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Clin Med III: Dermatology > Infectious Dermatology Part 2 > Flashcards

Infectious Dermatology Part 2 Flashcards

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1
Q

MCC/types of Condyloma Acuminatum

A

HPV 6 & 11

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2
Q

HPV types ___, ___, ___, and ___ are the major etiologic factors for in situ and invasive SCC

A

16, 18, 31, and 33

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3
Q

how are Condyloma Acuminatum transmitted (incubation, development, etc)

A
  • Invasion of basal cells of epidermal layer via microabrasion
  • Active lesions are not required for transmission
  • Incubation 3w-8m
  • skin lesions develop 2-3 mos after exposure
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4
Q

RF for Condyloma Acuminatum

A
  1. Number of sexual partners
  2. Frequency of sexual intercourse
  3. Partner with HPV
  4. Other STI’s
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5
Q

transmission of condyloma acuminatum via how?

A
  1. sexual contact
    - Oral - genital
    - Genital - anal
  2. Delivery
    - mothers with infection transmit to baby
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6
Q

pathogenesis of condyloma acuminatum

A
  1. Low Risk – cause warts
  2. High Risk – cause warts
    - HPV may persist for years in a dormant state and becomes infectious intermittently
    - Immunosuppression high risk for warts if infected
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7
Q

clinical manifestations of condyloma acuminatum

A
  1. Usually asymptomatic
  2. Anxiety
  3. Obstruction if large mass - Mucocutaneous lesions (4 types)
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8
Q

4 types of mucocutaneous lesions

A
  1. Small papular
  2. Cauliflower-floret
  3. Keratotic warts
  4. Flat topped papules/plaques (MC on cervix)
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9
Q

presentation of condyoma acuminatum

A
  1. Skin colored/pink/red/tan/brown
  2. Solitary or scattered or isolated or mass
    - Immunocompromised patients may have many lesions and may be large
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10
Q

MC sites for condyloma acuminatum

A
  • Male = frenulum, corona, glans penis, prepuce, shaft, and scrotum
  • Female = labia, clitorius, periurethral, perineum, vagina, and cervix
  • BOTH = perineal, perianal, anal canal, rectal, urethral meatus, urethra, and bladder
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11
Q

what are Laryngeal Papillomas

A
  1. Uncommon HPV 6 and 11
  2. MC on vocal cords
  3. Age <5 years old or >20 years old
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12
Q

laryngeal papillomas are at - risk of ____ and ____

A
  • SCCis
  • invasive SCC
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13
Q

DDx condyllomas acuminatum

A
  1. PPP
  2. Sebaceous glands
  3. SCCis
  4. Skin tags
  5. Pilar cysts
  6. Molluscum
  7. Folliculitis
  8. Scabetic nodules
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14
Q

dx/tests for condyloma acuminatum

A
  1. Pap smear
  2. Dermatopathology
  3. typically clinical dx
  4. Dermoscopy = papillomatosis (hallmark)
    - Finger like knob projections
  5. Shave Biopsy – if refractory to tx
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15
Q

tx condyloma acuminatum

A
  1. Pt - Imiquimod, podofilox, trichloroacetic acid
  2. Provider - cryotherapy, electrosurgery, surgical removal, laser

*may resolve on their own

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16
Q

disposition/management for condyloma

A

Recommend follow up monthly until lesions gone then q3months

  1. Recurrence MC within 3 months of first treatment
  2. Routine PAP in females
    - PREVENTION
    — Gardasil vaccine– (6,11, 16,18) prior to sexual activity
    — Condoms
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17
Q

gardasil dosing

A
  • 9-14 y/o: 2-dose 0, 6-12 mo; 3-dose 0, 2, 6 mo
  • 15-45 y/o: 3-dose 0, 2, 6 mo
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18
Q

Cervical, vulvar, vaginal, anal, oropharyngeal and other head and neck cancers caused by what type of HPV

A

16, 18

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19
Q

provider tx of condylomas

A
  • Cryo - q2-4 wks x 3 mo (sometimes longer)
  • CO2 laser - Recurrent or resistant to tx
  • Surgical - Best option for >1cm; shave (same technique as shave biopsy)
  • Curettage (pairing) - Can be done before LN or SA application
  • Electrosurgery - Used alone or with curettage
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20
Q

MOA of Imiquimod 5%

A

Immunomodulator
induces immune system response to recognize and destroy lesions

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21
Q

application of imiquimod 5%

A

Application - (vehicle: cream)

  • 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
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22
Q

SE imiquimod 5%

A

Localized inflammatory reaction (redness, irritation, induration, ulceration, erosions, and vesicles)

  • Holiday of several days may be needed if SE are too severe for pt comfort
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23
Q

Pt ed for imiquimod 5%

A

Avoid sexual contact during application times (weakening of barrier contraception)

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24
Q

MOA of podofilox 0.5%

A

Antimitotic
prevents cell division and causes tissue necrosis

Vehicle: solution or gel

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25
Q

application of podofilox 0.5%

A
  1. Cotton tipped applicator (sol)/ finger (gel)
  2. 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
  3. tx area ≤ 10 cm₂ AND Total volume should be no more than 0.5 ml/d
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26
Q

SE Podofilox 0.5%

A
  • MC - Local mild-severe skin irritation
  • MC systemic SE - HA (only 7% per EBM)
  • Flammable (avoid flames or lit cigarette)
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27
Q

CI podofilox 0.5%

A

preg (cat C)

28
Q

pt ed podofilox 0.5%

A
  • Apply initial tx if possible in office to educate on proper application
  • Avoid sexual activity during rx application times
29
Q

MOA of Trichloroacetic Acid (TCA)

A
  1. burns, cauterizes and erodes skin lesions
  2. Strength = 80-90%
    - Apply vaseline around lesion to create barrier apply TCA to area with cotton tip applicator x 6-10 weeks
    - VERY effective
30
Q

which type of infection of molluscum contagiosum is benign and self limiting

A

Viral infection - poxvirus

31
Q

transmission of molluscum contagiosum

A

Direct skin – skin contact

  1. Bathing together
  2. Sexual encounter (Adults)
    - 2-6 weeks incubation
  3. MC in young children but can be adults
32
Q

RF Molluscum Contagiosum

A
  1. Childcare/daycare
  2. School
  3. Sports
  4. Risky sexual behavior
33
Q
  1. Small, smooth, dome shaped papules with umbilicated center
  2. In adults commonly in groin area or lower abdomen.
  3. range in size from 3-6mm
  4. White, curd-like material can be expressed from the depression of the lesion.
  5. Pink/pearly/flesh colored
  6. Grouped or linear
  7. Palms and soles are spared
    - ID reaction = “dermatitis”
  8. High risk = immunocompromised and atopic patients
A

Molluscum Contagiosum

34
Q

DDx Molluscum Contagiosum

A

Warts
Condyloma
BCC

35
Q

management for Molluscum Contagiosum? Why tx?

A
  1. Typically regress - 6 months to 2 years
  2. Why do we treat? Parents commonly want molluscum treated
    - Helps with spreading
    - Cosmetic
    - Recurrent dermatitis
    - Stress
36
Q

tx for Molluscum Contagiosum

A
  1. Cryotherapy / curettage
  2. Podofilox 0.5%
  3. SA (compound W)
  4. DON’T PICK…PICK = SPREAD
37
Q

cause of verrucae

A

HPV
Direct skin contact
Incubation = 2-6 months

38
Q

3 types of verrucae

A
  1. Verruca vulgaris - common wart
  2. Verruca plantaris - plantar wart
  3. Verruca plana - flat warts
39
Q
  1. 1-10 mm papules or >
  2. Isolated or multiple
  3. Red and brown spots - Seen under dermatoscope - thrombosed papilla capillary loops (patient’s common call them seeds)
  4. Isolated or multiple
    - MC: Trauma, Hands/fingers, Knees

which type of verruca?

A

Verruca Vulgaris

40
Q
  • Shiny papules plaque with rough hyperkeratotic surface
  • Thrombosed capillaries
  • Skin lines decrease
  • Usually uncomfortable
  • tender

which type of verruca?

A

Verruca Plantaris

41
Q
  1. Sharply defined
  2. 1-5 mm
  3. Flat surface
  4. Skin colored or light brown
  5. Round, oval, polygonal or linear
    - MC on face, beard area, dorsa of hands and shins

which type of verruca?

A

Verruca Plana

42
Q

dx verruca

A

Clinical
Biopsy can assist (SCC)

43
Q

DDx verruca vulgaris/planus

A
  • Molluscum
  • SK
  • AK
  • SCC
  • Skin tag
44
Q

DDx verruca plantaris

A

Corn/callus

45
Q

management + when to tx for verruca

A
  1. Resolve without treatment months years
  2. Should you treat?
    - Painful /discomfort
    - Impairment of function
    - Cosmetic
    - Immunosuppresion
  3. SA
  4. Cryo
  5. Imiquimod
  6. Cantharidin
  7. Electrosurgery (use caution-aerosolized virus)
46
Q

goal of salicyclic acid

A

Keratoylic agent
desquamation of hyperkeratotic epithelium

47
Q

what % SA to use for smaller and larger lesions?

A

10 -30% = smaller lesions
40% = larger
DAILY / SAND OR FILE
Liquid, ointment, pad or patch

48
Q

CI and SE of SA

A
  1. Contraindicated – hypersensitivity
  2. Side Effects – local irritation
    - Apply after soaking foot/file before application
49
Q

a substance derived from the blister beetle

A

Cantharidin

50
Q

MOA canthrone

A

causes a blister to form on the wart or viral lesion
leave on for 4-6 hours then rinse off.

51
Q

how to perform cryotherapy with verrucas

A
  • Debride thick surface
  • Repeat every 4 weeks (I usually do every 2-3 weeks x 3 months
52
Q

Acute dermatomal infection infection associated with reactivation of VZV

A

Herpes Zoster

53
Q

pathogenesis of herpes zoster

A
  • 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
54
Q

triggers for herpes zoster

A

immunosuppression, trauma, tumor, or irradiation

55
Q

phases for HZ

A
  1. Prodrome
  2. Active infection
  3. PHN
56
Q

4 Dermatomal Lesions (active infection) and when do these start forming?

A
  1. Papules - 24 hours
  2. Vesicles/bullae - 48 hours
  3. Pustules - 96 hours
  4. Crusts - 7-10 days
57
Q

prodomes of HZ

A
  1. Pain - Can mimic angina or acute abdomen
  2. Tenderness
  3. Paraesthesia - Flu like constitutional symptoms can occur
58
Q

HZ - New lesions appear for up to ? wk
how do they look?

A

1 week
Erythematous, edematous base, clear vesicles, and sometime hemorrhagic
Vesicles erode forming crusted erosions
Dermatome crusting usually resolves in 2-4 weeks - Unilateral, Dermatomal

59
Q

other involvement in HZ

A
  1. Mucous membrane can be involved
  2. LAD
  3. Sensory or motor changes
  4. Ophthalmic zoster
    - 1/3rd of cases – trigeminal nerve (V1) - (+) Hutchinson sign
    - Delayed contralateral hemiparesis
    - Headache
    - Constitutional symptoms
    - PHN - Months to years
    - Scars
60
Q

HZ DDx of Prodrome Phase

A
  1. Migraine
  2. Cardiac or pleural disease
  3. Acute abdomen
  4. Vertebral disease
61
Q

HZ DDx of Dermatomal Eruption

A
  • HSV
  • Photoallergic (poison ivy, poison oak)
  • Contact dermatitis
  • Erysipelas
  • Necrotizing Fasciitis
62
Q

how to dx HZ

A
  1. Prodromal
    - Unilateral pain - young and immunocompromised
  2. Active
    - Clinical
    - Tzanck test
    - DFA
    - Viral culture
    - PCR (Most Sensitive)
  3. Post-herpatic Pain
    - History and clinical
63
Q

tx/management HZ

f/u, prevention, meds

A
  1. Close follow up and ophthalmology referral if eye involvement
  2. Prevention
    - Vaccination reduces burden by >60% and incidence by 51%
  3. Antiviral therapy
    - Valcyclovir 1000mg TID x 7 days
    - Famciclovir 500mg q 8 hours x 7 days
    - Acyclovir 800mg 5x daily x 7 days
    — Immunocomp = extend to 10 d course
64
Q

supportives for HZ

A
  • Bed rest
  • Sedation
  • Pain management
  • Moist dressings
65
Q

pain management for HZ

A
  • NSAIDS
  • Gabapentin
  • Pregablin
  • TCA’s
  • Nerve block (SEVERE)

Clin Med III: Dermatology (13 decks)

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