Derm - Viral Exanthems & Soft Tissue Tumors - Exam 1 Flashcards
What is the secondary name and etiology for measles?
Secondary name: Rubeola
Etiology: paramyxovirus
How is measles contracted?
Infectious droplets- cough, sneeze, close breathing
How long does an area remain infectious after a measles infected person leaves?
For up to 2 hours
what risk factor should be considered when a patient presents with febrile rash?
Recent travel
How does the incubation period of measles present?
Typically asymptomatic
What is the prodrome of measles?
High fever (105+); followed by 3 C’s= cough, coryza, conjunctivitis
A patient presents to the clinic with a cluster of tiny bluish-white papules on buccal mucosa, described as “Grains of salt on a red background.” What is this and what disease process is it associated with?
Koplik spots
Associated with Measles
What is the clinical presentation of the rash seen in measles?
- Blanching, maculopapular
- Starts on face and spreads from head to toe
- Typically spares palms and soles
How long is measles infectious before and after rash?
5 days before and 4 days after
What are Koplik spots?
Cluster of tiny bluish-white papules on buccal mucosa; “Grains of salt on a red background”
How do you diagnose measles?
- Serology: measles virus specific IgM (most important)
- Serum or throat swabs for histologic analysis
- Urine may also contain virus
- Measles RNA RT-PCR
What are the more common complications of measles?
Diarrhea»_space; otitis media
Other than pneumonia and encephalitis, what is the distinguishable severe complication of measles?
Subacute sclerosing panencephalitis (SSPE) which presents 2-10 years later
What is SSPE?
- Subacute sclerosing panencephalitis
- Fatal degenerative disease of CNS (fatal within 1-3 years)
- Behavioral and intellectual deterioration, seizures
What are the highest risk groups for measles?
Pregnant women, immunocompromised, ages: <5 or >20
What must you do if you suspect a case of measles?
Report to CDC
How is measles treated?
- Symptomatic treatment
- Vitamin A
- Patient education (close contacts, avoid contact with pregnant women, prevent by immunization)
What is erythema infectiosum also known as?
Fifth disease
What is the etiology of erythema infectiosum?
Parvovirus B-19
What population is erythema infectiosum most commonly seen and how is it transmitted?
School-aged children; respiratory secretions
How long do the symptoms last with erythema infectiosum?
Weeks, months, years (rare); frequent clearing with recurrence of rash
What is the prodrome of erythema infectiosum?
Nonspecific flu-like symptoms for 2-3 days
What are the distinguishable features of erythema infectiosum?
- “Slapped cheek” = erythematous malar face rash
- Lacy, pink macular rash of trunk and extremities (extensor surfaces) 2-3 days later
- Polyarthropathy: joint pain/inflammation
Although rare, what are the complications associated with erythema infectiosum?
- Hydrops fetalis and/or possible fetal loss in pregnancy
- Transient aplastic crisis
What is used for management of erythema infectiosum?
- Reassurance and symptomatic treatment*
- For severe anemia, may need blood transfusion and immune globulin
- Avoid contact with pregnant women
What is Rubella also known as?
German Measles
What is the etiology of Rubella?
Rubella virus
How is Rubella transmitted?
Inhaled, large particle aerosols
What is the prodrome for Rubella?
Low grade fever, lymphadenopathy, and cold symptoms for 1-5 days prior to rash
What are the characteristics of the rash caused by Rubella?
- Pinpoint, pink maculopapules
- Head to toe progression
What other common symptom, besides the classic rash, may be seen in adults with Rubella?
Arthralgia/arthritis
What is a distinguishable complication seen with Rubella? What are characteristics associated with this complication?
Birth defect in pregnant women = Congenital rubella syndrome (lethal)
- “Blueberry muffin” rash in infants*
- Hearing loss
- Mental retardation
- Cardiovascular and ocular defects
What are other complications seen with Rubella besides congenital rubella syndrome?
- Encephalitis, thrombocytopenic purpura, GI hemorrhage
- Mortality
How is Rubella managed?
- Symptomatic treatment only
- Avoid contact with pregnant women
- Prevention by immunization (MMR)
What is the etiology of roseola infantum?
Most commonly caused by Herpes virus 6 (HHV-6)
What is the typical progression of roseola infantum that makes it distinguishable from other conditions?
High fever (102-105°) for 3-5 days –> fever resolves abruptly –> rash appears
What are the important prodrome characteristic seen with roseola infantum?
- High fever (potentially > 105°) with abrupt end*
- Irritability and potential for seizures
How does the rash for roseola infantum present and what is distinguishable about it?
- Blanching pink/ erythematous maculopapular
- Spreads from neck/trunk initially then to face/extremities*
- Typically nonpruritic/nontoxic appearance
What is the treatment for roseola infantum?
Supportive treatment (with antipyretics to keep fever under control)
Why is a UTI an important differential diagnosis of roseola infantum in a non-verbal age group?
UTI is a common cause of fever in infants
What is the etiology of hand, foot, and mouth?
Coxsackie A16 virus
What population is most commonly affected by hand, foot and mouth?
Children < 5 y/o
How is hand, foot, and mouth transmitted?
Oral ingestion of virus via fecal-oral or oral/respiratory secretions (vesicles)
Although the prodrome is typically absent in hand, foot and, what symptoms does it include when it does present?
Fever, fussiness, emesis, abdominal pain, diarrhea
What is the clinical presentation typically associated with hand, foot and mouth?
- Vesicles on hands, feet, and buttocks (classic appearance)
- Can also have sore throat, vesicles on buccal mucosa, vesicles on tongue
- Vesicles may create ulcers
What are the complications of hand, foot and mouth?
- Decreased oral intake, dehydration
- Encephalitis
- Aseptic meningitis
- Loss of nails
- Fetal loss, myocarditis, and conjunctival ulceration (rare)
How is hand, foot and mouth treated?
Symptomatic treatment only
How is hand, foot and mouth prevented?
Good hygiene; no vaccine currently
What is the etiology of molluscum contagiosum?
Poxvirus
What population is typically affected by molluscum?
Children (sometimes seen in adults and immunocompromised)
How does molluscum contagiosum spread?
- Transmitted via direct physical contact and contact with contaminated fomites
- Autoinoculation: self spreading by touching, scratching, shaving
What is the distinguishable feature of the lesions that present with molluscum?
Umbilication (dimple at the center)*
How does molluscum contagiosum present clinically?
- Flesh colored, pearly, umbilicated papules
- Anywhere except palms and soles
- No associated symptoms
What are the treatment options for molluscum contagiosum?
- No treatment
- Spontaneously resolves in 6-12 months
- Home treatment: podophyllotoxin cream
- Clinical office care: cryotherapy, curettage, cantharidin
In what case is treatment of molluscum contagiosum recommended?
Lesions in genital region
In what population is using Podophyllotoxin cream contraindicated?
Pregnant women as it causes fetal toxicity
What are the 2 types of Human Papilloma Virus (HPV)?
- Mucosal: condyloma acuminata
2. Cutaneous: common, plantar, and flat warts
What should be considered with respect to cutaneous HPV?
Play a role in oncogenesis of skin and mucosal malignancies (ex. SCC)
What is the etiology of condyloma acuminatum?
Human papillomavirus (HPV)
What is condyloma acuminatum, who does it commonly affect, and how is it transmitted?
Genital warts; homosexual males (most commonly); sexual contact
What is the clinical presentation of condyloma acuminatum?
Classic cauliflower-like lesions: perianal growth, mild pruritus
How are condyloma acuminatum treated?
Topical (podophyllin), immunotherapeutic, surgical
What are verruca vulgaris also known as and what is their etiology?
Common warts; HPV
What are the common characteristics for verruca vulgaris, including the population affected and how they are transmitted?
- More common in children/ young adults
- Transmission: skin to skin contact
- Spontaneous resolution in 1-2 years
- Recurrence is common
What is the clinical presentation of verruca vulgaris?
- Lesions are raised, rough-surfaced, with tiny, pigmented thrombosed capillaries (“seeds”)*
- Common on hands and feet (plantar)
How is verruca vulgaris treated?
- Nothing (spontaneous resolution may occur)
- Salicylic acid (at home or in clinic)
- Cryotherapy
- Electrodessication
- Snip/shave biopsy (filiform warts)
- lesion should be pared/shaved down prior to treatment
What is varicella also known as?
Chicken pox
What is the etiology of varicella?
Varicella-zoster virus (VZV), a herpes virus
How is varicella transmitted?
Aerosolized droplets or direct contact with skin lesions (highly contagious and can recur)
What is the clinical presentation of the rash associated with varicella?
- Generalized vesicular rash
- Pruritic
- Lesions occur at different stages*
What is the distinguishable characteristic of varicella and how does this help with diagnosis?
Visualizing lesions in all three stages at the same time
Other than visualizing the rash, what is another technique used to diagnose varicella and what does it show?
Tzanck smear which shows multinucleated giant cells
What complications can be seen with varicella?
- Group A strep
- Encephalitis and Reye syndrome (uncommon)
- Largest complications seen in immunocompromised patients
How is varicella treated?
- Symptomatic treatment and patient education
- Contagious until all lesions are crusted
- Avoid pregnant females
- Acyclovir used in immunosuppressed patients
- Vaccination
What is the etiology of herpes zoster?
Varicella zoster virus (VZV), a herpes virus
What is herpes zoster also known as?
Shingles
What population does herpes zoster most commonly appear in?
Elderly and immunocompromised patients
If shingles is caused by the same virus as varicella, describe how shingles occurs.
The varicella virus is dormant in the sensory ganglia. Immunity to this virus decreases with age, stress, trauma, or being immunocompromised. The virus begins to replicate, travel along a sensory nerve, and skin lesions will begin to appear.
What kind of pattern does herpes zoster follow?
It follows a dermatomal pattern. The lesions will be unilateral for this reason
What is the prodrome of herpes zoster?
Acute neurotic pain that precedes the eruption of lesions by 3-5 days.
May also have pruritis, fever, headache, and allodynia
Describe the herpes zoster rash.
Grouped vesicles on an erythematous base that follow a dermatomal distribution and are unilateral. Thoracic distribution is most common.
What is post herpeticum neuralgia (PHN)?
A chronic complication of herpes zoster, results in lancinating pain which can last months-years after resolution of lesions. Occurs 10-15 % of the time.
What is herpes zoster ophthalmicus (HZO)?
A chronic complication of herpes zoster which occurs when the lesions are around the eyes. This has a high risk for vision loss.
What is Hutchinson’s sign?
When herpes zoster vesicles are on the nose. Causes concern for herpes zoster ophthalmicus and vision loss.
What is the main treatment for herpes zoster?
To start treatment early (within 72 hours) with antivirals
- Famciclovir (Famvir)
- Valacyclovir (Valtrex)
- Acyclovir (Zovirax)
What patient education should be given to someone with herpes zoster?
Stay hydrated, keep skin clean and dry, and cover the lesions
What pain medications are given for acute herpes zoster?
Narcotics and NSAIDs
What pain medications are given for chronic herpes zoster?
Tricyclic antidepressants, gabapentin, and pregabalin
What is the treatment if someone has herpes zoster with ocular involvement?
Emergent ophthalmology consult
Can someone with Shingles transmit shingles to another person?
No. But they can transmit varicella since it is the same virus.
How can Herpes Zoster be prevented?
Zosravax injection (single dose) or Shingrix injection (2 doses, but more effective)
Only approved for patients older than 50.
What is HSV-1 most common presentation?
Herpes labialis - Cold sores
How is HSV transmitted?
Direct contact during viral shedding
What is HSV-II most common presentation?
Genital herpes
How is HSV-II transmitted?
Transmitted sexually
What happens to the Herpes simplex virus after primary infection?
It remains latent in nerve root ganglion and can be reactivated by changes in immune status –> stress, infection, menses, fatigue, sun exposure, etc
Describe the clinical presentation of the lesions from herpes simplex virus.
Grouped vesicles on an erythematous base with crusting of lesions at later stages.
What is the prodrome of herpes simplex virus?
Burning, tingling, or pruritis
How is herpes simplex virus diagnosed?
Clinical presentation, viral culture, direct microscopy via Tzanck smear, and serology.
What is a Tzanck smear?
When fluid is scraped from a vesicle and stained with Wrights stain. It is positive if there are giant multinucleated cells.
What are the complications of herpes simplex virus?
- Erythema multiforme
- Eczema herpaticum
- Recurrent aseptic meningitis
What is the recommended treatment for herpes simplex virus?
- Start treatment early (<72 hours preferred)
- Treatment of initial outbreak and subsequent outbreaks is valacyclovir, Famciclovir, or Acyclovir
When are antivirals used for chronic suppression of HSV?
If there are 4 or more outbreaks of herpes labialis in one year, or there are HSV recurrences with serious complications
What is the most common cutaneous cyst?
Epidermal inclusion cyst aka epidermoid cyst
What is the clinical presentation of an epidermal inclusion cyst?
A soft, mobile nodule that is fluctuate and often with a central punctum
What is the treatment of an uninfected epidermal inclusion cyst?
- Nothing
- Kenalog injections
- Incision and drainage
What is the treatment of an infected epidermal inclusion cyst?
Incision and drainage and possibly oral antibiotics
What is a lipoma?
The most common subcutaneous soft tissue tumor that is composed of adipose tissue
What is the clinical presentation of a lipoma?
Soft, mobile, and typically non-tender mass.
What is the treatment of a lipoma?
Surgical removal
What can lipomas mimic the look of?
Sarcomas
What is a sarcoma?
A rare malignant tumor that is comprised of 80% soft tissue
What is the clinical presentation of a sarcoma?
- An enlarging, painless mass, most commonly to extremities or trunk.
- Pain, edema, and paresthesias may present due to compression
How are sarcomas managed?
- Imaging of the primary lesion with MRI or CT
- Core needle biopsy and surgical resection
- Chest CT to rule out metastasis (or MRI for brain metastasis)
- Multidisciplinary sarcoma team referral
What is the incubation period for erythema infectiosum?
7-14 days
What is the incubation period of Rubella?
12-23 days
What is the incubation period of hand, foot and mouth?
3-5 days
What is the incubation period of varicella?
10-21 days
What is the incubation period of roseola infantum?
9-10 days
What populations should an individual infected with Herpes Zoster avoid?
- Pregnant women
- Infants
- Immunocompromised
How does measles most commonly result in death in children?
Pneumonia
What is the histology of molluscum contagiosum?
Eosinophilic cytoplasmic inclusion bodies
