Infectious Derm - Part 2 - Exam 1 Flashcards
What am I? What are the 2 MC types?
Condyloma Acuminatum
HPV virus: strains 6 and 11
What 4 HPV types are the major etiologic factors for in situ and invasive SCC?
HPV types 16, 18, 31, and 33
How does Condyloma Acuminatum invade? What is the incubation period? When do active skin lesions develop?
Invasion of the basal cells of the epidermal layer via microabrasion
Incubation 3w-8m
skin lesions develop 2-3 months after exposure
T/F: Condyloma Acuminatum is only spread if you have an active genital wart
FALSE!! **Active lesions are NOT required for transmission!
Describe the pattern of condyloma acuminatum. What is the MC pt population?
generally found in clusters/groups but can be seen solo
MC in young sexually active adults
How is condyloma acuminatum transmitted?
sexual contact either oral -> genital or genital-> anal
can pass from mother to baby during delivery
What increases risk of expressing HPV in wart form? Do the warts always show up immediately after sexual exposure?
Immunosuppression high risk for warts if infected
NO! HPV may persist for years in a dormant state and becomes infectious intermittently
How will a pt with condyloma acuminatum present?
usually asymptomatic, the physical appearance of skin colored/pink/red/tan/brown lesions is what bothers people the most
can cause physical obstruction if large enough
What are the 4 types of condyloma acuminatum?
Small papular
Cauliflower-floret
Keratotic warts
Flat topped papules/plaques (most common on cervix)
What is an important pt education point regarding Condyloma Acuminatum?
Do not shave the area!! will cause it to spread
What am I?
What strains?
Where are they MC?
Laryngeal Papillomas of Condyloma Acuminatum
HPV 6 and 11
MC on vocal cords
What am I?
penile pearly papules
benign condition
How do you dx Condyloma Acuminatum?
typically a clinical dx
If dermoscopy is done on Condyloma Acuminatum, what is the hallmark finding? What do they look like? _____ is done if refractory to tx
Dermoscopy = papillomatosis (hallmark)
Finger like knob projections
Shave Biopsy – if refractory to tx
What is the tx for Condyloma Acuminatum?
Patient - Imiquimod, podofilox, trichloroacetic acid
Provider - cryotherapy, electrosurgery, surgical removal, laser
or may resolve spontaneously on their own
What is the f/u recommendation for condyloma? When is it most likely to reoccur? What is the prevention?
Recommend follow up monthly until lesions gone then q3months
within the first 3 months
Gardasil vaccine and condoms
What is the gardasil vaccine recommendations?
age 9 through 14 years -> 2-dose series 0, 6 to 12 months
OR
3-dose series at 0, 2, 6 months
if over 15-45 years old need 3 dose series at 0, 2, 6 months
If choosing cryo therapy to tx condyloma, what is the interval? CO2 laser?
cryo: Treat every 2-4 weeks x 3 months (sometimes longer)
CO2 laser
Recurrent or resistant to treatment
If choosing surgical therapy to tx condyloma, what is the interval? curettage? electrosurgery?
Surgical: Best option for >1cm and do a shave bx
curettage: can be done before LN or SA application
electrosurgery: Used alone or with curettage
What is the caution with regards to using cryo therapy?
can cause permanent hypopigmentation in darker skin pts
**_______ MOA induces immune system response to recognize and destroy lesions. What is the drug class? What are the SE?
Imiquimod 5%
Immunomodulator
Localized inflammatory reaction (redness, irritation, induration, ulceration, erosions, and vesicles)
How do you apply imiquimod? **What is the important pt education? What type of vehicle?
Apply small amount at bedtime 3x/wk - rub cream in until no longer visible
**Wash off upon awakening with mild soap (after 6-10 h)
Cont Tx until complete clearance - maximum of 16 wks
cream
_____ MOA prevents cell division and causes tissue necrosis. What is the drug class? What type of vehicle?
Podofilox 0.5%
Antimitotic
solution or gel
How do you properly apply Podofilox?
Cotton tipped applicator (sol)/ finger (gel)
Apply q12h x 3 days, off 4 days, repeat therapy weekly until resolution (max 5 consecutive wks of therapy)
-Apply to normal skin between lesions (if applicable)
-avoid open wounds
-Wash medication off after 1-4 hours
What are the surface area requirements for Podofilox?
Treatment area ≤ 10 cm₂ AND Total volume should be no more than 0.5 ml/d
What are the 3 SEs of podofilox?
mild to severe skin irritation
may have HA
FLAMMABLE!!!!
Is podofilox safe in pregnancy? Can they have sex?
Preg cat C
avoid sexual activity during rx application times
_____ MOA burns, cauterizes and erodes skin lesions. How strong is it?
Trichloroacetic Acid (TCA)
80-90%
How do you apply TCA?
Apply vaseline around lesion to create barrier then apply TCA to area with cotton tip applicator daily x 6-10 weeks
What am I? What is it caused by? How is it transmitted? What is the MC pt?
Molluscum Contagiosum
Poxvirus but it is self limiting
any direct skin-skin contact including bathing together and sexual contact
MC in young children but can be adults
What am I?
Molluscum Contagiosum
What am I?
Molluscum Contagiosum
What am I?
Molluscum Contagiosum
Describe molluscum contagiosum in words. What is a PE test that will help you determine dx?
small, smooth, dome shape papule central with a pit
and transilluminate and will see the pit in the center
What is the common size range for molluscum contagiosum? Can anything be expressed? What 2 areas are spared?
3-6mm
White, curd-like material can be expressed from the depression of the lesion.
Palms and soles are spared
When will Molluscum Contagiosum typically go away? What will happen if you pick them?
6 months to 2 years
picking =spread
What is the tx for molluscum contagiosum? What is the OTC option?
Cryotherapy / curettage
Podofilox 0.5%
SA (compound W) -> OTC option
What is a verrucae? What causes them? What is the incubation period? How is it spread?
wart
HPV
2-6 months
direct skin contact
What are the 3 different types of verrucae?
Verruca vulgaris - common wart
Verruca plantaris - plantar wart
Verruca plana - flat warts
What am I? What is the size? What is commonly seen under dermatoscope? What are they composed of?
verrucae vulgaris
isolated or multiple 1-10mm in size
Red and brown spots
thrombosed papilla capillary loops (patient’s common call them seeds)
Where are the MC places to find verrucae vulgaris?
Trauma
Hands/fingers
Knees
Elbows
Feet
What am I? Describe it in words
verruca plantaris
Shiny papules plaque with rough hyperkeratotic surface and thrombosed capillaries
with DECREASED skin lines and will be uncomfortable and tender
What am I? Where are they most commonly found? Describe them in words? What size?
verruca plana
face, beard area, dorsa of hands and shins
sharply defined, skin colored or light brown
Round, oval, polygonal or linear
1-5 mm
What will you see when you transilluminate a verruca plana?
see elevation change
How do you dx verruca?
clinical and can bx because they can be SCC
What am I?
verruca
Will verruca resolve on there own without tx?
will resolve on their own without treatment but takes months to years
When should you tx verruca? What are the tx options?
Painful /discomfort
Impairment of function
Cosmetic
Immunosuppresion
SA
Cryo
Imiquimod
Cantharidin
Electrosurgery (use caution-aerosolized virus)
tx in office then cover with duct tape
_____ MOA is desquamation of hyperkeratotic epithelium. What is the drug class?
SA = Salicylic Acid
Keratoylic agent
____ is considered a larger lesion with considered treating with SA. What do you need to do first before applying?
40% = larger
DAILY / SAND OR FILE then apply SA
Liquid, ointment, pad or patch
(can also soak first before filing then topical SA)
_________ is a substance derived from the blister beetle. What does it cause? What is the pt education for application?
Canthrone
Canthraridin causes a blister to form on the wart or viral lesion
leave on for 4-6 hours then rinse off.
What is the proper cryotherapy technique for verruca?
Debride thick surface
Cryotherapy for 3 cycles, waiting for the wart to thaw out each time before spraying again
Repeat every 4 weeks (Alex does every 2-3 weeks x 3 months)
What am I? What is the pathogenesis?
herpes zoster (shingles)
Pathogenesis passes from lesions in the skin and mucosa via sensory fibers to sensory ganglia = lifelong latent infection
Virus multiples and spreads down the nerve fibers to the skin and mucosa produces vesicles
aka lives in nerves and can become reinflammed whenever it wants
What are some triggers for herpes zoster?
immunosuppression, trauma, tumor, or irradiation
What am I?
What are the 3 clinical phases?
Herpes zoster
Prodrome
Active infection
PHN
What will the pt complain of in the prodrome phase of herpes zoster?
pain
tenderness
paresthesia
+/- flu like constitutional symptoms
What are the 4 different types of lesion options that might be present during the active infection of herpes zoster? Give the timeframe
Papules - 24 hours
Vesicles/bullae - 48 hours
Pustules - 96 hours
Crusts - 7-10 days
Describe the lesions of herpes zoster.
Erythematous, edematous base, clear vesicles, and sometime hemorrhagic
can become crusted erosions once the vesicles erode
When does dermatome crusting resolve in HZ? **What is the location?
Dermatome crusting usually resolves in 2-4 weeks
**HZ is usually unilateral and follows a dermatomal pattern!!
What is Ophthalmic zoster?
when the V1 distribution of the trigeminal nerve is involved.
Hutchinson sign when the eye and tip of the nose are involved
**______ is the most sensitive dx tool for herpes zoster
PCR
What is the tx for herpes zoster? What is IC?
oral antiviral
Acyclovir 800mg 5x daily for 7 days
can also give NSAIDs, gabapentin, pregablin or TCAs for the associated nerve pain management
Immunocompromised = extend to 10 day course
_____ may be used if pain from HZ is SEVERE
nerve block
