Dermatology Flashcards
Discuss the phases of eczema
Acute phase: pruritic, erythematous papules and vesicles
Sub-acute phase: dry, scaly, oozing with crusts
Chronic: lichenification and excoriation with possible secondary staph aureus infection
Discuss the presentation and management of atopic eczema
Pathophysiology:
- gE mediated reaction so have history of asthma and rhinoconjunctivitis
Presentation:
- Birth: dry and rough skin on face, trunk and limbs
- Infantile: oozing erythematous papules and vesicles, erosions
- Childhood/adult: eczema lesions on face, scalp, neck, flexor surfaces, wrists, dorsal hands/feet
Diagnostic criteria:
- all of:
- pruritic skin
- erythematous papules/vesicles
- involvement of face, neck and extensor in infants and flexor surfaces in adults
- is not scabies, allergic/seborrheic dermatitis, cutaneous lymphoma or psoriasis
Management:
- avoid triggers and prevent dry skin
- muciporin 2% BID for 2-4 weeks, bleach baths or Acyclovir 15mg/kg PO 5xdaily for 1 week for HSV
- gravol 25-50mg q6h for pruritis
- steroids
Discuss the steroid treatment for eczema
Mild: dry skin, with infrequent itching, small areas of redness with little impact on daily life and psychological well being
Moderate: dry skin, itching, redness, excoriation with moderate impact on everyday activities and psychological well being
Severe: widespread dryness, with non-stop itching, extensive skin thickening and severe impact on everyday activities and psychological well being
Mild:
- remission: Hydrocortisone valerate 0.2%, betamethasone dipropionate 0.05% BID for 2-4 weeks
- maintenance: same as above on weekends for 16 weeks
Moderate:
- remission: flucinolone 0.025%, betamethasome dipropionate 0.05% BID for 2-4 weeks
- 2nd line: tracrolimus 0.1% BID (calcineurin inhibitor)
- maintenance: same as for mild
Severe:
- remission: UVB 1st, cyclosporine 3-5mg/kg PO for 6 weeks 2nd, DMARD
Discuss the presentation and management of irritant dermatitis
Pathophysiology - non-immunologic and non-specific Irritants: - water - friction - trauma - nickel Presentation: - eczema on eyelids, hands, and genitals that is burning
Discuss the presentation and management of allergic contact dermatitis
Pathophysiology: - type 4 delayed hypersensitivity reaction that is immunologic and specific requiring sensitization Allergen: - hair dye - shampoo - cosmetics Presentation: - delayed 1-2 days following contact - eczema lesions that are very pruritic and spread beyond the area of contact - may have poorly defined margins
Discuss the presentation and management of seborrheic dermatitis
Pathophysiology:
- seen in infants and puberty, due to pityrosporum ovale
Presentation:
- greasy erythematous yellow scale with minimally elevated papule or plaque
- infants: cradle cap
- children: scalp and flexor areas
- adults: diffuse on scalp margin
Discuss the presentation and management of ecthyma
Pathophysiology: - infection of epidermis that extends to dermis - strep pyogenes Presentation: - erythematous painful fluid vesicles - pustules that enlarge, crust and ulcerate on leg Diagnosis: - punch or tissue culture Management: - Cephalexin or Cloxacillin for 10 days
Discuss the presentation and management of staphylococcus scalded skin syndrome
Demographics: - <2 years old Pathophysiology: - exotoxin released by staph aureus leading to separation of dermis from epidermis Presentation: - fever - generalized erythema - acute exfoliation - Nikolsky’s sign - honey coloured crusts Management: - IV fluids - IV Cloxacillin
What are the typical doses for the common antibiotics?
Streptococcus: Penicillin 500mg q6h for 10 days
Staph and Strep: Cephalexin 500mg PO q6h for 10 days, Cloxacillin 250-500mg q6h for 10 days, cefazolin 1-2g IV q8h
MRSA: Clindamycin 450mg TID for 5-10 days, doxycycline 100mg BID for 5-10 days, Septra 1 tab PO BID for 5-10 days, vancomycin 15-20mg/kg/dose q8-14h (max 2g per dose)
Discuss the presentation and management of measles
Organism: - paramyxovirus Presentation: - maculopapular erythematous rash over entire body - fever - cough - coryza - conjunctivitis - Kopiks spot (clustered white lesion in mouth) Infectious: - 3 days before and after onset of rash
Discuss the presentation and management of Scarlet Fever
Organism: - group B hemolytic strep Presentation: - maculopapular sandpaper rash from axilla and neck to entire body - strep throat infection - strawberry tongue - precedent fever Management: - penicillin
Discuss the presentation and management of rubella
Organism: - togavirus Presentation: - macular rash over entire body for 5 days - fever - arthralgia - headache - conjunctivitis - petechiae on soft palate Infectious: - 7 days after rash Investigations: - rubella IgM
Discuss the findings with congenital rubella
In-utero growth restriction Microcephaly deafness Cataract Heart defect Hepatosplenomegaly Hyperbilirubinemia Thrombocytopenia purpura (blueberry)
Discuss the presentation and management of Fifths disease (erythema infectiosum)
Presentation: - maculopapular rash on cheeks (slapped cheeks) which progresses to reticular rash on rest of body, - fever - malaise - myalgia Last for 7-10 days
Discuss the presentation and management of Kawasaki disease
Demographics:
- <4 years old
Presentation:
- acute (7-10 days): fever, irritability, conjunctivitis, mucositis
- sub-acute (11-21 days): desquamation of extremities, arthralgia
- convalescent phase (>21 days): risk of coronary artery aneurysm, pericarditis, uveitis
Diagnostic criteria (Warm CREAM):
- fever for >5 days (warm) with 4 of the following
- conjunctivitis
- rash
- erythema on palms and soles
- cervical adenopathy
- mucous membranes (dry, red lips or strawberry tongue)
Investigations:
- CBC leukocytosis
- high CRP
- echo to rule out coronary aneurysm or pericarditis and follow up in 6 weeks-6 months
Treatment:
- IVIG within 10 days to reduce aneurysm
- ASA in acute phase
