Desquamation Disorders Flashcards
characteristic erythematous iris-shped papules and vesicobullous lesions involving the extremities (especially the palms and soles) and the mucus membranes
erythema multiforme
What are the major differences between EM minor and EM major?
EM minor is often due to HSV and has few systemic sx, whereas EM major is often due to meds and has systemic sx
What do the following medications have in common: bactrim, dapsone, anti-epilectics, PCN, cephalosporins, and allopurionol?
frequent offenders to cause erythema multiforme
drug induced or idiopathic rxn patterns characterized by skin tenderness and erythema followed by cutaneous and mucosal exfoliation. potentially life threatening
Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis
considered a maximal variant of Erythema Multiforme Major
Steven’s Johnsons
Considered a maximal variant of Steven’s Johnsons
toxic epidermal necrolysis
Most common age of presentation for SJS and TEN
> 40yrs
How long after drug exposure might SJS or TEN occur?
1-3 weeks
Conditions that are risk factors for SJS or TEN
Lupus, HIV, HLS-B12
Treatment for SJS/TEN
Cessation of causative drug. ICU, fluids, IVIG (halts progression). erythromycin ointment for eye lesions
Medication that is commonly associated with a drug rash
Bactrim (Septra)
Treatment for drug rash
benadryl, steroids, avoid sweating
What do the following have in common: petechiae, subungal splinter hemorrhages, Osler’s nodes, Janeway lesions, roth spots.
peripheral lesions of bacterial endocarditis
exudative lesions in the retina
roth spots
Small, non-blanching, reddish-brown macules on extremities, upper chest, mucus membranes. Occur in crops
petechial lesion
Establish the diagnosis of bacterial endocarditis
blood cultures (3 sets 1hr before abx)
Patient presents 1-2 wks after tick bite with fever > 102, chills, weakness, headache and photophobia. Indirect fluorescent antibody is positive
RMSF
What day of fever does a red macular rash of RMSF that evolves to petechiae usually show up?
2nd-6th day
Common areas involved in RMSF rash
palms and soles
What do you need to rule out when diagnosing RMSF with blood cultures and CSF?
meningoccemia
How is meningococcemia transmitted?
droplets
pain in the hamstrings upon extension of the knee with the hip at a 90 degree flexion
Kernig sign
flexion of the knee in response to flexion of the neck.
brudzinski
Patient presents with nuchal and back rigidity, high fever, chills, HA. Kernig and Brudzinkski are positive
meningococcemia
Common locations of the pink 2mm-10mm macule/papule rash of meningococcemia
pressure points and lower extremities
Important complication of meningococcemia typically present in toxic patients with ecchymotic skin lesions
DIC
fibrin degradation product, present when coagulation system has been activated
D-Dimer
What conditions does D-Dimer aid in diagnosing?
DIC and DVT
Caused by Neisseria gonorrhoeae. Early phase consists of tenosynovitis, arthralgias, dermatitis, and peripheral skin lesions.
Gonococcemia
Describe the classic skin lesions of gonococcemia
acral hemorrhagic pustules
Treatment for gonococcemia
ceftriaxone, 1 gram IV daily, until 48 hours after improvement begins then switch to cefixime for 1 wk
