Disease Of Skin Of The Lid Flashcards
Describe angioedema with urticaria (hives)
Characteristics, associations and Treatments
- secondary to histamine release and vasodilation
- severe swelling, may see hives, red raised lesions
- associated with severe itching
- Tx: oral antihistamine, cool compresses, if systemic associations steroids
You have a patient that has severe swelling on their lids with hives and raised red lesions. The lesion is also very itchy. Tests also show significant amounts of histamines and vasodilation around the swelling. What is the diagnosis?
A. Angioedema with urticaria B. Anthrax C. Erysipelas D. Shingles E. Syphilis
Angioedema with urticaria
What are the differences between Anthrax and preseptal cellulitis?
- no demarcation line
- no tenderness
- usually no pain
- itching
- no suppuration (pus)
- slight injection and redness
- possible anterior chamber response
You have a patient that has a macular rash that looks like a spider bite. One week later a Bullous formed giving a black eschar (ulcer) with a “pearly wreath” appearance. A week later, the eschar falls off leaving a scar. What is the diagnosis?
A. HZV (Shingles) B. Anthrax C. Erysipelas D. Erthyema multifome/ Stevens Johnson syndrome E. Ocular Cicatricial Pemphigoid
Anthrax
Describe cutaneous anthrax (ocular signs and symptoms)
- short onset ~ 2 weeks
- milder form of preseptal cellulitis
- no demarcation line, no tenderness, usually no pain, no suppuration (pus), slight injection and redness
- painless red macular rashes (spider bite appearance) can become bullous
- bullae can form eschar (black necrotic ulceration)
Describe the diagnostic tests, prevention and treatment for anthrax
- Px: vaccine, 3 sub-Q injections
- Dx: gram stain and culture, black eschar
- Tx: penicillin G (IV), oral doxycycline, coprofloxacin and amoxicillin, surgical repair and possible graft after eschar heals
Describe symphillis (eye signs and treatment)
- first and second degree lid lesion
- eye signs: conjunctival chancre (ulcerated lesion), madarosis (loss of lashes), scleritis, interstitial keratitis
- Tx: penicillin
You have a patient that has lid lesions. Upon A SLE you see an ulceration with a raised edge (Conjunctival chancre), loss of lashes (madarosis), scleritis and interstitial keratitis. What is the diagnosis?
A. Vitiligo B. Ocular Cicatrical Pemphigoid C. Impetigo D. Herpes Zoster Varicella (shingles) E. Syphilis
Syphilis
Describe elephantiasis
- severe edema caused by lymphatic fluid responding to parasitic infection
You have a patient that has severe edema on their lids comprised of lympathic fluid. What is the diagnosis?
A. Impetigo B. Erysipelas C. Vaccinia D. Elephantiasis E. Herpes Simplex Virus
Elephantiasis
Describe Vaccinia
- secondary to small pox vaccine
- contacted via direct contact/contamination of lid from vaccination site
- usually will heal up and scar
- widespread dermatitis, may become exofoliative and necrotic leading to severe scarring
You have a patient that has widespread dermatitis that has become necrotic leaving severe scarring. They’ve recently had a small pox vaccination. What is the diagnosis?
A. Impetigo B. Erysipelas C. Vaccinia D. Elephantiasis E. Herpes Simplex Virus
Vaccinia
What is the most common way to treat vaccinia?
Let it heal up and leave a scar
Describe Vitiligo (Vogt Koyanagi)
Lid and ocular signs
Hint: sun exposure
- leukoderma (white skin), poliosis (white lashes)
- Vogt Koyanagi: disorder causing whitening with sun exposure
- Ocular signs: poliosis, uveitis, post inflammatory retinal detachment
- headaches, encephalopathy, seizure limiting, vertigo, deafness
You have a patient that presents with leukoderma (white skin), poliosis (white lashes) and post inflammatory retinal detachment. They also experience encephalopathy, vertigo and deafness. The also mention that they become pale with sub exposure. What is the diagnosis?
A. Xeroderma Pigmentosa B. Impetigo C. Ocular Cicatricial Pemphigoid D. Vitiligo (Vogt Koyanagi) E. Erythema multifome - Steven Johnson Syndrome
Vitiligo - Vogt Koyanagi
Describe Xeroderma Pigmentosa (what it is and what can develop)
- progressive pigmentation changes (macules and scarring)
- increased incidence or basal cell carcinoma, squamous cell carcinoma, melanoma and conjunctival malignances
You have a patient that presents significant macules and scarring from pigmentation changes. You see the formation of carcinomas, melanomas and conjunctival malignances. What is the diagnosis?
A. Xeroderma Pigmentosum B. Impetigo C. Ocular Cicatricial Pemphigoid D. Vitiligo (Vogt Koyanagi) E. Erythema multifome - Steven Johnson Syndrome
Xeroderma Pigmentosum
Describe erysipelas
- B-hemolytic strep. Pyogenea secondary to skin trauma (bacterial infection)
- RAPID swelling associated with well defined expanding red line along lid
- scarring with entropian or ectropian
- Tx: oral antibiotics and hospitalization
You have a patient that had an accident that caused skin trauma. You do an SLE and see a rapid swelling and a well defined red line along their lid and the beginning of a scar with ectropian. What is the diagnosis?
A. Impetigo B. Anthrax C. Erysipelas D. Elephantiasis E. HZV (Shingles)
Erysipelas
What is the treatment for Erysipelas?
A. Oral antihistamines and steriods
B. penicillin, oral doxycycline, cyproflaxin and amoxicillin
C. Oral antibiotic
D. Topical antibiotics
E. analgesics, prednisone, antidepressants, acyclovir 800 mg 5x/day for 7-10 days, topical steriods and antihistamines
Oral antibiotics
Describe erythema multifome/Stevens Johnson syndrome (how it happens, what age group, ocular signs, treatment)
- happens to younger males
- severe delay type hypersensitivity to meds
- flu symptoms, severe rash with perivascular inflammation and a “bulls eye” appearance
- Ocular signs/ mucous discharge, papillary response, bullae (several blisters) formation, swollen crusted lids
- Complications: Fibrosis, iritis, corneal perforation, dry eye, distichiasis (lid sticks to conjunctiva), epiphoria, Cicatricial
Ectropian (scarring twists lid) - Tx: electrolytes, systemic topical steroids, bandage CL and surgery to reduce scarring
You have a 8 year old male patient that has mucous discharge and swollen crusted lids. The patient tells you that they have recently has flu symptoms but broke out in a severe rash. You see perivascular inflammation and “bulls eye” appearance. What is the diagnosis?
A. Xeroderma Pigmentosum B. Impetigo C. Ocular Cicatricial Pemphigoid D. Vitiligo (Vogt Koyanagi) E. Erythema multifome - Steven Johnson Syndrome
Erythema multifome/Stevens Johnson syndrome
What is the treatment for Erythema
Multiforme/Stevens Johnson syndrome?
A. Electrolytes, systemic topical steriods, bandage CL and possible surgery
B. penicillin, oral doxycycline, cyproflaxin and amoxicillin
C. Oral antibiotics
D. Topical antibiotics
E. analgesics, prednisone, antidepressants, acyclovir 800 mg 5x/day for 7-10 days, topical steriods and antihistamines
A. Electrolytes, systemic topical steriods, bandage CL and possible surgery
Describe Ocular Cicatricial Pemphigoid (age onset, signs, ocular signs, treatment)
- onset 6th decade, mucous membrane disorder & oral lesions
- bullous formation (blisters), fibrosis with conjunctival shrinking, symblepharon (adhesion of palpebral conjunctiva to bulbar conjunctiva), scarring and keratinzation of cornea
- Vision Loss (25-33% of patients)
Tx: supportive: tears, bandage lens, epilation (hair removal), (partially sewn eyelid), punctal occlusion, tarsorraphy
-Immunosuppresion: steriods, cyclophosphamide
