Inflammatory Blistering Diseases Flashcards
What does a Herpes Simplex infection look like?
a group of vesicles on a red base which rapidly become prurulent and crusted
How are HSV1 and HSV2 different?
HSV1 primarily occurs in childhood with lesions on the face or lips
HSV 2 is an STD in adulthood involving the genital area (you get painful vesiculations and necrosis)
What is the seropositiviity rate in the general population for HSV 1?
aabout 85%!
Which has a higher liklihood of recurrence, HSV 1 or 2?
2
Specifically, what does HSV 1 cause?
What is the treatment for this?
It causes orofacial lesions called herpes labialis
Treat with oral acyclovir, famciclovir, or valacyclovir
Otherwise you can just use cold sore cream - much cheaper
Specifically, what does HSV 2 cause? Treatment?
This is a recurrent, lifelong disease with NO CURE
The first episode is usually the most extensive - vesicles in the groin area (often areas of the thighs as well)
Treat with acyclovir, famciclovir, and valcyclovir
Describe a herpes varicella infection.
It’s chicken pox
transmitted through air droplets,
Incubation of 14 days
prodrome of fever, chills, malaise (2-3 days before rash onset)
“dew drop on a rose petal” rash develops - especially prominent on the trunk (each is about 2-3 mm)
the “dew drop” quickly become pustules and crust
What are the major complications to be concerned for with chicken pox?
- encephalitis
- pneumonia
- hepatitis
- Reye’s syndrome (especially if the patient is given aspirin)
What are the general recommendations for chickenpox immunizations?
If they’ve never had CPox, they should receive 2 doses (1 at 12-15 mos, 2nd at 4-5 years)
People over 13 years should receive the 2 doses at least 28 days apart
Describe the clinical presentation of a herpes zoster infection.
it’s shingles
only in people who had chicken pox growing up
- prodrome of pain along nerve root up to 5 days before rash
- vesicular eruption in a dermatomal distribution
- You can have up to 30 vesicles that cross into the next dermatome.
What are the treatment options for shingles?
acyclovir or predisone
In a shingles outbreak, what does “hutchinson’s sign” mean?
If they have vesicles on the tip of the nose, they will likely have occular involvement and you should get opthamology involved
What is the vaccine for shingles?
Zostavax
it’s a live, attentuated vaccine to prevent herpes zoster in patients over 50 years old
What is the major complication after the shingles has resolved? How can we prevent it?
postherpetic neuralgia - can be chronic
giving antivirals within 48 hours of onset greater reduces liklihood of this happening
Infections with what will cause non-bullous impetigo?
How about bullous impetigo?
non-bullous: Group A strep pyorgenes or staph aureus (coagulas positive), or mixed infections
bullous: phage group 2 staph aureus (with epidermolytic toxin)
Describe the clinical presentation of nonbullous impetigo.
It’s spread thorugh direct contact
- begins with single red macule or papule
- it quickly becomes a vesicle
- The vesicle reuptures easily to form an erosion
- the contents dry to form characteristic honey-colored crusts that may be pruritic
Describe the clinical presentation of bullous impetigo.
- same beginning as nonbullous impetigo
- the superficial vesicles progress to rapidly enlarging flaccid bullae with sharp margins and no surrounding erythema
- bullae rupture, yellow crusts with oozing result
WHat is the treatment for bullous impetigo?
Not disinfectants - we used to think that would work
topical antibiotics
if those don’t work, oral antibiotics
Describe the clinical presentation of a candidiasis.
bright beefy red dermatitis surrounded by satellite micropupstules
commonly on skin folds and on mucous membranes
What happens in dermatophyte fungal infections?
they produce superficial blisters or pustules with dermatophyte infection in stratum corneum
Which two forms of immunoglobulins are involved in different bullous diseases?
IgA and IgG
What occurs in bullous pemphigoid?
It’s an autoimmune disorder that results in tense bullae on normal or erythematous skin
What age range gets bullous pemphigoid most often?
60-80 year olds
How is diagnosis made for bullous pemphigoid?
based on histological exam
What is the treatment for bullous pemphigoid?
prednisone
topical for mild cases
What occurs in dermatitis herpetiformis?
What is the hallmark?
Also autoimmune
you get clusters of erythematous papules, excoriations and vesicles
they’re pruritic and distributed symmetrically along extensor surfaces
THIS IS ASSOCIATED WITH CELIAC DISEASE
usually between 20-40 years
What happens in pemphigus vulgaris?
Autoimmune again
it affects skin and mucous membranes
causes flaccid blisters on the head, trunk and groin areas (unlike bullous pemphigoid which caused firm blisters)
What age range is common for pemphigus vulgaris?
40-60 years (unlike bullous pemphigoid which was 60-80)
What is a positive Nikolsky sign in pemphigus vulgaris?
It’s a skin finding in which the top layers of the skin slip away from the lower layers when slightly rubbed - this may create a blister
What is the main concern with pemphigus vulgaris?
it has a mortality rate of 5 to 15 %
What is prophyria cutanea tarda caused by?
It’s a deficiency in a heme-synthesizing enzyme
What does porphyria cutanea tarda do to the skin?
blistering occurs on sun-exposed areas esp the hands, forearms and face
they may aso get hypertrichosis of the forehead and cheeks
skin hyperpigmentation
urine discoloration
What are the 3 main risk factors for porphyria cutanea tarda?
hepatitis C
hemochromatosis
alcoholism
