Pustular Skin Lesions Flashcards
Pustules
circumscribed collections of WBC and serous fluid. Papules and vesicles have clear fluid, pustules are serous fluid.
Acne rosacea
pustular eruptions on central face, neck and trunk. telangiectasia, erythema, papules, nodules, thickening of the soft tissue, and sebaceous prominence of the central face, Worse with stress, alcohol, spicy food and temperature extremes
Acne vulgaris
Common on face, trunk, extremities. Pustules or inflamed papules.
Perioral dermatitis
Small papules, vesicles, pustules with redness and scaling around the mouth nose and orbital region. Spares vermillion border. May burn.
Tinea barbae
Fungal infection of the beard with significant pustules. Scaling occurs with circular configuration. Tinea corporis is earlier stages before pustules are formed. Confirm with a potassium hydoxide test of a plucked hair. Get hx and check for that of a dermatophyte infection elsewhere in the body or exposure to an infected animal.
Acne keloidalis nuchae
Chronic scarring of the posterior neck, more common in dark skinned people. Follicular pustules and hypertrophic scars may result. Tx w abx, surgical incision or steroids.
Bacterial folliculitis and impetigo
Isolated pustules with a hair piercing the central aspect, men or women shaving can spread bacteria with a razor. Impetigo is more common on the face with honey crust, bullae, erythema, edema, and exudate.
Herpes simplex
grouped eruptions of pustules or vesicles on an erythematous base typically on lower vermillion of lip Can also be in genitals on with recurrent basis. prodrome before exacc, fever, sunburn, stress, wind.
Herpes zoster
May start as isolated pustules on the face with discomfort - pain, aching and burning. Grouped pustules on an erythematous base in dermatomal distribution
Chronic glucocorticoid use
Trunk and extremities. Asymptomatic pustular lesions on the face and trunk all in the same stage.
Pityrosporum folliculitis
Trunk and extremities, asymptomatic or itchy pustular lesions on the trunk, neck, face, upper arms in a patient with a hx of being in a very humid environment. Lesions are an overgrowth of normal yeast flora. If extensive may need antifungal – topic ketoconazole works well.
Keratosis pilaris
Trunk and extremities, Asymptomatic or pruritic caused by plugging of the follicle by keratin which has failed to exfoliate leading to a pustular eruption. Tx with chronic use of exfoliating moisturizers like lactic acid or urea containing creams, tretinoin gel. If itchy and inflamatory can use abx with topic creams.
Gram negative folliculitis
generalized pustular eruption, can cause severe pain and itching. Can occur on the face all of a sudden as a pusular flare of acne. Truncal involvement seen with young people using hot tubs w Pseudomonas.
Hidradenitis suppurativa
occurs in areas of hormonally influenced apocrine sweat glands: axillae, mammary, inguinal in those who are obese. Begins as pustule lesions can lead to follicle rupture causing deep and extensive scarring and sinus tract formation. Comedonal lesions are also present. Chronic, recurrent disease.
Millaria
accumulation of sweat beneath eccrine sweat ducts obstructed by keratin at the level of the stratum corneum. Different types. Dx based on clinical features. Tx is measures to reduce sweating, such as cool baths or compresses and loose clothing.
Milaria crystallina
small thin walled vesicles looking like dew drops with out any inflammation. “heat rash” “prickly heat”
Milaria rubra
obstructed sweat gland leaks into the dermis and causes a local inflammatory response resulting in small groups of papules and pustules. “prickly heat” “heat rash”
Scabies
isolated papules, vesicles and pustules, intense pruritic particullarly located interdigital web spaces, volar wrists, axillae, breats, umbilical, and groin areas. Family members are often symptomatic. Scraping may reveal mites, eggs or fecal materials.
Candida infection
beefy red areas with scaling in areas of moisture. Satellite pustules may occur beyond the erythematous plaques. KOH prep of the roof of the pustule will show the organism.
Dermatophyte infections
superficial fungal, such as tinea pedis or tinea corporis, typically with papules, plaques, and a peripheral scale. Pustules may be a key primary lesion when follicular units are involved particularly on the leg, scalp or forearms, Roof of the pustules has the hyphae.
Varicella
pustule in pts with fever or other systemic symptoms.
Vesicles and pustules in generalized form. Look for lesions that are in varying stages in febrile patients. Oral lesions can occur. Secondary staph infection may result in a pustular eruption of not only viral but bacterial origin.
Medications
meds may lead to truncal eruptions. Ask about a new med in the last two weeks. DIffuse pustular eruptions usually from bromides, iodides, isoniazid, lithium, and phenytoin. Abx can cause acute generalized exanthematous pustulosis AGEP rapid onset of wide spread pustular eruption 24 hours after the drug
Disseminated gonococcemia
lesions that begin as papules and vesicles, ultimately causing no more than 10 pustules that occur along a necrotic base. Rash, fever, migratory polyarthritis. Gram stain of the unroofed pustule shows the organism.
Secondary syphillus
Rash classically symmetric papular eruption involving the trunk and extremities including palms and soles. Red or red brown 0.5 to 2 cm in diameter. Often scaly but can be smooth and rarely pustular.
Pyoderma gangrenosum
inflammatory skin disease a/w underlying systemic disorders like IBD, arthritis and lymphatic disorders. Begins as an isolated pustule or as scattered red lesions on the trunk or extremities, surrounding edema and purple induration with a rapid progression into a large ulcer healing with cribriform scars. Dx made after infectious etiologies have been ruled out
