Dermatology Flashcards
Causes of erythema multi forms
Infection: 90%
- mycoplasma
-HSV
Drugs 10%
- NSAIDs
- abx: sulphonamides
- anti-epileptics
Description of erythema multiforme
Target lesions
Raised plaques
Confluent
Erythema
Describe herpes zoster opthalmicus
Vesicular
Small lesions
Dermatomal over V1
Erythematous
Unilateral
5 complications of herpes zoster opthalmicus
Eye: keratitis, uveitis, acute glucoma
Optic neuritis
Progressive outer retinal necrosis
Disseminated herpes zoster
Meninigoencephalitis
Ramsey hunt syndrome
Blindness
Heretic ulcers
Post herpetic neuralgia
Social/ employment complications
Analgesia dependent
Who requires admission for herpes zoster opthalmicus
Severe ocular involvement - globe
Pain requiring IV opiates
Systemically unwell
Immunocompromised
Blistering skin eruptions ddx
Erythema Miltiforme
Ten/SJS
Toxic shock syndrome
Staph scalded skin syndrome
Bullous Pemphigoid
Pemphigus vulgaris
Sunburn
Kawasaki
Insect bite
Impetigo
Drug reaction
Vesicular lesions
Primary varicella
HSV oral, genital, whitlow eczema
Hand foot and mouth cocksackie
Allergic and contact dermatitis
Maculopapular rashes
Viral exanthum
Erythema infectiousum
Roseola
Measles
Rubella
Infantile
Kawasaki
Scarlet fever
drug reaction dress
Petechial rash
cutaneous: trauma/ steroid use
Systemic: uraemic von wile brand disease
Infectious: meningococcal, influenza; haemophilia, streptococcus
Thrombocytopenia: itp, ttp, hITS, DIC, liver failure
Vasuclitis: hsp, Kawasaki chrug stras
Coughing, vomiting
Definition
Macular
Patch
Papule
Nodule
Petechiae
Pupura
Macular: flat discloration <10mm,
Patch: flat discolouration A>10mm
Papule raised <10mm
Nodule raised <10mm
Petechiae <3mm
Pupura >3mm
Diagnosis of Kawasaki
Crash and burn
Fever >5/7
4/5 criteria
1. Conjunctivitis, bilateral bulbar
2. Rash- polymorphous rash
3. Adenopathy, >1.5cm in cervical region
4. Strawberry tongue, mouth, mucosal involvement
5. Hand and feet hyperaemia, desquamatisation
Incomplete Kawasaki
Fever 5/7
And 2/3. Criteria
Or <6m and fever for 7 days unexplained
Ix Kawasaki
Fbc, crp, esr
Lfts, albumin alt
UA
Echo: coronary A aneurysm
Asot / anti dnase scarlet fever
Tx Kawasaki
Aspirin 5mg/kg
IVIG 2g/kg 10 days - prevent coronary artery aneurysm
Echo Kawasaki when
Diagnosis
2 weeks and 6 weeks
What is most common vasculitis in children
Henoch Schlein Pupura
IgA vaculitis
2-8 year olds
Henoch Schlein Pupura
IgA vaculitis
Age
Symptoms
Age 2-8 year olds
Symptoms
- palpable Pupura: lower limbs
- renal involvement: 25% Haematuria, proteinuria
- abdominal pain heme positive stool
Investigation and follow up hsp
Urinalysis and BP
Renal function
Weekly 1 month
Fortnightly 1 m
6 and 12m
Complications HSP
Interception and perforation
Renal failure
Erythema nodosum
Causes
Idiopathic
Infections: HSV, HIV, hepatitis, EBV,
Bacterial: streptococcal, TB, Yesenia
Drugs: sulfonamides, OCP, sulphonyureas
Inflammatory: sarcoidosis, IBD, bacterial, sle
Malignancy: lymphoma, leukaemia
Pregnancy
What is erythema nodosum symptoms
Tender nodules eryhematous, bilateral, subcutaneous nodules
Most: LL, ankles
Symmetrical pre tubial is most common
Tender nodule
Poor margins
1 week hard
2nd fluctuat
Lesions last 2 weeks
Arthralgia 90%
Biopsy of erythema nodusum
Michener granuloma
Treatment of erythema nodosum
Treat cause
Cease drugs
NSAIDs
Steroids
Follow up derm/ rheum
TeN// SJS different
SJS: <10%
SJS/ TEN 10-30%
TEN >30%
Severe cutaneous condition
Extreme necrosis and
Detachment of epidermis
Nikolsy sign
When pressure on skin leads to lateral expansion and detachment of the epidermis
Causes of SJS/ TEN
Drugs
1. ABX: penicillins, sulphonamides,
2. Anticonvulsants: carbamazapine, keepra
3. NSAIDs
Other
4. Malignancy
5. Infections: mycoplasma, hsv, hiv
6 autoimmune: sle
Erythema multi form
Minor and major
Minor - no mucous membrane involvement
Major - mucous membrane involvement less then 2
SJS/ ten - >2 mucous membrane
Staph scalded skin syndrome - nil
Complication of SJS/ ten
Fluid and electrolytes
Hypothermia
Pain
secondary bacterial infections
Sepsis
Ards
Mof
Erythema mulifrome causes
Infection: hsv, mycoplasma, ebv, adenovirus
Drugs: penicillin, NSAIDs, sulfonamides
Malignant
Erythema multiforme rash
Target lesions: darker central zone, light pink, bright red
Erythematous macular
Base raised plaque
Lesions central sparing
Varying size
Limbs- proximally
Scroten score
Mortality
Age >40 = 1
Hear rate >120= 1
Cancer/ malignancy =1
Epidermal detachment >10% =1 on day one
Urea >10 =1
Glucose >14 =1
Baird -<20mmol = 1
0-1= 13%
2 = 12%
3= 35%
4 = 60%
5 = 90%
What type of sensitive reaction is scabies
Pathognomic rash
Treatment
Type 4
Linear burrows
Rash- small erythema is, Papule, hemorrhagic cysts
Tx/ permethion cream 5%
What is symptoms of bachets disease
- Relapsing uveitis
- Oral ulcers
- Genital ulcers
Vasculitis
Biggest risk factor of cellulitis
Lymphedema
Risk factors for cellulitis
Immunosupression
Diabetes
Immunodeficiency
Cancer
Venous stasis
Chronic liver disease
Peripheral arterial disease
Causes of urticaria
Drugs: penicillin, sulfa, aspirin, NSAIDs, morhine
Infection: ebv, hep b cockamamie
Environment: dust, heat cold, animals
Foods: fish, eggs, fruit
Other: latex
Abcde melanoma
Asymetry
Border irregularity
Colour variation
Diameter >6mm
Evolution
What is association psoriasis
What is it
Hla b27
Autoimmune skin condition related cd 4 and 8 r cells
Auspik sign
When plaques removed in psoriasis leads to pin point bleeding
Treatment of psoriasis
Topical emollient
Steroids
Vitamin A and D ointment t
Cold tar
Immunomodulators
Uv therapy
What is associated Gerald patch
Pityriasis rosea
Herald path- 5-10 days widespread rash
Trunk and limb
Christmas tree on back
HPV 6,7,8
Tx reassurance
Treatment bullous pemphigoid
Doxycycline
Different bullous pemphigoid and pemphigus vulgaris
Bollous pemphigoid
Age >60
Intensely puritic large tense blisters
Rupture form erosions
No mucous membranes
Nikolsy -ve
Pemphigus vulgaris
Younger 40-60
Involves mucous membranes
Flaccid blisters
Nikolsy sign +ve
What causes erypsealis
Beta haemolytic streptococci pyogenes
Erypsealis rash
Intense erythematous plaques well demarcated tender and raised
Upper dermis only
Bite injuries abx
1st line
Augmentin 875/125 bd for 5 days
Or
Doxy 100mg bd
Bactrim 1 bd
Ciprofloxacin 450 tds
Levofloxacin 750 od
Plus one of
Metronidazole 500mg po tds
Clindamycin 450 tds
What organisms in human bites
Staph
Viridian strep
Ekinella
What organism causes moluscum contagiosum
Poxvirus
What rash is umbilcated small flesh coloured dome Papule S
Molluscum contagiosum
Hand foot and mouth
Cocksackie virus
Rosella
Human herpes virus 6
Erythema migrans
Lymes disease
Erythema marginatum
Disease related to
Rheumatic fever
Macular with central clearing spares face
Erythema infectiosum
Slapped cheek
Parovirus b19
Circumoral palor
What is ritters diseases
Staph scalded skin syndrome
What causes staph scalded skin syndrome
Exotoxin A/B
Break down desmosomes causing detachment within epidermal layer
Rocky Mountain spotted fever
Organisms
Ricketsia ricketsia
Macular rash on wrists ankles spares face
3 Cs measles
Conjunctivitis
Cough
Coryza
Mesels rash
Mobilitorm coarse blotches
Starts face 1-2 days
Spreads down
Kopilk - white spots in mouth 1-4 days pre rash
Measles MMR who gets dose
< 6 m immune
>6months non immune
>12 m 1 dose receive early
Immunocompromised or pregnancy or children -<6m
When infectious in measles
3-4 days pre rash
Post exposure fever 10 days
Rash 14 days post
Complications of measles
Acute otitis media
Pneumonia - leading cause of death
ADEM - acute disseminated encephalomyelitis
SSPE - sub acute pan encephalitis
What causes eczema herpetiform
HSV
Disseminated viral skin reaction complicating atopic eczema
Normal skin barrier is compromised
Common causes of contact dermatitis
Cosmetic dyes
Plants
Metals- nickel
Chemicals
Latex
Rubber
Photosensitive
Diagnostic criteria for eczema
Pruotic skin conditions
Plus 3 of
- hx of skin creases, elbows, knees and cheeks
- ph asthma, hay fever
- hx dry skin
- hx visible flex oral eczema
- onset <2 years
Scorad - scoring atopic dermatitis
What is erythroderma rash
> 90% inflammatory skin conditions erythema
Exfoliation
Oedema
Serous ooze
Eyelid swelling
Secondary infection
Lymphadenopathy
Causes of erythroderma
Secondary to chronic skin condition
- pre existing dermatitis atopic, contact
Pre existing psoriasis
Pre existing blisters
Generalised drug reaction
Malignancy
Other physical
Infection
Complications of erythroderma
Dehydration
Electrolyte loss
Hypothermia
Pain
Secondary bacterial infection
Protein loss
High output cardiac failure
Causes of toxic shock syndrome
Tampons
Osteomyelitis
Wounds
Post miscarriage
Causes of toxic shock syndrome
Organisms
Life threatening inflammatory reaction caused by infection with toxins
Staph or strep pyogenes
Treatment toxic shock
IVF
Supportive
ABX - flucloxacillin and clindamycin
Vasopressin
Strep
- Ben pen
- clinda
Symptoms toxic shock
Hypotension
Fever
Rash - diffuse eyrthematous
Desquamatisation
Headache
Reduced LOC
Staph scalded skin syndrome caused by
Age
Exfoliative toxin producing staph aureus - lysis
Children <5 years
Symptoms: widespread rash, progresses to blisters, rupture to burns
Fever and irritability
Systemically well
Nikolsy +ve
Good prognosis
No mucous membrane s
Most common skin cancer
BCC
Precursor SCC
Actinic keratosis
