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Clin Med 1 > Derm Lecture 1 > Flashcards

Derm Lecture 1 Flashcards

1
Q

what are the 3 most common skin and soft tissue infections?

A

cellulitis, erysipelas, abscess

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2
Q

how do cellulitis, erysipelas, and abscess develop? seen in who?

A

as a result of bacterial entry via breach of skin barrier

can see a lot with IV drug users or surgery post-op infections

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3
Q

risk factors of cellulitis, erysipelas, and abscesses

A

skin barrier disruption - trauma, pressure ulcer (ex. nursing home pts)

pre-existing skin conditions - eczema, impetigo, tinea

skin inflammation - radiation therapy

obesity - skin folds rub together

immunosuppression

close contact w/infected people

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4
Q

what layers of the skin does erysipelas affect?

A

upper dermis and superficial lymphatics

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5
Q

epidemiology of erysipelas

A

young children and older adults

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6
Q

pathogen of erysipelas

A

beta-hemolytic streptococci

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7
Q

clinical manifestations of erysipelas

A

erythema, edema, warmth, tender

ALWAYS UNILATERAL and non purulent

acute onset of sx’s

CLEAR DEMARCATION - butterfly involvement of face

systemic manifestations - fever, chills

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8
Q

what 2 skin infections are usually unilateral?

A

cellulitis and erysipelas

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9
Q

what skin disorder has clear demarcated borders and which one doesn’t?

A

clear border = erysipelas

non-demarcated border = cellulitis

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10
Q

erysipelas location

A

lower extremities M/C, but can be seen anywhere

FACE w/ butterfly shape

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11
Q

erysipelas diagnosis

A

Based on clinical manifestations and pt hx

Raised above level of surrounding skin with clear demarcations b/w involved and uninvolved skin (vs. cellulitis)

LRINEC SCORE – distinguish NF from other soft tissue infections

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12
Q

what is the LRINEC score and when do you use it? score?

A

lab risk indicator for NF
-used to distinguish NF from other soft tissue infections

use when pt has:

  • concerning hx & exam
  • pain out of proportion to the exam
  • rapidly progressing cellulitis

score >6 then rule IN NF

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13
Q

what layers of the skin does cellulitis effect?

A

deeper dermis and subcutaneous fat

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14
Q

cellulitis epidemiology

A

middle aged and older adults

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15
Q

cellulitis pathogens

A

beta-hemolytic strep and staph aureus including MRSA

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16
Q

cellulitis clinical manifestations

A
  • Erythema (redness), edema, warmth, tender
  • Always UNILATERAL & may present with or w/out purulence
  • Indolent course
  • More localized sx develop over days
  • Less distinct borders
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17
Q

cellulitis location

A

lower extremities most common site of involvement, but can be seen anywhere

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18
Q

cellulitis diagnosis

A

Based on clinical manifestations and pt hx

Not clear borders & indolent onset (vs. erysipelas)

LRINEC SCORE – distinguish NF from other soft tissue infections

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19
Q

differential diagnoses of cellulitis

A

Gout (distinguish w/X-rays or joint aspiration)

DVT (red, warm & swollen bump on leg)

Venous stasis dermatitis

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20
Q

what layers of the skin does an abscess effect?

A

upper and deeper dermis

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21
Q

abscess pathogens

A

staph aureus

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22
Q

abscess clinical manifestations

A
  • Erythema (redness), edema, warmth, tender
  • Collection of pus w/in dermis or SQ space
  • Painful, fluctuant, erythematous nodule with or w/out cellulitis
  • Surrounding induration (hardness around infection)
  • Regional adenopathy (e.g. abscess in thigh -> groin adenopathy)

-Rare fever, chills, systemic
toxicity

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23
Q

abscess locations

A

neck, face, axillae, buttocks

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24
Q

abscess diagnosis

A

Based on clinical manifestations and pt hx

Painful, fluctuant, erythematous nodule

LRINEC SCORE – distinguish NF from other soft tissue infections

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25
Q

what is a furuncle? carbuncle?

A

furuncle - abscess around follicle

carbuncle - abscess around multiple hair follicles

MEANS ABSCES CAN DEVELOP VIA INFECTION OF HAIR FOLLICLE

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26
Q

what is impetigo?

A

contagious superficial bacterial infection w/ principle pathogen being staph aureus

27
Q

who is impetigo most frequently found in?

A

children 2-5 y/o

can be seen in adults

28
Q

classification of impetigo

A

primary impetigo (direct bacterial invasion of normal skin)

secondary impetigo (infection at sites of skin trauma)

29
Q

epidemiology of impetigo

A
  • Most common bacterial infection in children
  • 3rd most common skin condition in children
  • More prevalent in summer and fall
  • More common in southeast US than northern states
30
Q

where does impetigo most commonly occur on the body?

A

the face

31
Q

types of impetigo (HINT: 3)

A

non-bullous impetigo

bullous impetigo

ecthyma

32
Q

non-bullous impetigo clinical manifestations

A

most common form of impetigo

  • papules progress to vesicles surrounded by erythema
  • pustules that rapidly enlarge breakdown and form thick adherent GOLDEN CRUSTS
33
Q

what is the most common form of impetigo?

A

non-bullous impetigo

will have GOLDEN CRUSTS

34
Q

bullous impetigo pathogens

A

staph aureus strain that produces a toxin that causes cleavage in the superficial skin layer

35
Q

bullous impetigo clinical manifestations

A

vesicles enlarge to form flaccid bullae with clear fluid

  • becomes darker and ruptures leaving thin BROWN CRUSTS (progresses over a week)
  • fewer lesions (vs. non-bullous impetigo)

-trunk more affected

36
Q

what area of the body does bullous impetigo affect more vs non-bullous?

A

trunk is affected more in bullous impetigo

37
Q

ecthyma clinical manifestations

A

ulcerative form of impetigo
-lesions extend through the epidermis to deep dermis

<b>-“punched-out” ulcers covered w/yellow crusts</b>

38
Q

impetigo diagnosis

A
  • Clinical picture & hx
  • Honey colored crusts (non-bullous)
  • Brown crusts (bullous)
  • Punched out ulcers w/yellow crusts (ecthyma)
  • Can gram stain & culture
39
Q

limited non-bullous and bullous impetigo topical therapy tx

A
  1. Mupirocin (Bactroban) TID

2. Retapamulin (Altabax) BID

40
Q

extensive impetigo and echythma oral therapy and alternative for PCN and ceph hypersensitivity

A

dicloxacillin or cephalexin

alternative for PCN and ceph hypersensitivity:
-erythromycin OR clarithromycin

41
Q

impetigo tx if MRSA suspected or confirmed

A
  1. Clindamycin OR
  2. Trimethoprim-sulfamethoxazole OR
  3. Doxycycline
42
Q

what is urticaria?

A
  • hives, welts, wheals
  • common disorder
  • very pruritic, erythematous plaque
43
Q

is there always a trigger for urticaria?

A

no, may have no identifiable trigger

44
Q

what can accompany urticaria?

A

angioedema

  • often presenting as very swollen lips
  • can also affect extremities and genitalia
45
Q

urticaria classification

A

acute - less than 6 weeks

chronic - recurrent, with s/sx’s recurring most days of the week for more than 6 weeks

46
Q

urticaria clinical manifestations

A

Circumscribed, raised, erythematous plaques with central pallor (central clearing)

Intensely itchy - Most severe at night

Any area of body may be affected

Lesions are transient - Appearing, enlarging, and then disappearing within 24 hours

47
Q

urticaria pathophysiology

A

Mediated by cutaneous mast cells in the superficial dermis (just in skin)

Mast cells release multiple mediators including:

  • Histamine (causes itching)
  • Vasodilatory mediators (causes swelling)
48
Q

urticaria diagnosis

A
  • Clinical exam and history
  • Signs and symptoms of allergic reaction
  • Any underlying disorder
  • No specific lab studies however if allergy is suspected then allergist can test for allergen specific IgE antibodies
49
Q

what is the focus for tx of urticaria?

A

focus on short term relief or pruritis and angioedema

2/3 spontaneously resolve and are self-limited

50
Q

urticaria tx

A

H1 antihistamines

  • Diphenhydramine
  • Chlorpheniramine
  • Hydroxyzine
  • Cetirizine
  • Loratidine
  • Fexofenadine

H2 antihistamines

  • Ranitidine
  • Nizatidine
  • Famotidine
  • Cimetidine

Glucocorticoids

  • Prednisone
  • used for severe cases or if they have angioedema (will not help itchiness, only antihistamine will)
  • may be used w/pts w/sx’s longer than 2-3 days
51
Q

urticaria H1 antihistamines for tx

A
  • Diphenhydramine
  • Chlorpheniramine
  • Hydroxyzine
  • Cetirizine
  • Loratidine
  • Fexofenadine
52
Q

urticaria H2 antihistamines for tx

A
  • Ranitidine
  • Nizatidine
  • Famotidine
  • Cimetidine
53
Q

when do you use glucorticoids (prednisone) for urticaria tx?

A
  • used for severe cases or if they have angioedema (will not help itchiness, only antihistamine will)
  • may be used w/pts w/sx’s longer than 2-3 days
54
Q

what is a lipoma? what does it consist of?

A

most common benign soft tissue neoplasm

consists of mature fat cells enclosed by a thin fibrous capsule

55
Q

lipoma epidemiology

A
  • Occur on any part of the body
  • Most commonly on the upper extremities and trunk
  • Range from 1-10 cm
56
Q

lipoma pathophysiology

A

> 50% develop in the SQ tissue

cause is unknown
-solitary lipomas have been associated with gene rearrangement of chromosome 12

57
Q

lipoma clinical manifestation

A

superficial, soft, painless, SQ nodule

round, oval, multilobulated

can occur on any part of body, but MOST COMMONLY ON UPPER EXTREMITIES & TRUNK

58
Q

lipoma diagnosis

A

history and PE

  • won’t be red, tender or hard
  • will grow over time and is movable
59
Q

lipoma tx

A

stable and asymptomatic - no tx

surgical excision if:

  • cosmesis
  • pain (pushing on a joint)
  • uncertain about dx
60
Q

what is an epidermal inclusion cyst?

A

most common cutaneous cysts

skin-colored dermal nodules

visible central punctum (usually around hair follicles)

61
Q

epidermal inclusion cyst epidemiology

A

Occur anywhere on the body

  • Anywhere there is hair
  • More common on face, scalp, neck, and trunk

Twice as common in men

Seen in hereditary conditions
-Gardener syndrome (get a lot of polyps)

62
Q

epidermal inclusion cyst pathophysiology

A
  • Implantation & proliferation of epithelial elements into the dermis by result of trauma
  • Cyst wall consists of normal stratified squamous epithelium
  • Lesions may stay stable or get larger
  • Spontaneous rupture can occur
  • Cheesy material comes out
63
Q

epidermal inclusion cyst clinical manifestations and dx

A
  • firm skin-colored nodule with central punctum
  • asymptomatic

dx: hx and PE

64
Q

epidermal inclusion cyst tx

A

asymptomatic - no tx

symptomatic

  • excision of cyst
  • incision and drainage
  • intralesional injections of triamcinolone (steroid)

Clin Med 1 (5 decks)

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