Pruritic Disorders

Question 1

Scabies

general overview

Answer 1

highly contagious skin infection due to the mite Sarcoptes scabei

Question 2

Scabies

pathophys

Answer 2

• female bites burrow into the skin to lay eggs, feed, and defecate
• these particles precipitate a hypersensitivity rxn

Question 3

Scabies

clinical manifestations

3 components

Answer 3

1. multiple, small, evidence papules w/ excoriations, linear burrows (hallmark)
2. red, itchy happy wheels or nodules on the scrotum, genitalia, or body folds (pathognomonic)
3. intense pruritis, esp at night

Question 4

Scabies

dx

2

Answer 4

• clinical
• mineral oil prep

Question 5

Scabies

tx

1

Answer 5

• topical permethrin x2 applications, 1 wk apart

Question 6

Scabies

when do you give oral permethrin?

Answer 6

can give to non-pregnant adults

Question 7

Scabies

general measures

2 components

Answer 7

1. treat all close contacts
2. all clothing, bedding, etc isolated for 72 hrs, then washed & dried w/ high heat

Question 8

Scabies

second line tx

Answer 8

lindane (cheaper, but NO PREG PTS or KIDS)

Question 9

Pediculosis

how is it transmitted P2P?

3

Answer 9

1. direct contact
2. fomite exposure
3. sexual transmission

Question 10

Pediculosis

strongly related to?

Answer 10

poor hygiene practices

Question 11

Pediculosis

who is head lice more common in?

2 components

Answer 11

1. girls > boys
2. kids 3-12 y/o

Question 12

Pediculosis

clinical manifestations

2

Answer 12

• primary: pruritis
• may see lice or nits

Question 13

Pediculosis

describe eggs

3

Answer 13

• white
• oval shaped
• at base of hair shafts

Question 14

Pediculosis

tx of head lice

2

Answer 14

• topical permethrin x2, 1 wk apart
• fine tooth comb to remove eggs

Question 15

Pediculosis

tx of body lice

2

Answer 15

• education on hygiene practices
• topical permethrin 5% cream

Question 16

Pediculosis

tx of pubic lice

3 components

Answer 16

• topical permethrin 1% cream
• pyrethrins
• 10d course

Question 17

Pediculosis

general measures for tx

3

Answer 17

1. hygiene improvement
2. launder items in hot water & dry in high heat
3. items that cannot be washed should be quarantined for 2 wks

Question 18

Lichen Planus

most commonly seen in who?

Answer 18

middle aged adults

Question 19

Lichen Planus

increased incidence with what infection?

Answer 19

Hep C

Question 20

Lichen Planus

associated with what?

3

Answer 20

1. medication induced
2. associated with graft vs host
3. lymphoma

Question 21

Lichen Planus

what are the 6 P’s of clinical manifestation?

Answer 21

1. purple
2. polygonal
3. plana
4. pruritic
5. papules
6. plaques

Question 22

Lichen Planus

clinical presentation

2

Answer 22

1. borders may have wickham’s striae
2. Koebner’s phenomenon

Question 23

Lichen Planus

Wickham’s Striae

Answer 23

fine, gray white lines of skin and/or oral mucosa

Question 24

Lichen Planus

Koebner’s phenomenon

Answer 24

new lesions in previously unimpacted areas

Question 25

# Lichen Planus dx

Answer 25

clinical

Question 26

# Lichen Planus tx | 2

Answer 26

* high or super high potency topical corticosteroids * oral anti-histamines | intralesional corticosteroids

Question 27

# Lichen Planus tx for generalized or refractory disease? | 1

Answer 27

oral glucocorticoids

Question 28

# Lichen Planus what occurs after 6-12mo in most patients?

Answer 28

spontaneous resolutions

Question 29

# Lichen Simplex Chronicus what is skin thickening secondary to?

Answer 29

repetitive rubbing and scratching

Question 30

# Lichen Simplex Chronicus clinical manifestations | 1

Answer 30

1. scaly, well-demarcated, rough, hyperkeratotic plaques w/ exaggerated skin lines

Question 31

# Lichen Simplex Chronicus tx | 1 general measures, 2 meds

Answer 31

1. avoid scratching lesions 2. high potency topical corticosteroids, antihistamines

Question 32

# Neurodermatitis clinical presentation | 2 components

Answer 32

1. diffuse excoriations 2. lichenified skin as secondary finding

Question 33

# Neurodermatitis what are diffuse excoriations secondary to? | 2

Answer 33

* chronic itch * repetitive rubbing, scratching, or picking at skin

Question 34

# Neurodermatitis associated with? | 1

Answer 34

mood disorders

Question 35

# Neurodermatitis tx | 3

Answer 35

1. anti-histamines 2. topical corticosteroids 3. wound care

Question 36

# Neurodermatitis general care tx | 2

Answer 36

1. avoidance of scratching 2. management of mood disorder