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Skin/MSk > Exam 3 part 2 acute skin infections > Flashcards

Exam 3 part 2 acute skin infections Flashcards

1
Q

What are the hallmarks of urticaria?

A

transient wheals, pruritic, type 1 hypersensitivity (IgE). HIVES

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2
Q

What are the hallmarks of angioedema?

A

swelling of lips, burning pain, emergency

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3
Q

What are the hallmarks of Steven Johnson syndrome?

A

2+ Mucous membranes,

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4
Q

What causes Steven Johnson syndrome?

A

Hypersensitivity to sulfa drugs (often a treatment for UTIs)

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5
Q

What are the hallmarks of erythema multiforme

A

Target lesions on palm, 1 mucous membrane

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6
Q

What are the hallmarks of Toxic Epidermal Necrolysis

A

2+ mucous membranes, 30+% skin sloughing

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7
Q

What are the hallmarks of fixed drug reaction

A

1 spot of hyper pigmentation, start demarcated lines

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8
Q

What are the hallmarks of erythema nodosum

A

Anterior leg nodules

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9
Q

What are the hallmarks of Erythema induratum

A

posterior leg nodules

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10
Q

Whats the difference between erythema nodosum and induratum?

A

EN is the anterior leg nodules, EI is the posterior leg nodules

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11
Q

What layer of skin does urticaria affect?

A

Dermis

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12
Q

What layer of skin does Erythema multiforme affect?

A

Epidermis and Dermis

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13
Q

What layer of the skin does Steven Johnson Syndrome and Toxic epidermal necrolysis affect?

A

Epidermis and Dermis

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14
Q

What layer of the skin does fixed drug eruption affect?

A

Epidermis

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15
Q

What layer of the skin does panniculitis (Erythema nudism and erythema induratum) affect?

A

Subcutaneous

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16
Q

What layer of the skin does angioedema affect?

A

Deep dermis and subcutaneous

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17
Q

What needs to be done when seeing a patient with urticaria or angioedema?

A

Thorough history (travel, recent infection, occupational exposure, meds, foods) Careful family history for pre-existing allergies, Look at total body (joints, skin surfaces, mucosal membranes)

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18
Q

How often are angioedema and urticaria acute reactions?

A

Over 2/3rds of all these reactions are acute

19
Q

Immune causes of urticaria and angioedema?

A

Type 1 IgE mediated (allergies), auto-immune (SLE, hashimoto’s immune thyroiditis, infectious agent (viral, bacterial, etc)

20
Q

Non-immune causes of urticaria and angioedema?

A

Physical urticarias (ice, sun, friction, pressure), direct mast-cell degranulation (narcotics, aspirin, NSAIDs), foods containing high levels of histamines (strawberries, tomatoes, shrimp)

21
Q

Different lab exams to evaluate urticaria and angioedema

A

CBC, ESR, TSH, basica chem panel, anti-thyroid antibodiy and FANA in female patients, punch biopsy to exclude vasculitis if lesion persists for 48 hrs

22
Q

What is the therapy for angioedema and urticaria?

A

Avoid allergen, avoid extremes in heat and cold, exercise, alcohol. Acute: antihistamines non-sedating H1 blockers

23
Q

name First choice antihistamines for treatment of urticaria and angioedema?

A

Second generation, non-sedating H1 blockers: Cetirizene (10-20mg/day), Fexofenadine (180mg/day), Desloratadine (5mg/day) , Loratidine (10mg/day)

24
Q

What is the last resort for antihistamines

A

Oral corticosteroids (prednisone, tapered over 10-14 days), EpiPen for type 1 IgE mediated

25
Q

What would you diagnose someone who comes into the clinic with bulls-eye lesions on their extremities (palms and soles) with?

A

Erythema multiforme

26
Q

What can cause erythema multiforme?

A

50% is idiopathic, drugs: sulfonamides, phytoin, barbituruates, phenylbutazone, penicillin, allopurinol. Infection: HSV, Mycoplasma

27
Q

What are the two forms of Erythema Multiforme?

A

EM minor (1 mucosal site, usually post-HSV infection), EM Major (SJS, usually due to drugs

28
Q

What usually causes erythema multiforme minor?

A

Post herpes simplex infection, EM rash at day 10

29
Q

What usually causes EM major?

A

Due to drugs (sulfa, PCN, dilantin, tegretol), and after mycoplasma pneumonia infection

30
Q

What is the therapy for erythema multiforme?

A

Prevention of HSV outbreaks, glucocorticoids for severe systemic illness

31
Q

T/F: SJS and TEN can be life threatening?

A

Yes

32
Q

How do you differentiate between EM and SJS and TEN?

A

EM (1 membrane)>SJS ( TEN (30% of epidermal detachment, 2 membranes)

33
Q

What are risk factors for SJS and TEN?

A

systemic lupus, HLA-B12, HIV disease

34
Q

What is the leading causative factor of SJS and TEN?

A

SJS: 50% associated with drugs, TEN: 80% associated with drugs

35
Q

How long does it take for SJS and TEN to develop after first drug exposure?

A

1-3 weeks, detachment is equivalent to a 2nd degree burn

36
Q

Treatment of SJS and TEN?

A

early diagnosis and withdrawal from drug, ICU, management of IV fluids, early glucocorticoids, high dose of Ig for TEN, debride only frankly necrotic skin, treat complications

37
Q

What are complications of SJS and TEN?

A

sepsis, GI hemorrhage and fluid/electrolyte imbalance

38
Q

Where do fixed drug eruptions happen?

A

face and genitals most common

39
Q

How do you treat fixed drug eruptions?

A

remove offending drug

40
Q

What are the two forms of panniculitis?

A

Erythema nodosum, erythema induratum

41
Q

How do you accurately diagnose panniculitis?

A

skin biopsy

42
Q

What triggers erythema nodosum?

A

Infection (strep, TB, infection) Meds (OCP, sulfa, NSAIDs), autoimmune (BD, sarcoid)

43
Q

What is erythema induratum usually associated with?

A

TB

44
Q

How do you treat panniculitis?

A

rest, ice, pain control

Skin/MSk (31 decks)

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