Most prevalent skin diseases Flashcards
What cause shingles/herpes zoster (helvetesild)
VZV, human herpes virus type 3
Who is usually the group of pat getting shingles?
Older people >50 or immunocompromised
What are the sx of shingles?
- Lancinating, dysesthetic or other pain in involved site
- Followed in 2-3 days by rash, crops of vesicles on erythematous base
- Site usually one or more dermatome in thoracic/ lumbar region, unilateral
- Hyperesthetic severe pain
Tx of shingles
Oral Acyclovir 800mg x5 pr day in 7-10 days. Start tx whitin 72hrs after skin lesions in age >50, immunocompromised patient, or ophthalmic shingles
Other: wet cool compress and systemic analgesia
What are the complications of shingles
Post herpetic neuralgia
What is the cause of roseola?
HHV 6 & 7
Other names of roseola?
Exanthema subitum, sixth disease, den fjerde barnesykdommen, den sjette barnesykdommen, tredagersfeber/utslett, roseola infantum
Signs and symptoms of roseola
- Fever 39-40C, subsides after 3-5 days followed by rash
- Rash: pink flat spots/patches that start on the face/neck and spread to chest/back. Not itchy or uncomfortable. Last hrs to days
- Sometimes slightly sore throat, runny nose or cough, diarrhea
- Febrile seizure
Age of roseola
6m - 2y (3)
Tx of roseola
symptomatic
what cause hand foot mouth disease?
Coxsackie virus A16 (rarely enterovirus 71)
age og H,F,M
Infants and children < 5 yrs, sometimes adult
S&S of H,F,M
- Prodromal phase + fever 39-40C followed by rash after 1-2 days
- Rash: red spots, followed by blisters, hurts, sometimes itchy (esp in adults). Localized in back of the mouth, palms, soles
Erythema infectiosum other names
“slapped check disease”, fifth disease, femte barnesykdommen
Erythema infectiosum cause
Parvovirus B19
Ery.inf. age
Preschool and school age children
Ery. inf. S&S
- Mild fever and red checks
- Rash: arms, legs and trunk. Not usually on palms, soles. Itchy raised blotchy red areas and lacy patterns, particularly on areas of the arms not covered by clothing (worsen by sunlight)
tx of ery.inf.
Symptomatic. NB! if transmission from mother to fetus it may cause hydrous fetalis
erysipelas cause
beta hemolytic group A streptococci (pyogenes)
Group of patients who get erysipelas
Elderly, imm.def., DM, alcoholism, skin ulceration, fungal inf, impaired lymphatic drainage
How do erysipelas start?
Infection can enter skin through minor trauma, insect bite, eczema, athletes foot, surgical incision and ulcer
erysipelas S&S
- Fever, shaking, chills, fatigue
- Red swollen, warm and painful rash w sharply demarkated raised edge
Tx of erysipelas
Depending on severity. Oral or IV ABs. Penicillins, clindamycin or erythromycin
Impetigo contagiosa are caused by
(brennkopper) Staphylococcus aureus, rarely streptococci
S&S of impetigo
- Start as red sore near nose/mouth
- Soon breaks, leak pus/fluid, form honey colored scab
- Followed by a red mask which heals w/o scarring
Tx of impetigo
Topical antiseptic and topical ABs, mupirocin (fucidin), in severe case treat w oral ABs.
Boils and furuncle are caused by
Staphylococcus aureus
Increased risk of boils
DM, obesity, lymphoproliferative neoplasm, malnutrition and using immuno suppressive drugs
Boils S&S
- Red bumby, pusfilled lumps around hair follicle
- Tender, warm, very painful. Yellow or white point at the center when ready to drain
Boils Tx
- Drainage
- ABs against MRSA for pat w imm.comp., or at risk for endocarditis, or if lesion are > 5mm, or expanding
Tinea versicolor cause
Malassezia globasa or furfur
Who get tinea versicolor?
Adolescents and young adults in summer, more obvious w tan
S&S of tinea versicolor
Multiple tan brown, salmon, pink or white scaling patches on the trunk, neck, abdomen and sometimes face
Tx of tinea versicolor
Antifungals: selenium sulfide or ketoconazole. Indicated for pat w extensive Dx: oral fluconazole or ketoconazole
Oral trush are caused by
Candida sp. They normally live on the skin and mucus w/o causing infection
Who get oral trush?
Most frequently among babies <1 m, elderly and groups of people w weak immune systems (HIV/ AIDS), cancer tx, DM, corticosteroids, ABs
Sx of oral trush
White coating on a tongue and white patches in mouth
Tx of oral trush
Topical miconazol gel or nystation suspension
Scabies cause
Female mite Sarcoptes scabiei
How does scabies spread?
Skin to skin contact, sharing clothes, towels, bedding
Who is at risk for scabies?
Nursing home, child care, extended care facilities, prisons
Scabies S&S
- Itching!! worse by warmth and at night
- Trails are linear/ s- shaped accompanied by rows of small, pimple-like mosquito/ insect bite
- Superficial burrows on finger webs, wrist, elbows, back, buttocks, external genitals
Scabies mx
- Permethrin topical from neck down before bed
- Oral ivermectin
- Others: lindane, benzyl benzoate, crotamitron, malathion, sulfur preparation
- Itchiness: antihistamines and antiinflammatory
- Bedding/ clothing/ towels: washed on 60C and dryer in hot dryer
Urticaria/ hives are caused by
Allergic reaction, or non-allergic cause.
Def of acute utricaria
Less than 6 w
Chronic urticaria
> 6 w
S&S of urticaria
Wheales, raised areas surrounded by red base
Tx of urticaria
- Identify trigger
- 2nd gen. H1 antihistamines: loratidine, cetrizine, desloratidine
- Systemic steroids: prednisolone PO, dexamethasone IM
Melanocytic nevus
- Type of lesion that contains nevus cells
- May be congenital, aqcuired, benign and malignant
How to differentiate melanocytic nevus w melanoma
A symmetry
B order (irregular)
C olour (dark, variable)
D iameter >0,6 cm
E volution, any change in color, size or shape
Look at the lesion in dermascope and remove if uncertain
What is the most dangerous type of skin cancer?
Melanoma
Who is at risk for melanoma?
M oles - >3 dysplastic melanocytic nevi M oles - many acquired melanocytic nevi R ed hair or freckles I nability to tan, skin type 1-2 S un burn history, one or more severe blistering K indered, family history of melanoma
Basal cell cancer
Most common skin cancer. Rarely metastasizes or kills. May cause significant destruction and disfigurement by invading tissues. Elderly over 50 y
What is the common wart (verruca vulgaris)?
Raised w roughened surface, most common on hands, but can grow anywhere
Flat wart (verruca plana)
Small, smooth flattened, flesh color, most common on face, neck , hands, wrist, knees
What virus is involved in warts?
Human papilloma virus
Plantar wart ( verruca plantaris)
Hard, painful lump w multiple black specks in the center. Commonly on the hands and soles of the feet.
Mosaic wart
Group of tightly clustered plantar type wart, commonly on the hands and soles of the feet
Filiform or digitate wart
Thread/ fingerlike, most common on face, esp near eyelids and lips
Genital wart (condyloma/verruca acuminata)
Wart on the genitalia
Periungual wart
Cauliflower like cluster of wart occurring around the nails
What are the Tx of wart
- Meds: 1) Salicylic acid 2) Imiquimod 3) Catharidin 4) Meloidae 5) Bleomycin 6) Dinitrochorobenzene 7) Cidofovir
- Procedures: 1) Electrodisection 2) Cryosurgery 3) Laser tx 4) Surgical curretage 5) Intrared coagulator
Cause of water wart
Molluscum contagiosum virus (MCV), a DNA poxvirus
Who get molluscum?
Children 1-11y and sexually active young adult
How does molluscum spread?
From person to person by touching affected skin
S&S of molluscum
- Flesh colored and pearly
- 1-5mm in diameter w dimpled center
- Generally not painful, but may itch or be irritated
- Picking scratching lead to further infection and scarring.
Management og molluscum
- Self-limiting, usually resolve in 6-18m
- Daily application of tretinoin, a combo of oils and iodine, potassium hydroxide, cryosurgery and laser
What are symptoms of acne vulgaris
- Open blackheads and closed comedones (white)
- Non-inflammatory-> inflammatory papules and pustules-> nodules (painful bump), severe nodular acne -> scars
Tx of acne
- Non infl: topical retinoids
- Mild/mod infl: topical ABs or retinoid + benzoyl peroxide cream
- Severe infl: oral ABs + topical retinoid / azelaic acid
- Severe nodular acne: isotretinoin orally
Atopic dermatitis are most common in ..
Children! In 50% it start before age of 1
S&S of atopic dermatitis
Dry, scaly skin, span entire body, intensely itchy red, splotchy, raised lesions, weep, crack, swell and crust. Increased risk for bacterial and fungal or viral inf.
Hanifin and Rajka criteria for atopic dermatitis major criteria (6)
- Major criteria (need 3 or more):
1. Pruritus 2. Typical morphology and distribution 3. Flexural lichenification in adults 4. Facial and extensor involvement in infants and children 5. Dermatitis - Chronically or chronically relapsing 6. Personal or family history of atopy (asthma, allergic rhinitis, atopic dermatitis)
Hanifin and Rajka criteria for atopic dermatitis minor criteria (22)
- Minor criteria (need 3 or more): 1) Cataracts
2) Cheilitis 3) Conjunctivitis, recurrent 4) Eczema , perifollicular accentuation 5) Facial pallor or erythema 6) Food intolerance 7) Hand dermatitis , nonallergic 8) Ichthyosis
9) IgE elevated 10) Immediate (type I) skin test reactivity 11) Infections (cutaneous) 12) Dennie-Morgan infraorbital fold 13) Itching when sweating 14) Keratoconus 15) Keratosis pilaris 16) Nipple dermatitis 17) Orbital darkening 18) Palmar hyperlinearity 19) Pityriasis alba 20) White dermographism 21) Wool intolerance 22) Xerosis
Tx of atopic dermatitis
- Avoid trigger
- Daily moisturizers x 3-4, emollients
- Topical corticosteroids, esp hydrocortisone
- If fail: short term topical calcineurine inhibitor (tacrolimus/ pimecrolimus) alternative systemic imm. supp (cyclosporine, methotrexate, Interferon gamma 1b, mycophenolate mofetil, azathioprine)
- Bacterial superinfection: topical ABs
- Antihistamines to control pruritus
Contact dermatitis cause
Exposure to allergens or irritants.
S&S of contact dermatitis
Confined to area exposed to trigger (or widespread). Red rash immediately after exposure. Blisters or wheals. Itchy burning skin.
Tx of contact dermatitis
- Avoid trigger
- Topical/systemic corticosteroids
- Antihistamines 1st gen.
- Oral ABs if superinfection
Types of psoriasis
- Plaque (most common)
- Scalp
- Guttate
- Inverse (skin folds)
- Palmar-plantar
- Erythrodermic
- Pustular
- Nail (pits, onycholysis, onychauxis/thickening)
- Psoriatric arthritis
Pityriasis rosea
Common acute eruption usually affecting children and young adults. Cause is unknown. Characterized by herald patch followed by diffuse papulosuamous rash.
