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Clin Med 1 > L2 Rosacea/insect > Flashcards

L2 Rosacea/insect Flashcards

1
Q

Acne Vulgaris

A

-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

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2
Q

What factors contribute to acne process

A
  • androgens stimulate growth and secretory function of sebacous glands
  • mechanical trauma can rupture comedo causing inflammatory lesion
  • stress has effect
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3
Q

Areas acne mostly affects

A

Face, neck, chest, upper back, and upper arms

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4
Q

What are some important consideration when diagnosing acne vulgaris?

A
  • 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
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5
Q

what treatment do you use for both comedonal and inflammatory lesions?

A

topical retinoids (tretinoin)

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6
Q

treatment for inflammatory lesions

A

topical antimicrobial and topical retinoids

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7
Q

what do you use for severe inflammatory acne

A

oral antibiotics

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8
Q

what does benzoyl peroxide do?

A

decreases the emergence of antibiotic resistant bacteria

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9
Q

what do you treat comedonal (noninflammatory) acne with?

A

Topical retinoid (tretinoin)

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10
Q

what do you treat mild papulopustular and mixed acne

A

benzoyl peroxide and topical antiobiotic (erythromycin clindamycin) and topical retinoid

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11
Q

how to treat moderate papulopustular and mixed acne

A

benzoyl peroxide and topical retinoid and oral antibiotics (tetracycline class

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12
Q

What to treat severe acne with

A

retinoid and oral antibiotics (tetracycline) and benzoul peroxide

or

Oral isotretinoin monotherapy (acutane)
-this has strong side effects and do not give if pregnant

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13
Q

what does teratogenic mean and what are some examples used for acne?
what are safe alternatives?

A

teratogenic = birth defects

  • retinoids are very contraindicated in pregnancy
  • also isotretinoin acutane
  • safe for pregnancy:
  • oral erythromycin, topical clindamycin, topical azelaic acid
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14
Q

what are some possible irritants of acne rosacea?

A
  • abnormalities in immunity
  • uv damage
  • vascular dysfunction
  • inflammatory reactions to cutaneous microorganisms
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15
Q

what areas does acne rosacea often present?

A

-nose, cheeks, chin, and forehead

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16
Q

what dos erythematotelangiectatic rosacea present with?

treatments?

A
  • 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
17
Q

what does papulopustular rosacea present with?

treatment?

A
  • 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
18
Q

what does phymatous rosacea present with?

treatment?

A
  • 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
19
Q

what does occular rosacea present with?

treatment?

A
  • 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
20
Q

what triggers rosacea?

A

hot/cold temp, sunlight, wind, hot drinks, exercise, spicy food, alcohol, emotions, cosmetics, topical irritants, menopausal flushing, meds that promote flushing

21
Q

what are the clinical findings with each grade of scorpion sting?

A
  • 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
22
Q

How do you diagnose scorpion sting?

A

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

23
Q

treatment for scorpion stings

A

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

24
Q

How to treat most common bee sting local reactions

A
  • treat with a cold compress

- swelling erthema can last a few hour to a few days

25
Q

What happens with be stings about 10% of the time and how to treat

A

large local reaction LLR

  • exaggerated erythema and swelling
  • gradually enlarges over 1-2 days
  • resolves in 5-10 days
  • cold compress, prednisone, antihistimines, NSAIDs
26
Q

hymenoptera stings rarely cause secondary bacterial infection. what happens and how to treat?

A
  • worsening symptoms 3-5 days after sting
  • more likely with fire ants and yellow jackets
  • may cause fever
  • tx with antibiotics
27
Q

Widow bites cause what symptoms and how to manage those

A
  • 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)
28
Q

Recluse bites symptoms and management

A

-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

29
Q

What is vitiligo, its features, and treatments

A
  • 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
30
Q

Hidradenitis Suppurative (acne inversa) what is it and treatment

A
  • 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

Clin Med 1 (11 decks)

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