L2 Rosacea/insect Flashcards
Acne Vulgaris
-psychological morbidity, tends to resolve in third decade
-Main factors:
follicular hyperkeratinization
increased sebum production
cutibacterium acnes within the follicle
inflammation
-Microcomedo (plugging) is precursor for clinical lesions
-accumulation of sebum and kertinous material converts a microcomedo to a closed comedo
-orfice will open with continued distension->open comedo
-follicular rupture and presence of bacteria develops inflammatory lesion and bacteria spreads
-immune sends white blood cells, walls of pore thin and rupture
-Follicle wall burst and a capsule is created by enzymes which can create a nodule or cyst
What factors contribute to acne process
- androgens stimulate growth and secretory function of sebacous glands
- mechanical trauma can rupture comedo causing inflammatory lesion
- stress has effect
Areas acne mostly affects
Face, neck, chest, upper back, and upper arms
What are some important consideration when diagnosing acne vulgaris?
- work up for hyperandrogenism is indicated for female patients with acne and additional signs of androgen excess
- rapid appearance of acne in conjunction with virilization suggests an underlying adrenal or ovarian tumor
- medication history for acne-inducing drugs
what treatment do you use for both comedonal and inflammatory lesions?
topical retinoids (tretinoin)
treatment for inflammatory lesions
topical antimicrobial and topical retinoids
what do you use for severe inflammatory acne
oral antibiotics
what does benzoyl peroxide do?
decreases the emergence of antibiotic resistant bacteria
what do you treat comedonal (noninflammatory) acne with?
Topical retinoid (tretinoin)
what do you treat mild papulopustular and mixed acne
benzoyl peroxide and topical antiobiotic (erythromycin clindamycin) and topical retinoid
how to treat moderate papulopustular and mixed acne
benzoyl peroxide and topical retinoid and oral antibiotics (tetracycline class
What to treat severe acne with
retinoid and oral antibiotics (tetracycline) and benzoul peroxide
or
Oral isotretinoin monotherapy (acutane)
-this has strong side effects and do not give if pregnant
what does teratogenic mean and what are some examples used for acne?
what are safe alternatives?
teratogenic = birth defects
- retinoids are very contraindicated in pregnancy
- also isotretinoin acutane
- safe for pregnancy:
- oral erythromycin, topical clindamycin, topical azelaic acid
what are some possible irritants of acne rosacea?
- abnormalities in immunity
- uv damage
- vascular dysfunction
- inflammatory reactions to cutaneous microorganisms
what areas does acne rosacea often present?
-nose, cheeks, chin, and forehead
what dos erythematotelangiectatic rosacea present with?
treatments?
- chronic redness of central face
- flushing (wet or dry)
- skin sensitivity
- dry appearance
- telangiectasias (dilated small blood vessels)
1st behavior modification -avoid triggers -sun protection -gentle skin care 2nd line -laser and pulsed light therapies -topical bromonodine
what does papulopustular rosacea present with?
treatment?
- papules and pustules of central face
- inflammation can be confluent
- no comedones*
1st line for mild-moderate disease: topical
- metronidazole
- azelaic acid
- second line topicals include ivermectin and slufacetamide-sulfur
Mod-severe disease or failed topical tx: oral
- tetracyclines
- Macrolides
what does phymatous rosacea present with?
treatment?
- tissue hypertrophy causing irregular contours on mostly nose but can occur on cheeks, forehead, and chin
- mostly affects men
Early: -isotretinoin Advanced: -surgical debulking -laser ablation
what does occular rosacea present with?
treatment?
- usually 50% or more with other types of rosacea
- children and adults
- Dry eyes, pain, itching blurry vision, photosensitivity, blepharitis(inflammation of eyelid eyelashes or tearproduction), keratitis(corneal inflammation), conjunctivitis, stye
- refer to opthalmologist
- topical abx and cyclosporin, oral abx
what triggers rosacea?
hot/cold temp, sunlight, wind, hot drinks, exercise, spicy food, alcohol, emotions, cosmetics, topical irritants, menopausal flushing, meds that promote flushing
what are the clinical findings with each grade of scorpion sting?
- Grade 1: local pain and paresthesias(tingling/numbness) at the sting
- Grade 2: local symptoms as well as REMOTE pain and paresthesias
- Grade 3: EITHER cranial nerve OR somatic skeletal neuromuscular dysfunction
- Grade 4: BOTH cranial nerve dysfunction AND somatic skeletal neuromuscular dysfunction
How do you diagnose scorpion sting?
Clinical diagnosis but history of sting is often absent
- time spent in an endemic region for the scorpion
- Characteristic signs such as local pain exacerbated by tapping near the sting site (tap sign)
-Cranial nerve dysfunction:
hypersalivation, abnormal eye movements, blurred vision, slurred speech, tongue fasciculations
-Somatic skeletal neuromuscular dysfunction:
fasciculations, shaking/jerking of extemities, opisthotonos (arching of back), emprosthotonos (tetanic forward flexion of the body), fever up to 104F from excess motor activity
treatment for scorpion stings
treatment is primarily supportive for mild envenomations
- pain management with oral medications
- cleansing of the sting site
- tetanus prophylaxis
- observe for 4 hours
Severe envenomations require monitoring for:
- respiratory compromise
- endotracheal intubation
- myocardial infarction
- hyperthermia
- rhabdomylolysis (muscle breakdown)
- multiple organ failure
treatment: intravenous fentanyl for pain, intravenous benzodiazepines
UNLESS
antivenom- respiratory depression may occur if used with benzodiazapines
be prepared for anaphylaxis to the antivenom
usually about 2-9 hours before symptoms except for kids are faster
How to treat most common bee sting local reactions
- treat with a cold compress
- swelling erthema can last a few hour to a few days
What happens with be stings about 10% of the time and how to treat
large local reaction LLR
- exaggerated erythema and swelling
- gradually enlarges over 1-2 days
- resolves in 5-10 days
- cold compress, prednisone, antihistimines, NSAIDs
hymenoptera stings rarely cause secondary bacterial infection. what happens and how to treat?
- worsening symptoms 3-5 days after sting
- more likely with fire ants and yellow jackets
- may cause fever
- tx with antibiotics
Widow bites cause what symptoms and how to manage those
- often cause few symptoms because no venom is injected
- blanched circular patch with surrounding red perimeter
- central punctum
Venom caused catecholamine release
- intermittant radiating pain
- abdominal/chest/back pain and muscle spasm
- local/regional diaphoresis(sweating in just that area), nausea, vomiting, HA
Management
- local wound care
- antiemetics (for nausea and vomiting)
- necrotic analgesics
- tetanus immunization
- muscle relaxers
- antivenom (caution for anaphalaxys)
Recluse bites symptoms and management
-often painless initially but will progress to severe pain in 2-8 hours
-red plaque or papule with central pallor
-may see 2 small puncture marks
-vesiculation (formation of vessels)
-can blister
-usually resolves in a week
UNLESS
-rarely severe ulcerative necrosis can occur
-dark, depressed center develops after 1-2 days
-systemic symptoms:
nausea vomiting,headache fever, chills,
-rarely renal failure, hemolytic anemia, hypotension, DIC (disseminated intravascular coagulation), rhabdomylolysis (breakdown of muscle release protein)
Management:
-cleansing, cold compress, anlagesics, antibiotics, surgical excision and reconstruction may be necessary. you must avoid surgical interventions until wound has stabilized
What is vitiligo, its features, and treatments
- an aquired skin depigmentation via an autoimmune process directed against melanocytes
- onset peaks in 2nd and 3rd decades
- can be associated with other autoimmune disease in 20-30% of patients
- Family history 20-30%
- Milk white macules with homogenous depigmentation and well defined borders
- slowly progressive
- spontaneous repigmentation
Treatment -topical (repigmentation) and systemic (halts progress) corticosteroids -calcineurin inhibitors narrowband ultraviolet b phototherapy -skin grafts -sunscreen -makeup -ask about psychological distress
Hidradenitis Suppurative (acne inversa) what is it and treatment
- chronic inflammatory skin disorder involving the hair follicle
- occurs in axillary, inguinal, and anogenital regions
- from a cycle of follicular occlusion, rupture, and associated immune response
- factors genetics, mechanical stress, obesity, smoking, diet
- more nodules form as disease progresses
- may form an abscess that opens to the skin
- purulet drainage occurs if ruptured
- sinus tracts, comedones, scarring
- diagnosed based on lesion, location, chronicity, and relapse
Treatment
- lifestyle modification: pt education and support, avoidance of skin trauma, hygiene, smoking cessation, weight management, dietary changes
- Topical clindamycin
- intralesional corticosteroids
- systemic antibiotics doxycycline
- anti-androgenic agents
- surgery
- TNF inhibitors
- oral retinoids
Fistulae (empty into another body cavity), strictures and contractures(melted flesh look), lymphatic obstruction, infections complications, squamous cell cancer, malaise, depression, suicide
