MTB Dermatology/emergency Flashcards
Imiquimod
Actinic keratoses
Molluscum Contagiosum
Chondylo Acuminatum
Kaposi sarcoma treatment
Antiretrovirals
Seborrhoeic keratoses, premalignant?
No
Atopic dermatitis is a common skin disorder associated with…
overactivity of mast cells and the immune system. Look for a history of:
• Asthma
• Allergic rhinitis
• Family history of atopic disorders
• Onset before age 5, very rare to start after age 30
Psoriasis treatment
- Topical high-potency steroids: fluocinonide, triamcinolone, betametha-sone, clobetasol
- Vitamin A and vitamin D ointment help get the patient off steroids. The vitamin D agent is calcipotriene. Steroids cause skin atrophy.
- Coal tar preparation
- Pimecrolimus and tacrolimus are used on more delicate areas such as the face and penis. They are an alternative to steroids and are less potentially deforming.
Extensive Disease
- Ultraviolet light
- Antitumor necrosis factor (TNF) inhibitors (etanercept, adalimumab, inflixirnab). These agents can be miraculous in efficacy for severe disease.
- Methotrexate: used last because of adverse effects on the liver and lung. It is a drug oflast resort except for psoriatic arthritis.
Eczema skin treatment
Moisturize
Avoid bath, soap, and washcloths
Cotton instead
Topical corticosteroids
Tacrolimus and pimecrolimus
Antihistamines:
Antibiotics if impetigo
Pityriasis rosea is…
an idiopathic, transient dermatitis that starts out with a single lesion (herald patch) and then disseminates. It can look like secondary syphilis but it spares the palms and soles. It is transient, but if symptomatic it is treated with steroids or ultraviolet light.
Bullous Pemphigoid
This is a much milder disease than pemphigus because:
• Bullae stay intact and there is less loss of fluid and infection. • Mouth involvement is uncommon.
Nikolsky sign absent
Prednisone
Pemphigus vulgaris (Blistering Diseases)
Autoimmune Associated with ACEi Autoantibodies split the epidermis, resulting in: • Bullae that easily rupture because they are thin walled • Involvement of the mouth • Fluid loss and infection if widespread; they act like a burn Nikolsky sign Biopsy to Dx Prednisone Azathioprine Rituximab
Impetigo causes
weeping, crusting, oozing, and draining of the skin.
Erysipelas is…
a much more severe disease than impetigo because it occurs at a deeper level in the skin. Erysipelas is much more often from Streptococcus than Staphylococcus.
Treatments for erysipelas, cellulitis, folliculitis, furuncles, and carbuncles.
Mild disease: Use oral medications:
• Penicillin, dicloxacillin, cephalexin, cefadroxyl
• Penicillin allergic: erythromycin, clarithromycin, or clindamycin
• MRSA: doxycycline, trimethoprim/sulfamethoxazole
Severe disease (fever present): Use intravenous medications:
• Oxacillin, nafcillin, cefazolin
• Penicillin allergic: clindamycin, vancomycin
• MRSA: vancomycin, linezolid, daptomycin, tigecycline, ceftaroline
Penicillin Allergy
If the reaction to penicillin is a rash, use cephalosporins.
If the reaction is anaphylaxis:
• Mild infection: macrolides, clindamycin, doxycycline, or TMP/SMZ
• Severe infection: vancomycin, or ceftaroline
Skin drug reactions
Morbilliform rash: mildest reaction. Skin stays intact without mucous mem-1 brane involvement. No specific therapy.
Erythema multiforme: widespread, small “target” lesions; most are on the trunk. No mucous membrane involvement. May also be from herpes or myco-plasma. Prednisone may benefit some patients.
Stevens-Johnson syndrome: very severe. Involves the mucous membranes. Sloughs off respiratory epithelium and may lead to respiratory failure. Steroids not clearly beneficial. Use intravenous immunoglobulins (IVIG).
Toxic epidermal necrolysis (TEN): rash with mucous membrane involvement and adds Nikolsky sign. Steroids definitely do not help. Treat with IVIG.
SSSS and TSS
Staphylococcal scalded skin syndrome (SSSS) and toxic shock syndrome (TSS) are different severities of the same event: a reaction to a toxin in the surface of Staphylococcus.
SSSS looks similar to TEN, including Nikolsky sign. TSS has the same skin involvement as well as life-threatening multiorgan involvement such as:
• Hypotension • Renal dysfunction (elevated BUN and creatinine) • Liver dysfunction • CNS involvement (delirium)
