Dermatology Flashcards
Stasis dermatitis
Usually bilateral lower extremities with CHRONIC VENOUS INSUFFICIENCY.
Hyperpigmentation
Varicose veins
Edema
Telangiectasia
Stasis dermatitis pathophys
Dysfunction of venous valves obstruct flow causing venous hypertension.
Changes dermis
Stasis dermatitis risk factors
Age
Family
Tobacco
Standing
Obesity
Hx of DVT, heart failure, HTN
Stasis dermatitis clinical manifestation
Erythematous scaling
Exzematous patches/plaques on legs with ema.
Medial ankle mostly
Dull pain worsened with standing
Where is stasis dermatitis mostly seen
Medial ankle
Acute forms of stasis dermatitis
Inflammation
Weeping plaques
Vesiculatoin
Crusting
Ulcerations on medial ankle
Chronic forms of stasis dermatitis
Pruritic
Hyperpigmentation
Scaling
Edema
Varicosities
Telangiectasias
Chronic stasis dermatitis management
Petrolatum jelly
Topical corticosteroids
Acute stasis dermatitis management
Topical steroids 1-2 weeks BID
Wet dressings
Compression bandages (Unna Boot)
Acute stasis dermatitis management for secondary infection
Culture
Mupirocin for staph or strep.
Assess for cellulitis
Cellulitis
Unilateral
Acute
Shiny
Erythema and edema
Warm
Tender
Telangiectasia
Harmless but can be sign of other condition
Small red blood vessels
Serpentine
Spider veins
Present in Rosacea
Telangiectasia management
Cosmetic
Laser treatment
Sclerotherapy
Hemangioma
Cherry angiomas
Benign vascular skin lesion from proliferating endothelial cells and dilation of capillary beds
Hemangioma clinical manifestation
Asymptomatic
Firm
Papular
Red, blue purple
Blanchable
Hemangioma management
Biopsy if suspicious (black)
Cosmetic
Petechiae
Smaller
Nonblanching red, purple macules.
Caused by hemorrhaging.
Purpura
Larger
Discoloration of skin or mucous membranes due to hemorrhage from small blood vessels.
Associated with platelet and coagulation disorders
Purpura treatment
Diagnose underlying coagulation issue.
Anagen
Hair active growing phase
90-95% of hairs
Catagen
Transitional phase
Lower portion of hair production ceases
Telogen
Resting/shedding phase
Scarring (cicatricial) alopecia
Hair follicle is irreversibly destroyed and replaced by fibrous scar tissue.
Occurs following trauma or inflammation.
Scarring (cicitricial) alopecia treatment
Topical steroid (clobetasol)
Tetracycline if topicalsteroid doesn’t work
Steroidal injection
Nonscarring (noncicitricial) alopecia
Hair follicles are preserved with potential for hair regrowth
Non scarring alopecia examples
Tinea capitis
Hypothyroidism
Anagen effluvium
Trichotillomania
Secondary syphilis
SLE
Telogen effluvium
Deficiency of zinc, iron, or vitamin D
Scarring Alopecia examples
Scleroderma
Tinea capitits
Folliculitis
DLE
Lupus vulgaris
Lichen planopilaris
Male progressive androgenetic alopecia
Reduction of hairs on scalp.
Genetic
80% of white men by age 80
Thinning starts 20-40
Male androgenetic alopecia treatment
Minoxidil - topical FIRST
Finasteride - oral
Photobiomodulation (lazer therapy)
Platelet rich plasma (PRP)
Hair transplant
Scalp reduction flaps
Female androgenetic alopecia
Gradual thinning over crown
Affected women have DHEA-S
Female androgenetic alopecia treatment
Minoxidil - topical
Finasteride - oral
Alopecia Areata
Immune-mediated
Family Hx important
25% have other autoimmune disorders
Random clearly defined oval patches
Rapid loss of hair
Tiny EXCLAMATION POINT hairs may be present
Alopecia Areata treatment
Can control but not prevent spread.
High potency topical or intralesional corticosteroids (triamcinolone acetonide).
Squaric acid dibutyl ester
Anthralin
Minoxidil
Alopecia totalis
Total hair loss of scalp
Alopecia universalis
Total hair loss on ENTIRE body
Telogen effluvium
Hair falls out all over scalp due to interruption of hair production
Anagen effluvium
Rapid hair loss from medical treatment
Loose anagen syndrome
Common in young children when hair not firml rooted in follicle
Advanced alopecia areata
Autoimmune disease in which body’s immune system attacks healthy tissues including hair follicles
Trichotillomania
Pulling out hair.
Random patches
Often unilateral (dominant hand)
Trichotillomania treatment
Habit reversal therapy
N-acetylcysteine
How fast does fingernail grow
1mm/month
Beau Lines
Transverse groves
Temporary arrest of roximal nail matrix proliferation.
Stippling/pitting of nails
Seen in psoriasis, alopecia areata, hand eczema.
Shallow or deep depressions in nails
Acral lentiginous melanoma
Dark streak in nail.
Yellow nail syndrome
Nails turn yellow, thicken, and stop growing
Could be lung disease, rheumatoid arthritis, nail infection
Clubbing of nails
Curved
Harmless or lung, heart, liver, or stomach/intestine probs
Splinter hemorrhages
narrow red to almost black longitudinal lines on nail bed.
Blood enclosed in subungual keratin
Develop either from thrombosed or ruptured capillaries in nail bed
Onychomycosis (Tinea unguium)
Fungal skin infection.
Caused by trichophyton rubrum or candida albicans.
Nail discoloration
50-60% of abnormal nails
Onychomycosis treatment
Terbinafine FIRST
Itraconazole
Fluconazole
Acute Paronychia
Inflammation involving lateral and proximal folds of nail.
Caused by Staph Aureus
Less than 6 weeks
Acute Paronychia treatment
Warm compress.
Topical mupirocin
Topical antibiotics
Oral abx that covers S. aureus for severe
Chronic Paronychia
6 weeks or longer
Proximal nail fold inflammation can cause loss of cuticle.
Can be secondary to candida infection
Chronic paronychia treatment
Topical steroids FIRST
ketoconazole or fluconazole
Surgery last resort
Felon
Subcutaneous abscess of distal phalanx MC caused by staph aureus
Pus collects
Felon treatment
Oral antibiotics that cover G+.
1st gen cephalosporin (Cephalexin)
or Bactrim (T-S) for MRSA
Onycholysis
Distal separation of nail plate from nail bed.
Nail looks white/yellow
Caused by exposure to water/soaps
Onycholysis treatment
Keep nails short.
Treat underlying cause
Subungual hemotoma
Collection of blood under nail
Subungual hematoma treatment
Drain with needle
Acne Vulgaris
Mostly in adolescents.
Less in asians and africans
Acne vulgaris pathogenesis
Androgen-mediated stimulation of sebaceous gland.
Imbalance in microbiome of pilosebaceous follicle.
Immune responses may be genetic.
Acne vulgaris lesion development
Follicular hyperkeratiniation and plugging blocks sebum drainage.
Androgns stimulate sebaceous glands to make more sebum.
Propionibacterium acnes lipase turn lipids to fatty acids and make proinflammatory mediators
C. acne
Most prominent bacteria within pilosebacious follicles.
Activates immune response causing inflammation
Acne vulgaris clinical manifestation
Open comedone (blackhead)
Closed comedone (whitehead)
Papaules
Papulopustules.
Seborrhea (looking greasy)
Nodules
Characteristics of mild acne vulgaris
Scattered, small, inflamed papules or pustules without scaring.
NO nodules
Characteristics of moderate to severe acne vulgaris
Visually prominent acne with many comedonal or inflamed papules or pustules.
Nodules
Scarring
Infantile Acne vulgaris
elevated androgens from immature adrenal glands.
Acne fulminans
Special form of Acne vulgaris.
Rare.
Adolescent boys.
Severe cystic acne with suppuration, hemorrhagic crusts, ulcerations on trunk/chest.
Malaise, fatigue, fever
Leukocytosis, increased ESR
Can be triggered by isotretinoin
Hyperandrogenism
Polycystic ovarian syndrome (PCOS)
Adrenal tumors
Ovarian tumors
Topical retinoids
First line acne vulgaris management (Tretinoin QD
Adapalene QD
Tazarotene QD)
Improvement in four weeks.
Can cause flaking, irritation, dryness, erythema, sun sensitivity.
Don’t use in pregnancy
Benzoyl peroxide
First line acne vulgaris management.
Antibacterial
Can cause stinging, irritation erythema
First line acne vulgaris management
Topical retinoids and benzoyl peroxide
Second line acne vulgaris management
Azelaic BID or Salicylic QD TIC
Topical antibiotics for acne vulgaris
Clindamycin FIRST
erythromycin, minocycline
USe with benzoyl peroxide to prevent resistance
Dapsone
Acne vulgaris topical antibiotic
Alternative topical therapy
Perscription only.
Do NOT use with benzoyl peroxide due to skin discoloration
Moderate to severe acne vulgaris management
Stepwise
Oral isotretinoin
Oral antibiotics
Oral contraceptive pills
Spironolactone
Isotretinoin (acutane)
Retinoid inhibits gland function and keratinization.
Given for months.
Tetratogenic
Don’t take with tetracycline
Oral antibiotics to use for Acne vulgaris
Tetracyclines
Acne vulgaris and oral contraceptive
Can be used to help females that have had their periods.
CCOCP with antiandrogenic progestin
Spironolactone with acne vulgaris
Blocks androgen receptors inhibiting androgen synthesis as K sparing effect.
Can be used with COCPs
Can’t use in preg
Folliculitis
Usually Staph aureus or Pseudomonas aeruginosa (hot tub)
Folliculitis clinical manifestation
Pinpoint pustule around hair follicle
Folliculitis management
Benzoyl peroxide.
TOpical mupirocin
Pseudomonal coverage (Ciprofloxacin)
Folliculitis barbae
Folliculitis of beard hair follicles.
Often from shaving.
Give oral antibiotics
Doxycycline
Rosacea clinical manifestations
Erythema
Telangiectasia
Papulopustules
Disfigurement of nose (rhinophyma), eyelids (metophyma) from sebaceous hyperplasia and lymphedema.
Rubbery
Rosacea eye involvement
Foreign body sensation
Blepharitis
Lid margin relangiectasia
Meibomian gland inflammation
Frequent chalazion
Conjunctivitis
Corneal ulcers
Rosacea course
Recurrences common.
After few years, may disappear spontaniously but usually lasts lifetime.
Rosacea management
Sun protection.
Avoid skin irritants like essential oils.
Metronidazole gel
Brimonidine gel
Azelaic acid
Ivermectin gel
Monocycline, doxycycline, or metronidazol for severe
Lazer therapy
Bea blockers
Perioral (peifacial) dermatitis
Variant of rosacea.
Multiple small inflammatory erythematous papules, papulovesicles, or papulopustules around mouth, nose, or eyes.
Itching, burning, tightness
Perioral (perifacial) dermatitis management
Topical metronidazol, erythromycin, calcineurin inhibitors.
Systemic oral tetracyclines for severe
NO topical steroids (makes condition worse)
Melasma
Usually in potentially child bearing pts.
Hyperfunctional melanocytes that deposit excessive melanin in dermis and epidermis.
Effected by sunlight, pregnancy, oral contraceptives, idiopathic
Melasma clinical manifestations
light or dark brown pigmentation on face.
Macular
Uniform but may be blotchy
Melasma management
Photoprotection.
Hydroquinone
Azelaic
Combo of fluocinolone , hydroquinone, and azelaic acid or tretiinoin
Chemical peel o wound skin to regenerate healthy skin.
Laser and light therapy
Vitilligo
Likely autoimmune and genetic.
Sometimes linked to injury, sunburn, or stress
Melanocyte self destruction
Vitiligo comorbities
Hashimoto’s
Type I diabetes
Alopecia aeata
PErnicious anemia
Rheumatoid arthritis
Psoriasis
Vitiligo diagnosis
Use Woods lamp
Lab studies used to rule out endocrine or autoimmune disease
Vitilligo treatment
FIRST Mid to high potency topical corticosteroids.
Second topical calcineurin inhibtors.
Oral glucocorticoids prednisone.
Phototherapy
Kaposi Sarcoma
Human Herpes Virus 8
Endothelial cells reproduce at uncontrollable rate
GI effects
Older males of mediterranean or central/eastern european ancestry
Kaposi sarcoma clinical findings
Multiple red or purple plaques or nodules.
Mucosal and cutaneous lesions
How to diagnose kaposi sarcoma
biopsy
Kaposi sarcoma management
Palliative local therapy
Radiation/chemo
Antiretroviral against AIDS
Transplant-associated kaposi sarcoma
Agressive
High mortality rate
Basal cell carcinoma
From UV exposure
Most common skin cancer
Not very deadly
Not ususally metastatic
Immunosuppressed have increased risk
Basal cell carcinoma
Pearly/translucent erythematous papule with central ulceration.
Telangiectasia
Slow growing
Could be nonhealing ulcer
How to diagnose basal cell carcinoma
Dermiscopy
Biopsy
Punch or shave
Basal cell carcinoma management
Electrodesiccatoin and curretage
Topical imiquimod
Topical 5-fluor
Mohs micrographic surgery
Radiation
Actinic keratosis
UV exposure
Premalignancy
Prevalence increases with age and sun exposure
Actinic keratosis clinical findings
Sun exposed areas.
Hyperpigmented, pink, or flesh-colored
Feels like sandpaper
Tender to palpation
Actinic keratosis diagnosis
Clinical
Lesions should be biopsied
Actinic keratosis management
Liquid nitrogen
Fluorouracil cream
Imiquimod
Squamous cell carcinoma
2nd most common skin cancer
Malignant neoplasm of keratinizing epidermal cells.
Actinic keratosis is a precursor
Common in immunosuppressed and organ transplant
Squamous cell carcinoma clinical findings
Red, pink, brown, hard keratotic nodules taht ulcerate.
Sun exposed areas
Bowen’s disease
Squamous cell carcinoma in situ
Intraepidermal
Squamous cell carcinoma diagnosis
Dermoscopy
Biopsy with histology
Punch or shave
Squamous cell carcinoma management
Electrodessicatoin and curettage
Topical imiquimod
TOpical 5-fluorouracil
Wide surgical incision
Cemiplimab
Radiation
Malignant melanom
The big bad boy
Leading cause of death due to skin disease
7.5% death rate
60% men
What increases risk of malignant melanoma
UV
History of any skin cancer
Abnormal melanocytes
multiple nevi
Immunosuppression
Malignant melanoma clinical findings
Asymmetric
Borders irregular
Color variation
Diameter>6mm
Evolution
Ugly duckling
Where is superficial melanoma usually found on men
Back
Where is superficial spreading melanoma usually found on women
Lower extremities
Superficial spreading melanoma
70% of all melanomas
Color variation
Plaque with irregular borders
Tumor thickness <1mm
Nodular melanoma
15-30% fo all melanomas
Hard to find early
Dark
Pedunculated
Polyploid
Tumor thickness >2mm
Lentigo maligna melanoma
10-15% of melanomas
Sun damage
Tan or brown macule with asymmetry and evolves with color changes and raised border
Acral lentiginous melanoma
<5% of all melanomas
Most melanoma on dark skin people
On palms, plantar, and sublingula surface
Ocular melanoma
Eye melanoma
Malignant melanoma diagnosis
Dermoscopy
Biopsy with histology
Localized Malignant melanoma management
WIde surgical excision
Mohs procedure
Topical imiquimodMeta
Metastatic malignant melanoma
Lymph node resection
Nivolumab
Malignant melanoma stages
0 - in situ
1 - localized
2 - localized
3 - spread to lymph nodes
4 - spread to lymph nodes
Seborrheic keratosis Clinical findings
Noncancerous
Stuck on appearance
Brown/black
Waxy/velvety
Size variation
Seborrheic keratosis diagnosis
clinical dermoscopy
Seborrheic keratosis management
Liquid nitrogen
Elextrodessication
Shave excission
Lipoma
Localized overgrowth of adipose cells
Under the skin
Lipoma clinical findings
Subcutaneous mass
Soft, mobile, flesch colored nodule well circumscribe
Lipoma diagnosis
Clinical
Excisional biopsy
Lipoma management
surgical excision if bothering pt
Epidermal inclusion cyst
Benign growth of upper portion of hair follicle.
Common in gardner syndrome
Epidermal inclusion cyst clinical findings
Flesh colored nodule or papule with overlying central punctum.
Foul smelling cheese inside
Epidermal inclusion cyst diagnosis
Clinical
Cultures are sterile (not infection)
Epidermal inclusion cyst Treatment
Punch incision with cyst removal of small lesions.
Surgical excision for large lesions
Triamcinolone acetomide intralesional administration for inflamed
Dermatofibroma
Benign fibrohistiocytic tumor of middermis.
Fibrous rxn triggered by trauma
Dermatofibroma clinical findings
Scarlike
Red, brown, or flesh-colored nosuel with hyperpigmented halo.
Most often on legs and arms.
Dimples downwaed
Dermatofibrosis diagnosis
Punch biopsy
Dermatofibroma management
Punch biopsy
Low recurrence rate
Pilonidal disease
DIsruption of skin overlying coccyx pit (butt crack) from butt hairs.
Peak incidence in males 16-20
Rare after age 40
Pilonidal disease clinical findings
Pain, redness, swelling in acute.
Midline with drainage and inflammation and hair extruding from pits in chronic.
Recurretn is from chronic nonhealing wounds inn midline of gluteal cleft after surgical brocedure
Pilonidal disease management
Usually regress over time
Incision and drainage.
Hair removal.
Just pull the hair out might fix it
When to do shave biopsy
Suspicion of malignancy is low
When to do punch biopsy
Suspicion of malignancy is low
Incisional biopsy
Only take out part of lesion
When to do excisional biopsy
Suspicion of malignancy high
Mohs Micrographic surgery
Take out lesion and test it to find where lesion goes under the skin.
Keep taking out layers but in more specific areas from what you find in layer above.
Acanthrosis Nigricans clinical manifestations
Velvety hypigmented plaques in skin folds.
Associated with insulin resistance
Acanthrosis nigricans management
Treatment of obesity and insulin resistance
Ichthyosis clinical manifestation
Fine, white-gray scaling of skin
Palms and soles show skin marking (hyperlinearity)
Ichthyosis Vulgaris Cause
Loss of function mutations in filaggrin gene.
Inherited through autosomal semi-dominant pattern
Recessive x-linked ichthyoses
Affects males
Mutation of STS gene
Ichthyosis management
Emollients
Petrolatum
Salicylic acid
Glycolic acid
Lactic acid
Urea
Cutaneous horns clinical manifestations
Projection of hard, yellow, brown stuff from skin.
Horn is taller than base width
Suspicious cutaneous horns
Painful
Large and red at base
Wide base
Keloids clinical manifestations
Purplish-red
Firm
Smooth
Raised scarring after injury
Keloids pathogenesis
Maybe excessive production of collogen, elastin, proteoglycans, fibroblasts, mast cells
Keloid management
Resistant to treatment
Excision could make it worse
Intralesional corticosteroid (triamcinolone) injection
Keloid prevention
Kenalog injection after surgury before closing up
Acrochordons
AKA Skin tags
Harmless
Loose collagen fibers and blood vessels
Acrochordons management
Cryotherapy
Excision
Electrosurgery
Ligation with suture (use lidocane)
Erythema nodosum
Inflammatory disorder of subcutaneous fat.
Hypersensitivity rxn of unknown cause
Most common in women 25-40
Erythema nodosum clinical manifestations
Erythematous, tender, nonulcerated, immobile nodules on bilateral shins.
Fatigue, fever, malaise
Erythema Nodosum risk factors
Strep infection
COCP
Pregnancy
Malignancy
Erythema Nodosum diagnositics
Clinical
CBC
Strep test
CXR
TB skin test
Preg test
Erythema Nodosum management
Leg elevation
Rest
Compression stockings
NSAIDs then glucocorticoids (prednisone)
Miliaria rubra
AKA heat rash
Caused by blockage, inflammation of sweat glands
Miliaria rubra clinical manifestations
2-4mm non follicular papules, papulorvesicles.
Pruritic
Miliaria rubra management
Hydrocortisone
Hidradenitis suppurativa
Chronic inflammatory involving sweat glands.
Common in perianal, perineal areas
Hidradenitis suppurativa pathophysiology
Follicular occlusiono from keratinocyte proliferation causing follicular hyperkeratosis and plugging
Hidradenitis suppurativa clinical manifestations
Infflammatory nodules
Painful
Open comedones
In skin folds
Scarring
Hurley staging
Hidradenitis suppurativa stging system.
1-abscess formation
2- recurrent abscess with skin tunnels and scarring
3- Diffuse involvement or multiple interconnected skin tunnels across entire area.
Hidradenitis suppurativa risk factors
Black
Women
Obesity
Smoking
Genetics
Androgenic contraception
Hidradenitis suppurativa management
- Topical clindamycin
- Oral doxycycline
Hidradenitis suppuratva complications
Abscess
Strictures
Fistula
Depression
Suicide
Polymorphus light eruption
AKA sun poisoning
More often in females
Pruritic erythematous papules or plaques hours-days after sun exposed area
recurrent
Chronic actinic dermatitis
Rare
Photo induced eczema
Older males
Eczematous patches on face, neck, hands, scalp , chest
Lichenification plaques
Actinic pruigo
Hereditary
PMLE variant
Childhood onset
Papulonodular hemorrhagic crust on sun exposed.
Actinic cheilitis
Conjunctivitis
Poryphyria cutanea tarda
Hypersensitivity to abnormal porphyrins causing skin blistering
Caused by low activity of liver enzyme uroporphyrinogen decarboxylase
Porphyria cutanea tarda risk factors
Estrogen use
Smoking
Liver disease
Porphyria cutaneatarda clinical manifestations
Chronic blistering on sun exposed areas.
Hyperpigmentation
Scarring
What test is used to diagnose fungal infection
KOH prep under microscope
Tinea corporis
Ring worm
Fungal infection
Ring shaped lesions with scaly border
Itchy
What people usually get ring worm
People that have been around infected pet
Tinea corporis prevention
Treat infected houshold pets
Use foot powder
Keep feet dry
Tinea corporis management
Terbinafine
Itraconazole
Tinea Cruris
Jock itch
Sharp margins
Clear center
Follicular pustules sometimes
Hyperpigmentation
Tinea cruris diagnosis
Candidiasis
Seborrheic dermatitis
Psoriasis of body folds
Tinea cruris treatment
Drying powder (miconazole nitrate)
Terbinafine cream
Itraconazole PO
Tinea Manuum
Fungal infection of palms of hand.
Tinea pedis
Athlete’s foot
Common in diabetics
Tinea Mauum/Pedis clinical manifestations
Itching, burning, stinging
Pain
Flaking
Tinea Munuum/Pedis treatment for macerated stage
Aluminum subacetate soaks.
Broad spectrum antifungal creams
Topical allylamine if imidazoles fail
Tinea Munuum/Pedis treatment for dy and scaly stage
Any antifungal
Systemic treatment for Tinea Munuum/Pedis
Itraconazole/terbinafine
Tinea Versicolor
Velvety/tan/pink/white macules that do not tan.
Central upper trunk
Malassezia infection
Spaghetti and meatballs on KOH prep
Tinea versicolor
Tinea versicolor treatment
Selenium sulfide lotion
Ketoconazole shampoo
Two doses of oral fluconazole
Mucocutaneous candidiasis clinical findings
Itching
Burning of vulva and anus
Superficial denuded, beefy-red areas
White stuff on oral and vaginal mucous membranes.
Groin glute cleft, under breast, webbing of fingers
Mucocutaneous candidiasis lab findings
Budding yeast and pseudohyphae
Mucocutaneous candidiasis treatment`
Clotrimazole for nails
Nystatin or cotrimazole for skin
Topical fluconazole for anus
Intertrigo
Caused by heat, moisture, and friction.
Folds of skin
Candidiasis can complicate
Inertrigo treatment
hydrocortzolne and imidazole or clotrimazole creams
Herpes (HSV) symptoms
Recurrent small group vesicles
Regional tender lymphadenopathy
Neuralgia
Nodular lesions at sights of involvement
Herpes treatment
Acyclovir (5x a day)
valacyclovir
Famciclovir
Pritelivir for suppression
Molluscum contagiosum
Pox virus.
Dome-shaped WAXY PAPULES
Face
trunk
extremeties
Molluscum contagiosum treatment
Curettage
Liquid nitrogen
Light electrosurgery
topical KOH solution
Cantharadin
Warts
Verrucous papules anywhere on the skin or mucous membrane
HSV lesion
Usually bo symptoms
Itch anogenital warts
Plantar warts resemble warts or calluses
Nongenital Wart treatment
Liquid nitrogen
Keratolytic agents and occlusion (salicylic acid products)
Disection
CO2 laser therapy
Squaric acid dibutylester
Bleomycin
Fluorouracil
Soaking in warm water
Genital wart treatment
Liquid nitrogen
Podophyllum resin
Imiquimod
Sinecatechins
Operative removalLaser therapy
Impetigo
Honey crust
Macules, pustules
Usually around mouth
Caused by staph or strep (G+)
Impetigo treatment
Soaks and scrubbing
Mupirocin (top)
Ozenoxacin (top)
Retapamulin (top)
Doxy or cephalexin for systemic
Bactrim for MRSA in community associated
Furunculosis (boils) and carbuncles
Painful inflammatory abscess on hair follicle
Staph
Carbuncle
Made of furuncles in adjoining hair follicles
Furunculosis and carbuncles clinical findings
Pain
Tenderness
Gradually enlarges
Softens
Inflammations subsides before necrosis
Furunculosis and carbuncle managemebt
Doxy
Bactrim
Clindamycin
Linezolid
45 chlorhexidine whole body wash
Hot compress
What to give for recurring Furunculosis (boils) and carbuncle
Cephalexin/doxy and rifampin or clindamycin
Cellulitis symptoms
Edema
Erthemia
Pain, chills, fever
Lower leg
Staph or strep
Cellulitis treatment
Naficillin
What to give for MRSA
Vancomycin
Linezolid
Clindamycin
Daptomycin
Doxycycline
Bactrim
Erysipelas symptoms
Edema
Circumscribes
Hot
Red
Pain
Vesicle or bullae on surface
Lesions heal without scar
Erysipelas cause
Superficial form of cellulitis
Caused by beta hemolytic strep
Necrotizing myositis cause
Caused by clostridia (gas gangrene
Necrotizing fasciitis cause
Strep pyogenes (group a hemolytic)
Sometimes Staph
Necrotizing fasciitis treatment
Emergency surgery.
IV IG to reduce mortality
Varicella
Chicken pox
Fever and malaise mild in children and worse in adult.
Maculopapules change to vesicles.
Lesions are in different stages at different times.
Will later on reactivate as shingles (HZV)
Herpes zoster (shingles) virus
Comes from dormant varicella.
Rash follow dermatome
Very painful
Hutchinson Sign
Lesion at tip of nose, corner of eye, and root and side of nose.
Indicates involvement of trigeminal nerval shingles.
Ramsey Hunt Syndrome
Shingles.
Facial palsy and lesions on external ear.
Possible tinnitus or deafness showing ganglion involvement
Varicella treatment
Antihistamine
Acetaminophen
Acylclovir
Herpes zoster (shingles) treatment
Valacylclovir or famciclovir
Gabapenin or lidocaine for neuropathic pain
Antidepresents
Varicella/shingles vaccines
Shingrix (subunit. Preferred)
Zostavax (live)
Varicella rash
Dew drops on a rose petal
Pustular and crusting
Pruritic
Centrifugal
Abscess
Deep infection mostly on back, trunk extremities after skin barrier broken.
Pus
Abscess treatment
Bactrim
Doxy
Minoxycline
Clindamycin
(MRSA)
Superficial burn
Epidermis only
No blistering
Superficial partial thickness burn
Epidermis and shallow dermis
Blisters
Blanches
Deep partial thickness burn
Epidermis and deeper dermis.
Blisters
Does not blanch
Full thickness burn
Epidermis, entire dermis, and subcutaneous tissue.
No blanching
No blisters
Painless
Deeper burn
Soft tissue, muscle, bone
Painless
Minor burn management
Cool with water for up to 5 mins or wet gauze for 30 min
NSAIDs or tylenol
NO abx
antihistamines
tetanus shot
Primary survey after burn
Check airway and inhalation effort
Need airway if black sud
Severe burn management
Narcotics, analgesics, sedatives IV.
Cover partial thickness wounds with sheets to lower pain.
NO cold compress bc of hypothermia
Compartment syndrome
Massive fluid accumulation can cause increase in compartment pressure
Parkland formula
4mL x kg x TBSA% = total crystalloid fluids in first 24 hours
Half total volume given in eight hours
Half of total volume given in next 16 hours.
Only for partial and full thickness (no superficial)
Pernio (chilblains)
Inflammatory change from exposure to wet cold above freezing point.
Edematous, reddish, purple, painful
Trench foot
Caused by prolonged exposue to cold water or mud
injury to vascular to feet
Red feet or hands, endematous, numb, extremely painful
Hemorrhagic bullae
Frostbite
Tissue freezing and forming ice crystal in tissue.
Palor
Numbness
Prickling
Severe is white, yellow, immobile with edema hemorrhagic blistors, necrosis, and gangrene
Cold injury management
Pain management
Rewarm with water slightly above body temp
Avoid dry heat
Don’t pop blisters
Cold injury pharmacologic management
Tissue plasminogen activator
Low MW heparin
Tetanus prophylaxes
Erethema multiforme
HSV
Mycoplasma pneumoniae
Target lesions
Erosions
Bullae
Negative nikolsky sign
Positive nikolsky sign
Ability to extend area of superficial sloughing by applying gentle pressure to skin
Erythema multiforme managemtn
High potency topical corticosteroid gel
Mouthwash with lidocaine
Acyclovir if HSV
Stebens Johnson Syndrome Toxic Epidermal Necrolysis
Same disease on spectrum.
Mucocutaneous severe rxn with extensive necrosis and epidermal detachment.
SJS<10% of body surface
TEN>30% of body surface
Risk factor for Sevens Johnson Syndrome and Toxic Epidermal Necrolysis
Meds are leading trigger (bactrim).
Mycoplasma pneumonia
SJS/TEN clinical manifestations
Flu-like
Erythematous macule with purpuric center and spreads to diffuse erythema then bullae then erosion.
Tender
Face/trunk
Mucosal lesions
SJS/TEN complications
Fluid loss
Hypovolemic shock
Fluid embalance
Renal failure
GI necrosis
Pemphigus vulgaris
Autoimmune blistering disorders from acantholysis.
Blisters in mucous membranes and skin.
Jews
Type II hypersensitivity rxn
Pemphigus vulgaris presentation
Mucosal and cutaneous bullae
Bullae becomes crusts and erosions
Positive nikolsky sign
Pemmphigus vulgaris compications
Secondary infection
FLuid and electrolyte imbalances
Septicemia from staph
Pemphigus vulgaris diagnostics
Punch biopsy
Immunofluorescence for igG.
ELISA
Bullous pemphigoid
Non-emergent
Mostly elderly
Mostly male
Bullous pemphigoid presentation
Pruritic urticarial or edematois lesions folllowed by tesne blisters.
Negative nikolsky
Bullous pemphgoid diagnostics
Punch biopsy with immunofluorescence.
C3 and IgG
Staph scalded skin syndrome (SSSS)
AKA Ritter’s disease
Children <6 yo
Staph Scalded Skin Syndrome pathophysiology
Hematogenous dissemination of exotoxins that leave desmoglein1 and desmosomal linking protein.
Detachment of superficial epidermsi
Staph infection
Staph Scalded Skin Syndrome clinical manifestations
flaccid bullae
Positive Nikolskyy sign.
Fissuring around mouth
NO mucosal involvement
Staph Scalded Skin Syndrome management
Oxacillin
Pressure ulcers
AKA decubitus ulcer, bed sore, pressure wound.
Pressure ulcer management
Redistribution of pressure
Wound care
Exanthematous drug eruption
Maculopapular eruption.
Commonly caused by abx
Exanthematous drug eruption clinical manifestations
Disseminated
Generalized
Symmetric erethematous macules/papules
Uticaria
AKA hives, welts, wheals
Caused by drugs, food insect sting, infection
Autoimmune
Uticaria presentation
Present in minutes and disappear within a day.
Pruritic
Erythematous, round/oval, raised circumscribed plaques often with central pallor
Urticaria management
Short term release of pruritis and angiodema.
H1 antihistamines (second gen is first line)
Angiodema Presentation
Anaphylaxis
Swollen lups, face, mouth, throat, genitals, extremities
Angiodema management
H1 antihistamines
H2 blockers
Hereditary angiodema
Angiodema episodes without urticaria or pruritis.
C1 inhibitor produces excessive bradykinin
Hereditary angiodema managament
Emergent infusion of C1 inhibitor
Bradykinin mediated angiodema treatment
Stop ace inhobitors.
Start bradykinin blocker (ecallantide) or Bradykinin receptor antagonist (Icatibant)
Exfolliatie dermatitis
red skinUticarial erythematous patches that get larger and turn into bright erthema
Rare
Severe
Usually caused by ace inhibitor, allopurinol, sulfa.
Elevated epidermal turnover
Primary intention of wound care
Wound is clean
Suture the wound
Secondary intentino of wound care
Wound heal s from inside out.
Don’t suture.
Example is abscess, animal bites, contaminated wound.
