DERM III Flashcards
Bullous impetigo is caused by
S. Aureus
Non Bullous impetigo is caused by
Group A beta-hemolytic Strep
How does Non Bullous impetigo present
Common in kids
Warm moist climates
Starts as stratum corneum pustule or vesicle ->ruptures to expose a red, moist base
Progresses to adherent “honey crusted”, weeping lesion!
What is the treatment for non Bullous impetigo
Cool or warm soaks to remove crust
Antibiotics:
-Limited number of lesions:
Topical mupirocin
-If widespread: Systemic antibiotics
Dicloxacillin or Cephalexin
Prevent acute glomerulonephritis!
Post-strep glomerulonephritis (PSGN) may follow impetigo
Dressing to prevent spread
ABX for limited vs widespread non Bullous impetigo
Limited number of lesions:
Topical mupirocin
If widespread: Systemic antibiotics
Dicloxacillin or Cephalexin
Define Bullous Impetigo
Staphylococcal impetigo!
(Non Bullous caused by strep)
Common, any age, MC in infants to adolescents
Bullous - less exudative crusting
- 1 or more vesicles enlarge rapidly to form bullae
- Turn from clear to cloudy
- Center collapses & leaves an inner tube-like rim
Honey colored crust at center, if removed leaves bright red, moist, base that oozes
What is the treatment for Bullous impetigo
Strict hand washing
Warm or cool soaks, to remove crusts
Antibiotics: Topical ointment if limited: -Mupirocin Systemic antibiotics if widespread: -Dicloxacillin, Cephalexin, Erythromycin, Clindamycin
Check local resistance rates
What is the approach to recurrent Impetigo
Patients with recurrent impetigo should be evaluated for carriage of Staphylococcus aureus
Culture and treat with mupirocin if found
Most common agent of cellulitis
Grp A beta-hemolytic strep (GABHS)
Cellulitis is DM pt
Pseudomonas
Read the question, does the infected pt have DM.!!??
Tx with ciprofloxacin
Cellulitis in kids under 2, what is the most common agent
Haemophilus influenzae
- kids under 2
Decreased incidence with immunizations
Tx with cephalosporins
Red streaks with swollen lymph nodes
Think
“Streaking” lymphangitis
Often seen with cellulitis
Treatment for Cellulitis
Cool compresses and extremity elevation
Outpatient
Dicloxacillin, Cephalexin, Clindamycin, TMP-SMX
Inpatient
IV nafcillin
IV vancomycin (if PCN allergic)
Pseudomonas (DM)- Aminoglycosides
H. FLu- (kids under 2) - cephalosporins
A pt presents with slightly raised plaque with a SHARP DEMARCATION, that is red, warm and painful,
Think
Erysipelas
(+lymphadenopathy)
(2/2 Strep pyro)
Tx with Systemic antibiotics orally or IV, depending on pt status
PO: Amoxicillin, Cephalexin, dicloxacillin
IV: Cephazolin, ceftriaxone
Blistering Distal Dactylitis
Superficial infectionx of anterior fat pad of fingertips
Progression: Faint erythema, vesicles to oval 1-3cm bullae, and exfoliation
MC in 2-16 yo
Tx: I&D and Oral ABX (STREP) x 10 days
What is the most common form of Folliculitis
Staph Folliulitis
How do you culture a folliculitis ?
Culture pustules: Scrape off entire pustule w/ 15 blade scalpel & deposit onto cotton swab of transport medium kit
Tx approach to Folliculitis
Removal of occlusion/irritants/etc
Good skin hygiene
Oral Antibiotics, 7-10 days
-Emycin, Clindamycin, Diclox, Cephalexin
Benzoyl peroxide (keratolytic/antibacterial) as adjunct
If persistent or deep
(ex: sycosis barbae)
- Use systemic antibiotics, up to 4-8 wks
If in scalp and long term
-Treat for folliculitis decalvans
What is Sycosis Barbae
Sycosis Barbae—inflammation of entire follicle
Staph impetigo of beard
-Razor spreads infection from follicle to follicle
Treat same as staph impetigo
-Oral antibiotics for at least 2 wks
If severe or antibiotic treatment failure:
- Eval for dermatophyte infx
- Remove hairs for culture
Define Furnuncle
boil/abscess
– walled off collection of pus
– painful, firm or fluctuant mass
Define Carbuncle
multi-headed boil
Frequently assoc’d with Cellulitis
What is the MC cause of Furnuncle/ Carbuncle
Both are painful perifollicular deep infection of hair follicle
MC in friction prone or traumatized areas
-Thighs, buttocks, groin, axillar, waist
Tx for Furnuncle/ carbuncle
Primary management is
Incision & Drainage (I&D)
Moist heat to localize and spontaneously rupture &/or to ease I&D
Systemic antibiotics not necessary after I&D but speed healing and prevent recurrence
-Necessary if associated cellulitis present !
What is the treatment of Furnuncle and carbuncle with asssoc Cellulitits
Systemic ABX
What is the common agent of recurrent furnuculosis
MRSA
Tx:
Mupirocin twice daily for 5-10 days in nares
-Chlorhexidine or dilute bleach baths are alternatives
Abx selection based on culture & sensitivity
- Trimethoprim/sulfamethoxazole DS
- Clindamycin
Why does SSSS effect infants and kids
Decreased renal toxin clearance
Of the staph aureus
Does SSSS effect the mucous membranes?
NO!
What is the Tx for SSSS
Depending on severity
Severe - requires hospitalization and parenteral abx
Mild - oral β-lactamase-resistant antibiotic (dicloxacillin, cephalexin) for 7-10 days
If you see DM in a vignette
Think
Pseudomonas
How does pseudomonas look like under woods lamp
Produces green pigment
Pyoverdin which fluoresces light green with Wood’s lamp
How does pseudomonas folliculitis present
AKA hot tub folliculitis
Infection 8 hrs – 5+ days after exposure
Develops multiple pruritic, round, urticarial plaques w/ central papule or pustule
What is the treatmetn for Pseudomonas Folliculitis
Usually self-limited, 7-10 days
May take up to 3 mo
Antihistamines PRN
Localized Dz - Vinegar soaks (acetic acid 5%), Domeboro’s, or Burrow’s
More involved/severe - ciprofloxacin 500-750mg BID x 5 days
Treatment for pseudomaonsa toe web infections
Keep it clean & dry
Open toed shoes whenever possible
Acetic acid soaks
3 tbsp white vinegar + 1 quart warm water, soak for 10min BID
Drysol (aluminum chloride) AAA BID
prevents hyperhidrosis and recurrence of maceration
Gentamycin cream once dried
Oral Ciprofloxacin if no response to topical therapy
A pt presents with white colored hair, that is very very odorous
Trichomycosis axillaris
Corynebacterium Infection of hair of axilla
Tx: Shave the area
-Topical erythromycin or clindamycin
-Topical naftifine (Naftin) – useful for superficial fungal infxs and has antibacterial properties
Control hyperhidrosis
- Antiperspirants
- Drysol
Define erythrasma
Skin infection caused by excessive proliferation of Corynebacterium minutissimum
MC site of Erythrasma
Most common site is 4th interdigital space
Also in bilateral inguinal area, axillae, inframammary fold
Does not spare the scrotum or labia (different from Tinea)
Coral red under woods lamp
Think
Erythrasma
What is the tx for Erythrasma
Keep area clean, dry
Topical (BID x 2 wks)
- Erythromycin
- Clindamycin
Systemic (if severe/recalcitrant)
- Erythromycin 250mg QID up to 2 wks, or
- Clarithromycin 1 gram x 1 dose
Multiple 1-3 mm pits to weight-bearing areas of feet
Think
Pitted Keratolysis 2/2 Kytococcus sedentarius, which produces exoenzymes that digest keratin
What are the distinctive features of pitted keratolysis
Hyper hydros is + Malodor and sliminess of skin are distinctive features
What is the treatment for pitted keratolysis
Clean daily, promote dryness, change socks frequently, rotate footwear
(MC Cause for occlusive footwear)
TOC: Topical erythromycin ointment, or clindamycin solution, or
Mupirocin ointment (BID for 7-10 Days)
Drysol (20% aluminum chloride) BID
Oral erythromycin – alternative Txt, if unresponsive to topicals
What is the treatment for litter keratolysis
Clean daily, promote dryness, change socks frequently, rotate footwear
TOC: Topical erythromycin ointment, or clindamycin solution, or
Mupirocin ointment (BID for 7-10 Days)
Drysol (20% aluminum chloride) BID
Oral erythromycin – alternative Txt, if unresponsive to topicals
What is the treatment for Verruca Vulagaris
Aka Common warts
Treatment
- Liquid nitrogen (LN2), repeated in 2-4 wks
- Topical salicylic acid (may take months)
- Topical Imiquimod 5% (Aldara)
- Cantharidin (clinician applied)
What is the approach to filiform warts?
Finger like warts on the face
Tx: Curettage or Cryotherapy/ Light electrocautery
What is the treatment for verruca plana
Aka flat warts on the forehead, mouth or back of hands
(Shaved areas)
Treatment
- Cryosurgery
- Imiquimod 5% cream (Aldara)
- Tretinoin cream
- 5-fluorouracil cream
How do you DDX plantar warts from corns
Shave and look for black dots and lack of skin lines (corns have skin lines)
Tx for plantar warts
Not required if painless – will regress over time
Debride (pare) and warm water soak prior to Tx
- Salicylic acid (Occlusal-HP, Duoplant)
- 40% salicylic acid plasters
- Imiquimod 5% cream (Aldara) – with occlusion
- LN2 (blistering may cause pain)
- Cantharidin, with occlusion
Blunt dissection
Most cervical dysplasia’s and cancers are related to…
HPV
Most dangerous HPV strains
High-risk HPV subtypes (cervical)
- 16 & 18 = cellular changes/cancer, esp. 16
- 6 & 11 rarely associated with cervical Ca
What are the provider administered HPV treatments
Trichloroacetic acid
Podophyllin resin
Cryosurgery
Scissor excision, curettage, or electrosurgery
Carbon dioxide laser
What are the patient applied HPV treatments
Podofilox gel
-Apply to warts for 3 days, 4 days off for 4-6 weeks
Imiquimod 5% cream
-Apply at bedtime every other day for 16 weeks
5-Fluorouracil cream
-Last line
What are pearly penile papules
Angiofibromsas of the corona
DDX for HPV
What are Bowenoid Papules
Small, brown or pink, flat or slightly irregular, discrete grouped papules on the penis or vulva
Resemble flat or genital warts
Etiology – Sexually transmitted
- HPV - oncogenic types
- Quasi-premalignant
If molluscum contagiosum is found on the groin or genitals
Suspect
Abuse
What is the best treatment for Molluscum Contagiosum
Few lesions
-Curette (best)
Use anesthesia
Control bleeding
-LN2
May need multiple applications
- Cantharidin
- Potassium hydroxide – requires TID application
-Topical retinoid
Limited data
Multiple lesions
-Trichloroacetic acid peel
What is the best treatment for few vs multiple lesions of molluscum contagiosum
Few: Curette
Multiple: Trichloroacetic acid peel
What is the agent of Molluscum Contagiosum
DNA poxvirus
When can HSV be cultured
Virus can be cultured for approx. 5 days when pt presents with active genital lesions
What is herpes gladiatorum
HSV contracted from contact sports
How does herpes present in the eyes
Dendritic pattern on fluorescein stain
Gold standard to test for HSV
PCR is the gold standard
Swab of: Cervix, rectum, urethra, vagina
Same day result, differentiates HSV 1 vs 2
How does HSV look on Tzanck smear
“multinucleated giant cells”
What is the time frame to treat shingles
Treat within first 72 hrs
How do you skin scrape a dermatophyte
KOH Prep - scrape with #15 blade at the active border; look for branching fungal hyphae that are uniform in width
DTM Culture (dermatophyte test medium) turns red in approx. 7-14 days if dermatophytes present
Obtain Cx for suspected fungal infxn of hair & nails
Tx for superficial Tinea Corporis
(Topicals) Clotrimazole, miconazole, ketoconazole, terbinafine, naftifine
All usually applied BID x 2-4 weeks
Continue application for 7 days after erythema resolves!!
Tx for extensive/ deep tinea corporis
Extensive/deep – use oral agent
Terbinafine, itraconazole, fluconazole
Griseofulvin - kids
What is the Rx for extensive tinea corporis in kids
Griseofulvin
Rx for interdigital tinea pedis
Topicals if interdigital
- Terbinafine 1% cream
- Clotrimazole 1% cream
What is the tx for moccasin- type tinea pedis
Oral if moccasin - type
- Terbinafine
- Itraconazole
- Fluconazole
DDX of tinea Cruris vs erythrasma
DDX – Erythrasma
- Fluorescence coral-pink color with Wood’s lamp
- Does not spare the scrotum or labia
Tx for Tinea cruris
Need to keep clean and dry
Usually treated with agent that will cover fungal and candida
-Clotrimazole, miconazole, ketoconazole
AAA BID min of 2 weeks – treat at least 2cm beyond active border
Oral agents for extensive/refractory – same as for Tinea corporis
Tx for Tinea Capitits in adults vs children
Must treat with systemic/oral agents
Children
-Griseofulvin
Adults
- Griseofulvin
- Terbinafine, Itraconazole
What is Keroin
Inflammatory tinea capitis
Tinea capitus with painful inflammation and tender, boggy nodules that drain
Txt with oral antifungal
-Griseofulvin or terbinafine preferred
Consider use of oral steroid
What is tinea incognito
Fungal infx treated with topical steroids
Alters characteristics of fungi
Margin scaling often absent
Diffuse erythema, scale, pustules
Absence of border
Inflammation improves while fungus flourishes
MC on groin, face, dorsal hands
What is the Dx for candidiasis
Clinical
Satellite lesions commonly present
-Esp. in intertriginous areas
KOH prep
-Pseudohyphae with budding spores
Tx for Candidiasis vulvovaginitis
Fluconazole (Diflucan) 150 mg po x 1 dose
-Don’t use in pregnancy
Topical – azoles or nystatin
(safe in Pregnancy)
-Clotrimazole & miconazole most widely used
Multiple forms – suppositories, creams, vaginal tablets, etc.
3 day regimen recommended
Tx for Oral Candida
Nystatin oral suspension
(infants and kids)
Clotrimazole troche (sucker)
Fluconazole po
Tx for Angular Cheilitis
Topical antifungal followed by Group V steroid
D/C steroid when inflammation resolved
What is the agent of Pityriasis (Tinea) Versicolor
Pityrosporum orbiculare & P. ovale
Formerly known as Malassezia furfur
How does tinea versicolor appear
Begin as multiple oval to round macules of various colors (white, brown, pink)
Typically turns darker in lighter phototypes & lighter in darker
Phototypes
Becomes more conspicuous in summer months, less in winter
MC site: Mid chest & upper back
How does tinea versicolor look under KOH
Numerous short, broad hyphae and clusters of budding cells
“Spaghetti and Meatballs”
What is the treatment for tinea versicolor
Topical
Treatment of choice is ketaconazole 2% shampoo
- Apply to whole body, leave on for 5 minutes, then wash off
- Use for 3 days
Selenium sulfide suspension 2.5% (Selsun or generic)
- Apply, leave on for 10 minutes, then wash off
- Use for 7 days
Oral
-azoles
(Exercise afterwards, no shower x 12 hours)
What is the tx to prevent Tinea Versicolor recurrences
Ketoconazole 2% shampoo AAA x 5-10 minutes once weekly
What is the MC subcutaneous infection
Sporotrichosis
MC found in florists, farmers, hunters
Inoculation by trauma
“Hand pricked by rose thorn”
What is the presentation for sporotrichosis
Initial lesion - painless papule/nodule/ulcer
Lesions increase in number over weeks
Lymphatic pattern - sporotrichoid
(Lymphatic streak)
Finger MC site
What is the treatment for sporotrichosis
Itraconazole 100-200 mg PO QD
May take as long as 3-6 months
3 phases of hair growth
Anagen (growing phase)
90-95% of hairs
~100 follicles enter anagen phase each day
Catagen (transitional phase)
Telogen (resting phase)
5-10% of hairs
Lose ~100 telogen hairs from head each day
What is telogen effluvium
Diffuse loss of resting hair
What are stressors that can cause hair loss
Severe physical/emotional stressors
Delivery of child
Profound weight loss/crash diet
High fevers, surgery
What are the topical treatments for Androgenetic Alopecia
Minoxidil - topical
Ophiasis pattern for Alopecia areata
Presents as band-like hair loss in the parietotemporooccipital area
Tx approach for alopecia areata in pts less than 10 years old
Potent topical steroid + 5% minoxidil
Tx for alopecai areata in pts older than 10 years old
<50% of scalp affected
-Intralesional steroid (triamcinolone acetonide, 10 mg/ml)
5% minoxidil
May use both, IL steroid typically attempted first and resolution assessed
> 50% of scalp affected
- Minoxidil +/- topical steroid
- Topical immunotherapy
- Anthralin
- Systemic corticosteroids
- Prosthesis
Define: brittle hair 2/2 over working ->Weak points/nodes in hair shaft
Can cause permanent loss due to scarring
Trichorrhexis Nodosa
Must stop all hair treatments
Consider screening for hypothyroidism
Define folliculitis decalvans
Chronic pustular eruption of the scalp
Patchy permanent alopecia due to scarring
What is the treatment for folliculitis decalvans
Clindamycin 300 mg BID x 10 weeks
What is the treatement for dissecting cellulitis of the scalp
Isotretinoin
What is the MC cuase of anovulatory infertility and hirsutism
Polycystic Ovary Syndrome (PCOS)
Can also be 2/2: Cushings Androgen secreting tumors Steroids Obestiy
Tx for Hirsutism
Cannot be cured, only suppressed
- Oral contraceptives
- Low dose corticosteroids
- Spironolactone
- Eflornithine HCL (Vaniqa) – facial hair removal cream
- Laser, electrolysis
- Waxing, tweezing, plucking
Nail manifestations in psoriasis
Oil spots/ pitting
And Onycholysis
What are the nail findings of lichen planus
Most common findings are longitudinal grooving and ridging
What ABX have nail changes
Tetracycline ABX
What is tinea unguium
Tinea of the nails
Look for psoriasis
and DDX with KOH and culture
What is the treatment (oral agents) for Onchymycosis
Terbinafine x 12 weeks
(6 weeks for fingernails)
Itraconazole x 12 weeks
NO Tylenol NO ALCOHOL
(Monitor CBC and LFTs)
What are the topical agents for onychomycosis
Ciclopirox nail lacquer
(Can’t have lunula involvement)
Efinaconazole
(50% cure rate)
What is the MGMT for chronic exposure nail deformity
Nail polish
Rehydrate the nail
Moisturizer/lubricant, protective gloves, nail enamel weekly
B-complex vitamin biotin (B7), to increase thickness
What is the treatment for subungal hematoma
If severe – Treatment: trephination ASAP
Field expedient – heated paperclip to melt small hole in surface of nail
Defect consists of longitudinal band of horizontal grooves with yellow discoloration
Habit-tic deformity
Pt may have psychiatric d/o (OCD)
Treatment: stop manipulating nails
What is the treatment for acute paronychia
Treatment:
I&D of abscess
Antistaphylococcal antibiotics
If the Nail plate turns green-black in color
Suspect
Pseudomonas Infection
Treatment: use mixture of chlorine bleach and water, or vinegar
(acetic acid).
Ciprofloxacin if severe/txt failure
What are Beaus Lines
Transverse depressions of all nails that appear at the base of lunula weeks after a stressful event has temporarily interrupted nail formation
Will grow out with nail, at normal rate
No treatment necessary
What is yellow nail syndrome
Occurs before, during, or after respiratory diseases and in diseases assoc. with lymphedema
Seen in AIDS pts
Nail plate becomes curved, turns yellow, and usually all nails are involved
Treatment: may spontaneously improve, or may try vitamin E (oral or topical)
DDX for clubbed nails
May be assoc. with heart & lung Dz, cirrhosis, colitis, and thyroid Dz
What is lovibonds angle
Angle of the nail bed
> 180 = clubbing
What is koilonychia
Spooned nails
Seen with iron-deficiency anemia
Treatment: improves with anemia correction
What are Mee’s lines
Transverse white line in nail plate
Associated with sepsis, renal failure, arsenic poisoning, hepatic failure, CHF, and chemotherapy
Treatment: treat underlying problem
grows out with nail and resolves
What are terrys nails
White or light pink but retain a 0.5- to 3-mm normal, pink, distal band
Associated with cirrhosis, chronic congestive heart failure, adult-onset diabetes mellitus, and age
Transmission of Scabies
SKin to skin
What is the Dx criteria for Scabies
Burrows or typical sx’s w/ characteristic lesions
Tx for Scabies
Permethrin 5%
Retreat in 7 days
(DO NOT APPLY TO THE FACE)
Antihistamines PRN (Ithcing)
If inflamed: 1% hydrocortisone x24 hrs ->Elimite
What is the Tx for scabies if the pt is institutionalized
Ivermectin :
Used in institutionalized patients, nursing homes, & those who fail topical therapy
Also for Norwegian Scabies and HIV
12 mg PO at day #1 & day #8
93% clearance
2-6 weeks of scabies activity is common after tx
Worsening symptoms 2-3 day after oral therapy - not failure
Is Lindane used first line for Scabies
NO!
ToXIC!
Don’t use in kids of preg
If you are going to use it at all, must pretreat with steroids
A pt presents w/ Norwegian Crusted scabies
Think
HIV
Variant of scabies with thousands of mites, but very little itch
Highly contagious
How does Lice look like on WOods Lamp
Wood’s light fluoresces lice and nits (yellow-green to blue-green)
Tx for Head lice
Permethrin 1% (Elimite or RID) lotion
Leave on for 10 min
Don’t shave head
Comb out nits after rinsing
Repeat in 7 days
Tx for lice in the eyelashes
Eyelashes coat with Vaseline, wash with baby shampoo TID x 5 days
Tx for body lice
Permethrin 5% cream (Elimite)
Head to toe
Leave on x10 minutes
Repeat in 7-10 days
What is the MGMT for fleas
Symptomatic treatment
- Antihistamine
- Topical Abx – 2’ infxn
- Topical steroids
Get rid of fleas – Treat family pets and bedding
A pt presents with rows of 3-5 bites in exposed sleeping skin
Think
Bed Bugs
What is the agent of bed bugs
Cimex lectularius
What is the MGMT for Bed Bugs
Get rid of bugs
Symptomatic Tx
Antihistamines, topical steroids
What is the presentation and MGMT for Chiggers
Legs and belt line - areas of constriction
Intense itch
Tx:
Symptomatic Tx
OTCs
Chigg-Away
DO NOT PUT NAIL POLISH OVER BITES!
What is the MGMT for FIre ants
Fire ants are in the same family as wasps
(Watch for anaphylaxis)
Management
- Kill the fire ant colony
- Symptomatic treatment
- Cool compress
- Sarna lotion (OTC anti itch prep)
- Antihistamine
- Steroids, if severe
What is the markings of a Brown recluse
Violin-shape pigment on thorax
A pt presents with a painless bite that becomes firm
Becomes a hemorrhagic blister (24hrs) that becomes blue
Then central area becomes ecchymotic (1week)
And then forms an ulcer
Think
Brown recluse (loxosceles)
What spider has red white and blue bite sign
Brown recluse
What is the MGMT for Brown recluse bites
No commercial spider antivenom
Supportive measures; Analgesics as needed
Tetanus prophylaxis and daily wound care
Antibiotics if infection develops
Most wounds heal without intervention
Consider Surgical Debridement for Ulcers:
> 2 cm size and 2 - 3 wks after the bite
Dapsone and Hyperbaric Oxygen used sporadically
No clear evidence supporting use
Threshold for Surgical Debridment for Brown Recluse Ulcers
Consider Surgical Debridement for Ulcers:
> 2 cm size and 2 - 3 wks after the bite
What is a Letrodectus spider
Black widow
Black widow venom releases what physiological chemicals
Massive release of Neurotransmitters
Acetylcholine & Norepinephrine
What is the clinical Dx for a black widow bite
Pain + Target Lesion + Muscle Spasms
MGMT for black widow spider
Supportive care
Tetanus prophylaxis and wound cleansing/care
Analgesics (Opioids) for pain
Benzodiazepines to relax muscle spasms
Antivenom reserved only for severe hospitalized cases
What is the MC skin disease among travels to tropical regions
Cutaneous Larva Migrans
What is the causative agent of cutaneous larva migrans
Caused by accidental invasion of dog and cat hookworm
Burrows 1-2mm qd
Long serpiginous lesion
Larva eventually dies
What is the MGMT for cutaneous larva migrans
Topical
->Topical steroid to decrease inflammation
Oral - severe cases
->Ivermectin (200mcg/kg in a single dose)
1-2 repeated courses if resistant
->Albendazole (400-800 mg/day x 3-7 days)
Can use topical version in small children
->3 x 400mg tabs crushed in 12g of petroleum jelly
How does SSSS present
Prodrome of malaise, fever, irritability, and tenderness of the skin
Diffuse, tender erythema appears
->Sandpaper-like texture
Often accentuated in flexural and periorificial areas
No involvement of mucous membranes
Within 1 or 2 days the skin wrinkles, forms transient bullae, and peels off in large sheets
+ Nikolsky Sign
multiple pruritic, round, urticarial plaques w/ central papule or pustule after being in a hot tub think
Pseudomonas Folliculitis
What is pseudomonas cellulitis
Common in dm pts
Or SOLIDERS IN SWAMPS!
Tx with Acetic acid (5% white vinegar) or Domeboro (aluminum acetate) soaks to dry out area
Systemic antibiotics
- Oral Ciprofloxacin 500-750mg BID
- Severe infxn: IV
RSK fx for Erythrasma
Warm humid climate Poor hygiene Hyperhidrosis Obesity Diabetes mellitus Advanced age Immunosuppression
How deep to warts effect the skin
Confined to the epidermis
Do not have ‘roots’
What is the Dx sign of warts
cylindrical projections, which may become fused and produce a mosaic pattern on surface (diagnostic sign)
What is the treatment approach to warts under the nail
A wart next to the nail may simply be the tip of the iceberg; much more wart may be submerged under the nail
Cuticle biting may spread the warts
More resistant to both chemical and surgical methods Tx: Cryosurgery Cantharidin (provider applied) Salicylic acid
Duct tape occlusion – 6 days, 12 hour break, 6 more days – repeat up to 2 months
Small discrete 2-5mm flesh colored papules, dome shaped
W/ Central umbilication
Express caseous material when opened
Think
Molluscum Contagiosum
What are the prevention for Herpes zoster
Zostavax (zoster vaccine live)
Shingrix (recombinant zoster vaccine)
Both for patients ≥ 50 y/o
What is a dermatophyte
Group of fungi that infect the stratum corneum (keratin layer), hair, and nails
Cannot survive on mucosal surfaces
Responsible for the vast majority of skin, nail, and hair fungal infections
What is the most common superficial fungus of the skin
Trchophyton rubrum
What is a tinea
A fungal infection
Tx for tinea manuum
More common in men
Txt same as tinea pedis
Usual involvement is 2:1 ratio
tx for tinea barbae
Oral agents only
What is the tx for tinea of the face
Topicals unless near the eye
Most common type of tinea capitis
Black dot type MC (hairs broken at orifice)
How do you culture or dx tinea Capitis
Gauze or toothbrush technique preferred over scraping
Sterile toothbrush rubbed over affected scalp ->inoculate fungal culture medium
What is the treatment for Candida in the diaper or genital area
Keep area clean and dry (as possible)
Hygiene education
Topical azoles BID
Miconazole, ketoconazole, clotrimazole
How does tinea versicolor look under woods lamp
Wood’s lamp may accentuate areas of altered pigmentation
How do you culture sporotrichosis
Punch or excision biopsy
1/2 for special stains/microscopic exam
1/2 for culture
Pull test for hair loss
Grasp 60 hairs And pull
Negative: 6 or fewer hairs
Positive: 6 or more hairs
(Do not use shampoo for 24 hours prior to test)
(Conduct on 4 areas of the scalp)
What is the cause of male pattern baldness
Due to progressive shortening of successive anagen cycles
Which hair follicules are androgen sensitive
Top/vertex - androgen sensitive
Sides - androgen independent
What are the oral treatments for male (androngenic) hair loss
Finasteride – oral (1 mg/day)
Dutasteride – oral (0.5 mg/day)
MOA of Fineasteride
Inhibits conversion of testosterone to dihydrotestosterone, slows further hair loss, inhibits miniaturization of hair follicles, and improves hair growth/weight
Also marketed as Proscar (5mg) for BPH
Efficacy evident within 3 mo. of tx
Tx continued indefinitely
Sexual side effects in 4-5% during first year of Tx
Minoxidil works on what phase of hair loss
Increases duration of anagen, causes follicles at rest to grow, and enlarges miniaturized follicles
MOA of dutasteride
Inhibits conversion of testosterone to DHT
3x more potent than finasteride
What is the w.u for female hair loss
Consider checking Dehydroepiandrosterone sulfate
(DHEA-S), prolactin, testosterone, SHBG
Who does dissecting cellulitis most affect
Black men
What is hypertrichosis
Excessive hair growth (density, length) beyond accepted limits of normal for age, race, sex in areas that are not androgen-sensitive
May be localized or generalized
May involve lanugo, vellus, or terminal hair
Spares palms and soles
What are the 4 drugs that can lead to hypertrichosis
Minoxidil, phenytoin, cyclosporine, corticosteroids,
What is hutchinsons sign
Can be a sign of melanoma is black people
Craig has one of these
How do you Dx Onychomycosis
15 scalpel to scrape nail surface and obtain subungual debris
Obtain KOH & Culture to confirm species of fungus before starting oral antifungal tx
Nail clipping
Most common pattern of onychomycosis
Distal subungual onychomycosis
How to treat lice in the eyelashes
Eyelashes ->coat with Vaseline, wash with baby shampoo TID x 5 days
Loxosceles spider=
Brown recluse
What is the systemic reaction from brown recluse bites that are more common in children
Fever, Chills, N/V, Myalgias, Arthralgias, Petechiae
