Most prevalent skin diseases Flashcards
1
Q
What cause shingles/herpes zoster (helvetesild)
A
VZV, human herpes virus type 3
2
Q
Who is usually the group of pat getting shingles?
A
Older people >50 or immunocompromised
3
Q
What are the sx of shingles?
A
- 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
4
Q
Tx of shingles
A
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
5
Q
What are the complications of shingles
A
Post herpetic neuralgia
6
Q
What is the cause of roseola?
A
HHV 6 & 7
7
Q
Other names of roseola?
A
Exanthema subitum, sixth disease, den fjerde barnesykdommen, den sjette barnesykdommen, tredagersfeber/utslett, roseola infantum
8
Q
Signs and symptoms of roseola
A
- 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
9
Q
Age of roseola
A
6m - 2y (3)
10
Q
Tx of roseola
A
symptomatic
11
Q
what cause hand foot mouth disease?
A
Coxsackie virus A16 (rarely enterovirus 71)
12
Q
age og H,F,M
A
Infants and children < 5 yrs, sometimes adult
13
Q
S&S of H,F,M
A
- 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
14
Q
Erythema infectiosum other names
A
“slapped check disease”, fifth disease, femte barnesykdommen
15
Q
Erythema infectiosum cause
A
Parvovirus B19
16
Q
Ery.inf. age
A
Preschool and school age children
17
Q
Ery. inf. S&S
A
- 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)
18
Q
tx of ery.inf.
A
Symptomatic. NB! if transmission from mother to fetus it may cause hydrous fetalis
19
Q
erysipelas cause
A
beta hemolytic group A streptococci (pyogenes)
20
Q
Group of patients who get erysipelas
A
Elderly, imm.def., DM, alcoholism, skin ulceration, fungal inf, impaired lymphatic drainage
21
Q
How do erysipelas start?
A
Infection can enter skin through minor trauma, insect bite, eczema, athletes foot, surgical incision and ulcer
22
Q
erysipelas S&S
A
- Fever, shaking, chills, fatigue
- Red swollen, warm and painful rash w sharply demarkated raised edge
23
Q
Tx of erysipelas
A
Depending on severity. Oral or IV ABs. Penicillins, clindamycin or erythromycin
24
Q
Impetigo contagiosa are caused by
A
(brennkopper) Staphylococcus aureus, rarely streptococci
25
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
26
Tx of impetigo
Topical antiseptic and topical ABs, mupirocin (fucidin), in severe case treat w oral ABs.
27
Boils and furuncle are caused by
Staphylococcus aureus
28
Increased risk of boils
DM, obesity, lymphoproliferative neoplasm, malnutrition and using immuno suppressive drugs
29
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
30
Boils Tx
- Drainage
| - ABs against MRSA for pat w imm.comp., or at risk for endocarditis, or if lesion are > 5mm, or expanding
31
Tinea versicolor cause
Malassezia globasa or furfur
32
Who get tinea versicolor?
Adolescents and young adults in summer, more obvious w tan
33
S&S of tinea versicolor
Multiple tan brown, salmon, pink or white scaling patches on the trunk, neck, abdomen and sometimes face
34
Tx of tinea versicolor
Antifungals: selenium sulfide or ketoconazole. Indicated for pat w extensive Dx: oral fluconazole or ketoconazole
35
Oral trush are caused by
Candida sp. They normally live on the skin and mucus w/o causing infection
36
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
37
Sx of oral trush
White coating on a tongue and white patches in mouth
38
Tx of oral trush
Topical miconazol gel or nystation suspension
39
Scabies cause
Female mite Sarcoptes scabiei
40
How does scabies spread?
Skin to skin contact, sharing clothes, towels, bedding
41
Who is at risk for scabies?
Nursing home, child care, extended care facilities, prisons
42
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
43
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
44
Urticaria/ hives are caused by
Allergic reaction, or non-allergic cause.
45
Def of acute utricaria
Less than 6 w
46
Chronic urticaria
>6 w
47
S&S of urticaria
Wheales, raised areas surrounded by red base
48
Tx of urticaria
- Identify trigger
- 2nd gen. H1 antihistamines: loratidine, cetrizine, desloratidine
- Systemic steroids: prednisolone PO, dexamethasone IM
49
Melanocytic nevus
- Type of lesion that contains nevus cells
| - May be congenital, aqcuired, benign and malignant
50
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
51
What is the most dangerous type of skin cancer?
Melanoma
52
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
```
53
Basal cell cancer
Most common skin cancer. Rarely metastasizes or kills. May cause significant destruction and disfigurement by invading tissues. Elderly over 50 y
54
What is the common wart (verruca vulgaris)?
Raised w roughened surface, most common on hands, but can grow anywhere
55
Flat wart (verruca plana)
Small, smooth flattened, flesh color, most common on face, neck , hands, wrist, knees
56
What virus is involved in warts?
Human papilloma virus
57
Plantar wart ( verruca plantaris)
Hard, painful lump w multiple black specks in the center. Commonly on the hands and soles of the feet.
58
Mosaic wart
Group of tightly clustered plantar type wart, commonly on the hands and soles of the feet
59
Filiform or digitate wart
Thread/ fingerlike, most common on face, esp near eyelids and lips
60
Genital wart (condyloma/verruca acuminata)
Wart on the genitalia
61
Periungual wart
Cauliflower like cluster of wart occurring around the nails
62
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
63
Cause of water wart
Molluscum contagiosum virus (MCV), a DNA poxvirus
64
Who get molluscum?
Children 1-11y and sexually active young adult
65
How does molluscum spread?
From person to person by touching affected skin
66
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.
67
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
68
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
69
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
70
Atopic dermatitis are most common in ..
Children! In 50% it start before age of 1
71
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.
72
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)
73
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
74
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
75
Contact dermatitis cause
Exposure to allergens or irritants.
76
S&S of contact dermatitis
Confined to area exposed to trigger (or widespread). Red rash immediately after exposure. Blisters or wheals. Itchy burning skin.
77
Tx of contact dermatitis
1. Avoid trigger
2. Topical/systemic corticosteroids
3. Antihistamines 1st gen.
4. Oral ABs if superinfection
78
Types of psoriasis
- Plaque (most common)
- Scalp
- Guttate
- Inverse (skin folds)
- Palmar-plantar
- Erythrodermic
- Pustular
- Nail (pits, onycholysis, onychauxis/thickening)
- Psoriatric arthritis
79
Pityriasis rosea
Common acute eruption usually affecting children and young adults. Cause is unknown. Characterized by herald patch followed by diffuse papulosuamous rash.
