Dermatologic Disorders and Communicable Diseases Flashcards
Coxsackie Virus
Hand-Foot-Mouth Disease:
highly contagious viral illness resulting in ulceration and inflammation of the soft palate and exanthema on hands and feet
S/Sx of coxsackie virus
fever malaise vomiting drooling papulovesicular rash
What is the management of coxsackie virus?
acetaminophen
possible topical applications
Rubeola AKA
ordinary measles or red measles that can occur at any age
Rubeola s/sx
VIRUS that leads to fever: fever runny nose cough red eyes spreading skin rash koplik's spots
What are koplik’s spots?
small, white, granular spots surrounded by red rings found inside the mouth–particularly on the inside of the cheek opposite the first and second molars
Rubella AKA
3 day measles or german measles that can occur at any age
Rubella s/sx
erythematous maculopapular rash
starts on face and spreads to extremities and trunk
gone in 72 hours
associated malaise
joint pain
postauricular and suboccipital lymphadenopathy
What is one consideration to remember with rubella?
it is teratogenicity
Roseola Infantum AKA
sixth disease in 6 months to 2 year olds (rare after 4 years)
What causes roseola infants?
Herpesvirus 6
What are the s/sx of roseola infantum?
URI symptoms
small pink, flat to raised bumps that start on trunk then move to extremities
High fever for 8 days with an abrupt end when rash develops
possible seizures associated with fever
Erythema Infectiosum AKA
fifth disease in 5-14 years olds
What causes erythema infectiosum?
human parvovirus B19
What are the s/sx of erythema infectiosum?
slapped cheek appearance
lacy reticular exanthem
face then arms, legs, trunk and dorsum of hands/feet
rash can last up to 40 days–average of 1.5 weeks
can cause fatal aplastic crisis and arthralgias
What are the laboratory tests to check for erythema infectiosum?
Parvovirus B19 IgM, IgG
What are special considerations of erythema infectiosum?
patient education–intrauterine infection can produce fatal anemia
If a pregnant woman is exposed, may need immunoglobulin
Infectiosum erythema is not contagious once the fever breaks
What is lyme disease?
Most common vector-borne disease in the US–mice and deer ticks are the major animal reservoirs, but birds may also be a source
Birrelia burgdorferi (spirochete) Ticks must feed for more than 24 to 26 hours to transmit infecting organism
What is stage 1 of lyme disease?
erythema migrants: a flat or slightly raised red lesion that expands over several days but has central clearing–most commonly appears in areas of tight clothing–looks like a target, concentric circles
50% of pts have flu like symptoms
What is stage 2 of lyme disease?
Headache, stiff joints migratory pains cardiac symptoms--dysrhythmias, heart block aseptic meningitis bell's palsy peripheral neuropathy
What is stage 3 of lyme disease?
joint and periarticular pain
subacute encephalopathy
acrodermatitis chronicum atrophicans: bluish red discoloration of the distal extremity with edema–localized DIC coagulation problem
How do you screen/dx lyme disease?
detection of antibody to b. burgdorferi via ELISA screening
western blot assay is confirmatory
elevated ESR
What are the diagnostic criteria of lyme disease?
Exposure to tick habitat within the last 30 days with:
erythema migrans or:
one late manifestation and:
laboratory confirmation
How to manage lyme disease?
7 yrs old: doxycycline
refer for stage 2 and 3
let health dept know
What is scabies?
skin infestation caused by a parasitic mite that burrows in startup corneum requiring
spread through the direct or indirect contact with personal items
Signs and symptoms of scabies
intense itching
irritability in infants
linear or curved burrows (snake like)
infants: red-brown vesiculopapular lesions on head, neck, palms, or soles
older children: red papillose on skin folds, umbilicus or abdomen
may see regional adenopahty
What is the management of scabies?
permethrin (nix) 5% rinse (1st treatment leave on for 8-14 hours), repeat in one week, OR:
ivermectin (not used if mother is pregnant, lactating or for children under 15 kg)
can give antihistamines for pruritus
What is impetigo?
a bacterial infection of the skin typically caused by gram positive strep or staph (staph aureus)
involves the face mostly, but can occur anywhere
occurs most often in summer–very contagious
S/sx of impetigo
signs of inflammation
pain, swelling, warmth
regional lymphadenopaty
HONEY, CRUSTING LESIONS
Treatment of impetigo
topical antimicrobials for minor infections (bacitracin, bactroban)
Use the oral lactase resistant antibiotics when oral route is preferred:
dicloxacillin, cephalexin, erythromycin (will treat staph and strep)
severe cellulitis: IV antibiotics–vanco, nafcillin, doxycycline
abstain from school and community until 48 hrs after treatment
apply burrow’s solution to clean lesions
Psoraisis
inflammatory skin disorder based on genetic predisposition in which the epidermal turnover is reduced from 14 days to 2 days. Normal maturation of skin cells cannot take place, and keratinization is faulty and epidermis is thickened
Signs and symptoms of psoraisis
can be asymptomatic
itching possible
lesions are red, sharply defined plaques with silvery scales
scalp, elbows, knees, palms, soles, and nails are common sites
fine pitting of the nails is strongly suggestive of psoriasis–as is separation of nail plate from bed
pink or red line in intergluteal fold
auspitz’s sign
What is auspitz’s sign?
drops of blood appear when scales are removed in someone with psoraisis
What is the treatment for psoriasis?
topicals for scalp: tar/salicyclic acid shampoo, topical steroid oil
Topical steroids for skin: 2x/day for 2-3 weeks, resume with calcipotriene, a synthetic vit B3 derivative, betamethasone or triamcinolone
Use UVB light and coal tar exposure if more than 30% of body surface is involved
moisturizer
What is pityriasis rosea?
mild, acute inflammatory disorder, which is self-limiting and can last 3-8 weeks
more common in spring/fall and pts typically have a URI prior
more common in females
Signs and symptoms of pityriasis rosea?
possibly asymptomatic
initial lesion (herald patch) is 2-10 cm–usually macular, oval, and fawn color with a crinkled appearance and collarette scale
**if on palms of hand, genitals, or mouth–think syphilis
pruritic rash in a christmas tree pattern may be found on turn and proximal extremities within 1-2 weeks–follows ripples on back
Management of pityriasis rosea?
possibly check for syphillis
if itching: ataraxic, oral antihistamines, topical antipuritic, cool compresses, topical steroids (triamcinolone)
daily sunlight exposure will hasten healing–UVB x1 week
oral erythromycin x2week is very effective
Irritant dermatitis
diaper rash–peaks at 9-12 months
Allergic contact dermatitis s/sx
redness, pruritus, scabbing
tiny vesicles and weepy, encrusted lesions in acute phases
scaling, erythema and thickened skin in chronic phase
location will suggest cause
affected areas hot and swollen
history of exposure
If severe allergic contact dermatitis what is the treatment
prednisone starting at 60 mg daily and tapering over 14 days
Atopic dermatitis
Eczema–sensitive to low humidity and worse in winter when air is dry
Signs and symptoms of atopic dermatitis
intense pruritis along face, neck, trunk, wrists, hands, antecubital, and popliteal folds
dray scaly skin
Diagnostics for eczema
RAST test–or skin tests whence may suggest dust mite allergy
serum IgE
eosinophilia may be present
Management of eczema
hallmark treatment: moisturizing lotion immediately after bathing–must blot dry
topical steroids applied 2-4x daily and rubbed in well
systemic steroids in severe cases: prednisone 40 mg daily, taper over 5-7 days
In acute weeping: use saline or aluminum sub acetate solution and colloidal oatmeal baths
Molluscum Contagiosum
pink to flesh-colored discrete papules, which become umbilicated papillose with a cheesy core
Varicella Zoster Virus
Chickenpox
caused by herpes virus and transmitted by direct contact with lesions or airborne
infected individuals are contagious for 48 hours before outbreak and until lesions have crusted over
most common in ages 5-10
S/sx of varicella zoster
erythematous merciless papules develop over merciless vesicles erupt--usually distributes initially on trunk, then scalp, then face intense pruritus low grade fever generalized lymphadenopathy
Treatment for varicella zoster
calamine/caladryl lotion
antihistamine
acetaminophen
Oral acyclovir 20 mg/kg x 5 days–given in first 24 hours can reduce the magnitude and duration
Tinea capitus
fungal infection of scalp
Tinea cruris
jock itch
Tinea corporis
body ringworm
Tinea manumm and tinea pedis
athlete’s foot
Tine versicolor
hypo/hyperpigmentation macules on limbs
Fungal infection under a microscope
spaghetti and meatballs hyphae microscopically when treated with KOH
Treatment of fungal infections
primary treatment: griseofulvin 20 mg/kg/day x 6 weeks
topical typically work for tinea carpers
For tinea versicolor: use selenium sulfide shampoo for 5-15 minutes daily x7 days; 200 mg itraconazle every day by mouth as an alternative
What do you need to be worried about with antifungals?
liver function
First degree burn
dry, red, no blisters involves epidermis only
2nd degree burn
partial thickness, moist, blisters, extends beyond dermis
3rd degree burn
full thickness–dry leathery, black, pearly, waxy, extends from epidermis to dermis to underlying tissues, fat, muscles, and or bone
Rule of 9s for adult and child:
Adult:
head, each arm: 9%
genitals: 1%
each leg, front, back: 18%
Child:
Head, front, back: 18%
each arm: 9%
each leg: 14%
Macule
a flat discoloration
Patch
a flat discoloration that looks as though it is a collection of multiple, tiny pigment changes; may be some subtle surface change
Papule
a small (
Nodule
an elevated, firm lesion >1 cm (big papule)
Tumor
a firm, elevated lump
Wheal
a lesion raised above the surface and extending a bit below the epidermis; many times an allergic reaction (either contact or systemic)
Plague
a scaly, elevated lesion–classic lesion of psoriasis
vesicle
a small (
bulla
serous fluid-filled vesicles >1 cm
pustule
a small (
abscess
a pus-filled lesion (>1 cm)
cyst
large, raised lesions filled with serous fluid, blood and pus
solitary or discrete configuration
individual or distinct lesions that remain separate
grouped configuration
linear cluster
confluent configuration
lesions that run together
linear configuration
scratch, streak, line or stripe
annular configuration
circular, beginning in the center and spreading to the periphery
polycyclic configuration
annular lesions merge
Open comdeone
blackheads; opening in the skin capped with blackened mass of skin debris
Closed comdeone
whiteheads; obstructed opening which may rupture, casing low-grade local inflammatory recation
Pharmacologic mild acne treatment
topical treatment with benzoyl peroxide, if not responsive–retinoic acid cream (pregnancy category C)
retinoin (only applied at night and not used concomitantly with benzoyl)
salicylic acid preparations
topical antibiotics (erythromycin or clindamycin)
Pharmacologic treatment for moderate acne
systemic along with topical treatments:
doxycycline (100 mg 2x daily)
erythromycin (1 gram in 2 to 3 divided doses)
minocycline (50-100 mg twice daily)
**tetracycline: can damage enamel of teeth, so don’t give before age 12)
