Dermatology conditions Flashcards
What is Basal cell carcinoma?
Common neoplasm, related to exposure of sunlight.
Can be locally aggressive, rarely metastasises
What causes basal cell carcinoma?
Repetitive and frequent exposure to UV radiation induces DNA damage in keratocytes.
Exponential increased of BCCS in relation to UV exposure
What are the risk factors of Basal cell carcinoma?
Prolonged sun UV radiation exposure Seen in Gorlin's syndrome Most commonly head and neck Increasing age Male sex Skin types I and II Immunosuppression Arsenic exposure Previous BCC Xeroderma pigmentoasum Albinism
What is Gorlin-Goltz syndrome?
A condition with multiple BCCs Pitting of palms and soles Jaw cysts Spine and rib anomalies Calcification of the falx cerebri Cataracts
What are the symptoms of Basal cell carcinoma?
Slow, progressive skin lesion
Papules with associated telangiectasis
Pearly papules and/or plaques
Found on: Face, scalp, ears, trunks
What are the types of Basal Cell Carcinoma?
Nodular (most common) Superficial Morphoeic Pigmented Basosquamous
What are the signs of nodular BCC?
- Pearly nodule with rolled telangiectatic edge
- Telangiectasis
- Slowly enlarges
- May have central ulcer
- Micronodular and micirocystic types may infiltrate deeply
What are the signs of superficial BCC?
- Multiple on trunk and shoulders
- Erythematous well-demarcated plaques, larger than 20mm, central clearing and a thread-like border, rolled edge if stretched (may bleed or weep)
- Slow growth, usually not aggressive, rarely invasive and very rarely metastasise
- Confused with Bowen’s disease or inflammatory dermatosis
- Particularly responsive to medical > surgical
What are the signs of Morphoeic BCC?
- Sclerosing or infiltrative BCC
- Found in mid-facial sites
- More aggressive with poorly defiend borders
- Characterised by thickened yellow plaques
- Present late and become very large and require extensive plastic surgical reconstruction, may infiltrate nerves
- Prone to recurrence after treatment
What are the signs of Pigmented BCC?
- Brown, blue or greyish lesion
- Nodular or superficial histology
- Seem nore often in dark skinned people
- May resemble malignant melanoma
What are the signs of basosquamous BCC?
- Mixed BCC / SCC
- Potentially more aggressive than other forms
What are the investigations for BCC?
Biopsy rarely needed but can do biopsy if wanted
Diagnosis is mainly on clinical suspicion
What is a burns injury?
Burns are very common injuries, predominantly to the skin and superficial tissues, caused by heat from hot liquids, flames or contact with heated objects, electrical current or chemicals
What are the risk factors for burns injuries?
Young children
>60
Male sex
What does a first degree burn look like?
Red and painless
What does a second degree burn look like?
Wet + Painful burns
What does a third degree burn look like?
Dry + Insensate burns
What does a 4th degree burn look like?
Burns affecting subcutaneous tissue, tendon or bone
What is a sign of severe burn?
Clouded corneas
What investigations are done for burns injuries?
FBC (Low Hct, hypovolaemia, neutropenia, thrombocytopenia)
Metabolic panel (High level urea, glucose, creatinine, hyponatraemia, hypokalaemia)
Carboxyhaemoglobin (high in inhlaation injruy)
ABG (Metbaolic acidosis in inhalation injury)
Flourescein staining (Damaged epithelial cells in burns)
CT scan head and spine (Based on history or mode of injury)
Wound biopsy culture (if septic)
Wound histology (If septic)
What is Candidiasis?
An infection caused by candida. Common commensal on skin, pharynx or Vagina. Invasion implies when the fungus is in normally sterile tissues.
What causes candidiasis?
Caused by 15 different candida species
Candida albicans is the most common cause
What are the main types of candidiasis?
Oral Oesophageal (AIDS defining condition) Candidial vulvovaginitis Candidal skin infections Invasive candidal infections
What are the Risk factors for candidiasis?
Broad-spectrum antibiotics Immunocompromised Central venous lines Cushing's disease Diabetes mellitus GI tract surgery Poor oral hygiene Pregnancy and pill
What are the signs and symptoms of Oral candidiasis?
Oral thrush
- Curd-like white patches in mouth, removed easily revealing an underlying red base. More common in neonates.
What are the signs and symptoms of oesophageal candidiasis?
Dysphagia
Pain on swallowing food or fluids
AIDS-defining illness
What are the signs and symptoms of candidal skin infections?
Soreness and itching
Skin appearance can be variable
Red, moist skin area with ragged, peeling edge and possibly papules and pustules
What are the signs of vaginal thrush?
White curd discharge
Vulva and vagina may be red, fissured and sore
What are the signs of invasive candidiasis?
Fever and chills
Can spread to cause fungemia, endocardiits, endophthalmost, osteomyelitis and CNS infections
What are the investigations for candidiasis?
Therapeutic trials of antifungal (fluconazole)
Skin scraping/oral swabbing/endoscopy
Culture on Sabouraud’s medium
Blood cultures
What is cellulitis and Erysipelas?
Commonly seen as manifestations of the same condition and the terms are often used interchangeably.
They are acute, painful and potentially serious infections of the skin and SC tissues.
What is the most common cause of cellulitis and Erysipelas?
Streptococcus spp.
Staphylococcus spp.
Caused by a wide range of aerobic and anaerobic bacteria
What is cellulitis?
Infection of dermis and subcutaneous tissue and has poorly demarcated borders
What is Erysipelas?
Superficial cellulitis (Dermis and Upper SC tissues) Sharply demarcated borders
What causes cellulitis?
Most infections that affect skin due to streptococci, although other organisms may be responsible if integrity is compromised
Gram negative organisms, anaerobes or fungi may cause cellulitis
Cellulitis around surgical wounds, less than 24hrs postoperatively may result from group A beta-haemolytic streptococci or clostridium perfringens (Producing gas/crepitus)
What is Erysipelas?
Most are group A streptococci
Strep. Pneumoniae, Klebsiella pneumoniae, haemophilus influenzae tybe B, yersinia enterocolitica adn moraxella spp.
What are the risk factors for Cellulitis and Erysipelas?
Previous erysipelas or cellulitis Venous insufficiency Elderly age Alcoholism IV drug use Lymphoedema Overweight/obesity Athlete's foot/skin abrasions Inflammatory dermatoses Insect bites Pregnancy
What are the symptoms of Erysipelas?
Painful, shiny light-red swelling of clearly defined area of skin
Cause blisters and swelling of nearby lymph nodes
Fever and malaise
What are the symptoms of cellulitis?
Reddened skin less clearly defined, often is dark-red/purple
Produces pus
History of cut, scratch or injury
Periorbital cellulitis - painful swollen red skin around the eye
Orbital cellulitis - Painful or limited eye movements, visual impairment
What are the signs of Cellulitis and Erysipelas?
Lesions (Erythema, oedema, warm, tender distinct margins, pyrexia (suggest systemic spread))
Periorbital (swollen eyelids and conjunctival infection)
Orbital cellulitis (Proptosis, Impaired visual acuity and eye movements, test for RAPD, visual acuity and colour vision)
What are the investigations for Cellulitis and Erysipelas?
Blood culture (pathogen growth) FBC (Leucocytosis) Discharge sample and send for MC&S Aspiration CT scan MRI (if NF suspected)
What is the management for cellulitis and Erysipelas?
General (Rest, elevation of limbs and analgesia)
Prescribe analgesia (paracetamol/ibuproden)
Flucloxacillin 500mg 4x/day, sometimes penicillin V for cellulitis
Erythromycin 50mg 4x daily if penicillin allergic, Clarithromycin if intolerant
Clindamycin (second line)
Co-amoxiclav if facial involvement
NSAIDs and CORTICOSTEROIDS
What are the complications of Cellulitis and Erysipelas?
Sepsis
Chronic oedema in affected extremity
What is Eczema?
Inflammatory skin condition characterised by dry, pruritic skin with a chronic relapsing course. Affects all age groups, commonly misdiagnosed before 5 and affects 10-20% of children
What causes Eczema?
Cells of stratum corneum form a barrier between cells that are lipids and proteins
Defects in barrier leads to eczema
Many patients have a gene mutation in filagrin gene
What are the risk factors/causes for exogenous eczema?
Irritants
Contact
Atopic
Eczema herpeticum
What are risk factors/causes for endogenous eczema?
Atopic Seborrheic Pompholyx Varicose Lichen simplex Discoid
What are the risk factors for eczema?
Age <5 years Family history of eczema Allergic rhinitis Asthma Antihelminthic treatment in utero Active and passive exposure to smoke
What are the symptoms of Eczema?
Itching Heat Tenderness Redness Weeping Crusting Ask about occupational exposure to irritants Ask about personal/gmaily history of atopy Loss of pigment
What are the signs of eczema?
Acute: - Poorly demarcated erythematous oedematous dry scaling patches - Papules - Vesicles with exudation and crusting - Excoriation marks Chronic: - Thickened epidermis - Skin Lichenification - Fissures - Change in pigmentation
Where does atopic eczema act?
Mainly faces and flexure surfaces
Where does seborrhoeic eczema act?
Yellow, greasy scales on erythematous plaques.
Found on eyebrows, scalp and presternal area
Where does pompholyx eczema act?
Vesiculobullous eruptions on palms and soles
Where does Discoid eczema act?
Coin shaped
On legs and trunk
Where does asteatotic eczema act?
Dry, crazy pairing patern
What investigations are done for eczema?
Clinical diagnosis
Allergy testing
IgE levels (elevated)
Skin biopsy
What is Erythema multiforme?
Acute hypersensitivity reaction of the skin and mucous membranes.
Stevens-Johnson syndrome is a severe, rare form with bullous lesions and necrotic ulcers
What causes erythema multiforme?
Skin-directed immune reaction which occurs following exposure to a trigger in predisposed individuals
What changes occur in erythema multiforme?
Degeneration of basal epidermal cells
Development of vesicles between cells in the basement membrane
Lymphocytic infiltrate around the blood vessels and at the dermo-epidermal junction
What can cause erythema multiforme?
Drugs (sulphonamides, NSAIDs, anti-convulsants, allopurinol)
Infections (HSV, EBV, adenovirus, chlamydia)
Inflammatory conditions (RA, SLE, Sarcoidosis, UC)
Malignancy (Lymphomas, leukaemia, myeloma)
Radiotherapy
50% are Idiopathic
What are the symptoms of Erythema multiformer?
Non-specific prodromal symptoms of URTI
Sudden itching/burning/painful skin lesions
Few to hundreds of red papules (spots) which begin over back of feet and hands and spread upwards to the trunk
Over time papules evolve to plaques and then to typically targe shaped lesions
Skin lesions fade leaving pigmentation
Steven-Johnsons’ syndrome (fever and mucosal involvement too)
What are the signs of Erythema multiforme?
Classic target lesions with a rim of erythema surrounding paler area
Vesicles / Bullae
Urticarial plaques
Lesions are symmetrical and distributed over arms and legs
What are the characteristic signs of Steven-Johnsons’ syndrome?
Affecting >2 mucous membranes (e.g. conjunctiva, cornea, lips, mouth, genitalia)
Systemic symptoms (e.g. sore throat, cough, fever, headache, myalgia, arthralgia, diarrhoea/vomiting)
Shock (hypotension and tachycardia)
What are the investigations for Erythema multiforme?
Usually unneeded
Bloods (Leucocytosis, Eosinophils, ESR/CRP)
Imaging (exclude sarcoidosis and atypical pneumonia)
Skin biopsy (if doubted)
What is Erythema nodosum?
Panniculitis (Inflammation of SC fat tissue) presenting as red or violet SC nodules on B/L shins
What causes Erytma nodosum?
Delayed hypersensitivity reaction to antigens associated with various infectious agents, drugs, diseases, pregnancy and BCG vaccinations
What infections cause Erythema nodosum?
Bacterial e.g. streptococcus Viral e.g. EBV Fungal e.g. Histoplasmosis Mycobacterium e.g. TB, leprosy Yersinia
What diseases cause Erythema nodosum?
Sarcoidosis IBD Behcet's disease Leukaemia Hodgkin's disease
What drugs cause erythema nodosum?
Sulphonamides
Penicillin
Oral contraceptive pills
Dapsone
What are the symptoms of Erythema nodosum?
Tender red or violet raised nodules B/L on both shins Occasionally on thighs or forearms Fatigue Fever Anorexia Weight loss Arthralgia Symptoms of underlying cause
What are the signs of Erythema nodosum?
Crops of red/violet dome-shaped nodules usually present on both shins
Occasionally appear on thighs and forearms
Nodules are tender to palpation
Low-grade pyrexia
Joints may be tender and painful on movement
Signs of underlying cause
What are the investigations for Erythema nodosum?
Anti-streptolysin-O titres FBC CRP/ESR U&Es Serum ACE (Raised in sarcoidosis) Throat swabs and cultures Mantoux/head skin test for TB CXR: B/L hilar lymphadenopathy indicates sarcoidosis and unilateral indicates TB
What is Herpes?
A disease resulting from HSV1/HSV2 infection
It can manifest in many ways
(Genital, Gingivostomatitis, Herpetic whitlow, Herpes gladiatorum, eczema herpeticum, herpes meningitis, HSV keratitis, Recurrent HSV)
What is gingivostomatitis?
Ulcers filled with yellow sough around mouth
What is herpetic whitlow?
Infection of the virus in abrasions near fingernail/nailbed
What is Herpes gladitorium?
Vesicles wherever HSV is ground into the skin by force
What is HSV Keratitis?
Corneal dendritic ulcers
What causes Herpes?
Transmitted via close contact with an individual who is shedding the virus.
After primary infection, virus becomes dormant
Reactivation occurs in response to physical and emotional stresses or immunosuppression
Virus causes cytolysis of infected epithelial cells leading to vesicle formation
What are the symptoms of HSV1 infection?
Possible symptoms of primary: - Pharyngitis - Gingivostomatitis - Herpetic whitlow Possible symptoms of reactivation: - Prodrome of perioral tingling and burning - Vesicles appear - Heal within 8-10 days
What are the symptoms of HSV2 infection?
- Painful blisters and rash in the genital, perigenital and anal area
- Dysuria
- Fever
- Malaise
Which virus causes herpetic encephalitis?
HSV1
What are the symptoms of HSV keratoconjunctivitis?
Watering eyes
Photophobia
What are the signs of HSV1 infections?
Presents as herpetic labialis (cold sores) Tender cervical lymphadenopathy Erythematous, oedematous pharynx Oral ulcers filled with yellow slough Herpetic whitlow Signs of encephalitis
What are the signs of HSV2 infections?
HSV2 is nearly always sexually transmitted and causes genital herpes - genital or anal blisters
- Maculopapular rash
- Vesicles
- Ulcers
- All found on external genitalia, anal margin and upper thighs
- inguinal lymphadenopathy, pyrexia
HSV keratoconjunctivitis - Dendritic ulcer on the iris
What are the investigations for Herpes?
Clinical diagnosis
Vesicle fluid can be sampled and sent for electron microscopy, PCR
What is a lipoma?
Slow-growing, benign adipose tumours that are most often found on SC tissues.
What causes a lipoma?
Benign tumours of adipocytes Occur wherever fat can expand i.e. not scalp or palm Conditions associated with lipomas: - Familial multiple lipomatosis - Gardner's syndrome - Decrum's disease - Madelung's disease Liposarcoma - rare malignant tumour of adipose tissue
What is Decrum’s disease?
A disease causing multiple scattered lipomas which may be painful, typically in post-menopausal women
What are the signs and symptoms of Lipomas?
Most are asymptomatic Compression of nerves can cause pain Soft or firm nodule Smooth normal surface Skin coloured Most are <5cm diameter Mobile Soft/doughy feel Hint of fluctuance
What are the investigations for lipoma?
Usually clinical
US/MRI/CT if any doubt
What is a melanoma?
Malignancy arising from neoplastic transformation of melanocytes, the pigment forming skin cells. The leading cause of death from skin disease.
What are the types of melanoma?
Lentigo maligna melanoma
Superficial melanoma
Nodular melanoma
Acral lentiginous melanoma
What are Lentigo maligna melanoma?
Patch of lentigo maligna develops a papule or nodule signalling invasive tumours
What is superficial melanoma?
Large, flat, irregularly pigmented lesion which grows laterally before vertical invasion develops
What is nodular melanoma?
Most aggressive type
Rapidly growing pigmented nodule which bleeds or ulcerates. Rarely amelanotic and mimic pyogenic granuloma
what is acral lentiginous melanoma?
Pigmented lesions on palm, sole or under the nail, usually presents late, most common in non-white people
How do melanomas mestastasise and where to?
Via blood and lymphatics
Metastasis to: Lymph nodes, liver, lung, bone and brain
What causes a melanoma?
Arises from melanocytes
Inheritance of sun-sensitive skin and specific melanoma-related genes
Mainly CDKN2A, encoding p16 and p14ARF, affecting p53 and retinoblastoma cycle
What are the risk factors for melanoma?
Family history of melanoma
Personal history of melanoma
Personal history of skin cancer (including actinic damage)
History of atypical naevi (6mm or larger with irregular pigmentation)
Fitzpatrick skin type I or II (Light-coloured skin)
Red or blonde hair
High freckle density
Sun exposure
Sun bed use
Light eye colour
Increased number of benign-appearing melanocyte naevi
Large congenital naevi
Immunosuppression
Xeroderma pigmentosum
What are the symptoms of a melanoma?
Change in size, shape or colour of pigmented skin lesion Redness Bleeding Crusting Ulceration
What are the signs of a melanoma?
ABCDE(F) A - Asymmetry B - Border irregularity C - Colour variation D - Diameter >6 mm E - Elevation F - Fast evolving
What are the investigations for melanoma?
Excisional biopsy Dermoscopy Lymphoscintigraphy Sentinal lymph node biopsy Staging Bloods CDKN2A genetic test
What is Molluscum contagiosum?
Common skin infection caused by a pox virus that affects children and adults/
Transmission is usually by direct skin contact
What causes molluscum contagiosum?
Viral skin infection caused by molluscum contagiosum virus (MCV)
It is a type of pox virus
What are the risk factors for molluscum contagiosum?
Mainly in children
Immunocompromised (HIV)
Atopic eczema
What are the symptoms of molluscum contagiosum?
Incubation period (2-8 weeks)
Usually asymptomatic
May be tenderness, pruritus and eczema around the lesion
Lesions last for around 8 months
What investigations are done for molluscum contagiosum?
Clinical diagnosis
Dermatoscopy may be useful if any doubt
What is a pressure sore?
Damage to skin, usually over a bony prominence, as a result of pressure
What causes a pressure sore?
Constant pressure limits blood flow to the skin leading to tissue damage
Occurs as a result of pressure, friction and shear
What are the Risk Factors for Pressure sores?
Immobility
Obesity
Alzheimer’s disease
Diabetes
What are the signs and symptoms of pressure sores?
Most commonly at the sacrum and heel
Pressure sores staged 1-4
Very tender
May become infected leading to fevers, erythema and foul smell
What are the investigations for pressure sores?
Clinical diagnosis
Waterlow score to predict risk
What is Psoriasis?
Chronic inflammatory skin disease characterised by erythematous, circumscribed, scaly papules and plaques.
It can cause itching, irritation, burning and stinging
What causes psoriasis?
Unknown cause
Made up of genes, infections, immunology and drugs
Immune response defined by T cells in dermis, initiating release of cytokines
What are the risk factors for Psoriasis?
Genetic Infection Local trauma Stress Smoking Light skin Beer intake
What are the types of Psoriasis?
Guttate
Palmoplantar
Generalised pustular
What is Guttate psoriasis?
Affects teens and those in early 20s
Triggered by streptococcal sore throat
Small pink and scaly lesions
What is Palmoplantar psoriasis?
Psoriasis on hands and feet
Smoking, middle-aged women, AI thyroid disease, pustules on hands and feet
What is generalised pustular psoriasis?
Hypoparathyroidism
What are the symptoms of psoriasis?
Commonly: Scalp, Elbows, Knees, Buttocks, Genital area, foot soles itching and occasionally tender skin
Pinpoint bleeding with removing scales (Auspitz phenomenin)
Skin lesions may develop at sites of trauma/scars (Koebner phenomenin)
What are the signs of psoriasis?
Discoid/nummular psoriasis (symmetrical, well-demarcated erythematous plaques with silvery scales over extensor surfaces)
Flexural psoriasis (Less scaly plaques in axilla, groins, perianal and genital skin)
Guttate psoriasis (small drop-like lesions over trunk and limbs)
Palmoplantar psoriasis - pustules distributed over limbs and torso
- Nail signs (Pitting, onycholysis, subungual hyperkeratosis)
- Joint signs (asymmetrical oligoarthritis, symmetrical polyarthritis, Distal interphalangeal joint, arthritis mutilans, psoriatic spondylitis)
What investigations are done for psoriasis?
Most do not need investigations
- Guttate psoriasis - anti-streptolysin-O titre, throat swab
- Flexural psoriasis - Skin swabs to exclude candidiasis
Nail clipping analysis for onychomycosis
Joint involvement analysed by checking for rheumatoid factor
Skin biopsy
What are sebacious cysts?
Either epidermoid or pilar cysts - epithelium lined, keratinous, debris-filled cysts
Both contain keratin, not sebum and do not originate from sebaceous glands
What is the difference between epidermoid and pilar cysts?
Epidermoid - Epidermis
Pilar - Hair follicles
What causes sebaceous cysts?
Occlusion of the pilosebaceous gland
Can be caused by traumatic insertion of epidermal elements into the dermis
Embryonic remnants
What are the risk factors for sebaceous cysts?
Gardner’s syndrome = Autosomal dominant characterised by multiple polyps in the colon and in extra-colonic sites
What are the symptoms of sebaceous cysts?
Non-tender slow-growing skin swelling
There are often multiple
Common on hair-bearing regions of the body
May become red, hot and tender if superimposed infection or inflammation
Infection is quite common - dischare cheesy foul-smelling pus
What are the signs of sebaceous cysts?
Firm, round, mobile SC nodules
Characteristic overlying central punctum
Foul pus (granular and creamy) exits through punctum
What are the investigations for sebaceous cysts?
None needed
Skin biopsy or FNA may be used to rule out other differentials
What is a squamous cell carcinoma?
Proliferation of atypical, transformed keratinocytes in the skin with malignant behaviour.
Ranges from in situ tumours (Bowen’s disease) to invasive and metastatic disease
What causes Squamous cell carcinoma?
Excess sun light exposure
What are the risk factors for squamous cell carcinoma?
UV radiation exposure Immunosuppression Fair skin Hereditary skin conditions Older age Male sex Ionising radiation Carcinogens Actinic keratosis Previous skin cancer HPV Tobacco smoking Thiazide diuretic and cardiac drugs Keratoconthomas Tattoos
What are the symptoms for Squamous cell carcinoma?
Skin lesion Ulcerated Recurrent bleeding Non-healing Bone pain Plaques
What are the signs of squamous cell carcinoma?
Variable appearance - may be ulcerated, hyperkeratotic (with keratin horn), crusted or scaly, non-healing
Sun-exposed areas
Palpate for local lymphadenopathy
Hepatomegaly
What are the investigations of squamous cell carcinoma?
Skin biopsy - staging
CT body scan / MRI scan / PET scan - lymphadenopathy and/or visceral nodules suggests mets
FBC with differential (Normal except with bone marrow mets)
LFT and CXR (Normal without mets)
What is Urticaria?
Itchy, red, blotchy rash resulting from swelling of the superficial part of the skin
Angioedema occurs when the deep tissues, lower dermis and SC tissues are involved and become swollen
Angio-oedema occurs in association with urticaria in about 40% of cases (AKA hives)
What causes urticaria?
Caused by activation of mast cells in the skin, resulting in the release of histamines
The cytokine release leads to capillary leakage, causing swelling of the skin and vasodilatation > erythematous appearance
What are the triggers for acute urticaria?
Allergies
Viral infections
Skin contact with chemicals
Physical stimuli
What are the triggers for chronic urticaria?
Chronic spontaneous urticaria - medication, stress, infections
Autoimmune
What are the signs and symptoms of Urticaria?
Central, itchy white papule or plaque surrounded by erythematous flare
Blanching, oedematous, non-painful, pruritic
Lesions vary in size and shape
May be associated with swelling of soft tissues of eyelids, lips and tongue
Individual lesions are transient
Stridor
Time scales
- Acute - quickly but recover over 48 hours
- Chronic - rash for > 6 weeks
What are the investigations for Urticaria?
Usually clinical
Tests may be required for chronic urticaria (e.g. FBC, ESR/CRP, patch testing, IgE tests) depending on history
What is Varicella Zoster?
Primary infection is varicella (Chicken pox)
Reactivates causing zoster (shingles)
What causes Varicella zoster?
Primary infection with human alpha herpes virus, varicella zoster, in a non-immnue host
Virus Takes a lifelong latency in cranial nerves and dorsal root ganglia
What are the risk factors for varicella zoster?
Age 1-9 years
Exposure to varicella
Unimmunised status
Occupational exposure
What are the symptoms of Varicella?
Prodromal malaise
Mild pyrexia
Sudden appearances of intensely itchy spreading rash affecting face and trunk
Vesicles weep and crust over
Contagious from 48hrs before rash until after they have all crusted over
What are the symptoms of zoster?
May occur after period of stress
Tingling/hyperaesthesia in a dermatome
Painful skin lesions
Recovery 10-14 days
What are the signs of varicella?
Maculopapular rash
Area of weeping and crusting
Skin excoriation (from scrathing)
Mild pyrexia
What are the signs of zoster?
Vesicular maculopapular rash
Dermatomal distribution
Skin excoriation
What is the management of varicella zoster?
Minimalise scratching
Avoid pregnant people and anyone immunocompromised
Analgesia and antipyretics for symptoms
Antivirals
What is the antiviral treatment for varicella zoster?
Some need IV aciclovir or oral aciclovir
Which people would need IV aciclovir?
- High- risk patients who are immunocompromised
- Sytemic disease
- Patients on high-dose steroids
- New lesions after 8 days
Which people need Oral aciclovir?
Chronic medical condition
Over 12 years old
Secondary case in a household
Pregnant patient
What are the complications for varicella?
Secondary infection Scarring Pneominits and ataxia Purpura fulminans DIX Pneumonia Encephalitis Congenital varicella syndrome
What are the complications for zoster?
Postherpetic neuralgia
Zoster ophthalmicus (rash in ophthalmic division of the trigeminal nerve)
Ramsay-Hunt syndrome (zoster of the ear and facial nerve - vesicles behind pinna of ear or in the ear canal)
Sacral zoster
Motor zoster
