Dermatology (15%) Flashcards

Question

# Atopic Dermatitis / Eczema Management

Answer 1

* **First line** = **topical steroids** (triamcinolone or hydrocortisone) q1-2x daily for x7d during flares + PO antihistamines (itching) * Second line = topical calcineurin inhibitors (tacrolimus) * Adjunct / Third line = systemic therapy (UVA / UVB, PO cyclosporine, mycophenolate, methotrexate) * **Lifestyle changes** = avoid products with alcohol / fragrances / astringents, pat skin dry (do not rub) and frequently use bland lubricant after shower (aquaphor or vaseline)

Answer 2

* patho is not fully understood; ? increased sebaceous fland activity + hypersensitivity reaction to Malassezia furfur * most common in **men** * worse in patients with parkinson's and HIV * worse during fall / winter and with stress

Answer 3

* erythematous plaques w/ fine white scales & greasy appearance * Common in areas w/ high sebaceous gland secretion; scalp, eyelids, beard, nasolabial folds, chest, groin * +/- burning and pruritis

Answer 4

* clinical BUT can consider swab culture to r/o bacterial or candidal infection

Answer 5

* **Mild** = topical selenium sulfate / zinc pyrithione / ketoconazole / low potency steroid / sodium sulfacetamide * **Severe or resistant** = PO antifungals (fluconazole, ketoconazole, terbinafine)

Answer 6

* Infants = bathing-related scalds, abuse * Toddlers = hot liquid spills * School-age = fire (playing with lighters/etc) * Adolescents = volatile agents, high-voltage electrical lines

Answer 7

* **Superficial 1st** = confined to epidermis, red and dry, tender to touch and blanches with pressure, heals in 3-6d without scarring * **Superficial parcial 2nd** = epidermis + papillary dermis, pink-red with weeping/moist and blistering, painful, blanches, heals in 7-21d no scarring +/- pigmentation changes * **Deep partial 2nd** = epidermis + reticular dermis, mottled color, wet / waxy with blistering, painful only to pressure, does NOT blanch, heals in 3-9 weeks WITH hypertrophic scarring * **Full 3rd** = epidermis + dermis (papillary / reticular) + subQ tissue, varies in color from waxy white to leathery gray or charred black, DRY and inelastic skin without blistering, minimal sensation or pain, does NOT blanch, requires surgical grafting * **4th degree** = down to fascia / muscle / bone, black and charred dry skin without blistering, NO sensation or pain, does NOT blanch, required surgery

Answer 8

* Use BSA calculations for determine severity and full care needed * anterior / posterior head = 9% each = 18% total * anterior / posterior torso = 18% each = 36% total * anterior / posterior arm = 4.5% each = 9% total * anterior / posterior leg = 7% each = 14% total * genitalia / perineum = 1% * LABS = aBG, CBC, CK, CMP, UA, carboxyhemoglobin

Answer 9

* **circumferential burns** = fasciotomy for compartment syndrome prevention * **Superficial and partial** = **wound care with topical abx** (bacitracin) and wound dressing (xeroform), daily dressing changes w/ 2d follow-up * **All other** = admission, **Fluid resuscitation** (parkland formula) + mIVF (4/2/1 rule), wound cares + **surgical grafting** ## Footnote Parkland = 3 mL x TBSA % x wt (kg) ; 50% of total given over 1st 8h, rest given over next 16hr 4/2/1 rule for calculating maintenance fluids = 4mL/hr for 1st 10kg + 2mL/hr 2nd 10 kg + 1mL/hr remaining kg = total rate for hour

Answer 10

* **> 10 % BSA** or ANY **deep partial** /** full-thickness** * burns to hand, face, feet, or genitalia / perineum * any electrical, chemical, or inhalation injury * **circumferential** burns, underlying chronic condition than can worsen outcome, abuse concerns ## Footnote *electrical = arrhthymia complication chemical = toxicity compliction inhalation = pulmonary / respiratory distress complication*

Answer 11

* type 4 hypersensitivity reaction of skin following infection or medication exposure * infections = HSV, M. pneumoniae, VZV, EBV, CMV, Coxsackie, Parvovirus B19 * medications = NSAIDs, sulfonamides, anticonvulsants, antibiotics * CLASSIC TARGET LESIONS ## Footnote *target lesions with THREE zones (central, white ring, red ring)*

Answer 12

* target lesions typically on extremities = dusky violaceous macule or blisters with ring of pallor and peripheral red ring * non-pruritic and blanches * NEGATIVE Nikolsky sign = no epidermal detachment when touching * ? Mucositis = mild and limited to one mucous membrane (usually oral)

Answer 13

* clinical diagnosis * Minor = mild mucositis and no systemic symptoms * Major = severe mucositis + systemic symptoms (fever, arthralgia)

Answer 14

* self-limited, treat the symptoms * bland emollients or topical abx + PO antihistamines * HSV related = PO Acyclovir

Answer 15

* rare hypersensitivity reactions affecting the skin AND mucosal membranes * Etiology = predominantly drug-related; penicillin, sulfonamides, allopurinol, NSAIDS, anticonvulstants * SJS = < 10% of BSA * SJS / TEN overlap = 10-30% BSA * TEN = > 30% BSA * ATYPICAL target lesions ## Footnote *two ringed lesion*

Answer 16

* **prodrome** = fever, malaise, pharyngitis, eye pain * **Cutaneous** = begins on torso / face and rapidly generalizes * **SJS** = atypical targetoid lesions +/- blisters and coalescence (face and torso) * **TEN** = ***tender*** erythematous patches / plaques that develop into large bullae that coalesce and rapidly slough → large denuded areas of skin * **POSITIVE** **Nikolsky** sign * **Ocular** = ***conjunctivitis***, eyelid edema, blepharitis, corneal erosions * **Mucositis** = ***OP***, conjunctival, urethral, genital, perirectal ## Footnote * Nikolsky = skin seperates from dermis with lateral pressure * OP = oropharyngeal

Answer 17

* clinical * Biopsy = full thickness skin necrosis (derm consult) * Consider = bacterial cultures and M. pneumoniae PCR * SJS more in kids vs TEN more in elderly

Answer 18

* Prompt STOP of all possible inciting meds * Underly infectious etiology? treat * Supportive = pain analgesia (morphine, tylenol, no NSAIDS), mIVF if nutrition support, body temp regulation * consider adding K or Phos to fluids (hypoK / NA / P often) * Wound care = leave bullae intact, petroleum gauze, topical abx * IVIg may stop progression * Close monitor for sepsis ## Footnote SIRS criteria: any 2+ of below * *fever ( > 100.4 / 38c) OR hypothermia ( < 96.8 / 36c)* * *HR > 90 bpm* * *RR > 20 or PaCO2 < 32 mmHg* * *WBC > 12k or < 4k* Sepsis criteria = SIRS + source of infection (*UTI, PNA, URI, cellulitis, pyelonephritis, appendicitis, etc*)

Answer 19

* medication induced changes in the skin and mucous membranes (most are hypersensitivity reactions) * self-limiting and improve with drug removal * typically starts 1-2 days after drug exposure BUT can take up to 2-3 weeks

Answer 20

* **Type 1** = IgE mediated, ***urticaria***, angioedema, ***immediate*** * **Type 2** = cytotoxic, antibody mediated, cell lysis * **Type 3** = immune ***antibody-antigen complex*** (drug-mediated vasculitis and drug serum sickness) * **Type 4** = ***delayed*** (cell-mediated), ***morbilliform*** reaction (erythema multiforme) * **Non-immunologic** = cutaneous drug reactions d/t*** genetic incapability*** to detoxify certain meds (anticonvulsants, sulfonamides) ## Footnote ****

Answer 21

* morbilliform or maculopapular drug eruption with macules or small papules s/p initiation of drug treatment * typically starts 5-14d after starting offending med * Type 4 delayed hypersensitivity reaction * MC drugs = aminopenicillins, sulfonamides, anticonvulsants (carbamazepine)

Answer 22

* latency onset period * erythematous macules or papules that are morbilliform (measles like) +/- rubelliform (rubella like) and usually on trunk / proximal extremities * mild = spares acral sites * sevre - involves face, palms, soles * Systemic symptoms usually mild = pruritis and low-grade fever

Answer 23

* clinical diagnosis * Labs = CBC w/ diff +/- urine eosinophil smear (mild eosinophila) * CRP / ESR likely elevated ## Footnote *consider kidney function in sicker kiddos, risk of AIN / ATN*

Answer 24

* stop offending med (recently started) * symptomatic = PO antihistamines (H1 blockers) * Severe = IV Methylprednisolone or Decadron (or PO steroids) ## Footnote * *2nd gen antihistamine choices = cetirizine, loratidine* * *1st gen (more sleepy / ADR) = diphenhydramine, hydroxyzine (good if anxious)*

Answer 25

* self-limited localized subQ (or submucosal) tissue swelling d/t extravassation of fluid into interstitium * affects mucosal tissue of face, lips, tongue, larynx, hands, feet, genitalia * onset in min-hours w/ spontaneous resolution in hours-days

Answer 26

* mast-cell (histamine) mediated (aka allergic reactions) = angioedema with urticaria, flushing, pruritis, bronchospasm +/- stridor, throat tightness, HOTN * bradykinin-mediated (aka ACEI-induced, hereditary) = angioedema w/o above symptoms ## Footnote *hereditary = C1 esterase inhibitor deficiency*

Answer 27

* if cause is unknown and there is no history to suggest external cause, consider C4 levels + C1 inhibitor antigenic level

Answer 28

* **Immediate** = ABC's → ***airway***, breathing, cardiac + first ***epi*** dose (consider IM vs racemic epi) * **Mast-cell mediated** = ***epi*** + decadron / prednisolone (***steroids***) + antihistamines (benadryl) * **Bradykinin-mediated** = C1 inhibitor concentrate, Ecallantide, Icatibant

Answer 29

* superficial skin edema d/t histamine-related increased vascular permeability * Type 1 (IgE) immediate hypersensitivity reaction * Patho = vasodilator release (histamine, bradykinin, PGs) form mast cells & basophils in the skin * Common triggers = food, meds, heat / cold, stress, insect bites, environmental allergens, infection * Chronic if > 6 weeks

Answer 30

* sudden onset **circumscribed hives / wheals** that are blanchable, raised, erythematous +/- coalesce * intense **pruritis** * usually **transient** and dissapear within 24hrs

Answer 31

* initial = PO antihistamine (1st gen vs 2nd gen) * Add on = H2 blocker if no response to H1 blockers (ie add Ranitidine) ## Footnote * *2nd gen antihistamine choices = cetirizine, loratidine* * *1st gen (more sleepy / ADR) = diphenhydramine, hydroxyzine (good if anxious)*

Answer 32

* distinct and ?** life-threatening** severe ADR characterized by → morbilliform **cutaneous** **eruption**, **fever**, LAD, thrombophilia, **heme** **abnormalities**, **multiorgan** involvement (usually hepatic transaminitis, thyroiditis, and/or renal AIN / ATN) * Patho = CD4 / CD8 T cell activation * most common ~2-6 weeks s/p medication initiation * Common meds = **anticonvulsants** ( !! phenobarbital, carbmazepine, phenytoin, lamotrigine), minocycline, **sulfa** **abx**

Answer 33

* Prodrome (2-3d before rash) = fever, pharyngitis, malaise * Skin = morbilliform exanthem w/ accentuation on face, upper trunk, and proximal extremities (may progress to erythroderma) * pruritis * facial edema (esp periorbital), LAD, mucosal involvement (cheilitis) * Organ involvement = heptitis, AIN, ATN, SOB, tachypnea, cough, thyroiditis, pancreatitis, etc

Answer 34

* graves (thyroiditis) * DM1 (pancreatitis)

Answer 35

* **Dx criteria** = acute onset exanthema w/ fever + drug reaction suspicion + hospitalization + LAD + involvement of 1+ organ, lymphopenia, lymphocytosis, eosinophilia > 10%, thrombocytopenia) * **CBC** = eosinophilia, thrombocytopenia, lymphocytosis, lymphopenia * **LFTs** = transaminitis (↑ ALT / AST / Alk phos) * **CMP** = ↑ Cr * ↑ LDH * **UA** = proteinuria, eosinophilic sediment +/- hematuria * Consider blood PCR = HHV6, HHV7, EBV, CMV * TFT at onset then again @ 6 weeks ## Footnote * *Thrombocytopenia = ↓ platelets* * *Lymphocytosis = ↑ WBC* * *Lymphopenia = ↓ WBC*

Answer 36

* **Derm consult!!!** * Identify and STOP causative medication * IV fluid replacement + electrolyte correction * **Mild** (mostly cutaneous) = topical corticosteroids (triamcinolone, hydrocortisone) + antihistamines for itching (atarax, diphenhydramine, loratidine) * **Systemic** = **IV** ***methylprednisolone*** or PO prednisone +/- IVIg or plasmapharesis

Answer 37

* measles virus (paramyxovirus family) * transmission via **respiratory** **droplets** or **contact** with **contaminated** **surface** * incubation 6-21 days * **vaccination** = MMR @ 12-15 months then again @ 4-6 years

Answer 38

* **Prodrome** = high fever and ***3 C's*** (*cough, coryza, conjunctivitis*) for 2-3 days * **Koplik spots** = small red spots w/ white centers on oral mucosa (rash usually then starts 1-2d later) * **Rash** = morbilliform rash with ***cephalocaudal progression*** (head down) that SPAREs palms/soles * rash fades in ~4 days * persistent cough for 10-14 days

Answer 39

* clinical diagonsis PLUS * measle-specific IgM antibodies and PCR ## Footnote *pregnant women usually get serum titer during gestation as screening measure*

Answer 40

* **supportive** = analgesia (tylenol / motrin), encourage PO hydration * kids can take** daily VitA** = can help boost immune response and decrease risk of complications * **Complications** = severe diarrhea most common, pneumonia, immune suppression for ~6 weeks (↑ AOM and bacterial PNA)

Answer 41

* group A strep * type 4 (delayed) hypersensitivity reaction to pyrogenic GAS strain (erythrogenic toxin A, B, C)

Answer 42

* **prodrome** = fever, chills, pharyngitis * **rash** = diffuse blanchable erythema with small papular elevations w/ ***sandpaper texture*** (starts @ axillae and spreads to trunk and extremities, sparing palms/soles) * ***flushed face with circumoral pallor & strawberry tongue*** * Pastia's lines = linea petechial lesions seen at pressure points, axillary, antecubital, abdominal, or inguinal areas

Answer 43

* clinical diagnosis +/- GABHS swab

Answer 44

* first line = penicillin G or amoxicillin * alternative = macrolides, clindamycin, cephalosporins

Answer 45

* etiology = GABHS * patho = type 4 delayed hypersensitivity rxn * S/S = prodromal URI, sandpaper rash in axillae/groin spread to trunk/extremities (no palms or soles) * "flushed face, circumoral pallor, strawberry tongue, sandpaper" * first line tx = amoxicillin

Answer 46

* rubella virus (togavirus family) * transmission via respiratory droplets * incubation period 14 days * TORCH infection! ## Footnote *congenital defects = teratogenic miscarriage 1st TM, deafness, cataracts / blindness, congenital heart defects (PDA)*

Answer 47

* prodromal flu sx's (mild fever), **arthraligia**, **postauricular LAD** * rash = erythematous **maculopapular** rash with **cephalocaudal** **spread** (face down), sparing palms and soles * **rash spreads fast** and resolves within 3 days * **Forchheimer spots** = pinpoint red petechiae on soft palate and uvula

Answer 48

* clinical diagnosis BUT = rubella-specific IgM Ab via EIA ## Footnote *moms are screened via serum IgM Ab titer during gestation*

Answer 49

* **Supportive cares** = analgesia (tylenol / motrin), encourage PO hydration * exposure? IVIg * **Vaccination**!! MMR @ 12-15 months and 4-6 years * **Complications mainly fetal** = teratogenic, deagness, blindness, CHD (PDA)

Answer 50

* rubella virus (togavirus family) * prodromal flu sx's with mild fever, **arthralgia**, **LAD** * **maculopapular** **cephalocaudal** **spread** rash with **rapid** resolution (3 days) * look in mouth = forchheimer spots * clinical diagnosis vs IgM Ab titer * supportive cares + vaccination * **TORCH** = deaf, blind, CHD

Answer 51

* parvovirus b19 = infects and destroys reticulocytes → slowed erythropoiesis * transmission via droplets * incubation period 4-14d

Answer 52

* **prodromal flu sx's** (mild fever, HA, malaise) followed by rash within few days * rash = **"slapped cheek" rash** sparing palms and soles, spreads to lacy reticular pattern on limbs * **arthritis / arthralgia** common complaint!!

Answer 53

* clinical BUT = parvovirus b19-specific IgM antibody titer

Answer 54

* supportive = tylenol and motrin * complications = hydrops fetalis (if pregnant), aplastic sickle cell crisis

Answer 55

* parvovirus b19 * slapped cheek rash with lacy pattern on limbs * arthalgia / joint pain * supportive cares * aplastic sickle cell crisis d/t destruction of reticulocytes

Answer 56

* **HHV6** (sometimes HHV7) * **droplet** tansmission, saliva * incubation period 10 days * MC in kiddos **6 month - 2 years** * abrupt fever onset!

Answer 57

* prodromal **2-3d of high fever** (kiddo may look good, fever can reach >104) * Rash = **pink maculopapular** blanchable rash **starting on TRUNK** then spreading to face * only viral exanthem with rash STARTING on trunk

Answer 58

* Clinical diagnosis + viral culture/PCR confirmation * also serum IgG antibody titer against HHV 6/7

Answer 59

* Supportive = rest, fluids, antipyretics for high fevers (tylenol q6h) * Immunocompromised = antivirals (ganciclovir) * Complications = febrile seizures!

Answer 60

* HHV 6/7 in kids 6m-2y * high fevers then rash on trunk * viral PCR or serum IgG antibody titer * supportive care * febrile seizure caution

Answer 61

* **coxsackie virus A** * transmission WIDE = person-person, droplet, feces, direct contact with contaminated surface * MC in **kiddos < 5 years** * MC in **summer / early fall!** ## Footnote *think through why this time period so common = kiddos play outside, less clothing, more contact with other kids / people, playing in parks / outdoors / on shared things*

Answer 62

* prodromal flu-like symptoms +/- oral pain followed by rash * rash = painful oral vesicles / uclers followed by vesicles on hands / feet * rash usually clears within 10 days

Answer 63

* clinical BUT = viral culture / PCR throat swab OR stool sample * Serum Coxsackie-specific IgA

Answer 64

* supportive = tylenol and motrin, hydration, topical lidocaine or lidocaine mouthwash * self-resolves in ~1-2 weeks * complications = aseptic meningitis, Guillain-barre syndrome ## Footnote ***Guillain-Barre*** = *rare neurological disorder in which a person's immune system mistakenly attacks part of their peripheral nervous system following viral/bacterial infection, starts with paresthesias in hands/feet then spreads to entire limbs / paralysis*

Answer 65

* coxsackie A virus that is HIGHLY contagious * kiddos < 5yr and summer / fall * prodrome flu sx's with oral pain then vesicles in/on mouth, feet, hands resolving within 10d * Guillain-barre and aseptic meningitis risk

Answer 66

* coxsackie virus (esp. type A) * MC in kids 3-10 yrs * MC in summer / early fall

Answer 67

* **sudden onset high fever** * **stomatitis** = small yellow/white papulovesicular lesions on posterior pharynx that ULCERATE before healing * **anorexia d/t oral pain** * pharyngitis / odynophagia * no sores on hands or feet!!! * older kids = malaise, HA, N/V, neck stiffness, back stiffness

Answer 68

* clinical +/- serum IgA titer +/- viral PCR

Answer 69

* supportive = tylenol / motrin, PO hydration, rest * consider lidocaine gargle * complications = aseptic meningitis, Guillain-Barre syndrome

Answer 70

* Coxsackie virus (usually A) * kids 3-10 years * HIGH fever with stomatitis and anorexia d/t oral pain * supportive cares * Guillain-Barre and Meningitis risk

Answer 71

* paramyxovirus * transmission via droplets, saliva, & household fomites * incubation period 12-14 days * vaccination!! 12-15 months then 4-6 years

Answer 72

* prodromal low-grade fever, fatigue, myalgia, malaisesa, HA, earache * parotitis = parotid gland swelling / pain (usually bilateral) * check for orchitis in males * PE = parotid gland swelling & tenderness

Answer 73

* clinical diagnosis * if really sick, consider = amylase and CBC w/ diff = ↑ amylase, leukopenia (low WBC) with ↑ lymphocytes

Answer 74

* supportive cares = tylenol, motrin, hydration * complications = epididymo-orchitis common

Answer 75

* paramyxovirus * 12-14d incubation * prodromal low-grade fever, malaise, HA, earache * bilateral parotitis +/- orchitis in males * clinical diagnosis * supportive cares

Answer 76

* 2 distinct diseases = primary chickenpox / varicells & reactivated herpes zoster / shingles * transmission via aerosolized droplets, direct contact with vesicular fluid * incubation 14-21 days * stays dormant (latent stage) in trigeminal ganglion and dorsal root ganglia = virus reactivation years later (aging, stress, immune suppression) ## Footnote * ***VZV vaccination** @ 12-15 months AND 4-6 years* * ***Shingles / recombinant vaccine** in pts > 50yrs (2 doses 6 months apart)*

Answer 77

* "**dew drops on a rose petal**" = varying macules, papules, vesicles with pustular component followed by crusted papules and crusting * other **prodromal sx's** = fever, malaise, anorexia, pharngitis = rash within 24 hrs * **pruritic**!!! * crusts fall off within 1-2 weeks leaving hypopigmentation

Answer 78

* prodromal **pain, itching, burning, tingling** (this is where rash will develop) * **rash** = single stripe of vesicles (**single dermatome**) that DOES NOT cross midline * usually resolves within 1 month BUT **pain can last > 90 days** (post-herpetic neuralgia) * **Zoster opthalmicus** = involves ophthalmic dibision of trigeminal nerve (5) = eye pain, rednes, swelling + fever + painful vesicular ash * **Zoster Oticus** (Ramsay-Hunt Syndrome) = facial nerve (8) involvement = otalgia, lesions on ear / auditory canal / TM, facial palsy, hearing loss

Answer 79

* clinical diagnosis, BUT = PCR or viral DNA, confirmatory blood IgM antibody * **Tzanck smear** = "multinucleated giant cells" * Zoster ophthalmicus = dendritic lesions on slit lamp IF keratoconjunctivitis present

Answer 80

* self-limiting **resolution within 1 week** * **ISOLATION** d/t high contagiousness * **healthy kids < 12** = supportive cares (No NSAIDS or ASA!!!) * **kids > 13y & unvaccination / immune** = PO antivirals (Acyclovir $ vs Valacyclovir $$$) * Consider VZV IgG (VZIG) therapy in sick / at risk kids ## Footnote *no NSAIDS/ASA d/t risk of Reye syndrome*

Answer 81

* rash resolves within 1 month but pain can last > 90 days * **PO Acyclovir within 72h onset** (prevents postherpetic neuralgia) * **Zoster ophthalmicus** = PO antivirals +/- acyclovir eye drops * **Ramsay-Hunt** = PO acyclovir and corticosteroids * **Postherptic neuralgia** = PO **gabapentin** or Capsaicin * Vaccination!!! shingles in pts > 50yrs (2 doses 6 months apart)

Answer 82

* **highly contagious** superficial vesiculopustular skin infection = ***S. aureus or GABHS*** * single **MOST COMMON skin infection in kids ** * highest incidence **2-6yrs** * RF = poor hygiene, **poverty**, **crowding**, warm / humid weather (less clothes to cover skin), skin trauma * **Complications** = cellulitis (10%), acute glomerulonephritis * does NOT lead to rheumatic fever

Answer 83

**Non-bullous** (MC type) = vesicles / pustules, weeping, "***honey-colored crust***", occurs at site of skin trauma (insect bites MC) * around mouth/nose, associated LAD **Bullous** = vesicules then bullae, varnish-like crust, more rare * fever, diarrhea, S. aureus only etiology **Ecthyma** = ulcerative pyoderma caused by GABHS (not common), scarring

Answer 84

* clinical diagnosis BUT = lesion swab culture with gram stain

Answer 85

**Mild** = ***topical Mupirocin TID x 10 days*** * or; bacitracin or retapamulin * keep area clean (mild soap/water) **Extensive** = ***PO Cephalexin*** or Erythromycin x 1 week * or; Macrolide abx MRSA complication = PO Doxy OR IV Vanco if quite sick

Answer 86

* S. aureus or GABHS * highly contagious common in kids 2-6 yrs (esp. in crowding, poverty, hot/humid weather) * Cellulitis common complication * S/S = weeping honey crusted lesions MC at sites of trauma (bug bites) and around mouth / nose with LAD * Diarrhea ? bullous, S. aureus * Can confirm with lesion culture / gram stain * Mild = topical mupirocin x 10 days * Extensive = PO Cephalexin * MRSA = Doxy or Vanco

Answer 87

* highly contagious skininfection d/t mite Sarcoptes scabiei * patho = female mites burrow into skin to lay eggs, feed, and defecate ## Footnote *fecal particles (scybala) are what cause the hypersensitivity reaction and itching*

Answer 88

Symptoms * intense pruritis worse at night * can be asymptomatic but infected for up to 4-6 weeks Exam * multiple small erythematous papules / excorations with linear burrows @ intertriginous zones (scalp, web spaces) * red itchy pruritic papules or nodules on scrotum, glans, penile shaft, or body folds

Answer 89

* clinical +/- skin scrapings = mites, eggs, feces (on magnification)

Answer 90

* **Topical Permethrin** DOC (do not use after showers = seizures d/t increased absorption through pores) * **Extensive** = **Ivermectin** * All bedding, clothing, etc should be placed in plastic air tight bags for AT LEAST 72-92 hours then washed and dried with high heat

Answer 91

* Sarcoptes scabiei females leave poop under skin causing hypersentivity itching * pruritis worse at night * skin burrows found in intertriginous zones * skin scraping = mites, eggs, feces * Topical Permethrin (seizure risk) or Ivermectin (extensive)

Answer 92

* pubis = pubic / genitalia area, STI, pruritis, topical permethrin * capitis = head lice, person to person, girls more common, 3-12 years, intense occipital itching, topical permethrin or Lindane (neurotoxic) * corporis = body lice, STI, poor body hygiene, vector for human blood disease person to person, pruritis, first line hygiene then permethrin 5% cream

Answer 93

* acute or chronic inflammatory dermatitis * cell-mediated immune response * increased incidence in = hepatitis C * "purple polygonal planar pruritic papules or plaquestion"

Answer 94

* pruritic rash MC on extremities (esp volar surfaces of wrist / ankles) * can involve mouth, scalp, genitals, nails, mucous membranes Exam * 5 P's = purple, polygonal, planar, pruritic, papules OR plaques * fine scales with irregular borders +/- Wickham striae * Koebner's phenomenon! * ? nail dystrophy +/- scarring alopecia ## Footnote * ***Wickham** **striae** = fine white lines on skin lesions or oral mucosa* * ***Koebner**'**s** = new lesions @ site of trauma (shins common)*

Answer 95

* clinical +/-** skin biopsy & immunofluorescence confirmatory** = ***saw-tooth lymphocyte infiltrate*** at dermal epidermal junction

Answer 96

* **First line** = ***topical steroids*** w/ occlusive dressings * antihistamines for itching * Second line = PO or intralesional steroids +/- topical tretinoin +/- UV light therapy * resolves spontaneously within 8-12 months

Answer 97

* cell-mediated immune response * pruritis * 5 P's = polygonal, planar, purple, pruritic, papules OR plaques * Wickham striae +/- koebner's * confirmatory biopsy and immunofluoresence (saw-tooth lymphocyte) * first line tx = topical steroids and PO antihistamines * resolves in 8-12 months

Answer 98

* unclear etiology but ? HHV6/7 * primarily in older kids / young adults * more common in spring / fall

Answer 99

* **herald patch** = solitary salmon-colored macule on trunk (2-6mm) * 1-2 weeks later = general exanthem with smaller pruritic 1cm round/oval salmon-colored papules w/ white collarette scaling * **christmas tree pattern**!! * confined to trunk and proximal extremities

Answer 100

* dissemination of S. aureus exfoliative toxins (esp strains 55 & 71) * Patho = toxins cleave desmoglein-1 = formation of flaccid fragile bullae * common in infants 3-7d OR children < 5 years

Answer 101

**Erythema phase** * ***fever***, irritability, skin tenderness, then; * ***cutananeous blanching erythema*** (usually *starts @ mouth*); worse in flexor areas & around orifices **Bullae phase** * sterile flaccid blisters 1-2d after erythema (esp in areas of mechanical stress = flexural, buttocks, hands, feet) * ***(+) Nikolsky*** sign!! **Desquamative phase** * skin that easily ruptures = denuded skin before healing * +/- conjunctivitis

Answer 102

* clinical but = skin biopsy, NP cultures, lesion cultures * Skin biopsy = splitting of lower stratum granulosum layer

Answer 103

* **Nafcillin** or **Oxacillin** * MRSA concern = IV Vancomycin * Supportive cares = keep skin clear and moist, emollients for barrier protection, encourage hydration * NO STEROIDS (can make worse)

Answer 104

**Tinea capitis = "ring worm"** * scalp, trichophyton, patches of alopecia w/ black dots OR scaly patches with varying alopecia, diagnosed KOH prep and definitive culture * tx via*** PO Griseofulvin x6-12 weeks*** (or PO Terbinafine) **Tinea pedis = "athlete's foot"** * common in ***young men***, ***dermatophyte infection***, ***interdigital*** itching and erythema with erosions or scaling, diagnosed via KOH prep and culture * tx via ***topical antifungal*** (butenafine or clotrimazole) ***x4 weeks*** * PO terbinafine or fluconazole if refractory **Tinea cruris = "jock itch"** * ***trichophyton T. rubrum fungal infection of groin*** / inner thights, common in males w/ copious sweating or close contact sports (wrestlers) * can ***spread from tinea pedis*** * diagnosed via KOH prep and definitive fungal culture * tx via ***topical clotrimazole and dessicant powders*** to area **Tinea corporis = "ringworm"** * ***trichophyton & microsporum genera*** (T. rubrum) fungal infection of body (trunk, legs, arms, neck, chest) * direct contact, risk if stray animal exposure * ***circular or oval plaques/patches with central clearing*** and well-defined raised borders * tx via ***topical clotrimazole or ketoconazole x1-3 weeks*** **Tinea (Pityriasis) veriscolor** * ***Malsassezia furfu***r yeast / fungal infection MC in adolescents * RF = hot humid weather * ***hyper/hypopigmented*** well-demarcated round/oval patches with fine scaling MC on upper trunk / proximal extremities * diagnosis via KOH prep (*spaghetti and meatballs*) and wood's lamp (yellow-green fluorescence) * tx via ***topical selenium sulfide or zinc pyrithion***

Answer 105

* immune-mediated multisystemic disease * Patho = keratin hyperplasia and proliferation @ stratum basale / spinosum d/t T cell activation & cytokine release * plaque is MC type * associated with arthritis and increased risk for CVD (plaque formation)

Answer 106

**Plaque** * well-demarcated pink-red plaques/papules w/ ***thick silvery-white scales*** * ***extensor*** surfaes (elbows, knees, scalop, nape of neck) * ***pruritic*** **Exam** * ***Auspitz*** sign = punctate bleeding w/ removal of plaque or scale * Koebner's = lesions at sign of trauma * ***Nails*** = pitting, onycholysis **Other variants** * Guttate = small erythematous "tear drop" papules w/ fine scales, discrete lesions, and confluent plaques, often s/p strep pharyngitis * Pustular = deep yellow pustules that coalesce to large areas of pus + fever, leukocytosis * Erythroderma = generalized erythematous rash involving most of skin (worst type)

Answer 107

* clinical diagnosis * first line = topical steroids and vitD analogs (calcipotriene) * moderate/severe = topical steroids PLUS UVA/B phototherapy PLUS PO Psoralen * severe = PO systemic (cyclosporine, acitretin, biologic agents adalimumab) ## Footnote *methotrexate usually last resort*

Answer 108

* common in first 72hrs of life, can be present at birth * higher incidence in neonates with LGA or greater gestational age * basically skin reaction to new outside world

Answer 109

* multiple erythematous macules / papules that rapidly progress to pustules on erythematous base * MC on trunk and proximal extremities * SPARES palms/soles

Answer 110

* clinical diagnosis usually without any testing * can consider Wright-stain smear if concerned = eosinophils

Answer 111

* no treatment required * resolves spontaneously in 5-7d

Answer 112

* mostly affects full-term black infants * 3 types of lesions that present @ birth and resolve over several weeks to months ## Footnote *need to look up why more frequent in black infants?*

Answer 113

* Small pustules on non-erythematous base @ birth * erythematous to hyperpigmented macules with surrounding collarette of scale +/- pustules (can persist for weeks to months) * hyperpigmented macules that gradually fade over months

Answer 114

* clinical diagnosis so no testing necessary * can consider wright-stain smear = neutrophils

Answer 115

none needed :) ## Footnote *can discuss skin care with parents, bland emollients*