Lecture 18: Skin Changes in SBL (Exam 2) Flashcards
What 6 organisms cause Maculopapular Rash? (MEILER)
Measles, Erythema infectiosum, Infectious Mono, Lyme Disease, Ehrlichiosis, Rubella
When does a measles rash appear? What does it look like and what direction does it spread?
- prodrome occurs 7-18 days after infection, with rash appearing 3-4 days after
- brick red and irregular; begins on face and moves “DOWN AND OUT” (palms and soles LAST)
What is the prodrome of Measles? (FCCC)
What finding is pathognomonic and what does illness confer?
P: Fever, cough, coryza, conjunctivitis
Koplik spots on cheek mucosa are PATH
- illness confers permanent immunity
What does the rash caused by Erythema Infectiosum look like? Where does it typically occur?
- “slapped cheek” appearance
- lacy, maculopapular fading rash on TRUNK and LIMBs (pruritis on PALMS and SOLES)
What is Parovirus a common cause of and what does it mimic in middle-aged patients, especially women?
CC of MYOCARDITIS
- mimics SLE and RA (limited symmetric polyarthritis) as well as other autoimmune states
- also mimics urticaria and eczema
What Parovirus symptom is uncommon in children and which is one is uncommon in adults?
Children: usually NO arthralgias
Adult: usually NO rashes. especially facial
What is Erlichiosis and when does its rash occur? What is a common symptom found in children infected with it?
rickettsial infection with erythematous macules/papules approximately 5 days after systemic symptoms
- children experience ABDOMINAL PAIN mimicking APPENDICITIS
What kind of neurologic problems occur due to Ehrlichiosis? (ME/D)
meningoencephalitis, altered mental state, motor nerve paralysis, sudden deafness
What kind of rash is caused by Lyme Disease?
Erythema Migrans (flat/slightly raised red lesion with central clearing)
- also headache/stiff neck, arthralgias (chronic)
Lymes Disease Staging:
Stage 1
Stage 2
Stage 3
S1: early localized erythema migrans (flat/slight raise)
- 1 wk after bite (groin, thigh, axilla)
- “bulls-eye” lesion
S2: early disseminated infections (wks-mths)
- bacteremia and 2nd skin lesions (smaller than first)
S3: late persistent infection (mths-yrs)
- MSK (polyarthralgia) and neuro problems
- Acrodermatitis Chronicum Atrophicans
- bluish-red discoloration of distal extremity
What disease can Lyme’s Disease be mistaken for?
SHINGLES
- Lyme does NOT follow dermatomal distribution
What is Infectious Mononucleosis a common manifestation of and how is it transmitted?
CM of Epstein Barr Virus (occurs at any age)
- infects 95% of adult population via saliva (or genital secretions)
Infectious Mononucleosis
What test is positive for EBV, what does a peripheral blood smear show, and what are 3 physical findings it can present with? (L/H/S)
(+) - Monospot Test (heterophile agglutination test)
PBS: atypical large lymphocytes (lymphocytosis)
PF: LAD, Hoagland Sign (upper lip edema), Splenomegaly
What are 4 possible complications of Infectious Mononucleosis infection? (HMHT)
hepatitis, myocarditis, hemolytic anemia, thrombocytopenia
What kind of Skin problems does Meningococcemia, Secondary Syphilis, and HFM Disease present as?
PERIPHERAL SKIN ERUPTIONS
What is Syphilis and how is it spread?
- caused by Treponema pallidum (spirochete) transmitted by sexual contact
- can infect almost any organ or tissue in the body
What is the difference between Early and Late Syphilis?
E: chancre and regional LAD, secondary lesions
L: gummatous lesions (skin, bones, viscera), CNS/ocular syndromes, and AORTITIS
What is a pretty classical cardiovascular complication of Late Syphilis?
AORTITIS
How does Secondary Syphilis rash usually present and where? (2)
- diffuse macular/papular/pustular combinations on PALMS and SOLES
- also Condylomata lata on genitals
What are 3 common clinical findings of Hand-Foot-Mouth Disease? How does Herpangina rash differ from HFM?
- stomatitis, vesicular (hand/feet) rash, nail dystrophies
Herpangina: petechiae/papules on soft palate that ulcerate in about 3 days and heal
What is the hallmark of Hand-Foot-Mouth Disease and what does its rash look like?
What 3 locations does the enanthem occur at? (HOT)
HM: vesicular eruption on PALMS and SOLES (bright pink macules/papules –> small vesicles w/erythema)
- erode –> yellow/gray “football” shaped erosion
- erythematous halo present
Enathem: oral erosion of tongue, hard palate, oropharynx
What Hand-Foot-Mouth Disease manifestations occur in both subtypes and ONLY subtype B?
Both: ASEPTIC MENINGITIS (usually kids)
Subtype B: Acute Pericarditis
What 3 diseases cause Desquamative Skin Changes? (TSE)
Toxic Shock Syndrome, Scarlet Fever, Erythema multiforme
What is Toxic Shock Syndrome characterized by and what does it rash look like?
- abrupt fever, vomiting, watery diarrhea –> staph related
- diffuse macular erythematous rash and conjunctivitis with desquamation occurring in recovery (PALMS and SOLES)
looks like MASSIVE SUNBURN = RED FACE AND EYES
What is Scarlet Fever caused by and what are 3 findings of its syndrome?
- caused by Group A Strep (pyrogenes)
- exudative pharyngitis, fever, scarlatiniform rash
What is Streptococcus pyrogenes the most common cause of in children and adolescents?
TONSILLOPHARYNGITIS
What does Scarlet Fever rash look like, what is a common condition it causes, and what test is it positive for?
- generalized on neck, axilla, groin, skin folds and desquamation on HANDS and FEET
- causes STRAWBERRY TONGUE
- anti-streptolysin O (ASO) titer rise
Where do Erythema Multiforme rashes occur at and what are the two most common causes?
- target lesions on face and extremities
- caused by Herpes Simplex Virus (HSV) and Mycoplasma pneumoniae
prodromal symptoms are absent in most cases but look at preceding 3 wks for HSV symptoms and respiratory infection/flu-like illness
What causes Vesicular and Bullous lesions? (VP)
varicella and pemphigus
What does the Varicella rash look like and how does it spread?
occurs in childhood
- begins on face/scalp and spreads to trunk but SPARES EXTREMITIES (SCATTERED LESIONS)
What are 3 common findings of Varicella rash?
- scattered lesions
- progress from rose-colored macules –> papules/vesicles/pustules/crusts
- lesions in ALL STAGES are present AT THE SAME TIME
What is Pemphigus and what does it look like?
- autoimmune blistering disease of skin/mucous that is exacerbated by UV radiation
- pruritic/painful that typically SPARES the PALMS and SOLES
- most common lesions are erosions from broken blisters that can spread at their periphery
What are 3 common causes of Petechial and Purpuric lesions? (GMT)
gonococcemia, menigococcemia, thrombotic thrombocytopenic purpura
What is Gonococcemia and what is the classical triad seen in disseminated infection? (D/MP/T)
- bacterial Neisseria gonorrhea (Gram -) aerobic cocci-shaped bacterium found in pairs
- STD from oral/anal/vaginal intercourse; can be trans. vertically to child (ophthalamia neonatorum)
TRIAD: dermatitis, migratory polyarthritis, tenosynovitis
What do Gonococcemia rashes look like? Where do they typically occur?
- small-medium macules or hemorrhagic vesicopustules on erythematous base on PALMS and SOLES
- can develop necrotic centers with “gun metal gray” lesions
- disappear after appropriate treatment
What is Meningococcemia and what do acute vs chronic rashes look like?
- Neisseria meningitidis that appears as meningitis, acute meningococcemia w or w/o meningitidis, or chronic meningococcemia
acute: petechial rash on extremities that can cause necrosis of skin/tissue in SEVERE cases
chronic: rose-colored macules/papules (wax and wane w/periodic fever)
What does Acute Meningococcemia with DIC produce?
PURPURA FULMINANS
- has a lacy look to it
What is the pentad of TTP? (MAHA/T/N/F/R)
microangiopathic autoimmune hemolytic anemia
thrombocytopenia, neuro problems, fever, renal failure
What is TTP caused by, when is it usually seen, and who is it seen in?
- severe ADAMSTS13 deficiency usually requiring additional inflammatory trigger to initiate
- median age: 40 yo with 9x higher incidence among blacks
What should you think of if purpura is palpable vs non-palapable?
Palpable - Vasculitis and Infection
Non-Palpable - Autoimmune
Basal Cell Carcinoma
- most common form of cutaneous cancer
- waxy, pearly appearance (diagnostic) with telangiectatic vessels or shiny, scaly reddish plaques (back/chest/legs)
- usually see umbilicated, bleeding lesions
Squamous Cell Carcinoma
- nonhealing ulcer or warty nodule (small, red, conical, hard nodules) –> KERATINIZED LESION appearing crusty
- can arise from actinic keratosis
What are common risk factors of Melanoma? (Lifestyle, physical, genetics)
- sun exposure history
- blue/green eyes, blonde/red hair, fair complexion
- prior history of melanoma, p16 mutation, > 100 typical nevi
Where does melanoma typically occur in men and women?
Men: back
Women: lower legs, then trunk
can occur anywhere on skin surface
What carries the greatest sensitivity and specificity for predicting metastatic potential of a melanoma lesion?
What diameter is usually concerning when using ABCDE screening for melanoma?
COLOR
diameter > 5 (6) mm is usually concerning
What is a Shave Biopsy?
- most common biopsy technique with good cosmetic result and occurs at depth of MID-DERMIS
- use a Dermablade Scalpel to get whole lesion
What is a Punch Biopsy?
- used for FULL THICKNESS skin sample
- rapidly heals but has limited diameter (may not be adequate for SubQ tissue)
What is an Excisional Biopsy?
- requires sterile technique; margins can be controlled/adjusted as needed
- can get down to SUBQ TISSUE
- limits: inc. produce time, longer healing time, greater scarring, SUTURES
