Eythema/Bullous/Papular

Question 1

• S/S: Lesions are itchy, red swellings of a few millimeters to many centimeters
  
  • Morphology of the lesion will change; individual lesions last less than 24 hours—the key is they move!!!
• Angioedema involvement of deeper subcutaneous tissue with swelling of the lips, eyelids, palms, soles and genitalia

Answer 1

Urticaria “Hives”

• Tx: search for cause of acute urticariaàusually medications, bug bites
  
  • mainstay for treatment is H1-antihistamines
  • initial therapy is hydroxyzine

Question 2

• classic target lesion, consists of three concentric zones of color change
• Medication associated symptoms are raised purpuric target lesions with only TWO zones of color change and a central blister, or nondescript reddish or purpuric macules favoring the trunk and upper extremities
• Pain on eating and urination can occur when mucosa are involved
• Prodome of flu like symptoms 1-3 days prior to skin changes
• Photophobia, conjunctival itching or burning, painful swallowing

Answer 2

Erythema Multiforme/SJS/TEN

SJS: less than 10% BSA detachment

TEN: More than 30% BSA detachment

Tx: best in an acute care environmentàICU or burn unit

• Pts should be admitted if mucosal involvement interfers with hydration and nutrition or extensive blistering develops
• Open lesions should be handled like 2nd degree burns
• STOP medication
• Nutritional and fluid support
• Intense wound care with nanocrystalline gauze materils containg silver or petroleum
• Get opthamology constult daily because of conjunctiva involvement
• Manage pts temperature

Question 3

• Gen: Superifical form of cellulitis caused by beta-hemolytic strep
• S/S: pain, malaise, chills and moderate fever
• Bright red spot appears and spreads to form a tense, sharply demarcated, glistening, smooth, hot plaque
• Margin makes noticeable advances in days or even hours
• Lesion is edematous with a raised edge and may pit slightly with the finger
• Vesicles and bullae occasionally

Answer 3

Erysipelas

Tx: antibiotics Iv or oral

• Penicillin, dicloxacillin, cephalosporin

Question 4

• Gen: potentially life threatening, drug-induced hypersensitivity rxn
• S/S: skin eruption, hematologic abnormalities, lymphadenopathy, and internal organ involvement (liver, kidney, lung)
  
  • 2-8 weeks between exposure and onset
  • prolonged course and frequent relapse even after quitting drug
  • associated with reactivating a latent human herpes virus infection
  • fever
  • Skin eruption: morbilliform (similar to measles) rapidly progressing to a diffuse, confluent, and infiltrated erythema with follicular accentuation

Answer 4

DRESS Sydrome

• Drug reaction with eosinophilia and systemic symptoms
• Tx: take away offending drug
  • Severe cutaneous rxn requires hospitalization
  • Topical super high potency steroids
  • If there is severe organ involvement use systemic steroids like prednisone until labs improve

Question 5

• Gen: infection of deeper tissues that results in progressive destruction of muscle fascia and subcutaneous fat
• S/S: initially overlying tissue can appear unaffected
• Early: erythema, edema, warm, shiny, tender w/ pain out of proportion with exam
  
  • skin looks normal but patient is screaming
• Late: patches of red-purple to blue gray

w/in 3-5 days, skin breaks down, bullae with thick pink or purple fluid, gangrene form, skin becomes anesthetic

• Subcutaneous gas results in palpable crepitus
• Edema can cause compartment syndrome
• Fever, tachycardia, hypotension, malaise, myalgias, diarrhea, and anorexia, altered mental status, tachypnea

Answer 5

Necrotizing Fascitis

Question 6

• Gen: contagious and autoinocuable infection of the skin caused by staph or strep
• S/S: macules, vesicles, bullae, pustules, and honey-colored crusts and when removed leave denuded red areas
• Lab: gram stain and culture confirm

Answer 6

Impetigo

• Diff: acute allergic contact dermatitis and herpes simplex
• Tx: soaks and scrubbing
• Bacitracin, mupirocin, and retapamulin
  
  • If widespread need system antibitioics: cephalexin

Question 7

• Gen: acute or chronic dermatitis results from direct skin contact with chemicals or allergens
• S/S: acute phase characterized by tiny vesicles and weepy and crusted lesions
• Chronic: scaling, erythema, thickened skin,
  
  • itching, burning, and stinging may be severe
  • erythematous macules, papules and vesicles
• Loc: exposed parts or in bizarre asymmetric patterns, consist of erythematous macules, papules, and vesiclesà pattern can be diagnostic

Answer 7

​Contact Dermatitis

• Lab: gram stain and culture will rule out impetigo or secondary infection
  
  • if itching is generalized consider scabies

Question 8

Gen: benign pruritic disease with tense blisters

S/S: blisters may be preceded by pruritic urticarial or edematous lesions for months

Loc: flexural areas, arms and legs

Prog: remitting in 5 to 6 yrs

Answer 8

Bullous Pemphigoid

• Diff: biopsy and direct immunofluorescence examination
• ELISA test for BP 180 or BP 230
• Tx: ultra potent corticosteroids
  
  • prednisone

Question 9

• S/S: itching is mild to severe, lesions are violaceous, flat topped, angulated papules with very fine white streaks
• papules may become bullous or eroded
• disease may be generalized
• mucous membrane lesions have a lacy white network overlying them
• Koebner phenomenon (appearance of lesions in areas of trauma)
• Loc: flexor surfaces and trunk, writs, penis, lips, tongue, vaginal, esophageal, anorectal mucous membranes

Answer 9

Lichen Planus

• Tx: super potent topical corticosteroids for localized in non-flexural areas
• Topical tacrolimus is effective in oral and vaginal erosive lichen planus
• Corticosteroids for systemic cases that are more severe

Question 10

• In young black men of equatorial Africa, homosexual men with HIV
• S/S: red or purple plaques or nodules on cutaneous or mucosal surfaces are characteristic
  
  • Marked edema may occur with few or no skin lesions
• Lab: often involves GI, can be screened by fecal occult blood testing

Answer 10

Kaposi Sarcoma

• Tx: old people- palliative care
  
  • HIV: reduction of immunosuppression drugs and ART
  • Cryotherapy or intralesional vinblastine

Question 11

• Gen: caused by poxvirus
  
  • Autoinocuable and spread by wet skin-skin contact
  • Common in pts w/aids
• S/S: single or multiple dome-shaped, waxy papules, 2-5 mm in diameter that are umbilicated
  
  • Lesions at first are firm, solid, and flesh colored but become soft, white, or pearly gray
• Loc: face, lower abdomen, and genitals

Answer 11

Molluscum Contagiosum

• Diff: easily established b/c of umbilication of dome-shaped lesion
• Tx: curettage or liquid nitrogen

Question 12

• Gen: most common form of cancer
  
  • Occur on sun-exposed areas, ultraviolet light is the cause
• S/S: papule or nodule that may have a central scab or erosion
  
  • Grow slowly, waxy pearly appearance with telangiectatic vessels easily visible

Answer 12

Basal Cell Carcinoma

• Tx: biopsy
  
  • Therapy is aimed at eradication with minimal cosmetic deformity
  • Mohs surgery
  • Must be monitored yearly

Question 13

Gen: occurs in sun exposed areas to people who tan poorly; may arise from an actinic keratosis

S/S: lesions appear as small red, conical, hard nodules that occasionally ulcerate

Answer 13

Squamous Cell Carcinoma

• Tx: excision
• Follow up must be more frequent than BSC, starting every 3 months and examination of lymph nodes for one year and twice yearly after