through direct contact with infected secretions:
- Sexual (oral or genital)
- Auto inoculation: Herpetic Whitlow (picking at it then spreading it to finger→ tenderness and erythema with deep seated blisters)
- Vertical: mother to baby
- Life long infection producing chronic latent infections hide in neurons (HSV1 resides in trigeminal ganglia and HSV2 hides in presacral ganglia )
