Diseases Week 3 Flashcards
HSV 2
Recurrent, lifelong w/o cure STD w/ worst outbreak the first time, reoccurence is often Treatment: Initial, episodic, or suppression with acyclovir, famciclovir, and valcyclovir.
Congenital malformation or absence of pec major (unilateral often right). Often including ipsilateral webbing of the fingers.
Poland Syndrome
Tularemia
CA - Franciscella tularensis Vectors: Ticks, deer flies, mosquitoes. Hosts: Rabbits > deer> other rodents exposure Inhalation, fresh blood, or flesh Mortality rate if untreated = 5% Symptoms: Abrupt onset of fever and chills. Headache, myalgias, sore throat, Bite site ulcerates and forms black eschar w/ ulcer. Pneumatic form by inhalation. Typhoideal form has highest morality. Treatments: Strepto, Genta, or Doxy for 7-14 days; Alternative of Cipro, moxifloxacin, chloramphenicol.
Sternocleidomastoid muscle on one side is spasmodic or shortened. Usually present at birth and discovered then or soon after. Cause may be related to small space in the uterus. Common to also have hip dysplasia.
Congenital torticollis
Panniculitis Erythema Induratum
Tender red nodules, lobular panniculitis and vasculitis, POSTERIOR legs. Chronic/recurrent Associated with TB
Marfan syndrome
Connective tissue disorder causes excessive long bone growth. Fibrillin-1-gene mutation long, thin limbs. Can affect heart, vessels, bones, eyes, lungs. Worry about dissecting aneurysms. Look for dislocated lens on eye exam.
Amelia - missing one arm Phocomelia - Flipper limbs. Both caused by thalidomide use in the 50s and 60s to treat morning sickness. Now used to treat leprosy, so be careful.
Amelia and Phocomelia
85% of population is + 90% orofacial lesions called herpes labialis Treatment with oral acyclovir
HSV 1
Contact Dermatitis
Inflammatory rxn of the skin precipitated by an exogenous chemical. Acute - linear streaks of vesicles; Chronic - lichenification, eczematous rxn. Two types: irritant- direct toxic effect on the skin or Allegic - immunologic rxn that causes tissue inflammation (type IV hypersensitivity) Common sensitizers: poision ivy, paraphyenylenediamine (perfumes), nickel, rubber, ethyleenediamine (topical meds) Differential - atopic dermatitis, seborrheic dermatitis, stasis dermatitis, fungal infx, bacterial cellulitis patch testing for allergic contact dermatitis: North American Contact Dermatits Standard Patch Test Series Treatment: prevention/avoidance, symptomatic treatment, psiochemical barriers, tolerance induction
Chronic Cutaneous Lupus
Discoid lupus: scarring lesions of skin Tumid Lupus: erythematous indruated plaques in sun exposed areas Lupus Panniculitis: infiltration and destruction of adipose tissue especially upper extremeties Verrucous Lupus: Very thick hyperketotic discoid lupus like lesions that usually occur on the extensor sun exposed surfaces.
Staphylococcal Scalded Skin Syndrome (SSSS)
Caused by Et-A and Et-B (most common) toxin secreted by Staph Aureus. Can occur in newborns or babies. Starts as skin redness followed by exofoliation of skin 2-5 days later. Sometimes fever. Treat with beta-lactamase resistant penicillin (ampicillin/sulbactam) or nafcillin/diclococillin Differential: viral exanthemas, scarlet fever, themal burns, pemphigus, kawaskai disease, SSSS
Failure of apoptosis leading to fused digits or fusion of bony components.
Syndactly
Fungal growth on or under the nail. Common cause: Trichophyton rubrum or t. mentagrophytes. Treat: terbinafine
Onychomycosis
Chronic, superficial inflammatory process affecting the hairy regions of the body (scalp, eyebrows, and face especially). Bilateral and symmetrical patches and plaques w/ indistinct margins. Hair loss uncommon. Affects infants (first three months) and adults (40-70). Wide range of disease from mild to severe. Common skin manifestation in patients w/ HIV (85% of patients) More common than psoriasis in adults. Men more than women. Unknown cause (malassezia furfur?) Associated w/ oily looking skin but not a disease of the seb gland. Associated w/ parkinson’s and a variety of other neural abnormalities. Treatment: Control not cure. Remove scales and crusts. Inhibition of yeast colonization and secondary infx. Treaty erythema and itching. Antifungals in adults.
Seborrhiec dermatits
Causative Agent: B. burgdorgeri carried by vectors of Ixodes scapularis and Ixodes pacificus. Carried by deer and mouse. Diagnose with exposure history, positive serology/ skin culture/ PCR Look for erythema migrans (bullseye rash), Bell’s palsy, arthralgia, av block, and lymphadenopathy Treatment- Doxycycline Differential diagnosis: human anaplasmosis, babenosis, RMSF, and enterovirus
Lyme’s Disease
Congenital fusion of any cervical vertebrae. Causes brevicollis.
Klippel-Feil Syndrome
Osteogenesis Imperfecta
Defect in type 1 collagen gene in most cases. Extreme bone fragility. Frequent fractures. Hypermobile joints. Thin, curved bones, decreased bone density.
Most common form of dwarfism. Affect long bones. Mutation of FGFR3 gene. Brain growth and intellect usually normal.
Achondroplasia
Inflammatory rxn of the skin precipitated by an exogenous chemical. Acute - linear streaks of vesicles; Chronic - lichenification, eczematous rxn. Two types: irritant- direct toxic effect on the skin or Allegic - immunologic rxn that causes tissue inflammation (type IV hypersensitivity) Common sensitizers: poision ivy, paraphyenylenediamine (perfumes), nickel, rubber, ethyleenediamine (topical meds) Differential - atopic dermatitis, seborrheic dermatitis, stasis dermatitis, fungal infx, bacterial cellulitis patch testing for allergic contact dermatitis: North American Contact Dermatits Standard Patch Test Series Treatment: prevention/avoidance, symptomatic treatment, psiochemical barriers, tolerance induction
Contact Dermatitis
Bullous Impetigo
Clinical presentation: Bullae, blisters occuring in the axillary, groin, folds especially in neonates and older adults. Superficial vesicles progress to rapidly enalarging bullae which rupture resulting in honey-colored crusts Cause: Toxin producing Staph Treatment: hygenic measures, oral and topical AB’s
Post Strep Infx, sudden onset of tear drop shaped scaled spots of trunk and proximal extremities
Psoriasis: Guttate Type
Ehrlichiosis and Anaplasma
Gram naegative bacteria, obligate intracellular organisms, tropism for WBC’s, form intracytoplasmic morulae. Resevoirs are white footed mouse and deer. Infx can be from animal blood or transfusion. Incubation time 2-14 days Mortality rate HME 2% and HGA 1% Tests: CBC non-specific, but often observe leukopenia, granulocytosis w/ maked left shift (need to manaully count blood smear) Mild increase AST/ALT, Thrombocytopenia, Elevated ESR and CRP Differential: Bacterial septicemia, flu, enterovirus, other tick infx, relapsing fever, juvenile RA, Hematological malignancies. Treatment: Doxycycline or Rifampin
Inflammatory seronegative arthritis with a variable course. Asymmetric and involves fingers and toes (doesn’t have RA’s ulnar bend) 1/3 patients with psoriasis
Psoriatic Arthritis
Immune based dermatitis in which UV light alters the antigen to make it an effective immunogen resulting in type IV hypersensitivity. Commonly seen w/ thiazide diuretics and tetracyclines. Therapy: stop med use and use UVA/UVB sunscreen
Photodermatitis
“impetigo contagiosa” - Group A strep pyogenes, Coagulase + Staph Aureus, mixed infx 70% nonbullous. Begins with single red pustule that ruptures to form an erosion that dries to honey-colored crust that may be pruritic.
Impetigo (non-bullous) impetigo contagiosa
Achondroplasia
Most common form of dwarfism. Affect long bones. Mutation of FGFR3 gene. Brain growth and intellect usually normal.
Prune Belly Syndrome
Poor development of ab muscles. Causes skin to wrinkle’ undescended testicles and urinary tract problems. No migration of hypaxial muscles.
Results from a deficiency in heme-synthesizing enzyme Blistering of the skin occurs in sun exposed areas Pts may also exhibit hypertrichosis, skin hyperpigmentation, and urine discoloration) Risk factors: Hep C, Hemochromatosis, and alcoholism
Porphyria Cutanea Tarda
mild form involving one or fewer mucousal sites major cause is post herpes simplex infxs with onset of EM rash at day 10
EM minor
Psoriatic Arthritis
Inflammatory seronegative arthritis with a variable course. Asymmetric and involves fingers and toes (doesn’t have RA’s ulnar bend) 1/3 patients with psoriasis
Type I Hypersensitivity
Characterized by the production of IgE antibodies vs foreign proteins that are commonly present in the environment (pollens, dander, dust mites). Identified by wheal and flare response to skin test within 15min. Anaphalaxis is this.
Polydactly
Extra digits. Most common hand anomaly. Extra digits may be fully formed or only soft tissues.
Erythema Multiforme
Erythemtous iris-shaped papular and vesiculobullous lesions involving extremities and mucous membranes
Recurrent, lifelong w/o cure STD w/ worst outbreak the first time, reoccurence is often Treatment: Initial, episodic, or suppression with acyclovir, famciclovir, and valcyclovir.
HSV 2
Incomplete formation of acetabulum. Legs held in positions that don’t match. Less movement. Uneven leg length. Treat with pavlik harness
Congenital Hip Dysplasia
The neural ectoderm fails to completely seperate from the surface ectoderm. The patient presents with a paramedian pit which may or may not communicate with the spinal cord. Most commonly found in the lumbar region. WORRY ABOUT MENINGITIS!!!!
Congenital Dermal Sinus
Panniculitis
Major focus of inflammation is SQ tissue.Erythemetous or violaceous nodule in the SQ fat. Lobular or septal depending on where disease begins Accurate diagnosis w/ biopsy
Pectus excavatum
Sterum caves inward. Becomes a problem when compression of heart and lungs occurs.
Ectrodactyly
Lobster claw deformity.
Congenital torticollis
Sternocleidomastoid muscle on one side is spasmodic or shortened. Usually present at birth and discovered then or soon after. Cause may be related to small space in the uterus. Common to also have hip dysplasia.
Incomplete closing of spinal cord. Key clinical sign is fawn’s spot on lower back.
Spina Bifida occulta
Congenital fusion of any cervical vertebrae. Causes brevicollis.
Klippel-Feil Syndrome
Inflammatory disease of the pilosebacous unit caused by excessive sebum production, follicular plugging, colonization or sebaceous follicle with Propionibacterium acnes, or immune response with inflammation. May be triggered by stress or steroid use (why we taper steroids to end dosage.) Also by meds like isoniazid, lithium, phenytoin Classified by a few ways: mild, moderate, severe or stage 1,2,3, or 4 Stage 1: Comedones and flesh colored papules Stage 2: Inflammation, papules/pustules -few to several Stage 3: Papules/pustules and a few nodules; little to no scarring Stage 4: Deep/Inflammatory; Extensive nodules, variable degree of stars No labs unless hyperandrogenism is expected. Differential: Acne Rosacea, Gram negative folliculitis, perioral dermatitis, steroid induced acne Treatment: decrease sebaceous gland activity, correct the altered pattern of keratinization, decrease follicular bacterial population, produce anti-inflammatory effect. Topical retinoids, benzoyl peroxide, topical antibiotics, intralesional corticosteroid injections, oral isotretinoin (OCPs for women), Incision and drainage, hormonal therapy (OCPs)
Acne Vulgaris
Pemphigous vulgaris
Autoimmune disease that affects skin and mucous membranes. The predominant skin lesions are flaccid blisters on head, trunk, and intertriginous areas (skin rubbing areas) Typically 40-60 year olds. Associated with Nikolsky sign (skin finding in which the top layers of skin slip away from the lower layers when slightly rubbed and may create blister). Mortality rate of 5-15%
Large aneurysm in spinal column with nerves in it. Very painful.
Myelomeningocele
Psoriasis: Inverse Type
Folds, scale may not appear
Atopic Dermatitis
Chronic, puritic eczemetous condition of the skin that is associated with a personal or family history of atopic disease (asthma, allergic rhinitus) Symptoms: Epidermal edema = spongiosis. Pale epidermis, swelling of keratinocytes, leaky cells, fluid pockets, weeping, vesicles. “the itch that rashes”. Disease of childhood (10% of US children) Uncommon for adults w/o a history of eczema in childhood. Increased prevalence may be due to exposure to pollutants, indoor allergens, and decline in breast feeding. Clinical features: pruritic, facial and extensor papulovesicles in infancy. Flexural lichenification in adults and older children. Chronic-relapsing course. Treatment: Cutaneous hydration, topical glucocorticoids, identify and eliminate flare factors. Tacrolimus, pimecrolimus. Treat pruritis. Complications: bacterial impetigization (staph a), secondary herpetic infection, contact sensitization. prognosis: spontaneous resolution after age 5 in 40%, 84% of children “outgrow” by adolescence. Poor prognosis if wide spread AD in childhood, associated allergic rhinitis or asthma. Family history of AD.
Caused by Et-A and Et-B (most common) toxin secreted by Staph Aureus. Can occur in newborns or babies. Starts as skin redness followed by exofoliation of skin 2-5 days later. Sometimes fever. Treat with beta-lactamase resistant penicillin (ampicillin/sulbactam) or nafcillin/diclococillin Differential: viral exanthemas, scarlet fever, themal burns, pemphigus, kawaskai disease, SSSS
Staphylococcal Scalded Skin Syndrome (SSSS)
Diffuse hair thinning as a complication of an existing medication or medical problem Common causes: chemotherapy, meds, thyroid dz, iron deficiency, Nutritional disorders, renal or hepatic failure, other chronic illness. treatment: remove the cause, minoxidil
Secondary Alopecia
Large aneurysm in spinal column w/o any nervous tissue in it. Benign.
Meningocele
Chronic, superficial inflammatory process affecting the hairy regions of the body (scalp, eyebrows, and face especially). Bilateral and symmetrical patches and plaques w/ indistinct margins. Hair loss uncommon. Affects infants (first three months) and adults (40-70). Wide range of disease from mild to severe. Common skin manifestation in patients w/ HIV (85% of patients) More common than psoriasis in adults. Men more than women. Unknown cause (malassezia furfur?) Associated w/ oily looking skin but not a disease of the seb gland. Associated w/ parkinson’s and a variety of other neural abnormalities. Treatment: Control not cure. Remove scales and crusts. Inhibition of yeast colonization and secondary infx. Treaty erythema and itching. Antifungals in adults.
Seborrhiec dermatits
Discoid lupus: scarring lesions of skin Tumid Lupus: erythematous indruated plaques in sun exposed areas Lupus Panniculitis: infiltration and destruction of adipose tissue especially upper extremeties Verrucous Lupus: Very thick hyperketotic discoid lupus like lesions that usually occur on the extensor sun exposed surfaces.
Chronic Cutaneous Lupus
Antigen-Mediated Occur when IgG or IgM are produced against surface antigens on cells of the body. These can trigger rxns either by activating complement or NK cells. Classic disease: hemolytic anemia
Type II Hypersensitivity
Characterized by the production of IgE antibodies vs foreign proteins that are commonly present in the environment (pollens, dander, dust mites). Identified by wheal and flare response to skin test within 15min. Anaphalaxis is this.
Type I Hypersensitivity
Tender red nodules, lobular panniculitis and vasculitis, POSTERIOR legs. Chronic/recurrent Associated with TB
Panniculitis Erythema Induratum
Fixed Drug Eruption
Localized sharply demarcated erythemetous pathc that can itch, burn, or be asymptomatic. Predisposition of face and genitals. Often heals as hyperpigmented area. Therapy: remove offending drug
Inflammation of nail folds. Can be infectious or noninfectious. Causes acute: trauma, bacteria, contact dermatitis, acute excema flair. Causes chronic: caused by irritant contact dermatitis, eczema, psoriasis, candida
Paronychia
Sternocleidomastoid muscle on one side is spasmodic or shortened. Usually present at birth and discovered then or soon after. Cause may be related to small space in the uterus. Common to also have hip dysplasia.
Congenital torticollis
Extra digits. Most common hand anomaly. Extra digits may be fully formed or only soft tissues.
Polydactly
Causes of immune uticaria and angiodema
A.) Type I IgE mediated hypersensitivity to allergens B.) Autoimmunity C.) Infection
A.) Type I IgE mediated hypersensitivity to allergens B.) Autoimmunity C.) Infection
Causes of immune uticaria and angiodema
Folds, scale may not appear
Psoriasis: Inverse Type
Major focus of inflammation is SQ tissue.Erythemetous or violaceous nodule in the SQ fat. Lobular or septal depending on where disease begins Accurate diagnosis w/ biopsy
Panniculitis
Paronychia
Inflammation of nail folds. Can be infectious or noninfectious. Causes acute: trauma, bacteria, contact dermatitis, acute excema flair. Causes chronic: caused by irritant contact dermatitis, eczema, psoriasis, candida
Sterum caves inward. Becomes a problem when compression of heart and lungs occurs.
Pectus excavatum
Amelia - missing one arm Phocomelia - Flipper limbs. Both caused by thalidomide use in the 50s and 60s to treat morning sickness. Now used to treat leprosy, so be careful.
Amelia and Phocomelia
Onychomycosis
Fungal growth on or under the nail. Common cause: Trichophyton rubrum or t. mentagrophytes. Treat: terbinafine
Poland Syndrome
Congenital malformation or absence of pec major (unilateral often right). Often including ipsilateral webbing of the fingers.
Meningocele
Large aneurysm in spinal column w/o any nervous tissue in it. Benign.
Extra digits. Most common hand anomaly. Extra digits may be fully formed or only soft tissues.
Polydactly
Poor development of ab muscles. Causes skin to wrinkle’ undescended testicles and urinary tract problems. No migration of hypaxial muscles.
Prune Belly Syndrome
CA - Franciscella tularensis Vectors: Ticks, deer flies, mosquitoes. Hosts: Rabbits > deer> other rodents exposure Inhalation, fresh blood, or flesh Mortality rate if untreated = 5% Symptoms: Abrupt onset of fever and chills. Headache, myalgias, sore throat, Bite site ulcerates and forms black eschar w/ ulcer. Pneumatic form by inhalation. Typhoideal form has highest morality. Treatments: Strepto, Genta, or Doxy for 7-14 days; Alternative of Cipro, moxifloxacin, chloramphenicol.
Tularemia
Deep dermal and SQ swelling. Burning/Painful. Laryngeal involvement = emergency Swelling of lip, eye, groin, palms/soles common
Angiodema
Syndactly
Failure of apoptosis leading to fused digits or fusion of bony components.
Type IV Hypersensitivity
Specific T cells are the primary effector cells. Examples of T cells causing unwanted responses are: contact sensitivity (contact dermatitis to nickel or poison ivy) Delayed hypersensitivity response to TB or leprosy Exaggerated response to viral infxs such as measles Persistent symptoms of allergic disease.
Thoracic outlet syndrome
Neurovascular compression due to narrowing of passageway between neck and axilla.
Autoimmune. Tense bullae on normal or erythemetous skin. Most common in 60-80 yr olds. Treat with prednisone. Attack between dermis and epidermis (hemidesmosomes).
Bullous Pemphigloid
Scalp, extensor surfaces, palms and soles
Psoriasis: Chronic Plague Type
Causative agent: B. microti most common in US - Babesia are hemato-parasites - vector is I. scapularis - hosts white footed mouse and white tailed deer Incubation time: 1-6 weeks Usually self limited clinical illness. Splenectomy/immunocomp fatality rate - 40% *most common transfusion related infx in US Symptoms: non-specific flu like, no rash, may show hepato-splenomegaly Tests: A positive blood smear is diagnostic. Specific diagnosis use PCR Treatment: Quinine and clindamycin or Atovaquone and Azithro NOT DOXY
Babesiosis
Congenital malformation or absence of pec major (unilateral often right). Often including ipsilateral webbing of the fingers.
Poland Syndrome
Rocky Mountain Spotted Favor
Causative Agent: Ricketsii ricketsii - intracellular gram negative rod carried by Dermacentor spp (wood tick) Amblyomma americanum (Lone Star tick) Mortality rate 20% if untreated Incubation time - 7 days Symptoms: flu like symtoms, centripetal rash around day 4, no exchar, splenomegaly (50%), DIC in serious cases, palms and soles often involved. Tests: Platelet reduced, WBC normal, LFTs and CPK elevated, ESR elevated Differential: Meningoccemia, Measles, Rubella, Typhoid, Human ehrlichiosis/anaplasmosis Treatment: Doxycycline
Poor development of ab muscles. Causes skin to wrinkle’ undescended testicles and urinary tract problems. No migration of hypaxial muscles.
Prune Belly Syndrome
Lobster claw deformity.
Ectrodactyly
Herpes Simplex
Group of vesicles on a red base which rapidly become purulent and crusted HSV 1 : Primary infection usually occurs in childhood with lesions on the lips or face HSV 2: STD of adults involving the genital areas, primary infx extensive, painful vesiculations and necrosis
A.) Physical (solar, cholinergic, cold, etc.) B.) Direct Mast Cell Degranulation (Narcotics, Aspirin, NSAIDs, Radiocontrast, Dextran, ACE, Vanco - Red Man) C.) Foods containing high levels of histamine (Strawberries, Shell fish, etc.)
Causes of non-immune uticaria and angiodema
Chronic and progressive dermatosis characterized by erythema, papules, and pustules, telangiectasia, and potential hyperplasia over the central portion of the face. Rhinophyma in stage 3. Can be a reaction to medications or irritants. Affects middle-aged adults. Unknown causes, but related to H. pylori Treatment: Tetracycline and metronidazole gel. Counseling for psych issues.
Acne Rosacea
Chronic, puritic eczemetous condition of the skin that is associated with a personal or family history of atopic disease (asthma, allergic rhinitus) Symptoms: Epidermal edema = spongiosis. Pale epidermis, swelling of keratinocytes, leaky cells, fluid pockets, weeping, vesicles. “the itch that rashes”. Disease of childhood (10% of US children) Uncommon for adults w/o a history of eczema in childhood. Increased prevalence may be due to exposure to pollutants, indoor allergens, and decline in breast feeding. Clinical features: pruritic, facial and extensor papulovesicles in infancy. Flexural lichenification in adults and older children. Chronic-relapsing course. Treatment: Cutaneous hydration, topical glucocorticoids, identify and eliminate flare factors. Tacrolimus, pimecrolimus. Treat pruritis. Complications: bacterial impetigization (staph a), secondary herpetic infection, contact sensitization. prognosis: spontaneous resolution after age 5 in 40%, 84% of children “outgrow” by adolescence. Poor prognosis if wide spread AD in childhood, associated allergic rhinitis or asthma. Family history of AD.
Atopic Dermatitis
Congenital Dermal Sinus
The neural ectoderm fails to completely seperate from the surface ectoderm. The patient presents with a paramedian pit which may or may not communicate with the spinal cord. Most commonly found in the lumbar region. WORRY ABOUT MENINGITIS!!!!
HSV 1
85% of population is + 90% orofacial lesions called herpes labialis Treatment with oral acyclovir
Autoimmune condition typified by clusters of erythemetous papules, excoriations and vesicles that arise as a consequence of GLUTEN SENSITIVITY ( associated with celiac’s disease) Most patients between 20-40 yrs old
Dermatitis herpetiformis
Erythemetous and usually scaling rash of upper trunk and extensor surfaces.That is psoriasis plaque like form or annular polycyclic form. Due to SSA or SSB antibody
Subacute SLE
Photosensitive pattern of Erythema, BUTTERFLY RASH, Raynaud’s Syndrome
Acute SLE
Defect in type 1 collagen gene in most cases. Extreme bone fragility. Frequent fractures. Hypermobile joints. Thin, curved bones, decreased bone density.
Osteogenesis Imperfecta
Connective tissue disorder causes excessive long bone growth. Fibrillin-1-gene mutation long, thin limbs. Can affect heart, vessels, bones, eyes, lungs. Worry about dissecting aneurysms. Look for dislocated lens on eye exam.
Marfan syndrome
Androgenetic Alopecia
Simple baldness, hereditary alopecia, and patter alopecia. Cause: Genetically determined miniaturization of follicles triggered by androgens. Area: top of scalp Treatment: Minoxidil, Finasteride, Hair Transplants
severe with extensive skin and mucous membrane involvement (Stevens-Johnson’s Syndrome). Usually due to drugs and after mycoplasma pneumoniae infx
EM major
Type III Hypersensitivity
Involve the formation of immune complesex in the circulation that are not adequately cleared by macrophages or other cells of the reticuloendothelial system. Takes significant quantities of antibody and antigen. Classic diseases of group : SLE, chronic glomerulonephritis, and serum sickness.
Autoimmune disease that affects skin and mucous membranes. The predominant skin lesions are flaccid blisters on head, trunk, and intertriginous areas (skin rubbing areas) Typically 40-60 year olds. Associated with Nikolsky sign (skin finding in which the top layers of skin slip away from the lower layers when slightly rubbed and may create blister). Mortality rate of 5-15%
Pemphigous vulgaris
Chronic, inflammatory, autoimmune disease. More common in perimenopausal women. Associated with Hep C Located on wrists, shins, mucous membranes, Wickman’s stria (lacy, reticular, white lines) Don’t confuse with poision ivy Histopathology: Interface dermatitis, Diagnose with punch biopsy ***Remember 6 P’s: Planar, purple, polygonal, pruritic, papules, plaques **** Treatment: may resolve spontaneously (1-2yrs.), topical steroids, oral steroids, phototheriapy, stop drug
Lichen Planus
Dermatitis herpetiformis
Autoimmune condition typified by clusters of erythemetous papules, excoriations and vesicles that arise as a consequence of GLUTEN SENSITIVITY ( associated with celiac’s disease) Most patients between 20-40 yrs old
Causative Agent: Ricketsii ricketsii - intracellular gram negative rod carried by Dermacentor spp (wood tick) Amblyomma americanum (Lone Star tick) Mortality rate 20% if untreated Incubation time - 7 days Symptoms: flu like symtoms, centripetal rash around day 4, no exchar, splenomegaly (50%), DIC in serious cases, palms and soles often involved. Tests: Platelet reduced, WBC normal, LFTs and CPK elevated, ESR elevated Differential: Meningoccemia, Measles, Rubella, Typhoid, Human ehrlichiosis/anaplasmosis Treatment: Doxycycline
Rocky Mountain Spotted Favor
Porphyria Cutanea Tarda
Results from a deficiency in heme-synthesizing enzyme Blistering of the skin occurs in sun exposed areas Pts may also exhibit hypertrichosis, skin hyperpigmentation, and urine discoloration) Risk factors: Hep C, Hemochromatosis, and alcoholism
Congenital Hip Dysplasia
Incomplete formation of acetabulum. Legs held in positions that don’t match. Less movement. Uneven leg length. Treat with pavlik harness
Neurovascular compression due to narrowing of passageway between neck and axilla.
Thoracic outlet syndrome
Telogen Effluvium
“stress hair loss” Nonscarring Cause: Disrupted growth cycle of hairs causing premature shift from anagen to telogen Triggers: Pregnancy, Surgery, high fever, extreme diet Area: diffuse scalp involvement. “coming out in bunches” Treatment: remove the trigger. Minoxidil, time, reassurence.
Chronic and progressive dermatosis characterized by erythema, papules, and pustules, telangiectasia, and potential hyperplasia over the central portion of the face. Rhinophyma in stage 3. Can be a reaction to medications or irritants. Affects middle-aged adults. Unknown causes, but related to H. pylori Treatment: Tetracycline and metronidazole gel. Counseling for psych issues.
Acne Rosacea
Generalized: Potentially life threatening. Small pustules becoming generalized with fever. Localized: Hand and foot form involves palms and soles. May be termed pustular psoriasis of Barber. *Don’t confuse with uticaria caused by penicillin due to strep infx
Psoriasis: Pustular Type
Acne Vulgaris
Inflammatory disease of the pilosebacous unit caused by excessive sebum production, follicular plugging, colonization or sebaceous follicle with Propionibacterium acnes, or immune response with inflammation. May be triggered by stress or steroid use (why we taper steroids to end dosage.) Also by meds like isoniazid, lithium, phenytoin Classified by a few ways: mild, moderate, severe or stage 1,2,3, or 4 Stage 1: Comedones and flesh colored papules Stage 2: Inflammation, papules/pustules -few to several Stage 3: Papules/pustules and a few nodules; little to no scarring Stage 4: Deep/Inflammatory; Extensive nodules, variable degree of stars No labs unless hyperandrogenism is expected. Differential: Acne Rosacea, Gram negative folliculitis, perioral dermatitis, steroid induced acne Treatment: decrease sebaceous gland activity, correct the altered pattern of keratinization, decrease follicular bacterial population, produce anti-inflammatory effect. Topical retinoids, benzoyl peroxide, topical antibiotics, intralesional corticosteroid injections, oral isotretinoin (OCPs for women), Incision and drainage, hormonal therapy (OCPs)
Lobster claw deformity.
Ectrodactyly
Immune based dermatitis in which UV light alters the antigen to make it an effective immunogen resulting in type IV hypersensitivity. Commonly seen w/ thiazide diuretics and tetracyclines. Therapy: stop med use and use UVA/UVB sunscreen
Photodermatitis
Stevens Johnson Syndrome / Toxic Epidermal Necrolysis
Mucocutaneous Drug-Induced or Idiopathic reaction patterns. Skin tenderness and erythema of skin and mucosa followed by extensive cutaneous and mucosa epidermal necrosis and sloughing. Potentially life threatening Risk factors: SLE, HLA-B12, HIV Causes: Rx ( 1-3 weeks after exposure) , cytotoxic immune reaciton Treatments: Withdrawal of Rx, IV fluids/lytes, systemic glucocoritcoids, debridement, and treat complications
Alopecia Areata
Autoimmune. Can associate with other AI disease. T-cells attack the hair bulb. HLA determined. Area: circular patches on scalp or beard. -A. totalis = all scalp lost. -A. Universalis = all body hair lost. Treatment: Topical or IL steroids. Minoxidil, anthralin,
Psoriasis: Chronic Plague Type
Scalp, extensor surfaces, palms and soles
Acne Rosacea
Chronic and progressive dermatosis characterized by erythema, papules, and pustules, telangiectasia, and potential hyperplasia over the central portion of the face. Rhinophyma in stage 3. Can be a reaction to medications or irritants. Affects middle-aged adults. Unknown causes, but related to H. pylori Treatment: Tetracycline and metronidazole gel. Counseling for psych issues.
Autoimmune. Can associate with other AI disease. T-cells attack the hair bulb. HLA determined. Area: circular patches on scalp or beard. -A. totalis = all scalp lost. -A. Universalis = all body hair lost. Treatment: Topical or IL steroids. Minoxidil, anthralin,
Alopecia Areata
Type II Hypersensitivity
Antigen-Mediated Occur when IgG or IgM are produced against surface antigens on cells of the body. These can trigger rxns either by activating complement or NK cells. Classic disease: hemolytic anemia
Characterized by the production of IgE antibodies vs foreign proteins that are commonly present in the environment (pollens, dander, dust mites). Identified by wheal and flare response to skin test within 15min. Anaphalaxis is this.
Type I Hypersensitivity
Lyme’s Disease
Causative Agent: B. burgdorgeri carried by vectors of Ixodes scapularis and Ixodes pacificus. Carried by deer and mouse. Diagnose with exposure history, positive serology/ skin culture/ PCR Look for erythema migrans (bullseye rash), Bell’s palsy, arthralgia, av block, and lymphadenopathy Treatment- Doxycycline Differential diagnosis: human anaplasmosis, babenosis, RMSF, and enterovirus
Lichen Planus
Chronic, inflammatory, autoimmune disease. More common in perimenopausal women. Associated with Hep C Located on wrists, shins, mucous membranes, Wickman’s stria (lacy, reticular, white lines) Don’t confuse with poision ivy Histopathology: Interface dermatitis, Diagnose with punch biopsy ***Remember 6 P’s: Planar, purple, polygonal, pruritic, papules, plaques **** Treatment: may resolve spontaneously (1-2yrs.), topical steroids, oral steroids, phototheriapy, stop drug
“stress hair loss” Nonscarring Cause: Disrupted growth cycle of hairs causing premature shift from anagen to telogen Triggers: Pregnancy, Surgery, high fever, extreme diet Area: diffuse scalp involvement. “coming out in bunches” Treatment: remove the trigger. Minoxidil, time, reassurence.
Telogen Effluvium
Herpes Zoster (Shingles)
Recurrence of varicella following nerve root. Vesicular erruption in a dermatomal distribution caused by recrudescence of latent varicella-zoster virus. Radical pain. Prodome: pain along nerve root up to 5 days prior to rash Treatment: Acyclovir, prednisone, now immunization for those over 50 (zostavax-live) treat within 48h to decrease postherpetic neuralgia
Erythemetous tender nodules, septal paniculitis, ANTERIOR SHINS. Triggered by infx, meds, or autoimmune Treatment - rest, ice, pain control
Panniculitis Erythema Nodosum
Klippel-Feil Syndrome
Congenital fusion of any cervical vertebrae. Causes brevicollis.
Recurrence of varicella following nerve root. Vesicular erruption in a dermatomal distribution caused by recrudescence of latent varicella-zoster virus. Radical pain. Prodome: pain along nerve root up to 5 days prior to rash Treatment: Acyclovir, prednisone, now immunization for those over 50 (zostavax-live) treat within 48h to decrease postherpetic neuralgia
Herpes Zoster (Shingles)
Localized sharply demarcated erythemetous pathc that can itch, burn, or be asymptomatic. Predisposition of face and genitals. Often heals as hyperpigmented area. Therapy: remove offending drug
Fixed Drug Eruption
Myelomeningocele
Large aneurysm in spinal column with nerves in it. Very painful.
Causes of non-immune uticaria and angiodema
A.) Physical (solar, cholinergic, cold, etc.) B.) Direct Mast Cell Degranulation (Narcotics, Aspirin, NSAIDs, Radiocontrast, Dextran, ACE, Vanco - Red Man) C.) Foods containing high levels of histamine (Strawberries, Shell fish, etc.)
Babesiosis
Causative agent: B. microti most common in US - Babesia are hemato-parasites - vector is I. scapularis - hosts white footed mouse and white tailed deer Incubation time: 1-6 weeks Usually self limited clinical illness. Splenectomy/immunocomp fatality rate - 40% *most common transfusion related infx in US Symptoms: non-specific flu like, no rash, may show hepato-splenomegaly Tests: A positive blood smear is diagnostic. Specific diagnosis use PCR Treatment: Quinine and clindamycin or Atovaquone and Azithro NOT DOXY
Secondary Alopecia
Diffuse hair thinning as a complication of an existing medication or medical problem Common causes: chemotherapy, meds, thyroid dz, iron deficiency, Nutritional disorders, renal or hepatic failure, other chronic illness. treatment: remove the cause, minoxidil
Linear, annular, atrophic, hypertrophic, vesiculobullous, erosive,/ulcerative
Cutaneous Lichen Planus forms:
Panniculitis Erythema Nodosum
Erythemetous tender nodules, septal paniculitis, ANTERIOR SHINS. Triggered by infx, meds, or autoimmune Treatment - rest, ice, pain control
Mucocutaneous Drug-Induced or Idiopathic reaction patterns. Skin tenderness and erythema of skin and mucosa followed by extensive cutaneous and mucosa epidermal necrosis and sloughing. Potentially life threatening Risk factors: SLE, HLA-B12, HIV Causes: Rx ( 1-3 weeks after exposure) , cytotoxic immune reaciton Treatments: Withdrawal of Rx, IV fluids/lytes, systemic glucocoritcoids, debridement, and treat complications
Stevens Johnson Syndrome / Toxic Epidermal Necrolysis
Bullous Pemphigloid
Autoimmune. Tense bullae on normal or erythemetous skin. Most common in 60-80 yr olds. Treat with prednisone. Attack between dermis and epidermis (hemidesmosomes).
EM minor
mild form involving one or fewer mucousal sites major cause is post herpes simplex infxs with onset of EM rash at day 10
Dermal Edema, Hives Transient Wheals persist for < 24 hrs. IgE and histamine mediated. Pruritic. Can be Immune or non-Immune
Uticaria
Erythemtous iris-shaped papular and vesiculobullous lesions involving extremities and mucous membranes
Erythema Multiforme
Simple baldness, hereditary alopecia, and patter alopecia. Cause: Genetically determined miniaturization of follicles triggered by androgens. Area: top of scalp Treatment: Minoxidil, Finasteride, Hair Transplants
Androgenetic Alopecia
Group of vesicles on a red base which rapidly become purulent and crusted HSV 1 : Primary infection usually occurs in childhood with lesions on the lips or face HSV 2: STD of adults involving the genital areas, primary infx extensive, painful vesiculations and necrosis
Herpes Simplex
Photodermatitis
Immune based dermatitis in which UV light alters the antigen to make it an effective immunogen resulting in type IV hypersensitivity. Commonly seen w/ thiazide diuretics and tetracyclines. Therapy: stop med use and use UVA/UVB sunscreen
Uticaria
Dermal Edema, Hives Transient Wheals persist for < 24 hrs. IgE and histamine mediated. Pruritic. Can be Immune or non-Immune
Psoriasis: Guttate Type
Post Strep Infx, sudden onset of tear drop shaped scaled spots of trunk and proximal extremities
Cutaneous Lichen Planus forms:
Linear, annular, atrophic, hypertrophic, vesiculobullous, erosive,/ulcerative
Risk Factors: Women, 14-40, African America, Hispanic, Asian. Lab Tests: Antinuclear Antibody Test (ANA) *** Histopathology: Long term autoimmune disorder that may affect skin, joints, kidney, brain Immunofluoresence: IgG in basement membrane Triggers: Sunlight, medications (anti-siezure, antibiotics, BP Rx) Treatments: NSAIDs, Antimalarials, Corticosteroids, Immunosuppressants
Systemic Lupus Erythematosus (SLE)
Clinical presentation: Bullae, blisters occuring in the axillary, groin, folds especially in neonates and older adults. Superficial vesicles progress to rapidly enalarging bullae which rupture resulting in honey-colored crusts Cause: Toxin producing Staph Treatment: hygenic measures, oral and topical AB’s
Bullous Impetigo
Gram naegative bacteria, obligate intracellular organisms, tropism for WBC’s, form intracytoplasmic morulae. Resevoirs are white footed mouse and deer. Infx can be from animal blood or transfusion. Incubation time 2-14 days Mortality rate HME 2% and HGA 1% Tests: CBC non-specific, but often observe leukopenia, granulocytosis w/ maked left shift (need to manaully count blood smear) Mild increase AST/ALT, Thrombocytopenia, Elevated ESR and CRP Differential: Bacterial septicemia, flu, enterovirus, other tick infx, relapsing fever, juvenile RA, Hematological malignancies. Treatment: Doxycycline or Rifampin
Ehrlichiosis and Anaplasma
Impetigo (non-bullous) impetigo contagiosa
“impetigo contagiosa” - Group A strep pyogenes, Coagulase + Staph Aureus, mixed infx 70% nonbullous. Begins with single red pustule that ruptures to form an erosion that dries to honey-colored crust that may be pruritic.
Involve the formation of immune complesex in the circulation that are not adequately cleared by macrophages or other cells of the reticuloendothelial system. Takes significant quantities of antibody and antigen. Classic diseases of group : SLE, chronic glomerulonephritis, and serum sickness.
Type III Hypersensitivity
Acute SLE
Photosensitive pattern of Erythema, BUTTERFLY RASH, Raynaud’s Syndrome
Sterum caves inward. Becomes a problem when compression of heart and lungs occurs.
Pectus excavatum
Seborrhiec dermatits
Chronic, superficial inflammatory process affecting the hairy regions of the body (scalp, eyebrows, and face especially). Bilateral and symmetrical patches and plaques w/ indistinct margins. Hair loss uncommon. Affects infants (first three months) and adults (40-70). Wide range of disease from mild to severe. Common skin manifestation in patients w/ HIV (85% of patients) More common than psoriasis in adults. Men more than women. Unknown cause (malassezia furfur?) Associated w/ oily looking skin but not a disease of the seb gland. Associated w/ parkinson’s and a variety of other neural abnormalities. Treatment: Control not cure. Remove scales and crusts. Inhibition of yeast colonization and secondary infx. Treaty erythema and itching. Antifungals in adults.
Failure of apoptosis leading to fused digits or fusion of bony components.
Syndactly
EM major
severe with extensive skin and mucous membrane involvement (Stevens-Johnson’s Syndrome). Usually due to drugs and after mycoplasma pneumoniae infx
Acromegaly
Excess GH after growth plates closed. Large, heavy bondes especially face, hands and feet.
Inflammatory disease of the pilosebacous unit caused by excessive sebum production, follicular plugging, colonization or sebaceous follicle with Propionibacterium acnes, or immune response with inflammation. May be triggered by stress or steroid use (why we taper steroids to end dosage.) Also by meds like isoniazid, lithium, phenytoin Classified by a few ways: mild, moderate, severe or stage 1,2,3, or 4 Stage 1: Comedones and flesh colored papules Stage 2: Inflammation, papules/pustules -few to several Stage 3: Papules/pustules and a few nodules; little to no scarring Stage 4: Deep/Inflammatory; Extensive nodules, variable degree of stars No labs unless hyperandrogenism is expected. Differential: Acne Rosacea, Gram negative folliculitis, perioral dermatitis, steroid induced acne Treatment: decrease sebaceous gland activity, correct the altered pattern of keratinization, decrease follicular bacterial population, produce anti-inflammatory effect. Topical retinoids, benzoyl peroxide, topical antibiotics, intralesional corticosteroid injections, oral isotretinoin (OCPs for women), Incision and drainage, hormonal therapy (OCPs)
Acne Vulgaris
Varicella
“Chicken Pox” - Herpes varicella -zoster virus Incubation: average 14 days Prodrome: fever, chills, malaise, 2-3 days before rash Hallmark of clinical exam - “dew drop on a rose petal” that rapidly become pustules and crust. Concentrated on trunk. Spread by respiratory droplets. Major complications: encephalitis, pneumonia, hepatitis, Reye’s syndrome (why we don’t give aspirin to kids) Immunitztion: Children who have never had chickenpox 1st dose at 12-15 months, and 2nd dose at 4-6 yrs. Over 13 two doses 28 days apart.
“Chicken Pox” - Herpes varicella -zoster virus Incubation: average 14 days Prodrome: fever, chills, malaise, 2-3 days before rash Hallmark of clinical exam - “dew drop on a rose petal” that rapidly become pustules and crust. Concentrated on trunk. Spread by respiratory droplets. Major complications: encephalitis, pneumonia, hepatitis, Reye’s syndrome (why we don’t give aspirin to kids) Immunitztion: Children who have never had chickenpox 1st dose at 12-15 months, and 2nd dose at 4-6 yrs. Over 13 two doses 28 days apart.
Varicella
Chronic, puritic eczemetous condition of the skin that is associated with a personal or family history of atopic disease (asthma, allergic rhinitus) Symptoms: Epidermal edema = spongiosis. Pale epidermis, swelling of keratinocytes, leaky cells, fluid pockets, weeping, vesicles. “the itch that rashes”. Disease of childhood (10% of US children) Uncommon for adults w/o a history of eczema in childhood. Increased prevalence may be due to exposure to pollutants, indoor allergens, and decline in breast feeding. Clinical features: pruritic, facial and extensor papulovesicles in infancy. Flexural lichenification in adults and older children. Chronic-relapsing course. Treatment: Cutaneous hydration, topical glucocorticoids, identify and eliminate flare factors. Tacrolimus, pimecrolimus. Treat pruritis. Complications: bacterial impetigization (staph a), secondary herpetic infection, contact sensitization. prognosis: spontaneous resolution after age 5 in 40%, 84% of children “outgrow” by adolescence. Poor prognosis if wide spread AD in childhood, associated allergic rhinitis or asthma. Family history of AD.
Atopic Dermatitis
Inflammatory rxn of the skin precipitated by an exogenous chemical. Acute - linear streaks of vesicles; Chronic - lichenification, eczematous rxn. Two types: irritant- direct toxic effect on the skin or Allegic - immunologic rxn that causes tissue inflammation (type IV hypersensitivity) Common sensitizers: poision ivy, paraphyenylenediamine (perfumes), nickel, rubber, ethyleenediamine (topical meds) Differential - atopic dermatitis, seborrheic dermatitis, stasis dermatitis, fungal infx, bacterial cellulitis patch testing for allergic contact dermatitis: North American Contact Dermatits Standard Patch Test Series Treatment: prevention/avoidance, symptomatic treatment, psiochemical barriers, tolerance induction
Contact Dermatitis
Subacute SLE
Erythemetous and usually scaling rash of upper trunk and extensor surfaces.That is psoriasis plaque like form or annular polycyclic form. Due to SSA or SSB antibody
Systemic Lupus Erythematosus (SLE)
Risk Factors: Women, 14-40, African America, Hispanic, Asian. Lab Tests: Antinuclear Antibody Test (ANA) *** Histopathology: Long term autoimmune disorder that may affect skin, joints, kidney, brain Immunofluoresence: IgG in basement membrane Triggers: Sunlight, medications (anti-siezure, antibiotics, BP Rx) Treatments: NSAIDs, Antimalarials, Corticosteroids, Immunosuppressants
Sharply demarcated erythema with thick micaceous scale, Auspitz sign (bleeds with scraping of scales), and Koebner phenomenon (spreads on scratch lines); nail disease in 50%, rarely pustular Histopathology: extensive hyperketosis and paraketosis, neutrophils in epidermis Pathogenesis: T-cell mediated Risk Factors: Genetic (30% w/ first degree relative, stress, meds, infx, HIV) Treatment: Depression/anxiety etc. due to self esteem form cosmetics, Increased non-melanoma skin cancers, psoriatic arthritis
Psoriasis
Excess GH after growth plates closed. Large, heavy bondes especially face, hands and feet.
Acromegaly
Amelia and Phocomelia
Amelia - missing one arm Phocomelia - Flipper limbs. Both caused by thalidomide use in the 50s and 60s to treat morning sickness. Now used to treat leprosy, so be careful.
Angiodema
Deep dermal and SQ swelling. Burning/Painful. Laryngeal involvement = emergency Swelling of lip, eye, groin, palms/soles common
Psoriasis
Sharply demarcated erythema with thick micaceous scale, Auspitz sign (bleeds with scraping of scales), and Koebner phenomenon (spreads on scratch lines); nail disease in 50%, rarely pustular Histopathology: extensive hyperketosis and paraketosis, neutrophils in epidermis Pathogenesis: T-cell mediated Risk Factors: Genetic (30% w/ first degree relative, stress, meds, infx, HIV) Treatment: Depression/anxiety etc. due to self esteem form cosmetics, Increased non-melanoma skin cancers, psoriatic arthritis
Gigantism
Excess GH during childhood before growth plates close. Overall large size: height and organs; normal proportions.
Spina Bifida occulta
Incomplete closing of spinal cord. Key clinical sign is fawn’s spot on lower back.
Specific T cells are the primary effector cells. Examples of T cells causing unwanted responses are: contact sensitivity (contact dermatitis to nickel or poison ivy) Delayed hypersensitivity response to TB or leprosy Exaggerated response to viral infxs such as measles Persistent symptoms of allergic disease.
Type IV Hypersensitivity
Psoriasis: Pustular Type
Generalized: Potentially life threatening. Small pustules becoming generalized with fever. Localized: Hand and foot form involves palms and soles. May be termed pustular psoriasis of Barber. *Don’t confuse with uticaria caused by penicillin due to strep infx
Involve the formation of immune complesex in the circulation that are not adequately cleared by macrophages or other cells of the reticuloendothelial system. Takes significant quantities of antibody and antigen. Classic diseases of group : SLE, chronic glomerulonephritis, and serum sickness.
Type III Hypersensitivity
Excess GH during childhood before growth plates close. Overall large size: height and organs; normal proportions.
Gigantism
