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Dermatology > Infectious Dermatology Part 2 > Flashcards

Infectious Dermatology Part 2 Flashcards

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1
Q

What is the common name of condyloma acuminatum?

A

Genital warts

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2
Q

Etiology of condyloma acuminatum

A

HPV 6 & 11 MC (>20 types)
HPV types 16, 18, 31, 33 major factors for in situ and invasive SCC

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3
Q

Transmission of condyloma acuminatum

A
  • Invasion of basal cells of epidermal layer via microabrasion
  • Active lesions not required for transmission
  • Incubation 3 w-8 m
  • Skin lesions 2-3 months after exposure
  • MC in young sexually active adults
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4
Q

Risk factors for condyloma acuminatum

A
  • Number of sexual partners
  • Frequency of sexual intercourse
  • Partner with HPV
  • Other STIs
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5
Q

Transmission of condyloma acuminatum

A
  • Through sexual contact
  • Oral - genital
  • Genital - anal: microabrasions in epithelial surface allowing virions from infected partner to gain access to basal layer of non infected partner
  • Delivery: mothers with infection transmit to baby
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6
Q

Pathogenesis of condyloma acuminatum

A
  • Low risk: cause warts
  • High risk: cause warts, HPV may persist for years in 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
  • Usually asymptomatic
  • Anxiety
  • Obstruction if large mass
  • Mucocutaneous lesions, 4 types: small papular, cauliflower floret, keratotic warts, flat topped papules/plaques
  • Skin colored/pink/red/tan/brown
  • Solitary or scattered or isolated or mass
  • Immunocompromised patients may have many lesions and may be large
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8
Q

MC sites of condyloma acuminatum

A
  • Male = frenulum, corona, glans penis, prepuce, shaft, and scrotum
  • Female = labia, clitorus, periurethral, perineum, vagina, cervix
  • Both = perineal, perianal, anal canal, rectal, urethral meatus, urethra, and bladder
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9
Q

What are laryngeal papillomas

A
  • Condyloma acuminatum
  • Uncommon HPV 6 and 11
  • MC on vocal cords
  • Age <5 years old or >20 years old
  • Risk of SCCis and invasive SCC
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10
Q

Tests for condyloma acuminatum

A
  • Pap smear
  • Dermatopathology
  • Typically clinical diagnosis
  • Dermoscopy = papillomatosis (hallmark): fingerlike knob projections
  • Shave biopsy if refractory to treatment
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11
Q

Treatment of condyloma acuminatum

A
  • Patient- imiquimod, podofilox, trichloroacetic acid
  • Provider: cryotherapy, electrosurgery, surgical removal, laser
  • May resolve on their own
  • Follow up months until lesions gone then q 3 months
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12
Q

Patient education for condyloma

A
  • Routine PAP in females
  • Recurrent condyloma MC in 3 months of first treatment
  • Prevention with gardasil vaccine (6, 11, 16,18) prior to sexual activity
  • Condoms (aren’t going to protect whole area)
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13
Q

When can gardasil be given?

A
  • Age 9-14: 2 dose–> 0, 6 to 12 months; 3 dose: 0, 2, 6 months
  • Age 15-45: 3 dose –> 0, 2, 6 months
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14
Q

How are provider therapies performed for condyloma?

A
  • Cryo: treat every 2-4 weeks x 3 months
  • CO2 laser: recurrent/resistant to treatment
  • Surgical: best option for >1 cm, shave
  • Curettage: can be done before LN (liquid nitrogen) or SA application
  • Electrosurgery: used alone or with curettage
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15
Q

What is the MOA of imiquimod?

A

Induces immune system response to recognize and destroy lesions

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16
Q

How is imiquimod applied?

A
  • At bedtime 3x/wk and rub cream in until no longer visible
  • Wash off upon awakening with mild soap
  • Continue treatment until complete clearance, max 16 weeks
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17
Q

SE of imiquimod

A
  • Localized inflammatory reaction (redness, irritation, induration, ulceration, erosions, vesicles)
  • Holiday of several days may be needed if SE too severe for pt comfort
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18
Q

Patient ed with imiquimod

A

Avoid sexual contact during application times (weaken barrier contraceptives)

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19
Q

MOA of podofilox

A

Prevents cell division and causes tissue necrosis

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20
Q

Vehicle for podofilox

A

Liquid or gel

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21
Q

Application of podofilox

A
  • Cotton tipped applicator/finger
  • Apply q12h x 3 days, off 4 days, repeat therapy weekly until resolution
  • Apply to normal skin between lesions (if applicable)
  • Avoid open wounds
  • Wash medication off after 1-4 hours
  • Treatment area <10 cm and total volume no more than .5 ml/d
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22
Q

SE of podofilox

A
  • MC- local mild-severe skin irritation
  • MC systemic SE- HA
  • Flammable
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23
Q

When is podofilox CI

A

Pregnancy

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24
Q

Pt ed for podofilox

A
  • Apply initial tx if possible in office to educate on proper application
  • Avoid sexual activity during application times
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25
Q

MOA of trichloroacetic acid

A
  • Burns, cauterizes, and erodes skin lesions
26
Q

How is TCA applied?

A
  • Strength = 80-90%
  • Apply vaseline around lesion to create barrier, apply TCA to area with cotton tip applicator x 6-10 weeks
27
Q

What is molluscum contagiosum?

A
  • Viral infection
  • Benign
  • Self limited due to pox virus
28
Q

How is molluscum contagiosum transmitted?

A
  • Direct skin-skin contact
  • Sexual encounter (adults) 3-6 weeks incubation
  • MC in young children but can be adults
29
Q

Risk factors for molluscum contagiosum

A
  • Childcare/daycare
  • Sports
  • School
  • Risky sexual behavior
30
Q

Presentation of molluscum contagiosum

A
  • Small, smooth, dome shaped papules with umbilicated center
  • In adults in groin area or lower abdomen 3-6 mm
  • White, curd like material can be expressed from depression of lesion
  • Pink/pearly/flesh colored
  • Grouped or linear
  • Palms and soles are spared
  • ID reaction = dermatitis
  • High risk = immunocompromised and atopic patients
31
Q

Diagnosis of molluscum contagiosum

A
  • CLinical
32
Q

Prognosis of molluscum contagiosum

A

regresses in 6 months to 2 years

33
Q

Why do we treat molluscum contagiosum

A
  • Parents want molluscum treated
  • Helps with spreading
  • Cosmetic
  • Recurrent dermatitis
  • Stress
34
Q

Treatment of molluscum contagiosum

A
  • Cryotherapy/curettage
  • Podofilox
  • SA
  • Dont pick! Picking –> spreading
35
Q

What is verrucae?

A
  • Cutaneous warts
  • Etiology = HPV
  • Spread by direct dkin contact
  • Incubation = 2-6 months
36
Q

Who is verrucae most common in? What are the types?

A
  • Kids
  • Verruca vulgaris - common wart
  • Verruca plantaris = plantar wart
  • Verruca plana = flat warts
37
Q

What is the presentation of verruca vulgaris

A
  • 1-10 mm papules or >
  • Isolated or multiple
  • MC due to trauma, hands/fingers, knees
  • Red and brown spots seen under dermatoscopy (thrombosed papilla capillary loops, patients commonly call them seeds)
38
Q

Verruca plantaris presentation

A
  • Shiny papules plaque with rough hyperkeratotic surface
  • Thrombosed capillaries
  • Skin lines decrease
  • Usually uncomfortable
  • Tender
39
Q

Verruca plana

A
  • Sharply defined
  • 1-5 mm
  • Flat surface
  • Skin colored or light brown
  • Round, oval, polygonal, or linear
  • MC on face, beard area, dorsa of hands and shins
40
Q

Diagnosis of verruca

A
  • Clinical
  • Biopsy can assist if concern for squamous cell carcinoma
41
Q

Management of verruca

A
  • Resolve without treatment in months –> years
  • SA
  • Cryo
  • Imiquimob
  • Cantharin
  • Electrosurgery
42
Q

Why treat verruca?

A
  • Painful/discomfort
  • Impairment of function
  • Cosmetic
  • Immunosuppression
43
Q

What is the MOA of salicylic acid

A

keratotic agent that desquamates hyperkeratotic epithelium

44
Q

What concentration is used for smaller lesions with salicylic acid? Larger?

A

Smaller = 10-30%
Larger = 40%

45
Q

What can be used along with salicylic acid for the best effect on verruca?

A
  • Daily sand or file
  • Can use liquid, ointment, pad, or patch of SA
  • Apply after soaking foot/file before application
46
Q

When is salicylic acid contraindicated?

A

Hypersensitivity reaction

47
Q

Side effects of SA

A

local irritation

48
Q

What is canthrone?

A
  • Cantharidin = substance derived from blister beetle
  • Causes blister to form on wart or viral lesion
  • Leave on for 4-6 hours then rinse off

used for wart or molluscum, not FDA regulated

49
Q

How is cryotherapy for verruca performed?

A
  • Debride thick surface
  • Repeat every 4 weeks (prof usually does every 2-3 weeks x 3 months)
50
Q

What is herpes zoster?

A
  • Acute dermatomal infection associated with reactivation of VZV
51
Q

Epidemiology of herpes zoster

A

Immunization with live virus vaccine

52
Q

Pathogenesis of herpes zoster

A
  • Lesions in skin and mucosa passess via sensory fibers to sensory ganglia = lifelong latent infection
  • Triggers = immunosuppression, trauma, tumor, or irradiation
  • Virus multiplies and spreads down nerve fibers to skin and mucosa produces vesicles
53
Q

What are the 3 phases of herpes zoster?

A
  • Prodrome
  • Active infection
  • PHN
54
Q

What are components of prodrome of herpes zoster?

A
  • Pain, can mimic angina or acute abdomen
  • Tenderness
  • Paraesthesia
  • flu like constitutional symptoms can occur
55
Q

Clinical presentation of active herpes zoster infection

A
  • Dermatomal lesions
  • Papules 24 hours
  • Vesicles/bullae 48 hours
  • Pustules 96 hours
  • Crusts 7-10 days
  • New lesions appear for up to 1 week: erythematous, edematous base, clear vesicles, and somtime hemorrhagic
  • Vesicles erode forming crusted erosions
  • Dermatome crusting usually resolves in 2-4 weeks: unilateral dermatomal
56
Q

What other body locations can be involved in herpes zoster other than skin?

A
  • Mucous membrane can be involved
  • Lymphadenopathy
  • Sensory or motor changes
  • Opthalmic zoster
57
Q

What are components of opthalmic zoster?

A
  • 1/3 of cases: trigeminal nerve + hutchinsons sign
  • Delayed contralateral hemiparesis
  • Headache
  • Constitutional symptoms
  • PHN: months to years
  • Scars

`

58
Q

Diagnosis of herpes zoster

A

Prodrome
* unilateral pain- young and immunocompromised

Active phase
* Clinical
* Tzanck test
* DFA
* Viral culture
* PCR (most sensitive)!

Post-herpetic pain
* History and clinical

59
Q

Treatment of herpes zoster

A
  • Close follow up and ophthalmology referral if eye involvement
  • Prevention with vaccination (zostavax)
  • Antiviral therapy with valcyclovir, famciclovir, or acyclovir x 7 days
  • Extend to 10 day antiviral if immunocompromised
  • Supportive treatment with bed rest, sedation, pain management, moist dressings
60
Q

Treatment of post herpetic neuralgia

A
  • NSAIDs
  • Gabapentin
  • Pregabalin
  • TCA’s
  • Nerve block (Severe)
61
Q

A otherwise healthy 70-year-old presents with a painful vesicular eruption spread throughout the left mid lower back. She has been taking 600 mg ibuprofen every 6 hours with minimal relief. Which of the following would best confirm the suspected diagnosis

Complete a Tzank smear, measure IgG for varicella, obtain a fungal culture, perform PCR of skin scraping

A

Perform PCR of skin scraping

62
Q
A

Dermatology (12 decks)

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