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First AId 2CK > Dermatology > Flashcards

Dermatology Flashcards

1
Q

Pemphigus Vulgaris

A

autoimmune of unclear etiology in which body becomes allergic to owen skin

  • antibodies are produced against anigens in the intercellular spaces of epidermal cells
  • bullae are within epidermis and are thin and fragile
  • painful bullae but not pruritic
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2
Q

Causes of Pemphigus Vulgaris

A
  • Idiopathic
  • ACE inhibitors
  • Penicillamine
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3
Q

Nikolsky’s sign

A

easy removal of skin by just a little pressure with the examiner’s finger pulling it off like a sheet

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4
Q

Diseases where Nikolsky’s sign is present

A
  • Pemphigus vulgaris
  • Staphylococcus scalded skin syndrome
  • Toxic epidermal necrolysis
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5
Q

Pemphigus Vulgaris: Dx

A

skin biopsy

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6
Q

Pemphigus Vulgaris: Tx

A
  • use glucocorticoids, such as prednisone
  • when steroids are ineffective, use the following:
    azathiaprine
    mycophenolate
    cyclophosphamide
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7
Q

Bullous pemphigoid

A
  • can be drug induced by sulfa drugs and others
  • fracture of skin is realtively deep and bullae are THICKER WALLED and LESS LIKELY TO RUPTURE
  • oral lesions are rare
  • less fluid loss and infection less likely
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8
Q

Bullous pemphigoid: dx

A
  • perform a biopsy with immunofluorescent antibodies
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9
Q

Bullous pemphigoid: tx

A
  • Use systemic steroids such as prednisone
  • Alternatives to steroids
    • tetracycline
    • erythomycin with nicotinamide
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10
Q

Pemphigus foliaceus

A
  • associated with other autoimmune diseases
  • can be drug induced from ACE inhibitors or NSAIDs
  • bullae are more superficial than pemphigus vulgaris
  • intact bullae rarely seen because they are so fragile
  • no oral lesions
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11
Q

Pemphigus foliaceus: dx and tx

A 
- diagnosed by biopsy and treated with steroids 
Alternatives to steroids
- mycophenolate
- cyclophosphamide
- azathioprine
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12
Q

Porphyria Cutanea Tarda (PCT)

A
  • disorder of porphyrin metabolism resulting in photosensitivity reaction to an abnormally high accumulaition of porphyrins
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13
Q

Conditions associated with Porphyria Cutanea Tardia

A
  • Alcholism
  • Chronic hep C
  • Liver disease
  • Oral contraceptives
  • Liver diease is associated with increased liver iron stores
  • Diabetes are found in 25% of these patients
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14
Q

Porphyria Cutanea Tarda: Clinical presentation

A
  • Nonhealing blisters on sun exposed parts of the body such as backs of hands and the face
  • Hyperpigmentation of the skin
  • Hypertrichosis of the face
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15
Q

Porphyria Cutanea Tarda: Diagnostic Testing

A

Test for urinary uroporphyrins

- uroporphyrins are elevated 2-5 times above coporyphyrins in this disease

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16
Q

Porphyria Cutanea Tarda: Tx

A
  • Stop drinking alcohol
  • Stop all estrogen use
  • Use barrier sun protection
  • Use phlebotomy to remove Fe. Deferoxamine used to remove Fe
  • Chloroquine increases the excretion of porphyrins
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17
Q

Urticaria

A
  • hypersensitive reaction, most often mediated by IgE and mast cell activation, which in EVANESCENT WHEALS AND HIVES
  • localized with hypotension and hemodynamically instability
  • onset within 30 minutes and last < 24 hrs
  • itching is prominent
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18
Q

Causes of urticaria

A
  • Meds (aspirin, NSAIDS, morphine, codene, penicilline, phenytoin)
  • Insect bites
  • Foods (peanuts, shellfish, tomatoes, and strawberries)
  • Emotions
  • Contact with latex
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19
Q

Chronic urticaria is associated with the following:

A
  • Pressure on skin (e.g. dermatographism)
  • Cold
  • Vibration
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20
Q

Severe acute urticaria: tx

A

H1 antihistamines (e.g. diphenhydramine, hydroxyzine, cyproheptatine

21
Q

Acute urticaria that is life threatening: tx

A

H1 antihistamines + systemic steroids

22
Q

Chronic urticaria tx

A

Newer antihistamines

  • loratadine
  • desloratadine
  • fexofenadine
  • certirizine
23
Q

If patient develops urticaria due to trigger that can’t be avoided, what’s long term solution?

A

Desensitization

** make sure to stop B-blockers because they inhibit the epinepherine

24
Q

Morbilliform rashes

A
  • milder form of urticaria
  • typical type of drug reaction
  • rash RESEMBLES MEASURES; it is GENERALIZED MACULOPAPULAR ERUPTION THAT BLANCHES WITH PRESSURE
  • can appear a few days after initial exposure
25
Q

Morbilliform rashes: dx and tx

A
  • Lymphocyte mediated

- teat with antihistamines

26
Q

Erythema Multiform Causes

A 
- caused by:
penicillins
phenytoins
NSAIDS
Sulfa drus
Infection with Herpes Simplex or Mycoplasma
27
Q

Erythema Multiforme

A
  • presents with TARGETLIKE LESION that occurs on palms and soles
  • lesions can be described as “irislike”
  • bullae not unformly found
  • does not involve mucous membranes
28
Q

Erythema Multiforme: Tx

A

Antihistamines and treat the underlying infection

29
Q

Stevens-Johnson Syndrome

A
  • hypersensitivity rxn to meds (e.g. penicillins, sulfa drugs, NSAIDS, phenytoin, and phenobarbitol)
  • usually involves 10 - 15 % of total body surface area
  • has mucous membrane involvement
  • respiratory tract involvement may be so severe as to require mechanical ventilation
  • should be managed in burn unit
30
Q

Mortality and morbidity associated with Stevens-Johnson Syndrome

A
  • infection, dehydration, and malnutrition
31
Q

Stevens-Johnson Syndrome: Tx

A

Supportive therapy

32
Q

Toxic Epidermal Necrolysis

A
  • most serious version of cutaneous hypersensitivt reaction
  • covers 30 - 100% of body surface area
  • sepsis is most common cause
  • Nikolsky sign is present and skin easily sloughs off
33
Q

Toxic Epidermal Necrolysis: Dx

A

Skin biopsy

** don’t use steroids

34
Q

Fixed Drug Reaction

A
  • localized allergic drug reaction that occurs at precisely the same anatomic site with repeated drug exposure
  • lesions are ROUND, SHARPLY DEMARCATD LESIONS THAT LEAVE HYPERPIGMENTED SPOT AT THE SITE
35
Q

Fixed Drug Rxn: Tx

A

Topical steroids

36
Q

Erythema Nodosum

A
  • painful, red, raised nodules appear on anterior surface of extremities
  • nodules are tender to palpation
  • nodules do not ulcerate
  • nodules last about 6 weeks
37
Q

Erythema Nodosum associated with which conditions:

A 
secondary to recent infections or inlammatory condtiions such as:
- Pregnancy
- Recent strep infxn
- Coccidiodomycoses
- Histoplasmosis
- Sarcoidosis
= Inflammatory bowel disease
- Syphilis
- Hepatitis
- Enteric infection (e.g. Yersinia)
38
Q

Erythema Nodosum: Tx

A
  • Analgesics and NSAIDS and treat the underlying disease

- if symptomatic treatment fails, potassium iodide

39
Q 
Suspected fungal infxn : diagnostis
- tinea pedis
- tinea cruris
- tinea corporis
- tinea versiclor
- tinea capris
-
A
  1. Perform KOHtest of skin. KOH can dissolve some epithelail cells and collage of the nail but doesn’t melt away fungus
  2. Most accurate test: culture of fungus
40
Q

Onychomycosis (nail fungal infection) : tx

A

Oral terbinafine or itraconazole

  • 6 weeks for fingernails
  • 12 weeks for toes
41
Q

Hair fungal infection (tinea capitus)

A

Oral terbinafine or itraconazole

42
Q

Terbinafine

A
  • used to treat skin and hair fungal infections
  • potentially hepatotoxic
  • check liver function tests periodically
43
Q

Adverse effects of ketaconazole

A
  • Hepatotoxicity
  • Gynecomastia
    • don’t use for onychomycosis**
44
Q

Impetigo

A
  • special bacterilal infection of skin limited to largely epidermis
  • infection is described as “weeping” “oozing” “honey-colored” or draining”
  • found in warm, humid conditions
  • seen in poverty and in children
  • can cause glomerulonephritis but no rheumatic fever
45
Q

Impetigo: etilogy

A

Staphylococcus

- can be caused by Streptococcus pyogenes (aka Group A Strep_)

46
Q

Impetigo: Tx

A
  • Any topical abx: mupirocin

- If topical abx not effective, antistaphyloccocus oral abx

47
Q

Erysipelas

A
  • involves both dermis and epiderms
  • most commonly caused by Group A Strep (pyogenes)
  • most likely bacterial infxn to lead to fevers, chills, and bacteremia
  • bright, red, angry, swollen appearance in face
48
Q

Erysipelas: tx

A

= use systemic oral or IV abx

- if there is culture confirmation of the organism as Streptococcus then penicillin G or ampicillin

49
Q

Cellulitis

A
  • bacterial infection of dermis and subcutaneous with Stap and Strep

First AId 2CK (22 decks)

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