Quick Derm Review Flashcards
vesicles form large bullae (rapidly)–> rupture–> thin “varnish-like crusts”
-fever diarrhea
Bullous impetigo
*S. auersus MC
TX:
- Mupirocin (Bactroban) topically drug of choice TID x10 days
- Extensive disease or systemic symptoms (ex. fever) systemic abx – cephalexin
Describe the different types of hypersensitivity reactions (cutaneous drug reactions)
1- IgE mediated, ex. urticarea and angio edema
2- Cytotoxic, Ab-mediated
3- immune antibody-antigen complex ex. drug-mediated vasculitis and serum sickness
4- delayed (cell mediated) morbiliform reaction ex. erythema Multiforme
5- nonimmunologic- due to genetic incapability to detoxify certain meds
mild fever, URI sx, decreased appetite starting 3-5 days after exposure
-Oral enanthem: vesicular lesion w/ erythematous halos in oral cavity (esp. buccal mucosa and tonge)–> exanthem 1-2 days afterwards- vesicular, macular or maculopapular lesion on the distal extremities on palms and soles
Hand foot and mouth (Coxsackie A)
Tx: supportive, encourage hydration
Cafe au lait macules are commonly associated with what other disease?
neurofibromastosis type 1
*if child has 6 or more cafe au lait macule (esp. w/ axillary or inguinal freckling) they should be evaluated for neurofibromastosis type 1
What type of burn?
- Extends through entire skin
- Waxy, white, leathery, dry
- PAINLESS
- Absent cap. refill
Full thickness (3rd degree)
*months to heal
Red, elevated thickened nodule with adherent white scaly or crusted, bloody margins
-hyperkeratosis and ulceration
Squamous cell carcinoma of the skin
dx: biopsy: atypical keratinocyte and malignat cells with large, pleomorphic, hypercchrommatic nuclei in epidermis
tx: wide local surgical excision*
Describe the rule of nine for burns
Head and neck- 9% (4.5 front and 4.5 back)
Upper limbs- 9% each (4.5 front and 4.5 back)
Trunk- 36% (9 chest, 9 upper back, 9 abdomen, 9 lower back)
Genitalia- 1%
Palms- 1%
Legs 18% each (9 front, 9 back)
Single or multiple dome-shaped, flesh-colored to pearly white WAXY papules with central umbilication.
-curd like material may be expressed from the center if lesion is squeezed
Molluscum Contagiosum
- benign viral condition (poxviridae family/ pox virus)
- highly contagious
TX: self-limited- resolves in 3-6 months
-Curettage
1-2 mm pearly white-yellow* papules esp. seen on cheecks, forehead, chin and nose in a newborn
Milia
TX: none- usually disappears by 1st month of line but may be seen up to 3 months
Diffusely red rash on the groin or on the scrotum.
Tinea cruris (jock itch)
TX: Topical antifungal*, PO Griseofulvin if ineffective
How do you dx Rubella (German measles)
Clinical
Rubella-specific IgM Ab via enzyme immunoassy
pink lesions that develop into Irregular discrete macule and papules of total depigmentation
- milky white patches
- commonly involves DORSUM OF HANDS, axilla, FACE, fingers, body folds and genitalia
Vitiligo
*autoimmune destruction of melanocytes–> skin depigmentation
DX workup: TSH (associated w/ autoimmune disorders like Hashimotots or Grave’s)
TX:
Localized: topical corticosteroids. Calcineurin inhibitors great for facial involvement
-Disseminated: systemic phototherapy (narrow band UVB)
PUVB****
- Comedones: small, noninflammatory bumps from clogged pores (open comedones=black heads= incomplete blockage, closed comedone= whitehead= complete blockage
- papules or pustules surrounded by erythema
- nodular or cysic
Acne vulargis
mild= comedones
moderate= comedones, larger amounts of papules and/or pustules
severe= nodular
TX:
Mild- topical retinoids***, benzoyl peroxide, topical Abx (clindamycin), OCPs (decrease androgen)
Moderate- as above + oral Abx (doxy or minocyline) +/- anti androgen agent (spironolactone)
Severe- Isotretinoins (severely teratogenic)
streaking from the infected area of cellulitis following the lymph vessels
Lymphangitis
Complications/clinical manifestations of high voltage electric injuries
- cardiac arrest: low voltage- Vfib, high voltage- asystole
- Rhabdomyolysis (urinalysis is performed to look for myoglobinuria)
- neurological
numerous, small, discrete, flesh-colored papules measuring 1-5mm in diameter and 1-2mm in height
- MC on hands
- often form linear patterns bc scratchin or shaving spreads the virus
verruca plana (aka flat warts) ***Human papilloma virus
TX: most warts resolve spontaneously w/in 2 yrs
- topical OTC salicylic acid and plasters
- cryotherapy, electrocautery
- Gardasil vx
How do you dx Pityriasis (Tinea) veriscolor
- KOH prep from skin scraping: hyphae and spores “spaghetti and meatball” appearance
- Wood’s lamp: yellow-green fluorescence
-Blanched circular patch with surrounding red perimeter and central punctum (target lesion) associated w/ piloerection* and sweating
Latrodectism: local sx: asymptomatic or pain at site of inoculation with the onset of generalized sx w/in 30 min -2hrs–> systemic sx: muscle pain*, spasms, and rigidity
Black Widow Spider Bites
TX: Mild: wound care, pain control
mod-severe: opioids +/- muscle relaxants (benzo and methocarbamol)
*antivenom reserved for patients not responsive to above meds
Congenital disorder associated with class triad:
- Facial port wine stain (esp. along trigeminal distribution and around eyelids)
- leptomeningeal angiomatosis
- Ocular involvment (ex. glaucoma)
Sturge-Weber syndrome
*may develop hemiparesis contralateral to the facial lesion, seizures or intracranial calcifications and learning disabiliites
Target (iris) lesion classic: dull, dusty-violet red purpuric macules/vesicles or bullae in the center surrounded by pale edematous rim and a peripheral red halo
-often afebrile
+/0 mucosal membrane lesions
Erythema multiforme (type 4 HSN rxn)
EM minor: no mucosal membrane lesions
EM major: 1 or more mucosal membrane lesions, *no epiderlam detachment
Tx: self-limiting, supportive, dc med
PROPHYLAXTIC tx: Acyclovir (MC due to HSV)
- Central blue color of impending necrosis w/ surrounding white area of vasospasm/vasoconstriction and peripheral RED HALO of inflammation
- 24-72 hr after hemorrhagic bullae that undergoes eschar formation
Brown Recluse Spider Bite (MC in SW and Mid-West)
TX: Local wound care: clean w/ soap and water, apply cold packs, keep area elevated or neutral position
- Pain control: NSAIDS
- Tetanus prophylaxis
- Debridement if necrosis develops
When is Rubella most teratogenic in pregnancy and what are the possible consequences?
1st trimester (TORCH infection)
- Sensorineural deafness*
- Cataracts
- TTP (“blueberry muffin rash”)
- mental retardation
- heart defects
What type of burn? -Epidermis -Erythemaous and dry -Painful , tender to touch \+ refill intact, blanches w/ pressure
Superficial 1st degree
- heals w/in 7 days
- no scarring
Inflammatory, erythematous blue-red papules or pustules–> PAINFUL,HEMORRHAGIC, necrotic ulcer with irregular purple/violet undermined borders and a purulent base
**Associated w/ inflammatory diseases: IBD, Crohn, UC, RA, spondyloarthropathies
Pyoderma gangrenosum
TX: Topical corticosteroids (HD) or tacrolimus. local wound care
- 2nd line- systemic corticosteroids
- 3rd line- IVIG