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Clinical Medicine > Dermatology Lecture 2 pt 2 > Flashcards

Dermatology Lecture 2 pt 2 Flashcards

1
Q

What bacterial infections do we cover in this lecture?

A
  • Cellulitis
  • Vasculitis
  • Erysipelas
  • Erysipelothrix
  • Impetigo/Ecthyma
  • Leprosy
  • Typhoid Fever
  • Ehrlichiosis
  • Necrotizing Fasciitis
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2
Q

What is cellulitis and causative agents

A
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3
Q

Clinical features of cellulitis and needed work-up?

A
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4
Q

What is this condition?

A

Cellulitis

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5
Q

Treatment of Cellulitis?

A

Treatment: Mild/early- Cephalosporins if allergic then Erythromycin

*Consider MRSA Coverage -Mark margins to monitor infection and response to treatment

  • Choice of antibiotic varies – based on severity, patient’s co-morbid conditions,
    community rates of drug-resistant pathogens.

-If poor response to treatment or necrosis of soft tissue occurs, surgical intervention is
mandatory

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6
Q

Treatment for cellulitis caused by dog and cat bites

A
  • DOG or Human bite – Amoxicillin-clavulanate (Augmentin), Doxycycline if PCN allergic
  • CAT bite – typically covering for Bartonella spp– Augmentin + Clindamycin or Bactrim or
    Doxy
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7
Q

What is this condition?

A

Definition – extravasation of red blood cells into the skin or mucous membrane

Non-blanchable. Can’t displace the blood

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8
Q

What are the 4 types of Purpura

A

4 types
– petechia – flat macules < or = to 4mm

-ecchymosis – flat, macules or patches, >5mm, fade in color

-palpable purpura – elevated, round/oval, red/purple

retiform – stellate or branching lesions, +/- palpable

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9
Q

Vasculitis presentation

A
  • May occur as an idiopathic, predominantly cutaneous vasculitis
  • Palpable purpura (nonblanching, elevated lesions) is the cutaneous
    hallmark of vasculitis
  • Other lesions include petechiae (esp. early lesions), necrosis with ulceration, bullae, and urticarial lesions
  • Lesions most prominent on lower extremities
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10
Q

What conditions is vasculitis associated with

A
  • Infections
  • Collagen-vascular disease
  • Primary systemic vasculitides
  • Malignancy
  • Hepatitis B
  • Drugs (esp. thiazides)
  • Inflammatory bowel disease
  • Exercise-induced (Disney rash)
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11
Q

What condition is this?

A
  • Palpable purpuric papules
    on the lower legs are seen
    in this patient with
    cutaneous small vessel
    vasculitis
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12
Q

What is this condition?

A

Cutaneous Acute Vasculitis

  • Characterized clinically
    by palpable purpura,
    especially of the legs
  • May be limited to the
    skin or involve other
    tissues as in Henoch-
    Schönlein purpura
    (HSP)
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13
Q

What is this condition?

A

Henoch-Schonlein Purpura (HSP)

  • It is immunoglobulin A (IgA)-mediated and mostcommonly occurs in children after a streptococcal or viral infection (type of severe vasculitis)
  • Petechiae and purpura of necrotizing vasculitis are usually localized to the lower third of the extremities.
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14
Q

What is the treatment for HSP

A
  • Treatment: Antibiotics if indicated. Prednisone if moderate to severe. Cyclophosphamide or azathioprine have been used in conjunction with prednisone
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15
Q

What is this condition?

A

Livedo Reticularis

  • Reticulated (lace-like or Net-like)
    blanching erythema
    symmetrically distributed over
    lower extremities.
  • Does blanche
  • Frequently seen in autoimmune
    vasculitis
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16
Q

Generalized treatment of vasculitis?

A
  • Will differ based on cause
  • Pursue identification and treatment/elimination of an exogenous cause or underlying disease
  • If part of a systemic vascultitis treat based on major organ-threatening features
  • Immunosuppressive therapy should be avoided in idiopathic predominantly
    cutaneous vasculitis as disease does not usually respond
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17
Q

What is this condition?

A
  • Systemic vasculitis characterized by
    necrotizing inflammatory lesions
    that affect medium-sized and small
    muscular arteries, preferentially at
    vessel bifurcations
  • Can lead to microaneurysm
    formation, aneurysmal rupture
    with hemorrhage, thrombosis, and,
    consequently, organ ischemia or
    infarction
  • Lungs are usually spared
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18
Q

Sxs and dx for Polyarteritis Nodosa?

A
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19
Q

Treatment of polyarteritis Nodosa?

A

Corticosteroids IV; if refractory,
may add biologics (Infliximab,
etanercept etc.) or methotrexate

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20
Q

Condition? How is it defined?

A
  • Sharply demarcated, painful, indurated,
    erythematous “fiery red”, edematous
    plaques
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21
Q

Condition? what causes it?

A
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22
Q

What are the clinical features of Erysipelas?

A
  • Begins as a small erythematous patch (bigger than macule) that rapidly progresses to a fiery-red, hot, indurated, tense, and shiny plaque
  • The lesion classically exhibits a sharply raised border with abrupt demarcation from healthy skin.
  • This is the differentiation from cellulitis, which has less defined
    border
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23
Q

Laboratory and treatment of Erysipelas?

A
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24
Q

What is this condition?

A
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25
Q

What is this condition?

A

Impetigo

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26
Q

What is this condition? Define

A

Ecthyma

  • Deeper form of impetigo * Ulcerative pyoderma of the skin caused by group A beta-
    hemolytic streptococci
  • It is often referred to as a deeper
    form of impetigo because it
    extends into the dermis
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27
Q

Treatment of Impetigo/Ecthyma?

A
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28
Q

What is this condition? Describe

A

Ecthyma Gangrenosum

  • Vesicular rash progressing to
    hemorrhagic bullae, and later to
    necrotic ulcers.
  • Note the eschar
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29
Q

What cause ecthyma grangrenosum and what is dx/treatment?

A

EX ciprofloxacin

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30
Q

Case Study

A
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31
Q

What is this condition?

A
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32
Q

Treatment for Hanson’s Disease (leprosy)

A

Dapsone+Rifampin+Clofazimine
for 6-12 months (extensive
treatment!)

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33
Q

What is this condition?

A
  • Salmonella species
  • Seen in Asia/Vietnam
  • See salmon colored rash and non-
    bloody diarrhea (enteric fever)
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34
Q

What is the dx and treatment of Typhoid Fever?

A
  • Dx: Antibody Widal test
  • Tx: Azithromycin or cephalosporin
    or fluoroquinolone depending on
    region resistance salmon-colore
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35
Q

What is this condition?

A

Ehrlichiosis

  • Tick-borne bacterial infection * Rash is uncommon, but
    accompanied by headache,
    myalgia, lymphadenitis and
    hepatomegaly
  • Spares palms and soles
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36
Q

What is the dx and treatment for Ehrlichiosis

A
  • Dx: PCR
  • Tx: Doxycycline or Minocycline,
    or Rifampin
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37
Q

What are the 3 types of necrotizing fasciitis

A
  • Type 1: polymicrobial/ salt-water contamination with Vibrio species,
    MRSA and others
  • Type 2: Group A streptococcal
  • Type 3: Clostridium infection, Clostridium myonecrosis (gas gangrene
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38
Q

What is this condition?

A

Widespread fascial necrosis
* Clostridial myonecrosis: gas (“air”) gangrene
* SQ emphysema or air seen on x-ray/ CT scan

  • Usually direct inoculation from an open wound; uterine following C-section; some “spontaneous” cases; anaerobic organism
  • Brawny edema, crepitance, brownish
    discoloration, malodorous serosanguinous discharge; bullae; air gangrene
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39
Q

Treatment of necrotizing fasciitis?

A
  • Update Tetanus
  • IV ABX broad spectrum to cover MRSA
  • Surgical debridement (fasciotomy, debridement, even amputation)
  • Progressive, life-threatening situation
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40
Q

What are the main fungal infection we cover in this lectures?

A
  • Candidiasis
  • Rhinocerebral Mucormycosis
  • Dermatophyte Infections
  • Tinea Versicolor
  • Tinea corporis/pedis
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41
Q

What is this condition?

A

Diaper Dermatitis from Candidiasis

Confluent erosions, marginal
scaling, and “satellite pustules” .

Often under folds of skins

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42
Q

What is this condition?

A

Candidiasis

Small erosions in the interdigital web space of the hand

Diabetics prone to this

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43
Q

Laboratory test for Candidiasis?

A
  • Laboratory: Grams stain or KOH to visualize pseudohyphae (no true septae) and
    elongated yeast forms

-Culture for fungus and bacteria

44
Q

Treatment for candidiasis?

A
  • Remove predisposing factors such as chronic wetness, antibiotics, or improving
    glucose control in diabetics
  • Nystatin or azole antifungals (ketoconazole, clotrimazole, miconazole, econazole)
  • Add hydrocortisone cream to decrease the associated inflammatory response in
    severe symptoms
45
Q

What condition is this?

A

Rhinocerebral Mucormycosis (Zygomycosis)

  • Necrotic lesions of palate and
    mucosa due to fungi
  • Clinically patients have depressed
    sensorium and CN palsies
  • Seen in immunocompromised
    state
  • Is a surgical emergency
46
Q

Dx and treatment of Rhinocerebral Mucormycosis (Zygomycosis)

A

Dx: PCR

  • DDx: Aspergillosis
  • Tx: Amphotericin B (very strong),
    surgical and ID consult
47
Q

What is this condition?

A

Tinea versicolor

  • Hypopigmented or
    hyperpigmented round or oval
    macules with fine scaling that do
    not tan and can be pruritic
  • Variation of presentation based
    on skin tone.
48
Q

How to diagnosis Tinea Versicolor?

A
  • Laboratory: KOH show hyphae and spores (spaghetti and meatballs)

-Wood’s light exam shows Blue-green fluorescence

49
Q

Treatment for Tinea Versicolor?

A

Topical Treatment:

-Selenium sulfide shampoo applied from neck to waist, leave on 15 min, once a
day for 7 days

-Ketoconazole 2% shampoo or cream – not first line due to liver SE

-Oral ketoconazole but patients shouldn’t shower for 18 hours as the medicine
works but being delivered through the patients sweat
———Sweating must be induced

50
Q

What is this condition?

A

Tinea Corporis (body)

  • Erythematous, annular patch with
    distinct borders and central clearing
    usually with scaling
51
Q

What condition is this?

A

Tinea Capitis

Scalp (Tinea Capitis)-broken hair
shafts are seen as black dots

  • Kerion (indurated, boggy
    inflammatory plaque studded with
    pustules) can be present in any
    location of tinea, but most commonly
    seen on the scalp
52
Q

What laboratory test is done for Tinea Corporis?

A

Potassium Hydroxide (KOH) to visualize hyphae

  • Multiple septated, tubelike structures and spore (hyphae or mycelia) formations *

Wood’s Lamp
* Hairs will fluoresce greenish
* Intertriginous sites will fluoresce coral red

-Fungal cultures

53
Q

Treatment for Tinea Corporis?

A
  • Topical imidazoles, allylamines, or substituted pyridone used twice a day for 4-6 weeks
  • Chronic or resistant: Oral griseofulvin, itraconazole, terbinafine, or ketoconazole
  • Kerions: Oral fluconazole or griseofulvin
54
Q

What condition is this?

A

Note: No hyphae with KOH. Thats how you know it is not candidiasis or tinea

55
Q

What condition is this?

A

Serpiginous lesion

Denoting a cutaneous lesion that extends with a wavy/creeping or serpent-like border.

  • Typically parasitic (hookworm) in nature
    and occur in tropical locations
  • Cutaneous Larva Migrans
  • Presents as pruritic and painful rash
56
Q

Diagnosis and treatment for serpiginous lesion/hook worm

A

Dx: Punch biopsy

  • Tx: Albendazole 400mg QD x 3 days
  • Alt: Thiabendazole TID until
    resolved
  • Alternatively ivermectin or
    cryosurgery
  • Triamcinolone can be given for
    symptomatic relief
57
Q

What condition is this?

A

Acanthosis Nigricans

Hyperpigmentation with thick,
velvety accentuation of the dermal
lines

  • Most commonly on the axillae, neck
    but can also be groin, anogenitalia,
    antecubital fossae, knuckles,
    submammary, and umbilicus.
  • Common in insulin resistance
58
Q

Lab and treatment for Acanthosis Nigricans?

A
  • Laboratory: R/O Diabetes Mellitus, Carcinoma if clinically suspected
  • Treatment: No proven treatment other than for underlying disorder if present
59
Q

Definition of first degree burn?

A

First-degree-red, moist, swollen, and painful and blanches when lightly touched but does not develop blisters

60
Q

Definition of second-degree burn?

A

Second-degree: red, swollen, and painful, and develops blisters

61
Q

Definition of third degree burn?

A

Usually are not painful because the nerves have been destroyed.

The skin becomes leathery and may be white, black, or bright red.

The burned area does not blanch, and hairs can easily be pulled from their roots without pain.

No blisters develop

62
Q

What is the rule of nines?

A
63
Q

Burn treatments

A

Treatment:
* 1st and 2nd degree burns: cool compresses
* Silver sulfadiazine is no longer recommended

  • Blisters should not be broken according to AAPA; however, rupturing the blister and using the top as a partial thickness skin grafts allows the wound to heal quicker and gives pain relief
64
Q

Burn treatment continued

A

Larger 2nd degree and any 3rd degree burns:

Hospitalization and fluid replacement.

Escharotomy and fasciotomy are done when indicated

  • Fluid replacement if >15% TBSA full thickness burn
  • LR is most common (Parkland Formula) * Total fluid = 4mL x wt (kg) x TBSA (%)
  • Early intubation if inhalation injury
  • Assess tetanus vaccine status with any open wound
65
Q

What are the first two stages of decubitus ulcers?

A

Stage I: Nonblanching erythema of intact skin

Stage II: Necrosis, superficial or partial-thickness involving the epidermis and/or
dermis; shallow ulcer

66
Q

The last two stages of decubitus ulcers?

A

Stage III: Deep necrosis; crater ulcers with full thickness skin loss; damage or necrosis can extend down to, but not through the fascia

Stage IV: Full thickness ulceration with extensive damage and necrosis to muscle,
bone, or supporting structure

67
Q

What causes Decubitus ulcers?

A
  • Decubitus: due to impaired blood supply because of pressure. Studies show cell
    damage occurs in as early as 30 minutes following constant pressure to the area.
    Sacrum and hips are most common. Complications include osteomyelitis,
    bacteremia, and sepsis
68
Q

What is the treatment plan for decubitus ulcer?

A

Treatment: Repositioning at least Q2hrs, massaging prone areas, and frequent
monitoring and contamination avoidance are key

-Minimize friction, air mattress, meticulous hygiene and good nutrition

-Ulcer-moist sterile gauze (Gelfoam), DuoDerm, and/or surgical Debridement

-Topical and/or systemic antibiotics if indicated

69
Q

Management of stage I and II decubitus ulcers?

A

Stage I and II

Topical antibiotics (not neomycin) – allergic reaction

If debridement is needed: wet to dry normal saline dressings

Consider hydrogels or hydrocolloid dressings if the ulcer does not heal by 30%
in 2 weeks.

70
Q

Management of stage III and IV ulcers

A

Stage III and IV
— Surgical management
— Debridement of necrotic tissue
— Bony prominence removal
— Skin grafts

*Prolonged systemic antibiotics depending on sensitivities for any secondary bacterial
infection

71
Q

What are the two types of leg ulcers? Define?

A

1) Diabetic-tend to be deep, punched out lesions over the malleoli, the plantar surface of the feet or toes and are usually painless

2)Arterial-Not preceded by dermatitis and are smaller than stasis ulcers. These are painful, pulses are diminished or absent, and
the distal areas are cold

72
Q

What condition is this?

A

Stasis dermatitis-

preceded by dermatitis,
then wide but not deep ulcers
develop, with irregular,
undulating edges and clean
base. Elevation relieves pain

73
Q

Treatment of diabetic and arterial ulcers?

A
  • Diabetic and Arterial:

Smoking cessation and moderate exercise to enhance flow
* Debridement if necrotic
* Wet to dry dressing or hydrogel

74
Q

Treatment of stasis dermatitis?

A

Stasis: Elevation and Compression

  • affected limb should be whirlpooled, lesion painted with gentien violet and an
    Unna boot applied weekly
  • Compression should be applied first thing in the morning with leg elevated
75
Q

What is this condition? Describe

A

Hidradenitis Suppurtiva

  • Multiple comedones, some
    paired (which is characteristic),
    associated with several deep
    exquisitely painful abscesses and
    old scars
76
Q

More symptoms of Hidradenitis suppurtiva

A
  • Occurs in axillae, groin, anogenital, and/or breasts
  • Purulent/seropurulent drainage often present from abscesses and/or
    open sinus tracts
  • Fibrosis, “bridge” scars, keloids and contractures are common
77
Q

Treatment for hidradenitis suppurtiva

A

Treatment: Intralesional cortisone or triamcinolone, I&D and excision of
sinus tract

-Oral antibiotics (doxycycline or cephalexin)

-Oral prednisone tapered over 2 weeks if pain/inflammation are severe

-Oral Isotretinoin – may be useful in early disease when combined with
surgical excision

-Infliximab (Remicade);Adalimumab or Etanercept IV infusion. These are an
anti-tumor necrosis factor alpha, reducing inflammation and alters immune
response.

78
Q

What is a lipoma and how do you treat?

A
79
Q

What is this condition?

A

Epithelial Inclusion Cysts-Freely movable subcutaneous masses

80
Q

Treatment of epithelial inclusion cysts?

A
81
Q

What condition is this? Describe it?

A

Melasma

Hyperpigmented macules occurring on sun-exposed areas of the face

Most common on the forehead, cheeks, and upper lips

Often happens after pregnancy due to hormonal changes

82
Q

What is treatment of Melasma?

A
  • Prevention is key: SUNSCREEN containing titanium dioxide or zinc oxide —

-3% hydroquinone solution in combination with topical .025% tretinoin gel —

-Combination of 4% hydroquinone and glycolic acid in a cream base

May disappear spontaneously without treatment

when seen in pregnancy - often disappears after the patient delivers —

when associated with oral contraceptive pills – often disappears after the medication is stoppe

83
Q

What type of rash is this and what is it associated with?

A

Malar or butterfly rash
Condition of Systemic lupus erythematosus (SLE)

  • Malar distribution = Cheeks and
    Nose
  • Showing prominent, scaly, malar
    erythema
  • Involvement of other sun-
    exposed sites is also common
84
Q

What is this condition?

A

Pilonidal cyst

85
Q

What is pilonidal cyst ?

A

Pore, sinus and/or fistulas may be visualized alone or in the presence of nodule on the midline sacral region at the upper end of the cleft of the buttocks

  • Lesions become inflamed due to rupture, or less commonly, infection
  • Often occur with nodulocystic acne, dissecting cellulitis, and hidradenitis suppurativa
86
Q

Laboratory and treatment for pilonidal cyst?

A
  • Laboratory: Bacterial Culture if purulent discharge is present
  • Treatment:
  • I&D if abscess
  • Referral to general surgeon for complete excision, as simple cystectomy and
    marsupialization have a high rate of reoccurrenc3
87
Q

What is this?

A

Urticaria

  • Present as generalized pruritic
    wheals
  • A sign of more
    systemic/generalized
    involvement of allergic reaction

Showing characteristic discrete
and confluent, edematous,
erythematous papules and
plaques

88
Q

Laboratory for urticaria?

A
89
Q

Treatment for Urticaria?

A
90
Q

What condition is ? Describe it

A

Vitiligo

  • Chalk white macules, sharply
    demarcated often occurring
    around eyes, mouth, neck,
    axillae, hands, wrists groin,
    knees, feet
  • Early lesions are off-white and
    can have normal or hyperpigmented border
  • Frequently are post-traumatic or
    solar
  • Koebner Phenomenon
91
Q

What laboratory should be ordered for vitiligo?

A

Laboratory:T4, TSH(r/o thyroid disease); fasting blood glucose(r/o DM); CBC, c Diff(r/o pernicious anemia); ACTH stimulation test if
Addison’s disease is suspected

92
Q

Treatment for vitiligo?

A
  • Treatment: Sunscreen, cosmetic cover-up, or repigmentation therapies
  • Ultrapotent topical steroids (if no response in 2 months unlikely to be effective – monitor for signs of early steroid atrophy and telangiectasia)
  • Systemic phototherapy * Skin grafting.
93
Q

What is this condition?

A
94
Q

What condition is this?

A
95
Q

What condition is this?

A

Sweet Syndrome

  • Acute febrile neutrophilic dermatosis,
    linked to HLA B54 * Autoimmune interleukin-1 and TNFα play a role in activation
  • On skin see very painful papulovesicular
    rash with annular erosions
  • Expect conjunctivitis and oral mucosal
    ulcerations
96
Q

Dx and treatment of sweet syndrome?

A
  • Dx: Clinical, but on biopsy see
    neutrophilia without vasculitis, ESR is
    elevated
  • Tx: Corticosteroids, not antibiotic
97
Q

What is this condition?

A

Still’s disease

  • Inflammatory arthritis with fever, rash and
    joint pain
  • Evanescent salmon-colored rash on trunk &
    proximal extremities that coincides with
    fever spikes
  • Appears similar to juvenile RA *

Dx: Clinical

  • Tx: Corticosteroids (prednisone) or IL-1 blockers (Anakinra) if steroids not sufficient
98
Q

What is this condition?

A
  • Noninfectious cause of fever and petechia
  • What’s the difference from ITP?
  • Triggered by various causes: Pregnancy, bacterial infections, autoimmune
  • Genetically linked to ADAMTS13 dysfunction
    (Upshaw-Schulman Syn.
99
Q

What is the dx and treatment for TTP

A
  • Dx: Fever, anemia, thrombocytopenia, AKI and mentation change
  • Tx: Plasmapheresis and steroids, FFP can be
    infused if pheresis not available. Do NOT
    transfuse platelets
  • Purpura Fulminans see in DIC
100
Q

What is this condition? causes and treatments?

A

Erythema Multiforme

101
Q

What condition is this?

A

Erythema Marginatum from scarlet fever

102
Q

What condition?

A

Erythema Migrans

103
Q

What condition?

A

Erythema Ab Igne

  • Toasted Skin Syndrome * Secondary to long-term exposure to infrared radiation/heat.
  • Develop reticulated erythema,
    hyperpigmentation, teleangiectasia,
    burning and pruritis.
  • Discontinue heat exposur
104
Q

What condition?

A

Erythema Induratum

  • Previously known as Bazin
    Disease, now just Panniculitis
  • Commonly associated with
    cutaneous TB
  • Small superficial and painful
    nodules are felt
  • Work-up for TB
  • Differentiate from early
    Erythema Nodosum
105
Q

What condition?

A

Erythema Nodosum

106
Q

What condition?

A

Er ythema Infectiosum (5th Disease)

  • Does not involve cheeks only, can
    spread to trunk
  • Caused by Parvovirus B19
  • Rash appears after low-grade fever
    drops and URI symptoms pass
  • Can cause hepatitis

Clinical Medicine (5 decks)

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